The outpatient department and long-term follow-up team serve as a common resource for investigators to evaluate patients prior to transplant and to follow patients who have received marrow transplants. Procedures performed in the clinic include general medical evaluation and physical examination, blood sampling and transfusions, skin tests, skin and oral biopsies, parenteral therapy, marrow aspirations, scheduled and emergency visits with physicians, nurses, dieticians, dentists, and social workers of the marrow transplant team. Key research data are generated in the outpatient clinic which involve all the program projects in the grant proposal. We propose to improve the quality of life and lower the cost of medical care by innovations in ambulatory and pediatric care. The specific research proposals include evaluations of the feasibility and cost effectiveness of early hospital discharge while still receiving full parenteral nutrition support and evaluation of the neuroendocrine system and of the psychological and intellectual effect of chemoradiation in children.
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