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Dzik WH, Ruby K, Brunker PAR, Collins J, Paik HI, Makar R. Auditing plasma transfusion in intensive care: Use of decision time interval analysis. Am J Clin Pathol 2024:aqae041. [PMID: 38635300 DOI: 10.1093/ajcp/aqae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES To present a new method for displaying blood utilization data based on analysis of decision time intervals (DTIs). METHODS Retrospective study of patients treated in a medical intensive care unit (ICU), surgical ICU, or postcardiac surgery ICU at an academic hospital between January 2018 and June 2023. Each patient's episode of care was divided into a series of DTIs. Transfusions during each time interval were recorded. RESULTS In total, 16,562 patients received 6980 units of plasma and 21,034 units of red blood cells during 111,557 time intervals of care. Patients had international normalized ratio (INR) values ranging from less than 1.0 to more than 4.0. Data on plasma transfusion at different INR values were displayed as the number of transfusion episodes, number of units given, or the proportion of DTIs with transfusion. Clinicians transfused plasma on 1.5% of occasions when the INR was 1.5 or less and on 2.2% of occasions when the INR was less than 2.0. Plasma was transfused without red blood cells in only 0.75% of DTIs. Transfusion practice was statistically different among the 3 ICUs. CONCLUSIONS Compared with traditional methods of displaying the results of blood audits, DTI analysis displays information regarding the decision both to transfuse and to not transfuse. Utilization reviews that display data based on decision time analysis reveal clinical practice patterns very different from those suggested by traditional displays of plasma audit data.
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Affiliation(s)
- Walter H Dzik
- Blood Transfusion Service, Massachusetts General Hospital, MGB Healthcare, Boston, MA, US
| | - Kristen Ruby
- Blood Transfusion Service, Massachusetts General Hospital, MGB Healthcare, Boston, MA, US
| | - Patricia A R Brunker
- Blood Transfusion Service, Massachusetts General Hospital, MGB Healthcare, Boston, MA, US
| | - Julia Collins
- Blood Transfusion Service, Massachusetts General Hospital, MGB Healthcare, Boston, MA, US
| | - Hyun-Il Paik
- Research Information Science and Computing, MGB Healthcare, Boston, MA, US
| | - Robert Makar
- Blood Transfusion Service, Massachusetts General Hospital, MGB Healthcare, Boston, MA, US
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Linhart C, Mehrens D, Gellert LM, Ehrnthaller C, Gleich J, Lampert C, Lerchenberger M, Böcker W, Neuerburg C, Zhang Y. Gluteal Muscle Fatty Atrophy: An Independent Risk Factor for Surgical Treatment in Elderly Patients Diagnosed with Type-III Fragility Fractures of the Pelvis. J Clin Med 2023; 12:6966. [PMID: 38002581 PMCID: PMC10671837 DOI: 10.3390/jcm12226966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Gluteal muscle fatty atrophy (gMFA) might impair pelvic stability and negatively influence remobilization in patients with fragility fractures of the pelvis (FFP). This study aimed to investigate the association between gMFA and surgical indication in patients with FFP. METHODS AND MATERIALS A retrospective analysis of 429 patients (age ≥80) diagnosed with FFP was performed. gMFA of the gluteus maximus, medius, and minimus was evaluated using a standard scoring system based on computer tomography images. RESULTS No significant difference was found in gMFA between genders or among FFP types. The severity of gMFA did not correlate with age. The severity of gMFA in the gluteus medius was significantly greater than in the gluteus maximus, whereas the most profound gMFA was found in the gluteus minimus. gMFA was significantly more severe in patients who underwent an operation than in conservatively treated patients with type-III FFP, and an independent correlation to surgical indication was found using logistic regression. CONCLUSION Our findings imply that gMFA is an independent factor for surgical treatment in patients with type-III FFP. Besides focusing on the fracture pattern, the further evaluation of gMFA could be a feasible parameter for decision making toward either conservative or surgical treatment of type-III FFP.
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Affiliation(s)
- Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Dirk Mehrens
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Luca Maximilian Gellert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Christian Ehrnthaller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Johannes Gleich
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Christopher Lampert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Maximilian Lerchenberger
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Yunjie Zhang
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
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3
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Maciejewska M, Przybyła M, Szczurek A. Aerosol penetration study for FFP2 half masks regarding protection against diesel particles in underground mines. J Occup Environ Hyg 2023; 20:480-492. [PMID: 37656966 DOI: 10.1080/15459624.2023.2238022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Filtering facepieces (FFP), mainly class FFP2 particle half masks (EN 149:2001#x02009;+ A1:2009), are commonly used in European mines to protect workers from respirable dust, especially from particulate matter (PM) with a diameter of 4 µm or less (PM4). The aerosol associated with diesel exhaust (DE) is dominated by submicrometer particles (with a diameter of less than 1 µm) and nanoparticles (size in the range between 10 and 500 nm). In the European Union (EU), the occupational exposure level (OEL) for DE has been defined in terms of elemental carbon (EC) concentration. Based on measurements in underground mines, on average, 60% of EC associated with PM4 was contained in PM with a diameter of 1 µm or less (PM1). Particle number size distribution (PNSD) of PM1 showed that the most numerous were particles in the size range of 20 to 300 nm. Four popular types of certified FFP2 half masks were tested for penetration. Brand new and thermally conditioned masks of each type were included in the study. NaCl aerosol in the particle size range of 7 to 270 nm was used for tests. Filtration efficiencies of 98.5% (median) or higher were achieved. Aerosol penetration was a function of particle size. Maximum penetration was observed between 20 and 60 nm, depending on the type of mask. During filtration, aerosol characteristics changed. Nanoparticles ranging in size from 7 to about 60 nm were removed to a very limited extent. The change was more noticeable for brand-new masks compared to the thermally conditioned ones. Usually, aerosol penetration through thermally conditioned masks was lower and more consistent. It was confirmed that the half masks of the FFP2 class are capable of filtering submicrometer aerosol in particle size range 7 to 270 nm with an efficiency exceeding 96% and can contribute to achieving compliance with the OEL for DE in the mining sector.
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Affiliation(s)
- Monika Maciejewska
- Faculty of Environmental Engineering, Wroclaw University of Science and Technology, Wrocław, Poland
| | - Marcin Przybyła
- Faculty of Environmental Engineering, Wroclaw University of Science and Technology, Wrocław, Poland
- Centrum Badań Jakości sp. z o. o., Capital Group KGHM Polska Miedź S.A, Lubin, Poland
| | - Andrzej Szczurek
- Faculty of Environmental Engineering, Wroclaw University of Science and Technology, Wrocław, Poland
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Qiu K, Liao X, Li Y, Huang K, Xu H, Fang J, Zhou D. Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia. Cancers (Basel) 2023; 15:4462. [PMID: 37760431 PMCID: PMC10526786 DOI: 10.3390/cancers15184462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose: To determine associations between allogeneic blood transfusion (ABT) during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with acute lymphoblastic leukemia (ALL). Methods: A total of 749 pediatric patients who were diagnosed with ALL were enrolled in this study by using a single-center retrospective cohort study method from February 2008 to May 2022. Results: Among the ABT patients, 711 (94.9%) children were transfused with packed red blood cells (PRBCs), 434 (57.9%) with single-donor platelets (SDPs), and 196 (26.2%) with fresh frozen plasma (FFP). Our multivariate analysis demonstrated that FFP transfusion was the unique independent factor that affected both relapse-free survival (RFS) and overall survival (OS). The transfusion of FFP was significantly associated with higher age (p < 0.001), being more likely to receive SCCLG-ALL-2016 protocol (p < 0.001), higher proportion of more than 25 blood product transfusions, more PRBC transfusion (p < 0.001), and higher D33-MRD-positive rates (p = 0.013). Generalized additive models and threshold effect analysis using piece-wise linear regression were applied to identify the cut-off value of 25 mL/kg for average FFP transfusion. K-M survival analysis further confirmed that average FFP transfusion > 25 mL/kg was an independent adverse indicator of inferior outcome in terms of RFS (p = 0.027) and OS (p = 0.033). Conclusions: In blood products, only FFP supplement is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg.
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Affiliation(s)
- Kunyin Qiu
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiongyu Liao
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yang Li
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Ke Huang
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Honggui Xu
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jianpei Fang
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Dunhua Zhou
- Department of Hematology/Oncology, Children’s Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; (K.Q.); (X.L.); (Y.L.); (K.H.); (H.X.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Samal S, Nayak R, Jena S, Balabantaray BK. Obscene image detection using transfer learning and feature fusion. Multimed Tools Appl 2023; 82:1-29. [PMID: 36846526 PMCID: PMC9942052 DOI: 10.1007/s11042-023-14437-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 04/27/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Deep learning-based methods have been proven excellent performance in detecting pornographic images/videos flooded on social media. However, in a dearth of huge yet well-labeled datasets, these methods may suffer from under/overfitting problems and may exhibit unstable output responses in the classification process. To deal with the issue we have suggested an automatic pornographic image detection method by utilizing transfer learning (TL) and feature fusion. The novelty of our proposed work is TL based feature fusion process (FFP) which enables the removal of hyper-parameter tuning, improves model performance, and lowers the computational burden of the desired model. FFP fuses low-level and mid-level features of the outperforming pre-trained models followed by transferring the learned knowledge to control the classification process. Key contributions of our proposed method are i) generation of a well-labeled obscene image dataset GGOI via Pix-2-Pix GAN architecture for the training of deep learning models ii) modification of model architectures by integrating batch normalization and mixed pooling strategy to obtain training stability (iii) selection of outperforming models to be integrated with the FFP by performing end-to-end detection of obscene images and iv) design of TL based obscene image detection method by retraining the last layer of the fused model. Extensive experimental analyses are performed on benchmark datasets i.e., NPDI, Pornography 2k, and generated GGOI dataset. The proposed TL model with fused MobileNet V2 + DenseNet169 network performs as the state-of-the-art model compared to existing methods and provides average classification accuracy, sensitivity, and F1 score of 98.50%, 98.46% and 98.49% respectively.
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Affiliation(s)
- Sonali Samal
- National Institute of Technology Meghalaya, Shillong, Meghalaya India
| | - Rajashree Nayak
- JIS Institute of Advanced Studies and Research, JISU Kolkata, West Bengal 700091 India
| | - Swastik Jena
- National Institute of Technology Meghalaya, Shillong, Meghalaya India
| | - Bunil Ku. Balabantaray
- Computer Science and Engineering, National Institute of Technology Meghalaya, Shillong, Meghalaya 793003 India
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6
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Novák M, Gloor C, Wicki E, Herb D, Schibli A, Richner G. Assessment of a novel, easy-to-implement, aerosolized H 2O 2 decontamination method for single-use filtering facepiece respirators in case of shortage. J Occup Environ Hyg 2022; 19:663-675. [PMID: 36107018 DOI: 10.1080/15459624.2022.2125519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has affected the world and caused a supply shortage of personal protection equipment, especially filtering facepiece respirators (FFP). This has increased the risk of many healthcare workers contracting SARS-CoV-2. Various strategies have been assessed to tackle these supply issues. In critical shortage scenarios, reusing single-use-designed respirators may be required. Thus, an easily applicable and reliable FFP2 (or alike) respirator decontamination method, allowing safe re-use of FFP2 respirators by healthcare personnel, has been developed and is presented in this study. A potent and gentle aerosolized hydrogen peroxide (12% wt) method was applied over 4 hr to decontaminate various brands of FFP2 respirators within a small common room, followed by adequate aeration and storage overnight. The microbial efficacy was tested on unused respirator pieces using spores of Geobacillus stearothermophilus. Further, decontamination effectiveness was tested on used respirators after one 12-hr shift by swabbing before and after the decontamination. The effects of up to ten decontamination cycles on the respirators' functionality were evaluated using material properties, the structural integrity of the respirators, and fit tests with subjects. The suggested H2O2 decontamination procedure was proven to be (a) sufficiently potent (no microbial recovery, total inactivation of biological indicators as well as spore inoculum on critical respirator surfaces), (b) gentle as no significant damage to the respirator structural integrity and acceptable fit factors were observed, and (c) safe as no H2O2 residue were detected after the defined aeration and storage. Thus, this easy-to-implement and scalable method could overcome another severe respirator shortage, providing enough flexibility to draft safe, effective, and logistically simple crisis plans. However, as highlighted in this study, due to the wealth of design and material used in different models and brands of respirators, the decontamination process should be validated for each FFP respirator model before its field implementation.
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Affiliation(s)
- Martin Novák
- Research and Strategic Business Development, SKAN AG, Allschwil, Switzerland
| | - Christian Gloor
- Federal Office for Civil Protection, Spiez Laboratory, Spiez, Switzerland
| | - Esther Wicki
- Division of Infectious Diseases and Hospital Epidemiology, Zurich City Hospital, Zurich, Switzerland
| | - Dorothea Herb
- Division of Infectious Diseases and Hospital Epidemiology, Zurich City Hospital, Zurich, Switzerland
| | - Adrian Schibli
- Division of Infectious Diseases and Hospital Epidemiology, Zurich City Hospital, Zurich, Switzerland
| | - Gilles Richner
- Federal Office for Civil Protection, Spiez Laboratory, Spiez, Switzerland
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7
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Ramser M, Vach W, Strub N, Cadosch D, Saxer F, Eckardt H. The impact of specific fracture characteristics of low-energy fractures of the pelvis on mortality. BMC Geriatr 2022; 22:669. [PMID: 35971065 PMCID: PMC9377136 DOI: 10.1186/s12877-022-03223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pelvic fractures in older patients are associated with relevant morbidity and mortality. Both might be determined by fracture morphology and/or patient characteristics. The aim of this project is to investigate the prognostic value of specific fracture characteristics with respect to overall survival and to compare it with an established classification system. Methods Retrospective analysis of patients ≥ 60 years, treated conservatively for a CT-scan verified, low-energy pelvic ring fracture between August 2006 and December 2018. Survival data was available from patients’ charts and cantonal or national registries. The prognostic value of fracture characteristic describing the anterior and posterior involvement of the pelvic ring was investigated. This analysis was repeated after patients were stratified into a high-risk vs a low-risk group according to patient characteristic (age, gender, comorbidities, mobility, living situation). This allowed to assess the impact of the different fracture morphologies on mortality in fit vs. frail senior patients separately. Results Overall, 428 patients (83.4% female) with a mean age of 83.7 years were included. Two thirds of patients were still living in their home and mobile without walking aid at baseline. In-hospital mortality was 0.7%, overall, one-year mortality 16.9%. An independent and significant association of age, gender and comorbidities to overall survival was found. Further, the occurrence of a horizontal sacral fracture as well as a ventral comminution or dislocation was associated with an increased mortality. The effect of a horizontal sacral fracture was more accentuated in low-risk patients while the ventral fracture components showed a larger effect on survival in high-risk patients. Conclusion Specific fracture characteristics may indicate a higher risk of mortality in conservatively treated patients with a low-energy pelvic ring fracture. Hence, they should be taken into account in future treatment algorithms and decisions on patient management.
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Affiliation(s)
- Michaela Ramser
- Department of Orthopaedic and Traumatology Surgery, University Hospital Basel, 4031, Basel, Switzerland.
| | - Werner Vach
- University of Basel, Basel, Switzerland.,Basel Academy for Quality and Research in Medicine, Basel, Switzerland
| | | | - Dieter Cadosch
- Department of Orthopaedic and Traumatology Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Franziska Saxer
- University of Basel, Basel, Switzerland.,Novartis Institutes for Biomedical Research, Novartis Campus, Basel, Switzerland
| | - Henrik Eckardt
- Department of Orthopaedic and Traumatology Surgery, University Hospital Basel, 4031, Basel, Switzerland
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8
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Klanderman RB, van Mourik N, Eggermont D, Peters AL, Tuinman PR, Bosman R, Endeman H, Cremer OL, Arbous SM, Vlaar APJ. Incidence of transfusion-related acute lung injury temporally associated with solvent/detergent plasma use in the ICU: A retrospective before and after implementation study. Transfusion 2022; 62:1752-1762. [PMID: 35919958 PMCID: PMC9544437 DOI: 10.1111/trf.17049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022]
Abstract
Background Transfusion‐related acute lung injury (TRALI) is a severe complication of plasma transfusion, though the use of solvent/detergent pooled plasma (SDP) has nearly eliminated reported TRALI cases. The goal of this study was to investigate the incidence of TRALI in intensive care units (ICU) following the replacement of quarantined fresh frozen plasma (qFFP) by SDP. Study design and methods A retrospective multicenter observational before–after cohort study was performed during two 6‐month periods, before (April–October 2014) and after the introduction of SDP (April–October 2015), accounting for a washout period. A full chart review was performed for patients who received ≥1 plasma units and developed hypoxemia within 24 h. Results During the study period, 8944 patients were admitted to the ICU. Exactly 1171 quarantine fresh frozen plasma (qFFP) units were transfused in 376 patients, and respectively, 2008 SDP units to 396 patients after implementation. Ten TRALI cases occurred during the qFFP and nine cases occurred during the SDP period, in which plasma was transfused. The incidence was 0.85% (CI95%: 0.33%–1.4%) per unit qFFP and 0.45% (CI95%: 0.21%–0.79%, p = 0.221) per SDP unit. One instance of TRALI occurred after a single SDP unit. Mortality was 70% for patients developing TRALI in the ICU compared with 22% in patients receiving at least one plasma transfusion. Conclusion Implementation of SDP lowered the incidence of TRALI in which plasma products were implicated, though not significantly. Clinically diagnosed TRALI can still occur following SDP transfusion. Developing TRALI in the ICU was associated with high mortality rates, therefore, clinicians should remain vigilant.
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Affiliation(s)
- Robert B Klanderman
- Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands
| | - Nielsvan van Mourik
- Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands
| | - Dorus Eggermont
- Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands
| | - Anna-Linda Peters
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care, Amsterdam University Medical Centers - VUmc, Amsterdam, The Netherlands
| | - Rob Bosman
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis - Locatie Oost, Amsterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis - Locatie Oost, Amsterdam, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sesmu M Arbous
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands
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9
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Ramser M, Cadosch D, Vach W, Strub N, Saxer F, Eckardt H. Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making. BMC Geriatr 2022; 22:543. [PMID: 35768764 PMCID: PMC9245220 DOI: 10.1186/s12877-022-03222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Pelvic ring fractures in the elderly are often caused by minor trauma. Treatment of these patients is currently based on fracture classification, clinical course, and ability to mobilize. Our aim was to identify morphological fracture characteristics with potential prognostic relevance and evaluate their association with clinical decision making and outcome, as well as their interobserver reliability. Methods Five fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Presence of a horizontal sacral fracture; 4. Ventral dislocation; 5. Ventral comminution. These characteristics were assessed retrospectively in a series of 548 patients. The association of their presence with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Further, the inter-observer reliability for the specific characteristics was calculated and the relation with survival assessed. Results Four of the five evaluated characteristics showed an association with clinical decision making and patient management. In particular the extent of the dorsal fractures (absent vs. unilateral vs. bilateral) (OR = 7.0; p < 00.1) and the presence of ventral comminution/dislocation (OR = 2.4; p = 0.004) were independent factors for the decision to perform surgery. Both the extent of the dorsal fracture (OR = 1.8; p < 0.001) and the presence of ventral dislocation (OR = 1.7; p = 0.003) were independently associated with a prolonged overall LOS. The inter-observer agreement for the fracture characteristics ranged from moderate to substantial. A relevant association with increased mortality was shown for horizontal sacral and comminuted ventral fractures with hazard ratios (HR) of 1.7 (95% CI: 1.1, 2.5; p = 0.008) and HR = 1.5 (95% CI: 1.0, 2.2; p = 0.048). Conclusion In the elderly, the extent of the dorsal fractures and the presence of ventral comminution/dislocation were associated to the decision to undergo surgery, failure of conservative treatment and length of stay. Survival was related to horizontal sacral fractures and ventrally comminuted fractures. These characteristics thus represent a simplified but highly informative approach for the evaluation of pelvic ring fractures in the elderly. This approach can support clinical decision making, promote patient-centred treatment algorithms and thus improve the outcome of individualized care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03222-0.
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Affiliation(s)
- Michaela Ramser
- University Hospital Basel, Department of Orthopaedic and Traumatology Surgery, 4031 Basel, Basel, Switzerland.
| | - Dieter Cadosch
- University Hospital Basel, Department of Orthopaedic and Traumatology Surgery, 4031 Basel, Basel, Switzerland
| | - Werner Vach
- University of Basel, Basel, Switzerland.,Basel Academy for Quality and Research in Medicine, Basel, Switzerland
| | | | - Franziska Saxer
- University Hospital Basel, Department of Orthopaedic and Traumatology Surgery, 4031 Basel, Basel, Switzerland.,Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Henrik Eckardt
- University Hospital Basel, Department of Orthopaedic and Traumatology Surgery, 4031 Basel, Basel, Switzerland
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10
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Boeing C, Sandten C, Hrincius ER, Anhlan D, Dworog A, Hanning S, Kuennemann T, Niehues C, Schupp T, Stec E, Thume J, Triphaus D, Wilkens M, Uphoff H, Zuendorf J, Jacobshagen A, Kreyenschmidt M, Ludwig S, Mertins HC, Mellmann A. Decontamination of disposable respirators for reuse in a pandemic employing in-situ-generated peracetic acid. Am J Infect Control 2022; 50:420-426. [PMID: 34562528 DOI: 10.1016/j.ajic.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND During shortages of filtering face pieces (FFP) in a pandemic, it is necessary to implement a method for safe reuse or extended use. Our aim was to develop a simple, inexpensive and ecological method for decontamination of disposable FFPs that preserves filtration efficiency and material integrity. MATERIAL AND METHODS Contamination of FFPs (3M Aura 9320+) with SARS-CoV-2 (1.15 × 104 PFUs), Enterococcus faecium (>106 CFUs), and physiological nasopharyngeal flora was performed prior to decontamination by submersion in a solution of 6 % acetic acid and 6 % hydrogen peroxide (6%AA/6%HP solution) over 30 minutes. Material integrity was assessed by testing the filtering efficiency, loss of fit and employing electron microscopy. RESULTS AND DISCUSSION Decontamination with the 6%AA/6%HP solution resulted in the complete elimination of SARS-CoV-2, E. faecium and physiological nasopharyngeal flora. Material characterization post-treatment showed neither critical material degradation, loss of fit or reduction of filtration efficiency. Electron microscopy revealed no damage to the fibers, and the rubber bands' elasticity was not affected by the decontamination procedure. No concerning residuals of the decontamination procedure were found. CONCLUSION The simple application and widespread availability of 6%AA/6%HP solution for decontaminating disposable FFPs make this solution globally viable, including developing and third world countries.
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11
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Siemens K, Donnelly P, Hunt BJ, Carter MJ, Murdoch IA, Tibby SM. Evaluating the Impact of Cardiopulmonary Bypass Priming Fluids on Bleeding After Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2022; 36:1584-1594. [PMID: 35000839 DOI: 10.1053/j.jvca.2021.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Cardiopulmonary bypass (CPB) predisposes young children to coagulopathy. The authors evaluated possible effects of CPB priming fluids on perioperative bleeding in pediatric cardiac surgery. DESIGN Meta-analysis and systematic review of previously published studies. SETTING Each study was conducted in a surgical center or intensive care unit. PARTICIPANTS Studies investigating patients <18 years without underlying hematologic disorders were included. INTERVENTIONS The authors evaluated randomized controlled trials (RCTs) published between 1980 and 2020 on MEDLINE, EMBASE, PubMed, and CENTRAL databases. The primary outcome was postoperative bleeding; secondary endpoints included blood product transfusion, mortality, and safety. MEASUREMENTS AND MAIN RESULTS Twenty eligible RCTs were analyzed, with a total of 1,550 patients and a median of 66 patients per study (range 20-200). The most frequently assessed intervention was adding fresh frozen plasma (FFP) to the prime (8/20), followed by albumin (5/20), artificial colloids (5/20), and blood-based priming solutions (3/20). Ten studies with 771 patients evaluated blood loss at 24 hours in mL/kg and were included in a meta-analysis. Most of them investigated the addition of FFP to the priming fluid (7/10). No significant difference was found between intervention and control groups, with a mean difference of -0.13 (-2.61 to 2.34), p = 0.92, I2 = 69%. Further study endpoints were described but their reporting was too heterogeneous to be quantitatively analyzed. CONCLUSIONS This systematic review of current evidence did not show an effect of different CPB priming solutions on 24-hour blood loss. The analysis was limited by heterogeneity within the dataset regarding population, type of intervention, dosing, and the chosen comparator, compromising any conclusions.
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Affiliation(s)
- K Siemens
- PICU Evelina London Children's Hospital, St Thomas' Hospital, London, United Kingdom
| | - P Donnelly
- PICU Evelina London Children's Hospital, St Thomas' Hospital, London, United Kingdom
| | - B J Hunt
- Haematology, St Thomas' Hospital, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - M J Carter
- PICU Evelina London Children's Hospital, St Thomas' Hospital, London, United Kingdom
| | - I A Murdoch
- PICU Evelina London Children's Hospital, St Thomas' Hospital, London, United Kingdom
| | - S M Tibby
- PICU Evelina London Children's Hospital, St Thomas' Hospital, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK..
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12
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Lu W. A Concise Synopsis of Current Literature and Guidelines on the Practice of Plasma Transfusion. Clin Lab Med 2021; 41:635-645. [PMID: 34689970 DOI: 10.1016/j.cll.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence-based indications for plasma transfusion are limited, and much of the clinical practice relies on expert opinion. This article highlights key studies, meta-analyses, and guidelines for plasma transfusion in adults. The goal is to limit non-evidence-based plasma transfusion that is outside of clinical guideline, because as with all transfusions, the administration of plasma is not without risk. Any intended potential benefit must be appraised against the real risks associated with transfusion. Moving forward, the practice of plasma transfusion would benefit greatly from randomized controlled trials to update and expand the existing guidelines.
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Affiliation(s)
- Wen Lu
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street Cotran 260, Boston, MA 02115, USA.
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13
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Company Sancho MC, González-María E, Abad-Corpa E. [Limited Reuse and Extended Use of Filtering Facepiece Respirators]. Enferm Clin 2021; 31:S78-S83. [PMID: 34629854 PMCID: PMC7241318 DOI: 10.1016/j.enfcli.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
Objetivo Los equipos de protección individual (EPI), y dentro de ellos las mascarillas, son fundamentales en una pandemia como la del COVID-19, que ha requerido, en muchas ocasiones, de reutilización de material debido a su escasez. El objetivo de esta revisión es sintetizar la evidencia disponible sobre la reutilización y uso extendido de las mascarillas de media y alta filtración. Método Revisión exploratoria. Búsqueda a través de lenguaje natural en PubMed y Centros, Agencias y Organizaciones para el Control de Enfermedades. Se limitó a artículos publicados entre 2010-2020 en inglés y en español. Resultados Se localizaron 83 artículos, seleccionándose 14, más cinco recomendaciones. Los temas abordados se clasifican en siete apartados: Caducidad, uso extendido y reutilización de mascarillas, técnica de manipulación, sellado, efectos físicos psicológicos y cumplimentación, contaminación y descontaminación de mascarillas. Conclusiones La reutilización de las mascarillas no está recomendada por los organismos oficiales ni los fabricantes, sólo se acepta en casos extraordinarios, como las pandemias. Los estudios se caracterizan por contar con muestras pequeñas, usan diferentes modelos de mascarillas ajustando su recomendación al modelo.
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Affiliation(s)
- María Consuelo Company Sancho
- Servicio de Promoción de la Salud, Dirección General de Salud Pública. Servicio Canario de la Salud (Investén-isciii). Las Palmas de Gran Canaria, Las Palmas, España
| | - Esther González-María
- Unidad de Investigación en Cuidados de Salud (Investén-isciii). Instituto de Salud Carlos III. CIBERFES, Madrid, España
| | - Eva Abad-Corpa
- Facultad de Enfermería, Universidad de Murcia; Hospital Reina Sofía, Servicio Murciano de Salud. Instituto Murciano de Investigación Biomédica (IMIB-Arrixaca). (Investén-isciii). CIBERFES, Murcia, España
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14
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Regli A, Thalayasingam P, Bell E, Sommerfield A, von Ungern-Sternberg BS. More than half of front-line healthcare workers unknowingly used an N95/P2 mask without adequate airborne protection: An audit in a tertiary institution. Anaesth Intensive Care 2021; 49:404-411. [PMID: 34325537 DOI: 10.1177/0310057x211007861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Front-line staff routinely exposed to aerosol-generating procedures are at a particularly high risk of transmission of severe acute respiratory syndrome coronavirus 2. We aimed to assess the adequacy of respiratory protection provided by available N95/P2 masks to staff routinely exposed to aerosol-generating procedures. We performed a prospective audit of fit-testing results. A convenience sample of staff from the Department of Anaesthesia and Pain Medicine, who opted to undergo qualitative and/or quantitative fit-testing of N95/P2 masks was included. Fit-testing was performed following standard guidelines including a fit-check. We recorded the type and size of mask, pass or failure and duration of fit-testing. Staff completed a short questionnaire on previous N95/P2 mask training regarding confidence and knowledge gained through fit-testing. The first fit-pass rate using routinely available N95/P2 masks at this institution was only 47%. Fit-pass rates increased by testing different types and sizes of masks. Confidence 'that the available mask will provide adequate fit' was higher after fit-testing compared with before fit-testing; (median, interquartile range) five-point Likert-scale (4.0 (4.0-5.0) versus 3.0 (2.0-4.0); P<0.001). This audit highlights that without fit-testing over 50% of healthcare workers were using an N95/P2 mask that provided insufficient airborne protection. This high unnoticed prevalence of unfit masks among healthcare workers can create a potentially hazardous false sense of security. However, fit-testing of different masks not only improved airborne protection provided to healthcare workers but also increased their confidence around mask protection.
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Affiliation(s)
- Adrian Regli
- Intensive Care Unit, Fiona Stanley Hospital, Perth, Australia.,School of Human Sciences, The University of Western Australia, Perth, Australia.,Medical School, The University of Notre Dame Australia, Fremantle, Australia
| | - Priya Thalayasingam
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia
| | - Emily Bell
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia
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15
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Zaman S, Seligman H, Lloyd FH, Patel KT, Chappell D, O'Hare D, Cole GD, Francis DP, Petraco R, Linton NW. Aerosolised fluorescein can quantify FFP mask faceseal leakage: a cost-effective adaptation to the existing point of care fit test. Clin Med (Lond) 2021; 21:e263-e268. [PMID: 34001582 DOI: 10.7861/clinmed.2020-0982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A qualitative fit test using bitter-tasting aerosols is the commonest way to determine filtering face-piece (FFP) mask leakage. This taste test is subjective and biased by placebo. We propose a cheap, quantitative modification of the taste test by measuring the amount of fluorescein stained filter paper behind the mask using image analysis. METHODS A bitter-tasting fluorescein solution was aerosolised during mask fit tests, with filter paper placed on masks' inner surfaces. Participants reported whether they could taste bitterness to determine taste test 'pass' or 'fail' results. Filter paper photographs were digitally analysed to quantify total fluorescence (TF). RESULTS Fifty-six healthcare professionals were fit tested; 32 (57%) 'passed' the taste test. TF between the taste test 'pass' and 'fail' groups was significantly different (p<0.001). A cut-off (TF = 5.0 × 106 units) was determined at precision (78%) and recall (84%), resulting in 5/56 participants (9%) reclassified from 'pass' to 'fail' by the fluorescein test. Seven out of 56 (12%) reclassified from 'fail' to 'pass'. CONCLUSION Fluorescein is detectable and sensitive at identifying FFP mask leaks. These low-cost adaptations can enhance exiting fit testing to determine 'pass' and 'fail' groups, protecting those who 'passed' the taste test but have high fluorescein leak, and reassuring those who 'failed' the taste test despite having little fluorescein leak.
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Affiliation(s)
| | | | | | - Keval T Patel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Darrel P Francis
- Imperial College London, London, UK and Imperial College Healthcare NHS Trust, London, UK
| | - Ricardo Petraco
- Imperial College London, London, UK and Imperial College Healthcare NHS Trust, London, UK
| | - Nick Wf Linton
- Imperial College London, London, UK and Imperial College Healthcare NHS Trust, London, UK
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16
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Illés B, Gordon P. Filtering efficiency measurement of respirators by laser-based particle counting method. Measurement (Lond) 2021; 176:109173. [PMID: 33642662 PMCID: PMC7896493 DOI: 10.1016/j.measurement.2021.109173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 02/07/2021] [Indexed: 05/09/2023]
Abstract
Respirators are one of the most useful personal protective equipment which can effectively limit the spreading of coronavirus (COVID-19). There are a worldwide shortage of respirators, melt-blown non-woven fabrics, and respirator testing possibilities. An easy and fast filtering efficiency measurement method was developed for testing the filtering materials of respirators. It works with a laser-based particle counting method, and it can determine two types of filtering efficiencies: Particle Filtering Efficiency (PFE) at given particle sizes and Concentration Filtering Efficiency (CFE) in the case of different aerosols. The measurement method was validated with different aerosol concentrations and with etalon respirators. Considerable advantages of our measurement method are simplicity, availability, and the relatively low price compared to the flame-photometer based methods. The ability of the measurement method was tested on ten different types of Chinese KN95 respirators. The quality of these respirators differs much, only two from ten reached 95% filtering efficiency.
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Affiliation(s)
- Balázs Illés
- Department of Electronics Technology, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Műegyetem rkp. 3-9, H-1111, Budapest, Hungary
| | - Péter Gordon
- Department of Electronics Technology, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Műegyetem rkp. 3-9, H-1111, Budapest, Hungary
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17
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Green L, Roberts N, Cooper J, Agarwal S, Brunskill SJ, Chang I, Gill R, Johnston A, Klein AA, Platton S, Rossi A, Sepehripour A, Stanworth S, Monk V, O'Brien B. Prothrombin complex concentrate vs. fresh frozen plasma in adult patients undergoing heart surgery - a pilot randomised controlled trial (PROPHESY trial). Anaesthesia 2020; 76:892-901. [PMID: 33285008 PMCID: PMC8246985 DOI: 10.1111/anae.15327] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
Abstract
There is equipoise regarding the use of prothrombin complex concentrate vs. fresh frozen plasma in bleeding patients undergoing cardiac surgery. We performed a pilot randomised controlled trial to determine the recruitment rate for a large trial, comparing the impact of prothrombin complex concentrate vs. fresh frozen plasma on haemostasis (1 h and 24 h post-intervention), and assessing safety. Adult patients who developed bleeding within 24 h of cardiac surgery that required coagulation factor replacement were randomly allocated to receive prothrombin complex concentrate (15 IU.kg-1 based on factor IX) or fresh frozen plasma (15 ml.kg-1 ). If bleeding continued after the first administration of prothrombin complex concentrate or fresh frozen plasma administration, standard care was administered. From February 2019 to October 2019, 180 patients were screened, of which 134 (74.4% (95%CI 67-81%)) consented, 59 bled excessively and 50 were randomly allocated; 25 in each arm, recruitment rate 35% (95%CI 27-44%). There were 23 trial protocol deviations, 137 adverse events (75 prothrombin complex concentrate vs. 62 fresh frozen plasma) and 18 serious adverse events (5 prothrombin complex concentrate vs. 13 fresh frozen plasma). There was no increase in thromboembolic events with prothrombin complex concentrate. No patient withdrew from the study, four were lost to follow-up and two died. At 1 h after administration of the intervention there was a significant increase in fibrinogen, Factor V, Factor XII, Factor XIII, α2 -antiplasmin and antithrombin levels in the fresh frozen plasma arm, while Factor II and Factor X were significantly higher in the prothrombin complex concentrate group. At 24 h, there were no significant differences in clotting factor levels. We conclude that recruitment to a larger study is feasible. Haemostatic tests have provided useful insight into the haemostatic changes following prothrombin complex concentrate or fresh frozen plasma administration. A definitive trial is needed to ascertain the benefits and safety for each.
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Affiliation(s)
- L Green
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK.,Department of Haematology, Barts Health NHS Trust, London, UK.,Department of Cardiac Surgery, Barts Health NHS Trust, London, UK
| | - N Roberts
- William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - J Cooper
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - S Agarwal
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - S J Brunskill
- Department of Anaesthesia, University Hospital Southampton, Southampton, UK
| | - I Chang
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - R Gill
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Johnston
- Department of Anaesthesia, Royal Papworth Hospital, Cambridge, UK
| | - A A Klein
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Platton
- Department of Cardiac Surgery, Barts Health NHS Trust, London, UK
| | - A Rossi
- William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - A Sepehripour
- William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - S Stanworth
- Department of Anaesthesia, Barts Health NHS Trust, London, UK.,NHS Blood and Transplant, Oxford, UK
| | - V Monk
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - B O'Brien
- Department of Anaesthesia, Barts Health NHS Trust, London, UK.,Outcomes Research Consortium, Cleveland Clinic, OH, USA
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18
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Scalvenzi M, Villani A, Ruggiero A. Community Knowledge About the Use, Reuse, Disinfection and Disposal of Masks and Filtering Facepiece Respirators: Results of a Study Conducted in a Dermatology Clinic at the University of Naples in Italy. J Community Health 2021; 46:786-93. [PMID: 33258051 DOI: 10.1007/s10900-020-00952-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/19/2022]
Abstract
In Italy, as well as in almost all countries, the use of masks in public with several other measures has been an important health measure during the ongoing COVID-19 pandemic. The correct use of masks is essential, as a wrong use and disposal may increase the rate of contagious. Herein, we report a descriptive study evaluating the knowledge and use, reuse and disposal of masks in community settings. An anonymous questionnaire called MaSK (Mask uSe and Knowledge) questionnaire was developed and offered to patients referring at our dermatologic outpatient clinic. A total of 2562 full complete patients’ questionnaires were considered for the study. Our results showed that awareness and information campaigns aimed at the general population are urgently needed in order to implement a correct use of masks and limit as much as possible the infection rate.
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19
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Ahmadpoor P, Aglae C, Garo F, Cariou S, Renaud S, Reboul P, Moranne O. Humanized anti CD-20 as an alternative in chronic management of relapsing thrombotic thrombocytopenic microangiopathy resistant to rituximab due to anti chimeric antibody. Int J Hematol 2020; 113:456-460. [PMID: 33067738 DOI: 10.1007/s12185-020-03020-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Acquired Immune thrombotic thrombocytopenic purpura (iTTP) is considered among clinical situations that needs not only urgent treatment in acute setting but also long term management to prevent relapses. Important progresses have been made in management of these patients that are definitely associated with reduced mortality and relapse rate. However, there are still noticeable percentage of patients that may relapse despite application of modern treatment strategies including preemptive rituximab infusions. Hereby, we share our experience concerning a frequently relapsing iTTP due to development of anti-rituximab antibody. In our case administration of obinutuzumab, a humanized type II anti CD-20 antibody was associated with complete peripheral blood B cell depletion and increasing plasma ADAMTS-13 activity.
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Affiliation(s)
- Pedram Ahmadpoor
- Department of Nephrology, Dialysis and Apheresis, University Hospital Caremeau, Nimes, France
| | - Cedric Aglae
- Department of Nephrology, Dialysis and Apheresis, University Hospital Caremeau, Nimes, France
| | - Florian Garo
- Department of Nephrology, Dialysis and Apheresis, University Hospital Caremeau, Nimes, France
| | - Sylvain Cariou
- Department of Nephrology, Dialysis and Apheresis, University Hospital Caremeau, Nimes, France
| | - Sophie Renaud
- Department of Nephrology, Dialysis and Apheresis, University Hospital Caremeau, Nimes, France
| | - Pascal Reboul
- Department of Nephrology, Dialysis and Apheresis, University Hospital Caremeau, Nimes, France
| | - Olivier Moranne
- Department of Nephrology, Dialysis and Apheresis, University Hospital Caremeau, Nimes, France. .,Service de Néphrologie, Dialyse, Apherese, Hopital Universitaire Caremeau, 4 place Pr Robert-Debré, Nimes, 3029, France.
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20
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Lane WG, Sinnott-Stutzman VB. Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009-2016. J Vet Emerg Crit Care (San Antonio) 2020; 30:558-566. [PMID: 32643232 DOI: 10.1111/vec.12972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/19/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To document indications for fresh frozen plasma (FFP) use in cats, doses administered, and frequency of adverse transfusion reactions (ATR). DESIGN Retrospective observational study from January 2009 to November 2016. SETTING Large urban referral and emergency facility. ANIMALS One hundred twenty-one client-owned cats that received FFP. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Signalment, indication(s), dose, pre- and posttransfusion total plasma protein, prothrombin time, activated partial thromboplastin time, as well as possible ATR, primary disease process, and outcome were recorded. Doppler blood pressure was increased posttransfusion (mean pre 99.5 ± 30.8 mm Hg; post 108.5 ± 32.5 mm Hg, P = .027). Cats were significantly less likely to be coagulopathic posttransfusion (P < 0.001). Most common indications were suspected coagulopathy (n = 105, 83%), hemorrhage (n = 45, 35%), and hypotension (n = 32, 25%). Median dose was 6 mL/kg (interquartile range = 3 mL/kg) and was negatively correlated with body weight (r = -.598, P < 0.001). Possible ATR occurred in 17 of 108 (16%, 95% confidence interval [CI], 10-24%) of transfusions. Increased body temperature was most common in 11 of 108 (10%, 95% CI, 5-18%), followed by tachypnea/dyspnea in 8 of 108 (7%, 95% CI, 3-13%). Common primary disease processes included liver disease (n = 41, 34%), neoplasia (n = 19, 16%), and sepsis (n = 15, 12%). Overall mortality was 54%. Improvement of clotting times was associated with increased odds of survival (odds ratio = 2.4; 95% CI, 1.1-5.3; P = 0.023). CONCLUSIONS Clinician justifications for FFP transfusions are comparable to that reported in dogs; however, the mL/kg dose is lower. Coagulopathy and blood pressure significantly improve posttransfusion. Possible ATR were as frequent as that reported with feline packed RBCs transfusions and classified as mild.
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Affiliation(s)
- William G Lane
- Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, Massachusetts
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21
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Bohonek M, Kutac D, Acker JP, Seghatchian J. Optimizing the supply of whole blood-derived bioproducts through the combined implementation of cryopreservation and pathogen reduction technologies and practices: An overview. Transfus Apher Sci 2020; 59:102754. [PMID: 32165117 DOI: 10.1016/j.transci.2020.102754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The essential historical knowledge and expertise developed over the past 5-6 decades on the safety / efficacy of conventional blood components therapy by blood transfusion establishments have guided the development of validated methods which have ensure optimal safety margins for frozen blood and its bioproducts with or even without pathogen reduction. Newer generations of pathogen reduced frozen red blood cell, plasma and platelet products and the standardised and safer pooling of human platelet lysate are now become available for potential clinical use. These types of whole blood-derived bioproducts not only reduce the risk of transmission of range of pathogenic blood-borne pathogen. As cryopreservation can be combined with PRT without significantly compromising in vitro quality characteristics or physiological capabilities, it allows us to maximize the available inventory of these blood products in both civil and military trauma settings. The main objective of this overview is to update readers and scientific / medical communities of the various building blocks needed to optimally grantee the pathogen safety of whole blood-derived bioproducts, with minimal untoward events to the recipients. While this is an emerging area, we are seeing the numerous potential opportunities that cryopreservation and pathogen inactivation can have on the transfused patient outcomes. This manuscript is informed by recent publications on this topic.
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Affiliation(s)
- Milos Bohonek
- Department of Haematology and Blood Transfusion, Military University Hospital Prague, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
| | - Dominik Kutac
- Department of Haematology and Blood Transfusion, Military University Hospital Prague, Faculty of Military Health Sciences, University of Defence Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Jason P Acker
- Centre for Innovation, Canadian Blood Services, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection, and DDR Strategies, London, England, UK.
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22
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Mansi ET, Waldrop JE, Davidow EB. Retrospective evaluation of the indications, safety and effects of fresh frozen plasma transfusions in 36 cats (2014-2018). J Feline Med Surg 2019; 22:696-704. [PMID: 31576775 DOI: 10.1177/1098612x19876728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The goals of this study were to classify the indications, risks, effects on coagulation times and outcomes of cats receiving fresh frozen plasma (FFP) transfusions in clinical practice. METHODS This was a retrospective study of FFP transfusions administered in two referral hospitals from 2014 to 2018. Transfusion administration forms and medical records were reviewed. Information was collected on indication, underlying condition, coagulation times and signs of transfusion reactions. Seven-day outcomes after FFP administration were also evaluated when available. RESULTS Thirty-six cats received 54 FFP transfusions. Ninety-four percent of cats were administered FFP for treatment of a coagulopathy. Twenty cats had paired coagulation testing before and after FFP administration. Eighteen of these cats had improved coagulation times after receiving 1-3 units of FFP. Eight of the 36 cats had probable transfusion reactions (14.8% of 54 FFP transfusions). These reactions included respiratory signs (n = 4), fever (n = 2) and gastrointestinal signs (n = 2). Five of the eight cats with probable reactions had received packed red blood cells contemporaneously. Overall mortality rate during hospitalization was 29.7%, with 52.8% (n = 19/36) of cats confirmed to be alive 7 days after discharge. CONCLUSIONS AND RELEVANCE This retrospective study shows that FFP transfusions improve coagulation times in cats. Transfusion reactions are a risk, and risk-benefit ratios must be measured prior to administration and possible reactions monitored. In the study cats, the FFP transfusions appeared to be a tolerable risk given the benefit to prolonged coagulation times.
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Affiliation(s)
- Elizabeth T Mansi
- Emergency and Critical Care Service, BluePearl Veterinary Partners, Seattle, WA, USA
| | - Jennifer E Waldrop
- Emergency and Critical Care Service, BluePearl Veterinary Partners, Seattle, WA, USA
| | - Elizabeth B Davidow
- Emergency and Critical Care Service, BluePearl Veterinary Partners, Seattle, WA, USA
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Lubbers R, Beaart-van de Voorde LJJ, van Leeuwen K, de Boer M, Gelderman KA, van den Berg MJ, Ketel AG, Simon A, de Ree J, Huizinga TWJ, Steup-Beekman GM, Trouw LA. Complex medical history of a patient with a compound heterozygous mutation in C1QC. Lupus 2019; 28:1255-1260. [PMID: 31357913 PMCID: PMC6710612 DOI: 10.1177/0961203319865029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction C1q is an essential part of the classical pathway of complement activation. Genetic deficiencies, caused by homozygous mutations in one of the C1q genes, are rare and are strongly associated with development of systemic lupus erythematosus (SLE). Here we describe a C1q-deficient patient with a compound heterozygous mutation. Material and methods Serum was analysed with enzyme-linked immunosorbent assay (ELISA) and Western blot for the presence of C1q, and DNA and RNA sequencing was performed to identify the mutations and confirm that these were located on different chromosomes. Results The medical history of the patient includes SLE diagnosis at age 11 years with cerebral involvement at age 13, various infections, osteonecrosis and hemophagocytic syndrome. Using ELISA and Western blot, we confirmed the absence of C1q in the serum of the patient. Using DNA sequencing, two mutations in the C1QC gene were identified: c.100G > A p.(Gly34Arg) and c.205C > T p.(Arg69X). With RNA sequencing we confirmed that the mutations are located on different chromosomes. Discussion The patient described in this case report has a compound heterozygous mutation in C1QC resulting in C1q deficiency.
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Affiliation(s)
- R Lubbers
- 1 Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - K van Leeuwen
- 2 Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - M de Boer
- 2 Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - K A Gelderman
- 2 Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - M J van den Berg
- 3 Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Rheumatology and Immunology, Amsterdam, the Netherlands
| | - A G Ketel
- 4 Spaarnegasthuis, Hoofddorp, the Netherlands
| | - A Simon
- 5 Radboud University Medical Center, Center for Immunodeficiency and Autoinflammation, Department of Internal Medicine, Nijmegen, the Netherlands
| | - J de Ree
- 4 Spaarnegasthuis, Hoofddorp, the Netherlands
| | - T W J Huizinga
- 1 Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - G M Steup-Beekman
- 1 Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - L A Trouw
- 1 Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,6 Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
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Berger-Groch J, Thiesen DM, Grossterlinden LG, Schaewel J, Fensky F, Hartel MJ. The intra- and interobserver reliability of the Tile AO, the Young and Burgess, and FFP classifications in pelvic trauma. Arch Orthop Trauma Surg 2019; 139:645-50. [PMID: 30715568 DOI: 10.1007/s00402-019-03123-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Several different systems of classification have been developed to understand the complexity of pelvic ring fractures, to facilitate communication between physicians and to support the selection of appropriate therapeutic measures. The purpose of this study was to measure the inter- and intraobserver reliability of Tile AO, Young and Burgess, and FFP classification in pelvic ring fractures. The Rommens classification system (FFP) is analyzed for the first time. MATERIALS AND METHODS Four reviewers (2 × senior pelvic trauma surgeon, 1 × resident, 1 × medical student) separately analyzed and classified 154 CT scans of patients with pelvic fracture. The Tile AO, the Young and Burgess, and the FFP classifications (subgroup with patients ≥ 60 years) were compared. Another blinded re-evaluation was carried out after 2 months to determine intraobserver reliability. RESULTS The overall interobserver agreement was fair for all classification systems (ICC: OTA 0.55, Young and Burgess 0.42, FFP 0.54). For specific categories, (e.g. type B or C fractures), there was a substantial agreement between the experienced surgeons (kappa: OTA 0.64, Young and Burgess 0.62, FFP 0.68). For inexperienced observers, there was a fair agreement in all systems (kappa: OTA 0.23, Young and Burgess 0.23, FFP 0.36). CONCLUSIONS All three classifications reach their maximum reliability with advanced expertise in the surgery of pelvic fractures. The novel FFP classification has proved to be at least equivalent when directly compared to the established systems. The FFP classification system showed substantial reliability in patients older than 60 years.
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25
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Pornsukarom S, van Vliet AHM, Thakur S. Whole genome sequencing analysis of multiple Salmonella serovars provides insights into phylogenetic relatedness, antimicrobial resistance, and virulence markers across humans, food animals and agriculture environmental sources. BMC Genomics 2018; 19:801. [PMID: 30400810 PMCID: PMC6218967 DOI: 10.1186/s12864-018-5137-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/02/2018] [Indexed: 11/13/2022] Open
Abstract
Background Salmonella enterica is a significant foodborne pathogen, which can be transmitted via several distinct routes, and reports on acquisition of antimicrobial resistance (AMR) are increasing. To better understand the association between human Salmonella clinical isolates and the potential environmental/animal reservoirs, whole genome sequencing (WGS) was used to investigate the epidemiology and AMR patterns within Salmonella isolates from two adjacent US states. Results WGS data of 200 S. enterica isolates recovered from human (n = 44), swine (n = 32), poultry (n = 22), and farm environment (n = 102) were used for in silico prediction of serovar, distribution of virulence genes, and phylogenetically clustered using core genome single nucleotide polymorphism (SNP) and feature frequency profiling (FFP). Furthermore, AMR was studied both by genotypic prediction using five curated AMR databases, and compared to phenotypic AMR using broth microdilution. Core genome SNP-based and FFP-based phylogenetic trees showed consistent clustering of isolates into the respective serovars, and suggested clustering of isolates based on the source of isolation. The overall correlation of phenotypic and genotypic AMR was 87.61% and 97.13% for sensitivity and specificity, respectively. AMR and virulence genes clustered with the Salmonella serovars, while there were also associations between the presence of virulence genes in both animal/environmental isolates and human clinical samples. Conclusions WGS is a helpful tool for Salmonella phylogenetic analysis, AMR and virulence gene predictions. The clinical isolates clustered closely with animal and environmental isolates, suggesting that animals and environment are potential sources for dissemination of AMR and virulence genes between Salmonella serovars. Electronic supplementary material The online version of this article (10.1186/s12864-018-5137-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suchawan Pornsukarom
- Faculty of Veterinary Medicine, Rajamangala University of Technology Tawan-ok, Chonburi, Thailand
| | - Arnoud H M van Vliet
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - Siddhartha Thakur
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA. .,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA.
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Ishikura H, Kitamura T. Trauma-induced coagulopathy and critical bleeding: the role of plasma and platelet transfusion. J Intensive Care 2017; 5:2. [PMID: 34798700 PMCID: PMC8600862 DOI: 10.1186/s40560-016-0203-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/17/2016] [Indexed: 11/25/2022] Open
Abstract
Hemorrhage is responsible for 30 to 40% of all trauma-related mortality. Among adult trauma patients, 94% of hemorrhage-related deaths occur within 24 h and approximately 60% of these deaths within 3 h of hospital admission. Therefore, appropriate initial fluid resuscitation for bleeding is crucial to avoid preventable trauma-related death. In particular, the resuscitation strategy must be designed to complement prompt correction of anemia, coagulopathies, and thrombocytopenia. Conventional damage control resuscitation (DCR) of patients with severe trauma and massive hemorrhage is usually begun with rapid infusion of 1000 to 2000 mL of crystalloid fluids with subsequent transfusion of type O or uncross-matched red blood cells (RBCs) without plasma such as fresh frozen plasma (FFP) or platelets (PLTs). However, this DCR technique often leads to several adverse events such as abdominal compartment syndrome, acute respiratory distress syndrome, multiple organ failure, and dilutional coagulopathy. Simultaneous transfusion of FFP and PLTs along with the first units of RBCs while minimizing crystalloid infusion was recently recommended as a renewed DCR strategy. This aggressive RBC transfusion with FFP and PLTs is not only essential for the correction of coagulopathies and thrombocytopenia but also has the potential to ensure a good outcome in trauma patients. Additionally, it is important to maintain the resuscitation ratios of FFP/RBC and PLT/RBC. Most recently, DCR has been advocated for rapid hemorrhage control through early administration of a mixture of FFP, PLTs, and RBCs in a balanced ratio of 1:1:1.
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Affiliation(s)
- Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Taisuke Kitamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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Abstract
Transfusion of various blood components can provide relief from symptomatic anemia and reduce the bleeding risks associated with low platelet counts or presence of coagulopathy. Blood components are collected from volunteer donors and processed into separate components to maximize efficient utilization of a scarce resource while also providing maximum clinical benefit. Tests including blood type and screening for clinically significant alloantibodies increase the likelihood of successful transfusion. Risks of transfusion include hypersensitivity and hemolytic transfusion reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, and transmission of infection. Indications for transfusion are reviewed along with various products available for transfusion.
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Affiliation(s)
- Nathan T Connell
- Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Cowan K, Gao X, Parab V, Nguy T, Wu L, Arron JR, Townsend M, Wallin J, Cheu M, Morimoto A, Wakshull E. Fit-for-purpose biomarker immunoassay qualification and validation: three case studies. Bioanalysis 2016; 8:2329-40. [PMID: 27712082 DOI: 10.4155/bio-2016-0184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM To improve on the efficiency of biomarker assay readiness, and for reliable biomarker data to support three drug programs, we implemented a fit-for-purpose approach, qualifying two biomarker assays and validating a third. Results/methodology: The qualification strategy and selection of experiments for two exploratory biomarkers (CXCL1, CCL19) was determined by the intended use of the biomarker data. The third biomarker, IL-6, was validated as the data would be used in monitoring patient safety during dose-escalation studies in a Phase I trial. All three assays passed a priori acceptance criteria. CONCLUSION These assays highlight strategies and methodologies for a fit-for-purpose approach. Minimum qualification, full qualification and validation were chosen and supported programs at different stages of drug development.
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Green L, Cardigan R, Beattie C, Bolton-Maggs P, Stanworth SJ, Thachil J, Kallis Y, Zahra S. Addendum to the British Committee for Standards in Haematology (BCSH): Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant, 2004 (Br. J Haematol 2004,126,11-28). Br J Haematol 2016; 178:646-647. [PMID: 27306832 DOI: 10.1111/bjh.14163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Green
- NHS Blood and Transplant, London, UK.,Barts Health NHS Trust, London, London, UK.,Blizard Institute Queen Mary University of London, London, UK
| | | | - Craig Beattie
- Dept of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Simon J Stanworth
- Oxford University Hospitals NHS Trust/NHS Blood and Transplant, Oxford, UK.,University of Oxford, London, UK
| | - Jecko Thachil
- Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Yiannis Kallis
- Blizard Institute Queen Mary University of London, London, UK.,Department of Hepatology, Barts Health NHS Trust, London, UK
| | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, UK
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30
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Heger A, Janisch S, Pock K, Römisch J. Comparative biochemical studies of fresh frozen plasma and pooled solvent/detergent-treated plasma (octaplasLG ® ) with focus on protein S and its impact in different thrombin generation assay set-ups. Vox Sang 2016; 111:266-273. [PMID: 27232115 DOI: 10.1111/vox.12420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 04/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The solvent/detergent treatment enables effective and robust inactivation of all lipid-enveloped viruses, but also inactivates partly sensitive plasma proteins such as protein S. The aim of this study was to investigate the thrombin generation capacity of octaplasLG® , in particular focusing on the function of protein S in thrombin generation assay and the impact of assay settings. MATERIALS AND METHODS Sixteen octaplasLG® batches and 32 units of single donor fresh frozen plasma (FFP) were investigated. For protein S, both functional activity and free antigen levels were measured. Thrombin generation assay was performed using two fluorogenic tests with different triggers. Finally, rotational thromboelastometry was performed. RESULTS Mean protein S levels were lower in octaplasLG® , but a wider range of values was found for FFP. Clotting parameters and thrombin generation capacities overlapped between the two plasma groups as demonstrated using both thrombin generation assays and different triggers. Spiking studies with protein S-depleted plasma, human purified protein S or antibodies against protein S confirmed a correlation between protein S and thrombin generation capacity under specific assay conditions, especially in an assay with low tissue factor concentration. CONCLUSION Correlation between protein S and thrombin generation capacity was demonstrated in the TGA. Due to higher variability in protein S content in the FFP group, overlapping haemostatic potentials of the two plasma groups were found.
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Affiliation(s)
- A Heger
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria.
| | - S Janisch
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
| | - K Pock
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
| | - J Römisch
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
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Abstract
BACKGROUND Despite limited evidence, fresh frozen plasma (FFP) transfusions are a relatively common neonatal procedure. OBJECTIVES Quantify FFP usage in our unit; determine indications for transfusions and compliance with published guidelines. METHODS Data were retrospectively collected on infants who received FFP from January 2009 to December 2013. RESULTS Admissions totalled 10 912 infants during the study period. In total, 113 case notes were reviewed and 142 FFP transfusions were administered. Infants receiving FFP had a high mortality rate (54.87%) and an increased odds ratio for mortality 17.9 (95% confidence interval 12.0-26.6). In total, 75% FFP transfusions were compliant with guidelines. The difference between pre- and post-transfusion coagulation profile in 36.3% of infants was not statistically significant. CONCLUSIONS FFP was often used in accordance with published guidelines in our neonatal unit. However, the appropriate use and effectiveness of FFP in improving neonatal outcomes undermines the rationale for FFP usage in current guidelines.
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Affiliation(s)
- M Shukri Raban
- Division of Neonatal Medicine, Department of Paediatrics, University of Cape Town, 7935 Cape Town, South Africa
| | - Michael C Harrison
- Division of Neonatal Medicine, Department of Paediatrics, University of Cape Town, 7935 Cape Town, South Africa
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Allen CJ, Shariatmadar S, Meizoso JP, Hanna MM, Mora JL, Ray JJ, Namias N, Dudaryk R, Proctor KG. Liquid plasma use during "super" massive transfusion protocol. J Surg Res 2015; 199:622-8. [PMID: 26182996 DOI: 10.1016/j.jss.2015.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND A massive transfusion protocol (MTP) presents a logistical challenge for most blood banks and trauma centers. We compare the ratio of packed red blood cells (PRBC) and plasma transfused over serial time points in those requiring MTP (10-30 U PRBC/24 h) to those requiring "super" MTP (S-MTP; >30 U PRBC/24 h) and test the hypothesis that changes in allocation of blood products with use of readily transfusable liquid plasma (LP) improves the ratio of PRBC and plasma during S-MTP. MATERIALS AND METHODS All transfused trauma patients (n = 1305) from January 01, 2009-April, 03, 2015 were reviewed. PRBC:plasma ratio was compared for MTP (n = 277) and S-MTP (n = 61) patients, before and after the availability of LP at our institution. Data are reported as mean ± standard deviation or median (interquartile range). RESULTS Age was 41 ± 19 y, 52% blunt mechanism, injury severity score 32 ± 16, and 46.3% mortality. In 24 h, requirements were 17 (14) U PRBC and 10 (11) U plasma, with a PRBC:plasma of 1.6 (0.8). Within the first hour, PRBC:plasma for S-MTP versus MTP was 2.1:1 versus 1.7:1 (P = 0.017). With LP, S-MTP patients received significantly lower PRBC:plasma at the first hour (P < 0.001). Before institutional changes, PRBC:plasma positively correlated with PRBC transfused at hour 1 (r = 0.410, R(2) = 0.168, P < 0.001); after institutional changes and the advent of LP, there was no correlation (r = 0.177, R(2) = 0.031, P = 0.219). CONCLUSIONS Within the first hour of transfusion, units of PRBC transfused positively correlated with PRBC:plasma, and patients receiving S-MTP had higher PRBC:plasma than those receiving MTP. Changes in our institution's MTP protocol to include LP improved the early PRBC:plasma transfused in patients requiring S-MTP.
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Affiliation(s)
- Casey J Allen
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Sherry Shariatmadar
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jonathan P Meizoso
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Mena M Hanna
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jose L Mora
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Juliet J Ray
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicholas Namias
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Roman Dudaryk
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Kenneth G Proctor
- Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
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Martin DT, Schreiber MA. Modern resuscitation of hemorrhagic shock: what is on the horizon? Eur J Trauma Emerg Surg 2014; 40:641-56. [PMID: 26814779 DOI: 10.1007/s00068-014-0416-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/23/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE Mortality rates among the severely injured remain high. The successful treatment of hemorrhagic shock relies on expeditious control of bleeding through surgical ligation, packing, or endovascular techniques. An important secondary concern in hemorrhaging patients is how to respond to the lost blood volume. A single method that is able to adequately address all needs of the exsanguinating patient has not yet been agreed upon, despite a large growth of knowledge regarding the causative factors of traumatic shock. METHODS A review of relevent literature was performed. CONCLUSIONS Many different trials are currently underway to discriminate ways to improve outcomes in the severely injured and bleeding patient. This paper will review: (1) recent advances in our understanding of the effects hemorrhagic shock has on the coagulation cascade and vascular endothelium, (2) recent research findings that have changed resuscitation, and (3) resuscitation strategies that are not widely used but under active investigation.
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Affiliation(s)
- D T Martin
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L-611, Portland, OR, 97239, USA. .,Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L-611, Portland, OR, 97239, USA.
| | - M A Schreiber
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L-611, Portland, OR, 97239, USA. .,Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L-611, Portland, OR, 97239, USA.
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Sano K, Yagi H, Hanamoto H, Fujita M, Iizuka T, Yamazaki K, Tsubaki K. Successful treatment of an elderly frail patient with acquired idiopathic thrombotic thrombocytopenic purpura under close monitoring of ADAMTS13 activity and anti-ADAMTS13 antibody titers. Transfus Apher Sci 2014; 50:235-8. [PMID: 24517874 DOI: 10.1016/j.transci.2013.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/29/2013] [Indexed: 11/20/2022]
Abstract
A 68-year-old woman was admitted to the regional hospital because of hemolytic anemia, thrombocytopenia, and neurological abnormalities including unconsciousness. One week before admission, she suffered from diarrhea and subsequently passed out and hit her face on the ground. She was suspected of having TTP and was transferred to our hospital. We performed the assays of ADAMTS13 activity and anti-ADAMTS13 antibody titers, and confirmed the diagnosis of acquired idiopathic TTP with total deficiency of ADAMTS13 activity with its inhibitor. She was initially treated with plasma exchange combined with corticosteroids, however, we were forced to substitute plasma exchange with fresh frozen plasma infusion due to procedure-associated complications. The infusion of fresh frozen plasma was known as less effective and more likely to boost inhibitor titers compared to plasma exchange. In this circumstance, we could successfully switch the plasma therapy under close monitoring of ADAMTS13 activity and anti-ADAMTS13 antibody titers which precisely revealed the disease status of TTP in our patient, and eventually she achieved complete remission with normal level of ADAMTS13 activity and no inhibitor. Our experience suggested that the measurement of ADAMTS13 activity and inhibitor titer might be valuable not only for making the diagnosis but also for guiding treatment decisions by precise evaluating of disease status in patients with the acquired form of TTP.
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Abstract
The scope of activity of the Blood Transfusion Service (BTS) makes it unique among the clinical laboratories. The combination of therapeutic and diagnostic roles necessitates a multi-faceted approach to utilization management in the BTS. We present our experience in utilization management in large academic medical center.
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Affiliation(s)
- Jeremy Ryan Andrew Peña
- Blood Transfusion Service, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Jackson 220, Boston, MA, USA 02114.
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36
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Northup PG, Caldwell SH. Coagulation in liver disease: a guide for the clinician. Clin Gastroenterol Hepatol 2013; 11:1064-74. [PMID: 23506859 DOI: 10.1016/j.cgh.2013.02.026] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/18/2013] [Accepted: 02/20/2013] [Indexed: 02/06/2023]
Abstract
The human hemostasis system is complex and poorly understood after decades of intense scientific study. Despite multiple defects in routine coagulation laboratory studies in patients with chronic liver disease, there is growing evidence that these patients are effectively "rebalanced" with regard to procoagulant and anticoagulant activity and that most of these patients remain in a tenuous but balanced state of hemostasis. A major difficulty in the assessment of these patients is that there are no established laboratory tests that accurately reflect the changes in both the procoagulant and anticoagulant systems; therefore, routine laboratory testing is misleading to the clinician and may prompt inappropriate or risky therapies with little real benefit to the patient. The international normalized ratio is an example of this type of misleading test. Although the international normalized ratio is inextricably linked to prognosis and severity of protein synthetic dysfunction in acute and chronic liver disease, it is a very poor marker for bleeding risk and should not be used in isolation for this purpose. Coagulation disorders are critical in the management of frequent clinical scenarios such as esophageal variceal bleeding, invasive and percutaneous procedures, portal vein thrombosis, venous thromboembolism, and acute liver failure. This article summarizes the pathophysiology of hemostasis in liver disease, describes the strengths and weaknesses of various laboratory tests in assessment of these patients, and outlines the optimal management of hemostasis for some common clinical scenarios. Further research is needed for proper understanding of hemostasis in liver disease to optimally and safely manage these complex patients.
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Affiliation(s)
- Patrick G Northup
- Division of Gastroenterology and Hepatology, Center for the Study of Coagulation in Liver Disease, University of Virginia, Charlottesville, Virginia, USA.
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Johansson PI, Oliveri RS, Ostrowski SR. Hemostatic resuscitation with plasma and platelets in trauma. J Emerg Trauma Shock 2013; 5:120-5. [PMID: 22787340 PMCID: PMC3391834 DOI: 10.4103/0974-2700.96479] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 06/28/2011] [Indexed: 12/28/2022] Open
Abstract
Background: Continued hemorrhage remains a major contributor of mortality in massively transfused patients and controversy regarding the optimal management exists although recently, the concept of hemostatic resuscitation, i.e., providing large amount of blood products to critically injured patients in an immediate and sustained manner as part of an early massive transfusion protocol has been introduced. The aim of the present review was to investigate the potential effect on survival of proactive administration of plasma and/or platelets (PLT) in trauma patients with massive bleeding. Materials and Methods: English databases were searched for reports of trauma patients receiving massive transfusion (10 or more red blood cell (RBC) within 24 hours or less from admission) that tested the effects of administration of plasma and/or PLT in relation to RBC concentrates on survival from January 2005 to November 2010. Comparison between highest vs lowest blood product ratios and 30-day mortality was performed. Results: Sixteen studies encompassing 3,663 patients receiving high vs low ratios were included. This meta-analysis of the pooled results revealed a substantial statistical heterogeneity (I2 = 58%) and that the highest ratio of plasma and/or PLT or to RBC was associated with a significantly decreased mortality (OR: 0.49; 95% confidence interval: 0.43-0.57; P<0.0001) when compared with lowest ratio. Conclusion: Meta-analysis of 16 retrospective studies concerning massively transfused trauma patients confirms a significantly lower mortality in patients treated with the highest fresh frozen plasma (FFP) and/or PLT ratio when compared with the lowest FFP and/or PLT ratio. However, optimal ranges of FFP: RBC and PLT : RBC should be established in randomized controlled trials.
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Affiliation(s)
- Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Denmark
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Gilmore DM, Khullar OV, Jaklitsch MT, Chirieac LR, Frangioni JV, Colson YL. Identification of metastatic nodal disease in a phase 1 dose-escalation trial of intraoperative sentinel lymph node mapping in non-small cell lung cancer using near-infrared imaging. J Thorac Cardiovasc Surg 2013; 146:562-70; discussion 569-70. [PMID: 23790404 DOI: 10.1016/j.jtcvs.2013.04.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 04/01/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Early-stage non-small cell lung cancer (NSCLC) has a high recurrence rate and poor 5-year survival, particularly if lymph nodes are involved. Our objective was to perform a dose-escalation study to assess safety and feasibility of intraoperative near-infrared (NIR) fluorescence imaging to identify the first tumor-draining lymph nodes (ie, sentinel lymph nodes [SLNs] in patients with NSCLC). METHODS A-dose escalation phase 1 clinical trial assessing real-time NIR imaging after peritumoral injection of 3.8 to 2500 μg indocyanine green (ICG) was initiated in patients with suspected stage I/II NSCLC. Visualization of lymphatic migration, SLN identification, and adverse events were recorded. RESULTS Thirty-eight patients underwent ICG injection and NIR imaging via thoracotomy (n = 18) or thoracoscopic imaging (n = 20). SLN identification increased with ICG dose, with fewer than 25% SLNs detected in dose cohorts of 600 μg or less versus 89% success at 1000 μg or greater. Twenty-six NIR(+) SLNs were identified in 15 patients, with 7 NIR(+) SLNs (6 patients) harboring metastatic disease on histologic analysis. Metastatic nodal disease was never identified in patients with a histologically negative NIR(+) SLN. No adverse reactions were noted. CONCLUSIONS NIR-guided SLN identification with ICG was safe and feasible in this initial dose-escalation trial. ICG doses greater than 1000 μg yielded nearly 90% intrathoracic SLN visualization, with the presence or absence of metastatic disease in the SLN directly correlating with final nodal status of the lymphadenectomy specimen. Further studies are needed to optimize imaging parameters and confirm sensitivity and specificity of SLN mapping in NSCLC using this promising imaging technique.
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Affiliation(s)
- Denis M Gilmore
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass 02115, USA
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Frankel TL, Fischer M, Grant F, Krone J, D'Angelica MI, DeMatteo RP, Jarnagin WR, Gönen M. Selecting patients for acute normovolemic hemodilution during hepatic resection: a prospective randomized evaluation of nomogram-based allocation. J Am Coll Surg 2013; 217:210-20. [PMID: 23731968 DOI: 10.1016/j.jamcollsurg.2013.03.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute normovolemic hemodilution (ANH) decreases transfusion rates but adds to the complexity of anesthetic management during hepatectomy. A randomized controlled trial was conducted to determine if selecting patients for ANH using a transfusion nomogram improves management and resource use compared with selection using extent of resection. STUDY DESIGN One hundred fourteen patients undergoing partial hepatectomy were randomized to a clinical arm (ANH used for resection of ≥ 3 liver segments) or a nomogram arm (ANH used for predicted probability of transfusion ≥ 50% based on a previously validated nomogram). The primary end point was appropriate management, defined as avoidance of ANH in patients at low risk or use of ANH in patients at high risk for allogeneic red blood cell transfusions. RESULTS Between September 2009 and May 2011, 58 patients were randomized to the clinical arm and 56 to the nomogram arm. Demographics, diagnoses, extent of resection, blood loss, and incidence and grade of complications did not differ between the 2 groups. There were no differences in perioperative transfusions or laboratory values. Nomogram-based allocation did not change appropriate management overall (80% vs 76% in the clinical arm; p = 0.65), but did result in comparable perioperative outcomes and a trend toward decreased ANH use (30% vs 47%; p = 0.09), particularly in low blood loss (estimated blood loss ≤ 400 mL) cases (12% vs 25%; p = 0.04). CONCLUSIONS Although allocation of intraoperative management using a transfusion nomogram did not improve appropriate management overall, it more effectively identified low blood loss cases and reduced ANH use in patients least likely to benefit.
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Affiliation(s)
- Timothy L Frankel
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Agarwal N, Subramanian A, Pandey RM, Albert V, Karjee S, Arya V. An audit of fresh frozen plasma usage in a tertiary trauma care centre in north India. Indian J Hematol Blood Transfus 2013; 30:328-32. [PMID: 25435737 DOI: 10.1007/s12288-013-0265-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 04/19/2013] [Indexed: 11/29/2022] Open
Abstract
Fresh frozen plasma (FFP) transfusion is a crucial part of management of trauma patients. There is a paucity of literature about the audit of appropriateness of FFP use in trauma patients. To evaluate and analyze the appropriateness of FFP transfusion practices for trauma patients. Prospectively compiled blood bank records of FFP transfusion practices over a period of 4 months from Augusts'08 through Deember'08 were retrospectively analyzed for 207 patients. The number of FFP units used in all these trauma patients were evaluated a propos the cause of injury, departments, type of surgery, presence of coagulopathy, bleeding, massive transfusion, length of hospital stay and patient outcome. Trauma scores such as Glasgow coma score and injury severity score were also calculated to estimate the severity of injury. The appropriateness of FFP transfusion was assessed according to the guidelines drafted by the College of American Pathologists. FFP transfusion for patients experiencing active bleeding, micro vascular bleeding, coagulopathy and/or massive transfusion, was deemed appropriate. Patients receiving FFP were categorized and individually correlated with the outcome. The influences of other variables which affect patient outcome were excluded using stepwise multivariate logistic regression analysis. p value < 0.05 were considered to be statistically significant. A total of 207 trauma patients were included in the study, 183 (88.4 %) males and 24 (11.6 %) females. The FFP use among neurosurgery patients was 46.9 %, general surgery patients 40.6 % and orthopedics 12.6 %. Appropriate use of FFP was 49.5 % according to the CAP guidelines. Trauma patients who required FFP as a part of treatment were categorized as; Patients who had bleeding alone (n = 40), bleeding with coagulopathy (n = 16), and coagulopathy alone (n = 43), and further correlated with the outcome and were found statistically insignificant. The prevalence of appropriate use of FFP at trauma centre was 49.5 %. The FFP use by neurosurgery:orthopedics:general surgery was 5:1:4. The highest appropriate FFP use was by Neurosurgery department (50.5 %). Assessing the pattern of usage and rate of misuse of FFP units, allows us to establish required strategies to improve the state of affairs.
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Affiliation(s)
- Neha Agarwal
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
| | - Arulselvi Subramanian
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India ; Department of Blood Bank, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
| | - Venencia Albert
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
| | - Sulekha Karjee
- Department of Blood Bank, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
| | - Vedanand Arya
- Department of Blood Bank, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
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Raval JS, Waters JH, Triulzi DJ, Yazer MH. Complications following an unnecessary peri-operative plasma transfusion and literature review. Korean J Hematol 2013; 47:298-301. [PMID: 23320010 PMCID: PMC3538803 DOI: 10.5045/kjh.2012.47.4.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 10/09/2012] [Indexed: 11/17/2022]
Abstract
Plasma is used to correct coagulopathies, but not all coagulation abnormalities are clinically significant enough to require correction before an invasive procedure. We report an 82 year old female who, in response to a mildly prolonged INR of unknown etiology, was unnecessarily transfused with plasma in advance of elective surgery. The patient suffered a moderately severe transfusion reaction, including hives and voice hoarseness, which caused a 4-week delay in her surgery. This delay and adverse reaction could have been avoided had the principles of evidence based plasma therapy, which we herein review, been followed and if the etiology of the mildly elevated INR been investigated before the day of her surgery.
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Affiliation(s)
- Jay S Raval
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. ; The Institute for Transfusion Medicine, Pittsburgh, PA, USA
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Dawczynski C, Massey KA, Ness C, Kiehntopf M, Stepanow S, Platzer M, Grün M, Nicolaou A, Jahreis G. Randomized placebo-controlled intervention with n-3 LC-PUFA-supplemented yoghurt: effects on circulating eicosanoids and cardiovascular risk factors. Clin Nutr 2013; 32:686-96. [PMID: 23332800 DOI: 10.1016/j.clnu.2012.12.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 11/22/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND & AIMS The study examined the value of n-3 LC-PUFA-enriched yogurt as means of improving cardiovascular health. DESIGN Fifty three mildly hypertriacylglycerolemic subjects (TAG ≥ 1.7 mmol/L) participated in a randomized, placebo-controlled, double-blind, parallel designed study. The subjects consumed 1) control yoghurt; 2) yoghurt enriched with 0.8 g n-3 LC-PUFA/d; or 3) yoghurt enriched with 3 g n-3 LC-PUFA/d for a period of 10 wks. Blood samples were taken at the beginning and the end of the study period. RESULTS Following daily intake of 3 g n-3 LC-PUFA for 10 weeks, n-3 LC-PUFA levels increased significantly in plasma and red blood cells (RBC) with concomitant increase in the EPA-derived mediators (PGE₃, 12-, 15-, 18-HEPE) in plasma whilst cardiovascular risk factors such as HDL, TAG, AA/EPA ratio, and n-3 index were improved (P < 0.05); the decrease of TAG and increase in HDL were associated with the CD36 genotype. CONCLUSION The observed increase of n-3 LC-PUFA in RBC and plasma lipids due to intake of n-3 LC-PUFA enriched yoghurt resulted in a reduction of cardiovascular risk factors and inflammatory mediators showing that daily consumption of n-3 PUFA enriched yoghurt can be an effective way of supplementing the daily diet and improving cardiovascular health.
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Abstract
Advances in shock resuscitation have occurred as a result of various military conflicts. Primary objective of trauma care is to minimize or reverse shock, avoiding the lethal triad of hypothermia, acidosis, and coagulopathy. The concept of Damage Control Resuscitation has evolved along with "damage control surgery" which includes hypotensive and haemostatic resuscitation, where small aliquots of fluid are infused, with hypovolaemia and hypotension tolerated as a necessary evil until definitive haemorrhage control can be achieved. In the initial stages of trauma resuscitation the precise fluid, crystalloid or colloid, used is probably not important as long as an appropriate volume is given. Haemostatic resuscitation includes early use of fresh frozen plasma in a 1:1 ratio with packed red cells with emphasis on whole blood, frequent cryo precipitates and platelets and the use of recombinant Factor VII for control of bleeding.
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Affiliation(s)
- R Datta
- Associate Professor, Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune-40
| | - R Chaturvedi
- Professor & HOD, Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune-40
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Abstract
Although traditionally fresh frozen plasma (FFP) has been the product of choice for reversing a significant coagulopathy, the modern blood bank will have several different plasma preparations which should all be equally efficacious in reversing a significant coagulopathy or arresting coagulopathic bleeding. Emerging evidence suggests that for a stable patient, transfusing plasma for an INR≤1.5 does not confer a hemostatic benefit while unnecessarily exposing the patient to the risks associated with plasma transfusion. This review will discuss the various plasma products that are available and present some of the current literature on the clinical uses of plasma.
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Affiliation(s)
- Mark H Yazer
- The Institute for Transfusion Medicine, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
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