Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial

Background: Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes. Methods: We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment. Results: Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference − 0.40 [95% CI − 0.71 to − 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference − 1.6% [95% CI − 4.3% to 1.2%]; P = 0.42) between groups. Conclusions: In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness. Trial registration: ISRCTN, ISRCTN12233792. Registered November 20th, 2017

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial.

BackgroundPrevious cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.MethodsWe conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.ResultsForty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups.ConclusionsIn this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.Trial registrationISRCTN, ISRCTN12233792 . Registered November 20th, 2017

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial (vol 26, 46, 2022)

BackgroundPrevious cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.MethodsWe conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.ResultsForty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups.ConclusionsIn this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.Trial registrationISRCTN, ISRCTN12233792 . Registered November 20th, 2017

An Integrated Model to Characterize Comprehensive Stiffness of Angular Contact Ball Bearings

The bearing dynamic behaviors will be complicated due to the changes in the geometric sizes and relative positions of the bearing components at high speed. In this paper, based on the Hertz contact theory, elastohydrodynamic lubrication (EHL) model, and Jones’ bearing theory, the comprehensive stiffness model of the angular contact ball bearing is proposed in consideration of the effects of elastic deformation, centrifugal deformation, thermal deformation, and the ball spinning motion. The influences of these factors on bearing dynamic stiffness are investigated in detail. The calculation results show that the centrifugal deformation and thermal deformation increase with the increase in rotation speed. When the centrifugal deformation and thermal deformation are considered, the bearing radial contact stiffness increases as the speed increases, whereas the axial contact stiffness and the angular contact stiffness decrease. When the deformations and the EHL are all considered, the comprehensive bearing stiffness decreases with the increasing speed. It is also found that the spinning motion of the ball causes the comprehensive bearing stiffness to increase

PAHs Source Identification in Sediments and Surrounding Soils of Poyang Lake in China Using Non-Negative Matrix Factorization Analysis

Identifying sources of soil and sediment PAHs and apportioning their contributions are key in building effective pollution abatement strategies, especially for Poyang Lake—the largest freshwater lake in China. PAHs were detected in all the monitored soil and sediment samples under three land use types, with the concentrations varying by area, ranging from moderate to relatively high. The order of PAHs content in different the land use types was as follows: industrial soil > grassland soil > agricultural soil. Although agricultural soil was dominated by LMW PAHs, industrial grassland soils were dominated by HMW PAHs. Based on factor analysis, non-negative matrix factorization analysis was effective in non-negative constrained skew rotation, especially for clear and interpretable source analysis of PAHs

Extended study of the atomic step-terrace structure on hexagonal SiC (0 0 0 1) by chemical-mechanical planarization

The atomic step-terrace structure on hexagonal silicon carbide (0 0 0 1) surface is significant in that it guides the improvement of chemical-mechanical planarization (CMP) and epitaxial technique. The final state of atomic step-terrace structure can be used as a feedback for improving the CMP process, the formula of slurry and the epitaxial technique. In this paper an extended study of the atomic step-terrace structure on 4H- and 6H-SiC (0 0 0 1) planarized by CMP is presented. Surface topography of the (0 0 0 1) facet plane of 4H- and 6H-SiC wafers during CMP process was studied by atomic force microscopy (AFM). The results demonstrate that high-definition atomic step-terrace structure of the (0 0 0 1) facet plane of both 4H- and 6H-SiC can be obtained by appropriate CMP process, and during CMP process, the formation of step-terrace structure had a certain rule. We studied the relationship between the CMP process and the characteristics of the atomic step-terrace structure, and analyzed the possible impact of the CMP process on the status of terraces. We studied the distribution of terraces in different areas of the wafer, and the origin of this distribution was discussed briefly. We also describe the formation of dislocations in hexagonal SiC. The results of this paper may provide some ideas and suggestions for CMP, crystal growth and epitaxy research