Evaluation of oncology infusion pharmacy practices: A nationwide survey.

PURPOSE: Oncology care continues to evolve at a rapid pace including provision of infusion-based care. There is currently a lack of robust metrics around oncology infusion centers and pharmacy practice. The workgroup completed a nationwide survey to learn about oncology-based infusion pharmacy services offered. The objective was to highlight consistent, measureable oncology-based infusion pharmacy metrics that will provide a foundation to describe overall productivity including emphasis on high patient-safety standards. METHODS: A nationwide survey was developed via a workgroup within the Vizient Pharmacy Cancer Care Group beginning in April 2019 and conducted electronically via the Vizient Pharmacy Network from September to November 2020. The survey was designed to capture a number of key metrics related to oncology-based infusion pharmacy services. RESULTS: Forty-one sites responded to the survey. Responses highlighted hours of operation (median = 11.5), number of infusion chairs (median = 45). Staffing metrics included 7.1 pharmacist full-time equivalent (FTE) and 7.6 technician FTE per week. 80.5% of sites had cleanrooms and 95.1% reported both hazardous and nonhazardous compounding hoods. 68.3% of sites reported using intravenous (IV) technology, 50.0% measured turnaround time, and 31.4% prepared treatment medications in advance. CONCLUSION: There was variability among oncology infusion pharmacy practices in regard to survey responses among sites. The survey results highlight the need for standardization of established productivity metrics across oncology infusion pharmacies in order to improve efficiency and contain costs in the changing oncology landscape. The survey provides insight into oncology infusion pharmacy practices nationwide and provides information for pharmacy leaders to help guide their practices.

Restraining orders among victims of intimate partner homicide.

BACKGROUND: Most intimate partner homicides (IPHs) follow a long history of violence and occur while the victim is ending the relationship. Restraining orders are a common legal recourse by which to seek protection from an abusive partner. This study expands on prior research by examining the restraining order history of IPH victims by characteristics of the victim, assailant, and homicide. METHODS: State-wide databases containing information about restraining orders and homicides were linked, and bivariate and multivariate statistics were then calculated to identify differences between IPH victims who had and had not been issued a restraining order. RESULTS: About 11% of 231 women killed by male intimates had been issued a restraining order. About one-fifth of the female IPH victims who had a restraining order were killed within 2 days of the order being issued; about one-third were killed within a month. Nearly half of those with a restraining order had been protected by multiple orders. Victims killed in a shared residence (versus elsewhere) had lower odds of having a restraining order, whereas victims from rural (versus urban) counties, married (versus dating) victims, and Latino (versus non-Latino) victim-offender dyads had higher odds of having a restraining order. The type of weapon used was not associated with whether the victim had been under the protection of a restraining order. CONCLUSIONS: Most female IPH victims did not have a restraining order when they were killed. Further research is needed to determine whether restraining orders protect against IPH and, if they do, on how to increase their utilization.

Effectiveness of third-generation chemotherapy on the survival of patients with advanced non-small cell lung cancer in Norway: a national study.

BACKGROUND: To investigate whether the introduction of modern third-generation chemotherapy was associated with survival benefits in a national population of patients with advanced non-small cell lung cancer (ANSCLC) and to explore geographical and temporary variations in the utilisation of chemotherapy. METHODS: All patients with ANSCLC in the Cancer Registry of Norway during 1994-2005 were included. Using sales of vinorelbine as an indicator for chemotherapy, annual county utilisation rates were calculated. Survival before and after the general introduction of vinorelbine and associations between survival and variations in utilisation in counties were investigated. In a subgroup, the predictors of having received chemotherapy were explored. RESULTS: Of 24 875 registered patients with lung cancer, 13 757 had ANSCLC. The annual utilisation of the indicator drug in Norway increased from 3.7 to 184.2 g (1998-2005). Median survival increased from 149 to176 days (p<0.001). The adjusted hazard ratio (HR) for a diagnosis after the introduction was 0.93 (95% CI 0.88 to 0.99). County utilisation rates of vinorelbine (increments of 100 mg/1000 inhabitants) were inversely associated with the risk of death (HR 0.84, 95% CI 0.73 to 0.98). County of residence predicted chemotherapy utilisation with odds ratios in the range 0.13 (95% CI 0.1 to 0.19) to 1.04 (95% CI 0.64 to 1.69), a county with traditionally high utilisation as reference. CONCLUSION: Utilisation of third-generation chemotherapy was associated with slightly increased survival of patients with ANSCLC. Geographical and temporal differences in utilisation indicate variable quality of delivered care.

A randomized phase III trial comparing standard and high-dose pemetrexed as second-line treatment in patients with locally advanced or metastatic non-small-cell lung cancer.

BACKGROUND: This phase III randomized trial compared pemetrexed 500 mg/m(2) (P500) with pemetrexed 900 mg/m(2) (P900) to determine whether higher dosing benefits non-small-cell lung cancer (NSCLC) patients as second-line therapy. PATIENTS AND METHODS: Patients with locally advanced or metastatic NSCLC, previously treated with platinum-based chemotherapy, were randomly assigned to receive i.v. P500 or P900 every 3 week. RESULTS: Accrual was terminated with 588/600 patients enrolled because an interim analysis indicated a low probability of improved survival and numerically greater toxicity on the P900 arm. P900 patients were permitted to continue treatment at P500. No statistical difference was observed between the treatment arms (P500 versus P900) for median survival {6.7 versus 6.9 months, hazard ratio [HR] = 1.0132 [95% confidence interval (CI) 0.837-1.226]}, progression-free survival [2.6 versus 2.8 months, HR = 0.9681 (95% CI 0.817-1.147)], or best overall tumor response [7.1% versus 4.3% (P = 0.1616)]. The incidence of drug-related grade 3/4 toxicity was typically <5% on both treatment arms, but was numerically higher on the P900 arm for most toxicity categories. CONCLUSIONS: P900 did not improve any efficacy measure over P500. P500 i.v. every 3 week remains the standard pemetrexed dose for second-line treatment of platinum-pretreated advanced NSCLC.

Acute and subchronic oral toxicity studies in rats of a hydrolyzed chicken sternal cartilage preparation.

Two acute and subchronic oral toxicity studies were conducted in rats to evaluate safety of a patented preparation of hydrolyzed chicken sternal cartilage (BioCell Collagen II) containing collagen type II, chondroitin sulfate, and hyaluronic acid. In the acute oral toxicity study, five males and five females of Sprague-Dawley rats were administered a single dose of 5000 mg of the test product per kg body weight and observed for 14 days. All animals survived and exhibited normal body weight gain throughout the study. Macroscopic necropsy examination conducted on day 15 revealed no gross pathological lesions in any of the animals. In the subchronic study, Sprague-Dawley rats (40 males, 40 females) were divided into four same-sex groups (10 animals/group). Animals in each group were administered daily either 0, 30, 300 or 1000 mg of the test product per kg of body weight for over 90 days. All animals survived and showed no significant changes in their body weights and histopathology. Although some differences were observed between the treated and control animals in several parameters, they were generally not dose-related or considered to be of toxicological significance. In conclusion, the results from the two oral toxicity studies with male and female young adult rats indicated that the test preparation from hydrolyzed chicken sternal cartilage collagen (BioCell Collagen II) was well tolerated at all four doses tested.

Palliative chemotherapy beyond three courses conveys no survival or consistent quality-of-life benefits in advanced non-small-cell lung cancer.

This randomised multicentre trial was conducted to establish the optimal duration of palliative chemotherapy in advanced non-small-cell lung cancer (NSCLC). We compared a policy of three vs six courses of new-generation platinum-based combination chemotherapy with regard to effects on quality of life (QoL) and survival. Patients with stage IIIB or IV NSCLC and WHO performance status (PS) 0-2 were randomised to receive three (C3) or six (C6) courses of carboplatin (area under the curve (AUC) 4, Chatelut's formula, equivalent to Calvert's AUC 5) on day 1 and vinorelbine 25 mg m(-2) on days 1 and 8 of a 3-week cycle. Key end points were QoL at 18 weeks, measured with EORTC Quality of Life Questionnaire (QLQ)-C30 and QLQ-LC13, and overall survival. Secondary end points were progression-free survival and need of palliative radiotherapy. Two hundred and ninety-seven patients were randomised (C3 150, C6 147). Their median age was 65 years, 30% had PS 2 and 76% stage IV disease. Seventy-eight and 54% of C3 and C6 patients, respectively, completed all scheduled chemotherapy courses. Compliance with QoL questionnaires was 88%. There were no significant group differences in global QoL, pain or fatigue up to 26 weeks. The dyspnoea palliation rate was lower in the C3 arm at 18 and 26 weeks (P<0.05), but this finding was inconsistent across different methods of analysis. Median survival in the C3 group was 28 vs 32 weeks in the C6 group (P=0.75, HR 1.04, 95% CI 0.82-1.31). One- and 2-year survival rates were 25 and 9% vs 25 and 5% in the C3 and C6 arm, respectively. Median progression-free survival was 16 and 21 weeks in the C3 and C6 groups, respectively (P=0.21, HR 0.86, 95% CI 0.68-1.08). In conclusion, palliative chemotherapy with carboplatin and vinorelbine beyond three courses conveys no survival or consistent QoL benefits in advanced NSCLC.

Buying a handgun for someone else: firearm dealer willingness to sell.

OBJECTIVE: To examine firearm dealer willingness to sell when a handgun is being purchased for another person. US law requires a background check of the purchaser but not the end user of a firearm. SUBJECTS AND METHODS: A total of 120 handgun dealers (six from each of the 20 largest US cities with 10 or more dealers) participated in telephone interviews. Dealers within each city were randomly assigned to a male or female interviewer and then randomly assigned to one of three purchase conditions-when the consumer said that the handgun was for him/herself, a gift for a girl/boyfriend, or for a girl/boyfriend "because s/he needs it". RESULTS: Most dealers were willing to sell a handgun regardless of the end user (self: 87.5%; gift: 70.8%; "need": 52.5%). Multivariate analyses indicate that dealers in the Midwest, South, and West were more willing to sell than those in the Northeast (adjusted odds ratio (AOR) = 21.30, 18.74, and 8.93, respectively) and that willingness to sell is lower when the sale would be illegal, that is, under the "need" condition (AOR = 0.20). CONCLUSIONS: and implications: Dealers are in a position to exercise judgment when a customer is explicit about buying a firearm for someone else. Some appeared willing to ignore or sidestep relevant information even when told that the end user was prohibited from purchasing a firearm him/herself. In the absence of federal handgun registration, which would track ownership changes, resources with which to conduct compliance checks (for example, as are conducted to identify retailers who sell tobacco or alcohol to under-age persons) seem warranted.

The nature of newspaper coverage of homicide.

OBJECTIVES: Previous research has shown that some homicides are more likely than others to receive newspaper coverage (for example, homicides by strangers). The present investigation examined whether, once the decision has been made to report on a homicide, the nature of the coverage (that is, how much visibility is given to a story, what information is included, and how a story is written) differs according to two key variables, victim ethnicity, and victim-suspect relationship. SETTING: Los Angeles, California (USA). METHODS: Homicide articles from the 1990-94 issues of the Los Angeles Times were stratified according to the predictors of interest (victim ethnicity and victim-suspect relationship) and a sample was drawn. Data that characterized two primary aspects of newspaper coverage, prominence and story framing (including background information, story focus, use of opinions, story tone, and "hook" or leading introductory lines) were abstracted from the articles. Descriptive statistics and cross tabulations were generated. Multivariate analyses were conducted to examine the predictive value of victim ethnicity and victim-suspect relationship on the nature of the newspaper coverage. RESULTS: Newspaper coverage of homicide was generally factual, episodic, and unemotional in tone. Victim-suspect relationship, but not victim ethnicity, was related to how a story was covered, particularly the story frame. Homicides by intimates were covered consistently differently from other types of homicides; these stories were less likely to be opinion dominated, be emotional, and begin with a "hook". CONCLUSION: Victim-suspect relationship was related to the nature of coverage of homicides in a large, metropolitan newspaper. Given the agenda setting and issue framing functions of the news media, these findings have implications for the manner in which the public and policy makers perceive homicides and, consequently, for the support afforded to various types of solutions for addressing and preventing violence.

Lipohemarthrosis

It describes the CT, MRI, and radiographic appearance of lipohemarthrosis of the elbow, hip, knee, and shoulder joints.

Musculoskeletal radiology of fractures

It presents radiologic images of fractures of the skull, chest, spine, shoulder, humerus, elbow, radius and ulna, hand and wrist, hip and pelvis, femur, knee, tibia and fibula, and foot and ankle, fracture eponyms, and fractures by profession.

The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of chemotherapy effects in some major tumour types--summary and conclusions.

This report by The Swedish Council on Technology Assessment in Health Care (SBU) reviews, classifies, and grades the scientific literature on cancer chemotherapy in some major tumour types, describes the practice of chemotherapy in Sweden, compares practice with scientific knowledge, and analyses the costs and cost-effectiveness of chemotherapy. The report is intended primarily for decision-makers at various levels, both practitioners and administrators. It is also of interest for the medical profession. The extensive body of scientific literature was reviewed according to strict criteria that reflected the scientific weight of the literature. Sixteen experts representing different disciplines (oncology, surgery, internal medicine, health economy and quality of life research) participated in the literature review. Each section was discussed within the project group and was reviewed by at least one, but usually two international researchers. Additional input was provided by national experts representing different scientific disciplines. For the final evaluation to be as close to the objective truth as possible, a concerted effort was made to guarantee objectivity and thorough assessment of current knowledge about the effects of chemotherapy on the selected cancers. The tumour types selected for this assessment include firstly those types where three investigations had shown an increased use of chemotherapy in Sweden during the latest decade. These were non-small cell lung cancer (NSCLC), gastric cancer, pancreatic cancer, colorectal cancer and urinary bladder cancer. Secondly, the two tumour types comprising the greatest number of patients treated with chemotherapy in Sweden, breast cancer and haematological malignancies, were included. Among the haematological malignancies, the most prevalent ones, acute myeloid leukaemia (AML), chronic lymphocytic leukaemia (CLL), Hodgkin's disease (HD), aggressive non-Hodgkin's lymphoma (NHL) of the large B-cell type and indolent NHL of follicular type were evaluated. These constitute about 75%, of all haematological malignancies. Thirdly, ovarian cancer was included since chemotherapy has been extensively used and since, at the time of the planning of this overview, a group of very expensive drugs, the taxanes, had preliminarily shown promising results. A wealth of scientific literature has been published on cancer therapy. The review presented in this report is limited to scientific studies judged to be important for evaluating chemotherapy efficacy. Assessments of the content and quality of these studies, and a critical summary of the results in all stages of the selected tumours, have never before been attempted in this way. However, similar comprehensive overviews of certain stages of the tumours have previously been made. These overviews were also critically evaluated. Totally 1,496 studies involving 558,743 patients were reviewed. The survey of practice of chemotherapy use involved all departments of surgery, urology, gynaecology, internal medicine including haematologic units, pulmonary medicine and general and gynaecologic oncology at 16 hospitals in two health care regions in Sweden, covering 39% of the Swedish population. During the 4 weeks of the survey, all patients with the diagnoses concerned who received chemotherapy were registered. The study included 1,590 patients. The working group's general conclusions are summarised in the following points: The literature on the effects of chemotherapy is extensive. Chemotherapy has a well-documented role in the curative and palliative treatment of patients with several types of cancer. The use of chemotherapy is of utmost importance for the possibility of cure in certain tumour types. In other tumours, chemotherapy increases the possibility of cure when added to local and regional treatments, particularly surgery. In the instances of no possibility of cure, chemotherapy may to a variable extent improve both patient survival and well-being. In Sweden chemotherapy is largely used in accordance with that documented in the scientific literature. The extent of both over- and under-treatment seems to be limited but cannot be excluded at the individual patient level. The literature-based knowledge is scientifically of lower quality in the most chemotherapy sensitive tumours than in tumours showing more limited sensitivity. In the more sensitive tumours, positive effects on a symptomatic stage and survival were seen several decades ago. In those days, clinical treatment studies did not fulfil the current high quality requirements. Small life-prolonging effects of chemotherapy are sometimes very well documented in large, high quality scientific studies. Some of these s

A systematic overview of chemotherapy effects in non-small cell lung cancer.

A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are described separately (Acta Oncol 2001; 40: 155-65). This overview of the literature on chemotherapy for non-small cell lung cancer (NSCLC) is based on 53 scientific publications including six meta-analyses based on 65 prospective randomised trials comprising 15,607 patients and an additional 32 prospective randomised studies including 8,902 patients. The conclusions reached can be summarised into the following points: In stage IIIB-IV disease, published data demonstrate that cisplatin-based chemotherapy confers a modest, median 1.5-3 months, prolongation of survival. The closely related compound carboplatin seems to provide similar effects. Randomised studies indicate symptomatic relief and improvement of indices of quality of life (QoL) for patients who receive platinum-based combination chemotherapy or single drug therapy with more recent compounds. Data supporting the use of chemotherapy are not available for patients in poor general condition (WHO performance status 3 4) and evidence is limited for elderly patients (above 70-75 years). Platinum-based chemotherapy can be recommended for selective use in routine care of advanced NSCLC although patients should be encouraged to participate in controlled clinical trials to further elucidate the role of chemotherapy in advanced disease. In advanced disease, recent data suggest that the newer agents gemcitabine, paclitaxel, irinotecan and vinorelbine, in combination with cisplatin, provide an additional survival benefit compared with earlier cisplatin-based regimens. Furthermore, paclitaxel, docetaxel and vinorelbine as single agents seemingly provide a survival benefit over supportive care alone comparable to that of older cisplatin-based combinations. A standard regimen for advanced disease cannot yet be defined. Until more data are at hand, it is recommended to be platinum-based and preferably combined with one of the newer agents. At progression after platinum-based chemotherapy for advanced disease, limited data indicate a small survival benefit from docetaxel over supportive care alone. Such second-line chemotherapy of advanced disease can be recommended for selected patients but should preferably be confined to controlled clinical trials. In stage III disease, published data show that induction cisplatin-based chemotherapy before radical radiotherapy modestly prolongs long-term survival and lowers the incidence of distant metastases compared with radiotherapy alone. Furthermore, published data show that concurrent chemo- and radiotherapy with cisplatin or carboplatin may enhance local control and long-term survival. Chemotherapy in this setting can be recommended for selected patients but treatment should preferably be given within a controlled clinical trial. In stage IIIAN2 disease, data from pilot studies demonstrate that surgery after induction chemotherapy is feasible. Pathologically complete remissions have been confirmed in 10-20% of treated patients. Two small randomised studies demonstrate a significant survival advantage for induction chemotherapy followed by surgery compared with surgery alone. Induction chemotherapy can be recommended for selected patients but treatment should preferably be given within a controlled clinical trial. The superiority of induction chemotherapy plus surgery compared with combined chemotherapy and radical irradiation has not been proven in a randomised trial but currently such studies are under way. In the adjuvant setting, published data suggest that cisplatin-based chemotherapy after radical surgery may increase five-year survival from around 50% by a further 5% but the confidence interval for this estimate is too wide for firm conclusions. Large-scale prospective randomised trials are under way to resolve this important issue and adjuvant chemotherapy is, thus, not recommended for routine treatment.

Handgun sales, beer sales, and youth homicide, California, 1972-1993.

Whether regulating access to firearms and alcohol will reduce violent injuries is an important policy question. Empirical answers are difficult to obtain because only observational data are available. The present study estimated the association of firearm sales and alcohol sales with subsequent homicides, after adjusting statistically for potential confounders (e.g., unemployment rates) using California data from 1972 through 1993. Handgun sales and beer sales were lagged one year and used to explain variation in the homicides of Californians (e.g., 1990 sales were used to explain 1991 homicides). Differences across population groups were investigated, with a focus on 15- to 34-year-olds, the highest risk age group. Even when taking potential confounders in the base population into account, beer sales and handgun sales generally are associated positively one year later with homicide, particularly among young men. Reducing beer sales may reduce homicides. And, although they represent a small fraction of existing firearms, regulating the number of handguns sold may reduce the number of homicides.

Atypical adult non-calcified pilomatricoma.

We present a rare case of a non-calcified pilomatricoma in a 67-year-old man. This tumor was extremely large in size, and its location, in the lower extremity, was very unusual. The clinical, radiographic, and histopathological features are described in detail. The role of magnetic resonance imaging (MRI) in the diagnosis of this entity is discussed. Definite internal reticulations and septations were observed. A possible explanation for this observation is that the high signal intensity reticulations may represent edematous stroma surrounding basaloid cells.

Young guns: an empirical study of persons who use a firearm in a suicide or a homicide.

OBJECTIVES: The purpose of this investigation was to identify population groups at highest risk of using a firearm in a fatal incident. SETTING: Los Angeles County (California, USA). METHODS: Data were gathered from vital statistics reports and law enforcement records on the characteristics of suicide victims (n = 4799) and homicide suspects (n = 5369) from 1990 through 1994. Logistic regression was used to identify characteristics of the actor/perpetrator that were associated with firearm use. RESULTS: Persons less than 21 years old and males were more likely to use a firearm to kill themselves or someone else. Even when their other demographic attributes and characteristics of the incident itself were taken into consideration, persons under the age of 18 were substantially more likely than those 21 or more years old to use a firearm in the commission of a homicide (adjusted odds ratio = 2.59). Asians were less likely than white people to use a firearm in the commission of a suicide, whereas black people, Hispanics, and Asians were more likely than whites to use a firearm in the commission of a homicide. CONCLUSIONS: The US enacts and enforces some policies differentially by age. These data support the idea that such an approach may be warranted when addressing fatalities associated with the use of a firearm. Of particular interest, given minimum age requirements for firearm purchases, is the source of the weapons themselves.

Mortality among young immigrants to California: injury compared to disease deaths.

The authors "investigated adolescent and young adult immigrants' risk of death due to disease and injury.... The death certificates of 15- to 34-year-old California residents who died from 1989 through 1993 comprised the study population. Disease and injury deaths were identified using ICD-9 codes on the California Master Mortality data files. Frequencies and gender-standardized rates and risk ratios were calculated by nativity (U.S., non-U.S.) and by ethnicity and nativity." The results suggest that "young immigrants, at least in terms of mortality, do not constitute a burden in that they are at lower or similar risk of death than U.S.-born youth."

News media coverage and the epidemiology of homicide.

OBJECTIVES: This study assessed how newspaper coverage of homicides corresponds to the epidemiology of homicide. METHODS: Stories in the Los Angeles Times about homicide (n = 2782) were compared with the homicides that occurred in Los Angeles County from 1990 through 1994 (n = 9442). The generalized linear model assessed how victim, incident, and suspect characteristics related to coverage. RESULTS: Even when multiple variables were taken into account, some homicides (those with female, child, or elderly victims; those in which the suspect was a stranger to the victim; those in wealthier neighborhoods) received more coverage and others (those with Black or Hispanic victims or victims with less than a high school education; those committed with nonfirearm weapons; those in which the suspect was an intimate of the victim) received less coverage than expected. CONCLUSIONS: Some homicides are more newsworthy than others. Potential implications of not providing the public with representative data are discussed.