Mother, may I ...?

If you've been working in EMS for much more than a week, the title of this column probably evoked some sort of visceral response from you--and not a positive one. The phrase "Mother, may I...?" has long been attached to EMS systems that require EMTs and paramedics to call their base hospitals prior to performing most interventions or delivering medications. Where the rub comes in is that most field people I know would prefer a little more leeway, something like a "Mother, I'm going out now" type of system.     

How much residual plasma may cause TRALI?

Although passive infusion of plasma-rich components containing white blood cell (WBC) antibodies are responsible for majority of the reported transfusion-related acute lung injury (TRALI) cases, the minimum volume of residual plasma, which might trigger TRALI, is not known. We report three cases of TRALI where the implicated donor component contained between 10 and 20 mL of residual plasma. Two cases were related to transfusion of red blood cells prepared in optimal additive solution, and the other was related to transfusion of pooled buffy coat platelets. In the latter case, WBC antibodies that matched the patient's human leucocyte antigen (HLA) antigens were only found in one buffy coat donor (female) who contributed a buffy coat for pooled platelets preparation. Plasma prepared from pooling platelets was collected from a male donor. Laboratory investigation confirmed that in all three cases, the donors' serum contained three to four different HLA class 1-specific and class 11-specific antibodies that matched with the patient's HLA type. Our cases suggest that the residual plasma volume as small as 10-20 mL containing donor derived WBC antibodies may cause TRALI. The risk of TRALI remains, despite providing pooled platelets suspended in male donor plasma. The significance of multiple HLA antigen/antibody matching between donor and recipient in immune TRALI warrants further study.     

What may alter the conclusions of reviews?

Abstract

Background: four out of five selected review articles concluded that no evidence of effect from physiotherapy was found. We decided to assess their methodology and analyse how the selections made by the review authors affected the review conclusions.

Materials and methods: a new literature search was performed before the methodology of the review articles were assessed according to a list of nine validity criteria and 25 subcriteria.

Results: all five reviews were found to have methodological shortcomings. Prevalent methodological flaws were: incomplete literature search, inadequate validity assessment, sensitivity to change of inclusion criteria, errors in data synthesis and conclusions not adhering strictly to evidence. No review assessed if treatment procedure was adequately performed. All the reviews could have altered parts of their conclusions if the authors had made other relevant selections in the reviewing process.

Conclusion: poor methodological quality and selections made in the reviewing process can bias the conclusions in review articles on physiotherapy.     

Am I dying nurse?

Tensions exist with regard to truth-telling about dying. Attitudes and opinions of doctors and nurses impact upon patients and their families. While traditionally doctors have assumed the role of telling patients and/or families, the nurse practitioner often has a closer relationship with the patient and may be the most appropriate person to answer the question "Am I dying?" If nurses accept they have a moral obligation to tell the truth then it is imperative that clinicians, researchers, educators, and the consumers of health services, deliberate on what truth-telling is. Cultural implications of both-truth telling and dying are little understood in New Zealand. The multi-cultural nature of New Zealand provides an opportunity for nurse researchers to address the many issues raised by the question "Am I dying, nurse?"