Neighborhood disadvantage, health status, and health care utilization after blood or marrow transplant: BMTSS report.

Living in a disadvantaged neighborhood is associated with poor health outcomes. Blood or Marrow Transplant (BMT) survivors remain at risk of chronic health conditions requiring anticipatory management. We hypothesized that among BMT survivors, neighborhood disadvantage was associated with poor self-reported routine health care utilization and health. We leveraged data from BMTSS - a retrospective cohort study examining long-term outcomes among individuals surviving ≥2 y following BMT at three institutions between 1974 and 2014. Participants in this analysis completed the BMTSS survey (sociodemographics; chronic health conditions; time since routine check-up; self-reported health). The Area Deprivation Index (ADI) represented neighborhood disadvantage; this composite indicator of 17 census measures is a percentile rank (0 = least deprived to 100 = most deprived). Multivariable ordered logit regression adjusted for clinical factors and individual-level sociodemographics, modeling associations between ADI, time since routine check-up, and self-reported health. Among 2,857 survivors, median ADI was 24 (interquartile range: 10-46). Adjusting for self-reported individual-level socioeconomic indicators and chronic health conditions, patients in more disadvantaged neighborhoods had higher odds of reporting longer intervals since routine check-up (ORADI_continuous = 1.007, P < .001) and poorer health status (controlling for time since check-up; ORADI_continuous = 1.005, P = .003). Compared with patients living in the least disadvantaged neighborhood (ADI = 1), patients in the most disadvantaged neighborhood (ADI = 100), had twice the odds (ORADI = 1.007^99 = 2.06) of reporting no routine visits and 1.65-times the odds of reporting poor health (ORADI = 1.005^99 = 1.65). In BMT survivors, access to health care and health status are associated with area disadvantage. These findings may inform strategies to address long-term care coordination and retention for vulnerable survivors.

Clinical use of intrapulmonary heparin.

Of 16 patients treated with intrapulmonary heparin at doses between 10,000 and 20,000 U/week for 1592 patient days, or 4.3 years, only one rethrombosed. This patient has a congenital antithrombin III deficiency. However, the use of intrapulmonary heparin, even in this particular patient, has remarkably decreased her thrombotic events as manifested by studying her history of deep vein thrombosis and pulmonary embolism prior to starting intrapulmonary heparin. This represents a failure rate of 4.2% in the total of 1592 patient days of therapy, or a rethrombosis rate of 1.4% per year. This recurrence rate is far superior to that reported for warfarin-type therapy or for platelet suppressive therapy. From this limited experience, it appears that heparin is an extremely safe and highly effective mode of outpatient prophylaxis for deep vein thrombosis and thromboembolic disease. The ultimate aim of this study is to determine the possibility of calcium heparin being placed into a hand-held aerosol nebulizer that a patient can use at home on a weekly basis. This would provide a highly convenient, safe, and apparently very efficacious mode of therapy for the long-term outpatient prophylaxis of deep vein thrombosis and thromboembolic disease.

Helping supervisors step into the educator's role.

Supervisors who lack the skills of the educator rarely visualize training as an integral part of their jobs. Consequently, new employees suffer from poor instruction and supervisors miss out on a potentially rewarding aspect of their duties. Seeking to remedy this situation, the University of Texas Medical Branch Department of Sterile Processing and Central Supply and the Personnel Office tailored a train-the-trainer program to meet the specific needs of their supervisors.