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Unique Transplant Program Has New Inpatient Unit for Adult Patients

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Duke Health News 919-660-1306

DURHAM, N.C. -- A precious package arrived late last night at Duke, and Jackie McPherson drove in from home to personally receive it. She carried its delicate contents into the laboratory for processing, then walked it over to Duke Hospital, where a patient desperately awaited its life-giving contents.

Inside a tightly sealed pouch were stem cells and bone marrow, which doctors fervently hope will restore their patient's damaged blood-forming and immune systems. The chemotherapy that wiped out his cancer also destroyed his bone marrow, an expected byproduct of treatment.

Such a scenario isn't unique to Duke, but the round-the-clock nature of its adult bone marrow transplant program is. Long after their workdays have ended, staff members like Jackie McPherson drive to the airport or into the office at any hour of night to receive bone marrow flown in from donors around the country. Seven days a week, nurses and doctors staff a free-standing bone marrow clinic, where patients can literally walk in to receive their transplants, then later go back to their apartments to recuperate. The Duke outpatient clinic is one of just a handful like it in the country, and it is open seven days a week - replete with doctors, nurses and emergency care -- for patients receiving transplants or experiencing complications from their transplant.

Patients who are too sick for outpatient treatment are admitted to a newly renovated inpatient unit, complete with the most advanced air filtering system of its kind. The unit's new generation of High Efficiency Particulate Air Filter (HEPA) system exchanges the air in the patient's room from 12 to 22 times per hour, to remove dangerous organisms that could transmit infections to immune-compromised patients.

"Our new system provides the best possible environment to reduce the risk of complications after transplant," said Angel Johns, clinical nurse specialist for the Adult Bone Marrow Transplant Program at Duke. "Isolation is a requirement for our inpatients, but the new filtering system will allow them to leave their rooms and move around the unit."

In particular, patients will soon be able to walk around the hallways and into the new exercise room, all of which are equipped with HEPAs. Muscle weakness can be a serious side effect for recovering patients, so the exercise room is equipped with a treadmill, recumbent bike, free weights and upper-extremity strengtheners.

The 16-bed unit also features a galley that allows patients to eat at times of their choosing instead of at designated hospital meal times. "Patients receiving chemotherapy may not be able to eat at usual mealtimes and they frequently want specialized foods that don't make them feel sick," said Johns. "If they want chicken soup at 2 a.m., they can get chicken soup." The galley will be stocked with its own supply of food and will be available to patients upon request.

"We are really excited for our patients and our staff to be in such a state-of-the art facility," said Melanie Cogan, nurse manager for the adult bone marrow inpatient unit. "We've been in borrowed space for 15 months, and we're really eager to move into our new surroundings."

As a measure of their enthusiasm and commitment, the nurses created a quilt with panels of inspirational messages to their patients - favorite poems or bible verses - to be displayed in the new unit.

"The theme was caring - how we feel about our patients," said Cogan. "We're all very close, and the process of creating the quilt brought us even closer as a team, it unified us. We just can't wait to be in the new unit."

A ribbon-cutting ceremony for the new unit will be held on June 16, 2003, at 11:30 am, with patients scheduled to move in on July 1. Dr. William Fulkerson, CEO of Duke Hospital, will speak at the event. Dr. Nelson Chao, director of the Duke Adult Bone Marrow Transplant Program, will also speak. Chao is widely recognized for his research on the prevention and management of graft-versus-host disease (GVHD), a potentially life-threatening, post-transplant complication . Chao and his colleagues are also experimenting with less toxic methods of transplanting older patients who are unable to withstand the rigors of standard transplants.

More than 180 patients are treated annually in the inpatient and outpatient units for diseases such as leukemia, lymphoma, multiple myeloma, breast cancer and several rare disorders.

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