Clinicians intuitively recognize that faster time to hemostasis is important in bleeding trauma patients, but these times are rarely reported.
Prospectively collected data from the Pragmatic ...Randomized Optimal Platelet and Plasma Ratios trial were analyzed. Hemostasis was predefined as no intraoperative bleeding requiring intervention in the surgical field or resolution of contrast blush on interventional radiology (IR). Patients who underwent an emergent (within 90 minutes) operating room (OR) or IR procedure were included. Mixed-effects Poisson regression with robust error variance (controlling for age, Injury Severity Score, treatment arm, injury mechanism, base excess on admission missing values estimated by multiple imputation, and time to OR/IR as fixed effects and study site as a random effect) with modified Bonferroni corrections tested the hypothesis that decreased time to hemostasis was associated with decreased mortality and decreased incidence of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), multiple-organ failure (MOF), sepsis, and venous thromboembolism.
Of 680 enrolled patients, 468 (69%) underwent an emergent procedure. Patients with decreased time to hemostasis were less severely injured, had less deranged base excess on admission, and lower incidence of blunt trauma (all p < 0.05). In 408 (87%) patients in whom hemostasis was achieved, every 15-minute decrease in time to hemostasis was associated with decreased 30-day mortality (RR, 0.97; 95% confidence interval CI, 0.94-0.99), AKI (RR, 0.97; 95% CI, 0.96-0.98), ARDS (RR, 0.98; 95% CI, 0.97-0.99), MOF (RR, 0.94; 95% CI, 0.91-0.97), and sepsis (RR, 0.98; 95% CI, 0.96-0.99), but not venous thromboembolism (RR, 0.99; 95% CI, 0.96-1.03).
Earlier time to hemostasis was independently associated with decreased incidence of 30-day mortality, AKI, ARDS, MOF, and sepsis in bleeding trauma patients. Time to hemostasis should be considered as an endpoint in trauma studies and as a potential quality indicator.
Therapeutic/care management, level III.
•Cytokines involved in inflammatory and thrombotic processes are elevated after SAH.•Positive correlations between the processes were observed in SAH and UA.•Negative correlations between the ...processes were present in UA but absent in SAH.•A growth colony stimulating factor cluster was unique in SAH.
Unregulated inflammatory and thrombotic responses have been proposed to be important causes of early brain injury and worse clinical outcomes after subarachnoid hemorrhage (SAH).
We hypothesize that SAH is characterized by an increased inflammatory and thrombotic state and disruption of associations between these states.
This is a retrospective cohort study of 60 patients with SAH. 23 patients with unruptured aneurysms (UA) and 77 patients with traumatic brain injury (TBI) were chosen as controls. Plasma cytokine levels were measured using a 41-plex human immunoassay kit, and cytokine patterns associated with SAH, UA and TBI were identified using statistical and informatics methods.
SAH was characterized by an increase in several cytokines and chemokines, platelet-derived factors, and growth factors. Cluster analysis identified several cytokine clusters common in SAH, UA and TBI groups – generally grouped as platelet-derived, vascular and pro-inflammatory clusters. In the UA group, the platelet-derived cluster had an inverse relationship with the inflammatory cluster which was absent in SAH. Additionally, a cluster comprising of growth and colony stimulating factors was unique to SAH.
A cluster of cytokines involved in growth and colony stimulation was unique to SAH. Negative associations between the thrombotic and inflammatory molecules were observed in UA but not in SAH. Further studies to examine the pathophysiology behind the cluster unique to SAH and the associations between the thrombotic and inflammatory cytokines are required.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The objective of this study was to quantify coagulopathy using thrombelastography (TEG) in patients with renal dysfunction and intracerebral hemorrhage (ICH).
We reviewed patients admitted with ...spontaneous ICH between November 2009 and May 2015. TEG was performed at the time of admission. Creatinine clearance (CCr) was calculated using the Cockroft–Gault equation. Patients were divided into 2 groups based on normal (CCr ≥ 90) or reduced renal function (CCr < 90). Multivariable regression models were conducted to compare the differences of TEG components.
A total of 120 patients were included in the analysis. The normal CCr group was younger (56.1 versus 62.3 years, P < .01), was more often male (73.6% versus 53.7%, P = .03), and had higher mean admission hemoglobin (14.2 versus 13.2 mEq/L, P < .01) than the reduced renal function group. The 2 groups were similar with respect to antiplatelet or anticoagulant use, coagulation studies, and baseline ICH volume. Following multivariate analysis, the reduced renal function group was found to have shorter K (1.5 versus 2.2 min, P = 004), increased angle (66 versus 62.2 degrees, P = .04), increased MA (67.3 versus 62.3, P = .02), and increased G (11.3 versus 9.9 dynes/cm2, P = .04) compared with the normal group. Mortality, poor functional outcome (modified Rankin Scale score 4-6), hematoma enlargement, hospital length of stay, and surgical interventions were not different between the 2 groups.
Patients with ICH and reduced CCr display faster clotting rate and increased clot strength, suggesting that patients with renal dysfunction present with a relatively hypercoagulable state based on TEG parameters thought to reflect platelet activity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
6.
Educación financiera en el ecosistema emprendedor Espino-Barranco, Laura Elena; Hernández-Calzada, Martín Aubert; Pérez-Hernández, Carla Carolina
Investigación administrativa,
12/2021, Volume:
50, Issue:
128
Journal Article
Peer reviewed
Open access
Resumen El objetivo es analizar la diversificación de las necesidades de educación financiera inmersas en el ecosistema emprendedor. Es una investigación que aplica el método cuantitativo mediante el ...índice de diversidad de Shannon y el índice de dominancia de Simpson para conocer la abundancia y preferencias de educación financiera. A partir del análisis de escalamiento multidimensional no paramétrico (nMDS) se muestra la similaridad entre las necesidades de educación financiera de los emprendedores. Los resultados indican equidad en las necesidades financieras de los emprendedores y el hallazgo más importante es la abundancia y ubicuidad de necesidades de educación financiera, lo que origina la priorización de los modelos financieros que integran la plataforma tecnológica para educar financieramente a los emprendedores. La originalidad reside en usar una técnica común en ecosistemas biológicos y ahora aplicada en un ecosistema emprendedor. La principal limitación es que únicamente se consideran a los suscriptores de la plataforma tecnológica.
Educación financiera en el ecosistema emprendedor Espino-Barranco, Laura Elena; Hernández-Calzada, Martín Aubert; Pérez-Hernández, Carla Carolina
Investigación administrativa,
6/2021, Volume:
50-2
Journal Article
Peer reviewed
El objetivo es analizar la diversificación de las necesidades de educación financiera inmersas en el ecosistema emprendedor. Es una investigación que aplica el método cuantitativo mediante el índice ...de diversidad de Shannon y el índice de dominancia de Simpson para conocer la abundancia y preferencias de educación financiera. A partir del análisis de escalamiento multidimensional no paramétrico (nMDS) se muestra la similaridad entre las necesidades de educación financiera de los emprendedores. Los resultados indican equidad en las necesidades financieras de los emprendedores y el hallazgo más importante es la abundancia y ubicuidad de necesidades de educación financiera, lo que origina la priorización de los modelos financieros que integran la plataforma tecnológica para educar financieramente a los emprendedores. La originalidad reside en usar una técnica común en ecosistemas biológicos y ahora aplicada en un ecosistema emprendedor. La principal limitación es que únicamente se consideran a los suscriptores de la plataforma tecnológica.
Educación financiera en el ecosistema emprendedor Espino-Barranco, Laura Elena; Hernández-Calzada, Martín Aubert; Pérez-Hernández, Carla Carolina
Revista Investigacion Administrativa,
07/2021
128
Journal Article
El objetivo es analizar la diversificación de las necesidades de educación financiera inmersas en el ecosistema emprendedor. Es una investigación que aplica el método cuantitativo mediante el índice ...de diversidad de Shannon y el índice de dominancia de Simpson para conocer la abundancia y preferencias de educación financiera. A partir del análisis de escalamiento multidimensional no paramétrico (nMDS) se muestra la similaridad entre las necesidades de educación financiera de los emprendedores. Los resultados indican equidad en las necesidades financieras de los emprendedores y el hallazgo más importante es la abundancia y ubicuidad de necesidades de educación financiera, lo que origina la priorización de los modelos financieros que integran la plataforma tecnológica para educar financieramente a los emprendedores. La originalidad reside en usar una técnica común en ecosistemas biológicos y ahora aplicada en un ecosistema emprendedor. La principal limitación es que únicamente se consideran a los suscriptores de la plataforma tecnológica.
Objective
The prevalence and types of psychosocial complications of juvenile localized scleroderma (JLS), also known as morphea, an inflammatory and sclerosing disease involving the skin, fascia, ...muscle, and bone, are poorly understood.
Methods
We performed a systematic review of literature published between 2000 and 2020 in PubMed, EMBASE, the Cochrane Skin Group Specialized Register, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature using the search terms “scleroderma, localized,” “Morphea,” “anxiety,” “depression,” “resilience,” “social stigma,” “quality of life,” “mood,” or “stress” and limited the search to pediatric patients and English language. Patient demographics, characteristics of JLS, and comorbidities were extracted. The outcomes included measures of health‐related quality of life (HRQoL), psychosocial functioning, evaluation of self‐perception, and the treatment burden of the study population. The protocol was registered with PROSPERO (CRD42021257124). Thematic synthesis generated descriptive analysis.
Results
Thirteen studies fulfilled the inclusion criteria: three retrospective cohort studies, two prospective cohort studies, and eight cross‐sectional studies. A total of 690 pediatric patients with JLS were included (n = 484 with linear scleroderma). Six studies used the Children's Dermatology Life Quality Index, reporting little to no effect on HRQoL. One study used the Health‐Related Quality of Life in Children and Adolescents Questionnaire and did not find differences between children with JLS or atopic dermatitis and healthy controls. One study used a self‐perception questionnaire that showed normal self‐worth of patients with JLS. Two studies used focus groups, both reporting elevated levels of stress, decreased self‐worth, “feeling different,” and bullying/teasing in patients with JLS. These emotions were associated with skin symptoms (pain, itch, and tightness), physical limitations, and treatment burden.
Conclusion
Overall, quantitative studies did not report a statistically significant impairment in HRQoL in JLS. However, qualitative studies (focus groups) reported significant psychosocial impacts related to JLS. There is a need to develop a JLS‐specific tool for the HRQoL evaluation of this population.
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