#45: Reopening a Successful Stem-cell Transplantation Unit in a Public Children’s Hospital in La Plata, Argentina
Notice bibliographique
Résumé
Abstract Background Hematopoietic stem cell transplantation (HSCT) is challenging because of economic, educational, and organizational reasons. Argentina is a middle-income country. HSML is a public pediatric hospital with an HSCT unit halted its services in July 2014. Among the reasons for suspending the services were healthcare providers(HCP) burn out, miscommunication, and tasks breakdown. The HSCT service resumed in December 2014. Objectives The primary objective was to describe and share the experiences in resuming the HSCT service by using a multicomponent strategic plan and interventions. The secondary objective was to review the outcomes. Methods Our strategic plan consisted of four main components: (1) Use of quality improvement tools for quality assessment and management (Six Sigma quality improvement processes, root-cause analysis, process maps, and brain storming); (2) participate in international collaborative networks (St. Jude Global Alliance and PRINCIPAL networks, the BFM-Forum-SCT, Sick-Kids Hospital, Canada); (3) participate in national and international training programs; and (4) improve healthcare delivery and organization processes, including infection care and prevention (develop and standardize all HSCT care delivery procedures). Results and Outcomes Healthcare facilities and services auditing and accreditation: An infection prevention and control program was started. This program managed: air and ventilation system improvement (air-conditioning, HEPA filters, positive pressure) and the creation of 47 standardized operating procedures. The HSCT wards were audited 3 times, and received accreditation (2018) by a national accreditation agency in Argentina. Human resources: 7 new doctors and 4 nurses were hired, the nurse:patient ratio was 1:2. 4 doctors attended a course for SPSS software®management; 6 doctors attended different American Society of Hematology H-Clinical Research Institute meetings. Personnel felt a reduction in the level of burn-out after the implementation of a plan designed by all stakeholders. Family information: 28 families received training for management of immunosuppressed patients. Scientific production: 4 clinical trials were accepted in indexed journals, 23 abstracts were presented in scientific meetings, and 27 educational national and international meetings were attended by personnel. Data management: Creation of a patient database (n = 310 patients), and registration of infection episodes for monthly assessment and monitoring patterns of infections (n = 776 events). Outcomes: During 2015–2019, 73 children were transplanted: autologous 11 (15%), match sibling donor (MSD) 35 (48%) and match unrelated donors (MUD) 27 (37%) Median age was 6 years of age (IQR 2–9), 53% were male, and 60% were acute leukemias. At a mean median time of 12 months (IQR 5–18), the overall survival by Kaplan–Meier for MSD and MUD was similar (62.3 ± 10.7% and 54.2 ± 15.0%, log-rank P = 0.54). The cumulative incidence of treatment-related mortality (log-rank P = 0.31), cumulative incidence of relapse (LR P = 0.99) were comparable as well. Infection rates were 40.5% and 69.6% in MSD vs. MUD (OR 3.36; 95% CI 1.14–9.98; P = 0.038). Conclusion The strategic plan implemented allowed us to offer optimal care to children in a public hospital without further financial cost and more satisfied HCPs. Results are comparable to published literature. Implementation of quality improvement interventions leads to the success of our program. Education and collaboration with national and international networks assisted improvement of the standard of care.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».