Background Patient blood management (PBM) describes a set of evidence-based practices to optimize medical and surgical patient outcomes by clinically managing and preserving a patient’s own blood. This concepts aims to detect and treat anemia, minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process. In combination with blood loss, anemia is the main driver for transfusion and all three are independent risk factors for adverse outcomes including morbidity and mortality. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds. Methods Semi-structured interviews were conducted with 1–4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country and underwent qualitative content analysis. Clustering the resulting implementation measures by levels of intervention for PBM implementation informed a PBM implementation framework. Results A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration. Conclusion The implementation matrix resulting from this research helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to design, initiate and develop strategies and plans to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.
We analyzed the outcome of a series of 19 newly diagnosed patients with acute promyelocytic leukemia treated with AIDA modified protocol, using mitoxantrone in place of idarubicin. Eleven patients achieved morphologic CR (58%). The remaining 8 patients had induction failure due to death during induction. Ten of eleven patients in CR achieved molecular remission after induction therapy and all the 8 patients had molecular remission after consolidation. Eight patients completed the three consolidation courses as scheduled and then proceeded to maintenance therapy. After a median follow up of 52 months, no molecular or hematological relapse has occurred. The 4-year disease-free survival is 82%. The study showed the antileukemic efficacy of mitoxantrone and that it could be used as a reasonable option in anthracycline-based strategies in APL.
Background and aims: Anemia is a common feature in patients presenting for major elective surgery, and it is considered an independent risk factor associated with adverse outcomes. Although several studies suggest that preoperative anemia is associated with poor outcomes after elective orthopedic surgery, data are still scarce in middle-and low-income countries where this problem may be even greater. The objective of this study was to evaluate the impact of preoperative anemia in clinical outcomes in patients submitted to hip and knee arthroplasty in a single tertiary hospital.
Figura 1. A e B. Citologia de medula óssea mostrando pró-eritroblastos gigantes com inclusões intranucleares sugerindo infecção viral (*). C e D. Histologia de medula óssea com eritroblastos gigantes com inclusões intranucleares (^)
4378 Introduction: Despite the increasing development of medicine there is no safe and practice substitute for blood. However the demand for blood are rising every day, due to increases in the number and complexity of procedures that require transfusions The greatest challenge of the hemotherapy service is to provide the blood supply needed “assuring” the safety of them. To meet the potential needs for adequate blood supplies, it is beneficial to increase the number of blood donors and the blood donation rate, without enhancing the risk of blood transmitted diseases. Many strategies have been used to achieve this goal, but most of than concluded that the results of blood donors satisfaction surveys have poor correlation with blood donation process performance. This problem is present in many other fields of the economy, such as hotels, air transportation and day-to-day industrial needs. In the beggining of the last decade developed a strategy called “Net Promoter Score”, that had the intention to establish a direct correlation between customers loyalty and enterprise/process performance. This methodology was based in several researches that could link the customers consuming behavior and the retaining issues. The survey were made with only one question, that was “Would you recommend this company/service for your family or friends” (The Ultimate Question). The customers could answer in a numeric scale from 0 to 10, where 0 was “No, I wouldn't” and 10 was “Yes, I would”. From that score the clients were stratified in three groups: 0–6 were called “Detractors”, the ones that would be the bad marketing of the company; 7–8 were called “Passive”, the ones that do not have a strong experience neither good or bad; and those 9–10, that were called “Promoters”, that were the ones that would be the marketing department of the company, and in our case, the ones that would recruit and retain more donors. To calculate the so called “NET Promoter Score” (NPS), the percentage of detractors were subtracted from the promoters. This score were than used prospectively to follow the enterprise performance, and to be the main guide to adjust customer services. When the NPS were used as the “core” of the strategy, and all the others management tools were taken together with it, we could call it the “Net Promoter System”. In this way the score is a tool that can be used to develop the system. Nowadays this methodology is widely used in the industry, commerce and other fields, and since its publication there were many economy activities that no company could optimize its performance without improving its score. There is no published research looking for its use in the Hemotherapy practice, and specifically in blood donor recruitment and retention. The objective of this study was to establish the feasibility of the utilization of the Net Promoter Score in the blood donation area. Methodology: The satisfaction survey were offered to the customers at the end of the blood donation process. The candidates to blood donation were analyzed and divided in the described groups according to the so called ultimate question (Detractor, Passive or Promoter) and the blood donations behavior (Clinical unfit for blood donation, First time donor and Repetition donor). These data were pulled together and were used as a guide to adapt customer relations strategy and blood supply optimization. Results: From may of 2011 until july of 2012, there were six thousand nine hundred and eight one researches available for analysis derived from seven thousand three hundred and thirty candidates for blood donation (95,23%). From those 11,9% were from unfit patients that were unable to donate, 44,2% of first time donors and 43,8% of repetition donors. The groups were analyzed according to the score, and the NPS were than calculated as follow: 97,66% ±1,30 (SD) for First time Donors; 98,66% ± 0,84 (SD) for Repetition donors and 90,80% ±4,42 (SD) for unfit candidates. Conclusion: The development of a tool to optimize the blood management is an on course task. Several methodologies have been trying to establish a strong link between donor satisfactions and blood donation behavior. In this study we concluded that NPS is an effective tool, with high feasibility and great potential impact in process performance. The efficacy of the score, the development of the NET Promoter System and the correlation between its methodology with blood donor recruitment and retention must be study in a prospective trial. Disclosures: No relevant conflicts of interest to declare.
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