Oncology Ward Research Articles

Factors associated with mortality and evaluation of clinical risk scores among cancer patients admitted with post-chemotherapy infection in Uganda: a prospective cohort study

Abstract Background Little is known about outcomes from cancer chemotherapy-associated infections in sub-Saharan Africa. Accordingly, among cancer patients admitted with post-chemotherapy infection in Mbarara, Uganda, we aimed to determine 1) the 30-day case fatality rate, 2) factors associated with mortality, and 3) clinical risk score performance. Methods We enrolled participants aged 18 years or older if they 1) received cancer chemotherapy within the past 30 days, 2) were admitted to the oncology ward, and 3) were prescribed intravenous antibiotics. We used Cox proportional hazards regression to determine predictors of 30-day mortality and calculated the area under the receiver operating characteristic curve (AUC) for each clinical risk score. Results Among 150 participants, 67 (45%) were female and the median (IQR) age was 56 (43-66) years. Esophageal cancer (18%) and pneumonia (42%) were the most common malignancy and infection, respectively. Death by 30 days occurred in 63 (42%) participants. qSOFA ≥2 (adjusted hazard ratio [aHR] 2.51, 95% confidence interval [CI] 1.42-4.44, p=0.001), and UVA score >4 (aHR 2.13, 95% CI 1.08-4.18, p=0.03) were independently associated with 30-day mortality. An ECOG score ≥3 was similarly independently associated with 30-day mortality in the qSOFA and UVA models. The AUCs for qSOFA and UVA were 0.70 (95% CI 0.63-0.79) and 0.72 (95% CI 0.64-0.80), respectively. Conclusions In participants with post-chemotherapy infection in Mbarara, Uganda, the case fatality rate was high. ECOG, qSOFA, and UVA scores were associated with 30-day mortality.

Exploring Caregiver Burden and Related Factors Among Primary Caregivers of Patients With Cancer in Taiwan.

To explore burden and its related factors among primary caregivers of patients with cancer. This study was conducted in an oncology ward at a medical center in southern Taiwan. A total of 137 dyads of patients with cancer and their primary caregivers were recruited. This cross-sectional correlational study used a structured questionnaire to assess the burden of primary caregivers. Data on patients' basic characteristics and disease profiles were extracted from medical records from January to June 2019. Linear regression analysis was used to identify factors associated with the burden of primary caregivers. The majority of primary caregivers were female (70%) and aged younger than 65 years (85%). Overall, the mean primary caregiver burden score was 38.83 (SD = 12.86), with spiritual burden ranking highest among the four domains assessed. Factors related to overall primary caregiver burden included psychiatric symptoms, daily care hours, patient age, and the lack of rotational support. Hospice and oncology nurses can actively identify psychiatric symptoms in primary caregivers, targeting high-risk groups to provide timely resources or psychiatric referrals, aiming to alleviate future caregiver burden.

"Doctor, would it surprise you if there were prescribing errors in this patient's medication?" Identifying eligible patients for in-hospital pharmacotherapeutic stewardship: A matched case-control study.

Evaluating a patient's medication list is critical to reduce prescribing errors (PEs), but is a labour- and time-intensive process. Identification of patients at risk of PEs could improve the allocation of scarce time and resources, but currently available prediction tools are not effective. To investigate whether ward doctors can identify patients at risk of PEs. This prospective matched case-control study was conducted on three clinical wards in an academic hospital. Otolaryngology and oncology ward doctors used clinical intuition to select patients requiring a clinical medication review (CMR) (cases). These patients were then matched 1:1 on age (±10years) and number (±1) of prescriptions with patients not selected for CMRs on the internal medicine and upper gastrointestinal surgery ward (controls). A multidisciplinary in-hospital pharmacotherapeutic stewardship team assessed the prevalence of PEs. A total of 387 patients with 5191 prescriptions were included. Overall, 799 PEs affecting 279 patients (72.1%) were identified. Most PEs (58.8%) occurred during hospitalization. There were no significant differences in age, number of prescriptions, sex, renal function or documented allergies or intolerances between the cases and controls or between controls and other patients who did not receive a CMR. The incidence of PEs was higher in cases than in controls (97.5% vs 72.5%, odds ratio= 14.8, 95% confidence interval [CI] 1.8-121.1, P= .002)). The rate of PEs was three times higher in cases than in controls (incidence rate ratio=3.0, 95% CI 2.3-4.0, P< .001). Ward doctors can effectively identify patients with PEs, and thus at risk of medication-related harm, using clinical intuition.

Study of Effectiveness of Spiritual Therapy on Life Satisfaction According to Coping Strategies in Patient with Cancer in Tehran

Encounter to Chronic diseases destroy the physical, psychic, economic, communicational, emotional balance of patient and his/her primary care and create new problems for the family members. The person is taken cancer diagnosis tolerate more physical and psychic pain than her/his family members. In this situation Existence of social protection like to give psychological interventions to patient and his/her primary care is need to increase positive emotions and decrease negative emotions. Spiritual therapy can be useful to arrive the goal. The aim of current study is comparsion of effectiveness of spiritual therapy on life satisfaction according to coping strategies in patient with cancer. The study population included patients with cancer were hospitalized for treatment in tehran in octobr 2015. Sampling method was Accessible and voluntary. 20 person participate as sample in this study. The current study was Semi-pilot with pre test and post test and control group. There were one pilot group and one control group such that experimental group member Received spiritual therapy in period of staying in hospital. control groups member received no intervention. All persons participated in two groups filled out the life satisfaction questionnaire as pre test and post test. To determine Intermediate effect of coping strategy filled out Lazarus and Folkman coping strategies questionnaire. Proposed 2 hypotesis based on this study and data analized with ANOVA and Multivariate covariance. Based on multivariate covariance resultes hipotesis two rejected. Based on Anova hipotesis one accepted. This means that spiritual therapy directly increased life satisfaction in patient with cancer but the mediated effectiveness of it was not meaningful. According to effectiveness of narrative therapy on life satisfaction in patient with cancer it is necessary clinical psychologies presence in Oncology ward.

Investigation of 5-fluorouracil cardiotoxicity in combinational therapy: Influence of risk factors and demographics in a Pakistani population.

5-Fluorouracil (5-FU) is a chemotherapeutic agent used to treat various types of cancers. Although widely used, it has consistently been attributed to cardiotoxicities after administration. The purpose of this study was to assess the parameters and predictors of cardiotoxicities associated with various 5-FU-based chemotherapeutic protocols in patients with GI/colorectal cancer, as well as the correlation of these cardiotoxic events with age, sex, cumulative dose, and risk factors such as obesity, hypertension, and family history of cardiac diseases. A prospective study consisting of 396 patients of both sexes was conducted in the oncology ward of Nishtar Hospital in Multan, Pakistan. Patients were grouped according to the therapeutic protocol they received (5-FU monotherapy or in combination, with different dosing regimens). Electrocardiography and serum troponin levels were used to assess 5-FU-induced cardiotoxicity. In cases where cardiotoxicity was detected, 5-FU treatment was interrupted; nitroglycerin, nitrates, and calcium channel blockers were administered; and cardiac monitoring was initiated. 5-FU was discontinued in all cases of acute myocardial infarction. Of the 396 patients, 28.5% reported different cardiotoxic symptoms after receiving various 5-FU-containing protocols. 35% had anginal pain, 13% suffered a myocardial infarction, 11% developed hypertension, and 10% presented heart failure. Patients receiving 5-FU combination therapy showed cardiotoxic events that were significantly different from those on 5-FU monotherapy. Based on the ECG results, only the QTc-d interval increased significantly (p < 0.001) after therapy. 68% of the patients had troponin levels > 2 ng/mL at the end of treatment. Pre-existing cardiac diseases, treatment duration, smoking, and obesity were found to be influential components in the development of cardiotoxicity, and patients with cancer should be closely monitored during 5-FU chemotherapy.

The impact of admitting ward on resource utilization and outcomes among hospitalized cancer survivors.

36 Background: With improvements in both early detection and cancer treatment, there is a growing population of cancer survivors; with a corresponding increase in acute care use. However, models of inpatient care delivery for cancer survivors differ between hospitals and regions, which may impact resource use and outcomes. Understanding how different models influence outcomes may help define optimal models for cancer inpatient care delivery. Methods: We created a multicenter cohort of all cancer patients admitted to medical wards across 26 hospitals in Ontario, Canada from 2015 to 2022, and deterministically linked population level administrative data including ambulatory oncology data, with each hospital’s patient-level electronic information (pharmacy, orders, notes, labs/imaging and results). Multivariable regression models compared characteristics and outcomes between patients admitted on oncology wards vs non-oncology wards adjusting for age, sex, income quintile, rurality, immigrant status, receiving IV systemic therapy within 120 days and comorbidity scores. Results: In total, there were 370,118 hospitalizations from 191,990 unique patients. Among these hospitalizations, 38,075 episodes (10%) were on an oncology ward. Median time from cancer diagnosis to hospitalization was 4 years; 10% received IV systemic therapy within 120 days and 16% within 1 year. The most common disease sites were GU (21%), GI (20%), breast (12%) and lung (10%). The most common discharge diagnoses from oncology wards were inpatient chemotherapy (9%), febrile neutropenia (7%), NHL (4%), AML (4%), myeloma (3%); while for non-oncology wards were heart failure (5%), palliative care (4%), UTI (2%), pneumonia (2%), acute renal failure (2%). In general, cancer patients admitted on oncology wards were younger (64 vs 76), had shorter length of stay (LOS; 9.6 vs 10.1 days), less in-hospital mortality (8% vs 11%), greater 30-day re-admission rates (30% vs 15%) and were more likely to undergo CTs (28% vs 21%), MRIs (11% vs 9%) and interventional procedures (8% vs 6%) (p&lt;0.001, all). Subgroup analysis focusing on the top 5 discharge diagnoses from non-oncology wards, showed that despite no difference in in-hospital mortality rates (aOR 0.92 95% CI [0.58-1.46] p=0.73), admission to a non-oncology ward for those diagnoses was associated with shorter LOS (aOR 0.84 [0.78-0.90] p&lt;0.001), reduced 30-day re-admission rates (aOR 0.60 [0.48-0.75] p&lt;0.001), and reduced use of CTs (aOR 0.60 [0.49-0.74] p&lt;0.001), MRIs (aOR 0.36 [0.25-0.52] p&lt;0.001), and interventional procedures (aOR 0.43 [0.29-0.64] p&lt;0.001). Conclusions: There are differences in resource use and outcomes for cancer survivors hospitalized on oncology versus non-oncology wards, including for patients with the same discharge diagnosis. To optimize inpatient cancer care delivery for hospitalized cancer survivors, further exploration of care models is needed.

A pilot study of precision treatment for patients with lung cancer pain by Longteng Tongluo recipe using serum genomics.

To investigate the efficacy of Longteng Tongluo recipe (, LTTL) combined with three-step analgesia for the treatment of lung cancer pain, and the changes in serum miRNA expressions before- and after treatment with LTTL and its correlation with lung cancer pain. The possible mechanism underlying LTTL effects on the treatment of lung cancer pain was conducted. The pilot study was conducted at the oncology ward of the Yueyang Hospital and the Longhua Hospital between March 2018 and October 2019. A prospective, single-blind, placebo controlled, randomized clinical trial of LTTL or placebo combined with three-step analgesia treatments were administered to 24 cancer pain patients diagnosed with lung cancer. Analgesic efficacy was investigated as the primary outcome. Equivalent morphine consumption and numerical rating scale (NRS) scores were used as the secondary outcome. In the present study, we utilized deep sequencing techniques to compare the differential miRNA expressions in serum samples obtained from two groups: the lung cancer pain treatment group (LTTL + three-step analgesia) and the control group (placebo + three-step analgesia). Next, we employed the target prediction database to investigate the target genes for differential miRNA expressions and Gene Ontology (GO) analysis along with Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis to examine the roles and the major biochemical and signaling pathways related to the differentially expressed target genes, respectively. LTTL treatment significantly reduces the NRS score (P = 0.021) as compared to those before treatment, along with significant reductions in the total morphine equivalent consumption (P = 0.007) and the average daily equivalent morphine consumption (P = 0.003) as opposed to the control group. The expressions of 31 miRNAs differed considerably between the two groups of patients (≥ 2 times up-modulated or down-regulated between these groups, P<0.05). For instance, the miRNAs expression levels for patients before treatment (has-miR-2110 and has-miR-7d-3p) were significantly enhanced as compared to the healthy people, after LTTL treatment, the expressions of miR-2110 and miR-7d-3p in patients with lung cancer pain reduced significantly. Studies show that the above two miRNAs were significantly associated with lung cancer pain, which could mediate lung cancer pain. Furthermore, we identified 355 genes as potential targets of the 31 differentially expressed miRNAs. Pathway enrichment analyses using KEGG and GO analysis indicated that these target genes may play a crucial role in the development and modulation of lung cancer pain. LTTL demonstrated a discernible impact on alleviating lung cancer pain and its mechanism of action may be related to the downregulation of has-miR-2110 and has-miR-7d-3p expressions. This pilot study provides support for further exploration of LTTL in patients with lung cancer pain.

Development and psychometric evaluation of the self-care of informal caregivers inventory

BackgroundIn recent years, a growing body of literature on informal caregivers’ health and well-being has emerged, highlighting the need for a tool to measure their self-care practices. ObjectiveThe aim of the study was to develop a theory-based instrument measuring the self-care behaviors of informal caregivers and test its psychometric properties. DesignThe initial phase of instrument development entailed a detailed, six-step process (conceptualization, theoretical adaptation, back-translation and cultural adaptation, cognitive interviewing, item enhancement, and content validity), followed by formal psychometric testing (participant engagement, validity, internal consistency reliability, test-retest reliability). SettingStudy conducted at a hospital located in Tehran, Iran. ParticipantsA sample of 234 informal caregivers of cancer outpatients receiving treatment in oncology wards was enrolled. Caregivers had to be 18 years or older, recognized as the primary caregiver by the patient, and willing to provide informed consent. MethodsThe Self-Care of Informal Caregivers Inventory items comprise three dimensions: self-care maintenance (11 items), self-care monitoring (7 items), and self-care management (9 items), which achieved a content validity index rating of 100 % in a panel of experts. Data were collected from caregivers during routine clinic visits. Construct validity was verified through exploratory structural equation modelling and reliability was verified using Cronbach's α and multidimensional model-based reliability. Test-retest reliability was evaluated using the Intraclass Correlation Coefficient. ResultsAll three dimensions showed good model fit indices (self-care maintenance: Comparative Fit Index = 1.00, Tucker-Lewis Index = 0.99, Root Mean Square Error of Approximation = 0.044; self-care monitoring: Comparative Fit Index = 1.00, Tucker-Lewis Index = 1.00, Root Mean Square Error of Approximation = 0.027; self-care management: Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99, Root Mean Square Error of Approximation = 0.048) and Cronbach's α of 0.88, 0.88, and 0.91, respectively. The overall multidimensional model-based reliability was 0.93. The Intraclass Correlation Coefficient values for the three dimensions were 0.94, 0.60, and 0.51, respectively. ConclusionPreliminary testing provides support for use of the Self-Care of Informal Caregivers Inventory in research. Using this theory-based instrument to assess the self-care practices of informal caregivers can assist in identifying topics to discuss and opportunities for guidance. Tweetable AbstractThe Self-Care of Informal Caregivers Inventory: A validated tool for informal caregivers is useful for research. #Informalcaregivers #SelfCare

Effect of reiki on people with advanced cancer: a randomized controlled trial

Introduction: Reiki is an Integrative and Complementary Health Practice (PICS), recognized and incorporated into the table of procedures of Brazil's Unified Health System (SUS). Objective: To evaluate the effects of applying Reiki in relieving the symptoms of people with advanced cancer who are hospitalized. Methodology: Randomized controlled study, approved by the Research Ethics Committee, to verify the effect of applying Reiki to people with advanced cancer, admitted to a large, highly complex university hospital located in the interior of the state of São Paulo, Brazil. Fourteen participants were selected from the clinical oncology ward and randomly divided into two groups - Reiki and control - with seven participants each. For data collection, an anamnesis was taken, blood pressure and heart rate were measured, saliva was collected to check cortisol levels; the Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HAD-S) and Karnofsky Performance Status (KPS) were applied; Reiki was applied for 21 minutes to participants in the Reiki group and, 30 minutes after Reiki, the scales were reapplied and salivary cortisol was collected again. Results: The Mann-Whitney U-test showed a statistically significant difference for the sleep variable (p&lt;0.007) in the intervention group when compared to the control group. Conclusion: The results showed that Reiki improved the sleep of the participants in this randomized controlled trial and demonstrated that, despite the small caseload, the methodology used is valid for studying the impact of Reiki on the symptoms of people with advanced cancer.

A Narrowing Place: Responsive Spirituality

Among the many distinct experiences of cancer is the experience of the parent who watches their child become pale and drained of energy in the weeks preceding diagnosis. The journey from there to the oncology ward is one that can be adequately described as increasingly claustrophobic. It is all one-way traffic from flourishing life to the abyss. Perhaps being a parent makes one even more prone to the universal human tendency to find fault with oneself where there is only the blind force of nature at work. Whatever dark alleyway that self-destructive sentiment emerges from to ambush the optimist, it is certainly an effective hiding place from which to cause them to stumble. The child slips inexorably out of the parent’s grasp. The notion of parental protection is no haven. Yet the blindness of nature unwittingly tips the scales. In the narrowest of narrow places, the human organism responds with homeostatic resilience. Whether death is near or far in this place is unknown. In the moment of constriction, however, the child and its parent respond with that most irreducible of passions, the will to live. The human spirit emerges.

Prevalence of Enteric Pathogens and Antibiotic Resistance: Results of a Six-Year Active Surveillance Study on Patients Admitted to a Teaching Hospital.

Acute Infectious Diarrhea (AID) and the short- and long-term complications associated with it are major causes of hospitalization worldwide. In Italy, due to a lack of robust surveillance programs, only limited data has been collected on their prevalence and circulation. This study aims to evaluate the resistance pattern of enteric pathogens and their epidemiological trends over a six-year period. This cross-sectional retrospective study was conducted from January 2018 to December 2023. Stool samples were analyzed during routine diagnosis with culture methods, syndromic molecular tests, and enzyme immunoassay. Bacteria were the most isolated enteric pathogens (62.2%), followed by fungi (29.0%), viruses (8.2%), and parasites (0.6%). Most bacteria were isolated from outpatients (29.5%) and from patients in the Oncology ward (26.2%). The most prevalent target was EPEC (11.1%), followed by C. difficile toxin A/B-producing strains (8.3%), C. jejuni (2.5%), and S. enterica, (1%.). Norovirus and Candida spp. were the most prevalent in pediatric patients (6.5% and 39.6%, respectively). In the last years, enteric pathogens have been a frequent cause of infections characterized by a problematic resistance to common antimicrobials. In our study, S. enterica showed resistance to amikacin, gentamicin, ampicillin, levofloxacin, and ciprofloxacin. C. jejuni was susceptible to all tested drugs. Timely notification of gastroenteric infections is crucial in identifying potential outbreak sources and ensuring strict adherence to food safety and hygiene practices, so as to protect the most vulnerable populations. The present study offers insights into the epidemiological characteristics and the antibiotic susceptibility of the main enteric AID pathogens in order to implement infection control measures in health care settings.

A sarcopenia screening test predicts mortality among hospitalized cancer patients.

This study investigated the ability of a sarcopenia screening test to predict mortality among cancer inpatients. We conducted a prospective study of patients admitted to the oncology ward of a teaching hospital in southern Taiwan. Over a 5-month period, 82 patients were enrolled for evaluation and were followed for 3 years. All participants received a comprehensive assessment at the time of admission, including Eastern Cooperative Oncology Group (ECOG) performance status, cognitive ability, nutrition index, body mass index, and short physical performance battery (SPPB). Age, ECOG performance status, dementia, SPPB score, and albumin level were associated with sarcopenia. Of the enrolled participants, 53 (64.6%) were diagnosed with sarcopenia. Patients with sarcopenia were associated with worse overall survival (OS) than patients without sarcopenia (28.8% vs. 82%, p = 0.01). Metastasis (hazard ratio [HR]: 5.166; 95% confidence interval [CI]: 1.358-19.656) and albumin level (HR: 4.346; 95% CI: 1.493-12.654) were independent and significant predictors of OS for the whole study population. Age was a predictor of 2-year all-cause mortality among patients aged ≥65 years but not among those aged <65 years (OS: 25.6% vs. 100%, p = 0.04). To summarize, the sarcopenia screening results were found to predict OS and all-cause mortality and may be helpful for patient stratification during in-hospital care.

Evaluation of hand hygiene practices of health care workers in tertiary care hospital by systematic hand hygiene audits

: Hand hygiene (HH) holds a pivotal role in infection control. However, compliance with hand hygiene has remained low worldwide. Hospital Acquired Infection (HAI) incidence is rising in most healthcare facilities. It is postulated that around 30% of HAI can be reduced by following strict hand hygiene protocols by healthcare workers (HCWs). This study was done to evaluate the level of compliance of healthcare personnel in our tertiary care hospital with respect to appropriate hand hygiene practices by employing HH audits. A cross-sectional observational study was conducted in a tertiary care teaching hospital over six months. A single‑ observer direct observation technique was used to collect the HH compliance data conducted by trained Infection control nurses. HCWs, including doctors, nurses, CRMIs and technicians, were observed for compliance in all the critical areas, outpatient and inpatient sections across all departments. The HH audit form designed based on the WHO's HH audit tool kit was used in the study. The audits were conducted randomly in all the areas for at least 20 minutes per day. : A total of 583 HCWs were observed for the Hand Hygiene Compliance audit. The overall HH compliance rate was 67.88%, with doctors at 74.31%, followed by nurses at 70.42%. Compliance was observed in OBG/Labour ward at 78.7% and the oncology ward at 78.5%. WHO moments-specific hand hygiene adherence showed the least compliance rate of 55% for moment 1, followed by moment 5 with 58.9%. Best compliance was observed for moment 3, with 79.2%.: The overall hand hygiene compliance was comparatively better in our study. Specific measures such as improved facilities, training and monitoring are needed to attain good H`H compliance.

Parents' experiences on handling paediatric anticancer drugs at home after an educational intervention.

The shift of treatment of paediatric cancer patients to include more care at home puts a lot of pressure on health care professionals (HCPs) to prepare and train parents on safe and correct drug handling at home. Parents must take in and understand the information presented to them while coping with their own fear related to their child's cancer diagnosis. In Sweden, parents are expected to handle and manipulate oral anticancer drugs (OADs) in the home setting. There is however a lack of a standardized method to inform and educate parents on how to handle OADs in a correct way at home. To describe parents' experiences of handling OADs at home after participating in an educational intervention. Educational intervention in the present study aimed to improve parents' knowledge in key concepts that is, handling OADs at home by using information presented in different forms. Fifteen parents to 12 children with cancer were recruited from a paediatric oncology ward in Sweden to participate in an interview. The interviews were transcribed verbatim and subjected to qualitative content analysis. Parents' experiences are presented in categories: Relieved stress, Awareness of own exposure, Facilitated my everyday life, Parents need continued support individually. The educational intervention resulted in both positive and negative feelings, increased awareness of drug exposure and correct drug handling at home. Practical training and information presented in different ways facilitated the process of drug handling. To handle the drug correctly at home parents requested to be trained and informed in the beginning of their child's oral drug treatment. In addition, parents requested to be individually approached by HCP to get answers to questions and concerns. This educational intervention study shows promising results for the method used by HCPs to inform and educate parents on complicated topics such as handling OADs at home.

Antimicrobial Use Rates by Patient Care Units using NHSN Antimicrobial Use Option in TN Reporting Facilities, 2015–2023

Background: Tracking antimicrobial use (AU) is a Core Element of Hospital Antimicrobial Stewardship Programs and important to help curb the public health threat of antimicrobial resistance. The National Healthcare Safety Network’s (NHSN) AU Option serves as a way for facilities, healthcare systems, and health departments to track and report AU rates within their jurisdictions. Many analyses at the state and national levels do not assess unit-level AU rates. This study investigates AU rates among patient care units in Tennessee reporting facilities from 2015 to 2023 and the most frequently used antimicrobial agents based on AU rates within select unit types. Methods: A retrospective analysis was conducted utilizing data obtained from the NHSN AU Option for inpatient units in Tennessee acute care hospitals. Units were defined as critical care (including neonatal), ward, oncology ward, stepdown, operating room (OR), and mixed acuity and specialty care areas, termed ‘other’. Unit types with fewer than five facilities represented were excluded. AU rates were determined by Antimicrobial Days of Therapy (DOT) per 1000 Days Present (DP). Statistical analyses , including descriptive statistics and comparison among the units by ANOVA test , were calculated using SAS Version 9.4. Results: Eighty-three facilities reported at least one month of data into the NHSN AU Option between 2015–2023. Among 70 facilities reporting inpatient units, the highest AU rate was observed in oncology ward units (n=12, 1114.6 DOT/1000 DP). A significant difference in AU rates was observed between oncology ward units compared to different unit types (p &lt; 0 .001). Vancomycin, ceftriaxone, and piperacillin/tazobactam were the most used antimicrobials with AU rates of 83, 76, and 65 DOT/1000 DP, respectively. Vancomycin AU rates were significantly higher in oncology ward units compared to stepdown, ward, other, and OR units (p &lt; 0 .0001). Ceftriaxone AU rate was significantly higher in stepdown units compared to oncology ward, other, and OR units (p &lt; 0 .0001). Piperacillin/tazobactam AU rate was significantly higher in critical care units compared to different unit types (p &lt; 0 .0001). Conclusion: During the study period, the AU rate varied across hospital inpatient units in Tennessee, with the highest AU rate in oncology wards. This unit-specific approach is critical to address the diverse antimicrobial prescribing behaviors observed, indicating that interventions should be customized to each unit’s distinct antimicrobial usage patterns for successful stewardship efforts. Targeted strategies focused on individual wards rather than facility-wide initiatives appear essential for effective reduction in antibiotic usage.

Quantity versus Quality: Chlorhexidine Bathing Adequacy Assessments in 3 High-Risk Units

Background: Chlorhexidine gluconate bathing (CHGB) prevents healthcare associated infections (HAIs). CHGB quality is rarely assessed; prior studies identified that concentrations of CHG can be suboptimal, particularly at the neck, and if rinsed after application. In the setting of increased HAI rates on 3 high-risk units, we evaluated CHG skin concentrations, comparing results to bathing documentation and patient reports as part of a quality improvement initiative. Methods: All patients admitted to 3 high-risk units were swabbed for CHG concentration testing at the neck, bilateral upper arms, and groin. Swabs were processed using a semi-quantitative colorimetric CHG assay. A threshold of 0.001875% CHG was used to determine adequacy based on prior studies. Adequacy was assessed by body site, timing of bath, and patient-reported skin care activities using Chi-square tests in SAS 9.4. Per hospital policy, all admitted patients are bathed daily with 2% CHG pre-packed wipes. Patients without a documented CHGB for the duration of the admission were excluded. Results: CHG testing was completed on 63 patients: 23 on medical ICU, 18 surgical ICU, 22 oncology ward, yielding 249 samples. Only ward patients could report the time of last CHGB, which agreed with nursing documentation for 12/21(57%) Adequacy by sample was no different across units: 59/88(67%) Oncology, 68/90(76%) MICU, 56/71(79%) SICU, p=0.2091. Site adequacy was different by site: neck 36/63(57%), left arm 49/62(79%), right arm 50/62(81%), groin 48/62(77%), p=0.0083. Samples taken from the 11 patients with &gt; = 24 hours since last CHGB were more likely to be below threshold concentration: 19/47(40%) versus 47/202(23%) not adequate in the recent treatment grouping. Three patients reported showering soon after the CHGB and 8 patients used moisturizing lotion. The percent of samples below threshold for the showering patients (6/12, 50%) and lotion-users (11/32, 34%) were not significantly different from the non-showering or non-lotion using patient samples (p=0.0588 and 0.2800 respectively). Conclusion: In a facility with longstanding daily CHGB policies in place, 66/249 samples from 63 patients lacked adequate concentrations of CHG for optimal HAI prevention. Even in patients with recent CHGB, 23% of sites tested revealed inadequate levels of CHG, while 60% of those overdue for CHGB kept adequate concentrations. Reliable implementation strategies are required for CHGB so as to ensure maximal infection prevention impact.

The role of surgery for invasive pulmonary aspergillosis in paediatric hemato-oncology patients-Can we better define it?

Invasive pulmonary aspergillosis (IPA) is a serious condition with high morbidity and mortality in paediatric patients with cancer, haematological diseases or immunodeficiencies with or without allogeneic haematopoietic stem cell transplantation (HSCT). The role of surgical intervention for the management of IPA has scarcely been investigated. The aim of this study was to present a single center experience of management of IPA in paediatric patients of an oncological ward, to determine the short and long-term outcomes after thoracic surgical interventions, and to outline the indications of surgical interventions in selected patients. We conducted a retrospective study of 44 paediatric patients with proven and probable IPA treated in our institution between January 2003 and December 2021. The primary endpoint was the overall survival after surgical interventions. Secondary endpoints included post-operative morbidity and mortality. The median age at diagnosis of IPA in our cohort was 11.79 years (range 0.11-19.6). The underlying conditions were malignancies in 34 (77%) patients and haematological or immunological disorders with allogeneic HSCT in 9 (23%) patients. We performed thoracic surgical interventions in 10 (22.7%) patients. Most patients received a video assisted thoracic surgery. Only one patient died within 90 days after surgery with a median follow-up time of 50 months. No other major post-operative complications occurred. The calculated 5-year survival rate from IPA for patients after surgical intervention with curative intention was 57% and 56% for patients without (p = .8216). IPA resulted in relevant morbidity and mortality in our paediatric patient cohort. Thoracic surgical interventions are feasible and may be associated with prolonged survival as a part of multidisciplinary approach in selected paediatric patients with IPA. Larger scale studies are necessary to investigate the variables associated with the necessity of surgery.

Centring children's lived experiences in understanding the importance of play in hospitals.

Children have a right to participate in matters affecting their lives. With increasing regularity, children's perspectives are being sought regarding their health and health care experiences. Though there is evidence that children find play to be one of the 'best' aspects of hospitalisation, studies rarely focus on children's perspectives on play in hospital. This qualitative study explored children's lived experiences of play during hospitalisation. Over five months, ethnographic observations were conducted on a paediatric oncology ward as well as interviews with 16 children ages 3-13 years. Using interpretative phenomenological analysis, children's expressions and experiences illuminated three key points: safety and comfort are integral to children feeling able to play in hospital; the value and efficacy of play is decided by children; and that play is a way for patients to be (and be treated as) children first. Hospitals can only be child-friendly if children find them friendly. Listening to and integrating children's perspectives in the discourse around the importance of play in hospital is essential for respecting children's rights and delivering person-centred paediatric healthcare.

Patient Perception on Physiotherapy and the Breath of Hope in Breast Cancer Patients Undergoing Chemotherapy: Impact of Breathing Exercises in Enhancing Lung Function and Quality of Life: A Quasi-Experimental Study

Background: Breast cancer is the leading type of cancer among women globally, significantly impacting mortality and morbidity rates. Respiratory complications and diminished quality of life are common among patients undergoing chemotherapy, highlighting the need for effective supportive treatments. Objective: This study aimed to evaluate the efficacy of respiratory physiotherapy interventions, specifically breathing exercises, in improving lung function and quality of life in breast cancer patients undergoing chemotherapy. Methods: This quasi-experimental study enrolled thirty female breast cancer patients from the oncology wards of Allied Hospital and PINUM, Faisalabad. Participants were selected using a purposive sampling technique and were provided with respiratory physiotherapy, including spirometry and breathing exercises, three times a week for six months. Data were collected through initial and final assessments of lung function and quality of life, using self-administered questionnaires and spirometry. Ethical considerations followed the Declaration of Helsinki guidelines, with all participants providing informed consent. Statistical analysis was conducted using SPSS Version 25, employing the Wilcoxon signed-rank test. Results: The interventions showed statistically significant improvements in lung capacity; Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) witnessed positive ranks in 22 and 21 patients respectively, with mean ranks of 11.50 and 11.00, and sum of ranks at 253.00 and 231.00 (p&lt;.001 for both). Quality of life assessments indicated improvements across physical, emotional, and cognitive functions with significant p-values (&lt;.001 to .025). About 70% of participants reported a good perception, and 10% reported an excellent perception of the physiotherapy's effectiveness in improving their condition. Conclusion: The study confirms that structured respiratory physiotherapy significantly enhances lung function and quality of life in breast cancer patients undergoing chemotherapy. These findings advocate for the integration of tailored respiratory physiotherapy into standard care protocols to improve clinical outcomes for this patient group. Keywords: Breast Cancer, Chemotherapy, Respiratory Physiotherapy, Breathing Exercises, Lung Function, Quality of Life, Patient Perception, SPSS Analysis, Oncology Rehabilitation.

The impact of admitting ward on resource utilization and outcomes among hospitalized cancer survivors.

1550 Background: With improvements in the early detection and treatment of cancer, there is a growing population of cancer survivors; with a corresponding increase in acute care use among cancer survivors. However, models of inpatient care delivery for cancer survivors differ between hospitals and regions, which may impact resource use and outcomes. Understanding how different models influence outcomes may help define optimal models for inpatient care delivery for this population. Methods: We created a multicenter cohort of all cancer patients admitted to medical wards across 26 hospitals in Ontario, Canada from 2015 to 2022, and deterministically linked population-level administrative data including ambulatory oncology data, with each hospital’s patient-level electronic information (pharmacy, orders, notes, laboratory/imaging and results). Multivariable regression models compared characteristics and outcomes between patients admitted on oncology wards vs non-oncology wards adjusting for age, sex and co-morbidity scores. Results: In total, there were 370,118 hospitalizations from 191,990 unique patients. Among these hospitalizations, 38,075 episodes (10.3%) were on an oncology ward. The median time from cancer diagnosis to hospitalization was 4 years. The most common disease sites were genitourinary (21%), gastrointestinal (20%), breast (12%), and lung (10%). The most discharge diagnoses from oncology wards were inpatient chemotherapy (9%), febrile neutropenia (7%), non-Hodgkin’s lymphoma (4%), acute myeloid leukemia (4%), myeloma (3%); while for non-oncology wards were heart failure (5%), palliative care (4%), UTI (2%), pneumonia (2%), acute renal failure (2%). In general, cancer patients admitted on oncology wards were younger (64 vs 76), had shorter length of stay (LOS; 9.6 vs 10.1 days), less in-hospital mortality (7.5% vs 11.4%), greater 30-day re-admission rates (29% vs 14%) and were also more likely to undergo CTs (28% vs 21%), MRIs (11% vs 9%) and interventional procedures (8% vs 6%) (all comparisons, p&lt;0.001). Subgroup analysis focusing on the top 5 discharge diagnoses from non-oncology wards, showed that despite higher in-hospital mortality rates (aOR 1.27 95% CI [1.15-1.40] p&lt;0.001), admission to a non-oncology ward for those diagnoses was associated with a shorter LOS (aOR 0.96 [0.92-1.00] p=0.03), reduced 30-day re-admission rates (aOR 0.77 [0.69-0.87] p&lt;0.001), and reduced use of CTs (aOR 0.74 [0.68-0.82] p&lt;0.001), MRIs (aOR 0.80 [0.68-0.95] p=0.01), and interventional procedures (aOR 0.84 [0.69-1.01] p=0.07). Conclusions: There are differences in both resource use and outcomes for cancer survivors hospitalized on oncology versus non-oncology wards, including for patients with the same discharge diagnosis. To optimize inpatient cancer care delivery for hospitalized cancer survivors, further exploration is needed.