Risultati per: Nuovi farmaci per il danno renale acuto (Acute kidney injury – AKI)

Treatment with antibiotics alone was safe and allowed two thirds of patients to avoid appendectomy within 1 year.

Stroke, Ahead of Print. BACKGROUND:Shorter times to initiate antihypertensive and anticoagulation reversal treatments enhance their benefits in acute intracerebral hemorrhage (ICH). Improving workflows to optimize time performance metrics is strongly advocated. We aimed to evaluate the impact of direct transfer to angiography suite (DTAS) on time metrics for antihypertensive and anticoagulation reversal treatments in patients with stroke with suspected large vessel occlusion whose final diagnosis was ICH.METHODS:We conducted a single-center, retrospective, observational cohort study using prospectively collected data from patients with ICH 4 and in-hospital National Institutes of Health Stroke Scale score >10) followed either direct transfer to computed tomography (DTCT) or DTAS protocol based on angiosuite availability. We compared door-to-needle times for initiating antihypertensive (primary outcome) and anticoagulation reversal treatments between both workflows.RESULTS:Among 220 patients with ICH (mean age, 73.0±13.6 years; 131 [59.5%] male), 199 (90.5%) followed the DTCT protocol and 21 (9.5%) followed the DTAS protocol. Door-to-imaging time was shorter in the DTCT group than in the DTAS group (11 [7–17] versus 15 [12–20] minutes;P=0.013). Antihypertensive treatment was initiated in 168 (76.4%) patients, with the DTCT group having shorter door-to-needle times (20 [15–26] versus 30 [18–40] minutes;P=0.002). The anticoagulation reversal was administered to 34 (87.2%) of 39 anticoagulated patients, with the DTCT group achieving shorter door-to-needle times (28 [22–38] versus 58 [39–78] minutes;P=0.047). Time-to-event analysis showed that the DTCT group had a higher probability of initiating antihypertensive (P=0.001) and anticoagulation reversal (P=0.014) treatments sooner compared with the DTSA group.CONCLUSIONS:Patients with ICH following the DTAS workflow, without tailored actions, present longer door-to-needle times to initiate antihypertensive and anticoagulation reversal treatments compared with those following the DTCT workflow protocol.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

To the Editor The KAT-AKI study reported a paradox related to the efficacy of clinical interventions in AKI. The intervention was associated with a 9.5% increase in implementation of recommendations, a secondary outcome, compared with the control (24.3% vs 33.8%) but was not associated with improvement in patient outcomes. The rates of meeting the primary composite outcome were similar in the intervention and control groups (19.8% vs 18.4%). This gap prompts questions about the association between adherence to clinical recommendations and actual patient outcomes.

To the Editor A recent trial reported that personalized diagnostic and therapeutic recommendations from a kidney action team (KAT), through electronic health records (EHRs), did not reduce the composite outcome among patients with acute kidney injury (AKI). We have some concerns about this study.

In Reply We thank Drs Zhang, Zhou, and Yap and their colleagues for their thoughtful Letters to the Editor in response to the KAT-AKI randomized clinical trial.

To the Editor A recent study found that the recommendations of a KAT did not improve the primary clinical outcomes of patients with AKI. However, there are several issues about this study that warrant discussion.