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1.
Validation of three models for prediction of blood transfusion during cesarean delivery admission
Bruno, A., Federspiel, J. J., McGee, P., Pacheco, L., Saade, G., Parry, S., Longo, M., Tita, A., Gyamfi-Bannerman, C., Chauhan, S., et al
American journal of perinatology. 2023
Abstract
OBJECTIVE Prediction of blood transfusion during delivery admission allows for clinical preparedness and risk mitigation. Although prediction models have been developed and adopted into practice, their external validation is limited. We aimed to evaluate the performance of three blood transfusion prediction models in a U.S. cohort of individuals undergoing cesarean delivery. METHODS This was a secondary analysis of a multicenter randomized trial of tranexamic acid for prevention of hemorrhage at time of cesarean delivery. Three models were considered: a categorical risk tool (California Maternal Quality Care Collaborative (CMQCC)), and two regression models (Ahmadzia et al and Albright et al). The primary outcome was red blood cell transfusion. The CMQCC algorithm was applied to the cohort with frequency of risk category (low, medium, high) and associated transfusion rates reported. For the regression models, the area under the receiver-operating curve (AUC) was calculated and a calibration curve plotted to evaluate each model's capacity to predict receipt of transfusion. The regression model outputs were statistically compared. RESULTS Of 10,785 analyzed individuals, 3.9% received a red blood cell transfusion during delivery admission. The CMQCC risk tool categorized 1,970 (18.3%) individuals as low-risk, 5,259 (48.8%) as medium-risk, and 3,556 (33.0%) as high-risk with corresponding transfusion rates of 2.1% (95% CI 1.5-2.9%), 2.2% (95% CI 1.8-2.6%), and 7.5% (95% CI 6.6-8.4%), respectively. The AUC for prediction of blood transfusion using the Ahmadzia and Albright models was 0.78 (95% CI 0.76-0.81) and 0.79 (95% CI 0.77-0.82), respectively (p=0.38 for difference). Calibration curves demonstrated overall agreement between the predicted probability and observed likelihood of blood transfusion. CONCLUSION Three models were externally validated for prediction of blood transfusion during cesarean delivery admission in this U.S. COHORT Overall, performance was moderate; model selection should be based on ease of application until a specific model with superior predictive ability is developed.
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Effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions: A randomized controlled trial
Badr, E. A., Ibrahim, H., Saleh, S. E.
Journal of pediatric nursing. 2023
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Editor's Choice
Abstract
BACKGROUND Children with thalassemia are generally dependent on blood transfusions and face a lot of stress and alteration in their physiological parameters through the procedure. AIM: This study aimed to investigate the effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions. DESIGN A randomized, controlled trial with three parallel groups. METHODS One hundred and twenty preschool-age children with thalassemia who underwent blood transfusions were randomly assigned to three groups. Children of the control group received only routine hospital care through blood transfusions. Music intervention group children listened to recorded Mozart's music and children of Benson's relaxation group received relaxation intervention before and during the blood transfusions. Outcome measures were physiological parameters and behavioral distress levels. SETTING Hematology outpatient clinic of the Children's University Hospital at El-Shatby in Alexandria from October 2022 to February 2023. RESULTS The mean total score of children's behavioral responses to stress before the blood transfusions procedure was 19.32 ± 4.08, 14.20 ± 0.93, and 16.92 ± 4.74 in the control, music, and Benson groups, respectively. Beyond that, there was a decline in their physiological parameters and behavioral stress response during and after procedure among groups of study (P = 0.005 & <0.001, respectively). CONCLUSION Music and Benson's relaxation interventions had a helpful effect on stabilizing the physiological parameters and reducing behavioral distress levels in children with thalassemia undergoing blood transfusions. PRACTICE IMPLICATIONS This study directs paediatric nurses to apply Benson's relaxation and music interventions for children with thalassemia to enhance their responses.
PICO Summary
Population
Preschool-age children with thalassemia who underwent blood transfusions (n= 120).
Intervention
Benson’s relaxation technique intervention (n= 40).
Comparison
Mozart's music intervention (n= 40); routine hospital care (n= 40).
Outcome
The mean total score of children's behavioral responses to stress before the blood transfusions procedure was 19.32 ± 4.08, 14.20 ± 0.93, and 16.92 ± 4.74 in the control, music, and Benson groups, respectively. Beyond that, there was a decline in their physiological parameters and behavioral stress response during and after procedure among groups of study.
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Learning transfusion medicine through scoring objective structured clinical examination
Badawi, M. A., Hussain, H. O., Badawi, M. A., Al Shawwa, L. A., Jamjoom, R. A., Park, Y. S., Tekian, A.
Transfusion. 2023;63 Suppl 1:S20-s27
Abstract
BACKGROUND Transfusion medicine education at the undergraduate level is typically limited in duration. In view of limitations of traditional teaching methods, we explore effectiveness of scoring (Objective Structured Clinical Examination) OSCE as an educational method. MATERIALS AND METHODS The study was of a randomized interventional three group pre-test-post-test design. Participants were undergraduate medical students in their two final years. The intervention was watching and scoring 2 videotaped OSCE stations about obtaining consent for blood transfusions and assessing the ability to explain risks, benefits, and alternatives of blood transfusion. Participants were asked to assess the performance of the videotaped actor using checklists. Participants were randomized to watch and evaluate one set of videos at either the highest, intermediate, or lowest compliance with required consent elements. Main measure was performance in a knowledge test containing multiple-choice and true/false questions. This was given before (pre-test), immediately after the intervention (post-test 1), and after 8 weeks (post-test 2). Student perceptions regarding the intervention was assessed immediately after the session. RESULTS Sixty-nine students were randomized. Post-test 1 results (mean 16.52, SD 1.88) were significantly greater than pre-test results (mean 11.83, SD 2.13) by group and across all groups (p < 0.001). Post-test 2 results for the complete cohort showed maintenance of significant improvement in comparison with the pre-test. The majority of students agreed that learning through scoring OSCE was an effective educational experience. CONCLUSIONS In the undergraduate medical setting, scoring OSCE stations may enhance learning of content discussed and evaluated in the stations.
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4.
Effect of Early Equal-Proportional Infusion of Plasma and Red Blood Cells on the Prognosis of Emergency Patients with Traumatic Hemorrhage
Fan, Y., Ye, Z., Tang, Y.
Clinical laboratory. 2023;69(7)
Abstract
BACKGROUND The goal was to study the effect of early equal-proportion transfusion on the prognosis of trauma patients with bleeding. METHODS Emergency hospital trauma patients were randomly divided into two groups, a group based on assessment of blood consumption (ABC) to assess whether need to start the massive blood transfusion patients, such as proportion of blood transfusion (fresh frozen plasma: suspended red blood cells = 1:1), and the other group using traditional methods of blood transfusion, namely according to routine blood and clotting function and hemodynamic parameters, to decide when and what blood constituents should be transfused. RESULTS The coagulation got better in the early equal-proportion transfusion group, there were significant differences of PT and APTT (p < 0.05). The amount of 24 hours RBC and plasma transfusion was decreased in the early equal-proportion transfusion group, compared to the control group (p < 0.05), the length of ICU stay was shortened, the 24-hours SOFA score was improved, and there was no significant difference in 24-hours mortality, in-hospital mortality and total length of in-hospital stay (p > 0.05). CONCLUSIONS Early transfusion can reduce the total amount of blood transfusion and shorten ICU time, but has no significant effect on mortality.
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Comparison of quantitative and calculated postpartum blood loss after vaginal delivery
Madar, H., Sentilhes, L., Goffinet, F., Bonnet, M. P., Rozenberg, P., Deneux-Tharaux, C.
American journal of obstetrics & gynecology MFM. 2023;:101065
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Full text
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Editor's Choice
Abstract
BACKGROUND Because there is no consensual method of assessing postpartum blood loss, the comparability and relevance of the postpartum hemorrhage-related literature is questionable. Quantitative blood loss assessment using a volumetric technique with a graduated collector bag has been proposed to overcome limitations of intervention-based outcomes but remains partly subjective and potentially biased by amniotic fluid or missed out-of-bag losses. Calculated blood loss based on laboratory parameters has been published and used as an objective method expected to reflect total blood loss, but few studies have compared quantitative with calculated blood loss. OBJECTIVE This study aimed to compare the distribution of postpartum blood loss after vaginal delivery assessed by two methods - quantitative and calculated blood loss - and the incidence of abnormal blood loss with each method. STUDY DESIGN The data came from the merged database of 3 multicenter, randomized controlled trials, all testing different interventions to prevent postpartum blood loss in individuals with a singleton live fetus ≥ 35 weeks, born vaginally. All 3 trials measured blood loss volume by using a graduated collector bag. Hematocrit was measured in the eighth or ninth month of gestation and on day 2 postpartum. The two primary outcomes were: quantitative blood loss defined by the total volume of blood loss measured in a graduated collector bag, and calculated blood loss mathematically defined from the peripartum hematocrit change (estimated blood volume × [(antepartum hematocrit - postpartum hematocrit)/antepartum hematocrit], where estimated blood volume (mL) = booking weight (kg) × 85). We modelled the association between positive quantitative blood loss and positive calculated blood loss with polynomial regression and calculated the Spearman correlation coefficient. RESULTS Among the 8341 individuals included in this analysis, the median quantitative blood loss (100 mL, interquartile range 50-275) was significantly lower than the median calculated blood loss (260 mL, interquartile range 0-630) (P<.05). The incidence of abnormal blood loss was lower with quantitative blood loss than calculated blood loss for blood loss ≥ 500 mL, ≥ 1000 mL and ≥ 2000 mL, respectively, it was 9.6% (799/8341) vs 32.3% (2691/8341), 2.1% (176/8341) vs 11.5% (959/8341), and 0.1% (10/8341) vs 1.4% (117/8341); (P<.05). Quantitative blood loss and calculated blood loss were significantly but moderately correlated (Spearman coefficient=0.44; P<.05). The association between them was not linear, and their difference tended to increase with blood loss. Negative calculated blood loss values occurred in 23% (1958/8341) of individuals; among them, more than 99% (1939/1958) had quantitative blood loss ≤ 500 mL. CONCLUSION Quantitative and calculated blood loss were significantly but moderately correlated after vaginal delivery. However, clinicians should be aware that quantitative blood loss is lower than calculated blood loss, with a difference that tended to rise as blood loss increased.
PICO Summary
Population
Patients who gave birth vaginally, participating in the TRACOR, CYTOCINON, and TRAAP randomised controlled trials (RCTs) in several French maternity units (n= 8,341).
Intervention
This study aimed to compare the distribution of postpartum blood assessed by two methods - quantitative and calculated blood loss - and the incidence of abnormal blood loss with each method.
Comparison
Outcome
The data came from 3 RCTs testing different interventions to prevent postpartum blood loss. All 3 trials measured blood loss volume by using a graduated collector bag. The authors modelled the association between positive quantitative blood loss and positive calculated blood loss with polynomial regression and calculated the Spearman correlation coefficient. The median quantitative blood loss (100 mL, IQR= 50, 275) was significantly lower than the median calculated blood loss (260 mL, IQR= 0, 630). The incidence of abnormal blood loss was lower with quantitative blood loss than calculated blood loss. Quantitative blood loss and calculated blood loss were significantly but moderately correlated (Spearman coefficient= 0.44). The association between them was not linear, and their difference tended to increase with blood loss. Negative calculated blood loss values occurred in 23% (1,958/8,341) of individuals; among them, more than 99% (1,939/1,958) had quantitative blood loss ≤ 500 mL.
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The Impact of a Humanized Nursing Model on the Nursing Outcomes of Emergency Transfusion Patients
Chen, J., Ding, D.
Alternative therapies in health and medicine. 2023
Abstract
BACKGROUND Emergency transfusion is a frequently performed invasive medical procedure. Patients often experience negative emotions and exhibit poor compliance during transfusion. Therefore, it is imperative to proactively implement effective nursing interventions. OBJECTIVE This study aims to investigate the impact of a humanized nursing model on the nursing outcomes of emergency transfusion patients. DESIGN This research was conducted as a randomized controlled experiment. SETTING The study was conducted in the emergency department of Suzhou Hospital of Integrated Chinese and Western Medicine. PARTICIPANTS A total of 120 patients who underwent emergency transfusion treatment in our hospital from February 2021 to October 2022 were selected. They were divided into two groups, the control group, and the observation group, using a random number table method, with 60 patients in each group. INTERVENTIONS The control group received standard nursing care, while the observation group received humanized nursing. PRIMARY OUTCOME MEASURES The primary outcome measures included (1) assessment of psychological states, (2) evaluation of physical and mental comfort, (3) assessment of transfusion compliance, (4) incidence of adverse transfusion events, and (5) assessment of nursing satisfaction. RESULTS Prior to nursing interventions, anxiety and depression scores were not significantly different between the two groups (P > .05). After nursing interventions, both groups exhibited a decrease in scores, with the observation group showing a more significant reduction compared to the control group (P < .05). In all aspects of physical and mental comfort, the observation group scored significantly higher than the control group (P < .05). Transfusion compliance and nursing satisfaction were significantly higher in the observation group compared to the control group (P < .01). The incidence of adverse transfusion events in the observation group was significantly lower than in the control group (P < .01). CONCLUSIONS Humanized nursing significantly improves anxiety and depression in emergency transfusion patients, enhances their physical and mental comfort, and increases transfusion compliance while reducing adverse transfusion events. It leads to high patient satisfaction with nursing services.
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Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial
Siegal, D. M., Belley-Côté, E. P., Lee, S. F., Hill, S., D'Aragon, F., Zarychanski, R., Rochwerg, B., Chassé, M., Binnie, A., Honarmand, K., et al
Jama. 2023
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Editor's Choice
Abstract
IMPORTANCE Blood collection for laboratory testing in intensive care unit (ICU) patients is a modifiable contributor to anemia and red blood cell (RBC) transfusion. Most blood withdrawn is not required for analysis and is discarded. OBJECTIVE To determine whether transitioning from standard-volume to small-volume vacuum tubes for blood collection in ICUs reduces RBC transfusion without compromising laboratory testing procedures. DESIGN, SETTING, AND PARTICIPANTS Stepped-wedge cluster randomized trial in 25 adult medical-surgical ICUs in Canada (February 5, 2019 to January21, 2021). INTERVENTIONS ICUs were randomized to transition from standard-volume (n = 10 940) to small-volume tubes (n = 10 261) for laboratory testing. MAIN OUTCOMES AND MEASURES The primary outcome was RBC transfusion (units per patient per ICU stay). Secondary outcomes were patients receiving at least 1 RBC transfusion, hemoglobin decrease during ICU stay (adjusted for RBC transfusion), specimens with insufficient volume for testing, length of stay in the ICU and hospital, and mortality in the ICU and hospital. The primary analysis included patients admitted for 48 hours or more, excluding those admitted during a 5.5-month COVID-19-related trial hiatus. RESULTS In the primary analysis of 21 201 patients (mean age, 63.5 years; 39.9% female), which excluded 6210 patients admitted during the early COVID-19 pandemic, there was no significant difference in RBC units per patient per ICU stay (relative risk [RR], 0.91 [95% CI, 0.79 to 1.05]; P = .19; absolute reduction of 7.24 RBC units/100 patients per ICU stay [95% CI, -3.28 to 19.44]). In a prespecified secondary analysis (n = 27 411 patients), RBC units per patient per ICU stay decreased after transition from standard-volume to small-volume tubes (RR, 0.88 [95% CI, 0.77 to 1.00]; P = .04; absolute reduction of 9.84 RBC units/100 patients per ICU stay [95% CI, 0.24 to 20.76]). Median decrease in transfusion-adjusted hemoglobin was not statistically different in the primary population (mean difference, 0.10 g/dL [95% CI, -0.04 to 0.23]) and lower in the secondary population (mean difference, 0.17 g/dL [95% CI, 0.05 to 0.29]). Specimens with insufficient quantity for analysis were rare (≤0.03%) before and after transition. CONCLUSIONS AND RELEVANCE Use of small-volume blood collection tubes in the ICU may decrease RBC transfusions without affecting laboratory analysis. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03578419.
PICO Summary
Population
Adult patients in 25 medical-surgical intensive care units (ICU) in Canada (n= 21,201).
Intervention
Small-volume vacuum tubes for blood collection (n= 10,261).
Comparison
Standard-volume vacuum tubes for blood collection (n= 10,940).
Outcome
In the primary analysis of 21,201 patients, which excluded 6,210 patients admitted during the early COVID-19 pandemic, there was no significant difference in red blood cell (RBC) units per patient per ICU stay (relative risk [RR] 0.91; 95% CI [0.79, 1.05]; absolute reduction of 7.24 RBC units/100 patients per ICU stay 95% CI [-3.28, 19.44]). In a prespecified secondary analysis (n= 27,411 patients), RBC units per patient per ICU stay decreased after transition from standard-volume to small-volume tubes (RR 0.88; 95% CI [0.77, 1.00]; absolute reduction of 9.84 RBC units/100 patients per ICU stay 95% CI [0.24, 20.76]). Median decrease in transfusion-adjusted haemoglobin was not statistically different in the primary population (mean difference 0.10 g/dL; 95% CI [-0.04, 0.23]) and lower in the secondary population (mean difference 0.17 g/dL; 95% CI [0.05, 0.29]). Specimens with insufficient quantity for analysis were rare (≤0.03%) before and after transition.
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Pharmacological and non-pharmacological interventions in management of peripheral venipuncture-related pain: a randomized clinical trial
Yu, Z., Zhou, Y., Xu, X., Lin, L., Le, Q., Gu, Y.
BMC pediatrics. 2023;23(1):58
Abstract
BACKGROUND Venipuncture is a routine nursing procedure in the pediatric ward for blood collection and transfusion. However, this procedure can cause severe pain and distress if not adequately managed. METHODS Children aged 3-16 years old were randomized into three groups: EMLA group, distraction group, and combined group. The primary outcome was children's self-reported pain scored using the Wong-Baker FACES® Pain Rating Scale. The parents-reported and observer-reported pain were scored using the Revised Face, Legs, Activity, Cry and Consolability Scale, and children's salivary cortisol levels, heart rate, percutaneous oxygen saturation, venipuncture duration and retaining time of IV cannulas were the secondary outcomes. RESULTS A total of 299 children (167 male, 55.8%, median age 8.5) were enrolled: EMLA group (n = 103), distraction group(n = 96) and combined group(n = 100). There was no statistical difference in self-reported pain (P = 0.051), parent-reported pain (P = 0.072), and observer-reported pain (P = 0.906) among the three groups. All three interventions can decrease children's pain during IV cannulations. Additionally, the distraction group's salivary cortisol levels were lower than the combined group(P = 0.013). Furthermore, no significant difference was observed in the heart rate(P = 0.844), percutaneous oxygen saturation (P = 0.438), venipuncture duration (p = 0.440) and retaining time of IV cannulas (p = 0.843) among the three groups. CONCLUSIONS All three groups responded with slight pain during the peripheral venipuncture procedure. Therefore, medical workers in pediatric settings can use the interventions appropriate for their medical resources and availability while involving parents and children's preferences whenever possible. TRIAL REGISTRATION This trial was registered on https://register. CLINICALTRIALS gov/ (Gov.ID NCT04275336).
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Trial-related blood sampling and red-blood-cell transfusions in preterm infants
Lewis, A. E., Kappel, S. S., Hussain, S., Sangild, P. T., Zachariassen, G., Aunsholt, L.
Acta paediatrica (Oslo, Norway : 1992). 2023
Abstract
AIM: To determine if trial-related blood sampling increases the risk of later red-blood-cell (RBC) transfusion in very preterm infants, we compared the volume of clinical- and trial-related blood samples, in a specific trial and correlated to subsequent RBC transfusion. METHODS For 193 very preterm infants, participating in the FortiColos trial (NCT03537365), trial-related blood volume drawn was in accordance to ethical considerations established by the European Commission. Medical records were reviewed to assess the number and cumulated volume (mL/kg) of blood samples (both clinical- and trial-related). Data were compared with need of RBC transfusions during the first 28days of life. RESULTS Mean (SD) gestational age and bith weight was 28 ± 1 weeks and 1168 ± 301 g. In total, 11% of total blood volume was drawn for sampling (8.1 ± 5.1 mL/kg) and trial-related sampling accounted for 1.6 ± 0.6 mL/kg. Trial-related blood sampling had no impact on RBC transfusion (p=0.9). CONCLUSION Clinical blood sampling in very preterm infants is associated with blood loss and subsequent need for RBC transfusions. In a specific trial requiring blood samples, we found no additional burden of trial-related blood sampling. The study suggest that trial-related sampling is safe if European criteria are followed.
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10.
Virtual reality simulation-enhanced blood transfusion education for undergraduate nursing students: A randomised controlled trial
Lee, J. J., Tsang, V. W. Y., Chan, M. M. K., O'Connor, S., Lokmic-Tomkins, Z., Ye, F., Kwok, J. Y. Y., Ho, M. H.
Nurse education today. 2023;129:105903
Abstract
BACKGROUND Nurse-administered blood transfusion (BT) is a common form of medical treatment, but nursing students are often excluded from participating in and observing BTs during clinical placements. To address clinical placement limitations, nursing educators have increasingly adopted technology-guided simulation pedagogies, including virtual reality (VR) simulation, for nursing students' clinical skills education. OBJECTIVES To develop VR simulation for BT practice and investigate its effectiveness with nursing students. DESIGN A single-blinded, two-arm randomised controlled trial. SETTINGS One university in Hong Kong. PARTICIPANTS A total of 151 nursing students enrolled in a nursing undergraduate course at a university in Hong Kong were recruited via convenience sampling in March 2022. METHODS Evidence-based VR simulation videos consisting of 1) animated blood formation physiology and side effects of BT and 2) 360° BT nursing practice were developed. The nursing students were randomly allocated into intervention and control groups. The intervention group (n = 75) received the usual BT education (i.e. Zoom lecture) with the developed VR video education, whereas the control group (n = 76) received the usual BT education (Zoom). The BT knowledge (RBTKQ-O), student satisfaction and self-confidence (SSSC) and self-efficacy (GSES) of BT practice were measured before and after BT education. Intention-to-treat analyses were performed. RESULTS The primary and secondary outcomes (RBTKQ-O, SSCS and GSES, respectively) improved over time in both groups. Analysis of covariance revealed that students who received VR simulation reported higher post-intervention measurement scores in BT knowledge and SSCS than those who did not receive VR simulation. CONCLUSIONS VR simulation-enhanced BT education effectively enhances the knowledge and SSCS of BT practice amongst nursing students. Nurse educators may adopt VR simulation to enhance the effectiveness of existing BT education for nursing students.