OBJECTIVES:Oral mucositis is a complication frequently associated with hematopoietic stem cell transplantation, decreasing a patient's quality of life and increasing the occurrence of opportunistic infections. The purpose of this study was to determine the incidence and severity of oral mucositis and to assess the correlation of this disease with the oral health of an individual at the time of hematopoietic stem cell transplantation.METHODS:Before transplantation, patients' oral health and inflammatory conditions were determined using the gingival index and the plaque index, which are based on gingival bleeding and the presence of dental plaque, respectively. Additionally, the dental health status was determined using the decayed, missing, and filled teeth index. The monitoring of oral mucositis was based on the World Health Organization grading system and was performed for five periods: from Day 0 to D+5, from D+6 to D+10, from D+11 to D+15, from D+16 to D+20, and from D+21 to D+30.RESULTS:A total of 97 patients (56% male and 44% female) who underwent hematopoietic stem cell transplantation at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo between January 2008 and July 2009 were prospectively examined. The incidence of ulcerative mucositis was highest from days +6 to +10 and from days +11 to +15 in the patients who underwent autologous and allogeneic hematopoietic stem cell transplantation, respectively.CONCLUSION:The data, including the dental plaque and periodontal status data, showed that these oral health factors were predictive of the incidence and severity of oral mucositis in a cohort of patients with similar conditioning regimens before hematopoietic stem cell transplantation.
IntroductionAutologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients’ short-term needs.AimTo analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct.MethodsA retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study.ResultsThe medical records of 100 patients with a median age of 48.5 years (19–69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic.ConclusionThe median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.
Introduction: Hematopoietic Cell Transplant (HCT) is a potential curative treatment for hematological diseases. Patients undergoing HCT are usually immunosuppressed and require frequent outpatient visits. Patients actively enrolled at Hospital das Clínicas, School of Medicine, University of Sao Paulo (HCFMUSP) HCT Outpatient Clinic were already reached via Whatsapp (personal or family members' cell phones) for clinic appointments and non-medical information before the COVID-19 pandemic. Since the onset of the pandemic, we have faced a challenge: providing medical care for HCT patients while preventing environmental exposure to SARS-CoV-2. Our HCT team started performing telehealth care using a HIPAA-compliant Google Meet-based institutional platform and telephone calls in March/2020. To evaluate this strategy as a permanent tool, we sent out a survey to patients in order to better understand their opinion on and early experience with telehealth. Methods: We sent out a questionnaire on Google Forms containing a few questions regarding barriers to commute to hospital, internet access, feelings about the use of telehealth at our outpatient clinic and their incipient experience with it. Participants were instructed to answer the questions from the patient's perspective, regardless if the survey was filled out by the patients themselves or caregivers. The questionnaire was anonymous, written in Portuguese, and remained open from August 3rd to 9th, 2020. Results: A survey invitation was sent out to 299 patients who had been seen in clinic over the last 12 months. During this period, all patients provided a contact number that could reached through Whatsapp, either on their own or a caregiver's smartphone. Of these, 133 patients answered the survey. The total time to go to and come back from hospital was <30 min for 5%, 30-60 min for 23%, 60-90 min for 20%, 90-120 min for 14% and >120 min for 38%. Total cost to commute to and from hospital (for both the patient and an eventual caregiver) was > US$ 10.00 for 42% (equivalent to 5% of the minimum wage per month). Thirty-two percent of participants reported any degree of mobility disability. Thirty-three and 29% of patients complained of long waiting times for in-person doctor and pharmacy appointments, respectively. In terms of technology, 97% had a personal cell phone or smartphone. Ninety-five percent of patients had access to internet on a smartphone, and 32% through a personal computer (some had both). Sixty-six percent reported no difficulty using a cell phone, 23% some difficulty and 9% significant difficulty. Ninety-five percent regularly used social media apps. Approximately half of the patients had at least one previous interaction via telehealth with our center during the COVID-19 pandemic, of whom 92% considered it a good or very good experience. When inquired if they would like to start receiving or continue to receive telehealth care, 83% answered yes, 10% expressed some interest and 7% declared no interest. When asked about their opinion on widening telehealth use at the HCFMUSP HCT Outpatient Clinic following the pandemic, 43% answered they would certainly use it, 45% thought it could be good, 5% had concerns, 4% were indifferent, and 3% did not approve the idea. Conclusions: In-person appointments seem to be both cost and time-consuming and represent a relevant burden on this limited-resource population. Despite being a public health institution from a middle-income country, most of our patients have personal cell phones with easy internet access. Among those who had an incipient experience with telehealth, the impression was overall positive. We cannot rule out selection bias towards participants who were more familiar with technology and thus more inclined to appreciate telehealth. Taken together, although not always fit for all clinical scenarios, our findings suggest telehealth may be efficient and complementary to in-person interactions with HCT patients, and prompt wider implementation of this health care modality. Disclosures No relevant conflicts of interest to declare.
Introdução o transplante de medula óssea, atualmente denominado como transplante de células tronco hematopoética (TCTH) é uma alternativa que vem se mostrando eficaz no tratamento de diversos tipos de neoplasias e doenças hematológicas. no entanto requer dos pacientes alterações em sua rotina que inclui além de vários procedimentos, muitas vezes dolorosos, mudanças físicas, isolamento e a necessidade de que um cuidador o acompanhe no tratamento. Observamos que os pacientes demonstram preocupações com suas próprias questões e também com as alterações provocadas na vida do cuidador. Estes fatores podem contribuir para aumento da ansiedade, estresse e reações depressivas. Objetivo: Auxiliar o paciente/cuidador a organizar e planejar questões pessoais antes do tcth. Metodologia: Após equipe médica constatar indicação para o TCTH, o paciente e cuidador são encaminhados para o programa de acolhimento pré-transplante onde a equipe multiprofissional (enfermagem, psicóloga, nutrição, serviço social) fará levantamento individual das necessidades apresentadas e em conjunto buscam as possíveis soluções. Posteriormente participam de grupo de orientação onde equipe multiprofissional abordam as etapas do transplante, permitindo expressão de expectativas e esclarecendo dúvidas. Resultados: Os pacientes/cuidadores que tem participado do programa, conseguem organizar questões importantes antes do inicio do tratamento, como local para hospedagem; quem poderá acompanhá-lo e se haverá necessidade de troca de acompanhantes; questões relacionadas ao trabalho; esclarecem dúvidas quanto ao tratamento contribuindo para a diminuição de reações de ansiedade e estresse. Conclusão: Este programa tem se mostrado importante suporte de apoio ao paciente/cuidador que consegue organizar questões pessoais e assim poder focar atenção no tratamento.
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