Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah’s Witness women (page 2)

nugget

So it looks as if their study was based on patient records rather than being set up as an independent study with participants recruited and screened. This mean that there was no way of ensuring parity across both groups.

OrphanCrow

Yes, nugget. They used patient files from an 6 year span.

They give little information on the selection process. Not enough to make an informed decision about the control of variables. The procedures weren't even the same - some women had tubal ligations, some didn't...some had partial hysterectomies...

But they were careful to include this information about the noblood group:

We observed that the guidelines were followed in
the care of the patients in our series. These included documented
evidence, for example a durable power of attorney
(DPA) which is a living will stating that the patient will not
accept blood transfusion even in the event of life-threatening
bleeding. Photocopies of the DPA card were observed
in the case notes of the JW patients who were not transfused
and its contents were respected.

It's too bad they didn't have guidelines for establishing good care for the transfused patients to ensure they received antibiotics. Because this is a retrospective study, it would seem that those patients who did not receive an adequate level of care should be excluded from the study.

Once that happens, the statistics dramatically change

OrphanCrow

And while I am at it...a word or two about patient #7 who died from the transfused group

One patient died of disseminated intravascular coagulation.

Disseminated intravascular coagulation can be caused by the following:

Risk factors for DIC include:
Blood transfusion reaction
Cancer, especially certain types of leukemia
Inflammation of the pancreas (pancreatitis)
Infection in the blood, especially by bacteria or fungus
Liver disease
Pregnancy complications (such as placenta that is left behind after delivery)
Recent surgery or anesthesia
Severe tissue injury (as in burns and head injury)
Large hemangioma (a blood vessel that is not formed properly)

In spite of this rare disorder possibly being a transfusion reaction, the study does not state this to be the case. Instead, the reader is left to draw their own conclusions. There is no cause or further information offered about this death.
For more information on the variety of causes that could be responsible for patient #7's death:http://emedicine.medscape.com/article/199627-overview

scratchme1010

Interesting discussion. What I do know now that I work in the medical industry, is that there have been a number of advances and changes in operating and using several procedures without the use of blood, but the JWs have absolutely nothing to do with it.

The purpose of developing such new treatments come as a result of the AIDS crisis in the late 70s and 80s that made the blood banks and the blood acquisition and processing system insufficient. Also, there's a lot of cost added to the use of blood in procedures, many of which have been substituted with more cost-effective and technologically advanced methods.

The JW attitude that they have influenced the medical industry to come up with blood-less treatment is top notch BS.

millie210

That is a moral question and not valid to be brought into the equation when analyzing results. Indigent is not a moral position even though some authors would like to subtly use it as one - it is a position defined by economic situation.
Millie, your query, I think, is exactly the one that the authors want you to make

Sometimes I assume I am communicating clearly when it becomes obvious I have not. I should have given background.

I have been aware for a long time that big ticket items can be made readily available for indigent people (of whom women and children are the most fragile and vulnerable) while simple things that could make them not need intensive interventive measures are denied them. For example a kidney transplant may be possible but a diet that contributes to health OR simple blood pressure screenings and drugs for hypertension are not available in some cases for some people.

This is something the World Health Org has tried with limited success to address, as have other groups.

So when I read this, I was wondering if access to simple antibiotics were out of the reach of women in their villages due to perhaps them living in a remote area or due to politics or due to big pharna, or some combination thereof.

Sorry I didnt make that more clear.

OrphanCrow

scratchme: What I do know now that I work in the medical industry, is that there have been a number of advances and changes in operating and using several procedures without the use of blood, but the JWs have absolutely nothing to do with it.

I am discovering the same thing to a certain extent.

For example, I am halfway through reading Denton Cooley's memoirs and finding out that the JWs had far less credit for some of the advances they try to claim were because of them, than what actually happened, according to Cooley.

And yet, if you read any amounts of the promotional material put out by the SABM and the HLC fellows, along with the textbook material for blood management, the Jehovah's Witness experience is set up as the 'gold standard' without giving credit to the many, many non-JWs who underwent the procedures so that they could benefit.

Without blood transfusions, surgery would never have advanced to the level it has. And the WT/HLC has the gall to refer to bloodless surgery as the 'golden standard' of care

OrphanCrow

Sokay, Millie. All discussion is valid.

I understand now where you are coming from.

My question, then, is this: if the antibiotic scarcity is an issue, why did the paper not address it?

And, regardless, even if that were the case, that the study dealt with indigent women...we already know that the JW women were NOT indigent. Bloodless surgery would be an additional cost from conventional methods of surgery in that environment. If a woman could not afford simple antibiotics, it would seem unlikely that she would be able to afford the extra care that goes along with bloodless methods. And, the paper did not identify lack of funds as the cause for the death in the noblood group like they did with the blood group deaths

The sample groups were not evenly matched. It is likely that there are other, inherent, problems in the cross matching.

The extra care taken with the no blood patients is detailed but the care for the transfused patients has little to no detail. And, we already know that it was substandard. 6 patients died when medication was held back for nonpayment.

Care cannot be measured on economical value of the patient. That is a huge ethical issue

Fisherman

OC, thanks for the wealth of information that you contribute-with this disclaimer: I do not endorse or encourage posting things that may violate copyright.

OrphanCrow

You are welcome Fisherman.

Don't worry about the copyright stuff. I sleep well at night.

None of the material I posted on this thread is in violation of copyright - it is freely available online for public consumption. It is a non issue

OrphanCrow

Sorry, Millie...I meant to add that your observations are valid and do reveal what could easily account for the results.

It is just that the reasons don't contribute to the validity of the study overall. It just explains the mistake in methodology and reveals the underlying bias of the authors and a possible motivation for the study being undertaken

Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah’s Witness women

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