-
JAMA The Journal of the American Medical Association 02/2013; 309(6):545. · 30.03 Impact Factor
-
Nusrat Zaffar,
Ashley Joseph,
C David Mazer,
Rosane Nisenbaum,
Keyvan Karkouti, Alan Tinmouth,
Mark D Peterson,
Katerina Pavenski,
Jeannie Callum,
Christine Cserti-Gazdewich,
Nadine Shehata
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: Platelet transfusion in cardiac surgery is often empiric as no established point-of-care tests are available for clear guidance of blood product administration, and there are many variables that can potentially increase the risk of bleeding during cardiopulmonary bypass. The objectives of this study were to determine the factors that influenced physicians' decisions to transfuse platelets perioperatively and to determine whether these factors coincide with characteristics using chart abstraction. METHODS: This study was conducted at three university affiliated hospitals using focused physician questionnaires to assess factors influencing decisions to transfuse platelets and data abstraction to determine characteristics of patients receiving platelet transfusion during cardiac surgery. RESULTS: Seventy-six physicians participated in the questionnaire; 41% identified bleeding and 22% identified both bleeding and the platelet count as the most significant factors influencing their decision to transfuse platelets. Of the 629 patients included in the study, 24.5% received a platelet transfusion intraoperatively and 4.5% received the transfusion postoperatively. The following factors were identified with the highest odds of receiving a platelet transfusion intraoperatively: combined bypass and valvular surgery (odds ratio [OR] 3.94; 95% confidence interval [CI] 1.94 to 8.00) and the presence of liver disease (OR 6.43; 95% CI 1.17 to 35.37). CONCLUSION: The use of focused physician questionnaires identified relevant aspects of patient care not apparent in the chart review that influenced the decision to transfuse platelets. The identification of bleeding, thrombocytopenia, more complex surgery, and the presence of liver disease highlights the requirement for standardized measures to assess the need for platelet transfusions in bleeding patients.
Canadian Anaesthetists? Society Journal 01/2013; · 2.31 Impact Factor
-
Dean A Fergusson,
Paul Hébert,
Debora L Hogan,
Louise LeBel,
Nicole Rouvinez-Bouali,
John A Smyth,
Koravangattu Sankaran, Alan Tinmouth,
Morris A Blajchman,
Lajos Kovacs, [......],
Shoo Lee,
C Robin Walker,
Brian Hutton,
Robin Ducharme,
Katelyn Balchin,
Tim Ramsay,
Jason C Ford,
Ashok Kakadekar,
Kuppuchipalayam Ramesh,
Stan Shapiro
-
Dean A Fergusson,
Paul Hébert,
Debora L Hogan,
Louise LeBel,
Nicole Rouvinez-Bouali,
John A Smyth,
Koravangattu Sankaran, Alan Tinmouth,
Morris A Blajchman,
Lajos Kovacs, [......],
Shoo Lee,
C Robin Walker,
Brian Hutton,
Robin Ducharme,
Katelyn Balchin,
Tim Ramsay,
Jason C Ford,
Ashok Kakadekar,
Kuppuchipalayam Ramesh,
Stan Shapiro
-
Dean A Fergusson,
Paul Hébert,
Debora L Hogan,
Louise LeBel,
Nicole Rouvinez-Bouali,
John A Smyth,
Koravangattu Sankaran, Alan Tinmouth,
Morris A Blajchman,
Lajos Kovacs, [......],
Shoo Lee,
C Robin Walker,
Brian Hutton,
Robin Ducharme,
Katelyn Balchin,
Tim Ramsay,
Jason C Ford,
Ashok Kakadekar,
Kuppuchipalayam Ramesh,
Stan Shapiro
-
Dean A Fergusson,
Paul Hébert,
Debora L Hogan,
Louise LeBel,
Nicole Rouvinez-Bouali,
John A Smyth,
Koravangattu Sankaran, Alan Tinmouth,
Morris A Blajchman,
Lajos Kovacs, [......],
Shoo Lee,
C Robin Walker,
Brian Hutton,
Robin Ducharme,
Katelyn Balchin,
Tim Ramsay,
Jason C Ford,
Ashok Kakadekar,
Kuppuchipalayam Ramesh,
Stan Shapiro
[show abstract]
[hide abstract]
ABSTRACT: Even though red blood cells (RBCs) are lifesaving in neonatal intensive care, transfusing older RBCs may result in higher rates of organ dysfunction, nosocomial infection, and length of hospital stay.
To determine if RBCs stored for 7 days or less compared with usual standards decreased rates of major nosocomial infection and organ dysfunction in neonatal intensive care unit patients requiring at least 1 RBC transfusion.
Double-blind, randomized controlled trial in 377 premature infants with birth weights less than 1250 g admitted to 6 Canadian tertiary neonatal intensive care units between May 2006 and June 2011.
Patients were randomly assigned to receive transfusion of RBCs stored 7 days or less (n = 188) vs standard-issue RBCs in accordance with standard blood bank practice (n = 189).
The primary outcome was a composite measure of major neonatal morbidities, including necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia, and intraventricular hemorrhage, as well as death. The primary outcome was measured within the entire period of neonatal intensive care unit stay up to 90 days after randomization. The rate of nosocomial infection was a secondary outcome.
The mean age of transfused blood was 5.1 (SD, 2.0) days in the fresh RBC group and 14.6 (SD, 8.3) days in the standard group. Among neonates in the fresh RBC group, 99 (52.7%) had the primary outcome compared with 100 (52.9%) in the standard RBC group (relative risk, 1.00; 95% CI, 0.82-1.21). The rate of clinically suspected infection in the fresh RBC group was 77.7% (n = 146) compared with 77.2% (n = 146) in the standard RBC group (relative risk, 1.01; 95% CI, 0.90-1.12), and the rate of positive cultures was 67.5% (n = 127) in the fresh RBC group compared with 64.0% (n = 121) in the standard RBC group (relative risk, 1.06; 95% CI, 0.91-1.22).
In this trial, the use of fresh RBCs compared with standard blood bank practice did not improve outcomes in premature, very low-birth-weight infants requiring a transfusion.
clinicaltrials.gov Identifier: NCT00326924; Current Controlled Trials Identifier: ISRCTN65939658.
JAMA The Journal of the American Medical Association 10/2012; 308(14):1443-51. · 30.03 Impact Factor
-
Canadian Journal of Anaesthesia 04/2012; 56(5):343-347. · 2.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Red blood cell (RBC) transfusion is required frequently for most patients after hematopoietic stem cell transplantation (HSCT). RBC transfusion, however, can be associated with adverse events including transfusion reactions, acquiring transmissible disease, and delayed recovery. Factors associated with avoidance of transfusion are not well documented.
Data concerning RBC transfusions between Day 0 and Day +30 were analyzed for patients undergoing HSCT at a single Canadian transplant center between January 2002 and December 2007.
Of 555 patients undergoing HSCT with complete RBC transfusion data, 59 patients (10.6%) did not require RBC transfusion in the first 30 days after HSCT. Univariate analysis showed no significant difference in age, graft source, donor type, or conditioning regimen between transfused and nontransfused patients. Factors that were significantly associated with avoidance of transfusion included male sex (p = 0.0013), diagnosis, specifically plasma cell dyscrasias (p < 0.0001), early-stage disease (p = 0.006), and higher baseline hemoglobin (Hb) at time of transplant (p < 0.0001). In multivariate analysis, higher pretransplant Hb, male sex, and early-stage disease remained significantly associated with avoidance of RBC transfusion. Pretransplant Hb correlated inversely with the number of RBC transfusions (r = -0.89).
Increased pretransplant Hb, male sex, and early-stage disease are associated with avoidance of RBC transfusion after HSCT. Interventions aimed at improving pretransplant Hb levels require further study.
Transfusion 02/2012; 52(9):2049-54. · 3.22 Impact Factor
-
Donald M Arnold,
Nancy M Heddle,
Julie Carruthers,
Deborah J Cook,
Mark A Crowther,
Ralph M Meyer,
Yang Liu,
Richard J Cook,
Anne McLeod,
Janet A MacEachern,
Joy Mangel,
David Anderson,
Linda Vickars, Alan Tinmouth,
Andre C Schuh,
John G Kelton
[show abstract]
[hide abstract]
ABSTRACT: The benefit of adding rituximab to standard treatment in nonsplenectomized patients with primary immune thrombocytopenia (ITP) is uncertain. We performed a pilot randomized trial to determine the feasibility of recruitment, protocol adherence, and blinding of a larger trial of rituximab versus placebo; and to evaluate the potential efficacy of adjuvant rituximab in ITP. Nonsplenectomized adults with newly diagnosed or relapsed ITP who were receiving standard ITP therapy for a platelet count below 30 × 10(9)/L were randomly allocated to receive 4 weekly infusions of 375 mg/m(2) rituximab or saline placebo. Sixty patients were recruited over 46 months, which was slower than anticipated. Protocol adherence and follow-up targets were achieved, and blinding was successful for research staff but not for patients. After 6 months, there was no difference between rituximab and placebo groups for the composite outcome of any platelet count below 50 × 10(9)/L, significant bleeding or rescue treatment once standard treatment was stopped (21/32 [65.6%] vs 21/26 [80.8%]; relative risk = 0.81, 95% confidence intervals, 0.59%-1.11%). Timely accrual poses a challenge to the conduct of a large randomized trial of rituximab for presplenectomy ITP. No difference in the frequency of the composite outcome was observed in this pilot trial (registered at www.clinicaltrials.gov NCT00372892).
Blood 02/2012; 119(6):1356-62. · 9.90 Impact Factor
-
Lauralyn McIntyre,
Dean A Fergusson,
Brian Rowe,
Deborah J Cook,
Yaseen Arabi,
Sean M Bagshaw,
Marcel Emond,
Simon Finfer,
Alison Fox-Robichaud,
Alasdair Gray, [......],
Paul Hebert,
Eddy Lang,
John Marshall,
Ian Stiell, Alan Tinmouth,
Joe Pagliarello,
Alexis Turgeon,
Timothy Walsh,
Andrew Worster,
Ryan Zarychanski
[show abstract]
[hide abstract]
ABSTRACT: Severe sepsis and septic shock are the most common reasons for admission to an intensive care unit; and the risk of death is substantial, estimated at approximately 40%. Evidence suggests that early resuscitation strategies that include the use of resuscitation fluids, antibiotics, blood, and inotropes reduce death. Although fluid resuscitation is an immediate life-saving intervention, a fundamental question that remains unanswered is whether the type of resuscitation fluid impacts survival when it is initiated very early in the course of septic shock. A randomized controlled trial published in 2008 confirmed that hydroxyethyl starch fluids cause acute renal failure defined by the requirement for renal replacement therapy. In contrast, a subgroup analysis from a randomized controlled trial suggests that 4% albumin fluid may reduce death from severe sepsis; however, these findings require confirmation in a large randomized trial. Our team is planning a pragmatic early septic shock fluid resuscitation trial that will compare the effectiveness of 5% albumin vs normal saline on 90-day mortality (PRECISE). In this article, we summarize the scientific rationale and inherent challenges associated with the conduct of PRECISE, the background work and planning elements that have been undertaken, and the PRECISE RCT protocol with rationale and justifications provided for the chosen population, the interventions, and the outcome measures.
Transfusion medicine reviews 01/2012; 26(4):333-341. · 3.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the relative risks of death, myocardial infarction, stroke, and renal failure or dysfunction between antifibrinolytics and no treatment following the suspension of aprotinin from the market in 2008 for safety reasons and its recent reintroduction in Europe and Canada.
Systematic review and network meta-analysis.
A Cochrane review of antifibrinolytic treatments was chosen as the starting point for this systematic review. Medline, Embase, and the Cochrane register of trials were searched with no date restrictions for observational evidence.
Propensity matched or adjusted observational studies with two or more of the interventions of interest (aprotinin, tranexamic acid, epsilon-aminocaproic acid, and no treatment) that were carried out in patients undergoing cardiac surgery.
Network meta-analysis was used to compare treatments, and odds ratios with 95% credible intervals were estimated. Meta-analyses were carried out for randomised controlled trials alone and for randomised controlled trials with observational studies.
106 randomised controlled trials and 11 observational studies (43 270 patients) were included. Based on the results from analysis of randomised controlled trials, tranexamic acid was associated on average with a reduced risk of death compared with aprotinin (odds ratio 0.64, 95% credible interval 0.41 to 0.99). When observational data were incorporated, comparisons showed an increased risk of mortality with aprotinin on average relative to tranexamic acid (odds ratio 0.71, 95% credible interval 0.50 to 0.98) and epsilon-aminocaproic acid (0.60, 0.43 to 0.87), and an increased risk of renal failure or dysfunction on average relative to all comparators: odds ratio 0.66 (95% credible interval 0.45 to 0.88) compared with no treatment, 0.66 (0.48 to 0.91) versus tranexamic acid, and 0.65 (0.45 to 0.88) versus epsilon-aminocaproic acid.
Although meta-analyses of randomised controlled trials were largely inconclusive, inclusion of observational data suggest concerns remain about the safety of aprotinin. Tranexamic and epsilon-aminocaproic acid are effective alternatives that may be safer for patients.
BMJ (Clinical research ed.). 01/2012; 345:e5798.
-
Lauralyn A McIntyre,
Dean A Fergusson,
Deborah J Cook,
Brian H Rowe,
Sean M Bagshaw,
Dave Easton,
Marcel Emond,
Simon Finfer,
Alison Fox-Robichaud,
Claude Gaudert,
Robert Green,
Paul Hebert,
John Marshall,
Nigel Rankin,
Ian Stiell, Alan Tinmouth,
Joe Pagliarello,
Alexis F Turgeon,
Andrew Worster,
Ryan Zarychanski
[show abstract]
[hide abstract]
ABSTRACT: Randomized, controlled trials of fluid resuscitation in early septic shock face many logistic challenges. We describe the Fluid Resuscitation with 5% albumin versus Normal Saline in Early Septic Shock (PRECISE) pilot trial study design and report feasibility of patient recruitment.
Six Canadian academic centers enrolled adult patients with early suspected septic shock from the emergency department and intensive care unit department. Consent was deferred. Using concealed allocation, participants were randomized to either 5% albumin or 0.9% sodium chloride. Blinded fluid resuscitation started immediately and continued for 7 days in the intensive care unit. Target recruitment was established a priori at 2 patients per site per month.
Fifty-one patients were enrolled; 50 patients received study fluid. We recruited a median of 2.5 patients (interquartile range [IQR], 1.5-3.0) per site per month into the trial. Median age and Acute Physiology and Chronic Health Evaluation II scores were 64.5 (IQR, 55.0-78.0) and 25.0 (IQR, 20.0-29.0), respectively. Most patients (n = 37 [74.0%]) were enrolled from the emergency department for a median of 1.6 hours (IQR, 0.8-3.5 hours) from their first hypotensive event and received a median of 2.4 L (IQR, 1.5-3.0 L) of resuscitation fluid before inclusion. Consent was deferred for 44 patients (89.8%).
Patient recruitment into the PRECISE pilot trial met our prespecified feasibility targets, and the PRECISE team is planning the larger trial.
Journal of critical care 12/2011; 27(3):317.e1-6. · 2.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Insight regarding transfusion practices in Hematopoietic Stem cell Transplantation (HSCT) are lacking and the impact of red cell transfusion in this high risk group on outcomes following HSCT are not well appreciated. Red blood cell transfusion can be life-saving, however, liberal use of transfusion in critically ill patients failed to demonstrate significant clinical benefit. A large number of other observational studies have also demonstrated an association between red blood cell transfusions and increased morbidity such as infections and multi organ failure as well as increased mortality. The role of red cell transfusion on the clinical outcomes observed in patients undergoing HSCT remains poorly understood and a prospective randomized study of transfusion is required to gain insight and knowledge on best transfusion practices in this high risk population.
This report describes the design and methodological issues of a randomized pilot study evaluating red cell transfusion triggers in the setting of Hematopoietic Stem Cell Transplantation. This study has been funded by a peer review grant from the Canadian Blood Services and is registered on Clinicaltrials.gov NCT01237639.
In 3 Canadian centres, 100 patients undergoing Hematopoietic Stem Cell Transplantation will be randomized to either a restrictive (target hemoglobin of 70-90 g/L) or liberal (target hemoglobin of 90-110 g/L) red cell transfusion strategy, based daily hemoglobin values up to 100 days post-transplant. The study will stratify participants by centre and type of transplant. The primary goal is to demonstrate study feasibility and we will collect clinical outcomes on 1) Transfusion Requirements, 2) Transplant Related Mortality, 3) Maximum grade of acute Graft versus Host Disease, 4) Veno-occlusive Disease, 5) Serious Infections, 6) Bearman Toxicity Score, 7) Bleeding, 8) Quality of Life, 9) Number of Hospitalizations and 10) Number of Intensive Care Unit (ICU) Admissions.
Upon completion, this pilot trial will provide preliminary insight into red cell transfusion practice and its influence in hematopoietic stem cell transplant outcomes. The results of this trial will inform the conduct of a larger study.
Trials 09/2011; 12:207. · 2.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Red blood cells (RBCs) are transfused to treat anemia and to maintain oxygen delivery to vital organs during critical illness. Laboratory and observational studies have raised the possibility that prolonged RBC storage may adversely affect clinical outcomes. Compared with RBCs stored less than 1 week, there are no clinical data demonstrating that RBCs stored longer remain as effective at carrying or releasing oxygen, and observational studies have risen to possibility that prolonged RBC storage might result in harm to vulnerable patients requiring blood transfusions. The "Age of Blood Evaluation" (ABLE) study (ISRCTN44878718) is a double-blind, multicenter, parallel randomized controlled clinical trial. It will test the hypothesis that the transfusion of prestorage leukoreduced RBCs stored for 7 days or less (fresh arm) as compared with standard-issue RBCs stored, on average, 15 to 20 days (control arm) will lead to lower 90-day all-cause mortality and reduced morbidity in critically ill adults. We include adults in intensive care units (ICUs) who (1) have had a request for a first RBC unit transfusion during the first 7 days of ICU admission and (2) have an anticipated requirement for ongoing invasive and noninvasive mechanical ventilation exceeding 48 hours. Enrolled patients are randomized at the time of transfusion to receive either standard-issue RBC units or RBCs stored 7 days or less issued by the local hospital transfusion service. The primary outcome is 90-day all-cause mortality. Secondary outcomes include ICU and hospital mortality, organ failure, and serious nosocomial infections. With 2510 patients, we will be able to detect a 5% absolute risk reduction (from 25% to 20%). The ABLE study is currently enrolling patients in 23 university-affiliated and community-hospital ICUs across Canada; sites in France and United Kingdom are expected to start recruitment in 2011. Regardless of the results, ABLE study will have significant implications on the duration of RBC storage. A negative trial will reassure clinicians and blood bankers regarding the effectiveness and safety of standard-issue RBCs. A positive trial will have significant implications with respect to inventory management of RBCs given to critically ill adults with a high risk of mortality and will also prompt research to better understand the RBC storage lesion in the hopes of minimizing its clinical consequences through the development of better storage methods.
Transfusion medicine reviews 07/2011; 25(3):197-205. · 3.61 Impact Factor
-
Nancy M Heddle,
Cynthia Wu,
Ralph Vassallo,
Patricia Carey,
Donald Arnold,
Miguel Lozano,
Katerina Pavenski,
Joseph Sweeney,
Simon Stanworth,
Yang Liu,
Aicha Traore,
Rebecca Barty, Alan Tinmouth
[show abstract]
[hide abstract]
ABSTRACT: In the SToP platelet dose study, the World Health Organization (WHO) bleeding grade was assigned using adjudication. This study describes the challenges associated with adjudicating bleeding events and compares the adjudicated and bedside results for bleeding grade.
To categorize bleeding, the following information was provided to adjudicators: daily bleeding assessments, interventions to stop or control bleeding, daily blood counts, and transfused blood components. Each daily assessment was sent to two adjudicators who independently assigned a grade and anatomic site of bleeding. Discordant cases where disagreement occurred were sent to a third adjudicator and subsequently to a fourth or fifth adjudicator in an attempt to reach agreement. Disagreement after five adjudicators was resolved by consensus. The final adjudicated grade was compared with the grade of bleeding assigned at the bedside by study personnel.
A total of 1150 case report forms were adjudicated. Disagreement on grade of bleeding was common: 31.2% after the first two adjudicators, 4.0% after the third adjudicator, 0.7% after four, and 0.05% after five. Disagreement on anatomic site was less but still occurred in 17% of cases after two adjudicators. The frequency of bleeding (≥ Grade 2) based on adjudication was higher than bedside grading (standard-dose arm, 47.5% vs. 34.4%; low-dose arm, 50.0% vs. 43.1%).
The frequency of WHO bleeding varies depending on the method used to assign grade. Adjudication to assign bleeding grade resulted in significant disagreement when two adjudicators were used.
Transfusion 05/2011; 51(11):2304-10. · 3.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Red blood cell (RBC) transfusion may prolong recovery in some patients, perhaps due to changes that occur during more prolonged RBC storage. We examined the impact of RBC transfusion and the age of transfused RBC units on clinical outcomes in hematopoietic stem cell transplantation (HSCT).
Data concerning RBC transfusions between Day 0 and Day +30 were analyzed for patients undergoing HSCT (n = 555) at a single institution. "Old" RBC units were defined as those stored for 15 days or longer.
The proportion of old RBC units transfused and the mean age of transfused units did not correlate with 100-day nonrelapse mortality, organ-specific toxicity, length of stay (LOS), or incidence of intensive care unit (ICU) admission (p > 0.05). In comparing the 71 patients who received only old RBC units with 218 patients who received only "new" RBC units, there was no increase in adverse clinical outcomes after HSCT. Autologous transplant recipients (n = 355, 3.8 units/patient) were more likely to avoid RBC transfusion and received fewer units compared with allogeneic recipients (n = 200, 6.4 units/patient, p < 0.0001). The mean number of transfused RBC units was greater in patients admitted to the ICU (10.5 units vs. 3.7 units/patient, p < 0.01), correlated with longer LOS (p < 0.0001), and correlated with increasing number of organ systems with toxicity of at least Grade 2 (p < 0.0001).
The importance of RBC storage time does not appear to influence clinical outcomes in HSCT. Patients with increased RBC transfusion requirements have greater toxicity after HSCT. Whether RBC transfusion contributes to toxicity, however, remains unclear.
Transfusion 05/2011; 51(11):2488-94. · 3.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The significance of ABO matching for platelet (PLT) transfusion has not been clearly defined. The primary objective of this report is to assess whether ABO-identical PLT transfusion is associated with improved mortality and/or morbidity for patients with hematologic/oncologic disorders.
A systematic review to January 2009 was conducted. Data on mortality, morbidity, PLT refractoriness, and PLT increment after transfusion were abstracted.
A total of 100 citations were identified. Nineteen studies were included in the systematic review. A total of 1502 patients from three randomized controlled trials and 16 observational studies were included. Survival, bleeding events, and transfusion reactions were only considered as secondary outcomes in the reports reviewed. The PLT count increment was the primary outcome of several studies and was consistently higher with ABO-identical PLT transfusion. The largest difference in increment between ABO-identical and nonidentical PLT transfusion was 4 x 10(9)/L. No consistent benefit in clinical outcomes was noted. Survival was assessed in three reports with conflicting results. Although two studies described bleeding as an outcome, the assessment of hemorrhage was considered inadequate. In six studies, ABO-nonidentical PLT transfusion was not associated with transfusion reactions, and the results from four studies addressing the impact of ABO-identical PLT transfusion on PLT and red blood cell utilization were conflicting.
ABO-identical PLT transfusion results in a higher PLT increment. Randomized controlled trials are required to definitely determine the effect of ABO-identical PLT transfusion on survival, bleeding events, or transfusion reactions.
Transfusion 11/2009; 49(11):2442-53. · 3.22 Impact Factor
-
Implementation Science 10/2009; · 3.10 Impact Factor
-
Canadian Journal of Anaesthesia 04/2009; 56(5):343-7. · 2.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Many theories of behaviour are potentially relevant to predictive and intervention studies but most studies investigate a narrow range of theories. Michie et al. (2005) agreed 12 'theoretical domains' from 33 theories that explain behaviour change. They developed a 'Theoretical Domains Interview' (TDI) for identifying relevant domains for specific clinical behaviours, but the framework has not been used for selecting theories for predictive studies. It was used here to investigate clinicians' transfusion behaviour in intensive care units (ICU). Evidence suggests that red blood cells transfusion could be reduced for some patients without reducing quality of care.
(1) To identify the domains relevant to transfusion practice in ICUs and neonatal intensive care units (NICUs), using the TDI. (2) To use the identified domains to select appropriate theories for a study predicting transfusion behaviour.
An adapted TDI about managing a patient with borderline haemoglobin by watching and waiting instead of transfusing red blood cells was used to conduct semi-structured, one-to-one interviews with 18 intensive care consultants and neonatologists across the UK.
Relevant theoretical domains were: knowledge, beliefs about capabilities, beliefs about consequences, social influences, behavioural regulation. Further analysis at the construct level resulted in selection of seven theoretical approaches relevant to this context: Knowledge-Attitude-Behaviour Model, Theory of Planned Behaviour, Social Cognitive Theory, Operant Learning Theory, Control Theory, Normative Model of Work Team Effectiveness and Action Planning Approaches.
This study illustrated, the use of the TDI to identify relevant domains in a complex area of inpatient care. This approach is potentially valuable for selecting theories relevant to predictive studies and resulted in greater breadth of potential explanations than would be achieved if a single theoretical model had been adopted.
British Journal of Health Psychology 02/2009; 14(Pt 4):625-46. · 2.70 Impact Factor
