Nationwide survey of home transfusion practices

BACKGROUND: Limited information exists on home transfusion practices. STUDY DESIGN AND METHODS: In 1995, a survey requesting data for 1994 was sent to 1273 American Association of Blood Banks (AABB) institutional members and 113 non-AABB home health care agencies that provide out-of-hospital transfusions. RESULTS: Of 943 respondents, 102 provide blood to a home transfusion program, 37 provide blood and run a home transfusion program, and 13 run a home transfusion program only, for a total of 152 (16%) with some involvement in home blood transfusions. Most of the 50 respondents with a home transfusion program are licensed by their state and accredited by the Joint Commission on Accreditation of Healthcare Organizations. All respondents have written policies for home transfusion, and 90 percent require a signed informed-consent document before initiating transfusions in the home. Most have policies requiring that there be a second adult and a telephone in the home, that the home be deemed safe for transfusion, that the patient's physician be readily available, and that the patient have had prior transfusions. The most common component issued by the blood providers was red cells, followed by platelets. White cell-reduced components were always provided by 36 percent of respondents. The most common patient diagnosis was cancer. Home transfusions were provided primarily by registered nurses. Only 14 percent of respondents indicated that the medical director of the blood bank is responsible for approving a patient for home transfusion. A posttransfusion visit is performed by 46 percent of respondents. CONCLUSION: Although most facilities have policies for the administration of home transfusions, there remains marked heterogeneity among blood providers and transfusionists regarding home transfusion practices.     

Haemodynamic Studies During the Management of Severe Tetanus

Detailed invasive haemodynamic studies were performed in 27of 32 patients with severe tetanus. Nineteen had severe uncomplicatedtetanus and eight had associated major complications, chieflyinfection and pulmonary complications. The results were comparedwith those obtained from 15 healthy male volunteers who servedas controls. There were two deaths in 32 patients (mortality6.25 per cent). Severe tetanus without major complications wascharacterized by a high output hyperkinetic circulatory statewith tachycardia (heart rate 131 (19.2) beats/minute), increasedstroke volume index (43.1 (10.7) ml/m²), increased cardiac index(5.48 (0.94)1/min/m²) and a normal left ventricular stroke workindex (60.5 (15.9) g/m/m²). Volume loading demonstrated a significanthaemodynamic response and increased vascular capacitance. Evenso the maximum percent rise from baseline values of these indicesafter volume load was significantly higher in controls (p <0.001). Autonomic cardiovascular disturbances affected bothsympathetic and parasympathetic activity. Hypertension and tachycardiaalternating with hypotension and bradycardia were related tosudden fluctuations in systemic vascular resistance. Our studiessuggested some degree of myocardial dysfunction in patientswith severe uncomplicated tetanus. The haemodynamics of severetetanus were masked and altered by complicating infection, pneumonia,and atelectasis.     

Stunting Among Under 5-Year-Olds in Nepal: Trends and Risk Factors

Maternal and Child Health Journal - Objectives Encouraging key parenting behaviors in early infancy may help decrease income-related developmental disparities. In this study we assessed whether a...     

Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

Introduction

Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal.

Methods

Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities.

Results

Of the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals.

Conclusions

These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

     

Profiles of acute bacterial meningitis isolates in children in National Hospital,Abuja

Background:

Acute bacterial meningitis (ABM) is an important cause of morbidity and mortality throughout the world. It is an acute medical emergency that requires urgent rational antibiotic therapy, especially in neonates and young infants. Determining the pattern and susceptibility of isolates of ABM among children for prompt treatment of this important cause of mortality and morbidity is very important. This study determined the types and the antimicrobial susceptibility pattern of ABM isolates among children at the National Hospital, Abuja.

Materials and Methods:

This is a retrospective study carried out at the National Hospital Abuja (NHA), Nigeria. Laboratory data for a period of 3 years, January 2010-December 2013 were reviewed, and all bacterial isolates and their antibiotics sensitivity testing results for children aged 0-15 years, and other relevant information extracted and analyzed. Study center was the NHA.

Results:

Twenty-eight bacterial pathogens were isolated from a total of 542 cerebrospinal specimens over the study period, giving a yield of 5.2%. The four most common pathogens isolated were Staphylococcus aureus (32.2%), Klebsiella pneumoniae (21.5%), Streptococcus pneumoniae (17.6%), and Escherichia coli (14.3%). Whereas, 28.6% of all the infections occurred in neonates alone, children 2 years and below had 85.7% of all the infections, with male preponderance. Isolates of S. aureus and S. pneumonia tested were both 100% susceptible to amoxicillin-clavulanic acid and Cefuroxime; S. pneumoniae was equally sensitive to Ceftriaxone. K. pneumoniae was 100% sensitive to Imipenem, but 83% to ceftriaxone. 75% of the isolated E. coli strains were sensitive to ceftriaxone, amoxicillin-clavulanic acid, and amikacin, 100% sensitive to imipenem.

Conclusion:

Meningitis in children as seen in the National hospital is almost equally caused by both Gram-positive and Gram-negative organisms, predominantly by S. aureus, S. pneumoniae, K. pneumoniae, and E. coli. Available drugs remain active against these organisms.