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Binder AF, Hossain A, Doshi R, Vivero A, Gonzalez KM, Gentsch A, Wilde L, Rising KL. Patient and caregiver perceptions of the possibility of home blood transfusions. Transfusion 2024; 64:483-492. [PMID: 38263774 DOI: 10.1111/trf.17728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Patients with hematologic malignancies (HM) often develop transfusion dependence. The patient and caregiver burdens associated with the need for frequent transfusions are high. Home blood transfusions has the potential to reduce these burdens, but is not widely practiced in the United States. We designed a qualitative study to evaluate the patient and caregiver perceptions of the potential for a home blood transfusion program. STUDY DESIGN AND METHODS Eligible patients included Adult (≥18 years) patients who were English speaking and met the definition for transfusion dependence within 3 months of study enrollment. We identified and interviewed eligible participants (patients and caregivers), using a semi-structured interview guide to elicit patient perceptions of the acceptability, barriers, and benefits related to home blood product transfusions. Interviews were audio recorded and transcribed. Results were imported into NVivo 12 (version 12; QSR International, Burlington, VT) for coding and analysis. RESULTS We recruited participants until we reached thematic saturation, which occurred at 29 participants (20 patients, 9 caregivers). Among the 20 patient participants, nine had MDS (45%) and 11 had acute leukemia (55%). Most of the patients (60%) reported getting one transfusion per week. Four themes emerged when the participants discussed their perception regarding the potential of a home blood transfusion program: (1) current in-person experience, (2) caregiver burden, (3) perceptions of home blood transfusions, and (4) interest in participating in a home blood transfusion program. CONCLUSION The concept of home blood transfusions was well received and further research to study its implementation is warranted.
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Affiliation(s)
- Adam F Binder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alavi Hossain
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Riyana Doshi
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Angelica Vivero
- Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Karla Martin Gonzalez
- Department of Emergency Medicine, Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexzandra Gentsch
- Department of Emergency Medicine, Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lindsay Wilde
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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2
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Knight HP, Brennan C, Hurley SL, Tidswell AJ, Aldridge MD, Johnson KS, Banach E, Tulsky JA, Abel GA, Odejide OO. Perspectives on Transfusions for Hospice Patients With Blood Cancers: A Survey of Hospice Providers. J Pain Symptom Manage 2024; 67:1-9. [PMID: 37777022 PMCID: PMC10873003 DOI: 10.1016/j.jpainsymman.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/07/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Abstract
CONTEXT Patients with blood cancers have low rates of hospice use. While lack of transfusion access in hospice is posited to substantially contribute to these low rates, little is known about the perspectives of hospice providers regarding transfusion access in hospice. OBJECTIVES To characterize hospice providers' perspectives regarding care for patients with blood cancers and transfusions in the hospice setting. METHODS In 2022, we conducted a cross-sectional survey of a sample of hospices in the United States regarding their experience caring for patients with blood cancers, perceived barriers to hospice use, and interventions to increase enrollment. RESULTS We received 113 completed surveys (response rate = 23.5%). Of the cohort, 2.7% reported that their agency always offers transfusions, 40.7% reported sometimes offering transfusions, and 54.9% reported never offering transfusions. In multivariable analyses, factors associated with offering transfusions included nonprofit ownership (OR 5.93, 95% CI, 2.2-15.2) and daily census >50 patients (OR 3.06, 95% CI, 1.19-7.87). Most respondents (76.6%) identified lack of transfusion access in hospice as a barrier to hospice enrollment for blood cancer patients. The top intervention considered as "very helpful" for increasing enrollment was additional reimbursement for transfusions (72.1%). CONCLUSION In this national sample of hospices, access to palliative transfusions was severely limited and was considered a significant barrier to hospice use for blood cancer patients. Moreover, hospices felt increased reimbursement for transfusions would be an important intervention. These data suggest that hospice providers are supportive of increasing transfusion access and highlight the critical need for innovative hospice payment models to improve end-of-life care for patients with blood cancers.
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Affiliation(s)
- Helen P Knight
- Department of Psychosocial Oncology and Palliative Care (H.P.K., J,A,T.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Caitlin Brennan
- Care Dimensions Inc. (C.B., S.L.H.), Boston, Massachusetts; Boston College Connell School of Nursing (C.B.), Chestnut Hill, Massachusetts
| | | | - Anna J Tidswell
- Division of Population Sciences (A.J.T., G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Melissa D Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine (M.D.A.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kimberly S Johnson
- Division of Geriatrics (K.S.J.), Duke University Medical Center, Durham, North Carolina
| | - Edo Banach
- Manatt Health (E.B.), Washington, District of Columbia
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care (H.P.K., J,A,T.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gregory A Abel
- Division of Population Sciences (A.J.T., G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Hematologic Malignancies (G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Oreofe O Odejide
- Division of Population Sciences (A.J.T., G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Hematologic Malignancies (G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts.
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3
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Tanaka A, Fujita H, Ohashi K, Tsujikawa A, Uchiyama K, Ito T, Kawashima K, Kodama R, Mine T, Okuda M, Endoh T, Fukuyoshi Y, Kitazawa J, Sueoka E, Nagai K, Ishida A, Matsuzaki K, Kato Y, Takanashi K, Takahashi K. Home transfusions are implemented using diverse approaches in Japan. Vox Sang 2023; 118:938-946. [PMID: 37671662 DOI: 10.1111/vox.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/04/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Japan's ageing society has increased the need for home healthcare, including home transfusions. We hence aimed to elucidate the purpose and utilization of home transfusions in Japan, which has not been clarified to date. MATERIALS AND METHODS Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The study period was February to December 2019, and information of patients receiving home red blood cell transfusions, including patient background, pre-transfusion laboratory data and the purpose of the transfusions, was collected. RESULTS Haematological malignancies and solid tumours accounted for 70% of the patients' underlying diseases, with the former being significantly more common in urban areas. Regarding the purpose of the home transfusions, haematologists focused on symptom improvement, whereas gastroenterology surgeons focused on life support. Furthermore, maintenance of life was more likely to be the aim in the group of patients with the lowest level of activities of daily living. The main items that were significantly associated with a low haemoglobin level before transfusion included age ≥90 years and a gastroenterologist being the physician in charge. CONCLUSION Home transfusions were found to be performed in a restrictive and diverse manner in Japan. Life support is the second most common purpose of home transfusion in Japan, and optimizing effective home transfusion remains a challenge.
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Affiliation(s)
- Asashi Tanaka
- Department of Clinical Laboratory Medicine and Department of Transfusion Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiroshi Fujita
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kota Ohashi
- TOTUS Home Care Clinic, Hemato-Homecare Network, Tokyo, Japan
| | | | | | - Tatsuya Ito
- Nishiosu Ito Internal Medicine and Department of Hematology, Hemato-Homecare Network, Aichi, Japan
| | | | | | - Takashi Mine
- Donated Blood Distribution Foundation, Tokyo, Japan
| | - Makoto Okuda
- Division of Blood Transfusion, Toho University Omori Medical Center, Tokyo, Japan
| | - Teruo Endoh
- Department of Clinical Laboratory Science, School of Medical Technology, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Youko Fukuyoshi
- Department of Transfusion Medicine and Cell Therapy, Kumamoto University Hospital, Kumamoto, Japan
| | - Junichi Kitazawa
- Division of Clinical Laboratory, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Eisaburo Sueoka
- Department of Laboratory Medicine, Saga University Hospital, Saga, Japan
| | - Kazuhiro Nagai
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Akaru Ishida
- Division of Transfusion Medicine and Cell Transplantation, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Yoko Kato
- Department of Transfusion Medicine, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Kazuo Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Koki Takahashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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4
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Feasibility of a Hospital-at-Home Program for Autologous Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023; 29:111.e1-111.e7. [PMID: 36436783 DOI: 10.1016/j.jtct.2022.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
The Hospital at Home (HaH) model has been positioned as an appropriate therapeutic strategy for selected patients undergoing autologous hematopoietic stem cell transplantation (ASCT). This care model provides hospital-equivalent care, in terms of both quality and quantity, with medical and nursing staff that go to the patient's home. Here we describe our experience with a full HaH model for patients undergoing ASCT during the phase of aplasia. The patients met the eligibility criteria between January 1997 and December 2019 and were discharged from the hospital and admitted into the HaH-ASCT program on the same day they in which hematopoietic stem cells were infused. A total of 84 patients were included. The median patient age was 54 years (range, 16 to 74 years), and the median duration of participation in the HaH program was 17 days (range, 3 to 86 days). Only 10 of these patients (12%) required hospital readmission to the hematology department, 9 of them due to sepsis and 1 because of family care support claudication. Seventy-two patients (86%) experienced an episode of neutropenic fever during the HAH admission, with a median duration of 2 days (interquartile range [IQR], 1 to 11 days); all were treated with empiric i.v. antimicrobial therapy. Most patients (88%) presented with mucositis (44% with grade 3-4). Parenteral nutrition was administered in 26% of patients for a median of 6 days (IQR, 1 to 12 days). Most patients (94%) required at least 1 blood product transfusion at home. There was no transplantation-related mortality during the HaH-ASCT program or in the patients who were readmitted. With careful selection of patients and a comprehensive and well- experienced multidisciplinary team (doctors, nurses, and auxiliary nurses) in the HaH department and in close collaboration with the hematology department, complete at-home management of ASCT recipients immediately after transplantation is possible. This allows patients undergoing an aggressive procedure such as ASCT to remain in their own familiar environment, providing a better quality of life with a program that has demonstrated to be effective and safe, with a low incidence of complications and no associated mortality.
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5
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Tanaka A, Fujita H, Ohashi K, Tsujikawa A, Uchiyama K, Ito T, Kawashima K, Kodama R, Mine T, Okuda M, Endoh T, Fukuyoshi Y, Kitazawa J, Sueoka E, Nagai K, Ishida A, Matsuzaki K, Kato Y, Takanashi K, Takahashi K. Management system of home transfusion in Japan: A nationwide survey in 2019. Vox Sang 2023; 118:59-67. [PMID: 36454538 DOI: 10.1111/vox.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND OBJECTIVES In Japan, there are various opinions on the pros and cons of home transfusion because of safety concerns. We hence aimed to elucidate the safety and availability of home transfusion in Japan, which has not been clarified to date. MATERIALS AND METHODS Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The analysis period was February to December 2019. Basic information about the clinics, their collaboration system with core hospitals, storage method of red blood cells (RBCs) and the system for the management of patient information regarding transfusion reactions were investigated. RESULTS Detailed information was obtained regarding the implementation of home transfusions by 51 clinics. The proportion of home care clinics performing home transfusions was 17.6%, and they were more frequently performed in urban regions. Approximately half of the clinics collaborated with a core hospital for emergency responses to transfusion reactions. At 84% of the clinics, RBC units were stored in refrigerators that were not exclusively allocated to blood storage. Nurses and family members were involved as patient attendants in 83% and 77% of the home transfusions, respectively. No serious transfusion reactions were reported among the 150 patients in 2019, nor the 623 patients up to 2018. CONCLUSION From data on its availability and safety, home transfusions are considered to be in the developing phase in Japan. Increased cooperation between hospitals and clinics is crucial towards improving the home transfusion system in Japan in the future.
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Affiliation(s)
- Asashi Tanaka
- Department of Clinical Laboratory Medicine and Department of Transfusion Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiroshi Fujita
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kota Ohashi
- TOTUS Home Care Clinic, Hemato-Homecare Network, Tokyo, Japan
| | | | | | - Tatsuya Ito
- Nishiosu Ito Internal Medicine and Department of Hematology, Hemato-Homecare Network, Aichi, Japan
| | | | | | - Takashi Mine
- Donated Blood Distribution Foundation, Tokyo, Japan
| | - Makoto Okuda
- Division of Blood Transfusion, Toho University Omori Medical Center, Tokyo, Japan
| | - Teruo Endoh
- Department of Clinical Laboratory Science, School of Medical Technology, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Youko Fukuyoshi
- Department of Transfusion Medicine and Cell Therapy, Kumamoto University Hospital, Kumamoto, Japan
| | - Junichi Kitazawa
- Division of Clinical Laboratory, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Eisaburo Sueoka
- Department of Laboratory Medicine, Saga University Hospital, Saga, Japan
| | - Kazuhiro Nagai
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Akaru Ishida
- Division of Transfusion Medicine and Cell Transplantation, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Yoko Kato
- Department of Transfusion Medicine, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Kazuo Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Koki Takahashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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6
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Miyashita N, Ohashi K, Fujita M, Hosoda T, Kawasaki Y, Takimoto M, Onozawa M. Prognostic factors in patients in the terminal phase of haematological malignancies who are receiving home medical care. Br J Haematol 2022; 201:290-301. [PMID: 36572123 DOI: 10.1111/bjh.18623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022]
Abstract
Although there are many prognostic models for patients in the terminal phase of solid tumours, a reliable prognostic scoring system in patients in the terminal phase of haematological malignancies (HM) has not been established. We retrospectively evaluated 180 patients in the terminal phase of HM who were receiving home medical care (HMC). Multivariate analyses revealed that clinician's estimate, consciousness, loss of appetite, dyspnoea, neutrophil count, lymphocyte count, and lactate dehydrogenase were associated with overall survival (OS). Based on this result, we developed a novel prognostic scoring system, the Japan palliative haematological oncology prognostic estimates, in which four risk groups were shown to clearly differ in survival (p < 0.001): a low-risk group (n = 41, median OS of 434 days), an intermediate-low-risk group (n = 80, median OS of 112 days), an intermediate-high-risk group (n = 38, median OS of 31.5 days), and a high-risk group (n = 21, median OS of 10 days). This is the first investigation of prognostic factors that influence the OS of patients in the terminal phase of HM who are receiving HMC. Providing patients with reliable information about their prognosis is important for them to consider how to spend their remaining life.
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Affiliation(s)
- Naohiro Miyashita
- Department of Hematology HOME CARE CLINIC N‐CONCEPT Sapporo Japan
- NPO Hemato‐Homecare Network Tokyo Japan
| | - Kota Ohashi
- NPO Hemato‐Homecare Network Tokyo Japan
- TOTUS Home Care Clinic Tokyo Japan
| | - Mariko Fujita
- Medical Home Care Center, Tenri Hospital Tenri Japan
| | - Toru Hosoda
- NPO Hemato‐Homecare Network Tokyo Japan
- Hamorebi Clinic Kamagaya Japan
| | - Yasufumi Kawasaki
- NPO Hemato‐Homecare Network Tokyo Japan
- Kaedenokaze Medical Clinic Tokyo Japan
| | - Madoka Takimoto
- NPO Hemato‐Homecare Network Tokyo Japan
- Kawasaki Nanafuku Clinic Kawasaki Japan
| | - Masahiro Onozawa
- Department of Hematology Hokkaido University Hospital Sapporo Japan
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7
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Rodríguez Corte J, Candal‐Pedreira C, Ruano‐Ravina A, Pérez‐Ríos M, Rivero‐de‐Aguilar A, López García M, Hermida Porto L, Varela‐Lema L. Home-based blood transfusion therapy: A systematic review. Br J Haematol 2022; 199:496-506. [PMID: 35778372 PMCID: PMC9796283 DOI: 10.1111/bjh.18344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 01/28/2023]
Abstract
Home care is a healthcare alternative to hospitalisation. Different types of procedures are performed at home care services, such as home transfusion of blood products. However, home blood transfusion is not fully implemented and there is a great lack of knowledge about it. The aims of this study were thus to assess the safety and effectiveness of home blood transfusions and patient acceptance and satisfaction. A systematic literature review was conducted in the main biomedical databases. We included all studies that covered patients who had received a home blood transfusion, regardless of their baseline diagnosis. The literature search yielded 290 studies, 14 of which were included in this study as they met the predefined criteria. The main patient profile of a home-transfusion recipient was a person with anaemia associated with other diseases. Overall incidence of severe adverse events was 0.05%. No studies evaluated the effectiveness of home versus hospital transfusions. One study showed that 51% of patients would be willing to receive home transfusions. Home blood transfusion appears to be a feasible, safe, and well-accepted procedure. Existing studies are of low quality, however, and this is an important limitation when it comes to drawing definitive benefit-risk conclusions.
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Affiliation(s)
- Jesús Rodríguez Corte
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain
| | - Cristina Candal‐Pedreira
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain
| | - Alberto Ruano‐Ravina
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
| | - Mónica Pérez‐Ríos
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
| | - Alejandro Rivero‐de‐Aguilar
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Neurology ServiceUniversity Hospital of the Canary IslandsTenerifeSpain
| | - Marisa López García
- Galician Health ServiceThe Galician Blood and Organ and Donation Agency (ADO)Santiago de CompostelaSpain
| | - Leticia Hermida Porto
- Galician Health Service, Home Hospitalisation Unit (HADO)A Coruña University Hospital ComplexSantiago de CompostelaSpain
| | - Leonor Varela‐Lema
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
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8
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Shaulov A, Aviv A, Alcalde J, Zimmermann C. Early integration of palliative care for patients with haematological malignancies. Br J Haematol 2022; 199:14-30. [PMID: 35670630 PMCID: PMC9796711 DOI: 10.1111/bjh.18286] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/30/2022] [Accepted: 05/17/2022] [Indexed: 01/07/2023]
Abstract
Early palliative care (EPC) significantly improves quality of life, symptoms, and satisfaction with care for patients with advanced cancer. International organizations have recognized and promoted the role of palliative care as a distinct specialty, advocating its involvement throughout the cancer trajectory. Although patients with haematologic malignancies (HMs) have a comparable symptom burden to patients with solid tumours, they face multiple barriers to EPC integration. In this review, we discuss these barriers, present updated evidence from clinical trials of EPC in HMs and propose models to support EPC integration into care for patients with HMs.
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Affiliation(s)
- Adir Shaulov
- Department of HaematologyHadassah Medical CenterJerusalemIsrael,Faculty of MedicineHebrew University of JerusalemIsrael
| | - Ariel Aviv
- Department of HaematologyHaEmek Medical CenterAfulaIsrael
| | - Jacqueline Alcalde
- Department of Supportive Care, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada,Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada,Department of MedicineUniversity of TorontoTorontoOntarioCanada,Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
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9
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Al-Riyami AZ, Estcourt L, Rahimi-Levene N, Bloch EM, Goel R, Tiberghien P, Thibert JB, Bruun MT, Devine DV, Gammon RR, Wendel S, Toungouz Nevessignsky M, Grubovic Rastvorceva RM, Oreh A, Romon I, van den Berg K, Kitazawa J, Patidar G, So-Osman C, Wood EM. Early and out-of-hospital use of COVID-19 convalescent plasma: An international assessment of utilization and feasibility. Vox Sang 2022; 117:1202-1210. [PMID: 36102139 PMCID: PMC9538090 DOI: 10.1111/vox.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives The use of coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) in the treatment of patients with severe acute respiratory syndrome‐2 infection has been controversial. Early administration of CCP before hospital admission offers a potential advantage. This manuscript summarizes current trials of early use of CCP and explores the feasibility of this approach in different countries. Materials and Methods A questionnaire was distributed to the International Society of Blood Transfusion (ISBT) CCP working group. We recorded respondents' input on existing trials on early/outpatient CCP and out‐of‐hospital (OOH)/home transfusion (HT) practices in their countries and feedback on challenges in initiating home CCP infusion programmes. In addition, details of existing trials registered on clinicaltrials.gov were summarized. Results A total of 31 country representatives participated. Early/OOH CCP transfusion studies were reported in the United States, the Netherlands, Spain and Brazil. There were a total of six published and five ongoing trials on the prophylactic and therapeutic early use of CCP. HT was practised in Australia, the UK, Belgium, France, Japan, Nigeria, the Netherlands, Spain, Italy, Norway, the United States and some provinces in Canada. Thirty‐four representatives indicated a lack of OOH CCP or HT in their institutions and countries. Barriers to implementation of OOH/HT included existing legislation, lack of policies pertaining to outpatient transfusion, and associated logistical challenges, including lack of staffing and resources. Conclusion Early administration of CCP remains a potential option in COVID‐19 management in countries with existing OOH/HT programmes. Legislation and regulatory bodies should consider OOH/HT practice for transfusion in future pandemics.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Lise Estcourt
- NHS Blood and Transplant & Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,ImpactLife Blood Centre and Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | | | | | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Dana V Devine
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Richard R Gammon
- Scientific Medical and Technical Direction, OneBlood, Orlando, Florida, USA
| | - Silvano Wendel
- Blood Bank, Hospital Sírio-Libanês Blood Bank, São Paulo, Brazil
| | | | - Rada M Grubovic Rastvorceva
- Institute for Transfusion Medicine of RNM, Skopje, North Macedonia.,Faculty of Medical Sciences, University Goce Delcev, Štip, North Macedonia
| | - Adaeze Oreh
- National Blood Service Commission, Federal Ministry of Health, Abuja, Nigeria
| | - Iñigo Romon
- Hematology Department, University Hospital Marques de Valdecilla, Santander, Spain
| | - Karin van den Berg
- Transfusion Medicine and Technical Services Division, South African National Blood Service, Johannesburg, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Junichi Kitazawa
- Department of Genomic Medicine, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Cynthia So-Osman
- Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands.,Department of Haematology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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10
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Gutwein O, Herzog Tzarfati K, Apel A, Rahimi‐Levene N, Michaeli H, Barki‐Harrington L, Koren‐Michowitz M. Haematological patients' perception of home transfusions: Effect of the
COVID
‐19 pandemic. Vox Sang 2022; 117:1195-1201. [DOI: 10.1111/vox.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Odit Gutwein
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
| | | | - Arie Apel
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
| | - Naomi Rahimi‐Levene
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
| | - Hani Michaeli
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
| | - Liza Barki‐Harrington
- Department of Human Biology, Faculty of Natural Sciences University of Haifa Haifa Israel
| | - Maya Koren‐Michowitz
- Department of Hematology Shamir Medical Center (Assaf Harofeh) Zerifin Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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11
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POLESE F, ROSSI C, POLES G, ARREGHINI N, GESSONI G. Cure palliative e terapia trasfusionale: le esperienze della "Serenissima". GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.20.04475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Shaw B, Wood EM, Callum J, McQuilten ZK. Home Delivery: Transfusion Services When and Where They Are Needed. Transfus Med Rev 2022; 36:117-124. [DOI: 10.1016/j.tmrv.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
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13
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Shaw B, Wood E, McQuilten Z, Callum J, Romon I, Sanroma P, Garcia D, Crispin PJ, Castilho L, Kutner JM, Yokoyama APH, Bravo A, Sanchez EF, Maldonado Silva K, Arora S, Radhakrishnan N, Dua S, Ziman A, Wikman A, Lubenow N, Bodecker Zingmark L, Louw VJ, Loebenberg P, Sidhu D, Redfern T, Nahirniak S, Dunbar N. International Forum on Home-Based Blood Transfusion: Summary. Vox Sang 2021; 117:616-623. [PMID: 34697808 DOI: 10.1111/vox.13200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
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14
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Nishikawa A, Fujimori Y, Sakano N, Mushino T, Tamura S, Kasahara S, Akasaka H, Sonoki T. Remote vital signs data monitoring during home blood transfusion: A pilot study. Health Sci Rep 2021; 4:e380. [PMID: 34541335 PMCID: PMC8439429 DOI: 10.1002/hsr2.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND AIMS Our study aimed to establish safer methods to manage home blood transfusion by using a remote vital signs data monitoring system. Home care is administered for patients with various medical disorders; however, home blood transfusion remains challenging owing to the risk of transfusion-related complications. METHODS We set up a remote vital signs data monitoring system to improve the safety of home blood transfusions. Using an Internet-based vital signs data monitoring system, the heart rate, electrocardiography, respiration rate, and percutaneous oxygen saturation (SpO2) were monitored and recorded during the entire home transfusion period. RESULTS Ten transfusions in three patients were monitored; two of the patients had an abnormality in a single vital sign (decreased SpO2 decrease and increased respiratory rate); these were not transfusion-related complications. Vital sign anomalies also occur because of errors in using the measurement device and noise associated with body movements. The presence of abnormalities in at least two vital signs among SpO2 decrease, tachycardia, and increased respiratory rate that persisted for >5 minutes was defined as a complicated vital sign abnormality (CVSA). There were no severe transfusion-related complications with CVSA in the present study. CONCLUSION This study indicates the feasibility and sustainability of real-time remote monitoring of vital signs for the safety of home transfusion. Although CVSA may function as an indicator of severe transfusion-related complications, these findings need to be confirmed with further studies.
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Affiliation(s)
- Akinori Nishikawa
- Division of Blood TransfusionWakayama Medical University HospitalWakayamaJapan
- Department of Hematology/OncologyWakayama Medical University HospitalWakayamaJapan
- Division of Medical InformationWakayama Medical University HospitalWakayamaJapan
- Akasaka ClinicKobeJapan
| | - Yoshihiro Fujimori
- Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular TherapyHyogo College of MedicineNishinomiyaJapan
| | - Noriko Sakano
- Department of Cardiovascular SurgeryOkayama University Graduate School of MedicineOkayamaJapan
| | - Toshiki Mushino
- Department of Hematology/OncologyWakayama Medical University HospitalWakayamaJapan
| | - Shinobu Tamura
- Department of Hematology/OncologyWakayama Medical University HospitalWakayamaJapan
| | - Shingo Kasahara
- Department of Cardiovascular SurgeryOkayama University Graduate School of MedicineOkayamaJapan
| | | | - Takashi Sonoki
- Division of Blood TransfusionWakayama Medical University HospitalWakayamaJapan
- Department of Hematology/OncologyWakayama Medical University HospitalWakayamaJapan
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15
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Barki-Harrington L, Baron-Epel O, Shaulov A, Akria L, Barshay Y, Dally N, Deshet D, Inbar T, Koren-Michowitz M, Leiba M, Moshe Y, Shvidel L, Tadmor T, Yagenah S, Zektser M, Preis M, Hellman I, Yahalom V, Aviv A. Willingness and concerns of transfusion-dependent hematological patients toward the option of home transfusion therapy. Palliat Med 2021; 35:927-932. [PMID: 33761783 PMCID: PMC8114422 DOI: 10.1177/02692163211000634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND One of the main obstacles of providing home-based palliative care to transfusion-dependent hematology patients is the lack of home transfusions services. While healthcare professionals are concerned with safety and cost of home transfusions, the attitude of the patients toward home transfusions are mostly unknown. AIM To obtain quantitative data regarding the willingness and concerns of transfusion-dependent patients with hematological diseases toward the option of home transfusions. DESIGN A cross sectional survey including a self-administered questionnaire in one of the three main spoken languages in Israel was administered to patients in 17 hospital hematology outpatient clinics between May 2019 and March 2020. RESULTS About 52% of 385 patients that participated in the survey preferred home transfusions to hospital transfusions. Gender, age, education, or type of disease were not associated with preference for home transfusions, nor were hospital location or its size. The likelihood to prefer home transfusions was significantly higher among the Hebrew-speakers and those who had not experienced adverse effects previously. The most significant factor associated with preference of home transfusions was a perceived negative effect of hospital-based transfusion on quality of life. The main reason to reject home transfusions was fear of possible adverse effects and concerns over losing contact with the medical staff at the treating hospital. CONCLUSION These data suggest that a significant portion of transfusion-dependent patients in Israel view home transfusions as a preferred treatment option and that its successful implementation requires maintaining ongoing contact with the treating hospital.
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Affiliation(s)
| | | | - Adir Shaulov
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Luiza Akria
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Yossef Barshay
- Department of Hematology, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel
| | - Najib Dally
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Hematology Institute and Blood Bank, Ziv Medical Center, Safed, Israel
| | - Dana Deshet
- Department of Hematology, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tsofia Inbar
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Maya Koren-Michowitz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Shamir Medical Center, Zerifin, Israel
| | - Merav Leiba
- Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel.,Department of Hematology and Blood Bank, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Yakir Moshe
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovoth, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shai Yagenah
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Hemato-Oncology, Padeh Poriah Medical Center, Poriah, Israel
| | - Miri Zektser
- Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel.,Hematology Department, Soroka Medical Center, Be'er Sheva, Israel
| | - Meir Preis
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ilana Hellman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Meir Medical Center, Kefar Sava, Israel
| | - Vered Yahalom
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Blood Services & Apheresis Institute, Rabin Medical Center, Petah Tiqva, Israel
| | - Ariel Aviv
- Hematology Unit, HaEmek Medical Center, Afula, Israel
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16
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Sharp R, Turner L, Altschwager J, Corsini N, Esterman A. Adverse events associated with home blood transfusion: A retrospective cohort study. J Clin Nurs 2021; 30:1751-1759. [PMID: 33656751 DOI: 10.1111/jocn.15734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/09/2020] [Accepted: 02/19/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To determine the rate of individual and system adverse events associated with blood transfusion at home. BACKGROUND Home or residential care facility based blood transfusion is beneficial for individuals requiring transfusion due to reduced disruption to daily life and the comfort of a familiar environment. However, blood transfusion may result in serious adverse events. There is a lack of research in this area, and there is a need to identify rates of adverse events and evaluate the system used for this service. DESIGN Retrospective cohort study. METHODS Existing data routinely collected for clinical care were used to determine client and system adverse events of medically stable adults with a chronic disease who underwent blood transfusion in a home setting provided by a nurse-led service. A STROBE EQUATOR checklist was used for this study (see Appendix S1). RESULTS There were 1790 episodes of care involving 533 participants, with 13 cases of transfusion reaction (incident rate [IR] 0.7%; 95% CI 0.43-1.25). Only five of these were severe, resulting in the cessation of the blood transfusion and further medical review or hospital admission (IR 0.28%; 95% CI 0.12-0.68). There were no cases of tampered blood packaging, expired or visually damaged blood products. There were 10 cases of incorrect paperwork (0.6%) and nine cases of incorrect temperature (0.5%). There were 153 cases of vascular access device adverse events (IR 8.5% 95% CI 7.3-9.9), most commonly, difficulty cannulating the individual (n = 82, 54%). CONCLUSIONS A nurse-led home blood transfusion service was associated with low rates of both individual and system adverse events. Further research is needed to explore the perception of those using this service and supports required to improve the experience. RELEVANCE TO CLINICAL PRACTICE Blood transfusions may be associated with increased risk of morbidity and mortality. This risk may be increased in a home setting due to the distance from an acute care facility. This study has demonstrated that a nurse-led home blood transfusion service is safe (<1% adverse event rate) for those with a medically stable, chronic condition. There were few failures in the system used to provide this service. Adverse events associated with the vascular access device were the most common complication and the reason for most blood product wastage. Mainly, this was due to difficulty inserting the short-term peripheral intravenous catheter (PIVC). RNs should consider ultrasound to aid PIVC insertion to facilitate treatment provision and enhance the experience of the individual.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences and Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | | | | | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Adrian Esterman
- Biostatistics and Epidemiology, Cancer Research Institute and Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Binder AF, Handley NR, Wilde L, Palmisiano N, Lopez AM. Treating Hematologic Malignancies During a Pandemic: Utilizing Telehealth and Digital Technology to Optimize Care. Front Oncol 2020; 10:1183. [PMID: 32676459 PMCID: PMC7333768 DOI: 10.3389/fonc.2020.01183] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
In late January 2020, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) was reported as an outbreak in Wuhan, China. Within 2 months it became a global pandemic. Patients with cancer are at highest risk for both contracting and suffering complications of its resultant disease, Coronavirus 19 (COVID-19). Healthcare systems across the world had to adapt quickly to mitigate this risk, while continuing to provide potentially lifesaving treatment to patients. Bringing care to the home through the use of telehealth, home based chemotherapy, and remote patient monitoring technologies can help minimize risk to the patient and healthcare workers without sacrificing quality of care delivered. These care models provide the right treatment, to the right patient, at the right time, in the right place. Whether these patient-centered models of care will continue to be embraced by key stakeholders after the pandemic remains uncertain.
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Affiliation(s)
- Adam F Binder
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Nathan R Handley
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Lindsay Wilde
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Neil Palmisiano
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Ana Maria Lopez
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
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Reply. Med Clin (Barc) 2019; 153:e50-e51. [PMID: 31427153 DOI: 10.1016/j.medcli.2019.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 11/22/2022]
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19
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Characteristics of palliative home care for patients with hematological tumors compared to those of patients with solid tumors. Int J Hematol 2019; 110:237-243. [DOI: 10.1007/s12185-019-02673-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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