Impact of fluoroquinolone prophylaxis on infectious-related outcomes after hematopoietic cell transplantation.

BACKGROUND: Patients immediately post-hematopoietic cell transplantation are at high risk for bacteremia. Judicious prophylactic antimicrobial utilization must balance anticipated benefits (reduction infections) versus risk (bacterial resistance, Clostridium difficile) . OBJECTIVE: To compare infectious outcomes (primary: incidence bacteremia; secondary: febrile neutropenia, C. difficile, susceptibility of bacteremia, time to discharge and 30-day mortality) between hematopoietic cell transplantation who received fluoroquinolone prophylaxis to those who did not. METHODS: A local institutional review board-approved retrospective study was conducted on all hematopoietic cell transplantation patients ( n = 171) comparing those who received fluoroquinolone prophylaxis ( n = 105) to those who did not ( n = 66). Data included infectious outcomes and mortality for the first 30 days post-hematopoietic cell transplantation. Chi-squared was performed for categorical variables (GraphPad Software Inc., 2015). Secondary analysis compared outcomes within autologous and allogeneic sub-groups. RESULTS: Bacteremia was significantly lower for the overall cohort receiving fluoroquinolone (median duration eight days) versus those without fluoroquinolone (15.2% vs. 31.8%; P < 0.01). No difference was seen in C. difficile infection ( P = 0.81) or 30-day mortality (2.9% vs. 4.5%; P = 0.67). In the autologous sub-group ( n = 115), bacteremia was significantly lower in the fluoroquinolone cohort (8.5% vs. 27.3%; P = 0.0069), while no differences were seen in C. difficile infection ( P = 1) or 30-day mortality ( P = 1). In the allogeneic sub-group ( n = 56), there was no difference between those with and without fluoroquinolone in bacteremia (29.4% vs. 40.9%; P = 0.4) or C. difficile ( P = 0.72); however, there was a trend toward improved 30-day mortality (2.9% vs. 9.1%; P = 0.55). CONCLUSIONS: Fluoroquinolone prophylaxis reduces incidence of bacteremia in autologous hematopoietic cell transplantation without increasing C. difficile after hematopoietic cell transplantation.

Adult Acute Lymphoblastic Leukemia: A Genetic Overview and Application to Clinical Practice.

BACKGROUND: Cytogenetic and molecular features of diseases, such as B-cell precursor acute lymphoblastic leukemia (BCP-ALL), are increasingly used for diagnostic, prognostic, and treatment decisions in health care. OBJECTIVES: This review provides information on the current recommendations for evaluating genetic aberrations in patients with BCP-ALL and details how the results are incorporated to determine risk stratification. It also offers a brief overview of developing research on newly found genetic features that may play a role in prognostic and treatment decisions. METHODS: Databases were reviewed using search terms relevant to BCP-ALL genetics, as well as to the prognostic significance of genetic changes commonly seen in BCP-ALL. Because of the scope of this review, studies identified as having outcomes with implications for clinical practice were included. FINDINGS: Cytogenetic and molecular aberrations in BCP-ALL are important not only for risk stratification but also for treatment decisions. To provide efficient and effective care for patients with BCP-ALL, clinical practitioners need to be aware of current recommendations and the state of prevailing research.

Misattributed paternity in hematopoietic stem cell transplantation: the role of the healthcare provider.

BACKGROUND: With emerging technologies and genetic advancements in the field of oncology, ethical controversies and questions on how to approach them will continue to grow. Advancements in the field of hematopoietic stem cell transplantation have led to increased testing of transplantation recipients' children and parents as potential donors related to an increase in the use of haploidentical transplantations. This testing opens the door for an increased incidence of misattributed paternity findings. OBJECTIVES: This article attempts to address the ethical conflicts and provide potential solutions to assist in the transition from individual-focused care to family-focused care. METHODS: The principlist approach was used. FINDINGS: Healthcare providers should be educated on methods of incidental finding disclosure and how to provide adequate support for those individuals.

Alcohol induced diabetic ketoacidosis exacerbated by an acute respiratory infection with Klebsiella pneumoniae.

Ketoacidosis is a metabolic condition that occurs as a result of an insufficient amount of insulin. The lack of insulin results in an increased release of glucose from the liver and an excess of ketone bodies as a result of the breakdown of adipose tissue. This occurs when carbohydrates are unable to be properly processed for needed energy requirements during cellular metabolism. Ketoacidosis is commonly linked to diabetes mellitus. Diabetes mellitus is a condition where the body is unable to produce the proper amount of insulin or is unable to effectively respond to insulin stimulation. Excessive alcohol use can damage the pancreas, reducing insulin secretion. Other conditions such as pneumonia or urinary tract infections can trigger the release of counter-regulatory hormones that may contribute to the decrease in insulin's activity and secretion. Symptoms of diabetic ketoacidosis often include nausea and vomiting, increased thirst and urine production, hyperglycemia, abdominal pain, shortness of breath, confusion, headache, general weakness, fatigue and increased heart rate. If left untreated, diabetic ketoacidosis can lead to more serious complications including circulatory collapse, decreased blood potassium levels, infection and cerebral edema. The following case study presents a complex condition of ketoacidosis associated with a bacterial infection compounded by the patient's history of alcohol abuse.

Cytogenetics: oncology nurses in advanced practice decipher del(13q14) and t(14:16).

Advances in genetics related to the diagnosis and treatment of cancer have transformed the oncology specialty into one with more promising outcomes. Because of the Human Genome Project, the association between genetics and cancer is more clearly defined and healthcare professionals need to be prepared to integrate new genetics knowledge into clinical practice. This article reviews basic genetic information essential for oncology nurses in advanced practice. Application of genetic guidelines uses the model of multiple myeloma. Multiple myeloma is an example of a disease in which cytogenetics has become increasingly important for diagnosis, prognosis, and treatment. As the basis of knowledge in genetics continues to expand, oncology providers are transitioning to a paradigm in which cytogenetic elements carry more weight in diagnosis and treatment.

HIV/AIDS interventions in an aging U.S. population.

According to the Centers for Disease Control and Prevention (CDC), 25 percent of people living with HIV in the United States in 2006 were age 50 and older. HIV prevention for people over 50 is an important health concern, especially as the U.S. population grows older. Scholarly research has identified the need for HIV/AIDS interventions in the population of people over age 50, but few interventions have been established. The ecological perspective, which integrates intrapersonal, interpersonal, organizational, community, and policy factors, was used to review the current interventions and propose possible new HIV/AIDS prevention efforts for older adults. Intrapersonal interventions are often based on the health belief model. The precaution adoption process model was explored as an alternative intrapersonal theory for modeling prevention efforts. Community interventions using diffusion of innovations theory are fully explored, and new interventions are proposed as an option for preventing HIV/AIDS in older adults. An agenda for future research and interventions is proposed. Social workers will be at the forefront of the effort to prevent HIV/AIDS in older adults. They must accept this responsibility, propose interventions, and evaluate their effectiveness.