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PubMed2006

Is cardiac surgery warranted in children with Down syndrome? A case-controlled review.

OBJECTIVES: To compare children with Down syndrome and children without Down syndrome and investigate whether there is a significant difference in the burden that is placed on the health care system between these two groups only in respect of the repair of congenital heart disease at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. DESIGN: This study is a retrospective case control review. SETTING: Red Cross War Memorial Children's Hospital, Cape Town, South Africa. SUBJECTS: The sample group of 50 Down syndrome children who had received cardiac surgery between January 1998 and June 2003 was compared with a control group of 50 nonsyndromic children who had received cardiac surgery during the same period. OUTCOME MEASURES: Sex and diagnoses (cardiac and noncardiac), number of days spent in hospital and in ICU, complication rates, re-operation rates, early mortality rates, planned further cardiac surgery. Costs of these outcomes were not quantified in exact monetary terms. RESULTS: There was no significant difference between the two groups in terms of the burden that was placed on the health care system. Similar complication rates, re-operation rates and early mortality rates were recorded for both groups. The Down syndrome group appeared to benefit more from cardiac surgery than the non-Down syndrome group. CONCLUSION: Denying cardiac surgery to children with Down syndrome does not improve the efficiency of resource allocation. It is therefore not reasonable to suggest that the problem of scarce resources can be ameliorated by discriminating against children with Down syndrome.

Cardiac Surgical Procedures↗
PubMedDate not supplied

[The cassocks under fire: priests in the health service during the World War I, supports and criticism from witnesses and press at the time].

The anticlerical Third Republic posted priests and monks to stretcher-bearer groups linked either to a division or an Army Corps. The 1889 law is known as the "rucksack priest law" appointed priests in the Military Health Service. On the opposite, the 1905 law dispatched the youngest priests and monks in fighting units. As soon as October 1914, Frederic Masson had championed priests employed as male nurses and stretcher-bearers. Their role was not easy, especially in the evacuation or temporary hospitals. The Minister of Defence Alexandre Millernd was obliged to justify their role in November 1914. Gradually without official and consistent allocations the priests acquired an unavoidable role in the army as long as sufferings took a firm hold. Among the Red Cross organisations their role was important and since August 1914 Albert de Mun had instituted a bureau of priests inside the Red Cross offices. As the war lasted priests were more and more esteemed but attacked by a harsh anticlericalism in 1916 and 1917. Even if the priests and monks were suffering so many losses their appointments as male nurses or stretcher-bearers appeared as advantages for the anticlerical opinion. In February 1916, at the beginning of the Battle of Verdun, newspapers as the Socialist Journal l'Humanité or the extreme left wing journal La Lanterne denounced priests supposedly shielded in the Military Health Service. In November 1916, the anticlerical and radical Deputy Sixte-Quenin proposed a bill to allocate every priest as a fighter according to republican equality. However, their role in such a bloody conflict was so significant that a Military Chaplainry was created and was not challenged after the war.

Clergy↗
PubMedDate not supplied

Computer interview for screening blood donors for risk of HIV transmission.

To test the ability of a computer-based interview to detect factors related to the risk of the human immunodeficiency virus (HIV) among potential blood donors, and to determine donor reactions to the use of the computer, we compared the rate of detection of HIV-related factors elicited by the computer interview with the rate elicited by standard American Red Cross procedures (written questionnaires and face-to-face interviews) for assessment of donor suitability. The study was performed at a Red Cross blood donor center and a hospital. A consecutive sample of 294 male and female blood donors 18 to 75 years of age participated in a randomized crossover trial in which the order of the two methods was reversed. Among 272 prospective donors who provided complete data, the computer identified 12 who reported either behavior associated with a risk of acquiring HIV or symptoms compatible with AIDS. None of these 12 was so identified by face-to-face interviews or written questionnaires. Only one used the confidential unit exclusion procedure to prevent use of his donated blood. Tests for antibody to HIV were negative in blood from all 272 subjects. The subjects enjoyed the computer interview and judged it to be more private than the standard method for donor assessment.

AIDS Serodiagnosis↗
PubMed1999

Targeted hepatitis C lookback: Quebec, Canada.

BACKGROUND: Since March 1990, all blood donations in Canada are screened for antibodies to hepatitis C virus (HCV). Because HCV may cause chronic asymptomatic hepatitis, in February 1995, the Canadian Red Cross began targeted HCV lookback studies. STUDY DESIGN AND METHODS: From March 1990 to March 1997, the Quebec Center of the Canadian Red Cross collected 1,750,846 donations, and there were 561 anti-HCV-positive repeat donors, from whom 3,196 blood components had been issued to the hospitals. Hospital blood bank directors were asked to test recipients and return results to the Quebec Center. One hundred nine hospitals were surveyed to determine methods and resources involved in lookback. The transfusion medicine service at the Royal Victoria Hospital (RVH) developed a standard operating procedure for performing lookbacks and analyzed the costs and outcomes of lookbacks. RESULTS: As of April 1998, information has been received on 2329 (73%) of components; 1020 patients had died of unrelated causes, 590 were untraceable, and 353 were tested. Of those tested, 215 (61%) were anti-HCV positive; their average age was 47, and at least 53 percent were already aware of their HCV status. Few hospitals had received any additional resources to perform lookbacks. At the RVH, lookback on 182 components resulted in the identification of nine seropositive recipients, average age 70, who did not previously know their HCV status; four of these patients had abnormal alanine aminotransferase levels. The cost of lookback per newly diagnosed case of HCV was estimated at $2727 (US) for the Quebec Center and $6014 (US) for the RVH. CONCLUSION: Targeted lookback in the province of Quebec on 3196 components has resulted in the identification of 101 seropositive recipients who did not previously know their HCV status.

Blood Banks↗
PubMed1990

[Confidential donor self-exclusion for raising the safety of blood preparations].

Since July 1987 the German Red Cross Baden-Württemberg has practised confidential and anonymous self-exclusion of potential blood donours. The answers given by all donours of the Red Cross Blood Donour Service in Baden-Württemberg (n = 297,648) between 23. 2. 1988 and 31. 1. 1989 were analysed. Virological data of self-exclusion donours (n = 1910) and of a control group (n = 1856) were compared. No donour who had excluded himself was anti-HIV positive, but two of the donours who had designated their blood for transfusion. Those that had excluded their blood donation had a significantly higher prevalence of hepatitis B markers. There was no significantly higher prevalence than among other blood donours with respect to anti-CMV antibodies, syphilis and increased GPT levels. The proportion of male first-time donours was twice as high among self-excluders than among those who released their blood for subsequent donation.

Antibodies, Viral↗
PubMedDate not supplied

Recruiting unrelated donors for the National Marrow Donor Program.

Medical advances have made bone marrow transplantation the treatment of choice for certain hematologic diseases. For those patients eligible for a marrow transplant only about 30 percent find an HLA-compatible match within their families. Studies indicate that unrelated volunteers are willing to donate their marrow. The National Marrow Donor Program was formed in 1986 as a result of a federal contract. This group is a network of donor centers, transplant centers, and collection centers. The Connecticut Red Cross Blood Services is one of approximately 70 donor centers. Recruitment methods vary with each donor center, depending on the resources available. The Connecticut Red Cross Blood Services has recruited more than 1,000 volunteers for entry into the National Marrow Donor Program.

Bone Marrow Transplantation↗
PubMed2002

Impact of respiratory syncytial virus infection as a cause of lower respiratory tract infection in children younger than 3 years of age in Japan.

BACKGROUND: Respiratory syncytial virus (RSV) is the most important viral pathogen for lower respiratory tract infection (LRI) in infants and children. An RSV-specific monoclonal antibody has been developed to provide prophylaxis against RSV associated LRI (RSV-LRI). The objective of this study was to determine the impact of RSV as a cause of LRI in children younger than 3 years of age to provide data to aide in the implementation of forthcoming prophylaxis against RSV. METHODS: We analyzed the viral etiology of LRI in hospitalized Japanese children younger than 3 years of age admitted to Shizuoka Red Cross Hospital from July, 1997 to June, 2000. RESULTS: A total of 535 patients younger than 3 years of age were hospitalized with LRI at Shizuoka Red Cross Hospital from July 1, 1997 to June 30, 2000. Of these, a positive diagnosis of RSV infection was made in 168 patients (31.4%). Most of the patients with RSV infection had been well and had had no underlying disease that was defined as risk factor of RSV infection (94.0%). The peak incidence of LRI was observed in the winter each year and the number of LRI was strongly associated with the epidemic of RSV (r=0.700, P<0.0001). The number of patients with LRI younger than 6 months of age was 116 (21.7%). Of these 116 patients younger than 6 months with LRI, 55 patients (47.4%) were confirmed to have RSV infection. The proportions of RSV infection to total LRI was greatest in early infants younger than 6 months (P<0.0001). The number of patients with which RSV infection was detected in LRI patients younger than 3 years was highest during the first five months of life and there was a dramatic decrease in incidence of RSV infection with increasing age thereafter. CONCLUSIONS: The incidence of LRI hospitalization is highly affected by RSV infection epidemic. The proportion of RSV infections among early infants younger than 6 months is greater than that of older patients. The prophylaxis against RSV will be needed to be toward early infants.

Age Factors↗
PubMedDate not supplied

Distraction reduces self-reported physiological reactions to blood donation in novice donors with a blunting coping style.

OBJECTIVE: Vasovagal reactions experienced by some blood donors (eg, faintness, lightheadedness, and dizziness) have been shown to be related to a decreased likelihood of future blood donations. This study evaluated the efficacy of audiovisual distraction as a means of reducing self-reported physiological reactions in first-time blood donors. Because interventions that are consistent with an individual's preferred coping style have been shown to be more effective at reducing physiological and psychological responses to stressful medical procedures, coping style (monitoring vs. blunting) was assessed as a possible moderating variable. METHODS: First-time blood donors were randomly assigned to one of two conditions: audiovisual distraction or no-treatment control. Participants in the distraction group donated blood at an American Red Cross blood drive while watching a three-dimensional video presentation on a personal visor and headset. The control group donated blood according to standard American Red Cross procedures. Score on a self-reported measure of physiological reactions completed immediately after donation served as the dependent variable. RESULTS: Individuals who typically use blunting coping strategies to cope with stress reported an attenuation of vasovagal reactions to blood donation in the distraction vs. the control condition (t(49) = 2.29, p < .05), whereas donors who prefer a monitoring coping style did not benefit from distraction. CONCLUSIONS: Among first-time blood donors, audiovisual distraction may be an effective means of reducing vasovagal reactions in donors who prefer to cope with stress using such strategies as distraction, denial, and reinterpretation.

Acoustic Stimulation↗
PubMed1986

Cross-reactive red blood cell antigen-related substances in human leukocyte alpha interferon.

Human leukocyte alpha interferon (IFN alpha) is a blood product. The possible contamination with blood-group antigens was studied using the double-immunodiffusion technique. With the exception of one lot received in 1980, which did not react, all three recent lots received in 1983 and 1984 reacted with 16, 20, and 21 of the 22 erythrocyte group-specific antisera tested. The only antiserum that did not react with any of the IFN alpha lots was anti-N. Preincubation of the IFN alpha with antisera abolished the precipitate lines seen in double immunodiffusion. Recombinant human alpha interferon used as a control did not show any reaction. Our results indicate the presence of red blood cell antigen-related substances in IFN alpha.

Cross Reactions↗
PubMed2001

Provision of phenotype-matched blood units: no need for pre-transfusion antibody screening.

BACKGROUND AND OBJECTIVES: The Hong Kong government is planning to introduce an electronic smart identity card for all seven million citizens in 2003. If the smart card contains the full red cell phenotype/genotype of the individual, it may be possible to transfuse phenotype-matched blood units without pre-transfusion antibody screening. We conducted a feasibility study. DESIGN AND METHODS: Red cell phenotype was determined for 407 donor blood units and 493 patients for whom an antibody screen had been ordered. The computer program selected phenotype-matched blood from the donor stock for the patients according to actual transfusion request. For patients with a positive antibody screen, full crossmatching was carried out with the computer-selected phenotype units. The frequencies of the various red cell phenotypes in the population were calculated from Red Cross data of antigen frequencies. The probabilities of finding at least one unit of phenotype-matched blood from a 300-unit hospital stock and a 4,000-unit Red Cross stock were determined for each phenotype. Cost analysis was performed. RESULTS: Ninety-two out of 493 patients received a total of 395 blood units. The required number of phenotype-matched blood units could be found for 92 patients using a 300-unit pool and for all patients using a 4,000-unit pool. We calculated that phenotype-matched blood could be provided for more than 98% of patients without antibody screening. The total cost of the project is US$ 98 million with potential savings of US$ 14 million per year. INTERPRETATION AND CONCLUSIONS: It is feasible and cost-effective to transfuse patients with phenotype-matched blood without antibody screening using a smart card system.

Blood Group Antigens↗
PubMed2004

[Online-conference using JGN.].

Telemedicine and online conference systems have some benefits so that equalizing medical level, improving efficiency of medical care and improving service for patients. It is possible to give advice and to support its medical projects stationed in other facility and to provide the same quality treatments for patients. In this paper, we set up an experimental network system to teleconference using JGN (Japan Gigabit Network) and tried to discussion alternatively for case study between Kanazawa university and Fukui red cross hospital, 70 km away. The JGN used in this study is an ultra-high-speed network for the purpose of research and development. Kanazawa university, and Fukui red cross hospital are connected by a 10 Mbps communication link of the JGN. We tried online conference on the experimental network using video chat system. In result, using video chat system, the average transmission rate of MRI images (256 X 256pixel, 16bit) is 0.2 s/frame.

Biomedical Research↗
PubMed2005

Development of emergency medicine administration in the People's Republic of China.

A collaborative partnership between the Johns Hopkins Hospital, Chaoyang Red Cross Hospital and Chinese Ministry of Health has been established to initiate Emergency Medicine (EM) administrative training in Beijing, China. The Emergency Medical Education and Training Center (EMETC) at Chaoyang Red Cross Hospital was opened as a training facility to foster EM administrative curriculum development and training nationwide. A six-step approach with problem identification, needs assessment, goals and objectives, educational strategies, implementation and evaluation was used to form a locally adapted curriculum. With a train-the-trainers model, the EMETC sponsored several EM administration courses, the first of their kind in China. Since its inception, the EMETC has trained 95 persons from throughout China in EM administration. An EM administration curriculum has been developed and refined. In conclusion, an international partnership between academic hospitals, supported by the local Ministry of Health, to develop a national training facility using this six-step approach may be an attractive strategy for dissemination of EM administration principles.

China↗
PubMed1987

Antibody response to suckling mouse brain rabies vaccines for post exposure treatment.

A new suckling mouse brain vaccine (SMBV) against rabies, produced by the Thai Red Cross Society, was compared with the well established Institut Pasteur SMBV in patients with very low risk rabies contact. The 4 regimens used were the standard daily injections with booster doses of Thai Red Cross vaccine (TRCV) and Institut Pasteur Vaccine (IPV), and a reduced dose scheme of 6 injections as used for tissue culture vaccines. The effect of 20 IU/kg of human rabies immune globulin (HRIG) was tested on each regimen, making 8 groups, a total of 122 patients. Blood samples taken on days 0, 7, 14, 28 and 91 were tested for neutralizing antibody. Only the standard IPV regimen produced antibody in every patient; all had levels greater than 0.5 IU at some stage. Two people (13%) given the standard TRCV produced no detectable antibody (less than or equal to 0.1 IU) throughout the study. The reduced dose regimens gave very low antibody levels. 7% of the IPV and 76% of the TRCV groups failed to produce antibody on any occasion. The antibody response was significantly suppressed by the administration of HRIG. Compared to the original South American SMBV, the vaccines tested induced low levels of short lived antibody. No reduction in the dosage of SMBV should be considered unless the potency of the product is adequate.

Adult↗
PubMed2004

History of King Chulalongkorn Memorial Hospital: 90 years anniversary.

The Thai Red Cross Society was founded by King Rama V (King Chulalongkorn) in 1893 (B.E. 2436) after an international conflict with France. The institute was originally called Saphaa Unaalom Daeng which was later named the Red Cross Society of Siam and did not get its permanent headquarters until 1914 in the reign of King Rama VI (King Vajiravudh) when Chulalongkorn Memorial Hospital was founded. It was the mandate of King Rama VI that the hospital is to be "most elegant, popular and marveled with the most modern medical equipments,..." the best hospital of the Orient, in order to be the most glorified memorial for King Chulalongkorn, the Father of King Rama VI. The hospital has been the leader in medical services, public health as well as medical science, and home to the Faculty of Medicine, Chulalongkorn University which has been the center of medical research at national and international levels.

History, 20th Century↗
PubMed2001

Risk factors for severe respiratory syncytial virus-associated lower respiratory tract infection in children.

BACKGROUND: Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract infection that can be a life-threatening disease in infants and children. This study was conducted to look for independent risk factors for severe respiratory syncytial virus-associated lower respiratory tract infection (RSV-LRI) that required oxygen supplementation or mechanical ventilation. METHODS: Medical records of patients younger than 4 years hospitalized with RSV-LRI at Shizuoka Red Cross Hospital from July 1, 1995 to June 30, 1999 were reviewed. The patients were compared using univariate and multivariate logistic regression analysis. RESULTS: A total of 157 patients were hospitalized with RSV-LRI at Shizuoka Red Cross Hospital from the study time period. Of these, 20 patients (12.7%) were diagnosed with severe RSV-LRI. Subjects younger than 3 months of age had an odds ratio (OR) of 59.9 (95% confidence interval (CI) 14.7_244.0) for the dependent variable of severe RSV-LRI (P<0.0001). Subjects with a history of congenital heart disease also had an OR of 99.2 (95% C1 8.5-1160.1) (P<0.0005). CONCLUSIONS: Infants younger than 3 months without any underlying diseases may be at high risk for severe RSV-LRI. Respiratory syncytial virus prophylaxis is needed not only for high-risk patients, but for healthy early infants.

Age Factors↗
PubMed2006

A Katrina experience: lessons learned.

PURPOSE: Almost no data exist on how best to respond to the medical needs of civilians displaced by natural disasters. After Hurricane Katrina destroyed the Gulf Coast and seriously damaged the infrastructure of Jackson, Miss, the University of Mississippi Medical Center (UMMC) was challenged with serving a large group of evacuees at a major Red Cross evacuation shelter near our campus. We reviewed our experiences and share lessons learned. METHODS: This is a retrospective review of administrative and clinical records for patients served by a medical clinic established emergently after Hurricane Katrina. RESULTS: Red Cross regulations precluded their volunteers from providing medical care other than first aid. Faced with numerous evacuees seeking medical assistance, UMMC established an ambulatory clinic at the shelter. The majority of patients had multiple medical problems, no medical insurance, and limited ability to purchase medications. The greatest need was for management of chronic illnesses. The clinic provided 2394 patient visits and filled more than 4902 prescriptions over 17 days. CONCLUSION: While medical facilities have emergency response plans for epidemics and mass trauma, little attention has focused on plans for care of evacuated populations. Shelter operators should consider advance coordination of medical care with existing health care systems. Medical facilities along evacuation routes should be aware that they may be asked to provide care for sheltered evacuees.

Academic Medical Centers↗
PubMedDate not supplied

Engineering select physical properties of cross-linked red blood cells and a simple a priori estimation of their efficacy as an oxygen delivery vehicle within the context of a hepatic hollow fiber bioreactor.

Bovine red blood cells (bRBCs) can potentially provide a simplistic and economic means of improving oxygenation within hollow fiber (HF) bioreactor cell cultures. Bovine RBCs are also interesting since many of their physical properties can be altered as a result of glutaraldehyde (G) cross-linking. Cross-linking bRBCs produces an oxygen carrier that is expected to be beneficial under specific circumstances (i.e., delivery of oxygen to cells that are sensitive to free hemoglobin (Hb) and cells that require low inlet oxygen tensions). We have examined the osmotic stability and electrophoretic mobility of cross-linked bRBCs and observed that cross-linking improves osmotic stability while minimally impacting electrophoretic mobility. The oxygen binding/dissociation properties (P(50) and n) of cross-linked bRBCs were also measured, and under the reported reaction conditions, cross-linking increased the oxygen affinity and reduced the cooperativity of bRBCs. A basic Krogh tissue cylinder model was then utilized to provide a quick a priori estimate of oxygen delivery and release to hepatocytes housed within a HF bioreactor in order to demonstrate potential oxygenation benefits arising with both normal and cross-linked bRBC media supplementation. This model showed that bRBCs generally improved oxygen delivery and release to HF cell cultures and that cross-linked bRBCs are particularly beneficial in specifically targeting oxygen delivery to cells maintained at low inlet oxygen tensions. Additionally, the model showed that bRBC supplementation can significantly improve oxygen delivery without requiring extreme bRBC concentrations.

Animals↗
PubMed1995

Child abuse services at a children's hospital in Cape Town, South Africa.

UNLABELLED: Since the establishment of a Child Abuse Management Service at the Red Cross War Memorial Children's Hospital in the early 1980s, there has been a steady increase in patient numbers. In order to assess the profile of patients, and also the allocation of staff to the service, all child abuse related patients seen at the Red Cross War Memorial Children's Hospital in Cape Town over the period of June 1989 through July 1990 were reviewed. Five hundred and three children with a median age of less than 7 years were seen. Abuse was confirmed in 389 (160 physical abuse and 229 sexual abuse). Abuse was suspected and not confirmed in 114 (41 physical and 73 sexual). Half of the patients presented to the hospital outside of normal working hours. Eighty-one percent of children less than 5 years of age were seen in the Trauma Unit by surgical residents with minimal pediatric training. One hundred and thirty four of the patients were Xhosa speaking while only one social worker and no medical staff could speak Xhosa. Pediatric residents were involved in the care of less than 2% of cases. CONCLUSION: Management of child abuse constitutes a significant commitment and appropriate staff allocation is essential. Although it is not possible for each child in whom abuse is suspected to be seen by a specialist, they should be seen by those staff with the most expertise. Staff allocation must take into account the needs for education, training, and audit as well as service provision.

Child↗