Physicochemical analysis of blood and urine in the course of acute kidney injury in critically ill patients: a prospective, observational study

Abstract Background Sequential physicochemical alterations in blood and urine in the course of acute kidney injury (AKI) development have not been previously described. We aimed to describe these alterations in parallel to traditional renal and acid–base parameters. Methods One hundred and sixty eight consecutive critically ill patients with no previous kidney disease, who had an indwelling urinary catheter at ICU admission and who remained with the catheter for at least two days without dialysis were included. A sample of blood and spot urine were collected simultaneously, once daily, until catheter removal or dialysis requirement. Traditional acid–base and renal parameters were sequentially evaluated in parallel to blood and urinary physicochemical parameters. Patients were classified during this period as having or not AKI and, for patients with AKI, duration (transient or persistent) and severity (creatinine-based AKIN stage) were evaluated. Results One hundred and thirteen patients (67.3%) had AKI: 92 at ICU admission and 21 during the observation period. AKI development was characterized in blood by increased values of phosphate and unmeasured anions (SIG), decreased albumin, and in urine by decreased values of sodium (NaU), chloride (ClU) as well as high urinary strong ion difference (SIDu). These alterations began to occur before AKI diagnosis, and they reverted in transient AKI but remained in persistent AKI. NaU, ClU and albumin decreased, and phosphate, SIG and SIDu increased with AKI severity progression. NaU and ClU values increased again when AKIN stage 3 was reached. Conclusions Simultaneous physicochemical analysis of blood and urine revealed standardized alterations that characterize AKI development in critically ill patients. These alterations paralleled AKI duration and severity. Future studies should consider including sequential evaluation of urine biochemistry as part of the armamentarium for AKI diagnosis and management.

Intelligent tutoring system for distance education

This study aims to develop and implement a tool called intelligent tutoring system in an online course to help a formative evaluation in order to improve student learning. According to Bloom et al. (1971,117) formative evaluation is a systematic evaluation to improve the process of teaching and learning. The intelligent tutoring system may provide a timely and high quality feedback that not only informs the correctness of the solution to the problem, but also informs students about the accuracy of the response relative to their current knowledge about the solution. Constructive and supportive feedback should be given to students to reveal the right and wrong answers immediately after taking the test. Feedback about the right answers is a form to reinforce positive behaviors. Identifying possible errors and relating them to the instructional material may help student to strengthen the content under consideration. The remedial suggestion should be given in each answer with detaileddescription with regards the materials and instructional procedures before taking next step. The main idea is to inform students about what they have learned and what they still have to learn. The open-source LMS called Moodle was extended to accomplish the formative evaluation, high-quality feedback, and the communal knowledge presented here with a short online financial math course that is being offered at a large University in Brazil. The preliminary results shows that the intelligent tutoring system using high quality feedback helped students to improve their knowledge about the solution to the problems based on the errors of their past cohorts. The results and suggestion for future work are presented and discussed.