Comparison of predictive models in postoperative nausea and vomiting in patients undergoing breast cancer surgery.

BACKGROUND: Post-operative nausea and vomiting remain an unresolved concern in Türkiye and some parts of the world, impacting the quality of the patient's recovery process and diminishing overall satisfaction. OBJECTIVE: This study was conducted as a descriptive investigation to compare the incidence of nausea and vomiting following breast cancer surgery with the nausea and vomiting risk scores proposed by Apfel and Koivuranta. METHODS: This study was conducted with 100 patients admitted to the General Surgery service of a university hospital between 31 August 2019 and 31 May 2021 for breast cancer surgery. The patient information form developed by the researchers, Apfel Nausea and Vomiting Risk Score, and Koivuranta Nausea and Vomiting Risk Score were used as data collection tools. RESULTS: It was identified that 61% of the patients experienced nausea and vomiting within the initial 24 h following surgery. A significant correlation was found between age, post-operative opioid use, motion sickness or history of PONV, and nausea and vomiting (p < 0,05). The sensitivity of the Apfel score obtained was 80%, the specificity was 46%, and the AUC value was 0.686. The sensitivity of the Koivuranta score was 80%, the specificity was 35%, and the AUC value was 0.675 (p < 0.05). CONCLUSION: It has been observed that patients experience high rates of nausea and vomiting after breast cancer surgery and that the Apfel and Koivuranta Risk Scores are equally applicable in predicting post-operative nausea and vomiting.

Comparison of Propofol and Sevoflurane Anaesthesia in Terms of Postoperative Nausea-Vomiting Complication in Cardiac Surgery Patients Undergoing Enhanced Recovery After Surgery Protocol: A Prospective Randomized Study.

Objective: Postoperative nausea (PN) and vomiting (PONV) in cardiac surgery increases adrenergic stimulation, limits mobilization and oral intake, and can be distressing for patients. The primary aim of our study was to investigate the effect of sevoflurane and propofol anaesthesia on the incidence of PONV in cardiac surgery patients undergoing Enhanced Recovery After Surgery (ERAS) protocol. Methods: Following ethics committee approval, 62 patients undergoing elective coronary artery bypass surgery with ERAS protocol were included in this prospective randomized study. After standard induction of anaesthesia, Group S received 1.5-2% sevoflurane and Group P received 50-100 µg kg-1 min-1 propofol infusion as maintenance anaesthetic agent with a bispectral index of 40-50. The incidence of PN and PONV between 0-6 hours (early) and 6-24 hours (late) after extubation was compared as the primary outcome. The incidence of delirium was analyzed as a secondary outcome for similar periods. Results: In the propofol group, 3 patients were excluded due to postoperative tamponade revision and prolonged mechanical ventilation. PN in the early post-extubation period (29% vs. 7.1%, P=0.031) was significantly higher in Group S. The incidence of delirium was similar between the groups in both periods. Conclusion: Propofol may reduce the incidence of PN in the first 6 hours after extubation compared with sevoflurane. We believe that this period will be beneficial for gastrointestinal tolerance as it is the period when oral intake is initiated in patients. In conclusion, propofol maintenance in cardiac surgery patients may facilitate patient rehabilitation as part of the ERAS protocol.

Association of amisulpride and recovery room length of stay among patients with postoperative nausea and vomiting following outpatient surgery.

STUDY OBJECTIVE: Postoperative nausea and vomiting (PONV) is a common sequela of surgery in patients undergoing general anesthesia. Amisulpride has shown promise in its ability to treat PONV. The objective of this study was to determine if amisulpride is associated with significant changes in PACU efficiency within a fast-paced ambulatory surgery center. METHODS: This was a retrospective cohort study of 816 patients at a single ambulatory surgery center who experienced PONV between 2018 and 2023. The two cohorts analyzed were patients who did or did not have amisulpride among their anti-emetic regimens in the PACU during two distinct time periods (before and after amisulpride was introduced). The primary outcome of the study was PACU length of stay. Both unmatched analysis and a linear multivariable mixed-effects model fit by restricted maximum likelihood (random effect being surgical procedure) were used to analyze the association between amisulpride and PACU length of stay. We performed segmented regression to account for cohorts occurring during two time periods. RESULTS: Unmatched univariate analysis revealed no significant difference in PACU length of stay (minutes) between the amisulpride and no amisulpride cohorts (115 min vs 119 min, respectively; P = 0.07). However, when addressing confounders by means of the mixed-effects multivariable segmented regression, the amisulpride cohort was associated with a statistically significant reduction in PACU length of stay by 26.1 min (P < 0.001). CONCLUSIONS: This study demonstrated that amisulpride was associated with a significant decrease in PACU length of stay among patients with PONV in a single outpatient surgery center. The downstream cost-savings and operational efficiency gained from this drug's implementation may serve as a useful lens through which this drug's widespread implementation may further be rationalized.

Prevention and management of acute toxicities from conditioning regimens during hematopoietic stem cell transplantation.

Hematopoietic stem cell transplantation (HSCT) remains the only curative option for several hematological malignancies. Its use has continued to grow, with an estimated 23,500 transplants performed annually in the United States alone. The acute toxicities that occur from conditioning chemotherapy can impact the peri-transplant period and have substantial implications on patients' tolerability and outcomes, irrespective of the treatment of their disease. Chemotherapy-induced nausea vomiting (CINV), mucositis, transplant-associated thrombotic microangiopathy (TA-TMA), and sinusoidal obstruction syndrome, also known as a veno-occlusive disease (SOS/VOD) can all have significant implications for patients. These acute complications begin with the start of conditioning chemotherapy and add to potential toxicity for patients throughout the early post-transplant period, from Day +30 for CINV, mucositis, and SOS, and which can continue through at least Day +100 with the onset of TA-TMA. These toxicities must be prevented and managed appropriately. This review will summarize the literature surrounding them and guide their management.

Determination of Risk Factors for Nausea and Vomiting in Children After Appendectomy.

PURPOSE: This study aimed at investigating the risk factors for postoperative nausea and vomiting (PONV) in pediatric patients undergoing appendectomy. DESIGN: This is a prospective, descriptive, cross-sectional study. METHODS: The study involved 163 children aged 5 to 18 years who underwent appendectomy in the pediatric surgery clinic of a tertiary hospital between December 2022 and June 2023. The study data were collected through the patient information form, Baxter Retching Faces scale, and Wong-Baker Faces Pain Rating Scale, which included questions about the descriptive and clinical characteristics of the participants and was prepared by the researcher consistent with the literature. FINDINGS: A significant relationship was observed between the severity of postoperative pain and the occurrence of PONV in patients with both nonperforated and perforated appendicitis (P < .001). In addition, operative time and the time to the first oral feeding were shorter in patients with nonperforated appendicitis in the non-PONV group (P = .005 and P = .042, respectively) Logistic regression analysis revealed that postoperative pain, family history of PONV and appendix perforation were risk factors for PONV in children with both nonperforated and perforated appendicitis (P < .001, P = .040, and P < .001, respectively). CONCLUSIONS: In children undergoing appendectomy, family history of PONV, severity of postoperative pain, increased operative time, and increased transition time to oral feeding are risk factors for PONV. Pediatric nurses, who have an important role in the management of PONV, should evaluate patients in terms of PONV risk in the preoperative period within the scope of evidence-based practices and perform pharmacological or nonpharmacological interventions according to the degree of risk.

The Effects of Emotional Freedom Techniques Implemented During Early Pregnancy on Nausea-Vomiting Severity and Anxiety: A Randomized Controlled Trial.

Objective: This randomized controlled trial investigated the effect of emotional freedom techniques (EFT) on the severity of nausea-vomiting and anxiety in early pregnancy. Design: The sample consisted of 131 pregnant women in the experimental and control groups between 6 and 16 weeks of pregnancy attending an antenatal clinic. Participants were randomly assigned to receive training on EFT or a control group. Data were collected using a personal information form, subjective experiences, the Pregnancy-Related Anxiety Questionnaire, and the Pregnancy-Unique Quantification of Emesis. Both groups attended two visits, a week apart. The participants in the EFT group received a session of EFT at each visit and completed two EFT sessions as home assignments, 2 and 4 days after the first visit. The participants in the control group attended two visits a week apart and completed assessments but did not receive EFT. Results: There were 55 women in each group who completed the study, and the groups were similar in terms of baseline measures, including socioeconomic status, smoking status, previous pregnancy, severity of nausea-vomiting, and total pregnancy-related anxiety. EFT significantly reduced anxiety levels from the baseline to the second session (fear of delivery, worries about bearing a handicapped child, concern about one's own appearance) and total pregnancy-related anxiety (total pretest 29.85 ± 9.87, post-test 20.67 ± 8.38; p < 0.001), while the control group showed no reduction in pregnancy-related anxiety (total pretest 26.1 ± 7.79, post-test 25.98 ± 8.49; p = 0.933). Although nausea-vomiting was reduced in both groups over the two-session period, at the end of treatment, the EFT group had significantly lower nausea intensity (EFT group 4.4 ± 1.81, control group 5.36 ± 2.48; p = 0.02). Conclusions: EFT is a nonpharmacologic intervention that can be effective in reducing nausea, vomiting, and anxiety in early pregnancy. Clinical Trials Registration Number: NCT05337852.

A Randomized Clinical Study to Compare the Perioperative Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block Over Thoracic Epidural in Modified Radical Mastectomy.

Aim This study aims to compare the effectiveness of ultrasound-guided erector spinae block (ESB) with thoracic epidural (TE) in managing postoperative pain among breast cancer (BC) surgery patients. Methods A total of 42 patients were enrolled and randomly divided into two groups, each comprising 21 participants. Primary endpoints assessed included intraoperative fentanyl consumption, postoperative pain scores, and the need for rescue analgesia. Secondary endpoints encompassed intraoperative hemodynamic changes and the incidence of postoperative nausea and vomiting (PONV). Results The study found no significant difference in intraoperative fentanyl requirement (p=0.62) or postoperative pain scores measured using numerical rating scores (NRS) throughout the 48-hour postoperative period. None of the patients in either group required rescue analgesia. Notably, there was a statistically significant difference in postoperative nausea and vomiting at the two-hour mark, favoring the erector spinae block. Both groups exhibited comparable hemodynamic changes during intraoperative monitoring. Conclusions Our investigation concludes that the ESF offers equivalent analgesic efficacy to the thoracic epidural during both surgery and the postoperative period without inducing any significant hemodynamic instability. Considering the lower complication rate associated with paraspinal blocks compared to neuraxial blocks, the ESB presents itself as a promising alternative method for effective pain relief in mastectomy procedures.

Effects of foot-massage in pregnant women with hyperemesis gravidarum on severity of nausea-vomiting and anxiety.

OBJECTIVE: This study was conducted to determine the effects of foot massage performed on pregnant women with hyperemesis gravidarum on the severity of nausea and vomiting and pregnancy-related anxiety. MATERIAL AND METHOD: This randomised controlled study was conducted between February and November 2020 with 104 pregnant women hospitalised in the pregnant women follow-up service ward of a public hospital in eastern Turkey with the diagnosis of hyperemesis gravidarum. Data were obtained from the pregnant women who were given a 'Personal Information Form' and before and after each application by using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) Test and the Pregnancy-Related Anxiety Scale-Revision 2 (PRAQ-R2). RESULTS: Before foot massage, the pre-test mean PUQE total, PRAQR-2 total, and PRAQR2 fear of childbirth and concerns about physical appearance dimension scores of the participants in the experimental and control groups were similar (p > 0.05), It was determined that the PRAQR2 fear of having a disabled child control group had significantly higher pre-test scores compared to the massage group (p < 0.05). After foot massage, the severity of nausea and vomiting was significantly lower in the participants in the experimental group compared to those in the control group (p < 0.001). Additionally, the mean PRAQR2 total and dimension scores of the participants in the experimental group were significantly lower than those in the control group (p < 0.05). CONCLUSION: These findings support the use of the foot massage is an effective intervention in reducing the severity of nausea and vomiting and pregnancy-related anxiety.

The Effectiveness of Ondansetron and Dexamethasone in Preventing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy.

Background The current research compared the effectiveness of dexamethasone with ondansetron in terms of the frequency of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Methodology A comparative cross-sectional study was conducted in the Department of Surgery, Civil Hospital, Karachi, Pakistan, between June 2021 and March 2022. All patients aged between 18 and 70 years who were scheduled for elective laparoscopic cholecystectomy under general anesthesia were included in the study. All women who were on antiemetics or cortisone before surgery pregnant, and had hepatic, or renal malfunction were excluded. Group A included patients who were administered 8 mg of dexamethasone intravenously, and group B included patients who were prescribed 4 mg of ondansetron intravenously. Observation of patients was done for any symptoms such as vomiting, nausea, or the need for any antiemetic medication after the surgery. The number of episodes of vomiting and nausea was recorded in the proforma along with the duration of stay in the hospital. Results A total of 259 patients were examined during the study - 129 (49.8%) in the dexamethasone group (group A) and 130 (50.2%) in the ondansetron group (group B). The mean age of group A was 42.56 ± 11.9 years, with a mean weight of 61.4 ± 8.5 kg. The mean age of group B was 41.19 ± 10.8 years, with a mean weight of 62.56 ± 6.3 kg. Upon assessing the effectiveness of each drug in preventing nausea and vomiting, postoperatively, it was found that both drugs were equally effective in preventing nausea in the majority of the patients (73.85% vs. 65.89%; P = 0.162). However, ondansetron was significantly more effective in preventing vomiting in patients than dexamethasone (91.54% vs. 79.07%; P = 0.004). Conclusions This study concluded that the use of either dexamethasone or ondansetron effectively reduces the incidence of postoperative nausea and vomiting. However, ondansetron was significantly more effective in reducing the incidence of vomiting in patients after laparoscopic cholecystectomy than dexamethasone.

Total diagnostic interval in children with brain tumours in a middle-income country: national experience from Serbia.

PURPOSE: The aim was to evaluate the total diagnostic interval (TDI) and presenting complaints in children with brain tumours in Serbia. METHODS: This study retrospectively analysed 212 children aged 0-18 years newly diagnosed with brain tumours in two tertiary centres from mid-March 2015 to mid-March 2020 covering virtually all children with brain tumours in Serbia. TDI was calculated as the difference between the date of diagnosis and the date of symptom onset presented as a median in weeks. This variable has been evaluable for 184 patients. RESULTS: Overall TDI was 6 weeks. TDI was significantly longer in patients with low-grade tumours (11 weeks) than in patients with high-grade tumours (4 weeks). Children with the most frequent complaints (headache, nausea/vomiting and gait disturbance) were more likely to be diagnosed sooner. Patients with a single complaint had significantly longer TDI (12.5 weeks) contrasted to patients with multiple complaints (5 weeks). CONCLUSION: TDI with a median of 6 weeks is similar to other developed countries. Our study supports the view that low-grade tumours will present later than high-grade tumours. Children with the commonest complaints and children with multiple complaints were more likely to be diagnosed sooner.

[Postoperative nausea and vomiting-recommendations for its prevention and therapy in paediatric medicine]. / Postoperative Übelkeit und Erbrechen ­ Handlungsempfehlungen zur Prävention und Therapie bei Kindern.

Post-operative nausea and/or vomiting (PONV/POV) are among the biggest problems occurring in the paediatric recovery room and in the course of the following post-operative period. Apart from pain and emergence delirium, PONV is one of the main causes of post-operative discomfort in children. The DGAI Scientific Working Group on Paediatric Anaesthesia already worked out recommendations for the prevention and treatment of PONV in children years ago. These recommendations have now been revised by a team of experts, the current literature has been reviewed, and evidence-based core recommendations have been consented. Key elements of the new recommendations consist of effective individual measures for prevention and therapy, next to the implementation of a fixed dual prophylaxis in the clinical routine applicable to all children ≥ 3 years of age.

Investigation of Postoperative Risks of Nausea and Vomiting in Patients With Breast Cancer.

PURPOSE: To examine the risks of postoperative nausea and vomiting (PONV) in breast cancer patients. DESIGN: Descriptive, cross-sectional study. METHODS: The study was conducted in the surgical oncology department of a tertiary hospital between June 2020 and December 2020. A total of 83 female patients who were scheduled for surgical treatment for breast cancer were included in the study. The patients were evaluated using the Patient Evaluation Form created by the researcher by scanning the literature, the VAS Pain Rating Scale, and the Apfel Risk Scoring System. FINDINGS: A significant relationship was found between age and PONV at the 2nd, 4th, 8th, 24th and 48th hours after surgery (respectively: P = .00, P = .00, P = .00, P = .00, P = .00). There was a significant correlation between the duration of surgery and PONV at 0 hour, PONV at first oral intake and PONV at 4 hours (respectively; P ˂ .01, P ˂ .01). The highest rate of PONV of all time (50.6%) at the 0th hour when the VAS scores of the patients was the highest. The PONV rate at the 48th hour was the lowest of all time periods (1.2%) (respectively; P ˂ .01, P ˂ .01). CONCLUSIONS: While women with breast cancer who have undergone mastectomy have the highest risk of postoperative and nausea vomiting in terms of age and pain severity, the duration of the operation and the first oral intake time also pose a risk. Nurses play a key role in the quality of care, patient safety, and patient satisfaction. It is recommended that institutions create evidence-based strategies and take necessary precautions in the preoperative evaluation of patients in terms of postoperative nausea and vomiting.

Effect of acupressure application on patients' nausea, vomiting, pain, and sleep quality after laparoscopic cholecystectomy: A randomized placebo-controlled study.

BACKGROUND AND OBJECTIVES: Nausea, vomiting, pain and insomnia in the postoperative period may cause discomfort, and this may adversely affect the patient's compliance with the treatment. This study was conducted to determine the effect of acupressure on nausea, vomiting, pain, and sleep quality after laparoscopic cholecystectomy. METHODS: This was a randomized controlled experimental study with a placebo group. The sample comprised 188 patients who underwent laparoscopic cholecystectomy (control:64;experimental:64;and placebo:60). Acupressure was performed on the experimental and placebo groups with a wristband for 24 hours. The data were collected at the 0th, 2nd, 6th, 12th, and 24th postoperative hours. Data were collected using the patient introduction form, numeric nausea scale, visual analog scale(VAS), verbal category scale(VCS), and Richards-campbell sleep questionnaire(RCSQ). RESULT: The difference between the mean scores of nausea severity and the presence of nausea at the postoperative 0-2, 2-6, and 12-24 hours was statistically significant between the groups and the presence and the severity of nausea was lower in the experimental group (p<0.05). Although not statistically significant, less vomiting was observed in the experimental group patients compared to the control group patients at postoperative 0-2, 2-6, and 12-24 hours. There was no significant difference between the mean VAS and VCS scores of the groups at postoperative 2nd, 6th, and 24th hours (p >0.05). The mean RCSQ total scores of the patients in the experimental group were significantly higher (p<0.001). CONCLUSION: Acupressure applied to the PC6 point after laparoscopic cholecystectomy reduced postoperative nausea and vomiting and positively affected sleep quality.

Prevalence and risk factors of post-operative nausea and vomiting in a tertiary-care hospital: A cross-sectional observational study.

Background: Post-operative nausea and vomiting (PONV) is an unpleasant and one of the most distressing symptoms for any patient undergoing surgery. The anaesthetist is usually blamed, despite evidence that PONV results from a variety of factors including patient characteristics, anaesthetic techniques, and the type of surgery and post-operative care. This study had been conducted to find out the current prevalence and to assess various risk factors for PONV in the Indian population. Methods: All patients above 18 years undergoing non-cardiac surgery under anaesthesia were selected from the daily operation theatre list by a systematic random sampling method. Koivuranta score was used to predict PONV in first 24 h post-operatively. Results: Prevalence of PONV in the study population was found to be 25.6%. There was association detected between female gender, non-smokers and occurrence of PONV (CI 95%, p ≤ 0.001, 0.005, respectively). PONV was seen to be more common in patients with history of PONV in prior surgeries, in patients who underwent surgery under general anaesthesia and in patients where opioids were used in the post-operative period (95% CI, p ≤ 0.001, 0.001 and 0.001 respectively). General, laparoscopic, abdominal, orthopaedic, obstetric, breast and urological surgeries showed a significant association with occurrence of PONV (95% CI, p ≤ 0.05). Conclusion: Inspite of use of antiemetics (single or dual) being given as part of the institutional protocol, the incidence of PONV was still high. There is a need to update our knowledge regarding newer antiemetics and their inclusion in PONV management guidelines. There is need for further research to study various other possible risk factors which may contribute to occurrence of PONV.

Age as a potential predictor of acute side effects during chemoradiotherapy in primary cervical cancer patients.

BACKGROUND: Toxicity during chemoradiotherapy (CRT) in cervical cancer patients might limit the chances of receiving an optimal treatment and to be cured. Few studies have shown relationships between acute side effects and patient's age. Here, the association between age and acute side effects such as nausea/vomiting, diarrhea and weight loss during CRT was analysed in cervical cancer patients. METHODS: This study included 93 patients with primary cervical cancer stage IBI to IVA who received CRT from 2013 to 2019. The frequency of symptoms/toxicity grade was analysed by using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. RESULTS: Patients ≥ 52 years had a significantly higher frequency of nausea/vomiting and increased grade ≥ 3 toxicity during CRT compared to younger patients (p < 0.001, p = 0.001). Toxicity grade ≥ 3 of nausea/vomiting was associated with increased frequency of weight loss (p = 0.001), reduced ADL (p = 0.001) and dose modifications of both radiotherapy (RT) (p = 0.020) and chemotherapy (CT) (p = 0.030) compared to toxicity grade 2. The frequency of diarrhea (p = 0.015) and weight loss (p = 0.020) was higher in older patients compared to younger. CONCLUSIONS: Older patients have an increased risk of acute side effects as nausea/vomiting, diarrhea and weight loss. Age could be useful in predicting acute side effects in primary cervical cancer patients with CRT.

A scoping review of nausea, vomiting and retching measurement methods in children with cancer.

Evaluation of chemotherapy-induced nausea and vomiting (CINV) in the pediatric population is subject to diverse approaches. This scoping review summarizes the methods used in clinical studies that assessed nausea, vomiting or retching in children with cancer. We conducted a literature search of studies indexed in EMBASE and Ovid MEDLINE after 2000. Studies were included if they involved patients ≤18 years of age diagnosed with cancer, and had nausea, vomiting or retching as a primary study outcome. We excluded studies that reported only parent- or clinician-proxy measures without including the child's self-reported NVR, and those without specifying the NVR data collection process. The literature search identified twenty-four studies evaluating pediatric nausea, vomiting or retching. In the assessment of NVR, structured surveys were the most commonly used instrument for NVR assessment (75%) and the use of patient diaries (50%). Nine studies (38%) relied solely on self-reports from children as the outcome measure, while fifteen studies (62%) solicited input from parents/ caregivers and healthcare providers in addition to children's self-reports. Almost all the studies reported the frequency (n = 24) and/or severity (n = 23) of NVR symptoms and the use of antiemetic therapy (n = 19). Fewer studies evaluated distress caused by the symptoms (n = 2) and the effects of symptoms on activities of daily living (n = 4). Incorporating NVR measurement tools as part of standard of care for pediatric patients undergoing chemotherapy is strongly advocated. Based on the age group, we recommend the use of such tools comprising Likert scale, pictorial scales and structured scripts to assess various dimensions of a child's NVR experience.

Preparative Fasting Orders for Medical/Surgical Interventions and Imaging Studies: Time to Review and Revise!

PURPOSE OF THE REVIEW: Preparative fasting orders arose out of a purported need to enhance imaging studies, reduce interference of food with intended medical/surgical interventions, and protect the patient from vomiting and aspiration pneumonia. This review discusses the frequency, appropriateness, and efficacy of fasting orders in meeting those needs and whether their use should be modified in the future. RECENT FINDINGS: Nil per os (NPO) orders are overused, as they are often inappropriate, typically excessive, and routinely create barriers which may increase risk for patients. Fasting orders are used more often for medical procedures than for surgical operations or imaging studies. One fourth of NPO orders are inappropriate, and the intended procedure or study is canceled 20% of the time usually for a change in plans or scheduling error and rarely because of patient eating. Nausea/vomiting associated with contrast media or imaging studies is rare, self-limited, and not linked to preparatory fluid or food ingestion. Prolonged fasting reduces patient cooperation and satisfaction, and may contribute to a higher rate of complications. Each institution should review and revise preparative fasting orders. Drinking of fluids should be allowed without restriction. Truncated periods of solid food restriction may be required due to technical reasons related to specific imaging studies, and for procedures or surgical operations which require sedation or general anesthesia. Inappropriate and prolonged fasting should be avoided, as they create barriers to adequate nutritional therapy and impose added risk with regard to patient outcomes.

A retrospective study on chemotherapy-induced nausea and vomiting in highly/moderately emetogenic chemotherapy: incidence and prescribing practice.

BACKGROUND: Chemotherapy-induced nausea vomiting (CINV) is a common and significant problem in oncology patients and rated as one of cancer chemotherapy's most distressing side effects. The objectives of this study are to describe the incidence of CINV in highly and moderately emetogenic chemotherapy-treated patients and the prescribing pattern of CINV prophylaxis. METHODS: This retrospective, cross-sectional single-center study randomly collected data on demographics, CINV episodes, and prescribing patterns for adult oncology patients receiving intravenous highly or moderately emetogenic chemotherapy (HEC/MEC) between January and December 2019. RESULTS: A total of 419 randomly selected records of HEC/MEC recipients with 2388 total chemotherapy cycles were included. The mean age was 53.6 ± 12.6 years old. The majority was female (66%), Malay (54.4%), diagnosed with cancer stage IV (47.7%), and with no comorbidities (47%). All patients were prescribed with IV granisetron and dexamethasone before chemotherapy for acute prevention, whereas dexamethasone and metoclopramide were prescribed for delayed prevention. Aprepitant was not routinely prescribed for the prevention of CINV. CINV incidence was 57% in the studied population and 20% in the total cycle. This study found a significant association between CINV incidence with performance status and cisplatin-based chemotherapy (OR = 3.071, CI = 1.515-6.223, p = 0.002; OR = 4.587, CI = 1.739-12.099, p = 0.02, respectively). CONCLUSION: CINV incidence was rather high per patient but relatively low per cycle. Most patients were prescribed with dual regimen antiemetic prophylaxis. IMPACT: This study provides evidence that there was suboptimal use of recommended agents for CINV, and there is a clear need for further improvements in CINV management.

Efficacy of evidence-based institutional protocol for prevention of postoperative nausea and vomiting: A prospective observational study.

BACKGROUND: Postoperative nausea and vomiting (PONV) is the second most common complaint in the postoperative period, often resulting in increased post anaesthesia care unit (PACU) and hospital stay. Translation of knowledge into consistent practice was considered a major gap. Hence, the present study was undertaken to test the efficacy of locally developed evidence-based institutional protocol for prevention of PONV. METHODS: Phase I consisted of determining the baseline incidence of PONV before introduction of the institutional protocol for PONV prophylaxis. In phase II, educational sessions for anaesthesiologists for PONV prevention and treatment were conducted, after which an institutional protocol was introduced. In phase III, this protocol was implemented, and the incidence of PONV was recorded using the same methodology as in phase I. The rate of adherence to the institutional protocol was also recorded. RESULTS: The incidence of postoperative nausea (PON) dropped significantly from 32.5% in phase I to 20% in phase III (p = 0.033). Similarly, the incidence of postoperative vomiting (POV) decreased from 20.5% in phase I to 9.1% in phase III (p = 0.016). Of all anaesthesiologists, 78.18% were noted to adhere to the protocol in phase III. Incidence of PON and POV was significantly less in patients in whom PONV prophylaxis was administered in adherence to protocol (8.3% vs 57.7%, p < 0.001; 3.6% vs 26.9%, p < 0.001, respectively). CONCLUSION: Evidence-based institutional protocols are effective in significantly reducing the incidence of PONV in adults undergoing noncardiac surgery under anaesthesia. CLINICAL TRIAL NUMBER AND REGISTRY URL: The trial was registered with Clinical Trials Registry of India (http:/ctri.nic.in) (CTRI/2015/12/006432).

The effect of text message reminders on nausea, vomiting and quality of life in children with cancer receiving cisplatin.

PURPOSE: This study was conducted to examine the effect of text message reminders on nausea, vomiting, and quality of life in children with cancer receiving cisplatin. METHODS: The study was conducted with a pretest-posttest unpaired group model design. The study included 80 children with cancer and their parents (40 controls and 40 experiments) aged between 8 and 18 years, who were on cisplatin treatment, who did not have cognitive disability as a clinical diagnosis, who received chemotherapy during their stay in the clinic, who were literate in Turkish and who volunteered to participate in the study. The educational contents prepared by the researchers to reduce nausea and vomiting were sent to the parents in the experimental group in the form of a text message every day for three weeks. Descriptive statistics, correlation analysis, and regression analysis were used to evaluate the data. RESULTS: While NVTS, ARINVc, ARINVp, Quality of Life Scale pretest and posttest mean scores of both 8-12 and 13-18 age control group children were similar, it was determined that the experimental group's posttest mean scores were higher than the pretest mean scores, and there was a statistically significant difference between the experimental group's pretest and posttest mean scores in terms of the group, time and group*time. In this study, the education program explains 42%, 15%, 16%, 43%, and 43% of the increase in the mean scores of NVTS, ARINVc, ARINVp, Quality of Life Scale Child and Parent Form, respectively, in children aged 8-12. Also, the education program explains 10%, 27%, 28%, 38%, and 39% of the increase in the mean scores of NVTS, ARINVc, ARINVp, Quality of Life Scale Adolescent and Parent Form, respectively, in children aged 13-18. CONCLUSIONS: It has been observed that text message reminders effectively reduce the level of nausea and vomiting and increase the quality of life. PRACTICE IMPLICATIONS: The results of this study, text message reminders can be applied as an alternative intervention method, and including technology-based practices in the care of children with cancer is important in increasing the quality of care.