Background: The development of anti-red blood cell alloantibodies remains a major problem in thalassemia major patients. We studied the frequency of red blood cell (RBC) allo-immunization among Beta thalassemia major patients who received regular transfusions at our center and analyzed the factors, which may be responsible for development of these antibodies.Methods:An observational study was conducted in department of Pediatric Medicine, SMS Medical College, Jaipur. A total of 150 patients of Beta Thalassemia major who already received multiple transfusions were randomly selected and screening of Red Cell Alloantibodies was done by using SPRCA (solid phase red cell adhesion) method during May 2015 to April 2016. Statistical analysis was done using computer software (SPSS version 20 and primer). The qualitative data were expressed in proportion and percentages and the quantitative data expressed as mean and standard deviations. The difference in proportion was analysed by using chi-square test and the difference in means were analysed by using student t- Test. Significance level for tests were determined as 95% (P <0.05).Results: Total 150 cases were included. Male female ratio was 1.63:1, 10 cases (6.67%) were positive for alloantibodies. Among these 10 positive cases, 2 had positive family history and 3 had history of splenectomy. In allo-immunised cases mean age, mean age at first transfusion and total number of transfusions were significantly higher in comparison to non-allo-immunized cases.Conclusions:If patient has red cell alloantibody on regular interval screening then the antibody identification should be performed and corresponding antigen negative blood transfusion is strongly recommended in transfusion dependent thalassemia patients.
The objective of this study was to assess the effectiveness of simulation-based training (SBT) of a ventilator-associated pneumonia (VAP) bundle of care on the knowledge and practice of nursing officers working in the pediatric intensive care unit (PICU) and its impact on the incidence of VAP. This study was a single-center, pre- and postsimulation-based educational interventional tool conducted in a six-bed PICU located in Western Rajasthan, India. Thirty nursing officers working in the PICU participated in the study. Baseline knowledge and practice regarding VAP bundle of care were assessed using a questionnaire and practice checklist. It was followed by 1:1 SBT of the VAP bundle of care following which all participants were immediately reassessed and then again at 3 months postintervention. The incidence of VAP (events/1,000 ventilation days) was subsequently compared both at 6 months pre- and postintervention. Thirty nursing officers participated in the study of which 63% were male. Baseline knowledge and practice increased significantly immediately after the VAP bundle of care training and then again at 3 months in comparison to preintervention testing (baseline 20.27 ± 4.51, immediate postintervention 26.0 ± 3.67, 3 months postintervention 23.97 ± 4.69). The incidence of VAP showed a declining trend from 46.1 to 36.5/1,000 ventilation days; however, this finding was not statistically significant (p = 0.22). The simulation-based teaching program significantly enhanced nursing officers' knowledge and practice toward utilization of a preventive VAP bundle of care. There was decay in knowledge with time indicating that repetitive sessions are required at regular intervals to sustain this effect.
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