RESUMEN
Adolescent and young adult (AYA) oncology patients experience many physical and psychological symptoms at the end of life (EOL); however, data on these experiences for AYA patients who have undergone hematopoietic cell transplantation (HCT) remains sparse. We sought to investigate the characteristics of AYA patients aged 15-25 years who received allogeneic HCT and subsequently died while inpatient at our institution between the years 2008 and 2014. A standardized data extraction tool was used to collect information about patient demographics, treatment and symptoms. We found that during this time frame, 34 AYA patients had received HCT and died while inpatient at our institution, 23 (68%) of whom died because of treatment-related complications. Compared with non-HCT AYA oncology patients (n=35), patients who received HCT (n=34) were more likely to have died in the intensive care unit (71% vs 23%, P<0 .0001) and to have received mechanical ventilation (68% vs 17%, P<0.0001) or hemodialysis (53% vs 0%, P<0.0001) in the last 30 days of life. These findings demonstrate that AYA patients who receive allogeneic HCT receive intensive EOL treatment, suggesting that these patients may benefit from early integration of expert interdisciplinary services to prospectively assess and manage distressing symptoms.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas/métodos , Cuidado Terminal/métodos , Acondicionamiento Pretrasplante/métodos , Adolescente , Adulto , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Adulto JovenRESUMEN
The indications and pathophysiological principles underlying the use of glucose electrolyte solutions for treating diarrhoea with dehydration are well understood. The exact composition for the Caribbean is disputed, because the WHO recommended solution which contains 90mmols/L of sodium was developed for cholera and may produce hypernatremia. To establish the value of this solution in Jamaican children, we studied 84 cases of diarrhoea in children aged 5 to 18 months attending Bustamante Children's Hospital, Kingston. The children were assessed clinically and body weight, blood samples, urine and stool samples were studied at 0, 6 and 24 hours. Treatment was with oral rehydration solution given at a rate of 200 mls per hour. Cases were divided at random into two groups, one given a solution containing 90 mmols Na, the other, 60 mmols of Na. In both groups, clinical and biochemical indices improved rapidly, weight increased, serum specific gravity fell and bicarbonates rose. In the high sodium group, 5 cases developed hypernatremia at 6 hours and persistence of hyponatremia was seen in a few cases in the low sodium group. In a second study, 25 children were given standard GE solution, but the potassium was increased from 20 to 35 mmols/1 and the cases divided randomly into high and normal potassium groups. The GEsol was given as 2 volumes of solution to 1 of water. In this study the high potassium group showed no cases of hypokalemia whereas 19 - 33 percent of the low potassium group had this problem at 24 hours. It was concluded that the standard oral rehydration fluid containing 90 mmols/1 of sodium, given as 2 volumes of water to 1 of water is safe and effective in the cases seen in Jamaica and that a higher potassium concentration of 35mmols/1 would be more effective in correcting hypokalaemia than the present 20 mmol/1 solution. This regime is now standard practise in both Bustamante Children's Hospital and at the University Hospital of the West Indies and has led to dramatic reductions in hospitalization rates, use of drip sets and of intravenous therapy (AU)