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Vanstone MG, Krewulak K, Taneja S, Swinton M, Fiest K, Burns KEA, Debigare S, Dionne JC, Guyatt G, Marshall JC, Muscedere JG, Deane AM, Finfer S, Myburgh JA, Gouskos A, Rochwerg B, Ball I, Mele T, Niven DJ, English SW, Verhovsek M, Cook DJ. Patient-important upper gastrointestinal bleeding in the ICU: A mixed-methods study of patient and family perspectives. J Crit Care 2024; 81:154761. [PMID: 38447306 DOI: 10.1016/j.jcrc.2024.154761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial. DESIGN This was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding. SETTING Canada and the United States. PARTICIPANTS 51 ICU survivors and family members of ICU patients. RESULTS Participants considered gastrointestinal bleeding to be important if it resulted in death, disability, or prolonged hospitalization. The following also signaled patient-important upper gastrointestinal bleeding: blood transfusion, vasopressors, endoscopy, CT-angiography, or surgery. Whether an intervention evinced concern depended on its effectiveness, side-effects, invasiveness and accessibility; contextual influences included participant familiarity and knowledge of interventions and trust in the clinical team. CONCLUSIONS Survivors of critical illness and family members described patient-important upper gastrointestinal bleeding differently than current definitions of clinically-important upper gastrointestinal bleeding.
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Affiliation(s)
- Meredith G Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Karla Krewulak
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shipra Taneja
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marilyn Swinton
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sylvie Debigare
- Patient and Family Partnership Committee, Commission Scolaire Central Québec, Canadian Critical Care Trials Group, Canada
| | - Joanna C Dionne
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John C Marshall
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada; Department of Surgery, Unity Health Toronto, University of Toronto, Canada
| | - John G Muscedere
- Department of Critical Care Medicine, Queens University, Kingston Health Sciences Center
| | - Adam M Deane
- Department of Critical Care, University of Melbourne, Melbourne Medical School, Victoria, Australia
| | - Simon Finfer
- Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, School of Public Health, Imperial College London, London, England, United Kingdom
| | - John A Myburgh
- Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Audrey Gouskos
- Patient and Family Advisory Committee and Steering Committee representative, FAST-NAWC Trial, University of Toronto, Canada
| | - Bram Rochwerg
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, Ontario, Canada.; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Tina Mele
- Department of Critical Care Medicine, Western University, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Madeleine Verhovsek
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, St. Joseph's Healthcare Hamilton.
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Bolcato M, Jommi C. Shortage of plasma-derived medicinal products: what is next? narrative literature review on its causes and counteracting policies in Italy. Front Pharmacol 2024; 15:1375891. [PMID: 38769998 PMCID: PMC11102971 DOI: 10.3389/fphar.2024.1375891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction: This paper describes the peculiarities of the plasma-derived medicinal product (PDMP) market and illustrates the results of a review of the literature on policies aimed at counteracting the shortage of PDMPs. Characteristics of PDMPs: Plasma is primarily used for the industrial production of blood products (80%). The demand for PDMPs, particularly immunoglobulins (IGs), is increasing. However, the production of PDMPs is complex, long (7-12 months), and expensive, accounting, according to US estimates, for 57% of the total costs of PDMPs compared to 14% for small molecules. PDMP market: Unexpected increases in clinical need cannot be addressed in the short term. Once the demand for some diseases is satisfied, the collection and fractionation of plasma will only be used to supply some specific patients. Hence, the full weight of the marginal costs, which remain constant, are borne by a few products. According to last liter economics, the industry stops producing when the marginal revenue equals the marginal cost, thereby reducing the convenience of producing the most commonly used PDMPs (albumin and IG). The imbalance between the demand and supply of PDMPs was exacerbated by the COVID-19 pandemic, which further increased the cost of plasma collection. Shortage issue and possible solutions: Policies to counteract this imbalance have also been discussed. If the demand is inappropriate, it should be reduced. If the demand is appropriate and supply cannot be increased, the demand should be prioritized for patients for whom PDMPs are the only available treatment. If the shortage depends on insufficient supply and technical and allocative efficiency, both production and supply should be improved, together with incentives for all stakeholders involved in the PDMP market to increase the sustainability of production/supply. The paper is focused on this second issue, that is supply-driven unbalance.
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Affiliation(s)
- Matteo Bolcato
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Lo BD, Pippa A, Sherd I, Scott AV, Thomas AJ, Hendricks EA, Ness PM, Chaturvedi S, Resar LMS, Frank SM. Clinical Outcomes, Blood Utilization, and Ethical Considerations for Pediatric Patients in a Bloodless Medicine and Surgery Program. Anesth Analg 2024; 138:465-474. [PMID: 38175737 DOI: 10.1213/ane.0000000000006776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Pediatric patients requesting bloodless care represent a challenging clinical situation, as parents cannot legally refuse lifesaving or optimal interventions for their children. Here, we report clinical outcomes for the largest series of pediatric inpatients requesting bloodless care and also discuss the ethical considerations. METHODS We performed a single-institution retrospective cohort study assessing 196 pediatric inpatients (<18 years of age) who requested bloodless care between June 2012 and June 2016. Patient characteristics, transfusion rates, and clinical outcomes were compared between pediatric patients receiving bloodless care and those receiving standard care (including transfusions if considered necessary by the clinical team) (n = 37,271). Families were informed that all available measures would be undertaken to avoid blood transfusions, although we were legally obligated to transfuse blood if the child's life was threatened. The primary outcome was composite morbidity or mortality. Secondary outcomes included percentage of patients transfused, individual morbid events, length of stay, total hospital charges, and total costs. Subgroup analyses were performed after stratification into medical and surgical patients. RESULTS Of the 196 pediatric patients that requested bloodless care, 6.1% (n = 12) received an allogeneic blood component, compared to 9.1% (n = 3392) for standard care patients ( P = .14). The most common indications for transfusion were perioperative bleeding and anemia of prematurity. None of the transfusions were administered under a court order. Overall, pediatric patients receiving bloodless care exhibited lower rates of composite morbidity compared to patients receiving standard care (2.6% vs 6.2%; P = .035). There were no deaths in the bloodless cohort. Individual morbid events, length of stay, and total hospital charges/costs were not significantly different between the 2 groups. After multivariable analysis, bloodless care was not associated with a significant difference in composite morbidity or mortality (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.12-1.11; P = .077). CONCLUSIONS Pediatric patients receiving bloodless care exhibited similar clinical outcomes compared to patients receiving standard care, although larger studies with adequate power are needed to confirm this finding. There were no mortalities among the pediatric bloodless cohort. Although a subset of our pediatric bloodless patients received an allogeneic transfusion, no patients required a court order. When delivered in a collaborative and patient-centered manner, blood transfusions can be safely limited among pediatric patients.
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Affiliation(s)
- Brian D Lo
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Pippa
- Department of Anesthesiology and Critical Care Medicine
| | | | | | | | | | - Paul M Ness
- Department of Pathology (Transfusion Medicine)
| | | | - Linda M S Resar
- Center for Bloodless Medicine and Surgery, Department of Medicine (Hematology), Oncology, Pathology & Institute for Cellular Engineering
| | - Steven M Frank
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Health System Blood Management Program, Faculty, The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Gammon RR, Dubey R, Gupta GK, Hinrichsen C, Jindal A, Lamba DS, Mangwana S, Radhakrishnan Nair A, Nalezinski S, Bocquet C. Patient Blood Management and Its Role in Supporting Blood Supply. J Blood Med 2023; 14:595-611. [PMID: 38053640 PMCID: PMC10695136 DOI: 10.2147/jbm.s387322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
Blood donors and voluntary blood donations are essential for ensuring the blood supply that can be maintained by good patient blood management (PBM) practices. This review article explores the role of blood donation in PBM and highlights the importance of donor screening and selection processes in different regions worldwide. The donor health questionnaires and the focused physical examination guidelines have changed in the last decade to increase donor and recipient safety. This article also discusses the status of transfusion practices, including the challenges of ensuring a safe blood supply. Significant among these are the effects of the COVID-19 pandemic on the blood supply chain and the impact of an aging donor population, especially. Promoting autologous donations and other blood conservation strategies are suggested to mitigate these issues. The role of replacement donors and the upper age limit for voluntary blood donation may be decided based on the demography and donor pool. The involvement of C-suite executives is also critical in implementing and running a successful PBM program. The review highlights how these different aspects of blood donation are integral to a successful PBM program and the safety of patients who receive blood transfusions.
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Affiliation(s)
- Richard R Gammon
- Scientific, Medical and Technical Department, OneBlood, Orlando, FL, USA
| | - Rounak Dubey
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Gaurav K Gupta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen Hinrichsen
- Department of Transfusion Medicine, Princeton Medical Center at Penn Medicine, Plainsboro, NJ, USA
| | - Aikaj Jindal
- Department of Transfusion Medicine, Mohandas Oswal Hospital, Ludhiana, India
| | - Divjot Singh Lamba
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sadhana Mangwana
- Department of Transfusion Medicine and Immunohematology, Sri Balaji Action Medical Institute, New Delhi, India
| | - Amita Radhakrishnan Nair
- Department of Transfusion Medicine Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram, Kerala, India
| | - Shaughn Nalezinski
- Department of Laboratory Medicine - Transfusion Services, Concord Hospital, Concord, NH, USA
| | - Christopher Bocquet
- Association for the Advancement of Blood and Biotherapies, Bethesda, MD, USA
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Kazamer A, Ilinca R, Vesa S, Lorenzovici L, Stanescu-Spinu II, Ganea I, Greabu M, Miricescu D, Biczo A, Ionescu D. A Potential Indicator for Assessing Patient Blood Management Standard Implementation. Healthcare (Basel) 2023; 11:2233. [PMID: 37628431 PMCID: PMC10454481 DOI: 10.3390/healthcare11162233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/13/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Patient blood management (PBM) program as a multidisciplinary practice and a standard of care for the anemic surgical patient has an increasingly important role in reducing transfusions and optimizing both clinical outcomes and costs. Documented success of PBM implementation is not sufficient for implementation of recommendations and correct use at hospital level. The primary objective of our study was to define a composite patient blood management process safety index-Safety Index in PBM (SIPBM)-that measures the impact of screening and treating anemic patients on the efficiency and effectiveness of the patient care process undergoing elective surgery. (2) Methods: We conducted a retrospective comparative study in a tertiary hospital by collecting data and analyzing the Safety Index in PBM (SIPBM) in patients undergoing major elective surgical procedures. (3) Results: The percentage of patients from the total of 354 patients (178 in 2019 and 176 in 2022) included in the study who benefited from preoperative iron treatment increased in 2022 compared to 2019 from 27.40% to 36.71%. The median value of the SIPBM was 1.00 in both periods analyzed, although there is a significant difference between the two periods (p < 0.005), in favor of 2022. (4) Conclusions: Measuring the effectiveness of PBM implementation and providing ongoing feedback through the Safety Index in PBM (SIPBM) increases the degree to which opportunities to improve the PBM process are identified. The study represents a first step for future actions and baselines to develop tools to measure the safety and impact of the patient blood management process in the surgical field.
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Affiliation(s)
- Andrea Kazamer
- CREST Association, 48 Alexandru Odobescu Street, 440069 Satu Mare, Romania
- Department of Anaesthesia and Intensive Care I, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; (S.V.); (D.I.)
| | - Radu Ilinca
- Discipline of Medical Informatics and Biostatistics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 4-6 Eforie Street, 050037 Bucharest, Romania
| | - Stefan Vesa
- Department of Anaesthesia and Intensive Care I, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; (S.V.); (D.I.)
| | - Laszlo Lorenzovici
- Faculty of Technical and Human Sciences, Sapientia Hungarian University of Transylvania, 4 Matei Corvin Street, 400112 Cluj-Napoca, Romania;
| | - Iulia-Ioana Stanescu-Spinu
- Discipline of Biochemistry, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania; (I.-I.S.-S.); (M.G.); (D.M.)
| | - Ionela Ganea
- Department of Modern Languages, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania;
| | - Maria Greabu
- Discipline of Biochemistry, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania; (I.-I.S.-S.); (M.G.); (D.M.)
| | - Daniela Miricescu
- Discipline of Biochemistry, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania; (I.-I.S.-S.); (M.G.); (D.M.)
| | - Andras Biczo
- Department Hamm 2 Manufacturing and Production Technology, Hamm-Lippstadt University of Applied Sciences, Allee 76-78, D-59063 Hamm, Germany;
| | - Daniela Ionescu
- Department of Anaesthesia and Intensive Care I, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; (S.V.); (D.I.)
- Outcome Research Consortium, Cleveland, OH 44195, USA
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Hsieh MY, Chen JS, Yin CH. Investigation of the patients with recurrent acute transfusion reactions: A single tertiary medical centre experience. J Int Med Res 2023; 51:3000605231181733. [PMID: 37421139 DOI: 10.1177/03000605231181733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE To assess the spectrum of patients who developed recurrent acute transfusion reactions (TRs) and to characterize these recurrent TRs. METHODS This retrospective study included patients who developed ≥2 acute TRs between April 2017 and March 2020 in a tertiary medical centre. RESULTS Among 216 TRs that occurred after 2024 transfusions in 87 patients, 66 (75.9%) patients reported a history of transfusions before the first TR and 70 (80.5%) patients received further transfusions after the last TR; with the same type of TR and reaction to the same type of blood product observed in 59 (67.8%) patients and 56 (64.4%) patients, respectively. TRs were most commonly associated with packed red blood cell (PRBC) transfusions and a febrile non-haemolytic transfusion reaction (FNHTR) was the most common type of TR. However, leukocyte reduced (LR) PRBCs were less common than LR platelets among transfusions with TR (22.7% [27/119] versus 75.0% [57/76], respectively) and premedication was prescribed before 196 of 216 (90.7%) transfusions with TR. CONCLUSION Most patients with recurrent TRs received repeated transfusions in addition to transfusions with TR. Instead of considering premedication, an increase in the use of LR might be the strategy to reduce the recurrence of TR.
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Affiliation(s)
- Ming-Yun Hsieh
- Department of Paediatrics, Kaohsiung Veterans General Hospital, Kaohsiung
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung
- Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung
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Ubbink R, Streng LWJM, Raat NJH, Harms FA, Te Boekhorst PAW, Stolker RJ, Mik EG. Measuring Mitochondrial Oxygen Tension during Red Blood Cell Transfusion in Chronic Anemia Patients: A Pilot Study. Biomedicines 2023; 11:1873. [PMID: 37509512 PMCID: PMC10376882 DOI: 10.3390/biomedicines11071873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
In light of the associated risks, the question has been raised whether the decision to give a blood transfusion should solely be based on the hemoglobin level. As mitochondria are the final destination of oxygen transport, mitochondrial parameters are suggested to be of added value. The aims of this pilot study were to investigate the effect of a red blood cell transfusion on mitochondrial oxygenation as measured by the COMET device in chronic anemia patients and to explore the clinical usability of the COMET monitor in blood transfusion treatments, especially the feasibility of performing measurements in an outpatient setting. To correct the effect of volume load on mitochondrial oxygenation, a red blood cell transfusion and a saline infusion were given in random order. In total, 21 patients were included, and this resulted in 31 observations. If patients participated twice, the order of infusion was reversed. In both the measurements wherein a blood transfusion was given first and wherein 500 mL of 0.9% saline was given first, the median mitochondrial oxygen tension decreased after red blood cell transfusion. The results of this study have strengthened the need for further research into the effect of blood transfusion tissue oxygenation and the potential role of mitochondrial parameters herein.
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Affiliation(s)
- Rinse Ubbink
- Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Lucia W J M Streng
- Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Nicolaas J H Raat
- Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Floor A Harms
- Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Peter A W Te Boekhorst
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Robert J Stolker
- Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Egbert G Mik
- Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
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Castro-Olmo F, Morales-Fernández P, Alcaide-Martín M, Fernández-Puntero B, Quintana-Díaz M, Aceña-Gil V. Minimizar el volumen de descarte para la extracción de muestras sanguíneas en los pacientes críticos: ¿es factible? ENFERMERIA INTENSIVA 2023. [DOI: 10.1016/j.enfi.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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9
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Jericó C, Puértolas N, Osorio J, Miranda C, Santamaría M, Artigau E, Galofré G, Garsot E, Luna A, Aldeano A, Olona C, Pulido L, Pera M. Cost analysis of a patient blood management program for patients undergoing gastric cancer surgery. Eur J Surg Oncol 2023; 49:293-297. [PMID: 36163062 DOI: 10.1016/j.ejso.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 01/24/2023] Open
Abstract
Patient Blood Management (PBM) programs have probed to reduce blood transfusions and postoperative complications following gastric cancer resection, but evidence on their economic benefit is scarce. A recent prospective interventional study of our group described a reduction in transfusions, infectious complications and length of stay after implementation of a multicenter PBM program in patients undergoing elective gastric cancer resection with curative intent. The aim of the present study was to analyze the economic impact associated with these clinical benefits. The mean [and 95% CI] of total healthcare cost per patient was lower (-1955 [-3764, -119] €) after the PBM program implementation. The main drivers of this reduction were the hospital stay (-1847 [-3161, -553] €), blood transfusions (-100 [-145, -56] €), and post-operative complications (-162 [-718, 411] €). Total societal cost was reduced by -2243 [-4244, -210] € per patient. These findings highlight the potential economic benefit of PBM strategies.
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Affiliation(s)
- Carlos Jericó
- Service of Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - Noelia Puértolas
- Department of Surgery, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
| | - Javier Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain.
| | - Coro Miranda
- Service of Surgery, Hospital Universitario de Navarra, Pamplona, Spain.
| | - Maite Santamaría
- Service of Surgery, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - Eva Artigau
- Service of Surgery, Hospital Universitari Josep Trueta, Girona, Spain.
| | - Gonzalo Galofré
- Service of Surgery, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - Elisenda Garsot
- Service of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
| | - Alexis Luna
- Service of Surgery, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain.
| | - Aurora Aldeano
- Service of Surgery, Hospital General de Granollers, Granollers, Barcelona, Spain.
| | - Carles Olona
- Service of Surgery, Hospital Universitari de Tarragona, Joan XXIII, Tarragona, Spain.
| | - Laura Pulido
- Service of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
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Implementing patient-centred decision making in peri-operative patient blood management. Eur J Anaesthesiol 2023; 40:1-3. [PMID: 36479986 DOI: 10.1097/eja.0000000000001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Castro-Olmo FJ, Morales-Fernández P, Alcaide-Martín MJ, Fernández-Puntero B, Quintana-Díaz M, Aceña-Gil V. Is minimising waste volume for drawing blood samples in critically ill patients feasible? ENFERMERIA INTENSIVA 2023; 34:19-26. [PMID: 36774248 DOI: 10.1016/j.enfie.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/07/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Drawing blood samples through a central venous catheter (CVC) is a customary practice in Intensive Care Units (ICUs). It is indicated to discard a volume of waste blood to avoid interference in the results. AIM To determine whether a lower discard volume for obtaining blood samples from temporary CVCs placed into the internal jugular, femoral or subclavian vein offers valid results. METHOD A quasi-experimental prospective cross-sectional study for which sixty-five patients of over 18 years of age in ICUs, who had been fitted with a triple lumen central venous catheter, were recruited over a period of eight months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and hemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5 ml from a total extracted volume of 10.2 ml, similar to the usual waste in our ambit (10 ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between methods. The reference change value (RCV) was established as the admissible limit of variation between the pairs of samples. RESULTS A total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α = .05 for chlorine (-.536; .012); prothrombin time (-.092; .019) and prothrombin activity (.284; 1.375).The ICC was greater than .9 in all the variables and the limit determined for the RCV was not surpassed by any value. CONCLUSIONS The results show the reliability of the blood samples drawn with a discard volume of 1.5 ml.
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Affiliation(s)
- F J Castro-Olmo
- Unidad de Cirugía Plástica, Reparadora y Quemados, Hospital Universitario La Paz, Madrid, Spain.
| | - P Morales-Fernández
- Unidad de Cirugía Plástica, Reparadora y Quemados, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - M Quintana-Díaz
- Unidad de Quemados Críticos, Hospital Universitario La Paz, Madrid, Spain
| | - V Aceña-Gil
- Data Science Laboratory (DSLAB), Universidad Rey Juan Carlos, Móstoles, Madrid, Spain
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12
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Magaldi M, de Santos P, Basora M. Patient Blood Management en ginecología. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Delgado C, Komatsu R. Patient Blood Management programs for post-partum hemorrhage. Best Pract Res Clin Anaesthesiol 2022; 36:359-369. [PMID: 36513431 DOI: 10.1016/j.bpa.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
Patient blood management (PBM) strategies aim to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Because postpartum hemorrhage (PPH) is a leading cause of maternal mortality and blood product utilization, PBM principles can be applied in its therapeutic approach. First, pre-operative identification of risk factors for PPH and identification of peri-delivery anemia should be conducted. Iron supplementation should be used to optimize hemoglobin concentration before delivery; it can also be used to treat anemia in the postpartum period after severe PPH. Both acute normovolemic hemodilution and intraoperative cell salvage can be effective techniques to reduce allogeneic blood transfusion during or after surgical procedures. Furthermore, these strategies appear to be safe when used in the pregnant population.
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Affiliation(s)
- Carlos Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356340, Seattle, WA 98195, USA.
| | - Ryu Komatsu
- Department of General Anesthesiology and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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14
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Hofmann A, Shander A, Blumberg N, Hamdorf JM, Isbister JP, Gross I. Patient Blood Management: Improving Outcomes for Millions While Saving Billions. What Is Holding It Up? Anesth Analg 2022; 135:511-523. [PMID: 35977361 DOI: 10.1213/ane.0000000000006138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patient blood management (PBM) offers significantly improved outcomes for almost all medical and surgical patient populations, pregnant women, and individuals with micronutrient deficiencies, anemia, or bleeding. It holds enormous financial benefits for hospitals and payers, improves performance of health care providers, and supports public authorities to improve population health. Despite this extraordinary combination of benefits, PBM has hardly been noticed in the world of health care. In response, the World Health Organization (WHO) called for its 194 member states, in its recent Policy Brief, to act quickly and decidedly to adopt national PBM policies. To further support the WHO's call to action, this article addresses 3 aspects in more detail. The first is the urgency from a health economic perspective. For many years, growth in health care spending has outpaced overall economic growth, particularly in aging societies. Due to competing economic needs, the continuation of disproportionate growth in health care spending is unsustainable. Therefore, the imperative for health care leaders and policy makers is not only to curb the current spending rate relative to the gross domestic product (GDP) but also to simultaneously improve productivity, quality, safety of patient care, and the health status of populations. Second, while PBM meets these requirements on an exceptional scale, uptake remains slow. Thus, it is vital to identify and understand the impediments to broad implementation. This includes systemic challenges such as the so-called "waste domains" of failure of care delivery caused by malfunctions of health care systems, failure of care coordination, overtreatment, and low-value care. Other impediments more specific to PBM are the misperception of PBM and deeply rooted cultural patterns. Third, understanding how the 3Es-evidence, economics, and ethics-can effectively be used to motivate relevant stakeholders to take on their respective roles and responsibilities and follow the urgent call to implement PBM as a standard of care.
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Affiliation(s)
- Axel Hofmann
- From the Faculty of Health and Medical Sciences, Discipline of Surgery, The University of Western Australia, Perth, Western Australia, Australia.,Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Aryeh Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, New Jersey.,College of Medicine, University of Florida, Gainesville, Florida.,School of Medicine at Mount Sinai, New York, New York.,Rutgers University, Newark, New Jersey
| | - Neil Blumberg
- Department of Pathology and Laboratory Medicine, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey M Hamdorf
- From the Faculty of Health and Medical Sciences, Discipline of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - James P Isbister
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Irwin Gross
- Department of Medicine, Eastern Maine Medical Center, Bangor, Maine
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15
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Schmidbauer SL, Seyfried TF. Cell Salvage at the ICU. J Clin Med 2022; 11:3848. [PMID: 35807132 PMCID: PMC9267827 DOI: 10.3390/jcm11133848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
Patient Blood Management (PBM) is a patient-centered, systemic and evidence-based approach. Its target is to manage and to preserve the patient's own blood. The aim of PBM is to improve patient safety. As indicated by several meta-analyses in a systematic literature search, the cell salvage technique is an efficient method to reduce the demand for allogeneic banked blood. Therefore, cell salvage is an important tool in PBM. Cell salvage is widely used in orthopedic-, trauma-, cardiac-, vascular and transplant surgery. Especially in cases of severe bleeding cell salvage adds significant value for blood supply. In cardiac and orthopedic surgery, the postoperative use for selected patients at the intensive care unit is feasible and can be implemented well in practice. Since the retransfusion of unwashed shed blood should be avoided due to multiple side effects and low quality, cell salvage can be used to reduce postoperative anemia with autologous blood of high quality. Implementing quality management, compliance with hygienic standards as well as training and education of staff, it is a cost-efficient method to reduce allogeneic blood transfusion. The following article will discuss the possibilities, legal aspects, implementation and costs of using cell salvage devices in an intensive care unit.
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Affiliation(s)
- Stephan L. Schmidbauer
- Department of Anesthesiology, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Timo F. Seyfried
- Department of Anesthesiology, Ernst von Bergmann Hospital, 14467 Potsdam, Germany
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16
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Cheung YT, Lam PH, Lam HHW, Ma CT, Leung AWK, Wong RSM, Li CK. Treatment Adherence and Health-Related Quality of Life in Patients with Hemophilia in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116496. [PMID: 35682087 PMCID: PMC9180237 DOI: 10.3390/ijerph19116496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Background: This study aims to identify factors affecting health-related quality of life (HRQoL) in Chinese patients with hemophilia in Hong Kong, and to examine the association between treatment adherence and HRQoL outcomes. Methods: Patients with hemophilia A or B from a non-governmental organization reported their HRQoL and treatment adherence to prophylactic therapy using validated tools. Univariate tests and multivariable regression analysis were used to compare differences in outcomes across clinically relevant subgroups. Results: Fifty-six patients were recruited (mean age 30.4 [17.4] years; majority hemophilia A: 75%; moderate-to-severe severity: 88%). Patients who received prophylactic treatment reported fewer work/school problems (25.8 [18.9] versus 51.5 [26.3]; p = 0.001) than those who received on-demand therapy. The multivariable model showed that older age (B = 0.42, 95% CI = 0.093−0.75) and living in public housing (B = 10.24, 95% CI = 0.70−19.77) were associated with worse HRQoL. Older age was associated with treatment non-adherence (r = 0.66, p < 0.0001). Patients with poor adherence tended to report worse functioning in sports/leisure (r = 0.31, p = 0.033). Conclusions: Our results suggest that patients who were older, had lower education attainment and received on-demand treatment had poorer perception of their health. Improving adherence may lead to better HRQoL. Future work includes evaluating the occupational needs prospectively in this population.
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Affiliation(s)
- Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
- Correspondence: ; Tel.: +852-3943-6833; Fax: +852-2603-5295
| | - Pok Hong Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (P.H.L.); (A.W.K.L.); (C.K.L.)
| | | | - Chung-Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Alex Wing Kwan Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (P.H.L.); (A.W.K.L.); (C.K.L.)
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond Siu Ming Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Chi Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (P.H.L.); (A.W.K.L.); (C.K.L.)
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
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17
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Impact of Fortified Infant Cereals on the Burden of Iron Deficiency Anemia in 6- to 23-Month-Old Indonesian Infants and Young Children: A Health Economic Simulation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095416. [PMID: 35564811 PMCID: PMC9105951 DOI: 10.3390/ijerph19095416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 01/27/2023]
Abstract
Iron deficiency and iron deficiency anemia (IDA) are highly prevalent among Indonesian infants and young children (IYC). Severe IDA hampers mental development in young children and is linked to lower quality of life and lower productivity as adults. The consumption of fortified infant cereals (FIC) increases iron intake during the weaning period, thus reducing the social burden of IDA. In this manuscript, we aimed to assess the impact of FIC on the burden of IDA on IYC in Indonesia. We analyzed data for IYC aged 6–23 months from the fifth wave (2014–2015) of the Indonesia Family Life Survey (IFLS) and the Indonesia Demographic and Health Survey 2017 (IDHS-17). We adapted a health economic simulation model to estimate the impact of FIC that accounted for lifetime health and cost consequences in terms of reduced future income and DALYs. The mean Hb level was 10.5 ± 1.4 g/dL. Consumers of FIC had a reduced burden of disease (43,000 DALYs; USD 171 million) compared with non-consumers. The consumption of fortified infant cereals plays an important role in reducing the burden of IDA, and it might complement the available strategy of nutritional interventions to address this problem in Indonesian IYC.
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18
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Bolcato M, Rodriguez D, Aprile A. Guiding Principles for Surgical Pathways: A Tool for Improving Outcomes and Patient Safety. Front Public Health 2022; 10:869607. [PMID: 35462846 PMCID: PMC9024031 DOI: 10.3389/fpubh.2022.869607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Surgical activity is an important aspect for the management of health and safety processes and from an organizational perspective is one of the most complex activities performed in hospitals. It is often a defining and high value feature for any healthcare facility while being one of the most high-risk procedures for patients with the highest number of avoidable adverse events. To ensure effective management of surgical pathways, they need to be considered from the perspective of clinical governance which takes a global approach to planning and management with the goal of improving safety and quality for patients. This paper contains the main features of this objective outlined within the document issued subsequent to the State-Regional Italian Government conference. This regulatory effort includes effective recommendations to make surgical pathways safer and more efficient with particular reference to lean management, patient blood management and patient safety.
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19
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Yazman S, Karaagac E, Iner H, Yesilkaya NK, Eygi B, Yakut N, Yurekli I, Gurbuz A. Impact of Preoperative Embolization on Carotid Body Tumor Surgery. Ann Vasc Surg 2022; 84:155-162. [PMID: 35247534 DOI: 10.1016/j.avsg.2022.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/02/2022] [Accepted: 01/25/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES In this study, investigation of the effect of preoperative carotid body tumor embolization (CBTE) on the amount of bleeding, vascular and neurological complications in carotid body tumors was aimed. METHODS 50 patients treated for 51 carotid body tumors in 2 clinics, between 2005 and 2020 were evaluated. Polyvinyl alcohol (PVA) embolization of the carotid body tumor was performed in 23 patients before the surgical excision. The results were compared with the remaining 28 patients, whom CBTE was not performed, in terms of neurological complications, requirement of additional vascular interventions, bleeding amount, and length of hospital stay. RESULTS Mean bleeding amount was significantly lower in CBTE group (406ml-217ml p<0.05). Median erythrocyte suspension (ES) transfusion was significantly lower in the CBTE group (0.3 units vs. 1.1 units, p<0.05). Neurological deficits developed in a total of 13 patients, 6 of whom were in the CBTE group and 7 in the non-CBTE group, in the early postoperative period (p=0.90). No significant difference was observed between the groups in terms of additional vascular interventions and length of hospital stay (p=0.79 and p=0.61). CONCLUSIONS Carotid body tumors are rarely encountered tumors. However, their surgical excision is challenging for surgeons regarding intraoperative and postoperative bleeding. This study demonstrates that preoperative CBTE significantly reduces the amount of bleeding, especially in Shamblin II/III tumors.
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Affiliation(s)
- Serkan Yazman
- Department of Cardiovascular Surgery, Mugla Sitki Kocman University, Faculty of Medicine, Mugla, Turkey
| | - Erturk Karaagac
- Department of Cardiovascular Surgery, Mus State Hospital, Mus, Turkey.
| | - Hasan Iner
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
| | - Nihan Karakas Yesilkaya
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
| | - Bortecin Eygi
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
| | - Necmettin Yakut
- Department of Cardiovascular Surgery, AKUT Heart Vascular Hospital, Izmir, Turkey
| | - Ismail Yurekli
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
| | - Ali Gurbuz
- Department of Cardiovascular Surgery, Katip Celebi University, Faculty of Medicine, Izmir, Turkey
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20
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Hofmann A, Aapro M, Fedorova TA, Zhiburt YB, Snegovoy AV, Kaganov OI, Ognerubov NA, Lyadov VK, Moiseenko VM, Trofimova OP, Ashrafyan LA, Khasanov RS, Poddubnaya IV. Patient blood management in oncology in the Russian Federation: Resolution to improve oncology care. J Cancer Policy 2022; 31:100315. [DOI: 10.1016/j.jcpo.2021.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/31/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
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21
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Shander A, Hardy JF, Ozawa S, Farmer SL, Hofmann A, Frank SM, Kor DJ, Faraoni D, Freedman J. A Global Definition of Patient Blood Management. Anesth Analg 2022; 135:476-488. [PMID: 35147598 DOI: 10.1213/ane.0000000000005873] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
While patient blood management (PBM) initiatives are increasingly adopted across the globe as part of standard of care, there is need for a clear and widely accepted definition of PBM. To address this, an expert group representing PBM organizations, from the International Foundation for Patient Blood Management (IFPBM), the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), the Society for the Advancement of Patient Blood Management (SABM), the Western Australia Patient Blood Management (WAPBM) Group, and OnTrac (Ontario Nurse Transfusion Coordinators) convened and developed this definition: "Patient blood management is a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment." The definition emphasizes the critical role of informed choice. PBM involves the timely, multidisciplinary application of evidence-based medical and surgical concepts aimed at screening for, diagnosing and appropriately treating anemia, minimizing surgical, procedural, and iatrogenic blood losses, managing coagulopathic bleeding throughout the care and supporting the patient while appropriate treatment is initiated. We believe that having a common definition for PBM will assist all those involved including PBM organizations, hospital administrators, individual clinicians and policy makers to focus on the appropriate issues when discussing and implementing PBM. The proposed definition is expected to continue to evolve, making this endeavor a work in progress.
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Affiliation(s)
- Aryeh Shander
- From the Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, New Jersey.,Society for the Advancement of Patient Blood Management (SABM), Mount Royal, New Jersey
| | - Jean-Francois Hardy
- Department of Anaesthesiology and Pain Medicine, Université de Montréal, Montréal, Quebec, Canada.,Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), Paris, France
| | - Sherri Ozawa
- Society for the Advancement of Patient Blood Management (SABM), Mount Royal, New Jersey.,Institute for Patient Blood Management and Bloodless Medicine and Surgery, Englewood Health, Englewood, New Jersey
| | - Shannon L Farmer
- Medical School and Division of Surgery, Faculty of Medicine and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia.,International Foundation for Patient Blood Management, Basel, Switzerland.,The Western Australia Patient Blood Management Group, The University of Western Australia, Perth, Western Australia, Australia
| | - Axel Hofmann
- Medical School and Division of Surgery, Faculty of Medicine and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,International Foundation for Patient Blood Management, Basel, Switzerland.,Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Steven M Frank
- Department of Anesthesiology, Critical Care Medicine, Johns Hopkins Health System Patient Blood Management Program, The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | - Daryl J Kor
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Michigan.,Patient Blood Management Program, Mayo Clinic, Rochester, Michigan
| | - David Faraoni
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), Paris, France.,Department of Anesthesiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Freedman
- Ontario Nurse Transfusion Coordinators Program (ONTraC), Ontario, Canada.,The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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22
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BOLCATO M, SANAVIO M, FASSINA G, RODRIGUEZ D, APRILE A. Organizational liability: new frontier of medical malpractice? Seventeen-year experience as a medico-legal observer. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.20.04461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Hendrikx J, Timmers M, AlTmimi L, Hoogma DF, De Coster J, Fieuws S, Herijgers P, Rega F, Verbrugghe P, Rex S. Fast-Track Failure After Cardiac Surgery: Risk Factors and Outcome With Long-Term Follow-Up. J Cardiothorac Vasc Anesth 2021; 36:2463-2472. [PMID: 35031218 DOI: 10.1053/j.jvca.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES An important cornerstone of the Enhanced Recovery After Cardiac Surgery initiative is a fast-track cardiac anesthesia management protocol. Fast-track failure has been described to have a detrimental impact on immediate postoperative outcomes. The authors here evaluated risk factors for short- and long-term effects of fast-track failure. DESIGN A retrospective cohort study. SETTING A single academic center. PARTICIPANTS Adult cardiac surgery was performed on 7,064 patients between January 2013 and October 2019. INTERVENTION The inclusion criteria for the fast-track program at the postanesthesia care unit were met by 1,097 patients. MEASUREMENTS AND MAIN RESULTS Univariate and multivariate logistic regression analyses were used to identify independent risk factors. Fast-track failure occurred in 69 (6.3%) patients. These were associated with significant increases in the incidences of coronary revascularization, cardiac tamponade or bleeding requiring surgical intervention, new-onset atrial fibrillation, pneumonia, delirium, and sepsis. Likewise, the postoperative length of stay, and up to 5-year mortality, were significantly higher in the fast-track failure than the nonfailure group. The European System for Cardiac Operative Risk Evaluation II and transfusion of any blood product could be identified as independent risk factors for fast-track failure, with only limited discriminative ability (area under the curve = 0.676; 95% confidence interval, 0.611-0.741). CONCLUSION Fast-track failure is associated with increases in morbidity and long-term mortality, but remains difficult to predict.
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Affiliation(s)
- Jore Hendrikx
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
| | - Maxim Timmers
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
| | - Layth AlTmimi
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Danny F Hoogma
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Johan De Coster
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paul Herijgers
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Cardiac Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Cardiac Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Cardiac Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
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24
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Mascolo P, Feola A, Zangani P, Famularo D, Liguori B, Mansueto G, Campobasso CP. Waterhouse Friderichsen Syndrome: Medico-legal issues. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Organizational Strategies for the Management of Intravenous Iron Therapy in Non-Hospitalized Settings: A Safe Opportunity to Implement Patient Blood Management in Italy. Healthcare (Basel) 2021; 9:healthcare9091222. [PMID: 34574994 PMCID: PMC8467602 DOI: 10.3390/healthcare9091222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 01/25/2023] Open
Abstract
This article analyzes the recommendations issued by the Emilia Romagna region in July 2020 on “Organizational strategies for the safe management of intravenous iron therapy in patients in non-hospitalized settings”. The objective of these recommendations is to set up safe intravenous iron administration sites outside the hospital environment across the national territory. The document facilitates the organization of methods for intravenous iron infusion that are safe for the patient and correct from a medico-legal perspective. In addition, it opens the way for the widespread use of iron infusion in the field, providing benefits to patient quality of life. This program prevents unnecessary transfusions, reduces costs, prevents overcrowding in hospitals in the event of a pandemic, and enables patient treatment in the field, thus, saving on the use of personnel.
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26
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Beverina I, Aloni A, Brando B. Impact of gender parity on preoperative anaemia prevalence and Patient Blood Management practice. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2021; 19:396-402. [PMID: 33196412 PMCID: PMC8486601 DOI: 10.2450/2020.0158-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Anaemia is a common finding in the preoperative setting, affecting around one-third of patients for whom major surgery is programmed. Moreover, preoperative anaemia has been shown to worsen patient outcome and increase length of hospital stay and costs. In the field of preoperative anaemia correction, a recent Consensus statement suggested reviewing the classic World Health Organization (WHO) criteria in adults by aligning the haemoglobin cut-off to 13 g/dL for both genders. The aim of our study was to assess the differences in terms of prevalence, transfusion rate, transfusion trigger, and blood losses according to gender in a mixed population of surgical patients. MATERIAL AND METHODS We reviewed data of 610 consecutive patients undergoing elective major surgery at a tertiary care hospital during a 9-month period. Transfusion rate and transfusion triggers were recorded, analysed and stratified by haemoglobin class, with a particular focus on the 12.0-12.9 g/dL range. RESULTS Since the anaemia threshold was redefined at 13 g/dL for both genders, its prevalence rose from 26.4 to 39.5% (161/610 vs 241/610; p<0.001) in the overall population and from 22.7 to 49.3% (68/300 vs 148/300; p<0.001) in women. Eighty women (26.7%) fell in the haemoglobin 12.0-12.9 g/dL range, and this category was the most represented among transfused women (34.0%). There was no statistical difference in transfusion triggers or overall transfusion rate between genders. Subjects of both genders were transfused at the same haemoglobin level (8.1 g/dL), but women reached the transfusion trigger after less red cell mass loss than men, i.e. 377 mL (249-472 mL) vs 528 mL (356-717 mL), respectively (p<0.001). DISCUSSION Treatment of pre-surgical anaemia is one of the core principles of Patient Blood Management. Aligning the haemoglobin threshold between genders in the management of pre-surgical anaemia may result in a lower transfusion rate, but in an increased workload for medical staff in the preoperative phase.
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Affiliation(s)
- Ivo Beverina
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - Alessandro Aloni
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - Bruno Brando
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
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Hofmann A, Spahn DR, Holtorf AP. Making patient blood management the new norm(al) as experienced by implementors in diverse countries. BMC Health Serv Res 2021; 21:634. [PMID: 34215251 PMCID: PMC8249439 DOI: 10.1186/s12913-021-06484-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/06/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient blood management (PBM) describes a set of evidence-based practices to optimize medical and surgical patient outcomes by clinically managing and preserving a patient's own blood. This concepts aims to detect and treat anemia, minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process. In combination with blood loss, anemia is the main driver for transfusion and all three are independent risk factors for adverse outcomes including morbidity and mortality. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds. METHODS Semi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country and underwent qualitative content analysis. Clustering the resulting implementation measures by levels of intervention for PBM implementation informed a PBM implementation framework. RESULTS A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration. CONCLUSION The implementation matrix resulting from this research helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to design, initiate and develop strategies and plans to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.
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Affiliation(s)
- Axel Hofmann
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
- University of Western Australia Faculty of Health and Medical Sciences, Perth, Australia
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstrasse 58, CH4055 Basel, Switzerland
- Faculty of the College of Pharmacy, University of Utah, Salt Lake City, UT USA
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COVID-19 Vaccine and Death: Causality Algorithm According to the WHO Eligibility Diagnosis. Diagnostics (Basel) 2021; 11:diagnostics11060955. [PMID: 34073536 PMCID: PMC8229116 DOI: 10.3390/diagnostics11060955] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 01/15/2023] Open
Abstract
The current challenge worldwide is the administration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. Even if rarely, severe vascular adverse reactions temporally related to vaccine administration have induced diffidence in the population at large. In particular, researchers worldwide are focusing on the so-called “thrombosis and thrombocytopenia after COVID-19 vaccination”. This study aims to establish a practical workflow to define the relationship between adverse events following immunization (AEFI) and COVID-19 vaccination, following the basic framework of the World Health Organization (WHO). Post-mortem investigation plays a pivotal role to support this causality relationship when death occurs. To demonstrate the usefulness and feasibility of the proposed workflow, we applied it to two exemplificative cases of suspected AEFI following COVID-19 vaccination. Based on the proposed model, we took into consideration any possible causality relationship between COVID-19 vaccine administration and AEFI. This led us to conclude that vaccination with ChAdOx1 nCov-19 may cause the rare development of immune thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4), which clinically mimics heparin-induced autoimmune thrombocytopenia. We suggest the adoption of the proposed methodology in order to confirm or rule out a causal relationship between vaccination and the occurrence of AEFI.
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Bolcato M, Shander A, Isbister JP, Trentino KM, Russo M, Rodriguez D, Aprile A. Physician autonomy and patient rights: lessons from an enforced blood transfusion and the role of patient blood management. Vox Sang 2021; 116:1023-1030. [PMID: 33826768 PMCID: PMC9291028 DOI: 10.1111/vox.13106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
This article provides an ethical and medico-legal analysis of ruling no. 465 of 30 May 2018 issued by the Court of Termini Imerese (Palermo) and confirmed on appeal on 11 November 2020, which, in the absence of similar historical precedents in Europe, convicted a medical doctor of a crime of violent assault for having ordered the administration of a blood transfusion to a patient specifically declining blood transfusion on religious grounds. We analyse the Court's decision regarding the identification of assault in performing the blood transfusion and its decision not to accept exculpatory urgent 'necessity' as a defence. In addition, we present an updated revision of the current standard of care in transfusion medicine as well as the ethical principles governing the patient's declining of transfusion. In doing so, we highlight that respect for the patient's self-determination in declining transfusions and respect for the professional autonomy of the doctor protecting the safety and life of the patient could be equally satisfied by applying the current peer-reviewed evidence.
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Affiliation(s)
- Matteo Bolcato
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy
| | - Aryeh Shander
- Department of Anesthesiology, Critical Care Medicine Pain Management and Hyperbaric Medicine Team, Health Research Institute, Englewood Medical Center, Englewood, NJ, USA
| | - James P Isbister
- School of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Kevin M Trentino
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Marianna Russo
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy
| | - Daniele Rodriguez
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy
| | - Anna Aprile
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy
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Bolcato M, Trabucco Aurilio M, Di Mizio G, Piccioni A, Feola A, Bonsignore A, Tettamanti C, Ciliberti R, Rodriguez D, Aprile A. The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052484. [PMID: 33802378 PMCID: PMC7967622 DOI: 10.3390/ijerph18052484] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022]
Abstract
The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.
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Affiliation(s)
- Matteo Bolcato
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Marco Trabucco Aurilio
- Department of Medicine and Health Sciences “V. Tiberio,” University of Molise, 86100 Campobasso, Italy
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Alessandro Bonsignore
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Camilla Tettamanti
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Rosagemma Ciliberti
- Department of Health Sciences, Section of History of Medicine and Bioethics, University of Genova, 16126 Genova, Italy;
| | - Daniele Rodriguez
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
| | - Anna Aprile
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
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Take-Home Messages from the COVID-19 Pandemic: Strengths and Pitfalls of the Italian National Health Service from a Medico-Legal Point of View. Healthcare (Basel) 2020; 9:healthcare9010017. [PMID: 33375544 PMCID: PMC7824087 DOI: 10.3390/healthcare9010017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/28/2023] Open
Abstract
The World Health Organization (WHO) declared the outbreak of the Coronavirus disease-2019 (COVID-19) infection a pandemic on 11 March 2020. As of the end of October 2020, there were 50 million cases of infection and over one million deaths recorded worldwide, over 45,000 of which occurred in Italy. In Italy, the demand for intensive care over the course of this pandemic crisis has been exceptionally high, resulting in a severe imbalance between the demand for and availability of the necessary resources. This paper focuses on elements of preventive medicine and medical treatments in emergency and non-emergency situations which, based on the international scientific literature, may prove to be useful to physicians on a behavioral level and avert professional liability problems. In order to achieve this objective, we have performed a search on MEDLINE to find published articles related to the risks associated with the pandemic that contain useful suggestions and strategies for mitigating risks and protecting the safety of the population. The results have been collocated in line with these specific study areas.
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Bolcato M, Rodriguez D, Aprile A. Risk Management in the New Frontier of Professional Liability for Nosocomial Infection: Review of the Literature on Mycobacterium Chimaera. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197328. [PMID: 33036499 PMCID: PMC7579562 DOI: 10.3390/ijerph17197328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022]
Abstract
Background: Mycobacterium chimaera (MC) is of recent origin and belongs to the large family of non-tuberculous mycobacteria. In recent years, it has shown a high infectious capacity via the aerosol produced by operating room equipment, such as heater–cooler units (HCU). The infection has a long latent period and high mortality rate. Genetic and epidemiological studies have shown that there is a clear link between the infection and a specific HCU model manufactured by LivaNova/Sorin. There is, therefore, a strong possibility that contamination occurs during device construction. The objective of this article is to describe the characteristics of this particular infection in view of the medico–legal implications on professional liability, specifically focusing on current evidence regarding contamination prevention. Methods: we have analyzed the clinical characteristics and data from the autopsic investigations performed on a patient who died as a result of MC infection, in addition to analyzing all pertinent recommendation documents available internationally. We searched for all articles in the literature available on MEDLINE between 1995 and 30 July 2020, using the search words “Mycobacterium chimaera”. We then analyzed those articles and reported only those that provide useful information regarding prevention techniques for containing dissemination and contamination. Results: the literature review produced 169 results that highlight the need to develop systems to mitigate and eliminate the risk of MC infection in operating rooms such as physical containment measures, e.g. device replacement, use of safe water, providing patients with information, and training healthcare professionals. Conclusions: from a medico–legal viewpoint, this particular situation represents a new frontier of professional liability, which includes manufacturers of electromedical equipment. In order to comprehend the true extent of this silent global epidemic, the development of an organic, preventative monitoring system is essential.
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