Effects of applied muscle tension on the likelihood of blood donor return

Experiences of knowledge translation among researchers in transfusion medicine: Findings from an international survey study

BACKGROUND

Translation of research knowledge is critical to ensure transfusion medicine policies and practices reflect current evidence and so effectively support the health of blood donors and recipients, as well as ensuring ongoing blood supply. The aim of this study was to investigate the barriers and facilitators of knowledge translation (KT) among transfusion medicine researchers and determine what KT supports are needed.

STUDY DESIGN AND METHODS

An anonymous, cross-sectional survey was distributed by emailing corresponding authors of papers in four major blood journals, emailing grant recipients in the area of transfusion medicine, posting on social media, and through an international blood operator network.

RESULTS

The final sample included 105 researchers. Participants had a positive orientation toward KT, with few perceiving KT as not relevant to their research or beneficial for their careers. However, many reported facing difficulties practicing KT due to time constraints, competing priorities, or lack of funds or resources. Fostering relationships with stakeholders was seen as a key facilitator of KT but a number of researchers expressed difficulties engaging and communicating with them. Collaboration opportunities, protected time for KT, and access to KT resources were some of the supports researchers felt were required to help their KT efforts.

CONCLUSION

To minimize the knowledge to practice gap in transfusion medicine and ensure findings from research lead to improved outcomes, organizations need to support researchers in their KT efforts and facilitate interactions between researchers and research end-users.

Counter pressure maneuvers for syncope prevention: A semi-systematic review and meta-analysis

Physical counter pressure maneuvers (CPM) are movements that are recommended to delay or prevent syncope (fainting) by recruiting the skeletal muscle pump to augment cardiovascular control. However, these recommendations are largely based on theoretical benefit, with limited data evaluating the efficacy of CPM to prevent syncope in the real-world setting. We conducted a semi-systematic literature review and meta-analysis to assess CPM efficacy, identify literature gaps, and highlight future research needs. Articles were identified through a literature search (PubMed, April 2022) of peer-reviewed publications evaluating the use of counter pressure or other lower body maneuvers to prevent syncope. Two team members independently screened records for inclusion and extracted data. From 476 unique records identified by the search, 45 met inclusion criteria. Articles considered various syncopal conditions (vasovagal = 12, orthostatic hypotension = 8, postural orthostatic tachycardia syndrome = 1, familial dysautonomia = 2, spinal cord injury = 1, blood donation = 10, healthy controls = 11). Maneuvers assessed included hand gripping, leg fidgeting, stepping, tiptoeing, marching, calf raises, postural sway, tensing (upper, lower, whole body), leg crossing, squatting, “crash” position, and bending foreword. CPM were assessed in laboratory-based studies (N = 28), the community setting (N = 4), both laboratory and community settings (N = 3), and during blood donation (N = 10). CPM improved standing systolic blood pressure (+ 14.8 ± 0.6 mmHg, p < 0.001) and heart rate (+ 1.4 ± 0.5 bpm, p = 0.006), however, responses of total peripheral resistance, stroke volume, or cerebral blood flow were not widely documented. Most patients experienced symptom improvement following CPM use (laboratory: 60 ± 4%, community: 72 ± 9%). The most prominent barrier to employing CPM in daily living was the inability to recognize an impending faint. Patterns of postural sway may also recruit the skeletal muscle pump to enhance cardiovascular control, and its potential as a discrete, proactive CPM needs further evaluation. Physical CPM were successful in improving syncopal symptoms and producing cardiovascular responses that may bolster against syncope; however, practical limitations may restrict applicability for use in daily living.

Donation related fears predict vasovagal reactions and donor attrition among high school donors

BACKGROUND

This longitudinal study of high school whole blood donors examined relationships among donation-related fears assessed prior to donation, vasovagal reactions to donation, and the proportion of donors who attempted another donation over the subsequent 60 weeks.

STUDY DESIGN AND METHODS

Data regarding vasovagal reactions and attempted donation were obtained from donor records of 530 female and 342 male high school donors who answered questions about five types of fear (ie, of blood draw, needles, seeing blood, feeling pain, or fainting) prior to their index donation.

RESULTS

Each type of fear was associated with an increased risk of vasovagal reactions (all P < .001) and a smaller percentage of attempted donations was seen among those who reported at least one type of fear (53%) as compared to those who did not report any fear (62.1%); P = .022; β = -0.374, OR = 0.69; 95% CI, 0.50-0.94. Path analyses of the relationships among fear, vasovagal reaction, and attempted donation revealed significant indirect effects for each type of fear. Specifically, donors who reported fear were at increased odds of experiencing a vasovagal reaction, which, in turn, was associated with decreased odds of attempting a repeat donation.

CONCLUSION

Donation-related fears are associated with reduced donor return rates, and this effect is mediated through an increased risk for vasovagal reactions. For both practical and ethical reasons, blood collectors are encouraged to identify and intervene with fearful donors to reduce the likelihood of negative donation-related symptoms and enhance donor retention.

Development of an Intervention to Reduce Pain and Prevent Syncope Related to Adolescent Vaccination

INTRODUCTION

There is a lack of research into the perspectives of patients, parents, and clinicians regarding strategies for vaccine-related pain and syncope prevention that may improve the adolescent vaccination experience and encourage future vaccination.

OBJECTIVE

To develop an intervention on the basis of preference for strategies to reduce pain and prevent syncope associated with adolescent vaccination.

METHODS

We conducted focus groups and interviews with 8 recently vaccinated Kaiser Permanente Northwest (KPNW) members aged 11 to 17 years and their parents to explore perceptions of pain and syncope after vaccination as well as receptivity to potential interventions. Additionally, we interviewed 7 clinical staff who routinely vaccinate children. We conducted content analysis to identify promising interventions and conducted a data synthesis workshop to select a final intervention for piloting.

RESULTS

All participants expressed willingness to use previsit education, breathing exercises, social support or distraction, and water consumption. Patients and parents expressed a need for verbal education and messaging about potential vaccine-related outcomes, and clinicians noted a need to identify patients who are anxious before a vaccination visit. Most participants suggested a "comfort menu" intervention, to include comfort and distraction items that medical staff offer adolescents before and during vaccination.

CONCLUSION

Patients, parents, and clinicians acknowledged the value of interventions to reduce pain and syncope after adolescent vaccination. Stakeholders identified a comfort menu as the intervention to be piloted at 2 KPNW pediatric clinics. Further research is needed to test the effectiveness of the "Vaccination Comfort Menu" intervention in improving vaccination experiences and continued receipt of vaccinations.

Interventions for Individuals With High Levels of Needle Fear: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials

BACKGROUND

This systematic review evaluated the effectiveness of exposure-based psychological and physical interventions for the management of high levels of needle fear and/or phobia and fainting in children and adults.

DESIGN/METHODS

A systematic review identified relevant randomized and quasi-randomized controlled trials of children, adults, or both with high levels of needle fear, including phobia (if not available, then populations with other specific phobias were included). Critically important outcomes were self-reported fear specific to the feared situation and stimulus (psychological interventions) or fainting (applied muscle tension). Data were pooled using standardized mean difference (SMD) or relative risk with 95% confidence intervals.

RESULTS

The systematic review included 11 trials. In vivo exposure-based therapy for children 7 years and above showed benefit on specific fear (n=234; SMD: -1.71 [95% CI: -2.72, -0.7]). In vivo exposure-based therapy with adults reduced fear of needles posttreatment (n=20; SMD: -1.09 [-2.04, -0.14]) but not at 1-year follow-up (n=20; SMD: -0.28 [-1.16, 0.6]). Compared with single session, a benefit was observed for multiple sessions of exposure-based therapy posttreatment (n=93; SMD: -0.66 [-1.08, -0.24]) but not after 1 year (n=83; SMD: -0.37 [-0.87, 0.13]). Non in vivo e.g., imaginal exposure-based therapy in children reduced specific fear posttreatment (n=41; SMD: -0.88 [-1.7, -0.05]) and at 3 months (n=24; SMD: -0.89 [-1.73, -0.04]). Non in vivo exposure-based therapy for adults showed benefit on specific fear (n=68; SMD: -0.62 [-1.11, -0.14]) but not procedural fear (n=17; SMD: 0.18 [-0.87, 1.23]). Applied tension showed benefit on fainting posttreatment (n=20; SMD: -1.16 [-2.12, -0.19]) and after 1 year (n=20; SMD: -0.97 [-1.91, -0.03]) compared with exposure alone.

CONCLUSIONS

Exposure-based psychological interventions and applied muscle tension show evidence of benefit in the reduction of fear in pediatric and adult populations.

Management of young blood donors

The emphasis on high-school blood drives and acceptance of 16-year-old blood donors led to more research on physiologic and psychological ways to decrease vasovagal reaction rates in young blood donors and to increase donor retention. Research on how to accomplish this has been advantageous for the blood collection industry and blood donors. This review discussed the current situation and what can be done psychologically, physiologically, and via process improvements to decrease vasovagal reaction rates and increase donor retention. The donation process can be significantly improved. Future interventions may include more dietary salt, a shorter muscle tension program to make it more feasible, recommendations for post-donation muscle tension / squatting / laying down for lightheadedness, more donor education by the staff at the collection site, more staff attention to donors with fear or higher risk for a vasovagal reaction (e.g. estimated blood volume near 3.5 l, first-time donor), and a more focused donation process to ensure a pleasant and safer procedure.

Donor anxiety, needle pain, and syncopal reactions combine to determine retention: a path analysis of two-year donor return data

BACKGROUND

Efforts to expand the donor pool by recruiting younger donors have resulted in higher numbers of initial donations, but retention of young donors continues to be challenging.

STUDY DESIGN AND METHODS

Path analysis was used to examine the simultaneous relationships among syncopal reactions, donation anxiety, needle pain, donor satisfaction, and donation intention in predicting repeat donation. Participants included 421 first- and second-time donors recruited for a study comparing the effects of predonation water loading with and without the use of applied muscle tension during donation (52% female, 60.8% first-time donor, mean age 20.3 years). For this longitudinal follow-up study, donor database records were accessed 2 years after the index donation to assess repeat donation.

RESULTS

Results of a series of path analyses demonstrated the influential role of donor anxiety in shaping donor retention (final model χ(2) = 35.75, root mean square error of approximation 0.03, comparative fit index 0.98, weighted root mean square residual 0.74). First, anxiety exerted a direct negative influence on donation intention, the proximal and sole direct predictor of repeat donation. Second, anxiety increased the likelihood of donor-reported needle pain, adversely affecting donation satisfaction and, subsequently, donation intention. Finally, anxiety was associated with donor ratings of syncopal reactions through its impact on needle pain, which also contributed to decreased donation intention.

CONCLUSION

These results provide novel evidence that donation anxiety plays a central role in shaping future donation behavior. Individual differences in anxiety must be considered when developing and testing strategies to enhance blood donor retention.

Applied tension and coping with blood donation: a randomized trial

BACKGROUND

Despite the ongoing need for blood donation, few people give blood. A common reason is concern about vasovagal symptoms.

PURPOSE

The aim of this study was to evaluate the effectiveness of applied tension in reducing vasovagal symptoms during blood donation and the mechanisms of action.

METHOD

Two hundred eighty-two young adult blood donors were randomly assigned to conditions involving applied tension during the pre-donation wait period, during the blood draw, both, or no applied tension at all.

RESULTS

Applied tension was effective in reducing vasovagal symptoms in blood donors, particularly when practiced during the pre-donation wait period (p < 0.001). People who practiced applied tension during the pre-donation wait period required less treatment for vasovagal reactions than people who did not (8% vs. 16%).

CONCLUSIONS

The results of this study suggest that the effects of applied tension on vasovagal symptoms are not mediated entirely by exercise-related changes in blood pressure and heart rate. Rather, it may reduce anxiety or physiological consequences of anxiety. Applied tension is a useful treatment which can help people cope during blood donation and other invasive medical interventions.

Adverse events and safety issues in blood donation--a comprehensive review

Although blood donation is generally safe, a variety of risks and complications exist, the most common being iron deficiency, vasovagal reactions and citrate-related events. In the last decades, extensive efforts have significantly improved recipient and product safety, but there is still great potential to optimise donor care. Many therapies in modern medicine depend on the prompt availability of blood products, therefore it is crucial to maintain a motivated and healthy donor pool in view of a limited number of healthy volunteers willing and able to give blood or blood components. We present a comprehensive review on adverse events addressing all types of blood donation including whole blood, plasma, platelet, peripheral blood stem cell, leucocyte and bone marrow donation. In addition, we outline strategies for the prevention and treatment of these events and give a blueprint for future research in this field.

Interdonation intervals and patterns of return among blood donors in Brazil

BACKGROUND

In Brazil, most donations come from repeat donors, but there are little data on return behavior of donors.

STUDY DESIGN AND METHODS

Donors who made at least one whole blood donation in 2007 were followed for 2 years using a large multicenter research database. Donation frequency, interdonation intervals, and their association with donor demographics, status, and type of donation were examined among three large blood centers in Brazil, two in the southeast and one in the northeast.

RESULTS

In 2007, of 306,770 allogeneic donations, 38.9% came from 95,127 first-time donors and 61.1% from 149,664 repeat donors. Through December 31, 2009, a total of 28.1% of first-time donors and 56.5% of repeat donors had donated again. Overall, the median interdonation interval was approximately 6 months. Among men it was 182 and 171 days for first-time and repeat donors, and among women, 212 and 200 days. Predictors of return behavior among first-time donors were male sex (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.13-1.20), community donation (OR, 2.26; 95% CI, 2.20-2.33), and age 24 years or less (OR, 0.62-0.89 for donors ≥ 25 years). Among repeat donors predictors were male sex (OR, 1.35; 95% CI, 1.32-1.39), age 35 years or more (OR, 1.08-1.18 vs. ≤ 24 years), and community donation (OR, 2.39; 95% CI, 2.33-2.44). Differences in return by geographic region were evident with higher return rates in the northeast of Brazil.

CONCLUSION

These data highlight the need to develop improved communication strategies for first-time and replacement donors to convert them into repeat community donors.

Gender differences in giving blood: a review of the literature

BACKGROUND

An overview of European blood donors shows that the distribution of men and women donors is similar in many countries, with Italy being an exception in that women account for only 30% of donors. Gender medicine is a key issue in this context, even though gender studies are very limited in the transfusion field, whether considered broadly or with specific regards to the selection, management and retention of donors. It, therefore, seemed important to compare the presence of women among blood donors in different European countries and examine the roles that gender is reported to play in the donation of blood in order to identify possible implications for communication with and management of the donor.

METHODS

To determine the proportion of women among donors in European countries, data were collected from annual reports or documents available on the websites of national associations; furthermore, all papers related to giving blood published in the five main journals in the sector (Transfusion, Vox Sanguinis, Transfusion and Apheresis Science, Transfusion Medicine, Blood Transfusion) were considered; about 80 publications were selected and the gender variable was examined.

RESULTS

The published studies showed that gender plays key roles in the motivation to give blood (women being more altruistic, men being more individualistic) and in adverse reactions, which was a particularly critical problem leading to fewer women become regular donors. A few aspects specific to the management of donors in Italy also emerged.

DISCUSSION

Gender seems to play an important role in the aspects studied and does, therefore, merit further consideration in relation to strategies to recruit donors and the management of critical events during donation.

Applied tension may help retain donors who are ambivalent about needles

BACKGROUND

Vasovagal symptoms can discourage people who might otherwise give blood on many occasions. However, the effects of symptoms on donor retention as well as the effects of treatments to reduce vasovagal symptoms on donor retention are probably moderated by a person's confidence that they can tolerate the procedure.

METHODS

Data from a study on the effects of the muscle tensing technique applied tension (AT) on donor retention were examined to determine if (1) the degree of donor ambivalence about needles influenced the impact of vasovagal symptoms on subsequent return and (2) ambivalence about needles moderated the effect of learning AT on donor return. One-year follow-up data on 614 people who had previously given blood and were randomly assigned to either a no treatment, donation-as-usual condition or one of two conditions involving AT were obtained. Self-reported degree of needle ambivalence and vasovagal symptoms were assessed during the initial blood donation.

RESULTS

Among participants in the no treatment group, increases in vasovagal symptoms were associated with decreases in donor return but only among people who expressed some fear of blood draws. Similarly, among people who expressed no fear of needles, learning AT had no effect on post-donation estimate of the likelihood they would give blood again or return rate. However, among people with some fear of blood draws learning AT led to both a higher estimate that they would give blood again as well as actual return rate.

CONCLUSIONS

The experience of vasovagal symptoms may not deter people who are generally confident in their ability to tolerate blood donation. However, among people who are ambivalent about needles, symptoms may 'confirm' pre-existing doubts about their suitability for blood donation and lead to drop-out. Targeted interventions that give the uncertain volunteer a sense of confidence that they might be able to realize their goal and become a regular blood donor may be useful.

Predonation hydration and applied muscle tension combine to reduce presyncopal reactions to blood donation

BACKGROUND

A randomized controlled trial was conducted to test the effects of hydration and applied muscle tensing on presyncopal reactions to blood donation. Both interventions are designed to prevent the decreases in blood pressure that can contribute to such reactions, but due to the distinct physiologic mechanisms underlying their pressor responses it was hypothesized that a combined intervention would yield the greatest benefit.

STUDY DESIGN AND METHODS

Before blood donation, first- and second-time blood donors (mean age, 20.2 years; SD, 4.9) were randomly assigned to 1) standard donation, 2) placebo (leg exercise before venipuncture), 3) predonation water, or 4) predonation water and leg exercise during donation.

RESULTS

Main effects of group were observed for phlebotomist classification of vasovagal reactions (chi(2)(3) = 8.38, p < 0.05) and donor reports of presyncopal reactions (chi(2)(3) = 13.16, p < 0.01). Follow-up analyses of phlebotomist classifications revealed fewer reactions in the predonation water and predonation water and leg exercise groups relative to placebo but not standard donation. Follow-up analyses of self-reported reactions revealed that women, but not men, had lower scores in both the predonation water and the predonation water and leg exercise groups relative to both placebo and standard donation.

CONCLUSIONS

Predonation hydration and a combination of hydration and leg exercise may help attenuate presyncopal reactions in relatively novice donors, although future studies with larger samples are required to confirm this effect.