ABSTRACT
Background: Infections contribute to an early mortality risk of 15 percent in newly diagnosed multiple myeloma(NDMM) cases. There is a limited literature on the type of infections in fully vaccinated NDMM patients. Aims: To study epidemiology, clinical profile and predictors of infection in NDMM who are immunised against pneumococci and influenza. Methods: NDMM patients were prospectively studied for 6 months for the pattern of infections . All patients were vaccinated with pneumococcal and Influenza vaccine at diagnosis. PJP prophylaxis and fluconazole prophylaxis was given for patients receiving high dose steroids while acyclovir was given to all. Infections were classified as microbiologically defined, clinically defined and fever of unknown focus according to definitions published by the International Immunocompromised Host Society. Severity of infections were graded according to the NCI CTCAE Ver5. Results: Forty-eight NDMM patients with a median age 55 years comprising of 26 males and 22 females were enrolled. Renal involvement was noted in 42% of enrolled patients and two third of them required renal replacement therapy. ISSIII and R-ISS III were 70.8 % and 62.5 % respectively. 85% had poor performance status(ECOG ≥2) at baseline. RVD was the most common regimen (37%)used. 6 patients received daratumumab based regimen. Treatment response of atleast VGPR was seen in 97 % of NDMM patients. A total of 19 episodes of infections were observed during 6 months. All episodes of infections were reported in the first 45 of myeloma diagnosis(Median 6 days;Range 0-45). Ten of these episodes of infection were diagnosed during the initial evaluation for myeloma defining events. Microbiological diagnosis was possible in 63 %. Commonest infectious agent was COVID 19(n=8) followed by Gram negative bacteria (n=5) viz E.coli and Klebsiella pneumoniae . None of the eight patients who developed COVID 19 infection had received COVID vaccine as they antedated the operationalisation of national guidelines for immunisation. Respiratory and the urinary tract were the most common focus of infection. All critically ill COVID patients succumbed to progressive respiratory failure and all patients with mild and moderate COVID illness recovered uneventfully. Early mortality in our cohort of forty eight patients was twenty percent(n=10). Three fourths of infections in our cohort were Grade≥3 severity. A total of seven deaths were attributable to infectious diseases in this cohort of NDMM patients. Imune paresis was seen in eighty four percent of patients at diagnosis. On follow up at 6 months;immune paresis had persisted in only thirty seven percent. Regression analysis of variables with odds of infection is shown in Table 1 Baseline BMI<18.5 kg/m2;albumin<3g/dl and ISS or R-ISS stage ≥ 2 was found to be have statistically significant odds of predicting infection risk in the cohort of patients. The choice of myeloma regimen, presence of high risk cytogenetics and response to therapy did not correlate with increased odds of infection in our cohort. Summary/Conclusion: Conclusion In this prospective study of NDMM patients vaccinated against pneumococci and influenza at baseline;infection attributable early mortality was 14.5 %. Advanced stage of presentation, hypoalbuminemia and baseline BMI < 18.5 kg/m2 correlated with increased odds of infection. COVID vaccination and COVID appropriate behavioural practices may mitigate COVID related outcomes including deaths in myeloma patients.
ABSTRACT
PurposeThe purpose of this study is to empirically examine the impact of technology-enabled service co-creation on patients' service patronage behaviour in healthcare retailing. The first objective is to examine the mediating roles of spatial presence and co-presence in the relationship between technology enabled co-creation and service experience. The second objective is to investigate if healthcare service experience impacts patients' relationship value with hospitals and subsequent patronage intention.Design/methodology/approachData were collected from a sample of 516 customers of three leading hospitals in India during the social isolation period of COVID-19. The data were analysed using structural equation modelling.FindingsThe study results demonstrate that customers' favourably perceived technology-enabled co-creation generates feelings of spatial presence and co-presence in the technology-enabled platform. The feeling of presence enhances patients' health care service experiences which in turn predict their relationship value perceptions towards the healthcare service provider. Co-presence dominates as a mediator in terms of magnitude over spatial presence. The favourable value perception positively impacts patients' intention to come back to the same hospital.Research limitations/implicationsThe study uses cross-sectional data, which does not incorporate any temporal variations in the investigated relationships. The study does not account for differences in government vs. private undertakings of healthcare system.Practical implicationsThe findings envisage a digital healthcare retail system, where hospitals can enhance patients' perceptions of healthcare service experience, relational value and re-patronage intention, based on the digital mediated environment design elements, i.e. spatial presence and co-presence. As co-presence is a dominant factor, ensuring that human healthcare experts (rather than technology based e-service elements like chatbots) participate in healthcare service co-creation is of prime importance to provide enriching service experience to the patients.Originality/valueThe value of the research lies in extending the theories of presence, UTAUT and S-O-R to understand digital healthcare retailing, in order to identify the mechanism of how online co-creative platform can generate hospital patronage behaviour among patients through the serial mediation of presence, augmented service experience and relationship value.
ABSTRACT
Purpose The purpose of this study is to empirically examine the impact of technology-enabled service co-creation on patients' service patronage behaviour in healthcare retailing. The first objective is to examine the mediating roles of spatial presence and co-presence in the relationship between technology enabled co-creation and service experience. The second objective is to investigate if healthcare service experience impacts patients' relationship value with hospitals and subsequent patronage intention. Design/methodology/approach Data were collected from a sample of 516 customers of three leading hospitals in India during the social isolation period of COVID-19. The data were analysed using structural equation modelling. Findings The study results demonstrate that customers' favourably perceived technology-enabled co-creation generates feelings of spatial presence and co-presence in the technology-enabled platform. The feeling of presence enhances patients' health care service experiences which in turn predict their relationship value perceptions towards the healthcare service provider. Co-presence dominates as a mediator in terms of magnitude over spatial presence. The favourable value perception positively impacts patients' intention to come back to the same hospital. Research limitations/implications The study uses cross-sectional data, which does not incorporate any temporal variations in the investigated relationships. The study does not account for differences in government vs. private undertakings of healthcare system. Practical implications The findings envisage a digital healthcare retail system, where hospitals can enhance patients' perceptions of healthcare service experience, relational value and re-patronage intention, based on the digital mediated environment design elements, i.e. spatial presence and co-presence. As co-presence is a dominant factor, ensuring that human healthcare experts (rather than technology based e-service elements like chatbots) participate in healthcare service co-creation is of prime importance to provide enriching service experience to the patients. Originality/value The value of the research lies in extending the theories of presence, UTAUT and S-O-R to understand digital healthcare retailing, in order to identify the mechanism of how online co-creative platform can generate hospital patronage behaviour among patients through the serial mediation of presence, augmented service experience and relationship value.