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In response to the French hospital system crisis and the challenges faced by the heads of departments, we have undertaken an initiative to create a community of heads of haematology departments willing to assist each other. Our inaugural seminar, held in January 2023, established the foundational "core" group of heads of department. Throughout 2023, this emerging community has prospered, offering sustained support to peers. In January 2024, we broadened our community to include other heads of departments, following a second seminar gathering 36 participants. During this event, we took the time to exchange thoughts and reflect on our missions. Building on the experience of guest speakers and employing methods of co-development and co-construction in plenary sessions, small-group workshops, and social gathering, we were able to discover and experience the collective intelligence, creativity, strength, and support stemming from such a group. This peer community of heads of departments stands as a powerful tool for management support, whereby personal experiences nourish and enrich the experience of others. We hope that our initiative will inspire heads of departments from other specialties so that, together, we can better work towards our missions as heads of departments and collaborate on rebuilding the hospital "from the bottom up"., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: This article describes the implementation and evaluation of pharmacogenomic testing within the hematology/oncology ambulatory care clinic at the William S. Middleton Memorial Veterans Hospital in Madison, WI., Summary: The Pharmacogenomic Testing for Veterans (PHASER) program provides preemptive pharmacogenomic testing for veterans nationally. Program implementation at the Madison Veterans Affairs site began in the hematology/oncology clinic with the goal of integrating the offer for pharmacogenomic testing, testing completion, and review of the results by the hematology/oncology clinical pharmacist practitioner (CPP) into current workflows to create a sustainable process for PHASER. The hematology/oncology CPP designed workflows outlining how testing would be offered to patients, how results would be reported and to whom, and how documentation would occur in the electronic medical record. Veterans are offered preemptive PHASER testing, before needing therapy requiring pharmacogenomic results. Exceptions to pharmacogenomic testing were patients with a history of liver or allogeneic hematopoietic stem cell transplantation., Conclusion: This article provides a summary of the role of the hematology/oncology CPP in the implementation of a pharmacogenomics service and the impact on medication management in a hematology/oncology clinic., (Published by Oxford University Press on behalf of the American Society of Health-System Pharmacists 2024.)

Background: Advanced practice nursing was introduced in France in 2018, in response to health needs. The first advanced practice nurses were graduated since 2019 and were trained in one among four medical areas including oncology and onco-hematology. The purpose of this article is to make an early assessment of the development of the profession of oncology Advanced Practice Nurse in France., Method: An exploratory study was conducted. A sample of 44 onco-hematology IPA graduated in 2019 and 2020 was recruited from June 2021 to end of July 2021. The 44 participants completed a questionnaire, by phone interviews or self-administered., Results and Conclusion: The distribution of the 44 participants concerns 12 of the 13 regions of metropolitan France. This profession shows an employability for 86% of the first graduates. These professionals practice in health care institutions and rather in oncology, 71% in the framework of an organizational protocol established with the oncologist. They appear to be well accepted by patients and oncology teams. Further studies on performance and quality indicators will make it possible to evaluate the added value of the oncology Advanced Practice Nurses in the cancer patient's pathway., (Copyright © 2022 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Little is known about the impact of coronavirus disease 2019 (COVID-19) on healthcare professional emotional health in pediatric hematology/oncology. Primary objective was to describe anxiety, depression, positive affect, and perceived stress among pediatric hematology/oncology healthcare professionals following a COVID-19 outbreak. Secondary objectives were to compare these outcomes based on contact with a positive person, and to identify risk factors for worse outcomes., Materials and Methods: We included 272 healthcare professionals working with pediatric hematology/oncology patients. We determined whether respondents had direct or indirect contact with a COVID-19-positive individual and then measured outcomes using the Patient-Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, and positive affect measures, and the Perceived Stress Scale., Results: Among eligible respondents, 205 agreed to participate (response rate 75%). Sixty-nine (33.7%) had contact with a COVID-19-positive person. PROMIS anxiety, depression, and positive affect scores were similar to the general United States population. Those who had contact with a COVID-19-positive individual did not have significantly different outcomes. In multiple regression, non-physicians had significantly increased anxiety (nurses: p = 0.013), depression (nurses: p = 0.002, pharmacists: p = 0.038, and other profession: p = 0.021), and perceived stress (nurses: p = 0.002 and other profession: p = 0.011) when compared to physicians., Conclusions: Pediatric hematology/oncology healthcare professionals had similar levels of anxiety, depression, and positive affect as the general population. Contact with a COVID-19-positive individual was not significantly associated with outcomes. Non-physician healthcare professionals had more anxiety, depression, and perceived stress when compared to physicians. These findings may help to develop programs to support healthcare professional resilience., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare disease characterized by the presence of anti-ADAMTS13 autoantibodies. Achieving accurate information on incidence and customary disease management is important to provide appropriate diagnostic and therapeutic resources. The aim of this study was to determine the incidence and outcomes of iTTP in Spain., Study Design and Methods: A cross-sectional survey was carried out among Spanish hospitals, focused on iTTP patients ≥16 years old attended between 2015 and 2017, and those at follow-up before that interval. Incidence, prevalence, mortality, refractoriness, exacerbations, treatment complications, relapses, and sequelae were estimated., Results: Forty-two hospitals covering roughly 20 million inhabitants answered the survey and reported 203 episodes (138 newly-diagnosed and 65 relapses), of which 193 (95.1%) were treated. Incidence was 2.67 (95% CI 1.90-3.45) patients per million inhabitants per year and prevalence 21.44 (95% CI% 19.10-23.73) patients per million inhabitants. At diagnosis, ADAMTS13 activity and anti-ADAMTS13 autoantibody were measured in 97% and 84.3% of reported episodes, respectively. Fifteen patients (7.4%) died as a direct consequence of iTTP, 6 of them before receiving any iTTP-specific treatment. Thirty-one (16.1%) of the 193 treated episodes were refractory to plasma exchange and corticosteroids, and 51 (26.4%) suffered at least one exacerbation., Conclusion: iTTP incidence and prevalence were somewhat higher than those documented in neighboring countries. Together with data on treatments and outcomes, this information will allow us to better estimate what is needed to improve diagnosis and prognosis of iTTP patients in Spain., (© 2021 Wiley Periodicals LLC.)

Importance: Measurable residual disease (MRD) is widely used as a therapy-stratification factor for acute myeloid leukemia (AML), but the association of dynamic MRD with postremission treatment (PRT) in patients with intermediate-risk AML (IR-AML) has not been well investigated., Objective: To investigate PRT choices based on dynamic MRD in patients with IR-AML., Design, Setting, and Participants: This cohort study examined 549 younger patients with de novo IR-AML in the South China Hematology Alliance database during the period from January 1, 2012, to June 30, 2016, including 154 who received chemotherapy, 116 who received an autologous stem cell transplant (auto-SCT), and 279 who received an allogeneic SCT (allo-SCT). Subgroup analyses were performed according to dynamic MRD after the first, second, and third courses of chemotherapy. The end point of the last follow-up was August 31, 2020. Statistical analysis was performed from December 1, 2019, to September 30, 2020., Exposures: Receipt of chemotherapy, auto-SCT, or allo-SCT., Main Outcomes and Measures: The primary end points were 5-year cumulative incidence of relapse and leukemia-free survival., Results: Subgroup analyses were performed for 549 participants (314 male participants [57.2%]; median age, 37 years [range, 14-60 years]) according to the dynamics of MRD after 1, 2, or 3 courses of chemotherapy. Comparable cumulative incidences of relapse, leukemia-free survival, and overall survival were observed among participants who had no MRD after 1, 2, or 3 courses of chemotherapy. Participants who underwent chemotherapy and those who underwent auto-SCT had better graft-vs-host disease-free, relapse-free survival (GRFS) than those who underwent allo-SCT (chemotherapy: hazard ratio [HR], 0.35 [95% CI, 0.14-0.90]; P = .03; auto-SCT: HR, 0.07 [95% CI, 0.01-0.58]; P = .01). Among participants with MRD after 1 course of chemotherapy but no MRD after 2 or 3 courses, those who underwent auto-SCT and allo-SCT showed lower cumulative incidence of relapse (auto-SCT: HR, 0.25 [95% CI, 0.08-0.78]; P = .01; allo-SCT: HR, 0.08 [95% CI, 0.02-0.24]; P < .001), better leukemia-free survival (auto-SCT: HR, 0.26 [95% CI, 0.10-0.64]; P = .004; allo-SCT: HR, 0.21 [95% CI, 0.09-0.46]; P < .001), and overall survival (auto-SCT: HR, 0.22 [95% CI, 0.08-0.64]; P = .005; allo-SCT: HR, 0.25 [95% CI, 0.11-0.59]; P = .001) vs chemotherapy. In addition, auto-SCT showed better GRFS than allo-SCT (HR, 0.45 [95% CI, 0.21-0.98]; P = .04) in this group. Among participants with MRD after 1 or 2 courses of chemotherapy but no MRD after 3 courses, allo-SCT had superior cumulative incidence of relapse (HR, 0.10 [95% CI, 0.06-0.94]; P = .04) and leukemia-free survival (HR, 0.18 [95% CI, 0.05-0.68]; P = .01) compared with chemotherapy, but no advantageous cumulative incidence of relapse (HR, 0.15 [95% CI, 0.02-1.42]; P = .10) and leukemia-free survival (HR, 0.23 [95% CI, 0.05-1.08]; P = .06) compared with auto-SCT. Among participants with MRD after 3 courses of chemotherapy, allo-SCT had superior cumulative incidences of relapse, leukemia-free survival, and overall survival compared with chemotherapy (relapse: HR, 0.16 [95% CI, 0.08-0.33]; P < .001; leukemia-free survival: HR, 0.19 [95% CI, 0.10-0.35]; P < .001; overall survival: HR, 0.29 [95% CI, 0.15-0.55]; P < .001) and auto-SCT (relapse: HR, 0.25 [95% CI, 0.12-0.53]; P < .001; leukemia-free survival: HR, 0.35 [95% CI, 0.18-0.73]; P = .004; overall survival: HR, 0.54 [95% CI, 0.26-0.94]; P = .04). Among participants with recurrent MRD, allo-SCT was also associated with advantageous cumulative incidence of relapse, leukemia-free survival, and overall survival compared with chemotherapy (relapse: HR, 0.12 [95% CI, 0.04-0.33]; P < .001; leukemia-free survival: HR, 0.24 [95% CI, 0.10-0.56]; P = .001; overall survival: HR, 0.31 [95% CI, 0.13-0.75]; P = .01) and auto-SCT (relapse: HR, 0.28 [95% CI, 0.09-0.81]; P = .02; leukemia-free survival: HR, 0.30 [95% CI, 0.12-0.76]; P = .01; overall survival: HR, 0.26 [95% CI, 0.10-0.70]; P = .007)., Conclusions and Relevance: This study suggests that clinical decisions based on dynamic MRD might be associated with improved therapy stratification and optimized PRT for patients with IR-AML. Prospective multicenter trials are needed to further validate these findings.

The worldwide spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated infectious coronavirus disease (COVID-19) has posed a unique challenge to medical staff, patients and their families. Patients with cancer, particularly those with haematologic malignancies, have been identified to be at high risk to develop severe COVID-19. Since publication of our previous guideline on evidence-based management of COVID-19 in patients with cancer, research efforts have continued and new relevant data has come to light, maybe most importantly in the field of vaccination studies. Therefore, an update of our guideline on several clinically important topics is warranted. Here, we provide a concise update of evidence-based recommendations for rapid diagnostics, viral shedding, vaccination and therapy of COVID-19 in patients with cancer. This guideline update was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology by critically reviewing the currently available data on these topics applying evidence-based medicine criteria., Competing Interests: Conflict of Interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: N.G. reports receiving personal fees from MSD, Roche, Pfizer; grants from BMS, Karyopharm, outside the submitted work. SCM reports grants from University of Cologne (KoelnFortune), DMyKG, DZIF, personal fees from Octapharma, outside the submitted work. YK reports personal fees from GILEAD Sciences, grants, personal fees and other from MSD SHARP & DOHME, outside the submitted work. GB reports grants from The German Federal Ministry of Research and Education, The German Federal Ministry of Health, personal fees from Jazz Pharmaceuticals, MSD, NewConceptOncology, outside the submitted work. CL reports non-financial support from Jazz Pharmaceuticals, Neovii, outside the submitted work. MH reports personal fees from Amgen, Janssen, Celgene, Sanofi, Takeda, outside the submitted work. MBB is the PI of the COVACTA Trial at LMU. OAC is supported by the German Federal Ministry of Research and Education, is funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy - CECAD, EXC 2030 - 390661388 and has received research grants from Actelion, Amplyx, Astellas, Basilea, Cidara, Da Volterra, F2G, Gilead, Janssen, Medicines Company, Melinta, Merck/MSD, Octapharma, Pfizer, Scynexis, is a consultant to Actelion, Allecra, Amplyx, Astellas, Basilea, Biosys, Cidara, Da Volterra, Entasis, F2G, Gilead, IQVIA, Matinas, MedPace, Menarini, Merck/MSD, Mylan, Nabriva, Noxxon, Octapharma, Paratek, Pfizer, PSI, Roche Diagnostics, Scynexis, and Shionogi, and received lecture honoraria from Astellas, Basilea, Gilead, Grupo Biotoscana, Merck/MSD and Pfizer. PK has received non-financial scientific grants from Miltenyi Biotec GmbH, Bergisch Gladbach, Germany, and the Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany, and received lecture honoraria from or has been advisor to Akademie für Infektionsmedizin e.V., Ambu GmbH, Astellas Pharma, Gilead Sciences GPR Academy Ruesselsheim, MSD Sharp & Dohme GmbH, Noxxon N.V., and University Hospital, LMU Munich, outside the submitted work. ES reports lecture honoraria from Gilead, outside the submitted work. M.v.L.T. reports personal fees from Celgene, Gilead, Chugai, Janssen, Novartis, Amgen, Takeda, BMS, Medac, Oncopeptides, Merck, CDDF, Pfizer, 4DPharma, Shionogi; grants from BMBF, Deutsche Jose Carreras Leukämie-Stiftung, IZKF Jena, DFG, Novartis, Gilead, Deutsche Krebshilfe, Celgene, outside the submitted work. RS, MR, MK, MS, HW, HHH, BW have nothing to disclose., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The article aims to discuss the consequences of social distancing measures on the availability of blood and organization of blood therapy services at the beginning of the Covid-19 pandemic in Brazil. News published in April 2020 on the websites of the country's state Blood Service Networks were consulted and organized in an Excel spreadsheet, presented in summary charts, and descriptions of results were prepared. A critical situation of blood supply, especially of some blood types, has been observed in many states. This situation is influenced by the circulation of the new coronavirus. The adoption of social distancing measures associated with unchanged transfusion demands for outpatient, urgency and emergency care required the implementation of strategies and actions for the reorganization of the services. Protection measures were incorporated, flows were changed and new routines were established. This study shows the extent to which the epidemiological situation of Covid-19 and the necessary measures for its control influenced the stocks and availability of blood. Changes in the organization of blood therapy services were fundamental in order to ensure protection, mitigate the risks of spreading the virus, and ensure the blood supply to meet the needs of the health system.

Introduction: Patients with hematological malignancies have less access to palliative care than other cancer patients, and benefit from it later in the course of their disease, though symptom burden is just as heavy., Methods: We created a specialized outpatient palliative care consultation in the hematology department to improve the quality of patient management and enhance cooperation with hematologists., Results: We found that though patient characteristics and survival were extremely variable, they all had in common a need for symptom management and care coordination. As a result of the consultation, hematology teams called upon a specialized palliative care multidisciplinary team more often to meet patients hospitalized within their departments, and more patients with hematological malignancies hemopathies were hospitalized in palliative care units., Discussion: We describe the benefits that can be anticipated when collaboration increases between hematology and palliative care, including early on in the course of disease. It is now up to policy-makers to establish priorities regarding the allocation of health resources, in particular regarding end-of-life. This requires identifying patient needs, optimizing patient access to specialized palliative care, and improving the pertinence of palliative care interventions as they cannot be generalized., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Italy is the second exposed country worldwide, after China, and Lombardia is the most affected region in Italy, with more than half of the national cases, with 13% of whom being healthcare professionals. The Clinica Pediatrica Università degli Studi di Milano Bicocca is a general pediatric and hematology oncology and transplant center embedded within the designated COVID-19 general Hospital San Gerardo in Monza, located in Lombardia, Italy. Preventive and control measures specifically undertaken to cope with the emergency within hemato-oncology, transplant, and outpatient unit in the pediatric department have been described. Preliminary COVID-19 experiences with the first Italian pediatric hemato-oncology patients are reported. The few available data regarding pediatrics and specifically hemato-oncological patients are discussed. The purpose of this report is to share pediatric hemato-oncology issues encountered in the first few weeks of the COVID-19 outbreak in Italy and to alert healthcare professionals worldwide to be prepared accordingly.

New York City has been at the epicenter of the coronavirus disease 2019 (COVID-19) pandemic that has already infected over a million people and resulted in more than 70,000 deaths as of early May 2020 in the United States alone. This rapid and enormous influx of patients into the health care system has had profound effects on all aspects of health care, including the care of patients with cancer. In this report, the authors highlight the transformation they underwent within the Division of Hematology and Medical Oncology as they prepared for the COVID-19 crisis in New York City. Under stressful and uncertain conditions, some of the many changes they enacted within their division included developing a regular line of communication among division leaders to ensure the development and implementation of a restructuring strategy, completely reconfiguring the inpatient and outpatient units, rapidly developing the ability to perform telemedicine video visits, and creating new COVID-rule-out and COVID-positive clinics for their patients. These changes allowed them to manage the storm while minimizing the disruption of important continuity of care to their patients with cancer. The authors hope that their experiences will be helpful to other oncology practices about to experience their own individual COVID-19 crises., (© 2020 American Cancer Society.)

Background: While institution-sponsored wellness programs may be effective, little is known about their availability and utilization in pediatric subspecialists, and about programs physicians wish were available., Methods: A survey of perceptions about, and availability and utilization of institutional wellness activities, was distributed electronically to pediatric subspecialists nationally. Bivariate analyses were performed using χ 2 tests or independent t tests. Multivariable logistic regression models for categories of institution-sponsored programming as a function of potential predictors of program utilization were performed. Qualitative content analysis was performed for free-text survey answers., Results: Approximately 60% of respondents participated in institution-sponsored wellness opportunities. Debriefs, Schwartz Center Rounds, mental health services, and team building events were the most available institution-sponsored wellness activities, whereas debriefs, team building, Schwartz Center Rounds, and pet therapy were most frequently utilized. Respondents desired greater social/emotional support, improved leadership, enhanced organizational support, and modifications to the physical work environment, with no significant differences across subspecialties for "wish list" items., Conclusions: Physician wellness requires more than a "one-size-fits-all" initiative. Our data highlight the importance of encouraging and normalizing self-care practices, and of listening to what physicians articulate about their needs. Pre-implementation needs assessment allows a "bottom-up" approach where physician voices can be heard.

Background: Invasive fungal diseases remain a major cause of morbidity and mortality in cancer patients undergoing intensive cytotoxic therapy. The choice of the most appropriate antifungal treatment (AFT) depends on the fungal species suspected or identified, the patient's risk factors (eg length and depth of granulocytopenia) and the expected side effects., Objectives: Since the last edition of recommendations for 'Treatment of invasive fungal infections in cancer patients' of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) in 2013, treatment strategies were gradually moving away from solely empirical therapy of presumed or possible invasive fungal diseases (IFDs) towards pre-emptive therapy of probable IFD., Methods: The guideline was prepared by German clinical experts for infections in cancer patients in a stepwise consensus process. MEDLINE was systematically searched for English-language publications from January 1975 up to September 2019 using the key terms such as 'invasive fungal infection' and/or 'invasive fungal disease' and at least one of the following: antifungal agents, cancer, haematological malignancy, antifungal therapy, neutropenia, granulocytopenia, mycoses, aspergillosis, candidosis and mucormycosis., Results: AFT of IFDs in cancer patients may include not only antifungal agents but also non-pharmacologic treatment. In addition, the armamentarium of antifungals for treatment of IFDs has been broadened (eg licensing of isavuconazole). Additional antifungals are currently under investigation or in clinical trials., Conclusions: Here, updated recommendations for the treatment of proven or probable IFDs are given. All recommendations including the levels of evidence are summarised in tables to give the reader rapid access to key information., (© 2020 The Authors. Mycoses published by Blackwell Verlag GmbH.)

Hospitals within the UK are paid for services provided by 'Payment-by-Results'. In a system that rewards productivity, effective collaboration between coders and clinicians is crucial. However, clinical coding is frequently error prone and has been shown to impact negatively on departmental revenue. Our aim was to increase the median number of diagnostic codes per sickle cell inpatient admission at Guy's Hospital by 3. Three interventions were implemented using the Plan, Do, Study, Act structure. This consisted of student doctors searching for diagnoses along with comorbidities that clinical coders had missed, distributing laminated cards with common clinical codes and implementing discharge pro formas. Through auditing, student doctors generated a total of £58 813 over 16 weeks. We observed an increase in the median number of codes by ≥2 additional codes. We improved coding accuracy where we identified errors in an average of 32.5% of admissions each month, improving the quality of patient documentation. We have demonstrated student doctor involvement in clinical coding as a potentially sustainable means of achieving accurate payment for services provided; increasing departmental revenue. We are the first to report the efficacy of student-coder collaboration in improving the accuracy of clinical coding., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Gaucher disease (GD) is a rare genetic lysosomal storage disorder caused by a beta-glucocerebrosidase deficiency and responsible for a lysosomal storage disorder. GD is characterized by haematological, visceral and bone involvements. The aim of this study was to describe the diagnostic journey of type 1 GD patients as well as the role of the internist., Methods: A retrospective multicentric study involving type 1 GD patients has been conducted in 16 centers, between 2009 and 2011., Results: Fifty-five type 1 GD patients were included, under the care of an internist or an haematologist. They were originally hospitalized in 8 different specialized units. Diagnosis was established by bone-marrow aspiration in 22 patients (40%), by enzymatic assay of glucocerebrosidase activity in 15 patients (27%), and by bone-marrow biopsy in 9 patients (16%). The use of enzymatic assay became more frequent after 1990. The delay between first hospitalization due to GD symptoms and definitive diagnosis was less than one year for 38 patients. Patients with suspected GD were mainly referred to an internist physician., Conclusion: GD seems to be better recognized and quickly diagnosed since 1990 in spite of the multiplicity of journeys. The role of the internist seems important., (Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Cancer and blood disorders in children are rare. The progressive improvement in survival over the last decades largely relies on the development of international academic clinical trials that gather the sufficient number of patients globally to elaborate solid conclusions and drive changes in clinical practice. The participation of Spain into large international academic trials has traditionally lagged behind of other European countries, mainly due to the burden of administrative tasks to open new studies, lack of financial support and limited research infrastructure in our hospitals., Methods: The objective of ECLIM-SEHOP platform (Ensayos Clínicos Internacionales Multicéntricos-SEHOP) is to overcome these difficulties and position Spain among the European countries leading the advances in cancer and blood disorders, facilitate the access of our patients to novel diagnostic and therapeutic approaches and, most importantly, continue to improve survival and reducing long-term sequelae. ECLIM-SEHOP provides to the Spanish clinical investigators with the necessary infrastructural support to open and implement academic clinical trials and registries., Results: In less than 3 years from its inception, the platform has provided support to 20 clinical trials and 8 observational studies, including 8 trials and 4 observational studies where the platform performs all trial-related tasks (integral support: trial setup, monitoring, etc.) with more than 150 patients recruited since 2017 to these studies. In this manuscript, we provide baseline metrics for academic clinical trial performance that permit future comparisons., Conclusions: ECLIM-SEHOP facilitates Spanish children and adolescents diagnosed with cancer and blood disorders to access state-of-the-art diagnostic and therapeutic strategies.

Competing Interests: On behalf of all co-authors, the first author declares no conflicts of interest regarding this guideline. All authors contributed equally in the creation of this guideline. The first author coordinated the working group.

In contrast to overanticoagulation, evidence on risk factors and outcome of subtherapeutic oral anticoagulation (OAC) with vitamin K-antagonists (VKAs) under optimum care is limited. We investigated the clinical phenotype, anticoagulation control, and clinical outcome of 760 VKA patients who received OAC therapy by a specialized coagulation service in the thrombEVAL study (NCT01809015). During 281,934 treatment days, 278 patients experience ≥ 1 episode of subtherapeutic anticoagulation control and had lower quality of OAC therapy compared to 482 patients without subtherapeutic international normalized ratio: 67.6%, interquartile range (IQR) 54.9%/76.8% versus 81.0%, IQR 68.5%/90.4%; p  < 0.001. In Cox regression analysis with adjustment for age, sex, cardiovascular risk factors, comorbidities, and treatment characteristics, female sex (hazard ratio [HR], 1.4, 95% confidence interval [CI], 1.0/1.9; p  = 0.03), diabetes (HR, 1.4, 95% CI, 1.0/2.0; p  = 0.03), and living alone (HR, 1.5, 95% CI, 1.1/2.1; p  = 0.009) were independent risk factors of subtherapeutic anticoagulation control, whereas atrial fibrillation (HR, 0.6, 95% CI, 0.4/0.9; p  = 0.02) and self-management of OAC therapy (HR, 0.2, 95% CI, 0.1/0.6; p  = 0.001) were protective. In addition, active smoking (HR, 1.7, 95% CI, 0.9/3.0; p  = 0.086) and living in a nursing home (HR, 1.6, 95% CI, 0.8/3.2; p  = 0.15) indicated an elevated risk at the borderline of statistical significance. For the prediction of recurrent subtherapeutic anticoagulation, living alone was the only independent risk factor (HR, 1.7, 95% CI, 1.1/2.5; p  = 0.013). The present study suggests that women, diabetics, and patients living alone experience an increased risk of low-quality VKA therapy and might potentially benefit from treatment with direct-acting anticoagulants., Competing Interests: P.S.W. has received research funding from Federal Ministry of Education and Research, Germany (BMBF 01EO1003); Boehringer Ingelheim; Philips Medical Systems; Sanofi-Aventis; Bayer Vital; Daiichi Sankyo Europe; Institute for the Modernization of Economic Base and Employment Structures; Portavita; Federal Institute for Occupational Safety and Health; Health Economy Initiative, Ministry of Health, and Ministry of Economics, Rhineland-Palatinate; Federal Ministry of Education and Research; Federal Ministry of Health, Rhineland-Palatinate; and Mainz Heart Foundation, and has also received honoraria for lectures or consulting from Boehringer Ingelheim and Public Health, Heinrich-Heine-University Dusseldorf. The remaining authors declare no conflict of interest., (Georg Thieme Verlag KG Stuttgart · New York.)

This commentary deals with the need of an early integration between hematologist and palliative care specialists as well as pain therapists as a routine basis in order to ensure the best management of patients affected by acute leukemia from the onset of the disease and in the stages of causal therapy. This strategy could limit the burden of painful symptoms and, in addition, avoid unnecessary suffering to patients, ensuring the best conditions for optimal outcome of these patients with extremely high clinical complexity and symptomatology who receive intensive treatments or who are managed with novel treatment approaches.

Background and Aim of the Work: Empowerment is very important to keep high staff motivation and attention on patient safety. The aim of this study was to produce a "Charter of Rights-Duties for Patients' Empowerment", by developing empowerment both of patients and professionals of the Hematology and Bone marrow transplant center Unit of Parma University Hospital., Methods: The professionals were actively involved in meetings to complete the Italian version of the SESM Empowerment Questionnaire, draft the Charter and produce some communication tools to be implemented in the Unit., Results: All professionals had participated to the research. The level of empowerment in the unit, both for doctors and non-medical staff, is very high. This result, the Charter and the others communication tools are now known and shared by all., Conclusions: Stimulating empowerment seems to be a winning choice. It is important to involve professionals right away in the process because a high level of staff empowerment can generate a good field for high degree of patients' empowerment, that can increase patient safety and reduce the risk of dangerous health choices. This approach aims to increase patient safety through the collaboration of patients, volunteer associations and professionals. Communication programs must include the development of empowerment: it motivates citizens to engage and the literacy enables them to make informed and reasoned choices. General Management is now evaluating how to realize the program in each ward, discussing the importance of carefully conceptualizing this approach for the design of health interventions.

Multidisciplinary care is believed to provide benefits to patients with cancer. Tumor board conferences as well aspalliative care or psycho-oncological services have not only become common in oncology, but also in hematology clinics dedicated to the treatment of hematological cancers. Malignant hematological diseases are highly prevalent among older persons. Demographic changes in many countries worldwide are prompting the integration of geriatric principles, methodology, and expertise into existing procedures and infrastructure of multidisciplinary care in hematology clinics. Achieving this goal requires the close collaboration or even incorporation of multiple new professions in the hematology clinic in order to meet the needs of older patients with hematological malignancies who also have comorbidities and functional impairments. We here review the rationale, current evidence, and practical approaches of integrating geriatric oncology into multidisciplinary care in the hematology clinic., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To describe key activities performed by a newly deployed clinical pharmacist in an outpatient pediatric hematology, oncology, transplant clinic. To demonstrate how utilization of the pharmacist evolved, as indicated by changes in frequency of key activities, during the first four months of integration., Design: Clinical pharmacists were made consistently available in an outpatient clinic serving hematology, oncology, transplant patients and their families. A list of key activities, based on provincial clinical pharmacist standards, was created to provide a framework for the role. Over a four-month period, the pharmacists recorded the number of times activities were performed., Results: Over the data collection period, obtaining best possible medication histories (203), providing medication counseling (150), and creating adherence aids (144) were the most commonly performed activities. In comparison to the first month, key activities increased by 73% in the fourth month. Notably, providing recommendations for drug therapy (156%), assessments of adherence (122%), and best possible medication history collection (88%) increased considerably., Conclusions: The integration of a pharmacist into an outpatient pediatric hematology, oncology, transplant clinic resulted in the provision of several key clinical pharmacy services. As the role developed, activities were performed more frequently, demonstrating growth in utilization of the pharmacist.

Purpose: Effective, timely and evidence-based nutritional management is important in patients receiving autologous haematopoietic stem cell transplant (HSCT) to prevent the negative consequences of developing malnutrition. This study describes a robust process for development and implementation of an evidence-based nutrition care pathway for HSCT patients in a tertiary cancer centre., Methods: A comprehensive review of the literature was completed to identify relevant articles and evidence-based guidelines to inform the development of the pathway. Evidence from the literature review was assessed and utilised to underpin the development of pathway. The pathway was implemented in the haematology service in collaboration with the multidisciplinary haematology team. Dietetic resource requirements for implementation of the pathway were determined and clinician compliance with the care pathway was assessed to evaluate the feasibility of the pathway in supporting delivery of evidence-based care., Results: The evidence-based care pathway was implemented in 2011 with the final care pathway based on recommendations from five international evidence-based guidelines. Overall clinician compliance with delivering nutrition management described in the care pathway was high at 84%. The dietetic resource requirement for implementation of the care pathway was 300 to 400 h per 100 patients depending on conditioning chemotherapy regimen., Conclusion: A robust process for developing and implementing a nutrition care pathway for HSCT patients was effective in supporting the delivery of evidence-based nutritional management for patients treated with HSCT.

Over the next decade, there is a predicted shortage of nonmalignant hematologist to maintain the workforce in the United States. To address this, the American Society of Hematology described the creation of the healthcare systems-based hematologist (SBH). The role of SBH has the potential to provide high-value, cost-conscious care to the healthcare system. In 2011, an Anticoagulation and Bleeding Management Medical Directorship position for a SBH was created at our healthcare system. We described our 6-year experience as SBH at a 750-bed tertiary academic medical center to improve clinical outcomes while reducing costs. Via four different initiatives, we were able to provide high-value, cost-conscious care as SBH by reducing cost of heparin-induced thrombocytopenia management, optimizing blood product utilization using goal-directed algorithms, reducing inappropriate thrombophilia testing and improving inferior vena cava filter retrieval rates. To ensure continuing success as a SBH, business plans need to include education, enforcement, monitoring, feedback, validation of safety and outcomes and a shared vision among leadership.

Docimology has allowed the development of evaluative processes assuring valid, reliable and objective assessments. It was adopted within the faculty of Medicine of Tunis since  2007. The aim of this study was to analyze the docimological survey results of hematology-oncology exams, to evaluate the interest of this analysis in the elaboration of exams and the construction of an item bank, and propose some corrections  in order to improve assessment.     Methods :We have analyzed the hematology-oncology exams of SCMS1 (Second cycle of Medical Studies 1) from educational year 2008-2009 to 2013-2014. The data input was already done with Excel. The test includes 4 disciplines (Hematology, Oncology, Genetics and the Anatomic Pathology). We have calculated docimological parameters allowing global analysis, by discipline and by item. Results : A total of 3281 papers and 1004 questions were analyzed. The average success rate per year was 91,54% ± 7,12. The highest average success rate was found in hematology (80,51% ± 10,18). The lowest rate was found in the anatomic pathology (51,61% ± 23,76). The average rate of students succeeding the test without having average note in hematology was 5,36%. It was 42,29% in the anatomic pathology. Average difficulty index was 0,57 ± 0,05. Items analysis showed that 38,04% were easy and 19,02% were difficult. Average discrimination index was 0,25 ± 0,02. Discrimination was very good in 20,51% of items and good in 17,13%. Useless and bad discrimination items were about 40,53%. The average of Cronbach Alpha coefficient was 0,84 ± 0,03, showing a good internal-consistency. Conclusion :This study allowed an objective evaluation of "contributive disciplines" in multidisciplinary evaluation and showed the interest of integrating questions. Question analysis with teachers would be important to reevaluate and improve these items.

Purpose of Review: This review aims to outline the general principles of how to build a cardio-onco-hematology clinic, acknowledging that there are diverse practices ranging from private community settings to academic hospitals and each practice environment has to build its own program., Recent Findings: The refinement of regimens and introduction of molecularly directed therapies have substantially increased survival rates for patients with cancer. In fact, a number of previous imminently fatal malignant disease processes have been turned into chronic diseases, such that patients now live with certain incurable cancers as they do, for instance, with rheumatoid arthritis. Improved cure rates and longer survivals have raised side effects of cancer treatments to a completely new level of significance. Cardiovascular toxicities are of particular concern given their impact on morbidity and mortality. In most extreme cases, patients might be cured from cancer but remain debilitated or die prematurely because of cardiovascular disease. Furthermore, not an insignificant proportion of cancer patients start cancer therapy with cardiovascular risk factors and diseases at baseline. With the aging of the population, this "joint venture" is only expected to increase with important implications for the management of cancer patients. Given the need for familiarity with both, cancer and cardiovascular diseases and their ever-evolving start-of-the-art therapy and interaction potential, specialized efforts have been invoked, which may collectively be termed "onco-cardiology," "cardio-oncology," or "cardio-onco-hematology." Herein, we provide recommendations for the creation and optimization of any such programmatic efforts.

Context: The International Consensus Group for Hematology Review (ICGHR) are essentially review criteria designed to reduce the number of manual smear reviews following analysis in automated hematology analyzers (AHAs). Although AHAs are an indispensable part of the present-day clinical laboratory, manual smear reviews still play an integral role in identifying morphological abnormalities and to confirm the results of the analyzers., Aims: The aim of this study is to evaluate the efficacy of the ICGHR criteria and our laboratory criteria using the Sysmex XN-1000 for manual peripheral smear review (MSR)., Study Design: A prospective cross-sectional comparative study between the two sets of criteria for MSR was performed., Material and Methods: A total of 860 whole blood samples sent over a period of 19 months for complete blood count testing to our laboratory were collected using systematic random sampling. Truth tables were prepared for each set of criteria. Tests of proportion were used to compare performance specifications between both sets of criteria., Results: Using ICGHR criteria, sensitivity was 81.58%, specificity was 84.61%, 83.38% positive predictive value, and 82.92% negative predictive value. The microscopic smear review rate was 47.56% and efficiency was 83.14%. Using our laboratory criteria, sensitivity was 98.80%, specificity was 41.40%, positive predictive value of 61.46%, and negative predictive value of 97.34%. The microscopic smear review rate was 78.14% and efficiency 69.30%., Conclusions: There was a significant reduction in the microscopic smear review rates using the ICGHR criteria compared to our laboratory criteria. The ICGHR criteria can thus be adapted to daily laboratory practice provided they are first optimized and locally validated before use., Competing Interests: There are no conflicts of interest

The article presents partial results of a study at Hospital Edgar Santos, Universidade Federal da Bahia (HUPES), Brazil, analyzing the service's experience with improvement in quality of care within a context of hospital accreditation. The article focuses on the hematology service and specifically its quality of care and intersubjective processes. The study adopted a qualitative approach, using interviews and observation. From the theoretical point of view, the work of Campos, Cecílio, and Merhy acknowledge healthcare's complex nature and micropolitical and intersubjective dimension and the capacity of health professionals to produce meanings and practice creativity. To understand the health professionals' processes of psychosocial linkage and subjective mobilization, we drew on concepts from the French school of psychosociology (Enriquez) and Dejours' psychodynamics of work. The analysis was organized along three lines: psychosocial linkage and the imaginary of self-management; bonding and affect: singularity of the subject's care and clinical case; real work and the healthcare team. One of the main conclusions is the building of a self-management imaginary, expressed in shared projects, expectations, and some forms of interpreting and operating reality, based on affectively invested representations of autonomy and unity. Alongside technical elements such as protocols, the article highlights professional judgment, proper to the intersubjective dimension, fostering the singularity of care. In our view, the real work in the patient care scene is traversed by adjustments that demonstrate team cooperation.

Primary immune thrombocytopenia (ITP) is a bleeding disorder commonly encountered in clinical practice. The International Working Group (IWG) on ITP has published several landmark papers on terminology, definitions, outcome criteria, bleeding assessment, diagnosis, and management of ITP. The Chinese consensus reports for diagnosis and management of adult ITP have been updated to the 4th edition. Based on current consensus positions and new emerging clinical evidence, the thrombosis and hemostasis group of the Chinese Society of Hematology issued Chinese guidelines for management of adult ITP, which aim to provide evidence-based recommendations for clinical decision making.

The American Society of Hematology (ASH)/ASCO Curricular Milestones is a tool for assessment and teaching for fellows in hematology/oncology. The expectations of the Next Accreditation System of the Accreditation Council of Graduate Medical Education (ACGME) was developed over years from the creation of the six core competencies in 1999 to the current data-driven outcomes-based system. The current internal medicine subspecialty milestones (ACGME reporting milestones) follow the general rubric of the general internal medicine milestones. The ASH/ASCO curricular milestones were developed from the foundational elements of the specialty, and they are interwoven with the ACGME reporting milestones. The 2017 ACGME Milestones Report shows that the milestones display progression in performance through clear anchors. Educational outcomes are available in many specialties. The internal medicine subspecialties have been given the opportunity to update the ACGME reporting milestones. The ACGME has acknowledged that these milestones may be different for each of the specialties. The program committees of ASH and ASCO agree that revision of the ACGME reporting milestones would decrease the overlap of domains, lack of clarity, and negative language that is present in version 1.0. ASH and ASCO are working with the ACGME and American Board of Internal Medicine (ABIM) to develop Curricular Milestones, version 2.0.

Lymphomas are a heterogeneous group of disease entities with well-defined clinical, morphological, immunophenotypic, and cytogenetic characteristics. Moreover, regional and racial differences have been reported in their incidence and subtype compositions. Here, we reviewed the epidemiology of lymphomas and summarized the recent achievements in specific subtypes prevalent in Korean population, focusing on clinical studies conducted by the Consortium for Improving Survival of Lymphoma (CISL) of the Korean Society of Hematology Lymphoma Working Party (KSH-LWP).

Objectives: Antibiotic stewardship is an integral aspect of hospital care, limiting the potential for resistance while working to minimize waste. A similar system is needed in oncology, given the rapid proliferation of new therapies and the challenges of navigating a complicated reimbursement environment. A "cancer therapy stewardship program" has never been described in the literature. Here, we detail our efforts to design and implement such a program and share lessons learned to inform future projects., Study Design and Methods: For 1 year, a hematologist-oncologist (the "cancer therapy steward") at Mount Sinai Hospital was in charge of addressing all requests for nonformulary or off-label chemotherapeutic and supportive medications and regimens. Requests consisted of the rationale for use and supporting data from medical journal articles. This pilot initiative was focused mainly on inpatient malignant hematology., Results: Sixty-seven requests were made by 23 physicians, and all requests were ultimately approved. Requests tended to fall into 3 categories: 1) use of a single drug in a setting not approved by the FDA, 2) use of multiple drugs in novel combinations not approved by the FDA, and 3) adding novel drugs to existing FDA-approved regimens., Conclusions: Our cancer therapy stewardship program yielded many useful insights into how our physicians face challenging clinical situations. It also helped to improve overall clinical quality and patient care by emphasizing the importance of value-based care and evidence-based medicine. Expanding this program will likely lead to many interesting experiments aimed at improving medical education and research, patient safety outcomes, and clinical quality.

Competing Interests: Conflict-of-interest disclosure: The authors declare no competing financial interests.

Cancer patients frequently suffer from gastrointestinal complications. In this manuscript, we update our 2013 guideline on the diagnosis and management of gastrointestinal complications in adult cancer patients by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). An expert group was put together by the AGIHO to update the existing guideline. For each sub-topic, a literature search was performed in PubMed, Medline, and Cochrane databases, and strengths of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using the 2015 European Society for Clinical Microbiology and Infectious Diseases (ESCMID) criteria. Final recommendations were approved by the AGIHO plenary conference. Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. Strengths of recommendation and levels of evidence are presented. A multidisciplinary approach to the diagnosis and management of gastrointestinal complications in cancer patients is mandatory. Evidence-based recommendations are provided in this updated guideline.

Objective: To understand key drivers of patient satisfaction in pediatric hematology/oncology., Methods: The "top-box" scores of patient satisfaction surveys from 4 pediatric hematology/oncology practices were collected from 2012 to 2014 at an integrated Children's Health Network. One item, "Likelihood of recommending practice," was used as the surrogate for overall patient satisfaction, and all other items were correlated to this item., Results: A total of 1244 satisfaction surveys were included in this analysis. The most important predictors of overall patient satisfaction were cheerfulness of practice ( r = .69), wait time ( r = .60), and staff working together ( r = .60). The lowest scoring items were getting clinic on phone, information about delays, and wait time at clinic., Conclusion: Families bringing their children for outpatient care in a hematology/oncology practice want to experience a cheerful and collaborative medical team. Wait time at clinic may be a key driver in the overall experience for families with children with cancer. Future work should be directed at using this evidence to drive patient experience improvement processes in pediatric hematology/oncology.

Despite a common use in industrial applications, only a few studies describe the lean management methods in medical laboratory. These tools have been evaluated in analysis laboratory of blood donors, especially in immuno-hematology sector. The aim was to optimize the organization and maintain team cohesion and strong staff involvement in a restructuring context. The tools used and the results obtained are presented in this study.