A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact.

PURPOSE: This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. METHODS: The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. For each article, two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results, and conclusions. RESULTS: Seventy-two interventional studies met the inclusion criteria. In addition, 49 intensity-modulated radiation therapy (IMRT) studies were included as a management strategy aiming for less salivary gland damage. Management guideline recommendations were drawn up for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. CONCLUSIONS: There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment. Management guideline recommendations are provided for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. Fields of sparse literature identified included effects of gustatory and masticatory stimulation, specific oral mucosal lubricant formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia.

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life.

PURPOSE: This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies. METHODS: The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article. RESULTS: The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy. CONCLUSIONS: Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.

Metabolic profiles of minimally absorbed orlistat in obese/overweight volunteers.

To determine the metabolic profile of minimally absorbed orlistat in obese/overweight patients, an open-label, single-dose study was performed in eight obese/overweight volunteers between 23 and 68 years of age. Each subject received a single oral dose of 360 mg orlistat containing approximately 400 muCi of 14C-labeled orlistat. Serial blood samples were collected at specified times over 10 hours after administration of orlistat for determination of total radioactivity, unchanged orlistat, and major metabolites in the plasma. Urine samples were collected over 24 hours and analyzed to evaluate the urinary recovery of total radioactivity and the profile of orlistat metabolites in the urine. In addition, all fecal samples were collected and analyzed for total radioactivity. Urinary and fecal recovery of the administered dose of total radioactivity were 1.13 +/- 0.50% (24-hour data only) and 96.4 +/- 18.1% (n = 7), respectively. Maximum observed concentration (Cmax) and time to Cmax (tmax) values of plasma total radioactivity were 150 +/- 51 ng.eq/mL and 6.8 +/- 1.5 hrs, respectively. All these parameters obtained in obese/ overweight subjects were similar to those reported previously in healthy subjects. On the basis of the area under the concentration-time curve from 0 to 10 hours (AUC0-10), two major metabolites comprise a total of approximately 42% of the total radioactivity in plasma. The primary metabolite (M1) has a short half-life (approximately 2 hours), whereas the secondary metabolite (M3) disappeared at a slower rate. No strikingly apparent difference in the urinary metabolic profile was observed between two gender groups. It is concluded that the disposition of orlistat appears to be similar between normal and obese/overweight subjects. Of the minimal fraction of the dose that was absorbed systemically, the presence of two major metabolites accounts for approximately 42%.

Virginia Henderson: theorist, prophet, poet.

This article addresses the contributions of Virginia Henderson to the metaparadigm of nursing. The focus is discovery. The aesthetic characteristics of her works are highlighted by translating selected thoughts into poetry.

Long-term vascular access devices.

Introduced in the 1970s, long-term vascular access devices are used in both adults and children, with about 500,000 devices placed annually. This integrative review of research on dressings to minimize infectious catheter-related complications showed that current practices were adapted from knowledge derived from short-term central venous and peripheral catheters without thorough investigation. Summary and critique of recent, as well as older significant studies, provide guidance for future research. Specifically, future research should demonstrate greater confidence in outcome measures with attention to reliability of laboratory methods, diagnostic criteria, and interrater reliability. Continuing research efforts are needed to capture unique design features of various devices, qualify device performance across prolonged time, examine nuances within patient subgroups, and address underrepresented patients and settings. Confounding and interacting variables require greater attention in study design and analysis.

Breast cancer: advances in diagnosis and surgical treatment.

With breast cancer affecting more than 180,000 women per year in the United States, improvements in diagnosis and treatment are paramount. Nurses and members of the interdisciplinary care team can actively support education, treatment, and research in development of new techniques and therapies.

Central venous access devices. Issues for staff education and clinical competence.

This article reviewed some of the challenges facing nurses in an ever-increasing quality-minded, cost-effective health care environment. Documenting competency will remain a concern of high regard as healthcare faces an uncertain future. The call for competency comes from both outside and within the profession. The notion of quality care is being associated with competency directed at outcomes. Each professional nurse must continuously assess his or her level of competency and seek out education. Institutions are taking responsibility for providing competency education and training for their employees, including nurses, but employment is not a substitute for professional behavior. Ultimately, competency is an individual professional responsibility. This article discussed two different institutional-based programs for providing competency education to nurses caring for patients with CVADs. Although the approaches are different, each program supports skill development and competency documentation. The programs are presented to stimulate thinking and offer ideas for practice settings confronted with ensuring competent practitioners. The challenge for nurses is to maintain skill in specialty practices heavily influenced by technology. The challenge for institutions and agencies is to ensure competency while maintaining cost effectiveness.

Chemotherapeutic treatment of colorectal cancer: rationale, trends, and nursing care.

Colorectal cancer is the second leading cause of cancer-related death in America. Historically, chemotherapeutic treatment of colorectal cancer has met with mixed success. Continued research is securing a role for chemotherapy in the treatment of colorectal cancer, with fluoropyrimidines (5-fluorouracil and fluorodeoxyuridine), alone or in combination with modulating agents, being the most promising area of treatment. Knowledge of cell kinetics forms the basis for understanding chemotherapeutic activity and the management of drug-induced side effects. Nursing care is essential to the management of such common side effects as myelosuppression, stomatitis, nausea and vomiting, diarrhea, and cutaneous problems. Inadequate management of side effects can result in serious and distressing complications, including inability to complete therapy, risking an opportunity for potential cure or causing needless suffering and expense. In addition to supporting continued medical research, nurses need to pursue research that identifies the most effective nursing interventions for management of side effects from chemotherapy.

Effectiveness of disinfectant techniques on intravenous tubing latex injection ports.

This randomized, experimental-design study compared the effectiveness of two different disinfectant techniques for eliminating bacteria from intravenous tubing latex injection ports. The two treatment groups received a one-minute preparatory scrub of 70% isopropyl alcohol or povidone-iodine; the control group did not receive any scrub. Results showed approximately equal effectiveness of 70% isopropyl alcohol or povidone iodine on the growth of all micro-organisms. The control group ports showed significant growth of all microbes studied.