This study compared the efficacy and safety of the VASCADE MVP Venous Vascular Closure System (VVCS) device (Cardiva Medical, Santa Clara, California) to manual compression (MC) for closing multiple ...access sites after catheter-based electrophysiology procedures.
The VASCADE MVP VVCS is designed to provide earlier ambulatory hemostasis than MC after catheter-based procedures.
The AMBULATE (A Randomized, Multi-center Trial to Compare Cardiva Mid-Bore VASCADE MVP VVCS to Manual Compression in Closure of Multiple Femoral Venous Access Sites in 6 - 12 Fr Sheath Sizes) trial was a multicenter, randomized trial of device closure versus MC in patients who underwent ablation. Outcomes included time to ambulation (TTA), total post-procedure time (TPPT), time to discharge eligibility (TTDe), time to hemostasis (TTH), 30-day major and minor complications, pain medication usage, and patient-reported outcomes.
A total of 204 patients at 13 sites were randomized to the device arm (n = 100; 369 access sites) or the MC arm (n = 104; 382 access sites). Baseline characteristics were similar between groups. Mean TTA, TPPT, TTDe, and TTH were substantially lower in the device arm (respective decreases of 54%, 54%, 52%, and 55%; all p < 0.0001). Opioid use was reduced by 58% (p = 0.001). There were no major access site complications. Incidence of minor complications was 1.0% for the device arm and 2.4% for the MC arm (p = 0.45). Patient satisfaction scores with duration of and comfort during bedrest were 63% and 36% higher in device group (both p < 0.0001). Satisfaction with bedrest pain was 25% higher (p = 0.001) for the device overall, and 40% higher (p = 0.002) for patients with a previous ablation.
Use of the closure device for multiple access ablation procedures resulted in significant reductions in TTA, TPPT, TTH, TTDe, and opioid use, with increased patient satisfaction and no increase in complications. (A Randomized, Multi-center Trial to Compare Cardiva Mid-Bore VVCS to Manual Compression in Closure of Multiple Femoral Venous Access Sites in 6 - 12 Fr Sheath Sizes AMBULATE; NCT03193021).
Background
The safety of platelet (PLT) concentrates with longer storage duration has been questioned due to biochemical and functional changes that occur during blood collection and storage. Some ...studies have suggested that transfusion efficacy is decreased and immune system dysfunction is worsened with increased storage age. We sought to describe the effect of PLT storage age on laboratory and clinical outcomes in critically ill children receiving PLT transfusions.
Study Design and Methods
We performed a secondary analysis of a prospective, observational point‐prevalence study. Children (3 days to 16 years of age) from 82 pediatric intensive care units in 16 countries were enrolled if they received a PLT transfusion during one of the predefined screening weeks. Outcomes (including PLT count increments, organ dysfunction, and transfusion reactions) were evaluated by PLT storage age.
Results
Data from 497 patients were analyzed. The age of the PLT transfusions ranged from 1 to 7 days but the majority were 4 (24%) or 5 (36%) days of age. Nearly two‐thirds of PLT concentrates were transfused to prevent bleeding. The indication for transfusion did not differ between storage age groups (P = .610). After patient and product variables were adjusted for, there was no association between storage age and incremental change in total PLT count or organ dysfunction scoring. A significant association between fresher storage age and febrile transfusion reactions (P = .002) was observed.
Conclusion
The results in a large, diverse cohort of critically ill children raise questions about the impact of storage age on transfusion and clinical outcomes which require further prospective evaluation.
To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children.
Secondary ...analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome.
Eighty-two PICUs in 16 countries.
Children (3 d to 16 yr old) were enrolled if they received a platelet transfusion during one of the predefined screening weeks.
None.
Five-hundred three children were enrolled and had complete ABO information for both donor and recipient, as well as laboratory data. Three-hundred forty-two (68%) received ABO-identical platelets, 133 (26%) received platelets with major incompatibility, and 28 (6%) received platelets with minor incompatibility. Age, weight, proportion with mechanical ventilation or underlying oncologic diagnosis did not differ between the groups. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups; the median (interquartile range) change for ABO-identical transfusions was 28 × 10 cells/L (8-68 × 10 cells/L), for transfusions with major incompatibility 26 × 10 cells/L (7-74 × 10 cells/L), and for transfusions with minor incompatibility 54 × 10 cells/L (14-81 × 10 cells/L) (p = 0.37). No differences in count increment between the groups were noted for bleeding (p = 0.92) and nonbleeding patients (p = 0.29). There were also no differences observed between the groups for any transfusion reaction (p = 0.07).
No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary.
This study compared the efficacy and safety of the VASCADE MVP Venous Vascular Closure System (VVCS) device (Cardiva Medical, Santa Clara, California) to manual compression (MC) for closing multiple ...access sites after catheter-based electrophysiology procedures.
The VASCADE MVP VVCS is designed to provide earlier ambulatory hemostasis than MC after catheter-based procedures.
The AMBULATE (A Randomized, Multi-center Trial to Compare Cardiva Mid-Bore VASCADE MVP VVCS to Manual Compression in Closure of Multiple Femoral Venous Access Sites in 6 - 12 Fr Sheath Sizes) trial was a multicenter, randomized trial of device closure versus MC in patients who underwent ablation. Outcomes included time to ambulation (TTA), total post-procedure time (TPPT), time to discharge eligibility (TTDe), time to hemostasis (TTH), 30-day major and minor complications, pain medication usage, and patient-reported outcomes.
A total of 204 patients at 13 sites were randomized to the device arm (n = 100; 369 access sites) or the MC arm (n = 104; 382 access sites). Baseline characteristics were similar between groups. Mean TTA, TPPT, TTDe, and TTH were substantially lower in the device arm (respective decreases of 54%, 54%, 52%, and 55%; all p < 0.0001). Opioid use was reduced by 58% (p = 0.001). There were no major access site complications. Incidence of minor complications was 1.0% for the device arm and 2.4% for the MC arm (p = 0.45). Patient satisfaction scores with duration of and comfort during bedrest were 63% and 36% higher in device group (both p < 0.0001). Satisfaction with bedrest pain was 25% higher (p = 0.001) for the device overall, and 40% higher (p = 0.002) for patients with a previous ablation.
Use of the closure device for multiple access ablation procedures resulted in significant reductions in TTA, TPPT, TTH, TTDe, and opioid use, with increased patient satisfaction and no increase in complications. (A Randomized, Multi-center Trial to Compare Cardiva Mid-Bore VVCS to Manual Compression in Closure of Multiple Femoral Venous Access Sites in 6 - 12 Fr Sheath Sizes AMBULATE; NCT03193021).
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What Is an Ontology? Spear, Andrew D; Smith, Barry; Arp, Robert
Building Ontologies with Basic Formal Ontology,
08/2015
Book Chapter
Odprti dostop
In order to design an ontology, it is important to understand just what an ontology is. Only on this basis can we be clear about both the steps that should be taken in ontology design and the kinds ...of pitfalls that should be avoided. The goal of this chapter and the next is to provide the basic definitions and distinctions in whose terms the process of ontology design can best be understood. Our definition of “ ontology ” is the following:
ontology = def. a representational artifact, comprising a taxonomy as proper part, whose representations are intended to designate some
A growing number of studies have been performed regarding the positive effect of physical activity on academic performance. Many of these studies were conducted on children and show that students who ...are less physically active obtain lower grades and that physical activity interventions can be effective in improving academic achievement, academic behaviour, and cognitive skills and attitudes. The purpose of this study is to investigate if and how the positive effects of physical activity on academic performance found for children extend into a university setting. We collected Fitbit heart rate and physical activity data, 1-mile field test times, and the results of a healthy lifestyle survey from 581 first-semester freshmen enrolled at Oral Roberts University and investigated the effect they had on academic performance as measured by semester grade point averages. We found positive and significant correlations between Fitbit step counts, 1-mile field test times, lifestyle survey scores and academic performance even when controlling for gender. These findings highlight the importance for students of maintaining a physically active and healthy lifestyle when they enter university.
An ontology, as we conceive it, is a representational artifact aimed at representing universals, defined classes, and relations among them. We are interested here specifically in the universals, ...defined classes, and relations discovered by and pertinent to scientific research. In this chapter we discuss in more detail the philosophical background of ontology in general, and introduce some distinctions between kinds of ontologies, including domain ontologies, top-level ontologies, reference ontologies, and application ontologies. We also discuss in more detail the idea of a structured classification or taxonomy.
Historically, ontology is a branch of philosophy having its origins in ancient Greece in
Principles of Best Practice I Spear, Andrew D; Smith, Barry; Arp, Robert
Building Ontologies with Basic Formal Ontology,
08/2015
Book Chapter
Odprti dostop
In our Introduction, we articulated the problem of managing scientific information in a way that allows combinability and comparability, and we discussed ontology as a proposed general solution to ...this problem. In chapters 1 and 2, an ontology was defined as a representational artifact whose representations are intended to designate universals, defined classes, and the relations among them. We also introduced some distinctions among different kinds of ontologies, and introduced the idea of a taxonomy as the central component of an ontology. In light of all of this, the problem of designing an ontology is the problem of designing a
Principles of Best Practice II Spear, Andrew D; Smith, Barry; Arp, Robert
Building Ontologies with Basic Formal Ontology,
08/2015
Book Chapter
Odprti dostop
We assume that, following the recommendations advanced in chapter 3, the appropriate scope of the ontology has been determined and the relevant domain information assembled. We assume also that the ...ontology builder has created a draft list of terms and associated these with a first draft set of definitions and a provisionalis_ahierarchy. The next step is to use this list of terms to regiment the domain information in a systematic way, while at the same time allowing an improved understanding of the domain to generate improvements in the list of terms. The goal is to develop a representational
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