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Mykhailova O, Brandon-Coatham M, Phan C, Yazdanbakhsh M, Olafson C, Yi QL, Kanias T, Acker JP. Red cell concentrates from teen male donors contain poor-quality biologically older cells. Vox Sang 2024; 119:417-427. [PMID: 38418415 DOI: 10.1111/vox.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND AND OBJECTIVES Donor factors influence the quality characteristics of red cell concentrates (RCCs) and the lesions that develop in these heterogeneous blood products during hypothermic storage. Teen male donors' RCCs contain elevated levels of biologically old red blood cells (RBCs). The aim of this study was to interrogate the quality of units of different donor ages and sexes to unravel the complex interplay between donor characteristics, long-term cold storage and, for the first time, RBC biological age. MATERIALS AND METHODS RCCs from teen males, teen females, senior males and senior females were density-separated into less-dense/young (Y-RBCs) and dense/old RBCs (O-RBCs) throughout hypothermic storage for testing. The unseparated and density-separated cells were tested for haematological parameters, stress (oxidative and osmotic) haemolysis and oxygen affinity (p50). RESULTS The O-RBCs obtained from teen donor samples, particularly males, had smaller mean corpuscular volumes and higher mean corpuscular haemoglobin concentrations. While biological age did not significantly affect oxygen affinity, biologically aged O-RBCs from stored RCCs exhibited increased oxidative haemolysis and decreased osmotic fragility, with teenage male RCCs exhibiting the highest propensity to haemolyse. CONCLUSION Previously, donor age and sex were shown to have an impact on the biological age distribution of RBCs within RCCs. Herein, we demonstrated that RBC biological age, particularly O-RBCs, which are found more prevalently in male teens, to be a driving factor of several aspects of poor blood product quality. This study emphasizes that donor factors should continue to be considered for their potential impacts on transfusion outcomes.
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Affiliation(s)
- Olga Mykhailova
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | | | - Celina Phan
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Mahsa Yazdanbakhsh
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Carly Olafson
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
| | - Jason P Acker
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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2
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Forster CM, Halls S, Allarakhia S, Modi D, Chung W, Derry K, Digby G, Flemming J, McGugan J, Mackulin H, Montague S, Sibley S, Silver SA, Sirosky-Yanyk A, Stevens A, de Wit K, Zhang L, Callum J. Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention. BMJ Open Qual 2024; 13:e002534. [PMID: 38626937 PMCID: PMC11029189 DOI: 10.1136/bmjoq-2023-002534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Intravenous albumin has limited indications supported by randomised controlled trials, yet it is often prescribed for indications not supported by evidence. AIM To reduce unnecessary transfusion of albumin. INTERVENTIONS Under the leadership of a multidisciplinary quality improvement team, evidence-based recommendations were disseminated in tandem with a new electronic order set, an educational strategy, qualitative interviews with prescribers and a return policy change to reduce wastage. IMPLEMENTATION AND EVALUATION Interventions were introduced in a staggered fashion. The primary outcome, appropriate use of albumin, was monitored and quantified using pre-intervention and post-intervention audits. Process measures included statistical process run charts of monthly usage of 5% and 25% albumin and wastage. Data on length of stay (hospital and intensive care), new inpatient starts on kidney replacement and mortality were collected as balancing measures. RESULTS Appropriate albumin usage based on indication increased from 30% to 50% (p<0.0001). There was significantly less overall albumin usage in the post-intervention period compared with the pre-intervention period (negative coefficient, p<0.0001), driven by a major reduction in the utilisation of the 5% formulation (p<0.0001). Overall albumin usage was significantly lower in the post-intervention period, decreasing from 800 to 450 vials per month. The intervention resulted in significantly less wastage (negative coefficient, p=0.017). Mortality, length of stay and new starts on kidney replacement therapy remained constant throughout the study period. CONCLUSION Improved prescribing of albumin was achieved with a multifaceted approach. Substantial and sustained reductions in usage were achieved without negatively impacting patient-important outcomes. The estimated annual savings for the purchase cost of albumin was CAN $300 000. We provide a structured process for other organisations to optimise their use of albumin.
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Affiliation(s)
- Corey M Forster
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | | | - Dimpy Modi
- Department of Medicine, Hamilton, Stockholm, Ontario, Sweden
| | - Wiley Chung
- Surgery, Queen's University, Kingston, Ontario, Canada
| | - Kendra Derry
- Department of Anesthesiology, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Jennifer Flemming
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John McGugan
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Heather Mackulin
- Nursing, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Steven Montague
- Department of Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Stephanie Sibley
- Department of Critical Care, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Samuel A Silver
- Department of Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Angela Sirosky-Yanyk
- Transfusion Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Andrew Stevens
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Kerstin de Wit
- Department of Emergency Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Liying Zhang
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jeannie Callum
- Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
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Wright I, Gahagan J. Improving gay, bisexual and transgender inclusion in blood and plasma donation policies and programmes in Canada: A qualitative study. Vox Sang 2024. [PMID: 38616552 DOI: 10.1111/vox.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND OBJECTIVES An increasing number of blood operators around the world, including those in Canada, have removed time-based deferral periods for gay, bisexual and other men who have sex with men and replaced them with sexual behaviour-based questions for all donors. While this marks a significant shift in screening approach, what remains unclear is how members of two-spirit, lesbian, gay, bisexual, transgender and queer (2S/LGBTQ+) communities view blood operators' initiatives to be more inclusive. As such, this study was conducted to assess the awareness of donor screening changes and other initiatives among members of 2S/LGBTQ+ communities and to explore their recommendations for blood operators' work with these communities. MATERIALS AND METHODS Semi-structured qualitative interviews (n = 15) were conducted with 2S/LGBTQ+ people across Canada. Data were analysed using open inductive coding methods. RESULTS Reported here are the key results on recommendations for blood operators. Three themes were identified from the data: (1) the need for increased communications with 2S/LGBTQ+ communities surrounding changes to donor policies and guidelines; (2) the need for trans-inclusive policy and procedures; and (3) the need for culturally responsive and equity-informed staff training at donor centres. CONCLUSION Results suggest that blood operators should consider 2S/LGTBQ+ communities when developing blood and plasma donation policies, screening procedures and staff training. Increased consultation with these communities is desired, and further research specific to the experiences of transgender blood donors is needed.
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Affiliation(s)
- Isaac Wright
- Research Office, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline Gahagan
- Research Office, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Yousuf B, Flint A, Weedmark K, Pagotto F, Ramirez-Arcos S. Comparative virulome analysis of four Staphylococcus epidermidis strains from human skin and platelet concentrates using whole genome sequencing. Access Microbiol 2024; 6:000780.v3. [PMID: 38737800 PMCID: PMC11083402 DOI: 10.1099/acmi.0.000780.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/29/2024] [Indexed: 05/14/2024] Open
Abstract
Staphylococcus epidermidis is one of the predominant bacterial contaminants in platelet concentrates (PCs), a blood component used to treat bleeding disorders. PCs are a unique niche that triggers biofilm formation, the main pathomechanism of S. epidermidis infections. We performed whole genome sequencing of four S. epidermidis strains isolated from skin of healthy human volunteers (AZ22 and AZ39) and contaminated PCs (ST10002 and ST11003) to unravel phylogenetic relationships and decipher virulence mechanisms compared to 24 complete S. epidermidis genomes in GenBank. AZ39 and ST11003 formed a separate unique lineage with strains 14.1 .R1 and SE95, while AZ22 formed a cluster with 1457 and ST10002 closely grouped with FDAAGOS_161. The four isolates were assigned to sequence types ST1175, ST1174, ST73 and ST16, respectively. All four genomes exhibited biofilm-associated genes ebh, ebp, sdrG, sdrH and atl. Additionally, AZ22 had sdrF and aap, whereas ST10002 had aap and icaABCDR. Notably, AZ39 possesses truncated ebh and sdrG and harbours a toxin-encoding gene. All isolates carry multiple antibiotic resistance genes conferring resistance to fosfomycin (fosB), β-lactams (blaZ) and fluoroquinolones (norA). This study reveales a unique lineage for S. epidermidis and provides insight into the genetic basis of virulence and antibiotic resistance in transfusion-associated S. epidermidis strains.
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Affiliation(s)
- Basit Yousuf
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Annika Flint
- Bureau of Microbial Hazards, Health Products and Food Branch, Health Canada, Ottawa, Canada
| | - Kelly Weedmark
- Bureau of Microbial Hazards, Health Products and Food Branch, Health Canada, Ottawa, Canada
| | - Franco Pagotto
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
- Bureau of Microbial Hazards, Health Products and Food Branch, Health Canada, Ottawa, Canada
| | - Sandra Ramirez-Arcos
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
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Kou Y, Kumaran D, Howell A, Ramirez-Arcos S. Comparable bacterial growth in platelet concentrates suspended in plasma and platelet additive solution and improved detection of bacterial contamination using a new generation automated culture system. Transfusion 2024; 64:665-673. [PMID: 38456520 DOI: 10.1111/trf.17772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Microbial screening of platelet concentrates (PC) with automated culture methods is widely implemented to reduce septic transfusion reactions. Herein, detection of bacterial contamination in PC was compared between units prepared in plasma and a mix of plasma and platelet additive solution (PAS) and between the BACT/ALERT 3D and next generation BACT/ALERT VIRTUO systems. STUDY DESIGN/METHODS Double apheresis units were split into single units, diluted in either PAS (PAS-PC) or plasma (plasma-PC), and tested for in vitro quality and sterility prior to spiking with ~30 CFU/unit of Staphylococcus epidermidis, Staphylococcus aureus, Serratia marcescens, and Klebsiella pneumoniae or ~10 CFU/mL of Cutibacterium acnes. Spiked PC were sampled for BACT/ALERT testing (36 and 48 h post-spiking) and colony counts (24, 36, and 48 h post-spiking). Times to detection (TtoD) and bacterial loads were compared between PC products and BACT/ALERT systems (N = 3). RESULTS Bacterial growth was similar in plasma-PC and PAS-PC. No significant differences in TtoD were observed between plasma-PC and PAS-PC at the 36-h sampling time except for S. epidermidis which grew faster in plasma-PC and C. acnes which was detected earlier in PAS-PC (p < .05). Detection of facultative bacteria was 1.3-2.2 h sooner in VIRTUO compared with 3D (p < .05) while TtoD for C. acnes was not significantly different between the two systems. DISCUSSION Comparable bacterial detection was observed in plasma-PC and PAS-PC with PC sampling performed at 36-h post blood collection. PC sampling at ≤36 h could result in faster detection of facultative pathogenic organisms with the VIRTUO system and improved PC safety.
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Affiliation(s)
- Yuntong Kou
- Product & Process Development, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Dilini Kumaran
- Product & Process Development, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Anita Howell
- Product & Process Development, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sandra Ramirez-Arcos
- Product & Process Development, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
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Mykhailova O, Brandon-Coatham M, Durand K, Olafson C, Xu A, Yi QL, Kanias T, Acker JP. Estimated median density identifies donor age and sex differences in red blood cell biological age. Transfusion 2024; 64:705-715. [PMID: 38420746 DOI: 10.1111/trf.17749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Donors possess heterogeneous red cell concentrates (RCCs) in terms of the biological age of their red blood cells (RBCs) as a direct result of various donor-dependent factors influencing rates of erythropoiesis. This study aimed to estimate the median biological age of RBCs in RCCs based on donor age and sex to investigate inherent differences in blood products' biological ages over hypothermic storage using estimated median densities (EMDs). STUDY DESIGN Sixty RCCs were collected from four donor groups; male and female teenagers (17-19 years old) and seniors (75+ years old). A Percoll density-based separation approach was used to quantify the EMDs indicative of biological age. EMD and mean corpuscular hemoglobin (MCHC) were compared by correlation analyses. RESULTS Differences in the median biological age of RCC units were observed with male donors having significantly higher EMDs compared to females (p < .001). Teen male donors possessed the highest EMDs with significantly elevated levels of biologically aged RBCs compared to both female donor groups, regardless of storage duration (p < .05). Throughout most of the 42-day storage period, senior donors, particularly senior females, demonstrated the strongest correlation between EMD and MCHC (R2 > 0.5). CONCLUSIONS This study provides further evidence that there are inherent differences between the biological age profiles of RBCs between blood donors of different sex and age. Our findings further highlight that biological age may contribute to RBC quality during storage and that donor characteristics need to be considered when evaluating transfusion safety and efficacy.
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Affiliation(s)
- Olga Mykhailova
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | | | - Kiarra Durand
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Carly Olafson
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - April Xu
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Tamir Kanias
- Vitalant Research Institute, Denver, Colorado, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jason P Acker
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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7
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Blake JT, Ganz K, Seftel M, Allan D. Determining the impact of current Canadian stem cell registry policy on donor availability via dynamic registry simulation. Vox Sang 2024. [PMID: 38523418 DOI: 10.1111/vox.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/10/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVES When a haematopoietic stem cell registry size is constrained by limits on recruiting, as in Canada, identifying the right person to recruit is a critical determinant of effectiveness. The aim of this study was to evaluate the impact of changes to donor recruitment effort, within ethnic groups, on the matching effectiveness of the Canadian registry as it evolves over time. MATERIALS AND METHODS Simulation methods are applied to create a cohort of donor recruits and patients over a 10-year time horizon. New recruits are added to the registry each year, while some existing donors 'age-out' upon reaching their 36th birthday. In a similar fashion, simulated patient lists are created. At the end of each simulated year, simulated patients are matched against the simulated registry. RESULTS There are increased matches in non-White populations when diverse registrants are preferentially recruited, but there are larger decreases in the number of matches for Caucasian patients. Additionally, ethnic communities that have limited registrants in the Canadian registry in 2021 do not benefit from increased recruiting efforts as much as communities with a larger initial number of registrants. CONCLUSION Preferentially recruiting from non-Caucasian populations reduces the number of matches from Canadian sources because increases in non-Caucasian populations will not fully counterbalance decreases to Caucasian patient matches. Nevertheless, more than 80% of all matches are for Caucasian patients, regardless of the donor recruiting effort within ethnic groups.
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Affiliation(s)
- John T Blake
- Industrial Engineering, Dalhousie University, Halifax, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Kathy Ganz
- Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - David Allan
- Canadian Blood Services, Ottawa, Ontario, Canada
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8
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Nizeyimana F, Pendergrast J, Ntegerejuwampayee A, Lin Y, Kanyamuhunga A, Gashaija C, Masaisa F, Uzamukunda C, Mutuyimana G, Ndicunguye F, Gaseminari A, Mulindwa B, Muyombo T, Chargé S, Skelton T. Transfusion Camp Rwanda 2023: A train-the-trainer workshop establishing locally driven leadership in knowledge translation and sustainability in transfusion medicine education. Vox Sang 2024. [PMID: 38425034 DOI: 10.1111/vox.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Blood transfusion is performed daily in hospitals. Gaps exist between transfusion guidelines and day-to-day clinical care. These gaps are prevalent in resource-limited settings due to scarce continuing medical education. Transfusion Camp Rwanda aims to bridge this gap by (1) delivering context-appropriate up-to-date education, (2) teaching participants how to independently deliver a case-based curriculum and (3) identifying strategies to promote change in transfusion practice in Rwanda. MATERIALS AND METHODS In May 2023, a multidisciplinary team from Canada and Rwanda carried out a Transfusion Camp train-the-trainer workshop for clinicians from all five provinces in Rwanda. Participants attended in-person lectures, seminars and workshop group discussions on the implementation of the Rwanda National Directives on Rational Use of Blood and Blood Components. Course feedback was based on the Kirkpatrick Model of Training and Evaluation. RESULTS Fifty-one physicians and laboratory technicians participated in the course. Confidence in caring for patients based on transfusion guidelines was self-rated as 'excellent' by 23% of participants before and 77% after, while 84% reported they planned to teach Transfusion Camp to others and 100% responded that they will apply course content to clinical practice. Workshop groups recommended strategies to improve transfusion medicine practice in Rwanda in four domains: Communication, Institutional Approval, Practice Audits and Education. CONCLUSION Transfusion medicine education in Rwanda using a train-the-trainer approach was well-received by participants and allowed for a more detailed understanding of the local medical and educational environment. These observations can inform the further expansion of the Transfusion Camp Rwanda project.
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Affiliation(s)
- Francoise Nizeyimana
- Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Jacob Pendergrast
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, Ontario, Canada
| | - Angelique Ntegerejuwampayee
- Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, Ontario, Canada
- Precision Diagnostics and Therapeutic Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aimable Kanyamuhunga
- Department of Pediatrics, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Christopher Gashaija
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Florence Masaisa
- Department of Internal Medicine, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Claudine Uzamukunda
- Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Grace Mutuyimana
- Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Fabrice Ndicunguye
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Alexis Gaseminari
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Bruce Mulindwa
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Thomas Muyombo
- National Centre for Blood Transfusion, Rwanda Biomedical Centre, University of Rwanda, Kigali, Rwanda
| | - Sophie Chargé
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Teresa Skelton
- Department of Anesthesiology, Pharmacology, and Therapeutics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Verret M, Le JBP, Lalu MM, McIsaac DI, Nicholls S, Turgeon AF, Hutton B, Zivkovic F, Graham M, Le M, Geist A, Berube M, Gilron I, Poulin P, Daudt H, Martel G, McVicar J, Moloo H, Fergusson DA. Effectiveness of dexmedetomidine during surgery under general anaesthesia on patient-centred outcomes: a systematic review and Bayesian meta-analysis protocol. BMJ Open 2024; 14:e080012. [PMID: 38307526 PMCID: PMC10836371 DOI: 10.1136/bmjopen-2023-080012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Dexmedetomidine is a promising pharmaceutical strategy to minimise opioid use during surgery. Despite its growing use, it is uncertain whether dexmedetomidine can improve patient-centred outcomes such as quality of recovery and pain. METHODS AND ANALYSIS We will conduct a systematic review and meta-analysis following the recommendations of the Cochrane Handbook for Systematic Reviews. We will search MEDLINE, Embase, CENTRAL, Web of Science and CINAHL approximately in October 2023. We will include randomised controlled trials evaluating the impact of systemic intraoperative dexmedetomidine on patient-centred outcomes. Patient-centred outcome definition will be based on the consensus definition established by the Standardised Endpoints in Perioperative Medicine initiative (StEP-COMPAC). Our primary outcome will be the quality of recovery after surgery. Our secondary outcomes will be patient well-being, function, health-related quality of life, life impact, multidimensional assessment of postoperative acute pain, chronic pain, persistent postoperative opioid use, opioid-related adverse events, hospital length of stay and adverse events. Two reviewers will independently screen and identify trials and extract data. We will evaluate the risk of bias of trials using the Cochrane Risk of Bias Tool (RoB 2.0). We will synthesise data using a random effects Bayesian model framework, estimating the probability of achieving a benefit and its clinical significance. We will assess statistical heterogeneity with the tau-squared and explore sources of heterogeneity with meta-regression. We have involved patient partners, clinicians, methodologists, and key partner organisations in the development of this protocol, and we plan to continue this collaboration throughout all phases of this systematic review. ETHICS AND DISSEMINATION Our systematic review does not require research ethics approval. It will help inform current clinical practice guidelines and guide development of future randomised controlled trials. The results will be disseminated in open-access peer-reviewed journals, presented at conferences and shared among collaborators and networks. PROSPERO REGISTRATION NUMBER CRD42023439896.
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Affiliation(s)
- Michael Verret
- Departments of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
- Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec, Quebec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - John Bao Phuc Le
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stuart Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexis F Turgeon
- Departments of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
- Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec, Quebec, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Fiona Zivkovic
- Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Megan Graham
- Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Maxime Le
- Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Allison Geist
- Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Melanie Berube
- Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec, Quebec, Canada
- Faculty of Nursing, Université Laval, Québec, Quebec, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Patricia Poulin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Helena Daudt
- Pain Canada, Pain BC, Vancouver, Alberta, Canada
| | - Guillaume Martel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jason McVicar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Husein Moloo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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10
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Jug R, Callum J, Ruijs T, Liu Y, Barty R, Thompson T. Intravenous albumin utilization audit at a large community hospital. Transfusion 2024; 64:39-46. [PMID: 38078484 DOI: 10.1111/trf.17610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/01/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND There is a literature gap in terms of albumin utilization practices. METHODS/MATERIALS We conducted a single-center retrospective observational electronic audit of adult admitted patients who received one or more vials of albumin (5% or 25%) between September 1, 2019 and August 31, 2020 at a large community hospital. The Research Ethics Board approval was obtained. Utilization data identified through the laboratory information system were independently adjudicated by two reviewers and resolved by consensus as appropriate-acceptable, appropriate-may be acceptable, or inappropriate. The primary objective of this audit is to determine the proportion of 5% and 25% intravenous albumin infusions meeting a priori appropriateness criteria for indication. Secondary outcomes include determining the patterns of practice surrounding intravenous albumin use: patient demographics, most responsible diagnosis, location at time of order, clinical outcomes of albumin recipients, and types, volumes, and cost of albumin infused. RESULTS The mean total albumin administered was 569.2 mL across 456 total recipients (58% male) with a 29% appropriateness rate. This cohort had an in-hospital mortality rate of 38%, with an average of 6 days from first dose of albumin to death. The mean length of stay was 14 days, with a mean intensive care length of stay of 8 days. The purchase cost of inappropriately transfused albumin was CAD $65,538. CONCLUSION Based on a lack of or an unacceptable indication provided, 71% of patients were inappropriately transfused. Albumin use deviating from guideline recommendations may be contributing to increased healthcare costs, pressure on limited supply, and potential patient harm.
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Affiliation(s)
- Rachel Jug
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | | | - Yang Liu
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
| | - Troy Thompson
- Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
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11
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Uy RJ, Serrano K, Hadjesfandiari N, Shih AW, Devine D. The effects of pen ink and surface disinfectants on red blood cells stored in plasticized polyvinylchloride transfusion bags. Transfusion 2024; 64:141-149. [PMID: 38059437 DOI: 10.1111/trf.17620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Each unit of red blood cells (RBCs) produced represents a significant cost to the healthcare system. Unnecessary blood wastage should be minimized. In clinical settings, alterations to blood component bags after issue from the protected setting of the blood bank include pen markings, and those that are exposed to an infectious environment require surface disinfecting. These units may be discarded due to unclear effects on RBC quality. In this study, we investigate whether pen markings or surface disinfection negatively affects the quality of packed RBCs and whether pen ink diffuses through the blood bag. STUDY DESIGN AND METHODS RBC bags were marked with pens (water, oil, or alcohol-based) or subjected to surface disinfection (ethanol, hydrogen peroxide [Preempt wipes], or benzalkonium chloride-based wipes [CaviWipes]) and sampled 24 h after applying the treatment and at day 42 post collection (n = 3 for each condition). The samples were analyzed for RBC in vitro quality markers. The presence of any ink in the RBC bags was investigated using mass spectrometry (n = 2). RESULTS Data from 24 h and day 42 time points indicated no differences in RBC count, mean corpuscular volume, morphology, deformability, potassium content, or hemolysis for either pen markings or disinfectants when compared with their untreated controls (p > .05). No trace of ink was detected inside the bag. CONCLUSION RBC units marked with ballpoint, gel, or Sharpie pens do not suffer a loss of in vitro quality, nor do RBC units which have been surface disinfected with 70% ethanol, Preempt wipes or CaviWipes.
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Affiliation(s)
- Ralph Justin Uy
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Serrano
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Narges Hadjesfandiari
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew W Shih
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Dana Devine
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Innovation, Canadian Blood Services, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Francoeur C, Silva A, Hornby L, Wollny K, Lee LA, Pomeroy A, Cayouette F, Scales N, Weiss MJ, Dhanani S. Pediatric Death After Withdrawal of Life-Sustaining Therapies: A Scoping Review. Pediatr Crit Care Med 2024; 25:e12-e19. [PMID: 37678383 PMCID: PMC10756696 DOI: 10.1097/pcc.0000000000003358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Evaluate literature on the dying process in children after withdrawal of life sustaining measures (WLSM) in the PICU. We focused on the physiology of dying, prediction of time to death, impact of time to death, and uncertainty of the dying process on families, healthcare workers, and organ donation. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and Web of Science. STUDY SELECTION We included studies that discussed the dying process after WLSM in the PICU, with no date or study type restrictions. We excluded studies focused exclusively on adult or neonatal populations, children outside the PICU, or on organ donation or adult/pediatric studies where pediatric data could not be isolated. DATA EXTRACTION Inductive qualitative content analysis was performed. DATA SYNTHESIS Six thousand two hundred twenty-five studies were screened and 24 included. Results were grouped into four categories: dying process, perspectives of healthcare professionals and family, WLSM and organ donation, and recommendations for future research. Few tools exist to predict time to death after WLSM in children. Most deaths after WLSM occur within 1 hour and during this process, healthcare providers must offer support to families regarding logistics, medications, and expectations. Providers describe the unpredictability of the dying process as emotionally challenging and stressful for family members and staff; however, no reports of families discussing the impact of time to death prediction were found. The unpredictability of death after WLSM makes families less likely to pursue donation. Future research priorities include developing death prediction tools of tools, provider and parental decision-making, and interventions to improve end-of-life care. CONCLUSIONS The dying process in children is poorly understood and understudied. This knowledge gap leaves families in a vulnerable position and the clinical team without the necessary tools to support patients, families, or themselves. Improving time to death prediction after WLSM may improve care provision and enable identification of potential organ donors.
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Affiliation(s)
- Conall Francoeur
- Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Amina Silva
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Laura Hornby
- Consultant, Canadian Blood Services, Hamilton, ON, Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Laurie A Lee
- Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Consultant, Canadian Blood Services, Hamilton, ON, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- School of Nursing, Queen's University, Kingston, ON, Canada
- Department of Pediatrics, CHU de Quebec - University of Laval, Montreal, QC, Canada
- Dynamical Analysis Lab, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Transplant Québec, Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | | | - Florence Cayouette
- Department of Pediatrics, CHU de Quebec - University of Laval, Montreal, QC, Canada
| | - Nathan Scales
- Dynamical Analysis Lab, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Matthew J Weiss
- Department of Pediatrics, CHU de Quebec - University of Laval, Montreal, QC, Canada
- Transplant Québec, Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Sonny Dhanani
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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13
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Brousseau K, Monette L, McIsaac DI, Workneh A, Tinmouth A, Shaw J, Ramsay T, Mallick R, Presseau J, Wherrett C, Carrier FM, Fergusson DA, Martel G. Point-of-care haemoglobin accuracy and transfusion outcomes in non-cardiac surgery at a Canadian tertiary academic hospital: protocol for the PREMISE observational study. BMJ Open 2023; 13:e075070. [PMID: 38101848 PMCID: PMC10729286 DOI: 10.1136/bmjopen-2023-075070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/15/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Transfusions in surgery can be life-saving interventions, but inappropriate transfusions may lack clinical benefit and cause harm. Transfusion decision-making in surgery is complex and frequently informed by haemoglobin (Hgb) measurement in the operating room. Point-of-care testing for haemoglobin (POCT-Hgb) is increasingly relied on given its simplicity and rapid provision of results. POCT-Hgb devices lack adequate validation in the operative setting, particularly for Hgb values within the transfusion zone (60-100 g/L). This study aims to examine the accuracy of intraoperative POCT-Hgb instruments in non-cardiac surgery, and the association between POCT-Hgb measurements and transfusion decision-making. METHODS AND ANALYSIS PREMISE is an observational prospective method comparison study. Enrolment will occur when adult patients undergoing major non-cardiac surgery require POCT-Hgb, as determined by the treating team. Three concurrent POCT-Hgb results, considered as index tests, will be compared with a laboratory analysis of Hgb (lab-Hgb), considered the gold standard. Participants may have multiple POCT-Hgb measurements during surgery. The primary outcome is the difference in individual Hgb measurements between POCT-Hgb and lab-Hgb, primarily among measurements that are within the transfusion zone. Secondary outcomes include POCT-Hgb accuracy within the entire cohort, postoperative morbidity, mortality and transfusion rates. The sample size is 1750 POCT-Hgb measurements to obtain a minimum of 652 Hgb measurements <100 g/L, based on an estimated incidence of 38%. The sample size was calculated to fit a logistic regression model to predict instances when POCT-Hgb are inaccurate, using 4 g/L as an acceptable margin of error. ETHICS AND DISSEMINATION Institutional ethics approval has been obtained by the Ottawa Health Science Network-Research Ethics Board prior to initiating the study. Findings from this study will be published in peer-reviewed journals and presented at relevant scientific conferences. Social media will be leveraged to further disseminate the study results and engage with clinicians.
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Affiliation(s)
- Karine Brousseau
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Leah Monette
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Aklile Workneh
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan Tinmouth
- Division of Hematology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Shaw
- Department of Biochemistry, Eastern Ontario Regional Laboratories Association, Ottawa, Ontario, Canada
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christopher Wherrett
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Guillaume Martel
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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14
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Riazi K, Ly M, Barty R, Callum J, Arnold DM, Heddle NM, Down DG, Sidhu D, Li N. An unsupervised learning approach to identify immunoglobulin utilization patterns using electronic health records. Transfusion 2023; 63:2234-2247. [PMID: 37861272 DOI: 10.1111/trf.17585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/20/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Managing Canada's immunoglobulin (Ig) product resource allocation is challenging due to increasing demand, high expenditure, and global shortages. Detection of groups with high utilization rates can help with resource planning for Ig products. This study aims to uncover utilization subgroups among the Ig recipients using electronic health records (EHRs). METHODS The study included all Ig recipients (intravenous or subcutaneous) in Calgary from 2014 to 2020, and their EHR data, including blood inventory, recipient demographics, and laboratory test results, were analyzed. Patient clusters were derived based on patient characteristics and laboratory test data using K-means clustering. Clusters were interpreted using descriptive analyses and visualization techniques. RESULTS Among 4112 recipients, six clusters were identified. Clusters 1 and 2 comprised 408 (9.9%) and 1272 (30.9%) patients, respectively, contributing to 62.2% and 27.1% of total Ig utilization. Cluster 3 included 1253 (30.5%) patients, with 86.4% of infusions administered in an inpatient setting. Cluster 4, comprising 1034 (25.1%) patients, had a median age of 4 years, while clusters 2-6 were adults with median ages of 46-60. Cluster 5 had 62 (1.5%) patients, with 77.3% infusions occurring in emergency departments. Cluster 6 contained 83 (2.0%) patients receiving subcutaneous Ig treatments. CONCLUSION The results identified data-driven segmentations of patients with high Ig utilization rates and patients with high risk for short-term inpatient use. Our report is the first on EHR data-driven clustering of Ig utilization patterns. The findings hold the potential to inform demand forecasting and resource allocation decisions during shortages of Ig products.
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Affiliation(s)
- Kiarash Riazi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark Ly
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rebecca Barty
- Ontario Regional Blood Coordinating Network, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Donald M Arnold
- Michael G. DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Michael G. DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Douglas G Down
- Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Davinder Sidhu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Na Li
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Michael G. DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
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15
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Ning S, Gupta A, Batarfi K, Liu Y, Lucier KJ, Barty R, Heddle NM. Exploring the potential harm of varied blood storage on patients undergoing cardiovascular surgery. Vox Sang 2023; 118:947-954. [PMID: 37673792 DOI: 10.1111/vox.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Debate exists surrounding the optimal duration of red blood cell (RBC) storage. A hypothesis emerging from previous research suggests that exposure to fresh blood may be harmful to patients undergoing cardiac surgery. This study uses a large transfusion medicine database to explore the association between in-hospital mortality and red cell storage duration. MATERIALS AND METHODS This is an exploratory retrospective cohort study of all adult patients at Hamilton, Canada, over a 14-year period that received at least one allogeneic red cell transfusion during their hospitalization for cardiac surgery requiring bypass. The primary outcome for the study was in-hospital death. Analysis was performed using multivariate Cox regression modelling with time-dependent and time-independent covariates and stratification variables. Five models with varying definitions for short, intermediate and prolonged duration of RBC storage were tested. RESULTS From March 2004 to December 2017, 11,205 patients met the inclusion criteria and were included in the regression analyses. No significant effect of short-duration red storage on patient mortality was observed in all statistical models, with the red cells stored for the longest duration as the reference group. When patients who received exclusively fresh (hazard ratio [HR] 1.040, 95% confidence interval [CI] 0.588-1.841, p-value = 0.893) and older aged (HR 1.038, 95% CI 0.769-1.1.402, p-value = 0.0801) RBCs were compared with those who received exclusively mid-age red cells as the reference, statistical significance was similarly not reached. CONCLUSION Red cells stored for the shortest duration are not associated with increased risk of mortality among cardiac surgery patients.
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Affiliation(s)
- Shuoyan Ning
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Akash Gupta
- Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Khalid Batarfi
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- Canadian Blood Services, Ottawa, Ontario, Canada
| | | | | | - Nancy M Heddle
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
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16
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Zavalkoff S, O'Donnell S, Karam IF, Lalani J, Shemie SD. Canadian organ donation organizations' donor audit processes: an environmental scan. Can J Anaesth 2023; 70:1807-1815. [PMID: 37853277 PMCID: PMC10656310 DOI: 10.1007/s12630-023-02584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE Deceased donor audits (DAs) allow organ donation and transplantation systems to measure and analyze missed donation opportunities (MDOs). Missed donation opportunities can harm both patients/families denied the opportunity to donate and patients on transplant waitlists denied access to lifesaving organs. In Canada, there are no national standards for DAs, data analysis, nor accountability processes surrounding MDOs. Understanding DA current practice in each jurisdicton would facilitate developing a national strategy for DAs. METHOD All provincial organ donation organizations (ODOs) were invited to participate in an environmental scan (ES) of current DA practices. The two ES phases were an electronic survey followed by semistructured interviews. We collected information about the objectives, frequency, scope, data collection methodology, resources required, definitions/metrics used, and process for reporting outcomes. RESULTS All eleven ODOs participated in both phases of the ES (July and October 2019). The primary purposes for conducting DAs were to estimate the following: 1) donor potential (5/11, 45%); 2) system performance at the provincial level (3/11, 27%); and 3) system performance at the hospital level (3/11, 27%). Frequency of DAs varied from weekly to annually, depending on the availability of death reports, urban vs rural setting, and staffing. High variability was observed in DA methodology, donor definitions, and metrics across jurisdictions. CONCLUSION There is significant variability across Canadian ODOs in the methodology, definitions, timeliness, data collection, and reporting of DAs. This underscores the need for a national donor audit strategy to reduce preventable harm from MDOs to patients/families at end of life and those on transplant waitlists.
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Affiliation(s)
- Samara Zavalkoff
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada.
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Division of Pediatric Critical Care, McGill University, Montreal Children's Hospital, 1001 Boulevard Décarie, Room B06.3834.2, Montreal, QC, H4A 3J1, Canada.
| | - Shauna O'Donnell
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Isabela F Karam
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Sam D Shemie
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Canadian Blood Services, Ottawa, ON, Canada
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17
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Holloway K. Exploring the increasing need for plasma collection: Perspectives of voluntary nonremunerated donors on payment for plasma in Canada. Transfus Med 2023; 33:390-397. [PMID: 37599234 DOI: 10.1111/tme.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/06/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES The aim of this paper is to understand how voluntary nonremunerated plasma donors in Canada view payment for plasma and the emerging commercial sector. BACKGROUND There is a growing global demand for plasma, to produce plasma-derived medical products. Source plasma for these products is collected through voluntary nonremunerated donation, sometimes by a national blood service, or by a commercial plasma collector, remunerating donors. METHODS/MATERIALS This paper presents findings from qualitative semi-structured interviews with source plasma donors in three new source plasma centres in Canada. Interview data were analysed using abductive analysis, an interpretivist approach that builds on grounded theory. RESULTS This study indicates that there are a range of perspectives on payment for plasma and the emerging commercial sector, from disinterest in payment, to opposition to payment based on the belief that it could undermine donating to help others, and risk public health and safety. One fifth of participants are open to CBS paying donors if it is necessary to increase national sufficiency of plasma. Almost two thirds of participants are opposed to commercial plasma collection in Canada, claiming that it could undermine Canada's public healthcare system, raising questions about transparency and accountability of the commercial plasma industry. CONCLUSION Findings point to important areas for future study, on publicly collected source plasma, the emerging commercial plasma sector, and the role of the donor as a social actor in a complex political system.
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Affiliation(s)
- Kelly Holloway
- Donation Policy & Studies, Canadian Blood Services, Toronto, Canada
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18
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Harmon M, Riazi K, Callum J, Arnold DM, Barty R, Sidhu D, Heddle NM, MacLeod L, Li N. Immunoglobulin utilization in Canada: a comparative analysis of provincial guidelines and a scoping review of the literature. Allergy Asthma Clin Immunol 2023; 19:85. [PMID: 37717038 PMCID: PMC10504792 DOI: 10.1186/s13223-023-00841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Canada has high immunoglobulin (IG) product utilization, raising concerns about appropriate utilization, cost and risk of shortages. Currently, there is no national set of standardized IG guidelines, and considerable variations exist among the existing provincial guidelines. The aims of this study were: (1) to compare the existing Canadian provincial guidelines on the use of IG products to identify their consistencies and differences and (2) to examine the existing research in Canada on IG supply and utilization following the establishment of IG guidelines to understand the scope of research and pinpoint the gaps. METHODS A comparative analysis accounted for the differences across provincial IG guidelines. We highlighted similarities and differences in recommendations for medical conditions. A scoping review of citations from MEDLINE, PubMed, Scopus and Embase databases was conducted for studies published from January 01, 2014, to April 12, 2023. RESULTS While provincial guidelines represented a considerable overlap in the medical conditions delineated and relatively uniform dose calculations, numerous differences were observed, including in recommendation categories, provision of pediatric dosing, and divergent recommendations for identical conditions based on patient demographics. The scoping review identified 29 studies that focused on the use of IG in Canada. The themes of the studies included: IVIG utilization and audits, the switch from IVIG to SCIG, patient satisfaction with IVIG and/or SCIG, the economic impact of self-administered SCIG versus clinically administered IVIG therapy, and the efficacy and cost-effectiveness of alternative medications to IG treatment. CONCLUSION The differences in guidelines across provinces and the factors influencing IVIG/SCIG use, patient satisfaction, and cost savings are highlighted. Future research may focus on clarifying costs and comparative effectiveness, exploring factors influencing guideline adherence, and evaluating the impact of updated guidelines on IG use and patient outcomes.
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Affiliation(s)
- Megan Harmon
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Kiarash Riazi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Donald M Arnold
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rebecca Barty
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Ontario Regional Blood Coordinating Network, Hamilton, ON, Canada
| | - Davinder Sidhu
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nancy M Heddle
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | - Laurie MacLeod
- Ontario Regional Blood Coordinating Network, Hamilton, ON, Canada
| | - Na Li
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
- Department of Computing and Software, McMaster University, Hamilton, ON, Canada.
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19
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Shahin J, Scales NB, Johara F, Hogue M, Hornby L, Shemie S, Schmidt M, Waldauf P, Duska F, Wind T, Van Mook WN, Dhanani S. Is the process of withdrawal of life-sustaining measures in the intensive care unit different for deceased organ donors compared with other dying patients? A secondary analysis of prospectively collected data. BMJ Open 2023; 13:e069536. [PMID: 37597867 PMCID: PMC10441082 DOI: 10.1136/bmjopen-2022-069536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/10/2023] [Indexed: 08/21/2023] Open
Abstract
OBJECTIVE To investigate whether observable differences exist between patterns of withdrawal of life-sustaining measures (WLSM) for patients eligible for donation after circulatory death (DCD) in whom donation was attempted compared with those patients in whom no donation attempts were made. SETTING Adult intensive care units from 20 centres in Canada, the Czech Republic and the Netherlands. DESIGN Secondary analysis of quantitative data collected as part of a large, prospective, cohort study (the Death Prediction and Physiology after Removal of Therapy study). PARTICIPANTS Patients ≥18 years of age who died after a controlled WLSM in an intensive care unit. Patients were classified as not DCD eligible, DCD eligible with DCD attempted or DCD eligible but DCD was not attempted. PRIMARY AND SECONDARY OUTCOME MEASURES The process of WLSM (timing and type and, if applicable, dosages of measures withdrawn, dosages of analgesics/sedatives) was compared between groups. RESULTS Of the 635 patients analysed, 85% had either cardiovascular support stopped or were extubated immediately on WLSM. Of the DCD eligible patients, more were immediately extubated at the initiation of WLSM when DCD was attempted compared with when DCD was not attempted (95% vs 61%, p<0.0001). Initiation of WLSM with the immediate cessation of cardiovascular measures or early extubation was associated with earlier time to death, even after adjusting for confounders (OR 2.94, 95% CI 1.39 to 6.23, at 30 min). Other than in a few patients who received propofol, analgesic and sedative dosing after WLSM between DCD attempted and DCD eligible but not attempted patients was not significantly different. All patients died. CONCLUSIONS Patients in whom DCD is attempted may receive a different process of WLSM. This highlights the need for a standardised and transparent process for end-of-life care across the spectrum of critically ill patients and potential organ donors.
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Affiliation(s)
- J Shahin
- Division of Critical Care, Respiratory Epidemiology and Clinical Research Unit, McGill University Faculty of Medicine, Montreal, Québec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | | | - F Johara
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - M Hogue
- CHEO, Ottawa, Ontario, Canada
| | - Laura Hornby
- System Development, Canadian Blood Services Organ Donation and Transplantation, Ottawa, Ontario, Canada
| | - Sam Shemie
- Division of Critical Care, Department of Pediatrics, Montreal Childrens Hospital, Montreal, Québec, Canada
- System Development, Canadian Blood Services, Ottawa, Ontario, Canada
| | - M Schmidt
- Third Faculty of Medicine, Charles University, Praha, Czech Republic
- FNKV University Hospital, Prague, Czech Republic
| | - P Waldauf
- Third Faculty of Medicine, Charles University, Praha, Czech Republic
- FNKV University Hospital, Prague, Czech Republic
| | - F Duska
- Third Faculty of Medicine, Charles University, Praha, Czech Republic
- FNKV University Hospital, Prague, Czech Republic
| | - Tineke Wind
- Maastricht University Medical Centre, Maastricht, The Netherlands
- Heart and Vascular Center, Maastricht, The Netherlands
| | - W N Van Mook
- Deparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sonny Dhanani
- Critical Pediatric Critical Care Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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20
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Caffrey N, O'Brien SF, Walsh GM, Haw J, Goldman M. Evolving the gay, bisexual and other men who have sex with men time-based deferral to sexual risk screening for all donors: The contribution of Canadian research programmes. Vox Sang 2023; 118:605-615. [PMID: 37191161 DOI: 10.1111/vox.13443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVES In Canada, the time deferral for gay, bisexual and other men who have sex with men (gbMSM) to donate blood has gradually decreased. In September 2022, this deferral was replaced with sexual behaviour-based screening for all donors. We investigate how data from targeted research programmes addressed knowledge gaps to support this change. MATERIALS AND METHODS We conducted a scoping review describing the Canadian literature available before the research programmes relating to (1) behavioural indicators of HIV risk and (2) attitudes to blood donation among gbMSM, current donors and the general population. We summarize the targeted research programmes, their outputs and impact to date. RESULTS For question 1, five projects met inclusion criteria. For question 2, three articles met inclusion criteria. Knowledge gaps identified were insufficient evidence of HIV incidence in gbMSM who met other donor eligibility criteria and scant data on opinions and views of blood donation and screening criteria for sexual risk behaviours. The research programmes funded 19 projects at 11 different research sites involving over 100 individual researchers/collaborators resulting in 19 peer-reviewed publications to date. Leveraging existing gbMSM cohorts yielded relevant HIV incidence data to inform safety modelling studies. Findings indicated that sexual behaviour-based screening was acceptable to gbMSM and donors, and donor discomfort around specific questions could be mitigated with clear explanations. CONCLUSION Targeted research programmes filled critical knowledge gaps and informed a change to gender-neutral, sexual behaviour-based screening for all donors. Findings supported successful implementation of these changes with research-informed staff training.
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Affiliation(s)
- Niamh Caffrey
- Donation Policy & Studies, Canadian Blood Services, Calgary, Alberta, Canada
| | - Sheila F O'Brien
- Donation Policy & Studies, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Geraldine M Walsh
- Innovation and Portfolio Management, Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Jennie Haw
- Donation Policy & Studies, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Donation Policy & Studies, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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21
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky N, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Coutlée F, Burchell AN. Vaccine Effectiveness Against 12-Month Incident and Persistent Anal Human Papillomavirus Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men. J Infect Dis 2023; 228:89-100. [PMID: 36655513 PMCID: PMC10304758 DOI: 10.1093/infdis/jiad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM. METHODS We recruited GBM aged 16-30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12-13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression. RESULTS Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24-1.31) for cumulative incidence and 0.53 (95% CI, .25-1.14) for persistence. PRs were 0.23 (95% CI, .05-1.03) and 0.08 (95% CI, .01-.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03-.68) and 0.12 (95% CI, .03-.54) among participants who were sexually active for ≤5 years before vaccination. CONCLUSIONS Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.
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Affiliation(s)
- Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut National de Santé Publique du Québec, Québec, Québec, Canada
| | | | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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22
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Blake JT, Clarke G, Bodnar M, Stepien J. Evaluating the inventory impact of utilizing low titer platelets in regional hospitals. Transfusion 2023. [PMID: 37227059 DOI: 10.1111/trf.17418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND As a result of constrained supply, it is sometimes necessary to provide patients with ABO-mismatched platelets. Such practices increase the risk of acute hemolytic transfusion reaction (AHTR). Providing patients with platelets suspended in O plasma having low-titer Anti-A and Anti-B antibodies (LtABO) could reduce the incidence of AHTR. However, natural scarcity limits the number of such units that can be produced. In this paper we present a study to evaluate strategies for deploying LtABO at regional hospitals in Canada. STUDY DESIGN AND METHODS Regional hospitals often experience demand for platelets on an irregular basis. They are, however, required to stock some number of platelets (typically one A-unit and one O-unit) for emergencies; outdates are common, with discard rates sometimes >>50%. A simulation study was completed to determine the impact of replacing a (1A, 1O) inventory with 2 or 3 units of LtABO at regional hospitals. RESULTS A significant decreases in wastage and shortage can be expected by replacing a (1A, 1O) inventory policy with 2 units of LtABO. In tested cases, a 2-unit LtABO dominated a (1A, 1O) policy, resulting in statistically fewer outdates and instances of shortage. Holding 3 units of LtABO, increases product availability, but results in an increase in outdates when compared to a (1A, 1O) policy. CONCLUSION Providing LtABO platelets to smaller, regional hospitals will lower wastage rates and improve patient access to care, when compared to existing (1A, 1O) inventory policies.
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Affiliation(s)
- John T Blake
- Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Blood Services, Calgary, Alberta, Canada
| | - Gwenn Clarke
- Canadian Blood Services, Calgary, Alberta, Canada
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23
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Chi SI, Yousuf B, Paredes C, Bearne J, McDonald C, Ramirez-Arcos S. Proof of concept for detection of staphylococcal enterotoxins in platelet concentrates as a novel safety mitigation strategy. Vox Sang 2023. [PMID: 37170419 DOI: 10.1111/vox.13440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Staphylococcus aureus is a predominant contaminant of platelet concentrates (PCs) that can evade detection during screening with culture methods. Importantly, S. aureus produces staphylococcal enterotoxins (SEs) during PC storage, which are linked to slow growth and enhanced biofilm formation. This study investigated timing of SE production during PC storage and feasibility of SE detection as a PC safety strategy. MATERIALS AND METHODS Genomic and transcriptomic data of transfusion-relevant S. aureus PS/BAC/169/17/W, PS/BAC/317/16/W, CI/BAC/25/13/W and CBS2016-05 were used to determine the presence and differential expression of exotoxin genes in PCs. Trypticase soy broth (TSB) and PCs were inoculated with 1.0E+06 cfu/mL of S. aureus PS/BAC/169/17/W and CBS2016-05. Expression of SEs at different growth phases was confirmed with Western blotting. PCs were inoculated with 30 cfu/unit of the same strains, and SE detection during PC storage was optimized with a sandwich dot-ELISA assay. RESULTS S. aureus genomes contain multiple exotoxin genes including those encoding for SEs. Transcriptome data revealed significant upregulation (0.5-6.7-fold, p < 0.05) of SE genes in PCs versus TSB. Western blots demonstrated SE production at all growth phases. Notably, dot-ELISA detected clinically relevant concentrations of SEs (~0.2 μg/mL) at 32 h of PC storage when S. aureus PS/BAC/169/17/W and CBS2016-05 counts were 1.8E+04 and 1.4E+04 cfu/mL, respectively. CONCLUSION Genomic analyses revealed that staphylococcal exotoxins are widely distributed and highly conserved among transfusion-relevant S. aureus isolates. Furthermore, SEs are significantly upregulated in PCs and detected at 30 h of PC storage. Therefore, bacterial toxin detection could supplement mitigation strategies to enhance PC safety.
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Affiliation(s)
- Sylvia Ighem Chi
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Basit Yousuf
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Carina Paredes
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Carl McDonald
- National Health Service Blood and Transplant, London, UK
| | - Sandra Ramirez-Arcos
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
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24
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O'Brien SF, Drews SJ, Yi QL, Osmond L, Tran V, Zhou HY, Goldman M. Monitoring syphilis serology in blood donors: Is there utility as a surrogate marker of early transfusion transmissible infection behavioral risk? Transfusion 2023. [PMID: 37158235 DOI: 10.1111/trf.17393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND In Canada the time deferral for gay, bisexual, and other men who have sex with men (gbMSM) was progressively shortened (lifetime, 5 years, 1 year, 3 months). Here we describe trends in syphilis rates (a potential sexual risk marker) and risk behaviors from blood donors in the past 12 years. STUDY DESIGN AND METHODS Syphilis positivity in 10,288,322 whole blood donations (January 1, 2010-September 10, 2022) and gbMSM deferral time periods, donation status, age, and sex were analyzed with logistic regression. Overall, 26.9% syphilis positive and 42.2% controls (matched 1:4) participated in risk factor interviews analyzed by logistic regression. RESULTS Syphilis rates were higher in first-time donors (OR 27.0, 95% CI 22.1-33.0), in males (OR 2.3, 1.9-2.8) and with the 3-month deferral (OR 3.4, 2.6-4.3) during which the increase was greater for first-time males (p < .001) but similar for male and female repeat donors (p > .05). Among first-time donors, histories of intravenous drug use (OR 11.7, 2.0-69.5), male-to-male sex 7.8 (2.0-30.2) and birth in a high prevalence country (OR 7.6, 4.4-13.0) predicted syphilis positivity; among repeat donors, history of male-to-male sex (OR 33.5, CI 3.5-317.0). All but 1 gbMSM syphilis-positive donors were noncompliant with the gbMSM deferral. About a quarter of first-time interviewed case donors had history of syphilis; 44% were born in a high-prevalence country. CONCLUSION Rising syphilis rates in donors correlates with the general population epidemic. Recent infection rates rose similarly in males and females. GbMSM history may contribute to donor syphilis rates but shortening time deferrals appears unrelated.
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Affiliation(s)
- Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven J Drews
- Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Lori Osmond
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Vanessa Tran
- Microbiology, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine & Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Hong Yuan Zhou
- Microbiology, ProvLab Alberta, Calgary, Alberta, Canada
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mindy Goldman
- Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology & Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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25
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Zavalkoff S, O'Donnell S, Lalani J, Karam IF, James L, Shemie SD. Preventable harm in the Canadian organ donation and transplantation system: a descriptive study of missed organ donor identification and referral. Can J Anaesth 2023; 70:886-892. [PMID: 36991298 PMCID: PMC10057689 DOI: 10.1007/s12630-023-02399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 03/31/2023] Open
Abstract
PURPOSE Deceased organ donation is predicated on timely identification and referral (IDR) of potential organ donors. Many Canadian provinces have legislated mandatory referral of potential deceased donors. Untimely or missed IDRs are safety events where best or expected practice has not occurred causing preventable harm to patients and denying families the opportunity of donation at end of life (EOL) as well as denying transplant waitlist patients access to lifesaving organs. METHODS We requested donor definitions and data to calculate IDR, consent, and approach rates from all Canadian organ donation organizations (ODOs) for 2016-2018. We then estimated the number of missed IDR patients who were eligible for approach (safety events) and the associated preventable harm to patients at EOL and on transplant waitlists. RESULTS Annually, there were 63-76 missed IDR patients eligible for approach (3.6-4.5 per million population [PMP]) from four ODOs-three with mandatory referral legislation. Applying each ODO's approach and consent rates for the corresponding year, there were 37-41 missed donors (2.4 donor PMP) annually. Assuming three transplants per donor, the theoretical number of missed transplants would be 111-123 (6.4-7.3 transplants PMP) annually. CONCLUSIONS Data from four Canadian ODOs show that missed IDR safety events resulted in important preventable harm measured by a lost opportunity for donation of 2.4 donors PMP annually and 354 potentially missed transplants between 2016 and 2018. Given that 223 patients died on Canada's waitlist in 2018, national donor audits and quality improvement initiatives to optimize IDR are essential to reduce preventable harm to these vulnerable populations.
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Affiliation(s)
- Samara Zavalkoff
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada.
- The Research Institute of the McGill University Health Centre, 2155 Guy St., Suite 500, Montreal, QC, H3H 2R9, Canada.
| | - Shauna O'Donnell
- The Research Institute of the McGill University Health Centre, 2155 Guy St., Suite 500, Montreal, QC, H3H 2R9, Canada
| | - Jehan Lalani
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, ON, K1G 4J5, Canada
| | - Isabela F Karam
- The Research Institute of the McGill University Health Centre, 2155 Guy St., Suite 500, Montreal, QC, H3H 2R9, Canada
| | - Lee James
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, ON, K1G 4J5, Canada
| | - Sam D Shemie
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, 2155 Guy St., Suite 500, Montreal, QC, H3H 2R9, Canada
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, ON, K1G 4J5, Canada
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26
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Sarti AJ, Honarmand K, Sutherland S, Hornby L, Wilson LC, Priestap F, Carignan R, Joanne B, Brewster H, Elliott-Pohl K, Weiss M, Shemie SD. When is a person dead? The Canadian public's understanding of death and death determination: a nationwide survey. Can J Anaesth 2023; 70:617-627. [PMID: 37131025 PMCID: PMC10202975 DOI: 10.1007/s12630-023-02409-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 05/04/2023] Open
Abstract
PURPOSE We aimed to describe the Canadian public's understanding and perception of how death is determined in Canada, their level of interest in learning about death and death determination, and their preferred strategies for informing the public. METHODS We conducted a nationwide cross-sectional survey of a representative sample of the Canadian public. The survey presented two scenarios of a man who met current criteria for neurologic death determination (scenario 1) and a man who met current criteria for circulatory death determination (scenario 2). Survey questions evaluated understanding of how death is determined, acceptance of death determination by neurologic and circulatory criteria, and interest and preferred strategies in learning more about the topic. RESULTS Among 2,000 respondents (50.8% women; n = 1,015), nearly 67.2% believed that the man in scenario 1 was dead (n = 1,344) and 81.2% (n = 1,623) believed that the man in scenario 2 was dead. Respondents who believed that the man was not dead or were unsure endorsed several factors that may increase their agreement with the determination of death, including requiring more information about how death was determined, seeing the results of brain imaging/tests, and a third doctor's opinion. Predictors of disbelief that the man in scenario 1 is dead were younger age, being uncomfortable with the topic of death, and subscribing to a religion. Predictors of disbelief that the man in scenario 2 is dead were younger age, residing in Quebec (compared with Ontario), having a high school education, and subscribing to a religion. Most respondents (63.3%) indicated interest in learning more about death and death determination. Most respondents preferred to receive information about death and death determination from their health care professional (50.9%) and written information provided by their health care professional (42.7%). CONCLUSION Among the Canadian public, the understanding of neurologic and circulatory death determination is variable. More uncertainty exists with death determination by neurologic criteria than with circulatory criteria. Nevertheless, there is a high level of general interest in learning more about how death is determined in Canada. These findings provide important opportunities for further public engagement.
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Affiliation(s)
- Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Stephanie Sutherland
- Department of Critical Care, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | | | | | | | - Robert Carignan
- Canadian Medical Association Patient Voice, Ponteix, SK, Canada
| | - Brennan Joanne
- Vascular Research, The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | | | - Sam D Shemie
- Division of Critical Care, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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Sarti AJ, Sutherland S, Meade M, Hornby L, Wilson LC, Landriault A, Vanderspank-Wright B, Valiani S, Keenan S, Weiss MJ, Werestiuk K, Beed S, Kramer AH, Kawchuk J, Cardinal P, Dhanani S, Lotherington K, Pagliarello G, Chassé M, Gatien M, Parsons K, Chandler JA, Nickerson P, Shemie SD. Death determination by neurologic criteria-what do families understand? Can J Anaesth 2023; 70:637-650. [PMID: 37131029 PMCID: PMC10203015 DOI: 10.1007/s12630-023-02416-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 05/04/2023] Open
Abstract
PURPOSE Currently, there is little empirical data on family understanding about brain death and death determination. The purpose of this study was to describe family members' (FMs') understanding of brain death and the process of determining death in the context of organ donation in Canadian intensive care units (ICUs). METHODS We conducted a qualitative study using semistructured, in-depth interviews with FMs who were asked to make an organ donation decision on behalf of adult or pediatric patients with death determination by neurologic criteria (DNC) in Canadian ICUs. RESULTS From interviews with 179 FMs, six main themes emerged: 1) state of mind, 2) communication, 3) DNC may be counterintuitive, 4) preparation for the DNC clinical assessment, 5) DNC clinical assessment, and 6) time of death. Recommendations on how clinicians can help FMs to understand and accept DNC through communication at key moments were described including preparing FMs for death determination, allowing FMs to be present, and explaining the legal time of death, combined with multimodal strategies. For many FMs, understanding of DNC unfolded over time, facilitated with repeated encounters and explanation, rather than during a single meeting. CONCLUSION Family members' understanding of brain death and death determination represented a journey that they reported in sequential meeting with health care providers, most notably physicians. Modifiable factors to improve communication and bereavement outcomes during DNC include attention to the state of mind of the family, pacing and repeating discussions according to families' expressed understanding, and preparing and inviting families to be present for the clinical determination including apnea testing. We have provided family-generated recommendations that are pragmatic and can be easily implemented.
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Affiliation(s)
- Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Stephanie Sutherland
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Maureen Meade
- Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Angele Landriault
- Practice, Performance and Innovation Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Brandi Vanderspank-Wright
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sabira Valiani
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Sean Keenan
- BC Transplant, Vancouver, BC, Canada
- Division of Critical Care, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Stephen Beed
- Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andreas H Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary and Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada
| | - Joann Kawchuk
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Pierre Cardinal
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Sonny Dhanani
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Giuseppe Pagliarello
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Michaël Chassé
- Department of Medicine, Centre hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Mary Gatien
- Horizon Health Network, Miramichi, NB, Canada
| | - Kim Parsons
- Organ Procurement and Exchange of Newfoundland and Labrador, St. John's, NL, Canada
| | - Jennifer A Chandler
- Common Law Section, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Peter Nickerson
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sam D Shemie
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
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Lin Y, Del Giudice ME, Kron A, Meirovich H, Sholzberg M, Swarup V, Huang M, Distefano L, Anani WQ, Armali C, Bussel JB, Callum J. A pilot feasibility trial of daily versus every other day oral iron supplementation in patients with iron deficiency anaemia. Br J Haematol 2023; 201:1000-1004. [PMID: 36999886 DOI: 10.1111/bjh.18792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/07/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - M Elisabeth Del Giudice
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amie Kron
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Harley Meirovich
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Hematology Oncology Clinical Research Group, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Hematology, Departments of Medicine, and Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, and University of Toronto, Toronto, Ontario, Canada
| | - Vidushi Swarup
- Hematology Oncology Clinical Research Group, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mary Huang
- Canadian Blood Services, Toronto, Ontario, Canada
| | | | | | - Chantal Armali
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - James B Bussel
- Weill Cornell Medical College, New York City, New York, USA
| | - Jeannie Callum
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Toronto, Ontario, Canada
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29
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Eltringham-Smith LJ, Meixner SC, Pryzdial ELG, Sheffield WP. Correction of haemorrhagic shock-associated coagulopathy and impaired haemostasis by plasma, prothrombin complex concentrates or an activated protein C-targeted DNA aptamer in mice. Sci Rep 2023; 13:3811. [PMID: 36882463 PMCID: PMC9992365 DOI: 10.1038/s41598-023-30794-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
Even with extensive transfusion support, trauma-induced bleeding often leads to death. Early intervention may improve outcomes, yet which blood products, factor concentrates, or other drugs constitute optimal treatment is unclear. Patients with acute traumatic coagulopathy (ATC), arising from trauma and haemorrhagic shock, have the worst prognosis. Here, multiple interventions were compared in a mouse model of ATC. After the trauma of tissue excision, anaesthetized mice were bled to 35 mm Hg mean arterial pressure, maintained under shock for 60 min, and resuscitated with fluids equal in volume to the shed blood. Resuscitated mice were subjected to liver laceration to test haemostasis and blood loss was quantified. Saline-treated mice lost two- to three-fold more blood than sham-treated animals and were coagulopathic by prothrombin time elevation post- versus pre-procedure. Murine fresh-frozen plasma (mFFP), anti-activated protein C aptamer HS02-52G, or prothrombin complex concentrates eliminated the bleeding diathesis and coagulopathy; fibrinogen, plasminogen activator inhibitor-1, or tranexamic acid ameliorated bleeding or coagulopathy, but not both. HS02-52G and mFFP also eliminated the changes in plasma aPC and tissue plasminogen activator levels observed in saline-treated mice, as judged via microtiter plate biomarker assays. Procoagulant interventions, especially inhibiting aPC, could be beneficial in human ATC.
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Affiliation(s)
| | - Scott C Meixner
- Medical Affairs and Innovation, Canadian Blood Services, Vancouver, BC, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Edward L G Pryzdial
- Medical Affairs and Innovation, Canadian Blood Services, Vancouver, BC, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - William P Sheffield
- Medical Affairs and Innovation, Canadian Blood Services, Hamilton, ON, Canada.
- Department of Pathology and Molecular Medicine, McMaster University, HSC 4N66, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Fisher WA, Kohut T, Woo H, Haw J. Alternatives to blood donor deferral of gay, bisexual, and other men who have sex with men: Acceptability of screening the sexual risk behavior of all blood donors. Transfusion 2023; 63:531-540. [PMID: 36637350 DOI: 10.1111/trf.17241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Blood operators screen donors to reduce the risk of transfusion-transmitted infections (TTIs). Many are evolving screening procedures from those that defer all who have had a sexual interaction with gay, bisexual, or other men who have sex with men (gbMSM) to an approach that assesses individual donors' recent sexual risk behavior with any partner. STUDY DESIGN AND METHODS A representative sample of current blood donors (N = 1194) was recruited online and randomized to complete either the existing (at the time of the study) Canadian Blood Services' donor questionnaire (DQ) that screens out those with recent gbMSM sexual experience, a modified donor questionnaire (MDQ) that assesses individuals' recent sexual behavior with any partner, or an MDQ that assesses individual sexual behavior with any partner and explains why these questions are asked. Respondents were asked for their perceptions concerning difficulty, comfort, and acceptability of these screening questionnaires. RESULTS Across experimental conditions, current donors regarded screening questionnaire difficulty to be low; discomfort in responding was minimal; screening questionnaires were perceived to be relatively inoffensive and justified, and very few donors would cease donating if the screening questionnaire they responded to became the one in general use. Some minor sex differences were observed, and in some cases, perceptions of the MDQ with explanation were somewhat more positive than those of the DQ and MDQ without explanation. DISCUSSION An individual risk behavior screening approach appears to be acceptable to current blood donors as an alternative to screening out all who have recently engaged in gbMSM sexual interactions.
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Affiliation(s)
- William A Fisher
- Department of Psychology and Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
| | - Taylor Kohut
- Department of Psychology, Western University, London, Ontario, Canada
- Institut de Recherche en Sciences Psychologiques, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Hyunjin Woo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jennie Haw
- Donation Policy and Studies, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
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31
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Ning S, Gabarin N, Li N, Liu Y, Lucier K, Barty R, Acker J, Webert KE, Warkentin TE, Arnold DM, Heddle NM. An evaluation of the clinical impacts of 7-day platelets. Transfusion 2023; 63:480-493. [PMID: 36744999 DOI: 10.1111/trf.17272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND In August 2017, Canadian Blood Services extended the shelf-life of platelet concentrates from 5 to 7 days. The clinical impacts of this policy change remain unclear. STUDY DESIGN AND METHODS We used a before-after retrospective design of platelet-transfused adult inpatients in Hamilton, ON, Canada. Data were captured for 18 months before (Period 1: February 2016-July 2017) and 18 months after (Period 2: September 2017-February 2019) 7-day platelet implementation. Primary outcome was absolute platelet count increment (ACI) in univariate and multivariate analyses adjusted for confounders. Data were obtained from our institution's transfusion database, Ontario's Transfusion Transmitted Injuries Surveillance System, and the blood supplier. RESULTS Overall, 1360 patients with single dose platelet transfusions were included in Period 1 and 1211 patients in Period 2. Median age at admission was 66 years, and approximately 40% of patients underwent cardiac surgery. Using a non-inferiority margin of -10 × 109 /L, platelets transfused during the 7-day storage period were non-inferior to those transfused in the 5-day storage period [mean count difference - 4.63 × 109 /L (95% CI -7.40 to -1.87, p = 0.0001)]. However, platelet ACIs following transfusion consistently trended lower in the 7-day group for all patients and subgroups. No differences in secondary clinical outcomes were observed. Platelet expiry reduced from 8.1 to 6.3% (p < 0.0001). CONCLUSION Platelet transfusions following 7-day storage policy were non-inferior to transfusions in the 5-day policy period, although reduced ACIs were observed. There were no increases in adverse clinical outcomes.
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Affiliation(s)
- Shuoyan Ning
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ancaster, Ontario, Canada
- Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Gabarin
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Na Li
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yang Liu
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Kayla Lucier
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Jason Acker
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Canadian Blood Services, Centre of Innovation, Ottawa, Ontario, Canada
| | - Kathryn E Webert
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ancaster, Ontario, Canada
- Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Theodore E Warkentin
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Centre of Innovation, Ottawa, Ontario, Canada
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32
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Verret M, Lam NH, Fergusson DA, G Nicholls S, Turgeon AF, McIsaac DI, Gilron I, Hamtiaux M, Srichandramohan S, Al-Mazidi A, A Fergusson N, Hutton B, Zivkovic F, Graham M, Geist A, Lê M, Berube M, Poulin P, Shorr R, Daudt H, Martel G, McVicar J, Moloo H, Lalu MM. Intraoperative pharmacologic opioid minimisation strategies and patient-centred outcomes after surgery: a scoping review protocol. BMJ Open 2023; 13:e070748. [PMID: 36858477 PMCID: PMC9980324 DOI: 10.1136/bmjopen-2022-070748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION For close to a century opioid administration has been a standard of care to complement anaesthesia during surgery. Considering the worldwide opioid epidemic, this practice is now being challenged and there is a growing use of systemic pharmacological opioid minimising strategies. Our aim is to conduct a scoping review that will examine clinical trials that have evaluated the impact of intraoperative opioid minimisation strategies on patient-centred outcomes and identify promising strategies. METHODS AND ANALYSIS Our scoping review will follow the framework developed by Arksey and O'Malley. We will search MEDLINE, Embase, CENTRAL, Web of Science and CINAHL from their inception approximately in March 2023. We will include randomised controlled trials, assessing the impact of systemic intraoperative pharmacologic opioid minimisation strategies on patient-centred outcomes. We define an opioid minimisation strategy as any non-opioid drug with antinociceptive properties administered during the intraoperative period. Patient-centred outcomes will be defined and classified based on the consensus definitions established by the Standardised Endpoints in Perioperative Medicine initiative (StEP-COMPAC group) and informed by knowledge users and patient partners. We will use a coproduction approach involving interested parties. Our multidisciplinary team includes knowledge users, patient partners, methodologists and knowledge user organisations. Knowledge users will provide input on methods, outcomes, clinical significance of findings, implementation and feasibility. Patient partners will participate in assessing the relevance of our design, methods and outcomes and help to facilitate evidence translation. We will provide a thorough description of available clinical trials, compare their reported patient-centred outcome measures with established recommendations and identify promising strategies. ETHICS AND DISSEMINATION Ethics approval is not required for the review. Our scoping review will inform future research including clinical trials and systematic reviews through identification of important intraoperative interventions. Results will be disseminated through a peer-reviewed publication, presentation at conferences and through our network of knowledge user collaborators. REGISTRATION Open Science Foundation (currently embargoed).
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Affiliation(s)
- Michael Verret
- Department of Anesthesiology and Critical Care Medicine, CHU de Québec-Université Laval, Québec, Quebec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Axe Traumatologie-urgence-soins intensifs, Université Laval, Québec, Quebec, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Nhat Hung Lam
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, CHU de Québec-Université Laval, Québec, Quebec, Canada
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Axe Traumatologie-urgence-soins intensifs, Université Laval, Québec, Quebec, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Myriam Hamtiaux
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Nicholas A Fergusson
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Fiona Zivkovic
- Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Megan Graham
- Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Allison Geist
- Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Maxime Lê
- Patient Partner, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Melanie Berube
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Axe Traumatologie-urgence-soins intensifs, Université Laval, Québec, Quebec, Canada
- Faculty of Nursing, Universite Laval, Quebec, Canada
| | - Patricia Poulin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Guillaume Martel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jason McVicar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Husein Moloo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Li W, William N, Acker JP. Donor sex, pre-donation hemoglobin, and manufacturing affect CD71 + cells in red cell concentrates. Transfusion 2023; 63:601-609. [PMID: 36655728 DOI: 10.1111/trf.17250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Circulating CD71+ red blood cells (RBCs) have been reported to play an immunomodulatory role in vivo, which may contribute to adverse donor-recipient sex-mismatched transfusion outcomes. However, it is not clear how CD71+ RBC quantity in red cell concentrates (RCCs) is affected by manufacturing methods and donor factors such as donor sex, donor age, pre-donation hemoglobin (Hb), venous Hb (Hbv ) levels, and donation frequency. METHODS We determined CD71+ RBCs and Hb levels in whole blood (WB) from healthy donors (42 male/38 female). Using small-scale red cell filtration (RCF) and whole blood filtration (WBF) methods, leukoreduced RCCs were processed from WB samples (n = 6) and the CD71+ RBCs were determined at days 1, 7, and 28. We examined uni- and multivariate associations among CD71+ RBCs, donor factors, and manufacturing method. RESULTS Male donors had a higher CD71+ RBC concentration than females (p < .001), especially male donors aged 17-50 years with 1 or 2 WB donations over the previous 12 months. Donors with a Hbv above 155 g/L had a higher CD71+ RBC concentration than an Hbv level below 140 g/L (p < .05). There was a positive correlation between pre-donation Hb and CD71+ RBC concentration (Pearson r = 0.41). WBF RCCs had a higher total number of CD71+ RBCs than RCF-produced RCCs on day 1 (p < .05). DISCUSSION RCCs have variable numbers of CD71+ RBCs. This makes understanding the impact of donor factors and manufacturing methods on the immunomodulatory effect of CD71+ RBCs critical in exploring donor-recipient sex-mismatched transfusions.
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Affiliation(s)
- Wenhui Li
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Nishaka William
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jason P Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Canada
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34
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Brennan DJ, Armstrong JP, Kesler M, Bekele T, Lachowsky NJ, Grace D, Hart TA, Souleymanov R, Adam BD. Willingness and eligibility to donate blood under 12-month and 3-month deferral policies among gay, bisexual, and other men who have sex with men in Ontario, Canada. PLOS Glob Public Health 2023; 3:e0001380. [PMID: 36962853 PMCID: PMC10021805 DOI: 10.1371/journal.pgph.0001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 11/17/2022] [Indexed: 05/25/2023]
Abstract
In Canada, gay, bisexual and other men who have sex with men (GBMSM) are a population that are willing to donate blood, if eligible, but have a history of ineligibility and deferrals due to concerns that their blood poses an increased risk of HIV entering the blood supply. Our objective was to examine the proportion of GBMSM who are willing and eligible to donate under the 12-month deferral policy (implemented in 2016) and the 3-month deferral policy (implemented in 2019). Data for this study comes from the #iCruise study, a mixed cohort study designed to examine sexual health outreach experiences through online services and mobile apps among GBMSM in Ontario. A total of 910 participants were recruited between July 2017 and January 2018. Eligibility criteria include identify as male (cisgender or transgender); at least 14 years old; having had sex with a man in the previous year or identifying as sexually/romantically attracted to other men or identifying as gay, bisexual, queer or two-spirit; and living or working in Ontario or having visited Ontario four or more times in the past year. Participants completed a baseline and a follow-up questionnaire. A subset of #iCruise participants (n = 447) further completed this questionnaire. Willingness and eligibility to donate blood were assessed under 12-month and 3-month deferral policies. Of the 447 GBMSM surveyed, 309 (69.1%) reported a general interest in donating blood. 109 (24.4%) GBMSM were willing, 75 (16.7%) were eligible, and 24 (5.4%) were both willing and eligible to donate blood under the 12-month deferral policy. Under the 3-month deferral policy, willingness and eligibility to donate blood increased significantly to 42.3% and 29.3%, respectively. The percent of GBMSM who were both willing and eligible to donate blood also increased significantly to 12.3% under the 3-month deferral policy. The increase in willingness to donate blood varied by age, ethnicity, and geographic residence of participants whereas the increase in eligibility to donate blood varied by education level of participants. Under the 3-month deferral policy, GBMSM who were 50 years or older, identified as bisexual or other, had a lower education level, and who were not 'out' to others were more likely to be eligible to donate. GBMSM who reported a general interest in donating blood were more likely to be willing to donate blood under both deferral policies. The most common reason for not being interested in donating blood was the MSM deferral policy itself; many participants interpreted the policy as discriminatory for 'singling out' GBMSM or self-assed themselves as ineligible. Among study participants, both willingness and eligibility to donate blood was significantly higher under the 3-month deferral policy. The results suggest that a time-based reduction to a 3-month deferral policy is impactful but limited. Future research should measure GBMSM's willingness and eligibility under the individual risk-based assessment (to be implemented in 2022).
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Affiliation(s)
- David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - JP Armstrong
- Department of Sociology, York University, Toronto, Canada
| | - Maya Kesler
- Ontario HIV Treatment Network, Toronto, Canada
| | | | - Nathan J. Lachowsky
- School of Public Health & Social Policy, University of Victoria, Victoria, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Trevor A. Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Rusty Souleymanov
- Faculty of Social Work, University of Manitoba (Fort Garry Campus), Winnipeg, Canada
| | - Barry D. Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, Canada
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Holloway K. Emotional Labor of Nurses and Phlebotomists in a New Source Plasma Collection Site During the COVID-19 Pandemic. Glob Qual Nurs Res 2023; 10:23333936231192000. [PMID: 37635764 PMCID: PMC10449104 DOI: 10.1177/23333936231192000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
As uses of plasma-derived medical products increase globally, so does the demand to collect plasma from donors. There is evidence that positive interactions with center staff motivate plasma donors to return. This paper reports on a focused ethnography investigating experiences of nurses and phlebotomists in one of Canadian Blood Services' first source plasma collection center during the COVID-19 pandemic. Participants found the transition from whole blood collection to source plasma amid a global pandemic challenging, but they adapted by coming together as a team, and then worked to put the donor experience first. Their experience resonates with scholarship on emotional labor. As blood services worldwide attempt to increase source plasma collection, there is a need to understand care work that nurses and phlebotomists perform on the front-line. This study offers insight into how blood services can support staff in plasma operations by recognizing emotional labor.
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Gil Gonzalez L, Fernandez-Marrero Y, Norris PAA, Tawhidi Z, Shan Y, Cruz-Leal Y, Won KD, Frias-Boligan K, Branch DR, Lazarus AH. THP-1 cells transduced with CD16A utilize Fcγ receptor I and III in the phagocytosis of IgG-sensitized human erythrocytes and platelets. PLoS One 2022; 17:e0278365. [PMID: 36516219 PMCID: PMC9749970 DOI: 10.1371/journal.pone.0278365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
Fc gamma receptors (FcγRs) are critical effector receptors for immunoglobulin G (IgG) antibodies. On macrophages, FcγRs mediate multiple effector functions, including phagocytosis, but the individual contribution of specific FcγRs to phagocytosis has not been fully characterized. Primary human macrophage populations, such as splenic macrophages, can express FcγRI, FcγRIIA, and FcγRIIIA. However, there is currently no widely available monocyte or macrophage cell line expressing all these receptors. Common sources of monocytes for differentiation into macrophages, such as human peripheral blood monocytes and the monocytic leukemia cell line THP-1, generally lack the expression of FcγRIIIA (CD16A). Here, we utilized a lentiviral system to generate THP-1 cells stably expressing human FcγRIIIA (CD16F158). THP-1-CD16A cells treated with phorbol 12-myristate 13-acetate for 24 hours phagocytosed anti-D-opsonized human red blood cells primarily utilizing FcγRI with a lesser but significant contribution of IIIA while phagocytosis of antibody-opsonized human platelets equally utilized FcγRI and Fcγ IIIA. Despite the well-known ability of FcγRIIA to bind IgG in cell free systems, this receptor did not appear to be involved in either RBC or platelet phagocytosis. These transgenic cells may constitute a valuable tool for studying macrophage FcγR utilization and function.
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Affiliation(s)
- Lazaro Gil Gonzalez
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto ON, Canada
| | | | - Peter Alan Albert Norris
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto ON, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Ottawa, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Zoya Tawhidi
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Yuexin Shan
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto ON, Canada
| | - Yoelys Cruz-Leal
- Innovation and Portfolio Management, Canadian Blood Services, Ottawa, ON, Canada
| | - Kevin Doyoon Won
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kayluz Frias-Boligan
- Innovation and Portfolio Management, Canadian Blood Services, Ottawa, ON, Canada
| | - Donald R. Branch
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto ON, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Ottawa, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alan H. Lazarus
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto ON, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Ottawa, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- * E-mail:
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Francoeur C, Hornby L, Silva A, Scales NB, Weiss M, Dhanani S. Paediatric death after withdrawal of life-sustaining therapies: a scoping review protocol. BMJ Open 2022; 12:e064918. [PMID: 36123110 PMCID: PMC9486282 DOI: 10.1136/bmjopen-2022-064918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The physiology of dying after withdrawal of life-sustaining measures (WLSM) is not well described in children. This lack of knowledge makes predicting the duration of the dying process difficult. For families, not knowing this process's duration interferes with planning of rituals related to dying, travel for distant relatives and emotional strain during the wait for death. Time-to-death also impacts end-of-life care and determines whether a child will be eligible for donation after circulatory determination of death. This scoping review will summarise the current literature about what is known about the dying process in children after WLSM in paediatric intensive care units (PICUs). METHODS AND ANALYSIS This review will use Joanna Briggs Institute methodology for scoping reviews. Databases searched will include Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials via EBM Reviews Ovid, Ovid PsycINFO, CINAHL and Web of Science. Literature reporting on the physiology of dying process after WLSM, or tools that predict time of death in children after WLSM among children aged 0-18 years in PICUs worldwide will be considered. Literature describing the impact of prediction or timing of death after WLSM on families, healthcare workers and the organ donation process will also be included. Quantitative and qualitative studies will be evaluated. Two independent reviewers will screen references by title and abstract, and then by full text, and complete data extraction and analysis. ETHICS AND DISSEMINATION The review uses published data and does not require ethics review. Review results will be published in a peer-reviewed scientific journal.
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Affiliation(s)
- Conall Francoeur
- Department of Pediatrics, Centre de recherche du CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
| | - Laura Hornby
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Amina Silva
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Matthew Weiss
- Department of Pediatrics, Centre de recherche du CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
- Transplant Québec, Quebec, Québec, Canada
- Canadian Donation and Transplantation Research Program, Ottawa, Ontario, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplantation Research Program, Ottawa, Ontario, Canada
- Critical Care, CHEO, Ottawa, Ontario, Canada
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Murru A, Allard MÈ, Paré G, Vaillancourt M, Boyer L, Cayer MP, Vitry J, Landry P, Labrecque MM, Robitaille N, Branch DR, Girard M, Fernandes MJ. Comparison of Neutrophil Function in Granulocyte Concentrates From Prednisone- and G-CSF-Treated Donors: Effect of Stimulant, Leukapheresis and Storage. Front Med (Lausanne) 2022; 9:839475. [PMID: 35317326 PMCID: PMC8934424 DOI: 10.3389/fmed.2022.839475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
Transfusion of granulocyte concentrates (GC) is an alternative therapy for neutropenic patients with life-threatening infections. While neutrophils are the main source of antimicrobial activity, only neutrophil numbers are used to certify GCs. The objective of this study was thus to functionally characterize neutrophils in GCs prepared by leukapheresis from G-CSF-stimulated donors and compare to the less characterized prednisone GCs. GCs prepared from healthy donors stimulated with prednisone and then G-CSF after a 6-month washout period were analyzed prior to and after leukapheresis, and after storage. Leukocyte composition, neutrophil viability, calcium mobilization, chemotaxis, phagocytosis, reactive oxygen species, cytokine production and metabolites were determined. G-CSF GCs contained significantly more neutrophils than prednisone GCs of which 40% were immature. In comparison to non-stimulated healthy donor neutrophils, prednisone GC neutrophils exhibited enhanced phagocytosis and G-CSF GC neutrophils showed decreased chemotaxis but increased IL-8 production. Leukapheresis altered prednisone GC neutrophil responses. Storage had a significant, negative impact on G-CSF GC neutrophils compared to prednisone GC neutrophils. G-CSF and prednisone GC neutrophils thus differ in maturity and function, and G-CSF GC neutrophils are more sensitive to storage. Functional testing of GC neutrophils and better storage conditions would improve the quality of this blood product.
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Affiliation(s)
- Andréa Murru
- Infectious and Immune Diseases Division, CHU de Québec Research Center, Laval University, Québec, QC, Canada
- Department of Microbiology-Infectious Diseases and Immunology, CHU de Québec Research Center, Faculty of Medicine, Laval University, Québec, QC, Canada
- Medical Affairs and Innovation, Hema-Québec, Québec, QC, Canada
| | | | - Guillaume Paré
- Infectious and Immune Diseases Division, CHU de Québec Research Center, Laval University, Québec, QC, Canada
- Department of Microbiology-Infectious Diseases and Immunology, CHU de Québec Research Center, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Myriam Vaillancourt
- Infectious and Immune Diseases Division, CHU de Québec Research Center, Laval University, Québec, QC, Canada
- Department of Microbiology-Infectious Diseases and Immunology, CHU de Québec Research Center, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Lucie Boyer
- Medical Affairs and Innovation, Hema-Québec, Québec, QC, Canada
| | | | - Julien Vitry
- Infectious and Immune Diseases Division, CHU de Québec Research Center, Laval University, Québec, QC, Canada
- Department of Microbiology-Infectious Diseases and Immunology, CHU de Québec Research Center, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Patricia Landry
- Medical Affairs and Innovation, Hema-Québec, Québec, QC, Canada
| | - Marie-Michèle Labrecque
- Infectious and Immune Diseases Division, CHU de Québec Research Center, Laval University, Québec, QC, Canada
- Department of Microbiology-Infectious Diseases and Immunology, CHU de Québec Research Center, Faculty of Medicine, Laval University, Québec, QC, Canada
| | | | - Donald R. Branch
- Center for Innovation, Canadian Blood Services, Departments of Medicine and Lab Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Mélissa Girard
- Medical Affairs and Innovation, Hema-Québec, Québec, QC, Canada
| | - Maria J. Fernandes
- Infectious and Immune Diseases Division, CHU de Québec Research Center, Laval University, Québec, QC, Canada
- Department of Microbiology-Infectious Diseases and Immunology, CHU de Québec Research Center, Faculty of Medicine, Laval University, Québec, QC, Canada
- *Correspondence: Maria J. Fernandes
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Karanicolas PJ, Lin Y, McCluskey S, Roke R, Tarshis J, Thorpe KE, Ball CG, Chaudhury P, Cleary SP, Dixon E, Eeson G, Moulton CA, Nanji S, Porter G, Ruo L, Skaro AI, Tsang M, Wei AC, Guyatt G. Tranexamic acid versus placebo to reduce perioperative blood transfusion in patients undergoing liver resection: protocol for the haemorrhage during liver resection tranexamic acid (HeLiX) randomised controlled trial. BMJ Open 2022; 12:e058850. [PMID: 35210348 PMCID: PMC8883280 DOI: 10.1136/bmjopen-2021-058850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Despite use of operative and non-operative interventions to reduce blood loss during liver resection, 20%-40% of patients receive a perioperative blood transfusion. Extensive intraoperative blood loss is a major risk factor for postoperative morbidity and mortality and receipt of blood transfusion is associated with serious risks including an association with long-term cancer recurrence and overall survival. In addition, blood products are scarce and associated with appreciable expense; decreasing blood transfusion requirements would therefore have health system benefits. Tranexamic acid (TXA), an antifibrinolytic, has been shown to reduce the probability of receiving a blood transfusion by one-third for patients undergoing cardiac or orthopaedic surgery. However, its applicability in liver resection has not been widely researched. METHODS AND ANALYSIS This protocol describes a prospective, blinded, randomised controlled trial being conducted at 10 sites in Canada and 1 in the USA. 1230 eligible and consenting participants will be randomised to one of two parallel groups: experimental (2 g of intravenous TXA) or placebo (saline) administered intraoperatively. The primary endpoint is receipt of blood transfusion within 7 days of surgery. Secondary outcomes include blood loss, postoperative complications, quality of life and 5-year disease-free and overall survival. ETHICS AND DISSEMINATION This trial has been approved by the research ethics boards at participating centres and Health Canada (parent control number 177992) and is currently enrolling participants. All participants will provide written informed consent. Results will be distributed widely through local and international meetings, presentation, publication and ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT02261415.
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Affiliation(s)
- Paul Jack Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Stuart McCluskey
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Roke
- Department of Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Tarshis
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chad G Ball
- Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Prosanto Chaudhury
- Department of Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Sean P Cleary
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elijah Dixon
- Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Gareth Eeson
- Department of Surgery, Kelowna General Hospital, Kelowna, British Columbia, Canada
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carol-Anne Moulton
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Sulaiman Nanji
- Department of Surgery, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Geoff Porter
- Department of Surgery, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leyo Ruo
- Department of Surgery, Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada
- Deparment of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anton I Skaro
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Department of Surgery, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Melanie Tsang
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, St. Joseph's Health Centre - Unity Health Toronto, Toronto, Ontario, Canada
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Marcon AR, Murdoch B, Caulfield T. Peddling promise? An analysis of private umbilical cord blood banking company websites in Canada. Cell Tissue Bank 2021; 22:609-622. [PMID: 33890172 PMCID: PMC8558271 DOI: 10.1007/s10561-021-09919-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/27/2021] [Indexed: 11/13/2022]
Abstract
Private umbilical cord blood banking is growing around the world. A family's decision to bank cord blood publicly or privately can be influenced by numerous sources including healthcare practitioners, personal networks, the popular press, social media and marketing discourse from private entities. Issues have been raised concerning how private banks market their services, particularly with regards to the likelihood of use and for what purposes cord blood can be used. The objective of this study was to analyze the marketing on the seven company websites offering private cord blood storage in Canada. We performed a mix of content and general qualitative analysis on the seven websites. Our analysis shows substantial hype around cord blood uses, amplifying the promise of speculative uses and distorting the likelihood of use. Findings show that this promotional messaging often deploys communication strategies which draw on testimonials and emotionally-charged narratives. Questions should be asked about whether the promissory aspects of these websites constitute breaches of Canadian law or regulation. Careful monitoring of the private cord blood space is important for ensuring that the Canadian public is adequately and accurately informed of the services being offered.
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Affiliation(s)
| | - Blake Murdoch
- Faculty of Law, Health Law Institute, University of Alberta, Edmonton, Canada
| | - Timothy Caulfield
- Faculty of Law, Health Law Institute, University of Alberta, Edmonton, Canada
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Doyle CM, Maheu-Giroux M, Lambert G, Mishra S, Apelian H, Messier-Peet M, Otis J, Grace D, Hart TA, Moore DM, Lachowsky NJ, Cox J. Combination HIV Prevention Strategies Among Montreal Gay, Bisexual, and Other Men Who Have Sex with Men in the PrEP Era: A Latent Class Analysis. AIDS Behav 2021; 25:269-283. [PMID: 32648063 PMCID: PMC7846508 DOI: 10.1007/s10461-020-02965-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pre-exposure prophylaxis (PrEP) became publicly available in Quebec for gay, bisexual and other men who have sex with men (GBM) in 2013. We used baseline data from Engage, a cohort of GBM recruited by respondent-driven sampling, to examine patterns of combination HIV prevention use among Montreal GBM since PrEP became available. Latent class analysis, stratified by HIV status, was used to categorize GBM by self-reported use of biomedical and behavioural prevention strategies. Correlates of resulting classes were identified using multinomial logistic regression. Among HIV-negative/unknown GBM (n = 968), we identified four classes: low use of prevention (32%), condoms (40%), seroadaptive behaviour (21%), and biomedical (including PrEP; 7%). Those using prevention (condoms, seroadaptive behaviour, and biomedical) had a higher number of anal sex partners and were more likely to report a recent sexually transmitted infection diagnosis. GBM using biomedical prevention also had a higher level of formal education. Among GBM living with HIV (n = 200), we identified three classes: mainly antiretroviral treatment (ART) with viral suppression (53%), ART with viral suppression and condoms (19%), and ART with viral suppression and seroadaptive behaviour (18%). Again, the number of anal sex partners was higher among those using condoms and seroadaptive behaviours. Our findings show antiretroviral-based prevention, either alone or in combination with other strategies, is clearly a component of the HIV prevention landscape for GBM in Montreal. Nevertheless, PrEP uptake remains low, and there is a need to promote its availability more widely.
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Affiliation(s)
- Carla M Doyle
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada
| | - Sharmistha Mishra
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Herak Apelian
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada
| | - Marc Messier-Peet
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada
| | - Joanne Otis
- Département de Sexologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, ON, Canada
- Division of Social & Behavioural Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
- Direction Régionale de Santé Publique de Montréal, Montreal, QC, Canada.
- Clinical Outcomes Research and Evaluation, Research Institute - McGill University Health Centre, Montreal, QC, Canada.
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Li EW, Lee A, Vaseghi-Shanjani M, Anagnostopoulos A, Jagelaviciute G, Kum E, Petraszko T, Elmoazzen H, Allan D, Fingrut W. Multimedia resources to support the recruitment of committed hematopoietic stem cell donors: Perspectives of the most-needed donors. Transfusion 2021; 61:274-285. [PMID: 33269472 PMCID: PMC8516029 DOI: 10.1111/trf.16186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Recruitment of committed unrelated hematopoietic stem cell donors from the most-needed demographics remains a challenge for donor recruitment organizations worldwide. Multimedia resources are gaining attention as a modality to support recruitment efforts; however, there is a lack of guidance for the development of such tools. This qualitative study explores the perspectives of eligible stem cell donors on an educational whiteboard video about stem cell donation, generating insights into how whiteboard videos and related multimedia may be optimized for donor recruitment. STUDY DESIGN AND METHODS Eight semistructured focus groups were conducted with 38 potential donors from the most-needed demographics (young, male, and non-Caucasian) after they had watched a 3.5-minute whiteboard video explaining key concepts in stem cell donation (https://youtu.be/V4fVBtxnWfM). Constructivist grounded theory was used to identify themes and to develop a framework for understanding participants' preferred features of recruitment multimedia. RESULTS Participants identified a range of features contributing to the effectiveness of recruitment multimedia, adding that the whiteboard video is an effective, integrated, and readily accessible format for supporting donor recruitment. Topics that participants felt are important to address include knowledge gaps regarding donation procedures, concerns about donor safety, and the particular need for specific donor demographics. Suggested avenues for improvement include the addition of donor/recipient/patient personal experiences, attention-grabbing hooks, and a call to action including opportunities for further learning. CONCLUSIONS Several considerations were generated to inform the development of future multimedia for donor education/recruitment and are relevant to donor recruitment organizations worldwide.
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Affiliation(s)
- Edward W. Li
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Lee
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Vaseghi-Shanjani
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Anagnostopoulos
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gabriele Jagelaviciute
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Elena Kum
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tanya Petraszko
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - David Allan
- Canadian Blood Services, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Warren Fingrut
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Silva E Silva V, Hornby L, Almost J, Lotherington K, Appleby A, Silva AR, Rochon A, Dhanani S. Burnout and compassion fatigue among organ and tissue donation coordinators: a scoping review. BMJ Open 2020; 10:e040783. [PMID: 33323439 PMCID: PMC7745321 DOI: 10.1136/bmjopen-2020-040783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To collate and synthesise available literature on burnout and compassion fatigue (CF) among organ and tissue donation coordinators (OTDCs) and to respond to the research question: what is known about burnout and CF among OTDCs worldwide? DESIGN Scoping review using Joanna Briggs Institute methodology for scoping reviews. DATA SOURCES Medline, EMBASE, PsycINFO, CINAHL, LILACS, PTSpubs and grey literature (ResearchGate, OpenGrey, Organ Donation Organization (ODO) websites, open access theses and dissertations) up to April 2020. STUDY SELECTION Studies reporting aspects of burnout and CF among OTDCs, including risk and protective factors. DATA EXTRACTION Two reviewers independently screened the studies for eligibility and extracted data from chosen sources using a data extraction tool developed for this study; NVIVO was used to perform a qualitative directed content analysis. RESULTS The searches yielded 741 potentially relevant records, of which 29 met the inclusion criteria. The majority of articles were from the USA (n=7, 24%), Canada (n=6, 21%) and Brazil (n=6, 21%), published between 2013 and 2020 (n=13, 45%) in transplant journals (n=11, 38%) and used a qualitative design approach (n=12, 41%). In the thematic analysis, we classified the articles into five categories: (1) burnout characteristics, (2) CF characteristics, (3) coping strategies, (4) protective factors and (5) ambivalence. CONCLUSION We identified aspects of burnout and CF among OTDCs, including defining characteristics, demographic predispositions, protective factors, coping strategies, precursors, consequences and personal ambivalences. Researchers described burnout and CF characteristics but did not use consistent terms when referring to CF and burnout, which may have hindered the identification of all relevant sources. This gap should be addressed by the application of consistent terminology, systematic approaches and appropriate research methods that combine quantitative and qualitative investigation to examine the underlying reasons for the development of burnout and CF among OTDCs.
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Affiliation(s)
- Vanessa Silva E Silva
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Laura Hornby
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Joan Almost
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Ken Lotherington
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Amber Appleby
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Amina Regina Silva
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Andrea Rochon
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sonny Dhanani
- Critical Care, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Grace D, Gaspar M, Klassen B, Lessard D, Brennan DJ, Lachowsky NJ, Adam BD, Cox J, Lambert G, Anand P, Jollimore J, Moore D, Hart TA. It's in Me to Give: Canadian Gay, Bisexual, and Queer Men's Willingness to Donate Blood If Eligible Despite Feelings of Policy Discrimination. Qual Health Res 2020; 30:2234-2247. [PMID: 32887538 PMCID: PMC7649935 DOI: 10.1177/1049732320952314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Blood donation policies governing men who have sex with men have shifted significantly over time in Canada-from an initial lifetime ban in the wake of the AIDS crisis to successive phases of time-based deferment requiring periods of sexual abstinence (5 years to 1 year to 3 months). We interviewed 39 HIV-negative gay, bisexual, queer, and other sexual minority men (GBM) in Vancouver, Toronto, and Montreal to understand their willingness to donate blood if eligible. Transcripts were coded following inductive thematic analysis. We found interrelated and competing expressions of biological and sexual citizenship. Most participants said they were "safe"/"low risk" and "willing" donors and would gain satisfaction and civic pride from donation. Conversely, a smaller group neither prioritized the collectivizing biological citizenship goals associated with expanding blood donation access nor saw this as part of sexual citizenship priorities. Considerable repair work is required by Canada's blood operators to build trust with diverse GBM communities.
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Affiliation(s)
- Daniel Grace
- The University of Toronto, Toronto, Ontario, Canada
- Daniel Grace, Dalla Lana School of Public Health, The University of Toronto, 155 College Street, 5th Floor, Room 556, Toronto, Ontario, Canada M5T 3M7.
| | - Mark Gaspar
- The University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Klassen
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | | | | | | | | | - Joseph Cox
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Praney Anand
- The University of Toronto, Toronto, Ontario, Canada
| | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - David Moore
- The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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Honarmand K, Ball I, Weiss M, Slessarev M, Sibbald R, Sarti A, Meade M, D'Aragon F, Chasse M, Basmaji J, Parsons Leigh J. Cardiac donation after circulatory determination of death: protocol for a mixed-methods study of healthcare provider and public perceptions in Canada. BMJ Open 2020; 10:e033932. [PMID: 32690728 PMCID: PMC7375636 DOI: 10.1136/bmjopen-2019-033932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Cardiac transplantation remains the best treatment for patients with end-stage heart disease that is refractory to medical or device therapies, however, a major challenge for heart transplantation is the persistent discrepancy between the number of patients on waiting lists and the number of available hearts. While other countries (eg, UK, Australia and Belgium) have explored and implemented alternative models of transplantation, such as cardiac donation after circulatory determination of death (DCDD) to alleviate transplantation wait times, ethical concerns have hindered implementation in some countries. This study aims to explore the attitudes and opinions of healthcare providers and the public about cardiac DCDD in order to identify and describe opportunities and challenges in ensuring that proposed cardiac DCDD procedures in Canada are consistent with Canadian values and ethical norms. METHODS AND ANALYSIS This study will include two parts that will be conducted concurrently. Part 1 is a qualitative study consisting of semi-structured interviews with Canadian healthcare providers who routinely care for organ donors and/or transplant recipients to describe their perceptions about cardiac DCDD. Part 2 is a convergent parallel mixed-methods design consisting of a series of focus groups and follow-up surveys with members of the Canadian general public to describe their perceptions about cardiac DCDD. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Board at Western University. The findings will be presented at regional and national conferences and reported in peer-reviewed publications.
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Affiliation(s)
- Kimia Honarmand
- Department of Medicine, Western University, London, Ontario, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Matthew Weiss
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval Faculté de Médecine, Québec, Québec, Canada
- Transplant Québec, Montreal, Québec, Canada
| | - Marat Slessarev
- Department of Medicine, Western University, London, Ontario, Canada
| | - Robert Sibbald
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Aimee Sarti
- Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Maureen Meade
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Universite de Sherbrooke Faculte de Medecine et des Sciences de la Sante, Sherbrooke, Québec, Canada
- Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Michael Chasse
- University of Montreal Research Center, Innovation Hub and Department of Medicine (Critical Care), University of Montreal, Montreal, Québec, Canada
| | - John Basmaji
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, New Brunswick, Canada
- Department of Epidemiology and Biostatistics, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
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D’Aragon F, Dhanani S, Lamontagne F, Cook DJ, Burns K, Akhtar A, Chassé M, Frenette AJ, Keenan S, Lize JF, Kutsogiannis DJ, Kramer A, Hand LE, Arseneau E, Masse MH, Ribic C, Ball I, Baker A, Boyd G, Rochwerg B, Healey A, Hanna S, Guyatt GH, Meade MO. Canada-DONATE study protocol: a prospective national observational study of the medical management of deceased organ donors. BMJ Open 2017; 7:e018858. [PMID: 28963316 PMCID: PMC5640087 DOI: 10.1136/bmjopen-2017-018858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Research on the management of deceased organ donors aims to improve the number and quality of transplants and recipient outcomes. In Canada, this research is challenged by regionalisation of donation services within provinces and the geographical, clinical and administrative separation of donation from transplantation services. This study aims to build a national platform for future clinical trials in donor management. Objectives are to engage collaborators at donation hospitals and organ donation organisations (ODOs) across Canada, describe current practices, evaluate the effectiveness of donation-specific interventions and assess the feasibility of future clinical trials. METHODS AND ANALYSIS This ongoing prospective observational study of the medical management of deceased organ donors will enrol more than 650 consented potential donors from adult intensive care units at 33 hospital sites across Canada, each participating for 12 months. ODOs ensure enrolment of consecutive eligible participants. Research staff record detailed data about participants, therapies, organ assessments, death declaration procedures and adverse clinical exposures from the time of donation consent to organ recovery. ODOs provide reasons that organs are declined, dates and places of transplantation, and recipient age and sex.Descriptive analyses will summarise current practices. Effectiveness analyses will examine donation-specific interventions with respect to the number of transplants, using multilevel regression models to account for clustering by donor, hospitals and ODOs. Feasibility analyses will focus on acceptance of the research consent model; participation of academic and community hospitals as well as ODOs; and accessibility of recipient data. ETHICS AND DISSEMINATION This study uses a waiver of research consent. Hospitals will receive reports on local practices benchmarked to (1) national practices and (2) national donor management guidelines. We will report findings to donation and transplant collaborators (ie, clinicians, researchers, ODOs) and publish in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03114436.
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Affiliation(s)
- Frederick D’Aragon
- Department of Anesthesiology, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sonny Dhanani
- Division of Critical Care, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Francois Lamontagne
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Universite de Sherbrooke, Sherbrooke, Ontario, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Karen Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Aemal Akhtar
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine (Critical Care), Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Anne-Julie Frenette
- Pharmacy Faculty, Universite de Montreal, Montreal, Quebec, Canada
- Hopital Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Sean Keenan
- Department of Critical Care, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Jean-Francois Lize
- Department of Medicine (Critical Care), Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | | | - Andreas Kramer
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lori E Hand
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Erika Arseneau
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Helene Masse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christine Ribic
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Nephrology, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Andrew Baker
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Departments of Anaesthesia and Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gordon Boyd
- Department of Medicine (Neurology), Queen’s University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Steven Hanna
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maureen O Meade
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Parker MJ, Thabane L, Fox-Robichaud A, Liaw P, Choong K. A trial to determine whether septic shock-reversal is quicker in pediatric patients randomized to an early goal-directed fluid-sparing strategy versus usual care (SQUEEZE): study protocol for a pilot randomized controlled trial. Trials 2016; 17:556. [PMID: 27876084 PMCID: PMC5120449 DOI: 10.1186/s13063-016-1689-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Current pediatric septic shock resuscitation guidelines from the American College of Critical Care Medicine focus on the early and goal-directed administration of intravascular fluid followed by vasoactive medication infusions for persistent and fluid-refractory shock. However, accumulating adult and pediatric data suggest that excessive fluid administration is associated with worse patient outcomes and even increased risk of death. The optimal amount of intravascular fluid required in early pediatric septic shock resuscitation prior to the initiation of vasoactive support remains unanswered. METHODS/DESIGN The SQUEEZE Pilot Trial is a pragmatic, two-arm, parallel-group, open-label, prospective pilot randomized controlled trial. Participants are children aged 29 days to under 18 years with suspected or confirmed septic shock and a need for ongoing resuscitation. Eligible participants are enrolled under an exception to consent process and randomly assigned via concealed allocation to either the Usual Care (control) or Fluid Sparing (intervention) resuscitation strategy. The primary objective of this pilot trial is to determine feasibility, based on the ability to enroll participants and to adhere to the study protocol. The primary outcome measure by which success will be determined is participant enrollment rate ("pass" defined as at least two participants/site/month, recognizing that enrollment may be slower during the run-in phase). Secondary objectives include assessing (1) appropriateness of eligibility criteria, and (2) completeness of clinical outcomes to inform the endpoints for the planned multisite trial. To support the nested translational study, SQUEEZE-D, we will also evaluate the feasibility of describing cell-free DNA (a procoagulant molecule with prognostic utility) in blood samples obtained from children enrolled into the SQUEEZE Pilot Trial at baseline and at 24 h. DISCUSSION The optimal degree of fluid resuscitation and the timing of initiation of vasoactive support in order to achieve recommended therapeutic targets in children with septic shock remains unanswered. No prospective study to date has examined this important question for children in developed countries including Canada. Recruitment for the SQUEEZE Pilot Trial opened on 6 January 2014. Findings will inform the feasibility of the planned multicenter trial to answer our overall research question. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01973907 , registered on 23 October 2013.
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Affiliation(s)
- Melissa J. Parker
- Division of Pediatric Critical Care, Department of Pediatrics, McMaster Children’s Hospital and McMaster University, HSC 3E-20,1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
- Division of Emergency Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Lehana Thabane
- Division of Pediatric Critical Care, Department of Pediatrics, McMaster Children’s Hospital and McMaster University, HSC 3E-20,1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
- Department of Anesthesia, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
- Biostatistics Unit,/FSORC, St Joseph’s Healthcare Hamilton, 3rd floor Martha Wing, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Alison Fox-Robichaud
- Department of Medicine, McMaster University, DBRI, Rm C5–106 and 107, 237 Barton Street East, Hamilton, ON L8L 2X2 Canada
| | - Patricia Liaw
- Department of Medicine, McMaster University, DBRI, Rm C5–106 and 107, 237 Barton Street East, Hamilton, ON L8L 2X2 Canada
| | - Karen Choong
- Division of Pediatric Critical Care, Department of Pediatrics, McMaster Children’s Hospital and McMaster University, HSC 3E-20,1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
| | - For the Canadian Critical Care Trials Group and the Canadian Critical Care Translational Biology Group
- Division of Pediatric Critical Care, Department of Pediatrics, McMaster Children’s Hospital and McMaster University, HSC 3E-20,1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
- Division of Emergency Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Anesthesia, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
- Biostatistics Unit,/FSORC, St Joseph’s Healthcare Hamilton, 3rd floor Martha Wing, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
- Department of Medicine, McMaster University, DBRI, Rm C5–106 and 107, 237 Barton Street East, Hamilton, ON L8L 2X2 Canada
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Parker MJ, de Laat S, Schwartz L. Exploring the experiences of substitute decision-makers with an exception to consent in a paediatric resuscitation randomised controlled trial: study protocol for a qualitative research study. BMJ Open 2016; 6:e012931. [PMID: 27625066 PMCID: PMC5030536 DOI: 10.1136/bmjopen-2016-012931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Prospective informed consent is required for most research involving human participants; however, this is impracticable under some circumstances. The Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS) outlines the requirements for research involving human participants in Canada. The need for an exception to consent (deferred consent) is recognised and endorsed in the TCPS for research in individual medical emergencies; however, little is known about substitute decision-maker (SDM) experiences. A paediatric resuscitation trial (SQUEEZE) (NCT01973907) using an exception to consent process began enrolling at McMaster Children's Hospital in January 2014. This qualitative research study aims to generate new knowledge on SDM experiences with the exception to consent process as implemented in a randomised controlled trial. METHODS AND ANALYSIS The SDMs of children enrolled into the SQUEEZE pilot trial will be the sampling frame from which ethics study participants will be derived. DESIGN Qualitative research study involving individual interviews and grounded theory methodology. PARTICIPANTS SDMs for children enrolled into the SQUEEZE pilot trial. SAMPLE SIZE Up to 25 SDMs. Qualitative methodology: SDMs will be invited to participate in the qualitative ethics study. Interviews with consenting SDMs will be conducted in person or by telephone, taped and professionally transcribed. Participants will be encouraged to elaborate on their experience of being asked to consent after the fact and how this process occurred. ANALYSIS Data gathering and analysis will be undertaken simultaneously. The investigators will collaborate in developing the coding scheme, and data will be coded using NVivo. Emerging themes will be identified. ETHICS AND DISSEMINATION This research represents a rare opportunity to interview parents/guardians of critically ill children enrolled into a resuscitation trial without their knowledge or prior consent. Findings will inform implementation of the exception to consent process in the planned definitive SQUEEZE trial and support development of evidence-based ethics guidelines.
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Affiliation(s)
- Melissa J Parker
- Division of Pediatric Critical Care, Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
| | - Sonya de Laat
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Schwartz
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Philosophy, McMaster University, Hamilton, Ontario, Canada
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