A protocolized approach to vancomycin dosing in conventional hemodialysis
Why this work is in the frame
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Bibliographic record
Abstract
BACKGROUND: We implemented a protocol at our center to automate intravenous vancomycin dosing in hemodialysis patients. The effectiveness of this protocol is evaluated. METHODS: This was a prospective cohort study of all hemodialysis patients in our unit. Patients were enrolled from August 2005 to May 2007. Thirty-eight episodes of infection required vancomycin in 32 patients over the study period. All patients were dialyzed with an F8 or F160 (Fresenius) membrane. A load of vancomycin was administered based on weight to a maximum of 1,500 mg in the last 90 minutes of dialysis. Subsequent doses were 500 mg with each dialysis. Trough levels were taken predialysis prior to the third and fifth doses. If a therapeutic range of 10-20 mg/L was not achieved, the next vancomycin dose was decreased by 50% (if greater than 20 mg/L) or increased by 50% (if less than 10 mg/L). RESULTS: Ninety-three levels were taken; 81 were in range. Of those requiring a dose change, 4 were above 20 mg/L, and 8 were below 10 mg/L. Membrane type did not predict a requirement for dose adjustment (chi-square test: p=0.9341). A dose change after the third dose did not predict subsequent dose adjustments. Thirty-five of the 36 episodes were eradicated with this protocol. No follow-up data were available on 2 infection episodes (censored). No side effects from vancomycin were identified. CONCLUSIONS: The protocol successfully achieved therapeutic vancomycin levels and treated infection in our patients. It worked for both high- and low-flux membranes.
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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 | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it