Praiseldy Langi Sasongko

32 Chapter 2 search strategies were also applied for gray literature (AABB, ISBT, World Health Organization, Centers for Disease Control and Prevention, and European Centre for Disease Control and Prevention). Finally, it was also applied for Google Scholar. For all searches, inclusion criteria included articles from 1998 to 2018, humans, and the English language. Due to the premise of this study, exclusion criteria included studies from low- to middle-income countries and studies primarily describing a time period prior to the 21st century. For the first aim, 1268 articles were found in total and after title and abstract screening, 107 were read full text. For the second aim, 81 articles were obtained and after title and abstract screening, 69 were specifically about RBCs, and read thoroughly. Twenty-seven relevant articles were selected from gray literature with regard to historical trends. 2.3 RESULTS Of the 42 experts that were interviewed, many (n = 17, 40%) held dual roles as a researcher-clinician, working both in their respective blood banks and the clinic or using their clinical background accordingly with their research. The majority of experts (n = 23, 55%) had 21+ years of experience in their roles. Experts represented nine countries, seven medical specialties, and were grouped according to if they worked in the Netherlands or abroad, with the former subdivided into whether they worked for Sanquin or not. A summary of their characteristics can be found in Table 2.1. I. Historical trends and drivers Two main trends emerged from the interviews regarding the historical trends of RBCs: RBC decrease and RBC increase. For each trend, various drivers were given. The literature review paralleled these interview findings, with a few differences described below (see Appendix D for the full listing of literature classified for its trends and drivers). Drivers of the decreased RBC demand Nearly all experts (n = 38; 90%), equivalent among those from the Netherlands (Sanquin and non-Sanquin experts) and abroad, spoke of the decline in RBC demand. Many emphasized that this decline began due to and part of significantly changed perceptions regarding RBC transfusions, which were attributable to the HIV scandals and/or evidence-based medicine, leading to great emphasis on safety and cost

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