Fever and Infection Prevalence in Hematology-Oncology Hospitalized Patients: A Single-Center Retrospective Study

Fever is prevalent in hospitalized patients. In hematology-oncology patients, it is related with infection, a disease manifestation or a consequence of immunological dysfunction. This single-center retrospective study aims to determine fever prevalence, describe its causes and evaluate the impact of infection on mortality. We reviewed clinical records of 222 patients admitted to the hospital in three random months of 2015. Around 35% of all hospitalizations were complicated by fever, 42.5% of unknown origin. 90.4% were under treatment. Around 81% did antibiotics, most commonly piperacillin/tazobactam, for around 11 days. 41% changed antibiotics due to fever persistence or microbiological results. The diagnostic yield of microbiological tests was 25%;in 66.7%, a Gram-negative microorganism was isolated. We didn’t find an association between infection and mortality. We conclude that fever is common in our hematology-oncology clinic and that the team is trained to assume infection;empirical treatment is in accordance with international recommendations.

Discipline of Nutritional Oncology:Principle,Theory,Practice and Perspectives

Cancer poses a major health problem worldwide.There is a trend of increasing incidence and mortality of several types of cancer in China.Although major breakthroughs have been made in cancer treatment,including advances in surgical procedures,radiotherapy,chemotherapy,targeted therapy,and immunotherapy,the prognosis of cancer patients is still not optimal.It is widely accepted that malnutrition is commonly seen in cancer patients and that nutritional intervention can improve such patients’overall survival status by supplementing deficient nutrients,regulating abnormal metabolism,improving immune function,and modulating tumor growth.Thus,fighting malnutrition can improve patients’quality of life and survival.This review article provides a summary of development of nutritional oncology as an independent clinical discipline,recent advances,and problems and challenges faced by health care professionals in managing malnutrition among cancer patients.We propose several strategies and approaches to establish nutritional intervention programs in hospitals,including education,clinical nutritional diagnosis and treatment,which may meet the nutrition and treatment goals for patients with cancer in China.We hope that with national-wide development and implementation of nutritional intervention programs,more cancer patient in China will benefit from such endeavors,making nutritional oncology the frontier of cancer treatment not only in China,but also in whole world.

Physician approaches to drug shortages: Results of a national survey of pediatric hematologist/oncologists

AIM To evaluate personnel involved in scarce drug prioritization and distribution and the criteria used to inform drug distribution during times of shortage among pediatric hematologists/oncologists. METHODS Using the American Society of Pediatric Hematology/Oncology(ASPHO) membership list, a 20 question survey of pediatric hematologists/oncologists was conducted via email to evaluate personnel involved in scarce drug prioritization and distribution and criteria used to inform scarce drug distribution. RESULTS Nearly 65% of the 191 study respondents had patients directly affected by drug shortages. Most physicians find out about shortages from the pharmacist(n = 179, 98%) or other doctors(n = 75, 41%). One third of respondents do not know if there is a program or policy for handling drug shortages at their institution. The pharmacist was the most commonly cited decision maker for shortage drug distribution(n = 128, 70%), followed by physicians(n = 109, 60%). One fourth of respondents did not know who makes decisions about shortage drug distribution at their institution. The highest priority criterion among respondents was use of the shortage drug for curative, rather than palliative intent and lowest priority criterion was order of arrival or first-come first-served.CONCLUSION Despite pediatric hematology/oncology physicians and patients being heavily impacted by drug shortages, institutional processes for handling shortages are lacking. There is significant disparity between how decisions for distribution of shortage drugs are currently made and how study respondents felt those decisions should be made. An institution-based, and more importantly, a societalapproach to drug shortages is necessary to reconcile these disparities.

儿童血液肿瘤科护士护理缺失现状及影响因素研究

目的 构建儿童血液肿瘤科护士护理缺失影响因素的结构方程模型,分析护理缺失影响因素。方法 采用便利抽样法,应用一般资料调查表、职业倦怠量表、医院磁性要素量表、杰弗逊共情量表、护理缺失信息反馈量表对北京市3所医院儿童血液肿瘤科的198名护士进行调查。采用SPSS 22.0软件进行数据统计分析。结果 儿童血液肿瘤科护士护理缺失总分为(121.41±18.77)分,得分率为73.58%。儿童血液肿瘤科护士护理缺失自评得分与医院磁性水平、护士共情能力水平呈正相关(P<0.05),与职业倦怠呈负相关(P<0.05)。医院磁性水平和护士共情能力水平在职业倦怠和护理缺失中的中介效应为0.023,占总间接效应的18.5%。结论 儿童血液肿瘤科护士护理缺失现状处于中等偏上水平,医院磁性水平和护士共情能力水平在职业倦怠和护理缺失中的中介效应成立。护理管理者应通过干预措施增强护士的共情能力,提升工作环境的磁性水平,减少护士的职业倦怠感,以减少或预防护理缺失。

骨髓增生异常综合征在斑马鱼中的研究进展

骨髓增生异常综合征(myelodysplastic syndrome,MDS)是一种常见的血液疾病,其发病率呈现逐年上升的趋势。斑马鱼作为一种生物医学研究的模式生物,广泛应用于各类疾病的研究中。本文关注了近年来血液疾病在斑马鱼中的研究,MDS在小鼠、大鼠和斑马鱼中的研究及动物模型的应用,揭示了斑马鱼模型在其中发挥的重要作用。

基于智慧病房系统的护理在肿瘤科患者中的应用效果分析

目的:分析基于智慧病房系统的护理在肿瘤科患者中的应用效果。方法:选取2023年4—6月广东省人民医院肿瘤科收治的618例患者作为研究对象,随机分为对照组和研究组,各309例。对照组实施常规护理,研究组实施基于智慧病房系统的护理。比较两组护理效果。结果:研究组输液管理、健康宣教、费用结算、信息核对耗时短于对照组,差异有统计学意义(P<0.001)。研究组护理不良事件总发生率低于对照组,差异有统计学意义(P<0.001)。研究组护理总满意度高于对照组,差异有统计学意义(P=0.008)。结论:基于智慧病房系统的护理在肿瘤科患者中的应用效果显著,可缩短护理耗时,降低护理不良事件发生率,提高患者护理满意度。

Concurrent renal cell carcinoma and hematologic malignancies: Nine case reports

BACKGROUND The presence of renal cell carcinoma(RCC)and hematologic malignancies(HM)in the same patient is rarely observed.Three primary findings have been described in these patients,including male gender and lymphoid malignancy predominance,and the HM are usually diagnosed before or simultaneously with the RCC.There is a lack of evidence about clinical outcomes in this setting.We report the common characteristics of 9 patients diagnosed with concurrent RCC and HM and their clinical course and response to treatment.CASE SUMMARY Four(44%)patients were diagnosed with RCC prior to the HM,the diagnosis was simultaneous in 4(44%)patients,and 1(11%)patient was diagnosed with the HM prior to the RCC.No patients were treated with cytotoxic chemotherapy or radiation between the diagnosis of RCC and HM.Several unique features were seen in our case series,such as 3 simultaneous cancers in 1(11%)patient,a splenectomy leading to remission of diffuse large B cell lymphoma without the use of chemotherapy in 1(11%)patient,chemotherapy and rituximab for lymphoma resulting in a complete response in primary RCC in 1(11%)patient,and immunotherapy providing an excellent response for primary renal leiomyosarcoma in 1(11%)patient.CONCLUSION These findings highlight the potential role of immune system dysregulation in patients with the diagnosis of RCC and HM whereby the first malignancy predisposes to the second through an immunomodulatory effect.HM have the potential of being confused with lymph node metastasis from kidney cancer.Lymph node biopsy may be necessary at the time of initial diagnosis or in cases of mixed response to therapy.Long-term medical surveillance is warranted when a patient is diagnosed with RCC or HM.Clinicians should be aware of the higher prevalence of male gender and lymphoid malignancy with concurrent RCC and HM and that either of these conditions may be diagnosed first or they may be diagnosed simultaneously.

医联体背景下专科护士主导的肿瘤护理专科联盟病房的构建与实施

目的探索医联体背景下以专科护士为主导构建肿瘤护理专科联盟病房的实践效果。方法分析医联体病房的发展现状,依托区域协同优势,通过组建专科联盟小组、规范专科联盟病房规章制度、实施以专科护士为主导的临床护理帮扶,并进行护理质量监控,带动护理同质化,对专科联盟病房完成工作量、护士专科护理能力、护理质量及患者满意度进行效果评价。结果以专科护士为主导的肿瘤护理专科联盟病房构建后科室收治患者数及专科数据均提高,护士专科理论和操作考核成绩较构建前明显提高(P<0.01);化疗药物经中心静脉输注率、化疗药物输注正确率、营养风险评估正确率均较构建前提高(P<0.01);化疗药物外渗发生率较构建前降低(P<0.05),患者满意度提高。结论医联体背景下以专科护士为主导的肿瘤护理专科联盟病房的构建,能促进基层医院的科室建设、提升护士专科护理能力、提高护理质量和患者满意度,从而保证专科服务质量,保证患者治疗安全,充分体现了医疗护理资源共享、优质护理资源向基层辐射的优势,是对分级诊疗的有益探索。

A brief introduction to the Hematology Oncology Center of Beijing Children's Hospital

The Hematology Oncology Center of Beijing Children's Hospital, affiliated to Capital Medical University is a unique center that integrates clinical care, scientific research, teaching, and training. It is staffed by 269 doctors, nurses, and other health professionals, including one academician and 31 senior medical staff. In addition, 26 staff members are doctoral degree holders and 56 are master's degree holders. Dr. Yamei Hu and her team were the first to carry out clinical research on childhood leukemia in China from 1976.

基于德尔菲法构建血液肿瘤患者跌倒风险指标

目的构建血液肿瘤患者的跌倒风险指标。方法在回顾文献的基础上,采用德尔菲法,结合专家意见制订专家咨询表,对血液科临床专家实行2轮调查,统计分析专家积极系数、意见集中程度和协调性。结果2轮专家咨询量表回收率均为100%,专家咨询Ca分别为0.872和0.902,Cs分别为0.852和0.864,Cr分别为0.862和0.883(Cr>0.7)。结论通过德尔菲法构建的血液肿瘤患者跌倒风险指标具有较高的可靠性及可行性,可用于对血液肿瘤患者进行跌倒风险评估,需进一步验证其“电子化”临床适用性。

基于人本思想探讨中医肿瘤专科人文病房的多元化构建

人本思想是中国传统思想文化的精髓,医学是人类社会文明发展的集中体现,而中医学是富含人文的医学且充满人文智慧。大健康理念下深入观察恶性肿瘤疾病的特质,可以发现人本思想视角下的“人文关怀”显得尤为重要。伴随着生物-心理-社会医学诊疗模式的转变,社会对医疗主体行为者提出更多更具体的要求。肿瘤专科病房是肿瘤患者主要诊疗场所,人文病房的构建将有助于患者得到更为客观、有效、全面、人性化的诊疗服务。本文基于人本思想角度,从医疗行为主体、医疗环境、医疗实践多方面对肿瘤专科人文病房构建提出构想和探讨,以期为医学人文在中医肿瘤学临床实践提供现实借鉴和指导。

血液系统恶性肿瘤治疗相关的心血管疾病研究进展

血液系统恶性肿瘤诊疗的持续进步改善了患者的长期预后,同时也凸显了肿瘤进展及抗肿瘤治疗引起的心血管事件的重要性。血液系统恶性肿瘤患者在接受现有及新兴的肿瘤治疗方案如蒽环类药物、蛋白酶体抑制剂、靶向治疗、免疫治疗后,部分患者在疾病缓解后可能出现心血管事件,严重影响其生存率及生存质量。本文从血液系统恶性肿瘤治疗药物引起的心脏毒性的机制、临床表现和干预治疗三方面进行综述,旨在为血液系统恶性肿瘤治疗相关心血管事件的预防和治疗提供参考。

多模态教学模式在临床医学课程思政建设应用策略--以《血液与肿瘤疾病整合课程》为例

课程思政是培养三观正确的医学生的重要载体,课程思政建设中教师是主力军,课堂是主渠道。以临床医学课程思政建设为主要目标,以《血液与肿瘤疾病整合课程》为例,进行思政建设顶层设计,挖掘课程思政元素,打造跨学科师资团队,整合线上+线下的思政资源,应用多模态教学模式,将思政元素有机融入整个课程,并探索思政建设评价体系,以期为临床医学的课程思政建设提供借鉴。

PICC在肿瘤血液科的应用及护理体会

目的 探讨PICC在肿瘤血液科的应用及护理体会。方法 研究对象为2018年10月至2019年10月在我院肿瘤血液科收治的80例患者,根据就诊的顺序对患者分组,分为两组,奇数和偶数编号分别为对照组(n=40,给予常规护理干预)和观察组(n=40,在对照组基础上实施综合护理干预)。全部患者均接受PICC穿刺治疗。比较两组患者的一次置管成功率、并发症发生率及护理满意度。结果 观察组患者一次置管成功率、并发症发生率、护理满意度均优于对照组(P<0.05)。结论 对肿瘤血液科接受PICC治疗患者采取有效的护理干预能够有效提高一次穿刺效果,减少并发症发生风险,患者护理满意度高,因此能为患者的安全提供保障。

安宁疗护应用于肿瘤科病房中对生命末期患者的护理效果分析

目的对安宁疗护应用于肿瘤科病房中对生命末期患者的护理效果进行分析。方法选择2021年1月—2022年12月本院肿瘤科病房收治的80例生命末期癌症患者为研究对象,将其随机设置对照组与实验组,每组40例,对照组采取常规护理,实验组采取安宁疗护,对比两组心理、睡眠、疼痛及生存质量情况。结果护理前两组SAS、SDS、疼痛评分和入睡潜伏期、实际睡眠时长、PSQI评分以及生存质量评分均值相比区别不明显(P>0.05);护理后,两组心理状态、疼痛评分、PSQI评分均有所降低,入睡潜伏期时间有所减少、实际睡眠时间有所延长,两组生理、心理、环境及社会关系等生存质量评分均有所升高,各项指标实验组均优于对照组(P<0.05)。结论对肿瘤科癌症生命末期患者采取安宁疗护方案,能够大大改善患者的心理、睡眠及疼痛情况,提高患者生存质量,值得参考。

腔内心电定位联合钝性分离经外周静脉置入中心静脉导管在血液肿瘤患者中的应用研究

目的:观察腔内心电定位联合钝性分离经外周静脉置入中心静脉导管(PICC)在血液肿瘤患者中的应用效果。方法:选取2021年3月—2023年2月江门市五邑中医院收治的拟行PICC置管的血液肿瘤患者60例为研究对象,随机分为对照组和研究组,各30例。对照组采用传统穿刺方法置管,研究组采用腔内心电定位联合钝性分离PICC置管。比较两组不同穿刺时间疼痛评分、一次性导管尖端位置准确率、穿刺点出血率。结果:研究组穿刺时、穿刺结束时、穿刺后1 min、穿刺后5 min视觉模拟评分均低于对照组,差异有统计学意义(P<0.001);两组一次性导管尖端位置准确率比较,差异无统计学意义(P>0.05);研究组穿刺点出血率低于对照组,差异有统计学意义(P=0.020)。结论:腔内心电定位联合钝性分离PICC可减轻血液肿瘤患者疼痛感,一次性导管尖端位置准确率较高,穿刺点出血率低。

血液病房院内感染病原菌变迁的临床分析

本研究旨在了解血液病房医院感染的病原菌特点及体外对常用抗生素的敏感性,为临床抗生素应用提供参考。留取2001-2005年化疗患者院内感染血、痰、尿等的非重复标本,体外分离、鉴定菌株,以Kieby-Bauer法进行药物敏感性测定。结果发现,5年来血液病房的检出细菌以G-杆菌多见,铜绿假单胞菌、阴沟肠杆菌、大肠埃希菌是最常见的致病菌,鲍曼不动杆菌有逐年增加的趋势;G+球菌及真菌近年比例缓慢上升,主要为肠球菌属和念珠菌属;体外药敏试验显示耐药菌株近年检出较多,大多数G-杆菌对半合成青霉素耐药,肠球菌和葡萄球菌对万古霉素仍高度敏感。结论:化疗后患者医院感染的细菌主要为G-菌,但G+菌、真菌以及耐药菌株检出增加,其原因可能与大量广谱抗生素应用及医院交叉感染有关。

血液科2388例次住院患者感染危险因素的分析

目的了解血液科住院患者发生感染的易患因素。方法对我院血液科2388例次住院患者进行回顾性分析,找出不同的危险因素及其与发生感染的关系。结果血液系统恶性肿瘤感染的发生率较高,常见的感染部位依次为上呼吸道和肺脏(16%)、败血症(4%)、肛周感染(4%)、皮肤软组织(2.9%)。在急性白血病患者中,254例次初治者和96例次复发患者感染发生率为80.9%和66.7%,明显高于完全缓解患者(19.0%)。中性粒细胞总数<0.5×109/L的患者感染发生率为98.1%,高于粒细胞总数正常的患者(8.8%)。随着住院天数的延长,感染的发生率明显增加。安置导管、老龄以及合并糖尿病患者感染发生率高。多元回归分析显示,初治或复发的急性白血病、粒细胞缺乏、住院时间≥20d、置管、糖尿病和年龄>60岁是发生感染的独立危险因素。结论血液病房中血液肿瘤感染发生率高,肺部感染和败血症多见。白血病初治和复发时、粒细胞缺乏、住院时间长、安置导管、老龄及合并糖尿病是感染的危险因素。

应用品管圈降低血液科病房输血相关缺陷发生率的实践

目的:探讨品管圈活动在降低血液科病房输血相关缺陷发生率方面的成效。方法:通过主题选定,活动计划拟定,现状调查,要因分析,对策拟定、实施,效果检验,效果巩固等程序进行品管圈活动。比较活动前后血液科病房输血相关缺陷发生率改善情况。结果:实施品管圈活动后,血液科输血相关缺陷发生率从19.50%降至4.42%,差异有统计学意义(P<0.05)。结论:品管圈活动能有效降低血液科病房患者输血相关缺陷发生率,保证输血安全。

百级层流病房预防恶性血液病患者化疗后感染的回顾性研究

目的探讨百级层流病房在预防恶性血液病化学治疗(化疗)后并发感染中的价值。方法回顾性调查2016年3月—2017年2月某院血液科病房收治接受化疗的恶性血液病患者,根据患者的意愿,入住百级层流病房接受化疗为试验组,在普通病房接受化疗为对照组。对两组的感染发病率、发热持续时间、抗菌药物使用时间、住院时间及感染指标进行比较分析。结果共收治接受化疗恶性血液病患者267例。试验组74例,对照组193例。治疗期间患者感染发病率试验组为47.3%,低于对照组的72.0%,差异有统计学意义(P<0.001)。两组患者感染部位均以呼吸道、消化道、泌尿道为主。两组患者共检出病原菌45株,试验组检出7株,对照组检出38株,检出病原菌为大肠埃希菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌、铜绿假单胞菌及酵母菌属。试验组发热持续时间、抗菌药物使用时间及住院时间低于对照组(均P<0.05);试验组感染病例血清降钙素原(PCT)和C反应蛋白(CRP)水平低于对照组(均P<0.01),且PCT、CRP恢复正常的时间短于对照组(均P<0.05)。结论恶性血液病患者在百级层流病房接受化疗可以减少感染发病率,缩短住院时间,减轻患者经济负担,值得临床进一步推广。