Connectivity in transfusion medicine: Challenges, benefits, and goals.

Transfusion medicine requires meticulous record keeping from the time a blood donation is made to the time a patient receives a transfusion. As such, blood collection establishments and processing laboratories generate large amounts of data. This data must be managed, analyzed, and visualized appropriately to ensure safety of the blood supply. Today, the use of information technology (IT) solutions for data management in transfusion medicine varies widely between institutions. In this report, blood center professionals describe how they currently use IT solutions to improve their blood processing methods, the challenges they have, and how they envision IT solutions improving transfusion medicine in the future.

Relato de experiência sobre um programa de assistência domiciliar do idoso em um município do estado do Pará: produção de cuidado em territórios afetivos

Objetivo: Este artigo tem por finalidade a apresentação de um relato de experiência do perfil, organização, processo de trabalho e funcionamento de um Programa de Assistência Domiciliar do Idoso de um município do Estado do Pará, desenvolvido a partir da realidade vivenciada no campo do trabalho em equipe. Metodologia: Optou-se pelo relato de experiência como modalidade de estudo, que permite analisar e observar variáveis significativas da realidade acerca do desenvolvimento do cuidado realizado aos sujeitos. Resultados: Foi possível refletir sobre os processos de trabalho e práticas de cuidado que norteiam a modalidade da Atenção Domiciliar, considerando que essa modalidade de assistência se caracteriza como valioso passo a ser exercido no campo de atenção aos idosos, pois além de ampliação da autonomia desta população e sua rede de apoio, diminui riscos psicossociais, diminui a hospitalização e colabora para um melhor suporte emocional para aqueles que se encontram em estado grave ou em fase final de vida. Ficou evidente a necessidade de maior valorização dessa modalidade de assistência, tanto no campo da macropolítica como no da micropolítica. O Programa de internação domiciliar da pessoa idosa, que está em funcionamento há 20 anos, apresenta um grande potencial no sentido de contribuir para processo de desospitalização, redução de custos, otimização do uso de leitos hospitalares e centralização do cuidado no usuário. Entretanto, apesar dos avanços já ocorridos desde a criação do serviço, alguns desafios ainda permanecem, dentre eles a dificuldade de articulação com os demais serviços da Rede Intersetorial e de Atenção à Saúde.

Emerging Pathogen Threats in Transfusion Medicine: Improving Safety and Confidence with Pathogen Reduction Technologies.

Emerging infectious disease threats are becoming more frequent due to various social, political, and geographical pressures, including increased human-animal contact, global trade, transportation, and changing climate conditions. Since blood products for transfusion are derived from donated blood from the general population, emerging agents spread by blood contact or the transfusion of blood products are also a potential risk. Blood transfusions are essential in treating patients with anemia, blood loss, and other medical conditions. However, these lifesaving procedures can contribute to infectious disease transmission, particularly to vulnerable populations. New methods have been implemented on a global basis for the prevention of transfusion transmissions via plasma, platelets, and whole blood products. Implementing proactive pathogen reduction methods may reduce the likelihood of disease transmission via blood transfusions, even for newly emerging agents whose transmissibility and susceptibility are still being evaluated as they emerge. In this review, we consider the Mirasol PRT system for blood safety, which is based on a photochemical method involving riboflavin and UV light. We provide examples of how emerging threats, such as Ebola, SARS-CoV-2, hepatitis E, mpox and other agents, have been evaluated in real time regarding effectiveness of this method in reducing the likelihood of disease transmission via transfusions.

Comparison of automated versus semi-automated whole blood processing systems: A systematic review.

BACKGROUND AND OBJECTIVES: Implementation of automated steps in preparing blood components for transfusion from whole blood collections has produced improvements in multiple fields. The aim of this review is to summarize data from existing literature related to automation of whole blood processing systems. MATERIALS AND METHODS: We searched MEDLINE for studies comparing semi-automated and fully automated whole blood processing systems published before 20 July 2021. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Additionally, we performed a manual search. RESULTS: We identified 500 studies, of which 459 (92%) did not meet the eligibility criteria, and finally 17 studies were included in the analysis. Manual search included six additional studies. Publication year ranged from 2004 to 2021. Automation reduced the run-time (from 92 to 76 min), improved recovery of haemoglobin in red cell concentrates (RCCs) and resulted in higher red blood cell and platelet yields. Automation also reduced discard rates due to whole blood bag ruptures (1.2%-0.1%), low volume of RCCs (<200 ml; 0.5%-0.03%) and haemolytic plasma (2.1%-0.6%). Automation could reduce the number of full-time equivalent (FTE) operators or maintain the number of FTE operators while performing additional procedures, and it reduced to 1.13 m2 the space required for the device. CONCLUSION: Automation of whole blood processing resulted in continued improvements in productivity, product quality and technical features. However, too few publications are available to reach strong conclusions. Therefore, it is necessary to expand the scientific knowledge in this field.

Prevalence and risk factors of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 mental health cohort.

BACKGROUND: There is mixed evidence on increasing rates of psychiatric disorders and symptoms during the coronavirus disease 2019 (COVID-19) pandemic in 2020. We evaluated pandemic-related psychopathology and psychiatry diagnoses and their determinants in the Brazilian Longitudinal Study of Health (ELSA-Brasil) São Paulo Research Center. METHODS: Between pre-pandemic ELSA-Brasil assessments in 2008-2010 (wave-1), 2012-2014 (wave-2), 2016-2018 (wave-3) and three pandemic assessments in 2020 (COVID-19 waves in May-July, July-September, and October-December), rates of common psychiatric symptoms, and depressive, anxiety, and common mental disorders (CMDs) were compared using the Clinical Interview Scheduled-Revised (CIS-R) and the Depression Anxiety Stress Scale-21 (DASS-21). Multivariable generalized linear models, adjusted by age, gender, educational level, and ethnicity identified variables associated with an elevated risk for mental disorders. RESULTS: In 2117 participants (mean age 62.3 years, 58.2% females), rates of CMDs and depressive disorders did not significantly change over time, oscillating from 23.5% to 21.1%, and 3.3% to 2.8%, respectively; whereas rate of anxiety disorders significantly decreased (2008-2010: 13.8%; 2016-2018: 9.8%; 2020: 8%). There was a decrease along three wave-COVID assessments for depression [ß = -0.37, 99.5% confidence interval (CI) -0.50 to -0.23], anxiety (ß = -0.37, 99.5% CI -0.48 to -0.26), and stress (ß = -0.48, 99.5% CI -0.64 to -0.33) symptoms (all ps < 0.001). Younger age, female sex, lower educational level, non-white ethnicity, and previous psychiatric disorders were associated with increased odds for psychiatric disorders, whereas self-evaluated good health and good quality of relationships with decreased risk. CONCLUSION: No consistent evidence of pandemic-related worsening psychopathology in our cohort was found. Indeed, psychiatric symptoms slightly decreased along 2020. Risk factors representing socioeconomic disadvantages were associated with increased odds of psychiatric disorders.

Assessing quality of blood components derived from whole blood treated with riboflavin and ultraviolet light and separated with a fully automated device.

BACKGROUND: Combining pathogen reduction and automated separation of whole blood (WB), together with the use of improved additive solutions, may increase reproducibility and extend shelf-life of blood components. MATERIALS AND METHODS: Forty WB units were collected from volunteer donors and randomised 1:1 into two groups: 1) pathogen reduction with riboflavin and ultraviolet light (PRT); or 2) no treatment (Control). After two hours (h) at room temperature, all units underwent fully automated separation into red blood cell concentrate (RBCC), plasma and leukopack components. RBCCs were leukoreduced and stored in phosphate-adenine-glucose-guanosine-saline-mannitol (PAGGSM) solution while plasma units were shock frozen within 8 h of collection and stored at ≤ -25°C. RBCCs were sampled on day 1 and weekly thereafter until day 42, while plasma was sampled on days 1 and 30. The main study objective was to assess the in vitro quality of separated RBCCs using biochemical and haematological parameters. Plasma protein content after one cycle of freeze-thaw was also analysed. RESULTS: The quality of RBCCs was largely comparable between the PRT and Control groups, except for a significantly higher degree of haemolysis and extracellular potassium levels in the PRT group after 35 days of storage. While potassium concentration was significantly higher in the PRT group at all timepoints, the degree of haemolysis exceeded the accepted European threshold (i.e., <0.8% of red cell mass in ≥ 90.0% of tested units) after day 35. Most plasma protein levels were significantly lower in the PRT than the Control group at both day 1 and day 30. DISCUSSION: Pathogen reduction with riboflavin and ultraviolet light treatment of WB can be combined with fully automated separation to obtain RBCCs that may be stored for up to 35 days in PAGGSM solution with acceptable quality, comparable to that of RBCCs from untreated blood. The relative differences between factor concentrations in plasma from the PRT and the Control groups were similar during the 30-day storage.

Improvement of Blood Processing and Safety by Automation and Pathogen Reduction Technology.

INTRODUCTION: The objective of the present study was to describe the experience of the Blood and Tissues Bank of Aragon with the Reveos® Automated Blood Processing System and Mirasol® Pathogen Reduction Technology (PRT) System, comparing retrospectively routine quality data obtained in two different observation periods. METHODS: Comparing quality data encompassing 6,525 blood components from the period 2007-2012, when the semi-automated buffy coat method was used in routine, with 6,553 quality data from the period 2014-2019, when the Reveos system and subsequently the Mirasol system were implemented in routine. RESULTS: Moving from buffy coat to Reveos led to decreased discard rates of whole blood units (1.2 to 0.1%), increased hemoglobin content (48.1 ± 7.6 to 55.4 ± 6.6 g/unit), and hematocrit (58.9 ± 6.5% to 60.0 ± 4.9%) in red blood cell concentrates. Platelet concentrates (PCs) in both periods had similar yields (3.5 ×1011). Whereas in the earlier period, PCs resulted from pooling 5 buffy coats, in the second period 25% of PCs were prepared from 4 interim platelet units. The mean level of factor VIII in plasma was significantly higher with Reveos (92.8 vs. 97.3 IU). Mirasol PRT treatment of PCs reduced expiry rates to 1.2% in 2019. One septic transmission was reported with a non-PRT treated PCs, but none with PRT-treated PCs. CONCLUSION: Automation contributed to standardization, efficiency, and improvement of blood processing. Released resources enabled the effortless implementation of PRT. The combination of both technologies guaranteed the self-sufficiency and improvement of blood safety.

Remodelling whole blood processing through automation and pathogen reduction technology at the Luxembourg Red Cross.

In 2014-2015, the Luxembourg Red Cross (LRC) implemented a fully automated system (FAS) able to process 4 whole blood units simultaneously, and a pathogen reduction technology (PRT) based on riboflavin and ultraviolet light to improve safety of platelet concentrates (PCs). In this observational study, the impact of both technologies to enable this centralised blood transfusion centre to provide safe and timely blood components supply for the whole country was analysed. Standard quality control parameters for blood components, productivity and safety were compared from data collected with the conventional semi- automated buffy coat method and with FAS/PRT. The FAS decreased processing time when compared with the buffy coat method and facilitated the daily routine at the LRC. Red blood cell concentrates, plasma units and PCs prepared with both methods were conform to the European Directorate for the Quality of Medicines & HealthCare specifications. PCs prepared by FAS showed high yields, with decreased variability when the device-related software (T-Pool Select) was used. PRT had minimal impact on platelet yields and product quality and induced no increase in transfusion reaction notifications. The FAS and PRT transformed the daily routine of blood component manufacture by allowing increased productivity and efficiency, notwithstanding resource containment and without impacting quality, yet promoting safety.

Effects of Motor Imagery as a Complementary Resource on the Rehabilitation of Stroke Patients: A Meta-Analysis of Randomized Trials.

BACKGROUND: Stroke is the second leading cause of death and a leading cause of disability worldwide. Motor imagery is a technique that can be utilized in the rehabilitation process to improve the lives of patients with a functional disability acquired by this pathology. AIM: To evaluate the effects of motor imagery as a complementary intervention for the rehabilitation of stroke patients. METHODS: We conducted a systematic review in MEDLINE/PubMed, Scopus, Web of Science, and PEDro databases. We included randomized controlled trials (RCTs) that used motor imagery as a complementary resource for the rehabilitation of patients affected by stroke, who had motor function and functional independence as outcomes. RESULTS: Of the 1,473 studies found, ten RCTs were included. Regarding the interventions, motor imagery was associated with traditional rehabilitation, virtual reality, physical practice, structured progressive circuit class therapy, and electromyography. The upper and lower extremity performance were accessed through the Fugl-Meyer Assessment (FMA) and gait speed, respectively. Although the practice of motor imagery at least twice a week during three weeks showed to be effective in improving the motor performance of post-stroke patients, the studies' protocols present a high heterogeneity, with training session times lasting between 30 to 180 minutes and a post-stroke invention window of one to 12 months. CONCLUSIONS: Motor imagery has been shown to be an efficacious technique in the treatment of post-stroke patients when used as a complement to traditional rehabilitation techniques. However, greater standardization of interventions and studies with higher methodological quality are required to determine further conclusions.

Revisiting study design and methodology for pathogen reduced platelet transfusions: a round table discussion.

Pathogen inactivation/reduction technologies for platelet components have been developed to enhance microbial safety, and many studies have been carried out to determine whether this technique adversely affects the platelet's ability to stop or prevent bleeding. These clinical trials require inclusion of several hundred patients, are costly, and take many years to complete. To address these challenges, a meeting was organized consisting of two expert presentations followed by a roundtable discussion focused on possible new approaches to evaluate the clinical efficacy of pathogen-reduced platelets. The value of laboratory measures to provide information on platelet count after transfusion or to serve as a surrogate for bleeding risk was discussed. Also, other types of trial designs (cluster trials, stepped wedge designs, and Phase 4 postmarketing surveillance studies) as well as a clinically meaningful standardized safety endpoint to evaluate pathogen- reduced platelets were also discussed.

Multielemental composition and consumption risk characterization of three commercial marine fish species.

Marine fish are considered a source of high quality proteins and fatty acids. However, the consumption of fish may pose a health risk as it may have potentially toxic elements in high concentrations. In this study we quantify the multielemental composition of muscle and fins for three species of commercial marine fish from Brazil: Sphyraena guachancho (Barracuda), Priacantus arenatus (Common bigeye) and Genidens genidens (Guri sea catfish). We then assessed the potential risk of fish consumption by means of a Provisional Hazard Indices. Amongst the elements detected in fish tissue were potentially toxic elements such as Ag, Ba, Cd, Cr and Hg. Concentration differences were species-specific, and affected by the species trophic level, morphological characteristics and feeding habits. Results suggest the higher the trophic level of the fish, the higher the risk of consumption. Caution is recommended for the frequent ingestion of high trophic level fish species in Brazil.

Predictive antidiabetic activities of plants used by persons with Diabetes mellitus.

BACKGROUND: There are several ways to identify medicinal power of phytoconstituents, such as in silico evaluations. Furthermore, ethnopharmacological researches are important alternatives for the identification of plants with medicinal potential. Significantly, medicinal plants are widely used by persons with Diabetes mellitus (DM) to treat manifestations of this syndrome. OBJECTIVES: i) to investigate the use of medicinal plants for individuals with DM and their health profile; ii) to evaluate in silico possible antidiabetic activities for main phytoconstituents of the commonly used plants. METHODS: A questionnaire was used to measure consumption of medicinal plants. The Prediction of Activity Spectra for Substances (PASS) platform was employed to perform in silico evaluations. In silico predictions for antidiabetic activities were performed with the main compounds identified in a literature review which focused on the more utilized plants. RESULTS: We interviewed 105 persons with DM, most them women (73.34%). Overall mean age was 59.35 years, and 97.14% of them were diagnosed with type 2 DM. An evaluation of the routine exams of the interviewees showed that they have a poor metabolic control. Among the interviewees, 67.62% confirmed the use medicinal plants. Main forms of consumed plant preparation were infusion of leaves and in association with mate (a typical beverage of southern Brazil). Most interviewees consume five or more cups of infusion per day, and when consumed with the mate, 1.73 liters per day. Forty-six medicinal plants were mentioned, and cow's paw (Bauhinia) and jambolan (Syzygium cumini) were the most used. The main informed objective for the plant use was blood glucose control (69.01%). The PASS analysis presented six phytoconstituents with high antidiabetic prediction, especially, vicenin-2, the main phytochemical identified in Passiflora genus (Pa = 0.822). CONCLUSION: Our data show that persons with DM use many plants as a complementary treatment to the traditional medicine. Moreover, part of these plants presented phytoconstituents with antidiabetic potential. These data can serve as a basis for future investigations, with the objective of exploring in vitro and in vivo antidiabetic effects of these plants and its compounds.

Reflections on the dynamics of bacterial and viral contamination of blood components and the levels of efficacy for pathogen inactivation processes.

Blood transfusion safety has been increasingly improving during the past two decades. However, threats from both known and emerging pathogens require continual improvement and re-assessment of blood safety measures. In this respect, we are currently witnessing the broader implementation of Pathogen reduction technology (PRT) for blood complements. These methods, combined with existing safety measures, have helped to reduce the pathogen risks of transfusion-transmitted infections. Currently multiple reviews have compared levels of inactivation between different commercialized PRTs. However, to analyze levels of pathogen inactivation, it is necessary to understand the dynamics of infectivity as well as the modes of disease transmission by blood transfusion for various pathogens. It is well known that contributing variables include donor characteristics through the processing of blood components to ultimately the recipient characteristics, which create enormous variability in overall outcomes relative to disease transmission. The aim of this paper is to discuss bacterial and viral contamination of blood components in order to determine adequate levels of efficacy and subsequent disease transmission safety of current pathogen inactivation protocols that are designed to reduce the risk of transfusion-transmitted infections. In such a conceptual analysis, however, it is important to understand several contributing factors including the measurement of pathogen load in blood products and the dynamics, infectivity and disease transmission of various pathogens via transfusion of blood components and products. In many cases, the log reduction values observed do not truly reflect the extent of reduction in the levels of infectivity that are observed clinically. Results from clinical trials and hemovigilance programs upon routine implementation of PRT methods provide a more direct insight into effectiveness with regard to clinical relevance of in vitro spiking studies. These issues are briefly addressed in this manuscript.

Improving the safety of whole blood-derived transfusion products with a riboflavin-based pathogen reduction technology.

Worldwide safety of blood has been positively impacted by technological, economic and social improvements; nevertheless, growing socio-political changes of contemporary society together with environmental changes challenge the practice of blood transfusion with a continuous source of unforeseeable threats with the emergence and re-emergence of blood-borne pathogens. Pathogen reduction (PR) is a proactive strategy to mitigate the risk of transfusion-transmitted infections. PR technologies for the treatment of single plasma units and platelet concentrates are commercially available and have been successfully implemented in more than 2 dozen countries worldwide. Ideally, all labile blood components should be PR treated to ensure a safe and sustainable blood supply in accordance with regional transfusion best practices. Recently, a device (Mirasol® Pathogen Reduction Technology System) for PR treatment of whole blood using riboflavin and UV light has received CE marking, a significant step forward in realising blood safety where WB transfusion is the norm, such as in sub-Saharan Africa and in far-forward combat situations. There is also keen interest in the ability to derive components from Mirasol®-treated whole blood, as it is seen as a more efficient and economical means to implement universal PR in the blood centre environment than treatment of components with different PR systems.

O Mix Público e Privado no Sistema de Saúde Brasileiro: Coexistência em Evidência / The Public And Private Mix In The Brazilian Health System: Coexistence In Evidence

Este artigo objetiva descrever e analisar as principais nuances da relação público e privado no sistema de saúde brasileiro. Além de apresentar uma discussão sobre conceitos de público e privado, também serão pontuadas características, tendências e impactos do mix público-privado no sistema de saúde brasileiro. Foi realizado um levantamento bibliográfico em forma de revisão narrativa sobre a produção clássica e atual de artigos científicos, dissertações, teses e relatórios de pesquisas que apresentassem reflexões pertinentes ao tema nos últimos quinze anos. Os resultados encontrados foram categorizados nos seguintes eixos: Considerações acerca dos conceitos de público e privado; Características do Sistema de Saúde Brasileiro; Tendências e Impactos do Mix Público-Privado no Sistema de Saúde Brasileiro. Ficou clara a existência de uma polissemia conceitual sobre os termos público e privado e devido aos arranjos entre essas duas dimensões na estrutura do sistema de saúde brasileiro, parte-se da premissa de que ele é um sistema misto, onde o setor público e o privado coexistem no provimento, no financiamento, na demanda e na utilização dos serviços de saúde. Nesse contexto, foram constatados problemas próprios dos sistemas com cobertura duplicada, com impactos sobre a equidade, financiamento, produção, uso e acesso aos serviços de saúde. Assim, torna-se urgente criar estratégias e mecanismos de resistência que garantam uma ação de regulação integrada para um Sistema Nacional de Saúde que, entre outras coisas, defina a relação público/privado, além da necessidade de integração de políticas públicas, não apenas voltadas para ao desenvolvimento, mas também, para o bem-estar.(AU)

This article aims to describe and analyze the main nuances of the public and private relationship in the Brazilian health system. In this sense, in addition to presenting a discussion on public and private concepts, characteristics, trends and impacts of the public-private mix in the Brazilian health system will also be punctuated. A bibliographic survey was carried out in the form of a narrative review on the classical and current production of scientific articles, dissertations, theses and research reports that presented pertinent reflections on the topic in the last ten years. The results were categorized in the following axes: Considerations about the concepts of public and private; Characteristics of the Brazilian Health System; Trends and Impacts of the Public-Private Mix in the Brazilian Health System. It was clear the existence of a conceptual polysemy on the public and private terms and due to the arrangements between these two dimensions in the structure of the Brazilian health system, it is based on the premise that it is a mixed system, where the public sector And the private sector coexist in the provision, financing, demand and use of health services. Within this context, problems of the systems with duplicate coverage were found, with impacts on equity, financing, production, use and access to health services. Therefore it is urgent to create strategies and mechanisms of resistance that guarantee an integrated regulatory action for a National Health System that, among other things, defines the public / private relation, besides the need to integrate public policies, not only aimed at For development, but also for well-being.(AU)

O caminho trilhado por usuários de um Centro de Atenção Psicossocial do Estado do Pará: construindo itinerários na busca do cuidado / The way taken by users of a Psychosocial Care Center in Pará state: building itineraries in search of assistence / El camino recorrido por usuarios de un Centro de Atención Psicosocial del Estado de Pará: construyendo itinerarios en la búsqueda del cuidado

Este artigo buscou conhecer e compreender os caminhos percorridos pelos usuários de um Centro de Atenção Psicossocial (CAPS) do Estado do Pará na busca do cuidado. A metodologia utilizada foi de abordagem qualitativa, de cunho discursivo e etnográfico. Participaram do estudo 14 usuários cadastrados no CAPS. As entrevistas foram analisadas de acordo com as categorias que emergiram a partir dos discursos e das produções de sentidos dos entrevistados quanto aos seus itinerários terapêuticos, quais sejam: trajetória assistencial; o acesso aos serviços de saúde; religiosidade e saúde mental; usuários e a busca por cuidado quando estão em sofrimento. Os itinerários terapêuticos escolhidos pelos usuários levaram em consideração aspectos concernentes ao contexto sociocultural no qual estão inseridos, utilizando-se de recursos e estratégias ligadas ao próprio acesso aos serviços de saúde da rede formal, bem como aos recursos pertinentes à religiosidade e aos aspectos relacionados ao apoio da família e dos amigos.

This paper aimed to know and understand the paths taken by users of a Psychosocial Care Centre of Pará state. The method used was qualitative, discursive and ethnographic. A total of 14 registered users were participants in this study. Interviews were analyzed according to the categories emerged from interviewed speeches and their sense of productions about therapeutic itineraries, which were: trajectory assistance care; access to health services; religiosity and mental health; users and their search for assistance when they are in distress. The therapeutic itineraries chosen by the users took in account aspects related to sociocultural context which they were involved, using the resources and strategies related to their own access in a formal health network service, as well as the relevant resources, religiosity and support offered by family and friends.

En este artículo se buscó conocer y comprender los caminos tomados por los usuarios de un Centro de Atención Psicosocial (CAPS) del Estado de Pará, en la búsqueda de cuidado. La metodología utilizada fue el enfoque cualitativo, de naturaleza discursiva y etnográfica. Los participantes del estudio fueron 14 usuarios registrados en el CAPS. Las entrevistas fueron analizadas de acuerdo a las categorías que surgieron de los discursos y de las producciones de sentidos de los usuarios en cuanto a sus itinerarios terapéuticos, los que sean: trayectoria asistencial; el acceso a los servicios de salud; religiosidad y salud mental; usuarios y la búsqueda por cuidado cuando están en sufrimiento. Los itinerarios terapéuticos elegidos por los usuarios tuvieron en cuenta aspectos relacionados con el contexto sociocultural en el que se insertan, utilizándose recursos y estrategias inherentes al propio acceso a los servicios de salud en la red formal, así como los recursos correspondientes a la religiosidad y a los aspectos relacionados con el apoyo de amigos y familiares.

Assessment of the Clinical Performance of Platelet Concentrates Treated by Pathogen Reduction Technology in Santiago de Compostela.

INTRODUCTION: This study assessed the feasibility, performance, and safety of Mirasol®-treated platelet concentrates (M-PC) stored for up to 7 days. METHODS: This prospective observational study was approved by the ethical committee of the University Clinic of Santiago de Compostela. Informed consent was asked from patients receiving M-PC. M-PCs were treated with the Mirasol system according to the manufacturer's instructions. Thrombocytopenic patients were transfused according to the Spanish transfusion guidelines. Post-transfusion platelet counts were measured at 1 h and/or 24 h after transfusion. Post-transfusion surveillance of patients was maintained during the study. RESULTS: Data from 54 evaluable patients and 135 transfusions were analyzed. The mean age of patients was 58 years. The mean age of M-PC at transfusion was 3.6 days. The mean platelet dose was 3.7 × 1011. The transfusion responses measured as mean corrected count increment 1 h after transfusion (CCI1h) and CCI24h were 9,659 and 4,751, respectively. 65% of transfusions resulted in CCI1h values ≥ 7,500. 51% of transfusions resulted in CCI24h values ≥ 4,500. CONCLUSION: The use of M-PC in the supportive treatment proved to be safe and effective for this cohort of thrombocytopenic patients.

Práticas de cuidado em saúde mental na voz dos usuários de um Centro de Atenção Psicossocial do estado do Pará / Care practices in mental health in the voice of users from a Psychosocial Care Center of the state of Pará

RESUMO Este artigo buscou analisar como as práticas de cuidado em saúde mental são percebidas pelos usuários de um Centro de Atenção Psicossocial (Caps) do estado do Pará. A metodologia utilizada foi de abordagem qualitativa, de cunho discursivo e etnográfico. Participaram do estudo 14 usuários cadastrados no Caps. As entrevistas foram analisadas de acordo com os eixos: Processo Saúde e Doença; Itinerário Terapêutico; Práticas de Cuidado em Saúde Mental; e Usuário e Autonomia. Nos discursos, o Caps foi o local em que os usuários se sentiram mais bem cuidados. Foi observada a coexistência de práticas de cuidado que corroboram os princípios da Reforma Psiquiátrica e outras que ainda reproduzem a lógica manicomial.

ABSTRACT This paper aimed to analyze how practices of care in mental health are perceived by users of a Psychosocial Care Center (Caps) of the State of Pará. The methodology used was a qualitative approach, discursive and ethnographic. 14 registered users participated in the study in Caps. The interviews were analyzed according to themes: Health and Disease Process; Route Therapeutic; Care Practices in Mental Health; User and Autonomy. In speeches, the Caps was the site where users felt better care. It was observed the coexistence of care practices that corroborate the principles of Psychiatric Reform and others that still reproduce the asylum logic.

Hemovigilance survey of pathogen-reduced blood components in the Warsaw Region in the 2009 to 2013 period.

BACKGROUND: In 2009 the Mirasol Pathogen Reduction Technology (PRT) was introduced to the routine blood component production of the Regional Blood Transfusion Center in Warsaw (RBTCW). The goal of this study was to investigate the safety of Mirasol-treated blood components. STUDY DESIGN AND METHODS: The accumulated passive hemovigilance data of Mirasol-treated blood components collected at the RBTCW are presented and compared to historical and contemporary data. Furthermore, active hemovigilance data collected from patients with different hematologic disorders transfused with Mirasol-treated or untreated blood components at the Institute of Hematology and Transfusion Medicine (IHTM) are presented and discussed. RESULTS: The adverse reaction (AR) reporting rate by hospitals to the RBTCW after the implementation of the Mirasol technology was 0.39% for Mirasol-treated platelet concentrates (M-PCs) and 0.05% for Mirasol-treated fresh-frozen plasma. When comparing contemporary rates of ARs recorded by RBTCW in the time period 2011 to 2012, no statistical difference was observed between Mirasol-treated and untreated blood components. No serious AR was attributed to Mirasol-treated components. At the IHTM a lower rate of ARs after transfusion of M-PCs was observed than with untreated PCs. Despite the fact that very large amounts of Mirasol-treated plasma have been transfused to patients with congenital or acquired thrombotic thrombocytopenic purpura, no significant increase in AR rates was observed. CONCLUSION: Treatment of blood components with the Mirasol PRT System has proven to be safe for patients and is not associated with increased rates and grades of adverse events in patients of hospitals in the Warsaw Region.