A smoking cessation program as a resource for bladder cancer patients.

BACKGROUND: Continued tobacco use following a bladder cancer (CaB) diagnosis puts patients at risk for other tobacco-associated diseases and has also been associated with heightened risks of treatment-related complications, tumour recurrence, morbidity and mortality. Our aim was to determine if patients with CaB who continue to smoke warrant a smoking cessation program as a resource for improving their prognosis and long-term health. METHODS: A cross-sectional quantitative questionnaire-based study was performed between January and April 2009. We surveyed patients with a pathologically confirmed diagnosis of CaB during their cystoscopy appointments at a single cancer centre. RESULTS: One hundred patients completed the survey with 72% of them admitting to smoking in their lifetime. A third of respondents smoked at the time of their diagnosis; 76% of patients who had been active smokers at the time of their diagnosis (n = 33) reported smoking at some point thereafter and 58% continued to smoke. Among continued smokers, they were classified in the following categories: 26% were in "precontemplation," 5% in "contemplation," 16% in "preparation," and 53% in "action;" 37% of patients who continued to smoke were interested in a hospital-based smoking cessation program. Overall, 70% reported smoking as a risk factor for a poor CaB prognosis. The two most common barriers to quitting were "trouble managing stress and mood" and "fear of gaining weight." CONCLUSION: Based on the data from our centre, patients with CaB who continue to smoke after their diagnosis warrant a smoking cessation program as a resource for improving prognosis and long-term health. Further research should focus on establishing an efficacious and cost-effective program that provides these patients with the resources they need to quit smoking.

Communication errors in dispatch of air medical transport.

BACKGROUND: Communication errors are a source of preventable medical errors. In high-risk health care settings, identifying the source and addressing root causes can reduce error and improve patient safety. While air medical transport is a high-risk setting, its sources and rates of error have been investigated only within the last several years. OBJECTIVES: This investigation examined the rate and types of communication errors during call booking of interfacility air medical transports. The primary objective was to determine the incidence and type of errors when the initial requests for transfer took place between the sending facility and transport medicine communication center. The secondary objective was to identify potential underlying causes of these errors. METHODS: Requests for urgent and emergent interfacility air medical transfers were examined prospectively during a consecutive two-week period. As the first step in call booking, sending facility staff speak directly to communication center staff and are asked for administrative, demographic, and medical details to determine patient acuity and call priority. After this information was captured, investigators contacted the sending facility to verify the information and identify any communication errors. Errors were classified as major (potentially impacting care) or minor (unlikely to impact care) and as errors of omission or commission. Common error types were presented to a management focus group to identify potential contributing causes for these errors. RESULTS: One hundred twelve calls were randomly selected during the study period, with 98 meeting study criteria. Of those, 41 (42%) calls contained a total of 65 errors. Eleven were classified as major, including five errors of omission and six errors of commission. The most common major errors were recording "no drug allergies" when a drug allergy was present (n = 4), incorrect diagnosis (n = 2), and failure to record that patients were intubated or required mechanical ventilation (n = 2 each). There were 54 minor errors, including 41 omission errors and 13 commission errors. Nearly half the errors were attributed to procedures and software. No identified error resulted in patient harm or an adverse outcome. CONCLUSIONS: Communication-based errors are common in the initial phases of call booking in air medical transport. Human and process-driven errors contribute equally to these errors.

Rh discrepancies caused by variable reactivity of partial and weak D types with different serologic techniques.

BACKGROUND: RhD discrepancies between current and historical results are problematic to resolve. The investigation of 10 discrepancies is reported here. STUDY DESIGN: Samples identified were those that reacted by automated gel technology and were negative with an FDA-approved reagent. Reactivity with a commercially available panel of monoclonal anti-D was performed. Genomic DNA was evaluated for RHD alleles with multiplex RHD exon polymerase chain reaction (PCR), weak D PCR-restriction fragment length polymorphism, and RHD exon 5 and 7 sequence analyses. RESULTS: The monoclonal anti-D panel identified two samples as DVa, yet possessed the DAR allele. Two weak D Type 1 samples had a similar monoclonal anti-D profile, but only one reacted directly with one of two FDA-approved anti-D. Only two of four weak D Type 2 samples reacted directly with one FDA-approved anti-D, and their D epitope profile differed. CONCLUSIONS: The monoclonal anti-D reagents did not distinguish between partial and weak D Types 1 and 2. Weak D Types 1 and 2 do not show consistent reactivity with FDA-approved reagents and technology. To limit anti-D alloimmunization, it is recommended that samples yielding an immediate-spin tube test cutoff score of not more than 5 (i.e., < or =1+ agglutination) or a score of not more than 8 (i.e., < or =2+ hemagglutination) by gel technology be considered D- for transfusion and Rh immune globulin prophylaxis. That tube test anti-D reagents react poorly with some Weak D Types 1 and 2 red cells is problematic, inasmuch as they should be considered D+ for transfusion and prenatal care. Molecular tests that distinguish common partial and Weak D types provide the solution to resolving D antigen discrepancies.