Arno Mank

Management of related donor care: a European survey.

Donating BM or peripheral stem cells is a challenging process that requires a considerable commitment on the part of the donating individual, especially when there is a relationship between donor and recipient. In order to develop a better understanding of related donor management, the research subcommittee of the European Group for Blood and Marrow Transplantation-Nurses Group (EBMT-NG) designed a questionnaire to survey European transplant centres. This questionnaire investigated several key areas, including guidelines, patient information, donor consent and follow-up services. It was distributed to a sample of delegates (N=150) at the 2005 meeting of the EBMT-NG. Guidelines for the information given to patients were primarily from local (33, 52%), and a combination of local and national (13, 21%) sources. Transplant information was predominantly given to related donors by the recipients transplant team (36, 57%). A total of 33 (52%) centres indicated that donors were also consented by transplant doctors, whereas 16 (25%) identified that consent was obtained by doctors who were not connected with the transplant team. At present, there is a lack of recognized standardized guidelines for the management of related donors. The development of such guidelines would assist in maintaining patient autonomy, confidentiality and access to accurate and objective information.

Coping with serious events at work: a study of traumatic stress among nurses.

Background: Nurses often encounter serious events during their work, which can lead to traumatic stress. Objective: To examine how serious events, demographic variables, and coping strategies are associated with traumatic stress in a sample of nurses working in the medical department of a university teaching hospital. Design: The data for this survey were collected in 2003. Two questionnaires were completed by nurses: the Utrecht Coping List (UCL) and the List of Serious Events and Traumatic Stress in Nursing (Nursing LIST). Results: The 69 nurses who participated in the study had experienced a mean of 8 serious events in the past 5 years. In all, 98% of all nurses reported traumatic stress. Active coping, social support, and comforting cognitions were independently associated with traumatic stress. Conclusion: The participating nurses had experienced multiple serious events, and many felt traumatized. Active coping decreased the risk of experiencing traumatic stress, whereas comforting cognitions and social support increased the likelihood of appraising a serious event as traumatic. More research needs to be conducted to support these findings and to develop strategies to support nurses after serious events.

Monitoring hyperhydration during high-dose chemotherapy: Body weight or fluid balance?

Body weight and fluid input/output are usually monitored for checking fluid balance in case of intravenous hyperhydration during nephrotoxic chemotherapy. The reliability of measuring fluid input/output is uncertain. Moreover, this measurement is redundant, complex, labour-intensive and represents an occupational hazard for nurses and other health-care workers handling fluids or body excreta. In a prospective cohort study, we determined the concordance between body weight and fluid intake/output. We also examined the clinical consequences with respect to the safety of selecting only body weight measurement as a parameter for fluid overload. A total of 591 combined observations of fluid balances and body weights were collected. We observed a higher increase in body weight than in fluid balance. The Pearson correlation between fluid balance and body weight was relatively low (r = 0.28). With regard to the safety of measuring body weight only, we found 4 cases (0.6%) who might not have received furosemide if the fluid input/output had not been measured, without clinical consequences, however. After standardization, body weight can safely be used as the only parameter for monitoring fluid retention in case of hyperhydration during chemotherapy.

Examining Low Bacterial Dietary Practice: A Survey on Low Bacterial Food

Patients with haematological malignancies have periods of neutropenia caused by the disease process and subsequent treatments, during which time they are at an increased risk of developing life threatening infections. Historically, many measures have been initiated to protect patients during this time. One such measure has been to provide a low bacterial diet to minimise the number of pathogens ingested from food. However, scientific literature lacks any substantial evidence confirming whether this is beneficial in the management of these patients while guidelines are often unclear and give conflicting advice. A detailed survey was carried out to examine the use of low bacterial diets considering criteria, conditions and specific dietary products. One hundred and eight questionnaires were completed, mainly European. Ninety-five (88%) centres used guidelines to advise practice for inpatients. Although 88% of the hospitals have guidelines, when these were examined there were enormous differences in both the guidelines themselves and the way in which they are implemented. The restrictions seen are varied and sometimes even contradict each other. Forty-eight (44%) of the respondents imposed restrictions on all products mentioned. Conditions for starting or stopping dietary restrictions were also diverse. This survey highlights the need to attempt to standardise dietary restrictions in a patient group for whom good nutrition is paramount.

Safe early discharge for patients undergoing high dose chemotherapy with or without stem cell transplantation: a prospective analysis of clinical variables predictive for complications after treatment.

AIM To identify which patient groups can be safely discharged early after high dose chemotherapy. BACKGROUND Until recently, the standard of care for patients with haematological malignancies who have been treated with high dose chemotherapy has been to hospitalise them until neutrophil recovery and clinical improvement. Over the past years, a more liberal approach has resulted in a tendency to discharge patients earlier. However, currently it is unclear which clinical variables are important and which patient groups are most suitable to be discharged early. DESIGN Prospective cohort study. METHODS The study group of 55 patients underwent 82 admission periods for a total of 2269 patient days, which could be classified into four categories: induction treatment, consolidation treatment and autologous or allogeneic stem cell transplantation. Different clinical variables potentially interfering with early discharge were subsequently analysed for their association with each treatment group. RESULTS The median duration of admission was 27 days. The incidence of fever (82.9%) and use of intravenous antibiotics (79.3%) was high in all treatment groups. The only statistically significant differences between groups were found for performance status and mucositis. In the patient group undergoing consolidation chemotherapy for acute myeloid leukaemia, the performance status was better and mucositis was less severe. The decline in performance status and the severity of mucositis were as expected most obvious 10-14 days after the start of chemotherapy. CONCLUSION Patients undergoing consolidation chemotherapy appear to be the most suitable candidates for early discharge, especially in the first-week postchemotherapy treatment. Early discharge can also be considered in patients with a good performance status in the autologous stem cell transplantation group, directly after transplantation. RELEVANCE TO CLINICAL PRACTICE An important factor in developing an early discharge programme is a good infrastructure, both at home and in the hospital.

Management of veno-occlusive disease: the multidisciplinary approach to care

Although it is considered a relatively rare disorder, veno‐occlusive disease (VOD) is one of the main causes of overall, non‐relapse mortality associated with haematopoietic stem cell transplantation (HSCT). This article, based on the consensus opinion of haemato‐oncology nurses, haemato‐oncologists and pharmacists from both adult and paediatric services at the VOD International Multi‐Disciplinary Advisory Board at the European Society for Blood and Marrow Transplantation (EBMT) meeting, Istanbul, 2015, aims to explore the multidisciplinary approach to care for the management of VOD, with an emphasis on current challenges in this area. The careful monitoring of HSCT patients allows early detection of the symptoms associated with VOD and timely treatment, ultimately improving patient outcomes. As part of a multidisciplinary team, nurses have an essential role to play, from pretransplant assessment to medical management and overall care of the patient. Physicians and pharmacists have a responsibility to facilitate education and training so that nurses can work effectively within that team.

Providing oral care in haematological oncology patients: Nurses’ knowledge and skills

In the international literature, the most commonly recommended intervention for managing oral mucositis is good oral care, assuming that nurses have sufficient knowledge and skills to perform oral care correctly. The aim of the present study was to investigate if knowledge and skills about oral care improve when education in oral care is provided to nurses in charge of patients who are at risk of oral mucositis. This intervention study consists of a baseline test on the knowledge and skills of nurses of the haematology wards of two different hospitals. Oral care education sessions were given in one hospital and follow-up tests were performed in both hospitals. Nursing records were examined and observations of nurses performing oral care were made at baseline as well as at follow-up. The results show significant differences in the scores for knowledge and skills before and after the education, whereas there was no difference in scores at the two points in time for the comparison hospital, where no education had taken place. The records test showed no differences at baseline or follow-up for the two groups. Observations showed that nurses who followed the education session implemented the oral care protocol considerably better than those who did not attended. Education in oral care has a positive influence on the knowledge and skills of nurses who care for patient at risk of oral mucositis, but not on the quality of oral care documentation.

Early discharge after high dose chemotherapy is safe and feasible: a prospective evaluation of 6 years of home care

Abstract A single-center, prospective, non-randomized clinical study was performed to examine the safety and feasibility of early discharge in patients undergoing consolidation chemotherapy for acute leukemia, or autologous stem cell transplant for lymphoma or multiple myeloma. Patients were discharged into ambulatory care the day after the last chemotherapy administration and were subsequently seen at the ambulatory care unit three times a week. One hundred and one of 224 patients were ineligible for the program, mostly because of their medical situation, the lack of a caregiver or the travel time to the hospital. The remaining 123 patients were able to spend more than 70% of the time at home. In 44% of cycles they were never readmitted. This study demonstrates the safety, feasibility and benefits of managing carefully selected patients. Patients and their caregivers felt safe and comfortable at home, and the vast majority preferred home care to in-hospital treatment.