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Ko RE, Kim Z, Jeon B, Ji M, Chung CR, Suh GY, Chung MJ, Cho BH. Deep Learning-Based Early Warning Score for Predicting Clinical Deterioration in General Ward Cancer Patients. Cancers (Basel) 2023; 15:5145. [PMID: 37958319 PMCID: PMC10647448 DOI: 10.3390/cancers15215145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Cancer patients who are admitted to hospitals are at high risk of short-term deterioration due to treatment-related or cancer-specific complications. A rapid response system (RRS) is initiated when patients who are deteriorating or at risk of deteriorating are identified. This study was conducted to develop a deep learning-based early warning score (EWS) for cancer patients (Can-EWS) using delta values in vital signs. METHODS A retrospective cohort study was conducted on all oncology patients who were admitted to the general ward between 2016 and 2020. The data were divided into a training set (January 2016-December 2019) and a held-out test set (January 2020-December 2020). The primary outcome was clinical deterioration, defined as the composite of in-hospital cardiac arrest (IHCA) and unexpected intensive care unit (ICU) transfer. RESULTS During the study period, 19,739 cancer patients were admitted to the general wards and eligible for this study. Clinical deterioration occurred in 894 cases. IHCA and unexpected ICU transfer prevalence was 1.77 per 1000 admissions and 43.45 per 1000 admissions, respectively. We developed two models: Can-EWS V1, which used input vectors of the original five input variables, and Can-EWS V2, which used input vectors of 10 variables (including an additional five delta variables). The cross-validation performance of the clinical deterioration for Can-EWS V2 (AUROC, 0.946; 95% confidence interval [CI], 0.943-0.948) was higher than that for MEWS of 5 (AUROC, 0.589; 95% CI, 0.587-0.560; p < 0.001) and Can-EWS V1 (AUROC, 0.927; 95% CI, 0.924-0.931). As a virtual prognostic study, additional validation was performed on held-out test data. The AUROC and 95% CI were 0.588 (95% CI, 0.588-0.589), 0.890 (95% CI, 0.888-0.891), and 0.898 (95% CI, 0.897-0.899), for MEWS of 5, Can-EWS V1, and the deployed model Can-EWS V2, respectively. Can-EWS V2 outperformed other approaches for specificities, positive predictive values, negative predictive values, and the number of false alarms per day at the same sensitivity level on the held-out test data. CONCLUSIONS We have developed and validated a deep learning-based EWS for cancer patients using the original values and differences between consecutive measurements of basic vital signs. The Can-EWS has acceptable discriminatory power and sensitivity, with extremely decreased false alarms compared with MEWS.
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Affiliation(s)
- Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; (R.-E.K.); (C.R.C.); (G.Y.S.)
| | - Zero Kim
- Medical AI Research Center, Samsung Medical Center, Seoul 06351, Republic of Korea; (Z.K.); (B.J.); (M.J.); (M.J.C.)
- Department of Data Convergence and Future Medicine, School of Medicine, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Bomi Jeon
- Medical AI Research Center, Samsung Medical Center, Seoul 06351, Republic of Korea; (Z.K.); (B.J.); (M.J.); (M.J.C.)
| | - Migyeong Ji
- Medical AI Research Center, Samsung Medical Center, Seoul 06351, Republic of Korea; (Z.K.); (B.J.); (M.J.); (M.J.C.)
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; (R.-E.K.); (C.R.C.); (G.Y.S.)
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; (R.-E.K.); (C.R.C.); (G.Y.S.)
- Devision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul 06351, Republic of Korea; (Z.K.); (B.J.); (M.J.); (M.J.C.)
- Department of Data Convergence and Future Medicine, School of Medicine, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Baek Hwan Cho
- Department of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13497, Republic of Korea
- Institute of Biomedical Informatics, School of Medicine, CHA University, Seongnam 13497, Republic of Korea
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Morton S, Fleming K, Stanworth SJ. How are granulocytes for transfusion best used? The past, the present and the future. Br J Haematol 2023; 200:420-428. [PMID: 36114720 DOI: 10.1111/bjh.18445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 02/04/2023]
Abstract
Granulocyte transfusions continue to be used in clinical practice, predominantly for treatment of refractory infection in the setting of severe neutropenia. There is biological plausibility for effectiveness in these patients with deficiencies of neutrophils, either as a consequence of disease or treatment. However, there is a chequered history of conducting and completing interventional trials to define optimal use, and many uncertainties remain regarding schedule and dose. Practice and clinical studies are severely limited by the short shelf life and viability of current products, which often restricts the timely access to granulocyte transfusions. In the future, methods are needed to optimise donor-derived granulocyte products. Options include use of manufactured neutrophils, expanded and engineered from stem cells. Further possibilities include manipulation of neutrophils to enhance their function and/or longevity. Granulocyte transfusions contain a heterogeneous mix of cells, and there is additional interest in how these transfusions may have immunomodulatory effects, including for potential uses as adjuncts for anti-cancer effects.
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Affiliation(s)
- Suzy Morton
- Transfusion Medicine, NHS Blood and Transplant, Birmingham, UK.,University Hospitals Birmingham, Birmingham, UK
| | - Katy Fleming
- Bristol Haematology and Oncology Centre, Bristol, UK.,School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.,Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK
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Singh S, Gupta V, Kaur G. Organizational aspects of critical care in patients with hematologic malignancies and those undergoing stem cell transplantation. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dahine J, Hébert PC, Ziegler D, Chenail N, Ferrari N, Hébert R. Practices in Triage and Transfer of Critically Ill Patients: A Qualitative Systematic Review of Selection Criteria. Crit Care Med 2020; 48:e1147-e1157. [PMID: 32858530 PMCID: PMC7493782 DOI: 10.1097/ccm.0000000000004624] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To identify and appraise articles describing criteria used to prioritize or withhold a critical care admission. DATA SOURCES PubMed, Embase, Medline, EBM Reviews, and CINAHL Complete databases. Gray literature searches and a manual review of references were also performed. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. STUDY SELECTION We sought all articles and abstracts of original research as well as local, provincial, or national policies on the topic of ICU resource allocation. We excluded studies whose population of interest was neonatal, pediatric, trauma, or noncritically ill. Screening of 6,633 citations was conducted. DATA EXTRACTION Triage and/or transport criteria were extracted, based on type of article, methodology, publication year, and country. An appraisal scale was developed to assess the quality of identified articles. We also developed a robustness score to further appraise the robustness of the evidence supporting each criterion. Finally, all criteria were extracted, evaluated, and grouped by theme. DATA SYNTHESIS One-hundred twenty-nine articles were included. These were mainly original research (34%), guidelines (26%), and reviews (21%). Among them, we identified 200 unique triage and transport criteria. Most articles highlighted an exclusion (71%) rather than a prioritization mechanism (17%). Very few articles pertained to transport of critically ill patients (4%). Criteria were classified in one of four emerging themes: patient, condition, physician, and context. The majority of criteria used were nonspecific. No study prospectively evaluated the implementation of its cited criteria. CONCLUSIONS This systematic review identified 200 criteria classified within four themes that may be included when devising triage programs including the coronavirus disease 2019 pandemic. We identified significant knowledge gaps where research would assist in improving existing triage criteria and guidelines, aiming to decrease arbitrary decisions and variability.
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Affiliation(s)
- Joseph Dahine
- Département de médecine spécialisée, Centre intégré de santé et services sociaux de Laval (CISSS de Laval), Hôpital Cité-de-la-Santé, Université de Montréal, Laval, QC, Canada
| | - Paul C. Hébert
- Département de médecine, Centre Hospitalier de l’Université de Montréal, Université de Montréal et Centre de Recherche, Montreal, QC, Canada
| | - Daniela Ziegler
- Bibliothèque, Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | | | - Nicolay Ferrari
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Réjean Hébert
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montreal, QC, Canada
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Lee JR, Jung YK, Kim HJ, Koh Y, Lim CM, Hong SB, Huh JW. Derivation and validation of modified early warning score plus SpO2/FiO2 score for predicting acute deterioration of patients with hematological malignancies. Korean J Intern Med 2020; 35:1477-1488. [PMID: 32114753 PMCID: PMC7652654 DOI: 10.3904/kjim.2018.438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/22/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS Scoring systems play an important role in predicting intensive care unit (ICU) admission or estimating the risk of death in critically ill patients with hematological malignancies. We evaluated the modified early warning score (MEWS) for predicting ICU admissions and in-hospital mortality among at-risk patients with hematological malignancies and developed an optimized MEWS. METHODS We retrospectively analyzed derivation cohort patients with hematological malignancies who were managed by a medical emergency team (MET) in the general ward and prospectively validated the data. We compared the traditional MEWS with the MEWS plus SpO2/FiO2 (MEWS_SF) score, which were calculated at the time of MET contact. RESULTS In the derivation cohort, the areas under the receiver-operating characteristic (AUROC) curves were 0.81 for the MEWS (95% confidence interval [CI], 0.76 to 0.87) and 0.87 for the MEWS_SF score (95% CI, 0.87 to 0.92) for predicting ICU admission. The AUROC curves were 0.70 for the MEWS (95% CI, 0.63 to 0.77) and 0.76 for the MEWS_SF score (95% CI, 0.70 to 0.83) for predicting in-hospital mortality. In the validation cohort, the AUROC curves were 0.71 for the MEWS (95% CI, 0.66 to 0.77) and 0.83 for the MEWS_SF score (95% CI, 0.78 to 0.87) for predicting ICU admission. The AUROC curves were 0.64 for the MEWS (95% CI, 0.57 to 0.70) and 0.74 for the MEWS_SF score (95% CI, 0.69 to 0.80) for predicting in-hospital mortality. CONCLUSION Compared to the traditional MEWS, the MEWS_SF score may be a useful tool that can be used in the general ward to identify deteriorating patients with hematological malignancies.
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Affiliation(s)
- Ju-Ry Lee
- Medical Emergency Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youn-Kyoung Jung
- Medical Emergency Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Jin Won Huh, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3985 Fax: +82-2-3010-6968 E-mail:
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Intensive care unit outcomes in patients with hematological malignancy. BLOOD SCIENCE 2020; 2:33-37. [PMID: 35399861 PMCID: PMC8974903 DOI: 10.1097/bs9.0000000000000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022] Open
Abstract
Hematological malignancies are usually life-limiting conditions. Limitations of care need to be decided early, based on acceptability to the patient, family, physician, and community. Inappropriate intensive care unit (ICU) admission is likely to result in significant physical, psychological, and economic burden. There is little published on the impact of non-acute preadmission disease factors on ICU outcomes in hematological malignancies.
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7
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Panay S, Ruiz C, Abarca M, Nervi B, Salazar I, Caro P, Muñiz S, Briones J, Bruhn A, Mondaca S. Mortality of Adult Patients With Cancer Admitted to an Intensive Care Unit in Chile: A Prospective Cohort Study. J Glob Oncol 2019; 4:1-9. [PMID: 30582431 PMCID: PMC7010452 DOI: 10.1200/jgo.18.00091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Increasing numbers of reports have shown acceptable short-term mortality of patients with cancer admitted into the intensive care unit (ICU). The aim of this study was to determine the mortality of critically ill patients with cancer admitted to the ICU in a general hospital in Chile. Materials and Methods This was a prospective cohort trial in which we included all patients with cancer admitted to the ICU between July 2015 and September 2016. Demographic, physiologic, and treatment data were registered, and survival at 30 days and 6 months was evaluated. A prespecified subgroup analysis considering the admission policy was performed. These subgroups were (1) ICU admission for full code management and (2) ICU trial (IT). Results During the study period, 109 patients with cancer were included. Seventy-nine patients were considered in the full code management group and 30 in the IT. The mean age of patients was 60 years (standard deviation [SD], 15), and 56% were male. Lymphoma was the most frequent malignancy (17%), and 59% had not received cancer treatment because of a recent diagnosis. The mean Acute Physiology and Chronic Health Evaluation and Sequential-Related Organ Failure Assessment scores were 22.2 (SD, 7.3) and 7 (SD, 3), respectively. There were no differences in vasopressor, fluid, or transfusion requirements between subgroups. Lactate levels, Sequential-Related Organ Failure Assessment scores (day 1, 3, and 5), complications, and ICU length of stay were similar. In the entire cohort, 30-day and 6-month mortality was 47% and 66%, respectively. There was no difference in mortality between subgroups according to the admission policy. Conclusion Patients admitted to the ICU in a developing country are at high risk for short-term mortality. However, there is a relevant subgroup that achieves 6-month survival, even among patients who undergo an IT.
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Affiliation(s)
- Sergio Panay
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Ruiz
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Abarca
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Nervi
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Salazar
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulo Caro
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sabrina Muñiz
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Briones
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Bruhn
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastian Mondaca
- Sergio Panay, Carolina Ruiz, Marcelo Abarca, Ignacio Salazar, Paulo Caro, Sabrina Muñiz, and Juan Briones, Complejo Asistencial Dr. Sótero del Río; Carolina Ruiz and Alejandro Bruhn, Universidad Católica de Chile; and Carolina Ruiz, Alejandro Bruhn, Bruno Nervi, and Sebastian Mondaca, Pontificia Universidad Católica de Chile, Santiago, Chile
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Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study. Eur J Oncol Nurs 2019; 39:70-80. [PMID: 30850141 PMCID: PMC6417764 DOI: 10.1016/j.ejon.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/04/2018] [Accepted: 02/06/2019] [Indexed: 12/19/2022]
Abstract
Purpose Patients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients’ places of care and death. Method Qualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach. Results Five inter-related factors were identified as contributing to the likelihood of patients’ receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home. Conclusions Hospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred. Patients with haematological malignancies are more likely to die in hospital than people with other cancers. No previous research has reported on UK haematology nurses' perspectives of their patients' place of care and place of death. Hospital deaths were largely attributed to disease characteristics, nature of treatment and difficulties with prognostication. However, other modifiable factors were also identified as barriers to death at home.
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One more lesson from a great man! The intensive care ethical dilemma exposed. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Timbrell D, Jankowski S, Stockwell M. Haematology and critical care - new bedfellows? Anaesthesia 2018; 71:732-3. [PMID: 27159004 DOI: 10.1111/anae.13485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Rigaud JP, Large A, Meunier-Beillard N, Gélinotte S, Declercq PL, Ecarnot F, Dargent A, Quenot JP. What are the ethical aspects surrounding intensive care unit admission in patients with cancer? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:S42. [PMID: 29302598 DOI: 10.21037/atm.2017.12.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Improvements in living conditions and increasing life expectancy have combined to result in ever older patients being admitted to hospital. In parallel, the increasing incidence of cancer, along with the improved efficacy of anti-cancer therapies has led to greater needs for intensive care among cancer patients. The objectives underpinning the management of cancer patients in the intensive care unit (ICU) are to achieve a return to a clinical status that would allow the patient to be either, transferred back to the original unit, or discharged from the hospital with an acceptable quality of life, and where warranted, pursuit of cancer therapy. The relevance of ICU admission should be assessed systematically for patients with active cancer. The decision needs to be made taking into account the expected benefit for the patient, the life-support therapies that are possible with discussion about a care project, and also considering the future quality of life and the short and long-term prognosis. Anticipating the question of potential ICU admission should help protect the patient against both inappropriate refusal of intensive care, and inappropriate admission to the ICU that might only lead to unreasonable therapeutic obstinacy. The intensive care physician has a major role to play in helping the cancer patient to develop an appropriate and flexible healthcare project. Anticipating the question of ICU admission in advance, as well as a close alliance between the oncologist and the intensive care physician are the two keys to the success of a healthcare project focused on the patient.
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Affiliation(s)
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Department of Sociology, Centre Georges Chevrier UMR 7366 CNRS, University of Burgundy, Dijon, France
| | | | | | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
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12
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O'Gara G, Tuddenham S, Pattison N. Haemato-oncology patients' perceptions of health-related quality of life after critical illness: A qualitative phenomenological study. Intensive Crit Care Nurs 2017; 44:76-84. [PMID: 29056247 DOI: 10.1016/j.iccn.2017.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/19/2017] [Accepted: 09/26/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Haemato-oncology patients often require critical care support due to side-effects of treatment. Discharge can mark the start of an uncertain journey due to the impact of critical illness on health-related quality of life. Qualitatively establishing needs is a priority as current evidence is limited. AIMS To qualitatively explore perceptions of haemato-oncology patients' health-related quality of life after critical illness and explore how healthcare professionals can provide long-term support. METHODS Nine in-depth interviews were conducted three to eighteen months post-discharge from critical care. Phenomenology was used to gain deeper understanding of the patients' lived experience. SETTING A 19-bedded Intensive Care Unit in a specialist cancer centre. FINDINGS Five major themes emerged: Intensive care as a means to an end; Rollercoaster of illness; Reliance on hospital; Having a realistic/sanguine approach; Living in the moment. Haemato-oncology patients who experience critical illness may view it as a small part of a larger treatment pathway, thus health-related quality of life is impacted by this rather than the acute episode. CONCLUSIONS Discharge from the intensive care unit can be seen as a positive end-point, allowing personal growth in areas such as relationships and living life to the full. The contribution of health-care professionals and support of significant others is regarded as critical to the recovery experience.
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Affiliation(s)
- Geraldine O'Gara
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom. Geraldine.O'
| | | | - Natalie Pattison
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom.
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Azoulay E, Schellongowski P, Darmon M, Bauer PR, Benoit D, Depuydt P, Divatia JV, Lemiale V, van Vliet M, Meert AP, Mokart D, Pastores SM, Perner A, Pène F, Pickkers P, Puxty KA, Vincent F, Salluh J, Soubani AO, Antonelli M, Staudinger T, von Bergwelt-Baildon M, Soares M. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med 2017; 43:1366-1382. [PMID: 28725926 DOI: 10.1007/s00134-017-4884-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
Abstract
Over the coming years, accelerating progress against cancer will be associated with an increased number of patients who require life-sustaining therapies for infectious or toxic chemotherapy-related events. Major changes include increased number of cancer patients admitted to the ICU with full-code status or for time-limited trials, increased survival and quality of life in ICU survivors, changing prognostic factors, early ICU admission for optimal monitoring, and use of noninvasive diagnostic and therapeutic strategies. In this review, experts in the management of critically ill cancer patients highlight recent changes in the use and the results of intensive care in patients with malignancies. They seek to put forward a standard of care for the management of these patients and highlight important updates that are required to care for them. The research agenda they suggest includes important studies to be conducted in the next few years to increase our understanding of organ dysfunction in this population and to improve our ability to appropriately use life-saving therapies or select new therapeutic approaches that are likely to improve outcomes. This review aims to provide more guidance for the daily management of patients with cancer, in whom outcomes are constantly improving, as is our global ability to fight against what is becoming the leading cause of mortality in industrialized and non-industrialized countries.
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Affiliation(s)
- Elie Azoulay
- ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France. .,Medical Intensive Care Unit, Hôpital Saint-Louis, Paris, France.
| | | | - Michael Darmon
- Saint-Etienne University Hospital, Saint-Etienne, France
| | | | | | | | | | | | | | | | | | | | | | | | - Peter Pickkers
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Jorge Salluh
- Instituto de Ensino e Perquisa da Santa Casa de Belo Horizonte, Rio de Janeiro, Brazil
| | | | | | | | | | - Marcio Soares
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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Analyse des recommandations britanniques 2015 sur la prévention et la prise en charge du syndrome de lyse tumorale. Rev Med Interne 2017; 38:36-43. [DOI: 10.1016/j.revmed.2016.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/24/2022]
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Parry-Jones J, Ardeshna K. Haematological malignancy and critical care - new bedfellows? Anaesthesia 2016; 70:1341-4. [PMID: 26558854 DOI: 10.1111/anae.13278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Parry-Jones
- Intensive Care Medicine, Aneurin Bevan Health Board, Newport, Wales.
| | - K Ardeshna
- Haemato-oncology, University College London Hospitals, London, UK
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