ABSTRACT
What is the current evidence base for patient blood management (PBM) in adults, and what international clinical recommendations can be derived for preoperative anemia, red blood cell transfusion thresholds, and PBM implementation strategies? Diagnosis and management of preoperative anemia is crucial, and iron-deficient anemia should be treated with iron supplementation. Red blood cell transfusion thresholds for critically ill, clinically stable patients (hemoglobin concentration <7 g/dL), patients undergoing cardiac surgery (hemoglobin concentration <7.5 g/dL), patients with hip fractures and cardiovascular disease or risk factors (hemoglobin concentration <8 g/dL), and hemodynamically stable patients with acute gastrointestinal bleeding (hemoglobin concentration 7-8 g/dL) are relatively well defined, although the quality of evidence is moderate to low. Further high-quality research to support PBM is required for a range of clinical scenarios and implementation of PBM programs.
Subject(s)
Humans , /diagnosis , Blood Loss, Surgical/prevention & control , Erythrocyte Transfusion/standards , Anemia, Iron-Deficiency/drug therapy , Anemia/diagnosis , Blood Transfusion/standards , Cardiac Surgical Procedures/methodsABSTRACT
This systematic review shows which promotional approaches are effective in changing handwashing and sanitation behaviour and which implementation factors affect the success or failure of such interventions. The authors find that promotional approaches can be effective in terms of handwashing with soap, latrine use, safe faeces disposal and open defecation. No one specific approach is most effective. However, several promotional elements do induce behaviour change. Different barriers and facilitators that influence implementing promotional approaches should be carefully considered when developing new policy, programming, practice, or research in this area.
Subject(s)
Humans , Hand Disinfection/methods , Basic Sanitation/organization & administration , Health Promotion/methods , Socioeconomic FactorsABSTRACT
Chronic obstructive pulmonary disease (COPD) and heart disease often coexist. Both diseases share risk factors such as smoking and inactivity. Roughly 15 to 20% of patients referred to pulmonary rehabilitation suffer from some degree of heart failure. Heart failure complicates the presentation of COPD and is often the cause of death in COPD. Exercise training as part of a comprehensive rehabilitation program is now recognized as a treatment for both COPD and congestive heart failure (CHF). It tackles the skeletal muscle abnormalities commonly seen in these diseases. The rehabilitation program that is offered to patients with COPD and coexisting CHF may need to be adapted in terms of the intensity and the components of self-management and counseling offered. This article discusses these adaptations.
