scholarly journals P126: Development of inclusion and exclusion criteria for ECPR in a regional hospital

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S101-S101
Author(s):  
D. Rollo ◽  
P. Atkinson ◽  
J. Fraser ◽  
J. Mekwan ◽  
J. P. French ◽  
...  

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR), a method of cardiopulmonary bypass, is increasingly being used to supplement traditional CPR to improve outcomes for cardiac arrest (CA). CA and particularly out of hospital CA (OHCA) have poor outcomes. Prior to development of a 3 phase ECPR program in a Canadian regional hospital, we wished to identify and optimize a practical selection process (inclusion and exclusion criteria) for patients who may benefit from ECPR. Methods: Using a locally modified Delphi technique, we followed a literature review to construct a proposed set of evidence based criteria with a questionnaire, where inclusion and exclusion criteria were scored by a selected group of 13 experts. Following 3 rounds, and additional review by an international expert in the field of ECPR, consensus was achieved for patient selection criterion. Results: First round responses achieved 87.5% agreement for selection of exclusion criteria. Inclusion criteria had agreement 62.5%. Responses to the second round for selection of inclusion criteria were unanimous at 100% with the exception of age parameters (<65 years vs. <70 years). The third and final set of criteria achieved 100% consensus though subsequent expert review refined a single exclusion criteria (asystole). Agreed inclusion criteria were: witnessed CA, age <70, refractory arrest, no flow time <10min, total downtime <60min, and a cardiac or select non-cardiac etiology (PE, drug OD, poisoning, hypothermia). Exclusion criteria were : unwitnessed arrest, asystole, certain etiologies (uncontrolled bleeding, irreversible brain damage, trauma), and comorbidities (severe disability limiting ADLs, standing DNR, palliation). Simplified criteria for EMS transport included witnessed OHCA, age, and no flow time. Conclusion: Selection criteria of candidates for ECPR are important components for any program. Expert consensus review of current evidence is an effective method for development of ECPR selection criteria.

2016 ◽  
Vol 37 (1) ◽  
pp. 55-66 ◽  
Author(s):  
Piotr Sawicki ◽  
Marcin Kiciński ◽  
Szymon Fierek

This paper deals with the problem of selection the most suitable trip-modelling tool (TMT), which is a part of the more complex integrated transport planning system (ITPS) at the regional scale. Since an application of TMT is not autonomous and several different users exist the selection problem is not a trivial. In this paper, an original five-phase selection procedure is presented. The first phase consists in specifica¬tion of both, detailed expectations of all identified users and technical requirements of ITPS. Second phase deals with research on available TMT while a third one is concentrated on defining a comprehensive set of criteria. In this phase critical criteria as well as selection criteria are defined. First one is utilised to eliminate unacceptable TMTs in phase four and second one to evaluate and select most adequate TMT in phase five. In the paper an exemplary application of this procedure is presented. The authors have defined 2 critical criteria and a set of 19 selection criteria. The last one is divided into 3 main subsets, i.e. functional, technical and financial contexts of selection process. All the selection criteria are characterised by 43 sub-criteria and some of them are more detailed extended. Using this procedure 3 out of 6 alternative TMTs including Emme, Aimsun and Visum have been initially accepted and next evaluated. Finally, Visum has been selected and recommended for application into ITPS.


2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Jiulun Fan ◽  
Jipeng Yang

Circular histogram represents the statistical distribution of circular data; the H component histogram of HSI color model is a typical example of the circular histogram. When using H component to segment color image, a feasible way is to transform the circular histogram into a linear histogram, and then, the mature gray image thresholding methods are used on the linear histogram to select the threshold value. Thus, the reasonable selection of the breakpoint on circular histogram to linearize the circular histogram is the key. In this paper, based on the angles mean on circular histogram and the line mean on linear histogram, a simple breakpoint selection criterion is proposed, and the suitable range of this method is analyzed. Compared with the existing breakpoint selection criteria based on Lorenz curve and cumulative distribution entropy, the proposed method has the advantages of simple expression and less calculation and does not depend on the direction of rotation.


2021 ◽  
Author(s):  
Paulo Cesar Morales Mayer ◽  
Caroline Amélia Gonçalves ◽  
Franz Porzsolt

Abstract Background: Evidence-Based healthcare deals basically with published clinical trials to guide the decision making on what treatment to use for any specific conditions.Aims: The present paper assessed the inclusion and exclusion criteria used in clinical trials of cervical cancer aiming at establishing a clear distinction between each criterion.Methods: We performed a bibliographical search in pubmed with the terms cervical cancer and treatment or therapy filtered for clinical trials with human subjects for the last ten years. A total of 30 papers were used extracting and classifying the inclusion and exclusion category according to the characteristic they described. Results: We found no clear parameter to establish which criteria could exclusively serve as inclusion or exclusion across the papers, about 56% of the categories identified were found either listed as inclusion or exclusion criteria or even as both in some cases.Conclusions: The key issue of selection criteria is not in its form but in its function, the first point to consider is if the trial is experimental (focused on efficacy and proof of principle) or observational (pragmatic trials, focused on effectiveness and real world conditions). We suggest, inclusion criteria should be broad, focused on the investigated condition; exclusion criteria should apply only to the subset of this “included” population, and do not take part in observational studies. These conclusions do not serve only for researchers but should affect practitioners and policy makers to correctly compare the results of investigated treatment.


Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Pedro Cardona ◽  
Helena Quesada ◽  
Luis Cano ◽  
Lucia Aja ◽  
De Miquel MA. ◽  
...  

In our comprehensive stroke center we analyze correct selection criteria to use self-expandable retrievable intracranial stents for acute stroke treatment. The criteria for intervention were the onset of neurological symptoms, a National Institute of Health Stroke Scale Score (NIHSS) ≥9 at presentation, large vessel occlusion stroke demonstrated by angio-CT, and failure of intravenous thrombolysis or exclusion criteria to administrate it. METHODS: We performed an retrospective analysis of 512 consecutive patients with acute ischemic stroke candidates for thrombectomy, from April of 2010 to June of 2012, that met inclusion criteria for intervention. Experienced vascular neurologists selected 171 patients to undergoing endovascular therapy using retrievable stents (Solitaire,Trevo). Successful recanalization results were assessed by follow-up angiography immediately after the procedure (TIMI 2-3/TICI 2b-3 score), and good functional outcome was considered when ≤2 mRankin score (mRS) was achieved at 90 days. RESULTS: A total of 171 patients were treated, 87% with anterior circulation stroke. The mean age was 67.5 years (range 32-87); 58% men. The median NIHSS at presentation was 17 (range 6-26). Recanalization (TICI 2b-3) was achieved in 73% of patients. Symptomatic hemorrhage occurred in 8%. Ninety-day mortality was 19, 5% and good 90-day functional outcome (mRS ≤2) was achieved by 45%. Unsuccessful recanalization (TICI 0-2a) was a significant predictor of poor outcome (mRS≤2: 9%). When we analyzed these patients according to inclusion criteria of IMS trial, 101 patients who met strict criteria achieved good neurological outcome more frequently (51% versus 34%) and significant lower mortality rates (17% vs 28%) compared with the group of 70 patients with IMS exclusion criteria. CONCLUSIONS: Efficacy in recanalization, safety of thrombectomy and its consequent good clinical outcome is sufficiently established. It is important an experienced vascular neurologist to select possible candidates (proportion of evaluated/treated patients 3:1). Inclusion criteria for acute stroke trials do not always represent real population of stroke patients as well as their clinical results.


2021 ◽  
Vol 02 ◽  
Author(s):  
Inshia Begum ◽  
Fathima Murthuza ◽  
Juwairiya Syed Iqbaluddin ◽  
Hafsah Fatima Arsal

Background: The pandemic caused by Coronavirus Disease 2019 (COVID-19), also known as Severe Acute Respiratory Syndrome-Related Coronavirus (SARS-CoV-2), is believed to be one of the greatest threats to global health in the 21st century. Recent collective evidence has warranted Ruxolitinib as a potential agent in recovery. Ruxolitinib is a potent and selective inhibitor of Jack kinase (JAK) 1 and 2 with modest to marked selectivity against tyrosine kinase two and JAK3. Objective: The review aims to outline the current evidence regarding the repurposed treatment for COVID- 19 and give insight into the clinical trials. There has been considerable interest in introducing existing therapeutic agents against COVID-19 to reduce the severity of illness and ease the burden on public healthcare systems. Method: A literature search was conducted using keywords like ‘Ruxolitinib trial’ and ‘COVID-19 Ruxolitinib’ on PubMed, Google Scholar, Science Direct, and Cochrane databases to select research papers and articles on the topic published from January to October 2020. Inclusion criteria were restricted to articles on Ruxolitinib and COVID. In contrast, the exclusion criteria stipulated that any study done on COVID-19 involving a mixed treatment regimen with Ruxolitinib and other drug/s or any studies not pertinent to the purpose of the study would be omitted. Conclusion: Based on the successful outcomes of various researches conducted and clinical trials performed, the use of Ruxolitinib has shown significant improvement and faster clinical recovery among COVID-19 patients of varying severity of infection, advanced age, and multiple comorbidities. This review provides an overview of various such studies with their promising outcomes.


Author(s):  
Claudia Karrapan ◽  
Mndeni Sishange ◽  
Elana Swanepoel ◽  
Peter J. Kilbourn

Background: In South Africa, deemed the ‘gateway to Africa’, there is limited evidence of the existence of a survey ranking third-party logistics providers (3PLs). This lack of comparative information of the major 3PLs based on key outsourcing and ranking criteria complicates the selection process for companies that intend to contract 3PLs.Objective: The purpose of this article was to determine the critical selection and ranking criteria for the creation of an index to evaluate 3PLs in South Africa for developing a 3PL benchmarking index.Method: Survey data were collected from 103 of the Top 500 Companies in Africa that use 3PLs and operate within the sectors that mostly outsource logistics services in South Africa. A factor analysis method was employed.Results: Three factors for 3PLs selection converged: service quality, information management and compliance, and collaboration. The top three ranked categories for 3PLs selection are cost and price structure, service delivery and the relationship with the 3PL provider. Most respondents (90%) confirmed a need for a 3PLs index in South Africa.Conclusion: The results help managers with the strategic selection of 3PLs as these critical logistics outsourcing selection criteria can be used to evaluate and rank 3PLs prior to contracting. Based on the selection criteria for logistics outsourcing identified and ranked in this article, a ranking index for 3PLs in South Africa can be developed.


2021 ◽  
Vol 104 (1) ◽  
pp. 003685042095012
Author(s):  
Ömer Faruk Görçün

This paper presents a novel integrated multi-criteria decision-making model consists of the CRITIC (CRiteria Importance Through Intercriteria Correlation) technique and the EDAS (The Evaluation based on Distance from Average Solution) method to evaluate the selection of the urban rail vehicles operated in the public transport systems. In order to determine the selection criteria in a more realistic perspective, a board of experts consists of seven members, who perform as senior executives in the public transport institutions of the country, was constructed and many round tables meetings were organized with together the members of the board for determining the procedure to follow to reach meaningful and applicable results. At the beginning of the research, approximately fifty selection criteria were determined by the research team and some of them were eliminated during the preparation process of this study. Finally, 22 factors were determined as the selection criteria, which will be used in this research. These factors are the selection criteria directly or indirectly affecting the selection process and results. Also, rail tram types currently operated in the various cities of Turkey were determined as decision alternatives. These options were evaluated by using the proposed integrated MCDM approach. When the obtained results are evaluated, it can be seen that the proposed model has the potential to give very successful results for evaluating the selection process of the urban rail systems. Moreover, it can be implemented as a decision support system by decision-makers, who perform in the public transport authorities. Finally, it can also be applied for decision-making problems faced in the various fields.


Ekonomika ◽  
2012 ◽  
Vol 91 (2) ◽  
pp. 97-116 ◽  
Author(s):  
Donatas Ratkevičius ◽  
Česlovas Ratkevičius ◽  
Rimvydas Skyrius

This article deals with the problems of Enterprise Resource Planning (ERP) system selection as the initial and vital phase of ERP system implementation.Firstly, the paper presents an analysis of different classifications of the fundamental criteria for the ERP system selection process, published in scholar sources, and defines two main groups – software-related, and implementation-related ERP selection criteria. Secondly, combining theoretical and practical approaches, the most significant ERP system selection criteria of both groups are identified and reviewed by analyzing and interpreting their definitions and differences. The study is complemented by adding practical/statistical findings produced by different consultancies.The paper concludes that there is no standard classification of ERP selection criteria. They are classified mostly on the basis of scientists’ research interests.The significance of ERP system functionality as the principal software-related ERP selection criterion is emphasized. Eleven other criteria were defined as important to consider, such as the total costs of the ERP implementation project, vendor reputation, ERP reliability, ease of integration with other systems, technology advance, scalability, upgrading ability, customization / parameterization possibilities; ease of use; flexibility and modularity.The importance of all-round knowledge for a successful ERP implementation is emphasized, including ERP software functionality, project and change management, business processes, organization of training etc. All these areas are closely connected with implementation-related ERP selection factors: organisational fit, end-user readiness, training, system support quality, and the overall ERP implementation success which is predefined by the complexity of business environment as well as the level of business transformation, defined by technological changes.Finally, it is stated that for creating a decision support system which would automate the ERP selection process, the quantitative analysis of ERP selection criteria would be required.


2004 ◽  
Vol 35 (1) ◽  
pp. 45-52 ◽  
Author(s):  
D. Das Neves ◽  
D. Fenn ◽  
P. Sulcas

In order to determine the process organisations go through in selecting an Enterprise Resource Planning (ERP) system, a field study was undertaken on eleven cases. Based on the findings a best practice selection process is proposed.A benchmark selection criteria checklist was drawn up as part of this investigation and each of the criteria listed should be considered prior to final selection.Other issues discussed in this article include the original motivation and justification for ERP purchase, change management, customisation of source code and the roles of the selection committee, consultants and vendors.


Author(s):  
Hannes Vallikivi

Criteria for the selection of judges should be objective and the selection process should be transparent in order to secure the independence of the judiciary. It would be natural to assume that the authoritarian governance in Estonia from 1934 to 1940 affected the independence of the judiciary. The article discusses criteria that were applied to the selection of judges during that period, how objective the criteria were and how transparent the selection process was. In 1934, there were 166 judges and investigating judges in three levels of the civilian courts in Estonia. This figure increased to 176 by the summer of 1940. There were close to 170 vacancies for judicial offices during the researched 6.5-year period. The process of application for vacancies, review of applications, and selection of candidates for appointment was prescribed by law and Supreme Court regulations. Judges were appointed by the head of state (the Prime Minister, later the President of the Republic). The head of state had a choice between two candidates (three from April of 1938) selected by the plenary of the Supreme Court. From 1938 onward, the President of the Republic could request up to three additional candidates. Before selecting the candidates, the Supreme Court consulted with lower courts and reviewed opinions given by the plenary of either the Court of Appeal or Circuit Courts. The process of selection was generally well documented. In around 80 per cent of cases, the head of state in 1933–40, Konstantin Päts, chose the first name on the list. In cases when he selected the second or third candidate, he did not explain his choice. There was an average of 6.4 candidates per vacancy during the researched period. The option introduced in 1938 of choosing from up to six candidates theoretically gave the executive branch the opportunity to select almost any applicant for the vacancy. In practice, Konstantin Päts required additional candidates only once, in January of 1940. Candidates had to meet several written and unwritten criteria. The law prescribed that Estonian citizens at least 25 years old with higher legal education could stand as candidates. Previous experience as a judge, prosecutor or lawyer ranging from four to ten years was required in most cases, and candidates had to have a clean criminal and personal solvency record. Unwritten criteria derived from the nature of the work of judges and from the text of the judicial oath. The latter required honesty, impartiality and loyalty to the Constitution. The unwritten criteria related to the qualifications, skills and capacity of the candidates (such as diligence, social communication skills, independence, addictions, health condition, Estonian language skills and even academic achievements) or to their integrity. In the selection process, all the unwritten criteria were applied. When a judge applying for a vacancy had some issues with the criteria (e.g. was deemed too slow or ineffective, not independent enough, or not smooth enough in communication), his progress was usually slower. Nevertheless, judges were always preferred over external applicants, with the exception of prosecutors. Prosecutors and judges had equal opportunities to be selected, while lawyers and notaries were left aside in the selection process. The ethnic origin or political views of the applicants were sometimes reviewed, but they did not play a major role in the selection process. Few ethnically non-Estonian judges (Russians or Germans) were turned down because of their weak Estonian language skills. As the research period begins with the coup staged in 1934 by Konstantin Päts and his allies against the League of Veterans’ of the Estonian War of Independence, the fate of judges who supported the League is of special interest. League members expelled from the judiciary or preparatory service of the judiciary were never selected. However, judges who were once members or supporters of the League, were selected and appointed to higher posts. In summary, the applied selection criteria were generally objective and there was no discrimination on grounds of ethnic origin or political views of judges applying for vacancies. While the selection process was transparent, the appointment of judges (i.e. selection from among the last 2–3 candidates by the head of state) was not.


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