NCBI (PubMed) toolbar

The NCBI (includes PubMed) has a toolbar (in beta testing) for use with either Internet Explorer or Mozilla Firefox.

If you use Google's toolbar, the NCBI toolbar is similar. Instead of choosing to search the web, news, images, etc., (as in Google), the NCBI toobar allows you to select from several databases (PubMed, gene, nucleotide, all). As in Google, you can also highlight your search terms.

Read more and download here:
www.ncbi.nlm.nih.gov/projects/toolbar/

Cheers, Pat

What's New on TraQ

Automatic e-mail updates on PubMed

PubMed now offers automatic e-mail updates in conjunction with saved searches, which are now called "My NCBI" (formerly"cubby"). NCBI is the National Center for Biotechnology Information at the US National Library of Medicine.

The e-mail updates automatically notify you when new papers are published with your search criteria and can be scheduled for various periods (daily, weekly, monthly). It's a nice feature for monitoring the latest literature. You can also log-in and run your saved searches at any time.

Get your free account here:
www.ncbi.nlm.nih.gov/entrez

Cheers, Pat

What's New on TraQ

Implementing new blood safety regulations in the UK

In the UK the NHS Operational Impact Group (OIG) has released its final report on implications of the new regulations on transfusion services, including financial implications. It's fascinating and it's now on TraQ.

For example, they have decided that some activities currently done by hospital transfusion labs might be classified as "processing" under the new regulations and therefore can only be carried out by licensed "Blood Establishments" (blood suppliers - their National Blood Service) after 8 Nov. 2005. Processing includes pooling cryoprecipitate, irradiating components, splitting components, and washing red cells.

The result is that either hospital transfusion services will need to get licensed (like the blood supplier) or else the NBS has to do all the processing for them. There are also other implication for traceability, quality systems, training, and hemovigilance.

TraQ has been following events in the UK related to implementing the EU blood directive because Canada is in a somewhat similar situation. The main difference is that the Canadian standard that affects transfusion services (CSA Standard Z902-04) is not yet regulation. The Canadian Society for Transfusion Medicine (CSTM) has also revised its standards for hospital transfusion services to provide a user friendly equivalent of the CSA standards.

Resources:

• TraQ's backgrounder on the EU directive

• UK OIG report
  
  

• Backgrounder on Canadian standard (CSA Z902-04) (pdf)
  

Cheers, Pat

What's New on TraQ

Usurpation of identity (more...)

Here's another example sent by a colleague in BC, Canada (names are changed):

We had a patient a few weeks ago who got into a fight while out with friends at a bar. He was brought into Emergency and crossmatched under
“Fred Flintstone”. He did not have a historical record so no one was the wiser.His friends even called him “Fred”. Who was to know?

Well,the police were notified and came to the hospital to investigate....Ooops! As he was about to go into the OR, a police officer recognized him as “Barney Rubble”. He was using a friend’s ID because he was well known to them and under house arrest!

All specimens were discarded, redrawn and retested. The record under the original name was expunged.

Cheers, Pat

What's New on TraQ

Dr. Jack Bowman (In Memoriam)

Updated: 19 Mar. 2014 (Revised broken links)

Dr. Jack Bowman, AABB Karl Landsteiner Memorial Award recipient, 2001, a transfusion medicine pioneer, and one of the world's leading experts in treating and preventing hemolytic disease of the newborn, died on May 22:

• John Maxwell Bowman (May 24, 1925 - May 22, 2005)

I was privileged to work with Dr. Bowman at the Canadian Red Cross BTS in Winnipeg from 1967 to 1977, after I joined the organization as a child prodigy <;-)

• Dr. B was group O Rh negative and often would donate his own blood for exchange or intrauterine transfusions (IUTs) when we were out of fresh O negs on the weekends

• His twin brother Bill wore a bow tie, making it easy to differentiate "bow tie Bill" from Dr. B

• Seeing him literally scurry about the donor room as he managed the plasmapheresis sessions of his "Rh ladies" who donated their anti-D for the production of Rh immune globulin. All of these women had had at least one baby die from HDN and at least one saved by an IUT managed by Dr. B. Their respect and affection for him was obvious to all.

• Getting the chance to work on many of Dr. B's projects, including monitoring anti-D production in Rh negative women who volunteered for the clinical trial of prenatal Rh immune globulin at 28 weeks gestation; monitoring the antibody titres of the women who donated anti-D for Rh immune globulin and were boosted periodically with D+ red cells; working as a go-fer during plasmapheresis of the "Rh ladies"

• Getting to donate anti-B (being group A) via plasmapheresis and experiencing the 5-minute transfusion of my cold autologous red cells

• Once when I came to Dr. B about a patient with a difficult serologic problem, he looked at me and said, "You tell me, Pat. You're the expert." As someone who believes that we recall life mainly as a series of short encounters, this is one of my defining moments. It was the first time that someone in a position of professional authority had told me that my knowledge and experience had value. Simple, but all too rare.

• Dr. B was the prototype of the busy professional who had far too much to do - university professor, medical director of a combined blood centre and transfusion service, director of another major laboratory (the "Rh Laboratory" pioneered by Bruce Chown and Marion Lewis), director of the Rh Institute, a pharmaceutical plant that developed intravenous Rh immune globulin (Win Rho), clinician who treated fetuses and newborns with HDN, husband and father.

Yet he was also the type of man who, years after I left the Red Cross, an organization with many technologists and nurses since it was not only the province's sole blood centre but also the transfusion service for all of Winnipeg, would never fail to recognize me at conferences and find time for a chat that showed he remembered.

Besides the many mothers and children affected by his work, Dr. B will be missed by everyone who had the good fortune to work with him. He was a "oner" - an all round good guy and true giant in transfusion medicine, a pioneer who played a key role in one of our greatest success stories, the prevention of Rh hemolytic disease of the newborn

I encourage you to add a comment below.

Finding free full text articles in PubMed

PubMed Central provides access to journals that provide free full text articles but did you know that a better way to get free full text articles is by using PubMed's "Search Field Descriptions and Tags"?

Enter search terms as usual in PubMed
and add (exactly as shown): AND Free Full Text [Filter]

Try this search:
transfusion AND platelets AND 2004:2005[dp] AND English[la] AND Free Full Text [Filter]

For more search tips and resources, see my personal search page:
www.ualberta.ca/~pletendr/search.html

What's New on TraQ

Usurpation of identity

A recent letter to the editor in Transfusion caught my eye:
Zimmermann R, J, Weisbach V, Eckstein R. ABO discrepancy by usurpation of identity Transfusion 2005 Mar; 45(3):454.

Over the years I have seen 2 cases of usurpation of identity, both while working in the centralized transfusion service of the Canadian Red Cross (now Canadian Blood Services) in Winnipeg, Canada. For U.S. readers, Winnipeg's blood system is similar to that of the Puget Sound Blood Center - a combined blood center/transfusion service, with a centralized crossmatch facility serving the city of Winnipeg and smaller sites across the province.

In one case, an unconscious young man was admitted to the emergency department of a local hospital following a car accident. A blood group done on his current sample was different than the historical record. It turned out that he was carrying his friend's identity card in order to meet the legal age of drinking alcohol.

The second case involved a young women who was having a therapeutic abortion. Similarly, her current blood group differed from her historical record. Once questioned, she admitted to passing herself off as her friend, to the point of deceiving a physician. The reason for the deception was social, not financial, since Canada, like most of the developed world, has universal healthcare.

In both instances, the discrepancy would not have been caught were it not for the record. No harm would have come to the perpetrators since they would have received blood of the correct groups, based on their current typing results. In the future, however, such deception might have consequences for their friends, should they ever require blood products based on historical records alone.

In the USA where many people lack health insurance, such deception may be more widespread.

Regardless, although records play a major role in preventing misidentification, both cases illustrate the importance of not relying on records.

If you have first-hand knowledge of similar cases of identity theft in patients requiring transfusion, please e-mail me. Many thanks!

Cheers, Pat

What's New on TraQ

"Who's who" in Transfusion Medicine- Mike Murphy

Thought it would be fun to do some blogs on "Who's who" in transfusion medicine, especially those involved in hot topics.

A current hot topic is use of mistake-proofing tools such as electronic blood transfusion systems using bar codes or RFID. One of the recent TraQ case studies includes a section on mistake-proofing technology:

See TraQ Case O-2

One of the experts actively involved in new technology is Dr. Mike Murphy from John Radcliffe Hospital and the University of Oxford:

Profile of Mike Murphy (BloodMed.com)

John Radcliffe develops e-prescribing for blood

Some key papers:

Barcode identification for transfusion safety (Curr Opin Hematol 2004 Sep;11(5):334-8)

Barcode technology: its role in increasing the safety of blood transfusion (Transfusion 2003 Sep;43(9):1200-9)

Patient safety and blood transfusion: new solutions (Transfus Med Rev 2003 Jul;17(3):169-80)

What's New on TraQ

Cheers, Pat

Access change at BMJ

February 2005 marks a transition at the British Medical Journal (BMJ).

Original research articles remain free but the full text of other articles (e.g., editorials and reviews) are free only for the first week after publication and then under access controls for the next 51 weeks, after which all content will once again be free.

Since editorials and reviews are important sources of topic overviews, I recommend that users subscribe to the weekly alerts for the BMJ table of contents.

Then be sure to access the editorials and reviews within one week. <;-)

• Tip: "Save as" (under FILE menu): Save reviews and editorials to your desktop as web pages (.htm or .html files) for reading later at your leisure.

What's New on TraQ

Tsunami victims & Rh negative rbc

Because I've always been interested in racial and ehtnic differences in blood groups, this news item from Thailand caught my eye:
Rh negative blood needed in Thailand to treat western tsunami victims

The frequency of the Rh(D) antigen in Caucasians in N.A and Europe is ~85% but has a frequency in parts of Asia approroaching 100%. It makes sense that western tourists requiring transfusion need other westerners to donate.

See all transfuson-related tsunami news on TraQ

What's New on TraQ

Ongoing controversy at South African National Blood Service

The controversy in South Africa that began over a racial profiling policy that accepted blood from black donors then destroyed it is multi-faceted. See TraQ's international news section.

After the policy was exposed, the South African National Blood Service (SANBS) said that its risk management program was flawed because it relied heavily on race as a risk factor and that the risk model would be revised. SANBS also apologized to President Mbeki whose blood was discarded.

Subsequently, the organization was accused of sexual discrimination because it classifies donors who admitted to man-to-man sex as high risk, despite the statistics that in SA heterosexual women aged 18 to 24 are at high risk for HIV infections.

The latest issue is that SANBS has had to defend its policy of selling donated blood, explaining that they do not charge for blood per se, but rather for services rendered in the procurement, collection, testing, processing,and issuing of blood.

Despite the controversies, it is likely that SANBS will be chosen as South Africa's new national blood transfusion service.

What's New on TraQ

Comprehensive review of Google Scholar

Must-read review of Google Scholar is found at Peter's Digital Reference Shelf -
If you were thinking of using Scholar to find papers, this comprehensive critique tells all you need to know.

What's New on TraQ

Limitations of Google Scholar

Limitations of Google Scholar (still in beta testing) are beginning to appear. For example:

• Google Scholar documentation (Search Engine Watch)
• Google Scholarly (Free Pint)

Main messages are that documentation is lacking on what's in the database (not always "scholarly") and that students may bypass established databases containing peer reviewed papers.

What's New on TraQ

Google Scholar

Google has launched Google Scholar, a new search engine for researchers aimed at increasing public access to academic material such as published papers, theses, technical reports, and books.

I particularly like the "cited by" feature, which provides links to other papers that have cited the original (at least the ones in Scholar's database). This type of citation analysis is an innovative variation of PubMed's invaluable "related articles" feature.

Sample Searches. Got to http://scholar.google.com and enter:

Ex. 1. Heddle transfusion

Ex. 2. predictive value transfusion

Ex. 3. root cause analysis transfusion

For more information see

• Google Scholar FAQs
• Biomed Central welcomes launch of Google Scholar
• Search Engine Watch's review
• Google Scholar is born

What's new on TraQ

TraQ has been following the UK's response to the EU Blood Directive, which extends regulation of the blood system from blood suppliers to hospital blood banks. This is similar to the situation in Canada, in which CSA Z902-04 Standards will eventually become government regulations that impact hospital transfusion services.

• See CSA Standards Z902-04:Implications and Issues

The UK Dept. of Health has now called for Public consultation on The Blood Safety and Quality Regulations 2005

Although the EU Directive does not specifically require accreditation, licensing or inspection of hospital blood banks, it does make them subject to several articles, including those concerning

• PersonnelQuality Management
• Quality system and DocumentationHaemovigilance - Traceability & Notification of serious adverse events and reactions
• Quality and Safety of Blood and Blood Components - Storage, transport and distribution conditions
• Data protection and confidentiality

In Canada, we do not yet know which Z902-04 clauses will become government regulations but it will be interesting see how closely they mirror the EU Directive approach. For more information, see TraQ's backgrounder on the EU Directive

What's new on TraQ

International Woman in Transfusion Award

In 2004 three of the major transfusion medicine organizations in the world were led by women. To honour the occasion the organizations (AABB, BBTS, and ISBT) created the International Woman in Transfusion Award

It's not surprising that a year would come when women headed several major TM organizations as women are incredibly active in transfusion medicine. I encourage everyone to consider nominating one of your colleages for this new award.

As to the 3 presidents - I'm tempted to say "3 amigos"....

- see brief profiles on

• AABB President Kathleen Sazama, MD, JD (Source: Society for the Advancement of Blood Management )


• BBTS President Judith Chapman, FIBMS, MBA
  (Source: UK Blood Stocks Management Scheme)


• ISBT President Francine Décary, MD, PhD, MBA(Source: University of Sherbrooke)

What's new on TraQ

Transfusion medicine forums and mailing lists

One of the things people tell me about the Internet is how difficult it is to keep up with all the resources that are available. This applies to a new resource just added to TraQ's Resource Library:

• Transfusion medicine forums & mailing lists

On the plus side, it's great to have multiple sources of information and places to ask questions. On the downside, searching in multiple places takes time and any information found must be carefully evaluated for validity and relevance.

A rule of thumb is that moderated lists have higher quality information, which would place the CBBS e-network Forum moderated by Ira Shulman, MD at the top of the pecking order in the TraQ list. Indeed, the entire CBBS website maintained by webmasters J. Lawrence Naiman, MD and Eileen A. Selogie, MT (ASCP) SBB) is a class act!

What's new on TraQ

Québec eliminates upper age limit for donors

You know the population is aging when they want your blood until you drop! On 31 October 2004 Héma-Québec (the blood supplier in the Canadian province of Québec) will eliminate the upper age limit for donors.

There are several safety criteria involving approval from the donor's physician but it seems that so long as "the bod is warm" and you are in good health, you can now be a life-long blood donor.

A few statisics to ponder:

• According to Statistics Canada, in 2004 ~5.6 million (17.7%) of Canada's total population of 32 million are over 60.
• In Canada only 3.7 % of eligible people are blood donors. By comparison, 6% of Britains donate blood; in the USA, Ireland and Japan, the figure is ~5%, while in Taiwan, it's 7.5 % - nearly double the total in Canada.
  

With demographics like these we definitely need our oldsters - tried and true donors with multiple donations to their credit, to continue to give, and give, and give.....

Resources:

• CBS press release (June 2004): Less than four out of every 100 eligible Canadians donate blood each year
• Statistics Canada: Population by age & sex

What's new on TraQ

vCJD found in frequent donor in France

Now that vCJD has been found in a frequent blood donor in France, it will be interesting to see if French officials follow the lead of the UK who notified 1000s of donors in September that they may be at increased risk of carrying vCJD. The donor's blood was transfused to 10 recipients but was also used to make unspecified "medicines" - enough for several 1000 people.

See TraQ's vCJD clearinghouse

New on TraQ

Readers beware

Two articles added today to TraQ's International News section present different "takes" on the same session held at a major transfusion medicine conference in Australia.The first article from The Age is titled Safety call on hospital blood use and begins, "Doctors yesterday called for identity wristbands for all blood transfusion patients to protect against the potentially fatal consequences of receiving the wrong blood type." The second article from the Sydney Morning Herald (Hospitals ignoring blood label rules) begins, "Blood transfusion protocols are being shunned in some hospitals, posing a potentially fatal threat to patient health, a conference has heard."

From what was reported in the articles, Dr. Lorna Wilkinson discussed the UK SHOT scheme. Chris Hogan (an Australian hematologist) and Neil Boyce (of the Australian Red Cross Blood Service) spoke on efforts in Australia to improve processes and develop a reporting scheme such as SHOT. All speakers noted the rare but potentially fatal consequences of identification errors.

From my perspective, The Age news report presents a more balanced view than the Sydney Morning Herald report does. The latter's headline (Hospitals ignoring blood label rules) sets the tone for the article and is misleading.

* Joint Annual Meeting of the Australia and New Zealand Society of Blood Transfusion, Hematology Society of Australia, and the Australian Society of Thrombosis and Haemostasis (17-24 October, Melbourne)

What's new on TraQ