Parent perceptions of emergent blood transfusion in children.

BACKGROUND: RhD-negative blood products are in chronic short supply leading to renewed interest in utilizing RhD-positive blood products for emergency transfusions. This study assessed parental perceptions of emergency RhD-positive blood use in children. METHODS: A survey of parents/guardians was conducted on their tolerance of transfusing RhD-positive blood to RhD-negative female children ≤17 years old at four level 1 pediatric hospitals. RESULTS: In total, 621 parents/guardians were approached of whom 378/621 (61%) completed the survey in its entirety and were included in the analysis. Respondents were mostly females [295/378 (78%)], White [242/378 (64%)], had some college education [217/378 (57%)] and less than $60,000 annual income [193/378 (51%)]. Respondents had a total of 547 female children. Most children's ABO [320/547 (59%)] and RhD type [348/547 (64%)] were not known by their parents; of children with known RhD type, 58/186 (31%) were RhD-negative. When the risk of harm to a future fetus was given as 0-6%, more than 80% of respondents indicated that they were likely to accept RhD-positive blood transfusions on behalf of RhD-negative female children in a life-threatening situation. The rate of willingness to accept emergent RhD-incompatible blood transfusions significantly increased as the potential survival benefit of the transfusion increased. CONCLUSION: Most parents were willing to accept RhD-positive blood products on behalf of RhD-negative female children in an emergency situation. Further discussions and evidence-based guidelines on transfusing RhD-positive blood products to RhD-unknown females in emergency settings are needed.

Resilient leadership and the organizational culture of resilience: construct validation.

Political, economic, and social unrest and uncertainty seem replete throughout the world. Within the United States, political vitriol and economic volatility have led to severe economic restrictions. Both government and private sector organizations are being asked to do more with less. The specter of dramatic changes in healthcare creates a condition of uncertainty affecting budget allocations and hiring practices. If ever there was a time when a "resilient culture" was needed, it is now. In this paper we shall discuss the application of "tipping point" theory (Gladwell, 2000) operationalized through a special form of leadership: "resilient leadership" (Everly, Strouse, Everly, 2010). Resilient leadership is consistent with Gladwells "Law of the Few" and strives to create an organizational culture of resilience by implementing an initial change within no more than 20% of an organization's workforce. It is expected that such a minority, if chosen correctly, will "tip" the rest of the organization toward enhanced resilience, ideally creating a self-sustaining culture of resilience. This paper reports on the empirical foundations and construct validation of "resilient leadership".