Allopurinol adjuvant in acute lymphoblastic leukaemia maintenance treatment

Hybrid Email and Outpatient Clinics to Optimize Maintenance Therapy in Acute Lymphoblastic Leukemia

“…In the future, additional information can be included to assist in treating inherent drug-sensitive patients with protocol modulation 3 or adjuvant therapy. 24 The system developed to support the e-clinic can be adapted to clinical decision-making software. [25][26][27] This will facilitate the standardization of MT therapy across centers in countries the size of India.…”

“…The digitized longitudinal data eases optimal dose titration practice. In the future, additional information can be included to assist in treating inherent drug-sensitive patients with protocol modulation 3 or adjuvant therapy 24 . The system developed to support the e-clinic can be adapted to clinical decision-making software 25–27 .…”

“…In era 3 and 4, a semiautomated spreadsheet (see spreadsheet, Supplemental Digital Content 2, http://links.lww.com/JPHO/A663) was created, individualized for each patient, stored on the hospital server, and accessible to both the e-clinic and OP teams. Data on MT information 12 (see spreadsheet, Supplemental Digital Content 3, http://links.lww.com/JPHO/ A664) were extracted from these records. Along with OP records, emails from patients were screened to check for additional comments by families.…”

“…As shown in Table 2, of the expected 48 clinic visits in era 4, "virtual" patients recorded a median 56 visits (e-clinics: 38 [35 to 42]; in-person visits: 18 [13 to 22]), with the additional visits: required for weekly supervision during neutropenia episodes. "Direct" patients recorded a 4:2 ratio of e-clinic to OP visits (median e-clinics: 30 [28 to 32]; median in-patient visits: 18 [13][14][15][16][17][18][19][20][21][22][23][24]) highlighting that these patients too were using the e-clinic more often than OP reviews. With the frequency of OP visits halved, the number of patients in each OP clinic reduced considerably.…”

“…A telephone survey was carried out with a pre-tested questionnaire to assess the acceptance of the hybrid clinic [11][12][13][14][15][16][17] 15 [12][13][14][15][16][17][18][19] 18 [13][14][15][16][17][18][19][20][21][22] 14 [12][13][14][15][16][17][18] Values represent median [interquartile range] unless stated otherwise. "Direct" refers to patients whose e-clinic consultations were ≤ the median e-clinic consultations per patient † for the respective era.…”