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Introducing a blood conservation coordinator

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HHS blood conservation coordinator Christa Chernesky checks a patient’s blood pressure. Chernesky’s role involves trying to reduce the number of hospital blood transfusions during and after surgery, and conserving donated blood.

Christa Chernesky is on a mission to tell people about her role as Hamilton Health Sciences (HHS)’ blood conservation coordinator.

Just like it sounds, her goal is to try and reduce the number of hospital blood transfusions during and after surgery, and conserve donated blood as a precious resource.

“Staff and patient education is a big part of my focus,” says the registered nurse based at HHS’ West End Clinic/Urgent Care Centre. Her position as the hospital’s blood conservation coordinator is funded through the province’s Ontario Transfusion Coordinators (ONTraC) program.

“It’s really about optimizing the patient’s own blood so that a transfusion isn’t required.”

The program’s goal is to identify patients with anemia (caused by low iron levels) before surgery and treat them with iron supplements so they won’t need a transfusion of donated blood during or after surgery. At HHS, the focus is on cardiac patients who are booked for major planned surgeries. Chernesky is currently working to expand the program to all HHS sites, starting with Juravinski Hospital for certain cancer patients.

“Cardiac and oncology departments are among our largest users of blood products during surgery,” she says.

Preventing anemia to save blood products

Chernesky works with doctors and nurses to identify patients who may be anemic, and offers these patients further testing and the opportunity to take oral iron supplements, or in some cases intravenous infusions, to bolster their iron levels before surgery.

Head and shoulders photo of Christa Chernesky, HHS blood conservation coordinator.

Christa Chernesky, HHS blood conservation coordinator

“It’s really about optimizing the patient’s own blood so that a transfusion isn’t required,” says Chernesky. “This would help reduce blood transfusions and save donated blood for patients who need it most, such as trauma patients arriving at the emergency department.”

HHS is one of 23 Ontario hospitals with a staff member in this role. These hospitals represent about 70 per cent of blood used provincially.

While the ONTraC program has been around for 20 years, it’s not well-known, says Chernesky, who took on the coordinator’s position in June after 14 years of nursing at HHS.

“When I told my colleagues about my new job, many didn’t even realize this position existed,” says Chernesky.  “I’m hoping to change that by promoting the ONTraC program to staff, physicians and patients with the goal of expanding it as a best practice.”

Blood conservation is an evidence-based approach to transfusion medicine, meaning that it’s based on scientific evidence. It’s endorsed by the World Health Organization and represents an international initiative and best practice in promoting bloodless medicine.

“Blood is basically a liquid organ, and while transfusions using donated blood are generally considered safe, there are some risks.”

Chernesky works with other health-care professionals including blood transfusion team members, doctors and nurses to promote alternatives for certain surgical patients. These patients are at higher risk of needing a blood transfusion during or after their operation, mostly because their anemia went undiagnosed or untreated.

What is anemia?

Anemia is a late sign of iron deficiency, and leaves people feeling tired, having heart palpitations and being short of breath. Anemia happens when a person doesn’t have enough red blood cells, which carry oxygen from the lungs to tissues and cells. The body needs oxygen in order to survive, so having anemia increases the risk of needing a blood transfusion during or after surgery.

Bags of Blood hanging in bags in the hospital

“In order to protect your brain, heart and organs, you’ll need more oxygen so the surgical team will need to transfuse you if your blood cells aren’t carrying enough to start off with,” says Chernesky, who predicts more cases of anemia as the cost of living and food continues to rise.

Fewer blood donations available

“Blood is basically a liquid organ, and while transfusions using donated blood are generally considered safe, there are some risks,” says Chernesky. “About one in 100 people will have a mild reaction such as a rash or fever. About one in 1,000 will have a more serious reaction that could be life-threatening.”

Reducing the number of transfusions helps manage blood supply shortages, especially with the pandemic when fewer people are donating, says Chernesky, who would eventually like to see an organized screening program in place to test all surgical patients for anemia.

“It would be better for patients, surgical teams and the health-care system too,” she says. “While implementing a screening program would be costly, there are much greater costs involved with blood transfusions including longer hospital stays, greater risk of infection, and increased mortality.”

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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