Structured decision-making drives guidelines panels’ recommendations ‘for’ but not ‘against’ health interventions

Background: The determinants of guideline panels’ recommendations remain uncertain. Objective: To investigate factors considered by members of 8 panels convened by the American Society of Hematology (ASH) to develop guidelines using GRADE system. Study Design and Setting: web-based survey of the participants in the ASH guidelines panels. Analysis: two level hierarchical, random-effect, multivariable regression analysis to explore the relation between GRADE and non-GRADE factors and strength of recommendations (SOR). Results: In the primary analysis, certainty in evidence [OR=1.83; (95CI% 1.45 to 2.31)], balance of benefits and harms [OR=1.49 (95CI% 1.30 to 1.69)] and variability in patients’ values and preferences [OR=1.47 (95CI% 1.15 to 1.88)] proved the strongest predictors of SOR. In a secondary analysis, certainty of evidence was associated with a strong recommendation [OR=3.60 (95% CI 2.16 to 6.00)] when panel members recommended “for” interventions but not when they made recommendations “against” [OR=0.98 (95%CI: 0.57 to 1.8)] consistent with “yes” bias. Agreement between individual members and the group in rating SOR varied (kappa ranged from -0.01 to 0.64). Conclusion: GRADE’s conceptual framework proved, in general, highly associated with SOR. Failure of certainty of evidence to be associated with SOR against an intervention, suggest the need for improvements in the process

American Society of Hematology 2019 guidelines for management of venous thromboembolism : prevention of venous thromboembolism in surgical hospitalized patients

Background: Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality. Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2). Conclusions: For patients undergoing major surgery in general, the panel made conditional recommendations for mechanical prophylaxis over no prophylaxis, for pneumatic compression prophylaxis over graduated compression stockings, and against inferior vena cava filters. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH). For major general surgery, the panel suggested pharmacological prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For major neurosurgery, transurethral resection of the prostate, or radical prostatectomy, the panel suggested against pharmacological prophylaxis. For major trauma surgery or major gynecological surgery, the panel suggested pharmacological prophylaxis over no prophylaxis.Peer reviewe

Cellular and complement-dependent cytotoxicity of Ep-CAM-specific monoclonal antibody MT201 against breast cancer cell lines

MT201 is a fully human monoclonal IgG1 antibody with moderate affinity for epithelial cell adhesion molecule (Ep-CAM) being clinically developed for the treatment of carcinomas. Like many other clinically validated IgG1 monoclonal antibodies, MT201 primarily acts by antibody-dependent cellular cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC). Here, we analysed ADCC and CDC induced by MT201 and, as reference, trastuzumab against a panel of nine human breast cancer cell lines expressing distinct surface levels of Ep-CAM and human epithelial growth factor receptor type 2 antigen. Maximal cell lysis by ADCC by MT201 and trastuzumab in the presence of peripheral mononuclear cells did not significantly differ when averaged over the nine cell lines, but showed marked differences with respect to individual cell lines. The extent of cell lysis at intermediate surface target density was highly variable, suggesting a dominant influence of other susceptibility factors. Only one breast cancer cell line was eliminated via CDC, but only by MT201. Resistance to CDC appeared to correlate with high expression levels of complement resistance factors. Our present data as well as recent data on the prevalence and prognostic relevance of Ep-CAM expression in metastatic breast cancer suggest that Ep-CAM-specific monoclonal IgG1 antibodies may have a significant therapeutic potential in the treatment of breast cancer

American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

Background: Coronavirus disease 2019 (COVID-19)-related critical illness and acute illness are associated with a risk of venous thromboembolism (VTE).Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness and acute illness who do not have confirmed or suspected VTE.Methods: ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.Results: The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness or acute illness who do not have confirmed or suspected VTE.Conclusions: These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.Thrombosis and Hemostasi

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients

Background: COVID-19-related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in making decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19-related critical illness who do not have confirmed or suspected VTE.Methods: ASH formed a multidisciplinary guideline panel that included 3 patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process by performing systematic evidence reviews (up to 5 March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the GRADE approach to assess evidence and make recommendations, which were subject to public comment. This is an update on guidelines published in February 2021.Results: The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation in favor of prophylactic-intensity over intermediate-intensity anticoagulation in patients with COVID-19-related critical illness who do not have confirmed or suspected VTE.Conclusions: This recommendation was based on low certainty in the evidence, which underscores the need for additional high-quality, randomized, controlled trials comparing different intensities of anticoagulation in critically ill patients. Other key research priorities include better evidence regarding predictors of thrombosis and bleeding risk in critically ill patients with COVID-19 and the impact of nonanticoagulant therapies (eg, antiviral agents, corticosteroids) on thrombotic risk.Thrombosis and Hemostasi

The effect of vacuum tank on basic vacuum parameters of a milking unit

Analizowano wpływ zmiany pojemności przechwytywacza (Vz) w dojarce bańkowej na średnie podciśnienie ssania (pss), amplitudę podciśnienia ssania (aps), różnicę podciśnień między końcem strzyka a kolektorem (dp1max1) oraz na dynamikę narastania podciśnienia na końcu strzyka (Sr). Stwierdzono istotny wpływ pojemności przechwytywacza na analizowane parametry ciśnieniowe doju przy zmiennym natężeniu cieczy mlekozastępczej Qm w zakresie od 2 do 8 kg/min.The basic vacuum parameters of milking were analyzed: average vacuum during suction phase (pss), the fluctuation of vacuum during suction phase (aps), the differences in vacuum levels between the teat end and the milk claw (dp1max1), increase of vacuum rate on the teat end (Sr) using vacuum tank 20-150 dm3 in bucket milking machine. The effect of vacuum tank during simulated outflow of liquid Qm was determined

The effect of the vacuum system stress on stabilization of the working vacuum milking machine

Analizowano stabilność podciśnienia roboczego Dsp (iloczyn maksymalnej amplitudy spadku podciśnienia a i czasu stabilizacji podciśnienia tsp) w krótkim przewodzie mlecznym podczas podłączania kolejnych aparatów udojowych przy zmiennym natężeniu cieczy. Stwierdzono istotne różnice pomiędzy wynikami uzyskanymi podczas pomiarów przy braku przepływu cieczy (Qm = 0 kg/min), oraz w obecności zmiennego natężenia przepływu w zakresie od 2 do 8 kg/min. Wraz ze wzrostem liczby podłączonych aparatów udojowych wzrastała wartość Dsp. Znaleziono równanie empiryczne opisujące parametr Dsp.The pressure parameters of vacuum systems were described (the amplitude of drop of vacuum a, the time of stabilization of vacuum the tsp, Dsp=a * tsp). Essential differences between theoretical research Qm=0 kg/min and results of studies Qm=2 - 8 kg/min were noted. Dsp value increased with increase of the connected milking unit

Energy consumption of wheat grain during static shearing process

W pracy przedstawiono zależność pomiędzy energią ścinania a masą i szklistością ziarniaków oraz temperaturą rozdrabnianego ziarna. Stwierdzono, że im większa masa i szklistość ziarniaków tym wyższe zapotrzebowanie na energię zgniatania. Przy szczelinie roboczej 0,4 mm i temperaturze ziarna 280-290K zapotrzebowaniu energii ścinania jest najmniejsze.The paper presents the relation between energy consumption per units and mass of kernel, vitreousity and temperature of shearing grain. The result showed that the bigger was mass of kernel and vitreousity, the higher was energy requirement for shearing. Under working gap 0.4 mm and temperatures 280K and 290K energy consumption of shearing have been smallest

Effect of grain moisture content and temperature on energy consumption at crushing

W pracy przedstawiono zależność pomiędzy energią zgniatania a wilgotnością i temperaturą rozdrabnianego ziarna. Wilgotność ziarna wynosiła 10,15 i 21%, natomiast temperatura zawarta była w przedziale 248 - 313K. Największą energochłonność procesu zarejestrowano przy gnieceniu ziarna o wilgotności 15-16%. Stwierdzono, że im niższa temperatura ziarna tym wyższe zapotrzebowanie na energię zgniatania. Przy szczelinie roboczej 0,4 mm i temperaturach 248°K i 313°K różnice w zapotrzebowaniu energii wynosiły 39-80%.The paper presents the relation between energy consumption per units and moisture content and temperature of crushing grain. Grains of the wheat were ground at their moisture contents 10,15 and 21%, temperature of kernel varying the range of 248-313K. The highest energy consumption was observed at grinding grain of 15-16% moisture content. It shows, that lower grain temperature causes bigger requirement of energy consumption. Under working gap 0,4 mm and temperatures 248°K and 313°K differences of energy consumption have achieved 39-80%