Ambulatory management in low risk neutropenic sepsis – A plea for integrated acute cancer care

2019 ◽  
Vol 18 (1) ◽  
pp. 6-7
Author(s):  
E Marshall ◽  
Keyword(s):  
Signs And Symptoms ◽  
Cytotoxic Chemotherapy ◽  
Medical Emergency ◽  
Acute Medicine ◽  
Management Guidelines ◽  
Neutropenic Sepsis ◽  
Incidence And Mortality ◽  
Nice Guidance ◽  
Treatment Complication ◽  
Sepsis Care

Neutropenic Sepsis (NS) is a well recognised treatment complication, typically occurring 7-10 days following cancer cytotoxic chemotherapy. Colleagues in acute medicine will be only too familiar with the scenario of cancer patients that present with fever in the absence of localising signs and symptoms and with a very low yield from microbiological cultures. The incidence and mortality of NS are poorly defined and historically, management guidelines have often been developed in relative isolation from the broader subject of infection and sepsis care. Despite the lack of a clear and pragmatic definition, NICE guidance CG151 (2012) identified suspected NS as a medical emergency requiring prompt empirical broad spectrum antibiotics.

scholarly journals Prevention and management of neutropenic sepsis in patients with cancer: summary of NICE guidance

BMJ ◽  
2012 ◽  
Vol 345 (sep19 1) ◽  
pp. e5368-e5368 ◽  
Author(s):  
R. Phillips ◽  
B. Hancock ◽  
J. Graham ◽  
N. Bromham ◽  
H. Jin ◽  
...  
Keyword(s):  
Patients With Cancer ◽  
Neutropenic Sepsis ◽  
Nice Guidance

Editorial

2002 ◽  
Vol 1 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Case Reports ◽  
Gastrointestinal Haemorrhage ◽  
Medical Emergency ◽  
Editorial Team ◽  
Original Research ◽  
Acute Medicine ◽  
Previous Edition ◽  
Interesting Paper ◽  
Medical Emergencies ◽  
A Minor

So the brief ‘respite’ of summer is over, and we find ourselves plunging, once more towards the abyss of winter bed pressures. Hopefully those of you working at the coalface will find time to browse through the following pages. The production of a third issue in this ‘shortened’ year, following the launch of the Journal in July, is a credit to the hard work of the editorial and publishing teams. I am, as ever, grateful for their support. Next year will see a return to the planned 4-monthly cycle, with issues anticipated in March, July and November. One casualty of the tight schedule has been a minor adjustment to the cycle of reviews – COPD will now appear next Spring. In its place we have included an interesting paper reviewing the management of Neuroleptic Malignant Syndrome and Serotonin Syndrome, submitted by Consultant Psychiatrist David McNamara. Gastrointestinal haemorrhage and atrial fibrillation will be more familiar to readers, while Dr Joanna Girling’s review of the management of medical emergencies in pregnancy is essential reading for any physician working close to a maternity unit. Myasthenia gravis may not be the commonest medical emergency; nonetheless it is important that physicians are able to suspect, diagnose and initiate treatment for this condition. As I mentioned in my last editorial, I am keen to encourage submissions of case reports, audits, and pieces of original research provided they would appeal to a general medical readership. Cases need not be rare conditions, but must contain a clear teaching message for the reader. In future editions case reports will be categorised as ‘Tales of the Unexpected’, and ‘A Case to Remember’ (a memorable case or one with a message that readers should remember in future). The report on page 106 is an example of the latter – an important reminder that a radiological diagnosis of ‘pneumonia’ does not always imply an infective cause. Finally, I would like to thank those of you who have written with feedback following the previous edition of CPD Acute Medicine. We are clearly attempting to appeal to physicians from a broad range of backgrounds, and I hope that all readers find something which appeals to them in the pages which follow. Please feel free to write with your comments on any issue which you would like to share with the editorial team – depending on the response we may consider including a correspondence section in future editions of the journal.

scholarly journals Management of clozapine treatment during the COVID-19 pandemic

2020 ◽  
Vol 10 ◽  
pp. 204512532092816 ◽  
Author(s):  
Siobhan Gee ◽  
Fiona Gaughran ◽  
James MacCabe ◽  
Sukhi Shergill ◽  
Eromona Whiskey ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Signs And Symptoms ◽  
Physical Contact ◽  
Full Blood Count ◽  
Risk Of Infection ◽  
Clozapine Treatment ◽  
Neutropenic Sepsis ◽  
Blood Assay ◽  
Blood Monitoring ◽  
Increased Risk

Clozapine is the only available treatment for refractory schizophrenia but its use involves frequent physical contact with healthcare workers for the purpose of mandatory blood monitoring. During the COVID-19 pandemic, patients taking clozapine will be self-isolating to reduce the risk of infection, not least because these patients are at high risk of serious illness and fatality because of high rates of diabetes, obesity and pulmonary disease and an increased risk of pneumonia. Problems may also arise because both clozapine-induced myocarditis and neutropenic sepsis share signs and symptoms with COVID-19 (fever, chest pain, dyspnoea, etc.). We recommend decreasing the frequency of physical contacts by extending the blood monitoring interval to 12 weeks in those patients taking clozapine for more than 1 year. To distinguish COVID-19 from clozapine-related physical adverse effects, we suggest an urgent antigen test alongside a full blood count. In those taking clozapine who develop COVID-19, we suggest continuing with clozapine whenever possible (even during ventilation), reducing the dose if necessary in line with blood assay results. Blood monitoring should continue but clozapine should only cease if there is a significant fall in neutrophils (COVID-19 is linked to lymphopenia but not neutropenia). To protect against the likelihood and severity of respiratory infection, we recommend the use of vitamin D in all clozapine patients. Initiation of clozapine is likely to remain problematic while the risk of infection remains, given the degree of physical contact required to assure safety.

Patients’ Experiences of Colorectal Cancer and Oncology Services in North Queensland

2008 ◽  
Vol 14 (3) ◽  
pp. 93 ◽  
Author(s):  
Craig Veitch ◽  
Lisa Crossland ◽  
Heather Hanks ◽  
Yik-Hong Ho ◽  
Marlous Steeghs
Keyword(s):  
Colorectal Cancer ◽  
Metropolitan Areas ◽  
Full Range ◽  
Signs And Symptoms ◽  
Incidence Rates ◽  
Postal Survey ◽  
Warning Signs ◽  
Related Factors ◽  
Incidence And Mortality

Colorectal cancer (CRC) accounts for 15% of cancer incidence and mortality in Australia. Incidence rates have been rising for two decades. Little is known about the experiences, attitudes and perceptions of people with CRC who live in non-metropolitan areas. The aim of this study was to investigate participants? experiences with and attitudes to CRC. This Cancer Council of Queensland-funded project collected data in three phases - focus groups, individual interviews, postal survey - from patients treated for CRC in north Queensland. Qualitative and quantitative approaches were used to analyse the data. Participants had very little knowledge of CRC signs and symptoms pre-diagnosis, which sometimes led to delays in diagnosis. The speed of diagnosis was dependent on several practitioner-related factors. Treatment-related issues included coming to grips with the diagnosis and preparedness for treatment and side-effects. Personal beliefs and attitudes influenced treatment and follow-up decisions. Rural participants encountered travel-related difficulties, particularly during treatment as outpatients. There was a strong belief in the need for more public education about CRC in general, warning signs and symptoms, and familial risk factors. Good understanding of people?s knowledge of CRC, their attitudes towards screening, diagnosis, treatment and follow-up, will enable health and cancer services provide focused and relevant support to people with CRC, their families and carers. This is especially important in non-metropolitan areas where the full range of specialist services is not locally available.

Incidence, Pathogenesis, and Management of Sepsis

2006 ◽  
Vol 17 (4) ◽  
pp. 385-393 ◽  
Author(s):  
Ruth M. Kleinpell ◽  
Brian T. Graves ◽  
Michael H. Ackerman
Keyword(s):  
Severe Sepsis ◽  
Nursing Care ◽  
Early Recognition ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
High Morbidity ◽  
Assessment And Monitoring ◽  
Clinical Signs And Symptoms ◽  
Evidence Based Guidelines ◽  
Sepsis Care

Sepsis is a complex condition that occurs as a result of the systemic manifestation of infection. It is associated with high morbidity and mortality risks for critically ill patients. Assessment and monitoring aimed at early recognition and treatment, on the basis of evidence-based guidelines, are advocated for optimizing outcomes for patients with severe sepsis. Awareness of the risk factors, clinical signs and symptoms, pathophysiology, and updates in the management of sepsis can enhance the nursing care for patients with severe sepsis to promote best practices for sepsis care in the intensive care unit. This article reviews the incidence and pathophysiology of sepsis, highlighting updates in treatment and implications for nursing care.

Improving Sepsis Care Through Systems Change: The Impact of a Medical Emergency Team

2008 ◽  
Vol 34 (3) ◽  
pp. 179-182 ◽  
Author(s):  
Babak Sarani ◽  
Stacey R. Brenner ◽  
Brandon Gabel ◽  
Jennifer S. Myers ◽  
Gene Gibson ◽  
...  
Keyword(s):  
Medical Emergency Team ◽  
Systems Change ◽  
Medical Emergency ◽  
Emergency Team ◽  
The Impact ◽  
Sepsis Care

scholarly journals Empirical antimicrobial treatment in haemato-/oncological patients with neutropenic sepsis

ESMO Open ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. e000348 ◽  
Author(s):  
Matthias Gerhard Vossen ◽  
Christopher Milacek ◽  
Florian Thalhammer
Keyword(s):  
Patient Survival ◽  
Clinical Course ◽  
Antimicrobial Treatment ◽  
Medical Emergency ◽  
Local Resistance ◽  
Neutropenic Sepsis ◽  
Profound Knowledge ◽  
Oncological Patients ◽  
Resistance Patterns ◽  
Neutropenic Patients

Neutropenic sepsis in haemato-/oncological patients is a medical emergency, as infections may show a fulminant clinical course. Early differentiation between sepsis and febrile neutropenic response often proves to be challenging. To assess the severity of the illness, different tools, which are discussed in this article, are available. Once the diagnosis has been established, the correct use of early empirical antibiotic and antifungal treatment is key in improving patient survival. Therefore, profound knowledge of local resistance patterns is mandatory and carefully designed antibiotic regimens have to be established in cooperation with local microbiologists or infectious diseases specialists. In the following, identification, therapy and management of high-risk, neutropenic patients will be reviewed based on experimental and clinical studies, guidelines and reviews.

The Oncology Symptom Control and Information Resource (OSCIR): Using information technology to improve the management of cancer treatment-related side effects

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17031-17031
Author(s):  
C. DeAngelis ◽  
A. Giotis ◽  
L. F. Charbonneau ◽  
S. Zannella
Keyword(s):  
Side Effects ◽  
Iterative Process ◽  
Symptom Control ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Management Program ◽  
Care Team ◽  
Pharmacological Management ◽  
Management Guidelines ◽  
Patient’S Experience

17031 Background: Management of treatment related side effects remains a challenge despite availability of effective therapies and management guidelines. The main reasons include ineffective assessment of the patient's experience, inability to access prevention and management guidelines in a timely manner, poor documentation and inefficient communication within the patient's care team. We postulate treatment related side effects could be more effectively managed using software designed to assist assessment and improve communication of the patient's experience. Methods: Software specifications included internet-based wireless capability, linking to existing electronic databases and facilitated data entry (drop down menus, check boxes, pop up windows, etc.). Oncology literature was reviewed to identify appropriate symptom assessment questionnaires, prevention and treatment strategies. The National Cancer Institute Common Terminology Criteria for Adverse Events v.3.0 was adapted. An iterative process was used for software development; content and functionality was discussed with programmers on an ongoing basis. This process is aimed at providing software that more completely meets the needs of users. Feedback from oncology pharmacists was sought regularly. Results: OSCIR has been developed to facilitate the assessment and management of nausea, vomiting, diarrhea, constipation, mucositis, and palmar-plantar erythrodysesthesia. Each side effect module includes onset and resolution, signs and symptoms, automated grading, non- and pharmacological management. Program features include downloading of electronic demographic information, chemotherapy regimen, laboratory results, call back roster, and communication tools. Conclusions: Using the iterative process we have created a program that addresses the needs of pharmacists involved in the assessment and management of treatment-related side effects. Further development will incorporate feedback from other members of the patient's care team and will include additional side effects and features. No significant financial relationships to disclose.

Do we overtreat patients with presumed neutropenic sepsis?

2021 ◽  
pp. postgradmedj-2021-140675
Author(s):  
Abbey King ◽  
Sharon Irvine ◽  
Angus McFadyen ◽  
Chris Isles
Keyword(s):  
Positive Impact ◽  
Statistical Significance ◽  
Risk Index ◽  
District General Hospital ◽  
Low Risk ◽  
Medical Emergency ◽  
Oral Antibiotic ◽  
Neutropenic Sepsis ◽  
Focus Of Infection ◽  
Group 3

PurposeMany aspects of the management of neutropenic sepsis remain controversial. These include the choice of empiric antibiotic, the duration of antibiotic therapy and the possibility that very low-risk cases may be managed safely with oral rather than intravenous therapy.Study designRetrospective cohort study conducted in a district general hospital serving a population of 148 000 in south west Scotland.ResultsFifty one patients with cancer, whose neutrophil count was less than 1.0×109/L within 21 days of their last chemotherapy, were admitted as a medical emergency in 2019. All received antibiotic because of presumed neutropenic sepsis. A total of 4 patients had positive blood cultures (group 1), 12 patients had a clinical focus of infection but no clear pathogen (group 2), while 35 patients had neither (group 3). Group 3 patients were more likely to have a solid tumour, less likely to be febrile, had shorter time to neutrophil recovery and higher Multinational Association of Supportive Care in Cancer scores, though not all of these comparisons achieved statistical significance. Median intravenous plus oral antibiotic duration in group 3 patients was 9 days with median hospital stay of 7 days, raising the possibility of overtreatment. Retrospectively, 23 (66%) group 3 patients had MASSC Risk Index greater than 21 suggesting they were at low risk of complications.ConclusionsIt seems likely that many low-risk neutropenic cancer patients with solid tumours could be managed as effectively and as safely with shorter courses of antibiotic, with oral rather than intravenous antibiotic, as outpatients rather than inpatients and with an overall positive impact on antimicrobial stewardship.

A Survey of School Nurse Emergency Preparedness 2014–2015

2017 ◽  
Vol 34 (5) ◽  
pp. 398-408 ◽  
Author(s):  
Margaret R. Ugalde ◽  
Danielle Guffey ◽  
Charles G. Minard ◽  
Angelo P. Giardino ◽  
Gwendolyn A. Johnson
Keyword(s):  
Emergency Response ◽  
Emergency Preparedness ◽  
School Nurses ◽  
School Characteristics ◽  
Medical Emergency ◽  
Management Guidelines ◽  
Exact Test ◽  
Experienced Nurses ◽  
Confidence Levels ◽  
Equipment Availability

Well-prepared school nurses are more likely to handle emergencies properly. Thus, assessing crisis management preparedness is important. In August 2014, a questionnaire was sent to 275 nurses in a large Texas school system to collect data about nurse and school characteristics, emergency frequency and management, and equipment availability. Completed surveys (201, 73%) were analyzed. Fisher’s exact test was used to evaluate comparisons among nurses’ confidence levels, school characteristics, emergencies, and medical emergency response plans (MERP). Logistic regression was used to estimate associations between characteristics and nurses reporting less confidence. Most respondents were experienced nurses. Shortness of breath was the most common event faced. Odds of less confidence were significantly higher among nurses with <5 years’ experience, working at elementary schools, schools without a MERP or where it was not practiced, or caring for <10 schoolchildren weekly. Overall, recommended emergency management guidelines were met.

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