Evaluation of Reproductive Care Provided to Adolescent Patients in Pediatric Nephrology Clinics
Bibliographic record
Abstract
Background: An increasing number of adolescents are living with end-stage renal disease (ESRD) or chronic kidney disease (CKD) in the US. Therefore; it is important that nephrologists can manage reproductive and women's health issues in adolescents with CKD. In this study, we aimed to determine the confidence levels of nephrologists in the US in managing women's health issues in adolescent females with CKD. Methods: Using Qualtrics Online Survey Platform, a survey was distributed by email to members of the Pediatric Nephrology Research Consortium. The survey contained 19 questions pertaining to provider demographics, training, current practice, frequency of documenting and/or discussing women's health issues, and level of confidence in managing women's health issues in adolescent female patients. Results: Seventy-five nephrologists participated, with a majority practicing in academic centers (88%). For most providers, adolescents comprised 25-74% of all patients. Ninety-eight percent denied formal training in women's health or obstetric nephrology. History of pregnancy termination/loss, last menstrual period (LMP), contraceptive use, sexual activity, number of sexual partners, and history of sexually transmitted infections were infrequently documented. Most providers documented discussions about risks of teratogenicity with use of ACEi/ARBs or mycophenolate and risks of infertility and fertility-preserving options with use of cyclophosphamide. Most providers weren't comfortable managing pregnant adolescents and referred them to adult nephrologists. Most were uncomfortable discussing fetal risks with pregnancy in CKD. While most were confident discussing barrier methods, they were much less confident discussing oral contraceptives and long-acting reversible contraceptives (LARCs). Conclusions: Sexual development and pregnancy appear not to be a focus of nephrologists caring for adolescent females with CKD. Providers also appeared to have a low level of confidence in discussing and managing fertility and pregnancy-related issues in adolescents. Nephrology training needs to incorporate focused women's health content to improve healthcare delivery to adolescent girls.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".