Severe Hyponatremia and Immune Nephritis Following an Initial Infusion of Nivolumab.

Anti-programmed cell death-1 (PD-1) antibodies pembrolizumab and nivolumab are becoming increasingly important in the treatment of melanoma and non-small cell lung cancer. These agents are known to induce many immune-related adverse events, but rapid-onset nephritis and immune-related hyponatremia have not been described to date. We describe the case of an adult patient who developed severe hyponatremia and rapid-onset nephritis following the first infusion of nivolumab for metastatic melanoma.

Outcomes of computerized physician order entry in an electronic health record after implementation in an outpatient oncology setting.

PURPOSE: Computerized physician order entry (CPOE) in electronic health records (EHR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after implementation of an outpatient oncology EHR/ CPOE system in a hospital-based outpatient cancer center within three treatment sites. METHODS: This study is a retrospective chart review of 90 patients who received one of the following regimens between 1999 and 2006: FOLFOX, AC, carboplatin + paclitaxel, ABVD, cisplatin + etoposide, R-CHOP, and clinical trials. Documentation completeness scores were assigned to each chart based on the number of documented data points found out of the total data points assessed. EHR/CPOE documentation completeness was compared with completeness of paper charts orders of the same regimens. A user satisfaction survey of the paper chart and EHR/CPOE system was conducted among the physicians, nurses, and pharmacists who worked with both systems. RESULTS: The mean percentage of identified data points successfully found in the EHR/CPOE charts was 93% versus 67% in the paper charts (P < .001). Regimen complexity did not alter the number of data points found. The survey response rate was 64%, and the results showed that satisfaction was statistically significant in favor of the EHR/CPOE system. CONCLUSION: Using EHR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. EHR/CPOE requires constant vigilance and maintenance to optimize patient safety.

The capacity ratio as a measure of solvency in experiential education.

OBJECTIVE: To determine the utility of the capacity ratio to measure and compare solvency in experiential education in 6 colleges and schools of pharmacy in the Northwestern United States. METHODS: The 6 colleges and schools of pharmacy combined data on student placements needed, site availability, and changes made to placements during the 2009-2010 and 2010-2011 academic years and calculated capacity ratios for the advanced and introductory experience programs in the region. Comparisons also were made to previously published capacity results to determine whether the capacity ratio was useful in identifying trends and guiding preceptor and site development. RESULTS: Capacity ratio calculations were successful in facilitating comparison of capacity within and across regions. Experiential education is solvent in the Northwest overall, but specific parts of experiential programs were found to have more capacity than others. Trends in the Northwest were consistent with capacity in other regions. CONCLUSIONS: The capacity ratio can determine and facilitate comparison of solvency within and across colleges and schools of pharmacy and thereby inform decisions about resource management in experiential education.