Chemotherapy induced phlebitis experienced by women with breast cancer following administration of epirubicin using a volumetric infusion pump: an observational study.

OBJECTIVE: To establish the incidence and severity of chemotherapy-induced phlebitis (CIP) following administration of epirubicin chemotherapy using a volumetric infusion pump (Hospira Plum 360), compared to a previous study of manual injection of epirubicin. Also the study aimed to gain insight into staff perceptions of ease of use and safety of infusion pump administration. METHODS: An observational study of women with breast cancer (n = 47) receiving epirubicin via volumetric infusion pump. Phlebitis was reported through a participant self-assessment questionnaire and graded by clinical assessment three weeks after each chemotherapy cycle. Staff perceptions were explored using questionnaires. RESULTS: Infusion pump administration delivered a significantly higher concentration of epirubicin (p < 0.001), a significantly higher rate of grade 3 and 4 participant reported CIP between cycles (p = 0.003) but demonstrated no significant difference in grade 3 and 4 CIP when assessed clinically three weeks after treatment (p = 0.157). CONCLUSION: Peripheral epirubicin administration will result in severe CIP being experienced by a proportion of patients irrespective of whether infusion pump or manual injection method is used. Those at high risk of severe CIP should be informed of the risk and offered a central line. For those with a lower risk of severe phlebitis use of the infusion pump appears to be a safe option.

Intermittent Pneumatic Compression for the Treatment of Lower Limb Lymphedema: A Pilot Trial of Sequencing to Mimic Manual Lymphatic Drainage Versus Traditional Graduated Sequential Compression.

Background: Recent advances in technology have allowed intermittent pneumatic compression (IPC) devices to develop so that their function mimics the process and principles of manual lymphatic drainage (MLD); however, research into the effectiveness of such devices is lacking. This study aimed to investigate the effectiveness of a patented IPC technique designed to mimic MLD (the LymphAssist), compared with a typical sequential IPC regimen. Methods and Results: Forty patients with a confirmed diagnosis of lower limb ISL (International Society of Lymphology) stage II or III lymphedema were recruited into this three-phased study. A bilateral leg volume assessment and quality-of-life assessment were completed at four clinic visits across the course of the study. The LymphAssist IPC regimen was significantly more effective in reducing distal leg volume than the sequential mode (mean volume reduction: 230 ± 135 mL vs. 140 ± 84 mL, respectively, p = 0.01). Improvements in leg volume were transient as both groups demonstrated a rebound or increase in volume during the washout period (LymphAssist: 238 ± 168 mL, sequential: 276 ± 158 mL, p = 0.3). Overall, IPC was effective in improving quality-of-life scores (mean reduction: 10 ± 11, p < 0.001). Conclusion: IPC is effective in reducing limb volume and improving quality of life for patients with lower limb lymphedema. IPC that mimics the MLD process has been shown to be more effective in reducing leg volume compared with traditional sequential IPC in the distal aspect of the leg. The increase in leg volume observed after discontinuation of IPC suggests that regular treatment is required to maintain its associated effects. Clinical Trial Registration Number: NTC 03856281.

Giraffe Stature and Neck Elongation: Vigilance as an Evolutionary Mechanism.

Giraffe (Giraffa camelopardalis), with their long neck and legs, are unique amongst mammals. How these features evolved is a matter of conjecture. The two leading ideas are the high browse and the sexual-selection hypotheses. While both explain many of the characteristics and the behaviour of giraffe, neither is fully supported by the available evidence. The extended viewing horizon afforded by increased height and a need to maintain horizon vigilance, as a mechanism favouring the evolution of increased height is reviewed. In giraffe, vigilance of predators whilst feeding and drinking are important survival factors, as is the ability to interact with immediate herd members, young and male suitors. The evidence regarding giraffe vigilance behaviour is sparse and suggests that over-vigilance has a negative cost, serving as a distraction to feeding. In woodland savannah, increased height allows giraffe to see further, allowing each giraffe to increase the distance between its neighbours while browsing. Increased height allows the giraffe to see the early approach of predators, as well as bull males. It is postulated that the wider panorama afforded by an increase in height and longer neck has improved survival via allowing giraffe to browse safely over wider areas, decreasing competition within groups and with other herbivores.

Proportion of patients with implanted permanent pacemakers with atrial fibrillation receiving appropriate medical prophylaxis in North Wales.

BACKGROUND: Atrial fibrillation (AF) is associated with an increased long-term risk of stroke, heart failure, and mortality. Previous studies have demonstrated the suboptimal use of anticoagulation therapy in patients with AF. METHODS: A retrospective survey of patients (N = 1,113) fitted with dual-chamber pacemakers found 71 patients (age 69 ± 35, mean ± standard deviation) with atrial tachycardia and AF (defined as >5 minutes per day). Their medical records and anticoagulation status were investigated and used to stratify each patient for stroke risk with the Birmingham 2009 schema (CHA(2)DS(2)-VASc) and assessed to determine the rate of appropriate thromboembolism (TE) prophylaxis prescription. RESULTS: The most common overall concomitant risk factor for stroke was hypertension (54%), followed by age ≥75 (51%), being female and previous stroke/transient ischemic attack/TE (39%). The average CHA(2)DS(2)-VASc score was 3.7 ± 1.6. Fifty-six percent of the patients were not receiving appropriate anticoagulation therapy. CONCLUSION: This study demonstrates an underutilization of the oral anticoagulant warfarin in patients with known AF and that the clinicians may not be regarding current stroke risk factors when adopting a thromboprophylaxis strategy.