No abstract

Coronavirus disease 2019 (COVID-19) continues to affect millions of people around the globe. As data emerge, it is becoming more evident that extrapulmonary organ involvement, particularly the kidneys, highly influence mortality. The incidence of acute kidney injury has been estimated to be 30% in COVID-19 non-survivors. Current evidence suggests four broad mechanisms of renal injury: Hypovolaemia, acute respiratory distress syndrome related, cytokine storm and direct viral invasion as seen on renal autopsy findings. We look to critically assess the epidemiology, pathophysiology and management of kidney injury in COVID-19.

Renal replacement therapy (RRT) is frequently required to manage critically ill patients with acute kidney injury (AKI). There is limited evidence to support the current practice of RRT in intensive care units (ICUs). Recently published randomized control trials (RCTs) have further questioned our understanding of RRT in critical care. The optimal timing and dosing continues to be debatable; however, current evidence suggests delayed strategy with less intensive dosing when utilising RRT. Various modes of RRT are complementary to each other with no definite benefits to mortality or renal function preservation. Choice of anticoagulation remains regional citrate anticoagulation in continuous renal replacement therapy (CRRT) with lower bleeding risk when compared with heparin. RRT can be used to support resistant cardiac failure, but evolving therapies such as haemoperfusion are currently not recommended in sepsis.

Chronic metabolic acidosis is a common complication seen in advanced chronic kidney disease (CKD). There is currently no consensus on its management in the Republic of Ireland. Recent trials have suggested that appropriate active management of metabolic acidosis through oral alkali therapy and modified diet can have a deterring impact on CKD progression. The potential benefits of treatment include preservation of bone health and improvement in muscle function; however, present data is limited. This review highlights the current evidence, available primarily from randomised control trials (RCTs) over the last decade, in managing the metabolic acidosis of CKD and outlines ongoing RCTs that are promising. An economic perspective is also briefly discussed to support decision-making.

Drawing on dynamic capabilities and the resource-based view, we propose a conceptual model that encompasses big data analytics capabilities (BDAC), digital platform capabilities and network capabilities, supply chain innovation, and firm performance. We use the structural equation modeling to empirically validate this model on the time-lagged data of 221 micro, small, and medium enterprises (MSMEs) in the manufacturing sectors. The empirical results of our data analysis showed that BDAC significantly improved platform and networking capabilities. BDAC also improved supply chain innovation and thus financial performance. Our data indicated that networking capabilities mediated the relationships of both (a) BDAC-supply chain innovation and (b) BDAC-financial performance. Meanwhile, digital platforms mediated only the BDAC-supply chain innovation relationship. The outcomes of sequential mediation confirmed the role of both digital platform and network capabilities and supply chain innovation in the BDAC-firm performance link. Our results provide theoretical implications to operations management and offer practical insights for managers working in manufacturing MSMEs.

Objective To investigate the occurrence of venous thromboembolic events (VTE) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, Turkey, Russia, UK, and North America. Methods Patients with a definite diagnosis of AAV who were followed for at least 3 months and had sufficient documentation were included. Data on VTE, including either deep vein thrombosis or pulmonary embolism, were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Over a median follow up of 63 (29; 101) months, VTE occurred in 278 (9.7%) of 2869 AAV patients with a similar frequency across different countries (from 6.3% to 13.7%), and AAV subtype (granulomatosis with polyangiitis: 9.8%; 95% CI 8.3–11.6, microscopic polyangiitis: 9.6%; 95% CI 7.9–11.4, and eosinophilic granulomatosis with polyangiitis: 9.8%; 95% CI 7.0–13.3). Most VTE (65.6%) were reported in the first-year post diagnosis. Multiple factor logistic regression analysis adjusted for sex and age showed that skin (OR 1.71, 95% CI 1.01–2.92), pulmonary (OR 1.78, 95% CI 1.04–3.14) and kidney involvement (eGFR 15–60 mL/min/1.73 m2, OR 2.86, 95% CI 1.27–6.47; eGFR < 15 mL/min/1.73 m2, OR 6.71, 95% CI 2.94–15.33) were independent variables associated with a higher occurrence of VTE. Conclusion Two thirds of VTE occurred during the initial phase of active disease. We confirmed previous findings from smaller studies that a decrease in kidney function, skin involvement and pulmonary disease are independently associated with VTE.

No abstract

Healthcare services are becoming vital and growing immensely with the passage of time, and so is the use of information technology in every aspect of life. Information and communication technologies are essential parts of any health care or life critical solution available in this era -the era of information technology. Quality is one of the major issues that are currently being faced. For healthcare and life critical solutions, quality can not be compromised. The use of information technology in healthcare potentially improves quality. This paper discusses the parameters of quality in healthcare, and how information technology ensures quality based on these parameters in some major domains of healthcare; Healthcare Information Management, Emergency