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Blood Transfusions & Infection Risk

Blood Transfusions & Infection Risk

Studies have shown that red blood cell (RBC) transfusions are commonly performed, with approximately 14 million units transfused in 2011 in the United States. RBC transfusions can modulate the immune system, which in turn may impact infection risk. One approach in blood management is to use a restrictive threshold transfusion strategy in which the hemoglobin thresholds at which RBC transfusions are indicated are lowered. “The restrictive strategy is recommended by guidelines, but only about 27% of hospitals report using them after surgery,” says Jeffrey M. Rohde, MD. In addition, only 31% of hospitals report having a blood management program in place to optimize the care of patients who might need a transfusion. A Systematic Review & Meta-Analysis Dr. Rohde and colleagues conducted a systematic review and meta-analysis of 21 randomized trials that compared restrictive and liberal RBC transfusion strategies. Published in JAMA, the article evaluated whether RBC transfusion thresholds were associated with risk of infection and whether these risks were independent of leukocyte reduction. The study included more than 8,700 patients who met eligibility criteria. All healthcare-associated infections reported after receiving donor blood in randomized trials were evaluated, including serious infections like pneumonia and bloodstream and wound infections. According to the results, a restrictive RBC transfusion strategy reduced the risk of healthcare-associated infections when compared with a liberal transfusion strategy. “The more RBCs that patients received, the greater their risk was for infection,” says Dr. Rohde. “The fewer the RBC transfusions, the less likely hospitalized patients were to develop infections.” He adds that these findings were most likely due to transfusion-associated immunomodulation. Overall, for every 38 hospitalized patients considered...
Optimizing Patient Health Before Surgery

Optimizing Patient Health Before Surgery

Throughout the United States, there has been a call to action to improve the quality and safety of surgical care while decreasing costs. In the state of Washington, clinicians have taken a unique approach to surgical quality improvement (QI) with the Strong for Surgery initiative. “Strong for Surgery is a physician-led initiative that identifies and evaluates evidence-based practices to optimize patient health prior to their surgery,” explains Thomas K. Varghese Jr., MD, MS. “We’re working with stakeholders from across the state to raise awareness of key factors in preoperative care that can improve postoperative outcomes.” A Unique Collaborative In 2006, the Surgical Care and Outcomes Assessment Program (SCOAP) was initiated as a peer-to-peer collaborative among hospitals in Washington. SCOAP is a grassroots, voluntary, clinician-led collaborative that includes doctors, statewide insurers, policymakers, and professional organizations of nurses, physicians, nurse anesthetists, and hospitals as well as the Washington state chapter of the American College of Surgeons. Hospitals participate in SCOAP by submitting detailed clinical information about patients undergoing surgical and interventional procedures at their sites. In return, hospitals receive reports that benchmark their performance in care delivery and outcomes. With SCOAP, data are linked from multiple sources (eg, medical records, payers, and surveys) to help participating hospitals assess the longer-term impact of care and complications on patients and the healthcare system. The program includes a set of interventions for standardization—tools like checklists, order sets, and training—to drive performance improvement and clinician education. “SCOAP engages surgeons to determine the processes-of-care metrics that go into an ideal operation,” explains Dr. Varghese. “It tracks risk-adjusted outcomes that are specific to a given operation and...
Med School Debt & Resident Salary

Med School Debt & Resident Salary

Medscape’s Residents Salary & Debt Report 2014 was just released this week, surveying over 1,200 medical residents across more than 25 specialty residency programs. The survey focused on medical residents’ salary, debt, and overall experiences in residency. Survey results found that the average resident salary was $55,300. Other highlights from the report are as follows: * Average salaries were highest in the Northwest (71k); lowest in the Southeast (50k) * Residents in critical care received the highest salary at 65k * Family Medicine residents received the lowest salary at 52k * Average salaries increased from 51k the first year to 60k after the fifth year * Men and women made an average of 56k and 54k, respectively * Only 48% of men feel fairly compensated, compared to 57% of women * 58% of residents owe over $100,000 of medical school debt after 5 years in * 36% of residents owe more than $200,000 * The majority of residents (77%) felt that the hours worked are sufficient for training Results of the Medscape survey follow closely with the Association of American Medical Colleges’ recent statistics of the indebted graduates, class of 2013, in their Medical Student Education: Debt, Costs, and Loan Repayment Fact Card. According to the AAMC, the mean debt for residents attending a public institution was 162k, and the mean debt was 181k for a private institution. The AAMC reports that 79% of graduates owe over 100k, while 40% owe over 200k. In May, the New England Journal of Medicine reported that in inflation-adjusted terms, compensation has been essentially unchanged for 40 years. And according to a recent...
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