A Comparison Between the Teg 6s and Teg 5000 Analyzers to Assess Coagulation in Trauma Patients

BACKGROUND Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients. METHODS Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum amplitude (CFF.MA), citrated kaolin percent clot lysis at 30 minutes (CK.LY30), citrated RapidTEG maximum amplitude (CRT.MA), and citrated kaolin maximum amplitude (CK.MA) parameters in adults meeting full or limited trauma team criteria. Blood was drawn ≤1 hour after admission. Assays were repeated in duplicate. Reliability (TEG 5000 vs. TEG 6s analyzers) and repeatability (interdevice comparison) was quantified. Linear regression was used to define the relationship between TEG 6s and TEG 5000 devices. RESULTS A total of 475 patients were enrolled. The cohort was predominantly male (68.6%) with a median age of 49 years. Regression line slope estimates (ß) and linear correlation estimates (p) were as follows: CK.R (ß = 1.05, ρ = 0.9), CFF.MA (ß = 0.99, ρ = 0.95), CK.LY30 (ß = 1.01, ρ = 0.91), CRT.MA (TEG 6s) versus CK.MA (TEG 5000) (ß = 1.06, ρ = 0.86) as well as versus CRT.MA (TEG 5000) (ß = 0.93, ρ = 0.93), indicating strong reliability between the devices. Overall, within-device repeatability was better for TEG 6s versus TEG 5000, particularly for CFF.MA and CK.LY30. CONCLUSION The TEG 6s device appears to be highly reliable for use in trauma patients, with close correlation to the TEG 5000 device and equivalent/improved within-device reliability. Given the potential advantages of using the TEG 6s device at the site of care, confirmation of agreement between the devices represents an important advance in diagnostic testing. LEVEL OF EVIDENCE Diagnostic test, level II

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Interpersonal assessment of psychopathy

This study was concerned with the relations between representations of psychopathy and interpersonal perceptions. From 147 inmates seen in a federal medium security prison, 79 of the men provided complete data for comparisons. Groups were defined under criteria from (1) the Psychopathy Checklist (PC) (Hare, 1985b), or (2) American Psychiatric Association (1980, 1987) outlines for Antisocial Personality Disorder (APD). Measures were derived from the Interpersonal Adjective Scales-Revised (IAS-R) (Wiggins, Trapnell, and Phillips, 1988 ) which relate interpersonally defined perceptions of personality as locations within a circumplex space--Interpersonal Circle (Wiggins, 1979, 1980). Self-ratings were obtained as descriptive of (1) self, (2) ideal self, (3) self as thought seen by a friends, and (4) self as thought seen by a specific member of the institutional staff. A rating was also obtained from the specific staff members as descriptive of the particular inmates. Comparisons were also made with respect to the specificity and sensitivity of MMPI profiles considered relevant to psychopathy. Supplementary comparisons used selected scales from the Adjective Checklist (ACL) (Gough and Heilbrun, 1980) and Rosenberg's (1965) Self- esteem Scale. These comparisons provided manipulation checks of the consistency of the data and contributed to the interpretive generalizability of the results. The primary hypotheses were that a group of individuals defined as psychopathic would show differences in representations obtained from self-rated and other-rated descriptions, with respect to circumplex location and derived difference scores from the IAS-R, in comparison to groups considered non-psychopathic. Results indicated differential perceptions, particularly by staff members, which provided good discriminations of groups based on the PC but not for groups defined by APD. Circumplex locations of psychopaths defined by the PC were consistent with expectations for the Interpersonal Circle. The discriminative utility of group differences was much higher for the PC-defined groups than for APD relative to the base rates for these different categorizations. The results are discussed in terms of (1) their contribution to the nomological network for the concept of psychopathy as represented by the PC, (2) specific limitations of the study, and (3) the evident confusion which can result from the use of measures assumed to to relate to the 'psychopath,' but that rely on primarily behavioural descriptions.Arts, Faculty ofPsychology, Department ofGraduat

Comparison of treatment modes in the management of myofascial pain dysfunction syndrome

Reviews of treatment studies dealing with TMJ syndromes and myofascial pain dysfunction (MPD) typically point out the lack of controlled comparative research. The purpose of this study was to provide such research, comparing three treatment modes for the management of MPD: dental splints and physiotherapy; relaxation training, biofeedback, and stress management; and transcutaneous electrical nerve stimulation. Also of interest was the analysis of variables which may be related to treatment outcome. Twenty-one females ranging in age from 19 to 45 years (M=27.2; SD = 7.1), assessed as meeting specific criteria for MPD and consenting to participate in a research project on treatment issues, were randomly assigned, over blocks of 3, to one of the three treatment conditions. Pre-treatment assessment included dental assessment of pain and jaw mobility, self-report measures of pain, EMG assessment of masseter muscle activity under baseline and task conditions, and psychometric questionnaires. The pre-treatment assessment was replicated post-treatment, and daily symptoms self-monitoring over the course of treatment was also included for treatment evaluation. The groups formed were assessed and found equivalent with respect to age, duration of pain history, measure of mouth opening, baseline masseter EMG, adjectival pain rating index, and expectations for treatment success.by multivariate analysis of variance (MANOVA). The treatment programs were balanced with respect to total duration (8 weekly sessions) and at-home programs. Post-treatment follow-up was limited to 3 months, and assessment was limited to whether or not further treatment was sought within that time. Analyses by 2-way MANOVA across groups pre- to post-treatment revealed no differences between groups with respect to dental assessment of pain remission or increased jaw mobility, or reduction of EMG activity, but overall effects pre- to post-treatment were significant for these variables (dental assessment: approx. F(3,16) =9.22, p_ = .0009; EMG assessment: approx. F(4,15) =10.38, p=.0003). Self-report measures were significant overall pre- to post-treatment (approx F(4,15) =3.27, p = .036) and indicated group differences (approx. F(10,28) =2.47, p_=. 029), suggesting superiority of the relaxation/stress group in the reduction of daily self-monitored pain ratings and the incidence of reported pain. From the overall pattern;of results, however, it was concluded that the principal response to treatment derived from "non-specific effects" — the provision of an explanation for the problem and treatment ostensibly specifically oriented to symptom relief. Diagnostic and assessment issues, and psychometric interests with this chronic pain population are also discussed.Arts, Faculty ofPsychology, Department ofGraduat

A Comparison Between the TEG 6s and TEG 5000 Analyzers to Assess Coagulation in Trauma Patients

BACKGROUND Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients. METHODS Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum amplitude (CFF.MA), citrated kaolin percent clot lysis at 30 minutes (CK.LY30), citrated RapidTEG maximum amplitude (CRT.MA), and citrated kaolin maximum amplitude (CK.MA) parameters in adults meeting full or limited trauma team criteria. Blood was drawn ≤1 hour after admission. Assays were repeated in duplicate. Reliability (TEG 5000 vs. TEG 6s analyzers) and repeatability (interdevice comparison) was quantified. Linear regression was used to define the relationship between TEG 6s and TEG 5000 devices. RESULTS A total of 475 patients were enrolled. The cohort was predominantly male (68.6%) with a median age of 49 years. Regression line slope estimates (ß) and linear correlation estimates (p) were as follows: CK.R (ß = 1.05, ρ = 0.9), CFF.MA (ß = 0.99, ρ = 0.95), CK.LY30 (ß = 1.01, ρ = 0.91), CRT.MA (TEG 6s) versus CK.MA (TEG 5000) (ß = 1.06, ρ = 0.86) as well as versus CRT.MA (TEG 5000) (ß = 0.93, ρ = 0.93), indicating strong reliability between the devices. Overall, within-device repeatability was better for TEG 6s versus TEG 5000, particularly for CFF.MA and CK.LY30. CONCLUSION The TEG 6s device appears to be highly reliable for use in trauma patients, with close correlation to the TEG 5000 device and equivalent/improved within-device reliability. Given the potential advantages of using the TEG 6s device at the site of care, confirmation of agreement between the devices represents an important advance in diagnostic testing

A Comparison Between the TEG 6s and TEG 5000 Analyzers to Assess Coagulation in Trauma Patients

BACKGROUND Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients. METHODS Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum amplitude (CFF.MA), citrated kaolin percent clot lysis at 30 minutes (CK.LY30), citrated RapidTEG maximum amplitude (CRT.MA), and citrated kaolin maximum amplitude (CK.MA) parameters in adults meeting full or limited trauma team criteria. Blood was drawn ≤1 hour after admission. Assays were repeated in duplicate. Reliability (TEG 5000 vs. TEG 6s analyzers) and repeatability (interdevice comparison) was quantified. Linear regression was used to define the relationship between TEG 6s and TEG 5000 devices. RESULTS A total of 475 patients were enrolled. The cohort was predominantly male (68.6%) with a median age of 49 years. Regression line slope estimates (ß) and linear correlation estimates (p) were as follows: CK.R (ß = 1.05, ρ = 0.9), CFF.MA (ß = 0.99, ρ = 0.95), CK.LY30 (ß = 1.01, ρ = 0.91), CRT.MA (TEG 6s) versus CK.MA (TEG 5000) (ß = 1.06, ρ = 0.86) as well as versus CRT.MA (TEG 5000) (ß = 0.93, ρ = 0.93), indicating strong reliability between the devices. Overall, within-device repeatability was better for TEG 6s versus TEG 5000, particularly for CFF.MA and CK.LY30. CONCLUSION The TEG 6s device appears to be highly reliable for use in trauma patients, with close correlation to the TEG 5000 device and equivalent/improved within-device reliability. Given the potential advantages of using the TEG 6s device at the site of care, confirmation of agreement between the devices represents an important advance in diagnostic testing