A model for blood components processing.

BACKGROUND: Blood component therapy is advantageous in terms of increasing the effective availability of blood units and reducing the transfusion-related risks. One unit of blood can be separated into components and made available to multiple patients by transfusing suitable components. It is often believed that most, if not all, of the blood should be fractionated. But the process of componentizing increases the availability of blood products at the expense of increased costs of holding, processing, and wastage at a blood bank. The objective of this study was to determine the optimum level of components to be produced at a blood bank given its objectives and context. STUDY DESIGN AND METHODS: We developed a simulation-based model to determine the optimum amount of fresh blood to be fractionated at a blood bank operating in southern India was developed. The simulation model is a virtual representation of an actual blood bank, and it can help the administrator to test the effects of changing the level of components production on the overall blood bank performance. RESULTS: The results from the model suggest that it may not be optimal for the chosen blood bank to componentize large amounts of fresh blood as it leads to high costs of operation and huge wastage in the system. CONCLUSIONS: The same methodology can be applied to determine the optimum level of componentizing at other blood banks by providing appropriate inputs to the simulation model.

Model for blood collections management.

BACKGROUND: A typical blood bank gets its major supply of blood from organizing blood donation camps. The quantity of blood collected in the blood donation drives is random and it might be sensible to cut off the supply at some level to reduce the wastages by overcollection. STUDY DESIGN AND METHODS: In this paper we introduce two new cutoff level policies and compare their performance with the policy of collecting all the available supply at blood collection drives, which is quite prevalent among the blood banks. We develop a simulation model for collection that enables such comparison on the basis of shortages, wastages, and total costs. RESULTS AND CONCLUSION: The results obtained from the simulation model for a real-life situation show that the cutoff level policies are better than the unrestricted collection policy in controlling total costs. They also result in less wastage in the system for a given level of shortages.

Stakeholder analysis for health research: case studies from low- and middle-income countries.

OBJECTIVES: Future Health Systems: Innovations for Equity (FHS) is working in six partner countries in Asia and Africa, focusing on strengthening the research-policy interface in relation to specific health system research projects. These projects present an opportunity to study the influence of stakeholders on research and policy processes. STUDY DESIGN: Qualitative stakeholder analysis. METHODS: Stakeholder analysis was conducted in each FHS country using a structured approach. A cross-country evaluation was performed concentrating on six key areas: chosen research topic; type of intervention considered; inclusion/exclusion of stakeholder groups; general stakeholder considerations; power level, power type and agreement level of stakeholders; and classification of and approaches to identified stakeholders. RESULTS: All six countries identified a range of stakeholders but each country had a different focus. Four of the six countries identified stakeholders in addition to the guidelines, while some of the stakeholder categories were not identified by countries. The mean power level of identified stakeholders was between 3.4 and 4.5 (1=very low; 5=very high). The percentage of classified stakeholders that were either drivers or supporters ranged from 60% to 91%. CONCLUSION: Three important common areas emerge when examining the execution of the FHS country stakeholder analyses: clarity on the purpose of the analyses; value of internal vs external analysts; and the role of primary vs secondary analyses. This paper adds to the global body of knowledge on the utilization of stakeholder analysis to strengthen the research-policy interface in the developing world.

Demographic & clinical profile of HIV infected children accessing care at Tambaram, Chennai, India.

BACKGROUND & OBJECTIVE: Human immunodeficiency virus (HIV) is severely affecting the poorly educated and economically disadvantaged in Indian society. When children start developing clinical manifestations, needing treatment, they have to travel long distances for accessing care and support at tertiary institutions. This places an extra burden on patients, who are already struggling to cope with their illness. Sufficient data are needed for the government to evolve appropriate policy for providing care to the children affected with HIV. We undertook this study to present the socio-demographic characteristics, signs and symptoms, clinical profile, distance travelled and follow up pattern of HIV positive children who accessed care for the first time in a referral hospital at Chennai, India. METHODS: Electronic medical records from patients diagnosed with HIV between 2002 and 2004 at the Government Hospital for Thoracic Medicine (GHTM) in Tambaram (Chennai) in India were analyzed to understand care-seeking behaviours. Demographic variables such as age, sex, education and occupation, data on clinical manifestations were examined together with geographic information. RESULTS: At GHTM 1,768 new paediatric patients accessed care from 2002 to 2004. Children aged less than 5 yr were 49.9 per cent; 1115 children had (63%) tuberculosis. Significantly, 14.9 and 20.6 per cent children had extra-pulmonary TB and disseminated TB respectively. Lower respiratory infection (15.8%), Pneumocystis carinii pneumonia (15.20%), oral/oesophageal candidiasis (13.5%), wasting (6.1%) and diarrhoeal disorders (3.5%) were the common clinical manifestations. In all 47 per cent children traveled between 200-400 km from home and 14 per cent travelled over 400 km. INTERPRETATION & CONCLUSION: Our findings showed that tuberculosis should be regarded as the indicator disease for HIV infection in children, especially when they have clinical manifestations of progressive, non pulmonary and disseminated disease. The primary and secondary health care centres should have the trained capacity to diagnose and treat HIV disease and opportunistic infections so as the children to have much needed care and support nearer to their residence.