Implementation of a High-Dose Cytarabine Outpatient Program for Acute Myeloid Leukemia Patients in a Limited-Source Setting

Background: The management of acute myeloid leukemia (AML) patients usually requires long inpatient treatments that can affect the limited care facilities, the quality of life, and increases healthcare costs. Additionally, leukemia treating centers in developing countries face limited sources to deliver high-dose chemotherapies as inpatient treatments. Therefore, several reports have established the feasibility and safety of outpatient consolidation. We aimed to implement a high-dose cytarabine outpatient program for AML in a limited-source institution at a public center in Peru.Methods: We conducted a prospective pilot study starting in January 2019 and ending before the COVID-19 Pandemic in March 2020. Eligible patients were ≥ age 14, met inclusion criteria for inpatient induction regimens, were without active infection, and had the following: normal chest x-ray and biochemistry, complete remission after one cycle of 7+3 induction. Logistical requirements included a 3-hours distance residence near the treatment center, caregiver support, trained nursing staff, infusion room capacity, and participation in follow-up. Patients received prophylactic antimicrobials such as oral levofloxacin, fluconazole, and acyclovir and were admitted to the hospital for predetermined complications of therapy (fever, G3-4 toxicity, febrile neutropenia, bleeding or refractory thrombocytopenia). Risk stratification was based on conventional cytogenetics and multiplex PCR using Leukemia.net criteria. Results: Forty-two patients were included during the study period. The median age was 38 years (16-63) and Female/Male ratio 4:3. According to Leukemia.net, 24% were classified as high, 50% intermediate and 26% as low risk group. Including FLT3 mutations in 26% of cases. Twenty-two and 20 subjects received 1-2 and 3-4 cycles of ambulatory HiDAC, respectively. About one-third of cases had emergency admissions during consolidation and 74% complete at least 3 cycles of cytarabine. Only 4 patients underwent sibling-donor allo-SCT. Sixty-four percent experienced relapses, and at 2 years follow-up only 21 subjects were alive. Median OS was 15 months, a better survival was shown among patients who received 3-4 cycles of ambulatory HiDAC (2-year OS 18 vs 23%, p=0.031). Conclusion: Our pilot study shows the feasibility to deliver HiDAC as outpatient consolidation in selected AML cases in a limited setting. Additionally, a high rate of relapses and poor survival was noted in our cohort that requires further consideration. Disclosures No relevant conflicts of interest to declare.

Knack et al. [2021] Preprint Faking paper

Self-report psychopathy scales are increasingly used in research and practice despite criticisms that they may be susceptible to response distortion and bias. We assessed the utility of including the Virtuous Responding (VR) and Deviant Responding (DR) validity scales from the Psychopathic Personality Inventory-Revised (PPI-R) for identifying underreporting and overreporting, respectively, on both the full and short-form versions of the Self-Report Psychopathy scale (SRP 4 and SRP-SF) in a pre/post experimental design. Using a sample of 384 male community members and a clinical comparison group of 99 males from a forensic outpatient program, we demonstrated that SRP scores were more susceptible to overreporting than underreporting, and that overreporting significantly and negatively affected convergent validity. Finally, baseline psychopathy scores were unrelated to successful response distortion (i.e., changing scores in correct direction while remaining undetected by the validity scales). It is recommended that assessments using self-report psychopathy scales consider including validity indices to detect response distortion. In doing so, it will be important to consider that general impression management may be conceptually distinct from specific forms of response distortion, such as the intentional amplification or minimization of psychopathic traits.

Comparing ERAS-Outpatient Versus Standard-Inpatient Hip and Knee Replacements: A Mixed Methods Study Exploring the Experience of Patients Who Underwent Both

BACKGROUND Optimizing patients’ total joint arthroplasty (TJA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience by exploring the patient experience of ERAS-outpatient programs compared to standard-inpatient programs, identifying elements that could optimize patients’ experience and determining how it is associated with patient characteristics, clinical outcomes and care components satisfaction. METHODS We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient TJA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients’ characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together. RESULTS The theme Support makes the difference—for better and for worse was identified in both programs and throughout the entire TJA care episode. Patients identified 3 main themes distinguishing the ERAS-outpatient program from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Providing more preoperative information and postoperative rehabilitation sessions (if needed) and ensuring better coherence of care between orthopaedic and homecare teams could further optimize the patient experience. Weak to moderate positive and statistically significant correlations were found between patients’ TJA experience and satisfaction with pain management, hospital stay, postoperative recovery, homecare and overall results (rs = + [0.36–0.66], p-value < 0.01) CONCLUSION Whatever the perioperative program, the key to improving patients’ TJA experience lies in improving support throughout the care episode. Compared to standard-inpatient care, the ERAS-outpatient program improves patients’ experience by providing dedicated support in post-operative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients’ TJA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams.