***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Abnormal bleeding after cardiopulmonary bypass ( CPB ) is a common complication of cardiac surgery , with important health and economic consequences . Coagulation test – based algorithms may reduce transfusion of non-erythrocyte allogeneic blood in patients with abnormal bleeding . Methods The authors performed a r and omized prospect i ve trial comparing allogeneic transfusion practice s in 92 adult patients with abnormal bleeding after CPB . Patients with abnormal bleeding  were r and omized to one of two groups : a control group following individual anesthesiologist ’s transfusion practice s and a protocol group using a transfusion algorithm guided by coagulation tests . Results Among 836 eligible patients having all types of elective cardiac surgery requiring CPB , 92 patients developed abnormal bleeding after CPB ( incidence , 11 % ) . The transfusion algorithm group received less allogeneic fresh frozen plasma in the operating room after CPB ( median , 0 units ; range , 0–7 units ) than the control group ( median , 3 units ; range , 0–10 units ) ( P = 0.0002 ) . The median number of platelet units transfused in the operating room after CPB was 4 ( range , 0–12 ) in the algorithm group compared with 6 ( range , 0–18 ) in the control group ( P = 0.0001 ) . Intensive care unit ( ICU ) mediastinal blood loss was significantly less in the algorithm group . Multivariate analysis demonstrated that transfusion algorithm use result ed in reduced ICU blood loss . The control group also had a significantly greater incidence of surgical reoperation of the mediastinum for bleeding ( 11.8%vs . 0%;P = 0.032 ) . Conclusions Use of a coagulation test – based transfusion algorithm in cardiac surgery patients with abnormal bleeding after CPB  reduced non-erythrocyte allogeneic transfusions in the operating room and ICU blood loss Purpose Many areas of medicine have shown bias towards the publication of studies with positive results . To estimate publication bias in the anesthesia literature , we review ed all abstract s presented at the American Society of Anesthesiologists ( ASA ) annual meetings over a four-year period and compared study results ( positive vs negative ) with publication outcomes . Methods This review included all abstract s from the 2001 - 2004 ASA annual meetings performed as r and omized-controlled trials in humans . We scored their outcome results as positive or negative and assessed abstract quality using a 13-point scoring system . We then performed a systematic literature search to identify any subsequent publication of the studies and calculated the relative risk ( RR ) for journal publication by comparing positive vs negative studies . Results Of 5,918 abstract s review ed , 1,052 met inclusion criteria , and 564 ( 53.6 % ) of the abstract s proceeded to publication . The RR for abstract s with positive results proceeding to journal publication was 1.42 ( 95 % confidence interval , 1.22 to 1.66 ; P < 0.001 ) . This result did not change significantly after adjusting for study size and abstract quality score during logistic regression modelling . There was no significant difference in the abstract quality score between positive vs negative studies or between abstract s proceeding vs not proceeding to publication . Conclusions Approximately half of the ASA annual meeting abstract s proceed to publication . After adjustment for study quality and size , abstract s with positive results were more likely to proceed to journal publication than those with negative results , suggesting publication bias in the anesthesia literature .RésuméObjectifDe nombreux domaines de la médecine font preuve d’un biais en faveur de la publication d’études rapportant des résultats positifs . Afin d’estimer le biais de publication dans la littérature anesthésique , nous avons passé en revue tous les résumés présentés lors des congrès annuels de l’American Society of Anesthesiologists ( ASA ) sur une période de quatre ans et comparé les résultats des études ( positifs vs négatifs ) avec la publication . MéthodeCe compte rendu a inclus tous les résumés d’études r and omisées contrôlées chez l’humain présentés lors des congrès annuels de l’ASA de 2001 à 2004 . Nous avons noté les résultats des études en positif ou négatif et évalué la qualité des résumés selon un système de notation à 13 points . Nous avons ensuite effectué une recherche méthodique de la littérature afin d’identifier toute publication subséquente des études et calculé le risque relatif ( RR ) de publication dans une revue en comparant les études positives vs négatives . RésultatsParmi les 5918 résumés passés en revue , 1052 respectaient nos critères d ’ inclusion , et 564 ( 53,6 % ) résumés ont été publiés . Le RR des résumés présentant des résultats positifs d’être publiés dans une revue était de 1,42 ( intervalle de confiance 95 % , 1,22 à 1,66 ; P < 0,001 ) . Ce résultat n’a pas changé de façon significative après ajustement pour tenir compte de la taille de l’étude et de la note de qualité des résumés dans un modèle à régression logistique . Aucune différence significative dans la note de qualité des résumés entre les études positives vs négatives ou entre les résumés étant publiés ou non n’a été observée . Conclusion Environ la moitié des résumés présentés lors des congrès annuels de l’ASA sont publiés . Après ajustements pour tenir compte de la qualité et de la taille des études , il était plus probable que les résumés rapportant des résultats positifs soient publiés dans une revue que les résumés présentant des résultats négatifs , ce qui laisse à penser qu’il existe un biais de publication dans la littérature d’anesthésie Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Using algorithms based on point of care coagulation tests can decrease blood loss and blood component transfusion  after cardiac surgery . We wished to test the hypothesis that a management algorithm based on near-patient tests would reduce blood loss and blood component use after routine coronary artery surgery with cardiopulmonary bypass when compared with an algorithm based on routine laboratory assays or with clinical judgement . METHODS Patients ( n=102 ) undergoing elective coronary artery surgery with cardiac bypass were r and omized into two groups . In the point of care group , the management algorithm was based on information provided by three devices , the Hepcon , thromboelastography and the PFA-100 platelet function analyser . Management in the laboratory test group depended on rapidly available laboratory clotting tests and transfusion of haemostatic blood components only if specific criteria were met . Blood loss and transfusion was compared between these two groups and with a retrospective case-control group ( n=108 ) , in which management of bleeding had been according to the clinician 's discretion . RESULTS All three groups had similar median blood losses . The transfusion of packed red blood cells ( PRBCs ) and blood components was greater in the clinician discretion group ( P<0.05 ) but there was no difference in the transfusion of PRBCs and blood components between the two algorithm-guided groups . CONCLUSION Following algorithms based on point of care tests or on structured clinical practice with st and ard laboratory tests does not decrease blood loss , but reduces the transfusion of PRBCs and blood components after routine cardiac surgery , when compared with clinician discretion . Cardiac surgery services should use transfusion guidelines based on laboratory-guided algorithms , and the possible benefits of point of care testing should be tested against this st and ard We set out to determine if the heparinase-modified thrombelastogram using anticoagulated blood from patients during cardiac surgery could guide treatment with haemostatic components . In 60 patients a simple algorithm predicted a possible 60 - 80 % decrease in the use of  haemostatic components .  In a second series , 30 patients were allocated to receive components using this intra-operative algorithm and 30 using clinical criteria and laboratory-based tests . Ten patients in the clinical group received a total of 16 units of fresh frozen plasma and nine platelet concentrates compared with five patients transfused with five units of fresh frozen plasma and one platelet concentrate in the algorithm group . Twelve-hour chest tube losses [ algorithm group 470 ( 295 - 820 ) ml , clinical ly managed group 390 ( 240 - 820 ) ml ( median , quartile values ) ] were not different between groups despite the threefold reduction in the use of haemostatic products , showing that intra-operative monitoring of coagulation in the anticoagulated patient can be used to guide treatment Background : Cardiac surgery is frequently complicated by coagulopathic bleeding that is difficult to optimally manage using st and ard hemostatic testing . We hypothesized that point-of-care hemostatic testing within the context of an integrated transfusion algorithm would improve the management of coagulopathy in cardiac surgery and thereby reduce blood transfusions . Methods : We conducted a pragmatic multicenter stepped-wedge cluster r and omized controlled trial of a point-of-care – based transfusion algorithm in consecutive patients undergoing cardiac surgery with cardiopulmonary bypass at 12 hospitals from October 6 , 2014 , to May 1 , 2015 . Following a 1-month data collection at all participating hospitals , a transfusion algorithm incorporating point-of-care hemostatic testing was sequentially implemented at 2 hospitals at a time in 1-month intervals , with the implementation order r and omly assigned . No other aspects of care were modified . The primary outcome was red blood cell transfusion from surgery to postoperative day 7 . Other outcomes included transfusion of other blood products , major bleeding , and major complications . The analysis adjusted for secular time trends , within-hospital clustering , and patient-level risk factors . All outcomes and analyses were prespecified before study initiation . Results : Among the 7402 patients studied , 3555 underwent surgery during the control phase and 3847 during the intervention phase . Overall , 3329 ( 45.0 % ) received red blood cells , 1863 ( 25.2 % ) received platelets , 1645 ( 22.2 % ) received plasma , and 394 ( 5.3 % ) received cryoprecipitate . Major bleeding occurred in 1773 ( 24.1 % ) patients , and major complications occurred in 740 ( 10.2 % ) patients . The trial intervention reduced rates of red blood cell transfusion ( adjusted relative risk , 0.91 ; 95 % confidence interval , 0.85–0.98 ; P=0.02 ; number needed to treat , 24.7 ) , platelet transfusion ( relative risk , 0.77 ; 95 % confidence interval , 0.68–0.87 ; P<0.001 ; number needed to treat , 16.7 ) , and major bleeding ( relative risk , 0.83 ; 95 % confidence interval , 0.72–0.94 ; P=0.004 ; number needed to treat , 22.6 ) , but had no effect on other blood product transfusions or major complications . Conclusions : Implementation of point-of-care hemostatic testing within the context of an integrated transfusion algorithm reduces red blood cell transfusions , platelet transfusions , and major bleeding following cardiac surgery . Our findings support the broader adoption of point-of-care hemostatic testing into clinical practice . Clinical Trial Registration : URL : http://www . clinical trials.gov . Unique identifier : NCT02200419 UNLABELLED Transfusion therapy after cardiac surgery is empirically guided , partly due to a lack of specific point-of-care hemostasis monitors . In a r and omized , blinded , prospect i ve trial , we studied cardiac surgical patients at moderate to high risk of transfusion . Patients were r and omly assigned to either a thromboelastography (TEG)-guided transfusion algorithm ( n = 53 ) or routine transfusion therapy  ( n = 52 ) for intervention after cardiopulmonary bypass . Coagulation tests , TEG variables , mediastinal tube drainage , and transfusions were compared at multiple time points . There were no demographic or hemostatic test result differences between groups , and all patients were given prophylactic antifibrinolytic therapy .  Intraoperative transfusion rates did not differ , but there were significantly fewer postoperative and total transfusions in the TEG group . The proportion of patients receiving fresh-frozen plasma ( FFP ) was 4 of 53 in the TEG group compared with 16 of 52 in the control group ( P < 0.002 ) . Patients receiving platelets were 7 of 53 in the TEG group compared with 15 of 52 in the control group ( P < 0.05 ) . Patients in the TEG group also received less volume of FFP ( 36 + /- 142 vs 217 + /- 463 mL ; P < 0.04 ) . Mediastinal tube drainage was not statistically different 6 , 12 , or 24 h postoperatively . Point-of-care coagulation monitoring using TEG result ed in fewer transfusions in the postoperative period . We conclude that the reduction in transfusions may have been due to improved hemostasis in these patients who had earlier and specific identification of the hemostasis abnormality and thus received more appropriate intraoperative transfusion therapy . These data support the use of TEG in an 
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Conclusion Our review indicates that in cardiac surgery patients , POC viscoelastic hemostatic testing is not associated with a reduction in the proportion of patients receiving any blood product or all-cause mortality .
However , viscoelastic testing is weakly associated with a reduction in proportion of patients transfused with specific blood products .
Presently , the benefits associated with viscoelastic testing in cardiac surgery patients are insufficiently robust to recommend routine implementation of this technology .
Conclusion Notre analyse indique que chez les patients subissant une chirurgie cardiaque , les tests de viscosité sanguine au point de service du patient ne sont pas associés à une réduction du pourcentage de patients recevant un produit sanguin ou à une réduction de la mortalité toutes causes confondues .
Cependant , les tests de viscosité sont faiblement associés à une réduction du pourcentage de patients transfusés avec des produits sanguins spécifiques .