Use Of Objective Criteria Research Articles

OBJECTIVE ASSESSMENT AND COMMUNICATION OF THE PHYSIOLOGIC STATUS OF THE SICK INFANT

The practice of midwifery involves the initial and ongoing assessment of newborn infants in terms of their maturity, transition to extrauterine life, completeness of resuscitation and ongoing health status. The universally familiar Apgar score is an essential tool for initial neonatal assessment for midwives as for other medical professionals.1 The score was developed by Virginia Apgar as an objective measure of the physiologic status of the infant after birth, and to quantify the progress through, and adequacy of, resuscitation and adaptation to extra-uterine life. While elements of the Apgar score are relevant for assessing and describing the status of the infant after 10 minutes of age, the score as a whole is not used routinely beyond this time. The Pediatric Assessment Triangle (PAT) is a newly developed tool for ongoing, objective assessment of an infant's (or child's) physical appearance.2,3 The PAT can be used to describe the presence of abnormal physiology, define whether an infant is in distress or actually experiencing system failure, and assess the infant's response to intervention by observing the resolution or progression of the clinical problem. The PAT has the potential to be a valuable tool for midwives, both for ongoing assessment, and as a means of describing the status of an infant to other health care professionals using objective terminology. The use of objective criteria and precise terminology can strengthen the impact and relevance of communication and contribute to logical decision-making about immediate care and long-term disposition. A consistent framework is also valuable when providing follow-up, particularly where a treatment or intervention has been suggested and it is important to communicate whether the infant has responded. The purpose of this paper is to describe the Pediatric Assessment Triangle, explain how it is applied and to suggest the use of this tool by midwives in practice.

Abstract 12624: Optimal Patient Selection for Simultaneous Heart-Kidney Transplant: A Modified Cost-Effectiveness Analysis

Introduction: Increasing rates of simultaneous heart-kidney (SHK) transplant in the United States exacerbate the shortage of deceased donor kidneys (DDK) for kidney-only transplant (KT-only) candidates. Current allocation policy imposes no constraints on eligibility for SHK, and how best to do so remains unknown. Methods: We apply a decision analytic model to evaluate options for heart transplant (HT) candidates with comorbid kidney dysfunction, comparing 1) upfront SHK transplant (using a DDK) and 2) a “Safety Net” strategy, in which HT-only is performed first and DDK transplant is performed six months later if native kidneys do not recover. We measure “cost” in expected number of DDKs allocated to HT recipients, effectiveness in quality-adjusted life years (QALYs), and cost-effectiveness in terms of QALYs gained per kidney. We evaluate each outcome for patients of varying “reversibility”, defined as their probability of native kidney recovery after HT-only. We identify those for whom SHK (compared to Safety Net) is efficient from a societal standpoint, producing more QALYs per kidney than each additional kidney used for KT-only. Results: For a candidate with 50% reversibility, SHK (compared to Safety Net) produces 0.54 - 0.77 more QALYs (varying by age) at a cost of 0.58 more kidneys used. SHK is inefficient in this scenario, producing fewer QALYs per DDK (0.92 - 1.31) than an additional DDK allocated for KT-only (2.2 QALYs per kidney, derived from published estimates). SHK confers more benefit and is more cost-effective with decreasing age and reversibility, and is preferred to Safety Net for patients with reversibility under 24 - 38%. Conclusions: A Safety Net strategy produces greater societal benefit than SHK for HT candidates with concurrent kidney dysfunction, excepting only those with a low probability of native kidney recovery. This finding favors implementation of a Safety Net provision and should inform the use of objective criteria to limit SHK eligibility.

Defining categories of Fintechs: A Categorization Proposal Based on Literature and Empirical Data

Purpose – The analysis of the competitive impact of FinTechs requires the standardization of their categories to compare their products and services with the already delivered by incumbent banks. In this study, we address the problem of the multiplicity of FinTechs categories and provide a solution using content and cluster analysis.Theoretical framework – The literature about FinTechs. In our bibliographical research, we do not find works aiming to present a standard definition of categories of FinTechs. This type of work is almost nonexistent and categorization of FinTechs is defined as a “blurry issue”.Design/methodology/approach – In this study, we address the problem of the multiplicity of FinTechs categories and provide a solution using content analysis, cluster analysis, and the software Gephi.Findings – The result is a model comprised of nine FinTechs categories: Payments and Transfers; Exchange; Lending; Insurance; Investments; Advice; B2B; Digital Banks; and Others. We also elaborate a portfolio with 157 products and services offered by Brazilian incumbent banks, which allows the comparison between these two types of companies.Originality/value – The main contribution is the use of objective criteria and existing literature, as well as Gephi software, to build categories of FinTechs analysis, an emerging theme in financial market studies.

US Ventilator Allocation and Patient Triage Policies in Anticipation of the COVID-19 Surge.

Before the predicted March 2020 surge of COVID-19, US healthcare organizations were charged with developing resource allocation policies. We assessed policy preparedness and substantive triage criteria within existing policies using a cross-sectional survey distributed to public health personnel and healthcare providers between March 23 and April 23, 2020. Personnel and providers from 68 organizations from 34 US states responded. While half of the organizations did not yet have formal allocation policies, all but 4 were in the process of developing policies. Using manual abstraction and natural language processing, we summarize the origins and features of the policies. Most policies included objective triage criteria, specified inapplicable criteria, separated triage and clinical decision making, detailed reassessment plans, offered an appeals process, and addressed palliative care. All but 1 policy referenced a sequential organ failure assessment score as a triage criterion, and 10 policies categorically excluded patients. Six policies were almost identical, tracing their origins to influenza planning. This sample of policies reflects organizational strategies of exemplar-based policy development and the use of objective criteria in triage decisions, either before or instead of clinical judgment, to support ethical distribution of resources. Future guidance is warranted on how to adapt policies across disease type, choose objective criteria, and specify processes that rely on clinical judgments.

A less evaluative measure of Big Five personality: Comparison of structure and criterion validity

Researchers and practitioners have long been concerned about detrimental effects of socially desirable responding on the structure and criterion validity of personality assessments. The current research examined the effect of reducing evaluative item content of a Big Five personality assessment on test structure and criterion validity. We developed a new public domain measure of the Big Five called the Less Evaluative Five Factor Inventory (LEFFI), adapted from the standard 50-item IPIP NEO, and intended to be less evaluative. Participants ( n = 3164) then completed standard (IPIP) and neutralized (LEFFI) measures of personality. Criteria were also collected, including academic grades, age, sex, smoking, alcohol consumption, exercise, protesting, religious worship, music preferences, dental hygiene, blood donation, other-rated communication styles, other-rated HEXACO personality, and cognitive ability (ICAR). Evaluativeness of items was reduced in the neutralized measure. Cronbach's alpha and test-retest reliability were maintained. Correlations between the Big Five were reduced in the neutralized measure and criterion validity was similar or slightly reduced in the neutralized measure. The large sample size and use of objective criteria extend past research. The study also contributes to debates about whether the general factor of personality and agreement with socially desirable content reflect substance or bias.

ОЦІНКА ЩІЛЬНОСТІ ЗАСЕЛЕННЯ БІОТОПІВ КЛІЩАМИ З ВИКОРИСТАННЯМ ІНДЕКСУ ЗАСЕЛЕННЯ. ПОРІВНЯННЯ ЕФЕКТИВНОСТІ РІЗНИХ ЗАСОБІВ ЗБОРУ КЛІЩІВ

Дослідницька та практична діяльність, пов’язана з вивченням та оцінкою певних явищ і процесів, вимагає використання до них об’єктивних критеріїв. Якщо ці критерії виражаються числовими значенням і співвідносяться з об’єктами, явищами чи процесами, що характеризуються певними одиницями вимірювань, то останні повинні надаватися в одиницях інтернаціональної метричної системи (СІ).
 Отримані результати мають бути відтворюваними та збіжними, тобто не залежати від суб’єктивних та інших обставин, що можуть на них впливати. Результати досліджень мають наукову цінність лише у випадку наявності можливостей їх відтворення та зіставлення. Це передбачає використання стандартизованих методів, а отримані кількісні показники мають відображатись у загальноприйнятій системі стандартів вимірів [1].
 Мета роботи – дослідити можливість оцінки чисельності кліщів у природньому середовищі запропонованим нами індексом заселення, що виражається в кількості кліщів на одиницю площі. Порівняти ефективність збору кліщів запатентованих нами пристрою та способу їх відлову і традиційних методів.
 Матеріали і методи. Використані матеріали власних польових досліджень, що проводились у біотопах природних та урбанізованих ландшафтів різних кліматичних районів Тернопільської області протягом 2017-2019 рр. із застосуванням традиційних та удосконалених нами засобів збору кліщів. Застосовані статистичні методи.
 Результати. Статистична обробка матеріалів акаралогічних досліджень обґрунтовує можливість оцінки чисельності кліщів за індексом заселення. На відміну від традиційних показників, запропонований нами індекс базується на використанні одиниць системи СІ.
 Ефективність запатентованих пристрою та способу відлову кліщів є достовірно вищою за традиційні методи.
 Висновки. Індекс заселення точніше характеризує заселеність територій кліщами, придатний для порівняльного аналізу ситуації на окремих територіях у різні роки, є стандартизованим.

Identification and quantification of single constituents in groundwater with Fourier-transform infrared spectroscopy and Positive Matrix Factorization

Fourier-transform infrared (FTIR) spectra of environmental samples usually comprise superposed pure component spectra of the individual constituents present. Thus, evaluation of band intensities and reconstruction of FTIR spectra by inverse techniques is often prone to ambiguity. Frequently applied multivariate curve resolution techniques (PCA, PCR, PLS) reduce the complexity in the observed spectra by isolating recurring components. However, due to mathematical constraints, such components usually do not resemble the physical spectra of the single constituents in mixed samples, which is, by contrast, principally possible with Positive Matrix Factorization (PMF). In the present study, we tested if PMF is appropriate to conduct quantitative FTIR spectroscopy on environmental samples. We quantified the concentration of humic acid-coated goethite (HA-Goe) in groundwater from two sites, which was sampled before and after HA-Goe was injected into the aquifers. PMF could successfully reconstruct the superposed FTIR spectra of the solids from freeze-dried groundwater, with explained variances of >0.99 and mean residuals of <0.01 (normalized on maximum absorbance). Due to normalization on an internal standard (potassium ferrocyanide), PMF allowed for the quantitative interpretation of compounds that were represented by dedicated PMF components (HA-Goe, kaolinite, montmorillonite, organic matter) even without a priori knowledge on the sample composition. The obtained HA-Goe concentrations agreed very well with those calculated from Fe concentrations determined with ICP-OES (correlation coefficients>0.96). Due to i) the use of objective criteria, which quantified the accuracy and uncertainty of each PMF solution, ii) repetitive PMF runs with randomized initial conditions and iii) physically meaningful PMF-components that resemble the FTIR spectra of single compounds in heterogeneously composed samples, the application of expert knowledge is replicable and less dependent on the operator than in other approaches of quantitative FTIR spectroscopy.

Alapismeretek a Diszkalkulia Pedagógiai Vizsgálatáról

A DPV koncepciója azon alapul, hogy a számolásban résztvevő numerikus rendszerek és egyéb, nem matematika-specifikus rendszerek (részképességek) különböző módokon és szinteken diszfunkcionálhatnak. A teszt feladatai adott életkorokhoz rendelt fejlődési fázisokhoz igazodnak. A vizsgálat a hibaelemzés módszerével és objektív kritériumokkal térképezi fel a diszkalkuliára utaló tipikus hibákat, majd további szempontokat ad az egyéb részképességek működésének megfigyeléséhez és a gondolkodási, kompenzáló stratégiák számbavételéhez. A hangsúlyozottan egyéni vizsgálóeljárás átfogó képet ad a gyermek matematikai és kognitív képességeinek szintjéről. Az egyéni teljesítményprofil alapján lehetővé válik a fejlődési diszkalkulia (súlyos tanulási zavar) és a tanulási nehézség elkülönítése, ezeknek megfelelően az egyénre szabott terápiás célok, feladatok és módszerek meghatározása (terápia-relevancia).

The Judgment Bias Task: A flexible method for assessing individual differences in social judgment biases

Many areas of social psychological research investigate how social information may bias judgment. However, most measures of social judgment biases are (1) low in reliability because they use a single response, (2) not indicative of individual differences in bias because they use between-subjects designs, (3) inflexible because they are designed for a particular domain, and (4) ambiguous about magnitude of bias because there is no objectively correct answer. We developed a measure of social judgment bias, the Judgment Bias Task, in which participants judge profiles varying in quality for a certain outcome based on objective criteria. The presence of ostensibly irrelevant social information provides opportunity to assess the extent to which social biases undermine the use of objective criteria in judgment. The JBT facilitates measurement of social judgment biases by (1) using multiple responses, (2) indicating individual differences by using within-subject designs, (3) being adaptable for assessing a variety of judgments, (4) identifying an objective magnitude of bias, and (5) taking 6 min to complete on average. In nine pre-registered studies (N > 9000) we use the JBT to reveal two prominent social judgment biases: favoritism towards more physically attractive people and towards members of one's ingroup. We observe that the JBT can reveal social biases, and that these sometimes occur even when the participant did not intend or believe they showed biased judgment. A flexible, objective, efficient assessment of social judgment biases will accelerate theoretical and empirical progress.

Fiabilidad y evidencias de validez de un instrumento para la evaluación de la calidad de los mapas conceptuales

Diversos autores han señalado el interés y la pertinencia de los mapas conceptuales como herramientas para el aprendizaje significativo. Sin embargo, la revisión de la literatura pone de manifiesto la escasez de propuestas dirigidas a la evaluación de los mapas con criterios objetivables y la complejidad de las existentes. El objetivo del presente estudio fue desarrollar un instrumento para la evaluación de los mapas conceptuales en formato rúbrica. De esta manera, se consigue que los alumnos posean una herramienta que permita, mediante indicadores precisos, la evaluación de la calidad tanto de sus ejecuciones como de las ejecuciones realizadas por otros. Se construyó una rúbrica que incluye los criterios más aceptados en la literatura para la evaluación de mapas conceptuales. Se realizaron dos estudios piloto con sendos grupos de alumnos universitarios (n=31 y n=18) que recibieron un programa de entrenamiento de cuatro horas. Los resultados indicaron que el instrumento diseñado muestra una buena fiabilidad interjueces e indicadores de validez discriminante. Se concluye que el instrumento diseñado para la evaluación de la calidad de los mapas conceptuales en formato rúbrica muestra adecuadas propiedades psicométricas. Asimismo, el instrumento permite aplicar criterios objetivables en la evaluación de los mapas y la comparación entre diferentes ejecuciones.

Assessment of the Characteristics of Orientation Distribution Functions in HARDI Using Morphological Metrics

Orientation distribution functions (ODFs) are widely used to resolve fiber crossing problems in high angular resolution diffusion imaging (HARDI). The characteristics of the ODFs are often assessed using a visual criterion, although the use of objective criteria is also reported, which are directly borrowed from classic signal and image processing theory because they are intuitive and simple to compute. However, they are not always pertinent for the characterization of ODFs. We propose a more general paradigm for assessing the characteristics of ODFs. The idea consists in regarding an ODF as a three-dimensional (3D) point cloud, projecting the 3D point cloud onto an angle-distance map, constructing an angle-distance matrix, and calculating metrics such as length ratio, separability, and uncertainty. The results from both simulated and real data show that the proposed metrics allow for the assessment of the characteristics of ODFs in a quantitative and relatively complete manner.

Structural Classification of Wild Boar (Sus scrofa) Vocalizations.

Determining whether a species' vocal communication system is graded or discrete requires definition of its vocal repertoire. In this context, research on domestic pig (Sus scrofa domesticus) vocalizations, for example, has led to significant advances in our understanding of communicative functions. Despite their close relation to domestic pigs, little is known about wild boar (Sus scrofa) vocalizations. The few existing studies, conducted in the 1970s, relied on visual inspections of spectrograms to quantify acoustic parameters and lacked statistical analysis. Here, we use objective signal processing techniques and advanced statistical approaches to classify 616 calls recorded from semi‐free ranging animals. Based on four spectral and temporal acoustic parameters—quartile Q25, duration, spectral flux, and spectral flatness—extracted from a multivariate analysis, we refine and extend the conclusions drawn from previous work and present a statistically validated classification of the wild boar vocal repertoire into four call types: grunts, grunt‐squeals, squeals, and trumpets. While the majority of calls could be sorted into these categories using objective criteria, we also found evidence supporting a graded interpretation of some wild boar vocalizations as acoustically continuous, with the extremes representing discrete call types. The use of objective criteria based on modern techniques and statistics in respect to acoustic continuity advances our understanding of vocal variation. Integrating our findings with recent studies on domestic pig vocal behavior and emotions, we emphasize the importance of grunt‐squeals for acoustic approaches to animal welfare and underline the need of further research investigating the role of domestication on animal vocal communication.

A comparison of orthodontic treatment outcomes using the Objective Grading System (OGS) and the Peer Assessment Rating (PAR) index

Abstract Introduction The use of objective criteria is essential to uniformly quantify and measure the severity of malocclusions and the efficacy of different treatment modalities. The Peer Assessment Rating (PAR) index and, more recently, the American Board of Orthodontics Objective Grading System (OGS) were developed to fulfill this need. Aim The aim of this retrospective study was to assess and compare treatment outcomes using the UK and US weighted PAR and the OGS. Materials and methods The sample consisted of randomly selected records of 50 patients treated by residents in one postgraduate orthodontic clinic. UK and US weightings for the PAR index were applied and compared with OGS. Results There was no statistically significant association between the OGS and the PAR index grading systems. Neither the UK nor the US PAR weightings showed statistically significant correlation with the OGS. All cases were ‘greatly improved’ or ‘improved’ according to the PAR index, while most cases (62%) failed according to OGS. There was a statistically significant correlation between the unweighted PAR index and the OGS (r = −0.32, p = 0.024). The US and the UK weightings for the PAR were highly correlated (r = 0.90, p &lt; 0.001). Both weighting systems were also highly correlated with the unweighted PAR (p &lt; 0.001). There were no gender differences found in any of the scoring systems. Conclusions The current PAR index cannot replace the OGS for evaluating treatment outcomes. The current OGS cannot detect the improvement achieved in a treated case.

COMMON AGRICULTURAL POLICY 2007 – 2013 VS. 2014 -2020

Slovakia is perceived as a leader among the European countries due to its size of farms. Despite of a high concentration of farms - up to 95.1% of the utilized agricultural land are farmed by large farms - the Slovak agriculture is considerably less productive. The reform of Common Agriculture Policy tries to develop not only the traditional role of agriculture, a food production, but shapes the face of country, affects the quality of environment and also helps to increase the potential of tourism development through the cooperation of direct payments system, capping and greening. To make a right decision in allocation of this support, it is necessary to become familiar with its advantages and disadvantages especially in Slovak agricultural conditions: Direct payments system – the use of objective criteria would ensure a more equitable and efficient use of budgetary resources in comparison to e.g. EU flat rate, where Slovakia is paid with lower direct payments than the other Member States. Objective criteria reflect the dual role of direct payments in providing income support and public goods. Capping - The primary objective of capping is to increase the downward nature of employment in animal production, or at least to maintain its current state in Member States like Slovakia, Czech Republic or Germany, where the biggest farms are located due to the historical development. In previous years, the animal production has been forgotten regarding to higher payments paid to the crop production. This unbalance could be changed by reform of Common Agriculture Policy. Greening – opponents of green rules, which should ensure the maintaining of the permanent pastures; diversification and maintaining the ecological landscape” highlight their possible negative impacts like reduction in the competitiveness of Slovak agricultural products; decrease of potential output growth; increased costs in crop production; etc. But one of its indisputable advantage hides in the opportunity to spread the crop of soybeans and pulses that could be a rewarding alternative of possible farms losses in these increasingly hotter summers.

Analyses of Extreme Wave Heights in the Gulf of Mexico for Offshore Engineering Applications

The 2004–2008 hurricane season in the Gulf of Mexico (GOM) saw several exceedances of what was regarded, prior to that period, as the 100-year significant wave heights (SWHs) that are used for the design of offshore oil and gas facilities. As a result, these facilities sustained considerable damage and disrupted U.S. energy supplies. The wave climatology in the GOM is therefore studied in detail. A 51-year database of SWHs was constructed by using a combination of wind and wave models, and both individual wave heights and statistical measures were validated, to the extent possible, using buoy data. Analyses of the modeled data show that there is an increasing trend in the annual maximum SWHs in the eastern part of the GOM; the maximum trend is approximately 5.6 cm/year, which is of the same magnitude as that reported for the U.S. west coast. The western part; on the other hand, shows a decreasing trend. The maximum estimated 100-year SWHs (denoted by SWH100) are 19.1 m, 22.6 m and 26.7 m for the Gumbel, Weibull, and the GEV distributions, respectively. The estimates obtained here using the Weibull distribution are comparable to those obtained independently by API (API—American Petroleum Institute, 2007, “Interim Guidance on Hurricane Conditions in the Gulf of Mexico,” API Bulletin No. 2INT-MET). However, the use of objective criteria to identify the optimal distribution suggests that the GEV estimates are to be preferred if the engineer wishes to emphasize the upper tail where extremes are likely to occur. The maximum increase in the SWH100 due to the 2004–2008 season is of the order of 0.9 m to 2.7 m (depending as the distribution). Information generated here is intended to supplement the design recommendations provided by API (American Petroleum Institute, 2007, “Interim Guidance on Hurricane Conditions in the Gulf of Mexico,” API Bulletin No. 2INT-MET).

Development of a Clinical Algorithm to Triage Potential Candidates for Upper Extremity Tendon Transfer Surgery in Individuals with Tetraplegia: A Retrospective Study

Background: Upper extremity (U/E) function may be greatly improved after reconstructive tendon transfer surgery in individuals with tetraplegia. An effective means of triaging potential candidates would optimize the referral process to rehabilitation and surgical teams. Objectives: To propose a set of criteria to target individuals with tetraplegia who may be potential candidates to undergo comprehensive assessment prior to reconstructive U/E surgery; to apply these criteria to a group of individuals with tetraplegia to determine the percentage of eligibility for presurgical assessment; and to compare these figures with those previously reported in the literature. Setting: A rehabilitation hospital offering specialized inpatient rehabilitation following spinal cord injury in Quebec, Canada. Methods: Retrospective chart review of individuals with tetraplegia discharged from a rehabilitation hospital between April 1, 2006 and March 31, 2010. Potential eligibility for surgery was assessed based on U/E motor function, age, medical comorbidities, compliance issues, and personal preferences. In subjects who were considered ineligible based on residual U/E strength, neurological level, injury severity and age were analysed to determine trends and significance. Results: Out of 221 individuals with tetraplegia, sixteen (7.2%) were deemed potential candidates, and three (1.3%) underwent reconstructive surgery within the defined time frame. One hundred and seventy six (176) individuals were considered ineligible for surgery due to sufficient (n=140; 63.3%) or insufficient (n=36; 16.3%) U/E motor function. Neurological level, injury severity and age were all significantly associated with potential surgery eligibility. Conclusion: The use of objective criteria is advocated to triage potential candidates to be referred for comprehensive assessment prior to planning reconstructive U/E surgery. A smaller percentage of individuals with tetraplegia seem eligible for reconstructive U/E surgery than previously reported. Most individuals considered ineligible for surgery had sufficient U/E motor function, were older and had sustained an incomplete SCI.

The future of direct payments system in the EU agriculture; European Commission scenarios

The paper deals with the future of direct payments system in the EU agriculture. Different scenarios of the current system adjustments, as proposed by the European Commission, are presented. Four possible scenarios are being discussed: An ‘EU flat rate’, a pragmatic approach, the use of objective criteria and a combination of a pragmatic approach and objective criteria. It seems that the best option for the New Member States are the flat rate or the pragmatic approach criteria.

What is Effective Implementation of EU Law?

Article 197 TFEU refers to the ‘effective implementation of Union law by the Member States’. Yet, neither the TFEU, nor the case law define the concept of ‘effective implementation.’ The purpose of this article is to extract from the case law possible meanings and relate them to specific actions that must be taken by the Member States. The judgments of the Court of Justice on infringements by Member States point towards certain elements and practices which are indispensable for the proper application of EU law. It is possible to place these inferred elements and practices into categories concerning methods (such as for example use of objective criteria, evidence-based decision making), procedures (for example decisions have to be motivated and explained, implementation procedures have to be open and transparent), institutional structures (for example separation of functions such as assessment and enforcement) and outcomes (for example preference for the least restrictive or the least distortive options).

Prognostic Significance of Applying the European Society of Cardiology Consensus Algorithm for Heart Failure With Preserved Systolic Function Diagnosis

The diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) is challenging. Although diagnostic criteria have been proposed, limited information exists concerning its implication on prognosis. We aimed to evaluate the prognostic significance of applying the European Society of Cardiology algorithm for HFpEF diagnosis, namely the tissue Doppler imaging information, in patients with acute heart failure (HF). The application of the European Society of Cardiology algorithm for HFpEF diagnosis, identifies a group of HF patients with high morbidity and mortality. Consecutive patients admitted due to acute HF were recruited. The European Society of Cardiology algorithm was used in the HFpEF diagnosis. Patients were followed for a 6-month period and mortality and rehospitalization due to HF were recorded. A total of 491 patients were included in this registry. Mean patient age was 78 years and 63% were women; 177 patients had HFpEF and 314 had HF with reduced ejection fraction (HFrEF). Of the HFpEF patients, 44.8% had an E/E' ratio >15 and 1.8% had an E/E' ratio <8. Patients with HFpEF and those with HFrEF had a similarly dismal prognosis when considering all-cause mortality, and morbidity and mortality, but there was a trend for better survival when HF death was the outcome in analysis (hazard ratio 1.63 [95% confidence interval: 0.95-2.80, P = 0.08]). The use of objective criteria for diagnosis of HFpEF identifies patients with similar outcomes as patients with HFrEF; this observation increases the robustness of the diagnostic criteria for HFpEF. The use of objective criteria for the diagnosis of HFpEF identifies patients with a similarly ominous prognosis as patients with HFrEF; this observation increases the robustness of the diagnostic criteria for HFpEF. Identifying these patients based on objective criteria, as we did, is an important step for future investigation, namely drugs, warranted to the HFpEF approach.

Effect of a 3-Step Critical Pathway to Reduce Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-Acquired Pneumonia

The length of hospital stay (LOS) for community-acquired pneumonia (CAP) varies considerably, even though this factor has a major impact on the cost of care. We aimed to determine whether the use of a 3-step critical pathway is safe and effective in reducing duration of intravenous antibiotic therapy and length of stay in hospitalized patients with CAP. We randomly assigned 401 adults who required hospitalization for CAP to follow a 3-step critical pathway including early mobilization and use of objective criteria for switching to oral antibiotic therapy and for deciding on hospital discharge or usual care. The primary end point was LOS. Secondary end points were the duration of intravenous antibiotic therapy, adverse drug reactions, need for readmission, overall case-fatality rate, and patients' satisfaction. Median LOS was 3.9 days in the 3-step group and 6.0 days in the usual care group (difference, -2.1 days; 95% CI, -2.7 to -1.7; P < .001). Median duration of intravenous antibiotic therapy was 2.0 days in the 3-step group and 4.0 days in the usual care group (difference, -2.0 days; 95% CI, -2.0 to -1.0; P < .001). More patients assigned to usual care experienced adverse drug reactions (4.5% vs 15.9% [difference, -11.4 percentage points; 95% CI, -17.2 to -5.6 percentage points; P < .001]). No significant differences were observed regarding subsequent readmissions, case fatality rate, and patients' satisfaction with care. The use of a 3-step critical pathway was safe and effective in reducing the duration of intravenous antibiotic therapy and LOS for CAP and did not adversely affect patient outcomes. Such a strategy will help optimize the process of care of hospitalized patients with CAP, and hospital costs would be reduced. isrctn.org Identifier: ISRCTN17875607.