Depression and anxiety in the heart transplant patient a case study


DEPARTMENTS

Some patients were too unwell for the journey and as a result the need for an in-house ECP service was identified. Here we describe the start of the ECP unit at Birmingham Children's Hospital, the population of patients we have treated and the impact ECP has had on patient outcomes. Methods: Setting up a new ECP service required four key stages; equipment and space, staff and training, patient scheduling, documentation and governance. This was an innovative and collaborative approach as they were recruited on an ad-hoc basis in addition to their full-time roles.

Results: In three years, we have developed a JACIE accredited service with a medical lead, substantive nursing team and a designated unit. The service now provides around paediatric ECP treatments per year, has treated 20patients and has started to accept referrals from out of centre. ECP also has a strong steroid-sparing quality. Conclusions: Patients requiring ECP therapy at Birmingham Children's Hospital are no longer obligated to travel out of centre for this life-saving treatment.

Setting up a new service requires four key stages and excellent team work across different setting. Within three years our service has grown into a specialised unit and has achieved JACIE accreditation. Background: CAR-T cells are a new cancer treatment, where T cells usually from the patient, but sometimes from a donor are modified in a laboratory to target cancer cells.

Depression And Anxiety In The Heart Transplant Patient A Case Study

There have been some promising results in early phase clinical trials and two products are now licensed, one for lymphoma and one for young adults with B-ALL. This could represent a very significant change to the range of treatment options available to certain patients. There are considerable toxicities which need appropriate management. The role of the nurse is crucial in this exciting and innovative field. Communication with referring hospitals is an important part of the role. Some trials may have waiting lists, meaning patients may be managed in their local hospitals whilst awaiting a slot.

As nationwide referrals are received, some pre-treatment investigations may be performed by referring hospitals under the direction of the trial team.

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The research nurse is involved in administering CAR-T cells, including ensuring patients have received appropriate pre-medications. Education: Educating and training nurses is essential to enable effective care and management of this complex treatment. The research nurse has implemented and coordinates a ward nurse teaching programme, including management of cytokine release syndrome and neurological toxicity.

Background

Teaching has extended to wider nursing team members, including clinical nurse specialists, advanced nurse practitioners and the intensive care outreach team. As the key worker for this group of patients a major role is the education of patients and their carers in the prompt recognition of toxicities. Research: The research nurse coordinates the CAR-T phase 1 trial, ensuring adherence with regulatory requirements. Cascading training on protocol amendments to all team members involved in patient care is also crucial. CAR-T cells are being used in many centres throughout Europe, there is potential for the nursing role to continue to develop in clinical, research, education and leadership roles within the field of CAR-T cells.

Orla Stewart - Gilead educational , Kite educational, advisory board , AbbVie educational, advisory board , Roche educational. Background: In the Optia platform was licensed for small body weight peripheral blood stem cell collection.

This group are primarily small body weight have had a significant treatment pathway following diagnosis, have poor peripheral venous and require high levels of specialist care to enable cell collection. Methods: A ten year retrospective analysis of the High Risk Neuroblastoma population within our Clinical apheresis service has been undertaken. Results: Since the service has evolved we have not required autologous bone marrow collection for this patient group.

The development of a specialist low body weight, clinical apheresis nursing service has increased the collection efficiency for this group of children. High risk neuroblastoma treatment is aggressive and this along with patient presentation, bone marrow involvement, and wide spread disease can lead to challenges for mobilisation and collection of cells within the paediatric group.

Optimising collection efficiency is seen as key in the success of our service. Priority is to enable collection of cells on optimal CD34 mobilisation; service provision has been developed to enable some flexibility around mobilisation. Priority of the service has been to minimise the impact of the apheresis procedure on this paediatric population. This has been achieved by minimising collection days, patient exposure to ACDA and reducing collection days and time spent on the apheresis machine.

Increasingly patients only require one day of apheresis to collect the cell target. Conclusions: Over the past ten years there has been a significant increase in the survival rate of children with High Risk Neuroblastoma. Ongoing development of our collection efficiency targets and optimisation of the apheresis procedure enables us to achieve target collection. Current protocols prioritise collection of cells to enable two autologous transplant procedures. Successful collection following Day 70 chemotherapy is identified within our service as an expected outcome.

Background: Steroid-resistant SR intestinal acute graft versus host disease aGVHD is a devastating complication of allogeneic hematopoietic stem cell transplantation; effective treatments are lacking. Recent studies have revealed that the microbial composition of the gut i. Therefore, modulation of the gut bacterial populations using fecal microbiota transplantation FMT may be beneficial for treatment of aGVHD.

Nine patients have been enrolled to date. To familiarize the nursing staff with the FMT procedure, we developed an educational intervention and evaluated the staffs' knowledge before and after the intervention. Methods: We constructed a questionnaire evaluating knowledge on the rational, protocol, safety, and potential adverse events of FMT for the treatment of GVHD. Nurses answered the questionnaire before and after educational, which included a lecture by the principal investigator of the FMT study and circulation of a nursing care plan.

The change in the staffs' knowledge was quantified. Results: A total of 20 nurses from the Bone Marrow Transplantation department participated. We believe that such improvement may enhance patients' safety by promoting early detection of complications. A better understanding of the role of FMT may improve nurses' cooperation with the investigators and contribute to accurate and reliable documentation and consequent reporting of the procedure outcomes.

Background: This qualitative study aims to explore the lived experience of children, young people and their families, faced with the further burden of complex novel invasive treatments that have uncertainties and outcomes that may be life threatening. By putting young patients and families at the heart of this project we will enable in-depth exploration through interview based field work and thematic analysis to provide insight into their perspectives around apheresis procedures for cell manipulations such as extracorporeal Photopheresis ECP and peripheral blood stem cell PBSC collection.

Methods: Engagement with young people and their families has been pivotal for the successful development of the methodological and ethical considerations of this study design. This has been established by involving a young people's advisory group YPAG , initially around the study concept and then further work was undertaken around semi-structured interview questions.

However within this dynamic it became apparent that the group had little complex health care experience. Therefore engagement with previously treated patients and their families was seen as integral in the development of patient information sheets, consent forms and interview topic guides that would strengthen and frame the scope of the study and meet the needs of this complex group of patients with life limiting condition requiring apheresis procedures.

Results: Given the lack of scientific papers relating to this specific area of study, developing informed interview topic guides and appropriate methodological choices that enable exploration of the lived experiences of this group was highlighted from both YPAG and expert groups. Information sheets were improved to reflect this contribution. Engagement with previously treated patients and their families has been integral to giving validity to the patient information sheets, consent forms and interview topic guides.


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Ensuring that these are appropriate and will support recruitment to the study. Conclusions: The PPI consultation journey for this study, helped to shape the focus of the study and was based on an ethical and acceptability standpoint from both the young peoples advisory and expert patient groups. Background: Preparing for stem cell transplantation for some patients can be a frightening and uncertain prospect.

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Heart Transplant Surgery: Procedure, Costs, Life Expectancy, and More

Patients in our centre often report that they are not fully prepared and often feel alone and isolated. Hence it was decided in to address these issues. Patients were asked to reflect on their experience of preparing for and undergoing a transplant and to tell us what we could have done better to prepare them. Four key areas were identified; gaining a better understanding of the transplant process, meeting key people involved in their care, meeting others undergoing a transplant and a forum to ask practical questions.

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Methods: After discussion with other members of the multidisciplinary team it was decided that a seminar would be the best forum for addressing these key ideas and concerns. The seminar is interactive allowing patients and family members an opportunity to meet one another in a friendly and informal setting to address any concerns about their impending transplant. At the core is the transplant nurse who sets the momentum and facilitates the seminar encouraging participation and ensuring the concerns of patients and family members. The multi-professional seminar consisting of a dietician, physiotherapist, occupational therapist and the transplant nurse last for two hours and is delivered in a nonclinical environment.

Patients are invited to bring a maximum of two family members or friends. The seminar is delivered every two weeks thus ensuring that patients are able to attend at any point prior to their transplant. Practical presentations from the team including a DVD on relaxation techniques are reinforced with written information including booklets that patients can read and reflect on. Results: To date we have delivered 60 seminars attended by patients family and friends. Patient and family evaluations show that that the seminar has been able to alleviate anxiety and fears. Patient and family members appreciate meeting other patients going through a similar process and have the opportunity to better understand the transplant process.

Having been able to meet members of the transplant team in this setting, to better understand some of the practicalities of transplant including the need for protective isolation and to have their concerns addressed, patients and family members reported that they felt better prepared for the transplant process. Conclusions: The opportunity to meet with other patients and family members preparing for transplantation is a core part of the seminar helping to reduce some of the isolation patients previously reported.

In this safe and less busy environment patients and their families can ask the questions they need to ask.


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  • Patients and families continue to be encouraged to attend the seminar, with most patients attending and appreciating this form of support. Within this service framework nurses will have the opportunity to gain experience and develop essential clinical skills in caring for a range of haematology patients with variable acuity levels. This includes developing advanced skills in managing patients undergoing HSCT and the associated treatment-related complications. Skills include administration of stem cells and chemotherapy, responding to acute complications, symptom control and end of life treatment interventions.

    To function effectively and to provide safe and high quality nursing care, it is essential that nurses have the opportunity to develop this specialist skill set.

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