Exercise is Medicine: Implementing a New Initiative to Increase Patients' Activity and Functional Mobility in Pediatric Stem-Cell Transplant Unit

2021 ◽  
Author(s):  
Lydia Robey ◽  
Haleigh Schreck ◽  
Gretchen Eames ◽  
Brittany Reiling ◽  
Jessica Munger ◽  
...  
Keyword(s):  
Stem Cell ◽  
Test Scores ◽  
High Frequency ◽  
Completion Rate ◽  
Functional Mobility ◽  
Cell Transplant ◽  
Stand Test ◽  
Sit To Stand ◽  
Cell Transplants ◽  
Improve Compliance

PURPOSE Patients undergoing stem-cell transplants endure prolonged hospitalizations and aggressive medical treatments. This combination can quickly evolve into loss of functional strength and physical debilitation. We aimed to promote independent patient activity during hospitalizations, to improve compliance with prescribed physical therapy (PT) sessions, and to focus those sessions on resistance and endurance exercises. METHODS We used the Institute for Healthcare Improvement Model of Improvement as our quality improvement (QI) framework, and we implemented an initiative called Exercise is Medicine. The initiative included three key components: (1) educating staff and caregivers about the importance of early ambulation, (2) incorporating the Miles in Motion (MiM) program to encourage patients' daily activity, and (3) eliminating barriers to allow for higher completion rates of prescribed PT sessions. Data were collected for the completion rate of PT sessions, rate of high-frequency PT sessions, participation in the MiM program, and 1-minute sit-to-stand test scores on admission and discharge. RESULTS Before intervention, 42% of patients required high-frequency PT because of significant debilitation, which decreased to 17% after intervention. The completion rate of PT sessions increased from 71% to 87%. By discharge, 79% of patients improved their 1-minute sit-to-stand test scores and 21% returned to baseline score, indicating stable or improved functional strength, and 92% of patients participated in MiM. CONCLUSION The Exercise is Medicine initiative facilitated positive changes with patients showing stable or improved functional strength and endurance and increased participation in independent activity during inpatient stays.

Optimal frequency of whole body vibration training for improving balance and physical performance in the older people with chronic stroke: A randomized controlled trial

2021 ◽  
pp. 026921552110505
Author(s):  
Ning Wei ◽  
Mengying Cai
Keyword(s):  
Older People ◽  
Physical Performance ◽  
High Frequency ◽  
Low Frequency ◽  
Chronic Stroke ◽  
Whole Body ◽  
Timed Up And Go ◽  
Stand Test ◽  
Sit To Stand ◽  
Frequency Group

Objective To explore the optimal frequency of whole-body vibration training for improving the balance and physical performance in older people with chronic stroke. Design a single-blind randomized controlled trial. Setting Two rehabilitation units in the Wuhan Brain Hospital in China. Participants A total of 78 seniors with chronic stroke. Interventions Low-frequency group (13 Hz), high-frequency group (26 Hz), and zero-frequency group (Standing on the vibration platform with 0 Hz) for 10 sessions of side-alternating WBV training. Main measures The timed-up-and-go test, five-repetition sit-to-stand test, 10-metre walking test, and Berg balance scale were assessed pre- and post-intervention. Results Significant time × group interaction effects in five-repetition sit-to-stand test (p = 0.014) and timed-up-and-go test at self-preferred speed (p = 0.028) were observed. The high-frequency group outperformed the zero-frequency group in both five-repetition sit-to-stand test (p = 0.039) and timed-up-and-go test at self-preferred speed (p = 0.024) after 10-sessions training. The low-frequency group displayed only a significant improvement in five-repetition sit-to-stand test after training (p = 0.028). No significant within- or between-group changes were observed in the Berg balance scale and walking speed (p > 0.05). No significant group-difference were found between low-frequency and high-frequency groups. No adverse events were reported during study. Conclusions Compared with 13 Hz, 26 Hz had no more benefits on balance and physical performance in older people with chronic stroke.

scholarly journals Survival following Mechanical Ventilation of Recipients of Bone Marrow Transplants and Peripheral Blood Stem Cell Transplants

2002 ◽  
Vol 30 (3) ◽  
pp. 289-294
Author(s):  
P. H. Scott ◽  
T. J. Morgan ◽  
S. Durrant ◽  
R. J. Boots
Keyword(s):  
Bone Marrow ◽  
Mechanical Ventilation ◽  
Stem Cell ◽  
Severity Of Illness ◽  
Marrow Transplant ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Retrospective Audit ◽  
Cell Transplants ◽  
Discharge From Hospital

Survival of bone marrow transplant recipients requiring mechanical ventilation is poor but improving. This study reports a retrospective audit of all haematopoietic stem cell transplant (HSCT) recipients requiring mechanical ventilation at an Australian institution over a period spanning 11 years from 1988 to 1998. Recipients of autologous transplants are significantly less likely to require mechanical ventilation than recipients of allogeneic transplants. Of 50 patients requiring mechanical ventilation, 28% survived to discharge from the intensive care unit, 20% to 30 days post-ventilation, 18% to discharge from hospital and 12% to six months post-ventilation. Risk factors for mortality in the HSCT recipient requiring mechanical ventilation include renal, hepatic and cardiovascular insufficiency and greater severity of illness. Mechanical ventilation of HSCT recipients should not be regarded as futile therapy.

scholarly journals Survival following Mechanical Ventilation of Recipients of Bone Marrow Transplants and Peripheral Blood Stem Cell Transplants

2002 ◽  
Vol 30 (3) ◽  
pp. 289-294 ◽  
Author(s):  
P. H. Scott ◽  
T. J. Morgan ◽  
S. Durrant ◽  
R. J. Boots
Keyword(s):  
Bone Marrow ◽  
Mechanical Ventilation ◽  
Stem Cell ◽  
Severity Of Illness ◽  
Marrow Transplant ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Retrospective Audit ◽  
Cell Transplants ◽  
Discharge From Hospital

Survival of bone marrow transplant recipients requiring mechanical ventilation is poor but improving. This study reports a retrospective audit of all haematopoietic stem cell transplant (HSCT) recipients requiring mechanical ventilation at an Australian institution over a period spanning 11 years from 1988 to 1998. Recipients of autologous transplants are significantly less likely to require mechanical ventilation than recipients of allogeneic transplants. Of 50 patients requiring mechanical ventilation, 28% survived to discharge from the intensive care unit, 20% to 30 days post-ventilation, 18% to discharge from hospital and 12% to six months post-ventilation. Risk factors for mortality in the HSCT recipient requiring mechanical ventilation include renal, hepatic and cardiovascular insufficiency and greater severity of illness. Mechanical ventilation of HSCT recipients should not be regarded as futile therapy.

scholarly journals Myasthenia Gravis Presenting as Graft versus Host Disease after Allogeneic Blood Stem Cell Transplant

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Zarir Ahmed ◽  
Martin Schoen ◽  
Nabeel Rajeh
Keyword(s):  
Stem Cell ◽  
Myasthenia Gravis ◽  
Graft Versus Host Disease ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Host Disease ◽  
Graft Versus Host ◽  
Rare Manifestation ◽  
Cell Transplants ◽  
New Onset

Myasthenia gravis is a very rare manifestation of graft versus host disease after stem cell transplants. Herein, we describe a case of new-onset myasthenia gravis after a stem cell transplant 34 months ago in a patient with myelodysplastic syndrome.

Efficacy of Performing a Second Non-Myeloablative Allogenic Stem Cell Transplant.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3664-3664
Author(s):  
Brian J. Byrne ◽  
Joseph H. Antin ◽  
Edwin P. Alyea ◽  
Nelson J. Choa ◽  
David A. Rizzieri
Keyword(s):  
Stem Cell ◽  
Umbilical Cord ◽  
Graft Failure ◽  
Viral Disease ◽  
Cell Transplant ◽  
Allogeneic Transplant ◽  
Cell Transplants ◽  
Long Term Follow Up ◽  
Allogenic Stem Cell Transplant

Abstract Introduction: Non-myeloablative stem cell transplants are being performed for a variety of benign and malignant hematologic conditions. The reported graft failure rates have been as high as 20%. Little is reported on the safety and efficacy of a second attempt at a nonmyeloablative allogeneic transplant. Methods: Patients who underwent at least 2 nonmyeloablative allogenic transplants at either Duke University or Dana Farber Cancer Centers were included. Results: 9 patients were identified who underwent at least 2 preparatory regimens with stem cell infusion. 7 patients underwent related donor stem cell infusions and 2 patients had an umbilical cord donor. 4 patients, including the 2 with an umbilical cord donor, had primary graft failure. The remaining had secondary graft failure within 1–9 months from viral disease/therapy or disease progression. 5 of 9 received a 5 day regimen of fludarabine 125mg/m2, campath100mg and cyclophosphomide 2 gm/m2 total for a secondary preparatory regimen (FCC). Two patients received a one-day prep with fludarabine 30mg/m2, 200cGyTBI, cyclophosphamide 2gm/m2 and campath 20mg (FCC/TBI). The two umbilical cord patients received a one day prep that included TBI, cyclophosphamide 500mg/m2, fludarabine 30 mg/m2, and campath 30 mg (FCC/One). One patient with refractory CML failed to engraft, though 8/9 did (1 required a 3rd attempt), including 4 patients who had the same donor as their first transplant. Long-term follow-up revealed the graft was intact in 5 patients at 6, 7, 8, 21, 39, and 63 months. Three patients died. Conclusion: Patients who have graft failure can be transplanted with a second nonmyeloablative allotransplant. Response and long-term engraftment is possible, even using the same donor. Table 1: Patients who have undergone greater than one mini allogeneic transplant. Disease Prep #1 Donor Engraftment Prep #2 Donor Engraftment Response Key: FCC: Fludarabine, campath, cyclophosphamide; ATG FM: Fludarabine, melphalan, ATG FCC/TBI: TBI, fludarabine, campath, cyclophosphamide, FCC/One: TBI, fludarabine, cyclophosphamide, campath Thalaseemia FCC 6/6 Yes FCC 6/6 RFLP 75% CR Aplastic anemia FCC 4/6 No FCC/TBI same RFLP 99% CR Myelofibrosis FCC/TBI 6/6 RFLP 63% FCC same RFLP 98% CR CML FCC 4/6 RFLP 61% FCC 4/6 No PD Renal Cell FCC 3/6 RFLP 30% FCC same RFLP 94% PD AML/MDS FCC 4/6 RFLP 5% FCC/TBI same RFLP 89% PR AML FCC/TBI 3/6 RFLP 44% FCC 3/6 RFLP 98% CR AA/MDS ATG,FM UCB 4/6 No FCC/One UCB 4/6 RFLP 100% CR AA/MDS ATG,FM UCB 4/7 No FCC/One UCB 4/7 RFLP 100% CR

Multi-Drug Resistant Organisms Are Common in Fecal Surveillance Cultures and Do Not Predict Bacteremia but Correlate with Poorer Outcomes in Patients Undergoing Allogeneic Stem Cell Transplants

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3406-3406
Author(s):  
Vikram Mathews ◽  
Alok Srivastava ◽  
Biju George ◽  
Anu Korula ◽  
Susmitha Perumalla ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Blood Cultures ◽  
Cell Transplant ◽  
Drug Resistant ◽  
Surveillance Cultures ◽  
Cell Transplants ◽  
Baseline Characteristics ◽  
Grade 3

Abstract Introduction: The use of fecal surveillance cultures in predicting bacteremia in patients undergoing intensive chemotherapy and stem cell transplant is an unsettled issue (Neshar et al. Transpl. Infect Dis. 2015). With the increasing incidence of multi-drug resistant (MDR) organisms and high mortality rates with these infections, we sought to describe the spectrum of MDR identified in fecal surveillance, and re-visit the use of fecal surveillance in predicting infection with MDR organisms post-allogeneic stem cell transplant (allo-SCT). Methods: We analyzed data from all patients who underwent allogeneic stem cell transplant during a 2 year period (2014-2015). Patients with MDR strains of bacteria (defined in this study as defined as Vancomycin resistant enterococcus (VRE), Extended spectrum Beta-Lactamases (ESBL) and Carbapenem resistant enterobacteriacea (CRE)) in fecal surveillance were compared with patients who did not have MDR in fecal surveillance cultures. Baseline characteristics and post allo-SCT outcomes including MDR blood culture positivity, severe sepsis and 100-day transplant related mortality (TRM) were compared. Multivariate analysis using logistic regression model was used to determine independent predictors of outcome. Results: A total of 313 allogeneic stem cell transplants were performed in 299 patients, of which data on pre-transplant fecal surveillance cultures were available in 232 transplants. The incidence of MDR isolates in fecal surveillance cultures was 56% (134/232, with E.Coli 118, Klebsiella 33 and Enterococcus 13). Of these, 129 were ESBL alone (78.6%), 17 were CRE alone (10.3%), 10 were ESBL + CRE (6%), 6 (3.6%) were VRE alone. More than one drug resistant organism was isolated in fecal surveillance in 31 patients. The incidence of any MDR positivity in post-transplant blood cultures in all patients was 13.8% (32/232), with 9.4% CRE, 2.6% ESBL, and 1.7% VRE. Thirty-one patients had severe sepsis without any MDR organism isolated on blood culture, but of these 3 had CRE in sputum, 2 had Colistin resistant Acetinobacter (sputum), 2 had candidemia, 3 had NF-GNB and one had Enterococcus. Baseline characteristics between patients who were positive and negative for MDR in fecal surveillance were similar in relation in relation to age (p=0.058), diagnosis (0.133), type of transplant - matched family/MUD/Haplo (p=0.610), stem cell source (0.370), grade 3-4 GVHD (0.834). There was a significantly higher subsequent blood MDR positivity (any MDR) (p=0.012), 100-day mortality (p=0.012) and poor outcome (severe sepsis or 100 day mortality) (p=0.006) in patients who had MDR detected in fecal surveillance cultures. However, of the 25 patients who had MDR isolated in both fecal surveillance culture as well as subsequent blood cultures, only 9 patients had the same organism and susceptibility pattern in both. Factors influencing 100-day mortality included patient's age (p=0.001), MDR positivity in blood (p=0.0001), MDR in fecal surveillance (p=0.01), use of an alternate (Haplo/MUD/family) donor (p=0.0001), GVHD grade 3-4 (p=0.000) and severe sepsis (p=0.000). On multivariate analysis, only patient's age (p=0.015), alternate donor (0.009), severe sepsis (p=0.000) and grade 3-4 GVHD (p=0.001) retained significance in predicting 100-day mortality. Conclusion: Multidrug resistant organisms are frequently seen on fecal surveillance in the pre-transplant setting. MDR in fecal surveillance is associated with a higher incidence of MDR positive blood cultures but not with the same organism, and on univariate analysis is associated with higher incidence of 100 day mortality. Newer strategies to reduce bacteremia and mortality in this group of high risk patients need to be considered. Disclosures No relevant conflicts of interest to declare.

scholarly journals Increasing Rates of Fluoroquinolone Resistance in Escherichia coli Blood and Urinary Isolates in Stem Cell Transplant and Hematologic Malignancy Populations

2016 ◽  
Vol 1 (2) ◽  
pp. 234 ◽  
Author(s):  
Christopher G. Hauck ◽  
Pearlie P. Chong ◽  
Melissa B. Miller ◽  
Katarzyna Jamieson ◽  
Jason P. Fine ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Stem Cell ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Fluoroquinolone Resistance ◽  
Cell Transplant ◽  
Cell Transplants ◽  
Stem Cell Transplants ◽  
Febrile Episodes ◽  
Urinary Isolates

Fluoroquinolone (FQ) antibiotics have been shown to reduce mortality and the number of febrile episodes when used as prophylaxis during neutropenia. Prior studies suggest that prophylaxis may result in increasing rates of FQ resistance. Fluoroquinolone non-susceptibility trends in Escherichia coli isolated from blood and urine cultures were evaluated over a 16-year period during which prophylaxis was initiated in patients with hematologic malignancies and stem cell transplants. Non-susceptibility rates increased after the introduction of prophylaxis, with yearly non-susceptibility rates rising from 30%­–33% to 40%–88% in blood isolates. The high rates of non-susceptibility now observed raise concerns about the continued efficacy of FQ prophylaxis. This concern exists particularly in those patients undergoing stem cell transplants where the total FQ non-susceptibility rates over the study period were 82.3%. Further evaluation of the effect of FQ prophylaxis on antibiotic resistance and its efficacy in the setting of increased rates of resistance is warranted.

scholarly journals 581. Risks versus Benefits of Metronidazole Use for the Prevention of Acute GVHD in Allogeneic Stem Cell Transplant Recipients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S355-S356
Author(s):  
Mary T Young ◽  
Marguerite Monogue ◽  
Hetalkumari Patel
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Adverse Drug Events ◽  
Cell Transplant ◽  
Post Transplantation ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Post Transplant ◽  
Clostridioides Difficile ◽  
Cell Transplants

Abstract Background Currently, acute graft versus host disease (aGVHD) prophylaxis in hematopoietic stem cell transplants (HSCT) varies amongst different institutions. There is a lack of data supporting the use of metronidazole for aGVHD prophylaxis in HSCT. To further investigate if metronidazole has an effect on aGVHD, allogeneic HSCT recipients will be examined to determine if metronidazole post-transplantation decreases the incidence of aGVHD and the risks of adverse drug events (ADE) associated with this practice. Methods This retrospective study included 120 adult patients who received an allogeneic HSCT between January 1, 2010 to December 31, 2013. The primary endpoint is the incidence of aGVHD, defined as within 100 days post-transplant. Secondary endpoints include the rate of metronidazole discontinuation due to intolerance, frequency of metronidazole-related adverse effects, incidence of Clostridioides difficile infection, mortality, and overall survival. Results One hundred six patients met the inclusion criteria. The majority of patients received metronidazole (88 vs. 18). Less patients in the metronidazole arm developed aGHVD (51.1% vs 61.1%, p=0.44). In the subcategories of liver, skin, and gastrointestinal aGHVD, patients who received metronidazole developed less gastrointestinal aGVHD (26.1% vs 50.0%, p=0.045). Gastrointestinal ADEs were the most common metronidazole-related ADEs (19.3%, Table 1). There were no significant differences in the incidence of C. difficile infection, mortality, and overall survival between the two arms (Table 2). Table 1. Adverse Drug Events and Discontinuation of Therapy Table 2. Additional Secondary Outcomes Conclusion Despite a reduction in gastrointestinal aGVHD in the metronidazole arm, approximately one in four patients experienced an ADE to the medication, likely due to the prolonged use of the medication (33 days). The utilization of post-transplant cyclophosphamide for GVHD prophylaxis likely eliminates the need for metronidazole; however our findings suggest a benefit in preventing gastrointestinal aGVHD with metronidazole; albeit, caution is warranted given the high incidence of ADE associated with prolonged use. Disclosures All Authors: No reported disclosures

The Correlation among 2-Minute Step Test, Time Up and Go Test, and Sit to Stand Test in Phayao Hypertensive Older Adults

2021 ◽  
Vol 104 (10) ◽  
pp. 1706-1710
Keyword(s):  
Elderly People ◽  
Functional Capacity ◽  
Rest Period ◽  
Functional Mobility ◽  
Step Test ◽  
Test Time ◽  
Test Results ◽  
Stand Test ◽  
Correlational Research ◽  
Sit To Stand

Objective: To investigating the correlation among the functional capacity using 2-minute step test (2MST), the functional mobility using the time up and go (TUG) test, and the sit to stand test (STS) in hypertensive elderly people. Material and Methods: The correlational research design was used to evaluate the correlation among 2MST, TUG test, and STS test in 60 hypertensive elderly people. Each subject performed one trial in 2MST, and then performed three trials in TUG test, STS10 test, and STS60 test. A 5-minute rest period was given between each test. Results: Functional capacity was correlated with functional mobility in hypertensive elderly people. The results revealed that 2MST was negatively correlated with TUG test and STS10 test (r=–0.635 and –0.266, respectively). Whereas, the 2MST was positively correlated with STS60 test (r=0.521). Conclusion: The functional capacity was correlated with functional mobility in hypertensive elder subjects. Keywords: 2-minute step test; Time up and go test; Elderly; Sit to stand test; Hypertension

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