European journal of anaesthesiology
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Medical practice guidelines (MPGs) are important in medicine to ensure well tolerated and effective healthcare. They provide evidence-based recommendations for healthcare professionals in daily clinical settings. MPGs help patients and practitioners make informed decisions, ensure quality of care, allocate healthcare resources effectively and reduce legal liability. ⋯ Finally, MPGs are also relevant in medical claims; thus, adherence to MPGs is highly encouraged in order to assure the best medical care. Nonetheless, MPGs have limitations and we advocate for wise usage of MPGs combined with the expertise of trained physicians that allows for individualisation and evidence-based recommendations. In this review, we describe the potential legal implications that MPGs may represent for healthcare providers and the role that MPGs have in daily practice at different stages in the doctor--patient relationship.
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Observational Study
Predicting 30-day mortality in intensive care unit patients with ischaemic stroke or intracerebral haemorrhage.
Stroke patients admitted to an intensive care unit (ICU) follow a particular survival pattern with a high short-term mortality, but if they survive the first 30 days, a relatively favourable subsequent survival is observed. ⋯ We developed and validated two prognostic models for patients with ischaemic stroke and ICH separately with a high discrimination and good calibration to predict 30-day mortality within 24 h after ICU admission.
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The Hypotension Prediction Index (HPI) algorithm is a commercial prediction algorithm developed to predict hypotension, a mean arterial pressure (MAP) below 65 mmHg. Although HPI has been investigated in several studies, recent concerns of have been raised regarding HPI's predictive abilities, which may have been overstated. ⋯ This CON position paper describes the selection bias further and summarises the scientific status of HPI's predictive abilities, including the meaning of a recent erratum retracting the primary conclusion of a published HPI validation study. We argue that the HPI algorithm needs re-validation or complete re-development to achieve a clinically relevant 'added value' in comparison with the predictive performance of a simple and costless MAP alarm threshold in the range of 70 to 75 mmHg.
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It is unclear how different degrees of left-lateral tilt affect the volumes of the abdominal aorta and inferior vena cava (IVC) in pregnancy. ⋯ IVC volume is significantly increased by 30° and 45° left-lateral tilt positions compared with supine in women with singleton and twin pregnancies.