Improving documentation of blood product administration using a standardized electronic health record-based system: a single-institution experience

OBJECTIVES

To improve documentation of blood product administration by assessing the completion status of blood transfusions. In this way, we can ensure compliance with the Association for the Advancement of Blood & Biotherapies standards and facilitate investigation of potential blood transfusion reactions.

METHODS

This before-and-after study includes the implementation of an electronic health record (EHR)-based, standardized protocol for documenting the completion of blood product administration. Twenty-four months of retrospective data (January-December 2021) and prospective data (January-December 2022) were collected. Meetings were held before the intervention. Ongoing daily, weekly, and monthly reports were prepared, and targeted education to deficient areas as well as spot in-person audits by the blood bank residents were conducted.

RESULTS

During 2022, 8,342 blood products were transfused, of which 6,358 blood product administrations were documented. The overall percentage of completed transfusion order documentation improved from 35.54% (units/units) in 2021 to 76.22% (units/units) in 2022.

CONCLUSIONS

Interdisciplinary collaborative efforts helped produce quality audits to improve the documentation of blood product transfusion through a standardized and customized EHR-based blood product administration module.

Pulmonary Granulomas and Mycobacterial Infection: Concordance between the Results of Special Stains Performed on Lung Tissue Sections and Tissue Cultures

Background: The most common cause of infectious pulmonary granulomas worldwide is Mycobacterium tuberculosis. The diagnosis is based on clinical presentation, histopathologic findings, detection of acid-fast bacilli (AFB) in tissue or sputum using special stains, and/or isolation of mycobacteria in cultures or via PCR-based methods. Different studies have shown that high levels of discrepancy exist between these diagnostic approaches in lung tissue specimens. Objective: To assess the degree of concordance between the results of special stains and cultures on lung tissue specimens in the diagnosis of mycobacterial infections. Methodology: Eighty-seven patients with a diagnosis of granulomas (necrotizing and non-necrotizing) on lung tissue specimens were identified. Cohen’s kappa was used to measure the general concordance between the results of the histopathological examination (special stains) and bacteriological tissue cultures. Results: With Kinyoun acid-fast stains, 8/48 (16.7%) cases were positive for AFB. With FITE stains, 10/57 (17.5%) cases were positive for AFB. There was strong agreement between Kinyoun acid-fast and FITE stains (Kappa = 0.806; p-value < 0.001). Tissue cultures were performed on 38/87 cases (43.7%), and 10/38 (26.3%) of the cultures were positive for mycobacteria. There was no concordance between Kinyoun acid-fast stains or FITE stains and tissue cultures results. Conclusion: Our observations represent an initial step in the process of reviewing the two methods used at our institution to diagnose mycobacterial infections on lung tissue specimens and highlight the need of incorporating more advanced diagnostic methods such as PCR to confirm mycobacterial infections and improve patient management. Importantly, species-level identification of mycobacteria is necessary to guide treatment.

Repurposing of Anticancer Stem Cell Drugs in Brain Tumors

Brain tumors in adults may be infrequent when compared with other cancer etiologies, but they remain one of the deadliest with bleak survival rates. Current treatment modalities encompass surgical resection, chemotherapy, and radiotherapy. However, increasing resistance rates are being witnessed, and this has been attributed, in part, to cancer stem cells (CSCs). CSCs are a subpopulation of cancer cells that reside within the tumor bulk and have the capacity for self-renewal and can differentiate and proliferate into multiple cell lineages. Studying those CSCs enables an increasing understanding of carcinogenesis, and targeting CSCs may overcome existing treatment resistance. One approach to weaponize new drugs is to target these CSCs through drug repurposing which entails using drugs, which are Food and Drug Administration-approved and safe for one defined disease, for a new indication. This approach serves to save both time and money that would otherwise be spent in designing a totally new therapy. In this review, we will illustrate drug repurposing strategies that have been used in brain tumors and then further elaborate on how these approaches, specifically those that target the resident CSCs, can help take the field of drug repurposing to a new level.

Biological activities of flavonoid-rich fraction of Eryngium caucasicum Trautv

OBJECTIVES

Eryngium (E.) caucasicum was found as a new cultivated vegetable plant in northern Iran and used in several local foods. Little information is available on biological properties of E. caucasicum. In this work antioxidant activity of flavonoid-rich fraction of this plant was investigated by eight in vitro assay systems.

MATERIALS AND METHODS

1,1-diphenyl-2-picryl hydrazyl radical (DPPH), nitric oxide and hydrogen peroxide scavenging activities, Fe2+ chelating ability, reducing power and hemoglobin-induced linoleic acid peroxidation were used to evaluate antioxidant activities. Antihemolytic activities were evaluated against CuOOH and H2O2 induced hemolysis in rat erythrocyte.

RESULTS

IC50 for DPPH scavenging activity was 391.2 +/- 14.9, 706.6 +/- 22.3 and 779.7 +/- 16.7 microg ml(-1) for aqueous (AQ), ethyl acetate (EA) and n-hexane (HE) fractions, respectively. There was no difference between reducing power of AQ fraction activity and vitamin C (p > 0.05). IC50 for NO radical-scavenging activity was in order of AQ (133.5 +/- 6.2 microg ml(-1)) > EA (350.1 +/- 14.8 microg ml(-1)) > and HE (639.9 +/- 21.7 microg ml(-1)) fractions, respectively. Extracts showed weak Fe2+ chelating ability. HE fraction showed better activity (173.5 +/- 9.6 microg ml(-1)). Extracts exhibited weak hydrogen peroxide scavenging activity but exhibited very good antioxidant activity against the hemoglobin-induced linoleic acid peroxidation. There was no significant difference between AQ fraction and vitamin C (p > 0.01). Fractions delayed the onset of the CuOOH induced hemolysis. AQ fraction showed very high total phenol and flavonoid contents which was higher than other fractions. High phenol and flavonoid content of AQ fraction may lead to its better antioxidant activity.

CONCLUSIONS

E. caucasicum fractions exhibited different levels of antioxidant and antihemolytic activities in all tested models. These results can be useful as a starting point of view for further applications of E. caucasicum aerial parts or its constituents in pharmaceutical preparations.