Progressive, malignant disease of the blood-forming tissue in the bone marrow, usually characterised by the production of abnormal white blood cells, which may be present in the bone marrow and blood.

Detrimental change in health, or side effect, occurring in a patient receiving the treatment.

Detrimental change in health that occurs in a patient; in this guideline a patient with an episode of suspected or proven neutropenic sepsis.

No fever, normal body temperature.

Main protein of plasma - protein that is water soluble.

Care that can provided on an outpatient basis

A group of antibiotics that are effective against certain types of bacteria, but which need careful monitoring of the levels in the body to reduce the chance of side effects, particularly kidney damage and hearing impairment. For example gentamicin and tobramicin.

Treatment which is given with the intent to reduce the level of cancer cells in a patient. This includes, but is not limited to, chemotherapy and radiotherapy.

Treatment of infectious disease using agents that either kill microbes or otherwise interfere with microbial growth.

Resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive.

Having achieved recognised professional competence in dealing with a specific area of clinical practice.

Occurs when harmful bacteria enters the body and multiply, causing unpleasant symptoms and/or an adverse event.

Beta-Lactams are a broad class of antibiotics that work by inhibiting cell wall synthesis by the bacterial organism and are the most widely used group of antibiotics. They include penicillin derivatives (penams), cephalosporins (cephems), monobactams, and carbapenems.

Laboratory tests performed upon a blood sample to indicate how well the kidneys and liver are working.

Blood obtained to be analaysed for the growth of a microbiological culture.

A blood test that is performed to show the level of acid, oxygen and carbon dioxide in the blood.

An antibiotic that is effective against a wide range of infectious bacteria, both Gram-positive and Gram-negative

Someone who provides support to the patient who could not manage without this help.

Central venous access devices are small, flexible tubes placed in large veins of patients who are likely to require frequent blood tests or venous access for treatment. They may be fully implanted under the skin or emerge from a tunnel through the skin.

A class of beta lactam antibiotics (See Beta Lactam Antibiotic)

Drug(s) that kill cells dividing faster than normal. These drugs are usually used in the treatment of cancer.

A photographic or digital image of the chest produced by the use of ionising radiation.

The extent to which an intervention produces an overall health benefit in routine clinical practice.

This term is sometimes used in guideline development work to refer to the questions about treatment and care that are formulated in order to guide the search for research evidence. When a clinical question is formulated in a precise way, it is called a focused question.

A group of people that are studied for health reasons.

An infection which has been diagnosed by the use of careful observation and physical examination of a patient.

An outcome or event which has a direct relevance to a patient's health status, or which is important in modifying which treatment is received or how it is delivered.

A type of bacteria that lives within the gut which can produce toxins (poisons), which cause illness such as diarrhoea and fever.

The simultaneous use of more than one drug.

Adverse clinical outcomes after an event, treatment or procedure.

A type of economic evaluation where both costs and benefits of healthcare treatment are measured in the same monetary units. If benefits exceed costs, the evaluation would recommend providing the treatment.

A type of economic evaluation comparing the costs and the effects on health of different treatments. Health effects are measured in health-related units, for example the cost of preventing one additional heart attack.

Value for money. A specific healthcare treatment is said to be cost effective if it gives a greater health gain than could be achieved by using the resources in other ways.

An explicit mathematical framework, which is used to represent clinical decision problems and incorporate evidence from a variety of sources in order to estimate the costs and health outcomes.

A protein that is produced by the liver and found in the blood. May be raised by a variety of problems, including infection.

Facilities within a hospital to look after patients whose conditions are life-threatening and need constant close monitoring and support from equipment and medication to keep normal body functions.

The process of identifying or determining the cause of a disease. The decision reached at the conclusion of such a process.

To become worse.

A technical procedure where a plastic strip with pre-formed chemical reagents is placed in urine, removed, and the results of the various tests examined.

An infection which has been diagnosed by clinical examination, or by the detection of pathogenic organisms.

An intervention is said to be dominated if there is an alternative intervention that is both less costly and more effective.

A phrase used to describe the duration between the arrival of a patient in a healthcare facility and the delivery of a particular intervention (which may not necessarily be delivered by a needle).

The total amount of chemotherapy delivered per time unit.

The simultaneous use of two drugs in treating one condition.

A Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine and can cause severe illness, including death.

A hospital facility which provides immediate diagnosis and management of severe, life or limb threatening health problems.

An action undertaken prior to determination of the underlying cause of a problem.

Treatment undertaken prior to determination of the underlying cause of a problem.

An empiric antibiotic is given to a person before a specific microorganism or source of the potential infection is known. It is usually a broad-spectrum antibiotic and the treatment may change if the microorganism or source is confirmed.

An inflammation of the inside lining of the heart chambers and heart valves.

The outer layer of the skin.

A standardised instrument used to measure a health outcome. It provides a single index value for health status.

A table summarising the results of a collection of studies which, taken together, represent the evidence supporting a particular recommendation or series of recommendations in a guideline.

In data analysis, predicting the value of a parameter outside the range of observed values.

A result that appears negative but should have been positive, i.e. a test failure

A result that appears positive but should have been negative, i.e. a test failure.

The development of fever, often with other signs of infection, in a patient with neutropenia.

A raise in body temperature above normal range.

A class of antimicrobial medicines used to treat infections caused by many bacteria.

A class of antibiotic that inhibits cell wall synthesis. Examples include vancomycin and teicoplanin.

The GRADE approach is a method of grading the quality of evidence and strength of recommendations in healthcare guidelines. It is developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group (www.gradeworkinggroup.org).”

A primary method of characterising organisms in microbiology.

A primary method of characterising organisms in microbiology.

A type of protein that stimulates the bone marrow to make white blood cells (granulocytes).

A type of protein that stimulates the bone marrow to make white blood cells (granulocytes and monocytes).

A protein molecule to regulate cell division & cell survival. Often used in this context to refer to G-CSF and GM-CSF.

An individual who provides health services within a nationally accredited framework of training and regulation.

A branch of economics which studies decisions about the use and distribution of healthcare resources.

A term used to describe the amount of difference of results or effects.

A term used to describe the amount of similarity of results or effects.

Infections that are not present and without evidence of incubation at the time of admission to a hospital.

The body's ability to fight infections is reduced due to a weakened immune system.

The analysis of additional costs and additional clinical outcomes with different interventions.

The mean cost per patient associated with an intervention minus the mean cost per patient associated with a comparator intervention.

The difference in the mean costs in the population of interest divided by the differences in the mean outcomes in the population of interest for one treatment compared with another.

The value (usually in monetary terms) of an intervention net of its cost compared with a comparator intervention. The INB can be calculated for a given cost-effectiveness (willingness to pay) threshold. If the threshold is £20,000 per QALY gained then the INB is calculated as: (£20,000 × QALYs gained) – Incremental cost.

The growth of a parasitic organism within the body.

Proteins or other molecules which are raised by inflammatory processes in the body and can be measured, usually by blood tests.

The care of patients whose condition requires admission to a hospital.

Infusion or injection into a vein.

A device-related infection seen in central venous access devices, related to the inside of the tube of the device.

A naturally produced acid which rises when energy expenditure outstrips oxygen supply, as can happen in severe sepsis.

An infection which may cause death.

Antibiotic used for the treatment of serious infections caused by Gram-positive bacteria.

A series of biochemical tests performed on a blood sample to indicate how well a patient's liver is working.

Knowledge of the antibiotic resistance patterns in the community in and around a health care setting which demonstrate which antibiotics should not be used empirically.

Knowledge of microbiological enviroment in the community in and around a health care setting which demonstrate which antibiotics should be used empirically.

To be safe or without problems.

To have a very low chance of problems occurring.

This test measures the amount of lymphocytes in blood. Lymphocytes are a type of white blood cell.

A method for estimating long-term costs and effects for recurrent or chronic conditions, based on health states and the probability of transition between them within a given time period (cycle).

A scoring system used to determine risk of serious complications.

A method of summarising previous research by reviewing and combining the results of a number of different clinical studies.

The effects that microorganisms have on other living organisms.

A type of meta-analysis which allows simultaneous comparisons of greater than two treatment options.

This test measures the amount of monocytes in blood. Monocytes are a type of white blood cell.

The use of a single drug for treatment.

A diseased condition or state.

Death.

A microbe which is resistant to a number of different classes of antibiotic.

Treatment that causes bone marrow suppression.

The poisonous effect of medication, on the kidneys.

An abnormally low number of neutrophils, the most important type of white blood cell to fight off bacterial infections.

An abnormal decrease in the number of neutrophils in the blood together with infection.

A type of white blood cell, important in fighting off particularly bacterial infections.

This test measures the number of neutrophils in blood. Neutrophils are a type of white blood cell.

A measure of treatment effectiveness. The odds of an event happening in the intervention group, divided by the odds of it happening in the control group. The ‘odds’ is the ratio of non-events to events.

Each parameter is varied individually in order to isolate the consequences of each parameter on the results of the study.

A doctor who specialises in managing cancer.

A team of healthcare professionals who specialise in looking after patients with malignant disease.

The loss of other health care programmes displaced by investment in or introduction of another intervention. This may be best measured by the health benefits that could have been achieved had the money been spent on the next best alternative healthcare intervention.

The best possible, most desirable period of time.

Antibiotics taken by mouth.

An individual form of life; such as bacterium in the context of this guideline.

An end result; a consequence.

The care of patients whose condition does not require admission to a hospital.

Time lived after a diagnosis of cancer. Often quoted as a percentage chance of living a number of years (e.g. 5 or 10).

Excessive treatment.

Blood obtained from a peripheral venous site to be analaysed for the growth of a microbiological culture.

A device-related infection seen in central venous access devices, related to the access port in a fully implanted device

Health care delivered to patients outside hospitals. Primary care covers a range of services provided by GPs, nurses and other healthcare professionals, dentists, pharmacists and opticians.

A preventative intervention administered in all cycles of chemotherapy.

Initial treatment used.

Probability distributions are assigned to the uncertain parameters and are incorporated into evaluation models based on decision analytical techniques.

A study that examines selected predictive variables, or risk factors, and assesses their influence on the outcome of a disease.

Treatment used to protect a person from a disease.

Prevention of a disease or complication

A study that looks at a new diagnostic method to see if it is as good as the current ‘gold standard’ method of diagnosing a disease.

A study in which people are entered into research and then followed up over a period of time with future events recorded as they happen.

Also known as reporting bias. A bias caused by only a subset of all the relevant data being available. The publication of research can depend on the nature and direction of the study results. Studies in which an intervention is not found to be effective are sometimes not published. Because of this, systematic reviews that fail to include unpublished studies may overestimate the true effect of an intervention. In addition, a published report might present a biased set of results (e.g. only outcomes or sub-groups where a statistically significant difference was found.

A study used to explore and understand peoples' beliefs, experiences, attitudes, behaviour and interactions.

A measure of health outcome which looks at both length of life and quality of life. QALYS are calculated by estimating the years of life remaining for a patient following a particular care pathway and weighting each year with a quality of life score (on a 0 to 1 scale). One QALY is equal to 1 year of life in perfect health, or 2 years at 50% health, and so on.

An overall appraisal of well being.

A treatment for cancer that uses high energy ionising radiation to kill cells.

A clinical trial in which subjects are randomised to different groups for the purpose of studying the effect of a new intervention, for example a drug or other therapy.

The ratio of risk in the intervention group to the risk in the control group. The risk (proportion, probability or rate) is the ratio of people with an event in a group to the total in the group. A relative risk (RR) of 1 indicates no difference between comparison groups. For undesirable outcomes, an RR that is less than 1 indicates that the intervention was effective in reducing the risk of that outcome.

Data that deals with the present/past and does not involve studying future events.

The chance of an adverse outcome happening.

A tool, usually a score from pieces of information given by patients, blood tests and examination finding, which is used to assess a patient's risk of a particular outcome. In this setting, it refers to a tool used to assess the risk of serious complications of infection. For example MASCC.

Services provided by the hospital, as opposed to the General Practitioner and the primary care team.

Prophylaxis are administered in all remaining cycles of chemotherapy after one episode of neutropenic sepsis.

The proportion of individuals who have disease correctly identified by the study test.

A means of representing uncertainty in the results of economic evaluations. Uncertainty may arise from missing data, imprecise estimates or methodological controversy. Sensitivity analysis also allows for exploring the generalisability of results to other settings. The analysis is repeated using different assumptions to examine the effect on the results.

Different structures of economic model are used to test the impact of model structure on the results of the study.

The body's response to an infection.

Septic shock is a medical emergency caused by decreased tissue perfusion and oxygen delivery as a result of severe infection and sepsis.

A life-threatening form of sepsis.

Death within a short period of time, for instance 30 days from onset of fever.

Physical changes noted in patients by healthcare providers or patients themselves.

Cancer of body tissues other than blood, bone marrow, or lymphatic system.

A healthcare facility which has been designated by an approved national process for the treatment of patients (in the present context) with cancer, leukaemia or lymphoma.

Advice given from a healthcare professional with appropriate training in the treatment of cancer, leukaemia or lymphoma.

The proportion of individuals who do not have a disease and who are correctly identified by the study test.

A group of bacteria that can cause a number of diseases as a result of infection of various tissues of the body.

A procedure that replaces the cells in a patient which make blood. (Accurately described as a haemopoietic stem cell transplant).

Decrease or reduction in treatment or medication.

An infection following a previous infection, especially when caused by microorganisms that have become resistant to the antibiotics used earlier.

The feelings and problems experienced by a patient relating to their illness.

A review of the literature done to answer a defined question often using quantitative methods to summarise the results.

Antibiotic used for the treatment of serious infections caused by some Gram-positive bacteria.

A major healthcare/medical centre providing complex treatments which receives referrals from both primary and secondary care. Sometimes called a tertiary referral centre.

The time span over which costs and health outcomes are considered in a decision analysis or economic evaluation.

Diagnosis based on the microscopic examination of biopsies from tissues in the body.

Undesirable and harmful side effects of a drug or other treatment.

Unsuccessful results or consequences of treatments used in combating disease.

A plan of treatment.

When testing for a condition or disease, this result confirms the absence of the condition in an individual who genuinely does not have the condition in question. (Contrast with false negative (see above) where the test may incorrectly indicate that the individual is free from the condition being investigated. The condition is present but not detected by the test).

When testing for a condition or disease, this result confirms the presence of the condition in question in individuals who have it. (Compare with false positive where the test may incorrectly indicate that the individual has a condition, but in fact they do not).

A device-related infection seen in central venous access devices, related to the tube as it passes beneath the skin.

The examination of urine, often by microscope or dip-stick.

A measure of the strength of an individual's preference for a specific health state in relation to alternative health states. The utility scale assigns numerical values on a scale from 0 (death) to 1 (optimal or ‘perfect’ health). Health states can be considered worse than death and thus have a negative value.

Antibiotic used for the treatment of serious infections caused by Gram-positive bacteria.

Types of chemotherapy which can cause local tissue damage if they escape from the vein.