Appropriate care for patients with upper gastrointestinal symptoms
Bibliographic record
Abstract
BackgroundInnovations in health care continue to improve quality and availability of health care.Accompanying these developments is the growing risk of overuse of health care.Overuse, also referred to as low-value services, has historically been defined as 'the provision of medical services for which the potential for harm exceeds the potential for benefit' 1 .To add to this definition, the provision of low-value services is often not cost-effective 2 .Overuse is reported on a global scale, although predominantly documented in high-income countries.Initiatives to reduce overuse are increasingly gaining interest, for example the National Institute for Health and Care Excellence (NICE) 'do not do' initiative and the Canadian 'Choosing Wisely' campaign.In the Netherlands, a 'rather not do' ('Beter niet doen') list was published by The Netherlands Federation of University Medical Centres in 2016 3 .This list presents 1.366 medical services described in guidelines for which evidence of its effectiveness lacks.Nevertheless, there is evidence of ongoing overuse of health care services and persistent efforts are needed to reduce this overuse.This thesis focuses on the reduction of overuse of health care for dyspeptic symptoms, which is discussed from two angles: 1) upper gastro-intestinal (GI) endoscopy for dyspepsia and 2) cholecystectomy for upper abdominal pain in patients with gallstones.12 Chapter 1 General introduction Research aims and approach Research aimsThe general aim of this thesis was to provide evidence and tools that may aid in reducing current inappropriate use of health care for upper GI symptoms.Three main aims were formulated to achieve the general aim: Stomach Dyspepsia: -Postprandial fullness -Early satiety -Epigastric pain -Epigastric burning Gallbladder Typical biliary colic: Steady abdominal pain -Epigastrium or right upper quadrant -May radiate to back -Atypical symptoms: Epigastric discomfort -Indigestion -Abdominal bloating -Belching -14 Chapter 1 General introduction -To investigate age as a selection criterion for upper GI endoscopy (Chapter 2 and 3) -To develop the dyspepsia educational tool and evaluate the tool as a measure to reduce upper GI endoscopy (Chapter 4, 5, and 6) -To determine the relationship between presence of gallstones and functional abdominal complaints (Chapter 7 and 8) 16 Chapter 1 General introduction
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 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".