Problems with precaution: the transfusion medicine experience

The precautionary principle is a dominant paradigm governing risk-based decision-making. Today, there are increasing pressures to re-examine aggressive precautionary approaches, and to assess how the principle should be applied in the modern system. In this paper, we examined three key applications of precautionary approaches in the field of transfusion medicine to provide insight into the risks and benefits of these approaches. The three case studies examined were the donor deferral policies to safeguard against transfusion transmission of human immunodeficiency virus, variant Creutzfeldt–Jacob disease, and, lastly, xenotropic murine leukemia virus-related virus. Characterization of precautionary applications was conducted using an embedded case study design. Our findings indicate that transfusion transmission mitigation strategies have become increasingly aggressive in the face of theoretical risks. In contrast, the review processes for implementation and reversal of precautionary policies have been slow, and historical donor deferral policies are still in place today. Application of precautionary approaches has proved challenging with both benefits and pitfalls. In light of emerging threats to the blood system, policy-makers should consider the implementation of frameworks to guide the appropriate application of precaution in transfusion medicine in the future.     

“输血”与“造血”的选择——对新疆农民增收问题的现实思考

新疆农民收入水平低、增长速度缓慢,而且城乡差距巨大。增加新疆农民收入,面,陆整体经济发展滞后、农民自身素质相对较低和二元结构三大困境;“输血”与“造血”是新疆农民增收短期作用与长效机制的必然选择,惟有加大“输血”和“造血”的力度,短期目标与长期计划相结合,资金、政策扶持与农民自身强化增收能力相结合,才有希望在农民增收上取得持续进展。     

再谈门诊输液安全隐患及护理对策

输液室是医院门诊对外服务的窗口,由于患者病情复杂,用药品种繁多,存在着许多不安全因素。通过对门诊输液室安全隐患的分析,采取有针对性的护理防范措施,提高护理工作人员的安全意识,加强质量管理,使门诊输液室能安全、便捷、高效地为患者提供满意优质的服务。     

颜色警示卡在静脉输液中的应用

目的:建立颜色警示卡标识,确保临床基础护理工作的落实,以保输液安全,保证合理正确用药,规避护理风险,防范护理缺陷。方法:对静脉输液的病人根据药物的性质挂上不同颜色的标识卡。结果:使用输液颜色警示卡前(2009年4月至2010年7月)与使用后(2010年7月至今)的输液护理缺陷对比:由46例下降至3例,输液相关投诉由25例下降至2例。结论:输液颜色警示卡的应用,规范了护士对药品的使用,保证了药物的疗效,增强了输液安全,适宜在临床推广。     

Perioperative outcomes and hospital costs associated with flowable gelatin hemostatic matrix for lumbar surgeries in real world hospital setting

Abstract

Background: Efficient hemostasis during lumbar surgery (LS) is associated with better perioperative outcomes. Flowable gelatin hemostatic matrix (FGHM) is a new type of absorbable hemostatic agent, which is effective to control bleeding during spinal surgery. This study aimed to assess the impact of FGHM on perioperative outcomes and hospital costs associated with LS.

Methods: This study retrospectively analyzed medical and billing records of patients who underwent LS for spinal degenerative disease in a Chinese tertiary care hospital from 2014 to 2016. The identified patients were further stratified into a FGHM group (n?=?108) (using the combination of FGHM and gelatin sponge) and a historical control group (using oxidized cellulose and/or collagen, n?=?82) for the adjusted comparisons of the perioperative outcomes using a propensity score matching method. Multiple generalized linear regression was conducted to assess the impact of using FGHM on total hospitalization costs.

Results: Comparisons of 64 propensity score matched pairs showed a significantly lower blood transfusion rate (34.4% vs 64.1%, p?=?0.005), lower blood transfusion volume (182.7?±?312.4 vs 301.3?±?281.0?mL, p?=?0.045), reduced post-surgery drainage tube placement rate (82.8% vs 93.8%, p?=?0.046), and shorter post-operative days on antibiotics (6.0?±?2.6 vs 7.1?±?2.4 days, p?=?0.010) in the FGHM group. Although with a relatively high acquisition price, the use of FGHM for hemostasis in LS did not increase the total hospitalization costs (coefficient = ?0.001, p?=?0.972).

Conclusions: The use of FGHM in LS improved perioperative outcomes related to hemostatic effects without increasing overall hospital costs in a real-world hospital setting.     

数字显示静脉输液无线监控系统的临床应用研究

根据电容值与介电常数成正比,用电容的变化来检测茂菲管内液位的变化,制成液位传感器,以非接触方式将液位的变化转化为电信号。电信号经过整流和放大输入接触器,接触器将信号送入下一级工作电路。一路信号触发报警系统可发出声、光信号。另一路信号触发控制电路,对药液加温或阻断液体的流动。第三路信号触发发射系统,向接收系统发射无线射频信号,接收系统报警并显示患者床位号,提醒陪护人员和医护人员进行处理。     

Reduction in hospital costs and resource consumption associated with the use of advanced topical hemostats during inpatient procedures

Abstract

Objective:

The use of hemostatic agents has increased over time for all surgical procedures. The purpose of this study was to evaluate the newer topical absorbable hemostat products Surgicel Fibrillar and Surgicel SNoW (Surgicel advanced products, abbreviated as SAPs) compared to the older product Surgicel Original (SO) with respect to healthcare resource use and costs in procedures where these hemostats are most commonly used.     

‘Someone else’s blood’: directed blood donation for neonatal transfusion and parental perceptions of risk

In Canada, parents can give blood exclusively for their child’s transfusion, a process known as directed donation. This qualitative study aimed to understand parents’ perceptions in seeking to provide blood for their newborn. Ten parents whose preterm children were cared for in the Neonatal Intensive Care Unit of one Canadian hospital were interviewed. The beliefs and experiences of parents with regard to directed donation were analyzed with reference to their understanding of the risks and benefits of this form of transfusion. Interview data revealed that parents had little knowledge or understanding of the medical benefits and risks of directed donation and based their decision to seek this type of transfusion largely on emotional grounds. In addition, despite their preference for directed donation, most infants whose parents were interviewed in this study, for practical reasons could not be given this type of transfusion. This may have magnified risk perceptions of non‐directed transfusions. Parents need to be better informed about the medical risks and benefits of directed donation and the actual likelihood that their child will be able to receive this type of transfusion.     

青海扶贫开发的难点与战略探究

反贫困是现代社会面临的重大课题。青海的贫困源于能力贫困,扶贫的难点在于贫困人口的劳动能力无法保持可持续发展。单纯依靠物质资本投资的“输血”型扶贫战略无法从根本上解决青海的贫困问题。确立能使贫困者的脱贫能力持续增长的“造血型”战略是青海扶贫开发的理性选择。     

产品设计在医学领域应用实例探索

介绍了基于物联网的智能化输液监护系统的输液过程实时监护仪外观设计研发过程。通过分析论证,阐述智能化输液监护系统的应用领域和创新情况,介绍对于产品外观、结构设计的研发思路及最终实现方式。论证了产品外观设计在医疗领域的重要研究价值和广阔前景。