JCM, Free Full-Text
Por um escritor misterioso
Last updated 29 julho 2024
Background: The optimal indication, dose, and timing of corticosteroids in sepsis is controversial. Here, we used reinforcement learning to derive the optimal steroid policy in septic patients based on data on 3051 ICU admissions from the AmsterdamUMCdb intensive care database. Methods: We identified septic patients according to the 2016 consensus definition. An actor-critic RL algorithm using ICU mortality as a reward signal was developed to determine the optimal treatment policy from time-series data on 277 clinical parameters. We performed off-policy evaluation and testing in independent subsets to assess the algorithm’s performance. Results: Agreement between the RL agent’s policy and the actual documented treatment reached 59%. Our RL agent’s treatment policy was more restrictive compared to the actual clinician behavior: our algorithm suggested withholding corticosteroids in 62% of the patient states, versus 52% according to the physicians’ policy. The 95% lower bound of the expected reward was higher for the RL agent than clinicians’ historical decisions. ICU mortality after concordant action in the testing dataset was lower both when corticosteroids had been withheld and when corticosteroids had been prescribed by the virtual agent. The most relevant variables were vital parameters and laboratory values, such as blood pressure, heart rate, leucocyte count, and glycemia. Conclusions: Individualized use of corticosteroids in sepsis may result in a mortality benefit, but optimal treatment policy may be more restrictive than the routine clinical practice. Whilst external validation is needed, our study motivates a ‘precision-medicine’ approach to future prospective controlled trials and practice.
Biographical Feature: Janet Hindler, MCLS, MT (ASCP), F(AAM)
JCM Telecom
Journal Citations Reports JCR – Clarivate
Ucr Spss Get File - Colaboratory
Journal of Clinical Medicine An Open Access Journal from MDPI
JCM Resources A Mineral Rights Acquisitions Company
Author Instructions - AIP Publishing LLC
Magnatone Slash Signature Collection SL-412 - Slash 4x12 Cabinet - Peach Guitars
Nabi De Dar Di Get File - Colaboratory
Recomendado para você
-
Charlotte Hornets live scores & schedule29 julho 2024
-
Poeni igrača Atlanta Hawks29 julho 2024
-
Panini said Lamelo is signing cards now but this look very suspicious. It's literally the same as bridges. Did melo pay bridges to sign the cards for him?? Hahahah : r/basketballcards29 julho 2024
-
Score Predictions for Charlotte Hornets vs. Milwaukee Bucks - Sports Illustrated Charlotte Hornets News, Analysis and More29 julho 2024
-
Dončić ob zanesljivi zmagi v Memphisu zadel svojo 1000. trojko - RTV SLO29 julho 2024
-
CD209L/L-SIGN and CD209/DC-SIGN Act as Receptors for SARS-CoV-229 julho 2024
-
PDF) Enhanced Recovery After Surgery Protocols in Major Urologic Surgery29 julho 2024
-
Access ohio east broad29 julho 2024
-
The association of smoking status with SARS-CoV-2 infection, hospitalisation and mortality from COVID-19: A living rapid evidence review with Bayesian meta-analyses (version 12) - Article (Preprint v15) by David Simons et al.29 julho 2024
-
PDF) Comparison of Unplanned Intensive Care Unit Readmission Scores: A Prospective Cohort Study29 julho 2024
você pode gostar
-
Spider-Man 2 (2004) Review by Stephen-Fisher on DeviantArt29 julho 2024
-
colorido - GIF animado grátis - PicMix29 julho 2024
-
Absolute MMA's Lyndsie Peterson wins 2023 IBJJF World Masters29 julho 2024
-
Go Read Classroom of the Elite's Only Good Manga29 julho 2024
-
O PAI DO ZORO CONFIRMADO EM WANO? YAMATO CONHECEU O PAI DO ZORO29 julho 2024
-
Behind the Scenes - Street Fighter: The Movie (The Game) [Making of]29 julho 2024
-
Stranger Things 5: última temporada será em 2025? Entenda29 julho 2024
-
Boruto Anime ganha data de retorno - NerdBunker29 julho 2024
-
Jogos de hoje na TV: veja onde assistir e horário das partidas de terça-feira (05) - Jogada - Diário do Nordeste29 julho 2024
-
Os 4 elementos e as 4 direções – Reiki-se29 julho 2024