Current management of adults receiving oral anti-cancer medications: A scoping review.

PURPOSE: Oral anti-cancer medication (OAM) has revolutionised oncology care. Due to their potential toxicities and associated safety challenges ongoing assessment and monitoring is essential; currently generally performed in acute care settings. Internationally there exists a transformative vision to shift patient care from acute to primary care. A nurse-led integrated model of care could be developed for OAM patient management in primary care. The aim of this study was to examine international literature regarding current clinical management practices for assessment and monitoring of patients receiving OAM. METHODS: Following PRISMA-ScR guidelines, databases MEDLINE, CINAHL and Web of Science were searched for English studies published between 2010 and 2020 using keywords: assessment, cancer, care, management, oral anticancer medications. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate and make a narrative account of the findings. RESULTS: 2261 papers were reviewed, 14 met inclusion criteria. Three phases of management are reported: 1. Patient treatment plan development; 2. Patient education; 3. Patient monitoring. Within these phases seven specific stages of care were identified broadly representing the patient's journey: (1) treatment decision, (2) prescribing of OAM, (3) OAM dispensing and administration, (4) maximising patient safety (5) ongoing patient assessment (6) patient support (7) communication with other health-care professionals. CONCLUSIONS: Despite a paucity of international literature, a dedicated OAM clinic was endorsed as a means to achieve improved care. Nurses and pharmacists were identified as being of particular importance especially in education and ongoing management of patients receiving OAMs.

The incidence and risk factors associated with postoperative delirium in geriatric patients undergoing surgery for suspected gynecologic malignancies.

BACKGROUND: The incidence of postoperative delirium (PD) in the elderly ranges between 3-60% but has never been examined in gynecologic oncology. Our goal was to identify pre, intra, and postoperative risk factors associated with the development of PD. METHODS: English speaking women of 60 years and above undergoing major surgery for suspected gynecologic malignancies were invited to participate. Enrolled patients were administered a pre and postoperative Mini-Mental State Exam (MMSE), and the postoperative Confusion Assessment Method was used to diagnosis PD. Pre, intra, and postoperative clinicopathology parameters were collected. Statistics included the Pearson chi-squared tests and multivariate logistic regression. RESULTS: Eighteen of a total of 103 patients (17.5%) developed PD. Univariate analysis revealed significant associations (p<0.05) between the development of delirium and age, albumin level, Charlson comorbidity index, performance status, dementia, level of education, number of pre and postoperative medications, prolonged oxygen or Foley catheter usage (>2 d), increased narcotic use (above standard regimens), postoperative transfusion, bed restriction and change in MMSE scores (pre vs. post). Using multivariate logistic regression analysis, older patients (p=0.0002), on multiple medications (p=0.008), given additional narcotic doses (p<0.0001) were at highest risk for the development of delirium. Intraoperative parameters were not correlated with outcome. CONCLUSIONS: PD is a common complication in older women undergoing major gynecologic surgery. Increased narcotics, age, and preoperative medications were strongly associated with this adverse event. Prevention needs to focus on i) identifying patients at higher risk for PD based on preoperative parameters, and ii) eliminating known postoperative risk factors.

Carcinosarcoma of the ovary.

The objective of this study was to evaluate the treatment and outcome in patients with ovarian carcinosarcoma. The Tumor Board Registry was reviewed for patients with ovarian carcinosarcoma treated at our institution from June 1993 to December 2004. The medical records were retrospectively analyzed with emphasis on cytoreduction, cytotoxic regimens, progression-free interval, and survival. Twenty-two patients were identified. All but two presented with advanced stage disease. The median survival for the entire cohort was 38 months. Median survival was 46 months for 18 optimally debulked (<1 cm) patients and 27 months for four suboptimally debulked (>1 cm) patients. Six patients were treated with optimal cytoreduction and adjuvant cisplatin (40 mg/m(2)x 1 day) and ifosfamide (1200 mg/m(2)/day x 4 days) every 28 days. Median progression-free interval in the cisplatin and ifosfamide group was 13 months, and median survival was 51 months. The combination of carboplatin (AUC 5) and taxol (175 mg/m(2)) every 21 days was administered to four patients as first-line chemotherapy following optimal cytoreduction. In the carboplatin and taxol group, median progression-free interval was 6 months and median survival was 38 months. The difference in survival between the cisplatin and ifosfamide group and the carboplatin and taxol group was not statistically significant (P= 0.48). In conclusion, patients with ovarian carcinosarcoma usually present with advanced stage disease. Treatment consists of optimal cytoreduction and chemotherapy. The most effective cytotoxic regimen remains to be determined. First-line cisplatin and ifosfamide or carboplatin and taxol can achieve survival rates observed in epithelial ovarian cancer.

The antagonism by BW A868C of PGD2 and BW245C activation of human platelet adenylate cyclase.

1. In glycerol-lysed human platelets, prostaglandin D2 (PGD2) and the hydantoin BW245C both activate adenylate cyclase in a biphasic manner. These activations are qualitatively different from those of carbacyclin, iloprost and prostaglandin E2 (PGE2) whose E/[A] curves can be adequately described by rectangular hyperbolae. 2. Prostaglandin E1 (PGE1) had E/[A] curves of slope significantly lower than that expected for a rectangular hyperbolae. 2. Prostaglandin E1 (PGE1) had E/[A] curves of slope significantly lower than that expected for a rectangular hyperbola. 3. The selective PGD2 antagonist BW A868C shifts the first phase of the PGD2 and BW245C E/[A] curves but has no effect on the second phase. 4. Applying a two-receptor model enables a pKB to be derived for BW A868C of 9.11. 5. BW A868C has no effect on carbacyclin, iloprost, prostacyclin, PGE1 and PGE2 at a concentration 1,000 fold that of its KB against PGD2 and BW245C. 6. These results indicate that PGD2 and BW245C are capable of activating adenylate cyclase in human platelets through the DP-receptor and by another mechanism as yet uncharacterized.

The classification of prostaglandin DP-receptors in platelets and vasculature using BW A868C, a novel, selective and potent competitive antagonist.

1. BW A868C, a novel compound, behaved as a simple competitive antagonist in a human washed platelet aggregation assay. Anti-aggregatory concentration-effect curves to BW 245C were displaced in a parallel manner. The shifts accorded with a Schild plot slope of unity and a pKB of 9.26. 2. Inhibition of platelet aggregation by prostaglandin D2 (PGD2) was antagonized with a similar potency, as were the relaxation effects of BW 245C and PGD2 in the rabbit jugular vein. BW A868C can, therefore, be classified as a DP-receptor antagonist. 3. Actions of BW A868C at other prostaglandin receptors (IP, EP1, EP2, TP and FP) were excluded at concentrations up to 1,000 times higher than the DP-receptor affinity. 4. Analyses of BW 245C- and PGD2-mediated effects were complicated by additional agonist receptor interactions which were revealed by BW A868C. In rabbit jugular vein a resistant phase of agonism was detectable, indicating that both agonists exerted effects through another receptor (possibly EP2). Also, PGD2, in addition to its anti-aggregatory effect on platelets, demonstrated a pro-aggregatory action in the presence of BW A868C. 5. The contractile effects of PGD2 in guinea-pig tracheal strips were resistant to 10 microM BW A868C indicating that they were not mediated through DP-receptors. 6. To our knowledge this is the first account of a well-classified competitive antagonist at the DP-receptor. Its potency and selectivity make it an important new tool in prostanoid receptor classification and identification.

Development and evaluation of an enzyme inhibition assay for methotrexate.

A method for the measurement of methotrexate based on its inhibition of dihydrofolate reductase (EC 1.5.1.3) is described. The performance of the method is evaluated and a brief assessment of its clinical usefulness made. Reaction time, pH, and the relative concentration of enzyme and inhibitor all have a significant effect on the shape of the standard curve. Pre-incubation of enzyme with methotrexate resulted in increased inhibition, but did not improve the sensitivity or linearity of the assay. Data are presented on the imprecision, specificity and accuracy of the method. The method is simple to perform, rapid and inexpensive. The sensitivity and specificity of the method are such as to allow for effective monitoring of patients on methotrexate therapy.

Use of similarity measures for quality control of benthic diatom samples.

A method for evaluating the similarity of replicate benthic diatom samples based on the Bray-Curtis similarity measure is described. This technique may be useful as part of quality control procedures where objective performance measures are required. Levels of similarity > 60% typically indicate good agreement between the primary analyst and auditor. However, an evaluation of 57 comparisons indicated that achievable levels of similarity were dependent upon the species diversity of the sample, with samples with high species diversity typically having lower levels of similarity than samples with low species diversity. Whilst a threshold value of 60% is adequate for most samples, a stiffer threshold of 70% should be applied to samples with very low levels of diversity.

Post accident/incident counseling: some exploratory findings.

An examination of the literature, and other sources of information, suggested that there might be prophylactic value in early psychological intervention following crewmember involvement in stressful incidents. An exploratory study, at a small commercial pilot base (c.200 pilots), was undertaken to assess the value of early intervention. Pilots were automatically referred to an independent counseling service if abnormal flight events were judged to have involved sudden, unanticipated, or extreme stress. While some individuals came through their experience relatively unaffected, a surprising proportion did not. Several individuals took the opportunity to voluntarily return for additional counseling while others required anxiolytic drug treatment. The initial findings of this exploratory study strongly suggest that commercial pilots are more frequently subject to a potentially debilitating stress reaction than heretofore suspected. This has obvious implications for intervention and prevention, as well as long-term stress management for commercial pilots.

Admissions with chronic obstructive pulmonary disease after publication of national guidelines.

BACKGROUND: The British Thoracic Society (BTS) published guidelines on managing acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in 1997. AIM: To audit admissions with AECOPD and to see how well these guidelines were adhered to. Methods All patients admitted were identified and 50 selected for audit. RESULTS: The mean age was 72 years and 52% were female. Admission C reactive protein (CRP) and white cell count (WCC) were 49 (12.7) mg/l and 10.97 (0.64) x 10(9)/l respectively. Six were acidotic and 16 hypercapnoeic. Median length of stay (LOS) was six days. Twenty-one fulfilled admission criteria. Thirty-seven had > or = 2 Anthonisen criteria. Nine had spirometry performed. Correlations were seen between appropriateness of admission score and pH (r=-0.41, p=0.01) and LOS (r=-0.43, p=0.002) and between Anthonisen criteria score and age (r=0.33, p=0.018). Symptom score correlated with PaO2 (r=-0.38, p=0.02), LOS (r=0.27, p=0.06) and age (r=0.38, p=0.007). LOS correlated with PaCO2 (r=0.33, p=0.04). CONCLUSION: Admissions are chiefly comprised of an ill, elderly population. Careful adherence to guidelines could result in fewer admissions.

Intercalibrating classifications of ecological status: Europe's quest for common management objectives for aquatic ecosystems.

Halting and reversing the deterioration of aquatic ecosystems requires concerted action across state boundaries and administrative barriers. However, the achievement of common management objectives is jeopardised by different national quality targets and ambitions. The European Water Framework Directive requires that quality classifications are harmonised via an intercalibration exercise, ensuring a consistent level of ambition in the protection and restoration of surface water bodies across the Member States of the European Union. We outline the key principles of the intercalibration methodology, review the achievements of intercalibration and discuss its benefits and drawbacks. Less than half of the required intercalibration has been completed, mostly due to a lack of national assessment methods. The process has fostered a scientific debate on ecological classification with important implications for environmental management. Despite a significant level of statistical abstraction, intercalibration yielded a fundamental and unified vision of what constitutes good ecology across Europe, in principle ensuring greater parity in the funds invested to achieve good ecological status.