Abstract:
BACKGROUND:Fever and neutropenia (F&N) is a pediatric oncology emergency due to the risk of disseminated infection. Quality improvement (QI) efforts to improve time to antibiotics for F&N in the emergency department have been documented, but the issue has not been studied in the established inpatient setting. PROCEDURE:We undertook a prospective cohort QI study to decrease time to antibiotics for neutropenic pediatric oncology inpatients with new fever to <60 min. Our key intervention was discussion of a plan in case of new fever, including antibiotic(s) to be started, for each patient on rounds. Timing for each step in the process, from fever identification to antibiotic administration, was measured through the electronic medical record for each fever event. RESULTS:The median time to antibiotics during the 3-three month intervention study period was 76.0 min, although the distribution was skewed due to several long outliers (mean 142.5, interquartile range 51-206, range 47-593 min). Time to antibiotics was significantly shorter when a fever contingency plan was documented in the most recent note than not (mean 102 vs. 254 min, P = 0.039). Over the total 2.75 year data-collection period, the quarterly percentage of patients receiving antibiotics within 60 min has improved from 35 to 65, whereas quarterly mean time to antibiotics has improved from 99 to 50 min. CONCLUSIONS:Daily discussion of a fever contingency plan appears effective in decreasing the time to antibiotics for neutropenic pediatric oncology inpatients with new fever, likely by circumventing the need for multi-level discussion of the antibiotic plan when fever is identified.
journal_name
Pediatr Blood Cancerjournal_title
Pediatric blood & cancerauthors
Green AL,Yi J,Bezler N,Pikman Y,Tubman VN,Obeng EA,O'Neil T,Mersereau R,Morrissey L,Billett ALdoi
10.1002/pbc.25712subject
Has Abstractpub_date
2016-01-01 00:00:00pages
112-7issue
1eissn
1545-5009issn
1545-5017journal_volume
63pub_type
杂志文章abstract:BACKGROUND:Extramedullary infiltration (EMI) is an occasional clinical symptom in childhood acute myelogenous leukemia (AML), but there is considerable controversy regarding the prognostic significance of EMI in AML. PROCEDURE:We evaluated the frequency and prognostic significance of EMI at diagnosis of AML in childre...
journal_title:Pediatric blood & cancer
pub_type: 杂志文章
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更新日期:2007-04-01 00:00:00
abstract::In Mexico, childhood cancer incidence and mortality have increased in the last decade. Through government actions since 2005, the Popular Medical Insurance (PMI) program for childhood cancer was created. The objective of PMI was to offer early cancer diagnosis, standardized treatment regimens, and numerous pediatric o...
journal_title:Pediatric blood & cancer
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abstract::Neuroblastoma is the most common extracranial solid tumor of childhood, and the outcomes for children with high-risk and relapsed disease remain poor. However, new international strategies for risk stratification and for treatment based on novel tumor targets and including immunotherapy are being employed in attempts ...
journal_title:Pediatric blood & cancer
pub_type: 杂志文章,评审
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abstract:BACKGROUND:Children with acute lymphoblastic leukemia (ALL) who fail to achieve complete remission (CR) after induction therapy (induction failure: IF) have a poor prognosis; however, there have been few prospective studies in patients with IF. PATIENTS AND METHODS:Between April 1997 and March 2005, 27 of 1,237 leukem...
journal_title:Pediatric blood & cancer
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更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Diamond Blackfan Anemia (DBA) is a rare congenital, bone marrow failure syndrome characterized by normochromic macrocytic anemia, reticulocytopenia and absence or insufficiency of erythroid precursors in normocellular bone marrow, frequently associated with somatic malformations. Here, we present our finding...
journal_title:Pediatric blood & cancer
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journal_title:Pediatric blood & cancer
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更新日期:2004-02-01 00:00:00
abstract::Angiotensin converting enzyme (ACE) gene insertion(I)/deletion(D) polymorphism influences the outcome of a number of cardiovascular diseases. ACE I/D polymorphism was investigated by PCR in 207 pediatric cancer patients and 144 controls. ACE I/D distribution of patients and controls was similar. The frequency of the D...
journal_title:Pediatric blood & cancer
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更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:A National Thalassemia Screening Program was adopted in Taiwan in 1993. This report examined that program's results and impact. METHODS:Patients with beta-thalassemia major born between 1994 and 2003 were recruited through the help of all thalassemia clinics in Taiwan. A structured questionnaire was designed...
journal_title:Pediatric blood & cancer
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更新日期:2008-01-01 00:00:00
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journal_title:Pediatric blood & cancer
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更新日期:2006-11-01 00:00:00
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journal_title:Pediatric blood & cancer
pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:Pediatric blood & cancer
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更新日期:2012-08-01 00:00:00
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journal_title:Pediatric blood & cancer
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journal_title:Pediatric blood & cancer
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更新日期:2009-03-01 00:00:00
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journal_title:Pediatric blood & cancer
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更新日期:2020-05-01 00:00:00
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更新日期:2007-12-01 00:00:00
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更新日期:2013-01-01 00:00:00
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