28 june 2024
Our eHealth team advised us yesterday of an international vulnerability relating to polyfill.io . This domain has become compromised and is spreading malware through a widespread supply chain attack, estimated to affect over 110,000 websites including major websites such as the BBC. The Polyfill site offered widely used bits of code for older browsers that allowed the use of modern Javascript features. Such code makes the work for web developers easier and allows compatibility with a broader range of browsers.
Websites that have used the Javascript code from Polyfill have been urged to remove such code immediately. The change occurred after a suspected Chinese firm purchased the domain in early 2024.
Tactuum have identified and are now testing a fix to remove all Polyfill code from the RDS site.. They will be deploying the fix on Monday 1 July along with other planned fixes and amendments. I will notify you of the timing of the deployment as soon as possible.
In the meantime, please ensure that you have up-to-date anti-virus software installed on your machines and personal devices.
Preoperative anaemia, even when mild, is a major risk factor for perioperative complications.
The prevalence of anaemia in patients presenting for major non-cardiac surgery is 27% in women and 31% in men.
Correction of preoperative anaemia is a key 'pillar' of a perioperative patient blood management strategy aiming to mitigate the effects of surgical blood loss and reduce later transfusion requirements with their additional associated hazards.
Early preoperative identification of anaemia on full blood count is crucial. Once detected, the underlying cause should be identified to facilitate management.
In some cases, anaemia may be the reason behind the operation itself but this should not deter maximum efforts to normalise haemoglobin by time of surgery.
Anaemia impairs the ability of the patient to withstand the surgical stress response through a much reduced ability to deliver oxygen to the tissues when demand is greatest.
Preoperative anaemia results in the following elevation in perioperative risk:
A range of factors may contribute to preoperative anaemia including;
Iron deficiency is the most common explanation through either insufficient intake or occult haemorrhage.
See 'Management of Preoperative Anaemia' for more information about investigation and management of the underlying cause.
In the majority of cases, iron supplementation will be required. In some cases preoperative intravenous iron replacement may be required.
Use NHS Lothian Preoperative Anaemia Pathway to guide decisions around timing of non-urgent surgery, investigation and treatment.
NHS Lothian Prehabilitation