Factors associated with nurses' poor knowledge and practice of transfusion safety procedures in Aquitaine, France.

OBJECTIVES: To (1) describe knowledge, attitudes, and reported practice of blood transfusion of nurses in Aquitaine's hospitals; (2) measure the potential threat for patient safety of poor transfusion-related knowledge and practice; and (3) identify factors associated with poor knowledge and practice. DESIGN: Survey conducted in 14 hospitals in Aquitaine (one university and 13 general hospitals). SETTING: Hospitalized care. PARTICIPANTS: A random sample of nurses. MATERIALS: Data were collected anonymously by investigators through structured individual interviews. The questionnaire contained mainly knowledge and practice questions about blood transfusion regulation. MAIN OUTCOME MEASURES: Hazardous knowledge and practice scores have been constructed, reflecting the levels of potential danger in the answers to the questionnaire. Factors associated with these scores have been studied using a random-effect linear regression. RESULTS: In our sample of 1090 nurses, poor knowledge and practice concerned mainly (1) the bedside blood compatibility test [proportion of responses (PR) with potential life threat between 12.7 and 35.5%]; (2) pre-transfusion compatibility check when receiving blood units (PR = 34.5%); (3) delay between screening of red cell antibodies and transfusion (PR = 20.5%); (4) delay in preservation of blood unit in the ward (PR = 33.4%); and (5) recognition of abnormal reactions after transfusion (PR = 47.1%). Frequency of transfusion and training were the factors most strongly associated with hazardous knowledge and practice scores. CONCLUSION: Low training and transfusion activity were key determinants of poor transfusion-related knowledge and practice.

Modelling of the probability of success of the stages of in-vitro fertilization and embryo transfer: stimulation, fertilization and implantation.

The aim of this study was to find the factors explaining the probability of success of in-vitro fertilization (IVF)-embryo transfer and its different stages: stimulation, fertilization and implantation. The sample came from a retrospective cohort followed in the IVF-embryo transfer centre of the Centre Hospitalier Universitaire of Pellegrin, Bordeaux, France; the data from 471 couples giving rise to 923 IVF-embryo transfer cycles were recorded. Four logistic regression models were specified for global process, stimulation, fertilization and implantation stages. Random effect models were used for taking into account the correlations of the different cycles for the same woman. The main outcome measures were: ongoing pregnancy, number of oocytes, number of embryos. A total of 135 ongoing pregnancies was observed. The significant explanatory variables were for global process: age [> or = 38 years: odds ratio (OR) = 0.28], donor sperm IVF-embryo transfer (OR = 2.1), number of ampoules (OR = 0.98), previous IVF-embryo transfer livebirth (OR = 2.36); for stimulation: age (> or = 35 years: OR = 0.38) and number of days of treatment > 13 days (OR = 0.20); for fertilization: accident during previous IVF-embryo transfer gestation (OR = 0.39), absolute tubal infertility (OR = 1.38) and the number of ampoules of human menopausal gonadotrophin (HMG) per day (OR = 0.85); for implantation: age (age > or = 38 years: OR = 0.34), donor sperm IVF-embryo transfer (OR = 4.58), number of ampoules (OR = 0.98), number and quality of the embryos. Estimates of the probabilities of success are also given for the global process.