Search

Evidence-based medicine is considered 1 of the 15 great inventions in medicine. It aims to remove bias in medical decision-making as much as possible through a rigorous process. In this article, the principles of evidence-based medicine are illustrated using the case of patient blood management (PBM). Acute or chronic bleeding, iron deficiency, and renal and oncological diseases may lead to preoperative anemia. To compensate for severe and life-threatening blood loss during surgery, doctors transfuse red blood cells (RBCs). PBM is an approach to take care of patients at risk for anemia, which includes detecting and treating anemia before surgery. Alternative interventions to treat preoperative anemia are the use of iron supplementation with or without erythro-stimulating agents (ESAs). The best available scientific evidence today indicates that preoperative intravenous (IV) or oral iron monotherapy may not be effective to reduce RBC utilization (low-certainty evidence). Preoperative IV iron supplementation in addition to ESAs is probably effective to reduce RBC utilization (moderate-certainty evidence), whereas oral iron supplementation in addition to ESAs may be effective to reduce RBC utilization (low-certainty evidence). The adverse events of preoperative oral/IV iron and/or ESAs and their impact on patient-important outcomes (morbidity, mortality, quality of life) remain unclear (very low-certainty evidence). Since PBM is a patient-centered approach, emphasis on monitoring and evaluation of patient-important outcomes in future research is urgently needed. Finally, the cost-effectiveness of preoperative oral/IV iron monotherapy is unproven, whereas preoperative oral/IV iron in addition to ESAs is extremely cost-ineffective. ispartof: HAMOSTASEOLOGIE vol:43 issue:01 pages:16-21 ispartof: location:Germany status: published

Background: Family and friends are particularly well placed to recognize early signs of mental health problems, provide initial support, and refer to professional help if needed. This project aimed to develop evidence-based guidance materials for laypeople on how to provide help to people experiencing mental health problems, adapted to the context of Flanders, Belgium. Methods: We performed a systematic literature review for 12 different mental health topics, focusing on communicative support interventions feasible to be performed by laypeople. Systematic literature searches were conducted in MEDLINE, Embase, and PsycNET (October 2018). One reviewer per topic conducted data extraction and methodological quality assessment using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The evidence was used to develop a draft manual, which was presented to a multidisciplinary expert panel involving both content experts (n = 10) and mental health peer workers in training (all people with lived experience) (n = 6). Results: Included studies involved 15 experimental and 75 observational studies, leading to 58 evidence conclusions on communicative interventions, risk factors or protective factors, and their relationship to mental health outcomes. The certainty of the evidence was very low for the majority of the evidence conclusions (84.5%), highlighting the need for expert and stakeholder input to inform practical recommendations. Scientific evidence and expert input were used to formulate 33 individual actions on how to provide first aid to people experiencing mental health problems. The recommendations were made available to laypeople via a guidance manual and a mobile application. Conclusions: Input from the scientific literature and the expert panel were essential to obtain evidence-based guidance materials that were meaningful for practice in a Flemish context., International Journal of First Aid Education, Vol. 6 No. 1 (2023)

Background: Many Sub-Saharan African countries lack effective emergency medical services. In response, Red Cross and Red Crescent National Societies, amongst other organizations implement first responder training programs across Africa. The current paper describes the development of an advanced manual for first responders (FAFR) in Sub-Saharan Africa. Methods: This FAFR manual was developed according to the principles of Evidence-Based Practice accounting for scientific evidence, expert opinion, and preferences of the target audience (i.e., Sub-Saharan African first responders). The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the certainty of evidence. A geographically balanced expert panel of African field and academic experts set the scope and defined the research questions. The best available evidence was systematically collected and presented to independent and dedicated content writers, drafting the manual. The expert panel discussed these draft recommendations during a two-day meeting and validated the final version of the manual. Results: The systematic literature addressed 87 research questions. Of these, 52 could be supported by scientific evidence, in thirteen cases by a Cochrane systematic review. We determined the GRADE certainty of the evidence as low (38%) or very low (53%). Where no evidence was found, good practice points were formulated based on expert opinion. Conclusions: The FAFR manual is used by Red Cross and Red Crescent National Societies across Africa and will be updated every five years by the Belgian Red Cross. The manual is freely available to anyone interested (https://www.rodekruis.be/en/what-do-we-do/first-aid-and-support/first-aid-for-first-responders/)., International Journal of First Aid Education, Vol. 6 No. 1 (2023)

Additional file 1: Supplementary file 1. Databases search strategy.

Additional file 3: Appendix B. Summary of low quality CPGs excluded.

IntroductionHIV prevalence and sexual risk have been estimated very high for transgender people. However, the limited sampling and data collection methods used in current research on transgender people potentially led to overrepresentation and generalisation of people at risk for HIV. Current HIV prevalence estimates in transgender populations are generalised from studies mainly focusing on transgender women engaging in sex work. Moreover, studies focusing on non-binary people, who identify with a broad range of identities beyond the traditional male and female gender identities, are scarce. ObjectivesTo estimate the HIV prevalence rate in the Flemish and Brussels (Belgium) transgender population, including transgender women, transgender men and non-binary people, and to identify the associated risk factors. MethodsIn this community-based cross-sectional study, self-identified transgender and non-binary (TGNB) people will be recruited through a two-stage time-location sampling approach. First, community settings in which TGNB people gather will be mapped to develop an accurate sampling frame. Secondly, a multistage sampling design is applied involving a stratification based on setting type (healthcare facilities vs outreach events), a selection of clusters by systematic sampling and a simple random selection of TGNB people within each cluster. Participants will complete an electronic self-reported survey to measure sociological, sexual and drug-using behaviors (risk factors) and oral fluid aliquots will be collected and tested for HIV antibodies. Logistic regression models will be used to evaluate risk factors independently associated with HIV infection. The presented study is registered at ClinicalTrials.gov (NCT04930614). DiscussionThis study will be the first to investigate the HIV prevalence rates and associated risk behaviors in an accurate representation of the TGNB population in a Western European country. The findings will globally serve as a knowledge base for identifying subgroups at risk for becoming infected with HIV within TGNB people and to set up targeted prevention programs. This work was made possible through funding from the Foundation for Scientific Research of the Belgian Red Cross (Mechelen, Belgium), the Institute for the Equality of Women and Men (Brussels, Belgium), University Fund Ghent University (Ghent, Belgium) and Gilead Sciences (Diegem, Belgium; Grant number: BE-2021-0049). The funding body had and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Additional file 2.

Additional file 1. Completed PRISMA harms checklist.

Additional file 4.

Additional file 3.

Additional file 5.

Additional file 1.

Additional file 6.

This is the first Cochrane Corner in the International Journal of First Aid Education, provided by Cochrane First Aid. It summarizes the findings of a Cochrane systematic review that compares the effectiveness of continuous versus interrupted chest compression cardiopulmonary resuscitation (CPR) in case of non-asphyxial out-of-hospital cardiac arrest. The review was developed by the Cochrane Emergency and Critical Care Group and is published in the Cochrane Database of Systematic Reviews 2017, Issue 3, DOI: 10.1002/14651858.CD0010134 (see www.cochranelibrary.com for information)., International Journal of First Aid Education, Vol. 4 No. 1 (2021)

Additional file 4. Summary of findings.

Additional file 2. Search strategies.

Additional file 1. PRISMA checklist.

Additional file 6. Risk of bias assessment and summary.

Additional file 3. Detailed study characteristics.

Additional file 5. Cluster information.

Background: First aid is the immediate help provided to the ill or injured. Although it can be lifesaving, many people refrain from helping when encountering a person in need. This study aimed to describe the types of accidents people are most likely to encounter in daily life and to assess the association between several variables, including having received first aid training and helping behavior. Methods: An online survey was distributed from December 2016 to February 2017. The factors affecting provision of first aid and calling of emergency services were analyzed using multivariable logistic regression. Results: More than half of the 59,477 respondents (51.9%) stated that they had encountered an accident in the past five years. A total of 59,110 accidents were reported. First aid was provided in 70.2% of accidents and emergency services were called in 72.0% of accidents. Age, gender, WHO region, type of accident and environment of the accident were all significantly associated with providing first aid and calling emergency services. People who were trained in first aid were more likely to provide first aid or to call for emergency services than untrained people (p, International Journal of First Aid Education, Vol. 3 No. 2 (2020)

ispartof: VOX SANGUINIS vol:114 issue:6 pages:633-634 ispartof: location:England status: published

Aims To summarize the best available evidence on the effectiveness of physical counterpressure manoeuvers (PCM) for vasovagal syncope management compared to a control intervention. Control interventions included either a PCM, no intervention, or other interventions feasible in a lay setting. Methods A systematic literature search (March 21 st 2018) was performed in the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase. PCM were subdivided into 1) PCM decreasing orthostatic load (PCMOL), 2) PCM shortening the hydrostatic column between heart and brain (PCMHC), 3) PCM using mechanical compression of the veins (PCMMC). The primary outcome was syncope, secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR). When possible, a random effects meta-analysis was performed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for dichotomous outcomes, and mean differences (MD) or standardized mean differences (SMD) were calculated for continuous outcomes. Heterogeneity was assessed by means of the I-2 statistic. The total body of evidence was evaluated by means of the GRADE methodology. Results Eleven trials involving 688 people with vasovagal syncope were included. Risk of bias was high in all included studies. The total body of evidence (GRADE) was considered to be low or very low. PCM were found to improve syncope as compared to control (OR: 0.52, 95% CI [0.33; 0.81], p = 0.004). Similarly, before-and-after studies without a control group showed a significant reduction in syncope following PCM (OR: 0.01, 95% CI [0.00; 0.01], p

BACKGROUND: Blood transfusions save lives, but carry the risk of causing transfusion-transmitted diseases. This risk is limited by strict donor selection criteria, the most controversial being the exclusion of men who had sex with men (MSM). This cross-sectional study investigated knowledge and beliefs of the general public concerning donor exclusion criteria, with emphasis on MSM. MATERIALS AND METHODS: A representative sample of the population of Flanders, Belgium was questioned using a web-based questionnaire. The effect of additional information on people's opinions was tested. RESULTS: People were less aware of the exclusion of MSM than of other risk populations, e.g. prostitutes. Correspondingly, they were more willing to accept blood from MSM than from other risk populations. MSM were also considered appropriate donors. Interestingly, prior knowledge about the exclusion of MSM appeared to be the strongest predictor for not accepting blood from MSM or a more stringent attitude on MSM exclusion. Receiving information on reasons for exclusion shifted opinions towards more stringency. Nevertheless, most people think that exceptions for MSM should be made under certain circumstances. This study identified several demographic factors associated with opinions concerning the exclusion of MSM for blood donation and the potential to change opinions after receiving information, e.g. age or socio-economic status. DISCUSSION: Blood collecting services can gain understanding from the general public about their exclusion policies by providing clear information. Communication efforts targeting specific audiences in function of their knowledge and likeliness to change their opinion, might improve the effectiveness of information campaigns. ispartof: BLOOD TRANSFUSION vol:16 issue:6 pages:475-482 ispartof: location:Italy status: published

ispartof: TRANSFUSION vol:58 issue:4 pages:1081-1082 ispartof: location:United States status: published

BACKGROUND: The purpose of a donor medical questionnaire is to identify the blood donor's history relative to the current known blood-safety risks. A temporary deferral from blood donation after an endoscopic examination is enforced because of the reusable nature of the endoscope and close contact with the inner body. The objective of this systematic review was to find the best available evidence on the association between an endoscopic examination and the risk of transfusion-transmissible infections. METHODS: Studies from five databases investigating the link between an endoscopic examination and transfusion-transmissible infections (hepatitis B virus, hepatitis C virus, human immunodeficiency virus infection, Treponema pallidum) were retained and assessed independently by two reviewers. The association between endoscopy and transfusion-transmissible infections was identified by conducting meta-analyses and calculating pooled effect measures (odds ratios and 95% confidence intervals). The Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to assess the quality of evidence. RESULTS: We identified 7571 references and finally included 29 observational studies. A significant association between an endoscopic examination and hepatitis B virus infection (pooled odds ratio [OR], 2.21; 95% confidence interval [CI], 1.26-3.86; p = 0.005) or hepatitis C virus infection (pooled OR 1.76, 95% CI, 1.45-2.14; p

A call for a revolutionary approach that puts first aid education at the intersection of public health and medical response, interprofessionally., International Journal of First Aid Education, Vol. 1 No. 1 (2017)

ispartof: pages:1-506 status: Published online

Vere Borra,1 Giovani Vandewalle,1 Hans Van Remoortel,1 Veerle Compernolle,1,2 Emmy De Buck,1 Philippe Vandekerckhove1–31Belgian Red Cross-Flanders, Mechelen, 2Faculty of Medicine, University of Ghent, Ghent, 3Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, BelgiumAbstract: Donor selection remains an important part in the safety of the blood supply all over the world. Yet, donor deferral criteria seem to be strongly based on the precautionary principle protecting safety and quality, and on supply and expense considerations. This review therefore provides an overview of the available evidence on donor exclusion criteria, as well as on their cost-effectiveness, for the most frequent reasons of donor deferral in our region. PubMed was queried to retrieve primary research studies, systematic reviews, and health technology assessments (HTAs) concerning donor exclusion criteria. With a similar approach, HTAs about the different blood-banking safety interventions were included. Reasons for donor deferral were recorded via the blood bank information system of the Belgian Red Cross-Flanders. Seven systematic reviews were identified: four on donor safety (hypotension, hypertension/type 2 diabetes, epilepsy, and higher age) and three on recipient safety (hemochromatosis, men who have sex with men, and endoscopy). Forty-three low-quality observational studies were included, as well as 16 HTAs: three about donor exclusion criteria and 13 cost-utility analyses about blood-banking safety interventions. In general, the available evidence for deferral reasons was of low quality, and for 60% of the top 30 reasons for excluding donors, no evidence was found. Blood banking shows its unique position as many safety measures far exceed the normally accepted cost of €50,000/quality-adjusted life-years. The historical model based on the precautionary principle and on supply and expense considerations provides adequate supplies of safe blood at a reasonable price. More and better primary research and evidence-based analyses are required, however, before this model can be replaced by an evidence-based approach. Meanwhile, policy makers should provide guidance at the level of principles, not at the level of technical measures, about the balance between patient and donor rights, and about the acceptable cost-effectiveness implications of these choices.Keywords: blood donation, deferral criteria, evidence-based, health technology assessment

ispartof: Campbell Systematic Reviews pages:1-46 status: published

status: Published online

BackgroundAdequate on-site first aid delivery at mass gatherings (MGs) is one of the cornerstones to ensure safe and healthy MGs. We investigated medical usage rates, frequency of triage categories and type of injury or medical complaint, among attendees at MGs in Belgium.MethodsWe analysed the Medical Triage and Registration Informatics System database, which includes prospectively collected person-level data regarding individuals visiting on-site posts at MGs in Belgium. MGs attended by >10 000 people and organised ≥5 times between 2009 and 2018 were included. We determined the proportion of patients in each triage category (‘first aid’ vs ‘medical condition’ vs ‘medical emergency’ vs ‘no treatment’) and each type of injury or medical complaint, and we calculated patient presentation rate (PPR) and transfer to hospital rate (TTHR).ResultsTwenty-eight MGs, totalling 194 events, were included involving 148 265 patient visits. ‘First aid’ was the most common triage category (80%, n=118 514). The need for a nurse/physician (‘medical condition’), and for the treatment of life-threatening conditions (‘medical emergency’) was rare (8.9%, n=13 052, and 0.6%, n=860, of all patient presentations, respectively), but remarkably higher during indoor electronic dance music (EDM) events (17.8% (n=26 391) and 4.0% (n=5930), of all patient presentations, respectively). ‘Skin wounds’ were the most common injury category (42.4%, n=62 275). ‘Respiratory problems’, ‘neurological problems’, ‘intoxication’, ‘heart complaints’ and ‘gastrointestinal complaints’ were more frequent during indoor (electronic) dance, whereas ‘burns’, ‘fracture/contusion’ and ‘skin wounds’ were higher during outdoor music, sports events and city festivals, respectively. PPR (per 10 000 attendees) was highest for outdoor EDM and outdoor music (median 130 (IQR 79) and 129 (IQR 104), respectively). TTHR (per 10 000 attendees) was highest for indoor EDM (median 4.4 (IQR 8.5)).ConclusionMedical usage rates, proportion of patients in triage and injury or medical complaint categories varied across different MG categories, suggesting opportunities for planning medical coverage at these events.

A Theory of Change (ToC) is an approach to map programmes aimed at inducing change in a specific context, with the goal of increasing their impact. We applied this approach to the specific case of handwashing and sanitation practices in low- and middle-income countries and developed a ToC as part of a systematic review exercise. Different existing sources of information were used to inform the initial draft of the ToC. In addition, stakeholder involvement occurred and peer review took place. Our stakeholders included methodological (ToC/quantitative and qualitative research) and content experts (WASH (Water, Sanitation, Hygiene)/behaviour change), as well as end-users/practitioners, policy-makers and donors. In conclusion, the development of a ToC, and the involvement of stakeholders in its development, was critical in terms of understanding the context in which the promotional programmes are being implemented. We recommend ToC developers to work with stakeholders to create a ToC relevant for practice. ispartof: International Journal of Environmental Health Research vol:28 issue:1 pages:8-22 ispartof: location:England status: published