scholarly journals Making sense of non-randomized comparative treatment studies in times of Covid-19: A case study of tocilizumab

2021 ◽  
Author(s):  
Ruth R C Owen ◽  
Nawab Qizilbash ◽  
Sara Velazquez Diaz ◽  
Jose Maria Castellano Vazquez ◽  
Stuart J Pocock
Keyword(s):  
Hospital Mortality ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Randomised Clinical Trial ◽  
Control Group ◽  
Making Sense ◽  
Competing Risk Models ◽  
Effectiveness Studies ◽  
The Impact

BACKGROUND Tocilizumab (TCZ) is an interleukin-6 inhibitor and the second established effective drug for the treatment of hospitalized patients with Covid-19. In this study, we sought to validate the recent positive findings from the randomised clinical trial RECOVERY and to evaluate the challenges in the analysis and interpretation of non-randomized comparative effectiveness studies in Covid-19. METHODS We performed a retrospective cohort study using an openly available database of hospitalised Covid-19 patients in Spain. The primary outcome was all-cause in-hospital mortality at 28 days. We used multivariable Fine and Gray competing risk models which adjusted for both fixed and time-variant confounders to investigate the effect of TCZ on the primary outcome. RESULTS We analysed 2547 patients hospitalised with Covid-19 between 1st January and 28th June 2020. Patients in the TCZ group tended to have more severe Covid-19 at admission, as measured by biomarkers of disease severity including CRP, D-dimer and LDH. At 28 days, 91 out of 440 TCZ patients had died compared to 267 out of 2107 patients in the control group. In multivariable analysis, there was no evidence of an association between TCZ and the primary outcome (adjusted hazard ratio 1.20, 95% CI 0.86 to 1.64, P=0.26). CONCLUSIONS Our observational study failed to find a benefit of TCZ on all-cause in-hospital mortality in Covid-19 patients compared with randomized trials, highlighting the impact that unmeasured confounding and other sources of bias can have in a retrospective observational setting. For future observational studies, we recommend prospective data collection to ensure all variables have the necessary quality, completeness and timing for reliable treatment evaluation.

scholarly journals Hyperoxaemia and hypoxaemia are associated with harm in patients with ARDS

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrew J. Boyle ◽  
David N. Holmes ◽  
Jonathan Hackett ◽  
Susanna Gilliland ◽  
Michael McCloskey ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Final Analysis ◽  
Arterial Oxygen ◽  
Icu Mortality ◽  
Mechanically Ventilated ◽  
Predicted Probability ◽  
Definition Of ◽  
The Impact

Abstract Background Oxygen therapy is routinely administered to mechanically ventilated patients. However, there remains uncertainty about the optimal oxygen titration target in patients with the acute respiratory distress syndrome (ARDS). Methods Prospectively identified adult patients meeting the Berlin definition of ARDS between 1st January 2014 and 13th December 2016 were analyzed. Oxygen exposure variables were collected at 6-hourly intervals. The primary exposure was the average time-weighted partial pressure of arterial oxygen (PaO2) calculated over a maximum of 7 days from meeting ARDS criteria. The primary outcome was ICU mortality. Univariable and multivariable logistic regression analyses were performed to assess the impact of exposure variables on clinical outcomes. Results are presented as odds ratio [95% confidence interval]. Results 202 patients were included in the final analysis. Overall ICU mortality was 31%. The average time-weighted PaO2 during the first 7 days of ARDS was similar between non-survivors and survivors (11.3 kPa [10.2, 12.5] (84.8 mmHg [76.5, 93.8]) vs. 11.9 kPa [10.9, 12.6] (89.3 mmHg [81.8, 94.5]); p = 0.08). In univariable and multivariable analysis, average time-weighted PaO2 demonstrated a U-shaped relationship with ICU mortality. There was a similar relationship identified with hospital mortality. Conclusions In patients with ARDS, the predicted probability of both ICU and hospital mortality was lowest when the average time-weighted PaO2 was between 12.5 and 14 kPa (93.8–105.0 mmHg), suggesting this is a reasonable oxygenation target for clinicians to aim for.

Librarians, step out of the classroom!: how improved faculty-led IL instruction improves student learning

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Meagan Lacy ◽  
Alexandra Hamlett
Keyword(s):  
Student Learning ◽  
Research Process ◽  
Control Group ◽  
Student Survey ◽  
Content Type ◽  
Actual Application ◽  
Faculty Teaching ◽  
Survey Results ◽  
The Impact

PurposeIn most higher education institutions, information literacy (IL) instruction is usually considered the purview of librarians, not disciplinary faculty. However, a small but growing body of research indicates that students learn the research process best when these skills are taught in the context of a course or a discipline. For this reason, teaching faculty should share ownership of IL instruction — but how? In this case study, community college librarians explain how they successfully trained faculty to integrate IL into their English Composition courses and teach IL independently.Design/methodology/approachUsing a multimethods approach, the investigators draw on faculty interviews, student surveys, and content analysis of student essays to evaluate the impact of faculty-led IL instruction on student learning after one semester.FindingsFaculty reported that their instruction of IL was improved, and students work better as a result of their collaboration with the librarians. Compared to previous semesters, faculty perceived gains in terms of students’ ability to synthesize and cite evidence in their writing. Student survey results indicate perceived gains in their IL skills, but an assessment of their written work reveals a discrepancy between this perception and the actual application of these skills.Research limitations/implicationsBecause there is no control group, no conclusions can be drawn as to whether faculty-led IL instruction is as effective as librarian-led IL instruction or whether students’ academic performance improves due to faculty teaching IL. However, the purpose of this study is primarily descriptive. It addresses how other libraries may create a culture of shared ownership of IL instruction on their campuses.Practical implicationsThis study offers an alternative model to library instruction and suggests ways instruction librarians can prioritize their outreach and instructional efforts to maximize impact on student learning.Originality/valueWhile much has been written about how librarians can improve IL instruction, few studies mention the role of faculty. This case study starts the conversation.

scholarly journals The Impact of Rhetorical Argumentation on Achieving the Mastery of Fluency and Accuracy in Communicative Competence: A Case Study of 2 nd Year Students at the University Des Frères Mentouri, Constantine

2021 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Abderrahim Bouderbane
Keyword(s):  
Communicative Competence ◽  
Classroom Interaction ◽  
Control Group ◽  
Procedural Fluency ◽  
Language Knowledge ◽  
Problematic Issue ◽  
Rhetorical Argumentation ◽  
The University ◽  
The Impact

The present study is a comparison between the impact of rhetorical argumentation and narrating stories on students’ fluency and accuracy in communicative competence. We aimed at evaluating the usefulness and suitability of these tasks, and their efficiency when it comes to teaching fluency and accuracy by analysing the direct effects of the tasks on the indices of fluency and accuracy. The problematic issue in this research investigates the effects of the task rhetorical argumentation, and whether it is an important task that teachers should rely on it in teaching speaking in academic contexts. The sample is composed of 65 students which are divided in between 30 students in the control group and 35 students in experimental group. The data was collected by a test which was used to evaluate three main areas which are: classroom interaction, topic knowledge and language knowledge. The results of the experiment show that there are two types of fluency which are procedural and automatic. Rhetorical argumentation can be used to develop procedural fluency, and not automatic since the task is considered as difficult and students were not familiar with it.

Abstract 17492: Extent and Pattern of Late Gadolinium Enhancement Predict Arrhythmic Events in Patients With Nonischemic Dilated Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dong Geum Shin ◽  
Hye-Jeong Lee ◽  
Junbeom Park ◽  
Young Jin Kim ◽  
Jae-Sun Uhm ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Ventricular Arrhythmia ◽  
Dilated Cardiomyopathy ◽  
Cardiac Death ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Gadolinium Enhancement ◽  
Nonischemic Dilated Cardiomyopathy ◽  
The Impact

Background: Late gadolinium enhancement (LGE) by cardiac MR (CMR) has been related to adverse clinical outcomes in patients with nonischemic dilated cardiomyopathy (NIDC). But, a statistically significant association between LGE and arrhythmic risk in NIDC has not been demonstrated consistently. This study evaluated the impact of the presence, location and pattern of LGE on arrhythmic risk prediction in NICM. Methods: This study included 365 patients (54±15years) with NICM who underwent CMR. The extent, location and pattern of LGE were categorized. We analyzed for the primary outcome of ventricular arrhythmia (VA) including sustained or nonsustained ventricular tachycardia (VT), appropriate implantable cardioverter-defibrillator (ICD) intervention and ventricular fibrillation (VF). Cardiac death and hospitalization for heart failure (HF) were evaluated as secondary outcomes. Results: LGE was seen in 267 (73 %) patients. During median follow-up of 44±36 months, patients with LGE had higher incidence of cardiac death (15 % vs. 2 %, p<0.001), hospitalization for HF (40 % vs. 15 %, p<0.001) and VA (14% vs. 6%, p=0.03). In multivariable analysis, the presence of LGE (HR 2.78; 95% CI 1.10-7.02; p=0.03) was the independent predictor of arrhythmias. Patients with extensive LGE had higher VA (32% vs. 10%, p<0.001) with lower cumulative survival free of VA than those without extensive LGE (p=0.001). The frequent LGE location was as follows: LV septum 64%, LV-RV junction 42% and inferior 10%. VA was lower in patients with than without localized LGE limited to LV-RV junction (21% vs. 46%, p=0.005). Interestingly, while the incidence of ventricular arrhythmia was higher in patients with transmural LGE (29% vs. 10%, p=0.003), it was lower in those with patch LGE (2% vs. 16%, p=0.02) than the other patients. Conclusions: In patients with NICM, the LGE was an independent prognostic predictor of VA. Extensive LGE and specific location of LGE was related with the arrhythmic events.

Elevation of inflammatory S100A8/S100A9 complexes in intracranial aneurysms

2020 ◽  
Vol 12 (11) ◽  
pp. 1117-1121
Author(s):  
Antonius Mattheus de Korte ◽  
René Aquarius ◽  
Thomas Vogl ◽  
Johannes Roth ◽  
Ronald H M A Bartels ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Primary Outcome ◽  
Control Group ◽  
Healthy Controls ◽  
Activated Macrophages ◽  
Related Factors ◽  
Aneurysm Wall ◽  
Healthy Control ◽  
Insight Into

BackgroundInflammation-related factors might give further insight into the pathophysiology of vessel wall inflammation and intracranial aneurysm (IA) rupture. One of these factors is the protein complex S100A8/A9, which is released by neutrophils, monocytes, and activated macrophages and is known for its role in cardiovascular disease.ObjectiveTo determine if venous S100A8/A9 levels in patients with a ruptured IA (rIA) or unruptured IA (uIA) are elevated compared with a control group. Second, to assess differences between venous and intra-aneurysmal S100A8/A9 levels of rIA and uIA patients.MethodsA prospective case study was performed between June 2016 and May 2017 in patients harboring a ruptured or unruptured saccular IA. Primary outcome measures were individual S100A8/A9 serum concentrations as measured in venous and intra-aneurysmal blood samples during endovascular treatment. Venous serum S100A8/A9 concentrations from a healthy control group served as a reference.ResultsWe included 16 patients with either a rIA or uIA and 47 healthy controls. Venous S100A8/A9 concentrations were higher in aneurysm patients (rIA and uIA) than those of healthy controls (P≤0.001). S100A8/A9 concentrations were higher in intra-aneurysmal samples than in venous samples of rIA patients (P=0.011). This difference was not found in uIA patients (P=0.054). Intra-aneurysmal S100A8/A9 levels were higher in rIAs than in uIAs (P=0.04).ConclusionsVenous S100A8/A9 levels are elevated in patients with both rIAs and uIAs compared with healthy controls and likely represents aneurysm wall inflammation. S100A8/A9 causes macrophage-induced inflammation and degeneration of the vessel wall which might explain higher intra-aneurysmal S100A8/A9 levels found in rIAs than in uIAs.

scholarly journals The Impact of WhatsApp on Learners’ Achievement: A Case Study of English Language Majors at King Khalid University

2018 ◽  
Vol 6 (2) ◽  
pp. 69 ◽  
Author(s):  
Abdulkhaleq Q. A. Hassan ◽  
Sayed Salahuddin Ahmed
Keyword(s):  
Content Knowledge ◽  
Mobile Application ◽  
English Language ◽  
Traditional Classroom ◽  
Control Group ◽  
E Learning ◽  
Additional Support ◽  
The Impact ◽  
Experimental Group

To investigate the effectiveness of e-learning by using a particular mobile application, namely WhatsApp, an empirical study was conducted on sixty undergraduate English language majors at King Khalid University in Saudi Arabia. The objective of the study was to determine whether the levels of motivation, content knowledge and grades of the students (who took the course “Syntax”)-, developed after receiving additional support through WhatsApp apart from traditional classroom lectures. The results showed that the experimental group that got extra support from fellow students and the course teachers through WhatsApp outperformed the students of the control group who studied the course only through traditional method. Moreover, the gap of success rate between the experimental group and the control group is about eighty nine percent with zero failure in the experimental group. The study proved that WhatsApp can be effectively used for providing supplementary support to motivate students to study properly and to get higher grades.

scholarly journals 449 Late-Breaking: Impact of feeding a propriety yeast-based synbiotic product on fecal shedding of top-7 Shiga toxin-producing Escherichia coli in feedlot cattle

2019 ◽  
Vol 97 (Supplement_3) ◽  
pp. 141-141
Author(s):  
Raghavendra Amachawadi ◽  
Xiaorong Shi ◽  
LeighAnn George ◽  
Miles Theurer ◽  
Twig Marston ◽  
...  
Keyword(s):  
Shiga Toxin ◽  
Virulence Genes ◽  
Multivariable Analysis ◽  
Feedlot Cattle ◽  
Control Group ◽  
Fecal Samples ◽  
Fecal Shedding ◽  
E Coli ◽  
Multiplex Pcr Assay ◽  
The Impact

Abstract Shiga toxin-producing E. coli (STEC) belonging to serogroups O26, O45, O111, O103, O121, O145, and O157, called ‘top-7’, are major foodborne pathogens. Cattle are a major reservoir, in which STEC colonize the hindgut and are shed in the feces, which is a major source of contamination of food. Our objective was to evaluate the impact of a proprietary yeast-based synbiotic product (prebiotic and probiotic; Alltech, Inc., Nicholasville, KY) on fecal shedding of top-7 STEC in feedlot cattle. Twenty existing pens, housing 40–112 steers per pen, with an estimated 60 to 90 days to slaughter, were randomly assigned to a control group or a treatment group that received 22 g of the synbiotic product per steer per day, as a top dress, in a finishing diet. Twenty pen-floor fecal samples were collected from each pen on days 0, 21, 42, and 54. Fecal samples were enriched and subjected to a multiplex PCR assay targeting serogroup-specific genes for the top-7 STEC and three major virulence genes, stx1 (Shiga toxin 1), stx2 (Shiga toxin 2), and eae (intimin). Bivariate descriptive statistics for the major serogroups and virulence genes were assessed prior to multivariable analysis using mixed effects logistic regression. The overall prevalence of the top-7 serogroups were 44.5% of O26, 41.3% of O157, 15.1% of O103, 13.7% of O45, 7.8% of O121, and 0.6% of O111. The overall prevalence of stx1, stx2, and eae were 43.9%, 70.8%, and 49%, respectively. E. coli O26, O157, and O45 had a significant treatment and sampling day interaction (P &lt; 0.0001). On d 42, fecal samples from treated group had lower prevalence (P &lt; 0.01) of O26, O103, and O45 compared to the control group. In conclusion, the in-feed administration of the synbiotic product appears to reduce fecal shedding of certain top-7 STEC serogroups in the feedlot cattle.

scholarly journals The Impact of Audit Committee Characteristics on Earnings Management: A Canadian Case Study

2015 ◽  
Vol 2 (1) ◽  
pp. 68
Author(s):  
Lynda Ioualalen ◽  
Hanen Khemakhem ◽  
Richard Fontaine
Keyword(s):  
Earnings Management ◽  
Audit Committee ◽  
Management Practices ◽  
Stock Exchange ◽  
Empirical Test ◽  
Control Group ◽  
Toronto Stock Exchange ◽  
Financial Expertise ◽  
The Impact

The objective of this study was to analyze the impact of three Audit Committee (AC) characteristics, financial expertise, diversity and activism on aggressive earnings management. We hypothesized that these AC characteristics are negatively related to aggressive earnings management. To test or hypothesis, we conducted an empirical test with a sample of 10 Canadian corporations listed on the Toronto stock exchange: 5 companies that were accused of aggressive earnings management and 5 other corporations used as a control group. We analyzed the 5-year period prior to the accusation (1999-2003). We measured earnings management by the level of discretionary accruals (using the modified Jones model (1995). Our results show that activism and the financial expertise of AC members are negatively related to aggressive earnings management; however, we did not find a significant relationship between diversity and aggressive earnings management. These results contribute to help governance oversight organizations identify AC characteristics that have the most influence on the detection of aggressive earnings management, which could help agencies develop and enforce methods to detect and reduce aggressive earnings management practices.

Active haematological manifestations of systemic lupus erythematosus lupus are associated with a high rate of in-hospital mortality

Lupus ◽  
2016 ◽  
Vol 26 (6) ◽  
pp. 640-645 ◽  
Author(s):  
D Miranda-Hernández ◽  
C Cruz-Reyes ◽  
C Monsebaiz-Mora ◽  
E Gómez-Bañuelos ◽  
U Ángeles ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Hospital Mortality ◽  
Lupus Erythematosus ◽  
Hospitalized Patients ◽  
High Rate ◽  
Hospital Death ◽  
Control Group ◽  
Systemic Lupus ◽  
Medical Referral ◽  
The Impact

The aim of this study was to estimate the impact of the haematological manifestations of systemic lupus erythematosus (SLE) on mortality in hospitalized patients. For that purpose a case–control study of hospitalized patients in a medical referral centre from January 2009 to December 2014 was performed. For analysis, patients hospitalized for any haematological activity of SLE ( n = 103) were compared with patients hospitalized for other manifestations of SLE activity or complications of treatment ( n = 206). Taking as a variable outcome hospital death, an analysis of potential associated factors was performed. The most common haematological manifestation was thrombocytopenia (63.1%), followed by haemolytic anaemia (30%) and neutropenia (25.2%). In the group of haematological manifestations, 17 (16.5%) deaths were observed compared to 10 (4.8%) deaths in the control group ( P < 0.001). The causes of death were similar in both groups. In the analysis of the variables, it was found that only haematological manifestations were associated with intra-hospital death (odds ratio 3.87, 95% confidence interval 1.8–88, P < 0.001). Our study suggests that apparently any manifestation of haematological activity of SLE is associated with poor prognosis and contributes to increased hospital mortality.

scholarly journals 60. Evaluation of Outcomes Associated with Intermittent Versus Extended Infusion of Piperacillin/tazobactam in Acutely Ill Veterans

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S50-S51
Author(s):  
Marianne Angeli Encarnacion ◽  
Ariel Ma ◽  
Scott T Johns
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Final Analysis ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Protocol Group ◽  
Elevated Liver Enzymes ◽  
The Impact ◽  
Extended Infusion

Abstract Background Antibiotic dosing optimization is a key principle of antimicrobial stewardship. This study evaluated the impact of an extended infusion piperacillin/tazobactam dosing protocol on clinical outcomes in acutely ill veterans treated for infections at VA San Diego. Methods This retrospective cohort study looked at veterans admitted to the medical-surgical unit who were treated with piperacillin/tazobactam for at least 48 hours. The control group included patients who received treatment between 12/14/2017 to 7/22/2018, and the “protocol” or after protocol implementation group included patients who received treatment between 7/23/2018 to 2/28/2019. Excluded from the study were veterans with microbiological cultures showing intermediate sensitivity or resistance to piperacillin/tazobactam, those who experienced interruption in therapy, or those who required dialysis. Primary clinical outcomes included in-hospital mortality rate, 30-day mortality rate, hospital length of stay (LOS), and 30-day readmission rates. Rates of adverse effects such as elevated liver enzymes, thrombocytopenia, acute kidney impairment (AKI), and Clostridium difficile infection were also collected. χ 2, Fisher’s exact, and Mann-Whitney U tests were used for statistical analysis. Results 260 veterans were included in the final analysis: 96% male, mean age 65 years, mean BMI 29, 84 met SIRS criteria for sepsis, and 55% received at least 48 hours of concomitant vancomycin. Groups had similar outcomes for median LOS, in-hospital mortality, and 30-day mortality. The incidence of AKI was significantly lower in the protocol group (39.2% vs. 56.9%, p=0.004), in veterans on concomitant vancomycin (42.3% vs. 63.2%, p=0.011), and in veterans with obesity (36.4% vs. 70.8%, p=0.001). Rates of liver enzyme elevation, thrombocytopenia, and C. difficile infection were lower in the protocol group though these were not significant. Conclusion There was a significantly lower rate of AKI with EI dosing which supports enhanced patient safety. This may be the preferred method of administration for obese patients and/or those receiving vancomycin concurrently. This is the first study to demonstrate that EI piperacillin/tazobactam dosing significantly reduces rates of AKI in patients on concomitant vancomycin. Disclosures All Authors: No reported disclosures

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