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Management of Transfusion Dependent Thalassaemia GUIDELINES DEVELOPMENT The development group for these guidelines consisted of paediatricians, paediatric haemato-oncologists, paediatric endocrinologists, haematologists, pathologists, public health physicians, a clinical geneticist, a family medicine specialist, a radiologist, a pharmacist and a nursing sister from the Ministry of Health and Ministry of Higher Education, Malaysia.
Associate Professor, Department of Pediatrics, National Cheng-Kung University, Aug.1986-Now Associate Professor, Department of Laboratory Medicine and Pediatrics, College of Medicine, National Taiwan University, Aug.1999-Now Board Certification： Taiwan Society of Pediatrics, 1989, re-certified 1995 Taiwan Society of Hematology, 1987 Taiwan Society of Cardiology , 1989 Taiwan Society of Clinical Pathology,1994 , re-certified 2007 Formosan Association of Blood Purification, 1998 Taiwan Society of Blood and Bone Marrow transplantation, 2007 Professional Experience： Secretary General, Society of Blood Transfusion, R.O.C.
1990 Undergraduate, School of Medicine, China Medical College 1996 Clinical and research fellow, National Health Institute Transfusion Medicine Laboratory, Mackay Memorial Hospital, Taipei, Taiwan 2005 Elite Leadership Program, John F.
He was infected with HCV in a blood transfusion he received in a hospital in 1981 after having been shot by a cop at a crime scene in which a cop was shot by someone before Mumia arrived on the scene.
FINAL DRAFT Waterworks Essay Final Draft Ryan Moore Medical Morality in the Gilded Age The Gilded Age was a time of radical change in America, right on the cusp of the Industrial Revolution. Americans living in urban regions had no choice but to adapt to the changes that came with obstacles such as rapid urban expansion, violent gang activity in major cities, and substandard hygiene. E.L. Doctorow’s novel, The Waterworks , is a book that depicts an accurate historical view of New York in this time period. In this book, the character of Dr. Sartorius serves two purposes: Sartorius shines a light on some of the beneficial advancements in Gilded Age medicine, in order to gain the reader’s trust; then, he provokes the issue of medical morality in his twisted experiments using deceased streetorphan children to prolong the lives of rich old men. The role of Dr. Sartorius in The Waterworks brings up a very relevant question: at what point does the pursuit of medicinal knowledge become immoral? Well, based on simple laws of ethics, one can easily deduce that the pursuit of medical knowledge becomes immoral if the patients, or people close to the patients, experience physical or emotional trauma as a direct result of your practice. What truly matters in deciding medical morality is the intention of the doctor: did the doctor intend to cause harm, or was the doctor doing the best they could with the knowledge available in that time period? Some doctors in the Gilded Age adhered to some sort of ethical code, while some did not. Both ends of this moral spectrum deserve to be examined, and the morality of the actions of Dr. Sartorius deserve the same scrutiny. For every medical advancement made during the Gilded Age, an outdated (and often terrifying) medical procedure would be eliminated from the average doctor’s arsenal of “normal medical procedures”. Many people know of the classic “horror movie” medical procedures, such as electroshock therapy, or the use of leeches for bloodletting. These practices might not have been common but they were most certainly used at one time. Those living in the Gilded Age saw the brief rise and fall of medical practices far more concerning than the aforementioned, such as the lobotomy, which was thought to “cure” homosexuality (4). In 1898, Heroin (diacetylmorphine) was manufactured and distributed by pharmaceutical companies to treat common symptoms like coughs, colds, and pain (4). “Radium therapy”, or the consumption of radioactive radiuminfused water, was thought to cure a number of illnesses such as arthritis and rheumatism, but actually led to far more serious health complications (4). Another periodic table element, mercury, was used as a treatment for syphilis until the early 20th century, until it was discovered that mercury led to very painful symptoms, including stomach ulcers and sometimes death (4). Doctors that performed these bizarre procedures did not always have ill intent; a great deal of these doctors simply did not know any better because they were going about their business based on the knowledge that was available to them in that time period. Dr. Sartorius is an example of a doctor operating without any regard for morals or ethical medicine; he had the potential to launch Gilded Age medicine years into the future, but instead he conducted his experiments in secret, knowing that he would be in trouble if he got caught. The actions of Dr. Sartorius are best described in this chilling quote from Doctorow’s novel: “I saw him transfuse blood from one living being to another. I saw him with a hypodermic tube inject cellular matter into deadened brains. I saw first one, then another, of the orphan children begin to age, like leaves turning yellow.” ( Waterworks pg. 198). In contrast to the horrors of precontemporary medicine, the Gilded Age was also a time of great growth in safe, benevolent medical practices. The most groundbreaking and wellknown change in medicine during this time was the creation of the condom for males around the turn of 1840 (6). During a time period when the concepts of abortion and “free love” were in direct insubordination of the “word of God”, this invention was a topic of great debate, and caused quite a stir. The invention of the condom was thought to promote sinful activity in the eyes of the predominantlyCatholic community of the Gilded Age, and were often condemned by local church preachers. However, the condom played a key role in drastically reducing the number of cases of venereal disease in sexually active people. The condom serves as a prime example of a harmless, victimless medical invention, quite contrary to the medical proceedings of Dr. Sartorius. Medical schools were also in desperate need of reformation due to substandard hygiene conditions and illinformed doctors. In 1910, Abraham Flexner did a study on American medical colleges which led to the closing of various shoddy medical schools; this sparked great changes in the medical curriculum as well as the teaching methods they used (1). The use of ether as a surgical anesthetic was introduced in 1846 which allowed surgeons to conduct their work without any screaming, thrashing, or unbearable pain being inflicted on their patients (2). This was particularly necessary during a time period when a crushed limb or a bullet wound could easily lead to a fatal systemic infection. Amputations before the introduction of ether were obviously very gruesome. As for Dr. Sartorius, his procedures were not all as deranged as his experiments with the orphan children; he actually created a brilliant machine used for measuring brain activity, an invention far ahead of his time. “Afterward he showed me what he said was a graphic representation of the electric impulsings of my brain...a fairly regular figuration similar to the path of the sine and cosine in mathematics. This remarkable picturing device was of his own invention.” ( Waterworks pg. 196) After examining the foundation of medical reforms of the Gilded Age, one can easily make an educated guess as to where Dr. Sartorius falls on the moral spectrum. At what point does the pursuit of medicinal knowledge become immoral? The facts of the matter are clear: Dr. Sartorius harvested the life force of orphan children in order to prolong the lives of rich men, in exchange for financial gain. Martin Pemberton described the nightmarish blood transfusions in an earlier quote, but Sartorius himself goes on to describe the zombielike state that became of the rich benefactors as well: “...They did not agree to give themselves to my care in a uniform condition, you understand. The illnesses varied, the ages, the prognoses. Though all the illnesses were fatal. Yet I had them conformed to a degree of existence I could lower or raise by my application, as you quicken or dampen a gas flame with a turn of the wrist. I reached only this early stage, that I could keep them biomotive, that is, where they did not stop breathing, to the extent that I did not overendow them with selfsustaining energies. This, of course, was not what they had dreamed of for themselves...” ( Waterworks pg. 215) Sartorius was obviously indifferent about the fates of those he experimented with. Martin comments on the absence of empathy in Sartorius, saying that, “...everything was Sartorius’s triumph. Though he scrupulously fulfilled his part of the contract, he was entirely without care or concern for his patients except as they were the objects of his thought. What he warranted was only his scientific attention. But this was all!” ( Waterworks pg. 200) Furthermore, when Martin was questioned by Dr. Hamilton on his observations of Dr. Sartorius conducting his experiments, Martin described how the orphan children were used, dead or alive. “Children died in their place.” “Never by his hand.” “What?” “Not from any of his procedures. Either he took them after an accidental death...or, if he worked with living...donors, as he did subsequently...those who died, died of fear. Of an undetectable...infirmity in their spirits of the...survival instinct.” ( Waterworks pg. 233) The pursuit of medical knowledge becomes immoral if your practice causes physical or emotional trauma to your patients or people close to your patients, and Dr. Sartorius certainly did a good enough job of causing trauma to his victims as well as the people in his community. This time period was monumental in the progress of American civilization. Doctors have always been held to the highest esteem for their indispensible skills, and rightly so; on the other hand, there have always been doctors that were either mentally unstable or just unaware of the “proper” way of doing things. Dr. Sartorius fell into the category of the former, despite the benevolent advances he made in blood transfusion and recording brain activity. Doctorow suggests that Sartorius is a medical genius who invented various surgical techniques, but is only concerned with the pursuit of medical knowledge, nothing else. Sartorius pays no mind to any pain or suffering that he inflicts on his patients. The facts are plain and simple: this character was conducting grisly experiments using orphan children and tried to keep it a secret. If Dr. Sartorius wanted to, he could have conducted his research the right way, and he could have applied his genius to a much more nobler goal. Instead, he fell under the persuasion of money and potential glory, and lost his sense of humanity in the process. The pursuit of medical knowledge should
He is also a Chief Investigator on leading clinical quality registries including the Victorian State Trauma Registry, the Victorian Orthopaedic Trauma Registry, the Victorian Cardiac Arrest Registry, the Massive Transfusion Registry, the Aus-ROC Epistry and the Burns Registry of Australia and New Zealand (BRANZ).
In this book the author becomes the first ever to discuss blood transfusion and demonstrates how to do it.
CONSENT FORM ___________________________________________ _______________________________ __________________________ Patient Name Account Record Date ____________________________________________________________________________ __________________________ Proposed Procedure Surgeon _________________________________________ _________________________________ __________________________ Date of Birth Age Sex CONSENT TO OPERATION, ADMINISTRATION OF ANESTHETICS AND RENDERING OF OTHER MEDICAL SERVICES, INCLUDING CONSENT FOR TRANSFUSION(S) AND RELEASE OF RECORD(S).
Declaration I/we agree to my/our son/daughter receiving medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.
Available at Saint John’s, Transfusion Free Medicine &
Immunotherapy on Cancer Management, problems in health service on The National Health Insurance (JKN) era, Bone Marrow Transplantation, Stem Cells, also advancement in cancer supportive treatment, such as blood component transfusion, anemia, thrombosis, cancer pain, and updates on systemic therapy, including newest medications on the treatment of most frequent cancers;
Page 3 Course Co-Directors Hillard Lazarus, MD Division of Hematology and Oncology University Hospitals Cleveland Medical Center Keith McCrae, MD Department of Hematology/Oncology Cleveland Clinic Guest Faculty Shruti Chaturvedi, MD Department of Medicine Johns Hopkins Hospital Baltimore, MD David Vesole, MD Co-Division Chief, Myeloma Hackensack Meridian Health Hackensack, NJ Cleveland Faculty Dana Angelini, MD Cleveland Clinic Suzanne Bakdash, MD, MPH Cleveland Clinic Paolo Caimi, MD Sudipto Mukheijee, MD Cleveland Clinic Yogen Saunthararajah, MD Cleveland Clinic Alvin Schmaier, MD University Hospitals Cleveland Medical University Hospitals Cleveland Medical Center Center Krista Dobbie, MD Cleveland Clinic Matt Kalaycio, MD Cleveland Clinic Page 4 Agenda January 24,2018 InterContinental Hotel and Conference Center 8:00 Registration 8:30 Welcome BENIGN HEMATOLOGY 8:35 Introduction/ASH Highlights Keith McCrae, MD 8:45 Thrombotic Disorders - Dana Angelini, MD 9:15 Transfusion Medicine - Suzanne Bakdash, MD, MPH 9:45 Platelet Disorders - Shruti Chaturvedi, MD 10:15 Break 10:30 Bleeding Disorders Alvin Schmaier, MD MALIGNANT HEMATOLOGY 11:00 Introduction/ASH Highlights - Hillard Lazarus, MD 11:05 Chronic Myeloid Leukemia - Sudipto Mukherjee, MD 11:40 Lunch 12:15 Healing Hooves:
Massive blood transfusion - large load of acidic blood Packed red blood cells - small amount of clotting factors - bleeding diathesis/tendencies Platelets - aggregate in the lungs - impair gas exchange Since there is hemolysis of blood as it passes through the heart-lung machine.
Not two days ago, Cheryl Daniels was admitted to St. Thomas Midtown Hospital in Nashville, TN, suffering from acute liver failure brought on by Hepatitis C, which she originally contracted via a blood transfusion. Currently unable to eat or drink normally, she requires infusion of fluid and nutrients from expensive IV “banana bags,” as she holds out for a liver transplant. She's also in immediate danger of losing both her home and her car.
Associate professor (Docent) Medical faculty, Lund University, April 2010 Clinical proficiency Junior resident (underläkare) Dep of Blood chemistry and transfusion, Malmoe University Hospital, 2 months 1984.
Hepatitis Chickenpox Influenza MMR Measles, Mumps, Rubella List any medical problems that other doctors have diagnosed Surgeries Year Reason Hospital Polio Other hospitalizations Year Reason Hospital Have you ever had a blood transfusion?
Shannon Billings of ASCLS-AK and current ASCLS Region IX director did an excellent talk on Transfusion-Related Acute Gut Injury (TRAGI).
Clotting activation after blood transfusion in patients receiving 5-fluorouracil and mitomycin -C treatment.
July 23, 2017) No Changes Posted The change in Doppler velocity indices, [ Time Frame: 24 week till 35 weeks ] Fetal growth velocity [ Time Frame: weekly till time of delivery ] Gestational age at delivery, [ Time Frame: at time of delivery ] APGAR score [ Time Frame: at 1 and 5 min of life ] Neonatal complication rates [ Time Frame: The first 28 day of delivery ] respiratory distress syndrome, intraventricular hemorrhage (IVH), neonatal necrotizing enterocolitis (NEC), neonatal anemia, and neonatal blood transfusion Neonatal ICU admission rate [ Time Frame: The first 28 day of delivery ] the interval between the diagnosis and delivery [ Time Frame: at time of delivery ] Original Secondary Outcome Measures Current Other Outcome Measures ICMJE Original Other Outcome Measures Same as current ICMJE ICMJE Not Provided Not Provided Descriptive Information Brief Title ICMJE Sildenafil Versus Low Molecular Weight Heparin in Fetal Growth Restriction Treatment Official Title ICMJE Sildenafil Versus Low Molecular Weight Heparin in Fetal Growth Restriction Treatment Brief Summary comparing the effect of using sildenafil citrate and LMWH in treatment of cases of IUGR due to placental insufficiency Detailed Description One hundred pregnant women with documented intrauterine growth restriction due to placental insuﬀiciency at 28-35 weeks of gestation will be distributed into two groups:
and, unless there is continued transfusion of new ideas to adjust to new times, they die.” You can reach Repository writer Tim Botos at (330) 580-8333 or e-mail: