Evaluation of Rocuronium Continuous Infusion in Critically Ill Patients During the COVID-19 Pandemic and Drug Shortages

2021 ◽  
pp. 089719002110331
Author(s):  
Mohammed Aldhaeefi ◽  
Kevin M. Dube ◽  
Mary P. Kovacevic ◽  
Paul M. Szumita ◽  
Kenneth E. Lupi ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Infusion Rate ◽  
Adult Patients ◽  
Limited Data ◽  
Dose Frequency ◽  
Hypoxemic Respiratory Failure ◽  
Maintenance Infusion ◽  
Single Center Study ◽  
Train Of Four ◽  
The Relationship

Background: Limited data exist to support the use of rocuronium continuous infusions in the intensive care unit (ICU). Objective: To evaluate the dosing and monitoring of adult patients who received rocuronium for hypoxemic respiratory failure during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: This was a retrospective, single-center study from March 1, 2020 to May 31, 2020. We identified all adult patients admitted to any ICU who received rocuronium via continuous infusion. Patients were excluded if they received rocuronium for <6 hours. The main outcome of this study was to determine the median rocuronium maintenance continuous infusion rate in the ICU. Secondary outcomes of this study included the initial continuous infusion rate, duration of therapy, cumulative dose, frequency and median of rocuronium boluses, time to resolution of neuromuscular blockade, and the relationship between the hourly administration rates of rocuronium and train-of-four (TOF) assessments. Results: Seventy-one patients and 97 paralytic infusions were included. Fifty-nine patients (83%) were positive for SARS CoV-2. Of the 97 rocuronium infusions, the median dose at initiation was 3 (3–5) mcg/kg/min and duration of infusion was 45 (23.6–92.5) hours. The median continuous infusion maintenance rate was 4.3 (2.8–7.2) mcg/kg/min. There was a negligible correlation between the dose of rocuronium and the TOF results (r = .04). A total of 1775 TOFs were assessed, of which 46.2% were over-paralyzed, 35.7% well-paralyzed, and 18.1% under-paralyzed. Conclusions: The initial and maintenance infusion doses in our analysis were lower than what have been previously referenced.

scholarly journals Convalescent Plasma Efficacy in Life-Threatening COVID-19 Patients Admitted to the ICU: A Retrospective Cohort Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2113
Author(s):  
Mohamed Abuzakouk ◽  
Khaled Saleh ◽  
Manuel Algora ◽  
Ahmad Nusair ◽  
Jawahir Alameri ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Improvement ◽  
Primary Outcome ◽  
Neutralizing Antibody ◽  
Limited Data ◽  
Inverse Probability Weights ◽  
Single Center Study ◽  
Life Threatening ◽  
Antibody Titers ◽  
Disease Severity Scale

(1) Background: There are limited data regarding the efficacy of convalescent plasma (CP) in critically ill patients admitted to the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). We aimed to determine whether CP is associated with better clinical outcome among these patients. (2) Methods: A retrospective single-center study including adult patients with laboratory-confirmed SARS-CoV-2 infection admitted to the ICU for acute respiratory failure. The primary outcome was time to clinical improvement, within 28 days, defined as patient discharged alive or reduction of 2 points on a 6-point disease severity scale. (3) Results: Overall, 110 COVID-19 patients were admitted. Thirty-two patients (29%) received CP; among them, 62.5% received at least one CP with high neutralizing antibody titers (≥1:160). Clinical improvement occurred within 28 days in 14 patients (43.7%) of the CP group vs. 48 patients (61.5%) in the non-CP group (hazard ratio (HR): 0.75 (95% CI: 0.41–1.37), p = 0.35). After adjusting for potential confounding factors, CP was not independently associated with time to clinical improvement (HR: 0.53 (95% CI: 0.23–1.22), p = 0.14). Additionally, the average treatment effects of CP, calculated using the inverse probability weights (IPW), was not associated with the primary outcome (−0.14 days (95% CI: −3.19–2.91 days), p = 0.93). Hospital mortality did not differ between CP and non-CP groups (31.2% vs. 19.2%, p = 0.17, respectively). Comparing CP with high neutralizing antibody titers to the other group yielded the same findings. (4) Conclusions: In this study of life-threatening COVID-19 patients, CP was not associated with time to clinical improvement within 28 days, or hospital mortality.

scholarly journals The Effect of Sex and Age on Bone Morphology and Strength in the Metacarpus and Humerus in Beef-Cross-Dairy Cattle

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 694
Author(s):  
Michaela Gibson ◽  
Rebecca Hickson ◽  
Penny Back ◽  
Keren Dittmer ◽  
Nicola Schreurs ◽  
...  
Keyword(s):  
Dairy Cattle ◽  
Quantitative Computed Tomography ◽  
Live Weight ◽  
Peripheral Quantitative Computed Tomography ◽  
Bone Size ◽  
Limited Data ◽  
Bone Morphology ◽  
Relationship Of ◽  
The Relationship ◽  
Effect Of Age

In cattle, limited data have been reported about the relationship between live weight, bone size, and strength and how this relationship can be altered by factors such as sex and age. The aim of this study was to describe the relationship of peripheral quantitative computed tomography (pQCT)-derived parameters of bone strength and morphology with live weight, age and sex in beef-cross-dairy cattle. All animals were weighed the day before slaughter. The metacarpus and humerus were collected at slaughter and scanned at the mid-diaphysis using pQCT. Live weight was the primary explanatory variable for bone size and strength in all cohorts. However, the effect of age was significant, such that magnitude of response to liveweight was less in the 24-month-old cohort. Sex was significant within cohorts in that bulls had a shorter metacarpus than steers and heifers had a shorter metacarpus than steers at age of slaughter.

Fecundity Comparisons for Various Stocks of Lake Whitefish, Coregonus clupeaformis

1975 ◽  
Vol 32 (3) ◽  
pp. 404-407 ◽  
Author(s):  
M. C. Healey ◽  
C. W. Nicol
Keyword(s):  
Northwest Territories ◽  
Lake Erie ◽  
Fork Length ◽  
Nonlinear Relationship ◽  
Coregonus Clupeaformis ◽  
Lake Whitefish ◽  
Limited Data ◽  
Relative Fecundity ◽  
Great Slave Lake ◽  
The Relationship

We found no significant differences in slope or intercept for the regression of loge fecundity on loge fork length among samples of whitefish from four lakes near Yellowknife in the Northwest Territories. The equation describing the relationship between fecundity and fork length for these populations was:[Formula: see text]Five other populations for which length–fecundity relationships could be calculated had length exponents ranging from 3.20 to 4.38, suggesting a nonlinear relationship between weight and fecundity. Six of the nine populations as well as four others for which limited data were available all had similar relative fecundities. Fish from Buck Lake in Alberta and from Lake Erie had high relative fecundities while fish from Great Slave Lake had low relative fecundity.

Knowledge management implementation in Indian automobile ancillary industries

2016 ◽  
Vol 11 (3) ◽  
pp. 802-810 ◽  
Author(s):  
Nitin Yashwant Patil ◽  
Ravi M. Warkhedkar
Keyword(s):  
Knowledge Management ◽  
Industrial Area ◽  
Total Quality ◽  
Limited Data ◽  
Interpretive Structural Modeling ◽  
Content Type ◽  
Relationship Of ◽  
Power And Dependence ◽  
The Relationship

Purpose In the past decade, much has been written about knowledge management (KM) in the manufacturing; however, less attention has been paid to the Indian automobile ancillary industries located in Chinchwad, Pune. It is suitable to find out the relationship of the factors of the study. It helps in identifying the hierarchy of factors to be taken, and interlinking of production department with KM improves the productivity of the industries. Categorization of these principles based on their driving power (principles which hold other principles) and dependence (principles which are dependent on other principles) has also been examined for KM implementation to study the driving power and dependence power of these principles. This paper aims to determine the roadmap of KM implementation and categorize KM principles based on their driving power for manufacturing industries with the use of the interpretive structural modeling (ISM)-based model. The results indicate that the principles possessing higher driving power, such as KM, inventory control, quality control, productivity and scheduling and their interlinking. The major contribution of this research lies in the development of contextual relationship among various identified factors of KM and determination of their driving and dependence power through a single systemic framework. Design/methodology/approach In this paper, author find out the suitability ISM for Indian Automobile industries to find the relation among the variables. Findings ISM model has been developed for the hierarchy of the identified KM. As ISM model results a hypothetical hierarchy which needs a proper quantitative analysis to evaluate their percentage effectiveness in the hierarchy. Research limitations/implications It is applied to automobile industries with limited number of variables that will show the dependence variable and driving variables and their interrelations. It can be applied other fields to fine the relationship of variables. Practical implications The ISM may be used in supply chain management and total quality management to find interlinking between the variables. Originality/value The limited data collected from Pimpri Chinchwad industrial area of Pune from Maharashtra state (India).

DESIGNING A HOLISTIC ADAPTIVE RECOMMENDER SYSTEM (HARS) FOR CUSTOMER RELATIONSHIP DEVELOPMENT: A CONCEPTUAL FRAMEWORK

2021 ◽  
Vol IV (2) ◽  
pp. 84-97
Author(s):  
Alina Popa ◽  
Keyword(s):  
Recommender System ◽  
State Of The Art ◽  
Customer Behavior ◽  
Relationship Development ◽  
Customer Relationship ◽  
Limited Data ◽  
Buying Behavior ◽  
Integrative View ◽  
Client Relationship ◽  
The Relationship

With the recent COVID-19 pandemic, the world we knew changed significantly. The buying behavior shifted as well and is reflected by a growing transition to online interaction, higher media consumption and massive turn to online shopping. Companies that aim to remain top of mind to customers should ensure that their way of interacting with user is both relevant and highly adaptive. Companies should invest in state-of-the-art technologies that help manage and optimize the relationship with the client based on both online and offline data. One of the most popular applications that companies use to develop the client relationship is a Recommender System. The vast majority of traditional recommender systems consider the recommendation as a static procedure and focus either on a specific type of recommendation or on some limited data. In this paper, it is proposed a novel Reinforcement Learning-based recommender system that has an integrative view over data and recommendation landscape, as well as it is highly adaptive to changes in customer behavior, the Holistic Adaptive Recommender System (HARS). From system design to detailed activities, it was attempted to present a comprehensive way of designing and developing a HARS system for an e-commerce company use-case as well as giving a suite of metrics that could be used for its evaluation.

Is duodenal biopsy always necessary for the diagnosis of coeliac disease in adult patients with high anti-tissue transglutaminase (TTG) antibody titres?

2021 ◽  
pp. flgastro-2020-101728
Author(s):  
Junaid Beig ◽  
Kamran Rostami ◽  
David T S Hayman ◽  
Summer Hassan ◽  
Stephen Gerred ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Linear Models ◽  
Tissue Transglutaminase ◽  
Signs And Symptoms ◽  
Duodenal Biopsy ◽  
Adult Patients ◽  
Antibody Titres ◽  
Red Flag ◽  
The Relationship ◽  
Duodenal Biopsies

ObjectiveAvoiding duodenal biopsy in adults for coeliac disease (CD) diagnosis is controversial. Some retrospective and prospective studies have shown that CD can be reliably diagnosed in adults with serology rather than duodenal biopsies. This study aimed to check the accuracy of a cut-off value of ≥10 upper limit of normal of anti-tissue transglutaminase antibody (anti-TTG IgA) titres for CD diagnosis in adult patients.MethodWe retrospectively analysed adult patients (≥16 years) who underwent gastroscopy from 2013 to 2018 for positive coeliac serology. The relationship between titres and disease was determined by using linear models, whereas sensitivity and specificity were assessed by receiver operator curve.ResultsWe analysed 144 newly anti-TTG antibody-positive adult patients with a median age of 48.5 years (IQR 32–62); among them, 86 (60%) patients had CD (Marsh III: n=68 and Marsh II and I: n=18) with a higher prevalence in females (n=59 (69%)) and Europeans (n=60 (70%)). Fifty (58%) patients with CD had colonoscopy and five (6%) had imaging; only six patients were diagnosed with additional conditions. An anti-TTG IgA titre cut-off value of 150 U/L was 100% specific for CD in our dataset, with 70% (95% CI: 60% to 88%) sensitivity for this patient group.ConclusionCoeliac serology using anti-TTG IgA with titres ≥10× normal value is an excellent predictor of CD, irrespective of age, gender and ethnicity. Duodenal biopsy may not be necessary in selected adult patients with CD, especially younger than 50 years of age without additional gastrointestinal red-flag signs and symptoms.

scholarly journals Are In Vitro Susceptibilities to Azole Antifungals Predictive of Clinical Outcome in the Treatment of Candidemia?

2018 ◽  
Vol 56 (12) ◽  
Author(s):  
Twisha S. Patel ◽  
Peggy L. Carver ◽  
Gregory A. Eschenauer
Keyword(s):  
Invasive Candidiasis ◽  
Randomized Trials ◽  
Published Data ◽  
Murine Models ◽  
Limited Data ◽  
Content Type ◽  
Clinical Breakpoints ◽  
The Impact ◽  
The Relationship

ABSTRACT The purpose of this review is to critically analyze published data evaluating the impact of azole pharmacokinetic and pharmacodynamic parameters, MICs, and Candida species on clinical outcomes in patients with candidemia. Clinical breakpoints (CBPs) for fluconazole and voriconazole, which are used to determine susceptibility, have been defined by the Clinical and Laboratory Standards Institute (CLSI) for Candida species. Studies evaluating the relationship between treatment efficacy and in vitro susceptibility, as well as the pharmacodynamic targets, have been conducted in patients treated with fluconazole for candidemia; however, for species other than Candida albicans and Candida glabrata, and for other forms of invasive candidiasis, data remain limited and randomized trials are not available. Limited data evaluating these relationships with voriconazole are available. While pharmacodynamic targets for posaconazole and isavuconazole have been proposed based upon studies conducted in murine models, CBPs have not been established by CLSI. Fluconazole remains an important antifungal agent for the treatment of candidemia, and data supporting its use based on in vitro susceptibility are growing, particularly for C. albicans and C. glabrata. Further investigation is needed to establish the roles of voriconazole, posaconazole, and isavuconazole in the treatment of candidemia and for all agents in the treatment of other forms of invasive candidiasis.

scholarly journals Variability of Burnout and Stress Measures in Pediatric Residents: An Exploratory Single-Center Study From the Pediatric Resident Burnout–Resilience Study Consortium

2018 ◽  
Vol 23 ◽  
pp. 2515690X1880477
Author(s):  
Suzanne Reed ◽  
Kathi J. Kemper ◽  
Alan Schwartz ◽  
Maneesh Batra ◽  
Betty B. Staples ◽  
...  
Keyword(s):  
Compassionate Care ◽  
Short Term ◽  
Cross Sectional ◽  
Pediatric Residents ◽  
Time Points ◽  
Single Center Study ◽  
Risk Period ◽  
Resident Burnout ◽  
Relationship Of ◽  
The Relationship

Residency is a high-risk period for physician burnout. We aimed to determine the short-term stability of factors associated with burnout, application of these data to previous conceptual models, and the relationship of these factors over 3 months. Physician wellness questionnaire results were analyzed at 2 time points 3 months apart. Associations among variables within and across time points were analyzed. Logistic regression was used to predict burnout and compassionate care. A total of 74% of residents completed surveys. Over 3 months, burnout ( P = .005) and empathy ( P = .04) worsened. The most significant cross-sectional relationship was between stress and emotional exhaustion (time 1 r = 0.61, time 2 r = 0.68). Resilience was predictive of increased compassionate care and decreased burnout ( P < .05). Mindfulness was predictive of decreased burnout ( P < .05). Mitigating stress and fostering mindfulness and resilience longitudinally may be key areas of focus for improved wellness in pediatric residents. Larger studies are needed to better develop targeted wellness interventions.

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