Change of hand sensation and function in patients with malignant lymphoma during early-stage vincristine chemotherapy: A single-center observational study.

This study aimed to investigate changes in hand sensation (finger tactile threshold and two-point discrimination) and function in patients with malignant lymphoma, particularly during the early stages of chemotherapy with vincristine. Eighteen patients with malignant lymphoma were enrolled in this study. Data on the Common Terminology Criteria for Adverse Events Version 4.0, the visual analog scale for hand numbness, the Semmes Weinstein monofilament test, static and moving two-point discrimination (2PD), grip strength, pinch strength, and the Purdue Pegboard test were collected at 3 time points: before the start of chemotherapy (T0), after the first cycle of chemotherapy (T1), and after the second cycle of chemotherapy (T2). No significant changes were observed in Semmes Weinstein monofilament test at T0, T1, or T2 in either hand. However, the static 2PD was significantly worse for the right ring, little, and left middle fingers, whereas the moving 2PD was significantly worse for the right ring, left index, middle, and ring fingers. Furthermore, the visual analog scale scores for hand numbness and left-hand grip strength worsened significantly. Right-hand grip strength, pinch strength of both hands, and Purdue Pegboard test showed no significant deterioration. Chemotherapy with vincristine may affect hand sensation and function in patients with malignant lymphoma by exacerbating finger 2PD and hand numbness. Additionally, during the early stages of vincristine chemotherapy, it is important to monitor for a decrease in grip strength specifically in the left hand.

[The Incidence and Management of Hypersensitivity and Infusion Reactions in an Outpatient Chemotherapy Center].

Hypersensitivity reactions(HSRs)are adverse events that are potentially caused by all anticancer agents. HSRs are unpredictable and can occur at any time, and prompt intervention is needed when symptoms occur. The types of symptoms and their degrees vary with the anticancer agent used and the number of chemotherapy cycles. Here, we evaluated the degree of HSRs and their frequencies in the outpatient chemotherapy center of Gunma University Hospital. Among 55,046 patients, 141 (0.26%)cases of HSRs and 70(0.13%)cases of infusion reactions were identified. Oxaliplatin and docetaxel conferred higher incidences of HRSs, whereas infliximab and rituximab conferred higher incidences of infusion reactions. The most common symptoms were skin reactions. HSRs to oxaliplatin were observed after a median of 7 cycles of chemotherapy, and the number of the patients developing HSRs was the highest during the second cycle of chemotherapy. The incidences of HSRs and the profiles of the anticancer drugs exhibiting higher frequencies of HSRs were similar to those in previous reports. The present study provides valuable information about appropriate management for HSRs depending on the anticancer agents used.

Trends in birth choices after caesarean section in Japan: A national survey examining information and access to vaginal birth after caesarean.

OBJECTIVES: in the context of a rising caesarean section (CS) rate in Japan, the objectives of this study were; to investigate the national situation for women's birth options after primary CS; to explore characteristics of institutions accepting planned vaginal birth after caesarean (VBAC); to identify the timing and type of information given to women about their birth options by health professionals. DESIGN: a national census study using a self-administered postal survey of nursing managers within obstetric departments in Japanese hospitals and clinics was conducted. Data were analyzed to explore characteristics of institutions accepting or not accepting VBAC and information given to women about planned VBAC and planned repeat CS. SETTING: institutions included hospitals and clinics providing childbirth services throughout Japan. PARTICIPANTS: nursing managers from hospitals (n=303) and clinics (n=196) completed surveys about their institutional policies and practices around birth after CS. FINDINGS: only 154 (30.9%) of 499 institutions examined, accepted planned vaginal birth as an option for birth after CS. The success rate of VBAC was 77.0% in these institutions. Availability of transport services for institutional transfer and existence of a Maternal Fetal Intensive Care Unit (MFICU) were significantly associated with acceptance of VBAC (OR=5.39, p<0.001; OR=2.96, p=0.04). Information about options for birth method was mostly provided in the form of consent documents, and doctors were the sole provider of information about method of childbirth in 55.7% of institutions. Nursing managers described challenges in caring for women who strongly desire VBAC when women did not have access to information or if institutional policies conflicted with women's wishes. They recommended evidence-based information for women regarding birth choices after CS and recognised the necessity of emotional support for women faced with decision dilemmas. KEY CONCLUSIONS: institutional policies and practices for birth after CS vary widely in Japan, with evidence of limited opportunities for women to make informed choices about planned VBAC. It was difficult for nurse managers to support women to choose VBAC when institutional policy conflicted with this choice and when women did not have consistent or balanced information. IMPLICATIONS FOR PRACTICE: strategies are needed to support women as well as pregnancy care providers to support women to consider VBAC as a possible birth option after CS and to expand the use of shared decision making in pregnancy care settings in Japan.