American journal of therapeutics
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The aim of this study was to investigate the changes in circulating blood volume (CBV) after infusions of Hemoglobin glutamer-200 (bovine; Hb-200) in combination with 6% hetastarch in an animal model of acute posthemorrhagic anemia. Fifteen rabbits with a mean body weight of 2.2 +/- 0.2 kg were studied. After determination of the circulating plasma volume (CPV) and CBV, one third of the CBV was withdrawn via an arterial catheter. ⋯ Study group 2 demonstrated the highest CPV and CBV. The two study groups demonstrated a statistically significant increase in circulating volumes compared with the control group. The magnitude of this difference was lower than expected based on in vitro colloid osmotic pressure measurements.
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This paper provides a brief history of the evolution of the Jehovah's Witness faith with a short discussion on the biblical justification for followers' refusal of blood transfusions. It also briefly considers the ethical principles leading to potential conflicts between health care workers and Jehovah's Witnesses patients and examines several significant legal rulings in the United States and Canada that caregivers should be aware of. A discussion of what blood products are and are not currently acceptable is also presented. Finally, the impact of the Jehovah's Witness reform movement aimed at allowing blood transfusions and the nature of recent doctrinal shifts in the Jehovah's Witness faith on the matter of blood transfusions are discussed.
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This review article discusses the development and implementation of a number of blood substitutes, including hemoglobin-based oxygen carriers (HBOCs) and perfluorocarbons. This review article will introduce the reader to blood substitutes by discussing an overview of an ideal blood substitute, the history of HBOCs and perfluorocarbons, strategies of oxygen carrying, side effects of HBOCs and perfluorocarbons, current clinical trials, and the future of blood substitutes.
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A number of pharmacologic and nonpharmacologic technologies are in current use to minimize perioperative homologous blood use. Clinical trials, many of them randomized controlled trials, have been done evaluating these approaches and have demonstrated their efficacy. However, data on safety has relied mostly on case reports, uncontrolled studies, and, for the pharmacologic agents, extrapolation from the nonsurgical setting. ⋯ DDAVP is low-risk, provided it is not overused, which can induce hyponatremia. Autologous predonation probably has similar risks as homologous blood with respect to transfusion errors and bacterial infection. As with most medical interventions, we must be vigilant to prevent human error.
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Decisions must be made when assigning analgesics, and such decisions involve comparing efficacy and adverse effects. The rules for assessing efficacy by systematic review and by large clinical trials are becoming clearer all the time. It is known, for instance, that trials that are not randomized, are not double-blind, or are too small will exaggerate efficacy. ⋯ The rules on how to collect and use evidence on adverse effects are less clearly formulated than they are for efficacy. For safety at or above therapeutic dose, the rules of evidence-gathering are necessarily different, and randomized trials are rarely an adequate or sufficient source. Databases of patient experience, with all the caveats, may be the most reliable data from which to work.