Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway
Bibliographic record
Abstract
Background: In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children’s Hospital (BCCH) and multiple regional clinics. Objective: The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP. Design, setting, and patients: This was a retrospective cohort study of children with NS in BC. Measurements and methods: We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna). Results: Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m 2 vs 3492, IQR 3397-3644 mg/m 2 , P = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, P = .575), or development of frequently relapsing courses (50% vs 62%, P = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, P = .655) and dietitian-reviewed food records (67% vs 47%, P = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, P = .01, BCCH vs regional). Limitations: Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance). Conclusion: Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.
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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 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".