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Mendieta A, Rios Lopez L, Vargas Arteaga M, Maradiegue E, Delgadillo Arone W, Rueda Bazalar C, Holguin A, Santillan Salas C, Maza I, Homsi M, Farias Barrios F, Assayag C, Vásquez L, Pascual C, Caniza M. A multimodal strategy to improve health care for pediatric patients with cancer and fever in Peru. Rev Panam Salud Publica 2023; 47:e140. [PMID: 37799822 PMCID: PMC10548892 DOI: 10.26633/rpsp.2023.140] [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: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
Objective The DoTT (Decreasing Time to Therapy) project aimed to minimize the interval between fever onset and medical interventions for children with febrile neutropenia. The objective of this study was to determine the effect of implementing the DoTT project on the hospital time to antibiotic (TTA) and patient time to arrival (PTA) at the hospital in children with febrile neutropenia admitted to the emergency department. Methods The DoTT project was implemented at a Peruvian hospital and followed the World Health Organization (WHO) multimodal improvement strategy model. Components included creating a healthcare delivery bundle and antibiotic selection pathways, training users of the bundle and pathways, monitoring patient outcomes and obtaining user feedback, encouraging use of the new system, and promoting the integration of DoTT into the institutional culture. Emergency room providers were trained in the care delivery for children with cancer and fever and taught to use the bundle and pathways. DoTT was promoted via pamphlets and posters, with a view to institutionalizing the concept and disseminating it to other hospital services. Results Admission data for 129 eligible patients in our registry were analyzed. The TTA and PTA were compared before and after the DoTT intervention. The median TTA was 146 minutes (interquartile range [IQR] 97-265 minutes) before the intervention in 99 patients, and 69 minutes (IQR 50-120 minutes) afterwards in 30 patients (p < 0.01). The median PTA was reduced from 1 483 minutes at baseline to 660 minutes after the intervention (p < 0.01). Conclusions Applying the WHO multimodal improvement strategy model to the care of children with febrile neutropenia arriving at the hospital had a positive impact on the PTA and TTA, thus potentially increasing the survival of these patients.
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Affiliation(s)
- Ana Mendieta
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Ligia Rios Lopez
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Maria Vargas Arteaga
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Essy Maradiegue
- Instituto Nacional de Enfermedades NeoplásicasLimaPeruInstituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Walter Delgadillo Arone
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Carlos Rueda Bazalar
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Alexis Holguin
- Instituto Nacional de Enfermedades NeoplásicasLimaPeruInstituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - Ivan Maza
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Maysam Homsi
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | | | - Claudia Assayag
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Liliana Vásquez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Claudia Pascual
- Pan American Health OrganizationLimaPeruPan American Health Organization, Lima, Peru
| | - Miguela Caniza
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
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Lemiech-Mirowska E, Gaszyńska E, Sierocka A, Kiersnowska Z, Marczak M. Clostridioides difficile Infections among Pediatric Patients Hospitalized at an Oncology Department of a Tertiary Hospital in Poland. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1363. [PMID: 37629653 PMCID: PMC10456884 DOI: 10.3390/medicina59081363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Gastrointestinal tract infections caused by Clostridioides difficile bacteria are diagnosed in pediatric patients with increasing frequency. Children treated at pediatric units are a group of patients at high risk of this infection; therefore, appropriate differential diagnostics and an individual approach to every case are of particular importance. The goal of the study was to assess the clinical parameters of patients with a confirmed CD infection and colonization. Materials and Methods: Every positive case was subjected to a retrospective analysis based on medical history and an infection notification note. Results: Positive results were obtained for 30 patients, among whom the results of 18 patients were considered to justify the diagnosis of an infection. In the remaining patients, treatment was not initiated in only three cases. Cases were detected where treatment was initiated despite the lack of sufficient clinical evidence. Conclusions: This study demonstrates that there are many factors that result in a high risk of the occurrence of CDI in oncology patients, such as antibiotic therapy, multiple hospitalizations, and myelosuppression.
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Affiliation(s)
- Ewelina Lemiech-Mirowska
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland; (A.S.); (Z.K.); (M.M.)
| | - Ewelina Gaszyńska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Aleksandra Sierocka
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland; (A.S.); (Z.K.); (M.M.)
| | - Zofia Kiersnowska
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland; (A.S.); (Z.K.); (M.M.)
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland; (A.S.); (Z.K.); (M.M.)
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Orford R, Slater P, Spencer B, Giarola T, Nicholls W, Walker R, Foresto S, Bradford N. One Hundred Times Better, at Home in Our Own Beds: Implementation of Home Intravenous Hydration After Chemotherapy in Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:265-276. [PMID: 37017002 DOI: 10.1177/27527530221147880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Background: Home-based cancer care offers new ways of delivering supportive therapies, including post-chemotherapy hydration, traditionally delivered in hospital settings. Understanding how programs are developed and how parents perceive managing care at home offers opportunities to improve services and experiences. Aim: To describe the implementation process and evaluation of a home intravenous hydration program for children with cancer and thus to provide practical information for future initiatives. Methods: Data were prospectively collected on clinical impact, safety indicators, and estimated costs; these were tabulated and analysed. Semi-structured interviews were undertaken with a subset of parents regarding their experience and analysed using content analysis. Results: Over 34 months, 21 children were eligible, and 16 parents were educated and assessed competent with providing home care. All 16 children received home hydration with a median of 5.5 days per child (IQR 6.65 days). This avoided 116 hospital bed-days and associated costs, at an estimated total value of USD $ 105,521, on average saving USD $ 910 per day and USD $ 6,596 per child. There were no adverse events reported, and no child required re-admission to hospital while receiving home hydration. Parents were overwhelmingly positive in their feedback about the program. Verbatim quotes were synthesized under one overarching theme-supporting normality promotes recovery. Conclusion: When adequately trained and well supported, parents highly value providing home-based care to their children. This offers opportunities to improve experiences and outcomes for children and families as well as reduce costs to health services, achieving clinical impact without reducing safety.
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Affiliation(s)
- Rebekah Orford
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Penelope Slater
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Brooke Spencer
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Teghan Giarola
- Oncology Pharmacy, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Wayne Nicholls
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Rick Walker
- Queensland Youth Cancer Service, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Steven Foresto
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research and School of Nursing, Queensland University of Technology, South Brisbane, Australia
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Koenig C, Kuehni CE, Bodmer N, Agyeman PKA, Ansari M, Roessler J, von der Weid NX, Ammann RA. Time to antibiotics is unrelated to outcome in pediatric patients with fever in neutropenia presenting without severe disease during chemotherapy for cancer. Sci Rep 2022; 12:14028. [PMID: 35982121 PMCID: PMC9388602 DOI: 10.1038/s41598-022-18168-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022] Open
Abstract
Fever in neutropenia (FN) remains an unavoidable, potentially lethal complication of chemotherapy. Timely administration of empirical broad-spectrum intravenous antibiotics has become standard of care. But the impact of time to antibiotics (TTA), the lag period between recognition of fever or arrival at the hospital to start of antibiotics, remains unclear. Here we aimed to analyze the association between TTA and safety relevant events (SRE) in data from a prospective multicenter study. We analyzed the association between time from recognition of fever to start of antibiotics (TTA) and SRE (death, admission to intensive care unit, severe sepsis and bacteremia) with three-level mixed logistic regression. We adjusted for possible triage bias using a propensity score and stratified the analysis by severity of disease at presentation with FN. We analyzed 266 FN episodes, including 53 (20%) with SRE, reported in 140 of 269 patients recruited from April 2016 to August 2018. TTA (median, 120 min; interquartile range, 49-180 min) was not associated with SRE, with a trend for less SREs in episodes with longer TTA. Analyses applying the propensity score suggested a relevant triage bias. Only in patients with severe disease at presentation there was a trend for an association of longer TTA with more SRE. In conclusion, TTA was unrelated to poor clinical outcome in pediatric patients with FN presenting without severe disease. We saw strong evidence for triage bias which could only be partially adjusted.
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Affiliation(s)
- Christa Koenig
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicole Bodmer
- Pediatric Oncology, Kinderspital Zürich, University of Zürich, Zurich, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc Ansari
- Pediatric Hematology/Oncology, Department of Women, Child and Adolescent, University Hospital of Geneva, Geneva, Switzerland.,Department of Pediatrics, Gynecology, and Obstetrics, Cansearch Research Platform of Pediatric Oncology and Hematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jochen Roessler
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Nicolas X von der Weid
- Division of Pediatric Hematology and Oncology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Roland A Ammann
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.,Kinderaerzte KurWerk, Burgdorf, Switzerland
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Emergency department nurse-initiated protocols for paediatric febrile neutropenia: A scoping review. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bradford N, Pitt E, Alexander K. Research priorities of Australian cancer nurses: A national consensus survey. Collegian 2022. [DOI: 10.1016/j.colegn.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bradford N, Cashion C, Condon P, Rumble S, Bowers A. Recruitment principles and strategies for supportive care research in pediatric oncology. BMC Med Res Methodol 2021; 21:178. [PMID: 34454413 PMCID: PMC8400402 DOI: 10.1186/s12874-021-01371-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Variations in clinical practice contribute to negative outcomes for children with cancer. Research in this area is imperative to standardise practice, yet such research is challenging to undertake, and a significant proportion of studies fail. A common reason for failure is poor recruitment, yet little information is available to support researchers and clinicians planning such research. METHODS Our primary aim was to describe the recruitment strategies and outcomes in a tertiary children's hospital across multiple observational supportive care studies. Secondary aims were to establish principles to improve both recruitment strategies and the reporting of recruitment. We undertook a retrospective descriptive analysis of the recruitment logs and data from three studies in pediatric oncology. The mean time to recruit one participant was calculated. Common reasons for not approaching eligible participants and reasons potential participants declined are described. RESULTS Of the 235 potential candidates across all studies, 186 (79%) were approached and of these 125 (67%) provided consent, with 117 (63%) completing baseline measures. We estimated recruitment per participant required an average 98 min of experienced research nurse time. Four factors are described that influence recruitment and six principles are outlined to maximise recruitment and the generalisability of research findings. CONCLUSIONS We highlight the recruitment experiences across three different projects in children's cancer supportive care research and provide a roadmap for other researchers planning to undertake clinical research in pediatrics.
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Affiliation(s)
- Natalie Bradford
- Queensland University of Technology, Cancer and Palliative Care Outcomes Centre and School of Nursing, Brisbane, Australia.
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia.
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.
| | - Christine Cashion
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Paula Condon
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Shelley Rumble
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Alison Bowers
- Queensland University of Technology, Cancer and Palliative Care Outcomes Centre and School of Nursing, Brisbane, Australia
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
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