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【Objective】 A framework to support nurses and midwives making the clinical decision and providing the written instruction for blood transfusion has been developed and implemented in the United Kingdom as a response to the changing needs of the patient and in recognition that blood transfusion services to patients could be improved by using the untapped knowledge and expertise of experienced nurses and midwives.Special education and training program for this role development are provided jointly by the national blood and nurse management authority, higher education institutions and transfusion societies.The British government has issued and implemented a compulsory professional indemnity which cover nurses and midwives as well.The development and implementation of the framework, policies and procedures for this role development is based on the regulatory compliance and the collaboration of, and beneficial to the multiple stakeholders, with the gaps left by doctors being fillled, work load of doctors reduced, nurses and midwives achieving professional development, hospitals performing more efficiently, and most importantly, the patients having a better transfusion services.At present, there is no similar policy or program for nurses and midwives in China.Therefore, this paper introduces the policy framework and implementation for this role development in UK, which would be a valuable reference for the role development and extension of nurses and the organization, education and training for transfusion professional teams as well in China in the near future.
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【Objective】 To pilot an informed consent audit system for clinical transfusion in a large tertiary hospital, so as to provide evidence and recommendations to improve the consent system. 【Methods】 A report table containing key items of transfusion informed consent such as transfusion risk, transfusion benefit and alternative treatment was developed in compliance with the national guidelines and regulations, and issued to a total of 206 patients with records on red blood cell transfusion from April 1 to June 30, 2019 in a tertiary hospital. 【Results】 The audit results showed that 98.06% (202/206) of transfusion informed consents were signed by patients, but only 65.05% (134/206) were signed by doctors. 31.07% did not record the reasons for transfusion, and 46.6% did not record the transfusion plan. 99.31% of the doctors participated in the audit claimed that the patients were informed of the risk of blood transfusion, but only 79.8% (158/198) patients recalled that the doctors mentioned the risk. Although 80.5% (116/198) of the patients were informed of alternative treatment, only 28.79% (57/198) recalled being told about alternative treatment. Allogeneic blood transfusion was the most frequently choice for patients recommended by doctors, accounting for 98.61% (142/144). However, only 48.99% (97/198) of patients could recall allogeneic blood transfusion. 80.5% of the patients recalled being informed of alternative treatment plans, and only 28.79% of the patients recalled being offered alternative treatment plans. Only 43.43% of the patients considered themselves as the main participants in decision-making of blood transfusion. In terms of training, 82.64% (119/144) doctors described having attended training programs. 【Conclusion】 The written consents for blood transfusion in our hospital were not well recorded. Patients received less information of blood transfusion informed by the doctors and did not fully participant in the decision-making of blood transfusion. There is a gap between the practice and the current national guidelines and regulations. The audit results indicated that it is necessary to further strengthen the professional knowledge of clinicians and communication skills between the doctors and patients. This audit results in this study will provide recommendations for further transfusion informed consent audit and continuous improvement of clinical transfusion informed consent practice in China in the future.
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【Objective】 To assess the sufficient information got by the informed transfusion recipients from the consents for blood transfusion and to explore the influencing factors, so as to provide scientific evidences for patients to comprehend the consent better. 【Methods】 A cohort study using questionnaire was conducted among 198 patients who received red blood cell transfusion from April 2019 to June 2019 in a tertiary hospital. 18 options were investigated, including basic information of patients, recall of the informed consent process performed by physicians and how well they comprehend the information. SPSS 23.0 statistical software was used for data statistical processing. 【Results】 All 198 questionnaires were returned and valid (100%, 198/198). The score of 198 informed transfusion recipients was 2~9 (5.293±1.549), and the score of Internal Medicine and Surgical transfusion patients was 6.07±1.77 vs 6.07±1.77 (P<0.05). Univariate comparative analysis showed that the clinical department, age, education background, instructions, including its time and identity of instructors, before transfusion were the variables that affected the comprehension of informed patients (P<0.05). Linear regression analysis indicated that the clinical department, pre-transfusion instruction and its time were independent influencing factors on the comprehension(P<0.05). The top 3 poorly-understood items included auto-transfusion, alternative transfusion therapy and 1-year donation deferral after blood transfusion. 【Conclusion】 More efforts are needed to help transfusion candidates to comprehend consent for blood transfusion better since their knowledge varied with clinical departments. Physicians′ transfusion knowledge and communication skills also need to be enhanced to provide targeted and multi-form informing methods.
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Blood transfusion is an important resuscitation method for combat casualties with severe hemorrhagic shock.The optimal resuscitation plan directly influences the treatment effect of the wounded.Whole blood,once the main resuscitation fluid,was replaced by blood components for various reasons and became a supplement when there was insufficient blood components supply.With the latest evidence of whole blood application in combat casualties,the development of blood transfusion technology and the deepened clinical and basic research,we realize that the obstacles in the use of whole blood are not insurmountable and that whole blood has the advantages that blood components do not have in the treatment of combat casualties.Therefore,whole blood has once again become a research hotspot in the field of combat casualties treatment.This article reviews the development history,advantages and disadvantages of whole blood application in the resuscitation of hemorrhagic shock after combat casualties,with a view to provide reference for further clinical and basic research.
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As the importance of clinical risks management grows hospital management,reducing hospital medical errors for patients safety has become a key quality management process.Failure Mode and effect analysis( FMEA) is a proactive technique for error detection and reduction.In this paper,based on a brief review of it's history of development,described in detail the implementation method and steps of FMEA,mainly introducing the research progress for using FMEA in reducing hospital medical errors.
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Objective To observe the effect of leukocytapheresis(LCAP)on the coagulation,fibrinolysis system and lung injury in the endotoxemia dog and explore the mechanism in the endotoxin-induced lung injury dog. Methods Endotoxemia-induced model in dogs was established by administration of lipopolysaccharide(LPS,2 mg/kg).Separation of the leucocytes wag performed with the automated continuous flow blood cell separators.A total of 30 male mongrel dogs were randomly divided into LPS group(group L,only injected with LPS,with no LCAP),sham LCAP group(group S,received sham LCAP at 12-14 hours after administration of LPS)and LCAP treatment group(group T,received LCAP at 12-14 hours after administration of LPS),10 dogs per group.The dynamic changes of the activated protein C(APC),soluble thrombomodulin and plagminogen activator inhibitor-1 in the serum were measured at 0 hour before LPS administration,at 2,6,12,14,16,24 and 36 hours after administration of LPS.Results Through LCAP,there found the following four results:(1) the APC level in the serum of the group T wag(50.805±4.422)μg/ml and(40.480±2.993)μg/ml at 14 hours and 16 hours respectively,which were significantly higher than(45.881±4.024)μml and(35.935±4.057)μg/ml in the group L(P<0.05).(2)The expressions of soluble thrombomadulin in the group T was (9.688±O.914)μml and(10.492±O.865)μg/ml at 14 hours and 16 hours respectively,which was statistically lower than(11.005±0.854)μg/ml and(12.04±0.954)ug/ml in the group L(P<0.05).(3)Thelevel of plagminogen activatorinhibitor-1 in the group T was lower than that in the group the group T Wag statistically lower than that in the group L(ALI/ARDS occurred in 2 and 7 dogs of the groups T and L respectively within 36 hours after infusion of LPS.P<0.05). Conclusions At the decrease the incidence of acute lung injury partly due to its role in improving the function of coagulation and fibrinolysis.
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Medical bilingual teaching method is a developing teaching form recently.And bilingual teaching method in Laboratory Diagnosis is one of the reforms to meet the present challenge.At present,it has no uniform mode.In this paper the understanding of the objective of Laboratory Diagnosis and the strategies in the Bilingual teaching are discussed.
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Objective To investigate the role of plasma ? endorphin(? EP) in the regulation of cellular immunity, mainly IL 2R expression and IL 2 production in rat splenic cells, following traumatic hemorrhagic shock(T HS). Methods ①Wistar rats with T HS were used and sacrificed at 0, 1, 3, 6, 12 and 24 h after T HS. Plasma specimens were collected and ? EP levels in plasma were detected. Rats with sham operation were served as the controls. ②Models of in vitro experiment were used. Spenic cells were isolated and mixed from four normal rats and cocultured with shock plasma or shock plasma+? EP antiserum. ConA induced splenic cell IL 2 production and IL 2R expression were observed. Results ①Level of plasma ? EP increased remarkably after T HS immediately, peaked at 1 h, showed decreasing tendency and restored to pre shock level 24 h after T HS. ②Shock plasma significantly suppressed ConA induced splenic cell function; Levels of plasma ? EP were negatively correlated with IL 2 production and IL 2R expression in spenic cells; Compared with that in SP group, splenic cell function elevated markedly in SP+? EP antiserum group, but was still lower than that in controls. Conclusion The increased plasma ? EP following T HS is involved in the suppression of cellular immunity.
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Objective To investigate the role of β-endorphin (β-EP) in conA-induced spleen cell proliferation after traumatic hemorrhagic shock. Methods ①Wistar rats with traumatic hemorrhagic shock were used and killed 0, 1, 3, 6,12 and 24 h after traumatic hemorrhagic shock. Plasma specimens were collected and β-EP levels in plasma were detected. Rats with sham-operation served as the control. ②Spleen cells isolated from normal rats were cultured in shock plasma (group Ⅰ), inactivated shock plasma (group Ⅱ) and shock plasma+β-EP antiserum (group Ⅲ) respectively. Con A-induced spleen cell proliferation was observed. Results ①The plasma β-EP level was elevated significantly immediately after shock, and reached the peak 1 h later, then showed a deceasing tendency and restored to the level as before shock at 24 h. ②Shock plasma remarkedly suppressed spleen cell response to the mitogen conA (P<0.01) compared with control; ConA-induced spleen cell proliferative function in group Ⅱ was significantly increased than that in group Ⅰ (P<0.01), so did in group Ⅲ, which still lower than in control. Conclusion The significantly elevated β-EP in the plasma after hemorrhagic shock might play an important role in inhibiting the proliferation of spleen cells.
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AIM: To explore the role of plasma ?-endorphin(?-EP) in the suppression of cellular immunity following trauma-hemorrhagic shock(T-HS). METHODS: ① Wistar rats with T-HS were sacrificed at 0 h, 1 h, 3 h, 6 h, 12 h, 24 h after T-HS. Plasma sample was collected and ?-EP levels in plasma was measured. Rats with sham-operated were served as the controls. ②In in vitro experiment, splenic cells were isolated and mixed from four normal rats and cocultured with shock plasma (SP) or SP +?-EP antiserum. ConA-induced splenic cell proliferation, IL-2 production, IL-2R expression were examined. RESULTS: ① Levels of plasma ?-EP elevated remarkably after T-HS immediately, peaked at 1h , showed decreasing tendency and restored normal 24 h after T-HS. ② Shock plasma significantly suppressed ConA-induced splenic cell function. Levels of plasma ?-EP were negatively correlated with spenic cell proliferation and IL-2 production and IL-2R expression. Compared with SP group, splenic cell function elevated markedly in SP + ?-EP antiserum group, but still lower than that in controls. CONCLUSION: The elevated plasma ?-EP following T-HS was involved in the suppression of cellular immunity.