Virchow’s triad revisited Ntusi, Ntobeko A.B.; Louw, Vernon J.
South African medical journal,
11/2019, Volume:
109, Issue:
11
Journal Article
Peer reviewed
Open access
Rudolf Ludwig Carl Virchow (13 October 1821 - 5 September 1902) was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor and politician who is widely regarded as ...the the ‘father of modern pathology’ and was affectionately called the ‘Pope of medicine’ by his friends. His investigation of the 1847 - 1848 typhus epidemic laid the foundation for the establishment of public health as a discipline in Germany, and paved his political and social careers. He famously coined the aphorism: ‘Medicine is a social science, and politics is nothing else but medicine on a large scale.’
Despite the burden of anemia among Hodgkin lymphoma (HL) patients, data evaluating red cell concentrate transfusion are limited. We retrospectively studied 285 newly diagnosed HL patients who ...received first-line adriamycin, bleomycin sulfate, vinblastine sulfate, and dacarbazine (ABVD) treatment at Groote Schuur Hospital, Cape Town. HIV prevalence in the cohort was 39.5% and 74.2% of patients had advanced stage HL. Patient prognosis was scored using the HL International Prognostic Score (IPS-7) and HL IPS-3. Seventy (24.6%) patients were transfused with a median of 2 (IQR 1-5) units per patient. Compared to HIV-negative patients, more HIV-positive patients were transfused (14.1% vs. 40.4%, p < .001) and received more units, median 2 (IQR 1-3) vs. 3 (IQR 2-5), p = .035. HL IPS-7 (OR 2.1, p < .001) and HL IPS-3 (OR 2.6, p < .001) were independently associated with transfusion. HL IPS-7, HL IPS-3, and HIV positivity remained associated with transfusion after adjusting for covariates. For patients with newly diagnosed HL, HL IPS-7, HL IPS-3, and HIV status predicted transfusion.
Abstract Background Much is known about outcomes and content of training programs in blood banking, but only a limited amount of formal research has been done on the outcomes required for a ...postgraduate training program aimed at medical doctors working in clinical practice. Study design and methods A formal qualitative and semi-quantitative research approach was followed to determine and test the factors considered important in determining the outcomes for clinicians completing a postgraduate diploma in transfusion medicine, and consisted of a literature survey, followed by semi-structured interviews and a Delphi survey. Results After a series of semi-structured interviews, based on an extensive literature survey, 42 factors were identified. These factors were categorized into eight groups and tested in a Delphi survey to determine which of these would be essential outcomes of a postgraduate training program in transfusion medicine. After three rounds of the Delphi survey, consensus was reached on 27 factors and stability on 14 factors. On one factor, neither consensus nor stability could be reached. Twenty-six factors were identified as essential outcomes. Conclusion This research provides support for the essential outcomes to be considered in any postgraduate training program in transfusion medicine aimed at clinicians.
Background
Physicianʼs knowledge in transfusion medicine (TM) is critical for patient safety. Therefore, ensuring that medical schools provide adequate education in TM is important. The aim of this ...study was to assess the status of TM education at a global level.
Study Design and Methods
A comprehensive anonymous survey to assess TM education in existing medical school curricula was developed. The survey was distributed to deans and educational leads of medical schools in a range of low‐, medium‐, high‐, and very high–human development index (HDI) countries. It included 20 questions designed to assess specific domains including structure of TM curriculum and teaching faculty.
Results
The response rate was 53%. The majority of responding schools from very‐high–HDI countries offered a 6‐year curriculum after high school or a 4‐year curriculum after college education, whereas most schools from medium‐HDI countries offered a 5‐year medical curriculum. A formal teaching program was available in only 42% of these schools in contrast to 94% of medical schools from very high‐HDI. Overall, 25% of all medical schools did not offer structured TM teaching. When offered, most TM teaching was mandatory (95%) and integrated within the third and fourth year of medical school. Formal assessment of TM knowledge was done in 72% of all responding medical schools. More than half of the deans considered the TM education in their medical schools as inadequate.
Conclusion
Despite its limitations, the current survey highlights significant gaps and opportunities of TM education at a global scale.
The characteristics and outcomes of patients with acute promyelocytic leukemia (APL) from sub-Saharan Africa have not been published.
We report retrospectively on consecutively diagnosed APL patients ...treated in Cape Town, South Africa, during 1998-2019. A total of 69 patients were treated, of whom 27 (39%) were classified as having high risk APL.
Early death rates at 7 and 30 days were 7% and 13%, respectively, including 4 patients who died before any treatment could be administered. Overall survival at 3 years was 76.5% (95% confidence interval, 63.9-85.2) for the entire cohort, and 82.5% (95% confidence interval, 69.7-90.2) if patients who died within 7 days of diagnosis were excluded. For 13 patients (18.8%), there was a delay of 5 or more days from time of initial presentation at a peripheral hospital until arrival at the leukemia center and administration of all-trans retinoic acid; only 1 of these patients died within 30 days.
Despite the challenges faced in the public healthcare system of a developing country, outcomes of APL patients treated at our center are similar to outcomes from developed countries.
To assess the characteristics and outcomes of patients with acute promyelocytic leukemia (APL) from sub-Saharan Africa, we retrospectively analyzed data from consecutively diagnosed APL patients treated in Cape Town, South Africa, during 1998-2019. Early death rates at 7 and 30 days were 7% and 13%, respectively; overall survival at 3 years was 76.5%. Outcomes of APL patients treated at our center are similar to outcomes from developed countries.
Modeling global transfusion medicine education Smit Sibinga, Cees Th; Louw, Vernon J.; Nedelcu, Elena ...
Transfusion (Philadelphia, Pa.),
October 2021, Volume:
61, Issue:
10
Journal Article
Peer reviewed
Open access
This document provides an analysis and oversight of the necessary educational infrastructure at national level needed for successful and sustainable education programs undergraduate and post-graduate ...and is focused on desired outcomes needed to secure general Transfusion Medicine (TM) competence and basic skills when appointed in a professional TM position. It provides a global model framework for TM education allowing individual countries to tailor the context and contents of the institutional curriculum.
Education in transfusion medicine is a complex set of intimately interrelated and interconnected components that allow student and fellow exposure to knowledge and skills, the ultimate curriculum. The extent to which knowledge and skills, professionalism and leadership principles are offered depends on the expected outcomes needed for the desired roles, tasks and functions.
A model for the development and implementation of an education (teaching and training) curriculum in Transfusion Medicine aimed at medical students and doctors, nurses and midwives, and laboratory professionals should ideally include an outcomes-based component, with clear recommendations on the required roles, skills, attitudes, and knowledge of a trainee completing such a curriculum. This should correspond to the environment and scope of practice required from such a vocational or academic professional and should address deficiencies in knowledge, skills and attitudes present before the curriculum is completed, while taking into account fundamental international standards of knowledge and the needs of their working climate and environment. Therefore, it is considered more practical to provide a set of outcomes that would be useful in most contexts and settings, while equipping students, as adult learners, with the tools for advancing their educational, professional and leadership development suited to their availability and socio-economic environment.
The framework or model recognizes that no one set of education or training initiatives will be appropriate in all countries or settings and should be tailored to specific settings based on the assessment of local needs and available environments.
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