Medical law: Exploring doctors' knowledge on the laws regulating clinical and medical laboratories in Nigeria

No Abstract

LB01: Cell Salvage during Caesarean Section: A Randomised Controlled Trial (The SALVO Trial)

Objective Excessive haemorrhage at caesarean section requires the use of donor (allogeneic) blood transfusion. The SALVO trial assessed whether the routine use of cell salvage during caesarean section can reduce the need for donor blood transfusion. Study Design We conducted a randomised controlled trial (26 UK obstetric units; June 2013 through April 2016) of routine cell salvage use (intervention) vs. current standard of care without routine salvage use (control) in caesarean section among women at risk of haemorrhage. We used multivariable models, adjusting for stratification variables and prognostic factors identified a priori, to compare rates of donor blood transfusion (primary outcome) and fetomaternal haemorrhage ≥2ml in RhD-negative women with RhD-positive baby (one of the secondary outcomes) between groups. Results Of 3028 women randomised, 2990 were analysed (after exclusions for vaginal delivery or hospital transfer after randomisation). Of 1498 assigned to intervention, 95.6% had cell salvage deployed (50.8% had salvaged blood returned; mean 259.9 ml) vs. 3.9% of 1492 assigned to control. Donor blood transfusion rates were lower in the intervention group than in control (2.5% vs. 3.5%, adjusted odds ratio [OR] 0.65, 95% confidence interval [CI] 0.42 to 1.01). No case of amniotic fluid embolism was observed. Fetomaternal haemorrhage was higher with intervention vs. control (25.6% vs. 10.5%, adjusted OR 5.63, 95% CI 1.43 to 22.14). Conclusion There was modest evidence for an effect of routine use of cell salvage during caesarean section on donor blood transfusion. The increased fetomaternal haemorrhage emphasises the need for adherence to guidance on anti-D prophylaxis and for research on risks of alloimmunisation to RhD and other red cell antigens following cell salvage. (Funder: UK National Institute of Health Research Health Technology Assessment programme, ISRCTN66118656)

International, multicenter standardization of acute graft-versus-host disease clinical data collection: a report from the Mount Sinai Acute GVHD International Consortium

Acute graft-versus-host disease (GVHD) remains a leading cause of morbidity and nonrelapse mortality after allogeneic hematopoietic cell transplantation. The clinical staging of GVHD varies greatly between transplant centers and is frequently not agreed on by independent reviewers. The lack of standardized approaches to handle common sources of discrepancy in GVHD grading likely contributes to why promising GVHD treatments reported from single centers have failed to show benefit in randomized multicenter clinical trials. We developed guidelines through international expert consensus opinion to standardize the diagnosis and clinical staging of GVHD for use in a large international GVHD research consortium. During the first year of use, the guidance followed discussion of complex clinical phenotypes by experienced transplant physicians and data managers. These guidelines increase the uniformity of GVHD symptom capture, which may improve the reproducibility of GVHD clinical trials after further prospective validation

Численное моделирование конвективного теплообмена с различным расположением испарителя теплового насоса в промышленном водоёме.

В процессе исследования проводилось математическое моделирование естественной конвекции в водоеме с теплообменником испарителем теплового насоса В результате исследования проведен анализ влияния местоположения теплообменника-испарителя теплового насоса на тепловой режим водоема. Предложенная модель естественной конвекции жидкости в водоеме, используемого в качестве низкопотенциального источника энергии испарителя теплового насоса, может быть использована для усовершенствования методики расчета тепловых режимов водоемов – источников низкопотенциальной теплоты.In the process of research was conducted mathematical simulation of natural convection in a reservoir with heat exchanger, the evaporator of the heat pump The study analyzes the impact location of the heat exchanger-evaporator of the heat pump on the thermal regime of the reservoir. The proposed model of natural convection of fluid in a reservoir to be used as low-grade energy source of the heat pump evaporator can be used to improve the calculation of thermal regimes of reservoirs – the sources of low-grade heat