Kumanan Wilson

The proportion of variation in perioperative transfusion decisions in Canada attributable to the hospital.

PurposeHospital variation in transfusion practices has been described previously but the proportion of variation attributable to the hospital has not. The objective of this report was to quantify hospital variation in red cell transfusion decisions perioperatively for patients undergoing coronary artery bypass surgery (CABG).MethodsWe used a cross-sectional study design using pretestedself-administered mailed questionnaires sent to all anesthesiologists and cardiac surgeons involved in CABG in Canada.ResultsResponses were received from anesthesiologists from all 32 hospital sites and from cardiac surgeons from 30/32 sites (94%). There was variation attributable to the hospital in transfusion triggers selected (P < 0.0001). For patients who had uncomplicated CABG surgery, the range of transfusion triggers among hospitals for the intraoperative and postoperative case scenarios were 61 to 80 g·L-1 and 64 to 80 g·L-1, respectively. The hospital accounted for 20% of the variation in the transfusion practice intraoperatively and postoperatively. The remainder of the variation was attributable to the individual physician. Academic affiliation and the number of surgical cases performed at the hospital were not significant factors impacting on the transfusion triggers selectedConclusionThis is the first study to quantify the variation in red cell transfusion practices according to individual physicians and the hospital. The variation attributed to the hospital is significant. The explanation for the variation in transfusion decisions that relate to the hospital needs to be explored further in order to help optimize transfusion practice.RésuméObjectifLa variation entre les hôpitaux en ce qui touche aux pratiques transfusionnelles a été précédemment décrite, mais la proportion de cette variation imputable aux hôpitaux ne l’a pas encore été. L’objectif de ce compte-rendu était de quantifier la variation entre les hôpitaux dans les pratiques transfusionnelles périopératoires de globules rouges chez les patients subissant un pontage aortocoronarien (PAC).MéthodeNous avons utilisé un concept d’étude transversale en nous basant sur des questionnaires pré-testés et auto-administrés envoyés à tous les anesthésiologistes et les chirurgiens cardiaques pratiquant des PAC au Canada.RésultatsDes réponses ont été reçues d’anesthésiologistes des 32 centres hospitaliers et de chirurgiens cardiaques de 30/32 sites (94 %). Une variation imputable à l’hôpital a été observée dans les seuils d’amorce de transfusion choisis (P < 0,0001). Chez les patients ayant une chirurgie PAC sans complication, la gamme de seuils transfusionnels entre les hôpitaux pour les scénarios de cas peropératoire et postopératoire allait de 61 à 80 g·L-1 et de 64 à 80 g·L-1, respectivement. L’hôpital était responsable de 20 % de la variation dans la pratique transfusionnelle peropératoire et postopératoire. Le reste de la variation était imputable au médecin lui-même. L’affiliation universitaire et le nombre de cas chirurgicaux effectués à l’hôpital n’ont pas constitué de facteurs significatifs ayant un impact sur les seuils de transfusion choisis.ConclusionCette étude est la première à quantifier la variation dans les pratiques de transfusion de globules rouges selon les médecins eux-mêmes et l’hôpital. La variation attribuée à l’hôpital est significative. L’explication pour la variation dans les décisions de transfusion liées à l’hôpital doit être approfondie afin d’améliorer la pratique de la transfusion.

The impact of severe acute respiratory syndrome on medical house staff a qualitative study

OBJECTIVE: To explore the impact of severe acute respiratory syndrome (SARS) on a medical training program and to develop principles for professional training programs to consider in dealing with future, similar crises. DESIGN: Qualitative interviews analyzed using grounded theory methodology. SETTING: University-affiliated hospitals in Toronto, Canada during the SARS outbreak in 2003. PARTICIPANTS: Medical house staff who were allocated to a general internal medicine clinical teaching unit, infectious diseases consultation service, or intensive care unit. RESULTS: Seventeen medical residents participated in this study. Participants described their experiences during the outbreak and high-lighted several themes including concerns about their personal safety and about the negative impact of the outbreak on patient care, house staff education, and their emotional well-being. CONCLUSION: The ability of residents to cope with the stress of the SARS outbreak was enhanced by the communication of relevant information and by the leadership of their supervisors and infection control officers. It is hoped that training programs for health care professionals will be able to implement these tenets of crisis management as they develop strategies for dealing with future health threats.

A new human genotype prone to variant Creutzfeldt-Jakob disease

New evidence may rekindle fears of a larger epidemic and greater risk of iatrogenic spread

The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach

Ernst E, Pittler MH, Stevinson C, et al , editors. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach St Louis: Mosby, 2001.nnnnMore than

The Desktop Guide to Complementary and Alternative Medicine: An Evidence-based Approach

25 billion is spent annually on complementary and alternative medicine (CAM) treatments in the USA, which indicates their popularity with the public.1 Increasingly, healthcare providers are being confronted with patients who are using these alternative treatments, and the providers have to determine their potential benefits and harm. In light of this trend, The Desktop Guide to Complementary and Alternative Medicine is a welcome new resource. This book has the ambitious objective of summarising a wide range of CAM interventions and of providing information on whether evidence exists to support their application. It also seems to be aimed at both healthcare providers and consumers.nnThe Desktop Guide to Complementary and Alternative Medicine is divided into 6 sections and includes a CD-ROM version. Section I, “Using this …

Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination

Ernst E, Pittler MH, Stevinson C, et al , editors. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach St Louis: Mosby, 2001.nnnnMore than

Transfusion transmission of vCJD: a crisis avoided?

25 billion is spent annually on complementary and alternative medicine (CAM) treatments in the USA, which indicates their popularity with the public.1 Increasingly, healthcare providers are being confronted with patients who are using these alternative treatments, and the providers have to determine their potential benefits and harm. In light of this trend, The Desktop Guide to Complementary and Alternative Medicine is a welcome new resource. This book has the ambitious objective of summarising a wide range of CAM interventions and of providing information on whether evidence exists to support their application. It also seems to be aimed at both healthcare providers and consumers.nnThe Desktop Guide to Complementary and Alternative Medicine is divided into 6 sections and includes a CD-ROM version. Section I, “Using this …