The use of fibrinogen concentrate for the management of trauma-related bleeding. A systematic review and meta-analysis

Haemorrhage following injury is associated with significant morbidity and mortality. The role of fibrinogen concentrate in trauma-induced coagulopathy has been the object of intense research in the last 10 years and has been systematically analysed in this review. A systematic search of the literature identified six retrospective studies and one prospective one, involving 1,650 trauma patients. There were no randomised trials. Meta-analysis showed that fibrinogen concentrate has no effect on overall mortality (risk ratio: 1.07, 95% confidence interval: 0.83-1.38). Although the metaanalytic pooling of the current literature evidence suggests no beneficial effect of fibrinogen concentrate in the setting of severe trauma, the quality of data retrieved was poor and the final results of ongoing randomised trials will help to further elucidate the role of fibrinogen concentrate in traumatic bleeding

Safety of intravenous tranexamic acid in patients undergoing major orthopaedic surgery. A meta-analysis of randomised controlled trials

Among the various pharmacological options to decrease peri-operative bleeding, tranexamic acid appears to be one of the most interesting. Several trials have consistently documented the efficacy of this synthetic drug in reducing the risk of blood loss and the need for allogeneic blood transfusion in patients undergoing total hip and knee arthroplasty. The safety of intravenous tranexamic acid in major orthopaedic surgery, particularly regarding the risk of venous thromboembolism, was systematically analysed in this review. A systematic search of the literature identified 73 randomised controlled trials involving 4,174 patients and 2,779 controls. The raw overall incidence of venous thromboembolism was 2.1% in patients who received intravenous tranexamic acid and 2.0% in controls. A meta-analytic pooling showed that the risk of venous thromboembolism in tranexamic acid-treated patients was not significantly different from that of controls (risk difference: 0.01%, 95% confidence interval [CI]: -0.05%, 0.07%; risk ratio: 1.067, 95% CI: 0.760-1.496). Other severe drug-related adverse events occurred very rarely (0.1%). In conclusion, the results of this systematic review and meta-analysis show that intravenous tranexamic acid is a safe pharmacological treatment to reduce blood loss and transfusion requirements in patients undergoing major orthopaedic surgery

The use of viscoelastic haemostatic assays in non-cardiac surgical settings. a systematic review and meta-analysis

Background: Thrombelastography (TEG) and rotational thromboelastometry (ROTEM) are viscoelastic haemostatic assays (VHA) which exploit the elastic properties of clotting blood. The aim of this systematic review and meta-analysis was to evaluate the usefulness of these tests in bleeding patients outside the cardiac surgical setting. Materials and methods: We searched the Cochrane Library, MEDLINE, EMBASE and SCOPUS. We also searched clinical trial registries for ongoing and unpublished studies, and checked reference lists to identify additional studies. Results: We found 4 randomised controlled trials (RCTs) that met our inclusion criteria with a total of 229 participants. The sample size was small (from 28 to 111 patients) and the follow-up periods very heterogenous (from 4 weeks to 3 years). Pooled data from the 3 trials reporting on mortality (199 participants) do not show any effect of the use of TEG on mortality as compared to standard monitoring (based on the average treatment effect from a fixed-effects model): Risk Ratio (RR) 0.71; 95% Confidence Interval (CI): 0.43 to 1.16. Likewise, the use of VHA does not reduce the need for red blood cells (mean difference -0.64; 95% CI: -1.51 to 0.23), platelet concentrates (mean difference -1.12; 95% CI: -3.25 to 1.02), and fresh frozen plasma (mean difference -0.91; 95% CI: -2.02 to 0.19) transfusion. The evidence on mortality and other outcomes was uncertain (very low-certainty evidence, down-graded due to risk of biases, imprecision, and inconsistency). Conclusions: Overall, the certainty of the evidence provided by the trials was too low for us to be certain of the benefits and harms of viscoelastic haemostatic assay in non-cardiac surgical settings. More, larger, and better-designed RCTs should be carried out in this area

Functional compounds of einkorn and emmer genotypes

Three einkorn and two emmer genotypes were analysed for concentration of microelements (Fe, Zn and Se) and lipid soluble antioxidants (α-tocopherol, α-tocotrienol and β-carotene). A diversity was observed in micronutrient content, but most of the genotypes have significantly higher trace element and antioxidant contents than the control wheat variety. The emmer genotypes contain lower Fe and β-carotene concentration than einkorn genotypes. The einkorn genotypes have significant higher antioxidant content than the wheat control. On average einkorn has more than three times more β-carotene than the wheat variety. Our results are useful for species/variety choice in functional food production not only for organic but also for conventional farmers, who have/want to operate under low input conditions, especially in Central Europe

Hospital energy demand forecasting for prioritisation during periods of constrained supply

Purpose: Sustaining healthcare operations without adequate energy capacity creates significant challenges, especially during periods of constrained energy supply. This research develops a clinical and non-clinical activity-based hospital energy model for electrical load prioritization during periods of constrained energy supply. Design/methodology/approach: Discrete event modelling is adopted for development of the hospital energy model (HEM). The building block of the HEM is business process mapping of a hospitals clinical and non-clinical activities. The model prioritizes the electrical load demand as Priority 1, 2 and 3; Priority 1 activities are essential to the survival of patients, Priority 2 activities are critical activities that are required after one to four hours, and Priority 3 activities can run for several hours without electricity. Findings: The model was applied to small, medium, and large hospitals. The results demonstrate that Priority 2 activities have the highest energy demand, followed by Priority 1 and Priority 3 activities, respectively for all hospital sizes. For the medium and large hospitals, the top three contributors to energy demand are lighting, HVAC, and patient services. For the small hospital, it is patient services, lighting, and HVAC. Research limitations/implications: The model is specific to hospitals but can be modified for other healthcare facilities. Practical implications: The resolution of the electrical energy demand down to the business activity level enables hospitals to evaluate current practices for optimization. It facilitates multiple energy supply scenarios, enabling hospital management to conduct feasibility studies based on available power supply options Social implications: Improved planning of capital expenditure and operational budgets. Improved operations during periods of constrained energy supply, which reduces the risk to hospitals and ensures consistent quality of service. Originality/value: Current hospital energy models are limited, especially for operations management under constrained energy supply. A simple to use model is proposed to assist in planning of activities based on available supplyPeer Reviewe

Pengaruh Kompetensi, Independensi dan Pengalaman terhadap Kualitas Audit Aparat Inspektorat Kota Tomohon dalam Pengawasan Pengelolaan Keuangan Daerah

This study examined the influence of the auditors\u27 competency, independency, and experiences towards audit quality of financial auditing of the staff of inspectorate in Tomohon City as part of their supervision function. The finding of this study could be an important input for improving the quality of financial management of the local government since the policy of decentralization has given the local governments authority not only to manage natural resources but also their financial sector. However, as could be seen there are still a lot of problems related to financial management mostly caused by the poor knowledge and skills related to financial auditing of government offici als responsible for this specific task. It is common to find inconsistency in the financial report of internal auditor ( inspectorate ) and external auditor, Supreme Audit Agency ( Badan Pemeriksa Keuangan) .There were two variables in this study. Audit quality was the dependent variable ( Y ) while the independent variables elaborated into three variables, namely: auditor\u27s competency ( X1 ) , auditor\u27s independency ( X2 ) and auditor\u27s experiences ( X3 ) . There were 36 personnel of the Inspectorate\u27s Office of Tomohon City participated as the sources of this study. Thus, the population of this research is the Tomohon City Regional Inspectorate officers. Data used in this study were primary and secondary data, while questioner and indepth interview as well as document study used as the data collection methods. The first consecutive methods employed to obtain primary data while the last used for obtaining secondary data. Both data analyzed using the multiple linear regression techniques.This study found that the influence of independent variable which were competency, independency and experiences towards dependent variables which was audit quality was significant. The 0.645 value of coeficient determination showed the significant relationship between both variables. This means that the equation model used in this study found the significancy at about 64,5%. The remaining proportion which was 35,5% explained by the other factors which were not part of this model. After examining the hypotheses, it can be concluded that partially competency had positive influence but not too significant to the quality of the inspectorate officer. However, independency and experiences had a positive and significant influence to the auditing quality of the public servant working in the inspectorate\u27s office.This study recommends to improving the knowledge and skills of the public apparatus by conducting short courses and training in accounting and auditing

Quantification of gait kinematics and walking ability of people with multiple sclerosis who are new users of functional electrical stimulation

Objective: To assess whether the application of Functional Electrical Stimulation improves gait kinematics and walking ability in people with multiple sclerosis who experience foot drop. Design: Acute open labelled comparative observation trial. Participants: Twelve people (3 females, 9 males, EDSS 2-4) with relapsing remitting multiple sclerosis (47.8 years (standard deviation 6.6)) who were new users of functional electrical stimulation. Methods: Gait kinematics were recorded using 3D gait analysis. Walking ability was assessed through the 10-m walk test and the 6-min walk test. All assessments were performed with and without the assistance of functional electrical stimulation. The effect of functional electrical stimulation was analysed using paired t-tests. Results: Ankle dorsiflexion at initial contact (p-=-0.026), knee flexion at initial contact (p-=-0.044) and peak knee flexion during swing (p-=-0.011) were significantly greater whilst walking with Functional Electrical Stimulation. The increased peak dorsiflexion in swing of nearly 4 degrees during functional electrical stimulation assisted walking approached significance (p-=-0.069). The 10-m walk time was significantly improved by functional electrical stimulation (p-=-0.004) but the 6 min walk test was not. Conclusion: The acute application of functional electrical stimulation resulted in an orthotic effect through a change in ankle and knee kinematics and increased walking speed over a short distance in people with multiple sclerosis who experience foot dropsch_phy45pub3130pub