Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Exploring Systematic Relationships of Evaluation Data for a Reduced Model of Evaluation

The purpose of this study was to investigate systematic relationships among various types of evaluation data with the goal of identifying a reduced model of evaluation. Meaningful evaluation requires considerable resources and expertise that often are not planned for or are not available. Evaluation models that provide meaningful results and utilize fewer resources will help researchers and practitioners better understand how to conduct meaningful and efficient evaluation. Based on the research and practice of others in evaluation, this study examined the relationships among various types of evaluation data used to assess and report the effectiveness of a series of training/development workshops. Participants in this study were technical teachers and faculty from across the United States who participated in professional development workshops with the goal of increasing disciplinary knowledge that could be implemented into curricula at their home institutions. Specifically, this study found that trainees\u27 plans to implement what they learn in training and perceptions of knowledge/skills gained for use on the job correlate significantly with transfer. In a predictive model, these factors account for roughly 30% of the variance in reported transfer. These results are discussed in terms of implications for future research and practice

A research agenda for information technology: Does research literature already exist?

The likelihood of IT surviving as an academically sound discipline is greatly enhanced if it can establish a distinct research agenda. While it is possible to establish a research agenda in a “top-down” version, this paper presents preliminary work being done using bottom-up analysis to the on-going discussion to define the meaning of Research in the context of IT as an academic discipline. We first document the current discussions surrounding the definition of IT research. We then use that conceptual framework to classify a set of seventy master’s theses from two graduate programs in IT. The titles reveal a set of topics and research directions that fit nicely into the conceptual framework provided by the IT body of knowledge, as embodied in the IT model curriculum. These theses provide specific instances that relate to the questions proposed by Reichgelt as a research agenda for Information Technology as well as the additional discussions that have followed. Moreover, one cannot distinguish the school of origin through analysis of the titles. The fact that there seems to be some consistency between the IT body of knowledge, initial theoretically motivated proposals of an IT research agenda, and the work that is actually produced in graduate programs in IT suggests that the IT research community seems to be converging around a set of specific research topics. We conclude by proposing some specific actions to accelerate this process of convergence

A research agenda for information technology: Does research literature already exist?

The likelihood of IT surviving as an academically sound discipline is greatly enhanced if it can establish a distinct research agenda. While it is possible to establish a research agenda in a “top-down” version, this paper presents preliminary work being done using bottom-up analysis to the on-going discussion to define the meaning of Research in the context of IT as an academic discipline. We first document the current discussions surrounding the definition of IT research. We then use that conceptual framework to classify a set of seventy master’s theses from two graduate programs in IT. The titles reveal a set of topics and research directions that fit nicely into the conceptual framework provided by the IT body of knowledge, as embodied in the IT model curriculum. These theses provide specific instances that relate to the questions proposed by Reichgelt as a research agenda for Information Technology as well as the additional discussions that have followed. Moreover, one cannot distinguish the school of origin through analysis of the titles. The fact that there seems to be some consistency between the IT body of knowledge, initial theoretically motivated proposals of an IT research agenda, and the work that is actually produced in graduate programs in IT suggests that the IT research community seems to be converging around a set of specific research topics. We conclude by proposing some specific actions to accelerate this process of convergence

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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