The supply of blood components and products in sufficient quantities is key to any effective health care system. This report describes the challenges faced by the English blood service, NHS Blood and ...Transplant (NHSBT), towards the end of the COVID-19 pandemic, which in October 2022 led to an Amber Alert being declared to hospitals indicating an impending blood shortage. The impact on the hospital transfusion services and clinical users is explained. The actions taken by NHSBT to mitigate the blood supply challenges and ensure equity of transfusion support for hospitals in England including revisions to the national blood shortage plans are described. This report focuses on the collaboration and communication between NHSBT, NHS England (NHSE), Department of Health and Social Care (DHSC), National Blood Transfusion Committee (NBTC), National Transfusion Laboratory Managers Advisory Group for NBTC (NTLM), National Transfusion Practitioners Network, the medical Royal Colleges and clinical colleagues across the NHS.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
IMPORTANCE: Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. OBJECTIVE: To develop a set of evidence-based recommendations ...for patient blood management (PBM) and for research. EVIDENCE REVIEW: The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018. FINDINGS: From 17 607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23 143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. CONCLUSIONS AND RELEVANCE: The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.
In a large study using registry data from Britain, overall cancer incidence was not increased among children born after assisted conception. Assisted conception was associated with an increased risk ...of hepatoblastoma and rhabdomyosarcoma, but the absolute risks were small.
Since the introduction of in vitro fertilization (IVF) in 1978, the number and proportion of children born after assisted conception have increased annually, and currently there are more than 5 million such persons worldwide.
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Well-recognized perinatal complications in this population include low birth weight, prematurity, and congenital malformations.
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However, there remains a dearth of population-based studies investigating important but rare health outcomes.
The possibility of an increased risk of cancer in this population has been suggested previously.
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This concern is supported by the discovery of altered epigenetic patterns in human embryos,
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cord blood,
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Concepts of blood transfusion in adults Goodnough, Lawrence T, Prof; Levy, Jerrold H, Prof; Murphy, Michael F, Prof
The Lancet (British edition),
05/2013, Volume:
381, Issue:
9880
Journal Article
Peer reviewed
Recent progress has been made in the identification and implementation of best transfusion practices on the basis of evidence-based clinical trials, published clinical practice guidelines, and ...process improvements for blood use and clinical patient outcomes. However, substantial variability persists in transfusion outcomes for patients in some clinical settings—eg, patients undergoing cardiothoracic surgery. This variability could be the result of insufficient understanding of published guidelines; different recommendations of medical societies, including the specification of a haemoglobin concentration threshold to use as a transfusion trigger; the value of haemoglobin as a surrogate indicator for transfusion benefit, even though only changes in concentration and not absolute red cell mass of haemoglobin can be identified; and disagreement about the validity of the level 1 evidence for clinical practice guidelines. Nevertheless, institutional experience and national databases suggest that a restrictive blood transfusion approach is being increasingly implemented as best practice.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Decisions determining the use of land for energy are of exigent concern as land scarcity, the need for ecosystem services, and demands for energy generation have concomitantly increased globally. ...Utility-scale solar energy (USSE) i.e., ≥1 megawatt (MW) development requires large quantities of space and land; however, studies quantifying the effect of USSE on land cover change and protected areas are limited. We assessed siting impacts of >160 USSE installations by technology type photovoltaic (PV) vs. concentrating solar power (CSP), area (in square kilometers), and capacity (in MW) within the global solar hot spot of the state of California (United States). Additionally, we used the Carnegie Energy and Environmental Compatibility model, a multiple criteria model, to quantify each installation according to environmental and technical compatibility. Last, we evaluated installations according to their proximity to protected areas, including inventoried roadless areas, endangered and threatened species habitat, and federally protected areas. We found the plurality of USSE (6,995 MW) in California is sited in shrublands and scrublands, comprising 375 km² of land cover change. Twenty-eight percent of USSE installations are located in croplands and pastures, comprising 155 km² of change. Less than 15% of USSE installations are sited in “Compatible” areas. The majority of “Incompatible” USSE power plants are sited far from existing transmission infrastructure, and all USSE installations average at most 7 and 5 km from protected areas, for PV and CSP, respectively. Where energy, food, and conservation goals intersect, environmental compatibility can be achieved when resource opportunities, constraints, and trade-offs are integrated into siting decisions.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Although a number of studies have observed that females respond better to serotonergic antidepressants than males and that postmenopausal females have a diminished response to antidepressants ...compared with younger females, there are also studies that conflict with both of these findings, making any generalizations regarding sex differences difficult to make. Sex variance in antidepressant efficacy and pharmacokinetics profiles have been attributed to sex-based physiological differences, behavioral differences, related disorders, and sex-specific conditions, including pregnancy and menopause. This paper will review the history and current research on sex effects of antidepressant treatment.
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