Stand-alone Centers Research Articles

The Anatomic Pathology Hospitalist Model.

Challenges to staffing a high-quality frozen section service include consolidation of health systems and pathology practices, off-campus relocation of some pathology offices, growing numbers of stand-alone surgery centers, and subspecialization among pathologists and surgeons. To address these challenges, we developed a novel anatomic pathology hospitalist model with explicit emphasis in frozen section. To evaluate our anatomic pathology hospitalist program's impact on (1) frozen section staffing, (2) frozen-permanent diagnostic concordance, and (3) turnaround time. Frozen section staffing and performance data were collected for the 28-month period spanning July 1, 2021, to October 31, 2023. Outcomes were compared between hospitalists, nonhospitalists, and fellows. Hospitalists performed more frozen sections per month than nonhospitalists (median, 87 versus 17, respectively; P = .002). After implementation, nonhospitalists' average frozen section staffing obligation fell from 3.7 (30%) of 12.3 total service days per month to 2.8 (22%) of 12.6 total service days per month (P = .005), compared with hospitalists' average of 9.5 frozen section days (69%) of 13.7 total service days per month. Frozen-permanent concordance was marginally but significantly higher for hospitalists (4701 of 4744 blocks, 99.1%) than nonhospitalists (7259 of 7362 blocks, 98.6%; P = .02). Concordance did not correlate with pathologists' academic rank or subspecialization. Turnaround times were comparable for hospitalists, nonhospitalists, and fellows across multiple metrics. Our anatomic pathology hospitalists significantly reduced the frozen section obligations of nonhospitalist faculty, with a small but significant increase in frozen-permanent concordance and no substantial change in turnaround time.

Categorization of the Inevitable Causes of Blood and Components Wastage Detected in South Indian Urban Blood Centre

Background: Since there is no artificial substitute for human blood, it plays a vital role in the patient management in this era of modern medicine. Therefore the donated blood from a healthy donor is precious and must not be wasted without proper utilization. Blood wastage is a universal phenomenon which needs a careful approach with strict guidelines. The study aims at categorizing the various inevitable causes of wastage with an attempt to determine ways of preventing the loss due to non-utilization. Materials and Methods: A retrospective – cross sectional study was conducted in a newly started Stand-alone Blood Centre in South Indian Urban city between June, 2022 and June 2024.All the components including Whole Blood (WB), Packed Red Blood Cell Concentrate (PRBC), Platelet concentrate (PC) and Fresh Frozen Plasma (FFP) were included in the study. The reasons for blood and component wastage was noted down from the various Registers of the Blood Centre and all the data was analyzed using Microsoft Excel Spread Sheet. Results: A total of 2456 units of blood were collected. 5284 components were prepared from these which includes 42 units of Whole Blood, 2397 Packed Red Blood cells(PRBC), 2393 Fresh frozen Plasma(FFP), 452 Platelet Concentrate(PC).Overall discard rate was found to be 11.90%. PC discard rate was highest (49.34%) followed by WBU (19.04%), PRBC (13.01%) AND FFP (3.59%). The commonest cause for the discarding was expiry of the shelf life of blood bags (74.72%) followed by damaged bags (9.69%) and TTI’s (6.76%). Conclusion: Blood and its components wastage is an inevitable reality which needs to be approached as upmost priority. Zero wastage of blood and components may be targeted by recommendations like appropriate training of the blood bank staff, keeping negative group donors on reserve, strictly following FIFO policy while dispensing blood, whole blood unit collection may be minimized, encouraging Single Donor Platelets (SDP) by apheresis instead of Random Donor Platelets (RDP) preparation, Blood Utilization Committee to be made mandatory and permission for reciprocal sharing of blood components among blood banks.

Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India.

India experienced a surge in COVID-19 cases during the second wave in the period of April-June 2021. A rapid rise in cases posed challenges to triaging patients in hospital settings. Chennai, the fourth largest metropolitan city in India with an 8 million population, reported 7564 COVID-19 cases on May 12, 2021, nearly 3 times higher than the number of cases in the peak of COVID-19 in 2020. A sudden surge of cases overwhelmed the health system. We had established standalone triage centers outside the hospitals in the first wave, which catered to up to 2500 patients per day. In addition, we implemented a home-based triage protocol from May 26, 2021, to evaluate patients with COVID-19 who were aged ≤45 years without comorbidities. Among the 27,816 reported cases between May 26 and June 24, 2021, a total of 16,022 (57.6%) were aged ≤45 years without comorbidities. The field teams triaged 15,334 (55.1%), and 10,917 (39.2%) patients were evaluated at triage centers. Among 27,816 cases, 19,219 (69.1%) were advised to self-isolate at home, 3290 (11.8%) were admitted to COVID-19 care centers, and 1714 (6.2%) were admitted to hospitals. Only 3513 (12.7%) patients opted for the facility of their choice. We implemented a scalable triage strategy covering nearly 90% of the patients in a large metropolitan city during the COVID-19 surge. The process enabled early referral of high-risk patients and ensured evidence-informed treatment. We believe that the out-of-hospital triage strategy can be rapidly implemented in low-resource settings.

Sustainable collaborative strategy in pharmaceutical refrigerated logistics routing problem

The rapid growth of pharmaceutical refrigerated logistics poses sustainability challenges, including elevated costs, energy consumption, and resource inefficiency. Collaborating multiple depots can enhance logistics efficiency when standalone distribution centres have limited transport resources, i.e. refrigerated vehicles. However, the sustainable benefits and performance across different strategies remain unexplored. This study fills this research gap by addressing a refrigerated pharmaceutical routing problem. While many collaborative strategies prioritise economic and environmental benefits, our approach highlights a vital social indicator: maintaining vehicle flow equilibrium at each depot during collaboration. This ensures the stability of transport resources for all stakeholders, promoting sustainable collaborative logistics. The problem is formulated as a multi-depot vehicle routing problem with time windows (MDVRPTW). Three collaborative strategies using Clustering VRP (CLUVRP) and improved Open VRP (OVRP) are proposed and compared. We develop two approaches to address traditional OVRP limitations in ensuring vehicle flow equilibrium at each depot. Our models consider perishable pharmaceuticals and time-dependent travel speeds. Three hybrid heuristics based on Simulated Annealing and Variable Neighborhood Search (SAVNS) are proposed and evaluated for efficacy. Computational experiments and a case study demonstrate distinct sustainable benefits across various strategies, offering valuable insights for decision-makers in the refrigerated logistics market.

Travelling overseas for proton beam therapy: Aretrospective interview study.

Travelling for cancer treatment comes with unique challenges, particularly for a young patient and his or her family. The aims of this study were to (1) gain an understanding of the experiences of families and patients who travelled overseas (OS) from Australia for proton beam therapy (PBT) and (2) identify the supportive care needs patients and their families require when living away from home, while having PBT. This was a retrospective, qualitative study using semi-structured interviews, conducted with participants aged under 25 years and their families who travelled OS for PBT between 2017 and 2020. Data were analysed using Microsoft Excel Software, where key themes were identified and coded based on their responses. A total of 17 participants were included in interviews from seven Australian families who travelled to America or Europe for PBT. The majority of participants reported a lack of coordination with travel and treatment arrangements prior to arrival OS. Families who stayed in hotel accommodation while OS reported greater feelings of isolation compared with those who stayed in share house-style accommodation. The acuity of cancer diagnosis played a significant part in patient experience, with those patients requiring the greatest amount of supportive care and availability of service provision at stand-alone centres reporting a lack of appropriate care provision. This study has identified services, accommodation provisions and care coordination requirements that are largely missing from the travel and treatment experience in patients travelling OS for PBT. Future use of consumer-led working groups or committees in creating models of care for families travelling for PBT treatment could be advantageous, with many families willing to share their experiences and provide support to others who are travelling for PBT.

Outpatient Total Knee Arthroplasty From a Stand-Alone Surgery Center: Safe as the Hospital?

BackgroundLiterature suggests that outpatient arthroplasty may result in low rates of complications and readmissions. There is, however, a dearth of information on the relative safety of total knee arthroplasty (TKA) performed at stand-alone ambulatory surgery centers (ASCs) versus hospital outpatient (HOP) settings. We aimed to compare safety profiles and 90-day adverse events of these 2 cohorts. MethodsProspectively collected data were reviewed on all patients who underwent outpatient TKA from 2015 to 2022. The ASC and HOP groups were compared, and differences in demographics, complications, reoperations, revisions, readmissions, and emergency department (ED) visits within 90 days of surgery were analyzed. There were 4 surgeons who performed 4,307 TKAs during the study period, including 740 outpatient cases (ASC = 157; HOP = 583). The ASC patients were younger than HOP patients (ASC = 61 versus HOP = 65; P < .001). Body mass index and sex did not differ significantly between groups. ResultsWithin 90 days, 44 (6%) complications occurred. No differences were observed between groups in rates of 90-day complications (ASC = 9 of 157, 5.7% versus HOP = 35 of 583, 6.0%; P = .899), reoperations (ASC = 2 of 157, 1.3% versus HOP = 3 of 583, 0.5%; P = .303), revisions (ASC = 0 of 157 versus HOP = 3 of 583, 0.5%; P = 1), readmissions (ASC = 3 of 157, 1.9% versus HOP = 8 of 583, 1.4%; P = .625), and ED visits (ASC = 1 of 157, 0.6% versus HOP = 3 of 583, 0.5%; P = .853). ConclusionThese results suggest that in appropriately selected patients, outpatient TKA can be safely performed in both ASC and HOP settings with similar low rates of 90-day complications, reoperations, revisions, readmissions, and ED visits.

The Challenges of MRI in Clinical Practice (P11-3.008)

The Challenges of MRI in Clinical Practice (P11-3.008)

A case study of stand-alone hybrid power systems for a data center using HOMER and DIgSILENT

The number of mega data centers is steadily expanding as the cloud business expands. The data center consumes heavy electrical power because of their structural and equipment characteristics (e.g., workstations and cooling equipment). The mega data center becomes a microgrid (e.g., islanding operation). So, a lot of researchers have proposed the architecture design of a green energy data center to solve the heavy energy consumption problem and to reduce the emission release. For example, the goal of a green energy data center is to maximize energy efficiency while reducing environmental impacts (e.g., the reduction of greenhouse gases). So, the goal of this study is to design the most effective power system for a stand-alone hybrid green data center at the aspects of energy savings and the reliable operation. The ideal architecture of a stand-alone data center powered by renewable energy is initially designed by the HOMER program. Then, the steady-state and transient responses of a data center that functions as an island microgrid using DIgSILENT© Power Factory are examined.

Assessment of Quality Management Practices across Asian Countries

Background and Objectives: Globally, there is a wide variation in Quality management practices and availability of Quality Standards. Because of a paucity of data on QM practices in BTS in various Asian countries, this study was undertaken to understand the quality assurance (QA) programme within the blood bank settings. Methods: The study was conducted by the Quality Working Group of Asian Association of Transfusion Medicine (AATM), by an online questionnaire having 25 questions which were circulated amongst various blood centres of member Countries of Asian Association of Transfusion Medicine (AATM). Results: 60 blood centres participated. 43 were Hospital based Blood Centres and 17 were from Stand-alone Blood Centres. The majority of the responders were from a tertiary care hospital (92%). More than 83% of blood centres, either accredited or planning to move forward, were conducting internal audits, more than 86% were having Quality policy and QMS. Conclusion: It is evident from this study that blood centres, by and large, maintain good practices as they are under the purview of regulatory bodies of the respective countries and hence follow Good Manufacturing Practices (GMP). As the Asian countries come under the LMIC category; hence the financial cost could be a major hindrance in achieving quality standards, but few extra miles to achieve quality standards or accreditation will ultimately lead to better patient care.

Abstract A055: Enhancing mammography quality in Wisconsin: Barriers and facilitators in developing a shared measurement system

Abstract Breast cancer mortality rates have decreased over several decades although these declines have been unequal. In Wisconsin, some parts of the state experience higher mortality than others, and Black women have the highest breast cancer mortality rate compared to women of other races/ethnicities although mammography screening rates are similar across populations. The Mammographic Quality Initiative (MQI) seeks to examine the role of mammography quality and develop a sustainable statewide model of monitoring and enhancing mammography quality, towards improving equity of early-stage breast cancer diagnoses and survival. Building on a collaborative statewide initiative in Illinois which showed reductions in disparities after documenting and addressing variability in mammographic technical quality and follow-up time, MQI will adapt the Illinois tools for Wisconsin using a transdisciplinary collaborative approach. MQI is a project of the Community and Cancer Science Network (CCSN), a statewide initiative to address cancer disparities. CCSN uses a transdisciplinary model that emphasizes learning and innovation, and full, equitable engagement of non-academic partners. Within MQI, this involves engaging research, community-based organizations, and radiology as initiative leadership and creating learning collaboratives in multiple Wisconsin regions. Learning collaboratives are employed in healthcare to improve patient outcomes through shared learning and practice improvement[CT1] . The learning collaboratives will contribute to the development of a common set of measures to monitor mammography quality and the development of a shared measurement system to monitor and improve outcomes. In its first year, MQI engaged large health systems, and high and low-resourced clinics and stand-alone mammography centers in Southeastern Wisconsin to involve them in the early stages of a learning collaborative. MQI’s leadership documents these engagements as part of the evaluation. Analysis of qualitative data collected identified barriers and facilitators to the development of a shared measurement system. Barriers included: 1) significant variation in how mammogram data reporting occurs that impedes participation, 2) difficulty in tracking follow-up data when a patient is referred for diagnostic services, and 3) multiple strains on system resources including staffing, capacity or payor models. However, a significant facilitator of engagement is a dedicated “champion” who is respected and trusted within the healthcare system. Champions included radiologists, technologists, or other key leaders. The initial analysis supports a front-loaded focus on development of partnerships and collaborative infrastructure. These findings give context and insight into a transdisciplinary approach that has the potential to be adapted and applied to other research programs and collaboratives working to impact population level disparity outcomes. Citation Format: Kelly Hackett, Laura Pinsoneault, Tobi Cawthra, Beth Brunner, Tommi Thompson, Melinda Stolley, Joan Neuner. Enhancing mammography quality in Wisconsin: Barriers and facilitators in developing a shared measurement system [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A055.

How much paediatric major trauma is truly paediatric? Experience from a level 1 urban Major Trauma Centre

Background: At its inception, there was no formal provision for children within the English major trauma network. There are now combined and stand-alone centres, but the scarcity of paediatric trauma facilities in some regions can result in long patient transfers and impact patient outcomes. The objective of this study was to determine the proportion of paediatric trauma patients who may benefit from input by adult services or may be safely managed within the local adult MTC, either because of patient physiology or injury patterns. Methods: All trauma presentations to our urban MTC aged ≤16 over a 3-year period were retrospectively identified and grouped, based on age and weight. ‘Young adult’ mechanisms of trauma and patient destinations (whether paediatric or adult wards) were determined. Results: There were 847 paediatric trauma cases recorded with a mean age of 9 and a male preponderance. Based on age and weight, 10–45% of cases could be considered physiologically adult-like, and 22–28% pubertal. Almost all penetrating trauma occurred in males, increasing with age. 14% of all admissions were managed on adult wards, with frequency increasing with patient age and with mechanism of actions (MOIs) relating to interpersonal violence. Conclusion: In this dataset, nearly half of paediatric trauma was ‘pubertal’ or ‘adult’ in their physiology and of these most presented with ‘young adult’ MOIs. These children likely benefit from combined paediatric and adult trauma services; where these do not exist, some older patients may be safely managed within local adult MTCs.

Evaluating urgent care center referrals to the emergency department.

Urgent care centers (UCCs) are increasingly popular with an estimated number of 9600 stand-alone centers in the United States compared to emergency departments (EDs). These facilities offer a potentially more convenient and affordable option for patients seeking care for a variety of low-acuity conditions. Because of the limitations of UCCs, patients occasionally are referred to EDs for further care. Prior studies have attempted to evaluate the appropriateness of these UCC referrals. Our study is the first to consider if these referrals require ED-specific care and the diagnostic concordance of these referrals. We performed a retrospective chart review to identify patients who were referred from UCCs to our ED between October 2020 and June 2021. We used a Boolean search strategy to screen charts for the terms urgent care, emergency department, referral, or transfer. Cases were manually screened until 300 met the inclusion criteria. Cases had to feature the patient being seen by a UCC provider and directly referred to the ED on the same day. Patients who presented to the ED of their own volition were excluded. Three independent abstractors reviewed the charts. All abstractors and a senior investigator piloted the use of a data collection sheet and discussed the management of any ambiguous data. A senior physician reviewed all discrepancies among abstractors. Data collected included ED final diagnosis and whether the final diagnosis was similar to the UCC diagnosis. A referral was deemed to require ED-specific care and resources if (1) the patient was admitted, (2) imaging (other than an x-ray) was performed, (3) specialist consultation was required, or (4) care was provided in the ED that is not conventionally available at UCCs. From the 300 patient charts, 55% of patients referred from UCCs to the ED did not require ED-specific care or resources and 64% had discordant diagnoses between UCC diagnosis and ED diagnosis. A total of 41% of patients underwent advanced imaging studies, 26% received specialty consultations, and 15% were admitted. Subgroup analysis for lacerations, extremity/fracture care, and abnormal electrocardiograms (ECGs) showed disproportionally high levels of discordant diagnoses and referrals that did not require ED-specific care or resources. Our data found that 55% of patients referred to EDs from UCCs did not require ED-specific care or resources and 64% carried a discordant diagnosis between UC and ED diagnosis. We suggest quality remedies, such as educational sessions and engagement with telemedicine sub-specialists as well as a coordinated formalized system for UCC to ED referrals.

Donor Notification and Response Rate in a Stand-alone Blood Center in Western India

Background and Objectives: Counseling and notification of reactive blood donors play an important part in maintaining the chain of safe blood. The process of notification involves informing donors about the status of their reactivity against five major and mandatory transfusion-transmitted infections (TTIs). Such notification and timely follow-up till the donor reaches the referred place help in reducing the burden of TTI in society, thereby improving blood safety. The aim of this study is to highlight the importance of prompt donor notification, referral, and follow-up. Materials and Methods: This was a retrospective cross-sectional study carried out at a stand-alone blood center from January 2019 to October 2021. A total of 36,162 donations were screened for the five mandatory TTIs-HIV (I and II), hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis, and malaria. All reactive results were retested with a duplicate tube sample and a bag sample to confirm the reactivity. Donors were notified regarding the serostatus by phone and called for reporting at our blood center, and referred to Integrated Testing &amp; Counseling Centre (ICTC) or any other referral center. Results: A total of 212 (0.58%) out of 36162 donors were tested reactive during the study period. Out of them, 40.56% (n = 86) were hepatitis B virus reactive, 21.7% (n = 46) were HIV (I and II) reactive, 20.7% (n = 44) were HCV reactive, and remaining 17.1% (n = 36) were syphilis reactive. All the donors were informed. Out of them, 71.69% (n = 152) responded to the communication and 52.83% (n = 112) personally visited the blood center or respective ICTC for further evaluation. Conclusion: Even after laying strict criteria for predonation screening and counseling, few donors do conceal their high-risk behavior or even their serostatus and continue to donate blood, leading to the wastage of resources. Thorough follow-up of seroreactive donors helps in improving blood safety and also improves their quality of life by the commencement of timely treatment.

Prevalence of Irregular Red Cell Antibodies in Healthy Blood Donors at a Stand-Alone Blood Centre in Gujarat

Background: Blood transfusion therapy involves multiple steps to ensure selection of safe blood component for transfusion. This includes testing for infectious markers, full ABO compatibility, free from any irregular red cell antibodies especially which are reacting at wide thermal amplitude and acceptable donor's red cell survival rates without destruction of recipient's red cells. Objective: This study was aimed to assess prevalence and type of irregular red cell antibodies in a large number of blood donor population at a standalone blood centre in Gujarat. Methods: This retrospective observational study included blood donor samples for antibody screening from January 2018 to March 2022. A total of 2,16,576 healthy blood donors including 2,00,493 (92.57%) males and 16,083 (7.43%) females were screened. Results: The prevalence of irregular red cell antibodies was 0.03 per cent in our donor population. Of the total 66 donors with red cell antibodies, 53(80.30%) had alloantibodies, 8(12.12%) had autoantibodies and 6 donors (9.09%) showed positive antibody screening with inconclusive results. We also found one case of cold antibody. Conclusion: Alloimmunization to red cell antigens is a challenging task for current transfusion practices. The antibody screening in blood donors may improve the quality and safety of blood transfusion in the recipients. It also reduces the risk of complications from incompatible blood transfusions. Keywords: antibody screening, allo-antibody identification, autoantibody, safe blood transfusion, hemolytic transfusion reaction.

Internal quality control of blood &amp; blood components - Two years study at a standalone blood centre, Ahmedabad

Internal Quality Control (IQC) describes steps taken by the blood centre to ensure that tests are performed correctly and as per the guidelines. Primary goal of Quality Control is transfusion of safe quality of blood components to give optimal benefit to patients. The aim of study was to ensure supply of safe and efficient blood component to patients.Quality control of blood components prepared between December 2019 to November 2021 were included in our study. Monthly Quality control (QC) of the blood components were done as per the national guideline, 1% of total components prepared or minimum 4 units. Packed red cell units were evaluated for haematocrit, random donor platelet concentrates for yield and fresh frozen plasma (FFP) and cryoprecipitate were evaluated for volume, factor VIII and fibrinogen concentrations.A total of 1302 units were tested for IQC. The mean hematocrit of RBC was 58.8%. In PLT, mean yield was 6.9 × 10/cu mm. Mean factor VIII and fibrinogen levels were found to be 377 IU/bag and 851.60 mg/bag in FFP respectively. Mean factor VIII and fibrinogen levels were found to be 311.81 IU/bag and 1694.4 mg/bag in cryoprecipitate respectively.In the present era, Quality Control is very important step in maintaining quality of blood components and the quality objectives of the blood centre, so that we ensure most efficient blood transfusion to patient. The IQC of blood components at our blood centre is in overall compliance and met recommended national standards. Implementation of standard operating procedures, accomplishment of standard guidelines, proper documentation with regular audit and staff competencies can improve the quality performance of the transfusion services.

Addressing surgical training inequities: city-wide collaboration in gynecologic surgical skills simulation for resident education

The objectives are to 1) create and implement a novel multi-institutional minimally invasive gynecologic surgical skills simulation course for first- and second-year obstetric and gynecology residents from four different residency programs, 2) address surgical training inequities by fostering a multi-institutional collaboration among different residency programs, 3) assess the efficacy of the simulation session on improving the residents’ confidence and knowledge, and 4) assess the impact of the multi-institutional collaboration on resident and faculty education. A four-hour gynecologic surgical skills simulation course for first- and second-year residents was developed by a team of gynecology faculty. The simulation course had multiple stations that focused on essential laparoscopic, vaginal and robotic surgical skills including the laparoscopic skills required for the Fundamentals of Laparoscopic Surgery (FLS) curriculum, trocar insertion, and vaginal clamp placement and suturing. There were additional interactive stations that provided education on various surgical energy modalities, hemostatic agents, and a three-dimensional virtual reality simulator for robotic surgical skills. The simulation session was piloted in September 2021 in a stand-alone simulation center. The participating residents and faculty completed a pre- and post-simulation survey. 27 first- and second-year residents participated in the course. 21 residents (78%) completed the pre-simulation survey, and 16 (59%) residents completed the post-simulation survey. On the pre-simulation survey, 15 (71%) respondents reported that they were either not familiar or slightly familiar with the FLS requirements. On the post-simulation survey, 12 (75%) respondents reported that they were moderately familiar or very familiar with the FLS requirements. 15 (94%) respondents found that the simulation session improved their overall surgical skills. Higher confidence ratings for various surgical skills were observed on the post-simulation survey compared to the pre-simulation survey. All the residents found that working with residents and faculty from different institutions was moderately to very beneficial to their learning. 13 faculty participated in teaching and 12 (92%) completed the pre-simulation survey, and 13 (100%) completed the post-simulation survey. Nearly all the faculty (92%) found that working with faculty from different institutions was moderately to very beneficial in improving their teaching skills. This novel multi-institutional minimally invasive gynecologic surgical skills simulation increased the residents’ confidence and preparedness for gynecologic surgery. Multi-institutional collaboration is a novel aspect of this simulation session which was well received by both the residents and faculty and can improve surgical training inequities.

Management of Safe and Adequate Blood Supply in COVID-19 Pandemic Amid National Lockdown

Background and Objectives: Blood centers around the globe are dependent on voluntary blood donation from healthy individuals to meet their blood supplies. The severe acute respiratory syndrome coronavirus-2 pandemic has become one of the most critical global health emergencies of modern times. Blood transfusion service (BTS) in India faced numerous challenges during the COVID-19 outbreak and the following imposed country lockdown. We aim to identify the challenges faced by a standalone blood center and explore the mitigation strategies implemented during the COVID-19 pandemic and subsequent lockdown. Methods: A cross-sectional study conducted at a standalone blood center done over a time period of 05 months including the nationwide lockdown phase. Personal invitation of donors, social media awareness, and in-house donation drives were implemented to improve donor inflow. Restricted donor entry, stringent donor selection, and adequate sanitization strategies were the key steps adopted to ensure the safety of donors and staffs. Results: After a declaration of nationwide lockdown in India, blood donation showed a drop of 13.36% and blood demand was also reduced by 25.70% in our study. Conclusions: The COVID-19 pandemic affected blood donation process and blood supply and adversely affected BTSs. BTS should always be vigilant to adopt new practices even before guidelines are set by regulatory authorities in adverse situations. Restrictive blood transfusion strategies need to be emphasized in the country.

Antibody Screening and Identification in Voluntary Blood Donors – Need of the Hour

Background and Objectives: Although unexpected antibody screening is mandatory according to the Food and Drug Administration and National Blood Policy, the prevalence of irregular red cell antibody and its specificities are not much reported in the donor population of western India. The objective of this study is to find the prevalence of unexpected antibodies in healthy blood donor population of western India. Methods: This is a retrospective study conducted in one of the largest stand-alone blood centers in western India. Data were retrieved from the Integrated Blood Bank Management System (powered by the blood center located in Ahmedabad) software. The data were analyzed for a period of 24 months, from March 1, 2019, to March 31, 2021. Unexpected antibody screening of all voluntary healthy blood donors was performed with fully automated blood grouping equipment Immucor NEO and Diagast EVO using commercial Capture-R Ready Indicator Red Cells (Immucor, USA) and Hemascreen Pool (Diagast, France). Further antibody identification was performed with 11 cell panels. Results: A total of 53,724 volunteer blood donors donated at our blood center during the study period comprised 51,185 (95.27%) male donors and 2539 (4.72%) female donors. A total of 25 (0.046%) donors showed the presence of unexpected antibodies. Most frequent alloantibodies were anti-M (n = 4, 16%) and multiple antibody (n = 4, 16%). Conclusion: Implementation of unexpected antibody screening in all the healthy blood donors routinely and identification of antibodies in antibody screen-positive donors helped us to understand the prevalence of antibodies in our region and its importance in providing compatible blood components which are devoid of irregular antibodies and to avoid delayed transfusion reactions.

Clinical Profile and Outcome in Long-term Hemodialysis: A Comparative Study of Hospital-based Versus Standalone Units.

Introduction:Chronic hemodialysis (CHD) remains the most “resorted to“ renal-replacement option in India. Pursuit for accessible and affordable dialysis has resulted in setting up standalone centers (SACs). We need more Indian data on the profile of CHD population and outcome of SAC compared to hospital-based units (HBUs).Material and Methods:We analyzed the clinical profile of patients on CHD for >5 years, compared the outcome between HBU and SAC, and analyzed the factors associated with mortality. Patients initiated between January 1, 2006 and December 31, 2012 and who have survived 5 years on CHD at HBU or SAC were enrolled and followed up prospectively for 2 years. Their clinical and biochemical profile, comorbidities, long-term complications, and mortality were analyzed.Results:The study included 137 patients, 41 (30%) from HBU and 96 (70%) from SACs. In both groups, the patients were predominantly male, aged 51–70 yrs, diabetic, unplanned initiation through catheters, and had average-dialysis vintage between 83 and 85 months. SAC had more patients with hemoglobin (> 11 gm/dL) and hyperparathyroidism with elevated SAP levels (P < 0.05). Both groups had comparable iron stores, serum calcium, and phosphorus. Comparable between groups, infections, coronary artery disease, and access complications accounted for most hospitalizations and sudden cardiac death and sepsis accounted for most mortality. A trend of better survival was seen in SAC. Multivariate analysis showed anemia, DM and hospitalizations were associated with mortality.Conclusion:We conclude that the outcomes of long-term CHD at SACs are not inferior to HBUs. Anemia, diabetes, and hospitalizations were associated with overall mortality. Benefits of SACs in cost, QOL, and employment opportunities need to be studied in the Indian context.

Stand-alone renewable power system scheduling for a green data center using integer linear programming

In light of the rapid growth of data centers around the world and their huge energy consumption, several researchers have focused on the task scheduling and resource allocation problem in order to minimize the energy consumed by the data center. Other initiatives focus on the implementation of green energy sources in order to minimize the consumption of fossil fuels and their emission of CO $$_{2}$$ . As part of the ANR DATAZERO project (Pierson et al. in IEEE Access 7, 2019. https://doi.org/10.1109/ACCESS.2019.2930368 ), several research teams have engaged in efforts at defining the main concepts of a full green data center, powered only by renewable energy. Achieving this goal necessitates a focus on the efficient management of an autonomous hybrid power system consisting of solar panels, wind turbines, batteries, and fuel cell systems. The purpose of this work is not to show that a stand-alone data center is economically viable, but rather is feasible. This paper proposes a set of models based on mixed integer linear programs capable of managing the energy commitment to address data center power demand. The approach takes the season and weather forecasts into account at the time of optimization.