Percutaneous autologous concentrated bone marrow grafting in the treatment for nonunion.

The purpose of this study was to evaluate the clinical and radiographic treatment effects of percutaneous autologous concentrated bone marrow grafting in nonunion cases and to evaluate the effectiveness of this grafting procedure. We enrolled 17 cases those had atrophic changes due to continuous nonunion for over 9 months after injury and had undergone low-intensity pulsed ultrasound treatment for more than 3 months. The site of nonunion was the femur in 10 cases, the tibia in 5 cases, the humerus in 1 case, and the ulna in 1 case. They underwent percutaneous autologous concentrated bone marrow grafting and continued low-intensity pulsed ultrasound stimulation treatment after grafting. Patients were evaluated using the visual analogue scale for pain at immediately before the procedure, 3, 6, and 12 months after grafting. Plain radiographs of the affected site were taken and evaluated about the healing of the nonunion site at each clinical evaluation. As quantitative assessment, CT scans were undertaken before the procedure and 6 months after grafting. The visual analogue scale pain score was reduced consistently after grafting in all patients. About the healing at the nonunion site, 11 and 13 cases of bone union were observed at 6 and 12 months after grafting. The mean volume of callus formation based on CT images was 4,147 (262-27,392) mm3 total between grafting and 6 months. Percutaneous autologous concentrated bone marrow grafting is an effective procedure for the treatment of patients with nonunion.

Return to primary service among bone marrow transplant rehabilitation inpatients: an index for predicting outcomes.

OBJECTIVE: To assess rehabilitation inpatient risk of return to primary (RTP) service in patients with bone marrow transplant (BMT). DESIGN: Retrospective review. SETTING: Inpatient rehabilitation unit within a tertiary referral-based cancer center. PARTICIPANTS: All patients with BMT (131) who were admitted a total of 147 times to inpatient rehabilitation between January 1, 2002, and April 30, 2010. INTERVENTIONS: None. MAIN OUTCOME MEASURES: We analyzed RTP service and demographic information, cancer characteristics, medications, hospital admission characteristics, and laboratory values. RESULTS: A total of 61 (41%) of 147 of BMT admissions were transferred from the inpatient rehabilitation unit back to the primary service. Of those transferred back, 23 (38%) of 61 died after being transferred back to the primary service. Significant or near-significant relationships were found for a platelet count of <43,000 per microliter (P<.01); a creatinine level of >0.9 milligrams/deciliter (P<.01); the presence of an antiviral agent (P=.0501); the presence of an antibacterial agent (P=.0519); the presence of an antifungal agent (P<.05); and leukemia, lymphoma, or multiple myeloma diagnosis (P<.05). Using 5 of these factors, the RTP-BMT index was formulated to determine the likelihood of return to the primary team. CONCLUSIONS: Patients with BMT have a high rate of transfer from the inpatient rehabilitation unit back to the primary service. The RTP-BMT index score can be a useful tool to help clinicians predict the likelihood of return to the primary acute care service.

Exercise promotes bone marrow cell survival and recipient reconstitution post-bone marrow transplantation, which is associated with increased survival.

Bone marrow transplantation (BMT) is associated with a high risk of mortality, partially because of the harmful effects of the preconditioning myeloablative regimens. We have recently demonstrated increased bone marrow cell survival and proliferation in response to exercise training, which may be attributable to increased quality of the niche. The purpose of the present study was to determine the extent to which exercise preconditioning of recipients could increase the success of BMT. Recipient mice remained sedentary (SED) or were exercise-trained (EX) on a treadmill (3 d/wk for 8 weeks) before reconstitution with green fluorescent protein (GFP)-labeled donor marrow. Recipient survival, both donor-derived and total (donor- and recipient-derived) blood reconstitution were measured by flow cytometry. The first and fourth day after BMT apoptosis, cellularity and donor cell homing were determined in the recipients' bone marrow cavity by flow cytometry. Whereas only 25% of SED mice survived, 82% of EX recipients survived the BMT. Homing of donor-derived marrow cells to the recipients' marrow cavity acutely after BMT was not altered in EX, but EX mice displayed decreased levels (10%; p < 0.05) of activated caspase-3/-7 one day after BMT, leading to a maintenance of marrow cellularity in mice preconditioned with exercise. The acute inhibition of marrow cell apoptosis in EX mice resulted in increased total blood cell reconstitution at 1 and 3.5 months after BMT in EX mice (42% and 43%, respectively; both p < 0.05). Short- and long-term donor-derived engraftment was not different between EX and SED recipients. Exercise training increases recipient survival after BMT with increased total blood cell reconstitution.

Kinematic analysis of motor recovery with human adult bone marrow-derived somatic cell therapy in a rat model of stroke.

BACKGROUND: The extent to which pharmaceutical and behavioral therapies following central nervous system injury may either deter or encourage the development of compensatory movement patterns is a topic of considerable interest in neurorehabilitation. However, functional outcome measures alone are relatively insensitive to compensatory changes in movement patterns per se. OBJECTIVE: This study used both functional outcome measures and kinematic analysis of forelimb movements to examine the effects of human adult bone marrow-derived somatic cells (hABM-SCs) on motor recovery in a rat model of stroke. METHODS: Adult male Long-Evans black-hooded rats (n = 12) were trained in a forelimb reaching task and then underwent surgical middle cerebral artery occlusion, producing a stroke that impaired the trained paw. One week poststroke, animals were randomly assigned to either a hABM-SC injection or control injection group. Reaching behaviors were then compared at baseline and at 10 weeks poststroke. RESULTS: Both groups improved their outcome scores during the 10-week recovery period. However, the hABM-SC group recovered significantly more function than controls in terms of the number of pellets retrieved. Furthermore, the control group appeared to improve their functional performance by using compensatory strategies that involved an increased number of trajectory adjustments, whereas the hABM-SC group's kinematics more closely resembled prestroke movement patterns. CONCLUSIONS: This study demonstrates that kinematic measures established in stroke research on humans are also sensitive to performance differences prestroke versus poststroke in the rat model, reinforcing the utility of this method to evaluate treatments that may ultimately translate to patient populations.

The impact of the dose of natural killer cells in the graft on severe acute graft-versus-host disease after unrelated bone marrow transplantation.

The impact of lymphocyte subpopulations on the outcome of bone marrow transplantation (BMT) remains uncertain. We investigated the relationship between the lymphocyte subpopulations of bone marrow grafts and the outcome of BMT. A total of 121 patients who underwent BMT at Kanagawa Cancer Center between 2000 and 2009 were analyzed. Grade III-IV acute graft-versus-host disease (GVHD) occurred in 35.9% of patients who received unrelated BMT with a CD56 cell dose ≤2.80×10(6)/kg versus only 9.7% of patients with a CD56 cell dose >2.80×10(6)/kg (P=0.017). In patients receiving related BMT, the cumulative incidence of grade III-IV acute GVHD did not differ significantly in relation to the CD56 cell dose. On multivariate analysis, older donor age (hazard ratio (HR): 1.09, 95% confidence interval (CI): 1.03-1.15, P=0.004) and a high dose of CD56 cells (>2.80×10(6)/kg) (HR: 0.15, 95%CI: 0.03-0.92, P=0.040) were significant determinants of grade III-IV acute GVHD after unrelated BMT. None of the lymphocyte subpopulations had a significant impact on the outcome of transplantation, including the rate of neutrophil engraftment, relapse, relapse-free mortality, and overall survival. Our findings suggest that a high natural killer cell dose prevents severe acute GVHD after unrelated BMT, while sparing the graft-versus-leukemia effect.

Aprendizagem organizacional e gestão do conhecimento: pautas para a gestão de pessoas / Organizational learning and knowledge management: guidelines for personnel management / Aprendizaje organizativo y gestión del conocimiento: pautas para la gestión de personas

Este estudo teórico tem o objetivo de discutir de que modo a aprendizagem corporativa e a gestão do conhecimento têm sido incorporadas à agenda dos profissionais da área de gestão de pessoas e como estes têm se imbricado nessa necessidade contemporânea. A aprendizagem organizacional representa como ideia central a forma como as organizações aprendem, com o objetivo de manterem-se em constante desenvolvimento, agregando vantagens competitivas. Coloca-se a necessidade de que o gestor de pessoas esteja apto para discutir formação no cenário contemporâneo do mundo do trabalho, desde a organização da demanda, passando pelo desenvolvimento de propostas, e consequente implementação, acompanhamento e avaliação de resultados. A formação desse profissional deve ampliar-se, discutindo as repercussões estratégicas que este gestor deve incorporar em sua prática.

This theoretical study aims to discuss how corporate learning and knowledge management have been embodied into the agenda of professionals in the area of personnel management and how they have committed themselves with this contemporary need. Organizational learning is represented, as a central idea, as the way that organizations learn, in order to keep in constant development, embodying competitive advantages. The need exists for the personnel manager to be able to discuss training in this new scenario, from organization of demand, to development of proposals, to eventual implementation, monitoring and evaluation of results. The formation of personnel managers must expand in order to discuss the strategic repercussions that managers must embody into their practice.

Este estudio teórico tiene el objetivo de discutir de qué modo el aprendizaje corporativo y la gestión del conocimiento han sido incorporados a la agenda de los profesionales del área de gestión de personas y cómo los mismos se han involucrado en esa necesidad contemporánea. El aprendizaje organizativo representa, como idea central, de qué forma aprenden las organizaciones con el objetivo de mantenerse en constante desarrollo y agregando ventajas competitivas. Se coloca la necesidad de que el gestor de personas esté capacitado para discutir formación en el escenario contemporáneo del mundo del trabajo desde la organización de la demanda, pasando por desarrollo de propuestas y consecuente implementación, acompañamiento y evaluación de resultados. La formación de este profesional se debe ampliar discutiendo las repercusiones estratégicas que este gestor debe incorporar en su práctica.

Live birth after ovarian tissue autograft in a patient with sickle cell disease treated by allogeneic bone marrow transplantation.

OBJECTIVE: To report the first case of restoration of ovarian activity and live birth after cryopreserved ovarian tissue autograft in a patient without cancer treated by allogeneic bone marrow transplantation. DESIGN: Case report. SETTING: University hospital. PATIENT(S): One woman with homozygous sickle cell anemia. INTERVENTION(S): An orthotopic autotransplantation of ovarian cortical strips was performed after freeze-thawing. MAIN OUTCOME MEASURE(S): Cryopreservation of ovarian tissue, bone marrow transplantation, ovarian autograft, and restoration of ovarian function. RESULT(S): In autumn 2005, biopsy samples of ovarian tissue were cryopreserved before chemotherapy followed by bone marrow transplantation. In spring 2008, because the patient had been menopausal for 2.5 years as a result of the conditioning therapy, an orthotopic autotransplantation of thawed ovarian cortex was performed. The patient conceived spontaneously in a natural cycle in autumn 2008, and delivered a healthy female child in June 2009. CONCLUSION(S): Cryopreservation of ovarian tissue with subsequent autotransplantation is an emerging procedure for preserving the fertility of young patients with a high risk of premature ovarian failure (POF) resulting from gonadotoxic treatment. This case opens up new perspectives in cases of nonmalignant diseases.

Utility of the psychosocial assessment of candidates for transplantation (PACT) scale in allogeneic BMT.

The psychosocial assessment of candidates for transplantation (PACT) scale was completed before the transplant on 120 patients who underwent allogeneic transplant from November 2003 to June 2007. The PACT has eight subscales, each rated on a 5-point scale, and an initial and final rating independently based on the rater's overall impressions of the candidate's acceptability for transplant. This exploratory study assessed the clinical utility of the PACT scale for psychosocial screening in allogeneic BMT. Associations of the PACT subscales and the final rating with sixteen post transplant medical outcomes were examined using the Jonchkheere-Terpstra test, the Cochran-Armitage test or the Cox proportional hazards analysis. Significant relationships (P

Mutational inhibition of c-Myb or p300 ameliorates treatment-induced thrombocytopenia.

The transcription factor c-Myb and coregulator p300 have a key role in maintaining production of controlled numbers of megakaryocytes and platelets. In mice, mutations in c-Myb or p300 cause thrombocytosis in otherwise wild-type animals and can ameliorate the thrombocytopenia in mice lacking the thrombopoietin receptor, c-Mpl, a model for human congenital amegakaryocytic thrombocytopenia. To examine whether inhibition of c-Myb/p300 is effective in other models of thrombocytopenia, the effect of the c-Myb(Plt4) mutation on thrombocytopenia associated with reduced platelet life span in Bcl-X(Plt20/Plt20) mice was assessed, as were responses in c-Myb(Plt4) and/or p300(Plt6) mutant mice to thrombocytopenia associated with antiplatelet antibodies, chemotherapy, or bone marrow transplantation. Homozygosity of the c-Myb(Plt4) allele ameliorated thrombocytopenia associated with reduced platelet life span, and c-Myb(Plt4/+) mice exhibited more rapid than normal recovery from thrombocytopenia caused by antiplatelet serum or bone marrow transplantation. Recovery to pretreatment platelet levels was unaltered in 5-fluorouracil-treated c-Myb(Plt4/+) mice relative to wild-type controls, but enhanced platelet production during subsequent thrombocytosis was evident. More modest enhancement of platelet recovery after 5-fluorouracil or bone marrow transplantation was also evident in p300(Plt6/+) animals. The data suggest potential utility of c-Myb/p300 as a target for therapeutic intervention in thrombocytopenia of diverse origins.

Rapidly proliferating CD44hi peripheral T cells undergo apoptosis and delay posttransplantation T-cell reconstitution after allogeneic bone marrow transplantation.

Delayed T-cell recovery is an important complication of allogeneic bone marrow transplantation (BMT). We demonstrate in murine models that donor BM-derived T cells display increased apoptosis in recipients of allogeneic BMT with or without GVHD. Although this apoptosis was associated with a loss of Bcl-2 and Bcl-X(L) expression, allogeneic recipients of donor BM deficient in Fas-, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)- or Bax-, or BM-overexpressing Bcl-2 or Akt showed no decrease in apoptosis of peripheral donor-derived T cells. CD44 expression was associated with an increased percentage of BM-derived apoptotic CD4(+) and CD8(+) T cells. Transplantation of RAG-2-eGFP-transgenic BM revealed that proliferating eGFP(lo)CD44(hi) donor BM-derived mature T cells were more likely to undergo to apoptosis than nondivided eGFP(hi)CD44(lo) recent thymic emigrants in the periphery. Finally, experiments using carboxyfluorescein succinimidyl ester-labeled T cells adoptively transferred into irradiated syngeneic hosts revealed that rapid spontaneous proliferation (as opposed to slow homeostatic proliferation) and acquisition of a CD44(hi) phenotype was associated with increased apoptosis in T cells. We conclude that apoptosis of newly generated donor-derived peripheral T cells after an allogeneic BMT contributes to delayed T-cell reconstitution and is associated with CD44 expression and rapid spontaneous proliferation by donor BM-derived T cells.

Estudo sobre qualidade de vida com pacientes pós-TMO: aplicação do questionário WHOQOL-Bref / Estudio de la calidad de vida de pacientes de post-TMO: aplicación del cuestionario WHOQOL-Bref / Study on quality of life of post-BMT patients: application of WHOQOL-Bref questionnaire

O presente trabalho teve por objetivo avaliar a qualidade de vida de pacientes submetidos ao transplante de medula óssea utilizando-se um questionário de avaliação de qualidade de vida, e refletir sobre as contribuições deste instrumento para a compreensão do impacto da doença na vida destes sujeitos, bem como a utilidade destes indicadores para formular e fundamentar o raciocínio clínico na prática da terapia ocupacional no campo da onco-hematologia. Quinze pacientes de ambos os sexos, maiores de idade submetidos ao tratamento de transplante de medula óssea (TMO) foram avaliados pela aplicação do questionário de avaliação de qualidade de vida WHOQOL-Bref (OMS) na forma de auto-avaliação, assistida ou aplicada pelo entrevistador. Todos os pacientes responderam ao questionário e a uma entrevista para a caracterização clínica e sócio-demográfica em uma única ocasião. Todos os pacientes avaliaram sua qualidade de vida como boa/satisfatória de acordo com as pontuações por domínios e escores totais do questionário. Não se encontrou associação significativa (p maior que 0,05) para as medidas de doença e os domínios do questionário WHOQOL-Bref. Não houve comprometimento negativo da qualidade de vida dos pacientes submetidos ao TMO nesta casuística; o questionário de avaliação WHOQOL-Bref aplicado pelo profissional possibilitou a escuta dos pacientes com relatos sobre os mecanismos de enfrentamento. Recomenda-se esta forma de aplicação e/ou a associação de ferramentas que favoreçam conhecer os aspectos de subjetividade para a formulação do raciocínio clínico da prática da assistência terapêutica ocupacional visando a contribuir com a qualidade de vida destes pacientes. PALAVRAS-CHAVE: Transplante de medula óssea-reabilitação. Transplante de medula óssea-apoio social. Qualidade de vida

Estudo sobre qualidade de vida com pacientes pós-TMO: aplicação do questionário WHOQOL-Bref / Estudio de la calidad de vida de pacientes de post-TMO: aplicación del cuestionario WHOQOL-Bref / Study on quality of life of post-BMT patients: application of WHOQOL-Bref questionnaire

O presente trabalho teve por objetivo avaliar a qualidade de vida de pacientes submetidos ao transplante de medula óssea utilizando-se um questionário de avaliação de qualidade de vida, e refletir sobre as contribuições deste instrumento para a compreensão do impacto da doença na vida destes sujeitos, bem como a utilidade destes indicadores para formular e fundamentar o raciocínio clínico na prática da terapia ocupacional no campo da onco-hematologia. Quinze pacientes de ambos os sexos, maiores de idade submetidos ao tratamento de transplante de medula óssea (TMO) foram avaliados pela aplicação do questionário de avaliação de qualidade de vida WHOQOL-Bref (OMS) na forma de auto-avaliação, assistida ou aplicada pelo entrevistador. Todos os pacientes responderam ao questionário e a uma entrevista para a caracterização clínica e sócio-demográfica em uma única ocasião. Todos os pacientes avaliaram sua qualidade de vida como boa/satisfatória de acordo com as pontuações por domínios e escores totais do questionário. Não se encontrou associação significativa (p > 0,05) para as medidas de doença e os domínios do questionário WHOQOLBref. Não houve comprometimento negativo da qualidade de vida dos pacientes submetidos ao TMO nesta casuística; o questionário de avaliação WHOQOL-Bref aplicado pelo profissional possibilitou a escuta dos pacientes com relatos sobre os mecanismos de enfrentamento. Recomenda-se esta forma de aplicação e/ou a associação de ferramentas que favoreçam conhecer os aspectos de subjetividade para a formulação do raciocínio clínico da prática da assistência terapêutica ocupacional visando a contribuir com a qualidade de vida destes pacientes.

The present work aims to evaluate the quality of life of patients submitted to bone marrow transplant, and for this used a questionnaire of quality of life evaluation, and aims also to reflect on the contributions of this instrument for the understanding of the impact of illnesses in the life of these subjects, as well as the utility of these indicators to formulate and to base clinical reasoning on the practice of occupational therapy in the field of oncohematology. Fifteen adult patients, both male and female, which submitted to bone marrow transplant (BMT) were evaluated by the application of a questionnaire of quality of life evaluation, WHOQOL-Bref (OMS) in the form of self-evaluation, both assisted and applied by he interviewer. All patients answered to the questionnaire and were interviewed for clinical and socio-demographic characterization at the same time. All patients evaluated their quality of life as good/satisfactory in accordance with the scores for domains and total scores of the questionnaire. No significant association (p < 0.05) was found between measures of illness and WHOQOL-Bref questionnaire domains. No negative compromising of the quality of life of patients submitted to BMT was found in this casuistry; WHOQOL-Bref questionnaire evaluation applied by the professional made possible listening patients as regards their accounts of coping mechanisms. One recommends the use of this procedure and/or an association of resources that favor knowledge of subjective aspects for clinical reasoning aiming at giving occupational therapy assistance for contributing to the quality of life of these patients.

Este trabajo intenciona evaluar la calidad de vida de pacientes sometidos al trasplante de la médula ósea — y para esto se utilizó un cuestionario de evaluación de la calidad de vida —, así bien reflejar acerca de las contribuciones de este instrumento para la comprensión del impacto de enfermedades en la vida de los sujetos así como la utilidad de estos indicadores para formular y para basar el razonamiento clínico en la práctica de la terapia ocupacional en el campo de la hematología oncológica. Se usó el cuestionario de evaluación de la cualidad de vida conocido como WHOQOL-Bref (OMS) con quince pacientes adultos, varones y mujeres, que fueran sometidos al trasplante de la médula ósea (TMO), en la forma de autoevaluación asistida y aplicada por el entrevistador. Todos los pacientes contestaran al cuestionario y fueron entrevistados como para la caracterización clínica y socio-demográfica en el mismo tiempo. Todos los pacientes evaluaron su calidad de vida como buena/satisfactoria de acuerdo con lo escores de los dominios y los escores totales del cuestionario. No se encontró ninguna asociación significativa (p < 0.05) entre las medidas de la enfermedad y los dominios del cuestionario WHOQOL-Bref. No se encontró ningún comprometimiento de la calidad de vida de los pacientes sometidos a TMO en esta casuística; la evaluación del cuestionario WHOQOL-Bref aplicada por el profesional posibilitó escuchar a los pacientes en lo que concierne a sus relatos de mecanismos utilizados para hacer frente a los problemas. Se recomienda la utilización de este procedimiento y/o una asociación de recursos que favorezcan el conocimiento de los aspectos subjetivos para el razonamiento clínico que tinga como objetivo dar ayuda de la terapia ocupacional para contribuir a la calidad de vida de estos pacientes.

Benefits of intrahospital exercise training after pediatric bone marrow transplantation.

The purpose of this study was to determine if an eight-week intrahospital supervised, conditioning program improves functional capacity and quality of life (QOL) in children (4 boys, 4 girls) (mean [SD] age: 10.9 [2.8] years [range: 8-16]) who have undergone bone marrow transplantation (BMT) for leukemia treatment within the last 12 months. A group of 8 age and gender-matched healthy children served as controls. The experimental group performed 3 weekly sessions of resistance and aerobic training inside an intra-hospital gymnasium. A significant combined effect of group and time (p < 0.05) was observed for muscle functional capacity (Timed Up and Down Stairs [TUDS] test) and peak oxygen uptake (V.O(2peak)), i.e., with BMT children showing greater improvements than controls (V.O(2peak) at pre- and post-training of 25.9 (8.2) and 31.1 (7.6) mL/kg/min in diseased children). Muscle strength (6 RM test for bench and leg press and seated row) also improved after training (p < 0.05) in the BMT group. Concerning QOL, a significant combined effect of group and time (p < 0.05) was also observed for children's self-report of comfort and resilience and for parents' report of their children's satisfaction and achievement. In summary, children who have received BMT experience physical and overall health benefits after a relatively short-term (8 weeks) supervised exercise training program.

Evaluation of early hospital discharge after allogeneic bone marrow transplantation for chronic myeloid leukemia.

CONTEXT AND OBJECTIVE: The increasing number of patients waiting for bone marrow transplantation in our service led to the implement of an early hospital discharge program with the intention of reducing the interval between diagnosis and transplantation. In this study we analyzed the results from early discharge, with outpatient care for patients with chronic myeloid leukemia who underwent allogeneic bone marrow transplantation. DESIGN AND SETTING: Retrospective study at the Bone Marrow Transplantation Unit of Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: We compared clinical outcomes within 100 days post-transplantation, for 51 patients with chronic myeloid leukemia (CML) who received partially outpatient-based allogeneic hematopoietic stem cell transplantation, and the results were compared with a historical control group of 49 patients who received inpatient-based hematopoietic stem cell transplantation. RESULTS: There were significantly fewer days of hospitalization (p = 0.004), Pseudomonas-positive cultures (p = 0.006) and nausea and vomiting of grade 2-3 (p < 0.001) in the outpatient group. There were no significant differences in mortality between the groups and no deaths occurred within the first 48 days post-transplantation in the outpatient group. CONCLUSIONS: This partially outpatient-based hematopoietic stem cell transplantation program allowed an increased number of transplantations in our institution, in cases of CML and other diseases, since it reduced the median length of hospital stay without increasing morbidity and mortality.

Family crisis in the context of bone marrow transplantation: an integrative review

This study presents an integrative literature review about the crisis experienced by relatives of bone marrow transplant (BMT) patients. The sample consisted of 25 publications, one of which came from Lilacs and 24 from Medline. The results evidenced that there were no experimental studies and that interventions are aimed at psychological and social aspects. In terms of aspects of family crisis indicated in the articles, all publications discussed the characteristic of the event (diagnosis of the disease and BMT) and the perceived threat; 52 percent of the articles mention the resources offered as being relevant and 20 percent mention that past crisis experiences influence the current crisis. Understanding the elements of family crisis and identifying appropriate interventions help nurses in care delivery to BMT patients.

Esta revisión integrada de la literatura se trata de la crisis vivenciada por los parientes del paciente con trasplante de médula ósea (TMO). La muestra se constituyó de 25 publicaciones, una de ellas obtenida del Lilacs y 24 del Medline. Los resultados mostraron la inexistencia de estudios experimentales, y que las intervenciones se dirigen a los aspectos psicológicos y sociales. Considerando los aspectos de la crisis familiar apuntados en los artículos, se observó que el 100 por ciento mencionó la característica del evento (diagnóstico de la enfermedad y TMO) y la amenaza percibida; el 52 por ciento citó como relevantes los recursos ofrecidos y el 20 por ciento indicó que experiencias de crisis pasadas influencian la crisis vivenciada. La comprensión de los elementos de la crisis familiar y la identificación de intervenciones apropiadas ayudan el enfermero en la atención a parientes de pacientes sometidos al TMO.

Trata-se de revisão integrativa que aborda a crise vivenciada pelo familiar do paciente com transplante de medula óssea (TMO). Foram selecionados 25 artigos, sendo um da Base Lilacs e 24 d Medline. Os resultados apontaram a inexistência de estudos experimentais e, também, que as intervenções estão voltadas aos aspectos psicológicos e sociais. Considerando os aspectos da crise familiar destacados nos artigos, observou-se que 100 por cento deles abordaram a característica do evento (diagnóstico da doença e TMO) e a ameaça percebida; 52 por cento citaram como relevantes os recursos oferecidos e 20 por cento mencionaram que experiências de crises passadas influenciaram a crise vivenciada. A compreensão dos elementos da crise familiar e a identificação de intervenções apropriadas auxiliam o enfermeiro na assistência aos familiares de pacientes submetidos ao TMO.

Evaluation of early hospital discharge after allogeneic bone marrow transplantation for chronic myeloid leukemia

CONTEXT AND OBJECTIVE: The increasing number of patients waiting for bone marrow transplantation in our service led to the implement of an early hospital discharge program with the intention of reducing the interval between diagnosis and transplantation. In this study we analyzed the results from early discharge, with outpatient care for patients with chronic myeloid leukemia who underwent allogeneic bone marrow transplantation. DESIGN AND SETTING: Retrospective study at the Bone Marrow Transplantation Unit of Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: We compared clinical outcomes within 100 days post-transplantation, for 51 patients with chronic myeloid leukemia (CML) who received partially outpatient-based allogeneic hematopoietic stem cell transplantation, and the results were compared with a historical control group of 49 patients who received inpatient-based hematopoietic stem cell transplantation. RESULTS: There were significantly fewer days of hospitalization (p = 0.004), Pseudomonas-positive cultures (p = 0.006) and nausea and vomiting of grade 2-3 (p < 0.001) in the outpatient group. There were no significant differences in mortality between the groups and no deaths occurred within the first 48 days post-transplantation in the outpatient group. CONCLUSIONS: This partially outpatient-based hematopoietic stem cell transplantation program allowed an increased number of transplantations in our institution, in cases of CML and other diseases, since it reduced the median length of hospital stay without increasing morbidity and mortality.

CONTEXTO E OBJETIVO: O número crescente de pacientes com indicação de transplante de medula óssea levou à implantação da alta hospitalar precoce em nosso serviço, com o intuito de reduzir o intervalo entre o diagnóstico e o transplante. Neste trabalho, avaliamos os resultados da alta precoce, com acompanhamento ambulatorial dos pacientes submetidos ao transplante de medula óssea alogênico portadores de leucemia mielóide crônica. TIPO E ESTUDO E LOCAL: Estudo retrospectivo, realizado no Serviço de Transplante de Medula Ossea do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: Foram avaliados os resultados do transplante de medula óssea alogênico, de doadores aparentados, até o dia 100 pós-transplante, de 51 pacientes portadores de leucemia mielóide crônica que receberam alta precoce, antes da pega medular. Os resultados foram comparados com o controle histórico constituído por 49 pacientes que receberam alta somente após a pega medular. RESULTADOS: Houve significativamente menos dias de hospitalização (p = 0,004), culturas positivas para Pseudomonas sp. (p = 0,006) e náusea e vômitos graus 2-3 (p < 0,001) no grupo de alta precoce. Não houve diferença significativa entre os grupos quanto à mortalidade e não ocorreu nenhum óbito até o dia 48 pós-transplante no grupo de alta precoce. CONCLUSÕES: O programa de alta precoce permitiu aumento do número de transplantes em leucemia mielóide crônica e outras doenças em nosso serviço, com redução do número de dias de internação hospitalar sem aumento da morbidade ou da mortalidade.