Supplemental Oxygen during Air Travel in Sickle Cell Disease -Common Clinical Practices
Bibliographic record
Abstract
Abstract Introduction: Air travel may expose patients with sickle cell disease (SCD) to an increased risk of disease related complications. Several factors are felt to contribute, including prolonged hypoxia, dehydration, temperature changes and stress. The Canadian Pediatric Society position statement recommends that SCD patients use supplemental oxygen on flights. While other notable guidelines including the National Heart, Lung and Blood Institute (NHLBI), the National Center for Biotechnology Information (NCBI), the Canadian Haemoglobinopathy Association (CanHaem) and the British Thoracic Society do not make specific recommendations. Since available guidelines and evidence lack consensus, it is unclear what recommendations healthcare practitioners (HCPs) should counsel to their SCD patients. Objectives: 1. Determine the recommendations North American hematology HCPs make to SCD patients regarding air travel. 2. Determine the proportion of HCPs recommending supplemental oxygen to SCD patients. 3. Among HCPs that recommend supplemental oxygen, determine which patient factors influence their decision. 4. Evaluate patient experiences regarding supplemental oxygen recommendations prior to air travel. Methods: First, a literature review using PubMed, TRIP database, Medline (Ovid) search engines was completed. Two investigators independently reviewed abstracts and references. Second, a cross-sectional online survey was circulated through CanHaem (186 members) and the American Society of Pediatric Hematology/ Oncology (ASPHO, 1991 members) listservs. North American hematology HCPs were asked to share their air travel recommendations. The survey was peer-reviewed by 7 practitioners prior to distribution for content and face validity. Similarly, a patient survey regarding experiences with air travel was distributed through the Sickle Cell Disease Association of Canada (SCDAC) listserv. University of Alberta ethics research board approved. Results: A review of the literature is summarized in Table 1. A total of 81 surveys were returned with 79 evaluable for analysis. Demographic data reveals that most survey respondents are physicians (90%), pediatric providers (77%), and practice at an altitude 6 hours, 31% for flights >10 hours and the remainder for all flight lengths. In a small sample of patients (n=5) the majority have experienced a sickle cell crisis during or shortly after air travel. Only one patient participant has used oxygen in the past. Conclusion: Most HCPs surveyed do not routinely recommend supplemental oxygen to their SCD patients as a prophylactic measure. Among HCPs that recommend oxygen both patient and flight factors influence their recommendations. Although oxygen is not a routine recommendation, most indicate that air travel is a likely risk factor for VOC. In fact, there are numerous published cases of air travel related complications, most commonly splenic complications and VOC, in the SCD population (Table 1). There is a lack of consensus among North American HCPs regarding supplemental oxygen recommendations. Further investigation is needed to delineate the need for supplemental oxygen to prevent complications during air travel for SCD patients. Download : Download high-res image (434KB) Download : Download full-size image Disclosures Bruce: Bristol-Meyers-Squibb - consultant 2016-2017: Consultancy; ovartis consult and ad board 2015-2016: Consultancy; Apopharma 2015: Consultancy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".