护理送血站对临床用血安全的作用

为了有效执行《临床输血技术规范》,确保临床用血的安全,降低护士人力成本。医院建立了护理送血站,对送血站的环境设施、信息化管理的基本配置、组织架构做了明确界定,对送血站的运行和管理模式进行了探讨。结果显示,送血站灵活的工作模式、标准的配送流程、安全及时的配送和对输血过程的质量监控,确保了临床用血的安全与有效;严格执行了《临床输血技术规范》;有效利用了人力资源;缓解了输血科的压力;提高了临床医护人员对输血科的满意度。     

单纯冠状动脉旁路移植术患者围术期输血的危险因素分析

目的分析影响单纯冠状动脉旁路移植术(CABG)患者围术期血制品使用的危险因素。方法回顾性分析行单纯CABG的4 022名患者围术期使用血制品的情况,单因素及多元Logistic回归分析影响CABG患者血制品使用的相关因素。结果 65.74%(2 644/4 022)的单纯CABG患者在围术期使用过血制品,包括红细胞、血浆、血小板。输血与未输血患者的院内死亡率及并发症发生率比较:未输血组分别为0.00%(0/1 378)、12.84%(177/1 378),输血组分别为0.98%(26/2 644)、26.06%(689/2 644)(P0.01)。Logistic回归多因素分析:性别、年龄、BMI、吸烟史、糖尿病史、病变冠脉数量、术者经验、体外循环、术前波立维使用为CABG患者围术期血制品使用的独立危险因素。结论掌握影响CABG患者围术期使用血制品的危险因素,利于合理、有效的输血治疗。     

Survey based cross-sectional study to analyse the variation of practices at blood centres during COVID-19 pandemic in India

India has almost 3,000 blood centres collecting more than 11 million units annually. Maintaining blood supply during the COVID-19 pandemic is a huge challenge. We conducted a cross-sectional study by an online survey to analyse the variation of practices across blood centers of India during this pandemic. A total of 196 blood centers completely responded to the online survey. Most of the blood centres who responded were part of Government hospitals (60 %), part of an academic institutes (55.6 %) and were directly supporting a COVID hospital (67.5 %). Almost 95.4 % blood centers reported reduction of blood donation mainly due to lockdown (50 %) and inability to conduct camps (17.3 %). Scheduling blood donations was one of the most difficult to implement strategy for maintaining adequate blood donation (40.2 %). Blood center manpower management was also a challenge and upto 48 % blood centers operated in two batches to ensure social distancing in blood banks and reduce the risk of exposure. Hemato-oncology (36.8 %) and obstetrics (33.7 %) were major utilizer of blood during the pandemic. There were marked variations in use of PPE by blood banks staff as well as strategies adopted while conducting immunohematology tests on COVID-19 positive patients samples. This pandemic has highlighted some of the major limitations of the health services but blood services have risen to the challenge and strived to maintain the blood supply chain while ensuring blood donor and staff safety. The wide variations in the practices adopted highlights the need for uniform guidelines for blood services in future pandemics.     

Plasma fibronectin concentrations in blood products

Plasma fibronectin is an important opsonic protein of the mononuclear phagocyte system (MPS). In this study, plasma fibronectin concentrations were measured in stored and fresh whole blood, fresh frozen plasma and AGH cryoprecipitate. Stored whole blood had the lowest concentrations (151±50 mg/l). The concentrations in fresh whole blood plasma (227±66 mg/l) and fresh frozen plasma (224±78 mg/l) were similar but significantly higher than in stored whole blood (p<0.05). In contrast, AHG cryoprecipitate had the highest fibronectin concentrations (3249±502 mg/l) (p<0.001). In correcting fibronectic deficiency the best results can thus be expected from an infusion of cryoprecipitate, but fresh whole blood and fresh frozen plasma may also increase depressed fibronectin levels.     

Nursing leadership in an academic hospital in Gauteng

Aim This study was aimed at describing nursing leadership in an academic hospital in Gauteng, South Africa. Background Nurse managers’ leadership styles affect nurses’ attitudes, behaviour and work performance. However, little is known about how nurses experience nurse leadership and what leadership styles are found in academic hospitals in Gauteng. Methods The study was based on Maxwell’s framework of leadership (relationships, equipping, leadership and attitude). A qualitative design was used in order to describe the experiences of registered nurses and nurse managers. The population of the study was all registered nurses and nurse managers of the hospital in which the study was conducted. In phase one of the study, a discussion group with 35 registered nurses using the nominal group technique was held to respond to the following statement: ‘Please explain how you have experienced leadership by nurse managers in this hospital’. In phase two of the study, five nurse managers were interviewed individually, using a semi-structured interview guide. Results Some nurse managers were practising autocratic leadership in this hospital. Implications for nursing management The nurse managers need to be taught about contemporary leadership styles such as transformational leadership and visionary leadership and also about supervision, role modelling and caring.     

Characteristics and causes of pre-donation deferrals at a Chinese blood center

ObjectivesThe purpose of this retrospective analysis was to understand the causes and characteristics of the pre-donation deferral, so as to enhance blood safety and improve donor satisfaction.BackgroundBlood transfusion is crucial in managing a variety of different medical and surgical needs. Its benefits are manifold but there are risks for the recipients. Thus some blood donors are deferred from donating when they do not meet certain criteria. An in-depth understanding of the underlying causes of donor deferral will not only improve donor selection but also ensure blood safety and avoid donor complaints.Materials and methodsThis single-center experience was carried out from 26th July 2018 to 25th July 2019 on all whole blood donors in Tianjin, China. Donors’ demographics and information were retrieved; comparisons between deferral data were summarized by the Chi-square test using Statistical Product and Service Solutions (SPSS) application version 22. The difference between groups were considered statistically significant when p < 0.05.ResultsA total of 190,846 participants were included; whereby 119,951 (62.85 %) of participants were first-time blood donors. The pre-donation deferral rate was 9.26 %, and deferral was more likely seen in first-time donors, male donors, and donors of age above 35 years (p < 0.05). Overall, raised alanine aminotransferase (ALT) contributed to 48.46 % of all temporary deferrals, followed by lipaemia (20.71 %). For female donors, low hemoglobin was the leading cause of temporary deferral. Positive hepatitis B surface antigen (Hepatitis B) and syphilis were the two common causes of permanent deferrals, with incidence at 11.65 % and 3.93 %, respectively.ConclusionPre-donation deferral remains a significant problem in China and accounted for 9.26 % of participants in this study. Raised ALT and lipaemia were common temporary deferrals, especially among first-time donors, males, and older donors. Appropriate interventions should be taken to address the blood quality, improve the donor retention strategies in order to secure an adequate and safe blood supply.     

End-of-life practices at a Lebanese hospital: courage or knowledge?

End-of-life care requires knowledgeable and culturally sensitive clinicians to assist patients and families dealing with the difficult journey of death. The authors present important end-of-life considerations for health care providers dealing with culturally diversified patients. A case study approach is used illustrating two case vignettes derived from the practice of an intensive care setting of a tertiary teaching facility in a large urban area in Lebanon. In a multidisciplinary fashion, practices of end of life were explored and a protocol developed to guide health care providers. Special cultural values were identified such as importance of family involvement and religious beliefs. Implications for practice are described.     

Platelet transfusions in clinical practice at a multidisciplinary hospital in North India

Specialty wise utilization pattern of platelet concentrates (PLT) over a period of 2 months was evaluated prospectively for appropriateness. Overall 4.87 random donor platelets (RDP) (total 1672) units were issued per request. A total of 1101 RDP (66%) were transfused prophylactically against 221 requests (64.4%) while, 571 RDP were transfused for therapeutic (requests = 122, 35.6%) reasons. Twenty-three percent of prophylactic requests and 15% of the therapeutic requisitions were not justified. Most common reason for unjustified prophylactic transfusion was unavailability of pre-transfusion platelet count. Concurrent screening of request forms to ensure optimized PLT usage may further decrease platelet misuse at our center.     

血脂异常患者健康知识与健康促进生活方式的相关性研究

目的 探讨血脂异常患者(以下简称"患者")健康知识与健康促进生活方式(HPL)的相关性,为采取针对性的护理干预措施提供科学依据.方法 采用一般资料调查表、血脂健康知识调查表、健康促进生活方式量表(HPLP),对360例患者进行相关的问卷调查.结果 仅22.22%患者的健康知识总体为高水平,21.11%HPLP总体水平为优,其健康知识水平与HPLP水平呈正相关(r=0.528,P＜0.001).结论 护士应对患者开展针对性、系统的血脂相关知识教育,以提高其健康知识水平,修正不健康的生活方式,从而减轻或治愈血脂异常,改善患者生活质量.

Abstract：

Objective To investigate correlation between healthy knowledge and health-promoting lifestyle of patients with blood lipid abnormality. Provide a scientific basis for targeted nursing intervention measures. Methods General information questionnaire,healthy knowledge of blood lipid questionnaire and health-promoting lifestyle profile (HPLP) were adopted and conducted among 360 patients. Results On the overall level of healthy knowledge, patients reaching high level took up 22. 22%. When it comes to the level of HPLP, 21.11% of the patients were excellent. A positive correlation was revealed between a patient's healthy knowledge and the level of HPLP ( r = 0. 528, P ＜ 0. 001 ) . Conclusions Nurses should take individualized and systematic strategies of health education which serve to increase patients'healthy knowledge and correct unhealthy lifestyle, so as to alleviate or cure blood lipid abnormality and improve the life quality of patients.     

Assessment of the clinical transfusion practice at a regional referral hospital in Uganda

The aim of this study was to determine the indications for transfusion, blood ordering practices and post‐transfusion complications, and to assess the clinical transfusion practice at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda. There are no guidelines on the appropriate use of blood at MRRH. Therefore, there was a need to assess the local clinical transfusion practice. Patients' hospital files were studied for evidence of blood transfusions in 2008. All five wards were reviewed and details on the transfusion process were recorded. A total of 1730 patients (median age, 19·0 years; range, 1 day to 88 years; female‐to‐male ratio, 1·4), for whom blood was cross‐matched, were studied. Of these, 1674 (96·8%) patients actually received transfusions, which were as whole blood in 58·4% of recipients. The mean number of units per recipient was 1·7 and the cross‐match‐to‐transfusion ratio was 1·3. The three most frequent indications for transfusion were malaria (38·8%), bleeding (27·1%) and other infections (16·1%). There were no records for pre‐transfusion haemoglobin, compatibility testing, transfusion start‐times and vital signs in 30·2, 51·8, 21·5 and 97·6% of the recipients, respectively. Transfusion reactions were recorded for 10 (0·6%) patients. Although there was no evidence of blood wastage, inadequacies were noted in the documentation of the transfusion process. There is a need to train staff in blood transfusion and to design a ‘blood transfusion form’ for easy monitoring and evaluation. A hospital transfusion committee and guidelines on the appropriate use of blood should be put in place at MRRH.     

Pre-transplant thrombocytopenia predicts engraftment time and blood products requirement in allogeneic hematopoietic stem cell transplantation patients

IntroductionThrombocytopenia is a common consequence of leukemia that affects the outcome of hematopoietic stem cell transplantation (HSCT). The stromal damage of bone marrow following pre-HSCT conditioning regimens can delay the hematopoietic engraftment and increased blood product transfusions. We tried to define threshold based on pre-transplant platelet count as a biomarker to predict engraftment time and blood product requirements in allogeneic HSCT patients.MethodsThis retrospective study was performed on 194 patients who received allogeneic HSCT. The median for platelet (PLT) count of patients at the admission day was considered as a cut off value. The association of platelet count with white blood cell (WBC) and PLT engraftment time and also the requirement of packed red blood cell or PLT transfusions as outcomes of interest were investigated.Results164 patients (84.5 %) had successful WBC engraftment, and PLT engraftment was seen in 155 patients (79.9 %) in 30 and 50 days after HSCT, respectively. The patients with PLT count higher than 154,000/μL had better PLT engraftment (P = 0.060), and WBC engraftment (P = 0.014) than those with PLT count lower than this cut off. The pre-transplant PLT count had negative relations with SD platelet requests after HSCT (P = 0.008).ConclusionThe thrombocytopenia before HSCT might delay the platelet and WBC engraftment time, which should be taken into account before transplantation. Since the blood product transfusion is one of the factors associated with engraftment, the pre-transplant platelet count can be used as a predictive biomarker to manage the blood product requirement during the HSCT until engraftment occurs.     

基于信息化系统输血样本配送管理模式建立与应用研究

目的 建立输血样本精准配送信息化系统管理模式,确保输血安全.方法 应用患者信息系统和临床输血信息管理系统联网动态跟踪,分别观察每月平均平诊、急诊(抢救)输血样本配送时间,发生样本配送错误和漏送例次数.结果 2016～2017年未实施信息联网配送、2018～2019年实施信息联网动态跟踪配送每月平均平诊输血样本时间分别为...