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      Teaching transfusion medicine: current situation and proposals for proper medical training

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          Abstract

          The current curricula in medical schools and hospital residence worldwide lack exposure to blood transfusion medicine, and require the reformulation of academic programs. In many countries, training in blood transfusion is not currently offered to medical students or during residency. Clinical evidence indicates that blood transfusions occur more frequently than recommended, contributing to increased risk due to this procedure. Therefore, the rational use of blood and its components is essential, due to the frequent undesirable reactions, to the increasing demand of blood products and the cost of the process. Significant improvements in knowledge of and skills in transfusion medicine are needed by both students and residents. Improvements are needed in both background knowledge and the practical application of this knowledge to improve safety. Studies prove that hemovigilance has an impact on transfusion safety and helps to prevent the occurrence of transfusion-related adverse effects. To ensure that all these aspects of blood transfusion are being properly addressed, many countries have instituted hospital transfusion committees. From this perspective, the interventions performed during the formation of medical students and residents, even the simplest, have proven effective in the acquisition of knowledge and medical training, thereby leading to a reduction in inappropriate use of blood. Therefore, we would like to emphasize the importance of the exposure of medical students and residents to blood services and transfusion medicine in order for them to acquire adequate medical training, as well as to discuss some changes in the current medical curricula regarding transfusion medicine that we judge critical.

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          Impact of more restrictive blood transfusion strategies on clinical outcomes: a meta-analysis and systematic review.

          There is accumulating evidence that restricting blood transfusions improves outcomes, with newer trials showing greater benefit from more restrictive strategies. We systematically evaluated the impact of various transfusion triggers on clinical outcomes.
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            Reducing the amount of blood transfused: a systematic review of behavioral interventions to change physicians' transfusion practices.

            Transfusion services have used various techniques to reduce blood product utilization. Given the potential adverse effects of transfusions and the resources consumed in implementing strategies to reduce transfusions, there is a need to understand their effectiveness. Therefore, we performed a systematic review of the literature to examine the effectiveness of behavioral interventions to reduce blood product utilization. We identified all relevant articles through the use of electronic searches of MEDLINE and EMBASE, as well as hand searches of review articles and personal files. The electronic searches included articles published between January 1966 and May 2003. The searches included the terms blood transfusion, plasma exchange, guidelines, education, practice patterns, and professional practice. The outcomes of interest were the number of units transfused and the proportion of patients who received transfusions. Nineteen studies examining the effectiveness of single (guidelines, prospective audits, retrospective audits, and reminders) or multifaceted interventions in reducing red blood cell, platelet, plasma, cryoprecipitate, and albumin transfusions met the inclusion criteria. Eighteen studies demonstrated a relative reduction in the number of units given (range, 9%-77%) or the proportion of patients receiving transfusions (range, 17%-79%). The reported reductions were qualitatively similar for the different blood products studied. No particular intervention or combination of interventions appeared more effective in reducing utilization. Behavioral interventions, including simple interventions, appear to be effective in changing physician transfusion practices and reducing blood utilization. Appropriately designed clinical trials are still needed to determine the relative effectiveness of different interventions to change practices.
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              Education in transfusion medicine for medical students and doctors.

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                Author and article information

                Contributors
                Journal
                Rev Bras Hematol Hemoter
                Rev Bras Hematol Hemoter
                Revista Brasileira de Hematologia e Hemoterapia
                Sociedade Brasileira de Hematologia e Hemoterapia
                1516-8484
                1806-0870
                21 November 2014
                Jan-Feb 2015
                21 November 2014
                : 37
                : 1
                : 58-62
                Affiliations
                [0005]Fundação Hemominas, Belo Horizonte, MG, Brazil
                Author notes
                [* ] Corresponding author at: Fundação Hemominas, Rua Grão Pará, 882, Belo Horizonte, MG, Brazil. annaproietti@ 123456gmail.com
                Article
                S1516-8484(14)00141-8
                10.1016/j.bjhh.2014.11.004
                4318849
                25638770
                a1414d15-7a2f-4a0e-b83f-0dfa97a25e45
                © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.
                History
                : 1 July 2014
                : 15 September 2014
                Categories
                Special Article

                Hematology
                blood transfusion,advisory committees,blood safety
                Hematology
                blood transfusion, advisory committees, blood safety

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