Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis.

Objective To investigate the effects of weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, quality of life, weaning duration, and length of stay in the intensive care unit and hospital.

Design Systematic review.

Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, LILACS, ISI Web of Science, ISI Conference Proceedings, Cambridge Scientific Abstracts, and reference lists of articles. We did not apply language restrictions.

Review methods We included randomised and quasi-randomised controlled trials of weaning from mechanical ventilation with and without protocols in critically ill adults.

Data selection Three authors independently assessed trial quality and extracted data. A priori subgroup and sensitivity analyses were performed. We contacted study authors for additional information.

Results Eleven trials that included 1971 patients met the inclusion criteria. Compared with usual care, the geometric mean duration of mechanical ventilation in the weaning protocol group was reduced by 25% (95% confidence interval 9% to 39%, P=0.006; 10 trials); the duration of weaning was reduced by 78% (31% to 93%, P=0.009; six trials); and stay in the intensive care unit length by 10% (2% to 19%, P=0.02; eight trials). There was significant heterogeneity among studies for total duration of mechanical ventilation (I(2)=76%, P

Conclusion There is evidence of a reduction in the duration of mechanical ventilation, weaning, and stay in the intensive care unit when standardised weaning protocols are used, but there is significant heterogeneity among studies and an insufficient number of studies to investigate the source of this heterogeneity. Some studies suggest that organisational context could influence outcomes, but this could not be evaluated as it was outside the scope of this review.

Managing Software Requirements Changes Based On Negotiation-Style Revision

For any proposed software project, when the software requirements specification has been established, requirements changes may result in not only a modification of the requirements specification but also a series of modifications of all existing artifacts during the development. Then it is necessary to provide effective and flexible requirements changes management. In this paper, we present an approach to managing requirements changes based on Booth’s negotiation-style framework for belief revision. Informally, we consider the current requirements specification as a belief set about the system-to-be. The request of requirements change is viewed as new information about the same system-to-be. Then the process of executing the requirements change is a process of revising beliefs about the system-to-be. We design a family of belief negotiation models appropriate for different processes of requirements revision, including the setting of the request of requirements change being fully accepted, the setting of the current requirements specification being fully preserved, and that of the current specification and the request of requirements change reaching a compromise. In particular, the prioritization of requirements plays an important role in reaching an agreement in each belief negotiation model designed in this paper.

Molecular characterization and phylogenetic analysis of quinolone resistance-determining regions (QRDRs) of gyrA, gyrB, parC and parE gene loci in viridans group streptococci isolated from adult patients with cystic fibrosis

This study demonstrated key resistance genes to fluroquinilones in Streptococcci isolated from sputum of people with CF. This suggests that other bacteria which are sometimes considered commensal may be a resovoir for resistance. Jse designed the study with Moore.

Protocolised versus non-protocolised weaning from mechanical ventilation in adult critical care.

Contribution: I co-authored this paper. This paper is primarily aimed at informing clinically based health professionals.