scholarly journals Bioethics in blood and marrow transplantation (BMT): Advanced care planning and advanced directive (AD)

2005 ◽  
Vol 11 (2) ◽  
pp. 96
Author(s):  
J.L. Neumann ◽  
M. Smith ◽  
C. Causton ◽  
C. Hosing
Keyword(s):  
Marrow Transplantation ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Advanced Directive ◽  
Blood And Marrow Transplantation

Structured advanced care planning facilitated by case managers.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 142-142
Author(s):  
Eric Rackow ◽  
Wendy Rodkey ◽  
Jackie Morrison
Keyword(s):  
Home Care ◽  
Care Management ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Advanced Directive ◽  
Advanced Directives ◽  
High Severity ◽  
Care Managers ◽  
Comorbidity Burden ◽  
Process Metrics

142 Background: Although advanced care planning facilitates end-of-life decisions, less than half of severely or terminally ill patients have completed an advanced care plan. Accordingly, Humana launched a pilot of care manager-facilitated structured advanced care planning discussions among individuals with complex chronic conditions, including cancer. Process metrics were reviewed to determine whether the pilot would be scalable to a larger population. Methods: The pilot included two groups, 1) high-severity patients who had been receiving long term in-home care management for ≥30 days with a high comorbidity burden, and 2) functionally-challenged patients who had been receiving telephonic care management for ≥30 days and had a moderate comorbidity burden. Twenty care managers participated in 2 live and 9 virtual training sessions on the structured discussion approach. Care managers documented the following process metrics: number and length of structured advanced care planning discussions, number of advanced directives completed or updated, and number of times hospice services were reviewed. Results: Among the 169 high-severity patients in home settings, structured discussions occurred with 54.4% of the population, and 20.1% either updated or completed an advanced directive. Among the 106 functionally challenged patients receiving telephonic care management, 37.7% had structured discussions, and 13.2% either updated or completed an advanced directive. Hospice services were reviewed with 23.6% of the high-severity patients, and 3.7% of the functionally-challenged patients. The amount of time spent by the care managers was longer for the home consultations (average=15.1 minutes) compared to the telephonic consultations (average=10.24 minutes). Conclusions: In this pilot, a higher percentage of advanced care discussions were completed with high-severity patients receiving home care management than functionally-challenged patients receiving telephonic care management. The differences could be attributed many variables, including the health state or setting. This pilot was determined not to be scalable to a broader population, and alternative approaches for advanced care planning currently being evaluated.

scholarly journals Plegia to walking: AHSCBMT in severe NMOSD relapse

2020 ◽  
Vol 2 (2) ◽  
pp. e000073
Author(s):  
Nicola Carlisle ◽  
Parameswaran Hari ◽  
Staley Brod
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Optic Neuritis ◽  
Marrow Transplantation ◽  
Transverse Myelitis ◽  
Working Party ◽  
Autoimmune Disorder ◽  
Haematopoietic Stem Cell ◽  
Partial Recovery ◽  
Blood And Marrow Transplantation

ObjectivesNeuromyelitis optica is a devastating, relapsing, inflammatory, autoimmune disorder characterised in large part by attacks of optic neuritis and transverse myelitis causing blindness and plegia in many patients. Eighty-three per cent of patients with transverse myelitic attacks and 67% of patients with optic neuritis attacks have no or a partial recovery.MethodsResults from The European Group for Blood and Marrow Transplantation Autoimmune Diseases Working Party imply failure of autologous haematopoietic stem cell bone marrow transplantation.Results and conclusionWe present a case that despite eventual relapse, made a remarkable functional recovery after bone marrow transplantation which may justify bone marrow transplantation in severe cases.

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