ABSTRACT
Although there has been a significant increase in the availability and use of oral chemotherapeutic agents, the guidelines around their safe handling are still evolving. Although oral chemotherapy is associated with ease of administration, it has the same exposure risks to health care practitioners, patients, and their caregivers as intravenous formulations, and because it is administered in the home, to the families of patients. However, the general misconception appears to be that exposure risk is low and therefore oral chemotherapeutic agents present little risk and are safer to handle. In a series of three roundtable meetings, a team of international pharmacists from North America and Europe reviewed existing guidelines and identified gaps in recommendations that we believe are important for safe handling. The present article is a compilation of these gaps, especially applicable to manufacturers and distributors, storage and handling, and patient education regarding safe handling. These recommendations, on the basis of our experience and of best practices, provide an international perspective and can be adapted by institutions and practices for development of standardized procedures specific to their needs for the safe handling of oral chemotherapeutic agents.
Subject(s)
Autistic Disorder/complications , Behcet Syndrome/diagnosis , Fever/microbiology , Hepatomegaly/microbiology , Histoplasmosis/diagnosis , Oral Ulcer/etiology , Splenomegaly/microbiology , Vision Disorders/etiology , Vitamin A Deficiency/diagnosis , Adolescent , Behcet Syndrome/drug therapy , Diagnosis, Differential , Feeding and Eating Disorders of Childhood/etiology , Female , Histoplasmosis/drug therapy , Humans , Infant , Male , Recurrence , Treatment Outcome , Vision Disorders/complications , Vision Disorders/therapy , Vitamin A Deficiency/complications , Vitamin A Deficiency/therapyABSTRACT
Factor VII (FVII) plays a critical role in the initiation of blood coagulation, and patients with dysfunctional or reduced levels of this protein are susceptible to mucosal bleeding. There is poor correlation between the clinical presentation and the phenotypic data; and in cases of a mild bleeding tendency, mild to moderate reductions in both FVII antigen and activity may be overlooked. The prevalence of FVII deficiency may therefore be underestimated. Polymorphic differences throughout the FVII gene are associated with variations in plasma FVII antigen and activity levels. This study highlights the significance of mild FVII deficiency, and examines the importance of seven previously published polymorphisms in such patients.