MOESM1 of The use of computerized echocardiographic simulation improves the learning curve for transesophageal hemodynamic assessment in critically ill patients

Additional file 1: Figure S1. Screenshot from TTE simulator with augmented reality image on the left and the simulated B-mode TTE image on the right

Flowchart of the study.

<p>Flowchart of the study.</p

Impact of clopidogrel withdrawal and reintroduction on platelet functions.

<p>A: Platelet aggregation response to 20 µM ADP, expressed as maximal aggregation (%). B: VASP phosphorylation level, expressed as the Platelet Reactivity Index (%). D-5: baseline value; Ds: day of surgery; D+7: seven days after surgery, five days after clopidogrel 75 mg resumption.</p

Platelet-Leukocyte Complex (PLC) levels in the three patient groups.

<p>PLC are expressed as a percentage of total leukocytes. D-5: baseline value for aspirin and clopidogrel groups. Ds: day of surgery, baseline value for the control group. D+7: seven days after surgery, five days after aspirin or clopidogrel 75 mg resumption.</p

Impact of aspirin withdrawal and reintroduction on arachidonic acid-induced platelet aggregation.

<p>D-5: baseline value determined during preoperative examination. Ds: day of surgery. D+7: seven days after surgery, five days after aspirin resumption Arachidonic acid was used at 2 mM. Platelet aggregation is expressed as maximal aggregation (%).</p

Patients’ characteristics.

<p>Data are presented as the mean value ± SD or number (%) of subjects. RCRI: Revised Cardiac Risk Index; ACE: angiotensin converting enzyme. CI = confidence interval.</p

Real Time Identification of Drug-Induced Liver Injury (DILI) through Daily Screening of ALT Results: A Prospective Pilot Cohort Study

<div><h3>Objective</h3><p>Identification of drug-induced liver disease (DILI) is difficult, even among hospitalized patients. The aim of this pilot study was to assess the impact of a specific strategy for DILI screening.</p> <h3>Design</h3><p>We prospectively compared the number of acute DILI cases identified in one week of a proactive strategy based on centralized elevated ALT values to those identified with a standard of care strategy for 24-week period based on referral cases to the hepatology unit. In the centralized strategy, a designated study biochemist identified patients with ALT greater than 3 times the upper limit of normal values (ULN) and notified the designated hepatologists, who then went to the patients' wards, analyzed the charts, and if necessary, interviewed the identified patients. During these two periods, patients with possible DILI were included after signing an informed consent in an ongoing European diagnostic study (SAFE-T consortium).</p> <h3>Results</h3><p>During the 24-week period of the standard strategy, 12 (0.04%) patients out of a total of 28,145 were identified as having possible DILI, and 11 of these accepted to be included in the protocol. During the one-week proactive period, 7 patients out of a total of 1407 inpatients (0.498%) [odds ratio vs. standard = 12.1 (95% CI, 3.9–32.3); P<0.0001] were identified with possible DILI, and 5 were included in the protocol.</p> <h3>Conclusion</h3><p>A simple strategy based on the daily analysis of cases with ALT >3 ULN by designated biochemists and hepatologists identified 12 times more acute cases of drug-induced liver disease than the standard strategy.</p> <p>This pilot cohort is registered on the number AP-HP P110201/1/08-03-2011 and AFSSAPS B110346-70.</p> </div

Characteristics of patients with DILI according to the screening period.

*<p>P<0.001 Hy's criteria ALT >3ULN and total bilirubin >31 micromol/L.</p

Flowchart of the identification of DILI during the centralized period in 1995 patients with ALT measurement.

<p>Flowchart of the identification of DILI during the centralized period in 1995 patients with ALT measurement.</p

Characteristics of patients analyzed during the centralized period.

<p>Characteristics of patients analyzed during the centralized period.</p