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

Investigating sequence patterns of collaborative problem-solving behavior in the online collaborative discussion activity

Collaborative problem solving (CPS) is an influential human behavior affecting working performance and well-being. Previous studies examined CPS behavior from the perspective of either social or cognitive dimensions, which leave a research gap from the interactive perspective. In addition, the traditional sequence analysis method failed to combine time sequences and sub-problem sequences together while analyzing behavioral patterns in CPS. This study proposes a developed schema for the multidimensional analysis of CPS. A combination sequential analysis approach that comprises time sequences and sub-problem sequences is also employed to explore CPS patterns. A total of 191 students were recruited and randomly grouped into 38 teams (four to six students per team) in the online collaborative discussion activity. Their discussion transcripts were coded while they conducted CPS, followed by the assessment of high- and low- performance groups according to the developed schema and sequential analysis. With the help of the new analysis method, the findings indicate that a deep exploratory discussion is generated from conflicting viewpoints, which promotes improved problem-solving outcomes and perceptions. In addition, evidence-based rationalization can motivate collaborative behavior effectively. The results demonstrated the potential power of automatic sequential analysis with multidimensional behavior and its ability to provide quantitative descriptions of group interactions in the investigated threaded discussions

The Stabilizing of 1T-MoS₂ for All-Solid-State Lithium-Ion Batteries

All-solid-state batteries (SSBs) are prospective candidates for a range of energy accumulation systems, delivering higher energy densities compared to batteries which use liquid electrolytes. Amongst the numerous solid-state electrolytes (SEs), sulfide-based electrolytes in particular have received more attention given that they have a high ionic conductivity. However, the incompatibility between the electrode and SEs is still an ongoing challenge that leads to poor electrochemical performance. In this work, we focus on 1T-MoS2. It is well known that 1T metallic MoS2 is unstable even at room temperature. However, we showed that 1T-MoS2 can be stabilized at 600 °C for at least 2 h, and the 1T-MoS2-600 interlayer spacing expanded to 0.95 nm. The high crystallinity of the 1T phase is highly compatible with solid electrolytes and coupled with the increased interlayer spacing, so in the all-solid-state lithium-ion battery (ALLLIB), we achieved outstanding cycling performance. At the current density of 0.2 C (1 C = 670 mA g−1), this material delivered a capacity of 406 mA h g−1 after 50 cycles

A lumbar disc degeneration model established through an external compressive device for the study of microcirculation changes in bony endplates

Objective: To establish a new animal model of intervertebral disc degeneration (IDD) by axial compression on lumbar spine of rabbits and to investigate the changes of microcirculation in bony endplates during the progress of IDD. Methods: 32 New Zealand white rabbits were equally divided into 4 groups as follows: Control group with no operation and compression, Sham operation group with apparatus placement only, 2-week compression group and 4-week compression group with the devices installed and compressed for their preset duration. All groups of rabbits underwent MRI, histological evaluation, disc height index measurement and Microfil contrast agent perfusions to examine the ratio of endplate microvascular channels. Results: The new animal model of IDD was successfully established after axial compression for 4 weeks. The MRI grades for the 4-week compression group was 4.63 ± 0.52 and significantly different to the sham operation group (P < 0.05). Histologically, decrease of normal NP cells and extracellular matrix and disorganization of the architecture of the annulus fibrosus apparently occurred in 4-week compression group, which was different to the sham operation group (P < 0.05). There was no statistically difference between the 2-week compression and sham operation group no matter in the histology and MRI assessment. The disc height index slowly decreased as the compression duration rose. The ratio of microvascular channel volume within the bony endplate in 2-week and 4-week compression group were both reduced whereas the 4-week compression group obtained significantly less vascularization volume (6.34 ± 1.52 vs. 19.52 ± 4.63, P < 0.05). Conclusion: A new model of lumbar IDD was successfully established by axial compression and the volume of microvascular channels in the bony endplate gradually decreased as the grade of IDD increased. This model provides a new choice for etiological studies on IDD and investigation of nutrient supply disturbance