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The World Health Organization (2019) has determined that patient safety is a global public health challenge. In UK clinical areas, policies and procedures are in place for the safe prescribing and delivery of blood and blood product transfusions, yet patient safety incidences continue. Undergraduate nurse education and training may provide the underlying knowledge to practitioners, while postgraduate standalone training sessions support skill development. However, over time, without regular experience, competence will diminish. Nursing students may have little exposure to transfusion practice and COVID-19 may have exacerbated this challenge with a reduction in placement availability. The use of simulation to support theory with follow-up and ongoing drop-in training sessions may help to inform practitioners and improve patient safety in the management and delivery of blood and blood product transfusion.
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COVID-19 , Education, Nursing, Baccalaureate , Nurses , Humans , Blood Transfusion , Education, Nursing, Baccalaureate/methods , Patient Safety , Clinical CompetenceABSTRACT
This review focuses on the characteristics of coronavirus disease-19 (COVID-19) including virus structure, ecoepidemiology and pathophysiology, signs and symptoms in infected people, and data on virus pathogenicity, severity, and survivability in COVID-19 infected patients. The emphasis is on immunological reactions, diagnosis, prophylactic methods, and the zoonotic significance of COVID-19. The authors feel that the review's contents will be valuable to epidemiologists, virologists, public health officials, diagnosticians, laboratory workers, environmentalists, and socioeconomic experts. It has information on the many types of coronavirus variants, the disease situation in Pakistan and the WHO criteria for COVID-19 prevention is given. Moreover, lessons learned from the COVID-19 pandemic are also outlined.
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[...]I specialised in clinical chemistry and transfusion science. Blood Transfusion is unique since you're providing products to patients, not solely reporting results. For Blood Transfusion in Northland, that means thinking of the people at component processing in Auckland who send us our orders of red cell components, as well as the doctors and nurses at the patient bedside, when making decisions.
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BackgroundFor patients with chronic, life limiting haematological conditions such as Myelodysplastic syndrome (MDS), regular transfusion for relief of symptoms of anaemia requires frequent attendance to acute hospital. Literature demonstrates MDS is associated with significant impairment and poor prognosis with critical palliative care needs.1 Opportunities to address these needs can be challenging in an acute environment.The Covid-19 pandemic led to a revision of services offered in St. Oswald’s Hospice Day Services with the development of a new Ambulatory Care service for patients requiring blood transfusion. This involves working with specialities to offer services to patients who would benefit from earlier palliative care support.MethodFollowing a successful pilot service we have continued to capture patient experience, patient need to access services available from palliative care MDT whilst working collaboratively with Haematology and Oncology services.Records were kept of MDT services accessed alongside collated patient feedback.ResultsFrom March to October 2021 there have been 13 patients with 86 attendances for blood transfusion:All patients had initial assessment with a senior palliative medicine Doctor5 patients have engaged in Advance Care Planning discussions3 patients reviewed by Physiotherapy6 patients received complementary therapy1 patient reviewed by social worker5 patients had medical review for specific symptom management1 patient assessed by lymphoedema specialist2 patients referred to music therapist1 patient admitted to the inpatient unit for observation overnight1 patient admitted for end of life care after outpatient attendanceFeedback has been very positive from patients and their familiesConclusionPatient feedback has been very positive with patients accessing palliative care services and engaging in ACP. Increasing the number of referrals to the service will continue to widen access to patients not typically referred until later in their disease process, promoting improved quality of life and Advance Care Planning.ReferenceNickolich M, El-Jawahri A, LeBlanc TW. Palliative and end-of-life care in myelodysplastic syndromes. Curr Hematol Malig Rep 2016;11:434–440.
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Background: Invasive medical procedures and their complications of Thalassemia Major still affect the quality of life of all patients and their caregivers. Aim: This study evaluates the experiences of parents of children with Thalassemia Major. Method: The qualitative phenomenological method was used to determine the parents' experiences. The study sample included 14 parents who met the inclusion criteria. Individual interviews, an introductory information form and a semi-structured interview form were used for data collection. The data were analyzed with Colaizzi's sevenstep method. Results: Four themes of the interviews were established: unprecedented psychosocial distress, social support, financial burden and concern about children in the future Parents stated that they experienced shock, sadness, fear, stress, depression, death anxiety, fatigue and burnout. Especially with the COVID-19 epidemic in our country, parents stated that their lives became more difficult and their concerns about their children increased. Conclusions: Healthcare staffs need to understand parents' psychosocial distress and coping strategies to provide support and guidance from the outset of treatment and care. It is recommended that interventions be planned and implemented in a way that maximizes the quality of life of children and families.
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Saving Blood Product in Nova Scotia Dr. Calvino Cheng, a staff hematopathologist at Queen Elizabeth II Health Sciences Centre (QEII), the centre's former Blood Transfusion Director and current Director of Pathology Informatics, and Professor in the Department of Pathology at Dalhousie University in Halifax, Nova Scotia, has developed an algorithm in conjunction with his colleague Dr. Jason Quinn, the Blood Transfusion Director at Queen Elizabeth II Health Sciences Centre. Theywere motivated to look at a strategy to minimize expired red blood cell units in the hospital's blood bank and improve the efficienc of the red cell inventory ordering process. The automated algorithm calculates the number of red blood cell units to be ordered from Canadian Blood Services based on both retrospective daily use and prospectively based on hemoglobin values on all patients in the hospital system. Bridging a Physical Gap for Patient Care in Alberta It was at a medical conference in late 2019 when Wade Hawkins, principal investigator at the Southern Alberta Institute for Technology's Centre for Innovation and Research in Unmanned Systems, had an informal chat with infectious diseases physician Dr. John Conly, a professor in the Cumming School of Medicine at the University of Calgary in Calgary, Alberta, about the concept of using drones to deliver medical supplies to remote First Nations communities.
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The acute respiratory distress syndrome (ARDS) is a life-threatening medical condition in which the lung is injured or inflamed to the degree that it cannot properly exchange gases and oxygenate the body. ARDS can be caused by a variety of conditions including trauma, severe blood loss, multiple or large volume blood transfusions, burns, and infections. The development of therapeutics that can limit the severity and/or progression of lung injuries that lead to ARDS and death is an immediate clinical need in both military and civilian sectors. Experimental studies carried out in small and large animals have demonstrated that specialized cells called mesenchymal stromal cells (MSC) can effectively reduce inflammation in multiple diseases including ARDS. The overall objective of this proposal is to carry out a randomized, blinded, placebo-controlled, multicenter phase 2b trial to test the therapeutic potential of allogeneic bone-marrow derived MSC for treating ARDS, with a major focus on civilian trauma patients. The specific aims of this project are: Specific Aim 1. To test the clinical efficacy of intravenously delivered allogeneic human MSC in patients with ARDS. Specific Aim 2. To test the mechanisms by which MSC reduce acute lung injury in patients with ARDS.
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Close to 40 of combat injuries sustained in Operation Iraqi Freedom and Operation Enduring Freedom involve severe extremity and craniofacial trauma. For many devastating injuries where conventional reconstruction is not possible, vascularized composite allotransplantation (VCA) has become a viable alternative, providing new, exciting options for Wounded Warriors that could better restore the appearance, anatomy, and function. However, clinical management of these injuries prior to reconstruction frequently requires multiple blood transfusion or skin allografts resulting in the formation of alloantibodies (anti-HLA IgG Abs, donor specific antibodies or DSA) and a high degree of sensitization. The role of DSA and mechanisms of antibody mediated rejection (AMR) in VCA are still largely unknown. To date, there is only one single experimental study published that has recently attempted to define the role of DSA in a rat model of vascularized osteomyocutaneous flap allotransplantation. As such, this project aims to comprehensively investigate the mechanisms and impact of pre-existing and de-novo DSA and AMR in in VCA. The goal is to develop a clinically translatable desensitization protocol that will subsequently broaden the eligible population for reconstructive transplantation to include those patients who have become sensitized to foreign antibodies
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Combat trauma-associated uncontrolled hemorrhage and coagulopathy remain the leading causes of morbidity and mortality in the military. Overwhelming evidence from military based resuscitation studies has indicated that platelet transfusion can significantly reduce these events in prolonged field care scenarios. However, platelet transfusion suffers from unique logistical and functional challenges in a far forward military setting, due to (i) limited availability and portability of platelet concentrates, (ii) special storage requirements to minimize platelet activation and granulation, (iii) high risk of bacterial contamination and (iv) very short shelf-life (3-5 days). Furthermore, blood type compatibility issues can limit early intervention. Other platelet-derived products, e.g., frozen (-80C), cold-stored (4C) or lyophilized platelets and platelet membrane-derived vesicle technologies (e.g. Infusible Platelet Membrane and Thrombosome)may suffer from similar limitations and performance variabilities. These challenges have led to robust research efforts for creating a shelf-stable, highly portable, readily deliverable platelet substitute that can mimic platelet-mediated mechanisms of hemostasis, while avoiding systemic immunogenicity and off-target harmful effects. To this end, we have created a lipid-peptide conjugate based synthetic platelet technology(SynthoPlateTM, US patent 9107845, TRL 4), that mimics the inherent platelet-mediated mechanisms of primary and secondary hemostasis in a bleeding site-selective fashion, without presenting systemic risks.
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Newly emerged pathogens such as SARS-CoV-2 highlight the urgent need for assays that detect levels of neutralizing antibodies that may be protective. We studied the relationship between anti-spike ectodomain (ECD) and anti-receptor binding domain (RBD) IgG titers, andSARS-CoV-2 virus neutralization (VN) titers generated by two different in vitro assays using convalescent plasma samples obtained from 68 COVID-19 patients, including 13 who donated plasma multiple times. Only 23% (16/68) of donors had been hospitalized. We also studied 16samples from subjects found to have anti-spike protein IgG during surveillance screening of asymptomatic individuals. We report a strong positive correlation between both plasma anti-RBD and anti-ECD IgG titers, and in vitro VN titer. Anti-RBD plasma IgG correlated slightly better than anti-ECD IgG titer with VN titer. The probability of a VN titer 160 was 80% or greater with anti-RBD or anti-ECD titers of 1:1350. Thirty-seven percent (25/68) of convalescent plasma donors lacked VN titers 160, the FDA-recommended level for convalescent plasma used for COVID-19 treatment. Dyspnea, hospitalization, and disease severity were significantly associated with higher VN titer. Frequent donation of convalescent plasma did not significantly decrease either VN or IgG titers. Analysis of 2,814 asymptomatic adults found 27 individuals with anti-RBD or anti-ECD IgG titers of 1:1350, and evidence of VN1:160. Taken together, we conclude that anti-RBD or anti-ECD IgG titers can serve as a surrogate for VN titers to identify suitable plasma donors. Plasma anti-RBD or anti-ECD titer of1:1350 may provide critical information about protection against COVID-19 disease.
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Many healthcare facilities now have limited clinical education contracts with local nursing programs (Organization of Nurse Leaders & Massachusetts/Rhode Island League for Nursing [ONL], 2020). According to Gubrud (2016), the clinical environment allows affective skill development. [...]preceptors must understand how limited clinical education experiences by the graduate nurse may affect the preceptor role. 1ШЗ REFERENCES Bloom, B.S. (1956).
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Background: The standard of care for stage I non-small cell lung cancer (NSCLC) is surgical resection. Stereotactic ablative radiotherapy (SABR) plays an important role in the management of early NSCLC in patients who are poor operative candidates, or more recently during the COVID-19 pandemic, as a bridge to surgery, when operating room access is limited. The impact of preoperative SABR on surgical resection has not been extensively explored in terms of length of hospital stay (LOS) and difficulty of surgical resection (DSR). Our unique published prospective MISSILE study afforded the opportunity to examine this. Methods: LOS and perioperative outcomes were assessed for patients with stage I NSCLC who received preoperative SABR and subsequent surgical resection (RS) within 10 weeks and compared with a similar cohort who underwent surgery alone (S) from 2014 to 2017 using a propensity-score matched analysis. DSR was assessed on the basis of operative time, blood transfusions, conversion rates (CR) and increased sublobar to lobar resection (SL). Results: Forty patients in the RS cohort were compared with 168 patients in the S cohort. Univariable and multivariable logistic regression models were generated as a comparison for all patients (n = 208). LOS was similar between the cohorts (mean 5.2 [standard deviation (SD) 4.7] d v. 4.3 [SD 2.2] d, p = 0.90). There were no differences between cohorts for blood transfusions (0% v. 0%), mean operative time (2.4 [SD 1.0] h v. 2.5 [SD 1.2] h, p = 0.60), conversion rates (21.9% v. 18.8%, p = 0.76) or increased SL (9.4% v. 0%, p = 0.24). Three patients who received radiotherapy did not proceed to surgery, 1 because of concerns of radiation pneumonitis. Conclusion: Preoperative SABR in patients with stage I NSCLC does not have a significant impact on the DSR and LOS.
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Despite the advances achieved in Medical Sciences, no substitute has been found for blood as a vital factor. Therefore, preparing sufficient and healthy blood in crisis conditions is a challenge that health systems encounter. Along with examining the conducted investigations in this field, the main contribution of current research is to develop a biobjective Mixed-Integer Linear Programming (MILP) model for relief supply under crisis condition. For this purpose, this paper proposes a model for routing of bus blood receiver under crisis conditions considering different blood groups. Besides, hours of unnecessary travel by bloodmobiles (buses) between each blood station (BS) and the crisis-stricken city for dispatching the collected blood is prevented thanks to considering a helicopter. The mentioned model has two objectives: maximizing the amount of blood collected by bloodmobiles and minimizing the arrival time of the blood receiver buses and a helicopter to a crisis-stricken city after the collected blood is used up. The model is coded by CPLEX software, and the results obtained from solving the model indicate that, without considering a helicopter, the demand is not supplied within the critical period after crisis. Given that blood cannot be artificially produced, its primary resource is blood donors. Concerning the importance of this issue under crisis conditions, this research investigates the relief vehicles’ routing problem, including bus and helicopter, in a crisis considering supply and transfer of different blood groups to a crisis-stricken city for maximum relief supply and blood transfer within the shortest period.
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BACKGROUND: The SARS-CoV-2 pandemic disrupted hospital operations, affected the blood supply, and challenged the health care system to develop new therapeutic options, including convalescent plasma (CCP). The aim of this study is to describe and analyze blood supply fluctuations and the use of convalescent plasma in 2020. METHODS: AABB distributed a weekly and biweekly questionnaire through email to hospital-based members (HBM). RESULTS: The survey was sent to 887 HBM with 479 unique respondents, most of the hospitals served pediatric and adult patients, and all states of the country participated, except Idaho and Vermont. Fifty four percent of HBM reported increased wastage in the early phase of the pandemic (May), which decreased to 4% by the end of June and throughout the rest of the year. The majority of HBM reported receiving alerts from their blood suppliers reporting blood shortages throughout the year. During March and April, only 12% of HBM were performing elective surgical procedures. The top reasons to delay procedures were: bed availability (28%); COVID-19 caseload (23%; and blood availability (19%). By mid-April, 42% HBM had transfused CCP and reported >24 h delay in getting the units; the vast majority obtained CCP using the Expanded Access Protocol, and later, the Emergency Use Authorization. HBM consistently prioritized the most severe patients to receive CCP, but the proportion of severely ill recipients fell from 52% to 37% between May and October, with an increase from 5% to 21% of HBM providing CCP transfusion early in the course of the disease. DISCUSSION: Blood utilization and availability fluctuated during the pandemic. The fluctuations appeared to be related to the number of COVID-19 in the community. The use and regulatory landscape of CCP rapidly evolved over the first 8 months of the pandemic.