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https://www.readbyqxmd.com/read/28811051/patient-blood-management-in-the-intensive-care-unit
#1
REVIEW
Aryeh Shander, Mazyar Javidroozi, Gregg Lobel
Patient Blood Management underscores a fundamental shift from a product-centered approach to a patient-centric approach through timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome. In this concept, allogeneic blood transfusion is not viewed as the treatment of default for anemic patients, but one among many treatment modalities that should be weighed based on its merits-potentials risks and benefits-for the individual patient in the context of other alternatives...
July 31, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28736010/predictors-of-mortality-in-living-donor-liver-transplantation
#2
S Elkholy, S Mogawer, A Hosny, M El-Shazli, U M Al-Jarhi, S Abdel-Hamed, A Salah, N El-Garem, A Sholkamy, M El-Amir, M S Abdel-Aziz, A Mukhtar, A El-Sharawy, A Nabil
BACKGROUND: Egypt has the highest prevalence of the world hepatitis C virus (HCV) load. Hence, the problem of end-stage liver disease (ESLD) is considered a huge burden on the community. Living donor liver transplantation (LDLT) is the only source of donation in Egypt till now. Survival rates had shown significant improvement in the past decades. This study provides analysis of the mortality rates and possible predictors of mortality following LDLT. It also aids in developing a practical and easy-to-apply risk index for prediction of early mortality...
July 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28719425/organizational-contributors-to-the-variation-in-red-blood-cell-transfusion-practices-in-cardiac-surgery-survey-results-from-the-state-of-michigan
#3
Anton Camaj, Darin B Zahuranec, Gaetano Paone, Barbara R Benedetti, Warren D Behr, Marc A Zimmerman, Min Zhang, Robert S Kramer, Jason Penn, Patricia F Theurer, Theron A Paugh, Milo Engoren, Alphonse DeLucia, Richard L Prager, Donald S Likosky
BACKGROUND: While large volumes of red blood cell transfusions are given to preserve life for cardiac surgical patients, indications for lower volume transfusions (1-2 units) are less well understood. We evaluated the relationship between center-level organizational blood management practices and center-level variability in low volume transfusion rates. METHODS: All 33 nonfederal, Michigan cardiac surgical programs were surveyed about their blood management practices for isolated, nonemergent coronary bypass procedures, including: (1) presence and structure of a patient blood management program, (2) policies and procedures, and (3) audit and feedback practices...
July 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28704007/-blood-transfusion-optimizing-the-use-of-a-scarce-and-expensive-resource
#4
Omar Kherad
Haemoglobin transfusion threshold remains debated with a high variability of practice among physicians. Several well-conducted studies revealed that a liberal transfusion policy is not only unnecessary, but can also prove harmful in certain situations. Blood transfusion is a costly act involving risks of infection, allergic and hemodynamic. Optimizing the use of this scarce and expensive resource becomes necessary. This article summarizes the different transfusion thresholds to respect in hospital clinical practice, based on the latest international recommendations, while emphasizing the importance of clinical judgment in each situation...
January 25, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28697866/quality-initiative-programs-can-decrease-total-joint-arthroplasty-transfusion-rates-a-multicenter-study-using-the-marcqi-total-joint-registry-database
#5
David C Markel, Mark W Allen, Richard E Hughes, Bonita M Singal, Brian R Hallstrom
BACKGROUND: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) noted wide variability between member hospitals in blood transfusion rates after primary total hip and knee arthroplasty (THA and TKA). Blood transfusion has substantial risks and accepted recommendations exist to guide transfusion practices. MARCQI began an initiative to decrease unnecessary transfusions by identifying/reporting outliers, discussing conservative transfusion practices, and recommending transfusion guidelines...
June 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28689939/variation-in-transfusion-practices-and-the-association-with-perioperative-adverse-events-in-patients-undergoing-open-abdominal-aortic-aneurysm-repair-and-lower-extremity-arterial-bypass-in-the-vascular-quality-initiative
#6
Zachary Osborne, Kristine Hanson, Benjamin S Brooke, Marc Schermerhorn, Peter Henke, Rumi Faizer, Andres Schanzer, Philip Goodney, Thomas Bower, Randall R DeMartino
INTRODUCTION: Blood transfusions are associated with adverse events. We examined perioperative transfusion practices and associated complications following open vascular procedures nationwide in the Vascular Quality Initiative (VQI). METHODS: Adults undergoing open abdominal aortic aneurysm repair (OAR) and lower extremity arterial bypass (Bypass) within VQI (2003-2016) were identified. All emergent cases, patients with pre-operative hemoglobin<7 g/dL, pre-operative hospitalization >1 day, or a return to OR during the index hospitalization were excluded...
July 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28673874/post-operative-outcomes-after-single-port-laparoscopic-removal-of-adnexal-masses-in-patients-referred-to-gynecologic-oncology-at-a-large-academic-center
#7
Laura J Moulton, Amelia M Jernigan, Chad M Michener
OBJECTIVE: To report surgical and pathologic outcomes after single port laparoscopy (SPL) for adnexal masses in patients referred to a gynecologic oncology practice at a single academic institution. DESIGN: Retrospective analysis (Canadian Task Force Classification II.2). SETTING: A single academic institution with multiple hospital centers PATIENTS: Women who underwent at least one single port laparoscopic surgery for treatment of an adnexal mass from 2009-2015 after referral to a gynecologic oncology practice...
June 30, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28669659/variability-in-the-use-of-platelet-transfusion-in-patients-with-intracerebral-hemorrhage-observations-from-the-ethnic-racial-variations-of-intracerebral-hemorrhage-study
#8
Waldo R Guerrero, Nicole R Gonzales, Padmini Sekar, Jorge Kawano-Castillo, Charles J Moomaw, Bradford B Worrall, Carl D Langefeld, Sharyl R Martini, Matthew L Flaherty, Kevin N Sheth, Jennifer Osborne, Daniel Woo
BACKGROUND: We examined platelet transfusion (PTx) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, hypothesizing that rates of PTx would vary among hospitals and depend on whether patients were on an antiplatelet therapy or underwent intracerebral hemorrhage (ICH) surgical treatment. METHODS: The ERICH study is a prospective observational study evaluating risk factors for ICH among whites, blacks, and Hispanics. We identified factors associated with PTx, examined practice patterns of PTx across the United States, and explored the association of PTx with mortality and poor outcome (modified Rankin Scale score 4-6)...
September 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28662771/predicting-delayed-discharge-in-a-multimodal-enhanced-recovery-pathway
#9
Deborah S Keller, Irlna Tantchou, Juan R Flores-Gonzalez, Daniel P Geisler
BACKGROUND: Despite advances with Enhanced Recovery Pathways(ERP), some patients have unexpected prolonged lengths of stay(LOS). Our goal was to identify the patient and procedural variables associated with delayed discharge despite an established ERP. METHODS: A divisional database was reviewed for minimally invasive colorectal resections with a multimodal ERP(8/1/13-7/31/15). Patients were stratified into ERP success or failure based on length of stay ≥5 days...
June 24, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28661062/randomised-feasibility-study-of-a-more-liberal-haemoglobin-trigger-for-red-blood-cell-transfusion-compared-to-standard-practice-in-anaemic-cancer-patients-treated-with-chemotherapy
#10
D Yakymenko, K B Frandsen, I J Christensen, A Norgaard, P I Johansson, G Daugaard, M Mau-Sorensen
OBJECTIVES: The primary objective of this feasibility study was to identify quality of life (QoL) scores and symptom scales as tools for measuring patient-reported outcomes (PRO) associated with haemoglobin level in chemotherapy-treated cancer patients. Secondary objectives included comparing QoL and symptoms between randomisation arms. BACKGROUND: Anaemia in cancer patients undergoing chemotherapy is associated with decreased QoL. One treatment option is red blood cell transfusion (RBCT)...
June 29, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/28602484/red-blood-cell-transfusion-and-outcome-in-cancer
#11
REVIEW
Nayyer Iqbal, Kamal Haider, Vinita Sundaram, Julia Radosevic, Thierry Burnouf, Jerard Seghatchian, Hadi Goubran
Oncology services utilize about 15% of the blood transfusion resources in the USA. Red blood cell transfusion is performed immediately before, during or after major surgery to compensate for blood loss and hemodilution. However, a lack of evidence-based guidelines leads to variable transfusion practices among clinicians. The benefits of transfusing blood products are obvious in life-threatening low blood cell counts or bleeding, but it is becoming apparent that deliberate blood transfusion in some cancer patients can trigger negative clinical impacts...
May 26, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28575484/comprehensive-analysis-of-liberal-and-restrictive-transfusion-strategies-in-pediatric-intensive-care-unit
#12
Basak Akyildiz, Nazan Ulgen Tekerek, Ozge Pamukcu, Adem Dursun, Musa Karakukcu, Nazmi Narin, Mehmet Yay, Ferhan Elmali
Background: We prospectively compared restrictive and liberal transfusion strategies for critically ill children regarding hemodynamic and laboratory parameters. Methods: A total of 180 children requiring packed red blood cells (PRBCs) were randomized into two groups: the liberal transfusion strategy group (transfusion trigger < 10 g/dL, Group 1) and the restrictive transfusion strategy group (transfusion trigger ≤ 7 g/dL, Group 2). Basal variables including venous/arterial hemoglobin, hematocrit and lactate levels; stroke volume; and cardiac output were recorded at the beginning and end of the transfusion...
May 30, 2017: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/28550979/status-of-blood-transfusion-in-world-health-organization-eastern-mediterranean-region-who-emr-successes-and-challenges
#13
REVIEW
Arezoo Darbandi, Pargol Mashati, Amir Yami, Arshia Gharehbaghian, Mehdi Tabrizi Namini, Ahmad Gharehbaghian
BACKGROUND: Blood products are used for patient treatment and survival in the cases of major surgery, hematological disorders or cancer therapy. Presently the main blood components are not yet replaceable by artificial products and all activities related to blood transfusion is highly dependent on the healthcare development of each country. The World Health Organization Eastern Mediterranean Region (WHO-EMR) comprises of 21 member states with variable socio-economic status effective on blood transfusion activities...
May 8, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28546100/does-the-timing-of-loop-ileostomy-closure-affect-outcome-a-case-matched-study
#14
Wanglin Li, Gokhan Ozuner
INTRODUCTION: The optimal timing for the closure of loop ileostomies remains controversial. The aim of this study is to determine whether ileostomy closure (<3 months post formation) affects stoma-related morbidity compared to late closure (≥3 months post formation). METHODS: All patients who had loop ileostomy and ileostomy closure between 2012 and 2015 were identified from an IRB-approved, prospectively maintained institutional database.The patients who underwent ileostomy closure (<3 months) were compared against matched patients undergoing ileostomy closure (≥3 months)...
July 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28523403/sleeve-gastrectomy-postoperative-hemorrhage-is-linked-to-type-2-diabetes-and-not-to-surgical-technique
#15
Hadar Spivak, Carmil Azran, Galia Spectre, Galina Lidermann, Orit Blumenfeld
BACKGROUND: The degree, prevalence, and risk factors linked to sleeve gastrectomy (SG) postoperative hemorrhage (POH) have not been fully defined. METHODS: An analysis was conducted on a prospectively collected database of 394 consecutive primary SGs performed in a single practice from January 2014 to December 2015. END POINTS: (1) acute POH, defined by red blood cell (RBC) transfusion and/or re-exploration; (2) subclinical POH, defined by postoperative hemoglobin drop (HgbD) >one standard deviation above mean...
May 18, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28488962/strategies-for-reducing-the-risk-of-transfusion-transmitted-leishmaniasis-in-an-area-endemic-for-leishmania-infantum-a-patient-and-donor-targeted-approach
#16
Teresa Jimenez-Marco, Cristina Riera, Enrique Girona-Llobera, Carmen Guillen, Laura Iniesta, Magdalena Alcover, Diana Berenguer, Alba Pujol, Miriam Tomás-Pérez, Beatriz Cancino-Faure, Teresa Serra, Martín Mascaró, Joan Gascó, Roser Fisa
BACKGROUND: In the Balearic Islands, as in other areas of the Mediterranean basin, there is a significant proportion of asymptomatic Leishmania (L.) infantum-infected blood donors, who may represent an important threat to transfusion safety. The Balearic Islands blood bank, located in an area endemic for L. infantum, carried out a study of donors and patients to investigate the impact of this infectious disease on blood safety in the region. MATERIALS AND METHODS: Twenty asymptomatic Leishmania-infected blood donors were followed-up between 2008 and 2011 to investigate the evolution of Leishmania infection in asymptomatic carriers...
March 15, 2017: Blood Transfusion, Trasfusione del Sangue
https://www.readbyqxmd.com/read/28458067/effect-of-liberal-blood-transfusion-on-clinical-outcomes-and-cost-in-spine-surgery-patients
#17
Taylor E Purvis, C Rory Goodwin, Rafael De la Garza-Ramos, A Karim Ahmed, Virginie Lafage, Brian J Neuman, Peter G Passias, Khaled M Kebaish, Steven M Frank, Daniel M Sciubba
BACKGROUND CONTEXT: Blood transfusions in spine surgery are shown to be associated with increased patient morbidity. The association between transfusion performed using a liberal hemoglobin (Hb) trigger-defined as an intraoperative Hb level of ≥10 g/dL, a postoperative level of ≥8 g/dL, or a whole hospital nadir between 8 and 10 g/dL-and perioperative morbidity and cost in spine surgery patients is unknown and thus was investigated in this study. PURPOSE: This study aimed to describe the perioperative outcomes and economic cost associated with liberal Hb trigger transfusion among spine surgery patients...
April 27, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28450103/regional-variation-in-outcomes-for-lower-extremity-vascular-disease-in-the-vascular-quality-initiative
#18
Peter A Soden, Sara L Zettervall, Katie E Shean, Ageliki G Vouyouka, Philip P Goodney, Joseph L Mills, John W Hallett, Marc L Schermerhorn
BACKGROUND: Increased focus has been placed on perioperative and long-term outcomes in the treatment of peripheral artery disease (PAD), both for purposes of quality improvement and for assessment of performance at a surgeon and institutional level. This study evaluates regional variation in outcomes after treatment for PAD within the Vascular Quality Initiative (VQI). By describing the variation in practice patterns and outcomes across regions, we hope that each regionally based quality group can select which areas are most important for them to focus on as they will have access to their regional data to compare...
April 24, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28426586/predictive-modeling-of-massive-transfusion-requirements-during-liver-transplantation-and-its-potential-to-reduce-utilization-of-blood-bank-resources
#19
Aliaksei Pustavoitau, Maggie Lesley, Promise Ariyo, Asad Latif, April J Villamayor, Steven M Frank, Nicole Rizkalla, William Merritt, Andrew Cameron, Nabil Dagher, Benjamin Philosophe, Ahmet Gurakar, Allan Gottschalk
BACKGROUND: Patients undergoing liver transplantation frequently but inconsistently require massive blood transfusion. The ability to predict massive transfusion (MT) could reduce the impact on blood bank resources through customization of the blood order schedule. Current predictive models of MT for blood product utilization during liver transplantation are not generally applicable to individual institutions owing to variability in patient population, intraoperative management, and definitions of MT...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28387644/medical-necessity-of-routine-admission-of-children-with-mild-traumatic-brain-injury-to-the-intensive-care-unit
#20
Jared D Ament, Krista N Greenan, Patrick Tertulien, Joseph M Galante, Daniel K Nishijima, Marike Zwienenberg
OBJECTIVE Approximately 475,000 children are treated for traumatic brain injury (TBI) in the US each year; most are classified as mild TBI (Glasgow Coma Scale [GCS] Score 13-15). Patients with positive findings on head CT, defined as either intracranial hemorrhage or skull fracture, regardless of severity, are often transferred to tertiary care centers for intensive care unit (ICU) monitoring. This practice creates a significant burden on the health care system. The purpose of this investigation was to derive a clinical decision rule (CDR) to determine which children can safely avoid ICU care...
June 2017: Journal of Neurosurgery. Pediatrics
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