Introduction: Pneumococcus is a common bacterium that can cause serious infections, such as pneumonia, meningitis or blood stream infection in patients receiving immunosuppressive therapy. Infection by pneumococcus bacteria can be life-threatening leading to hospitalizations, complications and even death. In this work we have established a system base intervention that provides pneumococcal vaccine (Prevenar 13) for patients before starting chemotherapy and/or biological treatment. Methods: The intervention program included a set of measures: 1. Standard operating procedure (SOP) for vaccination of patients with hematological disorders. 2. Increasing the awareness of the medical and nursing staff regarding the importance of administering the vaccine before chemotherapy/biological treatments. 3. Purchasing vaccines by the hospital. 4.Coaching patients about the importance of receiving the vaccine before starting treatment. 5. Building a computerized record for monitoring and controlling the administration of the vaccine before starting treatment. 6. Transferring the information about the vaccine to the patient outpatient providers. 7. Documentation of the vaccine in the patient's electronic medical record. 8. Monthly review of new patients and vaccination before starting treatment. Results: In 2015, before intervention, only about 25% of patients were vaccinated appropriately against pneumococcus. With the start of the quality improvement project in April 2016, there was a gradual increase in the number of vaccinated patient before starting treatment. In December 2016, all new patients before starting treatment were properly vaccinated against pneumococcus. Although there was a significant increase in the number of patients at the institute in 2017 there was a 35% decrease in the number of patients hospitalized for pneumonia or sepsis compared to 2015. In addition, there was a 41% decrease in the number of hospitalizations with pneumonia or sepsis in the institute's patients. There was also a significant trend towards decrease in mortality (11% vs. 7%). Conclusions: The intervention program included: The creation of cooperation at several levels, medical, nursing and pharmacological that created cooperation between the medical center and the outpatient community clinics which led to the creation of a system that ensures that the patient will be vaccinated prior to starting immunosuppressive therapy. As a result of the intervention at the Institute and the data that was examined over 3 years, there has been a significant decrease in the rate of hospitalizations of patients due to pneumonia or sepsis. Disclosures No relevant conflicts of interest to declare.
Introduction: Israel contains within it a unique variety of ethnic and religious groups with variable set of convictions and values. Integrating palliative care approach in routine care of patients with hematological malignancies is challenging although published data supports this approach that results in improved patient quality of life. In this study we tested the effect of this approach on adherence to the planned treatment plan and hospital admissions for symptoms management. Methods: Patients with hematological malignancies treated in Carmel Medical Center, Haifa, Israel were enrolled in our integrative palliative care program. All patients were diagnosed with hematological malignancy. Patients were in various stages of disease - during diagnosis, active treatment or follow-up. Patients were evaluated by a multidisciplinary team including a palliative care physician, palliative care nurse, treating hematologist and a social worker. Evaluation included recognition of patient's unique characteristics and identifying needs and areas for intervention. A patient specific plan was formulated based on needs and social background. We measured patient's satisfaction using a specific questioner. Adherence to care was measured by the percentage of patients that had to change treatment plan due to side effects. We measured hospital admissions for symptoms management during treatment. Results: Fifty patients were enrolled in our integrated program. The mean age of our patients was 68, 46% were women, 62% were immigrants to Israel, 12% were Arab Israelis, and 64% were married. Most patients evaluated in the clinic were prior to initiating chemotherapy treatment for the underlying disease (70%). Most common patients main complain was depression and anxiety (42%) followed by pain (26%). Other complains included GI symptoms (12%), fatigue and malaise (10%), peripheral neuropathy (6%), none (4%). Most patients were treated with pharmacological interventions (66%). Patient comprehension of their disease and treatment plan was significantly improved (81%) following palliative care intervention. The palliative care intervention significantly improved patient symptoms and 81% reported significant improvement. None of the patients had to stop or change treatment due to symptoms or side effects from therapy. A significant decrease in ED visits or inpatients admissions was noted. Over a period of 6 months there was 80% decrease in ED visits or inpatients admission for symptoms management (p=0.04). Conclusions: Integrating palliative care in the outpatient hematology clinic significantly increase patients satisfaction, adherence to care and decrease hospital admissions for symptoms management. Depression and anxiety are very significant symptoms in patients prior to chemotherapy initiation and should be addressed to improve patient care. This approach has tremendous value in treating newly diagnosed patients with hematological malignancies. Disclosures No relevant conflicts of interest to declare.
Background : Multiple myeloma (MM) is one of the most common hematological malignancies. The disease is characterized by multiple symptoms resulting from the disease itself, from complications related to therapy, and as a result of the involvement of other organ systems. MM influences various aspects of patient's and family's lives. Therefore, there is a need to better understand the balance between disease control and symptoms management. Objectives : The main goal of this study is to emphasize the power and importance of Patient Reported Outcome Measures (PROMs) and Family Reported Outcome Measures (FROMs) as additional tools for patient assessment. This study evaluated the correlation between Patient Reported Outcome Measures (PROMs) and Family Reported Outcome Measures (FROMs) and disease evaluation according to the International Myeloma Working Group (IMW) response criteria in active myeloma patients. A comparison between patient and family reporting (PROMs & FROMs) and the staging of the disease according to the revised international staging system (R-ISS) was done. In addition, this study examined the confounders that may explain the relationship between PROMs and FROMs and disease evaluation. Methods : This is a quantitative, prospective, observational and longitudinal study of active patients with MM. After receiving Carmel Institutional Review Board approval to conduct the study, we enrolled fifty seven MM patients, the participants completed questionnaires of PROMs and FROMs at intervals of 3 months for one year. In addition, we monitored multiple clinical measures of patient response to treatment. A descriptive analysis of the research variables has been performed; differences between the PROMs/FROM and clinical variables analyzed by Pearson correlation, comparing PROMs/FROMs mean at the beginning of the study with the results at 3, 6, 9 and 12 months . A mixed regression model was used to examine the predictive ability of the study. In other words, the ability of Patient/Family Reported Outcome to predict the disease evaluation. Sample size was calculated using Win-Pepi software, using 5% significance and 80% power. For a coefficient of 0.4 between Patient and Family Reported Outcome and MM clinical evaluations, the minimum sample size required is 47 patients, for a coefficient of 0.35, the minimum sample size required is 62 patients. for a coefficient of 0.50, the minimum sample size required is 37 patients. This study recruited a sample size of 57 patients. Results - Fifty-seven patients participated in this study. After 3 months of treatment, a better disease evaluation was associated with improvement in disease symptoms or side effects reported by the patient. Furthermore, a better disease response was associated with a better body image scale and better future perspective. We observed a similar association after 6 and 9 months. In addition, the more the patient reported side effects or disease symptoms, the more it affects the family member (PROMs were positively correlated with FROMs). A better body image and future perspective reported by patient was associated with a lower effect on family member (PROMs were negatively correlated with FROMs)). A positive significant correlation was found between physician ranking of physical status ECOG (Eastern Cooperative Oncology Group) and the effect on family members. In other words, the worse the physical status of the patient, the more it affect the family member (in months 0,3,6 and 9). These finding were supported by the mixed model analysis, which showed a significant effect of disease symptoms, appetite loss, physical function, future perspective, and global satisfaction in prediction of clinical status. Conclusion- There is a significant relation between PROM/FROM and the typical assessment tools. This study highlights the power of PROM/FROM tools to evaluate patient from his point of view and to adjust the treatment accordingly. Finally, this study raises up the importance of continuing the research about the effect on the family member as a result of the patient disease and clinical status. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
ObjectivesPatients with haematological malignancies receiving immunosuppressive therapy are at highest risk of invasive pneumococcal disease. Our goal was to investigate whether vaccination of haematological patients with pneumococcal 13-valent conjugated vaccine (PCV13) prior to therapy initiation is associated with decreased hospital admissions due to pneumonia or sepsis within 12 months.Design and settingA longitudinal retrospective cohort study was conducted at the haematology unit of Carmel Medical Center, Israel.ParticipantsInformation on adult patients (>18 years) who were diagnosed between 1 January 2009 and 30 December 2019 with haematological malignancies and received immunosuppressive therapy was retrieved from the electronic health records. Patients with haematological malignancies who received the PCV13 vaccination during or after initiation of the immunosuppressive therapy were excluded from the study.Outcome measuresA multivariate logistic regression model was performed to determine whether PCV13 vaccination is associated with fewer hospital admissions due to pneumonia or sepsis.ResultsThe cohort included 616 patients, of which 418 (67%) patients were not vaccinated and 198 (33%) were vaccinated. Within 12 months, 15.1% (n=63) of non-vaccinated patients compared with only 7.1% (n=14) of the vaccinated patients were hospitalised due to pneumonia or sepsis. The logistic regression analysis demonstrated that receiving PCV13 vaccination is associated with 45% (OR=0.45, 95% CI: 0.246 to 0.839, p=0.012) reduced odds of being hospitalised due to pneumonia or sepsis in patients with haematological malignancies receiving immunosuppressive therapy.ConclusionThis is the first observational study to demonstrate the association between PCV13 vaccination and hospital admissions in patients with haematological malignancies receiving immunosuppressive therapy. Patients receiving PCV13 vaccination before immunosuppressive therapy initiation had significantly reduced odds of hospitalisation due to pneumonia or sepsis compared with non-PCV13-vaccinated patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.