: One of the most feared complications of childhood cancer treatment is second malignant neoplasms (SMNs). This study evaluates the incidence, risk factors and outcomes of SMNs in a tertiary paediatric oncology centre in Singapore.: A retrospective review was conducted on patients diagnosed with childhood cancer under age 21 and treated at the National University Hospital, Singapore, from January 1990 to 15 April 2012. Case records of patients with SMNs were reviewed.: We identified 1124 cases of childhood cancers with a median follow-up of 3.49 (0 to 24.06) years. The most common primary malignancies were leukaemia (47.1%), central nervous system tumours (11.7%) and lymphoma (9.8%). Fifteen cases developed SMNs, most commonly acute myeloid leukaemia/myelodysplastic syndrome (n = 7). Median interval between the first and second malignancy was 3.41 (0.24 to 18.30) years. Overall 20-year cumulative incidence of SMNs was 5.3% (95% CI, 0.2% to 10.4%). The 15-year cumulative incidence of SMNs following acute lymphoblastic leukaemia was 4.4% (95% CI, 0% to 8.9%), significantly lower than the risk after osteosarcoma of 14.2% (95% CI, 0.7% to 27.7%) within 5 years (<0.0005). Overall 5-year survival for SMNs was lower than that of primary malignancies.: This study identified factors explaining the epidemiology of SMNs described, and found topoisomerase II inhibitor use to be a likely risk factor in our cohort. Modifications have already been made to our existing therapeutic protocols in osteosarcoma treatment. We also recognised the importance of other risk management strategies, including regular long-term surveillance and early intervention for detected SMNs, to improve outcomes of high risk patients.
Bone Neoplasms ; therapy ; Cancer Care Facilities ; Central Nervous System Neoplasms ; therapy ; Follow-Up Studies ; Humans ; Incidence ; Leukemia ; therapy ; Leukemia, Myeloid, Acute ; epidemiology ; Lymphoma ; therapy ; Myelodysplastic Syndromes ; epidemiology ; Neoplasms ; therapy ; Neoplasms, Second Primary ; epidemiology ; Osteosarcoma ; therapy ; Pediatrics ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Survivors ; statistics & numerical data ; Tertiary Care Centers ; Time Factors ; Topoisomerase II Inhibitors ; therapeutic use

Objective To explore the barriers in the clinical use of evidence-based urethral catheter cleaning. MethodsThe interview outline was developed based on the Theoretical Domains Framework (TDF) from September to October 2018. Totally 19 nurses working in the Department of Urinary Surgery at Peking University First Hospital was selected for semi-structural interview by convenient sampling, and content analysis was conducted based on the results. ResultsA total of 4 barriers related to 4 domains under the TDF were found in this study, namely, social / professional roles and identities, confidence in results, environmental factors and resources, and social impact. The subjects were extracted on this basis, which were lack of knowledge conversion process and norms in the department, poor self-management ability in the patients, and insufficient catheter cleaning resources. ConclusionsThe clinical use of evidence-based urethral catheter cleaning is affected by multiple factors, including systems, patients and resource availability. Departments need to explore and develop the norms for knowledge transformation, improve the self-management ability of postoperative patients, provide sufficient resources for catheter cleaning, and promote the clinical use of evidence-based urethral catheter cleaning.

Objective:To find out the obstacle factors in its clinical application according to the clinical situation of the application of urinary catheter fixation device.Methods:From September 2018 to October 2018, 19 nurses working in the urology ward of Peking University First Hospital were selected for a semi-structured interview. Based on the theoretical domain framework, the interview outline was formulated and the content was analyzed, and the topic was extracted again.Results:This study identified obstacle factors related to 5 areas of the theoretical domain framework, namely "knowledge, social or professional role and identity, motivation and goals, environmental factors and social influence". The themes were extracted again, respectively: "the system level of evidence implementation (organizational factors, training, product categories) needs to be optimized, the level of willingness of users (patients) for evidence implementation needs to be improved and the sustainability of evidence application needs to be strengthened".Conclusions:The factors that affect the clinical application of urinary catheter fixation devices are multiple, and future research needs to formulate targeted intervention plans based on evidence according to obstacles identified.