Effectiveness leukoreduction in neonates
Bibliographic record
Abstract
As of September 1999, all donated units of blood in Canada undergo a process known as pre-storage leukoreduction. This process removes a significant proportion of white blood cells from blood at the time of donation. The decision to implement universal leukoreduction was based on fairly strong evidence that leukoreduction was beneficial in some adult populations such as cardiac and colorectal surgical patients. However, very little information exists on its effectiveness in other populations such as the neonatal population. The purpose of this thesis was three fold: (1) to conduct a systematic review of the literature to assess the effectiveness of leukoreduction; (2) to undertake a methods paper outlining the optimal design to study the effectiveness of leukoreduction given its universal nature; and (3) to conduct a study assessing the effectiveness of leukoreduction in the neonatal population. The results of the systematic review elucidate the paucity of well-conducted, methodologically sound studies evaluating the effectiveness of leukoreduction in the neonatal population. The current evidence suggests that leukoreduction may be effective. However, further studies are needed especially with respect to clinically important outcomes. The lack of convincing data and the significant cost of leukoreduction mandate evaluations to determine its clinical and economic impact. The methods manuscript describes important methodological issues confronted in the design of the before/after evaluation. Because of the universal application of many transfusion interventions, one has to consider, carefully, the methodological rigor with which these interventions are evaluated. The methodological considerations discussed are: (1) threats to internal validity; (2) precision; and (3) generalizability. Properly conceived, designed, conducted, and analyzed, such a before/after study design can yield informative associations. The final paper presents the results of the before/after study. The study included a total of 515 infants <1250 grams from three sites across Canada. The effect of leukoreduction on our primary outcome of nosocomial bacteremia was an odds ratio of 0.59 (95%CI: 0.34--1.01). Crude and adjusted rates for all major neonatal morbidities suggest that leukoreduction improved all outcomes. The adjusted odds ratio for a composite measure of any major neonatal morbidity was 0.31 (95%CI: 0.17--.56). Based on the results of this study, it is concluded that the implementation of universal prestorage leukoreduction significantly improved clinical outcomes in premature infants requiring blood transfusions.
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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 | 0.019 | 0.067 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".