Dismantling applied tension: mechanisms of a treatment to reduce blood donation-related symptoms

BACKGROUND: Blood donation-related symptoms such as dizziness, nausea, and fainting are unpleasant for the donor and a significant disincentive for repeat donation. The muscle tensing technique of applied tension (AT) reduced symptoms in several studies. STUDY DESIGN AND METHODS: This study was a randomized controlled trial of different components of AT. A total of 1209 donors were randomly assigned to one of six conditions involving tension of different muscle groups or donation as usual. Dependent measures included a symptom questionnaire and whether or not the donor's chair was reclined to treat a reaction. RESULTS: Replicating previous findings, donors who practiced the "full" AT procedure reported significantly fewer symptoms, were less likely to require chair reclining, and rated their chances of giving blood again as greater than those in the donation-as-usual group. Of the component groups, donors who tensed only their lower body were most similar to the full-AT group. Upper-body tension in and of itself did not reduce symptoms though another condition involving upper body tension, which directed attention away from the arm with the needle in it had several significant effects. CONCLUSION: The positive effects of AT on blood donation outcome appear to be mediated primarily by lower-body tension though distraction also probably contributes to its impact.     

Blood bank on-call physician's experiences at a large university medical center

BACKGROUND: The responsibilities of the blood bank on-call physician (blood bank physician from here on) encompass many aspects of transfusion medicine and physician education. This physician is available 24 hours a day to address any issues concerning the collection and transfusion of blood and blood components. The purpose of this study was to identify and categorize the issues that may confront a blood bank physician. STUDY DESIGN AND METHODS: Each call received over a 4-month period was logged and the resolution documented. The calls were grouped into five categories: donor issues, therapeutic procedure issues, patient issues, physician education issues, and requests for blood components not meeting previously defined transfusion guidelines. RESULTS: The blood bank physician received 224 calls during the study period. To resolve each issue, an additional 1 to 14 telephone calls were needed to gather further information. Number of calls by category were donor issues, 20 (8.9%); therapeutic procedure issues, 9 (4.0%); patient issues, 4 (1.8%); physician education issues, 33 (14.7%); and requests for blood components not meeting previously defined transfusion guidelines, 158 (70.6%). Requests for blood components were denied in 39.8 percent of the cases not meeting guidelines. Other forms of therapy were warranted in 20.9 percent of the cases. CONCLUSION: This study revealed that 85.3 percent of the calls referred to the blood bank physician related to physician education and the appropriateness of blood component orders. These results emphasize the need for ongoing education of medical staff in transfusion medicine issues.     

Early morbidity of endoscopic ultrasound: 13 years' experience at a referral center

BACKGROUND AND STUDY AIM: Endoscopic ultrasonography (EUS) now has an important place in the diagnosis of gastroenteropancreatic diseases. However, prospective data on the morbidity and mortality related to its use are sparse and often retrospective. We attempted to assess the acute and immediate complications of both diagnostic and interventional EUS. PATIENTS AND METHODS: At our university-affiliated tertiary care referral center, immediate (occurring during the procedure) and acute (occurring within 24 hours) complications of EUS were prospectively investigated. Over a first period, spanning 10 years, complications of diagnostic EUS involving 3207 consecutive patients were assessed. During the second period of 3 years, complications observed after EUS-guided fine-needle aspiration (FNA) biopsy were evaluated from 224 procedures. EUS was mostly done with the patient under sedation with intravenous propofol and spontaneous ventilation, and complications were evaluated by both the operator and the anesthesiologist. RESULTS: There were no deaths, and no surgery was required over the two periods of assessment. Three mild complications occurred among patients who underwent standard diagnostic EUS: two immediate complications were related to anesthesia and one to the procedure. There were five complications associated with interventional EUS; all were related to the procedure (acute pancreatitis, duodenal perforation, upper digestive bleeding, cyst, and mediastinal infection), with a mean delay of occurrence of 30 hours, and mean duration of hospitalization of 7 days. CONCLUSION: In our experience, which is the longest reported in Europe, the morbidity rates of diagnostic EUS and EUS-guided FNA biopsy were 0.093% and 2.2%, respectively, with no mortality.     

Sharps injury prevention: select a safer needle

Explore the clinical benefits of passive safety needles, including reduced exposure risk, ease of use, and minimal training requirements.     

The impact of converting to an all frozen blood system in a large regional blood center

We studied the impact of converting to an all frozen blood system in a large regional blood center. Several basic assumptions were made including the availability of a sterile docking device which would increase the shelf life of deglycerolized blood to 72 hours. Our study indicated that the most economical manner in which to implement such a program would be to supply deglycerolized blood to all hospitals transfusing more than 500 units per year and to provide frozen units to hospitals transfusing less then this amount (those hospitals would deglycerolize the blood they use). The estimated total cost of the proposed conversion was 3.9 million dollars or a 76 per cent increase over the present operation. Relative to our present fee structure, the average cost of a unit of blood would increase 80 per cent if only frozen or deglycerolized red blood cells were distributed.     

Improving outcome of CAPD: twenty-five years' experience in a single Korean center.

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). We investigated the outcome of CAPD over a period of 25 years at our institution. METHODS: CAPD has been performed in 2301 patients in 25 years. After excluding patients with less than 3 months of follow-up and missing data, we evaluated 1656 patients who started peritoneal dialysis between November 1981 and December 2005. Data for sex, age, primary disease, comorbidities, follow-up duration, cause of death, and cause of technique failure were collected. We also examined data for urea kinetic modeling (UKM), beginning in 1990, and peritonitis episodes, including causative organisms, starting in 1992. RESULTS: Compared to incident patients from 1981-1992, mean age and incidence of ESRD caused by diabetic nephropathy increased in patients from 1993 to 2005. Technique survival after 5 and 10 years was 71.9% and 48.1% respectively. Technique survival was significantly higher in patients who started CAPD after 1992 than in those who started before 1992. Peritonitis was the main reason for technique failure. Overall peritonitis rate was 0.38 episodes per patient-year, with a significant downward trend to 0.29 per patient-year over 10 years, corresponding to a decrease in gram-positive peritonitis. Patient survival after 5 and 10 years was 69.8% and 51.8% respectively. Patient survival improved significantly during 1992-2005 compared to 1981-1992 after adjustment for age, gender, diabetes, and cardiovascular comorbidities [hazard ratio (HR) 0.68, p < 0.01]. Subgroup analysis based on UKM revealed that dialysis adequacy did not affect patient survival. However, diabetes (HR 2.78, p < 0.001), older age (per 1 year: HR 1.06; p < 0.001), serum albumin level (per 1 g/dL: increase, HR 0.52; p < 0.05), and cardiovascular comorbidities (HR 2.32, p < 0.01) were identified as significant risk factors. CONCLUSION: Technique survival has improved due partly to a decrease in peritonitis, which was attributed to a decrease in gram-positive peritonitis. Patient survival has also improved considering increases in aged patients and ESRD caused by diabetes. The mortality rate of CAPD is still high in older, diabetic, malnourished, and cardiovascular diseased patients. A more careful management of higher risk groups will be needed to improve the outcome of CAPD patients in the future.     

Experience of a combined apheresis, blood collection, and blood transfusion unit in a large tertiary care medical center

The Barnes Hospital Apheresis Blood Collection and Blood Transfusion Unit is part of Barns Hospital Blood Bank. Because of its size and complexity, we report our experience which may be useful to administrators and physicians involved in the planning or management of similar services. From 1985 through 1988 we collected platelets from 1,976 different donors, the majority of which (87%) were community donors. Sixty-nine percent of 1,976 donors donated in 1988 an average of 4.9 times. Of 6,568 apheresis products collected. 1.1% were discarded because of positive screening tests and 0.7% were discarded because of outdating or presence of fibrin clot. In 1988 a total of nine cell separators were used. All donor apheresis were done with seven blood separators, and on average a separator produced an apheresis product every 4.5 worked hours. All therapeutic apheresis (338) were done on two separators. Most of them (88%) were performed during work hours. In 1988 donor and therapeutic apheresis were done by 17 1/2 full-time employees (FTEs) during work hours. Considering the Workload Unit Value per procedure given by the College of American Pathologists (CAP) and that each FTE worked 1,864 hours per year, the worked hour productivity for donor and therapeutic apheresis was 78.2%. Blood collections, therapeutic bleeds, and outpatient transfusions (1,127, 114 and 1,745 respectively) were accomplished by two FTEs, for a worked hour productivity of 35.5%. Because 95.1% of total worked units was produced by efficient donor and therapeutic apheresis activities, overall efficiency remained high at 73.8%.     

Blood donation and donor recruitment in Iran from 1998 through 2007: ten years' experience

BACKGROUND: Recruiting and retaining blood donors is of utmost importance, especially since there is no alternative for human blood. This article describes different aspects of blood donation to evaluate recruitment activities.
STUDY DESIGN AND METHODS: Data were obtained from annual reports made by the Statistical Committee of the Iranian Blood Transfusion Organization and the national database.
RESULTS: The trend in yearly blood donations has significantly increased from 1,183,630 blood units in 1998 to 1,735,008 by the end of 2007. During this period the overall growth rate was 59.8% (p < 0.005). Yearly blood donation in the northwest region of the country was 13 per 1000 in contrast to 39 per 1000 in the central region. There was a significant decrease in the number of donations during the months of April, September, and January whereas in May, August, and the religious month of Muharram a significant increase was noted. Voluntary donations increased from 77% in 1998 to 100% by the end of 2007.
CONCLUSION: Continuous donor recruitment efforts in Iran have resulted in a significant increase in blood donation rates during the past decade as well as achieving 100% voluntary, nonremunerated blood donors. Nevertheless some provinces will have to put more effort into donor recruitment and retention so as to ensure self sufficiency in their blood supply. Educating blood donors and the public about the continuous need for a sufficient blood supply in every community is equally important and times where supply exceeds demand should be avoided at the most.     

研究利用血站数据库信息推动无偿献血业务发展的新方法

目的研究利用血站数据库信息推动无偿献血业务发展的新方法。方法选用经过国家卫生部评审的血站管理系统软件,为利用血站管理系统的数据库信息,实行二次开发,增加自动生成短信功能模块,与中国电信运营商的“商务通”对接,通过互联网或自购无线通讯设备、信息调度机、数据库服务器等实现同类信息集中发送。结果短信群发代替手工实物(如验血结果、生日贺卡等)邮寄,实现快捷价廉的实时交流。结论结合IT技术、计算机应用技术和现代无线通信技术,创建短信息自动生成与发送系统,完成短信息的自动检索、条件群发,可大幅降低管理成本,显著地提高工作效率和服务质量,体现了血站人性化的科学管理。     

研究利用血站数据库信息推动无偿献血业务发展的新方法

目的研究利用血站数据库信息推动无偿献血业务发展的新方法.方法选用经过国家卫生部评审的血站管理系统软件,为利用血站管理系统的数据库信息,实行二次开发,增加自动生成短信功能模块,与中国电信运营商的"商务通"对接,通过互联网或自购无线通讯设备、信息调度机、数据库服务器等实现同类信息集中发送.结果短信群发代替手工实物(如验血结果、生日贺卡等)邮寄,实现快捷价廉的实时交流.结论结合IT技术、计算机应用技术和现代无线通信技术,创建短信息自动生成与发送系统,完成短信息的自动检索、条件群发,可大幅降低管理成本,显著地提高工作效率和服务质量,体现了血站人性化的科学管理.     

Blood cultures: eight years' experience of a conventional in-house system and trends in antimicrobial susceptibilities

In a prospective analysis of 4234 significant isolates from 62,437 consecutive sets of blood cultures over an 8 year period, 79.4% were detected within 48 h. Routine examination of Gram-film smears made within 24 h of receipt of the cultures detected about half of all positive cultures. Many organisms were detected earlier on Castaneda slopes than in tryptone soya broth. Haemophilus influenzae (type b) and Neisseria spp. were usually suspected on clinical grounds, and early blind subculture was successful in 95.7% and 69% of cases respectively. Resistance to trimethoprim among Gram-negative coliforms increased significantly over the 8 year period. Production of beta-lactamase was detected in 12% of Haemophilus influenzae (type b). Unlike Staphylococcus aureus, Staphylococcus epidermidis was commonly resistant to methicillin, erythromycin, fusidic acid and gentamicin.     

Adverse reactions associated with autologous blood transfusion: evaluation and incidence at a large academic hospital

BACKGROUND: It is acknowledged that autologous blood is the safest for the patient to receive. However, it is generally not appreciated that transfusion reactions to autologous blood may occur, despite the fact that it is the patient's own blood. STUDY DESIGN AND METHODS: A retrospective review of all transfusion reactions reported to a hospital transfusion service from 1991 through 1996 was performed, and all reactions to autologous blood were further investigated. RESULTS: Reported adverse reactions to autologous blood composed 2.1 percent of all transfusion reactions investigated in the hospital, involving 0.16 percent (15/9,353) of all transfused preoperatively donated autologous red cell units and 0.027 percent (5/18,506) of all intraoperatively salvaged units. Further investigation revealed that 60 percent (12/20) of these adverse reactions were felt to be clinically important and directly attributable to the autologous blood transfusion. Adverse reactions included febrile nonhemolytic (5) and allergic (4) reactions, an acute hemolytic transfusion reaction secondary to a clerical error (1 intraoperatively salvaged unit), and other nonsignificant adverse reactions (2). Eight adverse reactions were determined these reactions to be unrelated to the autologous transfusion. CONCLUSION: Despite the fact that the blood given is the patient's own blood, transfusion reactions to autologous blood do occur. As it is for allogeneic transfusion, any suspected adverse reaction to autologous blood transfusion should be investigated.