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  • 1
    In: ANZ Journal of Surgery, December 2013, Vol.83(12), pp.918-923
    Description: Byline: Biswadev Mitra, Gerard O'Reilly, Peter A. Cameron, Amanda Zatta, Russell L. Gruen Keywords: blood component transfusion; blood transfusion; emergency medicine; fresh frozen plasma; resuscitation Abstract Introduction The effectiveness of massive transfusion protocols (MTPs) has been assumed from low quality studies with multiple biases. This review aimed to (i) evaluate the association between the institution of an MTP and mortality and (ii) determine the effect of MTPs on transfusion practice post trauma. Methods A systematic review of studies that examined patient outcomes before and after the institution of an MTP in the same centre was conducted. The design and results of each study were described. Heterogeneity was assessed using the Q test and the I.sub.2 statistic. Odds ratios (ORs) for dichotomous outcomes from each study were pooled. Results There were eight studies that satisfied inclusion criteria with marked heterogeneity in study populations (I.sub.2 = 72.1%, P = 0.001). Two studies showed significantly improved mortality following implementation of an MTP, and six studies showed no significant change. Pooled OR for the effect of an MTP on short-term mortality was 0.73 (95% confidence interval: 0.48-1.11). The effect of MTPs on transfusion practice was varied. Conclusion Despite the popularity of MTPs and directives mandating their use in trauma centres, in before-after studies, MTPs have not always been associated with improved mortality. Evidence-based standardization of MTPs, improved compliance and analysis of broader endpoints were identified as areas for further research. Article Note: B. Mitra MBBS, MHSM, PhD, FACEM; G. O'Reilly MBBS, MPH, MBiostat, FACEM; P. A. Cameron MBBS, MD, FACEM; A. Zatta BSc (Hons), PhD; R. L. Gruen MBBS, PhD, FRACS.
    Keywords: Blood Component Transfusion ; Blood Transfusion ; Emergency Medicine ; Fresh Frozen Plasma ; Resuscitation
    ISSN: 1445-1433
    E-ISSN: 1445-2197
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  • 2
    In: Emergency Medicine Australasia, December 2011, Vol.23(6), pp.665-676
    Description: The early management of patients who have sustained traumatic brain injury is aimed at preventing secondary brain injury through avoidance of cerebral hypoxia and hypoperfusion. Especially in hypotensive patients, it has been postulated that hypertonic crystalloids and colloids might support mean arterial pressure more effectively by expanding intravascular volume without causing problematic cerebral oedema. We conducted a systematic review to investigate if hypertonic saline or colloids result in better outcomes than isotonic crystalloid solutions, as well as to determine the safety of minimal volume resuscitation, or delayed versus immediate fluid resuscitation during prehospital care for patients with traumatic brain injury. We identified nine randomized controlled trials and one cohort study examined the effects of hypertonic solutions (with or without colloid added) for prehospital fluid resuscitation. None has reported better survival and functional outcomes over the use of isotonic crystalloids. The only trial of restrictive resuscitation strategies was underpowered to demonstrate its safety compared with aggressive early fluid resuscitation in head injured patients, and maintenance of cerebral perfusion remains the top priority.
    Keywords: Brain Injury ; Colloid ; Craniocerebral Trauma ; Crystalloid Solution ; Fluid Therapy ; Head Injury
    ISSN: 1742-6731
    E-ISSN: 1742-6723
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  • 3
    Language: English
    In: CA: A Cancer Journal for Clinicians, May 2009, Vol.59(3), pp.192-211
    Description: The authors systematically reviewed the association between provider case volume and mortality in 101 publications involving greater than 1 million patients with esophageal, gastric, hepatic, pancreatic, colon, or rectal cancer, of whom more than 70,000 died. The majority of studies addressed the relation between hospital surgical case volume and short‐term perioperative mortality. Few studies addressed surgeon case volume or evaluated long‐term survival outcomes. Common methodologic limitations were failure to control for potential confounders, post hoc categorization of provider volume, and unit of analysis errors. A significant volume effect was evident for the majority of gastrointestinal cancers; with each doubling of hospital case volume, the odds of perioperative death decreased by 0.1 to 0.23. The authors calculated that between 10 and 50 patients per year, depending on cancer type, needed to be moved from a “low‐volume” hospital to a “high‐volume” hospital to prevent 1 additional volume‐associated perioperative death. Despite this, approximately one‐third of all analyses did not find a significant volume effect on mortality. The heterogeneity of results from individual studies calls into question the validity of case volume as a proxy for care quality, and leads the authors to conclude that more direct quality measures and the validity of their use to inform policy should also be explored. CA Cancer J Clin 2009;59:192–211. © 2009 American Cancer Society.
    Keywords: Outcome Assessment (Health Care) ; Workload ; Digestive System Surgical Procedures -- Mortality ; Gastrointestinal Neoplasms -- Mortality;
    ISSN: 0007-9235
    E-ISSN: 1542-4863
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