"Make it fun": a qualitative study exploring key aspects of power mobility interventions for children.

PURPOSE: Research suggests there are three groups of paediatric power mobility learners: exploratory, operational and functional. The purpose of this modified grounded theory study was to explore the key aspects of power mobility interventions for children in each of these paediatric power mobility learner groups. MATERIALS AND METHODS: Data were gathered through face-to-face interviews conducted in-person or via Zoom®. Three stakeholder groups were interviewed: (1) children ages 8-18 years who used a power wheelchair (PWC); (2) parents whose children (≤18 years of age) used a PWC; and (3) therapists/therapist researchers experienced in paediatric power mobility. An interview guide was created for each stakeholder group. Interviews were transcribed verbatim and an initial coding scheme was used to identify intervention activities specific to each learner group. Data for each learner group were then coded to reflect the essence of each intervention activity. Finally, patterns within the data were identified and codes were collapsed into thematic categories reflecting the key aspects of intervention for each learner group. RESULTS: A total of 29 participants (nine children, seven parents and 13 therapists) took part in the study. Key aspects of power mobility interventions for each learner group, as well as fundamental aspects of power mobility intervention applicable to all learner groups, emerged in the data. CONCLUSIONS: This study highlights both the similarities (fundamental aspects) and differences (key aspects targeting the specific needs of each learner group) of power mobility interventions for children in each of the three power mobility learner groups.Implications for RehabilitationThere are both similarities (fundamental aspects) and differences (key aspects targeting the specific needs of each learner group) in the needs of children in each of the three power mobility learner groups.Key aspects of power mobility interventions vary for children in each of the three paediatric power mobility learner groups and correspond with the learning needs of each power mobility learner group.The findings of this study will help clinicians and researchers to tailor power mobility interventions to meet the unique needs of children in each power mobility learner group.

Bloodless tandem autologous transplant in Jehovah's Witness patients.

Tandem autologous transplants are generally the preferred therapy for newly diagnosed intermediate- and high-risk myeloma patients. More Jehovah's Witnesses (JW) are receiving single autologous peripheral blood stem cell transplants (PBSCTs). However, tandem autologous transplants have not been reported in JW patients. We performed a retrospective study of 54 patients, including four JW patients who received tandem autologous transplants between August 2000 and January 2017 and the last 50 consecutive tandem autologous transplants performed between August 2014 and August 2016. The bleeding complications, number, and cost of transfusions of blood products were compared. The median number of CD34 cells infused in non-JW patients was 8.16 million cells/kg versus 9.44 million cells/kg in JW patients. During the first 30 days, one JW experienced Grade III pulmonary hemorrhage, while none of the non-JW patients had a Grade III or higher bleeding problem. After tandem autologous transplants, complete remission was achieved in 88% of non-JW, compared with 75% in JW patients. In the first 30 days post-transplant, median platelet and packed red blood cell (PRBC) transfusions in non-JW patients was 2 (range: 0-40) and 1 (range: 0-11), respectively. Total cost of PRBC and platelet transfusions for the 50 non-JW was $214,664 (average $2147/transplant). Tandem autologous transplants can thus be performed safely without a single blood transfusion.

VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma.

The addition of cytotoxic drugs to high-dose melphalan as a preparative regimen for autologous stem cell transplantation in multiple myeloma has not resulted in superior activity. Although novel agents have significantly improved outcome in multiple myeloma, their role in preparative regimens remains largely unknown. We have evaluated the toxicity and efficacy of combining bortezomib, thalidomide, and dexamethasone with high-dose melphalan. An institutional review board-approved retrospective analysis was performed on 100 consecutive patients receiving 153 transplants; 53 had tandem transplants; 64 patients received early transplants; and 36 had salvage transplantation. Endpoints were treatment-related toxicity and mortality, and quality of response post-transplantation with assessment of stringent complete remission (sCR) and minimal residual disease (MRD) status. Median age was 61 years, and median follow-up was 16.2 months. At 6 months, sCR was attained in 56% of patients and CR in 20%. An MRD status, assessed by sensitive (10-4) multiparameter flow cytometry, was achieved in 85%. The 100-day mortality rate was 2.6% (4/153); 1.8% for early transplants and 4.5% for salvage transplants. Grade 3-5 non-hematologic toxicities were mainly related to metabolism/nutrition; gastrointestinal and infectious problems. Median time to absolute neutrophil count of >500/µL was 12 days for both early and salvage transplantations. No significant differences in quality of response were observed between early and salvage transplantation or between single and tandem autologous stem cell transplantation. Since both sCR and MRD are excellent early surrogate markers for progression-free and overall survival, this regimen will likely be superior to melphalan alone, but it needs to be formally assessed in a randomized study.