International survey on Current Standards for Immunosuppression in Fibrosing Interstitial Lung Diseases
Bibliographic record
Abstract
Rationale: Immunosuppression plays an important role in inflammatory ILD, but a significant knowledge gap exists for the efficacy of steroids in fILD. In the absence of evidence, our study aimed to establish consensus among ILD experts on the role of immunosuppression in fILD. Methods: A modified Delphi survey was conducted among global ILD experts. Following a qualitative review about criteria for inflammation in fILD statements were formulated and circulated. Participants were selected from the REMAP-ILD network and the Swiss Special Interest Group for ILD. In two rounds consensus was sought using a 5-point Likert scale, with a threshold of 75% for agreement or disagreement. Results: 56 and 67 physicians participated in the first and second rounds, respectively. Statements were adapted after comments from the first round. Consensus was reached for: 1) steroid treatment should be considered in fILD when inflammation is suspected, 2 and 3) initial assessment prior to steroids should include lung function and HRCT, 4) lung biopsies should not always be performed prior to steroids, 5) BAL lymphocytosis >30% provides support for the use of steroids, 6) HRCT with ground glass and consolidations indicate inflammation and provides support for steroid use, 7) there are no systemic markers indicating pulmonary inflammation to inform about steroid response, 8 and 9) if steroids are considered, most ILD physicians choose oral application doses between 10-50mg/d and 10) treatment should be reviewed within 3 months. Conclusions: Our survey reflects challenges in fILD with inflammation. New studies are needed to evaluate safety and effectiveness of steroids in fILD.
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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 | 0.028 | 0.046 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
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".