Homecare Encounters: An Organizational Response to Innovative Care for Patients Undergoing Hematopoietic Stem Cell Transplantation During COVID-19.

BACKGROUND: Healthcare delivery has been significantly changed because of the COVID-19 pandemic. Patients undergoing hematopoietic stem cell transplantation (HSCT) are vulnerable to infections because of their immunocompromised status. The risk of nosocomial infection may be reduced by providing care to patients at home. OBJECTIVES: This article describes one cancer center's approach for delivering safe patient care through homecare encounters, the benefits of home care for HSCT, and future directions. METHODS: Patients received detailed information on home encounters. Advanced practice providers visited patients daily and then returned to the clinic to formulate a plan of care with the interprofessional care team. Transplantation RNs visited patients on the same day to provide the prescribed care. FINDINGS: Based on evaluations from 32 patients and 12 providers, the results indicated that home care was safe, feasible, and beneficial for patient care post-HSCT during the COVID-19 pandemic.

Perioperative Nursing Management of Donor and Recipient Patients Undergoing Face Transplantation.

Individuals with debilitating facial injuries and deformities have achieved significant improvement of aesthetic form and function after undergoing a face transplantation. The involvement of surgical technologists and perioperative nurses in the care of the recipient and donor plays a critical role in the success of these procedures. There are unique challenges that staff members may be presented with when caring for a donor and recipient undergoing a face transplantation, including less comfort with and knowledge of the surgical procedure and instrumentation, an increased amount of equipment and personnel in the OR, donor and recipient admission and discharge care, and increased shift length. At New York University Langone Medical Center, New York, we have developed a comprehensive process to prepare staff members to care for patients undergoing face transplantation.

Preparing for a face transplant: development of a comprehensive nursing educational program.

To date, more than 30 face transplants have been performed worldwide. This innovative procedure has restored the functional and aesthetic aspects of the face in patients with cancer, congenital, and trauma-related deformities where the results of traditional reconstructive surgery have been deficient. The importance of nursing involvement in the care of these patients is undeniable; however, little has been published about how to properly prepare a nursing department to undertake such an important role. Although the care of patients undergoing face transplants has many similarities to the care of patients undergoing traditional head and neck flap procedures, patients undergoing face transplant provide unique challenges, including immunosuppression, allograft rejection, communication impairment, and psychosocial needs. Staff at New York University's Langone Medical Center have devised a specific plan of action to properly inform, educate, and prepare the nursing staff for this exciting endeavor.

Recuperador celular / No disponible

Los recuperadores de sangre son unos instrumentos usados cada vez más en los quirófanos. Resultan especialmente útiles en las intervenciones donde existe mucho riesgo de sangrado y las necesidades transfusionales son elevadas. En pediatría tienen una gran importancia en intervenciones complicadas con la finalidad de evitar transfusiones alogénicas (sangre obtenida de donantes). La aplicación del recuperador de sangre en el campo quirúrgico es muy simple y de fácil utilización. Se trata de una cánula de aspiración que recoge la sangre que queda libre, trasladándola a una centrifugadora donde se filtra y lava, almacenándola en una bolsa de recogida para su posterior infusión. La sangre es de gran calidad y contiene un hematocrito más elevado que la procedente de banco (AU)

The blood retrievers are instruments increasingly used in operating rooms. They are especially useful in operations where there is a high risk of bleeding and transfusion requirements are high. In paediatrics is of great importance in complex interventions in order to avoid allogeneic transfusion (blood collected from donors). The implementation of the recovery of blood in the surgical field is very simple and easy to use. This is a suction tube that collects the blood that is free, transferring it to a centrifuge where it is filtered and washed, stored in a blood collection bag for subsequent infusion. The blood is of high quality and contains a high hematocrit blood from the bank (AU)

Review of chronic graft-versus-host disease in children after allogeneic stem cell transplantation: nursing perspective.

This review presents a summary of the research literature related to the incidence and risk factors for chronic graft-versus-host disease in children following allogeneic hematopoietic stem cell transplantation. The range of incidence of chronic graft-versus-host disease in children found in this review was large, from 0% to 46%. Incidence of chronic graft-versus-host disease was influenced by sample size, time posttransplantation, and stem cell source. Characteristics of the person (eg, child's age and gender) and disease/treatment (eg, sources of transplant) are associated with chronic graft-versus-host disease in children after stem cell transplantation. Person and disease/treatment characteristics provide a framework for understanding the factors associated with chronic graft-versus-host disease symptom experiences in children after stem cell transplantation. Timely assessment of presenting chronic graft-versus-host disease symptoms is critical for treatment and prognosis. Nursing interventions should focus on educating children and parents about the signs and symptoms of chronic graft-versus-host disease. The summary of supportive nursing care for children with chronic graft-versus-host disease provides important information to tailor effective management strategies for children with chronic graft-versus-host disease.

Homoenxerto em cirurgia de valvas cardíacas: evidências para a prática da enfermagem perioperatória: [revisão] / Homografts in cardiac valves surgery: evidences for the perioperative nursing practice: [review] / Homoenxerto en la cirugía cardiaca, la válvula: las pruebas para la práctica de la enfermería perioperatoria: [revisión]

O uso clínico de homoenxertos de valvas cardíacas é amplamente utilizado como técnica cirúrgica para várias doenças cardiovasculares. Dentre as atividades realizadas pela enfermagem há o descongelamento de homoenxerto no período intra-operatório de cirurgia cardíaca. Para fundamentar tal prática desenvolvemos o presente estudo. Este estudo tem como objetivo buscar na literatura as evidências disponíveis sobre os cuidados no descongelamento de homoenxertos em cirurgias de valvas cardíacas no período intra-operatório. Trata-se de uma revisão integrativa da literatura. As bases de dados selecionadas foram Medline e Lilacs e os descritores de assunto utilizados foram: transplante homólogo, crio preservação e valvas cardíacas. Foram incluídos na revisão sete artigos, os quais foram abordavam principalmente aspectos da técnica para o descongelamento do enxerto, o tempo para a realização deste procedimento e a solução empregada. Concluímos que a prática do descongelamento do homoenxerto fundamenta-se em estudos de nível de evidências 6 e 7 e abordaram pouco sobre a atuação da enfermagem.

Homograft cardiac valves are largely used as surgical technique for several cardiovascular diseases. Graft defrosting is among activities performed by nursing in cardiac surgeries in the intraoperative period. The development of this study aims to support such practice through the search, in the literature, of evidence available on the care of graft defrosting in homograft cardiac valves in the intraoperative period. It is an integrative literature review. The databases selected were Medline and Lilacs and the following descriptors were used: transplantation, homologous; cryopreservation and heart valves. Seven articles were included in the review, which mainly approached aspects of the graft defrosting technique, length of time for performing such procedure, and solution adopted. We concluded that the graft defrosting practice is based on studies of evidence level 6 and 7, and little has been discussed about the nursing practice.

El uso clínico de homoinjerto de válvulas cardíacas se utiliza ampliamente como una técnica quirúrgica para diversas enfermedades cardiovasculares. Entre las actividades llevadas a cabo por la enfermería hay el descongelar del homoinjerto durante el intra-operatorio de cirugía cardíaca. Para fundamentar esta práctica hemos desarrollado el presente estudio. Este estudio tiene como objetivo examinar las pruebas disponibles la literatura sobre los cuidados en el descongelamiento de homoinjertos en cirugía de válvulas cardíaca, durante el intra-operatorio. Se trata de un revisión integrativa de la literatura. Las bases de datos seleccionadas fueron Medline y Lilacs y los descriptores fueron: trasplante homólogo, criopreservación y válvulas cardíacas. Fueron incluidos en la revisión siete artículos, los cuales abordaban principalmente los aspectos de la técnica para el descongelamiento del injerto, el tiempo para llevar a cabo este procedimiento y la solución empleada. Llegamos a la conclusión de que la práctica de la descongelación de homoinjerto se basa en estudios de nivel de evidencias 6 y 7 y abordaran poco acerca de la actuación de la enfermería.

Infection prevention strategies in a stem cell transplant unit: impact of change of care in isolation practice and routine use of high dose intravenous immunoglobulins on infectious complications and transplant related mortality.

OBJECTIVE: Nursing in 'live islands' and routine high dose intravenous immunoglobulins after allogeneic hematopoietic stem cell transplantation were abandoned by many teams in view of limited evidence and high costs. METHODS: This retrospective single-center study examines the impact of change from nursing in 'live islands' to care in single rooms (SR) and from high dose to targeted intravenous immunoglobulins (IVIG) on mortality and infection rate of adult patients receiving an allogeneic stem cell or bone marrow transplantation in two steps and three time cohorts (1993-1997, 1997-2000, 2000-2003). RESULTS: Two hundred forty-eight allogeneic hematopoetic stem cell transplantations were performed in 227 patients. Patient characteristics were comparable in the three cohorts for gender, median age, underlying disease, and disease stage, prophylaxis for graft versus host disease (GvHD) and cytomegalovirus constellation. The incidence of infections (78.4%) and infection rates remained stable (rates/1000 days of neutropenia for sepsis 17.61, for pneumonia 6.76). Cumulative incidence of GvHD and transplant-related mortality did not change over time. CONCLUSIONS: Change from nursing in 'live islands' to SR and reduction of high dose to targeted IVIG did not result in increased infection rates or mortality despite an increase in patient age. These results support the current practice.

Immune reconstitution: the foundation for safe living after an allogeneic hematopoietic stem cell transplantation.

With increasing frequency, oncology nurses are providing long-term care to hematopoietic stem cell transplantation (HSCT) recipients in nontransplantation settings. This may be a result of more patients receiving HSCTs, recipients living longer, and recipients' desire to return to their hometowns as soon as possible. Although critical to patients' initial recovery after HSCT, immune reconstitution also must remain a priority of oncology nursing care long beyond the date of discharge from a transplantation center. As patients resume their normal lives, oncology nurses need to be diligent in assessment and education to facilitate the ultimate goal, a safe life after HSCT. This article provides concise details about the short- and long-term immunologic effects of HSCT and focuses on the long-standing threat of opportunistic infections that can persist months and years after HSCT.

Measurement of nursing care time of specific interventions on a hematology-oncology unit related to diagnostic categories.

The aim of this study was to develop a tool that can aid nurse managers in planning nurse staffing levels and assessing workload in hematology-oncology wards. A task-oriented method based on a time-and-motion study was used. Three general nursing procedures and 7 specific oncologic and hematologic activities were clocked. It was checked in the charts of the patient, for each day of the admission, how often selected nursing procedures were performed. Then total amount of time needed for each patient was calculated. Data from 29 admissions to the ward were analyzed and divided into 5 categories based upon the treatment performed during that admission. The categories chosen were: autologous stem cell transplantation, allogeneic stem cell transplantation, graft versus host reaction, leukemia treatment, and chemotherapy for solid neoplasm. The results obtained are an estimate of the different daily workload that is required for these categories of patients in selected nursing procedures.

[Nursing diagnosis for allogeneic bone marrow transplantation patient: case study]. / Diagnósticos de enfermagem de paciente submetido à transplante de medula óssea alogênico: estudo de caso.

This case study aims at presenting the follow-up of a patient who underwent allogeneic bone marrow transplantation and the experience of the nursing team of the Centro de Transplante de Medula Ossea (Bone Marrow Transplantation Center) at the Hospital de Clínicas de Porto Alegre, Brazil, during the development of the systematization of the nurse practice emphasizing the period of elaboration of the nursing diagnosis. Twenty-six diagnosis established in this case are discussed and put together in the format of a table to allow the reader to have a view of their initial and ending periods, during the in-patient treatment time.

Treating glaucoma with drainage devices and pericardial grafts.

Glaucoma is caused by a sustained elevation of intraocular pressure due to the decreased drainage of aqueous humor from the anterior chamber of the eye. There are many types of glaucoma, which, if left untreated, may have devastating results for the patient. Glaucoma can remain uncontrolled after medical and surgical interventions. Glaucoma drainage device implants with pericardial graft placements often are helpful in relieving the effects of glaucoma and increasing the patient's quality of life.

The many uses of allograft skin.

Although allografts have traditionally been used on burn patients as temporary covers for large surface area burns before placement of autografts, recent investigations suggest other applications in wound healing. The purpose of this article is to discuss some of the applications for allograft skin, present illustrative examples of its usefulness, and explore possibilities for future research, including tissue banks, rejection of allograft skin, and cultured epithelial allografts. These applications and possibilities support the use of allograft skin as a true "biologic dressing."

Small intestine transplantation: a nursing perspective.

Intestinal transplantation has become a viable treatment modality for the patient with short gut syndrome. The potential for the development of serious postoperative complications contributes to the complexity of caring for these patients. Through astute observation, thorough assessment, and intelligent intervention, the nurse can directly affect the ultimate success of intestinal transplantation. A dedicated team approach, along with a sincere patient/family commitment, will help to provide for optimal patient management and a successful outcome.