Patient blood management when blood is not an option: a report of two cases.

There are many patients who refuse to receive blood transfusions for religious or other reasons. Bloodless medicine and surgery are no longer new concept, but patients who refuse blood transfusion are still transferred to the bloodless center, regardless of patients' intention, for treatment. Here, we discuss the need for patient blood management when blood is not an option to treat them. Two patients of advanced age were transferred to our bloodless center due to refusal of transfusion. They are Jehovah's Witnesses and refused to receive blood transfusion despite life-threatening anemia and severe underlying diseases. Patient blood management protocols including iron supplementation, subcutaneous erythropoietin, folic acid and vitamin B were implemented to improve hematopoiesis, and supportive care was also performed to treat underlying diseases. Levels of Hemoglobin/Hematocrit and their symptom gradually improved about a week after treatment, and their condition had gradually stabilized. They were discharged safely. We treated patients of advanced age with severe underlying diseases and life-threatening anemia using patient blood management due to refusal of a blood transfusion. The patient blood management may be a useful alternative strategy, which meet the needs of patients who refuse blood transfusions as well as the need to reduce the use of blood products due to limited supply.

Effects of healthcare interventions on psychosocial factors of patients with multimorbidity: A systematic review and meta-analysis.

PURPOSE: A systematic review and meta-analysis was conducted to assess the types of healthcare intervention programs offered to patients with multimorbidity and their effects on key psychosocial factors. METHODS: For this systematic review and meta-analysis, we searched databases like Cochrane Library, PubMed, Embase, CINAHL RISS, KISS, etc. for studies published between January 1, 2009, and April 30, 2019. In total, 8,248 studies in English or Korean were reviewed. We included only randomized controlled trials or quasi-experimental studies that applied healthcare interventions and had major effects on the psychosocial factors in adult patients with multimorbidity. Methodological quality was assessed using Cochrane collaboration risk of bias tool. Meta-analysis was performed using the Review Manager 5.3 version to estimate the effect size. RESULTS: We identified six randomized controlled trials and 1446 subjects were enrolled. The results reveal that healthcare interventions have an effect on self-rated health (SMD = 0.53 95 % CI: 0.26, 0.79, p < .001), reducing anxiety (SMD = -0.19 95 % CI: -0.36, -0.01, p = .030) and depression (SMD = -0.27 95 % CI: -0.44, -0.10, p = .002), and improving self-efficacy (SMD = 0.21 95 % CI: 0.06, 0.35, p = .005) for patients with multimorbidity. However, there was no significant effect on quality of life. CONCLUSION: Healthcare interventions had significant positive effects on self-rated health, anxiety, depression, and self-efficacy of patients with multimorbidity. These results are expected to serve as basic data for the development of a community-based integrated healthcare intervention program and health policy, especially for the vulnerable older population with multimorbidity.

Gastrodia elata Blume protects against stress-induced gastric mucosal lesions in mice.

Gastrodia elata Blume (GEB) is a traditional herbal plant that has been used in Asian countries for centuries as an anticonvulsant, analgesic, and also as a sedative for treating general paralysis, epilepsy, vertigo, and tetanus. Although numerous reports have addressed the effects of GEB against degenerative diseases, no previous study has examined the possible gastroprotective effects of GEB. Here, we examined the effects of pretreatment with GEB (0.02 ml/g, p.o.) in a mouse water immersion restraint (WIR) stress-induced gastric lesion model. Our results revealed that mice pretreated with GEB had significantly fewer gastric lesions than their respective controls. Moreover, GEB-treated mice showed significant decreases in serum and gastric nitric oxide (NO) levels to 50 and 28%, respectively. To examine one possible mechanism underlying this effect, we used reverse transcription-polymerase chain reaction (RT-PCR) to examine NOS mRNA expression in gastric lesion tissues. Our results revealed that the mRNA expression of inducible nitric oxide synthase (iNOS) was reduced by approximately 50% in GEB-pretreated mice versus the controls, whereas the mRNA expression levels of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) remained unchanged. These findings collectively suggest that GEB significantly protects the gastric mucosa against WIR-induced gastric damage, at least in part by decreasing NO levels via suppression of iNOS mRNA expression.