1. Infection Control / Microbiology
The patients' microbiological issues are always discussed with one of the senior Microbiology Specialists if needed, and again the following Monday during Grand Rounds - the first hour is dedicated to a review of the weekly problems and their outcomes, and any new cases which may have arisen.
During the weekly radiology rounds, the past week's imaging results are reviewed together with one of the radiology professors. We have regularly scheduled conferences with a specialist from Nuclear Medicine, reviewing the scans of the patients as they progress through therapy.
We have a particularly close, ongoing relationship with the pathology department, whose outstanding hematopathologist, Prof. Gail Amir, has trained with Prof. Elaine Jaffe of the National Institutes of Health. The basis for successful therapy is the initial, critical step of providing the specific diagnostic classification of the hematological disease and Dr. Amir has superior diagnostic ability. In our weekly conferences, Dr. Amir provides demonstrations of various specimens and reviews the many intricate processes performed in the laboratory for each precise diagnosis.
We have a monthly conference with cytogeneticists, who provide vital diagnostic services for our patients wh have been diagnosed with leukemia or lymphoma.
5. Social Medicine / Epidemiology
Ongoing interchange with the Department of Social Medicine allows us to critically evaluate the outcome of our patients' care.
6. Bone Marrow Transplantation
We have an extremely close relationship with the Department of Bone Marrow Transplantation and one of their senior physicians attends our weekly Thursday staff meeting to provide consultations on their recommendations regarding any patient's need for this type of therapy.
7. Blood Bank
We have the invaluable ongoing contribution from the outstanding Blood Bank staff who participate in our weekly rounds and in our clinics. A high caliber blood bank is absolutely essential for treating all hematological diseases. We are proud that the Hadassah University Hospital, Ein Kerem Blood Bank has set standards for safe administration of blood products. These standards are now followed throughout the country. Furthermore, a large portion of our blood products are prepared here at Hadassah in our Donor Center, thus saving crucial transit time in cases of urgent need for blood products.
There are a number of other diagnostic and therapeutic medical specialty services which are all readily available for the patients who need them. These are departments which have had close working relationships with us and provide invaluable immediate assistance for the particular individuals who require such expertise. Among them are:
- Neuro-Oncologists, who provide expert evaluation of neurological complications of hemato-oncological disease;
- Oncologists, who provide radiation as an adjuvant treatment when needed;
- Pain Consultation experts, who are anesthesiologists specifically trained in pain relief, using all medical modalities necessary to assuage pain. These include the use of a variety of medications (oral, transdermal, intravenous) or using such methods as specific, directed nerve blocks for localized pain.
We also have expert consultations available from all the medical subspecialties as needed (Cardiology, Pulmonary Medicine, Gastroenterology, etc). These may be necessary in case of an emergency or to resolve a chronic problem.
Social Work Services
Social work services are extremely helpful to the patients and their families who are faced with devastating illness. Our social worker is highly experienced, as well as sympathetic and dedicated to our patients. She provides important hospital information, referrals for extra help at home, and other suggestions to assist the patients and their families cope with the illness facing them. The social worker can be reached through the department telephone or through the department of social services. Aside from the various general work she does, she is also an experienced therapist and can help the patients and their families cope with their disease.
Our department treats all types of hematological disease, both benign and malignant, and some of the diseases are either chronic or ultimately fatal. These illnesses take an emotional toll on the patients and their families. The patient may become depressed, develop sleep disorders, or experience marital dysfunction after diagnosis. Various studies have shown that over 50% of patients develop a clinically apparent level of anxiety and/or depression which worsens as the disease progresses. These psychosocial problems require the help of a trained professional, as their therapy lies beyond the scope of the physician's duties and training. Therefore, for the past 5 years, our department has employed a psychologist for this purpose.
Dr. Liliana Libof is the our department's psychologist. Her task is to evaluate and treat the psychosocial and behavioral aspects of the patient's therapy. She follows the patient throughout their medical treatment and various stages of the illness, from the initial shock of the diagnosis, through the treatment phase, and after recovery, or chronicity sets in. Our psychologists have been trained in specific treatment interventions which have been found to be effective in these types of situations. As such, the psychologist's intervention markedly improves the quality of life of the severely ill patients, allowing them to better cope with their illness. Complete care can not ignore the psychosocial aspects of the patient's illness.
The psychologist provides evaluation of patients in the inpatient department, the Day Care, and the Clinic. Each setting has its own specific problems which the patient needs assistance overcoming. The psychologist may be needed as a resource for rpractical information, or may deal with deeply rooted psychological issues, such as overcoming the stigma of transferring the patient to a hospice when the family can not care for the patient at home.
Many other crises need to be handled as the patient's condition changes (for better or for worse). The psychologist's contributions to the staff meetings are invaluable. The psychologist may enlighten the staff to a psychosocial problem of which they were unaware. The psychologist can also be quite helpful in providing the staff with approaches that avoid confrontations with patients and/or family members who may have been problematic (due to depression, poor communication, etc).
Maintaining proper nutrition is of great importance for our patients. Consultation with a specially trained dietician is available. For patients undergoing chemotherapy for a period of several months to a year, weight loss and loss of appetite may present a severe problem. Not only is weight loss physically debilitating, causing loss of the body's protein mass, but it causes emotional distress which can be highly debilitating as well. Nutritional problems in patients with malignancies can be caused either by the disease itself (such as in cases where the tumor affects the mouth or other portions of the gastrointestinal tract) or it can result from treatment, such as chemotherapy or radiation which can decrease appetite or cause, even temporarily, more severe symptoms which interfere with food intake.
Recognizing the importance of maintaining proper nutrition, we have registered dieticians available to our department on a consultative basis. We have a regularly assigned dietician available as well. The dietician evaluates the patient through a complete nutritional assessment. Then she works closely with the physicians and the nurses to manage nutritional complications of the individual patient's disease. When supplements are recommended, she works closely with each patient to meet their particular needs, in view of the particular disease and the disability it may be causing.