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ii. Rationale, aims and objectives Fraser Health, a large health authority, undertook an audit of standardized order sets (SOS) listing ranitidine due to the Health Canada recall of ranitidine. Our primary objective was to determine if ranitidine use on SOSs was supported by the best available evidence, in order to sparingly use ranitidine in the hospital. ii. Method Two evaluators recorded the indication of ranitidine on every SOS and a scoping review of systematic review evidence was conducted in parallel to a comprehensive review of evidence quality. Clinical practice guideline recommendations were also recorded in order to make comparisons to systematic review evidence. iii. Results Twenty-seven SOSs were found. Seven SOSs (26%) clearly indicated the medical condition ranitidine was being used for. Twenty SOSs (74%) did not list an indication or had an unclear indication. Six SOSs (22%) were supported by systematic review evidence: 4 intensive care unit (ICU) SOSs for stress ulcer prophylaxis, 1 nausea and vomiting of pregnancy SOS for heartburn, and 1 emergency department SOS for heartburn iv. Conclusion The SOS ranitidine audit conducted at Fraser Health has highlighted inconsistencies between institutional prescribing policies and evidence. Drugs listed on SOSs should be carefully considered before being used at an institutional level. To aid prescribers’ decision making, it may also be beneficial to indicate what the purpose of each drug is on a SOS Our team plans to use this as an opportunity to revise other ranitidine SOSs to reflect best evidence. Evaluation of how ranitidine or other drugs were being prescribed from SOSs is encouraged.

Shinya Yamada

and 7 more

Background: The combination of electrical and structural remodeling may have a strong effect on the prognosis of non-ischemic heart failure (HF). We aimed to clarify whether prolonged PR-interval and the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) influence the outcomes of patients with non-ischemic HF. Methods: We studied 262 consecutive hospitalized patients with non-ischemic HF. In a clinically stable condition, a 12-lead electrocardiogram and CMR were performed, and the clinical characteristics and outcomes were investigated. Results: During the follow-up of 967.7±851.8 days, there were 68 (25.9%) cardiac events (HF or sudden death, re-hospitalization due to HF, or ventricular tachyarrhythmias). In a multivariable analysis, a median rate-adjusted PR (PRa)-interval of ≥173.5 ms and the presence of LGE were associated with cardiac events with a hazard ratio of 1.690 and 2.045 (P=0.044 and P=0.006, respectively). Study subjects were then divided into three groups based on PRa-interval and LGE status. The patients were given 1 point each for PRa-interval of ≥173.5 ms and the presence of LGE: score of 0 (n=79), score of 1 (n=123) and score of 2 (n=60). Cardiac events were 16.4% in score of 0, 26.0% in score of 1 and 38.3% in score of 2 (P=0.005), respectively. The multivariable analysis showed that score of 2 was an independent predictor for cardiac events compared to score of 0 (hazard ratio, 3.437, P=0.001). Conclusions: The combination of a long PRa-interval and the presence of LGE provides a better predictive value of cardiac events in non-ischemic HF.

Ahmed Eltarras

and 7 more

Introduction: In-hospital cardiac arrest(IHCA) constitutes a significant cause of morbidity and mortality. we devised this study to shed some light on it to better inform both hospitals and policymakers. Methods: We analyzed retrospective data from 680 IHCAs at the American University of Beirut Medical Center between July 1st, 2016, and May 2nd, 2019. Sociodemographic variables included age, sex, and comorbidities in the Charlson Comorbidity Index(CCI). IHCA variables were the day of the week, time from activation to arrival, event location, initial cardiac rhythm, the total number of IHCA events, and the months and years of the IHCAs. We considered the return of spontaneous circulation(ROSC) and survival to discharge(StD) to be our outcomes of interest. Results: The incidence of IHCA was 6.58 per 1000 hospital admissions. Non-shockable rhythms were 90.7% of IHCAs. Most IHCAs occurred in the Closed care units(87.9%) and on weekdays(76.5%). ROSC followed 56% of the IHCAs. Only 5.4% achieved StD. Survival outcomes were not significantly different between the time of the day and were higher in cases with a shockable rhythm. ROSC wasn’t significantly different between weekdays and weekends. however, StD was higher on weekdays. A high CCI was associated with decreased StD. Conclusion: The incidence of IHCA was high, and its outcomes were lower compared to other developed countries. Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of the day. These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon
This paper presents a complete design procedure, with an optimized feeding method, of two-dimensional slotted waveguide antenna arrays (2D SWAs). For a desired sidelobe level ratio, the proposed system provides a pencil shape pattern with a narrow halfpower beamwidth, large sidelobe level ratio (SLR), and very low sidelobe levels (SLL), which makes it suitable for high power microwave applications. The radiating slotted waveguide antennas use longitudinal slots, designed for a specified slidelobe level ratio and resonance frequency. The resulting two-dimensional slotted waveguide antenna array is formed by stacking a number of similarly designed radiating SWAs, and fed with an additional SWA. The proposed feeding method uses longitudinal coupling slots rather than the conventional inclined coupling slots, which can provide better values of SLR and easily obtain very low SLLs, in comparison with the conventional systems. The feeder dimensions and slots positions are deduced from the dimensions and total number of the radiating SWAs. For a desired SLR, the slots excitation in the radiating and feeder SWAs are calculated based on a specified distribution. Then, using simplified closed-form equations and for a desired resonance frequency, the slots lengths, widths, and their distribution along the length of the radiating SWAs and feeder SWA can be found. Two examples are illustrated with different number of slots and radiating elements, and one is fabricated and tested. Chebyshev distribution is used to estimate the excitations of the SWA slots in the examples. The obtained measured and simulated results are in accordance with the design objectives.

Xin Yin

and 7 more

Abstract Background Tumor immunity plays an important role in assessing the tumor progression. The purpose of this study was to investigate the prognostic value of combined systemic inflammation response index (SIRI) and platelet–lymphocyte ratio (PLR) for treatment of gastroesophageal junction cancer (AEG) and upper gastric cancer (UGC). Methods In this retrospective cohort study, patients from 2003 to 2014 were divided into training set (n=194) and validation set (n=177). The prognostic accuracy of each variable was compared using time-ependent ROC analysis. The scoring system was calculated by cut-off values of SIRI and PLR by ROC curve for survival in 5 years. Kaplan-Meier and Log-rank tests were used to analyze overall survival (OS). The chi-square test was used to analyze the association between clinical characteristics and the scoring system. Univariate and multivariate analyses based on the competitive risk regression model were used to analyze independent predictors of death due to AGC and UGC. The R software was used to construct the Nomogram model of risk assessment. Results Patients with SIRI–PLR=2 had worse survival time than those with 0 and 1 (P<0.001) and more suitable for postoperative adjuvant chemotherapy (P=0.003) and proximal gastrectomy (P=0.045). SIRI and PLR were independent predictors in training set (P=0.036, P=0.045), which could be combined with age and pTNM to construct Nomogram for predicting OS. Conclusions Preoperative SIRI–PLR score was an independent predictor for patients with AEG and UGC. The Nomogram model constructed by age, SIRI, PLR and pTNM can correctly predict the prognosis of patients.

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