Bibliographic record
Abstract
Introduction: Traditional management (TM) for septic stone events includes early goal-directed therapy (EGDT) with fluid resuscitation, broad-spectrum antibiotics, and source control.Once drainage is achieved, patients are typically discharged after microbial speciation and remaining afebrile for 24 hours.Once discharged with 10 days of antibiotics, they are seen in our stone clinic and booked for ureteroscopy with one of our endourologists.Given contemporary guidelines for pyelonephritis recommend five days of antibiotics, we created a care pathway to offer patients ureteroscopy while in hospital.This study sought to characterize the timelines and infectious complications associated with our consolidated care pathway (CCP) for septic stones.Methods: A retrospective review (IRB Pro137196) of patients was completed six weeks after instituting the CCP, with a 60-day followup period at a single tertiary care academic center in Edmonton Alberta, Canada.Consensus guidelines, created by our endourologists and infectious disease specialists, included: response to source control and EGDT within 72 hours, afebrile >48 hours, normalized labs, and no complicating features warranting longer courses of antibiotics.Results: Twenty-three septic stone events were reviewed (n=16 TM, n=7 CP), identifying shorter admissions (4 vs. 6.5 days, p<0.05), with longer time to definitive management (38.5 vs. 5 days, p<0.05) for traditionally managed patients.The majority of stones were <7 mm (68% TM, 57% CP), and only one infectious complication was identified in a traditionally managed patient.No patient undergoing CCP had a documented complication related to their stone management within 60 days.Conclusions: A preliminary assessment of our consolidated septic stone clinical pathway suggests expedited ureteroscopy can be safe in these patients.This information seeks to inform the construction of a prospective quality-improvement initiative to assess relevant patient outcomes and healthcare utilization metrics associated with this delivery model.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.381 | 0.128 |
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".