Telehealth involves the use of telecommunication and information technology for the delivery of clinical care and may be a mechanism to alleviate the burden of visits faced by patients undergoing hematopoietic cell transplantation (HCT). Few studies have evaluated the feasibility and acceptability of telehealth visits in the care of HCT patients. We conducted 27 telehealth visits with 25 patients undergoing HCT using a videoconferencing system that allows for realtime, 2-way interactions and administered satisfaction surveys to patients and providers. Of the 25 patients included in the study, 20 (80%) and 5 (20%) were undergoing autologous and allogeneic HCT, respectively. The telehealth visits were distributed as follows: 3 inpatient visits upon admission for HCT; 11 inpatient visits between 2 and 14 days post-HCT; 4 inpatient visits prior to discharge after HCT; 8 outpatient, post-HCT follow-up visits; and 1 handoff to a community oncologist. Out of a total of 54 provider assessments, 7 providers (13%) were unable to complete some part of the physical examination, but no provider reported being unable to manage patients' symptoms through telehealth. Eighty-one percent of patients were either satisfied or very satisfied with the telemedicine session. Overall satisfaction was higher among patients than providers (mean scores 4.12 versus 2.64; scale 1 to 5, with 1 = very poor to 5 = excellent). Technological barriers resulting in delays and suboptimal physical examination were largely responsible for provider dissatisfaction. The use of telehealth to deliver comprehensive follow-up care to HCT patients is feasible across different HCT types but is dependent upon quality of data streaming and videoconferencing technologies.
Adults undergoing hematopoietic stem cell transplant (HSCT) are at risk for vitamin D deficiency. After HSCT, exposure to sunlight is restricted, and patients may experience poor nutrition and malabsorption from HSCT-related side effects. Vitamin D affects bone health and immunologic processes. The aim of this project is to establish a process for monitoring and treating vitamin D deficiency and to evaluate if therapeutic vitamin D levels are attainable posttransplant using an HSCT vitamin D replacement algorithm. A multidisciplinary group led by advanced practice providers established a workflow for monitoring and supplementing vitamin D and created an HSCT vitamin D replacement guideline. The medical records of 144 adult HSCT patients were reviewed, and the records of another 72 patients were reviewed a year later. Historical baseline data before the intervention found that 81% of patients were vitamin D deficient and 30% received supplementation. Postintervention and at 1-year follow-up, 76% and 65% of patients were vitamin D deficient before transplant and 97.1% and 100%, respectively, received supplementation for vitamin D deficiency. Post-HSCT compliance with monitoring demonstrated that approximately 91% of patients had a vitamin D level checked within 6 months of transplant. After implementation of the algorithm, there was a statistically significant difference (p < .001) between deficient vitamin D levels pretransplant (72.9%) and posttransplant (26.4%). Results demonstrate sustained compliance over a 2-year period with monitoring and supplementation of vitamin D pre-and peritransplant. Aggressive vitamin D repletion posttransplant decreased the incidence of vitamin D deficiency in HSCT patients. Further study is needed to investigate the long-term effects of vitamin D repletion on posttransplant complications.
of cGVHD was diagnosed when either (1) NIH-CC for cGVHD were met (one diagnostic sign or one distinctive sign with additional features) (preferred), or (2) the physician felt cGVHD developed and immune suppression was escalated on a presumed diagnosis (less preferred). This interim analysis provides data about the clinical features seen at the onset of cGVHD in children and the applicability of NIH-CC for diagnosing pediatric cGVHD within the context of a multi-institution study. Results: Of 138 enrolled participants at the time of data analysis, 80 were at least 3 months from date of HSCT and evaluable for cGVHD (median day +338; IQR: 250-383). Although 23/80 (28.8%) were reported as having developed cGVHD, only 16 (20%) met NIH-CC for cGVHD at the time of diagnosis. For NIH cases, median age was 13.1 years (range: 1.9 e 17.9) and median day of onset was +149 (range: 90-385). Median number of organ systems with diagnostic and distinctive signs at cGVHD onset was 2 (range: 1-4), with mouth (lichenoid n¼10, hyperkeratotic plaques n¼4, xerostomia n¼4), skin (depigmentation n¼6, lichen planus n¼3, sclerosis n¼2), eyes (dry gritty eyes n¼7, keratoconjunctivitis sicca n¼4) and lungs (bronchiolitis obliterans n¼3) being most commonly affected. Maximal NIH severity score in any organ system at cGVHD diagnosis was 1 (n¼4), 2 (n¼7), or 3 (n¼5). Prior acute GVHD occurred in 13/16 patients, with 8 having quiescent cGVHD and 5 having overlap syndrome. Of the 7 cases diagnosed with cGVHD but not meeting NIH-CC (median day +190), two had distinctive signs (papulosquamous lesions, scalp scaling) but no additional features. The other five had exclusively common features of GVHD (maculopapular rash n¼4, anorexia, nausea, vomiting, diarrhea n¼2, liver enzyme abnormalities n¼1) and were better classified as late acute GVHD. Conclusions: Without detailed data capture of cGVHD clinical manifestations according to NIH-CC, this study would have inappropriately classified 30% (7/23) of cases as cGVHD had it relied only on physician assessment of the presence or absence of cGVHD. This supports multi-institution cGVHD studies (particularly biomarker studies) demanding rigorous clinical documentation of cGVHD manifestations according to NIH-CC. When NIH diagnostic criteria are met, most children present with cGVHD of the mouth, skin, eyes, and lungs. BMT CTN BEST ABSTRACTSBackground: Patient access in clinical trials can be challenging and research patients are particularly at risk for medication errors, especially in the face of complex protocols. Research pharmacy orders are critical to the success of clinical trials involving experimental drugs. A systematic, multi-disciplinary approach, in the form of a Research Order Committee could be effective in reducing the number of medication errors and improving data integrity. The effectiveness of a multi-disciplinary approach to medical research has been shown in both adult and pediatric care. However, the creation of research orders that accurately convey multifaceted protocol requirements a...
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