82 The Canadian Journal of CME / December 2005 Focus on CME at
Bibliographic record
Abstract
Foot complications account for 20 % of all diabetes-related admissions in the North American population. They are a major cause of morbidity and mortality in patients with diabetes and of increasing health-care costs. Appropriate interventions can prevent diabetic foot ulcers and, thereby, reduce mortality and the rate of amputation.1 Finding high-risk patients A history and physical examination can reveal much about a patient’s risk. Previous foot ulceration (relative risk [RR] 1.6), prior lower extremity amputation (RR 2.8), a diabetes history longer than 10 years (odds ratio [OR] 3.0), a hemoglobin A1c (HbA1c)> 9 % (OR 3.2), impaired vision defined by an acuity < 20/40 (RR 1.9), feet structural abnormalities (e.g., calluses and claw toes), increasing pressure points, diminished joint mobility, fissured skin, onychomycosis, tinea and inap-propriate shoes increase the risk.2,3 Screening for sensitive neuropathy helps target the group that is unaware of tissue injury because of lack of painful feedback. This is one of the major risk factors (RR 2.2 to OR 15.2) contributing to multiple repetitive injuries and postponing the discovery of the lesion.2,3 Loss of protective sensation can be easily assessed by monofilament and a tuning fork. Absent ankle and patellar reflexes can suggest a neuropathy. The 5.07 Semmes-Weinstein monofilament is made of nylon. It applies a 10-g pressure when the filament bulges, and inability to perceive it is indicative of a clinically sig-nificant large-fibre neuropathy. The patient is asked if he feels the monofilament bulging on his foot in a “yes ” or “no ” fashion. It should be used in at least four spots (pulp of the great toe and the plantar surface of the first, third and fifth metatarsal heads). Testing 10 sites evaluates all dermatomes (the four aforementioned Charles’s Feet • Charles, 76, a smoker with a 10-year history of Type 2 diabetes, has come to your office for his regular three-month appointment. • Last year, he had a bad ulcer on his left foot that took months to heal. • As you ask him how he is feeling, you wonder what you can do to help him avoid another foot complication related to his diabetes. For more on Charles, go to page 84.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.747 | 0.424 |
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; the direct Gemma label and the distilled Codex classifier 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".