Richard Lower: The Origins of Blood Transfusion

Millions of blood transfusions are performed yearly worldwide. With respect to its historical origins, this practice began in the 17^th century with an English physician. In 1666, Richard Lower reported the first successful transfusion between animals. The first transfusion in a human patient was performed the following year by Jean Baptiste Denis, a French physician. That same year, Lower transfused blood from a lamb into the bloodstream of a clergyman named Arthur Coga. However, the practice was subsequently abandoned for hundreds of years. Safe transfusion awaited the recognition of blood types and cross-matching, and did not occur until early in the 20^th century. A number of other advances in transfusion therapy have followed, and more are in development.     

过滤白细胞血液临床应用观察

[目的]探讨过滤白细胞血液在临床输血应用价值.[方法]随机抽取451名接受输血的病人进行观察,其中以241名输注采用一次性去除白细胞过滤器过滤白细胞血液的病人为观察组,210名输注非过滤白细胞血液的病人为对照组,观察两组输血后不良反应情况.[结果]输血反应发生率观察组为0.4%,对照组为3.8%,观察组明显低于对照组（P〈0.05）.[结论]输注过滤白细胞血液能够减少输血反应发生.     

Transfusion of Blood Products in Trauma: An Update

Background: Blood transfusion in the management of severely injured patients can be lifesaving. These patients are susceptible to developing early coagulopathy, thus perpetuating bleeding. Objectives: This article presents recent advances in both the civilian and military clinical arena to improve the treatment of trauma patients with severe hemorrhage, the use of agents to support coagulation, perspectives on restrictive transfusion strategies, and transfusion-related risks. Discussion: Massive blood transfusion is an adjunct to surgical care. The volume of blood products transfused and the ratio of blood components have been associated with increased morbidity and mortality rates. The adverse clinical effects of transfusion and the limited supply of blood products have resulted in modern resuscitation protocols to limit the volume of blood transfused. Conclusion: A restrictive blood transfusion strategy and the use of hemostatic agents may decrease morbidity and mortality in trauma patients, but insufficient data are available for their use in trauma patients. Massive transfusion should reflect an equal ratio of packed red cells and plasma to limit coagulopathy. Prospective randomized trials are needed to standardize an effective protocol.     

Organizational vision: experience at the unit level

Aims The main focus of this follow-up study was to describe how the vision statements were perceived to describe the work in the units and what kind of relationships there were between the vision statements and background factors during the 3-year follow-up. Background The vision statement gives a competitive advantage to the organization. It helps find the desired direction during a period of transformation in the organization. Satisfaction, empowerment and motivation are challenged in the vision-realization process. Methods The data were gathered by questionnaire from the multidisciplinary team members on three occasions. The response rate was 58% (n = 115, n = 112) for the first and second data sets, and 53% (n = 103) for the third data set. The data was analysed statistically. Results The organizational vision was perceived as quite stable during the 3 years. Factors associated with the vision statement at the end of the 3-year period were workload, experience of stress, work motivation, work satisfaction, importance of work independence and general empowerment. Implications for nursing management Leaders are able to sustain the vision statement by motivating and empowering the staff. Empowerment especially is worth reinforcing in a vision-realization process.     

Community nursing in systems reform: the London polyclinic experience

Internationally, the polyclinic has been a feature of many health systems. The recent UK policy shift towards enhanced coordination of care closer to home resulted in the development of polyclinics, most notably in London. This article explores the background to the development of polyclinics and draws on the early experience of developments in London to explore what their impact has been, and is likely to be, on community nursing. Emerging findings from an evaluation of four pilot polyclinics suggests that rather than one model, polyclinics evolved in distinctively different ways more appropriately labelled as polysystems. Although policy makers clearly identified community nursing as being one of the key components of integrated, community-based care, the evaluation suggests a focus on high-level organizational restructuring and system change can shift attention from what many would consider core activities such as community health services.     

Hepatitis C virus screening: UK Blood Transfusion Service on the threshold.

The implications of testing all blood donations in the UK for antibody to hepatitis C virus (HCV) are considered. Although the risks of serious liver disease arising from transfusion-transmitted HCV are relatively low in the UK, the cost of such screening will be high in terms of financial outlay and lost donations. In the UK, at least, screening of all blood donations for anti-HCV is unlikely to be as cost effective as screening for HBsAg or anti-HIV.     

Revival of the Ugandan Blood Transfusion System 1989: an example of international cooperation

10 yr of civil war in Uganda had destroyed the Blood Transfusion Service when the government came to power in 1986. AIDS had become recognized as a problem of severe proportion. In 1987, the E.E.C. pledged to rehabilitate the central blood bank. This paper describes the first year of operation from December 1988. Over 5000 units of blood, largely from volunteer donors, were delivered to 19 hospitals. The overall incidence of HIV-1 seropositivity was 14.6% and Hepatitis B surface antigen was 5.5%. The cost was 21.5 ECU (US $25) for each unit of HIV negative, H.B.s.Ag. negative, blood.     

Managing technology in the intensive care unit: the nurses' experience

This study investigates the experiences of a group of critical care nurses regarding the use of technology in the intensive care unit. The study is grounded in the phenomenological hermeneutics of Martin Heidegger and argues that this methodology is compatible with the humanistic values of nursing. Data were generated from in-depth interviews and overt participant observation. The process of data analysis was guided by Heidegger's notions of phenomenological reflection and hermeneutic circle, (Van Manen's, Researching lived experience: human science for an action sensitive pedagogy. The State University of New York press, Ontario, Canada, 1990) process of thematic analysis and (Draper's, Nursing perspectives on quality of life. Routledge, London, 1997) analytical principles. The ability to manage the technology emerged as a main component of being a critical care nurse. It is revealed also that the nurses' ability to manage the technology is gained mainly through experience. The effect of machinery management on patient care is seen as part of everyday routine in the critical care setting. Moreover, technical activities are seen as more important and stimulating than other nursing activities.     

Transfusion practice in the intensive care unit: a 10‐year analysis

BACKGROUND: Clinical guidelines recommend a restrictive transfusion strategy in nonhemorrhaging critically ill patients. STUDY DESIGN AND METHODS: We conducted a retrospective observational study of 3533 single‐admission patients, without evidence of acute coronary syndromes, hemorrhage, or hemoglobinopathy admitted to the medical intensive care unit (MICU) of a large, academic medical center. RESULTS: MICU admission hemoglobin (Hb) level did not change significantly over the study period. The proportion of transfused patients decreased from 31.0% in 1997 to 1998 to 18.0% in 2006 to 2007 (p < 0.001). Among patients receiving transfusion, the mean pretransfusion Hb level decreased over time from 7.9 ± 1.3 to 7.3 ± 1.3 g/dL (p < 0.001). These changes in practice were not accounted for by differences in patient characteristics. The mean nadir Hb level in nontransfused patients decreased from 11.2 ± 2.2 g/dL in 1997 to 1999 to 10.4 ± 2.3 g/dL in 2006 to 2007 (p < 0.001). The mean number of units per patient transfused decreased during this time from 4.3 ± 4.7 to 3.0 ± 3.8 units (p < 0.001). The proportion of transfused patients who were transfused at a Hb level of less than 7.0 g/dL increased by an estimated absolute increment of 3.2% (95% CI, 2.1%‐4.3%) per interval (p < 0.001), and the proportion of single‐unit transfusions during the first transfusion episode increased by 1.4% per interval (95% CI, 0.2 to 2.6%; p = 0.03) from 40.2% in 1997 to 1998 to 53.1% in 2006 to 2007. CONCLUSIONS: Between 1997 and 2007, important and sustained changes have occurred in our MICU physician transfusion practices, with overall reductions in the proportion of patients transfused, mean pretransfusion Hb level, and nadir Hb level in patients who were not transfused.     

The intensive care experience: development of the ICE questionnaire

BACKGROUND: Previous research has shown that patients' reported memories of intensive care are often of unpleasant events which are described as frightening and persecutory in nature. Currently, there is no standardized way of assessing perceptions of such an experience or relating it to long-term outcome. AIMS: This paper describes the development of an intensive care experience questionnaire which aims to (a) identify the domains of such an experience, (b) assess and quantify that experience, and (c) explore its impact on short- and long-term emotional outcome. METHODS: Data from two studies are reported. Participants were non-elective patients and > or =18 years of age with an ICU stay > or =24 hours. Study 1 (n = 34) generated and developed items. Study 2 (n = 109) allowed evaluation of the factor analytic structure and psychometrics of the questionnaire. RESULTS: From a set of 31 items, exploratory factor analysis identified four components of the intensive care experience: 'awareness of surroundings' (nine items), 'frightening experiences' (six items), 'recall of experience' (five items), and 'satisfaction with care' (four items). Cronbach's alpha statistics were acceptable for each component (0.71-0.93). Correlational analysis with the subscales of the Hospital Anxiety and Depression Scale and Impact of Event Scale demonstrated concurrent and univariate predictive validity. The intensive care experience was associated with adverse emotional outcome in both the short- and long-term. DISCUSSION: The intensive care experience questionnaire identified four dimensions of experience and performed satisfactorily in these developmental analyses. Further study of an independent intensive care unit data set is necessary to confirm these findings, including the four-component structure. Development of a standardized measure provides the opportunity to increase our understanding of the intensive care experience. The questionnaire may be useful to inform the development of effective interventions to improve subsequent outcomes for these patients.     

围术期输血对患者术后感染的影响

本研究通过对中国人民解放军总医院术后感染病例的回顾性分析,探讨患者围术期的输血状况是否会加重术后感染程度。应用中国人民解放军总医院输血科开发软件“临床输血数据库”进行检索,选取150例外科手术后感染病例,按感染部位分为深部感染组和浅部感染组,对两组患者的年龄、住院时间、红细胞输注量、非红细胞输注量、输血次数和平均每次输血量进行对比分析。结果表明,发生浅部感染患者的中位红细胞输注量和非红细胞输注量分别为4．50（0-59）u和2．95（0-119．6）U,深部感染组中位红细胞输注量和非红细胞输注量分别为9．00（0-153）U和8．05（0-136．6）U,两组患者存在明显差异（P〈0．05）。两组患者最显著的差异是输血次数的不同,发生浅部感染的患者中位输血次数为2（1-31）次,远远低于发生深部感染患者的输血次数4（1-49）次（P〈0．001）。两组患者的平均每次输注量没有明显差异。结论：手术患者围术期的输血量及输血次数同患者术后感染的严重程度似乎呈正相关。     

Patient Blood Management: A Patient-Orientated Approach to Blood Replacement with the Goal of Reducing Anemia,Blood Loss and the Need for Blood Transfusion in Elective Surgery

Patient Blood Management (PBM) describes an evidence-based, multidisciplinary therapeutic approach. Its focus is on the treatment of the individual patient and as such comprises transfusion therapy and pharmacotherapy. Furthermore, the applicability of PBM is not limited to the perioperative setting but is applicable also to other therapeutic measures and disciplines where significant blood loss is known to occur and where transfusion of blood products is part of the established treatment. PBM is fundamentally based on 3 pillars: (1) optimization of the (preoperative) erythrocyte volume, (2) reduction of diagnostic, therapeutic, or intraoperative blood loss, and (3) increasing individual tolerance towards anemia and accurate blood transfusion triggers. PBM primarily identifies patients at risk of transfusion and provides a management plan aimed at reducing or eliminating the risk of anemia and the need for allogeneic transfusion, thus reducing the inherent risks, inventory pressures, and the escalating costs associated with transfusion.     

山东省部分地区5类人群艾滋病防治相关知识调查

目的 解山东省5类人群艾滋病知识水平,评价项目实施健康教育效果,调整下一步健康教育的内容和方法.方法 2004年9~10月,在山东省6个全球基金项目县,采用整群抽样、连续抽样与方便样本相结合的方法,对5类人群进行问卷调查.结果 5类人群艾滋病知识总体知晓率分别为:一般村民67.59%、中学生58.47%、既往有偿献血员61.61%、性病门诊就诊者69.83%、暗娼59.34%;实际获得和喜欢获得艾滋病知识的途径均以电视为主,分别占72.60%和71.38%.结论 5类人群均对艾滋病知识了解较少,获得艾滋病防治知识的来源范围较窄,应充分发挥当地现有各种媒体资源和可利用卫生资源,开展内容丰富多彩、形式多样的宣传教育方式,使社会各类人群掌握艾滋病防治知识,提高对艾滋病的认识,从而预防控制艾滋病.