Development, implementation and evaluation of evidence-based treatment guidelines for herpes simplex keratitis
Bibliographic record
Abstract
Introduction Herpes simplex keratitis (HSK) is one the major causes of unilateral blindness in the developed world. Evidence-based recommendations for HSK had not been properly translated into practice. The overall aim of this thesis was to develop, implement, and evaluate a local HSK treatment guideline at the Sydney Eye Hospital. Methods The Registered Nurses’ Association of Ontario (RNAO) Toolkit: ‘Implementation of Best Practice Guidelines’ was utilised to develop, implement, and evaluate the guideline at the Hospital. A retrospective review was conducted to determine the knowledge gap. All HSK patients prescribed with antivirals, aged 18 years and above, from 2012 to 2013 were included. To assess the response to the guideline, an audit of all HSK patients aged 18 and over presenting during 6-months post-guideline implementation was conducted. A web-based survey assessed clinician awareness, usage and level of knowledge of the guideline. Patients were identified from viral swab results, pharmacy records, and hospital coding data. Results 296 patients were included in the retrospective review and 85 patients in the audit. The dose of prescribed antiviral medications was in alignment with the local guideline in 80% (51/64) of patients compared to 73% prior to implementation (p = 0.331). Post-implementation alignment was found in 72% (26/36) of patients with epithelial HSK vs 89% prior to implementation (124/139), p = 0.009. With SHSK-U, 33% (1/3) vs 9% (2/22), p = 0.3. With endothelial HSK, 67% (2/3) vs 33% (6/18), p = 0.5. With HSK prophylaxis, 100% (22/22) on prophylaxis vs 70% (31/44), p = 0.003. The web-based survey was sent to 95 clinicians, 41 (43%) responded. Of these, 35 (85%) were aware of the guidelines, 31 (75%) accessed them through the hardcopy and electronic versions available. Conclusions Most clinicians were aware of and adhered to the implemented local HSK treatment guideline. The guideline aided clinicians, mainly trainees, in prescribing antivirals for HSK according to the evidence to improve clinical outcomes.
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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 | 0.185 | 0.350 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.009 | 0.004 |
| Open science | 0.006 | 0.006 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.002 | 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".