An immigrant from Bangladesh living in the United Kingdom presented with a nonspecific febrile illness after visiting his homeland and subsequently developed fulminant hepatic failure accompanied by hypotension, ascites, a generalized coagulopathy, and thrombocytopenia. Serology and detection of dengue virus serotype 3 by PCR established a postmortem diagnosis of hepatic failure secondary to dengue hemorrhagic fever.
Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation.
Background: Professionalism is one of the five key attributes that the General Medical Council has focused on the guideline of Good Medical Practice. The primary aim of this study is to evaluate how the attributes of professionalism among medical students are perceived by themselves (SG) and patients, parents, carers, junior doctors, nurses, consultants and other allied health professionals (NSG). The secondary aim of this study is to evaluate methods of assessment for professionalism. Methods: This study was carried out for a period of 8 weeks. This was a multifaceted evaluation gathering opinions from SG and NSG. All participants filled-in a questionnaire, using a 5-point Likert score scale satisfaction. Results: In total, we had 185 participants: 88 (SG), and 97 (NSG). The mean score of medical professionalism rated by SG was 3.87 and NSG was 3.95. The top two attributes that scored the highest scores by SG were respectfulness and confidentiality. NSG were confidentiality and appearance. The two attributes that had the lowest score in both groups were attendance and punctuality. One-to-one feedback was the most favorable choice of assessment method among both groups. Conclusion: The level of professionalism among medical students in this study was observed to be positive. There was no significant difference between both groups. Professionalism is a crucial requirement for all medical doctors. It is all educator’s responsibility from all educators to instill medical professionalism from the moment medical school begins.
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