Management of fever and neutropenia in paediatric cancer patients: room for improvement?

PURPOSE OF REVIEW Fever and neutropenia is the most common complication in the treatment of childhood cancer. This review will summarize recent publications that focus on improving the management of this condition as well as those that seek to optimize translational research efforts. RECENT FINDINGS A number of clinical decision rules are available to assist in the identification of low-risk fever and neutropenia however few have undergone external validation and formal impact analysis. Emerging evidence suggests acute fever and neutropenia management strategies should include time to antibiotic recommendations, and quality improvement initiatives have focused on eliminating barriers to early antibiotic administration. Despite reported increases in antimicrobial resistance, few studies have focused on the prediction, prevention, and optimal treatment of these infections and the effect on risk stratification remains unknown. A consensus guideline for paediatric fever and neutropenia research is now available and may help reduce some of the heterogeneity between studies that have previously limited the translation of evidence into clinical practice. SUMMARY Risk stratification is recommended for children with cancer and fever and neutropenia. Further research is required to quantify the overall impact of this approach and to refine exactly which children will benefit from early antibiotic administration as well as modifications to empiric regimens to cover antibiotic-resistant organisms.

Na 1 Nachlass Max Horkheimer, 572 - Korrespondenzen mit Franz Neumann und Friedrich Pollock (p. VI 30, 225-484)

169 Briefe zwischen Franz Neumann und Max Horkheimer; 7 Briefe zwischen Walter L. Dorn und Franz Neumann, 1941 -1942; 2 Briefe zwischen Max Horkheimer und Walter L. Dorn, März 1943; 1 Brief von dem U. S. Department of Justice an Max Horkheimer, 13.07.1942; 1 Brief von Max Horkheimer an John R. Brooks, 30.08.1947; 1 Brief an Robert (Bob) Schmid von Franz Neumann, 06.05.1947; 1 Brief an Franz Neumann von James E. Murray, 05.06.1942; 21 Briefe zwischen Friedrich Pollock und Max und Maidon Horkheimer, 1911-1921; 1 Brief von Max Horkheimer an Andrée, 01.12.1918;

The relationship between hospital financial performance and information technology integration strategy selection

In light of the new healthcare regulations, hospitals are increasingly reevaluating their IT integration strategies to meet expanded healthcare information exchange requirements. Nevertheless, hospital executives do not have all the information they need to differentiate between the available strategies and recognize what may better fit their organizational needs. ^ In the interest of providing the desired information, this study explored the relationships between hospital financial performance, integration strategy selection, and strategy change. The integration strategies examined – applied as binary logistic regression dependent variables and in the order from most to least integrated – were Single-Vendor (SV), Best-of-Suite (BoS), and Best-of-Breed (BoB). In addition, the financial measurements adopted as independent variables for the models were two administrative labor efficiency and six industry standard financial ratios designed to provide a broad proxy of hospital financial performance. Furthermore, descriptive statistical analyses were carried out to evaluate recent trends in hospital integration strategy change. Overall six research questions were proposed for this study. ^ The first research question sought to answer if financial performance was related to the selection of integration strategies. The next questions, however, explored whether hospitals were more likely to change strategies or remain the same when there was no external stimulus to change, and if they did change, they would prefer strategies closer to the existing ones. These were followed by a question that inquired if financial performance was also related to strategy change. Nevertheless, rounding up the questions, the last two probed if the new Health Information Technology for Economic and Clinical Health (HITECH) Act had any impact on the frequency and direction of strategy change. ^ The results confirmed that financial performance is related to both IT integration strategy selection and strategy change, while concurred with prior studies that suggested hospital and environmental characteristics are associated factors as well. Specifically this study noted that the most integrated SV strategy is related to increased administrative labor efficiency and the hybrid BoS strategy is associated with improved financial health (based on operating margin and equity financing ratios). On the other hand, no financial indicators were found to be related to the least integrated BoB strategy, except for short-term liquidity (current ratio) when involving strategy change. ^ Ultimately, this study concluded that when making IT integration strategy decisions hospitals closely follow the resource dependence view of minimizing uncertainty. As each integration strategy may favor certain organizational characteristics, hospitals traditionally preferred not to make strategy changes and when they did, they selected strategies that were more closely related to the existing ones. However, as new regulations further heighten revenue uncertainty while require increased information integration, moving forward, as evidence already suggests a growing trend of organizations shifting towards more integrated strategies, hospitals may be more limited in their strategy selection choices.^

Interstitial water chemistry, Deep Sea Drilling Project, Leg 96

On Leg 96 of the Deep Sea Drilling Project (DSDP), holes were drilled in Orca and Pigmy basins on the northern Gulf of Mexico continental slope and on the Mississippi Fan. The holes on the fan encountered interbedded sand, silt, and mud deposited extremely rapidly, most during late Wisconsin glacial time. Pore-water chemistry in these holes is variable, but does not follow lithologic changes in any simple way. Both Ca and SO4 are enriched in the pore water of many samples from the fan. Two sites drilled in the prominent central channel of the middle fan show rapid SO4 reduction with depth, whereas two nearby sites in overbank deposits show no sulfate reduction for 300 m. Calcium concentration decreases as SO4 is depleted and Li follows the same pattern. Strontium, which like Li, is enriched in samples enriched in Ca, does not decrease with SO4 and Ca. Potassium in the pore water decreases with depth at almost all sites. Sulfate reduction was active at the two basin sites and, as on the fan, this resulted in calcium carbonate precipitation and a lowering of pore water Ca, Mg, and Li. The Orca Basin site was drilled through a brine pool of 258? salinity. Pore-water salinity decreases smoothly with depth to 50 m and remains well above normal seawater values to the bottom of the hole at about 90 m. This suggests constant sedimentation under anoxic hypersaline conditions for at least the last 50,000 yr.

Geochemistry of Peru margin sediments

This data report tabulates results of chemical analyses of sediments from four sites (680, 682, 685, and 688) drilled during Leg 112 offshore Peru. These sediments were recovered from the forearc basins underlying the Peru upwelling area. They are equivalent in facies and age to the Pisco and Monterey formations, both of which are of considerable economic and geological interest as hydrocarbon source rocks deposited under conditions of coastal upwelling. Sediments recovered from the shelf (Site 680) and slope (Sites 682, 685, and 688) during Leg 112 are unconsolidated and are thermally immature. A lack of consolidation and thermal catagenesis makes these deposits ideal targets for chemical investigation into effects of early diagenesis in organic-carbon-rich siliceous muds.