British Committee Research Articles

Audit of transfusion practices in pediatrics in a tertiary care hospital

Background: Audit of transfusion practices in pediatric patients was performed to study indications, clinical profile and whether transfusions were in accordance to guidelines.Methods: Retrospective analysis of all episodes of transfusions from a tertiary care centre was done. The study period was from January 2018 to December 2018.Patients in the age group of 4 months to 12 years were enrolled in the study. The data was reviewed according to the British Committee for Standards in Haematology guidelines for transfusion.Results: During the study period of 12 months,168 units of hemocomponents were transfused to children, 66.07% (111/168) of the total products transfused were packed red cell units, followed by 36 units (21.42%) of fresh frozen plasma and 21 units (12.5%) platelets. Overall usage of blood components was found to be appropriate in 58.33% (98/111). Red blood cells were the most appropriately transfused (64.86 %) (72 units out of 111) blood product as compared to 42.85% of platelets (9/21) and 47.22% of FFP (17/36).Conclusions: Most frequently transfused blood components are red blood cells in pediatrics. Inappropriate transfusion of blood components is hinders the utility of this valuable resource, Thus it becomes necessary to conduct regular audit of blood component transfusion for optimum utilization.

DIPLOMACY AS AN INSTITUTION OF INTERNATIONAL SOCIETY IN ENGLISH SCHOOL OF INTERNATIONAL RELATIONS

This article is devote to the analysis of one from the key institutions in the conception of international society. The aim of the article is identify historiographical aspects for the analysis diplomacy in the context of the English school’s approach to the study of international institutions. English school of International relations formed in the end 1950-1970. Some famous scientists (H. Butterfield, M. Wight, and H. Bull) took an active part in the creation of this scientific society. British Committee for the study of international politics was a main intellectual structure in the genesis of the school. Committee had worked during 25 years (1959-1985) and become a base for the development two first generations of English school of international relations. Herbert Butterfield was very famous English historian and first chief of British Committee during 1959-1967. He had conservative credo. He shared the idea of the decline of diplomacy and divided it into new and historical. During some time, his views on diplomacy in modern history came into conflict with wide interpretation international society - central concept of the school. Martin Wight saw in diplomacy as a minimal indicator of the social character of international system in any time, but he also inclined that diplomacy will not be play very much role in the future. At the same time, he did not accept the concept “international society” and preferred the idea of “system of state”. Concept “international society” become a symbol and different mark this scientific community thanks to the books by H. Bull in 1960-1970. Hedley Bull included diplomacy in his list main international institutes, but central place among them in his views played balance of power and international law. Modern adepts of the conception of international Society continue diplomatic research. The works of modern representatives of the English School are studies in the article. Main conclusion of this part of the article consist of that the functional analysis of the diplomacy become a base for the following development of British intuitionalism and an important part of the conception of international society today. The British institutionalism are highlighted general trends of the following development English school of international relations and some problems for the dialogue with American theory of International relations.

The English school and the classical approach: Between modernism and interpretivism

This article analyses the evolution of the English school’s approach to international relations from the work of the early British Committee in the late 1950s and early 1960s to its revival in the 1990s and afterwards. It argues that the school’s so-called ‘classical approach’ was shaped by the crisis of developmental historicism brought on by the First World War and by the reactions of historians like Herbert Butterfield and Martin Wight to the rise of modernist social science in the twentieth century. It characterises the classical approach, as advanced by Hedley Bull, as a form of ‘reluctant modernism’ with underlying interpretivist commitments and unresolved tensions with modernist approaches. It argues that to resolve some of the confusion concerning its preferred approach to the study of international relations, the English school should return to the interpretivist commitments of its early thinkers.

Compliance of hand written transfusion requisition form and improvement after online request - a clinical audit.

To assess the compliance of healthcare personnel with regard to sending completely filled transfusion requisition forms. The audit was conducted at Aga Khan University Hospital, Karachi, and comprised requisition slips received at the hospital blood bank from September 2014 to February 2015. The British Committee for Standards in Haematology guidelines was used as the standard. Percentage of each variable on the proforma was analsyed. Rating <50% for each form was defined as "needs improvement", 51-99% as "good compliance" and 100% as "excellent compliance". After implementing strategies to increase awareness and the launching of an online transfusion requisition form, a re-audit of physician compliance was done from February to April 2016 and the results were compared with the initial audit.. Data was analysed using SPSS 21. The audit and the re-audit both comprised 1000 transfusion requisition forms each. In the audit, The sum of total scores of all the transfusion requisition forms was 4911, indicating a compliance rate of 46.9%, while the corresponding numbers in the re-audit were 10000 and 100%. The implementation of online blood transfusion requisition system had a positive impact on compliance rate.

Clinical audit on management of aplastic anemia at hematology unit of Assiut University Children Hospital

Background Aplastic anemia (AA) is a rare bone marrow failure disorder with high mortality rate, which is characterized by peripheral blood pancytopenia, with a hypocellular bone marrow. Objective The aim was to evaluate the management of aplastic anemia in Assiut University Children Hospital, trying to find any defects and suggest methods of their correction. Patients and methods A retrospective cross-sectional study was done on 50 children having AA for a period of 1 year. Results Management of AA in Assiut University Children Hospital is compatible with the British Committee for Standards in Hematology guideline 2015 except for some defects such as using high dose of cyclosporine alone, due to no availability of antithymocyte globulin in definitive drug therapy. There is no availability of stem cell transplantation, although it is the only curative treatment. Conclusion Management of AA in Assiut University Children Hospital is compatible with British Committee for Standards in Hematology guideline (2015), but there are some defects owing to limited recourses.

Platelet Transfusion Practice in Dengue Epidemic; Current Trends and Challenges ? an Institutional Study

Introduction: Dengue is an arboviral disease with an inherited risk associated with the transfusion of blood components and to prevent unnecessary transfusion during dengue epidemic a standard criteria has to be followed. Aims/objectives: To record clinical features, laboratory investigations and management of hospitalized seropositive dengue patients. To review the appropriateness of platelet transfusion practices in order to ensure optimal utilization of platelets. Material and methods: The Retrospective study is being done at RL Jalappa Medical Hospital from April 2015 to June 2019 on seropositive dengue cases. All serologically confirmed dengue cases who received platelet transfusion were included in the study. Patient’s clinical data and platelet counts were obtained from platelet requisition forms and Medical Record Department. Case definition of Dengue/DHF/DSS applied in the present study was as recommended by WHO4 i.e. Guidelines for platelet transfusion in R. L. Jallappa Hospital Hospital were utilized as the criteria to assess the appropriateness of platelet transfusion adapted from British Committee for Standardization in Hematology (BCSH) has recommended a platelet count <10000/cmm for prophylactic platelet transfusion in those with no other risk factors which would increase the risk of bleeding. Statistical analysis: Data management and analysis was done by SPSS version 22.0. Results: During study period total of 1361 cases were diagnosed as dengue infection (out of which 757-males, 604-females). Maximum cases were seen in the age group of 11-18. All patients were categorized as per WHO dengue case classification into Dengue Fever, Dengue Haemorrhagic Fever, and Dengue Shock syndrome. In which 72.5% of patients were DF, 23.4% were DHF and 4% of DSS. In present study, maximum number of Patients and platelets transfused was seen when platelet count was 11-20 × 1000/cmm that is 777 units in which RDP was 697 and SDP was 80 and lowest number of platelets transfused was seen when platelet count was >60. A total of 2705 RDP and 359 SDP were transfused to 1361 patients, of these 1361 patients, 316 bleeding patient received PT and 1045 non bleeding patient received prophylactic platelet transfusion in which 140 patient was requiring actual platelet transfusion and 905 patients were not needed. Conclusion: Inappropriate usage of platelets leads to shortage of platelets. Strict adherence to British Committee for Standardization in Hematology (BCSH) Guidelines will optimize platelet usage with this true DHF and DSS will be benefited during epidemic outbreaks. Educating patients and Patients attenders will help reducing anxiety and this in turn help clinician for better judgment on evidence based transfusion reducing inappropriate transfusion. This study emphasis on platelet usage trends in regional areas and highlighting.

The Abolitionist Cause in Britain and in France (1787-1790): A Case of Counter-Productive Transposition ?

This article observes how the British Committee for the Abolition of the Slave Trade founded in 1787 in London tried to influence the activities of its French counterpart, La Société des Amis des Noirs, in the years 1787 to 1790. This transfer of ideas from Britain to France, through the actions of Brissot and Clarkson mainly, did not, as we shall see, really prove fruitful.

History, Agency and Eurocentrism in the English School

The recent English School literature within the discipline of International Relations has been successful in renewing that tradition’s popularity, along with revising some of its core elements. This work have generated innovations in its theoretical framework, resulting in important differences in relation to the classic works of the British Committee. Despite such innovations, some of its limits remain in place, as it is still centred on an Eurocentric historical perspective. In this paper, I address two recent contributions to the body of English School literature: the new narrative of globalisation of the international society, and the turn to process sociology. By analysing these contributions, I argue that by not presenting a systematic conception of agency and historical change, history becomes relegated to a secondary role in their explanatory process: it is mobilised as a set of examples that either confirms or expands the theoretical conception of the international society or its expansion. This secondary role of history provides shelter for Eurocentrism in IR theory, since it allows for the incorporation of extra-European agencies and processes without challenging the theory that was produced in their absence. In return, I argue for a radically historicist conception of theory, drawing from a particular push for historicism in the tradition of Political Marxism. This radical historicism shifts the focus from overarching processes and their outcomes towards the many conflicting agencies who played a role in the transformations of international politics.

PB2223 INTERFERON THERAPY FOR PREGNANT PATIENTS WITH MYELOPROLIFERATIVE NEOPLASMS IN JAPAN

Background:Philadelphia chromosome (Ph)‐negative myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis, are clonal hematopoietic disorders characterized by the overproduction of terminally differentiated hematopoietic cells. Although PV and ET have a favorable prognosis, the incidence of thromboembolic and hemorrhagic complications is high. Thus, the goal of the current treatment strategy for patients with PV and ET is to prevent these events. MPNs mainly occur in the elderly, but can also occur in younger patients, including childbearing‐aged women. For ET in particular, there is a second peak in female patients in their thirties. In addition, the risk of miscarriage and other complications in pregnant MPN patients is higher than that in the general population; therefore, the management of MPNs during pregnancy is often discussed. The European LeukemiaNet and British Committee for Standards in Haematology have suggested interferon (IFN) therapy for MPN patients during high‐risk pregnancy. However, there are currently no guidelines in Japan.Aims:To evaluate the efficacy and safety of IFN therapy for pregnant patients with MPNs in Japan.Methods:We retrospectively analyzed eight patients with MPNs who were treated using IFN‐alpha during pregnancy at our institute. This study was approved by the ethics review board of Juntendo University Hospital.Results:One patient with PV and seven patients with ET were included. Among the ET patients, three patients harbored the JAK2 V617F mutation, whereas three patients harbored the CALR type 1 or 2 mutation. The other patient was defined as having triple‐negative ET. All ET patients had JAK2 V617F mutation, history of miscarriage, or history of platelet counts higher than 1,500 x 109/L, which is why we considered their pregnancies to be high‐risk. The dose of IFN‐alpha was from 9 million units to 21 million units per week, and the median value was 9 million units per week. Two patients started IFN before pregnancy to prepare for pregnancy, whereas six patients were treated after confirming pregnancy. All patients received low‐dose aspirin and low‐molecular‐weight heparin or heparin in the perinatal stage. The most frequent adverse event of IFN was fever, but it occurred only for the first few days. All patients continued IFN therapy until delivery. The median platelet count of the seven ET patients was 1,129 x 109/L before IFN therapy, which decreased to 336 x 109/L at the time of delivery. The hematocrit level of the patient with PV decreased from 47.0% to 40.9%, and the JAK2 V617F allele burden decreased from 87.2% to 75.4%. Two babies were born at a low birth weight, however, all of the babies’ Apgar scores were in the normal range. Neither hemorrhagic nor thromboembolic complications were reported. Significant placental infarcts were found in only one patient.Summary/Conclusion:This study represents the largest single center examination of IFN treatment for MPN patients during pregnancy in Japan, and suggests the safety and efficacy of IFN therapy for pregnant patients with MPNs. Although evidence for treatment is limited and the use of IFN for Ph‐negative MPNs is not approved in Japan, we suggest considering IFN therapy for pregnant patients with MPNs.

Current Treatment Patterns of Aplastic Anemia in China: A Prospective Cohort Registry Study

Aplastic anemia (AA) is a hematologic disease characterized by pancytopenia and hypocellular bone marrow, potentially leading to chronic anemia, hemorrhage, and infection. The China Aplastic Anemia Committee and British Committee for Standards in Haematology guidelines recommend hematopoietic stem-cell transplantation (HSCT) or immunosuppressive therapy (IST) comprising antithymocyte globulin (ATG) with cyclosporine (CsA) as initial treatment for AA patients. With limited epidemiological data on the clinical management of AA in Asia, a prospective cohort registry study involving 22 AA treatment centers in China was conducted to describe the disease characteristics of newly diagnosed AA patients and investigate real-world treatment patterns and patient outcomes. Of 340 AA patients, 72.9, 12.6, and 3.5% were receiving IST, traditional Chinese medicine, and HSCT, respectively, at baseline; only 22.2% of IST-treated patients received guideline-recommended ATG with CsA initially. Almost all patients received supportive care (95.6%) as blood transfusion (97.8%), antibiotics (63.7%), and/or hematopoietic growth factors (58.2%). Overall, 64.8% achieved a partial or complete response, and 0.9% experienced relapse. No new safety concerns were identified; serious adverse events were largely unrelated to the treatment regimen. These results demonstrate the need to identify and minimize treatment barriers to standardize and align AA management in China with treatment guideline recommendations and further improve patient outcomes.

Critical audit of fresh frozen plasma transfusion practices in obstetric and gynecology departments in a tertiary care hospital – Where and what needs to be improved?

Introduction: Fresh frozen plasma (FFP) prepared from whole blood contains plasma proteins and all the coagulation factors including factor V and factor VIII. Many FFP transfusion guidelines have been published till now. However, the administration is inappropriate without any scientific basis or clinical indication in many hospital settings. Aims and Objectives: A retrospective study was carried out between February 2016 and August 2016 in the regional blood transfusion center of our institution to assess the appropriate usage of FFP in obstetrics and Gynecology. It was done using the FFP transfusion guidelines based on the British Committee for Standards in Hematology and College of American Pathologists. Materials and Methods: Blood bank requisition forms received from patients of obstetrics and gynecology department during this period were screened. Indications for transfusion requests were studied and further divided into appropriate and inappropriate requests. Results: A total of 901 units of FFP were issued to 250 patients during this period. Appropriate usage of FFP was found in 67% and inappropriate usage in 33% of the 250 patients evaluated. Bleeding related to surgery with deranged coagulation profile constituted the most common appropriate indication for FFP infusion, and severe anemia was the most inappropriate indication for FFP use. Conclusion: The usage of FFP requires a proper understanding and knowledge about the appropriate and inappropriate usages. It also involves training and supervising the medical staff at regular intervals. Computerized audit programs are required to do a prospective monitoring of the FFP issue and usage in any clinical setting. Further studies are required on the usage of FFP specifically in obstetric and gynecology patients to improve the utilization of this precious blood product.

Incorporation of Evidence Based Guidelines on Bleeding Risk Assessment PRIOR to Ent Surgery into Practice: Real Time Experience

Background: In spite of guidelines recommending the no need for coagulation profile prior to ENT surgeries when challenging history of bleeding is negative, yet surgeons still practice it. Cost and delaying surgeries are major issues faced when insignificant abnormalities are found in the coagulation profile results. In 2008, British Committee for Standards of Hematology has published guidelines (1) on assessing the bleeding risk prior to surgeries or invasive procedures, which stated that the indication for sending a coagulation profile is best based on the bleeding history of the patient.Aim: This study aimed to measure unbiased estimate of hemostatic outcomes in ENT surgeries in relation to coagulation testing.Methods: All patients who underwent ENT surgeries from three tertiary hospitals during the period from 1st July 2016 to 1st January 2017 were enrolled in the study. The retrieved data included gender, age, type of surgery, results of coagulation blood test (if done), other laboratory test results (complete blood count, biochemical profile, etc.), postoperative bleeds, how it was managed, need for blood transfusion and whether the patient required another surgery to stop the bleeding or not. Patients with known bleeding history or previous coagulation derangement were excluded from the study. The primary outcome was post-operative bleeding.Results: The study included data from 730 patients who underwent ENT surgical procedures. They were 432 males and 298 females. Their mean age was 19.6 + 16.92 year. Out the 730 patients, 372 patients were interviewed for a challenging bleeding history alone (group 1) and 358 were interviewed plus a pre-operative coagulation profile check (Group 2). Total of fourteen patients (1.9 %) developed postoperative bleeding. None of them was due to abnormal bleeding tendency and they didn't require any hemostatic support. Six of them bled early (primary hemorrhage) while at the hospital due to surgical reasons (surgical site bleed that required suturing). Eight patients had delayed postoperative bleeds, after being discharged (due to eating hard food/Trauma). Only total of four patients had major bleeds, requiring surgical intervention.Conclusion: Despite guidelines recommending not doing coagulation testing prior to surgeries, many local surgeons still consider preoperative coagulation testing as a standard practice to evaluate the patients bleeding risk prior to any surgical procedure. This has resulted in unnecessary delays in surgeries (reaching up to a year in many patients) besides the parents/patients anxiety and additional total cost. We recommend awareness campaigns for surgeons and adhering to guidelines of taking detailed hemostatic history.Reference:Chee YL1, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol. 2008 Mar;140(5):496-504.Keywords: Coagulation testing, Bleeding History, Surgery DisclosuresNo relevant conflicts of interest to declare.

The Utility of Hereditary Thrombophilia Testing Among Hospitalized Patients: A Single Center Experience

Background: Hereditarythrombophilias (HT) are a group of inherited diseases that predispose to venous thromboembolism (VTE). It can increase the risk of VTE by 3 to 20-fold compared to general population. HT are common and present in 7% of the population. Testing for HT is routine but knowing when to order the tests and how to interpret the results can be challenging. In the United Kingdom, it is estimated that 30,000 tests are done each year to screen for HT with an annual cost of 15,000,000 Euros. This led the British Committee For Standards in Haematology (BCSH) to release guidelines in 2010 that recommends against testing patients at the time of acute venous thrombosis as it will not influence the initial treatment. In the United States there are no clear guidelines regarding testing for HT. We performed a retrospective study to look at the utilization of HT tests among hospitalized patients. This study attempts to address the clinical utility of these tests and concurrent costs to the health care system.Methods: This is a retrospective study. We reviewed 2402 patient charts with at least one HT test ordered between 2/2016-1/2018 in St Luke's Health Care System records in Kansas City, MO. The following HT tests were included: Activated protein C resistance, antiphospholipid panel, antithrombin III level, factor V Leiden mutation, factor VIII level, homocysteine level, protein C level, protein S level, and prothrombin 20210 mutation. Only patients who had testing done during hospitalization were included. Positive actionable tests were analyzed to determine the clinical benefit of ordering the tests. A positive actionable test was defined as a positive test that changed the anticoagulation intensity, type or duration. Patients with history of previous thromboembolic disease, ongoing medical condition requiring life-long anticoagulation (such as atrial fibrillation), or unprovoked thromboembolic disease were considered non actionable. We also documented the total number of positive tests, ordering providers, and total cost related to ordering these tests (total cost of tests+ cost of hematology consult after an abnormal test).Results: A total of 2402 patients were reviewed. 954 patients were included with a mean age of 54 years. 397 (41.6%) were ordered for venous thromboembolism (VTE) (Deep vein thrombosis, pulmonary embolism or both). Among the included patients, 634 had at least one positive test (Table-1). Only 89 positive tests were actionable (14% of the positive tests and 9.3% of the total ordered tests). There was a statistically significant association between increasing age and having both a positive test result (P-value 0.006), and an actionable test (P-value 0.046). The chance of having actionable tests was more if the test was done in an inpatient setting rather that in the emergency room (OR 0.361, CI 95% (0.177-0.737)). The total cost of ordering these tests was estimated to be $551,218.1 and the cost of subsequent hematology consults was $15,367 leading to total cost of $566,585 during our study period.Conclusion: Inpatient testing for thrombophilia is associated with increased health care cost and did not change management in many situations. The decision of ordering these tests should be based on a clinical risk assessment. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Defying the IRA? Intimidation, Coercion and Communities during the Irish Revolution, by Brian Hughes

Brian Hughes here seeks to examine the means by which non-state militants, primarily the IRA, attempted to establish and maintain control over their communities during the Irish war of independence. He is also much interested in the forms of response which local people offered to address, and (at times) counter, these ambitions. His general idea is to map a rarely explored part of the landscape of revolutionary Ireland—that encompassing the large majority of the population who found themselves caught between the relatively small numbers of separatist guerrillas (perhaps no more than 3,000 at any one time) and the retreating forces of the United Kingdom state. In essence, he posits that this community, otherwise diverse, was united by a desire to avoid absolute commitment, by a willingness to elide loyalties where necessary and by a general desire to look out for itself. The book is meticulously researched, but is particularly effective when combining papers from the Bureau of Military History and the records of the Irish Grants Committee. Collating these Irish and British materials has enabled Hughes to expose the complex ways in which ordinary citizens, caught in the cross-fire of revolution, interpreted the course of events around them, as well as their own loyalties. A strikingly emblematic case is supplied by an egg-dealer from Arva, County Cavan, James McCabe, who simultaneously applied to both the Irish Free State and the British authorities for compensation arising out of the struggle of 1919–21. McCabe, a (long-) retired officer of the Royal Irish Constabulary, looked to the British Treasury-funded Irish Grants Committee for financial relief on the grounds of his service to the Crown; but he was also an Irish nationalist, who had a son active in the IRA, and he turned, too, to the Irish Free State authorities for financial redress, citing the family’s record in the revolution. Few were as bold as McCabe in seeking to milk the two competing jurisdictions for personal benefit; but his story does illustrate crisply the kind of ambiguous, alternate or sequential loyalties which characterised many at this time.

Reducing the use of inappropriate coagulation testing in emergency general surgical patients.

Background and aims Indiscriminate coagulation testing in emergency general surgical patients can lead to inappropriate delay in surgery, cause unnecessary concern and is associated with significant cost. The British Committee for Standards in Haematology recommends against coagulation testing to predict peri-operative bleeding risk in unselected patients. Our aim was to assess the appropriateness of coagulation tests performed in emergency general surgical patients and evaluate the effect of a series of educational interventions on clinical practice. Methods and results Appropriate indications for performing coagulation testing included a positive bleeding history, the presence of liver disease/cholestasis, sepsis or use of anticoagulants. Initial data on 142 patients were collected over 2 weeks of receiving. Following analysis, indications for appropriate coagulation testing were highlighted and data were collected on a further 190 patients. Comparing the audit cycles, we observed a decrease in the proportion of patients who underwent routine testing (49.3% vs 32.6%; p = 0.002) and inappropriate testing (67% of tests vs 34% of tests; p < 0.001). Despite being highlighted, there was no evidence of improved documentation of bleeding histories on admission. Conclusions This observational study suggests that simple educational messages can reduce the inappropriate use of coagulation screening tests in general surgical emergencies. This seems to result from clarification of the appropriate surgical indications for coagulation testing in this group.

The 2014 BCSH criteria and the 2016 WHO criteria for essential thrombocythemia: A comparison in a large-scale cohort.

There are currently 2 representative diagnostic criteria for essential thrombocythemia (ET), the 2014 British Committee for Standards in Hematology Guidelines (BCSH) criteria and the 2016 World Health Organization (WHO) criteria. We compare and discuss the advantages and disadvantages of the 2 criteria. We applied the 2 criteria to 403 patients with thrombocytosis and suspected myeloproliferative neoplasms (MPN) and compared patient populations. The BCSH criteria diagnosed ET in 279 patients (BCSH-ET) whereas the WHO criteria diagnosed ET in 203 patients (WHO-ET). There were 83 patients diagnosable only by the BCSH criteria (BCSH-only-ET), of which under the WHO classification, 69 patients fell under the category of MPN, unclassifiable (MPN-u), 12 patients were PMF, prefibrotic/early stage (pre-PMF), and 2 patients were polycythemia vera. Patient characteristics such as age, hemoglobin, hematocrit, platelet counts, lactate dehydrogenase levels, JAK2V617F allele burdens, prevalence of myelofibrosis and splenomegaly, and frequencies of thrombotic events and treatment did not differ between WHO-ET and BCSH-only-ET, but BCSH-only-ET patients showed higher WBC counts and higher JAK2V617F mutation frequencies. The BCSH criteria diagnosed ET in a broader range of patients encompassing a significant number of patients who would otherwise be diagnosed as pre-PMF or MPN-u.

Prophylaxis and treatment of venous thromboembolism in cancer patients: a systemic review and critical appraisal of clinical practice guidelines

: Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer and many organizations have published guidelines to help clinicians in prophylaxis and treatment with VTE in cancer patients. However, the quality of different guidelines remains unclear. In this study, we aimed to explore score and provide a whole picture of the current guidelines. Clinical guidelines and consensus statements in English to July 2017 were searched using MEDLINE via PubMed, EMBASE and some websites of guideline organizations. The guidelines containing recommendations on the prophylaxis and treatment with VTE in cancer patients were included. Three reviewers appraised the quality of the included guidelines by using Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Six domains with 23 items were appraised and standardized averages were calculated as the final scores in every domain. Of 2,335 citations identified, 13 guidelines were included in this study. Associazione Italiana di Oncologia Medica (AIOM), British Committee for Standards in Haematology (BCSH) and French national guideline were regard as “recommended for use with some modification” while the others were “strongly recommended for use in practice”. Most included guidelines scored high in domain 1 (scope and purpose) and domain 2 (stakeholder involvement), but scored poorly in domain 5 (applicability). The recommendations were consistent in general among the included guidelines. Low molecular weight heparin (LMWH) was the major choice for the prophylaxis and treatment but the duration for the long-term treatment for VTE was controversy and the guidelines with high quality tended to recommend 3 months. Apart from the BCSH guidelines, direct acting oral anticoagulants (DOACs) were not recommended on prophylaxis or treatment. The guidelines on VTE in cancer patients were of relative high quality. More effort is needed to decrease the gap between the practice and guideline. DOACs seem to be potential candidate when clinicians are reluctant to use LMWH, but more researches must be performed.

Diagnosis and management of von Willebrand disease in Slovakia

Background: Von Willebrand disease (VWD) is a common bleeding disorder with prevalence in the Slovak Republic of 11.2 cases per 100,000 people. Methods: We conducted a retrospective audit of 610 VWD patients in Slovakia. Results: Care of local patients with VWD primarily occurs through our comprehensive treatment centre, although some patients are managed solely by their primary care physician or community haematologist. Type 1 VWD is the most common subtype, with more females carrying this diagnosis than males. Diagnosis and treatment in general follows guidelines outlined by the European Group on VWD, British Committee for Standards in Haematology and Slovak Society on Haemostasis and Thrombosis. An ongoing study “Genetic Background and Haemostatic Changes in the Patients with VWD” is currently enrolling patients with all VWD subtypes across Slovakia in order to better delineate the extent of VWD and correlate bleeding symptoms with laboratory findings and von Willebrand factor (VWF) sequence variations. Conclusions: VWD diagnosis and management is best performed through hematology specialists familiar with the complexities of this condition, such as those in the hemophilia treatment centres.

Prophylaxis and treatment of venous thromboembolism in cancer patients: a systemic review and critical appraisal of clinical practice guidelines

Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer and many organizations have published guidelines to help clinicians in prophylaxis and treatment with VTE in cancer patients. However, the quality of different guidelines remains unclear. In this study, we aimed to explore score and provide a whole picture of the current guidelines. Clinical guidelines and consensus statements in English to July 2017 were searched using MEDLINE via PubMed, EMBASE and some websites of guideline organizations. The guidelines containing recommendations on the prophylaxis and treatment with VTE in cancer patients were included. Three reviewers appraised the quality of the included guidelines by using Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Six domains with 23 items were appraised and standardized averages were calculated as the final scores in every domain. Of 2,335 citations identified, 13 guidelines were included in this study. Associazione Italiana di Oncologia Medica (AIOM), British Committee for Standards in Haematology (BCSH) and French national guideline were regard as “recommended for use with some modification” while the others were “strongly recommended for use in practice”. Most included guidelines scored high in domain 1 (scope and purpose) and domain 2 (stakeholder involvement), but scored poorly in domain 5 (applicability). The recommendations were consistent in general among the included guidelines. Low molecular weight heparin (LMWH) was the major choice for the prophylaxis and treatment but the duration for the long-term treatment for VTE was controversy and the guidelines with high quality tended to recommend 3 months. Apart from the BCSH guidelines, direct acting oral anticoagulants (DOACs) were not recommended on prophylaxis or treatment. The guidelines on VTE in cancer patients were of relative high quality. More effort is needed to decrease the gap between the practice and guideline. DOACs seem to be potential candidate when clinicians are reluctant to use LMWH, but more researches must be performed.

The Indiscretion of Mark Oliphant: How an Australian Kick-started the American Atomic Bomb Project

In 1940, Mark Oliphant was the head of Physics at the University of Birmingham. In his hands, he held a memorandum from two of his research fellows, which proved, in theory at least, that a super-bomb made from the fission of the uranium-235 isotope could be produced. The significance of this research in war-time conditions was self-evident and it was tabled at a British government committee meeting on the atomic bomb and then forwarded to the USA. Yet in 1941, when Oliphant visited Washington, he was dismayed to learn that the British reports were kept locked in a safe and that they received no action. Rather than returning to Britain, Oliphant went instead to the University of California, Berkeley to visit his friend Ernest Lawrence. Oliphant and Lawrence's meeting was also attended by Robert Oppenheimer and from that moment a reinvigoration of the American atomic bomb project might be identified. Years later, Oppenheimer called Oliphant's visit to Berkeley an ‘indiscretion'. But was it? By combining archival research with an analysis of how scientists collaborate, this work argues that Oliphant did in fact breach secrecy protocols. However, itwas done in order to achieve the desired outcome of accelerated collaboration and research between Britain and the USA.