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1. Historical time trends in red blood cell usage in the Netherlands

Author

van Hoeven LR, Koopman MMW, Koffijberg H, Roes KCB, and Janssen MP

Subjects
time trends, lcsh:R, combinations of blood units, medical and surgical patients, lcsh:Medicine, red blood cell transfusion
Abstract

Loan R van Hoeven,1,2 Maria MW Koopman,3 Hendrik Koffijberg,4 Kit CB Roes,1Mart P Janssen1,2 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 2Transfusion Technology Assessment Department, Sanquin Research, 3Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, 4Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands Background: While the number of hospitalized patients in Dutch hospitals has increased since 1997, the demand for red blood cell units (RBCs) has simultaneously decreased. This implies a dramatic change in transfusion practice toward fewer blood transfusions on average per patient.Objectives: In order to explain the RBC reduction, different patient groups (surgical, medical, obstetrical, and specific age groups) were studied retrospectively in relation to RBC use. In addition, the use of combinations of RBCs, fresh frozen plasma, and platelets during a transfusion episode was examined for trends over time.Materials and methods: Data from the PROTON database, containing information on all transfusions in twelve Dutch hospitals in the period 1996–2005, including corresponding patient data (age, diagnosis, treatment, and hospitalizations) and blood unit data (type, amount, and date) were analyzed.Results: The proportion of RBCs used for surgical patients declined from 50% in 1996 to 40% in 2005, whereas medical use increased from 47% to 58% (the remaining 2%–3% went to obstetrical patients). Changes were more marked in the higher age groups. Also, a trend was observed toward the use of only one or two RBCs during a transfusion episode rather than three or more. Among surgical patients who received blood, the use of combinations of blood units, as compared to RBCs only, increased from 32% to 39%.Conclusion: The results suggest a more restrictive transfusion policy for surgical patients as well as an increase in medical indications for transfusion. This fits well with the current focus on more cost-effective transfusion policies. Keywords: red blood cell usage, combinations of blood units, trends in blood use, medical and surgical patients

Published
2016

2. Elevated levels of FVIII: C within families are associated with an increased risk for venous and arterial thrombosis

Author

Bank, [No Value], Libourel, EJ, Middeldorp, S, Hamulyak, K, van Pampus, ECM, Koopman, MMW, Prins, MH, van der Meer, J, Buller, HR, Restoring Organ Function by Means of Regenerative Medicine (REGENERATE), and Groningen Kidney Center (GKC)

Subjects
FIBRINOGEN, congenital, hereditary, and neonatal diseases and abnormalities, VON-WILLEBRAND-FACTOR, venous thromboembolism, ORAL-CONTRACEPTIVES, arterial thrombosis, DISEASE, premature, THROMBOEMBOLISM, hemic and lymphatic diseases, FVIII : C, FACTOR-V-LEIDEN, family study, THROMBOPHILIA, DEEP-VEIN THROMBOSIS, atherosclerosis, FACTOR-VIII LEVELS, POPULATION
Abstract

Elevated levels of coagulation factor VIII:C (FVIII:C) are associated with an increased risk for venous and arterial thromboembolism. Whether relatives of patients with elevated levels of FVIII:C are also at increased risk for thrombotic disease is unknown. The objective was to determine the annual incidences of both venous and arterial thrombotic events in first-degree relatives of patients with elevated levels of FVIII:C and venous thromboembolism (VTE) or premature atherosclerosis. A retrospective study with 584 first-degree relatives of 177 patients with elevated levels of FVIII:C was performed. The level of FVIII:C was determined and relatives with elevated and normal levels of FVIII:C were compared. Of the participants, 40% had elevated levels of FVIII:C. The annual incidence of a first episode of VTE was 0.34% and 0.13% in relatives with elevated levels of FVIII:C and those with normal levels, respectively [OR 3.7 (95% CI 1.9-7.5)]. The absolute annual incidence in the youngest age group with elevated levels of FVIII:C was 0.16% (0.05-0.37) and gradually increased to 0.99% (0.40-2.04) in those older than 60 years of age, although the odds ratios were not statistically significant. The annual incidences of a first arterial thrombotic event were 0.29% and 0.14% in relatives with and without elevated levels of FVIII:C, respectively [OR 3.1 (1.4-6.6)]. In particular the risks for a first myocardial infarction [OR 4.3 (1.0-18.1); P = 0.046] and a first peripheral arterial thrombosis [OR 8.6 (1.6-47.6)] were increased. Within families of patients with elevated levels of FVIII:C and VTE or premature atherosclerosis, 40% of their first-degree relatives has elevated levels of FVIII:C as well, and they are at increased risk for both VTE and arterial thrombosis as compared with their relatives with normal levels.

Published
2005

4. Efficacy of recombinant factor VIIa administered by continuous infusion to haemophilia patients with inhibitors

Author

Mauser-Bunschoten, EP, Koopman, MMW, Goede-Bolder, ADE, Leebeek, FWG, Van der Meer, J, Kooij, GMV, Van der Linden, PWG, and Faculteit Medische Wetenschappen/UMCG

Subjects
PLASMA, haemophilia, BLEEDING EPISODES, COAGULATION, TRANEXAMIC ACID, recombinant factor VIIa, bolus injections, HEMOPHILIA-A, continuous infusion, HEMORRHAGES, ACTIVATED FACTOR-VII, inhibitors, ORAL-SURGERY, FIBRINOLYSIS, EXPERIENCE
Abstract

We have prospectively monitored treatment of haemophilia patients with inhibitors by recombinant factor VIIa (rFVIIa) administered by continuous infusion to obtain more insight in the underlying factors of the clinical efficacy of this administration method. At present, 43 treatment episodes of 14 different Dutch haemophilia inhibitor patients are included in the database. Analysis of the data showed a discrepancy between the efficacy of rFVIIa continuous infusion treatment of acute and surgical bleeds in the oral cavity [one (14%) effective, two (29%) partially effective, four (57%) not effective] and other parts of the body [29 (80%) effective, four (11%) partially effective, two (6%) not effective, one (3%) impossible to classify]. Patients who had acute or surgical oral cavity bleeds, uncontrolled by rFVIIa continuous infusion, reacted favourably to rFVIIa continuous infusion in other locations of the body. Acute bleeding episodes in the oral cavity, which could not be controlled by rFVIIa continuous infusion, stopped when the treatment regimen was switched to rFVIIa bolus injections. Finally, haemostatic control during dental extractions was excellent after the initial rFVIIa bolus injection preceding the continuous infusion, but rebleeds occurred in all patients within 48 h under rFVIIa continuous infusion coverage. These observations suggest that the efficacy of rFVIIa continuous infusion depends, at least in part, on the location of the body in which the bleeding occurs and that rFVIIa bolus injections are more effective than rFVIIa continuous infusion in the oral cavity. We hypothesize that the inability of rFVIIa continuous infusion treatment to sufficiently inhibit fibrinolysis is the underlying cause of the decreased efficacy of rFVIIa continuous infusion treatment in the oral cavity.

Published
2002

5. The incidence of recurrent venous thromboembolism in carriers of factor V Leiden is related to concomitant thrombophilic disorders

Author

Meinardi, [No Value], Middeldorp, S, de Kam, PJ, Koopman, MMW, van Pampus, ECM, Hamulyak, K, Prins, MH, Buller, HR, and Faculteit Medische Wetenschappen/UMCG

Subjects
ORAL ANTICOAGULANT-THERAPY, FIRST EPISODE, factor V, RISK FACTOR, PROTHROMBIN GENE, thromboembolism, APC resistance, ACTIVATED PROTEIN-C, COAGULATION-FACTOR-V, blood coagulation disorders, DEEP-VEIN THROMBOSIS, MUTATION, RESISTANCE, HYPERHOMOCYSTEINEMIA
Abstract

The duration of anticoagulant treatment after a first episode of venous thromboembolism primarily depends on the risk of recurrence, Variability of recurrence rates in factor (F) V Leiden carriers may be due to concomitant thrombophilic disorders. A retrospective study was performed in 329 FV Leiden carriers with a history of venous thromboembolism (262 probands, 67 relatives). The annual rate of first recurrence was estimated in relatives. The contribution of concomitant thrombophilic disorders to the recurrence rate was evaluated in probands and relatives by a nested case-control analysis in 10 5 matched pairs of carriers either with or without recurrence, The overall annual recurrence rate was 2.3 per 100 patient-years, The adjusted risk of recurrence for concomitant thrombophilic disorders was: 9.1 (1.3-62.8) for the FII mutation; 1.0 (0.2-4.9) for homozygosity for FV Leiden; 1.5 (0.2-9.5) for inherited deficiencies of protein C or S: 1.8 (0.7-4.9) for FVIII coagulant activity (FVIII:C) levels > 122%.; 5.4 (1.6-18.6) for fasting homocysteine levels > 15.2 mumol/l: and 4.4 (1.0-18.7) for loading homocysteine levels >45.8 mumol/l. Of these disorders, only the FII mutation and hyperhomocysteinaemia significantly increased the risk of recurrence in FV Leiden carriers. The estimated recurrence rate ranged from 0.45 per 100 patient-years after a secondary first event in the absence of concomitant disorders to 4.8 per 100 patient-years when a spontaneous first event was combined with concomitant disorders, Our study provides supportive evidence that the incidence of recurrent venous thromboembolism in heterozygous FV Leiden carriers depends on the concomitance of other thrombophilic disorders. in addition to whether the first thrombotic event occurred spontaneously.

Published
2002

7. Low molecular weight heparin and compression stockings in the prevention of venous thromboembolism in neurosurgery

Author

Nurmohamed, MT, vanRiel, CMA, Henkens, CMA, Koopman, MMW, Que, GTH, dAzemar, P, Buller, HR, tenCate, JW, Hoek, JA, vanderMeer, J, vanderHeul, C, Turpie, AGG, Haley, S, Sicurella, M, and Faculteit Medische Wetenschappen/UMCG

Subjects
UNFRACTIONATED HEPARIN, PNEUMATIC COMPRESSION, ENOXAPARIN, ELECTIVE HIP-SURGERY, STANDARD HEPARIN, LOW-DOSE HEPARIN, DEEP-VEIN THROMBOSIS, POSTOPERATIVE THROMBOEMBOLISM, RANDOMIZED TRIAL, PROPHYLAXIS
Abstract

Perioperative anticoagulant prophylaxis for postoperative venous thromboembolism (VTE) in neurosurgical patients has not gained wide acceptance due to the fear of intracranial bleeding. Physical methods give a worthwhile reduction of postoperative VTE but there still remains a substantial residual incidence. In other clinical indications, low molecular weight heparins have proven to be effective for prophylaxis of VTE when administered postoperatively, with the advantage of no bleeding enhancement during surgery. Therefore, we performed a multicentre, randomized, double-blind trial in neurosurgical patients to investigate the efficacy and safety of adding a low molecular weight heparin (LMWH), nadroparin, initiated postoperatively, to graduated compression stockings in the prevention of VTE. Deep-vein thrombosis was detected by mandatory venography. Bleeding was determined according to pre-defined objective criteria for major and minor episodes. An adequate bilateral venogram was obtained in 166 of 241 LMWH patients (68.9%) and 179 of 244 control patients (73.4%). A total of 31 of 166 LMWH patients (18.79b) and 47 of 179 control patients (26.3%) had VTE up to Day 10 postoperatively (p = 0.047). The relative risk reduction (RRR) was 28.9%. The rates for proximal deep-vein thrombosis/pulmonary embolism were 6.9% and 11.5% for the two groups, respectively (RRR: 40.2%; p = 0.065). Secondary analyses involved all VTE up to day 56 post-surgery which was detected in 33 patients of 241 in the LMWH group (13.7%) and 51 of 244 control patients (20.9%; RRR 34.5%; p = 0.018). The corresponding percentages for proximal deep-vein thrombosis/pulmonary embolism were 5.8% and 10.2% for the two groups, respectively, giving a RRR of 43.3%; p = 0.036. Major bleeding complications, during the treatment period, occurred in six low molecular weight heparin treated patients (2.5%) and in two control patients (0.8%); p = 0.087. A higher mortality was observed in the low molecular weight heparin group over the 56-day follow-up period (22 versus 10; p = 0.026). However, none of these deaths was judged by a blinded adjudication committee to be related to the study drug. In conclusion, this study demonstrates that the low molecular weight heparin, nadroparin, added to graduated compression stockings results in a clinically significant decrease in VTE without inducing any significant increase of major bleeding.

Published
1996

11. Long-Term Risk of Subsequent Neoplasms in 5-Year Survivors of Childhood Neuroblastoma: A Dutch Childhood Cancer Survivor Study-LATER 3 Study.

Author

Westerveld ASR, Tytgat GAM, van Santen HM, van Noesel MM, Loonen J, de Vries ACH, Louwerens M, Koopman MMW, van der Heiden-van der Loo M, Janssens GO, de Krijger RR, Ronckers CM, van der Pal HJH, Kremer LCM, and Teepen JC

Abstract

Purpose: Neuroblastoma survivors have an increased risk of developing subsequent malignant neoplasms (SMNs), but the risk of subsequent nonmalignant neoplasms (SNMNs) and risk factors are largely unknown. We analyzed the long-term risks and associated risk factors for developing SMNs and SNMNs in a well-characterized cohort of 5-year neuroblastoma survivors., Methods: We included 563 5-year neuroblastoma survivors from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort, diagnosed during 1963-2014. Subsequent neoplasms were ascertained by linkages with the Netherlands Cancer Registry and the Dutch Nationwide Pathology Databank (Palga) and medical chart review. We calculated standardized incidence ratios (SIRs), absolute excess risk (AER), and cumulative incidences. Multivariable competing risk regression analysis was used to evaluate risk factors., Results: In total, 23 survivors developed an SMN and 60 an SNMN. After a median follow-up of 23.7 (range, 5.0-56.3) years, the risk of SMN was elevated compared with the general population (SIR, 4.0; 95% CI, 2.5 to 5.9; AER per 10,000 person-years, 15.1). The 30-year cumulative incidence was 3.4% (95% CI, 1.9 to 6.0) for SMNs and 10.4% (95% CI, 7.3 to 14.8) for SNMNs. Six survivors developed an SMN after iodine-metaiodobenzylguanidine ( 131I MIBG) treatment. Survivors treated with 131I MIBG had a higher risk of developing SMNs (subdistribution hazard ratio [SHR], 5.7; 95% CI, 1.8 to 17.8) and SNMNs (SHR, 2.6; 95% CI, 1.2 to 5.6) compared with survivors treated without 131I MIBG; results for SMNs were attenuated in high-risk patients only (SMNs SHR, 3.6; 95% CI, 0.9 to 15.3; SNMNs SHR, 1.5; 95% CI, 0.7 to 3.6)., Conclusion: Our results demonstrate that neuroblastoma survivors have an elevated risk of developing SMNs and a high risk of SNMNs. 131I MIBG may be a treatment-related risk factor for the development of SMN and SNMN, which needs further validation. Our results emphasize the need for awareness of subsequent neoplasms and the importance of follow-up care.

Published
2024
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12. Satisfaction of Paediatric Oncology Patients, Survivors, and Nurses with the Position of Their Totally Implantable Venous Access Port (SPACE-Study).

Author

van den Bosch CH, van de Ven CP, Hulsker CCC, Bökkerink GMJ, Terwisscha-van Scheltinga CEJ, van de Wetering MD, Koopman MMW, van der Pal HJH, Wijnen MWHA, and van der Steeg AFW

Subjects
Humans, Cross-Sectional Studies, Female, Child, Male, Adolescent, Catheterization, Central Venous methods, Cicatrix etiology, Young Adult, Cancer Survivors psychology, Catheters, Indwelling, Adult, Netherlands, Vascular Access Devices, Caregivers psychology, Patient Satisfaction, Neoplasms
Abstract

Background: To compare paediatric oncologic vascular access ports located on the anterior thoracic wall to ports on the lower lateral thoracic wall, in terms of perceived port-related hindrance and scar-quality., Methods: A cross-sectional survey study including paediatric oncology patients (≥8-<19 yrs), caregivers (in patients <8 yrs), survivors (>22 yrs with only anterior ports) and nurses of the Princess Máxima Center, the Netherlands, was performed. The survey consisted of questions regarding satisfaction, hindrance during daily life, and port position preference. For survivors, scar-quality was assessed using the validated Patient and Observer Scar Assessment Scale (POSAS 2.0); a high score (i.e., a displeasing scar) was defined as a score higher than the third quartile of the median for that question., Results: In total, 147 participants were included; 83 patients/caregivers, 31 survivors, and 33 nurses. Overall, 81 % was satisfied with the position of their port. Satisfaction, hindrance and complications did not differ between anterior and lower lateral ports. For the anterior position, minimal pressure on the port during daily life was a mentioned reason to prefer this position. For the lower lateral position, less visibility of the scar and easiest access were mentioned. Of all survivors with an anterior port scar, one in five had a displeasing scar and all scars observed were widened. Female patients preferred a lower lateral port, and scar-quality was better for left-sided port scars., Conclusion: The port position should be chosen together with patients/caregivers based on the (dis-)advantages of each position, as identified by this study., Level of Evidence: II., Competing Interests: Conflicts of interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2024
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13. Increased risk of subsequent neoplasm after hematopoietic stem cell transplantation in 5-year survivors of childhood acute lymphoblastic leukemia.

Author

Westerveld ASR, Roesthuis P, van der Pal HJH, Bresters D, Bierings M, Loonen J, de Vries ACH, Louwerens M, Koopman MMW, van den Heuvel-Eibrink MM, van der Heiden-van der Loo M, Hoogerbrugge P, Janssens GO, de Krijger RR, Ronckers CM, Pieters R, Kremer LCM, and Teepen JC

Subjects
Humans, Male, Female, Child, Child, Preschool, Adolescent, Risk Factors, Infant, Adult, Incidence, Young Adult, Hematopoietic Stem Cell Transplantation adverse effects, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy, Precursor Cell Lymphoblastic Leukemia-Lymphoma epidemiology, Neoplasms, Second Primary epidemiology, Neoplasms, Second Primary etiology, Cancer Survivors statistics & numerical data
Abstract

Acute lymphoblastic leukemia (ALL) survivors are at risk for developing subsequent neoplasms, but there is limited information on long-term risks and risk factors for both subsequent malignant neoplasms (SMNs) and subsequent non-malignant neoplasms (SNMNs). We analyzed long-term risk and risk factors for SMNs and SNMNs among 3291 5-year ALL survivors from the Dutch Childhood Cancer Survivor Study-LATER cohort (1963-2014). We calculated standardized incidence ratios (SIRs) and cumulative incidences and used multivariable Cox proportional hazard regression analyses for analyzing risk factors. A total of 97 survivors developed SMNs and 266 SNMNs. The 30-year cumulative incidence was 4.1% (95%CI: 3.5-5.3) for SMNs and 10.4%(95%CI: 8.9-12.1) for SNMNs. Risk of SMNs was elevated compared to the general population (SIR: 2.6, 95%CI: 2.1-3.1). Survivors treated with hematopoietic stem cell transplantation (HSCT) with total body irradiation (TBI) (HR:4.2, 95%CI: 2.3-7.9), and without TBI (HR:4.0,95%CI: 1.2-13.7) showed increased SMN risk versus non-transplanted survivors. Cranial radiotherapy (CRT) was also a risk factor for SMNs (HR:2.1, 95%CI: 1.4-4.0). In conclusion, childhood ALL survivors have an increased SMN risk, especially after HSCT and CRT. A key finding is that even HSCT-treated survivors without TBI treatment showed an increased SMN risk, possibly due to accompanied chemotherapy treatment. This emphasizes the need for careful follow-up of HSCT and/or CRT-treated survivors., (© 2024. The Author(s).)

Published
2024
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14. Monitoring health related quality of life in survivorship care of young adult survivors of childhood cancer using web-based patient-reported outcome measures: survivors' and health care practitioners' perspectives on the KLIK method.

Author

Maas A, Maurice-Stam H, van den Heuvel MH, Koopman MMW, den Hartogh JG, Kremer LCM, and Grootenhuis M

Subjects
Humans, Child, Young Adult, Survivorship, Quality of Life psychology, Survivors psychology, Surveys and Questionnaires, Delivery of Health Care, Patient Reported Outcome Measures, Internet, Cancer Survivors psychology, Neoplasms psychology
Abstract

Purpose: The KLIK method is a tool to systematically monitor and discuss Health Related Quality of Life (HRQOL) in clinical practice. It has been successfully used in clinical practice in The Netherlands, and has recently been implemented in survivorship care for young adult childhood cancer survivors (CCSs). This study evaluates implementation fidelity and satisfaction of CCSs and healthcare practitioners (HCPs) with the KLIK method in survivorship care., Methods: CCSs' HRQOL was monitored using the KLIK questionnaire (PedsQL generic 18-30 years). In a mixed-methods design, implementation fidelity was based on registrations, and user satisfaction was assessed with evaluation surveys (CCSs) and semi-structured interviews (CCSs, HCPs). Descriptive statistics and qualitative analysis methods were used., Results: A total of 245 CCSs were eligible for the study. Fidelity was 79.2% (194/245) for registration in the KLIK PROM portal, 89.7% (174/194) for completed KLIK questionnaires, 74.7% (130/174) for its discussion during consultation. Of the eligible CCSs, 17.6% (43/245) completed the study evaluation survey. Five CCSs and HCPs were invited for an interview and participated. CCSs (7.7/10) and HCPs (7.5/10) were satisfied with the KLIK method. Reported facilitators included increased insight into CCSs' functioning, improved preparation before, and communication during consultation, without lengthening consultation duration. Barriers included CCSs not always completing KLIK questionnaires, incomplete content of the KLIK questionnaire, and the need for customization for CCSs with cognitive disabilities., Conclusion: The KLIK method is a feasible and valuable tool to systematically monitor and discuss HRQOL in survivorship care. Integration of the KLIK method within the organization is essential, with structural support in reminding CCSs to complete questionnaires., (© 2023. The Author(s).)

Published
2024
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15. Neuroblastoma survivors at risk for developing subsequent neoplasms: A systematic review.

Author

Westerveld ASR, van Dalen EC, Asogwa OA, Koopman MMW, Papadakis V, Laureys G, van der Pal HJH, Kremer LCM, Tytgat GAM, and Teepen JC

Subjects
Female, Forecasting, Humans, Retrospective Studies, Risk Factors, Survivors, Neoplasms, Neoplasms, Second Primary epidemiology, Neoplasms, Second Primary etiology, Neuroblastoma epidemiology, Neuroblastoma etiology, Neuroblastoma therapy
Abstract

Neuroblastoma survivors have an increased risk of unfavorable long-term health outcomes, of which developing subsequent neoplasms is one of the most serious. We aimed to provide an overview of the current knowledge on the risk of subsequent neoplasms in neuroblastoma survivors. We conducted a systematic literature search in Medline/Pubmed (01-01-1945-13-01-2022) to identify studies that reported on ≥ 100 neuroblastoma survivors and assessed subsequent neoplasms as an outcome. We identified 410 potentially eligible articles, of which we eventually included 13 reports. All articles described retrospective cohorts with sizes varying from 145 to 5,987 neuroblastoma survivors. Within these cohorts 0.7% - 17.2% of the survivors developed a subsequent neoplasm. A wide variety of types of subsequent malignant and non-malignant neoplasms were observed, of which thyroid carcinoma and acute myeloid leukemia were most frequently reported. The risk of developing a subsequent neoplasm was 2.8 to 10.4 times higher in neuroblastoma survivors than in the general population. Although no statistically significant risk factors for subsequent neoplasms were observed in multivariable analyses, high-risk group survivors, women and those treated with radiotherapy seemed to have a higher risk. In conclusion, the studies in this systematic review consistently show that neuroblastoma survivors are at elevated risk of developing subsequent neoplasms. Future research should further explore risk factors for subsequent neoplasms in neuroblastoma survivors, so future treatment protocols and follow-up care can be improved., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Published
2022
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16. A Conceptual Framework for Optimizing Blood Matching Strategies: Balancing Patient Complications Against Total Costs Incurred.

Author

van Sambeeck JHJ, de Wit PD, Luken J, Veldhuisen B, van den Hurk K, van Dongen A, Koopman MMW, van Kraaij MGJ, van der Schoot CE, Schonewille H, de Kort WLAM, and Janssen MP

Abstract

Alloimmunization is currently the most frequent adverse blood transfusion event. Whilst completely matched donor blood would nullify the alloimmunization risk, this is practically infeasible. Current matching strategies therefore aim at matching a limited number of blood groups only, and have evolved over time by systematically including matching strategies for those blood groups for which (serious) alloimmunization complications most frequently occurred. An optimal matching strategy for controlling the risk of alloimmunization however, would balance alloimmunization complications and costs within the entire blood supply chain, whilst fulfilling all practical requirements and limitations. In this article the outline of an integrated blood management model is described and various potential challenges and prospects foreseen with the development of such a model are discussed.

Published
2018
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17. Validation of multisource electronic health record data: an application to blood transfusion data.

Author

Hoeven LRV, Bruijne MC, Kemper PF, Koopman MMW, Rondeel JMM, Leyte A, Koffijberg H, Janssen MP, and Roes KCB

Subjects
Humans, Netherlands, Blood Transfusion standards, Blood Transfusion statistics & numerical data, Electronic Health Records standards, Electronic Health Records statistics & numerical data, Hospitals standards, Hospitals statistics & numerical data, Medical Record Linkage standards, Validation Studies as Topic
Abstract

Background: Although data from electronic health records (EHR) are often used for research purposes, systematic validation of these data prior to their use is not standard practice. Existing validation frameworks discuss validity concepts without translating these into practical implementation steps or addressing the potential influence of linking multiple sources. Therefore we developed a practical approach for validating routinely collected data from multiple sources and to apply it to a blood transfusion data warehouse to evaluate the usability in practice., Methods: The approach consists of identifying existing validation frameworks for EHR data or linked data, selecting validity concepts from these frameworks and establishing quantifiable validity outcomes for each concept. The approach distinguishes external validation concepts (e.g. concordance with external reports, previous literature and expert feedback) and internal consistency concepts which use expected associations within the dataset itself (e.g. completeness, uniformity and plausibility). In an example case, the selected concepts were applied to a transfusion dataset and specified in more detail., Results: Application of the approach to a transfusion dataset resulted in a structured overview of data validity aspects. This allowed improvement of these aspects through further processing of the data and in some cases adjustment of the data extraction. For example, the proportion of transfused products that could not be linked to the corresponding issued products initially was 2.2% but could be improved by adjusting data extraction criteria to 0.17%., Conclusions: This stepwise approach for validating linked multisource data provides a basis for evaluating data quality and enhancing interpretation. When the process of data validation is adopted more broadly, this contributes to increased transparency and greater reliability of research based on routinely collected electronic health records.

Published
2017
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