Explore the vast range of titles available.

Background Jehovah’s Witness patients refuse blood transfusion because of their religious beliefs making total hip arthroplasty (THA) challenging. This study aims to determine the safety of THA in Jehovah’s Witness patients using standard perioperative protocols as well as evaluate the effectiveness of tranexamic acid (TXA) in controlling blood loss. Methods Databases from two tertiary academic centers were queried from 2003 to 2021 to identify THA patients. Demographics, pre- and postoperative hemoglobin (hgb) and hematocrit (hct) lab values, use of TXA intraoperatively, 90-day postoperative hospital utilization, and need for subsequent revision were extracted. Patients who identified as Jehovah’s Witness were then compared to a 3:1 propensity score matched cohort of non-Jehovah’s Witness patients. Linear regression analysis assessed the effect of intraoperative TXA on change in hgb from pre- to post-THA and logistic regression was used to assess risk of reaching hgb levels < 8.0 g/dL. Results A total of 207 non-Jehovah’s Witness patients and 69 Jehovah’s Witness patients who underwent THA were analyzed. Both groups were found to have similar preoperative hgb and hct as well as postoperative hgb, hct, and hgb shift. Of the Jehovah’s Witness patients 3 (6.4%) patients reached a hgb < 8.0 g/dL. Additionally, a higher proportion of Jehovah’s Witness patients receive intraoperative TXA (55 [79.7%]) compared to non-Jehovah’s Witness patients (127 [61.4%]) ( p  = 0.01; SMD = 0.41). Logistic regression analysis found that Jehovah’s Witness did not have greater odds of reaching a hgb < 8.0 g/dL (OR = 1.03 [0.95, 1.10]; p  = 0.49) and that patient who received intraoperative TXA had decreased odds of reaching a hgb < 8.0 (OR = 0.87 [0.80, 0.95]; p  = 0.001). Multivariate linear regression found that intraoperative TXA was also associated with a smaller decrease in hgb from pre- to post-THA (β = 0.69 [0.16, 1.22]; p  = 0.01). Overall, Jehovah’s Witness patients had excellent revision-free (97% [93%, 100%]) and infection-free (99% [96%, 100%]) survival at 7 years. Conclusion Although Jehovah’s Witness patients refuse transfusion, THA can be performed safely in these patients with excellent implant survivorship by optimizing preoperative hgb levels and utilizing intraoperative TXA. Level of evidence Level III Evidence.

Objectives The aim of the study is to assess obstetric and fetal outcomes of Jehovah’s Witnesses (JWs) mothers in an inner city teaching hospital, as well as to examine the acceptance rates of various blood fractions and blood transfusion alternatives. Methods Case series to evaluate the maternal and fetal outcomes of JWs over a nine period between 2013 and 2021. Results There were 146 pregnancies extracted from our database, of which 10 were early pregnancy losses. Data from 136 deliveries > 24 weeks’ gestation were assessed, with a mean maternal age and gestational age of 30.26 (± 5.4) years and 38.7 (± 5.3) weeks, respectively. 57% had normal vaginal deliveries, 8% had instrumental births and 35% had caesarean births. Mean estimated blood loss at caesarean was 575 (± 305.6) mls, while the overall mean estimated loss was 427.8 (± 299.8) mls. Cell salvage was performed in all caesarean sections but autologous transfusion was only necessary for 26%. Consultant presence was documented in 62% of caesarean births. The mean birthweight and 5-min Apgar scores were 3.31 (± 0.05) kg and 9.1 (± 0.09), respectively. There were no maternal deaths or admissions to the adult intensive care unit and the most serious complication was a uterine rupture following a trial of scar, after which the baby required cooling for hypoxic ischaemic encephalopathy. Conclusions Pregnant JWs received obstetric care led by senior clinicians, with optimisation of haematinics, minimizing of blood loss at delivery and access to technology such as cell salvage.

Addressing a relative lack of research investigating the experiences of individuals who have left the Jehovah’s Witnesses (JW), this research utilizes a social identity approach to examine qualitatively, the process of transitioning towards post-JW life, experiences of ostracism and perceived threats to self-identity. Semi-structured interviews were carried out in the homes of six former JWs, and transcripts were analysed using interpretive phenomenological analysis. Narratives suggest that experiences of ostracism following religious exit can be associated with diminished mental health, while having a sense of agency and establishing new (online) social connections may help mitigate adverse consequences. Implications and future research directions are discussed.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Background and Aims Preoperative optimization of anemia is particularly important in Jehovah’s Witnesses before major surgery. However, when presenting in an acute setting there are no recommendations, and a multimodal and multidisciplinary approach is necessary to safely deliver treatment. Regional anesthesia has a particular role in reducing complications.MethodsCase report.ResultsA 74-year-old male was admitted in our institution for above-knee amputation of the left lower extremity due to irreversible ischemia. His past medical history was relevant for multiple myeloma, hypertension and type 2 diabetes mellitus. His baseline hemoglobin was 7.7 g/dL. He was a Jehovah’s Witness who refused blood transfusions, having been transferred from another institution, where he was denied surgery. Two days before surgery, ferric carboxymaltose 500 mg was administered. Surgery was performed under combined spinal-epidural anesthesia, with 7 mg of intrathecal hyperbaric bupivacaine. Before the beginning of surgery, tranexamic acid 1 g was administered. Hemodynamic stability was achieved, with minimal blood loss (200 mL). The final hemoglobin was 6.4 g/dL. For postoperative analgesia a multimodal approach was implemented, with patient-controlled epidural analgesia with ropivacaine 0.2%. After surgery, darbepoetin alfa 500 micrograms was administered. He was transferred back to his original institution after two days.ConclusionsLower extremity amputation carries a significant risk of perioperative morbidity and mortality. Regional anesthesia may confer several advantages over general anesthesia, having demonstrated a reduction of blood transfusion requirements in the setting of lower extremity amputation. Therefore, it should be considered as part of a blood conservation strategy.AttachmentPatient Consent for Publication.pdf

Jehovah’s Witnesses (JWs) are known as a religious group compliant with the national laws in the case of smoking, but not-compliant when it comes to blood treatment. Their beliefs prevent them from taking part in a blood transfusion, which is widely included in standard methods of a life-saving treatment. The aim of this study was to compare the behavior of JWs regarding their approach to blood treatment and to smoking in relation to legal regulations in the field of health. We measured JWs’ compliance with health laws regarding blood treatment and smoking (the Framework Convention on Tobacco Control—FCTC). We used the concept of a semi-autonomous social field by Moore and the theory of planned behavior developed by Ajzen. Our findings show that in the case of JWs, the group rules often prevail over state rules contained in generally-binding legislation. In the case of smoking, this means that they seem compliant to the FCTC and to their group rules. In the case of blood treatment, it seems that they are breaking the national rules, because of their group rules. Breaking the latter can result in exclusion from the JWs community. JWs are compliant with national laws as long as these are congruent with their own group rules. If this is not the case, the group influence is very strong and the fear of exclusion from the JW group is often greater than the potential negative health consequences in real life.

INTRODUCTION:Hemobilia is a rare cause of upper gastrointestinal bleeding, which requires high index of suspicion for diagnosis. In various case series, hemobilia due to neoplastic disease of the hepatobiliary system ranges from 6% - 15%. ICPNs are rare neoplasms of the gallbladder that are usually detected incidentally. This is a case of a Jehovah’s Witness patient with severe symptomatic anemia secondary to hemobilia due to invasive ICPN.CASE DESCRIPTION/METHODS:71-year-old Jehovah’s Witness patient with a 4 month history of anemia, suspected to be due to multiple small intestine angioectasias seen on prior enteroscopies, presented with a 3 day history of fatigue, dyspnea on exertion, and melena. Patient’s hemoglobin/hematocrit at presentation was 6.4/23.4. She underwent gastroduodenoscopy which showed blood in the second part of the duodenum which prompted a side viewing duodenoscopy examination which showed blood oozing from the ampulla (Figure 1). Abdominal MRI showed markedly distended gallbladder with polypoid appearing wall thickness and blood (Figure 2). Patient received iron infusions to improve hemoglobin and hematocrit. She then underwent open cholecystectomy, and intraoperatively the surgeons did not appreciate any mass lesion in the gallbladder. Surgical pathology found invasive mucinous adenocarcinoma (1.0 cm) arising from a large (14.5 cm) ICPN with high-grade dysplasia (Figures 3a,b). The tumor invaded the muscularis propria and had negative cystic duct margins for carcinoma or dysplasia. Two lymph nodes were positive for malignancy. It was staged as III-b and pT1b, pN1, pMx. After discussion in the tumor board, she was recommended to have surveillance imaging in 3 months because her comorbidities precluded chemotherapy.DISCUSSION:To the best of our knowledge this is the only reported case of ICPN presenting as hemobilia. Residual changes of ICPN are seen in only 6.4% of the patients with invasive GB carcinomas. The presence of angioectasias in the small intestine acted as a red herring in this patient. The fortuitous timing of endoscopy to visualize bleeding from the ampulla clinched the diagnosis of hemobilia. The presence of blood in the gallbladder made it difficult to identify the mass lesion which was eventually confirmed on surgical pathology. Hemobilia should always in the differential diagnosis for patients presenting with upper GI bleed and should be actively investigated when no obvious bleeding lesions are noted from the gastric or intestinal mucosa.

Cardiac surgery in Jehovah’s Witnesses (JW) patients who refuse blood transfusion is challenging requiring dedicated strategies. We aimed to analyze non-selected JW patients undergoing cardiac surgery and to compare with matched controls both perioperative outcomes and long-term survival. We retrospectively analyzed JW patients undergoing cardiac surgery from January 2016 to March 2021 and compared them with matched controls. The primary outcome was a composite of in-hospital perioperative adverse events and in-hospital mortality. The secondary outcome was all-cause mortality at long-term follow-up. A total of 113 JW patients and 113 controls were included. Baseline clinical characteristics, including laboratory parameters were comparable. Overall, there were no statistical differences between JW vs controls in terms of in-hospital mortality (2.7% vs 1.8%, p = 1.00) but mortality was remarkably high (40%) in JW patients with post-op hemoglobin < 8 g/dl. Logistic regression analysis found that the JW group was not associated with a higher occurrence of the composite outcome (adjusted odds ratio 0.91, 95% confidence interval [CI] 0.54–1.57). After a median follow-up of 1397 [IQR 922.7–1723.5] days, JW patients were not associated with a significantly higher all-cause mortality (adjusted hazard ratio 0.77, 95% CI 0.24–2.42). Cardiac surgery can be safely performed in non-anemic JW patients despite the refusal of blood transfusions. Favorable clinical outcomes can be achieved by the use of specific perioperative strategies for bloodless surgery with no differences as compared to control patients except in JW patients with a very low level of post-operative hemoglobin not supported by immediate transfusions.

Background Transcultural nursing recognises the significance of cultural backgrounds in providing patients with quality care. This study investigates the opinions of master’s students in nursing and midwifery regarding the attitudes of Jehovah’s Witnesses towards refusing blood transfusions. Methods 349 master’s students in nursing and midwifery participated in a quantitative study and were surveyed via the Web to evaluate their awareness of the stance of Jehovah’s Witnesses on blood transfusions and the ethical and legal dilemmas associated with caring for Jehovah’s Witness (JW) patients. Results The study yielded three significant findings. It unequivocally demonstrates that nursing and midwifery students possess inadequate knowledge regarding Jehovah’s Witnesses’ stance on blood transfusions and their acceptance of specific blood products and medical procedures. Despite being cognisant of the ethical and legal dilemmas of caring for JW patients, students lack an understanding of patients’ autonomy to reject blood transfusions and their need for bloodless medicine. Students also articulated educational needs regarding cultural competencies regarding the Jehovah’s Witnesses’ beliefs on blood transfusions and non-blood management techniques. Conclusions Healthcare professionals need the knowledge and skills necessary to provide holistic, patient-centred and culturally sensitive care. This study emphasises the urgent need for university curricula and nursing postgraduate training to include modules on transcultural nursing and strategies for minimising blood loss.