RESUMEN
Immunologic and non-immunologic loss of islet cells upon their transplantation into the liver leads to suboptimal outcomes. Anti-inflammatory agents are used during autologous and allogeneic transplantation. The aim of this qualitative systematic literature review is to evaluate their clinical use and safety. Electronic databases Embase, PubMed, Cumulative Index for Nursing and Allied Health Literature, ClinicalTrials.gov, and EU Clinical Trials Register were searched. Of the 216 unique citations, 10 with tumor necrosis factor (TNF) blockers [etanercept (ETA) or infliximab] and 3 with both TNF blockers and an interluekin-1 receptor antagonist [anakinra (ANA)]) were included. Of these, 12 were in allogeneic and one in autologous transplant. Insulin independence with decreased islet cells and number of transfusions were reported with their use. One infection was reported in a group receiving ETA. Analysis suggested that the use of ETA ± ANA have the potential to improve outcomes in islet cell transplant.
Asunto(s)
Antiinflamatorios/uso terapéutico , Trasplante de Islotes Pancreáticos , Antiinflamatorios/efectos adversos , Humanos , Trasplante de Islotes Pancreáticos/métodosRESUMEN
BACKGROUND: Patients with cancer frequently experience neuropsychiatric symptoms due to their medical illness or its treatment. In recent decades, psychiatrists have become increasingly involved in the care of patients with cancer. However, psychiatrists may be less familiar with hematopoietic stem cell transplantation (HSCT), a distinct cancer treatment modality associated with multiple neuropsychiatric sequelae. OBJECTIVE: To provide an overview of HSCT, and describe the prevalence, impact, risk factors, and suggested management of psychiatric consequences of HSCT. METHODS: We performed literature searches in PubMed and PsychInfo to identify articles describing neuropsychiatric symptoms, including depression, anxiety, distress, post-traumatic stress disorder, delirium and cognitive impairment, resulting from HSCT in adults. Those articles most relevant to this manuscript were included. RESULTS: Psychiatrists may be involved in the treatment of patients before, during, or after inpatient hospitalization for HSCT. Each phase of treatment introduces unique stressors that may lead to or exacerbate psychiatric disorders. Appropriate management requires evaluation of HSCT-related medications, an understanding of the impact of complications from HSCT, and consideration of how the patient's underlying medical condition should influence psychiatric recommendations. CONCLUSION: To optimize patient outcomes, consulting psychiatrists should be familiar with the basic principles of HSCT, and the neuropsychiatric sequelae that may result from treatment. Further research is needed to identify strategies to manage psychiatric complications in this unique population.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas/psicología , Trastornos Mentales/etiología , Ansiedad/etiología , Ansiedad/terapia , Depresión/etiología , Depresión/terapia , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Trastornos Mentales/terapia , Estrés Psicológico/etiología , Estrés Psicológico/terapiaRESUMEN
Interdisciplinary health care teams have numerous opportunities to investigate more efficient health care delivery mechanisms using technology that bridges information science and human-centered care. At the onset of team formation, technology can be strategically integrated to enhance health care delivery for patients and providers using multiple strategies.