Hematology Ward Research Articles

The role of registered dietitians in the hematology ward

The role of registered dietitians in the hematology ward

Five-year outcome of peripherally inserted central catheters in adults: a separated infectious and thrombotic complications analysis.

To assess infectious and thrombotic complications of peripherally inserted central catheters (PICCs) in adults. A 5-year prospective cohort study. Tertiary-care teaching hospital in Seville, Spain. Adult patients undergoing PICC insertion. Catheter-associated bloodstream infection (CABSI) including catheter-related bloodstream infection (CRBSI), primary bacteremia (PB), and upper extremity deep vein thrombosis (UEDVT) were recorded. Independent predictors of complications were assessed by multivariate analysis. In total, 1,142 PICCs were inserted, with 153,191 catheter days (median, 79). Complications included 66 cases of CABSI (5.78%; 0.43‰ catheter days), 38 cases of CRBSI (3.33%; 0.25‰ catheter days), 28 cases of PB (2.45%; 0.18‰ catheter days), and 23 cases of UEDVT (2.01%; 0.15‰ catheter days). The median times to infection were 24, 41, and 60 days for CRBSI, PB, and UEDVT, respectively. Parenteral nutrition (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.77-6.52) and admission to the hematology ward (OR, 4.90; 95% CI, 2.25-10.71) were independently associated with CRBSI and PB, respectively. Admission to the hematology ward (OR, 12.46; 95% CI, 2.49-62.50) or to the oncology ward (OR, 7.89; 95% CI, 1.77-35.16) was independently associated with UEDVT. The crude mortality rate was 24.8%. Only 2 patients died of complications. PICCs showed a low rate of thrombotic and infectious complications. Compared to PB, CRBSI showed significantly different risk factors, a higher incidence density per catheter days, and a shorter median time to infection. Separate analyses of CRBSI and PB are more specific and clinically useful when analyzing infectious complications.

Impact of the First Wave of COVID-19 on Pediatric Oncology and Hematology: A Report from the French Society of Pediatric Oncology.

Simple SummaryData regarding coronavirus disease 2019 (COVID-19) description are still limited in pediatric oncology. The French society of pediatric oncology (SFCE) initiated a study to better describe COVID-19 presentation and evolution in patients followed in French pediatric oncology and hematology wards. By describing COVID-19 in this specific population, we aimed to identify the patients who may be the most at risk of severe COVID-19 and establish specific recommendations.Data regarding coronavirus disease 2019 (COVID-19) description are still limited in pediatric oncology. The French society of pediatric oncology (SFCE) initiated a study to better describe COVID-19 in patients followed in French pediatric oncology and hematology wards. All patients diagnosed with COVID-19 and followed in a SFCE center were enrolled. Data from medical records were analyzed for all patients enrolled up to the end of May 2020. Data were available for 37 patients. Thirty-one were children under 18 years of age. Nineteen patients were female. Seventeen patients had a solid tumor, 16 had a hematological malignancy and four recently underwent hematopoietic stem cell transplantation (HSCT) for non-oncological conditions. Twenty-eight patients presented symptoms, most often with fever, cough, rhinorrhea and asthenia. Ground-glass opacities were the most frequent radiological finding with abnormalities mostly bilateral and peripherally distributed. Twenty-four patients received chemotherapy a month prior to COVID-19 diagnosis. Most patients did not require hospitalization. Three patients required oxygen at the time of diagnosis. In total, five patients were admitted in an intensive care unit because of COVID-19 and one died from the disease. Children and young adults treated for a cancer and/or with a HSCT may be at risk for severe COVID-19 and should be closely monitored.

Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study.

BackgroundAdmission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity.ObjectiveThis protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge.MethodsThe Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers.ResultsThis study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021.ConclusionsThis study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients.Trial RegistrationNetherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480International Registered Report Identifier (IRRID)DERR1-10.2196/19000

Comparison of Care Outcomes Between Two Methods of Drug Injection Through Ports and Peripheral Veins in Patients Undergoing Chemotherapy

Background: One of the common treatments for cancer is chemotherapy that is usually done by intravenous injection. Central catheters and portholes are used for the intravenous administration of chemotherapy drugs through peripheral vessels. Objectives: This study aimed to compare the caring outcomes of the two methods of drug injection through the peripheral vessels and ports in patients undergoing chemotherapy. Methods: In this descriptive study, 68 cancer patients admitted to the Hematology and Oncology Wards of Shahid Baghaei Hospital 2 in Ahwaz during three months were evaluated in two groups of 34 patients receiving chemotherapy (one group via ports and one group via peripheral blood vessels). Data were collected by a questionnaire consisting of two parts: demographic information (sex, age, and type of disease) and information about the patient's condition (drug injection method, serum, and catheter number), and an observational checklist including inflammation rate, drug extravasation, limitation of patient movement, medical expenses, and patient satisfaction. Data were analyzed using SPSS version 24 software. Results: According to the results of the study, the two groups were compared in terms of inflammation (P = 0.0001, T = 4.908), drug extravasation (P = 0.0001, T = 3.872), movement limitation P = 0.000, T = 4.922) the cost of treatment (P = 0.0001, χ2 = 56.973, P = 0.000, and patient satisfaction (P = 0.0001, T = -23.66). Conclusions: Performing chemotherapy through the port has fewer side effects and brings more comfort to the patients.

Active screening of intestinal carbapenem-resistant Enterobacteriaceae in high-risk patients admitted to the hematology wards and its effect evaluation

目的观察血液科肠道碳青霉烯类耐药的肠杆菌科细菌（CRE）主动筛查患者CRE定植、感染的特征，并评价主动筛查结合加强干预在血液科患者CRE感染预防控制中的效果。方法以2017年3月至2019年12月血液内科接受化疗或免疫抑制治疗且预期会出现粒细胞缺乏（粒缺）的患者为研究对象，进行至少3个时间点（治疗前、治疗后粒缺期、粒缺伴发热期）的肠道CRE筛查，以2016年12月至2017年2月血液内科未开展肠道CRE主动筛查的、接受化疗或免疫抑制治疗的115例患者为历史对照组，两组患者均进行CRE感染实时监测，CRE筛查阳性者均采取接触隔离措施，CRE筛查阳性者出现发热或者感染症状时启动针对CRE联合抗生素治疗。结果主动筛查患者CRE定植率为16.46%（66/401）；病种分布上，以急性白血病定植率最高，为23.03%（26/113）。66例筛查阳性患者中，其中第1次筛查阳性患者为27例，占40.9%（27/66），第2次筛查阳性患者为15例，占22.7%（15/66），第3次及以后筛查阳性患者为24例，占36.4%（24/66）。CRE定植病原菌中耐碳青霉烯类肺炎克雷伯菌（CRKP）最多，占54.55%（36/66）。主动筛查患者CRE感染率（2.49%）及死亡率（50.00%）低于历史对照组的11.30%及69.23%；干预期间10例CRE血流感染患者病原菌种类与前期主动筛查病原菌完全相同，符合率为100.0%。结论血液科病房急性白血病患者CRE定植率最高，CRKP是CRE定植、感染的主要病原菌，提高筛查频率可以显著提高筛查阳性率，采取主动筛查并及早干预能有效降低血液科患者CRE发生率及死亡率，CRE筛查阳性病原菌与后续CRE感染病原菌符合率高。恶性血液病患者肠道CRE筛查可以对后期CRE血流感染起到预警以及优化抗菌药物使用的作用。

Epidemiologic profile of nosocomial infections among paediatric patients in a referral hospital in Hamadan, west of Iran

Healthcare-associated infections (HC-AI) are major health problem with high financial impact. HC-AIs are one of the main causes of morbidity and mortality in paediatric hospitals. This study was performed to determine the epidemiology of HC-AIs in children admitted to medical wards of Besat Hospital in Hamadan, west of Iran. Data on cases of HC-AIs in paediatrics were collected from March 2017 to February 2018 in Besat Hospital. The medical records of eligible cases were extracted from Iranian Nosocomial Infections Surveillance Software. During the study period, a total of 355 HC-AIs in children were detected, 213 (60%) in boys and 214 (60.3%) in the 0–4-year age group. Of these, bloodstream infection was the most frequent infection in both age groups (37.38% in 0–4 years and 34.75% in 5–14 years). Escherichia coli was the common detected microorganism in girls (25.84% in those aged 0–4 years and 24.53% in 5–14 years), whereas Staphylococcus was more prevalent in boys (33.6% in those aged 0–4 years and 29.55% in 5–14 years). HC-AIs were more prevalent in burn, haematology and intensive care unit wards. In Besat Hospital, bloodstream infection and urinary tract infection were the most frequent infections among paediatric patients, and E. coli and Staphylococcus were the commonest detected microorganism in girls and boys respectively. Preventive activities should be targeted to reduce the rate of HC-AIs in wards associated with more contamination.

Two-Year Surveillance of Central-Line–Associated Bloodstream Infections in Non-ICU Wards in a Dutch Teaching Hospital

Background: Central-line–associated bloodstream infections (CLABSIs) are serious complications of modern health care, leading to increased morbidity, mortality, and costs. Since 2012, a multimodal insertion and care bundle for central venous catheters (CVCs) has been implemented in the intensive care unit (ICU) of the Amphia Hospital Breda, The Netherlands. The implementation of this bundle was associated with sustainable low CLABSI rates (1 per 1,000 CVC days). There was no surveillance of CLABSI in the other departments of the hospital. Objectives: We implemented semiautomated surveillance for CLABSI in non-ICU inpatients. Methods: A single-center, retrospective study was conducted in a 1,370-bed teaching hospital in The Netherlands between January 2017 and December 2018. All hospitalized patients (aged ≥18 years) in non-ICU wards, with a CVC inserted, were screened for CLABSI. CLABSIs were diagnosed using the definitions of the national nosocomial surveillance network PREZIES, excluding infections already present on admission and secondary bloodstream infection. CLABSI rates were calculated as cases per 1,000 CVC days with 95% CIs. Results: In 2017, 14 CLABSI were reported during 4,656 CVC days (3.0 per 1,000 CVC days; 95% CI, 1.8–5.1). In 2018, 13 CLABSIs were reported during 4,995 catheter days (2.6 per 1,000 CVC days; 95% CI, 1.5–4.5). The mean duration of CVC days prior to CLABSI in 2017 and 2018 were 20 days (range, 4–28) and 14 days (range, 4–25), respectively. Most CLABSI events occurred in patients admitted to the hematology ward (13 of 27, 48.1%). Of those, 11 of 13 (84,6%) were patients with an acute myeloid leukemia (AML) and severe mucositis due to the intensive chemotherapy at the time of CLABSI. The remaining cases occurred in patients of 4 different surgical departments. Coagulase-negative staphylococci were the most common organisms recovered (25 of 27, 92.6%). Conclusions: To our knowledge, this is the first report of CLABSI-rates in non-ICU wards in the Netherlands. The CLABSI rates were higher in non-ICU wards compared to the ICU of our hospital. This difference was mainly because of the high CLABSI rate in the patients with AML.Funding: NoneDisclosures: None

Quantification of 1,3-β-d-glucan by Wako β-glucan assay for rapid exclusion of invasive fungal infections in critical patients: A diagnostic test accuracy study.

Rapid and reliable exclusion of invasive fungal infections (IFI) by markers able to avoid unnecessary empirical antifungal treatment is still a critical unmet clinical need. We investigated the diagnostic performance of a newly available β-d-Glucan (BDG) quantification assay, focusing on the optimisation of the BDG cut-off values for IFI exclusion. BDG results by Wako β-glucan assay (lower limit of detection [LLOD]=2.16pg/mL, positivity≥11pg/mL) on two consecutive serum samples were retrospectively analysed in 170 patients, admitted to haematological wards (N=42), intensive care units (ICUs; N=80), or other wards (N=48), exhibiting clinical signs and/or symptoms suspected for IFI. Only patients with proven IFI (EORTC/MSG criteria) were considered as true positives in the assessment of BDG sensitivity, specificity and predictive values. Patients were diagnosed with no IFI (69.4%), proven IFI (25.3%) or probable IFI (5.3%). Two consecutive BDG values<LLOD performed within a median of 1 (interquartile range: 1-3) day were able to exclude a proven IFI with 100% sensitivity and negative predictive value (primary study goal). Test's specificity improved by using two distinct positivity and negativity cut-offs (7.7pg/mL and LLOD, respectively), but remained suboptimal in ICU patients (50%), as compared to haematological or other patients (93% and 90%, respectively). The classification of Wako's results as negative when<LLOD, and positive when>7.7pg/mL, could be a promising diagnostic approach to confidently rule out an IFI in both ICU and non-ICU patients. The poor specificity in the ICU setting remains a concern, due to the difficulty to interpret positive results in this fragile population.

Risk assessment in hematology ward renovation, a FMEA example in a tertiary hospital in Italy

Abstract Background Hospital construction and renovation works cause derangement, increasing mistake rate in healthcare workers and resulting in dust contamination and dispersal of fungal spores that could improve morbidity and mortality in severely immune suppressed patients. The necessary renovation of hematology ward at IRCCS Policlinico San Martino in Genoa, scheduled for February 2020 required a risk assessment to avoid logistical, organizational and clinical problems. Two possible scenarios were proposed: (1) displacement of patients in another building previously used as hematological unit or (2) department split in 2 sections to carry out renovation works in different periods. Risk management of the choice relies on failure mode and effects analysis (FMEA) method, a proactive tool based on risk priority number (RPN) that ranks failure modes in terms of occurrence, severity and detection. Aim of this work is to analyze and compare the two scenarios; a team of experts in Public health with specific skills in risk management and hospital governance used FMEA to single out failure modes and to compute RPN. Methods Thirteen failure modes were combined together in four major possible risks: (a) lengthening waiting times and delay haematopoietic stem cell transplant procedures, (b) exposure to airborne contamination, (c) cross contamination and water contamination, (d) wrong behaviors. RPN was computed for each failure mode. Results Relevant failure modes were: reduction of bedsides in both scenarios (7 bedsides lost in first scenario RPN1 540 vs 9 bedsides lost in second scenario RPN2 630), less air exchange/hour in the first scenario (4/h RPN1 500 vs 6/h RPN2 400) balanced by closeness to the work site in the second scenario(RPN2 500). First scenario total RPN was 2430, second scenario was 3250. Conclusions Using FMEA, we assessed the different risks profile of two scenarios. Although some residual risks persisted, the first scenario shows a lower risk profile for all major risks. Key messages Risk assessment is a key element to better understand hospital problems and improve environmental health in healthcare setting FMEA represents a useful tool to guide hospital manager in difficult choices concerning severely immune suppressed patients.

CML-245: Central Nervous System Restricted Lymphoid Blast Phase Transformation of CML

Objective We describe the clinical manifestations and management of a patient with lymphoid blast transformation of CML with sole compromise of central nervous system. Design case report Setting Hematology ward of Hospital San Juan de Dios, Caja Costarricense Seguro Social, Costa Rica Patients or other participants A 65-year-old male with chronic myelogenous leukemia with a history of non-adherence to TKI. Due to not reaching the European LeukemiaNet milestones, the patient was switched from imatinib to nilotinib. After three months on nilotinib, the patient complained of leg weakness and deafness. Due to persisting neurological symptoms, lumbar puncture was performed. Cerebrospinal fluid flow cytometry demonstrated 92% lymphoblasts. Interventions Full blood count was normal. Bone marrow aspiration showed no evidence of blast phase transformation, polymerase chain reaction showed 17% of BCR ABL transcripts. Head and spine CT and MRI showed no lesions. Tyrosine kinase inhibitor change to dasatinib was solicited. Systemic combination chemotherapy was started. The patient received induction with weekly vincristine and dexamethasone. Anthracycline was omitted due to cardiac disfunction. Triple intrathecal chemotherapy with was administered twice a week until the spinal tap analysis showed no blast presence by flow cytometry. The patient continued on a BFM-like protocol with high dose methotrexate of which he has received four courses. Results In his last follow-up visit the patient had a normal blood count. His last PCR for BCR ABL transcripts had failed to achieve molecular response. BCR ABL mutation study showed no evidence of mutations, medication non-adherence was suspected and addressed. His last spinal tap showed no evidence of blast presence by flow cytometry, his bone marrow aspiration showed no evidence of lymphoblasts. Conclusions The progression to blast phase is a rare event, most of the time related to the development of resistance to tyrosine kinase inhibitors. Less than 20 cases are described in the literature. Central nervous system is the most frequent location. Blast crisis usually presents with a lymphoid phenotype, the frequency of ABL mutations is usually low. The prognosis in these cases is usually dismal with overall survival less than six months.

Prevalence and aetiology of moderate and severe thrombocytopenia in a tertiary and quaternary centre in KwaZulu-Natal.

BackgroundThrombocytopenia is a common haematological disorder, characterised by platelet counts below 150 × 109/L. The aetiology of thrombocytopenia is multifactorial; notably, in a misdiagnosis this condition may be due to pre-analytical laboratory artefacts. Knowledge about the common aetiology of thrombocytopenia will assist clinicians in decision-making and interpretation of laboratory tests and this may lead to prompt, adequate patient management and cost-saving measures.ObjectiveThis study determined the prevalence and aetiology of moderate and severe thrombocytopenia in a tertiary or quaternary laboratory in Durban, KwaZulu-Natal, South Africa.MethodsWe conducted a retrospective study at the Inkosi Albert Luthuli Central Hospital haematology laboratory between October 2015 and April 2016. A total of 2076 full blood count results with a platelet count of less than 100 × 109/L were retrieved from the Inkosi Albert Luthuli Academic Hospital database. Laboratory data were extracted and matched with clinical data and used to identify the potential aetiology of thrombocytopenia.ResultsThe prevalence of thrombocytopenia was 14.9% within the selected study period. The haematology or oncology wards and clinic accounted for 55.2% of thrombocytopenia cases, whereas the adult and paediatric intensive care units accounted for 29.3%. Notably, 15.5% of thrombocytopenia cases were reported in non-haematology wards and clinics. The most common cause of thrombocytopenia was chemotherapy which accounted for 38.5% of all causes.ConclusionIn our tertiary and quaternary setting, thrombocytopenia in adults was most common in patients admitted to haematology and oncology wards. Moreover, chemotherapy-induced thrombocytopenia accounted for more than a third of all these cases.

The ethics of DNR-decisions in oncology and hematology care: a qualitative study

BackgroundIn cancer care, do not resuscitate (DNR) orders are common in the terminal phase of the illness, which implies that the responsible physician in advance decides that in case of a cardiac arrest neither basic nor advanced Coronary Pulmonary Rescue should be performed. Swedish regulations prescribe that DNR decisions should be made by the responsible physician, preferably in co-operation with members of the team. If possible, the patient should consent, and significant others should be informed of the decision. Previous studies have shown that physicians and nurses can experience ethical dilemmas in relation to DNR decisions, but knowledge about what ethical reasoning they perform is lacking. Therefore, the aim was to describe and explore what ethical reasoning physicians and nurses apply in relation to DNR-decisions in oncology and hematology care.MethodsA qualitative, descriptive and explorative design was used, based on 287 free-text comments in a study-specific questionnaire, answered by 216 physicians and nurses working in 16 oncology and hematology wards in Sweden. Comments were given by 89 participants.ResultsThe participants applied a situation-based ethical reasoning in relation to DNR-decisions. The reasons given for this were both deontological and utilitarian in kind. Also, expressions of care ethics were found in the material. Universal rules or guidelines were seen as problematic. Concerning the importance of the subject, nurses to a higher extent underlined the importance of discussing DNR-situations, while physicians described DNR-decisions as over-investigated and not such a big issue in their daily work.ConclusionThe study revealed that DNR-decisions in oncology and hematology care gave rise to ethical considerations. Important ethical values described by the participants were to avoid doing harm and to secure a peaceful and “natural” death with dignity for their dying patients. A preference for the expression “allow for natural death” instead of the traditional term “do not resuscitate” was found in the material.

Optimizing care for high-risk neuroblastoma patients treated with dinutuximab: Challenges for the multidisciplinary team.

Current treatment protocols for high-risk neuroblastoma include high-dose chemotherapy, surgery, stem cell transplantation and radiation. Recently, dinutuximab, a chimeric monoclonal antibody, specifically targeting the disialoganglioside highly expressed on neuroblastoma cells, has been licensed. Its incorporation in maintenance therapy represents a promising treatment approach. The introduction of its use was a challenge for the entire multidisciplinary team in our pediatric hematology and oncology ward just as for the pharmacy team. An overview of the key points that were observed is presented.

Characterization of Ba813 harbouring Bacillus cereus in patients with haematological malignancy and hospital environments at a medical centre in Japan.

Introduction. Bacillus cereus harbouring Ba813, a specific chromosomal marker of Bacillus anthtacis, is found in patients with severe manifestations and causes nosocomial outbreaks.Aim. We assessed the genetic characteristics and virulence of Ba813(+) B. cereus in a hospital setting.Methodology. Three neutropenic patients with haematological malignancy developed B. cereus bacteraemia within a short period. Fifteen B. cereus were isolated from different sites in a haematology ward. A total of 18 isolates were evaluated for Ba813- and B. anthracis-related virulence, food poisoning-related virulence, genetic diversity, bacteria motility and biofilm formation.Results. Ba813(+) B. cereus was detected in 33 % (1/3) of patients and 66 % (9/15) of the hospital environment. The 18 strains were divided into 2 major clusters (clade 1 and clade 2), and 14 strains were classified into clade 1. All Ba813(+) strains, including four sequence types, were classified into clade 1/the cereus III lineage, which is most closely related to the anthracis lineage. Two strains belonging to clade 1/non-cereus III carried the B. anthracis-associated cap gene, but not Ba813. B. cereus, including Ba813(+) strains, had significantly lower prevalence of enterotoxin genes than clade 2 strains. In clade 1, B. cereus, Ba813(+) strains showed significantly higher swimming motility and biofilm formation ability than Ba813(-) strains.Conclusion. Ba813(+) B. cereus, which are genetically closely related to B. anthracis, were abundant in a haematological ward. Ba813(+) B. cereus with high motility and biofilm formation abilities may spread easily in hospital environments, and could become a hospital-acquired infection.

Nested multiplex PCR for detection of bacterial and fungal blood stream infections in patients with hematological malignancies.

Bloodstream Infections (BSIs) are a main cause of life-threatening complications among patients with cancer. This study aimed to identify microbial pathogens causing BSI in febrile neutropenic patients with hematologic malignancy and compare the results of conventional blood culture with a nested multiplex real time PCR assay done directly on whole blood samples. The nested multiplex PCR was based on 16S rDNA and 18S rDNA sequence-specific primers; hence, it allowed the identification of most species of bacteria and fungi. Forty adult patients with febrile neutropenia, admitted at Hematology ward of Ain Shams University Hospitals, were included in this study. Each patient was subjected to conventional blood culture and nested multiplex PCR. Blood culture was positive in 19 patients (47.5%). About 68.4% of the positive cultures were monomicrobial, while 31.6% were polymicrobial. A total number of 26 isolates were grown from positive cultures; Staphylococcus aureus was the most common (30.8%), followed by Klebsiella pneumoniae (19.2%). Regarding nested PCR, positive results were detected in 37/40 patients (92.5%) which was statistically significantly higher than that of blood culture. Eighteen samples that tested negative by culture were positive using the molecular approach. The agreement between the two approaches was 55%. nested multiplex real time PCR can be a promising tool in order to achieve rapid diagnosis in cancer patients clinically suspected of BSIs. Its utilization could affect the choice of antimicrobial treatment whether bacterial or fungal and, therefore avoid unnecessary use of antimicrobials.

Metastatic spinal cord compression - a retrospective audit of current practice on medical oncology and haematology wards at GSTT

Metastatic spinal cord compression - a retrospective audit of current practice on medical oncology and haematology wards at GSTT

A Preliminary Study of the Comfort in Patients with Leukemia Staying in a Positive Pressure Isolation Room.

Background and Aim: Patients with leukemia who are isolated in positive pressure rooms for infection prevention usually experience significant physical and psychological distress. This study aimed to examine changes in leukemia patients’ comfort level during chemotherapy in isolation wards. Methods: A longitudinal survey was conducted with measures which were repeated four times. Data were collected before chemotherapy, on the first and second week after receiving chemotherapy in positive pressure isolation rooms, and on the third week in the non-isolated hematology ward. Each patient received six questionnaires measuring demographic data, comfort status, functional status, fatigue related to cancer therapy, anxiety level, and distress symptoms. A mixed model with repeated measure analysis was used to examine the changing trajectories in physical and psychological health. Results: Twenty-one patients completed the study. During the process, the highest score for comfort level was shown before chemotherapy, and this decreased from the second week under isolation. Anxiety and uncertainty (p < 0.05) declined over time, and emotional states improved during the recovery period in the third and fourth weeks outside isolation. Physical well-being (p < 0.01), cancer-related fatigue (p < 0.05), hemoglobin (p < 0.01) and white blood cell count (p < 0.05) began to rise two weeks after chemotherapy. Conclusion: Comfort levels declined after chemotherapy until the third week of treatment. Anxiety, fatigue and distress symptoms varied across the four time points of chemotherapy from isolation to return to the non-isolated ward. Health care professionals should be aware of psychological symptoms when patients are in isolation rooms, and interventions for promoting a humanized environment, quality of life, and comfort should be considered and provided along with the treatment stages of chemotherapy.

Epidemiologic and Clinical Characteristics of 2019 Novel Coronavirus Disease Diagnosed in Hospital Haematology Wards in Wuhan, China: A Retrospective Cohort Study

Background: 2019 novel coronavirus disease (COVID-19) has caused a pandemic, but data about hospital-associated infection in haematological units are yet to kno

Understanding and suggestion on prevention and control of COVID-19 infection in hematological wards

Understanding and suggestion on prevention and control of COVID-19 infection in hematological wards