The role of patient education in the safe management of autologous HSCT patients in an outpatient setting
Bibliographic record
Abstract
The Ottawa Hospital accommodates care for patients undergoing high-dose chemotherapy with autologous stem cell support (HSCT) on an outpatient basis. Nursing has played a pivotal role in facilitating the transition of complex patients from an inpatient venue to an outpatient venue. Although advances in pain and nausea control and infection prevention have enabled patients to undergo intense therapy, it is the continuous, comprehensive teaching that patients and caregivers receive that ensures the safety of outpatient care. Morbidity and mortality associated with an infectious complication during the pancytopenic period remains the greatest risk in transplantation; however, informed patients and caregivers are capable of recognizing symptoms that may require immediate attention. According to Talcott and colleagues’ criteria for assessing risk in patients with febrile neutropenia, our group of patients is at the highest risk of developing significant problems that would require hospitalization. Despite this high risk, the use of PBSC with higher-than-average CD34 counts, the predictability and consistency of engraftment, and the use of once-daily broad-spectrum antibiotics facilitates outpatient care delivery. A total of 279 malignant hematology patients (53% NHL, 32% MM, 15% HD) who underwent autologous HSCT over the last 5 years were reviewed for evaluation of the safety of this outpatient program. In this group, 63% were male and 37% female, and the average age was 47 years (range, 13–68 years). The average LOS was 11.3 days as an outpatient and 12.4 as an inpatient. Eight patients were admitted to ICU from the outpatient program within 24 hours, with 1 death. Common complications were related to febrile neutropenia or bacteremia. This presentation will outline the interventions used by nurses in the program to maintain safe and effective patient care in the outpatient setting.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.002 | 0.005 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".