Quality of asthma treatment in children and adolescents (QUAST-CA)
Bibliographic record
Abstract
Asthma is a chronic heterogeneous condition of the airway and is prevalent in large number of Canadian children and adolescents. Despite the existence of evidence-based treatment guidelines, the management of asthma remains suboptimal, and many patients continue to experience ‘uncontrolled’ asthma. The aim of this study was to describe the prescribing pattern of asthma-related drugs (anti-asthmatic medications, inhalational devices, antibiotics, vaccines) among children and adolescents and examine the clinical consequences of inappropriate prescribing and lack of prescribers’ adherence to expert treatment recommendations (Global Initiative for Asthma (GINA) guidelines). A retrospective longitudinal descriptive cohort study spanning 2013-2017 was conducted using health administrative data from Manitoba Centre for Health Policy (MCHP). Out of 25,732 patients receiving anti-asthmatic prescriptions with a physician confirmed asthma diagnosis, 7140 constituted the cohort of newly treated persistent asthma patients. Two-year treatment follow-up from their index date revealed that 45.53% of them failed to take any anti-asthmatic medications in their second year. Antibiotic prescriptions, particularly broad-spectrum antibiotics was common among patients with asthma as compared to non-asthmatic matched controls and were mainly prescribed for Upper Respiratory Tract Infections (URTI). Multivariate logistic regression analysis indicated that non-compliant prescriptions defined against the expert treatment recommendations from GINA were not associated with any risk of exacerbation in two years, however patients with notable overuse of Short-Acting β-Agonist (SABA) [adjusted Odds Ratio (aOR) : 1.25 (1.07-1.46) -first year; 1.57 (1.19-2.06)-second year] and lower (<50%) Inhaled Cortico Steroids to total asthma drug ratio (ICS/R03) [aOR: 2.10 (1.73-2.52)-first year; 2.50 (1.84-3.39)- second year] in both the follow-up years had higher likelihood of experiencing asthma exacerbations.
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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 | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 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".