Temporary Stoppages and Burden of Treatment in Patients With Cancer.

OBJECTIVES: To examine the effect of burden of treatment and multimorbidity on the relationship between baseline characteristics and oral oncolytic agent (OOA) temporary stoppages. SAMPLE & SETTING: 272 patients newly prescribed OOAs at six National Cancer Institute-designated comprehensive cancer centers. METHODS & VARIABLES: Patients were randomly assigned to an adherence and symptom management group or a usual care/control group. Temporary OOA stoppages, symptom interference, OOA regimen complexity, and multimorbidities were explored. Data were collected at four-week intervals for 12 weeks. RESULTS: Burden of treatment variables and multimorbidity had no significant effect on OOA temporary stoppages. Women and those prescribed kinase inhibitors were significantly more likely to experience a temporary stoppage. IMPLICATIONS FOR NURSING: Oncology nurses are in a crucial position to educate patients on self-management of OOAs and symptoms. Nurses should be aware of patients who may be more susceptible to severe symptoms, including those with multimorbidities. Future research is needed to better understand OOA stoppages and factors associated with preventing stoppages.

High-Dose Subcutaneous Immunoglobulin in Patients With Multifocal Motor Neuropathy: A Nursing Perspective.

Multifocal motor neuropathy (MMN), an immune neuromuscular condition causing progressive weakness, usually responds to immune-mediated treatments, including intravenous immunoglobulin (IVIG). Fifteen patients with MMN receiving IVIG were enrolled in an open-label, single-center trial and switched to 20% subcutaneous immunoglobulin (SCIG) using a smooth transition protocol (ie, changing the therapy without interruption or impact on the intended outcome of the therapy). Patients received individualized training and support based on motivation and ability to learn, follow directions, and maintain compliance. Although some patients required assistance during the training phase, most managed self-infusion and reported satisfaction in managing therapy autonomously. Educating patients with neuropathies to self-infuse high-dose SCIG at home and with flexibility in dosing schedules was successfully demonstrated in this patient group.

Acceptance of the extracare program by Beta interferon-treated patients with multiple sclerosis: results of the explore study.

BACKGROUND: To gain full benefit from disease-modifying therapies such as interferon ß-1b, patients with multiple sclerosis (MS) need to adhere to treatment in the long term. Treatment adherence requires high patient satisfaction with treatment and care. OBJECTIVES: Our aim was to evaluate the satisfaction of patients with MS receiving interferon ß-1b Extavia with the patient care program Extracare. Efficacy and safety of treatment were evaluated as secondary objectives. METHODS: In this prospective, noninterventional 1-year study, data on the satisfaction of 174 patients with MS with Extracare were obtained by questionnaires. Disability and symptom severity as well as patients' reported activity limitations, quality of life, and fatigue were recorded. RESULTS: We observed high levels of patients' satisfaction with MS nurses, telephonic care, and information provided by Extracare (values ≤ 1.53 on a Likert scale ranging from 1 [very good] to 6 [insufficient]). Patient reported quality of life (Patient Reported Indices for MS QoL) improved from 11.82 ± 11.36 at baseline to 9.74 ± 10.94 at the end of the study (p = .02), whereas clinical parameters of disease progression remained unchanged. Rate of adverse events was as expected. CONCLUSIONS: This study provides the basis for further improvements of care programs to increase treatment adherence of patients with MS.

A patient care program for adjusting the autoinjector needle depth according to subcutaneous tissue thickness in patients with multiple sclerosis receiving subcutaneous injections of glatiramer acetate.

BACKGROUND: The perceived pain on injection site caused by subcutaneous (SC) self-injection may negatively affect acceptance and adherence to treatment in patients with multiple sclerosis (MS). Pain on injection may be caused by inaccurate injection technique, inadequate needle length adjustment, or repeated use of the same injection body area. However, information is lacking concerning the optimal needle depth to minimize the injection pain. OBJECTIVE: The purpose of this program was to characterize the perceived injection-site pain associated with the use of various injection depths of the autoinjector of glatiramer acetate (GA) based on SC tissue thickness (SCT) of the injection site. METHODS: This was a pilot program performed by MS-specialized nurses in patients with MS new to GA. Patients were trained by MS nurses on the preparation and administration of SC injection and on an eight-site rotation (left and right arms, thighs, abdomen, and upper quadrant of the buttock). The needle length setting was selected based on SCT measures as follows: 4 or 6 mm for SCT < 25 mm, 6 or 8 mm for SCT between 25 and 50 mm, and 8 or 10 mm for SCT > 50 mm. Injection pain was rated using a visual analog scale (VAS) at 5- and 40-minute postinjection and during two 24-day treatment periods. RESULTS: Thirty-eight patients with MS were evaluated. The mean SCT ranged from 15.5 mm in the upper outer quadrant of the buttocks to 29.2 mm in the thighs. The mean perceived pain on injection was below 3 for all the injection sites, at both time points (5 and 40 minutes) and during both 24-day evaluation periods. The mean VAS scores were significantly greater after 5 minutes of injection compared with that reported 40-minute postinjection during both 24-day treatment periods and for all the injection areas. Mean VAS measures at 5- and 40-minute postinjection significantly decreased during the second 24-day treatment period with respect to that reported during the first 24 SC injections for all injection sites. CONCLUSIONS: Our findings suggest that the adjustment of injection depth of SC GA autoinjector according to SCT of body injection areas is suitable to maintain a low degree of postinjection pain. Moreover, our results also may indicate that the use of needle lengths of 6 mm or shorter is appropriate with regard to injection pain for adult patients with MS with SCT < 50 mm.

Practical approach to self-administration of intravenous C1-INH concentrate: a nursing perspective.

At an international hereditary angioedema (HAE) expert meeting, results from a survey were used to guide discussion on how best to advise patients on self-administering intravenous C1 esterase inhibitor therapy. Treatment differences across Europe were highlighted, together with the practicalities of self-administration and useful resources for patients in the future. The international HAE experts noted an increase in the uptake of self-administration, with patients being trained by nursing staff. All patients who are willing and able to self-administer should be offered this treatment option and patients should be encouraged to treat attacks early. Several initiatives were suggested regarding support for patients who self-administer therapy, including a 24-hour helpline and home care agencies.

Changing practice for safe insulin administration.

Insulin is a life-saving medication but, if wrongly administered, it can cause death or severe harm. Errors in insulin administration are common, including the inappropriate use of intravenous syringes. We surveyed all clinical areas in our trust to identify types of syringes and needles available and how these were stored and distinguished from IV syringes. Based on these results, we developed recommendations to promote safety and good practice and are standardising insulin syringes throughout the trust.

Teaching adults SAFE medication management.

One in nine visits to the emergency department is the result of a drug-related adverse event and is possibly preventable (Zed et al., 2008). The rehabilitation nurse has the opportunity to teach adults a comprehensive medication management plan that will help reduce medication errors. Most patients have minimal medication experience or instruction; this article documents the effectiveness of using a S = systematic, A = accurate, F = functional, and E = effective instructional methodology to help patients learn about their medications. The methodology helps rehabilitation nurses teach the average patient about handling, absorbing, and implementing the information. This article presents detailed instruction about the salient points of the SAFE instructional program. Several figures, a checklist, and pictures demonstrate the techniques utilized. Prevention of medication errors is emphasized throughout.

Injectable disease-modifying therapy for relapsing-remitting multiple sclerosis: a review of adherence data.

Long-term adherence to disease-modifying therapy in relapsing-remitting multiple sclerosis (RRMS) is associated with improved patient outcomes, including a reduced risk of relapse and a better preserved quality of life. However, the unpredictable nature of the disease--even when it is being treated--may make it difficult to convince patients of the importance of treatment adherence. A number of studies have attempted to pinpoint factors that affect adherence. Nursing interventions that address some of these factors may improve adherence and, thus, the disease course for a variety of RRMS patients. This article summarizes literature that approximates the prevalence and impact of nonadherence and reviews factors identified in clinical trials that affect adherence. Nursing interventions that can improve adherence, including telephone counseling and motivational interview techniques, are also addressed.

Medication adherence is a partnership, medication compliance is not.

Medication adherence is a complex phenomenon. As individuals assume greater responsibility for, and participation in, decisions about their health care, teaching and supporting adherence behaviors that reflect a person's unique lifestyle are the essence of a clinician-patient partnership-and it is a perfect fit with assisted living communities and nursing practice. The notion of compliance is an outdated concept and should be abandoned as a clinical practice/goal in the medical management of patient and illness. It connotes dependence and blame and does not move the patient forward on a pathway of better clinical outcomes. This article discusses the differences between compliance and adherence, identifies purposeful and unintentional reasons for nonadherence, and describes assessment tools for adherence, medication effect, and self-management capacity. Drawing on the scholarly work of others, we introduce a model for medication adherence, the ACE-ME Model: assessment, collaboration, education, monitoring, and evaluation. This model draws on the strengths and science of nursing and engages nursing participation in the continuing evolution of adherence strategies. For purposes of clarity in discussing these concepts, we use the word patient in this article rather than the word resident-that is, the older adult living in an assisted living community.

Type 1 diabetes: identifying and evaluating patient injection technique.

A diagnosis of type 1 diabetes is life changing, both physically and psychologically. This transformation requires a solid rapport between the patient and the diabetic specialist team to ensure the condition is managed successfully. Nevertheless, all general ward nurses should be aware of issues surrounding insulin administration, and thus participate in opportunistic identification, evaluation and empowerment of such patients when hospitalized. Patients that may be mismanaging their condition, irrespective of the length of diagnosis, would then be identified and referred appropriately to the specialist nurse before unnecessary complications arise. It is, however, evident that such measures are overlooked as a result of other constraints. This article explores how the ward is an ideal environment for identifying and evaluating the practical, physical and psychological components of patient insulin administration, through a direct observational approach. Discussion surrounding contributory barriers pertaining to its neglect, proactive implications for practice that potentially could overcome such issues, along with the underpinning pathophysiology, are addressed. Nurses will thus gain a greater perspective concerning the significance of routinely evaluating the competencies of patients' insulin administration within the ward environment.