Paper and electronic versions of HM-PRO, a novel patient-reported outcome measure for hematology: an equivalence study.

Aim: To determine measurement equivalence of paper and electronic application of the hematological malignancy-patient-reported outcome (HM-PRO), a specific measure for the evaluation of patient-reported outcomes in HMs. Patients & methods: Following International Society of Pharmacoeconomics and Outcomes Research ePRO Good Research Practice Task Force guidelines, a total of 193 adult patients with different HMs were recruited into a multicenter prospective study. The paper and the electronic version of the instrument were completed in the outpatient clinics in a randomized crossover design with a 30 min time interval to minimize the learning effect. Those who completed the paper version first, completed the electronic version after 30 min and vice versa. Instrument version and order effects were tested on total score of the two parts of the HM-PRO (Part A: quality of life and Part B: signs & symptoms) in a two-way ANOVA with patients as random effects. Intraclass correlation coefficients (95% CI) and Spearman's rank correlation coefficients were used to evaluate test-retest reliability and reproducibility. The effects of instrument version and order were tested on total score of the two parts of HM-PRO. Results: The questionnaire version and administration order effects were not significant at the 5% level. There were no interactions found between these two factors for HM-PRO (Part A [quality of life]; p = 0.95); and (part B [signs and symptoms]; p = 0.72]. Spearman's rank correlation coefficients were greater than 0.9, and intraclass correlation coefficients ranged from 0.94 to 0.98; furthermore, the scores were not statistically different between the two versions, showing acceptable reliability indexes. Noteworthy, the difference between the completion time for both paper (mean = 6:38 min) and electronic version (mean = 7:29 min) was not statistically significant (n = 100; p = 0.11). Patients did not report any difficulty in completing the electronic version during cognitive interviews and were able to understand and respond spontaneously. Conclusion: Measurement equivalence has been demonstrated for the paper and electronic application of the HM-PRO.

Challenging blood transfusion practice: effect of targeted behavioural intervention on red cell transfusion in a district general hospital.

Existing evidence shows that restrictive blood transfusion is safe and may avert potential harm associated with more liberal transfusion strategies. A significant number of patients are being both unnecessarily transfused and over-transfused for their age, diagnosis and comorbidities. We describe the implementation of a behavioural strategy through educational sessions and the provision of individualised patient-centred advice, offering haematinic investigation and supplementation where appropriate. We compared our interventional data with a retrospective analysis of patients receiving blood transfusion for number of units transfused, haemoglobin triggers and incidence of haematinic investigations. The data were also analysed for patient length of stay and cost effectiveness. There was a significant reduction in the number of red cell units transfused across all specialties (p=0.003). In total, 431 units were transfused in the interventional group compared with 571 in the control group. There was a significant reduction in over-transfusion (p=0.003). Patients undergoing haematinic testing increased by 16.6% (p=0.0002). There was no change in length of hospital stay and our strategy has been shown to not only be cost effective, but provide significant monetary saving. Our patient-centred approach, through clinician engagement and challenging outdated behaviours, has been shown to significantly reduce inappropriate blood transfusions.

Acute myeloid leukaemia secondary to treatment with capecitabine for metastatic colorectal cancer.

A 63-year-old woman was diagnosed with acute myelo-monocytic leukaemia, associated with MLL gene rearrangement, 16 months after completion of oral capecitabine for metastatic colon cancer. Capecitabine, recommended for use in metastatic breast and colon cancer and more recently as adjuvant treatment of colon cancer, has not previously been reported to be associated with secondary cancer.