How do I manage a blood product shortage?

BACKGROUND: The demand for blood products sometimes exceeds the available inventory. Blood product inventories are dependent upon the availability of donors, supplies and reagents, and collection staff. During prolonged extreme shortages, blood centers and transfusion services must alter practices to meet the needs of patients. STUDY DESIGN AND METHODS: The Association for the Advancement of Blood and Biotherapies Donor and Blood Component Management Subsection compiled some strategies from its blood center and hospital transfusion service members that could be implemented during blood product shortages. RESULTS: Some strategies that blood centers could use to increase their available inventories include increasing donor recruitment efforts, using alternate types of collection kits, manufacturing low-yield apheresis-derived platelets and/or whole blood-derived platelets, using cold-stored platelets, transferring inventory internally among centers of the same enterprise, using frozen inventory, decreasing standing order quantities, prioritizing allocation to certain patient populations, filling partial orders, and educating customers and blood center staff. Transfusion service strategies that could be implemented to maximize the use of the limited available inventory include increasing patient blood management efforts, using split units, finding alternate blood suppliers, trading blood products with other hospital transfusion services, developing a patient priority list, assembling a hospital committee to decide on triaging priorities, using expired products in extreme situations, and accepting nonconforming products after performing safety checks. DISCUSSION: Blood centers and transfusion services must choose the appropriate strategies to implement based on their needs.

Utility of passive photography to objectively audit built environment features of active transport journeys: an observational study.

BACKGROUND: Active transport can contribute to physical activity accumulation and improved health in adults. The built environment is an established associate of active transport behaviours; however, assessment of environmental features encountered during journeys remains challenging. The purpose of this study was to examine the utility of wearable cameras to objectively audit and quantify environmental features along work-related walking and cycling routes. METHODS: A convenience sample of employed adults was recruited in New Zealand, in June 2011. Participants wore a SenseCam for all journeys over three weekdays and completed travel diaries and demographic questionnaires. SenseCam images for work-related active transport journeys were coded for presence of environmental features hypothesised to be related to active transport. Differences in presence of features by transport mode and in participant-reported and SenseCam-derived journey duration were determined using two-sample tests of proportion and an independent samples t-test, respectively. RESULTS: Fifteen adults participated in the study, yielding 1749 SenseCam images from 30 work-related active transport journeys for coding. Significant differences in presence of features were found between walking and cycling journeys. Almost a quarter of images were uncodeable due to being too dark to determine features. There was a non-significant tendency for respondents to under-report their journey duration. CONCLUSION: This study provides proof of concept for the use of the SenseCam to capture built environment data in real time that may be related to active transportation. Further work is required to test and refine coding methodologies across a range of settings, travel behaviours, and demographic groups.

Utility of accelerometer thresholds for classifying sitting in office workers.

OBJECTIVE: To investigate the utility of a variety of Actical accelerometer count thresholds for determining sitting time in a sample of office workers. METHODS: Data were collected from 21 participants in Auckland, New Zealand, between December 2009 and January 2010. Participants wore a hip-mounted Actical accelerometer and thigh-mounted activPAL inclinometer (criterion) for a 48-h period. Raw inclinometer and accelerometer data for each 15s epoch of wear time were matched by date and time. Candidate accelerometer count thresholds for sitting classification were compared with the criterion measure using receiver operating characteristic analyses. Agreement in sitting time classification was determined using Bland-Altman methodology. RESULTS: Significant differences in area under the curve (AUC) values by threshold criteria were found (p<0.001). A threshold of 0 counts provided the highest combined sensitivity and specificity (AUC 0.759, 95%CI 0.756, 0.761). The 95% limits of agreement for time spent sitting were wide, at 328min (range -30.8, 297.5). CONCLUSION: A threshold of 0 counts/15s epoch with Actical accelerometers is likely to yield the most accurate quantification of sitting in office-based workers, however the wide limits of agreement found indicate limited utility of this threshold to accurately distinguish sitting time in office-based workers.