1
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Jung Y, Luo O, Sen N, Li FM, Hasan RA, Hess AS, Hess JR, Sabath DE, Tsang HC, Pagano MB. The safety of ABO minor incompatible platelets transfusions using a rapid infuser. Transfusion 2024; 64:449-453. [PMID: 38299721 DOI: 10.1111/trf.17739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Administering platelets through a rapid infuser is proven to be safe. However, the clinical significance of infusing ABO-incompatible platelets with red blood cells (RBCs) in a rapid infuser remains unclear. There is a theoretical risk that isoagglutinin in the plasma of a platelet unit can interact with RBCs and induce hemolysis. MATERIALS AND METHODS Seven in vitro studies were performed including five cases (type A RBCs and type O platelets) and two controls (type A RBCs and platelets). Anti-A titers were measured in platelet units. An RBC unit and a platelet unit were mixed in the rapid infuser reservoir and incubated for 30 min. The primary outcome was the presence of hemolysis based on the following parameters: free hemoglobin concentration, hemolysis check, direct antiglobulin test (DAT), and direct agglutination. RESULTS The post-mix DAT was positive for IgG in all test samples (5/5), and weakly positive for complement in 3/5. The changes in free Hb in test cases between measured and calculated post-mix spanned -2.2 to +3.4 mg/dL. Post-mix hemolysis check was negative in 3/5 and slightly positive in 2/5 cases, with no significant differences compared to the control case. Anti-A titers ranged from 16 to 512 and were not associated with hemolysis. All samples were negative for direct agglutination. CONCLUSION Our study suggested that mixing ABO-incompatible platelets with RBCs in a rapid infuser does not induce in vitro hemolysis. These findings support the use of rapid infusers regardless of platelet compatibility in support of hemostatic resuscitation.
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Affiliation(s)
- Yujung Jung
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Bloodworks Northwest, Seattle, Washington, USA
| | - Oscar Luo
- American Red Cross Northern California Coastal Region, Oakland, California, USA
| | - Nina Sen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Flora M Li
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Rida A Hasan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Aaron S Hess
- Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Pathology & Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Daniel E Sabath
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Hamilton C Tsang
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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2
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Hurley NC, Gupta RK, Schroeder KM, Hess AS. Danger, Danger, Gaston Labat! Does zero-shot artificial intelligence correlate with anticoagulation guidelines recommendations for neuraxial anesthesia? Reg Anesth Pain Med 2024:rapm-2023-104868. [PMID: 38253610 DOI: 10.1136/rapm-2023-104868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/18/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Artificial intelligence and large language models (LLMs) have emerged as potentially disruptive technologies in healthcare. In this study GPT-3.5, an accessible LLM, was assessed for its accuracy and reliability in performing guideline-based evaluation of neuraxial bleeding risk in hypothetical patients on anticoagulation medication. The study also explored the impact of structured prompt guidance on the LLM's performance. METHODS A dataset of 10 hypothetical patient stems and 26 anticoagulation profiles (260 unique combinations) was developed based on American Society of Regional Anesthesia and Pain Medicine guidelines. Five prompts were created for the LLM, ranging from minimal guidance to explicit instructions. The model's responses were compared with a "truth table" based on the guidelines. Performance metrics, including accuracy and area under the receiver operating curve (AUC), were used. RESULTS Baseline performance of GPT-3.5 was slightly above chance. With detailed prompts and explicit guidelines, performance improved significantly (AUC 0.70, 95% CI (0.64 to 0.77)). Performance varied among medication classes. DISCUSSION LLMs show potential for assisting in clinical decision making but rely on accurate and relevant prompts. Integration of LLMs should consider safety and privacy concerns. Further research is needed to optimize LLM performance and address complex scenarios. The tested LLM demonstrates potential in assessing neuraxial bleeding risk but relies on precise prompts. LLM integration should be approached cautiously, considering limitations. Future research should focus on optimization and understanding LLM capabilities and limitations in healthcare.
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Affiliation(s)
- Nathan C Hurley
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Rajnish K Gupta
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Aaron S Hess
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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3
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Hess AS. What's in Your Transfusion? A Bedside Guide to Blood Products and Their Preparation. Anesthesiology 2024; 140:144-156. [PMID: 37639622 DOI: 10.1097/aln.0000000000004655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
An understanding of the contents of blood products and how they are modified before transfusion will help any physician. This article will review five basic blood products and the five most common product modifications.
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Affiliation(s)
- Aaron S Hess
- Departments of Anesthesiology and Pathology & Transfusion Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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4
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Carson JL, Stanworth SJ, Guyatt G, Valentine S, Dennis J, Bakhtary S, Cohn CS, Dubon A, Grossman BJ, Gupta GK, Hess AS, Jacobson JL, Kaplan LJ, Lin Y, Metcalf RA, Murphy CH, Pavenski K, Prochaska MT, Raval JS, Salazar E, Saifee NH, Tobian AAR, So-Osman C, Waters J, Wood EM, Zantek ND, Pagano MB. Red Blood Cell Transfusion: 2023 AABB International Guidelines. JAMA 2023; 330:1892-1902. [PMID: 37824153 DOI: 10.1001/jama.2023.12914] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Importance Red blood cell transfusion is a common medical intervention with benefits and harms. Objective To provide recommendations for use of red blood cell transfusion in adults and children. Evidence Review Standards for trustworthy guidelines were followed, including using Grading of Recommendations Assessment, Development and Evaluation methods, managing conflicts of interest, and making values and preferences explicit. Evidence from systematic reviews of randomized controlled trials was reviewed. Findings For adults, 45 randomized controlled trials with 20 599 participants compared restrictive hemoglobin-based transfusion thresholds, typically 7 to 8 g/dL, with liberal transfusion thresholds of 9 to 10 g/dL. For pediatric patients, 7 randomized controlled trials with 2730 participants compared a variety of restrictive and liberal transfusion thresholds. For most patient populations, results provided moderate quality evidence that restrictive transfusion thresholds did not adversely affect patient-important outcomes. Recommendation 1: for hospitalized adult patients who are hemodynamically stable, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). In accordance with the restrictive strategy threshold used in most trials, clinicians may choose a threshold of 7.5 g/dL for patients undergoing cardiac surgery and 8 g/dL for those undergoing orthopedic surgery or those with preexisting cardiovascular disease. Recommendation 2: for hospitalized adult patients with hematologic and oncologic disorders, the panel suggests a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (conditional recommendations, low certainty evidence). Recommendation 3: for critically ill children and those at risk of critical illness who are hemodynamically stable and without a hemoglobinopathy, cyanotic cardiac condition, or severe hypoxemia, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). Recommendation 4: for hemodynamically stable children with congenital heart disease, the international panel suggests a transfusion threshold that is based on the cardiac abnormality and stage of surgical repair: 7 g/dL (biventricular repair), 9 g/dL (single-ventricle palliation), or 7 to 9 g/dL (uncorrected congenital heart disease) (conditional recommendation, low certainty evidence). Conclusions and Relevance It is good practice to consider overall clinical context and alternative therapies to transfusion when making transfusion decisions about an individual patient.
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Affiliation(s)
- Jeffrey L Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Simon J Stanworth
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
- NHSBT, Oxford, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Transfusion Medicine, NHS Blood and Transplant, Oxford, United Kingdom
| | - Gordon Guyatt
- Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stacey Valentine
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester
| | - Jane Dennis
- Cochrane Injuries Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sara Bakhtary
- Department of Laboratory Medicine, University of California, San Francisco
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | | | - Brenda J Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Gaurav K Gupta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison
| | - Jessica L Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York
- NYC Health + Hospitals/Bellevue, New York, New York
| | - Lewis J Kaplan
- Department of Surgery, Division of Trauma, Surgical Critical Care and Surgical Emergencies, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City
| | - Colin H Murphy
- Pathology Associates of Albuquerque, Albuquerque, New Mexico
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto and St Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque
| | - Eric Salazar
- Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas
| | - Nabiha H Saifee
- Department of Laboratory Medicine and Pathology, Seattle Children's Hospital, Seattle, Washington
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia So-Osman
- Department of Unit Transfusion Medicine (UTG), Sanquin Blood Bank, Amsterdam, the Netherlands
- Department Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jonathan Waters
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erica M Wood
- Department of Haematology, Monash Health, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
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5
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Hurley NC, Schroeder KM, Hess AS. Would doctors dream of electric blood bankers? Large language model-based artificial intelligence performs well in many aspects of transfusion medicine. Transfusion 2023; 63:1833-1840. [PMID: 37644845 DOI: 10.1111/trf.17526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Large language models (LLMs) excel at answering knowledge-based questions. Many aspects of blood banking and transfusion medicine involve no direct patient care and require only knowledge and judgment. We hypothesized that public LLMs could perform such tasks with accuracy and precision. STUDY DESIGN AND METHODS We presented three sets of tasks to three publicly-available LLMs (Bard, GPT-3.5, and GPT-4). The first was to review short case presentations and then decide if a red blood cell transfusion was indicated. The second task was to answer a set of consultation questions common in clinical transfusion practice. The third task was to take a multiple-choice test experimentally validated to assess internal medicine postgraduate knowledge of transfusion practice (the BEST-TEST). RESULTS In the first task, the area under the receiver operating characteristic curve for correct transfusion decisions was 0.65, 0.90, and 0.92, respectively for Bard, GPT-3.5 and GPT-4. All three models had a modest rate of acceptable responses to the consultation questions. Average scores on the BEST-TEST were 55%, 40%, and 87%, respectively. CONCLUSION When presented with transfusion medicine tasks in natural language, publicly available LLMs demonstrated a range of ability, but GPT-4 consistently scored very well in all tasks. Research is needed to assess the utility of LLMs in transfusion medicine practice. Transfusion Medicine physicians should consider their role alongside such technologies, and how they might be used for the benefit and safety of patients.
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Affiliation(s)
- Nathan C Hurley
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Aaron S Hess
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Pathology & Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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6
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Hess AS, Long MT. Bicarbonate: From Physiology to Clinical Practice: Comment. Anesthesiology 2023; 139:549. [PMID: 37581529 DOI: 10.1097/aln.0000000000004695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Aaron S Hess
- University of Wisconsin, Madison, Wisconsin (A.S.H.).
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7
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Metcalf RA, Cohn CS, Bakhtary S, Gniadek T, Gupta G, Harm S, Haspel RL, Hess AS, Jacobson J, Lokhandwala PM, Murphy C, Poston JN, Prochaska MT, Raval JS, Saifee NH, Salazar E, Shan H, Zantek ND, Pagano MB. Current advances in 2022: A critical review of selected topics by the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee. Transfusion 2023; 63:1590-1600. [PMID: 37403547 DOI: 10.1111/trf.17475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The Association for the Advancement of Blood and Biotherapies Clinical Transfusion Medicine Committee (CTMC) composes a summary of new and important advances in transfusion medicine (TM) on an annual basis. Since 2018, this has been assembled into a manuscript and published in Transfusion. STUDY DESIGN AND METHODS CTMC members selected original manuscripts relevant to TM that were published electronically and/or in print during calendar year 2022. Papers were selected based on perceived importance and/or originality. References for selected papers were made available to CTMC members to provide feedback. Members were also encouraged to identify papers that may have been omitted initially. They then worked in groups of two to three to write a summary for each new publication within their broader topic. Each topic summary was then reviewed and edited by two separate committee members. The final manuscript was assembled by the first and senior authors. While this review is extensive, it is not a systematic review and some publications considered important by readers may have been excluded. RESULTS For calendar year 2022, summaries of key publications were assembled for the following broader topics within TM: blood component therapy; infectious diseases, blood donor testing, and collections; patient blood management; immunohematology and genomics; hemostasis; hemoglobinopathies; apheresis and cell therapy; pediatrics; and health care disparities, diversity, equity, and inclusion. DISCUSSION This Committee Report reviews and summarizes important publications and advances in TM published during calendar year 2022, and maybe a useful educational tool.
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Affiliation(s)
- Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara Bakhtary
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Gaurav Gupta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sarah Harm
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Richard L Haspel
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Jessica Jacobson
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Parvez M Lokhandwala
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Colin Murphy
- TriCore Reference Laboratories, Albuquerque, New Mexico, USA
| | - Jacqueline N Poston
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Micah T Prochaska
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Eric Salazar
- Department of Pathology, UT Health San Antonio, San Antonio, Texas, USA
| | - Hua Shan
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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8
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Kenfield MR, Tannenbaum AP, Hess AS, Rose WN. Fundamentals of blood banking in anesthesiology: A problem-based learning simulation session as an addition to a novel curriculum of transfusion medicine education for anesthesiology residents. Acad Pathol 2023; 10:100089. [PMID: 37559705 PMCID: PMC10406958 DOI: 10.1016/j.acpath.2023.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/29/2023] [Indexed: 08/11/2023] Open
Abstract
We have previously published a novel transfusion medicine curriculum for first-year anesthesiology residents, making available open access learning materials. We now present a curriculum iteration, by incorporating resident feedback and developing an additional "capstone" session for use at the end of the rotation that integrates several learning points into a practical problem-based simulation. This iteration of the curriculum was piloted with the 2019-2020 PGY-1 anesthesiology residents of the University of Wisconsin Hospitals and Clinics. Pre-course and post-course surveys, which assessed trainee understanding of course topics, were used to subjectively evaluate the usefulness of the curriculum. Results of the surveys demonstrated post-test mean scores were significantly increased when compared with the equivalent pre-course questions. This suggests the piloted curriculum iteration serves as a useful tool for resident learning. As an adjunct to our previous existing materials, in the spirit of open-access education, we share this additional curriculum material, consisting of four patient cases with 16 questions that can be used immediately for teaching purposes.
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Affiliation(s)
- Meaghan R. Kenfield
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alex P. Tannenbaum
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron S. Hess
- Department of Anesthesiology, University of Wisconsin Hospital, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital, Madison, WI, USA
| | - William N. Rose
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital, Madison, WI, USA
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9
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Affiliation(s)
- Aaron S Hess
- From the Departments of Anesthesiology
- Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
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10
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Connor JP, Destrampe E, Robbins D, Hess AS, McCarthy D, Maloney J. Pre-operative anemia and peri-operative transfusion are associated with poor oncologic outcomes in cancers of the esophagus: potential impact of patient blood management on cancer outcomes. BMC Cancer 2023; 23:99. [PMID: 36709278 PMCID: PMC9883921 DOI: 10.1186/s12885-023-10579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Both Red Blood Cell (RBC) transfusion and anemia are thought to negatively impact cancer survival. These effects have been reported with mixed findings in cancer of the esophagus. The potential impact of the application of restrictive transfusion strategies on this patient population has not been defined. MATERIALS AND METHODS We conducted a retrospective study of esophagectomies and studied cases based on whether they were anemic or were transfused peri-operatively. Clinical characteristics and known clinicopathologic prognosticators were compared between these groups. Survival was compared by Cox proportional hazard modeling. Post-operative transfusions were assessed for compliance with restrictive transfusion thresholds. RESULTS Three-hundred ninety-nine esophagectomy cases were reviewed and after exclusions 348 cases were analyzed. The median length of follow-up was 33 months (range 1-152 months). Sixty-four percent of patients were anemic pre-operatively and 22% were transfused. Transfusion and anemia were closely related to each other. Microcytic anemia was uncommon but was evaluated and treated in only 50% of cases. Most anemic patients had normocytic RBC parameters. Transfusion but not anemia was associated with a protracted/prolonged post-operative stay. Transfusion and anemia were both associated with reduced survival however only anemia was associated with decreased survival in multi-variable modeling. Sixty-eight percent of patients were transfused post-operatively and 11% were compliant with the restrictive threshold of 7 g/dL. CONCLUSIONS Pre-operative anemia and transfusion are closely associated, however only anemia was found to compromise survival in our esophageal cancer cohort, supporting the need for more aggressive evaluation and treatment of anemia. Adherence to restrictive transfusion guidelines offers an opportunity to reduce transfusion rates which may also improve short-term outcomes.
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Affiliation(s)
- Joseph P. Connor
- grid.28803.310000 0001 0701 8607Department of Pathology and Laboratory Medicine, Section of Transfusion Medicine, University of Wisconsin, 3147 MFCB 1685 Highland Ave, Madison, WI 53705 USA
| | - Eric Destrampe
- grid.28803.310000 0001 0701 8607Department of Pathology and Laboratory Medicine, Section of Transfusion Medicine, University of Wisconsin, 3147 MFCB 1685 Highland Ave, Madison, WI 53705 USA
| | - Daniel Robbins
- grid.28803.310000 0001 0701 8607Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI USA
| | - Aaron S. Hess
- grid.28803.310000 0001 0701 8607Department of Pathology and Laboratory Medicine, Section of Transfusion Medicine, University of Wisconsin, 3147 MFCB 1685 Highland Ave, Madison, WI 53705 USA ,grid.28803.310000 0001 0701 8607Department of Anesthesiology, University of Wisconsin, Madison, WI USA
| | - Daniel McCarthy
- grid.28803.310000 0001 0701 8607Department of Surgery, Section of Thoracic Surgery, University of Wisconsin, Madison, WI USA
| | - James Maloney
- grid.28803.310000 0001 0701 8607Department of Surgery, Section of Thoracic Surgery, University of Wisconsin, Madison, WI USA
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11
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DeSimone RA, Hess AS, Rajendran P, Tanaka KA, Cushing MM, Eichbaum Q. Blood utilization in liver transplantation (BUILT): A multidisciplinary survey of transfusion practices. Transfusion 2023; 63:83-91. [PMID: 36377099 DOI: 10.1111/trf.17180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to survey liver transplant centers in the United States to assess baseline practices in blood utilization and identify opportunities for standardization to optimize blood use in these complex cases. STUDY DESIGN AND METHODS Two surveys, one for transfusion medicine physicians and the other for anesthesiologists, were distributed to high-volume liver transplant centers. RESULTS The response rate was 52% for both surveys. The majority of respondents (90%) indicated they issue a standardized number of blood products to start surgeries. The most common number of products issued before the start of cases were 10 red blood cells (RBC) and 10 plasma units with no platelets or cryoprecipitate. On average, fewer RBC (7.5) and plasma (7) units were transfused than issued. Decisions to transfuse RhD+ RBCs to RhD- patients and use antigen untested units in alloimmunized patients were mainly handled on a case-by-case basis. Many centers reported utilizing viscoelastic testing (97%) and cell salvage (97%). Most centers reported standardized, laboratory-based intraoperative transfusion goals for RBCs (65%) and fibrinogen replacement (52%) but lacked a standardized approach for plasma (55%) and platelets (58%). DISCUSSION More blood products are issued during surgery than are transfused. Responses from anesthesiology providers suggest a broad consensus on practice. Almost all respondents use viscoelastic testing in the management of intraoperative coagulopathy, either alone or in combination with classical coagulation tests. The majority of programs do not transfuse clotting factor concentrates, including fibrinogen concentrate, prothrombin complex concentrates, and recombinant activated FVII, and do not use antifibrinolytics prophylactically.
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Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Pranesh Rajendran
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Kenichi A Tanaka
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Quentin Eichbaum
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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12
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Kopanczyk R, Lester J, Long MT, Kossbiel BJ, Hess AS, Rozycki A, Nunley DR, Habib A, Taylor A, Awad H, Bhatt AM. The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action. Medicina (Kaunas) 2022; 59:47. [PMID: 36676669 PMCID: PMC9867461 DOI: 10.3390/medicina59010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Cardiothoracic surgical critical care medicine (CT-CCM) is a medical discipline centered on the perioperative care of diverse groups of patients. With an aging demographic and an increase in burden of chronic diseases the utilization of cardiothoracic surgical critical care units is likely to escalate in the coming decades. Given these projections, it is important to assess the state of cardiothoracic surgical intensive care, to develop goals and objectives for the future, and to identify knowledge gaps in need of scientific inquiry. This two-part review concentrates on CT-CCM as its own subspeciality of critical care and cardiothoracic surgery and provides aspirational goals for its practitioners and scientists. In part one, a list of guiding principles and a call-to-action agenda geared towards growth and promotion of CT-CCM are offered. In part two, an evaluation of selected scientific data is performed, identifying gaps in CT-CCM knowledge, and recommending direction to future scientific endeavors.
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Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jesse Lester
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Micah T. Long
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, Madison, WI 53792, USA
| | - Briana J. Kossbiel
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Aaron S. Hess
- Department of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin Hospitals & Clinics, Madison, WI 53792, USA
| | - Alan Rozycki
- Department of Pharmacology, The Ohio State Wexner Medical Center, Columbus, OH 43210, USA
| | - David R. Nunley
- Department of Pulmonary, Critical Care & Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Alim Habib
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Ashley Taylor
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Hamdy Awad
- Department of Anesthesiology, Division of Cardiothoracic and Vascular Anesthesia, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Amar M. Bhatt
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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13
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Hasan RA, Hess AS, Hess JR. Preoperative coagulation testing and patient blood management. Transfusion 2022; 62:2155-2157. [PMID: 36239558 DOI: 10.1111/trf.17149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rida A Hasan
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Aaron S Hess
- Department of Anesthesia, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Pathology & Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
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14
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Pillai AA, Kriss M, Al‐Adra DP, Chadha RM, Cushing MM, Farsad K, Fortune BE, Hess AS, Lewandowski R, Nadim MK, Nydam T, Sharma P, Karvellas CJ, Intagliata N. Coagulopathy and hemostasis management in patients undergoing liver transplantation: Defining a dynamic spectrum across phases of care. Liver Transpl 2022; 28:1651-1663. [PMID: 35253365 PMCID: PMC9790275 DOI: 10.1002/lt.26451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/10/2023]
Abstract
Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies and society guidance address this emerging paradigm and offer recommendations to assist with hemostatic management in patients with liver disease. However, patients undergoing LT are unique and diverse, often with unstable disease that requires specialized approaches. Our aim is to provide a focused review of hemostatic management of the LT patient, distinguish unique aspects of the three main phases of care (before LT, perioperative, and after LT), and identify knowledge gaps and critical areas of future research.
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Affiliation(s)
- Anjana A. Pillai
- Department of MedicineUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Michael Kriss
- Department of Internal MedicineUniversity of ColoradoAuroraColoradoUSA
| | - David P. Al‐Adra
- Department of SurgerySchool of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Ryan M. Chadha
- Department of Anesthesiology and Perioperative MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Melissa M. Cushing
- Department of Pathology and Laboratory MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Khashayar Farsad
- Department of Interventional RadiologyOregon Health & Science UniversityPortlandOregonUSA
| | | | - Aaron S. Hess
- Department of AnesthesiologyUniversity of WisconsinMadisonWisconsinUSA,Department of Pathology & Laboratory MedicineUniversity of WisconsinMadisonWisconsinUSA
| | | | - Mitra K. Nadim
- Department of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Trevor Nydam
- Department of SurgeryUniversity of ColoradoAuroraColoradoUSA
| | - Pratima Sharma
- Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
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15
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Hess AS, Hess JR. A dozen places to lose a liter or two of blood. Transfusion 2022; 62:1908-1911. [PMID: 35815560 DOI: 10.1111/trf.17011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Aaron S Hess
- Departments of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
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16
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Lu W, Yazer M, Li N, Ziman A, Wendel S, Tang H, Tsang H, Titlestad K, Thibodeaux SR, Shih AW, Poisson JL, Pham T, Pandey S, Pagano MB, Shan H, Murphy M, Murphy C, Savioli ML, Kutner JM, Hess AS, Fontaine MJ, Fachini R, Dunbar NM, Kaufman RM. Hospital red blood cell and platelet supply and utilization from March to December of the first year of the COVID-19 pandemic: The BEST Collaborative Study. Transfusion 2022; 62:1559-1570. [PMID: 35808950 PMCID: PMC9349645 DOI: 10.1111/trf.17023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Background At the start of the coronavirus disease 2019 (COVID‐19) pandemic, widespread blood shortages were anticipated. We sought to determine how hospital blood supply and blood utilization were affected by the first wave of COVID‐19. Study Design and Methods Weekly red blood cell (RBC) and platelet (PLT) inventory, transfusion, and outdate data were collected from 13 institutions in the United States, Brazil, Canada, and Denmark from March 1st to December 31st of 2020 and 2019. Data from the sites were aligned based on each site's local first peak of COVID‐19 cases, and data from 2020 (pandemic year) were compared with data from the corresponding period in 2019 (pre‐pandemic baseline). Results RBC inventories were 3% lower in 2020 than in 2019 (680 vs. 704, p < .001) and 5% fewer RBCs were transfused per week compared to 2019 (477 vs. 501, p < .001). However, during the first COVID‐19 peak, RBC and PLT inventories were higher than normal, as reflected by deviation from par, days on hand, and percent outdated. At this time, 16% fewer inpatient beds were occupied, and 43% fewer surgeries were performed compared to 2019 (p < .001). In contrast to 2019 when there was no correlation, there was, in 2020, significant negative correlations between RBC and PLT days on hand and both percentage occupancy of inpatient beds and percentage of surgeries performed. Conclusion During the COVID‐19 pandemic in 2020, RBC and PLT inventories remained adequate. During the first wave of cases, significant decreases in patient care activities were associated with excess RBC and PLT supplies and increased product outdating.
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Affiliation(s)
- Wen Lu
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Na Li
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, California, Los Angeles, USA
| | | | - Hongying Tang
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Hamilton Tsang
- Department of Laboratory Medicine and Pathology, Transfusion Medicine Division, University of Washington, Seattle, WA, USA
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University, South Danish Transfusion Services, Odense, Denmark
| | - Suzanne R Thibodeaux
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tho Pham
- Stanford Blood Center, Palo Alto, CA, USA
| | | | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, Transfusion Medicine Division, University of Washington, Seattle, WA, USA
| | - Hua Shan
- Transfusion Medicine Service, Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mike Murphy
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Colin Murphy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mariana Lorenzi Savioli
- Hemotherapy and Cell therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - José Mauro Kutner
- Hemotherapy and Cell therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Magali J Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine and Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
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17
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Hartman WR, Hess AS, Connor JP. Hospitalized COVID-19 Patients treated with Convalescent Plasma in a Mid-size City in the Midwest. RESEARCH SQUARE 2020:rs.3.rs-54167. [PMID: 36575754 PMCID: PMC9793834 DOI: 10.21203/rs.3.rs-54167/v2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BackgroundSARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge. Methods Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively. Results 31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion. ConclusionOur results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.
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18
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Abstract
Background SARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge. Methods Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively. Results 31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion. Conclusion Our results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.
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19
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Abstract
BACKGROUND Helping patients to understand relative risks is challenging. In discussions with patients, physicians often use numbers to describe hazards, make comparisons, and establish relevance. Patients with a poor understanding of numbers-poor "health numeracy"-also have difficulty making decisions and coping with chronic conditions. Although the importance of "health literacy" in perioperative populations is recognized, health numeracy has not been well studied. Our aim was to compare understanding of numbers, risk, and risk modification between a patient population awaiting surgery under general anesthesia and attending physicians at the same center. METHODS We performed a single-center cross-sectional survey study to compare patients' and physicians' health numeracy. The study instrument was based on the Schwartz-Lipkus survey and included 3 simple health numeracy questions and 2 risk reduction questions in the anesthesiology domain. The survey was mailed to patients over the age of 18 scheduled for elective surgery under general anesthesia between June and September 2019, as well as attending physicians at the study center. RESULTS Two hundred thirteen of 502 (42%) patient surveys sent and 268 of 506 (53%) physician surveys sent were returned. Median patient score was 4 of 5, but 32% had a score of ≤3. Patients significantly overestimated their total scores by an average of 0.5 points (estimated [mean ± standard deviation (SD)] = 4.3 ± 1.2 vs actual 3.8 ± 1.3; P < .001). Health numeracy was significantly associated with higher educational level (gamma = 0.351; P < .001) and higher-income level (gamma = 0.397; P < .001). Physicians' health numeracy was significantly higher than the patients' (median [interquartile range {IQR}] = 5 [4-5] vs 4 [3-5]; P < .001). There was no significant difference between physicians' self-estimated and actual total numeracy score (mean ± SD = 4.8 ± 0.6 vs 4.7 ± 0.6; P = .372). Simple health numeracy (questions 1-3) was predictive of correct risk reduction responses (questions 4, 5) for both patients (gamma = 0.586; P < .001) and physicians (gamma = 0.558; P = .006). CONCLUSIONS Patients had poor health numeracy compared to physicians and tended to overrate their abilities. A small proportion of physicians also had poor numeracy. Poor health numeracy was associated with incomprehension of risk modification, suggesting that some patients may not understand treatment efficacy. These disparities suggest a need for further inquiry into how to improve patient comprehension of risk modification.
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Affiliation(s)
| | - Aaron S Hess
- From the Departments of Anesthesiology.,Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
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20
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Abstract
Background: SARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge. Methods: Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively. Results: 31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion. Conclusion: Our results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.
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Affiliation(s)
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology and Laboratory Medicine
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21
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Hartman WR, Hess AS, Connor JP. Persistent viral RNA shedding after COVID-19 symptom resolution in older convalescent plasma donors. Transfusion 2020; 60:2189-2191. [PMID: 32533556 PMCID: PMC7323103 DOI: 10.1111/trf.15927] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022]
Abstract
Introduction The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is responsible for a worldwide pandemic. While the medical community understands the mode of viral transmission, less is known about how long viral shedding occurs once viral symptoms have resolved. Our objective was to determine how long the SARS‐CoV‐2 remains detectable following self‐reporting of viral symptom resolution. Methods This study was approved by the University of Wisconsin Institutional Review Board. A cohort of patients who were previously SARS‐CoV‐2 positive less than 28 days after self‐reported symptom resolution were retested for proof of viral recovery by nasal swab reverse transcriptase polymerase chain reaction for SARS‐CoV‐2 RNA. Results A total of 152 potential participants were screened, of which 5 declined, 54 were ineligible, and 93 were recruited; 86 of 93 completed testing. Eleven of 86 (13%) were still positive at a median of 19 days (range, 12‐24 days) after symptom resolution. Positive participants were significantly older than negative participants (mean, 54 years; 95% confidence interval [CI], 44‐63 vs 42 years; 95% CI, 38‐46; P = .024). CT values were significantly, inversely associated with age (β = −.04; r2 = 0.389; P = .04). The number of days since symptom recovery was not apparently different between positive and negative participants. Conclusion We found evidence of persistent viral shedding in nasopharyngeal secretions more than 2 weeks after resolution of symptoms from confirmed COVID‐19 infection. Persistent shedding was more common in older participants, and viral load was higher among older positive participants. These results underscore the necessity of testing COVID‐19 convalescent plasma donors less than 28 days after symptom resolution.
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Affiliation(s)
- William R Hartman
- Department of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aaron S Hess
- Department of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.,Department Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joseph P Connor
- Department Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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22
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Hartman W, Hess AS, Connor JP. Hospitalized COVID-19 patients treated with Convalescent Plasma in a mid-size city in the midwest. medRxiv 2020. [PMID: 32607514 DOI: 10.1101/2020.06.19.20135830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background SARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge. Methods Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively. Results 31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion. Conclusion Our results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.
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23
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Affiliation(s)
- Micah T Long
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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24
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Affiliation(s)
- Aaron S Hess
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - John R Hess
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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25
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Robbins DJ, Taylor NE, Narayanan D, Hess AS, Rose WN. Therapeutic plasma exchange for exogenous insulin antibody syndrome in combined variable immunodeficiency: a case report. J Clin Apher 2020; 35:128-130. [PMID: 31981239 DOI: 10.1002/jca.21769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/12/2022]
Abstract
A 32-year-old male with type I diabetes presented with profound hypoglycemia due to exogenous insulin antibody syndrome in the setting of newly-diagnosed common variable immunodeficiency. Immunomodulatory therapy was not initially effective, but after the initiation of plasma exchange hypoglycemia resolved, and glucose lability improved.
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Affiliation(s)
- Daniel J Robbins
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Natalie E Taylor
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Damodaran Narayanan
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Aaron S Hess
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI.,Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - William N Rose
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
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26
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Hartman WR, Hess AS, Connor JP. Hospitalized COVID-19 patients treated with convalescent plasma in a mid-size city in the Midwest. Transl Med Commun 2020; 5:17. [PMID: 33072871 PMCID: PMC7549340 DOI: 10.1186/s41231-020-00068-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/18/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND SARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge. METHODS Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively. RESULTS 31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion. CONCLUSION Our results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.
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Affiliation(s)
- William R. Hartman
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, USA
| | - Aaron S. Hess
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, USA
| | - Joseph P. Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, USA
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27
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Affiliation(s)
- Aaron S Hess
- Department of Anesthesiology, University of Wisconsin-Madison
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison
| | - John R Hess
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Douglas B Coursin
- Department of Anesthesiology, University of Wisconsin-Madison
- Department of Medicine, University of Wisconsin-Madison
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28
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Long MT, Hess AS, McCarthy DP, DeCamp MM. Power for the Sickest: Vitamin C for Vasoplegia after Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 34:1123. [PMID: 31623966 DOI: 10.1053/j.jvca.2019.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/14/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Micah T Long
- Department of Anesthesiology, Division of Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Aaron S Hess
- Department of Anesthesiology, Division of Transplant Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daniel P McCarthy
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Malcolm M DeCamp
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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29
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Hess AS, Ramamoorthy J, Connor J, Raife T, Hess JR. Stored platelet number and viscoelastic maximum amplitude are not altered by warming or rapid infusion. Transfusion 2019; 59:2997-3001. [DOI: 10.1111/trf.15446] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/08/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Aaron S. Hess
- Department of AnesthesiologyUniversity of Wisconsin Hospital and Clinics Madison Wisconsin
- Department of PathologyUniversity of Wisconsin Madison School of Medicine and Public Health Madison Wisconsin
| | - Jagan Ramamoorthy
- Department of AnesthesiologyUniversity of Wisconsin Hospital and Clinics Madison Wisconsin
| | - Joseph Connor
- Department of PathologyUniversity of Wisconsin Madison School of Medicine and Public Health Madison Wisconsin
| | - Thomas Raife
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Madison Wisconsin
| | - John R. Hess
- Department of Laboratory MedicineThe University of Washington Seattle Washington
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Affiliation(s)
- Aaron S Hess
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - John R Hess
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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Stansbury LG, Hess AS. Can we answer transfusion questions with retrospective data? Transfusion 2019; 59:1891-1893. [PMID: 31161671 DOI: 10.1111/trf.15321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Lynn G Stansbury
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Aaron S Hess
- Department of Anesthesiology, University of Wisconsin School of Medicine, Madison, WI
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Hess AS, Abd-Elsayed A. Outcome Measures in Clinical Studies. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hess AS, Abd-Elsayed A. Observational Studies: Uses and Limitations. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hess AS, Abd-Elsayed A. Use of Data from Epidemiologic Studies of Pain. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hess AS, Abd-Elsayed A. Principles of Valid Clinical Research. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Hess AS, Abd-Elsayed A. Case Control Studies. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hess AS, Abd-Elsayed A. Use of Risk Factors to Guide Treatment. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hess AS, Abd-Elsayed A. Components of Clinical Trials. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hess AS, Abd-Elsayed A. Measurement of Burden in a Population, Including Epidemiologic Measures of Occurrence. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Hess AS, Abd-Elsayed A. Effects of Analysis on the Clinical Applicability of Study Results. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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42
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Affiliation(s)
- Aaron S. Hess
- Department of Anesthesiology; University of Wisconsin Hospital and Clinics; Madison Wisconsin
| | - John R. Hess
- Department of Laboratory Medicine; University of Washington; Seattle Washington
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Affiliation(s)
- Aaron S. Hess
- Department of AnesthesiologyUniversity of Wisconsin Hospital and ClinicsMadison Wisconsin
| | - John R. Hess
- Department of Laboratory MedicineUniversity of WashingtonSeattle Washington
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Hess AS, Rice GM, Jochman JD, Muldowney BL. Volatile anesthesia for a pediatric patient with very long-chain acyl-coenzyme A dehydrogenase deficiency: A case report. Paediatr Anaesth 2018; 28:296-297. [PMID: 29316010 DOI: 10.1111/pan.13314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 11/28/2022]
Abstract
We report the case of a 3-year-old boy with very long-chain acyl-coenzyme A dehydrogenase deficiency presenting for adenotonsillectomy who was successfully and safely managed with a balanced anesthetic including sevoflurane. The anesthetic management is described, and the controversy surrounding volatile anesthetics in these patients is discussed.
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Affiliation(s)
- Aaron S Hess
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Gregory M Rice
- Department of Pediatrics, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - John D Jochman
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Bridget L Muldowney
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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Affiliation(s)
- Aaron S Hess
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - John R Hess
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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Hess AS, Hess JR. Understanding tests of the association of categorical variables: the Pearson chi-square test and Fisher's exact test. Transfusion 2017; 57:877-879. [PMID: 28295394 DOI: 10.1111/trf.14057] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron S Hess
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - John R Hess
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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47
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Affiliation(s)
- Aaron S Hess
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, Seattle, Washington
| | - John R Hess
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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Kranner PW, Mussehl DA, Hess AS. Gender Diversity in Anesthesiology Programs: The Role of Current Residents and Department Leadership in the 2014 Match Results. J Educ Perioper Med 2016; 18:E401. [PMID: 27957512 PMCID: PMC5131263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Nearly half of graduates of American medical colleges are women, yet the percentage of women entering accredited anesthesiology programs remains less than 40%. There are obviously many factors that influence the choice of a residency training program, from geography to reputation to the atmosphere, composition and camaraderie of the department. We examined whether a greater number of current female residents, a female Chair, or a female Program Director were associated with a program matching a greater number of female candidates in the 2014 NRMP Match. METHODS An electronic questionnaire was sent to all 132 ACGME-accredited anesthesiology programs immediately following the 2014 Match seeking information on the gender mix of their current residents, the gender of the Chair and Program Director, and the gender composition of their newly-matched candidates. RESULTS The percentage of current female residents was significantly associated with the percentage of incoming female residents (p = 0.013). There was no association between the percentage of new female residents obtained in the Match and the presence of a female Chair or Program Director. CONCLUSIONS The results of the 2013 NRMP anesthesiology match indicate that programs with a higher proportion of female residents were able to sustain that diversity and successfully match a higher percentage of female candidates. No correlation was seen with Chair and Program Director gender, suggesting further work is needed to define the influence of female role models on female applicants' choice of anesthesiology residency programs.
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Affiliation(s)
- Paul W. Kranner
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Denise A. Mussehl
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron S. Hess
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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49
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Affiliation(s)
- Aaron S Hess
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - John R Hess
- Department of Laboratory Medicine, Harborview Medical Center, University of Washington, Seattle, WA
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Hess AS, Kleinberg M, Sorkin JD, Netzer G, Johnson JK, Shardell M, Thom KA, Harris AD, Roghmann MC. Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients. Diagn Microbiol Infect Dis 2014; 79:73-6. [PMID: 24582582 DOI: 10.1016/j.diagmicrobio.2014.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 01/13/2014] [Accepted: 01/21/2014] [Indexed: 11/27/2022]
Abstract
We hypothesized that prior colonization with antibiotic-resistant Gram-negative bacteria is associated with increased risk of subsequent antibiotic-resistant Gram-negative bacteremia among cancer patients. We performed a matched case-control study. Cases were cancer patients with a blood culture positive for antibiotic-resistant Gram-negative bacteria. Controls were cancer patients with a blood culture not positive for antibiotic-resistant Gram-negative bacteria. Prior colonization was defined as any antibiotic-resistant Gram-negative bacteria in surveillance or non-sterile-site cultures obtained 2-365 days before the bacteremia. Thirty-two (37%) of 86 cases and 27 (8%) of 323 matched controls were previously colonized by any antibiotic-resistant Gram-negative bacteria. Prior colonization was strongly associated with antibiotic-resistant Gram-negative bacteremia (odds ratio [OR] 7.2, 95% confidence interval [CI] 3.5-14.7) after controlling for recent treatment with piperacillin-tazobactam (OR 2.5, 95% CI 1.3-4.8). In these patients with suspected bacteremia, prior cultures may predict increased risk of antibiotic-resistant Gram-negative bacteremia.
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Affiliation(s)
- Aaron S Hess
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA.
| | - Michael Kleinberg
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | - John D Sorkin
- Baltimore VA Medical Center Geriatric Research, Education, and Clinical Center, University of Maryland School of Medicine, Baltimore, MD, USA; Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Giora Netzer
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | | | - Michelle Shardell
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Kerri A Thom
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Mary-Claire Roghmann
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA; Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA.
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