Are lapsed donors willing to resume blood donation,and what determines their motivation to do so?

BACKGROUND: This study investigated the possibility of rerecruiting lapsed blood donors. Reasons for donation cessation, motivation to restart donation, and modifiable components of donation motivation were examined. We distinguished between lapsed donors who had passively withdrawn by merely not responding to donation invitations and donors who had contacted the blood bank to actively withdraw. STUDY DESIGN AND METHODS: A cross‐sectional survey was sent to 400 actively lapsed donors and to 400 passively lapsed donors, measuring intention to restart donation and psychological correlates of restart intention. The data were analyzed using multiple regression analyses. RESULTS: The response rate among actively lapsed donors was higher than among passively lapsed donors (37% vs. 25%). Actively lapsed donors typically ceased donating because of physical reactions, while passively lapsed donors quit because of a busy lifestyle. Nonetheless, 51% of actively lapsed responders and 80% of passively lapsed responders were willing to restart donations. Multiple regression analysis showed that, for passively lapsed donors, cognitive attitude was the strongest correlate of intention to donate in the future (β = 0.605, p < 0.001), with affective attitude (β = 0.239, p < 0.05) and self‐efficacy (β = 0.266, p < 0.001) explaining useful proportions of the variance as well. For actively lapsed donors, cognitive attitude was also the strongest correlate of intention (β = 0.601, p < 0.001), with affective attitude (β = 0.345, p < 0.001) and moral norm (β = ?0.118, p < 0.05) explaining smaller proportions of the variance. CONCLUSION: The majority of lapsed donors indicated a moderate to high intention to restart donations. Interventions focusing on boosting cognitive and affective attitudes and self‐efficacy could further raise such intentions.     

Sleepy nurses: are we willing to accept the challenge today?

With a shortage of supply of nurses and the increasing demand for nursing care, hospitals require or allow nurses to work extended shifts (in excess of 12 hours) and many shifts per week (up to and in excess of 60 hours per week). The result of these excessive hours of work is that many nurses care for patients while suffering from sleep deprivation. Sleep deprivation has been shown to negatively impact judgment and performance resulting in errors and accidents. Sleep deprivation also negatively affects the health of individuals. Sleep deprivation in nurses is a significant issue that requires more attention.     

Procalcitonin in liver transplantation: are high levels due to donors or recipients?

Introduction

To date, a specific marker to evaluate and predict the clinical course or complication of the liver-transplanted patient is not available in clinical practice. Increased procalcitonin (PCT) levels have been found in infectious inflammation; poor organ perfusion and high PCT levels in the cardiac donor appeared to predict early graft failure. We evaluated PCT as a predictor of early graft dysfunction and postoperative complications.

Methods

PCT serum concentrations were measured in samples collected before organ retrieval from 67 consecutive brain-dead donors and in corresponding recipients from day 0, before liver transplantation, up to day 7 after liver transplantation. The following parameters were recorded in donors: amount of vasopressive drug doses, cardiac arrest history 24 hours before retrieval, number of days in the intensive care unit, age of donor, and infection in donor, and the following parameters were recorded in recipients: cold and warm ischemia time, veno-venous bypass, transfusion amount during orthotopic liver transplantation (OLT), and occurrence of postoperative complication or hepatic dysfunction.

Results

In the donor, the preoperative level of PCT was associated with cardiac arrest and high doses of catecholamines before organ retrieval. In the recipient, elevated PCT levels were observed early after OLT, with a peak at day 1 or 2 after OLT, then a decrease until day 7. A postoperative peak of PCT levels was associated neither with preoperative PCT levels in the donor or the recipients nor with hepatic post-OLT dysfunction or other postoperative complications, but with two donor parameters: infection and cardiac arrest.

Conclusion

PCT level in the donor and early PCT peak in the recipient are not predictive of post-OLT hepatic dysfunction or other complications. Cardiac arrest and infection in the donor, but not PCT level in the donor, are associated with high post-OLT PCT levels in the recipient.     

Anti‐hepatitis C virus‐positive blood donors: are women any different?

We sought to assess clinical, epidemiological, biochemical, serological and histological characteristics of anti-hepatitis C virus (HCV)-positive female blood donors and compare them with men. As women are frequently the minority among blood donors, studies evaluating this population usually reflect characteristics of male gender. This retrospective study included 380 blood donors with confirmed positive anti-HCV. The mean age was 36.9 +/- 11.3 years and 33.2% were women. Compared with men, female donors showed higher prevalence of prior transfusion of blood products (P = 0.031) and lower prevalence of intravenous drug use (P = 0.001) and alcohol abuse (P < 0.001). Women exhibited lower medians of alanine aminotransferase (P < 0.001) and gamma-glutamyltransferase (P < 0.001). They also showed higher platelet count (P < 0.001) and prothrombin activity (P = 0.049), and a lower frequency of antibody against core antigen of hepatitis B virus (anti-HBc) positivity (P = 0.032). A higher proportion of spontaneous viral clearance (P = 0.001) and a lower frequency of viraemia (P < 0.001) were observed among women. On liver biopsy, women had lower prevalence of fibrosis stage > or = 2. Multivariate analysis identified age (OR = 1.050, 95% CI: 1.019-1.081, P = 0.001) and anti-HBc positivity (OR = 2.184, 95% CI: 1.010-4.722, P = 0.047) as independent predictors of significant fibrosis. Female blood donors presented higher prevalence of spontaneous viral clearance as well as biochemical and histological evidence of less advanced liver disease. These findings could be because of intrinsic characteristics of female gender or secondary to associated factors such as younger age or anti-HBc positivity.     

Incidence rates of viral infections among repeat donors:are frequent donors safer?

BACKGROUND: Incidence rates (IRs) for viral infections may vary with the frequency of donation among repeat, community, whole-blood (WB) donors, with IRs thought to be lower among donors with higher frequency of donation. STUDY DESIGN AND METHODS: IRs for HIV, HTLV, HCV, and HBV infection were stratified by frequency of donation among 868,403 repeat WB donors who gave approximately 4 million donations at five United States blood centers from 1991 through 96. All donors had given at least 2 donations during those years, with the first donation being nonreactive on confirmatory testing. Frequency of donation was measured in three ways: by the number of donations per year; at the time of donation, by the number of donations given within the preceding 2-year period; and by the number of donations given from 1991 through 1993. RESULTS: The IRs for HIV, HCV, and HBV infection did not appear to differ among donors with lower or higher numbers of donation per year. However, the IR for HTLV infection decreased as the number of donations per year increased (p = 0.0004). IRs for all viral markers remained stable, regardless of the number of donations given within the 2-year period before the donation. Although IRs for HIV, HTLV, and HCV infection did not vary by the number of donations given in 1991 through 1993, the IR for HBV infection appeared to be lower in donors who gave more donations in that period (p = 0.01). CONCLUSION: These findings do not provide evidence of a lower IR for transfusion-transmissible viral infections among repeat WB donors who give more frequently. Abbreviated screening histories for frequent repeat donors might not be advisable.     

Turbid plasma donations in whole blood donors: fat chance?

BACKGROUND: Blood donations resulting in “nontransparent turbid milky” plasma must be discarded. The aim of this study was to objectively determine opacity and to identify risk factors for turbid plasma donations. STUDY DESIGN AND METHODS: This case‐control study included 238 whole blood donors who provided turbid plasma (cases) and 309 random control subjects with normal plasma. Participants filled in a questionnaire regarding cardiovascular risk factors. Fat intake was assessed using a validated questionnaire. Opacity and lipids were measured. Additional data were retrieved from the blood bank information system. Mean differences and odds ratios were calculated with 95% confidence intervals. RESULTS: Cases had a less favorable cardiovascular profile compared to control subjects. The usual intake of fat was not associated with turbid plasma donation. In a multivariate model, having dinner before donation (OR, 4.9; 95% CI, 2.2‐11.1), triglyceride levels (OR, 7.1; 95% CI, 4.6‐10.8), and smoking (OR_{yes vs. no}, 2.5; 95% CI, 0.9‐6.7; and OR_{ever vs. no}, 5.7; 95% CI, 1.8‐18.4) were associated with an increased risk. Opacity was clearly increased in turbid plasma. Total cholesterol levels were 0.51 (95% CI, 0.35‐0.66) mmol/L and triglyceride levels 4.28 (95% CI, 3.92‐4.68) mmol/L higher in cases. High‐density lipoprotein cholesterol levels were 0.34 (95% CI, ?0.39 to ?0.30) mmol/L lower. Forty‐two percent of all cases had very high triglyceride levels (≥5.65 mmol/L) compared to less than 1% of control subjects. CONCLUSION: Donors who provided a turbid donation have a less favorable cardiovascular profile compared to other donors. Having dinner, high triglyceride levels, and smoking are independent risk factors for turbid plasma donations.     

Do blood donors read and understand screening educational materials?

BACKGROUND: Blood donors with high-risk behaviors may not self-defer because they failed to read or understand the screening educational materials. STUDY DESIGN AND METHODS: In 1993, a total of 34,726 allogeneic donors responded to an anonymous mail survey of 50,162 donors that inquired about demographics, donor status, amount of the donor educational materials read, new HIV knowledge gained, and donors' opinions on the length and difficulty of materials. RESULTS: Although 78 percent reported reading all materials, only 32 percent indicated reading carefully; 34 percent learned new information about HIV and 95 percent perceived the materials as easy to understand. First-time donors were more likely to read carefully (OR, 7.9) and gain more HIV knowledge from the materials (OR, 1.9) than repeat donors. Minority, less educated, screening test-reactive, and HIV test-seeking donors reported reading the materials more carefully and learning more about HIV than their respective counterparts. Donors with less education, those with reactive screening tests, those seeking HIV test results, and those not reporting a risk behavior were more likely to find the materials difficult to understand. CONCLUSION: Most donors reported skimming and not having difficulty understanding the educational materials. Some donors may be aware that they should not donate or are failing to assimilate the information in the materials. Methods to present information more clearly and concisely are clearly needed. However, some high-risk donors may still continue donating no matter how improved the educational materials are.     

Taking blood pressure: too important to trust to humans?

The measurement of blood pressure in the physician's office is subject to a number of observer errors and also to the "white-coat effect." Automatic devices that measure blood pressure without a human observer in the room can eliminate many of these problems. We argue for greater use of these devices in the physician's office.     

Consenting to blood: what do patients remember?

We sought to characterize the consent process for transfusion and determine its impact on patients' knowledge and level of comfort with receiving blood. We identified all adult patients who had received blood transfusion at a tertiary care centre over 3 months. Patients who were discharged each received a survey that assessed their (1) recall of the consent process, (2) recall of information conveyed, (3) assessment of the discussion's understandability and (4) perceived knowledge of as well as comfort level with transfusion as a result of the discussion. Overall, 80% of respondents recalled discussing and signing an informed consent. Information was mostly conveyed by attending physicians (35%) and consent obtained in the patient's hospital room (38%) or the preadmission clinic (19%). Although the majority recalled the consent process, many did not recall the discussion of specific transfusion risks or alternatives to donor blood (88%). Although the majority felt the discussion was at least somewhat understandable (77%), only 35% felt better informed and more comfortable with accepting blood. Despite implementation of written informed consent for transfusion, patients' recollection and understanding of risks and alternatives remain poor. This suggests the need for improving risk communication.     

The child's right to participate in research: myth or misconception?

The growing acceptance of the need for children's participation in any issues that affect them, including research, has been fuelled by the 'children's rights' agenda, which has occurred in the UK since the ratification in 1991 of the UN 'Convention on the Rights of the Child' (UNCRC, 1989), which provides a framework for the development of national policies and laws to protect the rights of children (O'Hallorhan, 1999). There is a clear indication of this both within the UNCRC (1989) and the growing 'sociology of childhood', where the importance of children actively constructing their own lives by, for example, participating in and negotiating their own health care, education and social welfare by utilizing skills that go unrecognized (Mayall, 1998). With the current emphasis in the NHS on evidence-based care there is a need for those working with children and young people to include best evidence from research with children (as opposed to 'on' children) in both clinical and healthcare decisions. Recommendations for future research with children include the use of more innovative methodologies, such as action research and focus groups that will enable children to actively participate and to describe personal experiences through their own unique points of view.