Transfusion Practices Among General Surgeons at a Tertiary Care Center: a Survey Based Study

Attitude of Self-Medication Among Pharmacy Students in King Abdulaziz University, Jeddah, Saudi Arabia: A Cross-Sectional Survey

Background/purpose Self-medication is a public health concern because of the potential for medication overuse or abuse, as well as the physical, social, and psychological consequences. In Saudi Arabia, self-medication is common, especially among health science students. Inappropriate self-medication can cause several adverse effects, such as increasing the risk of medication abuse or delaying hospital appointments due to concealing specific symptoms with some medications. Therefore, our study aims to investigate and evaluate health science students' practices, awareness, and attitudes towards self-medication in the Faculty of Pharmacy at King Abdulaziz University, Jeddah, Saudi Arabia. Materials and methods A cross-sectional study was conducted using an online self-administered survey to measure the attitude, awareness, and prevalence of self-medication among pharmacy students at King Abdulaziz University in Jeddah, Saudi Arabia. Students in the pharmacy program from the first to the sixth year were invited to participate in the study from April 2019 to June 2019. Raosoft was used to compute the sample size (n = 235) with a 5% margin of error and a 95% confidence range. Results The factors associated with significant effects were an academic year (p = 0.001), smoking (p = 0.018), average sleeping time (p = 0.032), having any headache (p = 0.022), and their opinion about self-medication (p < 0.0001). Conclusion According to the study, the self-medication of analgesics is common among pharmacy students, and the most used medication was paracetamol.

Changing red blood cell transfusion practice in obstetrics and gynaecology: A before and after study of hospital-wide education

OBJECTIVES

To assess transfusion practices at a Canadian tertiary care center before and after a hospital-wide blood management educational campaign based on the Choosing Wisely toolkit.

BACKGROUND

Red blood cell (RBC) transfusions are an essential intervention in obstetrics and gynaec ology (O&G). However, with limited guidelines outlining the appropriate use of RBC transfusions, clinicians routinely transfuse based on haemoglobin values and habits.

METHODS/MATERIALS

We conducted a retrospective chart review of all patients who received a RBC transfusion while admitted under an O&G provider in two 12-month periods-before and after the intervention. The campaign consisted of Grand Rounds, formal and informal teaching, and posters placed within the hospital. We judged appropriateness from a set of criteria guided by the status of ongoing bleeding, pre-transfusion haemoglobin, and the number of units ordered simultaneously.

RESULTS

Transfusion appropriateness was poor in pre- and post-intervention periods (46% vs. 51%, p = 0.59). The overall rate of RBC transfusion was reduced from 1.8% to 1.2% (83/4610 vs. 55/4618, p = 0.02) after the intervention. There was a 52% reduction in the total number of RBC units of transfused (229 vs. 111, p < 0.001), a 33% reduction in the number of patients transfused (83 vs. 55, p = 0.016), and fewer multiple-unit transfusions without reassessment (39 vs. 13, p = 0.005).

CONCLUSION

RBC transfusion appropriateness remained low after a hospital-wide educational campaign. However, there was a marked decrease in overall transfusion use, reflecting the adoption of more restrictive transfusion practices. The low rate of transfusion appropriateness represents an opportunity for further improvement.

Association of perioperative red blood cell transfusions with all-cause and cancer-specific death in patients undergoing surgery for gastrointestinal cancer: Long-term outcomes from a population-based cohort

BACKGROUND

Red blood cell transfusions are common in patients undergoing gastrointestinal cancer surgery. Yet, to adequately balance their risks and benefits, clinicians must understand how transfusions may affect long-term outcomes. We aimed to determine if perioperative red blood cell transfusions are associated with a higher risk of all-cause and cancer-specific death among patients who underwent gastrointestinal cancer resection.

METHOD

We identified a population-based cohort of patients who underwent gastrointestinal cancer resection in Ontario, Canada (2007-2019). All-cause death was compared between transfused and nontransfused patients using Cox proportional hazards regression, while cancer-specific death was compared with competing risk regression.

RESULT

A total of 74,962 patients (mean age, 67.7 years; 55.4% male; 79.7% colorectal cancer) had gastrointestinal cancer surgery during the study period; 20.8% received perioperative red blood cell transfusions. Patients who received red blood cell transfusions had increased hazards of all-cause and cancer-specific death relative to patients who did not (hazard ratio: 1.39, 95% confidence interval 1.34-1.44; cause-specific hazard ratio: 1.36, 1.30-1.43). The adjusted risk of all-cause death was higher in early follow-up intervals (3-6 months postoperatively) but remained elevated in each interval over 5 years. The association persisted after restricting to patients without postoperative complications or bleeding and was robust to unmeasured confounding.

CONCLUSION

Red blood cell transfusion among patients with gastrointestinal cancer is associated with increased all-cause death. This was observed long beyond the immediate postoperative period and independent of short-term postoperative morbidity and mortality. These findings should help clinicians balance the risks and benefits of transfusion before well-designed trials are conducted in this patient population.

Red blood cell prescription and recognition of transfusion reactions by pediatricians

Objective

To assess the level of knowledge of emergency pediatricians on red blood cell transfusions and their reactions.

Methods

Written survey with emergency pediatricians from a pediatric hospital.

Results

Less than 20% of pediatricians showed appropriate knowledge on prescribing red blood cells and recognition of transfusion reactions. There was no significant statistical regarding time since graduation and blood transfusion classes in undergraduate studies or during medical residency.

Conclusion

Pediatricians have insufficient knowledge about red blood cell transfusions and recognition of transfusion reactions.

Prescription of red cell concentrates by emergency physicians

OBJECTIVE

To evaluate the adequacy of the prescription of red cell concentrates by emergency physicians.

METHODS

A cross-sectional study based on the survey of transfusion requests records completed by emergency physicians, from May/2018 to April/2019, in an emergency hospital. Adequacy in the indication, volume, and subtype (filtered, irradiated, and washed) of prescribed erythrocytes were evaluated. To compare the qualitative data, we used the χ2 test. The significance level adopted was 5%.

RESULTS

One thousand and twenty-two transfusions were evaluated. The indication, volume, and subtypes were correct in 72.7%, 45.9%, and 81.6% respectively. Transfusion in symptomatic patients presented superior adequacy when compared to asymptomatic individuals with significant statistical difference (indication: 79,6% vs 67.2%, p <0.001; Volume: 63.5% vs 31.7%, p <0.001; subtype: 85.3% vs 78.7%, p 0.006). Among clinical situations, there were more errors in sepsis (39.7%) and pneumonia (36.3%). More than half of the prescriptions presented excessive volume, raising the risk of circulatory overload, observing that the mean age was 60.6 years. The specific analysis of the prescribed subtypes showed adequacy of 17.9% in the filtered, 1.7% in the irradiated, and none in the washed. Thirty transfusions should have been filtered, but the prescriber did not request the subtype.

CONCLUSION

One hypothesis for the observed inaccuracies is inadequate medical training on the subject, both in undergraduate and medical residency, associated with a lack of continuing education on transfusion protocols. The transfusion Committee received the results of this study with a proposal for continuing education measures on transfusion hemotherapy.