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Pastori D, Palareti G. Open Issues in the Choice and Management of Direct Oral Anticoagulants in Patients with Cancer-Related Venous Thromboembolism. Thromb Haemost 2024. [PMID: 39106896 DOI: 10.1055/s-0044-1788997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Affiliation(s)
- Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Jia J, Fan X, Zhang W, Xu Z, Wu M, Zhan Y, Fan B. Predictive model for totally implanted venous access ports‑related long‑term complications in patients with lung cancer. Oncol Lett 2024; 28:326. [PMID: 38807672 PMCID: PMC11130750 DOI: 10.3892/ol.2024.14459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Totally implanted venous access ports (TIVAPs), which are typically used in oncological chemotherapy and parenteral nutritional support, are convenient and safe, and thus offer patients a higher quality of life. However, insertion or removal of the device requires a minor surgical operation. Long-term complications (>30 days post insertion), such as catheter migration, catheter-related thrombosis and infection, are major reasons for TIVAP removal and are associated with a number of factors such as body mass index and hemoglobin count. Since management of complications is typically time-consuming and costly, a predictive model of such events may be of great value. Therefore, in the present study, a predictive model for long-term complications following TIVAP implantation in patients with lung cancer was developed. After excluding patients with a large amount of missing data, 902 patients admitted to The First Affiliated Hospital with Nanjing Medical University (Nanjing, China) were ultimately included in the present study. Of the included patients, 28 had complications, indicating an incidence rate of 3.1%. Patients were randomly divided into training and test cohorts (7:3), and three machine learning-based anomaly detection algorithms, namely, the Isolation Forest, one-class Support Vector Machines (one-class SVM) and Local Outlier Factor, were used to construct a model. The performance of the model was initially evaluated by the Matthew's correlation coefficient (MCC), area under curve (AUC) and accuracy. The one-class SVM model demonstrated the highest performance in classifying the risk of complications associated with the use of the intracavitary electrocardiogram method for TIVAP implantation in patients with lung cancer (MCC, 0.078; AUC, 0.62; accuracy, 66.0%). In conclusion, the predictive model developed in the present study may be used to improve the early detection of TIVAP-related complications in patients with lung cancer, which could lead to the conservation of medical resources and the promotion of medical advances.
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Affiliation(s)
- Jian Jia
- Department of General Practice, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
- School of Business, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
| | - Xutong Fan
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
| | - Zhiyang Xu
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Mian Wu
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yiyang Zhan
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Boqiang Fan
- Department of Oncology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Ullman A, Hyun A, Gibson V, Newall F, Takashima M. Device Related Thrombosis and Bleeding in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e25-e41. [PMID: 38161187 DOI: 10.1542/hpeds.2023-007345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT The risk of invasive device-related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood. OBJECTIVES This study aimed to estimate pooled proportions and rates of thrombotic and bleeding complications associated with invasive devices in pediatric health care. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) reporting thrombotic and bleeding complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device-specific pooled thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor). RESULTS Of the 107 studies, 71 (66%) focused on central venous access devices. Symptomatic venous thromboembolism in central venous access devices was 4% (95% confidence interval [CI], 3-5; incidence rate 0.03 per 1000 device-days, 95% CI, 0.00-0.07), whereas asymptomatic was 10% (95% CI, 7-13; incidence rate 0.25 per 1000 device-days, 95% CI, 0.14-0.36). Both ventricular assist devices (28%; 95% CI, 19-39) and extracorporeal membrane oxygenation (67%; 95% CI, 52-81) were often associated with major bleeding complications. CONCLUSIONS This comprehensive estimate of the incidence and prevalence of device-related thrombosis and bleeding complications in children can inform clinical decision-making, guide risk assessment, and surveillance.
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Affiliation(s)
- Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | - Areum Hyun
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Fiona Newall
- Royal Children's Hospital Melbourne, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
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Tian L, Su Y, Gao H, Wang L, Zeng J, Yang Q, Li W, Lin P, Gao Y, Tan X, Yang H, Feng X, Luo H, Li W, Zhang X, Wu X, Li Y. Development and validation of a nomogram model for central venous access device-related thrombosis in hospitalized children. Eur J Pediatr 2023; 182:4909-4919. [PMID: 37606700 DOI: 10.1007/s00431-023-05078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023]
Abstract
This study aimed to develop and validate a nomogram model of central venous access device-related thrombosis (CRT) for hospitalized children. A total of 503 consecutive cases from a hospital in Changsha City, Hunan Province were stochastically classified into the training set and internal validation set at a ratio of 7:3, and 85 consecutive cases in two hospitals in Urumqi City, Xinjiang Uygur Autonomous Region were collected as an external validation set. Univariate analysis and multivariate analysis on CRT-related risk factors of hospitalized children were conducted, a logistic regression model was employed to establish the nomogram, and the discrimination, calibration, and decision curve analysis was performed to assess the proposed nomogram model. The nomogram model involved seven independent risk factors, including blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and bed rest > 72 h. The discrimination results showed that the area under the receiver operating characteristic curve of the training set, internal validation set, and external validation set was 0.74, 0.71, and 0.76 respectively, and the accuracy rates of the proposed nomogram model were 79%, 72%, and 71% in the training set, internal validation set, and external validation set. The calibration results also showed that the calibration curve had great fitness for each dataset. More importantly, the decision curve suggested that the proposed nomogram model had a prominent clinical significance. CONCLUSION The nomogram model can be used as a risk assessment tool to reduce the missed diagnosis rate and the incidence of CRT in hospitalized children. WHAT IS KNOWN • Central venous access device-related thrombosis is generally asymptomatic for hospitalized children, causing the missed diagnosis of central venous access device-related thrombosis easily. • No risk prediction nomogram model for central venous access device-related thrombosis in hospitalized children has been established. WHAT IS NEW • A visual and personalized nomogram model was built by seven accessible variables (blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and bed rest > 72 h). • The model can effectively predict the risk of central venous access device-related thrombosis for hospitalized children.
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Affiliation(s)
- Lingyun Tian
- Department of Nursing, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yanan Su
- Reproductive Center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Huimin Gao
- Operation Room, Xiangya Hospital of Central South University, Changsha, China
| | - Liqian Wang
- Ward of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Jiaqi Zeng
- Department of Pain, the , Third Xiangya Hospital of Central South University, Changsha, China
| | - Qiuhong Yang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Wan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Pan Lin
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yijing Gao
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Xin Tan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Haifan Yang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xinyu Feng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hui Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Weijuan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiumin Zhang
- Department of Nursing, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Xing Wu
- Department of Nursing, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Office of hospital, the Seventh Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China.
- National Clinical Research Center of Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, China.
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Feng X, Luo H, Liu M, Jiang J, Li W, Li Y, Tian L. Development and validation of knowledge, attitude and practice questionnaire for pediatric nurses to prevent central venous device-related thrombosis in hospitalized children. Nurse Educ Pract 2023; 71:103694. [PMID: 37453368 DOI: 10.1016/j.nepr.2023.103694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
AIM This study aimed to develop and validate a scientific and standardized knowledge, attitude and practice questionnaire of pediatric nurses' preventive care for central venous device-related thrombosis among hospitalized children. BACKGROUND Pediatric nurses play a significant role in the prevention of central venous device-related thrombosis for hospialized children. However, the status of pediatric nurses' knowledge, attitude and practice of central venous device-related thrombosis prevention has not been revealed due to the lack of assessment tools. METHODS This questionnaire was framed by the theory of knowledge, attitude and practice. The item pool was compiled through a literature review and a preliminary questionnaire was formed based on expert consultation. A total of 457 pediatric nurses from 10 tertiary class A general hospitals and specialized pediatric hospitals in China were selected for pre-survey. Item analysis, reliability and validity test were conducted to refine and evaluate the items to form a formal questionnaire. RESULTS A total of 54 items were proposed in three dimensions of knowledge, attitude and practice. In the exploratory factor analysis, five, three and three common factors were extracted for each dimension, accounting for 60.552%, 89.829% and 84.258% of the total variance, respectively. The content validity index of the three dimensions ranged from 0.968 to 1.000 at the scale level and from 0.833 to 1.000 at the item level. The Cronbach's α coefficients for the total questionnaire and each dimension were between 0.926 and 0.973. The retest reliability for the total questionnaire and each dimension was between 0.688 and 0.898. CONCLUSION The proposed questionnaire has good reliability and validity and it can be applied to evaluate pediatric nurses' knowledge, attitude and practice in preventing central venous device-related thrombosis for hospitalized children.
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Affiliation(s)
- Xinyu Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hui Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Mengyuan Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jing Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Weijuan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, Hunan, China; School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China.
| | - Lingyun Tian
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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Tian L, Feng X, Yang H, Tan X, Gao Y, Luo H, Li W, Yan P, Li Y. Knowledge, attitude, and practice of pediatric nurses in prevention of central venous access device-related thrombosis in hospitalized children: a nationwide cross-sectional survey. Eur J Pediatr 2023; 182:3481-3490. [PMID: 37184646 DOI: 10.1007/s00431-023-04997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023]
Abstract
Central venous access device-related thrombosis (CRT) is a common complication in hospitalized children. The pediatric nurses' knowledge, attitude, and practice are of great significance for CRT prevention in hospitalized children. The purpose of this study was to elaborate on the level and influencing factors of pediatric nurses' knowledge, attitude, and practice on the prevention related to CRT in hospitalized children. This national cross-sectional study was carried out in China from January 16, 2021, to April 23, 2021. A multi-stage sampling method was adopted, and 1060 pediatric nurses from 21 hospitals participated in this study. The current situation and influencing factors of pediatric nurses' knowledge, attitude, and practice were investigated by descriptive statistics, approximate t test or independent-sample t test, nonparametric Kruskal-Wallis H test, one-way analysis of variance, and multiple linear regression analysis. The relationship among pediatric nurses' knowledge, attitude, and practice was explored by the Pearson correlation analysis. Among all pediatric nurses involved in this study, 25% had insufficient knowledge, 18% had negative attitudes, and 24% had poor behaviors. The main influencing factors on the knowledge, attitude, and practice included the highest education level of pediatric nurses (β = 0.10, P = .001), whether received training related to CRT prevention (β = 0.09-0.14, P < .01), whether CRT-related knowledge was enough for dealing with clinical work (β = 0.18-0.21, P < .001), and the importance of hospitals/departments on children CRT prevention (β = 0.16-0.24, P < .001). There was a positive correlation between knowledge, attitude, and practice (r = 0.24-0.77, P < .01). Conclusion: Pediatric nurses' CRT-prevention knowledge and practice are unsatisfactory, while their preventive attitude toward CRT prevention is optimistic. This study assists the formulation of comprehensive intervention strategies for pediatric nurses in preventing CRT in hospitalized children by hospital-related organizations and nursing managers, so as to improve the participation of pediatric nurses in CRT prevention and reduce the occurrence of CRT for hospitalized children. What is Known: • As a common complication in hospitalized children, CRT can induce many potentially serious complications. • A professional nursing team is an important prerequisite for reducing CRT incidence. What is New: • The levels of pediatric nurses' knowledge and practice are not satisfactory, while pediatric nurses' preventive attitude toward CRT prevention is optimistic. • Hospital-related organizations and nursing managers should highlight the importance of CRT prevention and encourage pediatric nurses to improve their expertise and strengthen the training related to CRT prevention.
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Affiliation(s)
- Lingyun Tian
- Department of Nursing, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xinyu Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Haifan Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xin Tan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yijing Gao
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Hui Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Weijuan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ping Yan
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China.
| | - Yinglan Li
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China.
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.
- National Clinical Research Center of Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Murray MJ, Moleron R, Adamski J, English M, Burke GAA, Cross J, Ajithkumar T, Stoneham S, Nicholson JC. Vinblastine monotherapy induction prior to radiotherapy for patients with intracranial germinoma during the COVID-19 pandemic. Pediatr Blood Cancer 2022; 69:e29359. [PMID: 34520101 PMCID: PMC8662027 DOI: 10.1002/pbc.29359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with localized intracranial germinoma have excellent survival. Reducing treatment burden and long-term sequelae is a priority. Intensive inpatient chemotherapy (e.g., carboPEI = carboplatin/etoposide/ifosfamide) has been effectively employed to reduce radiotherapy treatment volume/dose. Outpatient-based carboplatin monotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology), and successful vinblastine monotherapy induction (with 77% tumor volume reduction after just two weekly vinblastine doses) has recently been reported in an intracranial germinoma patient. METHODS Adapted UK guidelines for germ cell tumor management were distributed during the COVID-19 pandemic, including nonstandard treatment options to reduce hospital visits and/or admissions. This included vinblastine monotherapy for intracranial germinoma (6 mg/m2 intravenously, or 4 mg/m2 for moderate count suppression, delivered weekly). We describe two such patients treated using this approach. RESULTS A 30-year-old male with a localized pineal tumor received 12-week vinblastine induction, with >60% volume reduction, prior to definitive radiotherapy. A 12-year-old female with a metastatic suprasellar tumor and progression at all sites of disease whilst awaiting proton radiotherapy received two vinblastine doses with good early response, including 36% primary tumor volume reduction. The patients tolerated vinblastine well. CONCLUSION Patients with intracranial germinoma have excellent outcomes, and reduction of late effects remains a priority. The description of vinblastine monotherapy in these intracranial germinoma patients warrants further exploration.
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Affiliation(s)
- Matthew J. Murray
- Department of PathologyUniversity of CambridgeCambridgeUK,Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Rafael Moleron
- Department of Clinical OncologyAberdeen Royal InfirmaryAberdeenUK
| | - Jennifer Adamski
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - Martin English
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - G. A. Amos Burke
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Justin Cross
- Department of RadiologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Thankamma Ajithkumar
- Department of OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sara Stoneham
- Department of Paediatric and TYA OncologyUniversity College Hospital LondonLondonUK
| | - James C. Nicholson
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
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