Preference for the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection in patients with HER2-positive early breast cancer (PHranceSCa): A randomised, open-label phase II study.

AIM: The aim of the study was to assess patient preference for the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) in patients with HER2-positive early breast cancer in PHranceSCa (NCT03674112). MATERIALS AND METHODS: Patients who completed neoadjuvant P + H + chemotherapy + surgery were randomised 1:1 to three intravenous (IV) P + H cycles followed by three cycles of PH FDC SC or vice versa (crossover) and then chose subcutaneous (SC) injection or IV infusion to continue up to 18 cycles (continuation). Assessments were via patient and healthcare professional (HCP) questionnaires. RESULTS: One hundred and sixty patients were randomised (cut-off: 24 February 2020); 136 (85.0%, 95% confidence interval: 78.5-90.2%) preferred SC; 22 (13.8%) preferred IV; 2 (1.3%) had no preference. The main reasons for SC preference were reduced clinic time (n = 119) and comfort during administration (n = 73). One hundred and forty-one patients (88.1%) were very satisfied/satisfied with SC injection versus 108 (67.5%) with IV infusion; 86.9% chose PH FDC SC continuation. HCP perceptions of median patient treatment room time ranged from 33.0-50.0 min with SC and 130.0-300.0 min with IV. Most adverse events (AEs) were grade 1/2 (no 4/5s); serious AE rates were low. AE rates before and after switching were similar (cycles 1-3 IV → cycles 4-6 SC: 77.5% → 72.5%; cycles 1-3 SC → cycles 4-6 IV: 77.5% → 63.8%). CONCLUSION: Most patients strongly preferred PH FDC SC over P + H IV. PH FDC SC was generally well tolerated, with no new safety signals (even when switching), and offers a quicker alternative to IV infusion.

Brinquedo terapêutico instrucional: preparando a criança para a quimioterapia endovenosa / Instructional Therapeutic Toy: preparing child for Intravenous Chemotherapy

Introdução: O câncer merece destaque entre as doenças que causam transtornos em adultos e crianças, pois continua sendo um diagnóstico dos mais temidos da atualidade. Vincula-se a um estigma de sofrimento, mutilação e morte, envolvendo uma série de ameaças e dificuldades, que afetam não só a criança, mas sua família como um todo, ao longo do processo de diagnóstico e tratamento Objetivo: Comparar os comportamentos de crianças durante a quimioterapia endovenosa antes e após a aplicação do brinquedo terapêutico instrucional (BTI). Materiais e Métodos: Pesquisa não controlada do tipo "antes e depois", realizada na oncopediatria de um hospital público. Foram avaliadas 10 crianças submetidas a quimioterapia endovenosa. Na coleta de dados, utilizou-se um questionário com questões sociodemográficas, clínicas, comportamentais e reações esboçadas durante o tratamento, antes e após a sessão de BTI. A análise de dados foi feita no programa SPSS, sendo realizado o teste de Mc Nemar, considerando um intervalo de confiança de 95%. Resultados: O câncer infantil mais frequente foi a Leucemia Linfoide Aguda (40%). Dos comportamentos analisados, percebeuse redução significativa após o uso do BTI do comportamento "postura retraída". Conclusão: O BTI representou uma ferramenta importante no controle da ansiedade e sofrimento gerado pelo tratamento quimioterápico endovenoso.

Introduction: Cancer plays a notable role among diseases that afflict adults and children. Its diagnosis is still much feared and connects to a stigma of suffering, mutilation and death. It is related to difficulties and treats that affects not only the child but also his whole family during the long process of diagnosis and treatment. Objective: to compare the behaviors of children during intravenous chemotherapy before and after the application of therapeutic instructional toy (BTI). Materials and methods: Uncontrolled search such as "before and after", held in oncopediatria of a public hospital. Ten children were evaluated, subjected to intravenous chemotherapy. For collection, it was used a questionnaire asking for sociodemographic, clinical and behavioral questions, as well as issues and reactions outlined during treatment, before and after the session of BTI. The data analysis was done in SPSS program, being carried out the Mc Nemar test, assuming a confidence interval of 95%. Results: the most frequent childhood cancer was Acute Lymphoblastic leukemia (40%). Among the behaviors examined, it was significantly reduced after the use of BTI "retracted posture" behavior. Conclusion: the BTI represented an important tool in the control of anxiety and suffering generated by intravenous chemotherapy treatment.

Postoperative ambulation in thoracic surgery patients: standard versus modern ambulation methods.

AIM: A single-subject study of two methods of postoperative ambulation of patients recovering from thoracic surgery. BACKGROUND: During the postoperative setting, patients are often burdened by their condition that reduces their ability to ambulate. This problem is compounded by the addition of devices that make walking more cumbersome. To simplify the process of ambulation during the postoperative period, an intravenous pole/walker (IVPW) was specifically designed to allow all patient devices and attachments to accompany the patient during ambulation, without the need for supplemental caregiver assistance. METHODS: The IVPW method of ambulation was compared with standard method of ambulation (SMA) in a single-subject clinical trial. Thirty-nine consecutive thoracic surgery patients with at least an IV and chest tube were ambulated using alternatively either the IVPW or the SMA. Immediately following the ambulation periods, the patient and patient's health care worker assessed both methods using satisfaction surveys consisting of several questions about the episodes of ambulation and the number of health care workers needed to assist during ambulation. RESULTS: Patient satisfaction was significantly higher in the ability of the IVPW to provide support and assist in ambulation in comparison with the SMA (p < 0·001). Nurses felt the IVPW both facilitated and provided a safer method for ambulation compared with the SMA (p < 0·001). On average, one less employee was required during ambulation with the IVPW (p < 0·001). CONCLUSION: The IVPW provided better support and was perceived as a safer method for ambulation compared with the SMA. The IVPW also required one less person to assist with ambulation. RELEVANCE TO CLINICAL PRACTICE: Facilitation of ambulation in the postoperative setting can impact nursing care and patient satisfaction.

[Experimental prospective cognitive study on the evaluation of connection of fatigue perception and depression among caregivers and team treating cancer patients receiving oral chemotherapy to systemic chemotherapy. Equi-Car 10 study]. / Studio sperimentale prospettico conoscitivo di valutazione della relazione della percezione di fatigue e depressione tra caregiver, equipe curante e pazienti oncologici in trattamento chemioterapico con terapie somministrate per via orale verso terapie somministrate per via sistemica Studio Equipe-Caregivers 10 (Studio Equi-Car 10).

OBJECTIVE: The Equi-Car 10 is an spontaneous, observational study. The objective was to assess the connection of fatigue perception and depression of caregivers, oncological team and oncological patients in oral chemotherapy to intravenous METHOD: The study recruited 60 patients and 60 caregivers. The study was carried out on patients with lung, breast and colon cancer requiring chemotherapy, and family members were chosen as caregivers. Patients, caregivers and doctors filled in FACT-F and Zung questionnaires at the opening day of the medical record, after three and six cycles of chemotherapy, and three months after the end of the treatment. RESULTS: The Zung depression and Functional Assessment of Cancer therapy-Fatigue (FACT-F) showed: (a) on patients treated with intravenous therapy showed significantly higher levels of fatigue and depression than those of patients treated with oral therapy, even when the latter were treated for advanced disease; (b) on caregivers of patients treated with systemically administered therapies showed elevated levels of Fatigue and depression which proved to be significantly higher than those of caregivers of patients treated with oral therapies, even when treated for advanced disease; (c) on three oncologist has highlighted low levels of Fatigue and depression, for both types of patients, higher for patients with systemic therapy related to the management of side effects. CONCLUSIONS: The results showed that cancer patients and caregivers have high levels of fatigue and depression both related to the disease stage and to the mode of drug administration. It is necessary to provide cancer patients and caregivers with appropriate psychological support and preventive programs for secondary and relapse prevention.

The preferences and experiences of different bisphosphonate treatments in women with breast cancer.

OBJECTIVE: The objective of this study was to examine women's experiences with oral and intravenous (i.v.) bisphosphonate therapy, the impact that treatment had on bone pain and Quality of Life (QoL), and their preferences if choice were available between oral and i.v. administration. METHODS: This was a prospective study of women with metastatic breast cancer receiving either oral or i.v. bisphosphonate therapy. Semi-structured interview techniques and QoL questionnaires were employed. Participants in the study were interviewed three times, once in person and twice by telephone. RESULTS: A total of 79 patients from eight UK hospitals participated in the study; 35 were receiving oral bisphosphonate medication and 44 i.v. treatments. Self-reported adherence to oral therapy was good although 21% had chosen not to take their drugs at some time. Most had adapted their lifestyle to accommodate oral therapy with 29/37(74%) completely satisfied. However 9/37(24%) expressed dissatisfaction with constraints especially the time required to stand upright after taking their tablets. By 6 months 23/25 (91%) of patients receiving (i.v.) therapies were generally satisfied with the frequency and 22/25 (88%) with the convenience especially if given concurrently with chemotherapy. Overall 25/54 (46%) patients reported improved bone pain scores on the validated FACT-BP scale from baseline to 6 months. CONCLUSIONS: Both oral and i.v. therapies have disadvantages but were acceptable to most patients some of whom had reduced bone pain over time. More data regarding acceptability, adherence, and patients' preference for bisphosphonate therapies are required. Until randomised trials demonstrate superior efficacy for one mode of bisphosphonate therapy over another, we suggest offering patients a choice of bisphosphonate therapy.

Percutaneous lines for delivering intravenous antibiotics in people with cystic fibrosis.

BACKGROUND: Percutaneous long lines (long intravenous lines) and short intravenous lines (also termed cannulae) are both used to deliver intravenous antibiotics in cystic fibrosis to treat respiratory exacerbations of the disease. The perceived advantage of a long intravenous line is a greater duration of line function, which has to be balanced against a technically more challenging insertion procedure, and the possibility of more discomfort on insertion. OBJECTIVES: To compare long intravenous lines with short intravenous lines in people with cystic fibrosis receiving intravenous antibiotics, in terms of lifespan of the line, ease of insertion, complication rates of the line and patient satisfaction. This will help patients and clinicians choose between devices. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Date of most recent search: 26 August 2010. SELECTION CRITERIA: Randomised studies comparing long intravenous lines lines with short intravenous lines or comparing different types of long intravenous lines. DATA COLLECTION AND ANALYSIS: We identified two studies, one comparing long intravenous lines with short intravenous lines, and one comparing two different types of long intravenous lines. MAIN RESULTS: Two studies (67 participants) were included in the review. Based on the published reports, both studies had potential for bias in several domains. There is some evidence that long intravenous lines are superior to short intravenous lines. One study of 20 participants found that the lifespan of a long intravenous line is longer than that of a short intravenous line, and that participants preferred the long intravenous lines to short intravenous lines. A further study of 47 participants found no difference in lifespan, or participant preference when comparing two different long intravenous lines (the Hydrocath and Vygon EC). Neither study was powered to detect differences in serious complications of the devices. AUTHORS' CONCLUSIONS: There is some evidence to support the use of long intravenous lines rather than short intravenous lines, in terms of lifespan of the line and patient satisfaction. There is no evidence to suggest that any one type of long intravenous line is superior, and currently choice of line should be determined by operator and patient preference. There are numerous devices available which are used in cystic fibrosis. Further research is required to identify clinically important differences between these devices.

Patients' assessment of the convenience of fentanyl HCl iontophoretic transdermal system (ITS) versus morphine intravenous patient-controlled analgesia (IV PCA) in the management of postoperative pain after major surgery.

The patient-controlled fentanyl HCl iontophoretic transdermal system (ITS) is a compact, self-contained, needle-free system that has been approved for acute postoperative pain management in hospitalized adults. The objective of the present analysis was to evaluate patients' assessment of fentanyl ITS and morphine intravenous patient-controlled analgesia (IV PCA) convenience on 7 different subscales, using a validated patient ease of care (EOC) questionnaire in 2 prospective, open-label, randomized, phase IIIb clinical trials. Patients received fentanyl ITS or morphine IV PCA (N = 1,305) for up to 72 h after total hip replacement surgery (THR study) or abdominal or pelvic surgery (APS study). For the majority of items on the patient EOC questionnaire, trends suggest that greater percentages of patients reported the most positive response for fentanyl ITS than they did for morphine IV PCA in both studies; differences were particularly noteworthy for items on the Movement subscale. In the THR study, more patients in the fentanyl ITS group were responders compared with those in the morphine IV PCA group for the subscales Confidence with Device, Pain Control, Knowledge/Understanding, and Satisfaction. In the APS study, responder rates for these subscales did not differ between treatment groups. These findings indicate that patients assessed the EOC associated with fentanyl ITS higher compared with morphine IV PCA for the management of acute postoperative pain and suggest that fentanyl ITS has the potential to improve acute postoperative pain care for patients and nurses.

Taking care of the little things: preparation of the pediatric endoscopy patient.

The practice of pediatric endoscopy offers unique challenges in both the physiological and emotional well-being of children and their families. Successful procedures result in part from providing thorough preprocedure education and preparation. Staff preparing these patients must be knowledgeable about the developmental and physiological needs of each age group of patients entrusted into their care. Awareness and understanding of the developmental approaches to their care is essential to provide positive outcomes for children and their families. This article discusses preparation of the child undergoing endoscopic procedures and interventions to assist in positive outcomes.

Patient preference for oral or intravenous chemotherapy: a randomised cross-over trial comparing capecitabine and Nordic fluorouracil/leucovorin in patients with colorectal cancer.

Until recently, fluorouracil (F) and leucovorin (L) had been considered the standard therapy for patients with colorectal cancer. However, several studies have shown that oral therapy with UFT/L or capecitabine is as effective as intravenous (i.v.) therapy and in addition it is claimed that patients prefer oral to i.v. therapy as long as efficacy is not compromised. In a previous crossover study by Borner et al., it was shown that 26 out of 31 patients preferred oral therapy with UFT/L to i.v. FL (Mayo regimen) [Borner M, Schöffski P, de Wit R, et al. Patient preferences and pharmacokinetics of oral modulated UFT versus intravenous fluorouracil and leucovorin: a randomised crossover trial in advanced colorectal cancer. Eur J Cancer 2002;38:349-58]. The objective of the present study was to investigate patient preference between i.v. FL and oral capecitabine using the design described by Borner. The Nordic FL schedule is a bolus regimen with efficacy comparable to other i.v. regimens and at the same time a very tolerable and easy administered regimen. We randomised 60 patients with colorectal cancer (53 patients received adjuvant therapy and seven patients received palliative therapy) to start therapy with either oral capecitabine or Nordic bolus FL. After 6 weeks of therapy (two courses of capecitabine or three courses of Nordic FL) patients were crossed over to the other regimen. After having completed 12 weeks of therapy the patients (49 evaluable patients) were asked to choose one of the regimens for a further 12 weeks of therapy. Patients had more side-effect when treated with capecitabine and a total of 30 out of 49 (61%) preferred the Nordic FL regimen and 19 (39%) preferred capecitabine. We conclude that patients prefer the regimen with less toxicity and that it is of minor importance whether the medication is administrated orally at home or i.v. at the hospital.

La comunicación terapéutica durante instalación de venoclisis: uso de la simulación filmada / The therapeutic communication during installation of endovenous therapy: the use of video-taped simulation / A comunicação terapêutica durante instalação de terapia endovenosa: uso de simulação filmada

El uso de la comunicación terapéutica contribuye para la calidad de la atención de enfermería, sobre todo en los procedimientos que causan miedo y ansiedad en el paciente, tales como la instalación de venoclisis. El objetivo de este estudio fue evaluar la percepción de enfermeras sobre una comunicación terapéutica durante la instalación de venoclisis, mostrada en una simulación filmada. Se realizó estudio descriptivo-exploratorio en una ciudad de México; la población fue de 30 enfermeros y 12 docentes. Los pasos metodológicos fueron: Construcción y validación de un contenido de texto; Filmación del contenido de texto con actores y validación; Presentación del video y aplicación de cuestionario semiestructurado para identificar as técnicas de comunicación terapéutica presentes en la simulación; la percepción de la calidad de la comunicación enfermero-paciente; la percepción de similitudes entre su práctica y la simulación; y las dificultades para utilización de estas técnicas en la práctica cotidiana. Los participantes consideraron "buena" la relación interpersonal mostrada; identificaron técnicas de comunicación terapéutica, que en su mayoría correspondieron a la categoría de descripción de la experiencia y expresión de pensamientos y sentimientos; no se encontraron diferencias sustanciales entre docentes y personal asistencial. La dificultad más referida para utilizar técnicas comunicativas fue el problema del paciente para relacionarse.

The use of therapeutic communication contributes to nursing care quality, mainly in procedures that cause fear and anxiety in patients, such as the installation of endovenous therapy. This study aimed to identify how nurses perceive therapeutic communication during the installation of endovenous therapy, as shown in a filmed simulation. This exploratory-descriptive and comparative study was developed in a Mexican city and involved 30 clinical nurses and 12 nursing faculty. The methodological process was: Construction and validation of textual content; Filming textual content with actors and validation; Presentation of the video to nurses and faculty and application of the semistructured questionnaire to identify therapeutic communication techniques in the simulation; perception of nurse-patient communication quality; perception of similarities between care practice and simulation; and difficulties to use these techniques in daily practice. Participants perceived the interpersonal relationship shown as "good"; they identified therapeutic communication techniques, which mostly corresponded to the description of the experience and expression of thoughts and feelings; no substantial difference was found between the perceptions of educational and care personnel. The most frequent difficulty to use communicative techniques was attributed to patients' problems to establish relations.

O uso da comunicação terapêutica contribui para a qualidade da assistência de enfermagem, sobretudo nos procedimentos que causam medo e ansiedade ao paciente, como a instalação de terapia endovenosa. O trabalho buscou identificar a percepção de enfermeiras sobre uma comunicação terapêutica, durante a instalação de terapia endovenosa, apresentada em uma simulação filmada. Este estudo descritivo-exploratório foi realizado em uma cidade do México com 30 enfermeiros assistenciais e 12 docentes de enfermagem. Os passos metodológicos foram: Construção e validação do texto; Filmagem do texto com atores e validação; Apresentação do vídeo aos enfermeiros e aos docentes e aplicação de questionário semi-estruturado para identificar as técnicas de comunicação terapêutica presentes na simulação; a percepção da qualidade da comunicação enfermeiro-paciente; a percepção de semelhanças entre a sua prática e a simulação; e as dificuldades para utilização destas técnicas na prática cotidiana. Os participantes consideraram como "bom" o relacionamento interpessoal apresentado; identificaram as técnicas de comunicação terapêutica que majoritariamente correspondem à descrição da experiência e expressão de pensamentos e sentimentos; não foram encontradas diferenças substanciais entre docentes e enfermeiros. A dificuldade mais freqüente para utilizar técnicas comunicativas foi atribuída aos problemas do paciente para se relacionar.

Pilot study on the "quality of life" as reflected by psychosocial adjustment of children with thalassemia major undergoing iron-chelating treatment in western Taiwan.

Comprehensive care for thalassemia major (TM) patients has achieved great advances in the world, yet psychosocial developmental aspects of care in families with afflicted members has made only limited progress. Besides confronting the disease itself, a major task for children with TM is to develop into autonomous, healthy, and functioning adults. An emerging concept in considering the adjustment of children with chronic physical disorders is "quality of life"(QL). To study the QL with regard to reflection by psychosocial adjustment in TM children, we enrolled 55 TM patients undergoing intravenous (IV) and/or oral iron chelation, 39 of whom completed the content on issues related to QL according to Cramer and Devinsky. It was concluded that oral iron chelation can be better adjusted than IV iron chelation for a thalassemic child. This favors its use, but not necessarily in combination with IV iron chelation. Perception gaps that arise from age or generation merit concern. This approach to the study of QL, as reflected by psychosocial adjustment in children with TM, is an excellent method for learning about parental-child adjustment regarding a chronic physical condition such as TM.

Pilot study on parental stress and behavioral adjustment to the thalassemia major disease process in children undergoing iron-chelation in western Taiwan.

Thalassemia was first described by Cooley and Lee in 1952 in several Italian children as a severe anemia with spleen and liver enlargement, skin discoloration, and bony changes. Great strides in management and intervention have not been matched by progress in psychosocial rehabilitation. Because parental stress and adaptation are of concern, this study focuses on parental stress and adjustment in response to the disease process of their afflicted children in western Taiwan. The parents of 18 thalassemia major patients (under 12 years of age) were interviewed (in two sessions) to determine their feelings, sources of stress, and support during their childrens' disease process. The study found that: 1) many parents suffer from stress as a result of the disease process, 2) all parents had similar concerns about iron chelation treatment, and 3) some resilience factors were present in the support system.

Patients' and relatives' perceptions about intravenous and subcutaneous hydration.

Hydration during palliative care is a controversial topic. Most of the arguments are based on anedoctal reports that have not been substantiated with scientific data. Given that the choice is problematic from a clinical perspective, preferences of patients and family should dictate whether intravenous fluids are administered. The aim of this study was to evaluate patient and family perceptions about hydration and two modes of providing hydration. Fifty-four consecutive patients admitted to an acute pain relief and palliative care unit who required hydration completed a questionnaire regarding their perceptions on hydration and modes of hydration. Similarly, the principal family carer was chosen and similar questions were posed. For most items, patients and relatives agreed, considering hydration as a useful medical treatment that is able to provide some nutrition. The intravenous route was considered able to improve the clinical condition and to have a positive psychological meaning, representing an acceptable burden. The subcutaneous route was considered less effective, and not less bothersome than the intravenous route. Most patients and relatives agreed with continuing hydration at home, if necessary, preferring the intravenous route. Other than technical considerations, which can be variable according to the clinical setting, the perceived benefits of artificial hydration by the caregivers and patients are central to the ethical, emotional, and cultural considerations involved in their decision making. Most patients and relatives surveyed accepted and were in favor of intravenous hydration.

Addressing patient concerns about intravenous iron therapy.

Hemodialysis patients may not fully understand the relationship between anemia and kidney disease and the role of intravenous (i.v.) iron therapy in anemia management. To address this, nephrology nurses have willingly undertaken the role of patient educator in addition to technical expert. This responsibility is challenging because nurses need to understand the rationale for i.v. iron therapy and the efficacy and safety characteristics of the available i.v. iron therapies, which include iron dextran, iron sucrose, and sodium ferric gluconate. Nurses must then be able to effectively communicate this knowledge to their patients in an understandable fashion. This manuscript offers suggestions to nurses for approaches to address patient concerns about i.v. iron therapies, the latest information regarding the efficacy and safety of i.v. iron treatments, and strategies to communicate this information to patients.

Painful procedures in pediatric cancer. A comparison of interventions.

Different interventions (i.e., cognitive-behavioral, pharmacological) and their combination were examined and compared to assist pediatric patients with cancer to manage distress during painful procedures. Findings revealed that cognitive protocols are effective in relieving procedural distress for a significant number of children. Pharmacological therapies were found to be relatively safe and effective when carefully administered and monitored by medical personnel. Data from combined cognitive therapies and pharmacological interventions, particularly those more recent pharmacological interventions, reveal generally mixed results, with both types of interventions yielding distinct benefits and disadvantages. Recommendations are made for future studies that match interventions to specific characteristics of the children for whom they are intended, as well as additional studies that combine pharmacological approaches together with cognitive techniques.

Double lumen port access in patients receiving allogeneic blood stem cell transplantation.

We performed a prospective trial investigating the feasibility of a double lumen port access in 26 patients with hematological malignancies or solid tumors receiving either standard conditioning (n = 9, median age 49 years (range 19-65)) or dose-reduced conditioning (n = 17, median age 56 years (range 35-66)) followed by allogeneic blood stem cell transplantation. The port system was implanted within 3 months (n = 20, range 7-91 days) before transplantation or as indicated at different time points after transplantation (n = 6, range 28-680 days). Most infusions, including the graft itself and all blood drawings, were performed via the port. Over a cumulative duration of 5622 days (1310 days after standard conditioning (range 56-349) and 4431 days after dose-reduced conditioning (range 49-489)) two port systems of patients receiving standard conditioning were removed due to early postimplantation pocket infection on day 6 and 8 after insertion, respectively. In the dose-reduced conditioning group only one late removal (day 287) of a port was required. Most of the patients in both groups reported less pain and a higher degree of comfort compared to peripheral or central venipuncture. The use of double lumen port access during conditioning and in an outpatient setting after allogeneic hemopoietic stem cell transplantation is feasible and advantageous for both patient and medical staff. Implantation several weeks before the start of conditioning might help in avoiding early infectious complications after conventional myeloablative conditioning.

Home intravenous anti-infective therapy (HIVAT): do the benefits outweigh the risks?

Home intravenous anti-infective therapy (HIVAT) has become an accepted mode of treatment worldwide. There are a number of risks intrinsic to such therapy which can be reduced by a team approach, coupled with careful patient selection criteria, a structured follow-up process and an emphasis on patient education. The benefits of HIVAT include the well-being accrued as a result of being at home, the possibility of returning to work or school, and a reduced risk of infectious and intravenous (IV) cannula-related problems. From a societal standpoint, economic cost-benefit analyses provide ample evidence of cost effectiveness. Studies indicate that potential risks, such as noncompliance, interruption of therapy, drug and IV catheter-associated problems, are infrequent. In the US, reimbursement for HIVAT services for the elderly remains a problem.

Preparation for oral surgery: evaluating elements of coping.

Third-molar extraction patients (N = 231) underwent one of five preparatory interventions offering different levels of relaxation, control, and self-efficacy to evaluate the relative importance of each of these elements of coping in the context of an acute stressor. Prior to surgery subjects completed measures of monitoring and blunting. Results indicated that relaxation, perceived control, and self-efficacy were each significant, and roughly equivalent, contributors to coping, and operated in an additive way. Intervention type, and the interaction of intervention type with blunting score, significantly predicted distress prior to and during surgery. It was concluded that no single element is crucial to effective coping and that interventions that provide more coping elements are generally superior. Additionally, the interaction of coping style with intervention is as strong a contributor to coping outcome as the other factors. Those who prefer to distract themselves may benefit most from interventions that require the least possible personal investment of effort and attention.

Reinforcing effect as a function of infusion speed in intravenous self-administration of nicotine in rhesus monkeys.

The influence of infusion speed on the reinforcing effect of nicotine (NIC) 30 micrograms/kg/infusion was studied in rhesus monkeys using intravenous self-administration at infusion speeds of 5.2, 1.3, and 0.3 micrograms/s under a fixed-ratio 5 schedule with a 15-min time-out after each intake. The 24-h self-administration rate was observed in 3 periods of 8 days each for each speed, separated by saline self-administration periods of 2 weeks each. As a result, when a fixed infusion speed of 5.2 micrograms/s was used throughout the 3 periods, the average rates of NIC were not significantly different each other, but when the infusion speed was changed from 5.2 to 1.3, and then to 0.3 micrograms/s, the average rates significantly decreased. The plasma level following a single-dose infusion of NIC 30 micrograms/kg positively correlated with the infusion speeds. These results indicate that the reinforcing effect of NIC is a function of the infusion speed, most likely through elevation of the peak level of NIC in the plasma.

Anticipatory nausea in cancer patients receiving chemotherapy: classical conditioning etiology and therapeutical implications.

The delivery of cytotoxic drugs in cancer treatment is often accompanied by posttreatment side effects (e.g., nausea). Moreover, there is evidence that cancer patients are at risk to develop these side effects in anticipation of chemotherapy (i.e., anticipatory nausea [AN]). AN can be explained as the result of a classical conditioning process with the cytotoxic drug as the unconditioned stimulus (US). Stimuli paired with the US (e.g., smells, tastes) can become conditioned stimuli (CSs) eliciting AN as the conditioned response (CR). The present study was conducted to test whether AN shows characteristics of a CR. Fifty-five ambulatory cancer patients were asked to record nine kinds of physical symptoms (e.g., nausea, vomiting, sweating) on time-scheduled symptom lists: after an infusion (indicating posttreatment symptoms) and prior to their next infusion (indicating anticipatory symptoms). Each measurement period covered a maximum of 48 hours. AN was reported by ten patients (18.08%). Data revealed (a) a statistically significant association between posttreatment nausea and vomiting, respectively, and AN; (b) the occurrence of AN increased with drug emetogenity (i.e., US-intensity); and (c) the duration of AN increased with temporal proximity to the infusion. The results support the conditioning model. Thus, it is proposed to prevent AN by classical conditioning techniques (e.g., overshadowing).