JCM, Free Full-Text

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.

Tnm Elevation Get File - Colaboratory

Joint Base Lewis-McChord on X: JBLM FLU DRIVE Nov. 2-4; 8 a.m. – 3 p.m. - Lewis Main Exchange Nov. 6, 8 and 14; 3 – 6 p.m. - Nov. 6 –

Convert many RAW formats to JPGs in seconds for free!

Dirtbox Layouts: Marshall PAL 800 JCM Emulator

Anorectal Malformation In Children Holschneider Free Pdf Download - Colaboratory

Managed IT Services in Miami

Origin: Data Analysis and Graphing Software

Journal Citations Reports JCR – Clarivate

JCM, Free Full-Text

General Instructions, Journal of Computer-Mediated Communication

Development and validation of a next-generation sequencing assay with open-access analysis software for detecting resistance-associated mutations in CMV

Ucr Spss Get File - Colaboratory

Come Follow Me- For Primary 2021,D&C 98-101, Sept. 6-12, Free LDS primary lesson helps.

AmpliTube 5 CS - FREE amp simulation and guitar gear modeling software

JCM, Free Full-Text