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[EN] Febrile neutropenia is a very common complication in patients with hematological malignancies receiving chemotherapy, and is associated with high morbidity and mortality. Infections caused by multidrug-resistant bacteria have become a therapeutic challenge in this high-risk patient population, since inadequate initial empirical treatment can seriously compromise prognosis. However, reducing antimicrobial exposure is one of the most significant cornerstones in the fight against resistance. The objective of these new guidelines is to update recommendations for the initial management of hematological patients who develop febrile neutropenia in this scenario of multidrug resistance. The two participating Societies (the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica [Spanish Society of Infectious Diseases and Clinical Microbiology] and the Sociedad Española de Hematología y Hemoterapia [Spanish Society of Haematology and Haemotherapy]), designated a panel of experts in the field to provide evidence-based recommendations in response to common clinical questions. This document is primarily focused on bacterial infections. Other aspects related to opportunistic infections, such as those caused by fungi or other microorganisms, especially in hematopoietic stem cell transplantation, are also touched upon., [ES] La neutropenia febril es una complicación muy frecuente en los pacientes hematológicos que reciben tratamiento quimioterápico, y se asocia a una importante morbimortalidad. Las infecciones por bacterias multirresistentes se han convertido en un reto terapéutico en esta población de pacientes de alto riesgo, en los que un tratamiento empírico inicial inadecuado puede comprometer gravemente su pronóstico. Sin embargo, reducir la exposición a los antimicrobianos es uno de los pilares más importantes en la lucha frente a las resistencias. El objetivo de esta nueva guía es actualizar las recomendaciones sobre el manejo inicial del paciente hematológico que desarrolla neutropenia febril en el escenario actual de multirresistencia. Para la elaboración de este documento, las 2 sociedades implicadas (la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica y la Sociedad Española de Hematología y Hemoterapia) designaron expertos en este tema, quienes han realizado recomendaciones basadas en la evidencia, en respuesta a cuestiones clínicas habituales. Este documento está enfocado básicamente a la infección bacteriana. Otros aspectos relacionados con las infecciones oportunistas, como las producidas por hongos u otros microorganismos, sobre todo en el seno del trasplante de progenitores hematopoyéticos, se abordan de forma tangencial.

Bakgrund: Patienter med hematologisk sjukdom erhöll en tunnellerad central venkateter i lokal anestesi inför behandling. Det är vanligt att patienter som är vakna under operation upplever oro. Syfte: Syftet med studien var att undersöka hur patienter med hematologisk sjukdom upplever att få en tunnelerad CVK i lokalanestesi samt hur de anser att upplevelsen kan förbättras. Metod: Studien har en deskriptiv design med kvalitativ metod. Semistrukturerade intervjuer genomfördes med 10 patienter där en intervjuguide med öppna frågor användes. Intervjuerna analyserades med hjälp av systematisk textkondensering enligt Malterud. Resultat: Gemensamt för samtliga patienter i studien var att CVK-ingreppet överlag var en positiv upplevelse. Patienterna beskrev att kontinuerlig information och ett gott omhändertagande på operation bidrog till en positiv upplevelse av att få en tunnelerad CVK. I resultatet framkom fyra teman; 1- mental styrka hjälpte patienterna att känna sig redo, 2- att vara utsatt i en miljö där smärta och obehag förekom, 3- omhändertaget av professionell och erfaren personal bidrog till en lugn stämning, 4- tidigare erfarenheter och information minskade oro och gav patienterna ökad trygghet. Slutsats: Studien visar att det finns potential att göra upplevelsen av att få en tunnelerad CVK bättre med enkla medel. Förbättringen kan ske genom tydligare information, varmare temperatur inne på operationssalen och genom att anestesisjuksköterskan stödjer patienten vid oro. Informationen och vården behöver således bli mer personcentrerad och vårdpersonal behöver öva för att bli bättre på att ge denna vård., Background: Prior to treatment, patients with haematological disease receives a tunnelled central venous catheter in local anesthesia. It is common for patients who are awake during surgery to experience anxiety. Aim: The aim of this study was to describe how patients suffering from hematological diseases experience tunelled central venous cathetrization in local anesthesia and how their experience could be improved. Design: Semistructured interviews using an interview guide with open-ended questions where performed with 10 patients. Data were analysed with systematic text condensation according to Malterud. Result: The included patients had an overall positive experience from recieving a tunelled central venous catheter. The patients described how continuous information and good care improved their experience of recieving a tunelled central venous catheter. Four themes were identified in the result; 1- having mental a strenght made the patients feel relieved and prepared, 2- being exposed to an environment where pain and discomfort were present, 3- being taken care of by experienced professionals contributed to a calm atmosphere, 4- previous experiences and information reduced anxiety and promoted an increased feeling of safety Conclusion: The present study shows the potential to make patients experiences better by simple means, for example by giving more distinct information, raising the temperature in the operating room and by the nurse anesthetist acting more supportive when patients feel anxiety. The information and nursing care need to be more personalized and professionals need to practice in order to improve.

Bakgrund: Patienter med hematologisk sjukdom erhöll en tunnellerad central venkateter i lokal anestesi inför behandling. Det är vanligt att patienter som är vakna under operation upplever oro. Syfte: Syftet med studien var att undersöka hur patienter med hematologisk sjukdom upplever att få en tunnelerad CVK i lokalanestesi samt hur de anser att upplevelsen kan förbättras. Metod: Studien har en deskriptiv design med kvalitativ metod. Semistrukturerade intervjuer genomfördes med 10 patienter där en intervjuguide med öppna frågor användes. Intervjuerna analyserades med hjälp av systematisk textkondensering enligt Malterud. Resultat: Gemensamt för samtliga patienter i studien var att CVK-ingreppet överlag var en positiv upplevelse. Patienterna beskrev att kontinuerlig information och ett gott omhändertagande på operation bidrog till en positiv upplevelse av att få en tunnelerad CVK. I resultatet framkom fyra teman; 1- mental styrka hjälpte patienterna att känna sig redo, 2- att vara utsatt i en miljö där smärta och obehag förekom, 3- omhändertaget av professionell och erfaren personal bidrog till en lugn stämning, 4- tidigare erfarenheter och information minskade oro och gav patienterna ökad trygghet. Slutsats: Studien visar att det finns potential att göra upplevelsen av att få en tunnelerad CVK bättre med enkla medel. Förbättringen kan ske genom tydligare information, varmare temperatur inne på operationssalen och genom att anestesisjuksköterskan stödjer patienten vid oro. Informationen och vården behöver således bli mer personcentrerad och vårdpersonal behöver öva för att bli bättre på att ge denna vård., Background: Prior to treatment, patients with haematological disease receives a tunnelled central venous catheter in local anesthesia. It is common for patients who are awake during surgery to experience anxiety. Aim: The aim of this study was to describe how patients suffering from hematological diseases experience tunelled central venous cathetrization in local anesthesia and how their experience could be improved. Design: Semistructured interviews using an interview guide with open-ended questions where performed with 10 patients. Data were analysed with systematic text condensation according to Malterud. Result: The included patients had an overall positive experience from recieving a tunelled central venous catheter. The patients described how continuous information and good care improved their experience of recieving a tunelled central venous catheter. Four themes were identified in the result; 1- having mental a strenght made the patients feel relieved and prepared, 2- being exposed to an environment where pain and discomfort were present, 3- being taken care of by experienced professionals contributed to a calm atmosphere, 4- previous experiences and information reduced anxiety and promoted an increased feeling of safety Conclusion: The present study shows the potential to make patients experiences better by simple means, for example by giving more distinct information, raising the temperature in the operating room and by the nurse anesthetist acting more supportive when patients feel anxiety. The information and nursing care need to be more personalized and professionals need to practice in order to improve.

Clinicians should provide fertility counseling to all patients receiving gonadotoxic treatment. International scientific societies have mainly focused on oncological patients, and fewer efforts have been made to apply these recommendations to women diagnosed with benign disease (eg benign hematological diseases, auto-immune diseases, and gynecological or genetic disorders). However, these indications account for 8% to 19% of the demand for fertility preservation. The risk of premature ovarian failure due to treatment, or to the disease itself, can be considered fairly high for many young women. Counseling and adequate management of these women requires particular attention due to the severe health conditions that are associated with some of these diseases. In this review, we address specific issues related to providing adequate fertility counseling and management for women who have been diagnosed with the major non-oncological indications, based on the literature and on our clinical experience. This article is protected by copyright. All rights reserved., SCOPUS: re.j, info:eu-repo/semantics/published

We read with interest the paper by La Torre et al.,1 which conducted two systematic reviews and a meta-analysis to summarize the results of scientific works about influenza and pneumococcal vaccines in oncohematological patients. We paid specific attention to influenza vaccine results. The protection rate of H1N1 vaccine resulted in 31% and 30% after the first dose and booster dose, respectively. Protection rate of H3N2 and influenza B first dose was 42.6% and 39.6%, respectively. Considering the response rate, the pooled prevalence for H1N1 was 30% and 35% after the first dose and booster dose, respectively. The response rate for H3N2 was 21.7% after first dose and 24% after booster dose. Finally, the response rate for influenza B was 23.6% after the first dose and 29% after booster dose. Only a minority of patients experienced adverse events, most of them were mild and did not require treatment. Even though influenza vaccine elicits a low response rate among oncohematological patients, particularly in those who received transplantation, splenectomy or rituximab, it is an inexpensive intervention with few side effects. However, the first vaccine dose induces a small response, and the booster dose induces additional antibodies.

Syfte: Syftet har varit att beskriva hur patienter uppfattar begreppet egenvård samt deras uppfattningar gällande information om egenvård. Metod: Empirisk studie med kvalitativ design. Strategiskt urval av åtta patienter som genomgått stamcellstransplantation. Datainsamling skedde genom semistrukturerade intervjuer. Resultat: Patienter uppfattar att egenvård är att ta hand om sig så att den egna fysiska samt psykiska hälsan främjas, utan inblandning av sjukvården. De flesta patienter uppfattade att informationen om egenvård hade varit tillfredsställande. Dock förekom svårigheter med att koppla ihop begreppet egenvård med den information som givits om egenvårdande åtgärder. Ett fåtal av informanterna ansåg att informationen om egenvård hade varit av bristande kvalitet. Informanter upplevde svårigheter med att tillgodogöra sig informationen om egenvård. Kontinuerlig och upprepad information upplevdes som positivt. Personalens tillgänglighet samt möjlighet att ta sig tid värderades högt. Majoriteten av de intervjuade saknade ingen information om egenvård men däremot en förklaring av vad själva begreppet egenvård betyder. Slutsats: På hematologkliniken används inte begreppet egenvård när information om egenvård ges till patienter. Därmed finns det ett behov av att definiera och tydliggöra vad begreppet egenvård innebär. Patienter värderar personalens tillgänglighet samt förmåga att ge individanpassad och upprepad information högt, eftersom det ökar förmågan att tillgodogöra sig informationen om egenvård., Aim: The aim was to describe how patients perceive the concept of self-care and their perceptions concerning self-care information. Method: Empirical study of qualitative design. Eight patients undergoing stem cell transplantation was strategically selected. Semi-structured interviews were used. Results: Patients perceive that self-care is to take care of oneself in order to promote physical and mental health, without involvement of health care. Most patients felt that the need of self-care information had been content. Patients had difficulties in linking the concept of self-care with the information that had been given about self-care interventions. A few informants felt that the self-care information had been unsatisfactory. Informants experienced difficulties in assimilating the information. Continuous and repeated information was appreciated. The staff´s availability and willingness to take time for the patient were valued highly. The majority of the interviewees did not lack any self-care information but were in need of an explanation of what the concept of self-care means. Conclusion: The term self-care is not used when information about self-care is given. The concept of self-care needs to be defined. Staff availability and the ability to provide personalized and repeated information is appreciated, because it increases the ability to assimilate information about self-care.

Syfte: Syftet har varit att beskriva hur patienter uppfattar begreppet egenvård samt deras uppfattningar gällande information om egenvård. Metod: Empirisk studie med kvalitativ design. Strategiskt urval av åtta patienter som genomgått stamcellstransplantation. Datainsamling skedde genom semistrukturerade intervjuer. Resultat: Patienter uppfattar att egenvård är att ta hand om sig så att den egna fysiska samt psykiska hälsan främjas, utan inblandning av sjukvården. De flesta patienter uppfattade att informationen om egenvård hade varit tillfredsställande. Dock förekom svårigheter med att koppla ihop begreppet egenvård med den information som givits om egenvårdande åtgärder. Ett fåtal av informanterna ansåg att informationen om egenvård hade varit av bristande kvalitet. Informanter upplevde svårigheter med att tillgodogöra sig informationen om egenvård. Kontinuerlig och upprepad information upplevdes som positivt. Personalens tillgänglighet samt möjlighet att ta sig tid värderades högt. Majoriteten av de intervjuade saknade ingen information om egenvård men däremot en förklaring av vad själva begreppet egenvård betyder. Slutsats: På hematologkliniken används inte begreppet egenvård när information om egenvård ges till patienter. Därmed finns det ett behov av att definiera och tydliggöra vad begreppet egenvård innebär. Patienter värderar personalens tillgänglighet samt förmåga att ge individanpassad och upprepad information högt, eftersom det ökar förmågan att tillgodogöra sig informationen om egenvård., Aim: The aim was to describe how patients perceive the concept of self-care and their perceptions concerning self-care information. Method: Empirical study of qualitative design. Eight patients undergoing stem cell transplantation was strategically selected. Semi-structured interviews were used. Results: Patients perceive that self-care is to take care of oneself in order to promote physical and mental health, without involvement of health care. Most patients felt that the need of self-care information had been content. Patients had difficulties in linking the concept of self-care with the information that had been given about self-care interventions. A few informants felt that the self-care information had been unsatisfactory. Informants experienced difficulties in assimilating the information. Continuous and repeated information was appreciated. The staff´s availability and willingness to take time for the patient were valued highly. The majority of the interviewees did not lack any self-care information but were in need of an explanation of what the concept of self-care means. Conclusion: The term self-care is not used when information about self-care is given. The concept of self-care needs to be defined. Staff availability and the ability to provide personalized and repeated information is appreciated, because it increases the ability to assimilate information about self-care.