Supportive care and symptom management in patients with advanced hematological malignancies: a literature review.

BACKGROUND AND OBJECTIVE: Recent advances have led to cure or long-term disease control for patients with hematological malignancy (HM). Unfortunately, some of them still have poor prognoses and are often associated with significant symptom burden and poor quality of life for patients and families. These patients usually require supportive care including red blood cell and platelet transfusion, due to disease itself and the oncological treatment, apart from their symptom management. However, there is currently lack of the literatures review in these aspects. The objective of this review is to summarize practical supportive care recommendations for physicians or nurses practicing in palliative care (PC)/hematology-oncology unit, starting with core approaches in use of blood products for anemia and thrombocytopenia, management of tumor lysis syndrome, PC and oncology nursing care. METHODS: Evidence for this review was obtained from a search of the Cochrane database, PubMed, guidelines of European Society of Medical Oncology, British society of Hematology, American Society of Clinical Oncology, National Comprehensive Cancer Network and peer-reviewed journal articles. KEY CONTENT AND FINDINGS: For asymptomatic cancer patients who are anaemic, a threshold of haemoglobin level of 7 g/dL is considered to be safe and generally favored for blood transfusion. 'Single-unit' red cell transfusion is safer and at least as effective as 'double-unit' transfusion. Prophylactic platelet transfusion should be given to stable patients without bleeding and with platelet count less than 10×109/L. In febrile patients, the threshold is lifted to 20×109/L. There are also recommendations for the use of blood products during COVID-19 pandemic. In general, HM patients were more prone to painful infections when compared with solid cancer patients. Thus, antibiotics to treat underlying infections should be applied whenever possible and as required to control pain. CONCLUSIONS: This narrative review showed the recent literatures in the supportive care and symptom management of advanced HM patients. However, it is limited by some of the 'evidence-based' recommendations for interventions (including symptom management) based on early phase of HM populations rather than those receiving end-of-life care.

The COVID Positive Pathway: a collaboration between public health agencies, primary care, and metropolitan hospitals in Melbourne.

OBJECTIVES: To assess the capacity of the COVID Positive Pathway, a collaborative model of care involving the Victorian public health unit, hospital services, primary care, community organisations, and the North Western Melbourne Primary Health Network, to support people with coronavirus disease 2019 (COVID-19) isolating at home. DESIGN, SETTING, PARTICIPANTS: Cohort study of adults in northwest Melbourne with COVID-19, 3 August - 31 December 2020. MAIN OUTCOME MEASURES: Demographic and clinical characteristics, and social and welfare needs of people cared for in the Pathway, by care tier level. RESULTS: Of 1392 people referred to the Pathway by the public health unit, 858 were eligible for enrolment, and 711 consented to participation; 647 (91%) remained in the Pathway until they had recovered and isolation was no longer required. A total of 575 participants (81%) received care in primary care, mostly from their usual general practitioners; 155 people (22%) received care from hospital outreach services, and 64 (9%) needed high tier care (hospitalisation). Assistance with food and other basic supplies was required by 239 people in the Pathway (34%). CONCLUSIONS: The COVID Positive Pathway is a feasible multidisciplinary, tiered model of care for people with COVID-19. About 80% of participants could be adequately supported by primary care and community organisations, allowing hospital services to be reserved for people with more severe illness or with risk factors for disease progression. The principles of this model could be applied to other health conditions if regulatory and funding barriers to information-sharing and care delivery by health care providers can be overcome.

Learning from work-from-home issues during the COVID-19 pandemic: Balance speaks louder than words.

During the 2019 novel coronavirus disease (COVID-19) pandemic, many employees have switched to working from home. Despite the findings of previous research that working from home can improve productivity, the scale, nature, and purpose of those studies are not the same as in the current situation with the COVID-19 pandemic. We studied the effects that three stress relievers of the work-from-home environment-company support, supervisor's trust in the subordinate, and work-life balance-had on employees' psychological well-being (stress and happiness), which in turn influenced productivity and engagement in non-work-related activities during working hours. In order to collect honest responses on sensitive questions or negative forms of behavior including stress and non-work-related activities, we adopted the randomized response technique in the survey design to minimize response bias. We collected a total of 500 valid responses and analyzed the results with structural equation modelling. We found that among the three stress relievers, work-life balance was the only significant construct that affected psychological well-being. Stress when working from home promoted non-work-related activities during working hours, whereas happiness improved productivity. Interestingly, non-work-related activities had no significant effect on productivity. The research findings provide evidence that management's maintenance of a healthy work-life balance for colleagues when they are working from home is important for supporting their psychosocial well-being and in turn upholding their work productivity.

Piloting an Augmented Reality Life Review Experience to Promote Mental Health Outcomes in Aging Asian American Women

Asian-American older women report the highest prevalence of suicidal ideations and rates of completed suicide compared to other racial groups. Ironically, Asian-American communities report disproportionately low rates of formal mental health utilization—this may be attributed to the lack of culturally-relevant services and negatively ingrained perceptions of mental health aid. One potential solution that has not been widely investigated is the use of technology to help older Asian-American women engage in mental health interventions. This study leverages innovations in augmented reality (AR) technology (i.e., overlaying of digital holograms onto the real world) to create a life review intervention aimed at promoting mental health well-being. The application, Tell-Being, is a personalized holographic life review experience that facilitates older adults to foster a sense of coherence and wholeness within their lives. Pilot data collection was amassed from four aging Asian-American female participants averaging 51.3 (SD=8.61) years of age. Initial pre/post analyses showcased mean differences that trend towards a higher presence of emotion regulation from pre-test (M=4.88, SD=1.08) to post-test (M=5.21, SD=1.17). Although data collection was prematurely halted due to COVID-19, results trended in promising directions. The technological innovations and findings from this study may lead to promising novel avenues to address barriers for older Asian-American women in seeking mental health assessment and treatment in a “new normal” world.

Dynamic Network Analysis of COVID-19 with a Latent Pandemic Space Model.

In this paper, we propose a latent pandemic space modeling approach for analyzing coronavirus disease 2019 (COVID-19) pandemic data. We developed a pandemic space concept that locates different regions so that their connections can be quantified according to the distances between them. A main feature of the pandemic space is to allow visualization of the pandemic status over time through the connectedness between regions. We applied the latent pandemic space model to dynamic pandemic networks constructed using data of confirmed cases of COVID-19 in 164 countries. We observed the ways in which pandemic risk evolves by tracing changes in the locations of countries within the pandemic space. Empirical results gained through this pandemic space analysis can be used to quantify the effectiveness of lockdowns, travel restrictions, and other measures in regard to reducing transmission risk across countries.