How soon to start: aspirin resumption after upper gastrointestinal bleed?

Background\ud It is uncertain whether aspirin therapy should be continued after endoscopic hemostatic therapy in patients who develop peptic ulcer bleeding while receiving lowdose aspirin.\ud \ud Objective\ud To test that continuing aspirin therapy with protonpump inhibitors after endoscopic control of ulcer bleeding was not inferior to stopping aspirin therapy, in terms of recurrent ulcer bleeding in adults with cardiovascular or cerebrovascular diseases.\ud \ud Design\ud A parallel randomized, placebo-controlled noninferiority trial, in which both patients and clinicians were blinded to treatment assignment, was conducted from 2003 to 2006 by using computer-generated numbers in concealed envelopes. (ClinicalTrials.gov registration number: NCT00153725)\ud \ud Setting\ud A tertiary endoscopy center.\ud \ud Patients\ud Low-dose aspirin recipients with peptic ulcer bleeding.\ud \ud Intervention\ud 78 patients received aspirin, 80 mg/d, and 78 received placebo for 8 weeks immediately after endoscopic therapy. All patients received a 72-hour infusion of pantoprazole followed by oral pantoprazole. All patients completed follow-up.\ud \ud Measurements\ud The primary end point was recurrent ulcer bleeding within 30 days confirmed by endoscopy. Secondary end points were all-cause and cause-specific mortality in 8 weeks.\ud \ud Results\ud 156 patients were included in an intention-to-treat analysis. Three patients withdrew from the trial before finishing follow-up. Recurrent ulcer bleeding within 30 days was 10.3% in the aspirin group and 5.4% in the placebo group (difference, 4.9 percentage points [95% CI, -3.6 to 13.4 percentage points]). Patients who received aspirin had lower all-cause mortality rates than patients who received placebo (1.3% vs. 12.9%; difference, 11.6 percentage points [CI, 3.7 to 19.5 percentage points]). Patients in the aspirin group had lower mortality rates attributable to cardiovascular, cerebrovascular, or gastrointestinal complications than patients in the placebo group (1.3% vs. 10.3%; difference, 9 percentage points [CI, 1.7 to 16.3 percentage points]).\ud \ud Limitations\ud The sample size is relatively small, and only low-dose aspirin, 80 mg, was used. Two patients with recurrent bleeding in the placebo group did not have further endoscopy.\ud \ud Conclusion\ud Among low-dose aspirin recipients who had peptic ulcer bleeding, continuous aspirin therapy may increase the risk for recurrent bleeding but potentially reduces mortality rates. Larger trials are needed to confirm these findings

Dirty mouth? Should you clean it out? Decontamination for the prevention of pneumonia and mortality in the ICU

Background\ud Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting.\ud \ud Methods\ud Objective: To evaluate the effectiveness of SDD and SOD in intensive care unit (ICU) patients.\ud \ud Design\ud A controlled, crossover study using cluster randomization.\ud \ud Setting\ud 13 ICUs in the Netherlands between May 2004 and July 2006.\ud \ud Subjects\ud 5939 patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible.\ud \ud Intervention\ud In each ICU, three regimens (SDD, SOD, and standard care) were applied in random order over the course of 6 months. SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach. SOD consisted of oropharyngeal application only of the same antibiotics.\ud \ud Outcomes\ud Mortality at day 28 was the primary end point. Monthly point-prevalence studies were performed to analyze antibiotic resistance.\ud \ud Results\ud A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to SOD, and 2045 to SDD; crude mortality in the groups at day 28 was 27.5%, 26.6%, and 26.9%, respectively. In a random-effects logistic-regression model with age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates, odds ratios for death at day 28 in the SOD and SDD groups, as compared with the standard-care group, were 0.86 (95% confidence interval [CI], 0.74 to 0.99) and 0.83 (95% CI, 0.72 to 0.97), respectively.\ud \ud Conclusions\ud In an ICU population in which the mortality rate associated with standard care was 27.5% at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD. (Controlled Clinical Trials number, ISRCTN35176830.

Clinical review: Considerations for the triage of maternity care during an influenza pandemic - one institution's approach

The ongoing pandemic of 2009 H1N1 swine-origin influenza A has heightened the world's attention to the reality of influenza pandemics and their unpredictable nature. Currently, the 2009 H1N1 influenza strain appears to cause mild clinical disease for the majority of those infected. However, the risk of severe disease from this strain or other future strains remains an ongoing concern and is noted in specific patient populations. Pregnant women represent a unique patient population that historically has been disproportionately affected by both seasonal and pandemic influenza outbreaks. Data thus far suggest that the current 2009 H1N1 outbreak is following this same epidemiologic tendency among pregnant women. The increased predilection to worse clinical outcomes among pregnant women has potential to produce an acute demand for critical care resources that may overwhelm supply in facilities providing maternity care. The ability of healthcare systems to optimize maternal-child health outcomes during an influenza pandemic or other biologic disaster may therefore depend on the equitable allocation of these limited resources. Triage algorithms for resource allocation have been delineated in the general medical population. However, no current guidance considers the unique aspects of pregnant women and their unborn fetuses. An approach is suggested that may help guide facilities faced with these challenges. © 2010 BioMed Central Ltd

Azimuthal Angle Correlations for Rapidity Separated Hadron Pairs in d+Au Collisions at sqrt(s_NN) = 200 GeV

We report on two-particle azimuthal angle correlations between charged hadrons at forward/backward (deuteron/gold going direction) rapidity and charged hadrons at mid-rapidity in deuteron-gold (d+Au) and proton-proton (p+p) collisions at sqrt(s_NN) = 200 GeV. Jet structures are observed in the correlations which we quantify in terms of the conditional yield and angular width of away side partners. The kinematic region studied here samples partons in the gold nucleus carrying nucleon momentum fraction x~0.1 to x~0.01. Within this range, we find no x dependence of the jet structure in d+Au collisions.Comment: 330 authors, 6 pages text, 4 figures, no tables. Submitted to Phys. Rev. Lett. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

System Size and Energy Dependence of Jet-Induced Hadron Pair Correlation Shapes in Cu+Cu and Au+Au Collisions at sqrt(s_NN) = 200 and 62.4 GeV

We present azimuthal angle correlations of intermediate transverse momentum (1-4 GeV/c) hadrons from {dijets} in Cu+Cu and Au+Au collisions at sqrt(s_NN) = 62.4 and 200 GeV. The away-side dijet induced azimuthal correlation is broadened, non-Gaussian, and peaked away from \Delta\phi=\pi in central and semi-central collisions in all the systems. The broadening and peak location are found to depend upon the number of participants in the collision, but not on the collision energy or beam nuclei. These results are consistent with sound or shock wave models, but pose challenges to Cherenkov gluon radiation models.Comment: 464 authors from 60 institutions, 6 pages, 3 figures, 2 tables. Submitted to Physical Review Letters. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

Improved Measurement of Double Helicity Asymmetry in Inclusive Midrapidity pi^0 Production for Polarized p+p Collisions at sqrt(s)=200 GeV

We present an improved measurement of the double helicity asymmetry for pi^0 production in polarized proton-proton scattering at sqrt(s) = 200 GeV employing the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). The improvements to our previous measurement come from two main factors: Inclusion of a new data set from the 2004 RHIC run with higher beam polarizations than the earlier run and a recalibration of the beam polarization measurements, which resulted in reduced uncertainties and increased beam polarizations. The results are compared to a Next to Leading Order (NLO) perturbative Quantum Chromodynamics (pQCD) calculation with a range of polarized gluon distributions.Comment: 389 authors, 4 pages, 2 tables, 1 figure. Submitted to Phys. Rev. D, Rapid Communications. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

J/psi Production and Nuclear Effects for d+Au and p+p Collisions at sqrt(s_NN) = 200 GeV

J/psi production in d+Au and p+p collisions at sqrt(s_NN) = 200 GeV has been measured by the PHENIX experiment at rapidities -2.2 < y < +2.4. The cross sections and nuclear dependence of J/\psi production versus rapidity, transverse momentum, and centrality are obtained and compared to lower energy p+A results and to theoretical models. The observed nuclear dependence in d+Au collisions is found to be modest, suggesting that the absorption in the final state is weak and the shadowing of the gluon distributions is small and consistent with Dokshitzer-Gribov-Lipatov-Altarelli-Parisi-based parameterizations that fit deep-inelastic scattering and Drell-Yan data at lower energies.Comment: 331 authors, 6 pages text, 3 figures. Published in PRL. Version 2 has minor changes required during the review and production process. Of significant note are that (a) the original Figs. 3 and 4 are combined into a single Fig. 3 and (b) the value of (p_T)**2 at x_F=0 changed from 3.17+/-0.33 to 3.03+/-0.40. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are publicly available at http://www.phenix.bnl.gov/papers.htm

Centrality Dependence of pi^0 and eta Production at Large Transverse Momentum in sqrt(s_NN) = 200 GeV d+Au Collisions

The dependence of transverse momentum spectra of neutral pions and eta mesons with p_T <16 GeV/c and p_T < 12 GeV/c, respectively, on the centrality of the collision has been measured at mid-rapidity by the PHENIX experiment at RHIC in d+Au collisions at sqrt(s_(NN)) = 200 GeV. The measured yields are compared to those in p + p collisions at the same sqrt(s_(NN)) scaled by the number of underlying nucleon-nucleon collisions in d+Au. At all centralities the yield ratios show no suppression, in contrast to the strong suppression seen for central Au+Au collisions at RHIC. Only a weak p_T and centrality dependence can be observed.Comment: 332 authors, 6 pages text, 2 figures, one table. Submitted to Phys. Rev. Lett. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

Scaling properties of azimuthal anisotropy in Au+Au and Cu+Cu collisions at sqrt(s_NN) = 200 GeV

Detailed differential measurements of the elliptic flow for particles produced in Au+Au and Cu+Cu collisions at sqrt(s_NN) = 200 GeV are presented. Predictions from perfect fluid hydrodynamics for the scaling of the elliptic flow coefficient v_2 with eccentricity, system size and transverse energy are tested and validated. For transverse kinetic energies KE_T ~ m_T-m up to ~1 GeV, scaling compatible with the hydrodynamic expansion of a thermalized fluid is observed for all produced particles. For large values of KE_T, the mesons and baryons scale separately. A universal scaling for the flow of both mesons and baryons is observed for the full transverse kinetic energy range of the data when quark number scaling is employed. In both cases the scaling is more pronounced in terms of KE_T rather than transverse momentum.Comment: 422 authors from 58 institutions, 6 pages, 3 figures. Submitted to Physical Review Letters. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm