The use of fibrinogen concentrate for the management of trauma-related bleeding. A systematic review and meta-analysis

Haemorrhage following injury is associated with significant morbidity and mortality. The role of fibrinogen concentrate in trauma-induced coagulopathy has been the object of intense research in the last 10 years and has been systematically analysed in this review. A systematic search of the literature identified six retrospective studies and one prospective one, involving 1,650 trauma patients. There were no randomised trials. Meta-analysis showed that fibrinogen concentrate has no effect on overall mortality (risk ratio: 1.07, 95% confidence interval: 0.83-1.38). Although the metaanalytic pooling of the current literature evidence suggests no beneficial effect of fibrinogen concentrate in the setting of severe trauma, the quality of data retrieved was poor and the final results of ongoing randomised trials will help to further elucidate the role of fibrinogen concentrate in traumatic bleeding

Direct oral anticoagulants in atrial fibrillation: can data from randomized clinical trials be safely transferred to the general population? No

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Effectiveness of sepsis bundle application in cirrhotic patients with septic shock: A single-center experience

Purpose: To evaluate the effect of adherence to evidence-based guidelines of the Surviving Sepsis Campaign (SSC) on the outcome of cirrhotic patients with septic shock admitted to the intensive care unit. Methods: This prospective observational cohort study included 38 patients with documented liver cirrhosis and septic shock admitted to a multidisciplinary intensive care unit at a University Hospital from January 2005 to June 2009. In each patient, the compliance to 4 resuscitation (ie, 6-hour bundle) and to 3 management (i.e. 24-hour bundle) interventions recommended by the SSC guidelines and the 30-day mortality were measured. Results: The 6-hour, 24-hour, and all bundles were completed in 50 %, 52%, and 39% of the patients, respectively. The characteristics at admission and the 30-day mortality of patients with all-bundle compliance (n = 15; mortality 86.6%) were similar to those of patients without bundle compliance (n = 23; mortality 78.2%), except for central venous O 2 saturation. Unadjusted and adjusted regression analysis showed that none of the single sepsis interventions and bundles were independently associated with 30-day mortality. Conclusions: In our observational study, the adherence to the interventions recommended by the SSC evidence-based guidelines did not provide an improvement in the survival rate of cirrhotic patients with septic shock. © 2012 Elsevier Inc. All rights reserved.Purpose: To evaluate the effect of adherence to evidence-based guidelines of the Surviving Sepsis Campaign (SSC) on the outcome of cirrhotic patients with septic shock admitted to the intensive care unit. Methods: This prospective observational cohort study included 38 patients with documented liver cirrhosis and septic shock admitted to a multidisciplinary intensive care unit at a University Hospital from January 2005 to June 2009. In each patient, the compliance to 4 resuscitation (ie, 6-hour bundle) and to 3 management (i.e. 24-hour bundle) interventions recommended by the SSC guidelines and the 30-day mortality were measured. Results: The 6-hour, 24-hour, and all bundles were completed in 50 %, 52%, and 39% of the patients, respectively. The characteristics at admission and the 30-day mortality of patients with all-bundle compliance (n = 15; mortality 86.6%) were similar to those of patients without bundle compliance (n = 23; mortality 78.2%), except for central venous O2 saturation. Unadjusted and adjusted regression analysis showed that none of the single sepsis interventions and bundles were independently associated with 30-day mortality. Conclusions: In our observational study, the adherence to the interventions recommended by the SSC evidence-based guidelines did not provide an improvement in the survival rate of cirrhotic patients with septic shock. © 2013 Elsevier Inc

Quantitative process measures in interventions to improve employees’ mental health: A systematic literature review and the IPEF framework

Interventions to improve mental health can target individuals, working groups, their leaders, or organisations, also known as the Individual, Group, Leader, and Organisational (IGLO) levels of intervention. Evaluating such interventions in organisational settings is complex and requires sophisticated evaluation designs taking into account the intervention process. In the present systematic literature review, we present state of the-art of quantitative measures of process evaluation. We identified 39 papers. We found that measures had been developed to explore the organisational context, the intervention design, and the mental models of the intervention and its activities. Quantitative process measures are often poorly validated, and only around half of the studies linked the process to intervention outcomes. Fifteen studies used mixed methods for process evaluation. Most often, a qualitative process evaluation was used to understand unexpected intervention outcomes. Despite the existence of theoretical process evaluation frameworks, these were not often employed, and even when included, frameworks were rarely acknowledged, and only selected elements were included. Based on our synthesis, we propose a new framework for evaluating interventions, the Integrative Process Evaluation Framework (IPEF), together with reflections on how we may optimise the use of quantitative process evaluation in conjunction with a qualitative process evaluation.publishedVersio

When and in which patients can anticoagulation be resumed after intracerebral haemorrhage?

Whether to resume the anticoagulant or the antiaggregant therapy after an episode of major haemorrhage is a difficult dilemma for the physician. The physician has to take into consideration two major questions: whether the benefits of restarting anticoagulation outweigh the risk, and if so, when and how should anticoagulation be restarted. Although some case reports suggest that anticoagulation can be withheld safely for short periods after ICH, even in patients with mechanical heart valves, it is still not clear if long-term anticoagulation can be safely reinstituted after haemorrhage, for example in patients with atrial fibrillation. In fact, no large and well-conducted randomised clinical trials are available, and there is lack of strong evidence on which guidelines recommendations can be based. The article summarise the available literature findings. Finally, a protocol is suggested which may represent a useful tool for assessing treatment options

When and in which patients can anticoagulation be resumed after intracerebral haemorrhage?

Whether to resume the anticoagulant or the antiaggregant therapy after an episode of major haemorrhage is a difficult dilemma for the physician. The physician has to take into consideration two major questions: whether the benefits of restarting anticoagulation outweigh the risk, and if so, when and how should anticoagulation be restarted. Although some case reports suggest that anticoagulation can be withheld safely for short periods after ICH, even in patients with mechanical heart valves, it is still not clear if long-term anticoagulation can be safely reinstituted after haemorrhage, for example in patients with atrial fibrillation. In fact, no large and well-conducted randomised clinical trials are available, and there is lack of strong evidence on which guidelines recommendations can be based. The article summarise the available literature findings. Finally, a protocol is suggested which may represent a useful tool for assessing treatment options

Gynecological Cancer and Venous Thromboembolism: A Narrative Review to Increase Awareness and Improve Risk Assessment and Prevention

The prevention and appropriate management of venous thromboembolism in cancer patients is of paramount importance. However, the literature data report an underestimation of this major problem in patients with gynecological cancers, with an inconsistent venous thromboembolism risk assessment and prophylaxis in this patient setting. This narrative review provides a comprehensive overview of the available evidence regarding the management of venous thromboembolism in cancer patients, focusing on the specific context of gynecological tumors, exploring the literature discussing risk factors, risk assessment, and pharmacological prophylaxis. We found that the current understanding and management of venous thromboembolism in gynecological malignancy is largely based on studies on solid cancers in general. Hence, further, larger, and well-designed research in this area is needed

Early Monitoring Response to Therapy in Patients with Brain Lesions Using the Cumulative SUV Histogram

Featured Application The study proposes a methodology to evaluate the response of patients with brain lesions to Gamma Knife treatments through the use of Positron Emission Tomography imaging. Gamma Knife treatment is an alternative to traditional brain surgery and whole-brain radiation therapy for treating cancers that are inaccessible via conventional treatments. To assess the effectiveness of Gamma Knife treatments, functional imaging can play a crucial role. The aim of this study is to evaluate new prognostic indices to perform an early assessment of treatment response to therapy using positron emission tomography imaging. The parameters currently used in nuclear medicine assessments can be affected by statistical fluctuation errors and/or cannot provide information on tumor extension and heterogeneity. To overcome these limitations, the Cumulative standardized uptake value (SUV) Histogram (CSH) and Area Under the Curve (AUC) indices were evaluated to obtain additional information on treatment response. For this purpose, the absolute level of [11C]-Methionine (MET) uptake was measured and its heterogeneity distribution within lesions was evaluated by calculating the CSH and AUC indices. CSH and AUC parameters show good agreement with patient outcomes after Gamma Knife treatments. Furthermore, no relevant correlations were found between CSH and AUC indices and those usually used in the nuclear medicine environment. CSH and AUC indices could be a useful tool for assessing patient responses to therapy

Dual-use Technology: Cross-sector Cooperation in the Cybersecurity Sector

This document is the third policy brief resulting from the letter of intent signed during CYBERSEC EXPO & FORUM 2024 on June 19th in Kraków, in the presence of Deputy Prime Minister and Minister of Digital Affairs Krzysztof Gawkowski. The agreement was concluded between the Kosciuszko Institute and the European Cyber Security Organisation (ECSO) regarding the organization of a series of events focused on the priorities of digital and technological policy during Poland’s Presidency of the EU Council in 2025. The third meeting in the Road to the Polish Presidency series was dedicated to addressing challenges and overcoming obstacles in dual use technology. In recent years, dual use technologies have become increasingly critical for economic competitiveness, national security, and technological sovereignty. Rapid advancements in areas such as artificial intelligence, quantum computing, and advanced digital systems offer transformative potential. However, they also introduce challenges, including regulatory fragmentation, export control complexities, and the need for effective collaboration across sectors. Furthermore, geopolitical tensions and evolving global security threats have highlighted the importance of fostering a balanced, coordinated, and forward-looking approach to dual use innovation and deployment. Drawing from a meeting held on November 26, 2024, attended by representatives of the Ministry of Digital Affairs of Poland, the European Cyber Security Organisation (ECSO), the private sector, academia, and the Kosciuszko Institute, together we were able to identify key challenges and solutions surrounding regulatory harmonization, export controls, cross-sector collaboration, and innovation support for dual use technologies. The developed recommendations represent a significant step in building a digital and secure society