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Miyashita N, Ohashi K, Fujita M, Hosoda T, Kawasaki Y, Takimoto M, Onozawa M. Prognostic factors in patients in the terminal phase of haematological malignancies who are receiving home medical care. Br J Haematol 2022; 201:290-301. [PMID: 36572123 DOI: 10.1111/bjh.18623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022]
Abstract
Although there are many prognostic models for patients in the terminal phase of solid tumours, a reliable prognostic scoring system in patients in the terminal phase of haematological malignancies (HM) has not been established. We retrospectively evaluated 180 patients in the terminal phase of HM who were receiving home medical care (HMC). Multivariate analyses revealed that clinician's estimate, consciousness, loss of appetite, dyspnoea, neutrophil count, lymphocyte count, and lactate dehydrogenase were associated with overall survival (OS). Based on this result, we developed a novel prognostic scoring system, the Japan palliative haematological oncology prognostic estimates, in which four risk groups were shown to clearly differ in survival (p < 0.001): a low-risk group (n = 41, median OS of 434 days), an intermediate-low-risk group (n = 80, median OS of 112 days), an intermediate-high-risk group (n = 38, median OS of 31.5 days), and a high-risk group (n = 21, median OS of 10 days). This is the first investigation of prognostic factors that influence the OS of patients in the terminal phase of HM who are receiving HMC. Providing patients with reliable information about their prognosis is important for them to consider how to spend their remaining life.
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Affiliation(s)
- Naohiro Miyashita
- Department of Hematology HOME CARE CLINIC N‐CONCEPT Sapporo Japan
- NPO Hemato‐Homecare Network Tokyo Japan
| | - Kota Ohashi
- NPO Hemato‐Homecare Network Tokyo Japan
- TOTUS Home Care Clinic Tokyo Japan
| | - Mariko Fujita
- Medical Home Care Center, Tenri Hospital Tenri Japan
| | - Toru Hosoda
- NPO Hemato‐Homecare Network Tokyo Japan
- Hamorebi Clinic Kamagaya Japan
| | - Yasufumi Kawasaki
- NPO Hemato‐Homecare Network Tokyo Japan
- Kaedenokaze Medical Clinic Tokyo Japan
| | - Madoka Takimoto
- NPO Hemato‐Homecare Network Tokyo Japan
- Kawasaki Nanafuku Clinic Kawasaki Japan
| | - Masahiro Onozawa
- Department of Hematology Hokkaido University Hospital Sapporo Japan
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Rodríguez Corte J, Candal‐Pedreira C, Ruano‐Ravina A, Pérez‐Ríos M, Rivero‐de‐Aguilar A, López García M, Hermida Porto L, Varela‐Lema L. Home-based blood transfusion therapy: A systematic review. Br J Haematol 2022; 199:496-506. [PMID: 35778372 PMCID: PMC9796283 DOI: 10.1111/bjh.18344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 01/28/2023]
Abstract
Home care is a healthcare alternative to hospitalisation. Different types of procedures are performed at home care services, such as home transfusion of blood products. However, home blood transfusion is not fully implemented and there is a great lack of knowledge about it. The aims of this study were thus to assess the safety and effectiveness of home blood transfusions and patient acceptance and satisfaction. A systematic literature review was conducted in the main biomedical databases. We included all studies that covered patients who had received a home blood transfusion, regardless of their baseline diagnosis. The literature search yielded 290 studies, 14 of which were included in this study as they met the predefined criteria. The main patient profile of a home-transfusion recipient was a person with anaemia associated with other diseases. Overall incidence of severe adverse events was 0.05%. No studies evaluated the effectiveness of home versus hospital transfusions. One study showed that 51% of patients would be willing to receive home transfusions. Home blood transfusion appears to be a feasible, safe, and well-accepted procedure. Existing studies are of low quality, however, and this is an important limitation when it comes to drawing definitive benefit-risk conclusions.
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Affiliation(s)
- Jesús Rodríguez Corte
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain
| | - Cristina Candal‐Pedreira
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain
| | - Alberto Ruano‐Ravina
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
| | - Mónica Pérez‐Ríos
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
| | - Alejandro Rivero‐de‐Aguilar
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Neurology ServiceUniversity Hospital of the Canary IslandsTenerifeSpain
| | - Marisa López García
- Galician Health ServiceThe Galician Blood and Organ and Donation Agency (ADO)Santiago de CompostelaSpain
| | - Leticia Hermida Porto
- Galician Health Service, Home Hospitalisation Unit (HADO)A Coruña University Hospital ComplexSantiago de CompostelaSpain
| | - Leonor Varela‐Lema
- Department of Preventive Medicine and Public HealthUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela ‐ IDIS)Santiago de CompostelaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP)MadridSpain
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Al-Riyami AZ, Estcourt L, Rahimi-Levene N, Bloch EM, Goel R, Tiberghien P, Thibert JB, Bruun MT, Devine DV, Gammon RR, Wendel S, Toungouz Nevessignsky M, Grubovic Rastvorceva RM, Oreh A, Romon I, van den Berg K, Kitazawa J, Patidar G, So-Osman C, Wood EM. Early and out-of-hospital use of COVID-19 convalescent plasma: An international assessment of utilization and feasibility. Vox Sang 2022; 117:1202-1210. [PMID: 36102139 PMCID: PMC9538090 DOI: 10.1111/vox.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives The use of coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) in the treatment of patients with severe acute respiratory syndrome‐2 infection has been controversial. Early administration of CCP before hospital admission offers a potential advantage. This manuscript summarizes current trials of early use of CCP and explores the feasibility of this approach in different countries. Materials and Methods A questionnaire was distributed to the International Society of Blood Transfusion (ISBT) CCP working group. We recorded respondents' input on existing trials on early/outpatient CCP and out‐of‐hospital (OOH)/home transfusion (HT) practices in their countries and feedback on challenges in initiating home CCP infusion programmes. In addition, details of existing trials registered on clinicaltrials.gov were summarized. Results A total of 31 country representatives participated. Early/OOH CCP transfusion studies were reported in the United States, the Netherlands, Spain and Brazil. There were a total of six published and five ongoing trials on the prophylactic and therapeutic early use of CCP. HT was practised in Australia, the UK, Belgium, France, Japan, Nigeria, the Netherlands, Spain, Italy, Norway, the United States and some provinces in Canada. Thirty‐four representatives indicated a lack of OOH CCP or HT in their institutions and countries. Barriers to implementation of OOH/HT included existing legislation, lack of policies pertaining to outpatient transfusion, and associated logistical challenges, including lack of staffing and resources. Conclusion Early administration of CCP remains a potential option in COVID‐19 management in countries with existing OOH/HT programmes. Legislation and regulatory bodies should consider OOH/HT practice for transfusion in future pandemics.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Lise Estcourt
- NHS Blood and Transplant & Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,ImpactLife Blood Centre and Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | | | | | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Dana V Devine
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Richard R Gammon
- Scientific Medical and Technical Direction, OneBlood, Orlando, Florida, USA
| | - Silvano Wendel
- Blood Bank, Hospital Sírio-Libanês Blood Bank, São Paulo, Brazil
| | | | - Rada M Grubovic Rastvorceva
- Institute for Transfusion Medicine of RNM, Skopje, North Macedonia.,Faculty of Medical Sciences, University Goce Delcev, Štip, North Macedonia
| | - Adaeze Oreh
- National Blood Service Commission, Federal Ministry of Health, Abuja, Nigeria
| | - Iñigo Romon
- Hematology Department, University Hospital Marques de Valdecilla, Santander, Spain
| | - Karin van den Berg
- Transfusion Medicine and Technical Services Division, South African National Blood Service, Johannesburg, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Junichi Kitazawa
- Department of Genomic Medicine, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Cynthia So-Osman
- Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands.,Department of Haematology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Sharp R, Turner L, Altschwager J, Corsini N, Esterman A. Adverse events associated with home blood transfusion: A retrospective cohort study. J Clin Nurs 2021; 30:1751-1759. [PMID: 33656751 DOI: 10.1111/jocn.15734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/09/2020] [Accepted: 02/19/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To determine the rate of individual and system adverse events associated with blood transfusion at home. BACKGROUND Home or residential care facility based blood transfusion is beneficial for individuals requiring transfusion due to reduced disruption to daily life and the comfort of a familiar environment. However, blood transfusion may result in serious adverse events. There is a lack of research in this area, and there is a need to identify rates of adverse events and evaluate the system used for this service. DESIGN Retrospective cohort study. METHODS Existing data routinely collected for clinical care were used to determine client and system adverse events of medically stable adults with a chronic disease who underwent blood transfusion in a home setting provided by a nurse-led service. A STROBE EQUATOR checklist was used for this study (see Appendix S1). RESULTS There were 1790 episodes of care involving 533 participants, with 13 cases of transfusion reaction (incident rate [IR] 0.7%; 95% CI 0.43-1.25). Only five of these were severe, resulting in the cessation of the blood transfusion and further medical review or hospital admission (IR 0.28%; 95% CI 0.12-0.68). There were no cases of tampered blood packaging, expired or visually damaged blood products. There were 10 cases of incorrect paperwork (0.6%) and nine cases of incorrect temperature (0.5%). There were 153 cases of vascular access device adverse events (IR 8.5% 95% CI 7.3-9.9), most commonly, difficulty cannulating the individual (n = 82, 54%). CONCLUSIONS A nurse-led home blood transfusion service was associated with low rates of both individual and system adverse events. Further research is needed to explore the perception of those using this service and supports required to improve the experience. RELEVANCE TO CLINICAL PRACTICE Blood transfusions may be associated with increased risk of morbidity and mortality. This risk may be increased in a home setting due to the distance from an acute care facility. This study has demonstrated that a nurse-led home blood transfusion service is safe (<1% adverse event rate) for those with a medically stable, chronic condition. There were few failures in the system used to provide this service. Adverse events associated with the vascular access device were the most common complication and the reason for most blood product wastage. Mainly, this was due to difficulty inserting the short-term peripheral intravenous catheter (PIVC). RNs should consider ultrasound to aid PIVC insertion to facilitate treatment provision and enhance the experience of the individual.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences and Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | | | | | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Adrian Esterman
- Biostatistics and Epidemiology, Cancer Research Institute and Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Charron J, Gouëzec H, Bajeux E. [Home blood transfusion in France: Benefits and development terms]. Transfus Clin Biol 2018; 26:304-308. [PMID: 30268597 DOI: 10.1016/j.tracli.2018.08.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/29/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Patients with cancers or malignant homeopathies can suffer from chronic anemia and be regularly transfused in hospitals. Most of the time, their performance status is low. Few local structures currently provide blood transfusion services and patients have to go under difficult and costing transportation to the hospital. The objective of this work is to evaluate benefits and development terms of home blood transfusion for patients with chronic anemia and having to get transfused regularly. METHODS A field investigation-mixing observations and interviews and a literature review were conducted. RESULTS Home blood transfusion represented a little part of home health care activity. When it was practiced, its organization was heterogeneous: it was sometimes performed by a doctor, sometimes by a nurse. Home blood transfusion was benefic for patients: it was more comfortable and it allowed them to avoid harmful transportation to the hospital. Few adverse events occurred during various experiments, all were mild. Before its revaluation in March 2018, home blood transfusion was not enough funded by National health insurance. Home blood transfusion also suffered from a lack of framework until the publication of recommendations in April 2018. CONCLUSIONS Lack of a framework and sufficient funding prevented home blood transfusion development until changes that occurred in 2018. Therefore, this activity should develop in years to come. Allowing reducing unnecessary hospitalizations, home blood transfusion fit into French health national strategy.
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Affiliation(s)
- J Charron
- Service d'épidémiologie et de Santé publique, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France.
| | - H Gouëzec
- Service d'épidémiologie et de Santé publique, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - E Bajeux
- Service d'épidémiologie et de Santé publique, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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