Report from the 13th EBMT Nurses Group International Study Day - 7 October 2021
Summary report written by Sandra Schoenfeld, member of the Nurses Group Scientific Committee.
This year’s EBMT Study Day revolved around Acute Leukemia. First, Antonia Müller, Senior Physician from the University Hospital Zurich, talked about Acute Lymphoblastic Leukemias in adults and the indications for Stem Cell Transplantation. This was followed by a presentation from Ursula Tanriver from the Children Hospital Basel, illuminating the children’s perspective on acute Leukemias and Stem Cell Transplantation. For me, these two views of acute leukemia cannot be separated. Rather, it is important that the approach and the goal is the same for both groups of patients. Patients receive high-dose chemotherapy to treat the leukemia. Children, however, are much less likely to be candidates for stem cell transplantation. Only children at high or very high risk for relapse are scheduled for stem cell transplantation. Children benefit much more from immunotherapy, i.e., activation of their own immune system by applying CAR-T therapy.
Januska De Marie-Lee, a Clinical Nurse Specialist in Lausanne, talked about the CINV, chemotherapy induced nausea and vomiting. She has developed an interprofessional working group with the goal to prevent CINV by using guideline-recommended antiemetics and by including prophylaxis lines directly within the chemotherapy protocols. Furthermore, their intention was to integrate mon-pharmacological interventions as prophylaxis. The program, that was developed to achieve the goals, includes the following training sequences: new antiemetic regimes, digital implementation of the antiemetic regimes in the chemotherapy protocol, education of the nurses and the physicians, starting with a risk assessment of the patients, treatment decision by nurses and the observation of the patient outcomes. Januska described the different sequences very well and detailed that the audience was able to follow their rationale. I was most pleased that the program has significantly increased the use of non-pharmacologic interventions, as the burden of medications is already very high for hematologic patients.
Jörg Halter, senior physician in Basel, reported on the importance of steroids in the treatment of hematological patients. For this, he first explained how steroids work and when they are specifically used in hematology. Important reasons are e. g. as supportive therapy (for fever or against nausea), acute GvHD, chronic GvHD or as part of the protocol before transplantation. Very helpful are the pictures he showed to better explain how steroids work. On a daily basis, there is often not enough time for such explanations. This leads us directly to our next presentation.
I personally enjoyed Rémy Frieden's report the most. He has a very long story behind him, including a relapse and various complications. Despite all this, he is a very upbeat patient who seems to go through life without any major psychological burden. He is studying medicine, which he decided to do only after the first HSCT. When he has clinical assessment, he is happy to see familiar faces. One thought of his has stuck in my mind: For him, the isolation ward is linked to the disease were most of the serious complications happened. He can enter all the other rooms in hospital without any special memories. For him, home is associated with being healthy and with good memories. For the moment, he enjoys his life as most as possible.
Over lunch, José Luis Pinana presented to us on vaccination and what it means for hematology patients. The speaker made the participants understand which viruses are especially threatening for hematological patients. He brought up many exciting aspects related to COVID and hematologic diseases, such as respiratory virus transmission, transmission reduction measures, COVID-19 related hematological disorders and epidemiological data about SAR-COV-2 in hematology. He showed very well how serious COVID is for hematological patients and how our patients react on the different vaccinations to COVID.
The afternoon was dominated by new therapeutic approaches in the treatment of AML and experiences in the use of CAR-T. Ulrike Bacher, senior physician in Bern, explained to the participants that therapy is increasingly moving towards targeted therapy for fit patients, even if they are already somewhat older. In this train she presented different specific protocols for the therapy of AML. I think it is important that there are also options for patients in a palliative setting to offer them a certain quality of life. Thomas Pabst, senior physician in Bern, introduces us to different CAR-T protocols in his presentation. Using a patient example, he explains very specifically how a CAR-T therapy works and which steps have to be considered. It is exciting to see how differently the various CAR-T products work, even though they all run under CAR-T therapy. He also shows very nicely why CAR-T therapy is a therapy option especially for older patients.
The last contribution of the study day introduced us to the physiotherapy program of a hospital in eastern Switzerland. It shows how well nurses and physiotherapists can work together to bring out the best for our patients. Before working out the program, a literature research was done to see what problems patients have during therapy and what they could benefit from. Based on the results, a program was created to incorporate the needs of hematology patients. Johanna von Wartburg explained to us what difficulties they had in implementing the program.
Report from the 5th EBMT Nurses Group Research Study Day - 8 October 2021
Summary report written by Annika Kisch, Chairperson NG Research Committee.
On the 8th October 2021 the 5th EBMT Nurses Group Research Study Day was arranged virtually by the NG Research Committee. The aim with this day was to inspire nurses to do and take part in nursing research and convey knowledge from various knowledgeable speakers.
The day opened with a presentation from Monica Guberti presenting her teams work on efficacy and safety of a colostrum based oral care protocol for the prevention and treatment of oral mucositis in stem cell. This was the Best Research Abstract Award winner at EBMT 2021. This original idea for research came from natural products available to patients and a review of the literature indicating potential utility in management of oral mucositis. Future research plans include a larger randomised controlled trial.
Hilda Mekelenkamp presented her experience of becoming a nurse researcher, challenges faced and opportunities. Hilda talked about balancing a clinical and academic position but also her motivating theme and the importance of the ‘patient experience’ that has guided many of her research projects. This inspiring talk highlighted how career choices are not necessarily a straightforward path, but sometimes depend on the opportunities that arise.
Session II started with an inspiring presentation by Cordula Landgraf from the Swiss Clinical Trial Organization. She explained in detail the concept and justification of Patient and Public Involvement (PPI), "nothing about us, without us", focusing especially on setting research priorities. Besides ethical considerations, patient can offer a unique perspective on clinical research and they can help with the design of recruitment and retention strategies, reducing unnecessary losses that may impact on the study validity. With some real studies, Cordula showed the importance of involving patients as partners during the whole research process.
The session continued with Bregje Verhoeven, chair of the EBMT Patient Advocacy Committee. She talked about how patients are engaged in EBMT to help save patients’ life and improve their quality of life, focusing on patient reported outcomes research. She also summarised some of the most important cancer patient organizations in Europe. She provided some real examples on how to involve patients in research with some practical tools like "The involvement matrix".
To end up this interesting session focused on patient involvement and recruitment, two senior statisticians, Liesbeth de Wreede and Dr. Nan van Geloven gave a friendly lecture on how to calculate the sample size we may need for research studies. They addressed the importance of using the right number of patients for research based on statistical, methodological but also ethical issues.
Coming to the end of the Research Day, session III was about questionnaire design, content and validation within nursing research. We had two very knowledgeable speakers conveying their knowledge and experiences. Fiona Timmins, Professor of Nursing, UCD College of Health Sciences, Dublin and Valentina Biagioli, PhD, MSN, RN, Ospedale Pediatrico Bamino Gesú, Rome, Italy. The two speakers provided a useful overview of the context of questionnaire use and great information about best practice in questionnaire development. It became very clear that a systematic approach when designing questionnaires is very important, starting with the research question and literature review and identify a theoretical framework.
During the Q&A sessions, nurses attending had the chance to ask the speakers questions, add comments and discuss issues with special interest in. In summary, this was a day rich in content about different aspects in nursing research, which hopefully has inspired nurses to do and/or take part of research. The NG Research Committee is happy to receive research proposals and support nurses in their research activities.