ABSTRACT
Mechanical circulatory support in the form of ventricular assist devices (VADs) in children has undergone rapid growth in the last decade. With expansion of device options available for larger children and adolescents, the field of outpatient VAD support has flourished, with many programs unprepared for the clinical, programmatic, and administrative responsibilities. From preimplantation VAD evaluation and patient education to postimplant VAD management, the VAD program, staffed with an interdisciplinary team, is essential to providing safe, effective, and sustainable care for a new technology in an exceedingly complex patient population. Herein, this paper describes the Boston Children's Hospital VAD experience over a decade and important lessons learned from developing a pediatric program focusing on a high-risk but low-volume population. We highlight the paramount role of the VAD coordinator, clinical infrastructure requirements, as well as innovation in care spanning inpatient and outpatient VAD supports at Boston Children's Hospital.
Subject(s)
Heart Failure/surgery , Heart-Assist Devices , Hospitals, Pediatric , Program Development , Adolescent , Boston , Child , Child, Preschool , Continuity of Patient Care , Female , Hospitals, Pediatric/organization & administration , Humans , Infant , Infant, Newborn , Male , Patient Care Team , Program Development/standards , Program Evaluation/standards , Young AdultABSTRACT
Objective To investigate the efifcacy of thalidomide combined with VAD in treatment of elderly multiple myeloma(MM). Methods 76 cases of elderly MM were randomly divided into two groups, control group (n=38) were treated with VAD alone while the observation group (n=38) were treated with thalidomide and VAD. Clinical efifcacy and adverse reactions in two groups were compared. Results The total effective rate in observation group was 84.21%, which was signiifcantly higher than 55.26%in control group (P<0.05). After treatment, the M protein, myeloma cells andβ2-microglobulin in observation group were (20.77±4.15)×10-2μg/mL, (12.84±2.85)×10-2μg/mL and (2.48±0.53)μg/mL, which were signiifcantly lower than before treatment and control group(P<0.05). Hemoglobin in observation group was (108.83±5.81) g/L, which was signiifcantly higher than before treatment and control group(P<0.05). The adverse reactions were nausea, vomiting, drowsiness, constipation, infection and rash and so on in two groups after treatment, and there was no signiifcant difference between two groups. Conclusion Thalidomide combined with VAD regimen has a better effect in treatment of elderly multiple myeloma than single VAD, has less adverse reactions and well tolerated.
