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M A Gillies, A S V Shah, J Mullenheim, S Tricklebank, T Owen, J Antonelli, F Strachan, N L Mills, R M Pearse
BACKGROUND: Evidence suggests that cardiac output-guided haemodynamic therapy algorithms improve outcomes after high-risk surgery, but there is some concern that this could promote acute myocardial injury. We evaluated the incidence of myocardial injury in a perioperative goal-directed therapy trial. METHODS: Patients undergoing major gastrointestinal surgery (n=723) were randomly assigned to cardiac output-guided haemodynamic therapy (intervention group) or usual care as part of the OPTIMISE trial...
August 2015: British Journal of Anaesthesia
Vipul Jairath, Brennan C Kahan, Alasdair Gray, Caroline J Doré, Ana Mora, Martin W James, Adrian J Stanley, Simon M Everett, Adam A Bailey, Helen Dallal, John Greenaway, Ivan Le Jeune, Melanie Darwent, Nicholas Church, Ian Reckless, Renate Hodge, Claire Dyer, Sarah Meredith, Charlotte Llewelyn, Kelvin R Palmer, Richard F Logan, Simon P Travis, Timothy S Walsh, Michael F Murphy
BACKGROUND: Transfusion thresholds for acute upper gastrointestinal bleeding are controversial. So far, only three small, underpowered studies and one single-centre trial have been done. Findings from the single-centre trial showed reduced mortality with restrictive red blood cell (RBC) transfusion. We aimed to assess whether a multicentre, cluster randomised trial is a feasible method to substantiate or refute this finding. METHODS: In this pragmatic, open-label, cluster randomised feasibility trial, done in six university hospitals in the UK, we enrolled all patients aged 18 years or older with new presentations of acute upper gastrointestinal bleeding, irrespective of comorbidity, except for exsanguinating haemorrhage...
July 11, 2015: Lancet
Marie Crandall, Karolina Kucybala, Jess Behrens, Steven Schwulst, Thomas Esposito
BACKGROUND: The association between alcohol and interpersonal violence is well established. Up to 80% of homicide perpetrators and victims are known to have used alcohol before the incident. However, the association between proximity to a liquor-selling establishment and gun violence is more controversial. METHODS: Scene address data from the Illinois State Trauma Registry from 1999 to 2009 were used to geocode all gunshot wounds (GSWs) presenting to trauma centers in Chicago during the study period...
July 2015: American Journal of Surgery
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