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Charles H. Best, the Canadian Red Cross Society, and Canada's first national blood donation program.

This article examines how Canada's first national blood donation program originated during World War II. It focuses on the genesis of Charles H. Best's serum project at the University of Toronto, and the federal government's decision in 1940 to sponsor it as the nation's most viable blood banking option. While Best's personal initiatives were crucial, his project's success was also a result of the larger scientific, political, and institutional circumstances of Canadian medicine. The article also analyzes why the federal government gave responsibility for blood collection to the Canadian Red Cross Society. It shows how the organization's traditional association with military medicine, its more recent involvement with community health services (including blood transfusion), and its flexible national structure suited it for this task. Moreover, Ottawa's willingness to assign this role to a volunteer agency was an indication of the structural deficiencies in Canada's primitive health-care system. The decisions of 1940 flowed from the immediate wartime pressures and individual initiatives. They reflected as well the deeper scientific, institutional, and cultural realities of the time.

Blood Banks↗

New image network system and its informational background at Yamada Red Cross Hospital.

To assess the relationship between the numbers of images and films under the influence of the recent growth in imaging technology in a general hospital, we made a survey of 4424 and 4959 X-CT examinations conducted in the first halves of 1994 and 1995, respectively. We made a survey of 2344 MRI examinations conducted in the first half of 1995 also. This study revealed that the increase in the number of images obtained with latest imaging modalities was rather high compared to the number of examinations and it was difficult to print all of the images obtained. But the image network system, where distributed diagnostic workstations and network cameras formed important parts of the system, could solve or reduce some difficulties and produce a new service for out-patients. In this study, we show the newly-introduced image network system into Yamada Red Cross Hospital, its informational background and the results of the routine use of the system.

Evaluation Studies as Topic↗

Anti-hepatitis C virus (HCV) screening at a Canadian Red Cross center: significance of a positive c100 HCV enzyme-linked immunosorbent assay.

The c100 hepatitis C virus (HCV) enzyme-linked immunosorbent assay (ELISA) has been used to screen blood donors to prevent transfusion-associated non-A,non-B hepatitis. This test is not specific, and only about 25 percent of c100 HCV ELISA-positive blood samples appear to transmit hepatitis C. However, the intensity of the ELISA (sample/cutoff ratio [S/C], greater than 2) could identify a subpopulation of donors that are at high risk for transmitting hepatitis. Blood samples from 20,186 volunteer blood donors at a Canadian Red Cross blood transfusion center were screened for antibodies to HCV using the c100 HCV ELISA. Fifty-nine (0.3%) of these donors were repeatably reactive on ELISA. When their samples were tested with the c100 recombinant immunoblot assay (RIBA) and second-generation RIBA (RIBA-2), 26 (44%) and 31 (52%) samples, respectively, were found to be positive. Thirty-three of the 59 ELISA-reactive donors had an S/C greater than 2. Of these 33 donors, 30 (91%) had elevated alanine aminotransferase (ALT), 27 (82%) were RIBA-2 positive, and 22 (67%) had risk factors for hepatitis. In contrast, of the 26 ELISA-reactive donors with S/C less than 2, only 7 (27%) had elevated ALT, and 4 (15%) were RIBA-2 positive and also had high risk factors for hepatitis. Thus, while the HCV ELISA may lack specificity, its intensity can serve to identify a subgroup of donors that are at high risk for transmitting hepatitis.

Adult↗

[HIV retrospective study of the German Red Cross blood donation service in Germany].

OBJECTIVE: It was tried to retrospectively identify HIV infections in recipients of transfusions from donors who were tested HIV positive at a subsequent donation. These lookback data were traced back to answer the following questions: 1. How many transfusion recipients were infected before the start of the routine HIV testing in 1985? 2. How great is the risk of HIV infections from infected but not yet HIV antibody-positive donors? 3. Furthermore, the transfusion of HIV-infected transfusion recipients was traced back to the involved donor to establish causality. DESIGN: Retrospective ('lookback') study. SETTING: HIV Study Group of the Red Cross Blood Banks of the Federal Republic of Germany. PARTICIPANTS: Preceding donations of HIV antibody-positive repeat donors were traced back to the transfusion recipients in order to establish their HIV antibody status. In a second lookback study, HIV-infected transfusion recipients and their corresponding donors were investigated after they had been reported to the blood bank as infected by transfusion-associated HIV. INTERVENTIONS: None. RESULTS: Recipients of 156 respectively 133 transfusions from repeat donors found to be Western blot-positive were investigated from 1985 to 1987 and from 1987 to 1992, respectively. About 50% of the recipients had died. About 40% of the recipients could not be examined, because they either were not available for testing or refused to be tested or because it was impossible to clarify the fate of the blood products. 25 HIV recipients were identified from 1981 to 1985, when routine HIV testing began. Nine transfusion-associated HIV infections were identified from 1985 to 1992. 25 million units of blood were prepared during this period. CONCLUSIONS: The risk of HIV transmission by tested transfusions is extremely rare (in the order of 1:1 million). The second lookback study suggests that in more than 50% of the blood recipients in whom HIV infection was attributed to transfusion, a causal relationship to an infected donor could not be established.

AIDS Serodiagnosis↗

Hepatitis B surface antigen: regional variation in sub-type ratio in the Canadian Red Cross donor population.

A total of 344 sera positive for hepatitis B surface antigen from volunteer blood donors at several Canadian Red Cross centres were subtyped for ad and ay specificity by counterelectrophoresis. Of the 50 sera from Toronto 21 (42%) were ad and 29 (58%) were ay; of the 95 from Montreal 82 (86%) were ad and 13 (14%) were ay; of the 199 from Quebec 179 (90%) were ad and only 20 (10%) were ay. The w and r specificities were also determined in 125 of the samples: 123 were w; the 2 samples of r specificity were from Toronto. On the other hand, among 45 sera from patients with acute hepatitis type B in Quebec 13 (29%) were ad and 33 (71%) ay.

Acute Disease↗

[Optimal versus maximal safety of the blood transfusion chain in The Netherlands; results of a conference. College for Blood Transfusion of the Dutch Red Cross].

An invitational conference was held on September 11, 1996 by the Medical Advisory Commission to the Blood Transfusion Council of the Netherlands Red Cross, addressing the issues of 'maximal' versus 'optimal' safety measures for the blood supply. Invited were blood transfusion specialists, clinicians, representatives of patient interest groups, the Ministry and Inspectorate of Health and members of parliament. Transfusion experts and clinicians were found to advocate an optimal course, following strategies of evidence-based medicine, cost-benefit analyses and medical technology assessment. Patient groups depending on blood products, such as haemophilia patients would rather opt for maximal safety. Insurance companies would choose likewise, to exclude any risk if possible. Health care juridical advisers would advise to choose for optimal safety, but to reserve funds covering the differences with 'maximal safety' in case of litigation. Politicians and the general public would sooner choose for maximal rather than optimal security. The overall impression persists that however small the statistical risk may be, in the eyes of many it is unacceptable. This view is very stubborn.

Blood Transfusion↗

Tracheobronchial foreign bodies. Experience at Red Cross Children's Hospital, 1985-1990.

Ninety-six children with suspected tracheobronchial foreign bodies were referred to the Department of Cardiothoracic Surgery at Red Cross War Memorial Children's Hospital, Cape Town, between February 1985 and February 1990. Foreign bodies were removed by rigid bronchoscopy from 63 patients, 79% of whom were under 5 years of age. The majority of patients (59%) presented more than 24 hours after aspiration of the foreign body, and this delay in definitive management was associated with an increased incidence of complications (P = 0.01). Complications occurred in 28 patients, and there was one fatality at bronchoscopy due to overwhelming aspiration of an unanticipated release of pus, following the removal of a chronically impacted foreign body. The complete classic diagnostic triad (sudden onset of coughing, wheezing and decreased air entry) was seldom present, and we recommend diagnostic bronchoscopy in children presenting with either a history of sudden choking or a witnessed aspiration of a foreign body, an unexplained acute wheeze or cough or a chronic pulmonary infection. This report also highlights the continued need for increased awareness on the part of both parents and medical practitioners of the need for early referral if a foreign body is suspected. Furthermore, public education is needed as regards the dangers of allowing young children to eat peanuts. Peanuts were the commonest foreign bodies removed.

Bronchi↗

[Clinical statistics of the patients admitted to the Department of Urology Shizuoka Red Cross Hospital between 1981 and 1990].

A statistic survey was made on the patients, diseases and operations experienced at the Urological ward of Shizuoka Red Cross Hospital between 1981 and 1991. The total number of inpatients was 2,830 and the male to female ratio was 3.5 to 1. The most frequent diseases among the inpatients were obstructive uropathy (25.5%), malignant neoplasia (23.7%), non-specific infection (16.4%) urolithiasis (16.1%). The number of operations was 1922. Endoscopic surgery was the most frequent form of operation (55.2%).

Adult↗

The age, nutritional status and major diagnoses of outpatients at the Red Cross War Memorial Children's Hospital.

In 1961 a study of the age, sex, race, nutritional status and common diagnoses of children attending the Red Cross War Memorial Children's Hospital in Cape Town during one 12-month period was reported. A similar study was undertaken during two 2-week periods in 1972--1973. Comparison of the studies shows: (i) that a greater number of older children attended the hospital in 1972/1973; (ii) that the proportion of malnourished children whose percentage of expected weight for age was less than 66% had decreased from 8--10% to 5,5--6%; and (iii) that the overall pattern of disease had not changed appreciably, most of the children presenting with minor or preventable conditions.

Age Factors↗

A profile of the socio-demographic background of children admitted with acute diarrhoea to the Red Cross Children's Hospital, Cape Town.

The demographic and health profile and anthropometry of 106 young children hospitalised with acute diarrhoea during winter at the Red Cross War Memorial Children's Hospital, Cape Town, is reported. Information regarding socio-economic status, feeding practices and mothers' knowledge/perceptions about the aetiology of diarrhoea and the use of Oral Rehydration Therapy (ORT) was collected on a predetermined questionnaire in English or Xhosa. The findings underline the need for an aggressive, well-targeted education programme to reduce the morbidity and mortality of vulnerable children as well as the financial drain on the hospital budget.

Acute Disease↗

Tracheostomy in the management of laryngotracheobronchitis. Red Cross War Memorial Children's Hospital experience, 1980-1985.

In the 6-year period 1980-1985 162 children required tracheostomy during treatment of laryngotracheobronchitis at Red Cross War Memorial Children's Hospital, Cape Town. This represents 4.6% of 3,500 children with this disorder and 28% of those requiring airway intervention. Fifty-eight percent of the children were decannulated within 4 weeks and 75% within 10 weeks. Fifty-four per cent of the children required one or more further procedures before decannulation, including 7 children who required a laryngotracheoplasty. Obstructing stomal granulation tissue had to be removed from 24 children and suprastomal collapse was a cause of decannulation failure in 29 children. Use of an expiratory valve as an aid to decannulation is discussed. Three children died of tracheostomy airway complications and 6 of a medical disorder. Another complication, laryngeal incompetence, was particularly associated with herpetic laryngeal ulceration.

Age Factors↗

Relationship between the clinical course and HPV typing of recurrent laryngeal papillomatosis. The Red Cross War Memorial Children's Hospital experience 1982-1988.

During the period 1982-1988, 20 new cases of laryngeal papillomatosis in children were seen at The Red Cross War Memorial Children's Hospital. HPV typing of biopsy specimens was performed. Their clinical course was reviewed and age at presentation ranged from 1 to 10 years. There was no correlation between age and either aggression or a prolonged clinical course. HPV DNA was identified in all 20 cases (100%). Fifteen (75%) were HPV Type 11 and 5 (25%) were HPV Type 6. There were no mixed infections. HPV Type 6 infection was more clinically aggressive than HPV Type 11 infection. The intensity of the virus signal in the biopsy specimens was not in general indicative of the clinical behavior of the disease, although two children with particularly strong intensity exhibited aggressive disease. It is suggested that identification of HPV type 6 infection has prognostic significance.

Antigens, Bacterial↗

[Medical and psycho-technical examination centers in the prevention of traffic accidents: 1480 examinations carried out at the Spanish Red Cross Center in Valencia].

The centres for medical and psycho-technical examinations in the prevention of traffic accidents: 1480 examinations carried out in the Spanish Red Cross Centre (Valencia). The centres for medical and psycho-technical examinations are included within the field of primary accident prevention, as they participate in the selection of drivers. In this study, we analyze the results of 1480 examinations of applicants for different types of driving licences (first-time and renewals) who applied to this centre during the first quarter of 1989. To this end we have followed the regulations in force set out in Royal Decree 2272/85. Thus, 90.13% were declared TOTALLY FIT, 8.65% PARTIALLY FIT and 1.22% UNFIT to drive. By age groups these percentages vary: in those under 50, there were 95.76% TOTALLY FIT, 4.04% PARTIALLY FIT and 0.2% UNFIT; in the group between 50 and 70 years of age and those over 70, the numbers of TOTALLY FIT drop (86.15 and 49.04%) while those PARTIALLY FIT (12.19 and 41.35%) and UNFIT (1.66 and 9.61%) increase. Our results show these centres to be useful for selection and for the detection of disabilities and illnesses which may lead to the restriction or cancellation of a driving licence. On the other hand, they should be totally integrated in the Health Education and Health Protection systems.

Accidents, Traffic↗

Most patients attending a 'walk-in' clinic at Red Cross War Memorial Children's Hospital could safely be managed at primary care level.

OBJECTIVES: (i) To ascertain what proportion of patients attending the general medical outpatient service at Red Cross War Memorial Children's Hospital (RXH) could safely be managed at peripheral primary care facilities; and (ii) to measure the effect of the introduction of free health care for children under 6 years of age on requirements for levels of care ranging from home to super-specialist referral centres. DESIGN: Prospective survey of patients attending on a stratified, randomised sample of 7 days in March 1994 (N = 1 962) and again in November 1994 (N = 1 404)-before and after the introduction on 6 June 1994 of free care for children under 6 years of age. SETTING: The general outpatient department of an academic/referral children's hospital. PATIENT SELECTION: All patients attending the outpatient department on the study days (7h00 to 6h59 the following day), excluding those who were referred, returning for follow-up, attending a specialist clinic or attending the surgical outpatient department. QUESTIONNAIRE: The questionnaire completed by medical officers recorded the following: patient's name, folder number, date and time of arrival, whether referred, clinic, treating doctor, disposal, diagnoses, home suburb and the level of care required: (i) home: (ii) clinic without a doctor; (iii) clinic with a doctor; (iv) hospital with non-specialists; (v) hospital with general paediatricians; or (vi) super-specialist hospital. MAIN RESULTS: In March 1994 the percentages of unreferred patients requiring the 6 levels of care defined for the study were 0.3, 25, 62, 8, 3 and 1, respectively. In November 1994 the percentages were 4, 41, 43, 8, 4 and 1. The graph of the number of patients seen at the outpatient department each month shows a large month-to-month variation but the trend is clearly towards an increase. CONCLUSIONS: The general medical outpatient department at RXH provides care to a large number of children, 48% of whom are unreferred. Of the unreferred patients 95% could be treated (more appropriately for the health services and more conveniently for their families) at a local primary health care facility. The situation has been aggravated by the introduction of free care for children under 6 years of age, who constitute 83% of the unreferred workload.

Child Health Services↗