新冠肺炎疫情期间开展门诊放疗流程防控管理有效措施探究

目的 分析总结综合性医院门诊放疗过程中新型冠状病毒肺炎(简称新冠肺炎)流程防护的有效管理措施.方法 根据疫情防控要求,结合中国人民解放军总医院第一医学中心放疗门诊诊疗过程中可能存在的问题,回顾性梳理在新冠肺炎疫情下放疗门诊诊疗过程中采取的流程调整、环境分区、患者防控及消杀等防控措施,并对防控成效进行效果评价.结果 在门...     

肿瘤合并感染新冠肺炎患者临床分析及疫情期间肿瘤患者的管理建议

目的:探讨分析肿瘤合并新冠病毒感染患者情况并提出自己的思考与建议。方法:通过统计2020年1月至2020年3月期间纳入的313名本院肿瘤科在新冠疫情期间肿瘤合并感染新冠肺炎患者情况,汇总临床资料,分析患者肺部影像学特点,总结肿瘤合并新冠肺炎病毒感染患者临床特征、预后及转归等,并提出自己建议。结果:科室总共313名患者住院,5名新冠感染患者,新冠病毒肺炎发生率为1.6%,这比之前所报道的武汉市新冠病毒普通人群发生率0.37%要高接近3倍,肿瘤合并新冠患者死亡率接近20%。结论:对于疫情结束初期病房应尽量减少患者非必要往返医院次数,实行肿瘤患者分层管理,加强轻症患者随访,线上管理等;而对于住院患者,则采取缓冲分诊模式,做好病房消毒隔离以及管理,避免感染,减少肿瘤病房新型冠状病毒爆发概率。     

COVID-19疫情下妇科恶性肿瘤的临床管理策略

新冠肺炎疫情期间,由于医疗资源的再分配,妇科恶性肿瘤患者的常规医疗受到极大影响。恶性肿瘤患者因为接受抗肿瘤治疗后免疫力低,合并感染后症状重,成为疫情的易感人群和预防的重点对象。随着疫情的好转,妇科恶性肿瘤患者的治疗需求尤为强烈。在复杂的新冠肺炎疫情下,接受化疗、免疫治疗及需手术治疗的妇科恶性肿瘤患者如出现发热及呼吸道症状,更需要仔细地进行鉴别诊断,评估新冠肺炎感染的风险。因此对于这一类患者,在新冠肺炎疫情期间的抗肿瘤治疗,需要进行全面的管理。本文从对手术患者及化疗、免疫治疗患者的门诊管理、院内患者及陪同人员、医护工作人员的管理及对患者的院外管理三个方面全面阐述了COVID-19疫情下,妇科恶性肿瘤的临床管理策略,力求在有效防范新冠肺炎的同时,最大程度地治疗肿瘤。     

肿瘤患者新冠疫苗接种:临床研究进展与初步临床推荐

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19,简称新冠肺炎)疫情对全球公众健康产生了严重影响.广泛接种新型冠状病毒疫苗(简称新冠疫苗)成为终止新冠疫情的最可能有效的手段之一.肿瘤患者在新冠肺炎疫情中感染风险大、严重事件发生率高、死亡率高,应是疫情防治的重点对象.目前肿瘤患者新冠疫...     

新冠肺炎时期肿瘤内科工作的总结和反思

在新型冠状病毒肺炎(简称“新冠肺炎”)暴发期间,全国各医院各诊疗科室积极参与防治疫情发展的工作。在此期间肿瘤内科,一方面组织医护力量支援新冠肺炎疫情防控的最前线,另一方面坚持本职工作完成对肿瘤患者的日常诊疗。肿瘤内科的医护人员在诊疗工作、临床用药、患者管理等方面都迎来巨大挑战。经过不懈努力,他们克服种种困难,保障了正常的诊疗工作。同时,在疫情期间的临床实践中积累下的经验值得总结。目前疫情得到了有效的控制,在疫情过后,肿瘤内科有必要在重大公共卫生事件预警、肿瘤患者终身治疗中的角色、患者诊疗模式、新药开发等方面进行反思。     

2019新型冠状病毒病(COVID-19)疫情期间北京市放疗工作情况调查报告

目的 对北京市各家医院在COVID-19疫情期间放疗工作与防控措施的调查研究进行经验总结,为下一步工作提供参考。方法 本次调查采用电子调查问卷,通过北京医学会放射肿瘤治疗学分会和北京医师协会放射治疗专科医师(技师)分会的各位委员对各家医院放疗科进行调查问卷的填写与反馈。结果 截止2020年4月10日全北京市开展放疗工作的40家医院全部反馈了调查问卷,除1家医院因非疫情原因暂停治疗外,各医院均采取了相应的防控措施,并持续进行放疗工作。所有工作人员与收治患者均未发现COVID-19感染病例。结论 COVID-19疫情期间,各医院高度重视,优化临床收治流程,采取合理的防控措施;在满足疫情防控的基础上,坚持开展放疗工作,满足广大肿瘤患者的治疗需求。     

疫情期间肿瘤患者应当如何就医

新冠肺炎来势汹汹,不仅给全社会造成了巨大的损失,也对整个医疗体系提出了严峻的考验。在疫情期间如何就医,尤其是肿瘤患者如何就医,是当前面临的巨大难题。肿瘤患者受疾病或抗肿瘤治疗的影响,机体的免疫功能低下,成为了病毒的易感人群。特殊时期如何既保证肿瘤的诊治,又降低患者的感染风险,我们给不同治疗时期的肿瘤患者在疫情期间的就医提出一些建议。     

新冠肺炎疫情后肿瘤内科患者的诊疗思考

2019年12月,湖北省武汉市首发多例新型冠状病毒引起的新型冠状病毒肺炎(简称“新冠肺炎”),具有传染力强、人群易感性高、潜伏期长等特点。中央疫情领导小组、中国疾病预防控制中心及国家卫健委迅速响应,使得目前疫情防控走向良好,相信不久的将来疫情定会得到控制。这场突如其来的疫情防控,给同样是大病的肿瘤患者带来了诸多诊治困难。疫情过后,肿瘤患者返院就医或可能出现就诊高峰,特别是肿瘤内科患者病情重、身体情况差、急于就医、焦躁情绪等都给诊疗带来新的挑战。本文将结合对新冠肺炎的认识、肿瘤患者的特殊性、疫情过后患者的防护工作及有序诊治等方面针对肿瘤内科患者的诊疗管理提出思考,希望对后疫情时期的肿瘤内科医疗工作有所帮助。     

肿瘤专科医院特需门诊新型冠状病毒肺炎疫情常态化防控管理实践分析

摘 要：［目的］分享中国医学科学院肿瘤医院特需门诊在新型冠状病毒肺炎（简称：新冠肺炎）疫情背景下常态化安全防控管理运营的经验与体会。［方法］针对疫情期间特需门诊的防护配备及人员管理、出诊管理、患者就医及流程管理等各个环节,结合中国医学科学院肿瘤医院特需门诊运营实际,分析常态化防控安全管理中的重点、难点及应对措施。［结果］实施特需门诊新冠肺炎疫情常态化防控管理后,中国医学科学院肿瘤医院通过严格执行预防消毒措施,保障了医务人员与患者的安全;通过改进坐诊制度,合理调配专家出诊单元,满足了患者的就医需求;通过实现就诊流程优化,全面实施网络预约制,增加网络公益门诊,一定程度上解决了预约号源的爽约问题,避免了人员的聚集,做到了防控、就医两不误。［结论］在公共安全卫生事件突发时,特需门诊在保障患者就诊的同时,应不断调整就诊渠道,完善诊疗策略,严格遵守常态化防控流程,保障来诊患者及在诊专家的安全,在制度范围内最大限度满足患者的就诊需求。     

新型冠状病毒肺炎疫情下乳腺癌日间化疗病房运行管理实践

2019年12月以来,湖北省武汉市部分医院陆续发现了多例有华南海鲜市场暴露史的不明原因肺炎病例,现已证实为一种新型冠状病毒感染引起的急性呼吸道传染病,被命名为新型冠状病毒肺炎(简称新冠肺炎)。国家卫生健康委员会发布1号公告,将新冠肺炎纳入《中华人民共和国传染病防治法》规定的乙类传染病,采取甲类传染病防控[1]。中国多省市均启动了重大突发公共卫生事件Ⅰ级响应,限制人员流动,同时全国各大医院也面临收治或筛查新冠肺炎患者的艰巨任务,这给需要及时到医院救治的其他疾病患者带来了诸多的不便。在疫情之下,如何解决这部分患者的诊治,也成为当前医务工作者亟待解决的关键问题。     

Organisation d’un service de radiothérapie pendant l’épidémie de COVID-19 : expérience du centre hospitalier de Mulhouse

The COVID-19 outbreak grows exponentially in our country. Despite most of patients develops benign symptoms, cancer patients are at risk of a severe form of the disease. Radiotherapy centres are a potential contamination place due to the number of patients treated and staff present. Their organization during the outbreak period aims to ensure continuity of care while limiting the risk of death from COVID-19. In the radiotherapy department of Mulhouse hospital (France), we pointed five points out: protection of medical and paramedical staff, protection of patients undergoing treatment, detection of patients suspected of being infected by SARS-CoV-2 and their management, reorganization of the patient circuit and measures regarding the quality management. This reflection, which began at the beginning of the outbreak in our city, allows us to preserve the access to radiotherapy treatments by anticipating the risk of spreading the virus. Through biweekly meetings, we continue to adapt to the epidemic in our department, considering our material resources. The ability to perform diagnostic tests in all suspect patients would also allow us to refine our procedures.     

全程营养管理在胸部肿瘤患者术后放疗中的应用效果研究

目的:探讨全程营养管理在胸部肿瘤术后放疗患者的应用效果.方法:连续纳入某三甲肿瘤专科医院胸部肿瘤放疗科2018年2月至2019年3月收治的112例胸部肿瘤术后行放疗的患者,其中试验组与对照组各56例,对照组采用常规饮食护理,实验组在常规饮食护理基础上采用全程营养管理;比较两组患者放疗期间营养指标、放疗不良反应发生情况、...     

Outbreak management in health care facilities

An outbreak of healthcare-associated infection is a disastrous event. Thus, it is essential to understand an overview of outbreak management. Cautious management is needed especially for cancer patients, due to their high risk of acquiring healthcare-associated infections. An outbreak is defined as a healthcare-associated infection when its frequency clearly exceeds normal expectancy. The early detection of an outbreak through appropriate surveillance and collections of sentinel events is a primary step in its management. After detection, infection prevention and control measures must be rapidly implemented. An epidemiological investigation is concurrently conducted to clarify the overall picture, estimate the source and route of infection, and establish recommendations. In addition, the stress of healthcare providers, relationships with public health officials, and risk communication must be considered. However, the capacities of epidemiological investigations are generally limited due to insufficient healthcare resources for outbreak management. Basic infection prevention measures and early response are the most efficient approaches for preventing future outbreaks.     

Outbreak of vancomycin-resistant enterococci (VRE) in a hematological oncology ward and hygienic preventive measures. A long-term study

BACKGROUND: We report on two endemic outbreaks of VRE (vancomycin-resistant enterococci, vanA type Enterococcus faecium) on a hematological oncology ward in a university hospital and a new strategic concept to fight against spread of VRE. PATIENTS AND METHODS: During management of the outbreak, a total of 1,124 patients and 1,700 specimens were investigated from June 1999 to December 2001. Protective measures were instituted. Intensive prophylactic infection control was practiced until December 2003. RESULTS: Of the 1,124 patients, 44 were VRE-positive. From 1,700 environment specimens, 110 VRE isolates were obtained from the inanimate environment, 5 from the living environment. Molecular biological typing identified 5 different clones which had spread on the ward in different locations. CONCLUSION: The study shows the need for prophylactic microbiological screening investigations in the risk group of hematological oncology patients and consistent implementation of protective hygiene measures to prevent the spread of multiresistant infectious pathogens on risk wards. It is also shown that intervention can to control such an endemic outbreak.     

An investigation report of radiotherapy centers in Beijing during the COVID-19 pandemic

Objective An investigation on the prevention and control measures taken by radiotherapy centers of various hospitals in Beijing during the COVID-19 pandemic was conducted. The experience was summarized to provide reference for further work. Methods Electronic questionnaires were distributed to each radiotherapy center through members of the radiation oncology therapeutics branch of Beijing medical association and members of Society of Radiotherapy Specialists (Technicians) of Beijing Medical Doctors Association. Statistical analysis was performed based on the feedback results of electronic questionnaires. Results All forty radiotherapy centers in Beijing returned the questionnaires by the end of April 10, 2020. Except for the suspension of treatment in one center due to COVID-19 pandemic, all radiotherapy centers have taken corresponding prevention and control measures and continued to carry out radiotherapy. No COVID-19 infection of patients or medical staffs occurred during this pandemic. Conclusions During the COVID-19 pandemic, all radiotherapy centers attach great importance to optimizing the clinical process and adopt reasonable prevention and control measures. On the basis of efficient prevention and control measures, radiotherapy is delivered to fulfill the treatment demands of cancer patients.     

Extended Spectrum Beta-Lactamase-producing Klebsiella pneumoniae outbreaks during a third generation cephalosporin restriction policy

In spite of the adoption of third generation cephalosporin restriction policies, two independent outbreaks by Extended Spectrum Beta-Lactamase (ESBL)-producing Klebsiella pneumoniae occurred in two different wards (Neonatal Intensive Care Unit, NICU and Neurosurgery) of a teaching hospital in Rome, Italy. In the former 19 infected neonates were reported, whereas in the latter there were 10 infected patients. In both wards no differences were observed in the mortality rates in periods of outbreak and those with no outbreak. Molecular typing on a total of 19 isolated strains was carried out and restriction patterns were compared. The PFGE showed that nine isolates responsible for infection in the NICU were all included in three closely related clusters. In Neurosurgery nine strains out of ten were strictly related and part of an outbreak occurring between August-December 2003, while one isolate was temporarily (February 2003) and genetically (seven band differences) unrelated to the outbreak strains. When ESBL producing K. pneumoniae clusters from the two wards (NICU vs Neurosurgery) were compared, they appeared to be completely different both for their genotype pattern and plasmid type or presence, thus demonstrating cross transmission by two different genotypes.     

新型冠状病毒疫情期间肿瘤内科患者的应急管理及诊治流程

肿瘤的治疗有着很强的时效性和周期性。因新型冠状病毒肺炎疫情持续时间不确定,恶性肿瘤患者若长时间得不到有效治疗,可能发生病情反复甚至进展。多项研究显示延迟化疗及内分泌治疗等可能对肿瘤患者预后产生不良影响。疫情之下,如何更好地服务肿瘤患者,防控肿瘤患者及家属的感染,如何调整和优化院内就医流程,让临床工作科学有序地开展,把疫情对肿瘤患者的治疗影响降到最低,成为肿瘤专科医师亟待解决的关键问题。本文重点论述有效指导肿瘤患者就医应急管理、诊治流程、合理随访、降低传播风险、关注心理健康等具体问题,为抗击新型冠状病毒肺炎,改善肿瘤患者的预后提供参考。     

The persistence and clonal spread of a single strain of Acinetobacter 13TU in a large Scottish teaching hospital

This study describes the persistence and spread of a single strain of Acinetobacter 13TU in a large Scottish teaching hospital. Acinetobacter spp. are reported with increasing frequency as a cause of nosocomial infection. The species most implicated in these infections is Acinetobacter baumannii. Following an outbreak of infection with Acinetobacter 13TU within the intensive therapy unit (ITU) of Edinburgh Royal Infirmary (ERI) during 1994-1995, the current epidemiological Acinetobacter situation within the hospital was monitored to determine whether or not control of infection procedures instigated at that time had been successful in controlling the outbreak. Sixty-eight strains of Acinetobacter spp were isolated from clinical specimens received from various wards in the ERI and other associated hospitals over a 7-month period. Each isolate was typed phenotypically by the API20NE system and genotypically by pulsed field gel electrophoresis (PFGE) in order to compare them with the previous outbreak strain. Fifty-three percent of the isolates collected were originally identified as A. junii by API 20 NE, of which 83% (mainly from ITU) were shown to be genotypically related to the previous outbreak strain. Subsequent tDNA fingerprinting of one of the original outbreak strains showed it to be a member of the genospecies 13TU and not A. junii as originally thought.