bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physicians Vary in Approaches to the Clinical Management of Delirium
Authors: Carnes Molly , Howell Timothy , Rosenberg Marjorie , Francis Joseph , Hildebrand Christopher , Knuppel Jeffrey 
Published: March 2003

OBJECTIVES: To ascertain the variation in strategies for managing delirium of physicians with expertise in geriatrics.DESIGN: Cross‐sectional mail survey.SETTING: United States.PARTICIPANTS: A probability sample of physician members of the American Geriatrics Society.MEASUREMENTS: Management choices presented in a two‐part case vignette of an older woman hospitalized with a hip fracture who develops mild and then severe delirium.RESULTS: One hundred twenty‐two respondents (43%) selected the three answers constituting current “best practice,” 50 (18%) selected an unnecessary diagnostic test (brain imaging, lumbar puncture, or electroencephalogram), and 47 (17%) selected unnecessary pharmacologic therapy for mild delirium. For severe delirium, 270 (96%) selected pharmacological therapy, of whom 180 chose haloperidol alone, 55 chose lorazepam alone, 23 chose lorazepam in combination with haloperidol, and 12 wrote in another drug. Thirty percent of the respondents made any selection of lorazepam, alone or in combination with haloperidol, for mild or severe delirium. Sixty‐one percent of those selecting haloperidol for severe delirium chose a dose greater than that recommended for geriatric patients. Sex, date of graduation from medical school, clinical specialty, completion of a geriatric fellowship, or certification in geriatrics had no significant effect on responses.CONCLUSIONS: The common selection of lorazepam to treat delirium is troubling because benzodiazepines themselves are implicated in delirium. Selection of an initial dose of haloperidol higher than that recommended for geriatric patients by more than half of the respondents is also of concern. There is a paucity of sound clinical evidence to guide the choice of pharmacological agents for treating delirium in older hospitalized patients.
Epidemiology of hepatitis C virus: a study of male blood donors in Saudi Arabia
Authors: Abdelaal M. , Rowbottom D. , Zawawi T. , Scott T. , Gilpin C. 
Published: March 2003

Background: Few epidemiologic reports on the prevalence of hepatitis C in Saudi blood donors have been published.Study Design and Methods: Men (of several nationalities) donating blood at the King Khalid National Guard Hospital (Jeddah, Saudi Arabia) were randomly selected (n = 744) for this study examining the prevalence of hepatitis C virus (HCV) in the local donor population, the relationship of antibody to HCV (anti‐HCV) to the surrogate markers alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti‐HBc), and the effect of the use of these markers on the discard rate.Results: The prevalence of anti‐HCV in the group examined was 3.2 percent (24/744), with a significantly high prevalence of 24.5 percent (12/49) in donors who were Egyptian (p < 0.0001). Exclusion of this group would lower the prevalence to 1.7 percent (12/695). Anti‐HCV prevalence peaked in the group aged 30 to 39, and a significant relationship was found between anti‐HCV and ALT level > 65 U/L (p < 0.0001). There was no significant relationship between anti‐HCV and anti‐HBc (p = 0.66). The prevalence of anti‐HCV in the Saudis studied was 1.7 percent (9/528). The prevalence of anti‐HCV in non‐Bedouin Saudis was significantly greater than that in Bedouin Saudis (7/165 [4.2%] vs. 2/363 [0.5%]; p < 0.01). The prevalence of anti‐HBc was found to be 28.7 percent (214/744). The use of elevated ALT (> 90 U/L) and anti‐HBc as surrogate markers would increase the current discard rate (8.3%) by 2.8 and 23.8 percent, respectively.Conclusion: These findings demonstrate the practical difficulties of using anti‐HBc as a surrogate marker for hepatitis C in areas endemic for hepatitis B virus.
Duration of time from onset of human immunodeficiency virus type 1 infectiousness to development of detectable antibody
Authors: Petersen L.R. , Satten G.A. , Dodd R. , Busch M. , Kleinman S. , Grindon A. , Lenes B. ,   The HIV Seroconversion Study Group
Published: March 2003

Background: For persons newly infected with the human immunodeficiency virus type 1 (HIV‐1), the time from the onset of infectivity to the development of detectable HIV‐1 antibody is unknown. Persons who donate blood during this period account for nearly all instances of HIV‐1 transmission from HIV‐1 antibody‐screened blood transfusions.Study Design and Methods: To estimate the window period from infectivity to HIV‐1 antibody positivity, 701 HIV‐1‐seropositive blood donors who made a previous seronegative donation at 40 United States blood centers were studied. The HIV‐1 antibody status was determined for at least one recipient of blood from the seronegative donation preceding the seropositive donation made by 182 of the 701 donors.Results: There were 39 seropositive recipients of blood from these 182 donors. Three donors were excluded from further analysis because the seropositive recipients of their blood had other HIV‐1 risk factors or had HIV‐1 infection before transfusion. The final study population comprised the remaining 179 donors, of whom 36 (20%) transmitted HIV‐1 infection to recipients. When the interval between the seropositive donation and the preceding seronegative donation was less than 180 days, 46 percent of the donors transmitted HIV‐1. In contrast, when that interval exceeded 540 days, only 2 percent transmitted HIV‐1. A mathematical model was developed to explain the relationship between the probability that the previous seronegative donation occurred during the donor's window period of infectiousness, and hence transmitted HIV‐1, as a function of both the window period and the duration between the seropositive and previous seronegative donations. This model indicated that the transmission data were most consistent with an average window period of 45 days. Assuming a log‐normal window period distribution, it was estimated with 95 percent certainty that at least 90 percent of persons had a window period of less than 141 days.Conclusion: The window period averages 45 days, with few, if any, donors remaining infectious and seronegative for longer than 6 months.
Comparison of a transfusion preparation of newly formed red cells and standard washed red cell transfusions in patients with homozygous β‐ thalassemia
Authors: Collins A.F. , Gonçalves‐Dias C. , Haddad S. , Talbot R. , Herst R. , Tyler B.J. , Zuber E. , Blanchette V.S. , Olivieri N.F. 
Published: March 2003

Background: Previous studies of transfusions of newly formed red cells (neocytes) demonstrated modest extensions of transfusion interval in patients with homozygous beta‐thalassemia.Study Design and Methods: The clinical benefits of a new system of neocyte preparation (Neocel, Cutter Biological, Berkeley, CA), reported to combine ease of preparation with reduction in the transfusion requirements of thalassemia patients, were evaluated. Sixteen thalassemic patients who had undergone splenectomy received eight consecutive, standard, automated, washed red cell transfusions (standard transfusions), followed by eight transfusions with the neocyte preparation (neocyte transfusions). In each arm of the study, mean pretransfusion hemoglobin and mean red cell mass transfused were carefully controlled and were similar.Results: A significant (p < 0.0001) extension of transfusion interval was observed in patients receiving neocyte transfusions (mean ± SD; 38.7 ± 34 days; range, 35.0–44.5), over that in those receiving standard transfusions (32.9 ± 2.5 days; range, 29.6–38.5). The mean prolongation of transfusion interval by neocyte transfusion corresponded to a mean reduction of 25 mL in packed red cells transfused per kg of body weight per patient per year and a mean reduction in transfused iron of 15 percent per year per patient. During neocyte transfusions, blood preparation costs were considerably increased and donor exposure was significantly (p < 0.0005) higher than during the standard transfusion period.Conclusion: These data demonstrate that extension of the transfusion interval, and reduction in transfused iron, may be achieved in thalassemic patients by use of the Neocel system. These benefits are achieved, however, with substantial increases in donor exposure and in component preparation costs.
Accuracy of statistical methods in TRANSFUSION: a review of articles from July/August 1992 through June 1993
Authors: KANTER M.H. , TAYLOR J.R. 
Published: March 2003

BACKGROUND: Statistical errors have been noted in a large percentage of articles appearing in medical journals. Their incidence in a blood banking journal, however, has not been studied.STUDY DESIGN AND METHODS: Original articles appearing in the journal TRANSFUSION from July 1992 through June 1993 were analyzed for correctness of statistical methods. Each article was reviewed by both a transfusion medicine physician and a statistician.RESULTS: There were 122 original articles, of which 59 contained statistical methods and were reviewed. Of these, 23 (39%) contained an error in the statistical description of their data, 47 (80%) failed to describe clearly the statistical tests performed, and 44 (75%) involved an incorrect statistical test or contained an error in test calculation or interpretation. As a result of these errors, 13 (22%) of the 55 articles analyzed reported conclusions not supported by the data. CONCLUSION: Misuse of statistical methodology may not be uncommon in transfusion medicine research, and it would be prudent to give more attention to statistical methodology in such research
Factors affecting the labor efficiency of hospital‐based blood bank laboratories
Authors: LAM H.C. , KOMINSKI G.F. , PETZ L.D. , SOFAER S. 
Published: March 2003

BACKGROUND: A variety of financing mechanisms and managerial innovations have been developed in the past decade to control hospital costs. Some evidence suggests that those changes have not produced substantial improvements in labor efficiency among employees in the hospital's technical level, such as in the blood bank laboratories.STUDY DESIGN AND METHODS: This study measured labor efficiency in 40 hospital‐based blood bank laboratories in Southern California during the year from July 1989 to June 1990 and explored the impact of financial, managerial, and operational factors on labor efficiency.RESULTS: With standardized output measures used in all blood bank laboratories, a wide variation of labor efficiency was found. Multivariate analyses indicate that the labor efficiency of blood bank employees was not influenced by organizational financial incentives, but was affected by the managerial styles of blood bank managers.CONCLUSION: Interpretation of the findings suggests that labor efficiency is affected by operational designs intended to improve responses to variable workloads and reduce slack time.
Cryopreservation of human platelets with dimethyl sulfoxide: changes in biochemistry and cell function
Authors: Bock M. , Schleuning M. , Heim M.U. , Mempel W. 
Published: March 2003

BACKGROUND: The shelf life of liquid‐stored platelet concentrates is limited to 5 days. Therefore, much work has been carried out in an attempt to establish the optimum method for cryopreservation. Among the various cryoprotectants, dimethyl sulfoxide (DMSO) has been shown to be the most effective. However, DMSO‐frozen platelets are characterized by a number of cell lesions. This report describes metabolic and functional changes that should give rise to some concern about the functional integrity of these cells.STUDY DESIGN AND METHODS: Single‐ donor platelet concentrates were frozen in liquid nitrogen by use of DMSO (5%). After thawing, the cells were washed and resuspended in autologous plasma. Before, during, and after the freezing process, samples for analysis of metabolic measures (e.g., pH; calcium, potassium, and lactate dehydrogenase concentrations; plasma complement factors) and functional measures (e.g., aggregometry, in vitro bleeding time, alpha‐granule membrane protein‐140 expression) were taken.RESULTS: Mean platelet volume increases during the deep‐freezing process. Potassium, calcium, and lactate dehydrogenase are released from the intracellular space to the extracellular space. A strong activation of complement, which is mainly due to the addition of DMSO, is observed. Platelets become activated as indicated by the expression of alpha‐granule membrane protein‐140. Accordingly, decreased platelet function can be observed.CONCLUSION: DMSO‐frozen platelets are characterized by several metabolic and functional changes. Although these cells have been shown to exert hemostatic effects in vivo, it is conceivable that those effects could be improved by further development of platelet‐freezing techniques.
Cytokine generation in stored, white cell‐reduced, and bacterially contaminated units of red cells
Authors: Stack G. , Baril L. , Napychank P. , Snyder E. L. 
Published: March 2003

BACKGROUND: Proinflammatory cytokines were measured in the supernatant portion of stored, bacterially contaminated, and/or white cell (WBC)‐ reduced units of red cells (RBCs). Previous studies from this laboratory and others have shown that cytokines are generated in platelet concentrates during storage. This earlier work has been expanded to the study of stored RBCs.STUDY DESIGN AND METHODS: Units of AS‐1 RBCs (n ? 10 non‐WBC‐reduced; n ? 10 WBC‐reduced) were obtained from a regional blood center, and each was split on Day 3 of storage into three equal portions by sterile techniques. One portion was kept sterile (control), and the other two were inoculated with Yersinia enterocolitica and Staphylococcus aureus, respectively, at 1 to 3 colony‐forming units per mL. The RBCs were stored at 1 to 6 degrees C for 42 days. Sequential samples were taken during storage and assayed for interleukin 8 (IL‐8), interleukin 1 beta (IL‐1 beta), interleukin 6, WBC count, and bacteria count. For the WBC‐reduced group (n ? 10), WBC removal was done by filtration on Day 3 of storage, before bacterial inoculation.RESULTS: IL‐8 was detected in the supernatant portion of all 42‐day‐old, non‐WBC‐reduced (mean WBCs ? 4760 ± 3870/μL) units of AS‐1 RBCs at levels ranging from 63 to 1610 pg per mL. By contrast, at 2 to 3 days of storage, lower levels of IL‐8 (range, 0‐280 pg/mL) were detected in the same units. IL‐8 levels increased progressively during storage in most (7/10) units. The highest mean levels of IL‐8 were reached by outdate at Day 42. Y. enterocolitica‐contaminated units had statistically higher levels of IL‐ 8, with a range of 170 to 2100 pg per mL, by 42 days of storage. S. aureus grew poorly in stored units of RBCs and failed to further stimulate cytokine production. No WBC‐reduced unit (mean WBCs ? 0.5 ± 0.6/μL), even when contaminated with bacteria, had more than 260 pg per mL of IL‐8. Although IL‐1 beta was not detected in any unit of RBCs at 3 days of storage, it increased to low levels (5‐13 pg/mL) in all units tested at 42 days. Interleukin 6 was not detected in any unit at any storage time.CONCLUSION: IL‐8 and IL‐1 beta accumulated in the supernatants of stored RBCs despite cold storage conditions. IL‐8 reached levels > 1000 pg per mL in the supernatants of some RBC units. IL‐1 beta increased to significant but low levels (< 13 pg/mL). WBC filtration early in storage prevented the accumulation of IL‐8. The physiologic significance to transfusion recipients of IL‐8 in RBC supernatants is currently unknown and deserves further investigation.
Transfusion practices in human immunodeficiency virus‐infected patients
Authors: Popovsky M. A. , Benson K. , Glassman A. B. , Hume H. , Oberman H. A. , Pisciotto P. T. , Anderson K. C. 
Published: March 2003

BACKGROUND: The reported immunomodulatory effects of transfusion raise concern about the potential for virus activation and tumor growth in human immunodeficiency virus (HIV)‐infected patients. In the absence of “standards” of transfusion practice for such patients, a survey of transfusion policies among institutions specializing in the care of HIV‐ infected patients was performed to delineate current practices.STUDY DESIGN AND METHODS: A survey developed by the Transfusion Practices Committee of the American Association of Blood Banks was sent to 47 AIDS clinical trial units and 14 regional hemophilia centers in North America.RESULTS: Forty‐three percent of centers completed the survey. Most centers observed more than 200 HIV‐infected patients each. The key findings were that 1) 81 percent of centers used identical red cell transfusion criteria for HIV‐infected and noninfected patients; 2) 52 percent used recombinant human erythropoietin as initial treatment for zidovudine‐induced anemia, while 46 percent used recombinant human erythropoietin for anemia not associated with zidovudine; 3) 35 percent of centers used white cell‐reduced blood components in lieu of cytomegalovirus (CMV)‐seronegative components when administering transfusion(s) to CMV‐seronegative patients; 4) 27 percent gamma‐ radiated cellular components, but no case of graft‐versus‐host disease had been observed; 5) > 85 percent of centers used monoclonal factor VIII for pediatric and adult hemophiliacs infected with HIV; 6) approximately one‐third of centers routinely white cell‐reduced cellular components; and 7) the most common reasons for white cell reduction included reduction of febrile reactions and CMV risk, reduction of platelet alloimmunization, and delay of immunomodulatory consequences of transfusion.CONCLUSION: There is marked heterogeneity in transfusion practice for HIV‐infected patients. Modification of cellular components to achieve different objectives is routine in many centers.
Human immunodeficiency virus type 1 activation after blood transfusion
Authors: Mudido P.M. , Georges D. , Dorazio D. , Yen‐Lieberman B. , Bae S. , O'Brien W.A. , Spritzler J. , Lederman M.M. 
Published: March 2003

Background: Anemia and transfusion are predictors of disease progression in AIDS patients. This study was designed to examine the effects of blood transfusion on human immunodeficiency virus type 1 (HIV‐1) expression.Study Design and Methods: Assays of plasma viral load were performed before and after transfusion in nine HIV‐1‐infected patients who required blood transfusion for refractory anemia.Results: There was a modest rise in plasma HIV‐1 p24 antigen and plasma HIV‐1 RNA beginning 1 to 2 weeks after the blood transfusion. The mean change in plasma p24 antigen for all patients was 9.3 ± 5.1 (mean ± SE) pg per mL at Week 2 after transfusion and 18 ± 11.1 pg per mL at Week 4. Plasma HIV‐1 RNA levels were unchanged immediately after transfusion and exceeded pretransfusion levels with a mean rise of 84 ± 40 percent (SE) at Week 1, 70 ± 27 percent at Week 2, and 67 ± 38 percent at Week 4 (p equals; 0.006, exact permutation test). There was no increase in spontaneous or interleukin 2‐induced lymphocyte proliferation or p24 antigen production by patients' lymphocytes that were examined immediately after blood transfusion.Conclusion: The transfusion of blood to persons with advanced HIV‐1 infection modestly increases plasma levels of HIV‐1. The activation of HIV‐1 expression by transfusion may help to explain the accelerated course of HIV‐1 disease in recipients of blood transfusion.
A novel system for providing compatible blood to patients during surgery: “self‐service” electronic blood banking by nursing staff
Authors: Cheng G. , Chiu D.S.M. , Chung A.S.M. , Wong H.F. , Chan M.W.K. , Lui Y.K. , Choy F.M.F. , Chan J.C.M. , Chan A.H.C. , Lam S.T. , Fan T.C.W. 
Published: March 2003

Background: A good blood bank must be able to provide compatible blood units promptly to operating room patients with minimal wastage. A “self‐ service” by nursing staff blood banking system that is safe, efficient, and well‐accepted has been developed.Study Design and Methods: Specific blood units are no longer assigned to surgical patients who have a negative pretransfusion antibody screen, irrespective of the type of surgery. A computer‐generated list of the serial numbers of all group‐identical blood units currently in the blood bank inventory is provided for each patient. The units themselves are not labeled with a patient's name. The group O list will be provided for group O patients, the group A list for group A patients, and so forth. Should the patient require transfusion during surgery, the operating room nurses go to the refrigerator, remove any group‐identical unit, and check the serial number of the unit against the serial numbers on the patient's list. If the serial number is on that list, the blood bank will accept responsibility for compatibility. The system was implemented in 1995.Results: Since implementation, a total of 2154 patients have undergone operations at this hospital. Thirty‐two patients received more than 10 units of red cells each. There were no transfusion errors. The crossmatch‐to‐transfusion ratio was reduced from 1.67 to 1.12. Turnaround time for supplying additional or urgent units to patients in operating room was shortened from 33 to 2.5 minutes. There was no incidence of a blood unit's serial number not being on the list. Work by nurses and technical staff was reduced by nearly 50 percent.Conclusion: The “self‐service” (by nursing staff) blood banking system described is safe and efficient. It saves staff time and can be easily set up.
High frequency of HLA‐A*0207 subtype in Chinese population
Authors: Shieh D.‐C. , Lin D.‐T. , Yang B.‐S. , Kuan H.‐L. , Kao K.‐J. 
Published: March 2003

Background: HLA‐A2 is the most polymorphic and most common HLA phenotype found in various ethnic populations. Seventeen HLA‐A2 subtypes have been reported and characterized by molecular techniques. Differences among these subtypes are limited to a few amino acids. Among them, HLA‐A*0201 is the predominant subtype among whites. The results of a recent study, however, suggest that the HLA‐A*0207 subtype may be present at a high frequency in the Chinese population. Study Design and Methods: To determine the exact frequency of the HLA‐A*0207 Sep s1996 Septype in the Chinese population, genomic DNA samples obtained from 54 HLA‐A2‐positive Chinese in Taiwan were studied by using sequence‐specific primers and polymerase chain reaction. Results: HLA‐A*0207 was present in 56 percent of the studied subjects. The estimated gene frequency for HLA‐A*0207 is 17.8 percent in the Chinese population. Conclusion: HLA‐A*0207 is the most common HLA‐A2 subtype among Chinese. The high frequency of the HLA‐A*0207 allele in this population offers a unique opportunity to study the ways in which different HLA‐A2 subtypes may influence the clinical outcome of allograft transplantation and the disease susceptibility of recipients.