The practice of reporting transfusion-related acute lung injury: a national survey among clinical and preclinical disciplines.

BACKGROUND: Transfusion-related acute lung injury (TRALI) is hypothesized to be a "two-hit" entity, in which an inflammatory condition (e.g., sepsis) predisposes to TRALI. TRALI is a clinical diagnosis. Disciplines involved in managing TRALI may differ in decision-making on the reporting of TRALI. STUDY DESIGN AND METHODS: A survey was conducted among critical care physicians, hematologists, hemovigilance workers, and transfusion medicine physicians, using case vignettes and a questionnaire. The vignettes varied in patient- and blood product-related factors that may influence the decision to report a TRALI case. Multiple linear regression analysis was performed. A positive beta-coefficient is in favor of reporting. RESULTS: Ninety-two questionnaires were returned (response rate, 68%). For all disciplines, preferences in favor of reporting TRALI were onset of symptoms within 1 hour (beta = 0.4), after transfusion of a single unit of FFP (beta = 0.5), and in the absence of acute lung injury before transfusion (beta = 1.3). An admission diagnosis of sepsis was a negative preference (beta = -0.3). Massive transfusion (6 RBC plus 4 FFP units) was a negative preference for transfusion medicine physicians (beta = -0.3), but a positive preference for the other disciplines. The questionnaire revealed that massive transfusion and the age of blood products were considered relatively more important reasons to report TRALI by critical care physicians compared to the other disciplines (p < 0.05). CONCLUSION: A pretransfusion inflammatory condition is a reason to withhold from reporting of a suspected TRALI case. Disciplines involved in managing TRALI differ in decision-making of reporting TRALI, which may contribute to variance in incidence.

The Feasibility and Utility of Cystoscopy-Guided Hydrogel Marker Placement in Patients With Muscle-Invasive Bladder Cancer.

PURPOSE: Fiducial markers at the borders of bladder tumors are useful to facilitate target delineation radiation therapy (RT) and offer the possibility of image guided RT for a focal boost. Our purpose was to evaluate the feasibility and technical performance of cystoscopy-guided placement of hydrogel markers in patients with bladder cancer referred for RT. METHODS AND MATERIALS: Ours was a prospective, multicenter, feasibility, and utility study. Thirty-two consecutive patients with muscle-invasive bladder cancer, referred for RT, underwent cystoscopy-guided implantation of hydrogel markers. Feasibility, clinical performance of the markers, and adverse events were registered. Computer tomography (CT) scans and cone beam CT (CBCT) scans acquired during RT were analyzed to evaluate the visibility and stability of the markers during the radiation period. RESULTS: A total of 107 hydrogel spots were implanted in 32 patients with bladder cancer. There were no procedure-related adverse events. On the simulation CT scan 76.6% of the implanted markers were sufficient for tumor delineation. At start of treatment 52.3% were visible on the CBCT and adequate for positional verification on a routine basis. The washout rate during treatment was 9.3%. At the end of treatment 46.7% of implanted spots were visible on CBCT scan and adequate for routine positional verification. At patient level, in 31.2% of cases, use of hydrogel fiducials showed adequate performance throughout the whole course. CONCLUSIONS: Cystoscopy-guided placement of hydrogel markers is both safe and feasible for muscle-invasive bladder tumors. Adequate performance for radiation purposes throughout the whole course (implantation, delineation, and positional verification) was 46.7% of all implanted markers, leaving room for improvement.

Validation of a visual analogue score (LRTI-VAS) in non-CF bronchiectasis.

BACKGROUND AND AIM: Quality of life in patients with non-cystic fibrosis (non-CF) bronchiectasis is largely defined by respiratory symptoms. To date, no disease-specific tool for symptom measurement in this patient group was available. We developed the lower respiratory tract infections - visual analogue scale (LRTI-VAS) in order to quickly and conveniently quantify symptoms in non-CF bronchiectasis. This study aimed to validate LRTI-VAS for use in non-CF bronchiectasis. METHODS: This study included outpatients with radiologically proven bronchiectasis and no evidence of CF. Results of LRTI-VAS were compared with other markers of disease activity {lung function parameters, oxygen saturation and three health-related quality of life questionnaires [Medical Outcomes Study Short-Form 36 Health Survey (SF-36), St Georges Respiratory Questionnaire (SGRQ) and Leicester Cough Questionnaire (LCQ)]} and validity, reliability and responsiveness were assessed. RESULTS: Thirty stable and 30 exacerbating participants completed the LRTI-VAS questionnaire. When testing for repeatability on two separate occasions, no statistically significant difference between total scores was found {1.4 [standard deviation (SD)] 5.3}, P = 0.16). Internal consistency was high across items (Cronbach's alpha 0.86). Correlation with SGRQ, SF-36 and LCQ total scores was high. Following antibiotic treatment, mean (SD) LRTI-VAS total score improved from 18.1 (SD 9.9) to 26.1 (SD 6.6) (P < 0.001). CONCLUSIONS: LRTI-VAS showed excellent validity, reliability and responsiveness to change and therefore appears a reliable tool for symptom measurement in non-CF bronchiectasis.