Global Assessment Tool Research Articles

Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial

IntroductionEuropean Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated...

Swaying sickle cell research forward in support of patient reported outcomes.

Swaying sickle cell research forward in support of patient reported outcomes.

Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study

Malnutrition is prevalent in upper gastrointestinal cancer patients. The purpose of this study was a comprehensive assessment of nutritional status in newly diagnosed patients with esophageal cancer. Newly diagnosed esophageal cancer patients were referred to a chemo-radiation referral center in Mashhad, Iran, between February 2017 to February 2019. Anthropometric indices, a Patient-Generated Subjective Global Assessment (PG-SGA) tool, body composition, dietary intake, nutritional-related complications, and laboratory tests were assessed. One hundred and eighty-nine patients with a mean age of 67.1±12 and a male to female ratio of 98 to 91 were included. Ninety-seven (51.3%) of patients had experienced significant weight loss and 56 (29.6%) were underweight at diagnosis. According to PG-SGA, 179 (94.7%) needed nutritional interventions. Reduced muscle mass and low handgrip strength were observed in 70 (39.4%) and 26 (14.4%) of patients, respectively. Inadequate intakes of energy (less than 24kcal/kg/day) and protein (less than 1.2g/kg/day) were found in 146 (77.8%) and 171 (91%) patients, respectively. The mean total daily energy and protein intakes of subjects were 943.8±540kcal/day, and 30.6±21g/day, respectively. The most common nutritional-related complications were as follows: dysphagia (84.8%), anorexia (31.6%), constipation (62.1%), esophageal pain (48.4%), and dyspepsia (41.1%). Our study demonstrated a high prevalence of malnutrition in newly diagnosed esophageal cancer patients. This fact demonstrates the importance of early screening of nutritional status via PG-SGA tool, clinical evaluation, dietary intake evaluations, and laboratory tests, based on which effective nutritional interventions and Symptoms management may be introduced in these patients.

Prevalence of Psychiatric Morbidity in Undergraduate Medical Students in a Rural Medical College of Central India using Global Mental Health Assessment Tool - Primary Care (GMHAT-PC)

Prevalence of Psychiatric Morbidity in Undergraduate Medical Students in a Rural Medical College of Central India using Global Mental Health Assessment Tool - Primary Care (GMHAT-PC)

Time-Varying Insomnia Symptoms and Incidence of Cognitive Impairment and Dementia among Older US Adults.

There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms which were compiled in an insomnia severity index, ranging from 0 to 4. In analysis, participants’ symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive assessment tool. Respondents were classified as either having dementia, MCI, or being cognitively healthy. Cox proportional hazards models with time-dependent exposure using the counting process (start-stop time) were used for analysis. For each one-unit increase in the insomnia symptom index, there was a 5-percent greater hazard of MCI (HR = 1.05; 95% CI: 1.04–1.06) and dementia (HR = 1.05; 95% CI: 1.03–1.05), after fully adjusting. Using a nationally representative sample of adults age 51 and older, this study found that time-varying insomnia symptoms are associated with risk of MCI and dementia. This highlights the importance of identifying sleep disturbances and their change over time as potentially important risk factors for MCI and dementia.

Knowledge, attitude and practice of family physician regarding global cardiovascular risk assessment in PSMMC primary health care centers in Riyadh, Saudi Arabia

Background: Most cardiovascular diseases (CVD) can be prevented by addressing their risk factors. The conventional clinical approach to primary prevention of cardiovascular disease relies on identification and treatment of individual risk factors. There are several guidelines that recommend CV risk assessment tools to support CV prevention strategies (ATP III, European guidelines that include Systematic Coronary Risk Evaluation SCORE 2003, ACC/AHA cardiovascular disease risk 2013 based on Framingham risk score. This study aimed to assess knowledge, attitude and practice of family physician regarding global cardiovascular risk assessment, aiming to improve cardiovascular prevention services.Method: A cross-sectional study conducted among family physicians working in family medicine clinics of Prince Sultan Military Medical City (Riyadh, Saudi Arabia) between November 2019 and June 2020. 188 physicians asked to fill a questionnaire that based on knowledge, attitude and practice questions regarding global CV risk assessment. Results: A total 188 physicians were included in this study. The majority (61.2%) of the physicians were between 25 and 30 years. ASCVD of AHA was the most frequent (75.5%) cardiovascular risk assessment tool used in practice. The majority of physicians often used the cardiovascular risk assessment tools regularly (62.8%). Less than half of physicians believed that assessment tools depend on investigations that patients can afford (46.8%). The majority (58.5%) of the physician had unsatisfactory self-assessment of own knowledge and skills. Unsatisfactory self-assessment of own knowledge and skills was significantly associated with lower knowledge and attitude (49.5% versus 68.1%, p=0.004). Satisfactory self-assessment of own knowledge and skills was significantly associated with higher knowledge and attitude (50.5% versus 29.7%, p=0.004). Conclusion: A high proportion of physicians reported using clinical guidelines for primary CVD prevention. However, laboratory investigations and time constrain were common reasons for not using global CV risk assessment tools. Unsatisfactory self-assessment of own knowledge and skills was significantly associated with lower knowledge and attitude of physicians.

Patient-Reported Outcomes Measurement Information System Correlates With Modified Harris Hip Score in Total Hip Arthroplasty.

The modified Harris Hip Score (mHHS) is a validated and disease-specific instrument commonly used to assess outcomes in total hip arthroplasty (THA). The Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated, computer adaptive testing (CAT)-based global health assessment tool. The authors' goal was to examine the correlation between PROMIS Pain Interference and Physical Function CATs and the mHHS in patients undergoing primary THA. All THAs were performed by 1 of 2 fellowship-trained dedicated total joint surgeons at 1 academic institution. Patients completed PROMIS and mHHS assessments preoperatively and at 3, 6, 12, and 52 weeks postoperatively. Descriptive statistics and Pearson correlation values were determined. A total of 48 patients were prospectively enrolled in the study. Preoperatively, mean total PROMIS score (Pain Interference and Physical Function) was 74.2 and mHHS was 50.8. Preoperatively, mean total PROMIS score showed a moderate correlation (r=0.56; P<.0001) with total mHHS. Postoperatively, mean total PROMIS score at 3, 6, 12, and 52 weeks was 82.4, 93.4, 100, and 100, respectively (all P<.01 vs baseline), and mHHS was 68.2, 81.1, 85.9, and 88.6, respectively (all P<.01). At 3, 6, 12, and 52 weeks postoperatively, a strong and consistent correlation was observed between the total PROMIS score and mHHS (r=0.74, 0.74, 0.73, and 0.80, respectively; all P<.0001). The PROMIS Pain Interference and Physical Function CATs accurately assessed preoperative pain and dysfunction, as well as clinical improvement following THA. Combined PROMIS Pain Interference and Physical Function is comparable to the mHHS when assessing outcome following THA for osteoarthritis. [Orthopedics. 2021;44(1):e19-e25.].

Malnutrition after pancreatic enzyme replacement therapy in chronic pancreatitis: Risk factors in real world practice

BackgroundRCTs that have shown improvement in coefficient of fat absorption with pancreatic enzyme replacement therapy (PERT) have seldom evaluated the impact on overall nutritional status. ObjectiveIn this study we evaluated factors responsible for persistence of malnutrition after PERT. MethodsIn this cross-sectional observational study, patients were enrolled based on predefined enrolment criteria. Patients were divided into those taking PERT regularly (Group A), irregularly (Group B) and not taking (Group C) for at least 3 months. Comprehensive evaluation of anthropometric measurements, nutritional assessment and dietary intake was performed. Malnutrition was measured using the Subjective Global Assessment (SGA) tool. Relationship between PERT status, dietary intake and nutritional status were evaluated using standard statistical methods. Logistic regression was performed to identify factors associated with persistence of malnutrition after PERT. Results377 patients with CP and 50 controls were included. 95 (25.2%) patients with CP were in Group A, 106 (28.1%) in Group B and 176 (46.7%) in Group C. 130 (34.5%) patients were malnourished, of which 76 (58.5%) were continuing PERT. There were no differences in clinical and biochemical nutritional markers between Groups A, B, and C. Calorie deficit and daily intake of calorie, protein, carbohydrates and fats were not different between those with and without PERT, but was significantly less in those with malnutrition. Logistic regression demonstrated inadequate dietary intake as independent risk factor for persistence of malnutrition. ConclusionEven though PERT is effective in PEI, comprehensive nutritional assessment, personalized nutritional counselling and therapy along with PERT is mandatory.

The analysis of hand maximum voluntary contraction and its associated factors among hemodialysis-dependent chronic kidney disease patient in Jordan

Introduction: Maximum voluntary contraction (MVC) of handgrip strength is considered a reliable subjective global assessment tool and has been used as predictive tools for human body performance. The usefulness MVC for continuous assessment of muscle strength in chronic kidney disease (CKD) patient's hemodialysis patients need to be investigated.Methods: The research involved 100 CKD patients that underwent routine hemodialysis in Jordan. The subject's demographic and anthropometric data were collected. Subjects also tested for MVC using a dynamometer. The data was analyzed to find the relationship between each of the independent factors, including age, body mass index (BMI), handgrip circumference (HGC), forearm circumference (FAC), to the maximum voluntary contraction (MVC). Linear and nonlinear modeling were generated to estimate the effect of each independent variable.Results: Subjects ages varied from 20-70 years old, for males mean age was 46.48 years old, mean weight 83.74 kg, mean height 167.24 cm, mean BMI 30.28 kg/m2, mean handgrip circumference 21.34 cm, and mean forearm circumference 26.13 cm. For females, the mean age was 47.62 years old, weight 77.28 kg, mean height 162.96 cm, mean BMI 29.24 kg/m2, mean handgrip circumference 20.09 cm, and mean forearm circumference 24.83 cm. For males, the highest MVC Value was 49.3 lbf, while for females, the highest MVC Value was 38.6 lbf, and both from the group aged &lt;30 years old. ANOVA revealed that age was the primary factor that was significantly associated with MVC.Conclusion: The age has major and significant effects on maximum voluntary contraction in CKD patients.

Universal upper estimate for prediction errors under moderate model uncertainty.

We derive universal upper estimates for model prediction error under moderate but otherwise unknown model uncertainty. Our estimates give upper bounds on the leading-order trajectory uncertainty arising along model trajectories, solely as functions of the invariants of the known Cauchy-Green strain tensor of the model. Our bounds turn out to be optimal, which means that they cannot be improved for general systems. The quantity relating the leading-order trajectory-uncertainty to the model uncertainty is the model sensitivity (MS), which we find to be a useful tool for a quick global assessment of the impact of modeling uncertainties in various domains of the phase space. By examining the expectation that finite-time Lyapunov exponents capture sensitivity to modeling errors, we show that this does not generally follow. However, we find that certain important features of the finite-time Lyapunov exponent persist in the MS field.

How to enhance and assess reflection in specialist training: a mixed method validation study of a new tool for global assessment of reflection ability

BackgroundIn Danish GP training we had the ambition to enhance and assess global reflection ability, but since we found no appropriate validated method in the literature, we decided to develop a new assessment tool. This tool is based on individual trainee developed mind maps and structured trainer-trainee discussions related to specific complex competencies. We named the tool Global Assessment of Reflection ability (GAR) and conducted a mixed method validation study. Our goal was to investigate whether it is possible to enhance and assess reflection ability using the tool.MethodsIn order to investigate acceptability, feasibility, face validity, and construct validity of the tool we conducted a mixed method validation study that combined 1) qualitative data obtained from 750 GP trainers participating in train-the-trainer courses, 2) a questionnaire survey sent to 349 GP trainers and 214 GP trainees and 3) a thorough analysis of eight trainer-trainee discussions.ResultsOur study showed an immediate high acceptance of the GAR tool. Both trainers and trainees found the tool feasible, useful, and relevant with acceptable face validity. Rating of eight audio recordings showed that the tool can demonstrate reflection during assessment of complex competencies.ConclusionsWe have developed an assessment tool (GAR) to enhance and assess reflection. GAR was found to be acceptable, feasible, relevant and with good face- and construct validity. GAR seems to be able to enhance the trainees’ ability to reflect and provide a good basis for assessment in relation to complex competencies.

Value of l-alanyl-l-glutamine parenteral formula in patients with head and neck cancer receiving radiotherapy

Objective The aim was to determine the effect of administration of parenteral l-alanyl-l-glutamine-containing formula on occurrence of treatment-related malnutrition and acute radiotherapy (RT)-related toxicities in patients with head and neck cancer. Background Studies have shown that glutamine-containing nutritional therapy can improve the nutritional status of adult patients with cancer. Patients and methods A total of 40 patients with head and neck carcinoma were randomized to receive either parenteral l-alanyl-l-glutamine-containing formula (0.4 mg/kg) during the first 2 weeks of RT (with or without chemotherapy) or placebo. Nutritional assessment was done for all patients at diagnosis and on weekly basis till end of treatment using subjective global assessment tool and anthropometric measures. Treatment-related toxicity was reported and graded. Quality of life (QoL) was assessed using Functional Assessment of Cancer Therapy for patients with head and neck cancer. Results There was a significant difference between the studied groups regarding subjective global assessment tool score from third week till 7th week (P = 0.019, 0.005, <0.001, <0.001, and 0.021, respectively). Low BMI was more frequent in group 2 patients. Conversely, severe weight loss was significantly different between both groups starting from third week (P = 0.020, 0.010, 0.004, 0.031, and 0.044). There was higher frequency and severity of acute RT toxicities in group 2 patients. There was a significant difference between the two groups regarding QoL as well (P = 0.005). Conclusion l-alanyl-l-glutamine nutritional supplement resulted not only in better nutritional status but also in improved treatment tolerance and QoL.

Bladder pain syndrome/interstitial cystitis in contemporary UK practice: Outcomes of phenotype-directed management.

Problem bladder pain syndrome/interstitial cystitis (BPS/IC) is a heterogeneous disorder with variation in management worldwide. Phenotyping aims to personalize therapy and optimize outcomes. The most well-described phenotype is Hunner lesion disease (HLD). The prevalence of HLD and outcome of phenotype-directed management in the UK is not well-studied. We describe the management of a contemporary cohort of patients with BPS/IC in the UK. Retrospective analysis of all patients with BPS/IC from January 2015-November 2018. Outcomes of patients who underwent laser ablation to Hunner lesions were collected using the Global Response Assessment tool. One hundred and sixty-three patients (mean age of 43 years [20-85]) were included. 78% were female and patients had experienced symptoms for an average 6 years (1-30) prior to specialist assessment. Eighty-three percent of patients had pelvic imaging (44% ultrasound, 42% magnetic resonance imaging and 14% computed tomography), and a relevant abnormality was found in five (4%). Twenty-two patients (14%) had HLD (International Society for the Study of BPS [ESSIC] 3), with a mean bladder capacity of 373 mL (175-650 mL); 77% were ESSIC C on histopathology. All patients with HLD underwent laser ablation, with 55% experiencing a moderate/marked improvement in symptoms, with a mean duration of effect of 10 months (3-36); 27% of patients had a repeat treatment. The presence of HLD in patients with BPS/IC is not uncommon. Pelvic imaging rarely identifies any cause for pain and so cystoscopy under anesthesia is essential for accurate phenotyping. Phenotype-directed management with holmium laser ablation to Hunner lesions has good short-term efficacy in improving pain, but re-intervention is often required.

The Assessment of Impacts and Risks of Climate Change on Agriculture (AIRCCA) model: a tool for the rapid global risk assessment for crop yields at a spatially explicit scale

ABSTRACT A main channel through which climate change is expected to affect the economy is the agricultural sector. Large spatial variability in these impacts and high levels of uncertainty in climate change projections create methodological challenges for assessing the consequences this sector could face. Crop emulators based on econometric fixed-effects models that can closely reproduce biophysical models are estimated. With these reduced form crop emulators, we develop AIRCCA, a user-friendly software for the assessment of impacts and risks of climate change on agriculture, that allows stakeholders to make a rapid global assessment of the effects of climate change on maize, wheat and rice yields. AIRCCA produces spatially explicit probabilistic impact scenarios and user-defined risk metrics for the main four Intergovernmental Panel on Climate Change’s (IPCC) emissions scenarios.

The prevalence of malnutrition in hemodialysis patients

Introduction: Malnutrition is a complex, multi-factorial and common problem in patients with end-stage renal disease (ESRD) undergoing hemodialysis that increases morbidity and mortality rate in them. Objectives: To assess the prevalence of malnutrition and associated factors in hemodialysis patients. Patients and Methods: This cross-sectional study was conducted on 239 hemodialysis patients (162 males and 77 females) referred to three dialysis centers in Ahvaz, Iran in 2018. The nutritional statuswas measured using subjective global assessment (SGA)tool. The anthropometric indices, body mass index (BMI) and biochemical parameters including albumin, triglyceride, C-reactive protein (CRP), and adequacy of dialysis (Kt/V) were also measured in all patients. Results: Based on SGA, 45 (18.8%) patients including 32 males and 13 females had mild to moderate malnutrition while 26 (10.9%) patients consisting of 11 men and 15 women had severe malnutrition. We found a significant association between patients’ gender and malnutrition status (P=0.013). In addition, a significant association was seen between age (P=0.024), BMI (P=0.0001), CRP (P=0.047) and serum albumin concentration (P=0.007) with nutritional status. However, we did not find any significant association between triglyceride, Kt/V and duration of hemodialysis per week with malnutrition (P&gt;0.05). Moreover, BMI, patient’s gender and serum albumin were the significant predictors of severe malnutrition in hemodialysis patients (P&lt;0.05). Conclusion: According to high prevalence of malnutrition in ESRD patients undergoing hemodialysis, periodic assessment of nutritional status is necessary for them. Moreover, female patients, CRP, serum albumin and BMI showed a significant correlation with SGA score, which are important to determine the nutritional status of hemodialysis patients (HD) patients.

Speciális Olimpia mozgalom Kölyök Sportoló programjának állapotfelmérő-eszköze a gyakorlatban

A tanulmány a Speciális Olimpia mozgalom Kölyöksportoló Programjának nemzetközi felmérő eszközének magyarországi adaptációs folyamatáról ad pillanatképet. A vizsgálat a Magyarországon működő Kölyök Sportoló csoportokat vezető szakemberek bevonásával jött létre abból a célból, hogy az angol nyelvű Young Athletes Motor Skills Assessment Check List magyarra fordítását követően azt kipróbálva a gyógypedagógusok véleményezzék a felmérőlapot és ezzel segítsék annak a magyar gyakorlatban való meghonosítását.

Challenges in the Recognition and Management of Acute Kidney Injury by Hospitals in Resource-Limited Settings

IntroductionAcute kidney injury (AKI) is prevalent in low- and middle-income countries (LMIC) and is associated with significant morbidity and mortality, particularly among hospitalized patients. Successful strategies for the prevention and management of AKI in these countries are dependent on the capacity of primary care centers to provide optimal initial management of patients at risk for this disorder.MethodsFrom December 2018 to February 2019, using mixed methods, we assessed hospital capacity and the knowledge of clinicians relevant to the prevention, diagnosis, and management of AKI in Rwanda. A checklist based on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and clinical vignette-based assessment tool were used to assess hospital capacity and provider knowledge base, respectively. Data were analyzed using stata 13 with findings reported as simple frequencies or means with standard deviation. Multivariate analysis was used to assess factors associated with a higher knowledge score among clinicians.ResultsTen hospitals and 193 health care providers from sites throughout Rwanda participated in the survey. Surveyed hospitals were equipped with basic general medical equipment but were deficient in diagnostic tools and medical supplies that would allow the diagnosis and nondialytic management of AKI. Although 20% of the hospitals could offer hemodialysis services, peritoneal dialysis services were nonexistent. With regard to knowledge base, the health care providers demonstrated significant deficiencies in the diagnosis and management of AKI. The mean knowledge score for all health providers was 6.3 (±1.5) of a maximum of 11, with a mean (±SD) score for doctors, nurses, and midwives of 6.3 ± 2.05, 6.4 ± 1.3, and 6.08 ± 1.2, respectively. On multivariate analysis, the length of clinical experience and age of the respondents were significantly associated with participants’ knowledge score.ConclusionThis study documents significant barriers to providing optimal management of AKI in primary health care settings in Rwanda, a resource-limited setting. These include lack of specialized medical personnel, significant knowledge gaps among primary health care providers, suboptimal diagnostic capacity, and limited treatment options for detection and management of AKI.

Health Behaviors and Psychosocial Attributes of US Soldiers

BackgroundHealth trends, which promote performance enhancement and maintaining or increasing muscle strength, may appeal to soldiers looking to maintain health standards set by the US Army, but often these trends require further investigation to assess safety and efficacy. High-intensity interval training (HIIT) and use of weight loss and/or performance-enhancing/body-building dietary supplements (WL/PES DS) are two such trends that, if implemented inappropriately, can negatively impact soldier health and readiness. ObjectiveOur aim was to establish health/psychosocial profiles of US Army soldiers who participate in HIIT and/or use WL/PES DS. DesignThis cross-sectional observational study used data from the 2016 US Army Global Assessment Tool. ParticipantsData were analyzed from respondents to the 2016 US Army Global Assessment Tool (n=299,996) who consented to have their data used for research purposes. ResultsSoldiers were classified into four groups based on HIIT and/or WL/PES DS use. Thirty-five percent of soldiers participated in HIIT and 10% took WL/PES DS at least once per month in the last year. HIIT participation was associated with higher reported odds of healthy behaviors and higher emotional and social fitness. In contrast to HIIT, WL/PES DS use was associated with higher reported odds of risky behaviors (hazardous drinking and tobacco use) and lower psychosocial fitness. The group participating in HIIT but not using WL/PES DS reported fewer unhealthy behaviors compared to the HIIT+WL/PES DS and WL/PES DS-only groups. ConclusionsEngaging in HIIT is associated with higher reported odds of healthy behaviors and increased psychosocial fitness. However, soldiers who engaged in HIIT also have increased odds of WL/PES DS use, which is associated with greater reported risky behaviors and reduced fitness. Although HIIT and WL/PES DS use are related, they are associated with different reported health/risky behaviors and different psychosocial attributes.

The global risk continuum (GRC)

Space-related hazards come from both natural and man-made sources; these hazards pose risks based on the likelihood of exposure and consequence of that exposure. The use of satellites in Earth orbit is now essential to the functioning of nation-states and commerce. The loss of these resources increases global risk as both the world population and global reliance on technology increase. Risks from natural cosmic threats from outside the confines of Earth include asteroids (i.e., Near Earth Objects, NEOs), solar flares, and coronal mass ejections (CMEs). Threats from Near-Earth Objects (NEOS) are becoming clearer as our ability to detect and characterize them improves. Space weather, driven largely by solar dynamics, and changes to the Earth's magnetic field that could decrease the natural protective shielding of Earth against solar storms, likewise threaten our planet.At the same time, the risk to the world's population from catastrophes originating from human activity, war, pandemics, geophysical phenomena, weather, and other Earth-based risks appear to be increasing. As the global population has increased from 800 million in 1800 to nearly eight billion in 2019, the number of people whose lives might be affected by these low probability and high consequence events has risen significantly.While it is difficult to precisely determine the effect of any of these risks individually, it can be instructive to create a common framework that allows comparison of a diverse set of hazards to evaluate risk awareness, mitigation, and remediation. These hazards span from high probability, moderate consequence events to low probability high consequence scenarios.The Global Risk Continuum (GRC) presents individual scenarios within these threat classes along a single risk scale. As a first step in this analysis, a GRC is created by independently determining the probability for each type of event, and the consequence of each as represented in an estimated economic impact. The risk is then determined by taking the product of these two terms. Assumptions and conversion factors needed to enable this common baseline and preliminary observations of the results are provided.This is a "work in progress" that will require significant cooperation and collaboration to refine over time into a useful tool for policymakers, scientists, and others. The process of establishing 'estimates' of risk is an iterative process that will evolve and improve over time. This paper describes a thought process and the beginnings of a methodology rather than a complete tool for global risk assessment.

What haematologists need to know about viscoelastic devices in bleeding patients

The rationale for coagulation management in acute bleeding must be based on an understanding of the pathophysiological processes and functional assessment of the entire coagulation system leading to targeted replacement of platelets, fibrinogen and clotting factors or the use of anti-fibrinolytic agents. Standard coagulation assays such as prothrombin time and activated partial thromboplastin time are measures of clot initiation and do not test the entire cell based coagulation system only providing indirect correlation with the clinical picture in critical bleeding. Evidence is growing that viscoelastic assays, such as ROTEM or TEG are superior to standard coagulation tests in guiding critical bleeding coagulation management. ROTEM/TEG provides a quantitative global in vitro assessment of haemostasis with multiple end points reflecting the interaction between platelets, fibrinogen and clotting factors and fibrinolysis. The tests are sensitive to qualitative and quantitative differences in the factors which influences clot generation and stability. Normal results in the presence of ongoing bleeding have a high negative predictive value of surgical bleeding rather than that associated with coagulopathy. ROTEM/TEG provides useful tools for global assessment of haemostasis and hyperfibrinolysis and may be used to facilitate targeted, timely and appropriate use of blood components in trauma, surgical and obstetric patients.