RESUMEN
Background: Perley Health has implemented SeeMe™: Understanding frailty together (www.perleyhealth.ca), a comprehensive approach to care that integrates the assessment and management of frailty, with an emphasis on goals of care planning. Methods: Program evaluation over the first year of SeeMe™ used a mixed-methods approach involving quantitative data from surveys, goals of care preferences, hospital transfers, and qualitative data from interviews. Results: The SeeMe™ training is an effective way to educate nurses and physicians in long-term care about frailty. For residents with documented care preferences prior to SeeMe™, there was a 15% reduction in the number of residents who preferred to be transferred to hospital post-SeeMe™ implementation. There was no significant decrease in hospital transfers during the first year the program was introduced. Conclusion: After the roll-out of SeeMe™, nurses, physicians, and families reported high satisfaction with the program, and nurses reported an increase in knowledge and confidence. There was also a reduction in the number of residents and families selecting to transfer to hospital. This suggests that the education from SeeMe™ influenced residents and families to choose less invasive interventions in the context of frailty and quality of life goals.
Asunto(s)
Síndromes de Inmunodeficiencia/diagnóstico , Síndromes de Inmunodeficiencia/genética , Biomarcadores , Preescolar , Cromosomas Humanos Par 21/genética , Facies , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Humanos , Síndromes de Inmunodeficiencia/complicaciones , Hibridación Fluorescente in Situ , Infecciones/etiología , Cariotipificación , Fenotipo , Cromosomas en Anillo , UltrasonografíaRESUMEN
AIM: Haematopoietic stem cell transplantation (HSCT) is a central therapy in the treatment of primary immunodeficiency diseases (PIDs). Over the past 5 years, outcomes have been greatly improved due to earlier diagnosis, improved donor availability, advancements in graft manipulation and the use of less toxic preparative regimens. We present a 5-year audit of HSCT for PID at a single Australian tertiary hospital. METHODS: Retrospective case note review identified diagnosis, pre-transplant medical morbidity, transplant protocol, engraftment, adverse events, post-transplant immune reconstitution and general health. RESULTS: A total of 22 patients with PID underwent 24 HSCTs at our institution between 2012 and 2016. The most common indications were severe combined immunodeficiency, chronic granulomatous disease and familial haemophagocytic lymphohistiocytosis, with a genetic diagnosis in all but two patients. Reduced intensity or reduced toxicity conditioning was used in 91% of cases, and 75% of the donors were unrelated. Transplant-related mortality at day +100 was 9.5%, and cumulative overall survival was 86%. There were three mortalities, all secondary to viral infection, one of which occurred in the context of graft failure. Two patients remained on immune support, with the remainder achieving adequate immune reconstitution. CONCLUSIONS: The outcomes for HSCT for PIDs performed at Sydney Children's Hospital were in line with the world's best practice. HSCT should be considered a potential therapeutic option for all Australian PID patients with a valid disease indication.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Síndromes de Inmunodeficiencia/terapia , Centros de Atención Terciaria , Adolescente , Australia , Niño , Preescolar , Femenino , Enfermedad Injerto contra Huésped , Humanos , Lactante , Masculino , Auditoría Médica , Estudios RetrospectivosRESUMEN
Changes in U.S. Army hearing conservation policy require that many previous non-noise hazardous areas be reclassified as noise hazardous and that employees in these areas be included in hearing conservation programs. The purpose of this study was to determine if a group of employees affected by this policy suffered occupational hearing loss between 1987 and 2001 while working in previously classified noise hazardous areas. The 45 subjects included in the study were demographically similar to the 211 from which they were selected. Differences between measured and predicted hearing thresholds in 1987 and in 2001 did not change significantly over the 15 years. Predicted noise-induced thresholds in 2001 calculated from average noise exposures were not clinically significant. It was concluded that these subjects were adequately protected from hearing loss under the previous classification criteria and application of the new criteria provided no additional benefit.
