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1.
Cuad. Hosp. Clín ; 60(2): 39-45, dic. 2019. ilus.
Artigo em Espanhol | LILACS | ID: biblio-1046722

RESUMO

OBJETIVO: determinar la supervivencia de pacientes con cáncer de mama en el Hospital Seguro Social Universitario, de la Gestión 2000 a 2016 MÉTODO: estudio de supervivencia. RESULTADOS: la supervivencia de pacientes con cáncer de mama, tuvieron un promedio global de 8,6 años, (104 meses I.C. 96,728 ­ 111,272) de supervivencia en los casos Hormono positivo (+) que recibieron como tratamiento exemestano. El grupo de mujeres que recibió como tratamiento Adriamicina (Doxorrubicina) y Ciclofosfamida su tiempo de supervivencia en promedio fue de 8,2 años (99,5 meses) con intervalo de confianza de 83,2-115.78. En pacientes con cáncer de mama Herb New (-) tratados con Trastuzumab, después de recibir Adriamicina y Ciclofosfamida fue de 8,6 años (103,28 meses) con un IC 86,54 -120,024. CONCLUSIONES: la supervivencia de pacientes con cáncer de mama, tratados en el Hospital Seguro Social Universitario, de la Gestión 2000 a 2016, fue de 8,6 años, resultado equivalente a los reportados en la literatura.


OBJECTIVE: to determine the survival of patients with breast cancer in the University Social Security Hospital, from term 2000 to 2016 METHOD: mixed cohort study RESULTS: survival of patients with breast cancer, had an average survival time of 104 months (8,6 years), in Hormonal cases (+) who received treatment with Exemestane, after Adriamycin and Cyclophosphamide survival time was 99,5 months (IC 83,2 - 115,78). In contrast, in patients with breast cancer Herb New (-) treated with Trastuzumab, after receiving Adriamycin and Cyclophosphamide was 103,28 months (IC 86,54 -120,024). The median survival time was 104,13 months. The only factor that predicts the survival of patients with breast cancer, in this study was the histological type (p = 0,026), with a relative risk of 17,6. CONCLUSIONS: the survival of patients with breast cancer, treated at the University Social Security Hospital, from the term 2000 to 2016, was 8.6 years, a result equivalent to those reported in the literature.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/tratamento farmacológico , Doxorrubicina/uso terapêutico , Serviço Hospitalar de Oncologia , Estatística
2.
BMC Palliat Care ; 18(1): 67, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387568

RESUMO

BACKGROUND: Palliative patients generally present with symptoms of dyspnea, easy fatigability, lethargy and feeling of being unwell which can broadly be attributed to one root cause: cancer-related anemia. So, packed red cell transfusion is often carried out aiming to improve patients' functional status. Different cut off hemoglobin values have been suggested, with Hb < 9 g/dL the most commonly accepted. The present study aims at evaluating and comparing the benefits in subjective symptoms of fatigue and breathlessness among transfused and non-transfused palliative patients on Day 0 and Day 7. METHODS: Hemoglobin values, anemia related subjective symptoms of fatigue and breathlessness were recorded from 122 patients. The patients were re-evaluated on day-7 post-transfusion. The pre and post-transfusion symptomatic benefit was compared in both transfused and non-transfused palliative care patients. RESULTS: The currently practiced hemoglobin trigger for packed red cell transfusion is 10 g/dL. The units of packed red cell to be transfused was decided according to the hemoglobin values targeting the rise to > 10 g/dL. A mean 1.36 units were transfused. Statistically significant improvement was observed in patient reported symptoms of fatigue and breathlessness among both transfused and non-transfused palliative patients. CONCLUSION: Anemic cancer palliative patients were found to benefit following packed red cell transfusion, suggesting a favorable association between the transfusion and patient-reported fatigue and dyspnea.


Assuntos
Transfusão de Eritrócitos/normas , Neoplasias/terapia , Cuidados Paliativos/normas , Adulto , Idoso , Dispneia/terapia , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Fadiga/terapia , Feminino , Hemoglobinas/análise , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nepal , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Cuidados Paliativos/métodos
3.
J Med Radiat Sci ; 66(3): 212-217, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31317665

RESUMO

One of the largest change operations to take place in South Australia was the moving of the Royal Adelaide Hospital (RAH) to its new site in 2017. Change can influence workplace effectiveness and staff satisfaction and morale. Understanding the stages of change, staff experience and carefully managing the process is important. This paper aims to describe the successful move of the radiation therapy department at the RAH to its new site, focusing on the staff experience and management strategies to ensure the success of the move. A four-stage model of change was used to guide understand, manage and reflect upon the transition of the RAH radiation therapy department to a new site. Key change events and management strategies are described and aligned with the four stages of change. The move to the new site was a great success with a transition period working across two sites enabling a slower ramp up of activity at the new site supporting staff and patients in adjusting to the new environment. The four-stage model of change assisted in the smooth implementation of a transition plan for radiation oncology. At the RAH, innovation and development are encouraged, along with management having a comprehensive understanding of organisational change enabling the radiation oncology department to successfully navigate rapid change.


Assuntos
Gestão de Mudança , Serviço Hospitalar de Oncologia/organização & administração , Radio-Oncologistas/organização & administração , Serviço Hospitalar de Radiologia/organização & administração , Serviço Hospitalar de Oncologia/normas , Radio-Oncologistas/normas , Serviço Hospitalar de Radiologia/normas , Austrália do Sul
4.
Nurs Adm Q ; 43(3): 280-288, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162348

RESUMO

Traditional quality assurance processes provide significant opportunities for positive disruption. Doctor of Nursing Practice (DNP) students are well positioned to apply program learning to large-scale change in complex organizations. This article presents an innovative approach for creating a point-of-care interdisciplinary approach to address high fall risk frequencies in ambulatory oncology clinics using complexity leadership principles. Processes for nurse executives to consider for replication of this approach for other challenging clinical situations are suggested using the emerging competence of DNP educated nurses. Adults with cancer who are older than 65 years are at a higher risk for falls than older adults without cancer. Oncology providers and nurses are not routinely screening, documenting, and preventing falls. A fall injury in an older adult with cancer may not only delay or impact cancer treatment but also result in hospitalization, loss of function, and/or death. Increasing awareness of the impact of falls and implementing change within a large ambulatory health care organization requires an interdisciplinary team approach. Complexity theory supports nonlinear change initiated at the grassroots level to create a dynamic movement to bring forth emergence and adaptation. The use of the Centers for Disease Control and Prevention STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative will enable oncology professionals to screen, assess, and intervene by collaborating, communicating, and coordinating with other health care specialists to introduce a fall prevention quality improvement system process. Nurse executives need to know about STEADI.


Assuntos
Acidentes por Quedas/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/normas , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria/métodos , Geriatria/normas , Humanos , Masculino , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/normas , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
5.
Bull Cancer ; 106(6): 514-526, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31126678

RESUMO

The emergence of oral cancer treatment in oncology has shifted patient follow-up from the hospital to the home. This trend has resulted in an increase in phone and e-mail interactions initiated by patients, but also by pharmacists, by liberal nurses, by general practitioners, and an increase in calls to the emergency response services (SAMU) both for real or perceived emergencies. This increased volume of patient and pharmacist communication has caused significant disruption in the daily activity of affected oncology departments and in particular of the secretariats. The procedures for formulating and securing appropriate responses within a short time frame are generally not established, and as a result, there is a risk that decisions made could be inappropriate for the patient's situation, especially in the case of complications.. Tracking responses to phone calls is necessary and answers should be noted in the medical file, including side effects, in particular the serious AEs for a good quality of care. This guideline describes best practices for oncologists who manage "incoming" calls from patients or professionals involved in the care pathway.


Assuntos
Antineoplásicos/uso terapêutico , Correio Eletrônico , Serviço Hospitalar de Emergência/organização & administração , Sistemas de Comunicação no Hospital/organização & administração , Neoplasias/tratamento farmacológico , Serviço Hospitalar de Oncologia/organização & administração , Guias de Prática Clínica como Assunto , Telefone , Administração Oral , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Continuidade da Assistência ao Paciente , Serviço Hospitalar de Emergência/estatística & dados numéricos , Assistência Domiciliar , Humanos , Comunicação Interdisciplinar , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Equipe de Assistência ao Paciente
6.
Rev. enferm. UFPE on line ; 13(5): 1295-1299, maio 2019. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1024292

RESUMO

Objetivo: identificar as principais comorbidades relacionadas ao câncer de mama em mulheres em tratamento com quimioterapia. Método: trata-se de um estudo quantitativo, do tipo descritivo e transversal, em um hospital público, com a participação de 317 mulheres com câncer de mama submetidas a tratamento quimioterápico. Coletaram-se os dados por meio de questionário estruturado contendo questões fechadas e utilizaram-se, para a análise dos dados, frequências absolutas e relativas, apresentando-se os resultados em tabelas. Resultados: observou-se que 36,3% das participantes possuíam patologias associadas, onde as condições clínicas mais comuns foram a hipertensão arterial (65,2%) e a Diabetes Mellitus (36,5%). Conclusão: conclui-se que as mulheres com câncer de mama em tratamento quimioterápico possuem doenças e agravos associados, tanto físicos, como psicológicos, e os mais prevalentes foram a hipertensão arterial, o Diabetes Mellitus e a depressão.(AU)


Objective: to identify the main comorbidities related to breast cancer in women receiving chemotherapy. Method: this is a descriptive and cross-sectional quantitative study in a public hospital with the participation of 317 women with breast cancer undergoing chemotherapy. Data was collected using a structured questionnaire containing closed questions and absolute and relative frequencies were used for data analysis, and the results were presented in tables. Results: it was observed that 36.3% of the participants had associated pathologies, where the most common clinical conditions were hypertension (65.2%) and Diabetes Mellitus (36.5%). Conclusion: it is concluded that women with breast cancer undergoing chemotherapy have associated diseases, both physical and psychological, and the most prevalent were hypertension, diabetes mellitus and depression.(AU)


Objetivo: identificar las principales comorbilidades relacionadas con el cáncer de mama en mujeres en tratamiento con quimioterapia. Método: se trata de un estudio cuantitativo, del tipo descriptivo y transversal, en un hospital público, con la participación de 317 mujeres con cáncer de mama sometidas a tratamiento quimioterápico. Se recolectaron datos por medio de un cuestionario estructurado que contenía cuestiones cerradas y se utilizaron, para el análisis de los datos, frecuencias absolutas y relativas, presentándose los resultados en tablas. Resultados: se observó que el 36,3% de las participantes poseía patologías asociadas, donde las condiciones clínicas más comunes fueron la hipertensión arterial (65,2%) y la Diabetes Mellitus (36,5%). Conclusión: se concluye que las mujeres con cáncer de mama en tratamiento quimioterápico poseen enfermedades y agravios asociados, tanto físicos, como psicológicos, y los más prevalentes fueron la hipertensión arterial, la Diabetes Mellitus y la depresión.


Assuntos
Humanos , Feminino , Enfermagem Oncológica , Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Comorbidade , Saúde da Mulher , Serviço Hospitalar de Oncologia , Antineoplásicos/uso terapêutico , Epidemiologia Descritiva , Estudos Transversais
7.
Med Sante Trop ; 29(1): 97-101, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31031260

RESUMO

Cancer is a major cause of morbidity and mortality in children under the age of 15 years worldwide. To contribute to better knowledge of childhood cancers in Africa. To determine the causes of pediatric cancers and compare them with the results of a previous study and with data available for sub-Saharan Africa. This observational, descriptive study of the data recorded from 2007 to 2015 in the pediatric oncology unit of the University Hospital Center of Treichville in Abidjan analyzes the general and the age- and sex-specific proportions of children under the age of 15 years with neoplasia according to the International Classification of Childhood Cancer, 3rd edition (ICCC.3). This study includes 863 new cases. The sex ratio (M/F) was 1.4, and the mean age 7 years (range: 3 months to 14 years 9 months). The neoplasia rate peaked in the group aged 5-9 years (38.6 %). The most common cancers were: lymphomas (44 %), retinoblastoma (11.7 %), renal tumors (10.1 %), leukemias (6.3 %), and soft tissue sarcomas (5, 9 %). Burkitt lymphoma (85.3 %) and nephroblastoma (90.8 %) were the dominant histological type of lymphoma and renal tumors. This study shows an increase in the annual number of new cases, and an epidemiology close to that reported in other centers in sub-Saharan Africa.


Assuntos
Neoplasias/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Costa do Marfim/epidemiologia , Feminino , Hospitais Universitários , Humanos , Lactente , Masculino , Serviço Hospitalar de Oncologia , Pediatria , Distribuição por Sexo
8.
BMC Complement Altern Med ; 19(1): 62, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866916

RESUMO

BACKGROUND: Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients' own use of CAM. The aim of this cross-sectional study was to explore Swedish cancer patients´ patterns of CAM use, their experiences and preferences. METHODS: Questionnaires were distributed consecutively to 1297 cancer patients at a university hospital's out-patient oncology units. The response rate was 58% (n = 755). Descriptive statistics were used to analyze the survey data. A logistic regression model was used to investigate the association between CAM use and gender, age and level of education. Open-ended responses were analyzed, using qualitative content analysis. RESULTS: Lifetime CAM use was reported by 34% (n = 256), and 26% (n = 198) used CAM after cancer diagnosis. Being female, younger and having higher education predicted CAM use. Most commonly used methods were natural products including vitamins and minerals and relaxation. Main reasons for CAM use were improvement of physical, general and emotional wellbeing and increasing the body's ability to fight cancer. Satisfaction with CAM usage was generally high. Reported adverse effects were few and mild; 54% of users spent < 50 Euro a month on CAM. One third had discussed their CAM use with cancer care providers. More than half of all participants thought that cancer care providers should be able to discuss (58%) and to consider (54%) use of CAM modalities in cancer care. CONCLUSIONS: Despite limited access and advice within conventional cancer care, one fourth of Swedish cancer patients use CAM. The insufficient patient-provider dialogue diverges with most patients' wish for professional guidance in their decisions and integration of CAM modalities in conventional cancer care. Concurrent and multimodal CAM use implies challenges and possibilities for cancer care that need to be considered.


Assuntos
Terapias Complementares , Neoplasias/epidemiologia , Neoplasias/terapia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Serviço Hospitalar de Oncologia , Inquéritos e Questionários , Suécia/epidemiologia
9.
Rev. bioét. (Impr.) ; 27(1): 67-75, jan.-mar. 2019.
Artigo em Português | LILACS | ID: biblio-990541

RESUMO

Resumo Este estudo exploratório e descritivo tem como objetivo compreender as percepções da equipe interdisciplinar da Unidade de Oncologia Pediátrica do Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brasil, sobre cuidados paliativos no contexto do câncer infantil. A amostra incluiu um representante de cada uma das 12 profissões que compõem a equipe interdisciplinar. Foram realizadas entrevistas individuais semiestruturadas, e o exame do material se deu por análise de conteúdo. Verificou-se confusão entre os conceitos de cuidados paliativos exclusivos e cuidados paliativos desde o diagnóstico, gerando sentimentos de frustração, impotência e culpa. Os resultados apontam a necessidade de criar espaços de discussões teóricas sobre morte e cuidados paliativos, bem como de encontros sistemáticos para abordar as percepções relacionadas ao cuidado desses pacientes.


Abstract This exploratory and descriptive study aims to understand the perceptions of the interdisciplinary team of the Porto Alegre Clinical Hospital Pediatric Oncology Unit, Rio Grande do Sul, Brazil, regarding palliative care in the context of childhood cancer. The sample consisted of one representative from each of the 12 professions that make up the interdisciplinary team. Individual semi-structured interviews were carried out and the material was analyzed by content analysis. There has been confusion, starting at diagnosis, between the concepts of palliative care and exclusive palliative care, generating feelings of frustration, impotence and guilt. The results point to the need to create spaces for theoretical discussions about death and palliative care, as well as systematic meetings to address the perceptions related to the care of these patients.


Resumen Este estudio exploratorio y descriptivo tiene como objetivo comprender las percepciones del equipo interdisciplinario de la Unidad de Oncología Pediátrica del Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brasil, sobre los cuidados paliativos en el contexto del cáncer infantil. La muestra incluyó un representante de cada una de las 12 profesiones que componen el equipo interdisciplinario. Se realizaron entrevistas individuales semiestructuradas, y el examen del material estuvo dado por el análisis de contenido. Se verificó una confusión entre los conceptos de cuidados paliativos exclusivos y cuidados paliativos desde el diagnóstico, generando sentimientos de frustración, impotencia y culpa. Los resultados señalan la necesidad de crear espacios de discusión teórica sobre la muerte y los cuidados paliativos, así como de generar encuentros sistemáticos para abordar las percepciones relacionados con el cuidado de estos pacientes.


Assuntos
Humanos , Masculino , Feminino , Criança , Cuidados Paliativos , Equipe de Assistência ao Paciente , Pediatria , Bioética , Serviço Hospitalar de Oncologia , Oncologia
11.
Medisan ; 23(1)ene.-feb. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-990186

RESUMO

El melanoma cutáneo es una enfermedad grave y potencialmente mortal que afecta a la población de todo el orbe y que se encuentra condicionada por muchos factores de riesgo relacionados con algunos estilos de vida, que pueden ser modificables. El hallazgo oportuno y precoz de esta entidad clínica eleva la sobrevida de las personas afectadas y favorece el resultado terapéutico; sin embargo, en ocasiones no se diagnostica a tiempo. Actualmente ya se presenta en individuos más jóvenes de 25-29 años de edad y con gran probabilidad de generar metástasis, lo cual constituye una preocupación en el ámbito de la salud. Al respecto, se decidió efectuar esta revisión bibliográfica, con el fin de actualizar algunos elementos sobre el tema y darlos a conocer a la comunidad médica nacional y extranjera.


The cutaneous melanoma is a severe and potentially mortal disease that affects the population of the whole world and that is conditioned by many risk factors related to some lifestyles that can be modified. The opportune and early finding of this clinical entity elevates the survival of affected people and it favors the therapeutic result; however, it is not diagnosed on time occasionally. At present it is already presented in younger individuals with 25-29 years old and with great probability of generating metastasis, which constitutes a concern in the health field. In this respect, it was decided to make this literature review, with the purpose of to update some elements on the topic and to make them known in the national and foreign medical community.


Assuntos
Humanos , Masculino , Neoplasias Cutâneas/epidemiologia , Melanoma , Serviço Hospitalar de Oncologia
12.
Medisan ; 23(1)ene.-feb. 2019. ilus
Artigo em Espanhol | CUMED | ID: cum-74724

RESUMO

El melanoma cutáneo es una enfermedad grave y potencialmente mortal que afecta a la población de todo el orbe y que se encuentra condicionada por muchos factores de riesgo relacionados con algunos estilos de vida, que pueden ser modificables. El hallazgo oportuno y precoz de esta entidad clínica eleva la sobrevida de las personas afectadas y favorece el resultado terapéutico; sin embargo, en ocasiones no se diagnostica a tiempo. Actualmente ya se presenta en individuos más jóvenes de 25-29 años de edad y con gran probabilidad de generar metástasis, lo cual constituye una preocupación en el ámbito de la salud. Al respecto, se decidió efectuar esta revisión bibliográfica, con el fin de actualizar algunos elementos sobre el tema y darlos a conocer a la comunidad médica nacional y extranjera(AU)


The cutaneous melanoma is a severe and potentially mortal disease that affects the population of the whole world and that is conditioned by many risk factors related to some lifestyles that can be modified. The opportune and early finding of this clinical entity elevates the survival of affected people and it favors the therapeutic result; however, it is not diagnosed on time occasionally. At present it is already presented in younger individuals with 25-29 years old and with great probability of generating metastasis, which constitutes a concern in the health field. In this respect, it was decided to make this literature review, with the purpose of to update some elements on the topic and to make them known in the national and foreign medical community(AU)


Assuntos
Humanos , Masculino , Humanos , Neoplasias Cutâneas/epidemiologia , Melanoma , Serviço Hospitalar de Oncologia
13.
Arq Bras Oftalmol ; 82(2): 107-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30698230

RESUMO

PURPOSE: To evaluate the first three years of The Amazon Ocular Oncology Center, the first ocular cancer center in the North of Brazil. METHODS: Here, we report patient information including patients' age, gender, diagnosis, treatment, and city of origin. RESULTS: Two hundred and twenty-one patients were included on this study: 160 (72%) patients came from the city of Manaus, 52 (24%) from other cities in Amazonas, and 9 (4%) from other states. Of the 221 patients, 150 (68%) were afflicted with benign lesions and the remaining 71 (32%) had malignant lesions. Benign diagnosis included pterygium, chalazium, conjunctival nevus, and papilloma, cataract, and retinal detachment. Of the malignant cases, squamous cell carcinoma (SCC) of the conjunctiva was the most frequent with 43 cases (60%). Other diagnoses included choroidal melanoma (8 cases, 11%), retinoblastoma (7 cases, 9%), lymphomas (5 cases, 7%), basal cell carcinomas of the eyelid (4 cases, 5%), conjunctival melanoma (2 cases, 2%), and Kaposi sarcomas (1 case, 1%). Of the 43 patients with SCC, the mean age was 62 years old, and 30 (69%) were male; 29 patients (67%) were treated with an excisional biopsy, and 14 (33%) were treated with neoadjuvant topic chemotherapy, followed by surgery.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Neoplasias Oculares/epidemiologia , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Carcinoma/epidemiologia , Criança , Pré-Escolar , Cidades/epidemiologia , Oftalmopatias/epidemiologia , Feminino , Humanos , Lactente , Linfoma/epidemiologia , Masculino , Melanoma/epidemiologia , Pessoa de Meia-Idade , Retinoblastoma/epidemiologia , Estudos Retrospectivos , Sarcoma de Kaposi/epidemiologia , Adulto Jovem
15.
J Med Microbiol ; 68(3): 303-308, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30663951

RESUMO

INTRODUCTION: The majority of vancomycin-resistant Enterococcus faecium (VREfm) in Australia is of the vanB genotype. An outbreak of vanA VREfm emerged in our haematology/oncology unit between November 2014 and May 2015. The first case of daptomycin non-susceptible E. faecium (DNSEfm) detected was a patient with vanA VREfm bacteraemia who showed clinical failure of daptomycin therapy, prompting microbiologic testing confirming daptomycin non-susceptibility. OBJECTIVES: To describe the patient profiles, antibiotic susceptibility and genetic relatedness of vanA VREfm isolates in the outbreak. METHODS: Chart review of vanA VREfm colonized and infected patients was undertaken to describe the demographics, clinical features and outcomes of therapy. Whole genome sequencing of vanA VREfm isolates involved in the outbreak was conducted to assess clonality. RESULTS: In total, 29 samples from 24 patients tested positive for vanA VREfm (21 screening swabs and 8 clinical isolates). Five isolates were DNSEfm (four patients colonized, one patient with bacteraemia), with only one patient exposed to daptomycin previously. In silico multi-locus sequence typing of the isolates identified 25/26 as ST203, and 1/26 as ST796. Comparative genomic analysis revealed limited core genome diversity amongst the ST203 isolates, consistent with an outbreak of a single clone of vanA VREfm. CONCLUSIONS: Here we describe an outbreak of vanA VREfm in a haematology/oncology unit. Genomic analysis supports transmission of an ST203 vanA VRE clone within this unit. Daptomycin non-susceptibility in 5/24 patients left linezolid as the only treatment option. Daptomycin susceptibility cannot be assumed in vanA VREfm isolates and confirmatory testing is recommended.


Assuntos
Daptomicina/farmacologia , Genótipo , Infecções por Bactérias Gram-Positivas/epidemiologia , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Enterococos Resistentes à Vancomicina/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Austrália/epidemiologia , Bacteriemia/epidemiologia , Proteínas de Bactérias/genética , Carbono-Oxigênio Ligases/genética , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Daptomicina/uso terapêutico , Surtos de Doenças , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecium/genética , Feminino , Genômica , Infecções por Bactérias Gram-Positivas/sangue , Humanos , Linezolida/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Serviço Hospitalar de Oncologia , Resultado do Tratamento , Vancomicina/farmacologia , Sequenciamento Completo do Genoma
16.
Artigo em Inglês | MEDLINE | ID: mdl-30678332

RESUMO

Burnout in a hospital oncology service takes place when there is a high level of interaction between nurses and patients. The aim of the present study is to identify models that will enable us to accurately classify a person at a given level within each of the three dimensions of burnout, according to the values presented for personality related explanatory variables, for a sample of 96 oncology nurses working in the regional health service of Andalusia (Spain). A quantitative, crosscutting, multicentre, descriptive study was designed, and for this purpose data on sociodemographic and personality variables and on the three dimensions of burnout were compiled. Three categorical-response logit ordinal models were used and the prognostic ratios for each level were obtained, with respect to every other level, according to possible changes in the explanatory variables considered. Certain personality factors are associated with one or more dimensions of burnout syndrome. Thus, nurses are more likely to develop high levels of burnout if they present high levels of neuroticism and low levels of friendliness and responsibility. Further research in this field is needed to confirm and extend these findings.


Assuntos
Esgotamento Profissional/diagnóstico , Enfermeiras e Enfermeiros/psicologia , Personalidade , Adulto , Esgotamento Profissional/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Serviço Hospitalar de Oncologia , Espanha
17.
Clin Microbiol Infect ; 25(8): 1013-1020, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30641228

RESUMO

OBJECTIVES: Colonization and infection with third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) are frequent in haematological and oncological patients. In this high-risk setting, German guidelines recommend single-room contact precautions (SCP) for patients with 3GCR-EC that are non-susceptible to fluoroquinolones (F3GCR-EC). However, this recommendation is controversial, as evidence is limited. METHODS: We performed a prospective, multicentre cohort study at four haematology and oncology departments assessing the impact of SCP on hospital-acquired colonization or bloodstream infection (BSI) with F3GCR-EC. Two sites performed SCP for F3GCR-EC patients including single rooms, gloves and gowns (SCP sites), and two did not (NCP sites). Active screening for 3GCR-EC was performed and isolates were characterized with molecular typing methods including whole genome sequencing and core genome multiple locus sequence typing to assess patient-to-patient transmission. Potential confounders were assessed by competing-risk regression analysis. RESULTS: Within 12 months, 1386 patients at NCP sites and 1582 patients at SCP sites were included. Hospital-acquisition of F3GCR-EC was observed in 22/1386 (1.59%) and 16/1582 (1.01%) patients, respectively (p 0.191). There were 3/1386 (0.22%) patients with BSI caused by F3GCR-EC at NCP sites and 4/1582 (0.25%) at SCP sites (p 1.000). Patient-to-patient transmission occurred in three cases at NCP and SCP sites each (p 1.000). The number of patients needed to screen in order to prevent one patient-to-patient transmission of F3GCR-EC was determined to be 3729. CONCLUSIONS: Use of SCP had no significant impact on hospital-acquisition or patient-to-patient transmission of F3GCR-EC in this high-risk setting.


Assuntos
Infecção Hospitalar/prevenção & controle , Infecções por Escherichia coli/prevenção & controle , Controle de Infecções/métodos , Precauções Universais , Adulto , Idoso , Bacteriemia/prevenção & controle , Bacteriemia/transmissão , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Escherichia coli/isolamento & purificação , Feminino , Luvas Protetoras , Hematologia , Unidades Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Serviço Hospitalar de Oncologia , Estudos Prospectivos
19.
Rev Gastroenterol Mex ; 84(2): 174-184, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29884570

RESUMO

INTRODUCTION AND AIMS: In Colombia, cancer of the colon is the third most frequent cancer in relation to incidence and mortality. Five-year survival depends on stage at diagnosis, albeit that rate is not known for the country. The aim of the present study was to characterize the overall survival and disease-free survival rates in an adult population with colorectal cancer treated at an oncology center in Medellín, Colombia. MATERIALS AND METHODS: A retrospective cohort study was conducted. The case records of patients with a histologic diagnosis of colorectal cancer, seen within the time frame of 2011 and 2015, were reviewed. The overall survival and disease-free survival curves were calculated using the Kaplan-Meier method. RESULTS: A total of 824 (54.9%) patients with cancer of the colon and 676 (45.1%) with cancer of the rectum were treated. Mean patient age was 63.3 years, female sex predominated (56.3%), and 98.1% of the tumors were adenocarcinomas. The majority of the lesions were stage iii (31.9% in the colon and 35.5% in the rectum) at the time of diagnosis. Surgery was the most frequent treatment in the colon (85.2%) and radiotherapy was the most frequent in the rectum (75.4%). Overall survival at the median follow-up (27.3 months) was 66.7% for cancer of the colon and 63.9% for cancer of the rectum. Disease-free survival at the median follow-up (18.6 months in colon and 14.9 in rectum) was 72.5 and 68.9%, respectively. CONCLUSIONS: The clinical characteristics and treatment of patients were similar to those found in other studies. Two-year survival was higher than in other Colombian reports and 5-year survival was lower than that observed in developed countries.


Assuntos
Neoplasias Colorretais/mortalidade , Serviço Hospitalar de Oncologia , Adenocarcinoma/mortalidade , Adenocarcinoma/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colômbia/epidemiologia , Neoplasias Colorretais/terapia , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Análise de Sobrevida , Adulto Jovem
20.
J Bronchology Interv Pulmonol ; 26(2): 114-118, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30048417

RESUMO

BACKGROUND: When patients present with pleural effusion and structural abnormalities consistent with malignancy on imaging, the traditional approach has been to perform a thoracentesis and await the results before proceeding to more invasive diagnostic procedures. The objective of this study was to evaluate whether concurrent thoracentesis and tissue biopsy is superior to sequential sampling. METHODS: Retrospective chart review was performed for patients who had a pleural cytology from May 2014 until January 2017. Patients without parenchymal, pleural, or mediastinal abnormalities and those with a prior primary thoracic malignancy were excluded. Patients with an effusion and additional suspect findings were grouped based upon whether initial approach was concurrent versus sequential. The following outcomes were documented: lag time to diagnosis from thoracentesis, lag time to hematology/oncology (HONC) service consult, time to molecular study results, lag time to therapy, and time to death. RESULTS: Of 565 cases, 45 met criteria, 28 (62%) having undergone concurrent and 17 (38%) sequential sampling. The median lag time to biopsy for the concurrent group, 3 days, was significantly shorter than the 9-day lag time for the sequential group (P=0.006). Five patients in the sequential group and one in the concurrent group were lost to follow-up. Patients in the concurrent group had earlier diagnosis and oncology visits (2 d, 7 d) than those in the sequential group (6.5 d, 16 d) (P<0.001 and <0.039, respectively). Time from diagnosis to death did not differ for the 2 groups. CONCLUSION: For patients presenting with pleural effusion accompanied by additional suspect findings, concurrent tissue sampling, and thoracentesis may both reduce loss to follow up and accelerate care.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Tardio , Neoplasias Pulmonares/diagnóstico , Derrame Pleural/diagnóstico , Encaminhamento e Consulta , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Tempo para o Tratamento , Adenocarcinoma de Pulmão/complicações , Adenocarcinoma de Pulmão/patologia , Idoso , Broncoscopia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/patologia , Assistência à Saúde , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Feminino , Humanos , Perda de Seguimento , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Serviço Hospitalar de Oncologia , Derrame Pleural/etiologia , Derrame Pleural/patologia , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/complicações , Carcinoma de Pequenas Células do Pulmão/patologia , Toracentese , Toracoscopia , Fatores de Tempo
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