Six-minute walking distance and desaturation-distance ratio in allogeneic stem cell transplantation.

BACKGROUND: Most patients with haematological malignancies who undergo allogeneic haematopoietic stem cell transplant (HSCT) receive chemotherapy before the transplant to control the disease. Certain chemotherapy drugs can cause lung toxicity. Conversely, in patients with chronic respiratory conditions, the 6-min walking test (6MWT) and the desaturation-distance ratio (DDR) have demonstrated prognostic significance. Our objective was to determine whether the 6MWD and DDR, assessed prior to HSCT, have a prognostic impact on survival at 24 months post-HSCT. METHODS: A prospective experimental study was conducted in consecutive patients referred for allogeneic HSCT at Hospital Clinic, Barcelona, Spain. A complete functional respiratory study, including the 6MWT and DDR, was conducted prior to admission. The area under the curve (AUC) and cut-off points were calculated. Data on patients' characteristics, HSCT details, main events, with a focus on lung complications, and survival at 24 months were analysed. RESULTS: One hundred and seventy-five patients (39% women) with mean age of 48 ± 13 years old were included. Before HSCT, forced vital capacity and forced expiratory volume in the first second were 96% ± 13% predicted and 92% ± 14% predicted, respectively; corrected diffusing capacity for carbon monoxide 79% ± 15% predicted; 6MWD was 568 ± 83 m and DDR of .27 (.20-.41). The cut-off points for 6MWD and DDR were 566 m, [.58 95% CI (.51-.64)], p = .024 and .306, [.63 95% CI (.55-.70)], p = .0005, respectively. The survival rate at 24 months was 55%. CONCLUSION: Our results showed that individuals who exhibit a 6MWD shorter than 566 ms or a decline in DDR beyond .306 experienced reduced survival rates at 24 months after HSCT.

Implementation of a vascular access team and an intravenous therapy programme: A first-year activity analysis.

BACKGROUND: Creating Vascular Access Teams (VAT) provides an expert nursing role that contributes to the training and continuous improvement of healthcare personnel. They can offer greater clinical safety, reducing complications and costs. Peripherally inserted central catheters (PICCs) and midline catheters (ML) can be safe and cost-effective alternatives to other types of venous access (VA). The aim of the study was to analyse our centre's VAT first 12 months of activity. The primary outcome was reported complications. Secondary outcomes were cause of catheter removal, consultancy activity and economic impact of VAT implantation. METHODOLOGY: A longitudinal, descriptive study was carried out from March 2019 to March 2020. Using consecutive sampling, all VA inserted, and all consults received were included. Patients under 18 years of age were excluded. RESULTS: The VAT inserted 1257 catheters into 1056 patients (291 MLs, 966 PICCs). The mean dwell time was 14.9 days for MLs and 59.07 days for PICCs. The main reason for removing VA was end of treatment (80.7%). During VA follow-up confirmed infection was detected in 1 ML (0.3%) and nine PICCs (0.9%). Symptomatic thrombosis was reported in 2 MLs (0.7%) and 16 PICCs (1.7%). The VAT received 367 consultations, and the main reason for consultation was to resolve doubts regarding the management of VA (80.9%). The insertion of ML and PICC catheters represented annual estimated economic savings of €867,688.44€. CONCLUSIONS: Our study provides a detailed analysis of VAT's activity, its relevance to clinical safety, and to efficient resource management within our hospital. It demonstrates how VAT establishment can be a safe and efficient intervention that enhances care quality.

Rol de la enfermera en el anciano con cáncer. Revisión bibliográfica / Role of the nurse in the elderly with cancer. Bibliographic review

El aumento de la incidencia y prevalencia de procesos cancerígenos en los ancianos representa un nuevo reto para las políticas sanitarias y sociales. El presente artículo reflexiona sobre la necesidad de un modelo de atención integral, integrada y multidimensional para el cuidado del anciano con cáncer y su familia. El objetivo principal es identificar, recopilar, analizar y sintetizar la literatura científica más actual y relevante sobre las funciones y/o rol de la enfermera en el cuidado del anciano con cáncer. MATERIAL Y MÉTODO: se realizó una revisión bibliográfica en PubMed (Medline), Cochrane Library Plus, Dialnet y ScienceDirect® (Elsevier), entre enero de 2007 y diciembre de 2017, de la literatura científica sobre las funciones y/o rol de la enfermera en el cuidado del anciano con cáncer. Los estudios fueron seleccionados por revisores pares de forma independiente utilizando el instrumento PRISMA. RESULTADOS: Se identificaron 28 estudios que cumplieron los criterios de inclusión. Toda la bibliografía revisada recomienda el desarrollo e implementación de programas de atención individualizados como el pilar principal de atención al anciano con cáncer. En ellos, las enfermeras desempeñan un papel clave en la gestión y coordinación durante todo el proceso de atención. CONCLUSIONES: El modelo de cuidado de los ancianos con cáncer debe abarcar todo el proceso de atención: prevención, detección precoz, evaluación, tratamiento, educación e investigación. Es esencial el rol de la enfermera como gestora, coordinadora, educadora y cuidadora en la atención al anciano con cáncer

The increase in the incidence and prevalence of carcinogenic processes in the elderly represents a new challenge for health and social policies. This article reflects on the need for a comprehensive, integrated and multidimensional care model for the care of the elderly with cancer and his family. The main objective is to identify, compile, analyse and synthesize the most current and relevant scientific literature on the roles and/or role of the nurse in the care of the elderly person with cancer. MATERIAL AND METHOD: a bibliographic review was made in PubMed (Medline), Cochrane Library Plus, Dialnet and ScienceDirect® (Elsevier) between January 2007 and December 2017 of the literature on the functions and/or roles of the nurse in the care of the elderly with cancer. The studies were selected by peer reviewers independently using the PRISMA instrument. RESULTS: Twenty-eight studies that met the inclusion criteria were identified. All the revised literature recommends the development and implementation of individualized care programs as the main pillar of care for the elderly with cancer. In them, nurses play a key role in the management and coordination throughout the entire care process. CONCLUSIONS: The model of the care of the elderly with cancer must cover the whole process of attention: prevention, early detection, evaluation, treatment, education and research. The role of the nurse is essential as a manager, coordinator, educator and caregiver in the care of the elderly with cancer

Competencias de la enfermera de práctica avanzada de hematología en la terapia CAR-T / Competencies of the Hematology Advanced Nurse Practitioner in CAR-T therapy

La terapia celular CAR-T es una inmunoterapia personalizada de última generación. Se basa en la modificación genética de linfocitos T autólogos del paciente para expresar un antígeno quimérico que identifique a las células cancerosas y las destruya. El rápido progreso de nuevos tratamientos de inmunoterapia ha generado una oportunidad a las enfermeras para que aporten su experiencia y sus competencias para liderar y facilitar la coordinación, educación y continuidad de cuidados a los pacientes beneficiarios de estas terapias. La enfermera de práctica avanzada de hematología en terapia CAR-T (EPACAR-T) es esencial para garantizar la continuidad de cuidados y la seguridad en la atención a pacientes tratados con CAR-T. En el presente trabajo se describen las competencias de la EPACAR-T basadas en el marco conceptual de Hamric y se determinan sus funciones en las diferentes etapas del proceso (acogida y valoración, leucoaféresis, producción celular y terapia puente, tratamiento linfodeplectivo, infusión de linfocitos T modificados, seguimiento y vigilancia activa), con el objetivo principal de ofrecer un plan de cuidados centrados en la persona y coordinar la atención, colaboración y comunicación entre centros remitentes y proveedores y conseguir su manejo exitoso

The CAR T-cell therapy is a personalized last-generation immunotherapy. It consists in the genetic modification of the patient's autologous T-lymphocytes in order to express a chimeric antigen that will identify cancer cells and destroy them. The fast progress of new immunotherapy treatments has created an opportunity for nurses to provide their experience and skills to lead and ensure coordination, education, and continuity of care for patients who will benefit of said therapies. The Hematology Advanced Nurse Practitioner in CAR-T therapy is essential to ensure continuity and safety of care for patients treated with CAR-T. The present article describes the competencies of the Hematology Advanced Nurse Practitioner in CAR-T therapy based on the conceptual framework by Hamric, and determines their role in the different stages of the process (reception and assessment, leukapheresis, cell production and bridge therapy, lymphodepletion treatment, infusion of modified T-lymphocytes, follow-up and active monitoring), with the main objective to offer a plan of care focused on the patient, and coordinate the care, collaboration and communication between referring centers and providers, and achieve a successful management

Level of adherence to an extravasation protocol over 10 years in a tertiary care hospital.

BACKGROUND: Extravasation of chemotherapy is an undesirable complication related to the administration of antineoplastic therapy. Establishing the real incidence is difficult. Because of the importance of a quick intervention after an extravasation, every hospital should have an extravasation protocol. OBJECTIVES: The purpose of this study was to determine the degree of observance of an extravasation protocol by nursing staff and to determine extravasation incidence. METHODS: This descriptive, longitudinal, retrospective study was set in a tertiary-level hospital. The researchers reviewed 117 extravasation notification forms received by the pharmacy department during a 10-year period. Nursing actuation, particularly observance of the extravasation protocol, was analyzed. FINDINGS: Protocol adherence was 89%. Twelve deviations from the protocol in the application of recommended measures were detected. An antidote was used in 41 patients, and temperature measures were applied in 14 cases. Ninety-nine patients had at least one episode of reported follow-up. No cases of necrosis or skin ulcers were described, except by one patient, who developed a delayed skin ulcer to vinorelbine. Drugs most frequently reported were etoposide, carboplatin, and paclitaxel. Nursing staff should be continuously trained in extravasation protocol because a rapid actuation can prevent skin lesions.