Clinical research in febrile neutropenia in cancer patients: Past achievements and perspectives for

来源 :World Journal of Clinical Infectious Diseases | 被引量 : 0次 | 上传用户:jym956
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
Febrile neutropenia(FN) is responsible for significant morbidity and mortality. It can also be the reason for delaying or changing potentially effective treatments and generates substantial costs. It has been recognized for more than 50 years that empirical administration of broad spectrum antibiotics to patients with FN was associated with much improved outcomes; that has become a paradigm of management. Increase in the incidence of microorganisms resistant to many antibiotics represents a challenge for the empirical antimicrobial treatment and is a reason why antibiotics should not be used for the prevention of neutropenia. Prevention of neutropenia is best performed with the use of granulocyte colonystimulating factors(G-CSFs). Prophylactic administration of G-CSFs significantly reduces the risk of developing FN and consequently the complications linked to that condition; moreover, the administration of G-CSF is associated with few complications, most of which are not severe. The most common reason for not using G-CSF as a prophylaxis of FN is the relatively high cost. If FN occurs, in spite of prophylaxis, empirical therapy with broad spectrum antibiotics is mandatory. However it should be adjusted to the risk of complications as established by reliable predictive instruments such as the Multinational Association for Supportive Care in Cancer. Patients predicted at a low level of risk of serious complications, can generally be treated with orally administered antibiotics and as out-patients. Patients with a high risk of complications should be hospitalized and treated intravenously. A short period of time between the onset of FN and beginning of empirical therapy is crucial in those patients. Persisting fever in spite of antimicrobial therapy in neutropenic patients requires a special diagnostic attention, since invasive fungal infection is a possible cause for it and might require the use of empirical antifungal therapy. It has also been recognized for more than 50 years that empirical administration of broad spectrum antibiotics to patients with FN was associated with much improved outcomes; that has become a paradigm of management. Increase in the incidence of microorganisms resistant to many antibiotics represents a challenge for the empirical antimicrobial treatment and is a reason why antibiotics should not be used for the prevention of neutropenia. Prevention of neutropenia is best performed with the use of granulocyte colonystimulating factors (G-CSFs). Prophylactic administration of G-CSFs significantly reduces the risk of developing FN and caused the complications linked to that condition; moreover, the administration of G-CSF is associated with few complications, most of which are not severe. The mo st common reason for not using G-CSF as a prophylaxis of FN is the relatively high cost. If FN occurs, in spite of prophylaxis, empirical therapy with broad spectrum antibiotics is mandatory. However it should be adjusted to the risk of complications as established by reliable predictive instruments such as the Multinational Association for Supportive Care in Cancer. Patients predicted at a low level of risk of serious complications, can generally be treated with orally administered antibiotics and as out-patients. Patients with a high risk of complications should be hospitalized and treated intravenously. A short period of time between the onset of FN and beginning of empirical therapy is crucial in those patients. Persisting fever in spite of antimicrobial therapy in neutropenic patients requires a special diagnostic attention, since invasive fungal infection is a possible cause for it and might require the use of empirical antifungal therapy.
其他文献
众所周知,学校教育是我国国民综合素质文化教育的重要组成部分,它为孩子今后的学习和发展奠基了深厚的基础.在当前的新形势下,人们也愈来愈重视学生的文化发展,社会各界人士
【摘要】语文是一门相当重要的社会人文学科。语文知识的学习更像是一个正视自身情感、发现自身情感、规范自身情感的过程。语文教育对于人类的作用不仅仅是提升个人素质和水平,它更是人类在当今社会生存和发展的基础。如果学生想要保证其他学科也能有优异的成绩,前提条件就是学好语文。可以说语文对各个学科有促进作用,所以学生是否能够掌握语文知识是至关重要的。在这个过程中,教师语文教学水平更是占据了举足轻重的地位。  
【摘要】口语交际是一项培养学生倾听、表达与应对能力的语文实践活动,是一个特殊的互动过程。本文从“明确教学目标、收集相关资料、分层设计情境和交流语言支架”四方面介绍如何有效开展口语交际教学。  【关键词】口语交际;有效开展  【中图分类号】G623 【文献标识码】A  案例:人教版小学语文四年级下册口语交际四:“生命”。  口语交际教学流
【摘要】核心素养理念下的小学硬笔书法教学,应该结合学生的实际情况,认真分析现存问题,坚持以学生为本、因材施教的教学策略,关注每位学生的发展情况,鼓励学生自主积极参与、互助探究、交流合作、实践提升。 但是,书法教育存在着诸多问题,特别是缺乏相应的书法评价机制。评价定位模糊化、评价趋势模式化,制约了书法教学的有效开展。根据《义务教育语文课程标准(2011年)》的要求,硬笔书法评价可以从学生评价和教师评
AIM: To estimate the levels of serum cytokines in chronic pancreatitis(CP) and pancreatic ductal adenocarcinoma(PDAC) patients in order to evaluate their useful
【摘要】在现代教育中,情感教育被广泛应用到各学科之中,尤其在语文、历史等文科教学过程中应用得更为广泛。而在实际情感教育中,如何营造和谐的情感氛围、加强师生间的情感交流,是情感教育开展的关键。基于此,本文围绕情感教育进行剖析,其中重点针对初中语文教学工作指出了情感教育对于初中语文教学的重要价值,同时也基于当前我国初中语文教学中情感教育的开展现状进行了分析,提出了具体的解决对策,旨在能够给予广大初中语
贵刊第六期刊载的调查报告《“无冕之王”安然 无恙乎?》对我触动很大。由此看来,新闻工 作者的健康状况应该引起新闻工作者、新闻单位乃至全社会的高度重视。我以为,可以采取以
随着课程改革的进一步推进,“核心素养”这一崭新的概念被引入到语文教学中,高效课堂教学成为一线教师关注的焦点.构建高效语文课堂教学,提升学生语文素养,必须紧紧抓住“课
目的:  本研究采用低频振幅(ALFF)方法来分析恒河猴氯胺酮慢性成瘾前后静息态功能磁共振激活脑区改变,以期探究氯胺酮的慢性成瘾机制,为临床诊断及治疗提供科学依据。  方法: 
【摘要】小學语文与心理健康教育的发展之间具有互相推动作用,本文将根据小学语文与心理健康教育之间的关系,详细阐述小学语文与心理健康教育活动相结合的优势,以及如何在教学过程中充分发挥小学语文教材的作用,实现小学语文教材为小学生心理健康教育服务的功能。  【关键词】小学语文教材;心理健康教育;小学生  【中图分类号】G625 【文献标识码】A