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Hematopoietic Stem Cell Transplantation MED INFO 402 Group Project Group 5 Terry Pientok David Robbins Jason Sagan.

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Presentation on theme: "Hematopoietic Stem Cell Transplantation MED INFO 402 Group Project Group 5 Terry Pientok David Robbins Jason Sagan."— Presentation transcript:

1 Hematopoietic Stem Cell Transplantation MED INFO 402 Group Project Group 5 Terry Pientok David Robbins Jason Sagan

2  Presentation Goals  Overview of the transplant process  Case example  Introduction to clinical informatics solutions  Hematopoietic Stem Cell Transplantation  “Father” of white, red and platelets  95% of your bodies blood cells  Transplantation Goals:  Replace diseased non-functioning bone marrow  Restore bone marrow after damaged  Replace bone marrow with genetically health bone marrow

3 Chief Complaint  45 year old male  Fatigue  Feeling sick; flu-like symptoms  Has fevers  Bruises easily  Dyspnea  Pallor

4 Intake History and Physical Name: ____________________________­ Date:___/___/___ I.D. # ___________ Date of birth:___/___/___ Age:_____ Sex: M / F Race: B / W /other:__________ Past Medical History: hospitalization: yes no - list date, hospital and reason. ________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ______________________________________________________________________ HBP o heart dz o endocarditis o asthma o pneumonia o PUD o HIV o psych o liver dis./hepatitis o anemia o diabetes o thyroid dz o CA o seizure o Medications (include OTC): ________________________________________________________ Allergies: ________________________________________________________________________ Immunizations: Last Td ________ Doesn’t know o Accepts booster (> 10yrs.):_______ Pneumonia vaccine: no yes date:____________ Previous PPD: _____________ Result:___________ Treated:______________________________ Previous HIV test:_____________ Result:___________ Prior Drug Tx.: total #_______ _______________________________________________________________ _______________________________________________________________________________ Inpatient Detox: #______ ___________________________________________________ Drug Overdose: #_______ __________________________________________________

5 Intake History and Physical Family History (first degree rel.) If deceased, give age and cause of death.: Heart dz o Diabetes o HBP o Kidney dis.o Alcohol or drug problem o Mental illness o CA o _______________________________________________________________________________ Substance Use History: DurationUse Heroin ______ $_______/day ______days/wk. I.V. I.N. Dependent_________ yrs. Other opiates______ $______/day _____days/wk. P.O. I.V. drug_________________ Cocaine ______ $______/day _____days/wk. I.V. I.N. Smoked Last use___________ Alcohol ______ Type & amt____________________/day _____days/wk. Current: y n Benzodiazep.______ Drug & amt._______________/day ____days/wk. Current: y n Marijuana_______ Amt.____________/day ________days/wk. Tobacco ______ ______pack(s)/day Current: yes no, quit date________________ Other: (clonidine, phenergan, other sedatives, PCP, LSD, amphetamines,inhalants) __________________ ________________________________________________________ Last drug use:(what, when)_____________________________________________________ Social History: Currently working: yes no Type (present or previous work):_______________________________ Healthcare: yes no where:______________________________________ last visit:_____________ Health insurance: M.A.o Private o VA o None o Prescription coverage: yes no Marital status:____________________ Lives with:_________________________________ Does spouse or partner use drugs?______________________________________________ Children:(ages)________________________________________________________________ Children live with:____________________________________________________________ Dietary: Avg. # meals/day:_________ Food intolerance, no yes:____________________ Comments:_______________________________________________________________________ Behavioral History: Number sexual partners in past 5 yrs.:___0, ___1, ____2-5, ____>5 Opposite sex o Same o Number sexual partners in last 4 wks: ___0, ___1, ____2-5, ____>5 Opposite sex o Same o Have you shared works?__________ How recently?________________________________ Contraceptive used:_______________________ Condoms used:_________times/last 10 STD: Ever had Syphilis o Gonorrhea o Herpes o Chlamydia o Genital warts o OB/Gyn: Last menstrual period:____________ Interval:___________ Flow: Nl.o Heavy o Scant o Abnormal discharge:n / y ________________________ # times pregnant:_____ # deliveries_____ Breast: c/o Pain_____ Lump_____ Discharge_____ Last Pap smear:______________ Result: Nl o Abn.o ___________________________

6 Intake History and Physical Review of Systems:  if pos. Drug/withdrawal related: Runny nose___, Bodyaches___, Irritable___, Chills___, Nausea___, Stomach cramps___, Diarrhea___, Agitation___, Difficulty concentrating___, Tremors___. General: Weight change___, Loss of appetite___, Fever___, Night sweats___, Fatigue___. Immunol./Integ.: Swollen “glands”___, Skin rash___, Abscess___. ENT: Poor vision___, Poor hearing___, Dental problems___, Hoarseness___. Pulmonary: Cough___, Wheezing___, Shortness of breath___. Circulatory: Chest pain___, Fainting___, Palpitations___, Ankle swelling___, Cold or painful extremity___. Gastrointest.: Heartburn___, Abdominal pain___, N / V / D / C (circle)___, Hemorrhoids___. Urogenital: Nocturia x ___, Urgency/freq.___, Hematuria___, Discharge___, Decreased Libido___, Irregular Periods___, Amennorhea___. Musculoskeletal: Back pain___, Joint pain___, Joint swelling___, Muscle weakness___. Neurologic: Headache___, Memory loss__, Incoordination___, Depression___, Anxiety___. Comments:______________________________________________________________________ _______________________________________________________________________________ Patient Education: (√) if done HIV prevention ( ) TB prevention ( ) Quit smoking ( ) Other:______________________________ ( ) Advanced Directives information offered: Yes ( ) No ( ) If no, document reason in progress note. Signature person completing this form:________________________________________ Date: __________________________________________________________________________

7 Intake History and Physical Laboratory results:___________________________________________________________ EKG:____________________________________________________________________________ Immunization needs: Td:______ Pneumonia vaccine:______ Diagnoses: 1. _________________________ 2. _________________________ 3. _________________________ 4. _________________________ 5. _________________________ History of, S/P: _______________________________________________________________________________ Problem List / Plan: 1._____________________________________________________________________________ 2._____________________________________________________________________________ 3._____________________________________________________________________________ 4.______________________________________________________________________________ 5._____________________________________________________________________________ 6._____________________________________________________________________________

8 Title?

9 Electronic Health Record

10 Diagnostic Tool Example

11 Additional Diagnosis Differentials

12 Diagnosis Suspect a blood disorder. Ordering a series of blood tests to evaluate the type and quantity of blood cells that are present, the blood chemistry, and bone marrow tests

13  Data mining to determine the best treatments and progressions of the disease  PubMed  Electronic Medical Records (EMR  Additional Research  Websites  Books  Periodicals  Speaking to Colleague’s  Review Treatment Effectiveness  Review EMR  Selective Analysis

14 Physician discovers the only effective treatment for myelofibrosis is allogeneic bone marrow transplant.  Two ways to collect stem cells  Bone marrow donation  Peripheral blood stem cell (PBSC)  Donation  Donor Registry: National Bone Marrow Registry  Help s physician find suitable donor for patient  Can be oneself  Family member  Unrelated donor

15  Once suitable donor is found the stem cell harvesting process begins  Process is called PBSC collection  Donor is given Filgrastim for five days to help separate the stem cells from the marrow into the blood stream  The use a separator machine called “Apheresis” to collect and isolate the stem cells  The stem cells, platelets and some white blood cells are gathered into a collection bag  Collection bag is inventoried and bar-coded  Bag is then transported to the lab for testing and quality assurance  After testing and QA the bag is re-scanned and transported to gaining hospital  Gaining hospital inventories the bag and stores it until patient is ready for a transfusion

16  Autologous:  Means the donor is him/herself  Allogeneic:  Means the donor is a different person  Procedure  Plasma bag into hickman line (IV) Stem cells enter blood stream  Stem cells recognize problems in the bone marrow  Stem cells reproduce and produce platelets, white blood cells, red blood cells

17  Electronic Medical Record (EMR)  Computerized Physician Order Entry (CPOE)  Laboratory Information Systems (LIS)  Radiology Information Systems (RIS)  Picture Archiving and Communication Systems (PACS)  Barcode Medication Administration System

18  Pharmacy Barcoding  Bedside Wireless Scanning  EMAR  Patient Bracelet

19  Potential Benefits  Safety: 5 Rights  Allergy Allerts  Inventory Improvements  Record Improvements  Accreditation: JCAHO  Workflow: Drive care to the bed side Possible Drawbacks  Technology Related  Task Related  Organizational  Patient Related  Environmental

20  Videos  Overview of Hematopoeitic Cells  http://www.youtube.com/watch?v=TTnSwGhvYmI  Tranplant Case  http://www.youtube.com/watch?v=EMNZSYUr_iE  Transplant Explanation  http://www.youtube.com/watch?v=yESmOCuTLDA&feature=related  Overview of Inpatient Experience at Duke:  http://www.youtube.com/watch?v=tXJiDytvqpA  Barcode Medication Administration  http://www.youtube.com/watch?v=bhqw1_u_L8M  Barcode Medication Administration Demonstration  ttp://www.youtube.com/watch?v=V40SY0LtBnQ  Articles:  Oncology Bone Marrow Transplant  http://www.healthsystem.virginia.edu/uvahealth/peds_oncology/bonetran.cfm  Barcode Systems to Reduce Hospital Drug Errors Not Foolproof  http://www.medpagetoday.com/PublicHealthPolicy/PracticeManagement/9985  Hematopoietic Stem Cell Transplantation  http://en.wikipedia.org/wiki/Bone_marrow_transplant  Drive nursing activities to the bedside with a closed-loop system  http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=683033

21  Articles (cont):  Omni Medical Seach - Conditions and Disease: Cancer  http://www.omnimedicalsearch.com/conditions-diseases/leukemia-symptoms.html  Oncology Channel - Leukemia: Diagnosis  http://www.oncologychannel.com/leukemias/diagnosis.shtml  MedComSoft – Oncology EMR  http://www.medcomsoft.com/Oncology-EMR.aspx  Spring Charts EMR  http://www.springcharts.com/  Wikipedia - Leukemia  http://en.wikipedia.org/wiki/Leukemia  Mayo Clinic Staff. (2007). Myelofibrosis. Retrieved Jan. 30, 2009  http://www.mayoclinic.com/health/myelofibrosis/DS00886/DSECTION=treatments-and- drugs  Miller, J., & Confer, D. L. (2006). National marrow donor program. Retrieved Jan. 30, 2009  http://www.marrow.org/DONOR/When_You_re_Asked_to_Donate_fo/PDF/now_youre_a _match.pdf  MPD Research Center. (1999). MF faq. Retrieved Jan. 30, 2009  http://www.acor.org/mpd/mffaq.html#treatment_options  PubMed.gov.. (n.d.). PubMed. Retrieved Jan. 30, 2009  http://www.ncbi.nlm.nih.gov/sites/entrez


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