Nursing Alchemy: Transforming R-CHOP Information Into Essentials.

A combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is a first-line combination chemotherapy regimen for diffuse large B-cell lymphoma that has many nursing implications. Understand.

The Impact of an Embedded Oncology Pharmacist in an Outpatient Oncology Center in the Treatment of Hematologic Malignancies.

Background: The growing demand for clinicians in the ambulatory oncology setting to reduce fragmentation of care and improve patient outcomes represents a need for oncology pharmacists as advanced practitioners in the provision of direct patient-centered care. These provisions can include supportive care management, drug-drug interaction evaluation, and selection of appropriate chemotherapy regimens to reduce physician workload in a cost-effective manner, while increasing physician and patient satisfaction. However, robust data are currently lacking to support the impact of pharmacists in the ambulatory oncology setting. The primary objective of this study is to justify the benefit of a full-time clinical pharmacist in the ambulatory oncology setting through documenting pharmacist-driven clinical interventions, correspondence of those interventions with cost avoidance, and perceived benefit from provider and patient satisfaction surveys. Methods: In this observational single-center pilot study, pharmacist interventions were documented and quantified from March 4, 2019, to March 9, 2021. This study evaluated the impact of these interventions through correlating cost avoidance and overall patient and provider satisfaction surveys regarding oncology pharmacists embedded in the outpatient clinic. Results: During the study period, a total of 545 diverse interventions were made by pharmacists. The estimated cost avoidance during the study period was $363,760, resulting in a net benefit of $753,150 per year. Both provider (n = 5) and patient (n = 8) surveys indicated strong agreement to the benefits of an oncology pharmacist's involvement in clinic. Conclusion: This study demonstrates the clinical impact, financial benefit, and positive humanistic outcomes of an embedded oncology pharmacist within the ambulatory oncology setting.

Oral ulcers associated with mycophenolate mofetil use in a renal transplant recipient.

PURPOSE: A case study of mycophenolate mofetil-induced oral ulcers in a renal transplant patient is reported. SUMMARY: A 23-year-old Hispanic man who received a renal transplant from a living relative secondary to end-stage renal disease due to focal segmental glomerulosclerosis arrived at an outpatient clinic with gum swelling and pain. He had been on a maintenance immunosuppressive regimen consisting of cyclosporine 150 mg twice daily, mycophenolate mofetil 1 g twice daily, and prednisone 12.5 mg daily for approximately four months. Routine laboratory tests revealed an elevated serum creatinine concentration (2.2 mg/ dL) and a decreased white blood cell count (2.3 × 10(3)/µL). All other laboratory test values were within normal limits. Initially, cyclosporine-induced gingival hyperplasia was suspected. However, despite reduction of the cyclosporine dosage, the gum pain and swelling did not improve, and the patient began to complain of odynophagia and worsening of symptoms. On physical examination, scattered ulcerations on the gums and lips were noted. The diagnosis of oral ulcerations secondary to mycophenolate mofetil therapy was suspected when other etiologies, such as hematologic disorders, malignancies, and viral infections, were eliminated. Mycophenolate mofetil was discontinued. One week later, the patient's ulcers had regressed and odynophagia improved, as did his renal function and leukopenia. Mycophenolate mofetil was not restarted, and the patient reported complete resolution of symptoms six weeks after discontinuation of mycophenolate mofetil. CONCLUSION: After five months of therapy, a 23-year-old renal transplant recipient developed mycophenolate mofetil toxicity manifested as oral ulcers. Discontinuation of therapy resulted in rapid resolution of oral ulcers.