Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Diffuse microvascular bleeding remains a common problem after cardiac procedures.</p> <p>Systemic use of antifibrinolytic reduces the postoperative blood loss.</p> <p>The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting (CABG).</p> <p>Methods</p> <p>Thirty eight patients scheduled for primary isolated coronary artery bypass grafting were included in this double blind, prospective, randomized, placebo controlled study.</p> <p>Tranexamic acid (TA) group (19 patients) received 1 gram of TA diluted in 100 ml normal saline. Placebo group (19 patients) received 100 ml of normal saline only. The solution was purred in the pericardial and mediastinal cavities.</p> <p>Results</p> <p>Both groups were comparable in their baseline demographic and surgical characteristics. During the first 24 hours post-operatively, cumulative blood loss was significantly less in TA group (median of 626 ml) compared to Placebo group (median of 1040 ml) (P = 0.04). There was no significant difference in the post-op Packed RBCs transfusion between both groups (median of one unit in each) (P = 0.82). Significant less platelets transfusion required in TA group (median zero unit) than in placebo group (median 2 units) (P = 0.03). Apart from re-exploration for excessive surgical bleeding in one patient in TA group, no difference was found in morbidity or mortality between both groups.</p> <p>Conclusion</p> <p>Topical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient.</p

Medication knowledge, certainty, and risk of errors in health care: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Medication errors are often involved in reported adverse events. Drug therapy, prescribed by physicians, is mostly carried out by nurses, who are expected to master all aspects of medication. Research has revealed the need for improved knowledge in drug dose calculation, and medication knowledge as a whole is poorly investigated. The purpose of this survey was to study registered nurses' medication knowledge, certainty and estimated risk of errors, and to explore factors associated with good results.</p> <p>Methods</p> <p>Nurses from hospitals and primary health care establishments were invited to carry out a multiple-choice test in pharmacology, drug management and drug dose calculations (score range 0-14). Self-estimated certainty in each answer was recorded, graded from 0 = very uncertain to 3 = very certain. Background characteristics and sense of coping were recorded. Risk of error was estimated by combining knowledge and certainty scores. The results are presented as mean (±SD).</p> <p>Results</p> <p>Two-hundred and three registered nurses participated (including 16 males), aged 42.0 (9.3) years with a working experience of 12.4 (9.2) years. Knowledge scores in pharmacology, drug management and drug dose calculations were 10.3 (1.6), 7.5 (1.6), and 11.2 (2.0), respectively, and certainty scores were 1.8 (0.4), 1.9 (0.5), and 2.0 (0.6), respectively. Fifteen percent of the total answers showed a high risk of error, with 25% in drug management. Independent factors associated with high medication knowledge were working in hospitals (p < 0.001), postgraduate specialization (p = 0.01) and completion of courses in drug management (p < 0.01).</p> <p>Conclusions</p> <p>Medication knowledge was found to be unsatisfactory among practicing nurses, with a significant risk for medication errors. The study revealed a need to improve the nurses' basic knowledge, especially when referring to drug management.</p

Special cases : moons, rings, comets, trojans

Non-planetary bodies provide valuable insight into our current under- standing of planetary formation and evolution. Although these objects are challeng- ing to detect and characterize, the potential information to be drawn from them has motivated various searches through a number of techniques. Here, we briefly review the current status in the search of moons, rings, comets, and trojans in exoplanet systems and suggest what future discoveries may occur in the near future.Comment: Invited review (status August 2017

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Hubble Space Telescope/NICMOS near-infrared imaging of the proto planetary nebula OH 231.8+4.2

We present observations of the bipolar nebula OH 231.8+4.2, made with the Hubble Space Telescope (HST) NICMOS camera, in three wide filter bands (F205W, F160W, and F110W). The images have excellent dynamic range after removal of low-level instrumental artifacts. In the F205W filter (lambda approximate to 2.04 mum), we achieve a peak/rms of greater than 8000 with an angular resolution of 0."20 (FWHM). The combination of high dynamic range and angular resolution confirms previous observations but also reveals new features in the near-IR morphology of the nebula, which at these wavelengths is dominated by scattered light. The northern (approaching) lobe shows well-defined, limb-brightened edges. The central jet splits into two laments and exhibits some curvature between the center of the nebula and the end of the northern lobe. The southern (receding) lobe has a diffuse, occulent appearance without a sharply defined central jet, in contrast to the northern lobe. A sharpened version of the F205W image shows indications of turbulent structures both in the northern lobe and jet and in the southern lobe. A faint cylindrical halo of scattered light shows a sharp increase in surface brightness inside a radius of similar to4" from the center, possibly resulting from a transition from a spherical wind to a disk- or torus-like mass ejection, on the same timescale as the formation of the collimated fast wind seen in CO and HCO(+) images. We calculate the extinction through the nebula from the measured near-IR colors and a silicate grain model. For a simple geometric model of a dense central disk, we estimate a disk mass (gas and dust) in the range 0.03-0.06 M., relatively insensitive to grain size. The circumstance of an asymptotic giant branch (AGB) star with a massive, highly collimated, high-velocity bipolar flow may be understood in terms of the model of Soker & Rappaport if the central star underwent a change in mass-loss properties from a (roughly) spherical AGB wind to equatorially enhanced mass loss beginning similar to(1-3) X 10(3) yr ago. Supposing the presence of a dwarf companion in a suitable orbit, the bipolar nebula then is a consequence of a strong increase in mass loss as the central star evolves close to the tip of the AGB and will soon evolve to higher T(eff) and appear as a more typical proto planetary nebula

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We report results from a Hubble Space Telescope (HST) and Near-Infrared Camera and Multiobject Spectrometer (NICMOS) program to study the distribution of hot neutral (molecular hydrogen) and ionized circumstellar material in the young planetary nebulae NGC 7027. HST/NICMOS provided very high spatial resolution imaging in line and continuum emission, and the stability and large dynamic range needed for investigating detailed structures in the circumstellar material. We present dramatic new images of NGC 7027 that have led to a new understanding of the structure in this important planetary nebula. The central star is clearly revealed, providing near-infrared fluxes that are used to directly determine the stellar temperature very accurately (T* = 198,000 K). It is found that the photodissociation layer as revealed by near-infrared molecular hydrogen emission is very thin (Delta R similar to 6 x 10(15) cm) and is biconical in shape. The interface region is structured and filamentary, suggesting the existence of hydrodynamic instabilities. We discuss evidence for the presence of one or more highly collimated, off-axis jets that might be present in NGC 7027. The NICMOS data are combined with earlier Hubble Space Telescope data to provide a complete picture of NGC 7027 using the highest spatial resolution data to date. The evolutionary future of NGC 7027 is discussed