Adherence To Guidelines : Experience of a Canadian Stroke Prevention Clinic
Bibliographic record
Abstract
BackgroundIn 2010, we published our stroke prevention clinicu2019s performance as compared to Canadian stroke prevention guidelines. We now compare our clinicu2019s adherence with guidelines to our previous results, following the implementation of an electronic documentation form.MethodsAll new patients referred to our clinic (McGill University Health Center) for recent transient ischemic attack (TIA) or ischemic stroke between 2014 and 2017 were included. We compared adherence to guidelines to our previous report (N=408 patients for period 2008-2010) regarding vascular risk management and treatment.Results392 patients were included, of which 36% had a TIA and 64% had an ischemic stroke, with a mean age of 70 years and 43% female. Although the more recent cohort has shown a higher proportion of cardioembolic stroke compared to previous (19.1% vs 14.7%) following new guidelines regarding prolonged cardiac monitoring, increased popularity in CT angiography has not translated into greater proportion of large-artery stroke subtype (26.3% vs 26.2%). Blood pressure (BP) targets were achieved in 83% compared with 70% in our previous report (p<0.01). Attainment of low-density lipoprotein (LDL) cholesterol target was also improved in our recent study (66% vs 46%, p<0.01). No significant difference was found in the consistency of antithrombotic use (97.7% vs 99.8%, p=0.08). However, there was a decline in smoking cessation (35% vs 73%, p=0.02). Overall, optimal therapy status was better attained in the present cohort compared to the previous one (52% vs 22%, p<0.01). The male sex was associated with better attainment of optimal therapy status (odds ratio, 1.61; 95% confidence interval, 1.04 - 2.51). The number of follow-up visits and the length of follow-up were not associated with attainment of stroke prevention targets.ConclusionsOur study shows improvement in attainment of therapeutic goals as recommended by Canadian stroke prevention guidelines, possibly attributed in part to the implementation of electronic medical recording in our clinic. Areas for improvement include smoking cessation counselling and diabetes screening.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.015 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.006 | 0.008 |
| Open science | 0.009 | 0.004 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.044 | 0.002 |
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; both teacher heads agree on what is shown here.
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".