The degree of adherence to CONSORT reporting guidelines for the abstracts of randomised clinical trials published in anaesthesia journals: A cross-sectional study of reporting adherence in 2010 and 2016

BACKGROUND Abstracts are intended to be concise summaries of the entire randomised clinical trial (RCT). Despite their importance, few studies have examined the reporting quality of abstracts in the anaesthesiology literature. OBJECTIVES To examine the quality of RCT abstract reporting according to the CONSORT for Abstracts guidelines and determine whether recommended items omitted from the abstract were present in the body of the article. DESIGN A cross-sectional study of RCTs. SETTING This study was performed at the University of Western Ontario and University Hospital, London Health Sciences Centre. PARTICIPANTS All RCTs meeting inclusion criteria that were published in 2010 or 2016 in six general anaesthesiology journals (Anaesthesia, Anesthesia & Analgesia, Anesthesiology, British Journal of Anaesthesia, Canadian Journal of Anesthesia and European Journal of Anaesthesiology). MAIN OUTCOME MEASURES The 16 checklist items from the CONSORT for Abstracts statement were used to create a convenience score as a proxy for RCT abstract reporting quality, with each criterion measured as being reported in abstract, not reported in abstract but reported in full-text article, or not reported in abstract or full-text article. RESULTS Of the 395 RCTs identified, 219 were published in 2010 and 176 were published in 2016. Out of the maximum possible score of 16, the median abstract score increased from 4 points [interquartile range (IQR): 3 to 5] in 2010 to 6 points [IQR: 5 to 8] in 2016. Although most checklist items showed improvement from 2010 to 2016, around 75% of RCTs in 2016 met fewer than half of the 16 items with no RCTs reporting all 16 items in the abstract. A majority of the RCTs had the information present in the full-text. In 2016, only 71 out of 176 (40%) of RCTs reported outcomes conforming to the CONSORT guidelines (with an effect size and a confidence interval around the effect size) in the Abstract. CONCLUSION Abstracts for many anaesthesiology RCTs are incomplete selective summaries of the entire article. Correspondence to Dr Philip M. Jones, MD, MSc, Rm C3–110 - University Hospital, London Health Sciences Centre, 339 Windermere Rd, London, ON N6A 5A5, Canada, Tel: +1 519 685 8500 x36306; e-mail: pjones8@uwo.ca Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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How current transfusion practices in geriatric patients with hip fracture still differ from current guidelines and the effects on outcome: A retrospective observational study

BACKGROUND Transfusion guidelines have become increasingly restrictive. We investigated actual transfusion practices in geriatric hip fracture patients, why they differ from current guidelines and how this affects outcome. OBJECTIVES The primary aim was to examine transfusion timing, evaluate how many red blood cell (RBC) transfusions are in keeping with and how this affects morbidity (infection, cardiac events and delirium), mortality and length of stay (LOS). Our secondary aim was to test the hypothesis that guidelines were more likely to be guidelines are more likely to deviate with consecutive transfusions or before discharge. DESIGN A retrospective observational study. SETTING The Luzerner Kantonsspital, a major trauma centre, over a 12-month period from 1 February 2015 to 31 January 2016. PATIENTS All patients over 70 years of age admitted to the Luzerner Kantonsspital with hip fractures over a 12-month period in 2015 to 2016 were included. RESULTS 156 patients were included, and 141 units of RBCs were transfused. All pre and intra-operative transfusions were according to guidelines; 110 transfusions were postoperative and 37 of these were not according to guidelines. Patients who were transfused had longer LOS in hospital (P = 0.002) and an odds ratio (OR) of 2.7 of contracting an infection (P = 0.04) in comparison with patients who were not transfused. No significant differences in mortality, LOS or morbidity were found between patients transfused according to guidelines and more liberal thresholds. Guidelines were more likely to be deviated from within the last 2 days before discharge than prior to this (58 vs. 24%, P = 0.03). Furthermore, 24 stable patients received two consecutive RBC units resulting in posttransfusion haemoglobin values of between 83 and 124 g l−1. CONCLUSION Most RBC transfusions occur postoperatively, many still according to liberal transfusion thresholds, in particular shortly before discharge and as part of consecutive transfusions. Transfused patients had longer LOS and more infections than patients not transfused, but there was no difference in mortality, LOS or morbidity between patients transfused according to current guidelines and those where guidelines were deviated from. Correspondence to Dr Evelyn Leuzinger, Department of Anaesthesia, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland Tel: + 41 55 205 1111; e-mail: evelynctsa@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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The effect of virtual reality bronchoscopy simulator training on performance of bronchoscopic-guided intubation in patients: A randomised controlled trial

BACKGROUND The use of a flexible optical bronchoscopic (FOB) for intubation is an essential airway management skill. OBJECTIVE(S) Our primary objective was to compare the effects of simulator training (ORSIM high-fidelity simulator) with no simulation training on the performance of FOB intubation in anaesthetised patients. DESIGN Randomised controlled trial. SETTING Single-centre tertiary hospital; trial conducted between April 2015 to May 2016. PARTICIPANTS Medical students, anaesthesia assistants and anaesthesia residents with experience of less than five FOB intubations from whom informed consent was obtained. INTERVENTION Students, anaesthesia assistants and anaesthesia residents viewed a didactic presentation before performing an initial FOB intubation in an anaesthetised patient. Intubations were recorded and evaluated using the Global Rating Scale (GRS) and checklist scores. Subsequently, participants were randomised to control group (Group CON) and had no simulation training, or to a simulation group (Group SIM) and underwent 60 min of simulation practice. Within a week, participants performed a second FOB intubation and were similarly evaluated. MAIN OUTCOME MEASURES Pretraining and posttraining intubation time, GRS and checklist scores. RESULTS Baseline characteristics were similar between groups. In Group SIM, there was significant improvement between pre and posttraining GRS [22.9 ± 8.1 vs. 28.2 ± 7.3, mean difference (95% CI) 5.3 (0.3 to 10.3), P = 0.04], and intubation time [177.6 ± 77.6 vs. 119.3 ± 52.2 s, mean difference (95% CI) −58.4 (−100.3 to −16.5) s, P = 0.01]. There was no difference in Group CON, between pre and posttraining intubation time, GRS or checklist. CONCLUSION We conclude, posttraining performance of FOB intubation, as measured by intubation time and GRS, improved in Group SIM, while it was unchanged in the Group CON. The ORSIM simulator may be a useful adjunct in acquiring FOB intubation skills. CLINICAL TRIAL NUMBER AND REGISTRY ClinicalTrials.gov ID: NCT02699242. Correspondence to David T. Wong, Department of Anaesthesia, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 Tel: +1 416 603 5118; e-mail: David.Wong@uhn.ca Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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ICU mortality and variables associated with ICU survival in Poland: A nationwide database study

BACKGROUND Recently published international comparison data across European countries revealed high mortality rates in Polish ICUs. OBJECTIVES Estimation of the rate of ICU mortality and identification of variables associated with ICU survival in Poland. DESIGN Retrospective analyses of a database reporting ICU stays in Poland. SETTINGS AND PATIENTS The study included data from all adult patients admitted to an ICU in Poland from 1 January 2012 to 31 December 2012. MAIN OUTCOME MEASURES ICU mortality and variables associated with ICU survival. RESULTS A total of 48 282 patients were treated in 347 ICUs (mean age 63.1 ± 16.8 years, 59% men) with 20 278 deaths (42.0%). Variables associated with ICU survival were: tertiary level of hospital care [relative risk (RR) 0.86, 95% confidence interval (CI) 0.80 to 0.92, P 

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Potentiating Renal Regeneration using Mesenchymal Stem Cells

Background The potential of a Mesenchymal Stem Cell (MSC) therapy to accelerate the repair of ischemically damaged human kidneys during 24 hours of warm perfusion was evaluated. The hypothesis was that by administering MSC directly to the renal tissue, there would be an improved opportunity for cellular repair mediated by intrarenal paracrine effects. Methods Studies were performed using the Exsanguinous Metabolic Support (EMS) tissue-engineering platform. Five pairs of human kidney allografts from donation after cardiac death (DCD) donors were studied. One human kidney was EMS perfused for 24 hours (control), while its paired kidney was EMS perfused with MSC (1×108). The kidneys were evaluated for DNA synthesis, cytokine/chemokine synthesis, cytoskeletal regeneration and mitosis. Results Treatment with MSC resulted in reduced inflammatory cytokines synthesized by the kidneys. MSC treatment led to a significant increase in the synthesis of ATP and growth factors resulting in normalization of metabolism and the cytoskeleton. Toluidine Blue staining of MSC treated kidneys demonstrated a significant increase in the number of renal cells undergoing mitosis (26%) compared to EMS perfusion alone. Conclusions To our knowledge, our work is the first to have demonstrated actual renal regeneration while ischemically damaged human kidneys are perfused ex vivo for 24 hours. The observed regeneration entails: increased synthesis of ATP, a reduced inflammatory response, increased synthesis of growth factors, normalization of the cytoskeleton and mitosis. The ability to regenerate renal tissue ex vivo sufficiently to result in immediate function could revolutionize transplantation by solving the chronic organ shortage. Corresponding Author: Lauren Brasile, BREONICS INC, 44 Dalliba Avenue, Watervliet NY, 12189 (lbrasile@citlink.net) Authorship: Lauren Brasile Ph.D. Participated in research design Participated in the writing of the paper Participated in the performance of the research Contributed new reagents or analytic tools Participated in data analysis Nicholas Henry BA. Participated in research design Participated in the performance of the research Participated in data analysis Giuseppe Orlando Ph.D. Participated in the writing of the paper Bart Stubenitsky MD., Ph.D. Participated in research design Participated in the writing of the paper Participated in data analysis Disclosure: The authors declare no conflicts of interest. Funding Sources: This work was funded by the National Institute of Health R43 Grant # R43AI106362-01 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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VCA Deceased Donors in the United States

Background Vascularized composite allograft (VCA) transplants include diverse organ types and are made possible primarily by deceased donors. Methods We used Organ Procurement and Transplantation Network (OPTN) data to characterize VCA deceased donors (n=66 of 70) in the United States 1998-2017 and compare their characteristics with those of kidney donors in 2017. Results Through December 31, 2017, 20 transplant programs performed 72 deceased donor VCA transplants, with organs donated by 70 donors, including 30 upper limb (17 unilateral and 13 bilateral) and 11 face donors. Other donors donated both upper limbs and face (n=2), uterus (n=4), abdominal wall (n=19), larynx (n=2), penis (n=1), and scalp (n=1). About a third of VCA donors were female, and the majority (86.4%) were white. Almost half (45.5%) were between 18 and 34 years old. Smaller proportions were under 18 (19.7%), 35-44 (15.2%), 45-54 (13.6%), and over 55 years old (6.1%). Median body mass index for all VCA donors was 24.9 and varied widely, especially for upper limb and face donors. There was considerable variation in Kidney Donor Profile Index among VCA donors (median: 27.5; interquartile range: 11-59). Donor causes of death included head trauma (39.4%), cerebrovascular/stroke (25.8%), and anoxia (31.8%). VCA donors also donated solid organs that were transplanted, including 87.1% of kidneys, 93.9% of livers, 40.2% of lungs, and 56.1% of hearts. Conclusions VCA donors are a demographically and clinically diverse group. Understanding this diversity and future trends in VCA donor characteristics is critical in supporting this life-changing field of transplantation. Corresponding Author: Jennifer L. Wainright, 700 N 4th Street, Richmond, VA 23219, jennifer.wainright@unos.org Authorship: Participated in research design: Jennifer Wainright, Christopher Wholley, John Rosendale, Wida Cherikh, David Klassen Participated in writing of paper: Jennifer Wainright, Christopher Wholley, John Rosendale, Darren Di Battista, Wida Cherikh, David Klassen Participated in performance of the research: Jennifer Wainright Participated in data analysis: Jennifer Wainright Disclosure: The authors declare no conflicts of interest. Funding: This work was conducted under the auspices of the United Network for Organ Sharing (UNOS), contractor for OPTN, under Contract 234-2005-370011C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Kinetics of Torque Teno Virus-DNA Plasma Load Predict Rejection in Lung Transplant Recipients

Background Lung transplantation is the only therapeutic option in end stage lung diseases, however, survival after transplantation is limited by acute and chronic rejection or infectious events being results of inappropriate immunosuppression. Torque Teno Viruses (TTV) are ubiquitous DNA viruses in humans but not found to be causative for any disease. However, some reports suggest that TTV-DNA levels reflect the grade of immunosuppression with higher levels being found in more immunosuppressed individuals. Methods We investigated the TTV-DNA levels in 34 lung transplant recipients within their first year following transplantation by quantitative real-time PCR. Clinical data were extracted from charts. Results In accordance with previous results TTV-DNA levels increase after lung transplantation reaching a steady state after 3 months. TTV-DNA levels were not correlated with immunosuppressive trough levels and a selective increase was not observed with other DNA viruses. In steady state TTV-DNA levels were significantly higher in patients with infectious complications compared to the group of patients without. Additionally, TTV-DNA levels decreased significantly prior to biopsy-proven rejection. Sensitivity of a 10-fold decrease in TTV-DNA levels for a subsequent rejection episode was 0.74 with a specificity of 0.99. Conclusions In summary TTV-DNA might be used as an additional tool to monitor immunosuppression in lung transplant recipients. Higher TTV-DNA levels reflect more intense immunosuppression, whereas the TTV-DNA kinetic (ie, decrease of TTV-DNA levels) indicate rejection. Corresponding author: Dr. B. C. Frye, Department of Pneumology, University Medical Center, University of Freiburg, Killianstrasse 5, 79106 Freiburg, Phone: +49 (0)761 270 37060, Fax: +49 (0)761 270 37040. Mail: Joachim.mueller-quernheim@uniklinik-freiburg.de Authors' contribution: Research design: BCF, SB, VF, MG, HH, JMQ; Data collection: BCF, TCK, MG, IH, JMQ; Patient characterization: BCF, TCK, MG, IH, TD, MI, GZ, JMQ; Laboratory work: SB, VF, HH; Data analysis: BCF, SB, VF, GZ, HH, JMQ; Writing Paper: BCF, SB, VF, IH, GZ, HH, JMQ; Disclosure: All authors declare no conflicts of interest. Funding: No external funding Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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