BACKGROUND: Prophylaxis for gastrointestinal stress ulceration is frequently given to patients in the intensive care unit (ICU), but its risks and benefits are unclear.METHODS: In this European, multicenter, parallel-group, blinded trial, we randomly assigned adults who had been admitted to the ICU for an acute condition (i.e., an unplanned admission) and who were at risk for gastrointestinal bleeding to receive 40 mg of intravenous pantoprazole (a proton-pump inhibitor) or placebo daily during the ICU stay. The primary outcome was death by 90 days after randomization.RESULTS: A total of 3298 patients were enrolled; 1645 were randomly assigned to the pantoprazole group and 1653 to the placebo group. Data on the primary outcome were available for 3282 patients (99.5%). At 90 days, 510 patients (31.1%) in the pantoprazole group and 499 (30.4%) in the placebo group had died (relative risk, 1.02; 95% confidence interval [CI], 0.91 to 1.13; P=0.76). During the ICU stay, at least one clinically important event (a composite of clinically important gastrointestinal bleeding, pneumonia, Clostridium difficile infection, or myocardial ischemia) had occurred in 21.9% of patients assigned to pantoprazole and 22.6% of those assigned to placebo (relative risk, 0.96; 95% CI, 0.83 to 1.11). In the pantoprazole group, 2.5% of patients had clinically important gastrointestinal bleeding, as compared with 4.2% in the placebo group. The number of patients with infections or serious adverse reactions and the percentage of days alive without life support within 90 days were similar in the two groups.CONCLUSIONS: Among adult patients in the ICU who were at risk for gastrointestinal bleeding, mortality at 90 days and the number of clinically important events were similar in those assigned to pantoprazole and those assigned to placebo. (Funded by Innovation Fund Denmark and others; SUP-ICU ClinicalTrials.gov number, NCT02467621 .).
Introduction: Throughout life, a patient with severe haemophilia is confronted with many treatment-related challenges. Insight into self-management and non-adherence could improve the quality of care for these patients. The aim of this study was to provide an overview of the current evidence on self-management and adherence to prophylaxis in haemophilia. Method: Based on series of studies and published literature, aspects of treatment were explored: learning and performing self-infusion, achieving self-management skills in adolescence, adherence issues and coping with haemophilia. Evidence-based and age-group-specific recommendations for haemophilia professionals were formulated. Results: Nearly, all severe haemophilia patients and parents were able to perform self-infusion and the quality level of infusion skills was acceptable. Learning self-infusion was generally initiated before the onset of puberty and full self-management was obtained 10 years later. Adherence was defined using a Delphi consensus procedure and was determined by skipping, dosing and timing of infusions. Adherence levels varied according to age, with highest levels in children (1–12 years) and the lowest among 25–40 years. Adherence to prophylaxis was acceptable (43%), yet 57% of the population struggled with prophylaxis. Qualitative research showed that the position of prophylaxis in life is the main driver of adherence. This position is influenced by acceptance and self-management skills. Regarding coping with haemophilia, the majority of patients used a problem-focused approach. Conclusion: Self-management and adherence to prophylaxis vary during the life span. Acceptance of the disease and self-management skills were important aspects that may require tailored professional support.
In 2007 at Ropecon, a large Finnish roleplaying convention, Emily Care Boss coined the term bleed to refer to emotional transference that sometimes happened to players of roleplaying games. Bleed describes an effect where emotions and attitudes experienced while roleplaying a character continue on after the roleplaying session was over, or the other way around, where a player brings their own feelings into the character they are embodying. For example, a player would roleplay a romance with another player's character, and then develop feelings for said player after the game was over. Bleed can create powerful effects in a roleplaying session, both positive and negative, which has resulted in the development of various best practices and safety tools that analogue game designers can draw upon, and roleplaying games frequently have mechanics designed around inducing and maximizing particular types of bleed in their players. Bleed mechanics lend themselves particularly well to exploring queer and otherwise marginalized identities, generating empathy, and exploring acts of political resistance. They are a powerful tool in the analogue game designers’ toolbox. Digital games make comparatively far less use of bleed in their designs than analogue games—the concept of bleed is not well-known among digital game designers. Consequently, there is little guidance for designing digital bleed mechanics, and insufficient safety tools with which to do so. With how powerful these effects can be, the knowledge and tools gaps for digital games needs addressing. This research project will create primarily digital narrative games that are explicitly designed to invoke bleed, and seeks to provide designers with new frameworks and safety tools to create bleed effects for digital games. Games will be created with varying themes and approaches regarding identity and storytelling to explore how, in particular, narrative design influences bleed in digital games.
This is a doctoral research project on the Professional Doctorate Arts + Creative pilot scheme. The project studies design and safety tools around 'bleed', a term used in roleplaying game spaces to describe emotions from a roleplaying session affecting the player outside of the game (and viceversa). Bleed design will be applied to the production of digital narrative games.
