75 research outputs found
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Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery
ImportanceBefore surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.ObjectiveTo evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery.Design, setting, and participantsRandomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France.InterventionPatients were randomized to continue use of RASIs (nâ=â1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (nâ=â1115).Main outcomes and measuresThe primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery.ResultsOf the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; Pâ=â.85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes.Conclusions and relevanceAmong patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy.Trial registrationClinicalTrials.gov Identifier: NCT03374449
Real-time ultrasound (RTU) imaging methods for quality control of meats
In this chapter the use of real-time ultrasonography to predict in vivo carcass composition and meat traits will be reviewed. The chapter begins by discussing background and principles of ultrasound. Then aspects affecting the suitability of realtime ultrasonography and image analysis for predicting carcass composition and meat traits of meat producing species and fish will be presented. This chapter also provides an overview of the present and future trends in the application of real-time ultrasonography in the meat industry. © 2012 Woodhead Publishing Limited All rights reserved.info:eu-repo/semantics/publishedVersio
EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial
More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University MĂŒnster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369
Conditions dâaccĂšs Ă lâassistance mĂ©dicale Ă la procrĂ©ation et procrĂ©ation post-mortem : lâappel des juges Ă la rĂ©vision des lois de bioĂ©thique ?
International audienc
The dematerialization of access to genetic tests and the rights and obligations of partners in the care relationship
La dĂ©matĂ©rialisation de lâaccĂšs aux tests gĂ©nĂ©tiques apparaĂźt comme un outil concourant Ă satisfaire lâensemble des composantes du droit Ă la protection de la santĂ©. En effet, en la matiĂšre, la spĂ©cialisation de la mĂ©decine induit une limitation des personnes habilitĂ©es Ă prescrire des tests gĂ©nĂ©tiques. Aussi, la recherche de la meilleure sĂ©curitĂ© sanitaire possible pour la rĂ©alisation des tests gĂ©nĂ©tiques induit des problĂ©matiques dâĂ©gal accĂšs aux laboratoires de biologie mĂ©dicale autorisĂ©s Ă cet effet, mais auxquelles la dĂ©matĂ©rialisation peut apporter des rĂ©ponses. Aussi, elle nâapparaĂźt pas ĂȘtre antinomique de lâautonomie des patients, bien quâelle prĂ©sente des faiblesses.The dematerialization of access to genetic testing appears to be a tool to satisfy all the aspects of the right to health protection. Indeed, in this field, the specialization of medicine induces a limitation of the numbers of persons entitled to prescribe genetic tests. The quest for the best quality and health security for the realization of the genetic tests induces problems of equal access to the laboratories of medical biology authorized for this purpose, but to which dematerialization can give answers. Also, dematerialization does not appear to be antinomic of patient autonomy, although it presents weaknesses
La vente en ligne des tests génétiques, une offre prématurée ?
International audienc
La vente en ligne des tests génétiques, une offre prématurée ?
International audienc
Le droit des dispositifs médicaux de diagnostic in vitro : une analyse au prisme de la sécurité sanitaire
International audienc
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