British journal of anaesthesia
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Editorial
The misunderstood P-value: why statistical significance is not enough in clinical practice.
P-values have traditionally guided clinical research, but over-reliance on them can lead to misinterpretation and poor decision-making. This article highlights common misconceptions about P-values and suggests incorporating the minimum clinically important difference (MCID) along with other metrics such as effect sizes and Bayesian methods. Evidence-based practice is essential in anaesthesiology, and research findings should be evaluated in the context of patient outcomes to guide clinical decisions.
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Accurate and timely diagnostic information is a vital adjunct to clinical assessment to inform therapeutic decision-making, including decisions to transfuse, or not transfuse, blood components. A prospective cohort study of diagnostic point-of-care (POC) haemoglobin measurements on arterial or central venous samples from adults undergoing major noncardiac surgery compared three widely used devices, HemoCue®, i-STAT™, and the Rad-67™ pulse CO-Oxymeter® finger sensor device, against standard laboratory haemoglobin measurements, but importantly not against a blood gas analyser. ⋯ However, results from the HemoCue® had the lowest likelihood to lead to inappropriate red cell transfusion. Clinicians should be aware of the patient, sample, and device factors that can influence the accuracy of POC haemoglobin testing results.
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Editorial Review
Nonsteroidal anti-inflammatory drugs in the perioperative period: current controversies and concerns.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2-specific inhibitors provide significant analgesic and opioid-sparing benefits. However, these analgesics are commonly avoided owing to concerns of potential adverse effects. The evidence for NSAID-related adverse effects is conflicting and of poor quality, and these analgesics are safer than what has been implied. Thus, it is imperative that NSAIDs or COX-2-specific inhibitors are administered routinely unless there are well-founded contraindications.
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Editorial Review
New device, old algorithm? Bridging generations in perioperative coagulation management.
Viscoelastic testing permits targeted correction of coagulopathy in bleeding patients. As new generations of viscoelastic testing platforms become available, research exploring similarities and differences with older devices can provide insight for institutions seeking to use the newer technologies. Care must be taken to ensure such studies are designed to produce clinically meaningful guidance for adapting existing treatment algorithms to accommodate the latest viscoelastic testing technology.
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Preoperative estimated glomerular filtration rate is an inexpensive but useful tool in predicting cardiovascular perioperative complications. Estimated glomerular filtration rate, especially considering its interaction with age, might act as a proxy for severity of cardiovascular disease. Further studies regarding the predictive power of estimated glomerular filtration rate to identify patients at risk of perioperative cardiovascular complications are essential.