Search Results (8)

Febrile neutropenia (FN) is a major concern in patients undergoing chemotherapy for diffuse large B-cell lymphoma (DLBCL); however, the overall risk of FN is difficult to assess. This study aimed to develop a model for predicting the occurrence of FN in patients with DLBCL. In this multicenter, retrospective, observational analysis, a multivariate logistic regression model was used to analyze the association between FN incidence and pretreatment clinical factors. We included adult inpatients and outpatients (aged ≥ 18 years) diagnosed with DLBCL who were treated with chemotherapy. The study examined 246 patients. Considering FN occurring during the first cycle of chemotherapy as the primary outcome, a predictive model with a total score of 5 points was constructed as follows: 1 point each for a positive hepatitis panel, extranodal involvement, and a high level of soluble interleukin-2 receptor and 2 points for lymphopenia. The area under the receiver operating characteristic curve of this model was 0.844 (95% confidence interval: 0.777–0.911). Our predictive model can assess the risk of FN before patients with DLBCL start chemotherapy, leading to better outcomes. Full article

Elastomeric infusion pumps (EMPs) have been implemented in many fields, including analgesia, chemotherapy and cardiology. Their application in antimicrobials is mainly limited to the outpatient setting, but with a need to optimise inpatient antimicrobial treatment, the use of EMPs presents a potential option. This review aimed to identify if the use of EMPs within an inpatient setting is feasible, effective and safe for antimicrobial use. Criteria for inclusion were human studies that involved the treatment of an infection with intravenous antimicrobial agents via an EMP. A search strategy was developed covering both the indexed and grey literature, with all study designs included. The review found 1 eligible study enrolling 6 patients. There was strong patient preference for EMPs (6/6), and daily tasks were easily completed whilst attached to the EMP. Nurses (5/5) also preffered the pumps, and the majority reported them as easy to use. The review has identified the need for further research in the area. Evidence for the use of EMPs to administer antibiotics in the inpatient setting is scarce, and more work is needed to understand the advantages to patients, to healthcare workers and from an antimicrobial stewardship perspective. Potential disadvantages that may put patients at risk also need investigating. Full article

This research deals with the same-day chemotherapy outpatient scheduling problem that is recognized as a leading strategy to pursue the objective of reducing patient waiting time. Inspired by a real-world context and different from the other studies, we modeled a multi-stage chemotherapy ward in which the pharmacy is located away from the treatment area and drugs are delivered in batches. Processes in oncology wards are characterized by several sources of uncertainty that increase the complexity of the problem; thus, a stochastic approach was preferred to study the outpatient scheduling problem. To generate effective appointment schedules, we moved in two directions. First, we adopted a late-start scheduling strategy to reduce the idle times within and among the different stages, namely medical consultation, drug preparation and infusion. Then, since the problem is NP-hard in the strong sense, we developed a hybrid harmony search metaheuristic whose effectiveness was proved through an extended numerical analysis involving another optimization technique from the relevant literature. The outcomes from the numerical experiments confirmed the efficacy of the proposed scheduling model and the hybrid metaheuristic algorithm as well. Full article

This study aimed to: (1) externally validate the Visual/Verbal Analogue Scale of food ingesta (ingesta-VVAS) that previously showed good discrimination between oncology patients who ingest more or less energy than required; (2) explore the discriminative properties of other questions. Dietitians performed 322 interviews in 206 adult oncology patients undergoing chemotherapy in two Dutch hospitals, including a 24-h dietary recall, assessment of the ingesta-VVAS and 12 additional questions related to reduced food intake. The ingesta-VVAS score was linearly associated with energy intake as % of Total Energy Expenditure (TEE) (standardized beta = 0.39, p < 0.001), with no differences between groups based on use of oral nutritional supplements, body mass index, in/outpatient setting or sex. The accuracy of the ingesta-VVAS score to predict low energy intake (<75% of TEE) was poor (Area Under the Receiver Operating Characteristic curve (AUC) = 0.668, 95% CI 0.603–0.733). The optimal multivariate model included the ingesta-VVAS score and a question on ‘feeling sick’ (AUC = 0.680, 95% CI 0.615–0.746). In conclusion, in our study the ingesta-VVAS discriminates poorly between oncology patients undergoing chemotherapy who ingest more or less energy than required. Adding a question on feeling sick only slightly improved model performance. Further external validation is warranted. Full article

Making emergency evacuation plans for disaster prevention is always a high priority for hospital administrators to ensure the safety of patients and employees. This study employs the outpatient chemotherapy area of a cancer medical center as an example, and its area involves professional medical care and relatively complex human group behaviors. Hence, it is necessary to simulate evacuations in advance to formulate a special evacuation plan. To achieve this task, a constraint-based simulation system is developed with three major processes: defining spatial and activity constraints, agent-based modeling, and optimizing resource allocation. The spatial boundaries are converted from a three-dimensional model in the Building Information Modeling (BIM) to conduct a visualized simulation. Based on the spatial boundaries, the activities of the agents are set to obey the process specified by work studies. Finally, the Monte Carlo method is employed to simulate the stochastic rescue behaviors of nurses during disasters to determine the fittest resource allocation with the shortest evacuation time for different numbers of patients. The results reveal that the proposed system can output a suggested list of resource allocations and visualized results for administrators when making evacuation plans such that all the people in the area can be safely evacuated. Full article

Background: This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE. Methods: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE. Results: The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas. Conclusion: Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer. Full article

A 78 year old Caucasian woman, was admitted to the hospital for evaluation of a mass to the anterior surface of the left mandibular angle and left submandibular area present for the past year with rapid acceleration of growth over three weeks prior to admission. An incisional biopsy was performed and initial diagnosis of poorly differentiated neuroendocrine carcinoma (small cell carcinoma) was made. Dermatological evaluation revealed lesion was suspicious for Merkel cell carcinoma and the pathology specimen was re-analyzed and differential diagnoses was made for Merkel cell carcinoma. Patient was educated and discharged to a nursing home with plan for irradiation, chemotherapy, and outpatient follow up. This case study serves to raise awareness of a rare condition and describe how Merkel cell carcinoma may be mistaken for similarly presenting neuroendocrine tumors. Full article

Background: Timeliness of care (rapid initiation of treatment after definitive diagnosis) is a key component of high-quality cancer treatment. The present study evaluated factors influencing timeliness of care for U.S. Medicare enrollees. Methods: Data for Medicare enrollees diagnosed with breast, colorectal, lung, or prostate cancer while living in U.S. seer (Surveillance, Epidemiology and End Results) regions in 2000–2002 were analyzed. Patients were classified as experiencing delayed treatment if the interval between diagnosis and treatment was greater than the 95th percentile for each cancer site. The impacts of patient sociodemographic, clinical, and area-based factors on the likelihood of delayed treatment were analyzed using multivariate logistic regression. Results: Black patients (compared with white patients) and patients initially treated with radiation therapy or chemotherapy (rather than surgery) had a greater likelihood of treatment delays across all four cancer sites. Hispanic status, dual Medicare–Medicaid status, location of initial treatment (inpatient vs. outpatient), and stage at diagnosis also affected timeliness of care for some cancer sites. Surprisingly, area-based factors reflecting availability of cancer care services were not significantly associated with timeliness of care or were associated with greater delays in areas with greater numbers of service providers. Conclusions: Multiple factors affected receipt of timely cancer care for members of the study population, all of whom had coverage of medical care services through Medicare. Because delays in treatment initiation can increase morbidity, decrease quality of life, shorten survival, and result in greater costs, prospective studies and tailored interventions are needed to address those factors among at-risk patient groups. Full article