RESUMEN
BACKGROUND: The main functions of healthcare professionals include training and health education. In this sense, we must be able to incorporate new technologies and serious game to the teaching cardiopulmonary resuscitation. METHODS: a multicenter, comparative and cross-sectional study was carried out to assess the learning of resuscitation of a group that was trained with the use of serious gaming with virtual reality, as compared to a control group trained with conventional classroom teaching. RESULTS: the mean quality obtained in chest compressions for the virtual reality group was 86.1 % (SD 9.3), and 74.8 % (SD 9.5) for the control group [mean difference 11.3 % (95 % CI 6.6-16.0), p < 0.001]. Salivary Alpha-Amylase was 218.882 (SD 177.621) IU/L for the virtual reality group and 155.190 (SD 116.746) IU/L for the control group [mean difference 63.691 (95 % CI 122.998-4.385), p = 0.037]. CONCLUSION: using virtual reality and serious games can improve the quality parameters of chest compressions as compared to traditional training.
Asunto(s)
Reanimación Cardiopulmonar , Entrenamiento Simulado , Realidad Virtual , Humanos , Estudios Transversales , Reanimación Cardiopulmonar/educación , AprendizajeAsunto(s)
Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide Aguda , Síndromes Mielodisplásicos , Humanos , Daunorrubicina , Citarabina , Síndromes Mielodisplásicos/genética , Acondicionamiento Pretrasplante , Leucemia Mieloide Aguda/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversosRESUMEN
Haematopoietic stem cell reinjection may be a curative option for poor graft function after haematopoietic stem cell transplantation; however, literature supporting its use remains limited. We conducted a multicentre retrospective study on behalf of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy, including 55 patients. We demonstrated response rates of nearly 40% and two-year survival of more than 60% in the context of an otherwise deadly complication and we observed that the timing of injection and the degree of cytopenia are strongly associated with outcomes. This study shows the feasibility of the procedure informing on its epidemiology, outcomes and prognostic factors, setting the stage for future guidelines.
Asunto(s)
Trasplante de Médula Ósea , Trasplante de Células Madre Hematopoyéticas , Humanos , Estudios Retrospectivos , Sociedades Médicas , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Tratamiento Basado en Trasplante de Células y TejidosAsunto(s)
Trasplante de Células Madre Hematopoyéticas/métodos , Enfermedades Pulmonares/patología , Mucosa Respiratoria/citología , Quimera por Trasplante , Biopsia , Femenino , Supervivencia de Injerto , Enfermedad Injerto contra Huésped/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Trasplante Homólogo , Adulto JovenRESUMEN
Chronic GvHD-related keratoconjunctivitis sicca (cGvHD-related KCS) can significantly alter the quality of life of patients after allogeneic hematopoietic stem cell transplantation. The aim of this work was to assess the efficacy and tolerability of scleral lenses to treat severe cGvHD-related KCS. In this retrospective, multicenter study, we included 60 consecutive patients diagnosed with cGvHD-related KCS and fitted with scleral lenses. Patients were evaluated at baseline and at 2 months with the following tests: the Ocular Surface Disease Index (OSDI) to assess quality of life, the Oxford score to grade corneal damage and the logarithm of minimal angle of resolution (Log MAR) scale to determine visual acuity. We observed improvement in quality of life in 58 patients (97%). All parameters improved at 2 months. We observed significant differences at 2 months compared with baseline for the mean OSDI (86 versus 30, respectively, P<0.001), the mean Oxford score (3.2 versus 1.3, respectively, P<0.001) as well as visual acuity (Log MAR of 0.33 versus 0.10, respectively, P<0.001). Treatment with scleral lenses was discontinued in only 5 patients (8%) with a median follow-up of 20.5 months (range: 2-125 months). Scleral lenses were very efficient and well tolerated in patients with severe cGvHD-related KCS.
Asunto(s)
Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Queratoconjuntivitis Seca , Cápsula del Cristalino/patología , Calidad de Vida , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Aloinjertos , Niño , Enfermedad Crónica , Femenino , Enfermedad Injerto contra Huésped/patología , Enfermedad Injerto contra Huésped/terapia , Humanos , Queratoconjuntivitis Seca/etiología , Queratoconjuntivitis Seca/patología , Queratoconjuntivitis Seca/terapia , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Clinically useful pre-transplant predictive factors of acute graft-versus-host-disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-SCT) are lacking. We prospectively analyzed HSC graft content in CD34+, NK, conventional T, regulatory T and invariant natural killer T (iNKT) cells in 117 adult patients before allo-SCT. Results were correlated with occurrence of aGVHD and relapse. In univariate analysis, iNKT cells were the only graft cell populations associated with occurrence of aGVHD. In multivariate analysis, CD4- iNKT/T cell frequency could predict grade II-IV aGVHD in bone marrow and peripheral blood stem cell (PBSC) grafts, while CD4- iNKT expansion capacity was predictive in PBSC grafts. Receiver operating characteristic analyses determined the CD4- iNKT expansion factor as the best predictive factor of aGVHD. Incidence of grade II-IV aGVHD was reduced in patients receiving a graft with an expansion factor above versus below 6.83 (9.7 vs 80%, P<0.0001), while relapse incidence at two years was similar (P=0.5).The test reached 94% sensitivity and 100% specificity in the subgroup of patients transplanted with human leukocyte antigen 10/10 PBSCs without active disease. Analysis of this CD4- iNKT expansion capacity test may represent the first diagnostic tool allowing selection of the best donor to avoid severe aGVHD with preserved graft-versus-leukemia effect after peripheral blood allo-SCT.
Asunto(s)
Enfermedad Injerto contra Huésped/inmunología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Células T Asesinas Naturales/inmunología , Donantes de Tejidos , Enfermedad Aguda , Femenino , Enfermedad Injerto contra Huésped/diagnóstico , Humanos , Masculino , Células T Asesinas Naturales/metabolismo , Periodo Preoperatorio , Pronóstico , Índice de Severidad de la Enfermedad , Trasplante HomólogoAsunto(s)
Trasplante de Médula Ósea , Médula Ósea/efectos de los fármacos , Óxido Nitroso/toxicidad , Adolescente , Anemia/etiología , Células de la Médula Ósea/citología , Células de la Médula Ósea/efectos de los fármacos , Femenino , Humanos , Recurrencia , Factores de Tiempo , Trasplante Homólogo , Resultado del Tratamiento , Vitamina B 12/sangreRESUMEN
PURPOSE: Although evidence suggests considerable disruption to families, the impact of allo-Hematopoietic Stem Cell Transplantation (HSCT) on patients' partners and close relatives has not been sufficiently explored. The present mixed-methods study aimed to enlighten allo-HSCT effects on patients' and close relatives' quality of life (QOL) and their relationships. METHODS: Patients who received allo-HSCT between 2007 and 2010 (N = 58) and their close relatives (parents, partners and/or adult children) were asked to respond to an anonymous questionnaire including socio-demographic data, Likert-scale of the impact of HSCT on sexual, couple, family, professional and social life, as well as on perceived support. QOL of patients and close relatives was evaluated (by the FACT-BMT and by WHO-QOL-bref) as were the adjustments of the couples (patients/partners by the DAS). In-depth interviews were performed with patients and partners who consented to this proposition. RESULTS: Patients (N = 28) and close relatives (N = 48) reported fatigue, sleep and sexual problems, emotional distress and relationship difficulties. Patients were mainly concerned with « being a burden ¼ to their close relatives. Close relatives' main concerns were changes in marital and family dynamics, disruptions in daily routine tasks and the responsibility for being the main provider of physical and emotional care. These difficulties increased after HSCT - notably when patients have to face the long-term consequences of the procedure. CONCLUSION: HSCT has a negative impact on patients' partners and other close relatives' QOL. Data on this topic is still scarce and this study might pave the way for future research in this field and notably guide psychosocial interventions.
Asunto(s)
Familia/psicología , Trasplante de Células Madre Hematopoyéticas/psicología , Leucemia/psicología , Linfoma/psicología , Calidad de Vida , Adulto , Anciano , Ajuste Emocional , Femenino , Humanos , Relaciones Interpersonales , Leucemia/terapia , Linfoma/terapia , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Trasplante Homólogo , Adulto JovenRESUMEN
BACKGROUND: Hemorrhagic cystitis (HC) is a common complication after hematopoietic allogeneic stem cell transplantation (HSCT) associated with intensity of the conditioning regimen, cyclophosphamide (Cy) therapy, and BK polyomavirus (BKPyV) infection. METHODS: We analyzed 33 consecutive haploidentical (haplo) HSCT recipients transplanted for hematologic diseases. Eleven patients had a previous transplant. Median follow-up was 11 months. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine + mycophenolate mofetil and post-HSCT Cy. RESULTS: Thirty-two of 33 patients achieved neutrophil recovery. Cumulative incidence (CI) of platelet recovery was 65%. CI grade II-IV acute GVHD was 44%. Twenty patients developed HC in a median time of 38 days. CI of HC at day 180 was 62%. BKPyV was positive in blood and urine of 91% of patients at HC onset. HC resolved in 18/20 patients. Factors associated with HC were previous transplant (P = 0.01) and occurrence of cytomegalovirus reactivation before HC (P = 0.05). Grade II-IV acute GVHD was not associated with HC (P = 0.62). CI of day 180 viral infections was 73%. Two-year overall survival (OS) was 50%; HC did not impact OS (P = 0.29). CONCLUSION: The incidence of HC after haplo with post-HSCT Cy is high and is associated with morbidity, especially in high-risk patients such as those with a previous transplant history and with impaired immune reconstitution.
Asunto(s)
Cistitis/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Adolescente , Adulto , Anciano , Enfermedad Injerto contra Huésped/prevención & control , Haplotipos , Hemorragia , Humanos , Inmunosupresores/farmacología , Incidencia , Persona de Mediana Edad , Factores de Riesgo , Adulto JovenAsunto(s)
Trasplante de Células Madre Hematopoyéticas , Receptores Fc/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Trombocitopenia/tratamiento farmacológico , Trombopoyetina/administración & dosificación , Adolescente , Adulto , Anciano , Aloinjertos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas Recombinantes de Fusión/efectos adversos , Trombocitopenia/etiología , Trombopoyetina/efectos adversosAsunto(s)
Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedades Inflamatorias del Intestino/etiología , Acondicionamiento Pretrasplante/efectos adversos , Trasplante Homólogo/efectos adversos , Femenino , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Enfermedades Inflamatorias del Intestino/patología , Persona de Mediana Edad , Acondicionamiento Pretrasplante/métodos , Trasplante Homólogo/métodosRESUMEN
Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the only a curative treatment in patients with higher risk myelodysplastic syndrome (MDS), although demethylating agents (DMA) have been reported to improve survival. The advantage of HSCT over other treatment comes from retrospective studies and the aim of the current study was to prospectively test this hypothesis, analyzing in particular patients from the pre-transplant period to avoid the selection bias of performing transplantation. This study was conducted to compare overall survival in MDS patients candidates to transplantation according to donor availability. The majority of patients (76%) received a treatment with DMA after registration, 69% had a human leukocyte antigen (HLA)-identical donor, 70% of whom were transplanted. Baseline patient and disease characteristics were similar according to donor availability. Four-year overall survival was significantly better in patients with an HLA matched donor (37%) compared to patients without donor (15%). There was also evidence that this overall survival advantage was because of transplantation. Mortality risk was decreased after transplantation but it became significant only after the second year post transplant, because of early transplant-related mortality. Our results appear to justify, in higher risk MDS, a transplantation approach in all potential candidates who have an HLA identical donor.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Antígenos HLA/inmunología , Síndromes Mielodisplásicos/inmunología , Síndromes Mielodisplásicos/terapia , Trasplante de Células Madre , Anciano , Terapia Combinada , Femenino , Estudios de Seguimiento , Prueba de Histocompatibilidad , Humanos , Masculino , Persona de Mediana Edad , Síndromes Mielodisplásicos/mortalidad , Síndromes Mielodisplásicos/patología , Estadificación de Neoplasias , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Acondicionamiento Pretrasplante , Trasplante HomólogoAsunto(s)
Trasplante de Células Madre Hematopoyéticas/métodos , Infecciones por Mycobacterium/microbiología , Mycobacterium haemophilum/crecimiento & desarrollo , Acondicionamiento Pretrasplante/métodos , Trasplante Homólogo/métodos , Sangre Fetal , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium/patologíaRESUMEN
Haploidentical allogeneic stem cell transplantation (CST) has globally taken off in the past decade. It appears to be a valid alternative to other sources of stem cells; however, further research is necessary to validate the use of this approach in standard patient care. In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. This is part one of the recommendations regarding allogeneic stem cell transplantation from an HLA-haploidentical related donor.
Asunto(s)
Haplotipos , Prueba de Histocompatibilidad , Trasplante de Células Madre/normas , Donantes de Tejidos , Trasplante Homólogo/normas , Adulto , Anciano , Animales , Trasplante de Médula Ósea , Ciclofosfamida , Selección de Donante , Francia , Humanos , Inmunosupresores , Persona de Mediana Edad , Trasplante de Células Madre/métodos , Acondicionamiento Pretrasplante , Trasplante Homólogo/métodosRESUMEN
Haploidentical allogeneic stem cell transplantation (CST) has globally taken off in the past decade. It appears to be a valid alternative to other sources of stem cells; however, further research is necessary to validate the use of this approach in standard patient care. In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. This is part two of the recommendations regarding allogeneic stem cell transplantation from an HLA-haploidentical related donor.
Asunto(s)
Haplotipos , Prueba de Histocompatibilidad , Trasplante de Células Madre/normas , Donantes de Tejidos , Trasplante Homólogo/normas , Trasplante de Médula Ósea , Selección de Donante , Francia , Humanos , Inmunosupresores , Trasplante de Células Madre/métodos , Acondicionamiento Pretrasplante , Trasplante Homólogo/métodosRESUMEN
BACKGROUND: According to the National Institutes of Health classification of chronic graft-versus-host disease (cGVHD), skin ulcers after allogeneic haematopoietic stem-cell transplantation (HSCT) are recorded as having the maximal severity score but published data are scarce. OBJECTIVES: To describe skin ulcers related to cGVHD with an emphasis on clinical findings, associated morbidity, management and evolution. PATIENTS AND METHODS: A multicentre retrospective analysis was carried out of patients with a diagnosis of cGVHD skin ulcers. RESULTS: All 25 patients included in the study had sclerotic skin cGVHD and 21 had lichenoid skin lesions associated with the sclerotic skin lesions. Thirteen patients had severe cGVHD without considering the skin, because of the involvement of an extracutaneous organ by cGVHD. The median time from HSCT to the onset of ulcers was 44 months. In addition to scleroderma, initial skin lesions at the site of ulcers were bullous erosive lichen in 21 patients and bullous erosive morphoea in four patients. Fifteen patients had an inaugural oedema. Ulcers were mostly bilateral with a predilection for the lower limbs. They were frequently colonized but few infections occurred. Four patients died during a median follow-up period of 55 months. CONCLUSIONS: Chronic graft-versus-host disease skin ulcers occur in patients with sclerodermatous skin cGVHD, are associated with severe cGVHD, often start with bullous lichenoid lesions or bullous morphoea and seem to cause more morbidity than mortality, given the low rate of mortality observed in our series of patients.
Asunto(s)
Enfermedad Injerto contra Huésped/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Úlcera Cutánea/etiología , Piel/patología , Adolescente , Adulto , Enfermedad Crónica , Femenino , Enfermedad Injerto contra Huésped/patología , Enfermedades Hematológicas/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esclerosis/patología , Úlcera Cutánea/patología , Trasplante Homólogo , Adulto JovenRESUMEN
In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding vaccination post Hematopoietic Stem Cell Transplantation with practical focus on which vaccines to use and when and how to vaccinate?
Asunto(s)
Trasplante de Células Madre Hematopoyéticas/normas , Esquemas de Inmunización , Vacunación/estadística & datos numéricos , Vacunas/administración & dosificación , Adulto , Niño , Conferencias de Consenso como Asunto , Contraindicaciones , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Práctica Profesional/normas , Vacunación/normasRESUMEN
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