Determination of an appropriate size of unrelated donor pool to be registered for HLA-matched platelet transfusion

HLA-matched platelet transfusions from related or unrelated donors are effective in correcting bleeding tendencies of alloimmunized thrombocytopenic patients. To supply HLA-matched platelets, registration of unrelated HLA-typed donors and selection of compatible donors are necessary and practical considering HLA polymorphism. In this study, the frequencies of each possible HLA phenotype and of corresponding possible compatible donors were calculated with a computer from the table of frequencies of HLA-A and -B haplotypes. Appropriate sizes of such donor pools were theoretically evaluated in Japanese as well as in European Caucasoid and in North American Caucasoid populations. To enable more than 80 percent of patients to get more than five completely compatible donors, only 5000 donor candidates would be necessary for the Japanese population, whereas 18,000 and 25,000, respectively, would be required for European Caucasoid and North American Caucasoid populations.     

Determination of an appropriate size of unrelated donor pool to be registered for HLA-matched bone marrow transplantation

HLA-matched bone marrow transplantation from related or unrelated donors appears to be effective. To supply HLA-matched bone marrow for patients who do not have HLA-matched family donors, registration of unrelated HLA-typed donors and selection of matched donors will be necessary. In this study, the frequencies of each possible HLA phenotype and of corresponding, potentially matched donors were calculated by a computer from the table of frequencies of HLA-A, -B, and -DR haplotypes using data from 300 families in Japan and from the Eighth International Histocompatibility Workshop for European and North American whites. Appropriate sizes of such donor pools were evaluated theoretically in the Japanese population and in European and North American whites. To enable more than 80 percent of patients to have at least one identical donor, only 50,000 potential donors would be necessary for Japanese persons, whereas 1,000,000 and 400,000, respectively, would be required for European and North American whites.     

A budget model to determine the financial health of nursing education programs in academic institutions

In the allocation of resources in academic settings, hierarchies of tradition and status often supersede documented need. Nursing programs sometimes have difficulty in getting what they need to maintain quality programs and to grow. The budget is the crucial tool in documenting nursing program needs and its contributions to the entire academic enterprise. Most nursing programs administrators see only an operating expense budget that may grow or shrink by a rubric that may not fit the reality of the situation. A budget is a quantitative expression of how well a unit is managed. Educational administrators should be paying as much attention to analyzing financial outcomes as they do curricular outcomes. This article describes the development of a model for tracking revenue and expense and a simple rubric for analyzing the relationship between the two. It also discusses how to use financial data to improve the fiscal performance of nursing units and to leverage support during times of growth.     

Financial model to determine the effect of clinical education programs on physical therapy departments

The purpose of this study was to develop a financial model to help administrators determine the financial effect of physical therapy clinical education programs on facilities. I developed the model from an analysis of actual field data collected on the financial and time variables involved in the clinical education process. Therapists with and without students were matched in six (three large, three small) physical therapy departments. Each completed a modified time-motion study for a sample of typical days during 2 six-week student affiliation periods and for a one-week period without students. I identified and field tested five factors that can be integrated into a simple financial model. The field results also supported the concept that a clinical education program was profitable, producing an $89 per day per student net benefit, even though therapists working with students spent less time in income-generating activities.     

血小板分离机洗涤单个供者血小板工艺的研究

目的　研究便捷实用有效的全自动盐水洗涤血小板工艺。方法　利用单个供者血小板单采设备CS 30 0 0plus血细胞分离机及一次性分离管道 ,在血小板单采结束后进行管道改造和增加特定的洗涤处理程序 ,通过生理盐水连续梯度稀释效应达到洗涤效果。结果　用 15 0 0ml生理盐水进行血小板洗涤的处理量比较合适 ,洗涤后产品中的pH、血小板回收率、血浆蛋白清除率、血小板粘附聚集功能、血小板活化依赖性颗粒外膜蛋白 (GMP 14 0 )及血小板膜GPⅡb Ⅲa复合物的表达均能达到良好效果。结论　本工艺为目前临床有特殊需要的病人制备洗涤血小板 ,以及为将来进一步研究新的血小板制剂提供了较好的参考作用。     

A framework for optimizing measurement weight maps to minimize the required sample size

We propose a fully automatic statistical framework for identifying the non-negative, real-valued weight map that best discriminate between two groups of objects. Given measurements on a spatially defined grid, a numerical optimization scheme is used to find the weight map that minimizes the sample size required to discriminate the two groups. The weight map produced by the method reflects the relative importance of the different areas in the objects, and the resulting sample size reduction is an important end goal in situations where data collection is difficult or expensive. An example is in clinical studies where the cost and the patient burden are directly related to the number of participants needed for the study. In addition, inspection of the weight map might provide clues that can lead to a better clinical understanding of the objects and pathologies being studied. The method is evaluated on synthetic data and on clinical data from knee cartilage MRI. The clinical data contain a total of 159 subjects aged 21–81 years and ranked from zero to four on the Kellgren–Lawrence osteoarthritis severity scale. Compared to a uniform weight map, we achieve sample size reductions up to 58% for cartilage thickness measurements. Based on quantifications from both morphometric and textural based imaging features, we also identify the most pathological areas in the articular cartilage.     

Risk factors for acute, moderate to severe donor reactions associated with multicomponent apheresis collections

BACKGROUND: Legitimate concerns exist over the safety of donors during multicomponent apheresis collections (MACs), when large volumes of red blood cells (RBCs) and plasma are removed. This study evaluates the predictive value of various donor- and procedure-related variables for moderate to severe donor acute adverse events (AAEs). STUDY DESIGN AND METHODS: Data on all apheresis donation procedures performed at a large university hospital-based donor center over a 2-year period were obtained by a review of adverse event forms and procedure logs (Trima Accel 5.1, Gambro BCT). Various donor- and procedure-related variables were compared between procedures that resulted in moderate to severe AAEs and those that did not. RESULTS: Moderate to severe AAEs occurred in 53 (0.47%) of 11,333 apheresis donation procedures. The majority of events (96.2%) had predominantly features of vasovagal reactions (VVRs). Females were at significantly higher risk (odds ratio [OR] = 2.8, p < 0.0003) compared to males. Donors who experienced AAEs had significantly lower predonation total blood volume (TBV) and hematocrit (Hct) and higher total RBC loss and net fluid loss at the end of the procedures. Total plasma loss alone was not significantly different between the two groups. Total blood loss was significantly higher among donors who experienced AAEs as a percentage of the donor's TBV. CONCLUSION: Apheresis collections are well tolerated even when multiple components are collected, with a very low overall incidence of moderate to severe AAEs (0.47%). Small, female donors with lower predonation Hct are at higher risk, especially when RBCs are collected.     

A community model for arthritis rehabilitation

Arthritis is a widespread chronic disease which can result in severe disability. Arthritis is best managed by a triad of treatment, education, and research. A community model for arthritis rehabilitation, with emphasis on the team approach, is described and illustrated. Central to the design of the model is an arthritis centre which demonstrates exemplary treatment and has a commitment to develop education and research programs. Primary arthritis care is the responsibility of the health professionals in each community, and the arthritis centre provides the support and resources for their programs. The model is suggested as a prototype for the management of other major chronic diseases.     

Certification of donor apheresis nurses: Keys to develop an effective training program

Within Sanquin Blood Supply, a training program to train apheresis nurses was developed. The parts of the work for which qualification should be necessary was analysed. Based on this analysis, a modular program with theoretical and practical information and knowledge was developed. The modular program consists of two sections: a theoretical and technical / practical. The theoretical section consists of by the project group identified themes including basic hematology (e.g. the characteristics, kinetics, physiology and function of blood cells), basic apheresis physiology, indications for apheresis procedures, criteria for donors apheresis, difficulties and risks of procedures as well as the actions to be taken in case of side effects, and introduction to the apheresis machine available, including the mechanism of the machine. The program for the technical / practical section consists of machine and procedure knowledge (in theory and practise) and troubleshooting. To conclude each individual module, tests in theory and capability to perform procedures are taken. Each trainee needs to demonstrate to have sufficient insight and skill to master all the relevant critical features of the work. Also a text-book for the trainee was written. This educational program provides an approach to educate and test apheresis donor nurses. The combination of theoretical and practical components and monitoring of the progression are an important basis.     

A three-tiered team model for undergraduate preceptor programs

At the Georgetown University School of Nursing, a three-tiered team model is used to ensure the effectiveness of the undergraduate preceptor program. Using the three-tiered model, clinical teaching activities are shared among preceptors, clinical instructors, and the course coordinator. This strategy allows the assignment of more complex patients and groups of patients in a closely supervised learning environment. Through evaluations of the program, students have indicated that the preceptorship has increased their sense of independence with patient care and enhanced their satisfaction with the clinical experience.     

A novel bioassay model to determine clinically significant bisphosphonate levels

Purpose  

Bisphosphonate-associated osteonecrosis (BON) is a recently recognized oral complication of bisphosphonate (BP) therapy. Currently, research into the pathogenesis of BON has been hampered by being deficient in studies capable of measuring the level of BP in saliva or at the bone–soft tissue interface. The objective of this current study was to develop a novel bioassay model representative of the oral levels of BPs in patients presenting with or at risk for BON.     

A model to determine workforce needs for endocrinologists in the United States until 2020

The objective of this study was to define the workforce needs for the specialty of Endocrinology, Diabetes, and Metabolism in the United States between 1999 and 2020. An interactive model of factors likely to influence the balance between the supply and demand of endocrinologists during the next 20 years was constructed. The model used data from a wide range of sources and was developed under the guidance of a panel of experts derived from sponsoring organizations of endocrinologists. We determined current and projected numbers and demographics of endocrinologists in the U.S. workforce and the anticipated balance between supply and demand from 1999 to 2020. There were 3,623 adult endocrinologists in the workforce in 1999, of which 2,389 (66%) were in office-based practice. Their median age was 49 years. Both total office visits and services performed by endocrinologists (particularly for diabetes) increased substantially during the 1990s. Waiting time for an initial appointment is presently longer for endocrinologists than for other physicians. Compared with a balanced, largely closed-staff health maintenance organization, the current national supply of endocrinologists is estimated to be 12% lower than demand. The number of endocrinologists entering the market has continuously fallen over the previous 5 years, from 200 in 1995 to 171 in 1999. Even if this downward trend were abruptly stopped, the model predicts that demand will exceed supply from now until 2020. While this gap narrows from 2000 to 2008 due to projected growth of managed care, it widens thereafter due to the aging of both the population and the endocrine workforce. Inclusion of other factors such as projected real income growth and increased prevalence of age-related endocrine disorders (e.g., diabetes and osteoporosis) further accentuates the deficit. If the number of endocrinologists entering the workforce remains at 1999 levels, demand will continue to exceed supply from now through 2020 for adult endocrinologists, and the gap will widen progressively from 2010 onward. The present analysis indicates that the number of endocrinologists entering the workforce will not be sufficient to meet future demand. These data suggest that steps should be taken to stop the ongoing decline in the number of endocrinologists in training and consideration should be given to actions designed to increase the number of endocrinologists in practice in the years ahead.