Among PCI-treated patients receiving high-MD clopidogrel, carriage of CYP2C19 variant relates to increased PR and predicts risk of HPPR. (Adjunctive Cilostazol Versus High Maintenance-dose ClopidogrEL in Acute Myocardial Infarction [AMI] Patients According to CYP2C19 Polymorphism [ACCELAMI2C19]; NCT00915733; and Comparison of Platelet Inhibition With Adjunctive Cilostazol Versus High Maintenance-Dose Clopidogrel According to Hepatic Cytochrome 2C19 Allele (CYP2C19) Polymorphism [ACCEL2C19]; NCT00891670).

This study aimed to assess intensive care unit (ICU) nurses' experiences caring for delirious patients and the empirical evaluation of the clinical feasibility of the confusion assessment method (CAM) for ICU (CAM-ICU). In Korea, neither regular assessment of early-stage delirium nor preventive interventions are carried out properly in the ICU. This study was conducted using a qualitative research design with focus group interviews. Nurses received training about the CAM-ICU, and used it to assess surgical ICU patients for the presence of delirium during a 5-month period. None of the nurses had heard of the CAM-ICU before the study, and many complained that it was very challenging to use. One positive outcome of the CAM-ICU trial was that the clinical interest in delirium increased. The CAM-ICU could be used to facilitate communication once the instrument becomes well-known among health care professionals.

No abstract

In vitro "high post-treatment platelet reactivity" (HPPR) measured with light transmittance aggregometry (LTA) and the VerifyNow P2Y(12) assay has been associated with an increased risk of ischemic events after percutaneous coronary intervention (PCI). However, there are many criteria for HPPR according to the methods used for assessment, and correlations among suggested criteria have not been evaluated. To this end, we enrolled 1,058 unselected patients undergoing PCI in real clinical practice, simultaneously assessed platelet measures with LTA (both 5 and 20 μmol/l ADP-induced) and the VerifyNow P2Y(12) assay, and based on previous studies, evaluated the following criteria for HPPR: 5 or 20 μmol/l ADP-induced maximal platelet reactivity (PR(max)) ≥50%; 5 μmol/l ADP-induced late PR (PR(late)) >14%; 20 μmol/l ADP-induced PR(max) ≥62%; and P2Y(12) reaction unit (PRU) ≥240. Receiver-operating characteristics (ROC) curve analysis demonstrated that PRU (cut-off = 241) distinguished between patients with and without 5 μmol/l ADP-induced PR(max) ≥50% (area under curve [AUC] 0.822, sensitivity 83.0%, specificity 66.0%, P < 0.001), and 20 μmol/l ADP-induced PR(max) ≥62% (AUC 0.840, sensitivity 80.7%, specificity 71.4%, P < 0.001), respectively. PRU ≥240 showed a moderate agreement with 5 μmol/l ADP-induced PR(max) ≥50% (κ = 0.438, concordant rate 71.6%, P < 0.001) and 20 μmol/l ADP-induced PR(max) ≥62% (κ = 0.505, concordant rate 75.1%, P < 0.001). Cut-offs matched for 20 μmol/l ADP-induced PR(max) ≥50% (PRU = 195) and 5 μmol/l ADP-induced PR(late) >14 (PRU = 194) also were similar. The presence of significant correlations between the suggested criteria for HPPR has practical implications on the possible use of the VerifyNow P2Y(12) assay for risk stratification in PCI-treated patients.