Blood donation is an important public health issue globally and locally. Recruitment and retention of blood donors are the biggest challenge for blood donation. The purpose of this systematic review is to identify the motivators and deterrents for blood donation. PubMed, Medline and China Journal Net were searched using (blood donation OR blood donor) AND (motivation OR deterrent) and inclusion and exclusion criteria were applied. Nine studies on motivators or deterrents for blood donation were retrieved. Taking into account the situation in Hong Kong and findings gathered from this systematic review, policy suggestions are made. Limitations of this systematic review are also discussed. This systematic review suggests that more Asian studies should be conducted to inform the culturally pertinent measures in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Microbiology / Master / Master of Medical Sciences

Background: Blood safety is important to blood transfusion. As men who have sex with men (MSM) are considered to have a higher risk of sexually transmitted infections (STIs) compared to the general population, blood donations from MSM may lead to a higher risk of transfusion-transmitted infections (TTIs). For this reason, many countries have established lifelong deferral policies for MSM blood donors since 1980s. Research have been conducted to evaluate the risks and benefits of relaxing MSM deferral policies from lifelong to a finite period, and countries such as the United Kingdom have implemented such relaxation in recent years. Nevertheless, there remains a lack of risk-benefit analyses on this topic in many countries, especially the developing ones. This review can help such countries to reconsider their MSM deferral policies. Objective: The objectives of this review are (i) to review the current deferral policies of blood donation from MSM implemented in major countries and (ii) to review the major determining factors in the risk-benefit analyses of these countries. Method: PubMed, Google Scholar, and China Journal Net were used for literature search. Only literatures with abstract and/or available full text in English or Chinese were included. The PICOS approach was used for study selection, and 37 articles were finally selected. Surveys, cohort studies, cross-sectional studies reviews, and national reports were included in this systematic review. Result: Countries with permanent/indefinite MSM deferral policy include the United States, Canada, France, Mexico, Germany, Norway, Sweden and China (including Hong Kong). Countries with a finite deferral period include New Zealand (5 years), the United Kingdom (12 months), Australia (12 months), Brazil (12 months), Argentina (12 months), Japan (6 months) and South Africa (6 months). Countries without specific deferral criteria for MSM include Spain, Italy, Poland and Russia. The recent relaxation of deferral policies was based on scientific evidence provided by risk-benefit analyses that evaluated the residual risk of TTIs associated with alternative deferral policies. Major determining factors of risk-benefit analyses include the following: 1. epidemiological characteristics that determine the proportion of MSM among HIV-infected patients; 2. screening technologies that have shortened the window period and improved the early detection of STIs; and 3. non-compliance after relaxation, which determines the increasing risk of TTIs. Conclusion: Majority of countries that have recently relaxed their deferral policies for MSM blood donor reduced the deferral period to 12 or 6 months. Most of the risk-benefit analyses found that relaxation of deferral policies for MSM blood donors would lead to a relatively small increase in the risk of TTIs. Policies aimed at lowering the non-compliance may be an effective way to reduce the residual risk of TTIs from MSM blood donors who are within the window period. / published_or_final_version / Public Health / Master / Master of Public Health

No description available.

Thesis (doctoral)--Freie Universität Berlin, 1979.

M.Cur. / Awareness of the growing list of potential and inherent risks and hazards associated with receiving donor blood has created a mushrooming interest in alternatives to blood transfusion. Despite the fact that there are programmes, protocols and guidelines in place in the private health sector, blood conservation has not got off the ground. Therefore the aim of this study was to explore and describe the perceptions of health-care professionals regarding blood conservation in the private health sector. An exploratory descriptive contextual design was employed. Data was collected through the use of semi-structured focus group and individual interviews. Conceptualisation as well as data from the interviews served as the basis for the formulation of guidelines for health-care professionals to improve blood conservation. The results of this research show that the interaction among health-care professionals are negatively influenced by the lack of communication, feedback, support and uncertainty, a lack of trust, education, planning, implementation, involvement, commitment and co-ordination. Therefore the outcome of blood conservation cannot be achieved. Effective communication, education and participatory management have to improve in order for these negative factors to be overcome. It is recommended that these guidelines be implemented to improve blood conservation in the private health sector. Conclusions, limitations and further recommendations were made based on the results of this study.

Multicomponent transfusion, or the transfusion of two or more different blood products, has been poorly studied to date, as most of the existing literature has focused on the use of individual blood products. This is of concern as multicomponent transfusion recipients likely differ with respect to characteristics and health outcomes from patients transfused with only one type of blood component (e.g. greater illness severity). Consequently, available data on individual blood product use and outcomes may not be applicable to multicomponent transfused patients. This thesis project identified and synthesized existing literature on the epidemiology of multicomponent transfusion in hospital inpatients, as well as the characteristics and outcomes of its recipients. Based on 37 observational studies, we found that the prevalence of multicomponent transfusion varied greatly by patient population, transfusion timeframe, and type of multicomponent transfusion being studied. The most common types of multicomponent transfusion across the 37 studies were co-transfusions of red blood cells (RBCs) and platelets, and co-transfusions of RBCs and plasma. Multicomponent transfusion was found to be associated with several negative health outcomes, however this was based on low quality evidence due to lack of control for confounding by indication. Our systematic review on multicomponent transfusion identified several knowledge gaps, including the need for studies focusing on patients with hematological malignancies, and studies identifying patient characteristics predictive of multicomponent transfusion. To address areas of knowledge deficiency, and to characterize multicomponent transfusion locally at our own center, we designed and conducted a retrospective cohort study of adult, transfused hospital inpatients. Based on 55,719 transfused inpatient admissions at the Ottawa Hospital between 2007 and 2017, we calculated the overall prevalence of multicomponent transfusion to be 25.1% (95% CI: 24.7%, 25.5%). Similar to the findings of our systematic review, the prevalence varied greatly by patient type, transfusion timeframe, and type of multicomponent transfusion. In particular, in hematology patients, the prevalence of multicomponent transfusion was 51%. Other patient groups frequently receiving multicomponent transfusions at our institution were cardiac surgery, critical care, cardiology, vascular surgery, trauma, surgery, and internal medicine patients. Using multivariable regression analysis, we found that patient sex, age, and type were predictive of multicomponent transfusion requirement. Additionally, controlling for illness severity and burden, multicomponent transfusion was associated with increased odds of in-hospital mortality, institutional discharge compared to discharge home, and greater length of hospital stay compared to patients transfused with only RBCs. Given our findings that multicomponent transfusion recipients make up a large proportion of transfused hospital patients, and that they have poorer outcomes, it is of importance to continue characterizing these patients – and not only focus on patients receiving a single type of blood component – and to evaluate and monitor the appropriateness of multicomponent transfusion. Additionally, as transfusion practice and guidelines are known to vary from region to region, it is important to study multicomponent transfusion locally, as generalizing results from other studies and centers may not be appropriate. Obtaining robust information on multicomponent transfusion – including prevalence, predictors, and potential health consequences – can aid clinicians in their decision-making for patient blood management, potentially minimizing unnecessary patient exposure to blood products, and maximizing the use of transfusion alternatives and blood conservation methods.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background: The hip joint tends to be highly affected in patients with Cerebral Palsy (CP). Subluxation, problems with ambulation, posture, perineal hygiene, and pain can result. Severe cases often require corrective surgery of the affected dysplastic hip(s). This often is accomplished with varus derotational osteotomy (VDRO), femoral osteotomy, pelvic osteotomy, tendon releases/lengthening, or a combination of any of these procedures. These reconstructive hip surgeries can result in marked blood loss. Due to the highly vascularized nature of bone, surgery can result in marked blood loss. This increases the transfusion burden on the patient and increases exposure to blood products and the associated risks therein. By identifying the risk factors that contribute to intraoperative and postoperative blood loss, targeted strategies may be developed to reduce this risk to the patient. Aims: The purpose of this study is to provide descriptive analysis of the pediatric CP population undergoing corrective hip surgery. We will attempt to identify various risk factors that may predispose patients to significant blood loss during reconstructive hip surgery. This study will be the largest study analyzing blood management therapy with the VDRO procedure. Methods: This is a retrospective chart review of consecutive CP patients who have undergone reconstructive hip surgery at a single institution from 2000 to 2012. Demographic data to be analyzed includes patient age, gender, race/ethnicity, height, weight, BMI, and medical comorbidities. Also, type of procedure performed, bilateral vs unilateral reconstruction, specific diagnosis, preoperative hemoglobin and hematocrit (H and H), pre‐transfusion H and H, estimated blood loss (EBL), total operative time, cell saver volume, units transfused, complications, quantity of postoperative transfusion, and post‐transfusion H and H was recorded. Data was compared using the Chi‐squared method, or non‐parametric analog, to assess the likelihood of the need for postop transfusions as an initial univariate analyses. Results: 87 patients were included in the study. There was no significant relationship between the use of autologous blood and age, gender, weight, height, or BMI. Patients who received autologous blood also had a higher EBL (p=0.029) and were more likely to need allogenic transfusion (p=0.023). Concomitant DEGA procedure carried a 2.25 times relative risk of needing blood transfusion (p<0.001, 95% CI 1.402‐3.611). Bilateral VDRO was 1.64 times more likely to need a transfusion, however this was not quite statistically significant (p=0.052, 95% CI 0.972‐2.756) Conclusion: Varus derotational osteotomy for the correction of neuromuscular hip dysplasia can be associated with excessive blood loss, especially in the CP patient population. The use of autologous vs allogenic blood products carries various risks and benefits. This paper has identified that the need of concomitant DEGA osteotomy is correlated with increased blood loss. Also, the use of autologous blood product is correlated with increased blood loss.

Digitized by Kansas Correctional Industries

Blood safety is an issue of public health concern. Sensitive screening assays for excluding infectious donations have been widely adopted to reduce the risk of transfusion-transmitted infections, especially for hepatitis B virus (HBV), hepatitis C virus (HCV) and (human immunodeficiency virus) HIV infections. Even with sensitive screening assays, residual risk of undetectable infectious donations remains because donations may be made in the “window period” when the infection is present but difficult to detect with serological tests. Currently, serological screening tests are mainly used in China, rather than the more expensive and sensitive DNA based tests. From a public health perspective, choice of the screening test depends on overall cost-effectiveness, including assessment of the residual risk. To facilitate a full cost-effectiveness analysis, this review identifies the best residual risk estimating model in a Chinese setting. The search was conducted using databases including PubMed and ISI Web of Knowledge filtered by publication date, English language and accessibility of full text. Both exclusion and inclusion criteria were used for articles identification. Five papers on residual model estimation were retrieved. The blood donor profile in China was used to understand how these models differ and how these differences would affect their use and interpretation. This study identified the Michael P. Busch model as the optimal residual risk estimating model for Chinese blood banks’ to facilitate the cost-effectiveness assessment of a screening strategy in terms of achieving a balance of blood safety and cost. / published_or_final_version / Public Health / Master / Master of Public Health