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Transfusion emergency preparedness is increasingly being recognized as an important element in the healthcare response to mass casualty events (MCE). Planning should be designed to support an integrated response between the blood services and hospitals. The lessons identified from the Manchester Arena bombing in 2017 and recent incidents in London have led to new guidance. Demand planning has been informed by the global experience of civilian MCEs and the changing trends in trauma care. Past evidence suggests that only a modest number of hospitalized patients following MCEs require transfusion. The mean blood use per patient admitted is consistently calculated at 2–3 red cell units. Most blood is used within the first 6 h. However, a small number of critically injured with multi‐trauma may require massive transfusion and ongoing support. Many blood services have reported meeting the initial overall demand for blood from stock. However, universal components may be in short supply. The demand can be managed by pre‐agreed substitutions. Early transfusion triage enables the best use of hospital laboratory and blood service support. Careful communication with donor communities is essential to manage a controlled replenishment of stocks. Future challenges for the transfusion community include the trend towards lower red cell stock holdings and the changing trends in weapon use and tactics. A standardized approach to transfusion data collection is required to support future planning. The transfusion community is encouraged to plan for MCEs, contribute to ‘after action reviews’ and work together for safe and sustainable transfusion support. 相似文献
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Bernard Natukunda Grace Ndeezi Lay See Er Francis Bajunirwe Gayle Teramura Meghan Delaney 《ISBT科学丛刊》2019,14(4):366-373
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Gerald Chi Adeel Jamil Umer Jamil Muhammad A. Balouch Jolanta Marszalek Farima Kahe 《Clinical and experimental hypertension (New York, N.Y. : 1993)》2019,41(2):160-167
Background: Intensive blood pressure (BP) lowering may offer protective effects against major adverse cardiac event (MACE) but is also associated with a greater risk of a serious adverse event (SAE). The risk-benefit profile of intensive versus standard BP control has not been comprehensively assessed. Methods: Four studies were identified from a systematic literature search for randomized controlled trials comparing intensive versus standard BP lowering that reported both MACE and SAE endpoints. A previously described statistical approach was applied to characterize the efficacy-safety tradeoff of BP control. The bivariate outcome was computed to quantitatively assess the net clinical benefit (NCB) of intensive BP lowering as compared to standard treatment, with positive values indicating increased risks and negative values indicating decreased risks. Results: Data from the SPRINT trial demonstrated that intensive strategy was superior in MACE but inferior in SAE, thereby eroding the NCB (bivariate outcome: 0.33% [?0.50% to 1.21%]). Intensive strategy from the SPS3 trial fulfilled non-inferiority in both MACE and SAE but did not reach a favorable NCB (?1.31% [?2.25% to 0.01%]). The ACCORD trial suggested that intensive strategy was non-inferior in MACE but inferior in SAE (?0.19% [?0.79% to 1.37%]). Results from the VALISH trial were inconclusive for SAE but suggested non-inferiority in MACE (?1.19% [?3.24% to 0.68%]). Conclusions: Compared to the standard blood pressure target, pooled data from randomized controlled trials suggest that intensive strategy did not achieve a net clinical benefit when weighing the benefit of MACE reduction against the risk of SAE under the bivariate framework.Abbreviations: Blood pressure (BP), diastolic blood pressure (DBP), major adverse cardiac event (MACE), net clinical benefit (NCB), serious adverse event (SAE), systolic blood pressure (SBP). 相似文献
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《Clinical neurophysiology》2019,130(5):727-738
ObjectiveFunctional processes in the brain are segregated in both the spatial and spectral domain. Motivated by findings reported at the cortical level in healthy participants we test the hypothesis in the basal ganglia of Parkinson’s disease patients that lower frequency beta band activity relates to motor circuits associated with the upper limb and higher beta frequencies with lower limb movements.MethodsWe recorded local field potentials (LFPs) from the subthalamic nucleus using segmented “directional” DBS leads, during which patients performed repetitive upper and lower limb movements. Movement-related spectral changes in the beta and gamma frequency-ranges and their spatial distributions were compared between limbs.ResultsWe found that the beta desynchronization during leg movements is characterised by a strikingly greater involvement of higher beta frequencies (24–31 Hz), regardless of whether this was contralateral or ipsilateral to the limb moved. The spatial distribution of limb-specific movement-related changes was evident at higher gamma frequencies.ConclusionLimb processing in the basal ganglia is differentially organised in the spectral and spatial domain and can be captured by directional DBS leads.SignificanceThese findings may help to refine the use of the subthalamic LFPs as a control signal for adaptive DBS and neuroprosthetic devices. 相似文献
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