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Owing to their high risk in cardiac surgery, it is essential to define which transfusion strategy results in a lower rate of cardiovascular complications in older patients [1]. The aim of this study was to compare clinical outcomes after the implementation of either a restrictive or a liberal transfusion strategy in patients aged 60 years and above.
To determine whether an intervention, either therapeutic or diagnostic, is effective, it needs to be assessed according to a predefined endpoint (or outcome measure), the choice of which will vary according to the aims of the study in question and the anticipated effects of the intervention being tested. Studies can have one of several functions (which are not always mutually exclusive), including providing evidence of biological efficacy, determining a clinically important benefit, and achieving regulatory approval. In trials of therapeutic efficacy in sepsis, mortality rates are a good endpoint because death is common and mortality rates are an unambiguous measure: patients either survive or they do not. However, the time at which mortality should be recorded is less clear cut, and this single endpoint provides no information regarding the biological activity or disease modification effects of the agent under investigation. In this article, we will briefly discuss some of the potential alternative endpoints that could be used in the assessment of antisepsis agents.
Michel Goldman and colleagues call on the European medical and scientific community to coordinate efforts on immunotherapy-based approaches to coronavirus.
info:eu-repo/semantics/published
Introduction: The development of ventilator-associated pneumonia (VAP) is sometimes used as an index of the quality of care. However, the criteria used to diagnose VAP are variable. Using more strict criteria to diagnose VAP may result in a lower reported incidence of VAP and misleadingly suggest better quality of care. Methods: We included all adult patients who were treated with mechanical ventilation for more than 48 hours over a 7-month period (January-July 2012), and who had no lung infection during the first 48 hours of ventilation. We applied 89 algorithms composed of different criteria, including respiratory deterioration, inflammatory response, purulent tracheal secretions, abnormal chest radiography, and positive microbiologic findings. Results: Of 1806 patients admitted during the study period, 144 (8%) were treated with mechanical ventilation for more than 48 hours; 91 of these patients had no evidence of lung infection during the first 48 hours of mechanical ventilation. The application of the 89 algorithms resulted in a highly variable incidence of VAP, ranging from 0 to 44%. The mortality rate increased with increasing strictness of the criteria used, from 50 to 80% Conclusions: Applying different diagnostic criteria in a given patient population can result in a wide variation in the apparent incidence of VAP, and even eliminate it completely. The inverse correlation between the incidence of VAP and mortality, suggests that stricter criteria are more specific for VAP.
Comment
Delayed hemolytic transfusion reactions (DHTRs) are generally attributed to an anamnestic immune response. Case reports of DHTRs due to a primary immune response are rare. Transfusion reactions occurring in patients on the pediatric burn unit from 1981 to September 1988 were reviewed, and additional information was obtained for patients for whom a DHTR was documented. Of 62 transfusion reactions, 11 were classified as a primary immune response (DHTR), with either a positive antibody screen, a positive direct antiglobulin test (DAT), or both. None of the 11 patients included in the study had been previously tranfused or pregnant. The average number of units transfused prior to antibody identification was 19. The average time elapsed between the first transfusion and antibody identification was 3.6 weeks. Anti-K and anti-E were the most frequently identified. Three patients had a decrease in hemoglobin (average 1.5 g/dL) and hematocrit at the time that a positive DAT was detected. Such changes could not be demonstrated for the remaining eight patients. The conclusion was that a DHTR may he caused by a primary immune response in burned children more often than expected, but DHTR signs and symptoms are often not apparent due to the complications of burn trauma.
info:eu-repo/semantics/published
