Infusional cancer chemotherapy: the critical role for nurses.
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Ambulatory Care↗
Biomedical subjects
C Moore
Publications and source records attributed to C Moore.
Administrative and technical support of ambulatory infusional cancer chemotherapy (ICC).
The term "infusion" is generally equated with the parental administration of drugs in a continuous mode of delivery over some unspecified length of time. However, in terms of applicability to this paper, ICC will imply a minimum of a 24-hour delivery schedule and may include four to 7-day schedules up to protracted infusions covering many weeks. Infusional Cancer Chemotherapy programs may employ a single drug used with or without concomitant radiation therapy or admixtures of two and three drugs. Sequential alternating infusions of drug admixtures are a common mode of treatment which allow maximization of dose with minimal side effects and toxicities. The ICC model is based on the tenet that the quality of the program is directly related to the safety, efficiency, and continuity of the care provided. The supporting structures of an ICC program are rooted in four administrative and technical requisites. Strategies for program support include: 1) a team to carry out the treatment approach and to provide instructional and physical care support; 2) pre-established guidelines, protocols, policies, and procedures by which to administer the program; 3) achievement of a safe and reliable means of venous access which promotes the outpatient status; 4) a source for an accurate and reliable ambulatory infusion device and delivery system. A referral base may encompass a wide geographical area, and the patient population may be varied as to ethnicity, intellectual capacity, age, level of activity, family support and life style, thus it is important to develop a program to support the majority of patients as opposed to the carefully selected few.
Ambulatory Care↗
Ambulatory infusional cancer chemotherapy: nursing role in patient management. The Cancer Center of Boston.
The role of nursing in infusional cancer chemotherapy (ICC) may vary depending on the practice setting. Nurses in free-standing centers and office practices perform many duties that nurses in other facilities may not, because of the lack of many of the supports that benefit hospitals with their multidepartmental and hierarchical structures. Nurses function collaboratively with physicians in the planning and the implementation of patient treatment. Patient-related nursing responsibilities include patient/family education, drug preparation and administration, patient assessment for treatment toxicity, recognition and management of complications related to the catheter or infusion device, and telephone triage. Other duties more removed from patient care might include inventory management, research data collection and management, quality assurance and improvement, compliance with regulatory issues, and a myriad of other responsibilities. The transition of patient care to the outpatient setting has broadened the scope of nursing to include nonpatient care responsibilities due to financial constraints brought about by health care reform, changes in reimbursement patterns, and overhead required to maintain and deliver quality patient care. As a result of nursing responsibilities, it becomes paramount that the aforementioned constructs for program support are in place and that all nurses are consistently trained and have a template to follow for patient treatment and management. Nursing ability to perform patient-related tasks should be proven by formal written and practical competencies repeated annually and as procedural changes are implemented. The paragraphs to follow suggest nursing management of patients receiving ICC using a model developed at The Cancer Center of Boston (TCC).
Ambulatory Care↗
Surveillance of the patient receiving infusional cancer chemotherapy: nursing role in recognition and management of catheter-related complications. The Cancer Center of Boston.
Surveillance of the patient on infusional cancer chemotherapy (ICC) is paramount to patient safety. Key to this issue is diligence in monitoring for complications of infusion catheters. Nursing knowledge and awareness are essential for the early detection of such complications. The following is a composite of the manifestations of commonly experienced catheter-related complications. The incidence, detection and management issues are presented from the perspective of 15 years experience with ICC at The Cancer Center of Boston (TCC).
Ambulatory Care↗
Application of ambulatory infusion devices in infusional cancer chemotherapy: a model for nursing management.
Optimal support of the patient receiving infusional cancer chemotherapy (ICC) in the home setting is partially dependent on the provision of an infusional device that offers minimal complexity and maximal reliability and safety. The selection of the appropriate device is vital to positive patient outcomes and to the comfort level of both patient and care providers. This article presents issues and considerations in the selection of infusion devices and the nursing role in the management of patients utilizing such devices. Aspects of nursing management are presented from the perspective of The Cancer Center of Boston (TCC) model.
Ambulatory Care↗
Quality assessment in in vivo NMR spectroscopy: IV. A multicentre trial of test objects and protocols for performance assessment in clinical NMR spectroscopy.
A multicentre trial of test objects and protocols for performance assessment in single volume and slice selective magnetic resonance spectroscopy (MRS) was conducted by the European Community Concerted Action on MRI and MRS. The trial assessed phosphorus and proton localisation techniques implemented on commercially available MR systems at ten sites in Europe. At each site, a number of parameters devised by the Concerted Action were measured using prototype test objects. Some of these parameters related to the quality of localisation and others to the overall performance of the spectrometer. Results were obtained for the ISIS, DRESS, STEAM, and PRESS sequences with a range of acquisition parameters, allowing evaluation of the assessment methodology and comparison of the efficacy of various implementations of these localisation techniques. The results of this trial have been important in the development of the Concerted Action's final recommendations for MRS performance assessment, and demonstrate that such assessment provides valuable information in the comparison of spectroscopy data from different sites and in the development of new localisation sequences, and provides a means of quality assurance in MRS.
Magnetic Resonance Spectroscopy↗
Children's comprehension of the distinction between want and need.
Two experiments examined the development of children's understanding of the difference between want and need. In experiment 1, children were tested on their knowledge that want represents an intrinsic desire whereas need represents an instrumental desire. Forty-five children between three and five years of age heard four stories in which one character encountered a problem, while another did not. A desirable object which could alleviate the problem was then introduced, and after both characters requested the object, the children were asked whether each character wants the object or needs it. Three-year-olds were unable to differentiate the two terms in such contexts, whereas four- and five-year-olds were significantly more likely to say that the character experiencing the problem needed the object, while the other wanted it. In experiment 2, 45 subjects between three and five years of age were tested on their understanding that a request employing need expresses a stronger desire than one employing want. Subjects were required to give an object to one of two characters, one of whom asked for it using need and the other using want. In this experiment, three-year-olds were equally likely to give the object to the character using want as to the one using need. Both four- and five-year-olds were significantly more likely to give the object to the character who used need. The results from these two experiments show that the understanding of the semantic and pragmatic difference between want and need develops at about four years of age.
Child Language↗
Pain prevention after vitreoretinal surgery.
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Anesthetics, Local↗
Multi-day fractionated administration schedule for paclitaxel.
PURPOSE: To establish the feasibility of fractionating paclitaxel administration by utilizing daily one-hour infusions for three, four or five days with dose escalating to determine the patterns of hematologic and non hematologic toxicities. PATTERNS AND METHODS: Forty patients received 87 courses of daily fractionated paclitaxel for three, four or five days; cycles were repeated every 21 days. Six patients received concomitant daily cisplatin. The median number of cycles delivered per patient was two with a range of one to six. RESULTS: Cumulative doses per cycle ranged from 120 mg/m2 to 250 mg/m2 with 25% of the cycles delivering 200 mg/m2 or more. Ten cycles (11.5%) were associated with dose limiting neutropenia (grade 3 [7 cycles]; grade 4 [3 cycles]). No hypersensitivity reactions were observed and no patient required cytokine support. No patient required hospitalization. CONCLUSIONS: Administering paclitaxel on a daily fractioned schedule in an ambulatory setting is logistically feasible; does not require premedication; is associated with a toxicity pattern similar to single day schedules (e.g. 24-hour or three-hour infusion); is capable of delivering a higher dose per cycle than published 96- or 120-hour infusion schedules; and could possibly be escalated to doses higher than 250 mg/m2 in carefully selected patients. The optimal dose rate for five-day multifractionated administration of paclitaxel is 40 to 50 mg/m2/d or a cumulative cycle dose of 200 to 250 mg/m2 and does not require cytokine usage. Adding cisplatin on a fractionated daily schedule may accentuate the neurotoxicity associated with both agents. A prospective comparison of four-day fractionated vs. four-day continuous infusional paclitaxel has been proposed as a randomized study to determine clinical differences in response, dose intensity and toxicity.
Antineoplastic Agents, Phytogenic↗
Biodegradable polyglyconate plates and screws: a histological evaluation in a rabbit model.
Within the zygomatic arch, bilateral osteotomies were performed on 20 adult male New Zealand white rabbits. These were stabilized in an anatomical position with polyglyconate acid plates and screws. At 3, 4, 6, 9, and 12 months, rabbits were killed and their zygomatic complexes removed en bloc. Specimens were serially sectioned for standard histological examination. Although no gross reactions were noted throughout the course of this investigation, histological reactions were brisk. At 3 months, particulate material was surrounded by a foreign body giant cell-type reaction. The quantity of foreign material appeared to decrease by 4 months, at which time the foreign body reaction was partially replaced by fibrous tissue. By 6 months, there was a thick periosteal scar at the osteotomy site with a few islands of persistent foreign material. These were primarily seen in small, irregular vesicular spaces surrounded by a large number of histiocytes with their characteristic foamy-cytoplasm. Although this foreign body reaction had subsided by 12 months, small foci of chronic inflammation still persisted.
Animals↗
Evaluation of residual clubfoot deformities using gait analysis.
Gait analysis was used to evaluate 15 patients who had previously undergone clubfoot surgery. Because six patients had had bilateral surgery, 21 feet had undergone previous clubfoot surgery. Three of the operated feet had no residual deformity. In the remaining 18 feet, the reason for referral was intoeing in 13, calcaneovalgus in three, hindfoot varus in one, and supination/adduction in one. Clinical assessment and information from the gait analysis were used to establish a treatment plan. Satisfactory treatment outcome was achieved in 13 patients, one result was unsatisfactory, and one result was undetermined.
Child↗
Confidential unit exclusion: the North London Blood Transfusion Centre's experience.
A 'Confidential AIDS Questionnaire' has been used at North London Blood Transfusion Centre (NLBTC) donor sessions since July, 1985. The aim of the questionnaire is to encourage self-exclusion by those donors whose behaviour puts them at risk of HIV infection. In a situation where such individuals cannot avoid donating they can indicate, in confidence, that their blood should not be used for transfusion. Since the introduction of this procedure, an average of 10 donors per month, who admitted relevant risk behaviour, have been permanently excluded and a number of prospective donors have excluded themselves when faced with the questionnaire. We have found the questionnaire to be well accepted by donors. It is a useful adjunct to routine donor selection and microbiological testing of donations in our efforts to minimize transfusion-transmitted infection.
Acquired Immunodeficiency Syndrome↗
Corynebacterium aquaticum septicaemia in a neutropenic patient.
Corynebacteria are a well recognised cause of sepsis in the immunocompromised patient. Corynebacterium aquaticum, however, is rarely seen in the clinical setting, being an environmental organism associated with fresh water. A septicaemic episode caused by this organism in a 74 year old neutropenic woman with an indwelling central venous catheter is reported. It is postulated that the source of the organism was untreated stored rainwater which she used for showering.
Aged↗
Degree of activation of the pituitary-testicular axis in early pubertal boys with constitutional delay of growth and puberty determines the growth response to treatment with testosterone or oxandrolone.
Early pubertal boys (testicular volume, 4-6 mL) with constitutionally delayed growth and puberty were randomized to 3 months of treatment after a baseline 12-h overnight hormone profile: group 1 (n = 5), daily placebo; group 2 (n = 5), 2.5 mg oxandrolone daily; or group 3 (n = 6), 50-mg testosterone monthly im injections. LH and GH profiles (15-min samples) were analyzed by peak detection (Pulsar), Fourier transformation, and autocorrelation. FSH and testosterone levels were measured hourly, and insulin, sex hormone-binding globulin, insulin-like growth factor-I, and insulin-like growth factor-binding protein-3 levels were determined at 0800 h. Multiple regression was used to analyze the response to treatment (growth) with respect to baseline features. Endocrine variability was marked. Profiles ranged from unreactive to well established LH pulsatility and adult testosterone levels. The areas under the curve (AUC) for LH, FSH, and testosterone ranged 10-fold (4.4-46.3 IU/L.h), 8-fold (7.9-63.4 IU/L.h), and 45-fold (3.6-161.7 nmol/L.h), respectively. The growth response was individually varied, but significantly increased 0-6 months in the active treatment groups. Age, testicular volume, and LH AUC interacted significantly (r2 = 0.95; P < 0.05). Allowance for these produced a highly significant treatment effect (P = 0.006). Age, testicular volume, LH AUC, and testosterone AUC, but not treatment, significantly increased growth by 0-12 months (r2 = 0.88; P < 0.05). We demonstrate a spectrum of activation of the reproductive axis despite tight clinical staging. This, and not GH status at treatment commencement, influenced the growth response.
Adolescent↗
Comfort care path strengthens support for terminally ill.
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Critical Pathways↗
False-positive and false-negative rates in meconium drug testing.
To determine the number of false-negative results produced by inefficient extraction of drugs from meconium, three published procedures were compared by using previously confirmed positive and negative meconium specimens. The methods were not equivalent in their ability to extract drugs from the matrix. To determine the number of false positives reported by the use of screen-only (unconfirmed) results, 535 screen-positive meconium specimens were subjects to confirmation by gas chromatography-mass spectrometry. Fifty-seven percent of the samples were confirmed positive for one or more of the drugs under investigation, showing that a false-positive rate as high as 43% may exist when unconfirmed screening results are used.
Amphetamines↗
Multiple birth concordance of street drug assays of meconium analysis.
To determine the prevalence of maternal drug usage in a mid-size midwestern city (population 250,000), we analyzed 1,175 consecutive meconium samples from the neonatal intensive care unit from March 1991 through December 1993. We focused on meconium assays from multiple births as a quality control method. Meconium specimens were analyzed using fluorescence polarization immunoassay (FPIA-Abbott Diagnostics) with confirmation done by gas chromatography/mass spectrometry (GC/MS). Cutoff concentrations of 5 ng/g were utilized for all analytes. A total of 151 samples (12.9%) tested positive. Cocaine-exposed neonates had the highest positive rate (63 or 5.4%), followed by marijuana (52 cases or 4.4%), cocaethylene (12 cases or 1%), and amphetamine (1 case or 0.1%). Nine patients (0.8%) had multiple drugs present. There were a total of 23 sets of multiple births (21 twins, 2 triplets); 20 sets of multiple births (42 patients) had concordance with all births testing negative. Three sets of twins had concordance in testing positive, with 1 twin testing positive for cocaine while the other twin tested positive for cocaine and marijuana. No absolute discordance of twins assays were noted. The rate of maternal drug use through measurement of meconium is about 12.95% in this mid-sized midwestern city. Twin studies provide an excellent method for verifying fetal drug exposure. The use of sets of multiple births provides a unique internal quality control mechanism in determining fetal drug exposure.
Female↗
1H-magnetic resonance spectroscopy of the left temporal and frontal lobes in schizophrenia: clinical, neurodevelopmental, and cognitive correlates.
Twenty eight schizophrenic patients and 20 normal volunteers underwent proton magnetic resonance spectroscopy (MRS) on the left temporal and frontal lobe regions. Male patients showed a significant reduction in frontal but not temporal n-acetylaspartate (an intraneuronally distributed metabolite) in comparison with either male controls or female patients; frontal choline was raised in male patients relative to these groups. Putative neurodevelopmental indices, including obstetric complications, family history of schizophrenia, and minor physical anomalies, proved unrelated to MRS resonances. However, multiple aspects of memory function in patients were related to temporal but not frontal creatine, a pattern that was not apparent among controls. These MRS findings complement some previous structural MRI studies and much clinical and epidemiological evidence of important gender differences in schizophrenia. The findings also suggest that memory dysfunction in patients with schizophrenia may be associated with a particular pattern of temporal lobe metabolism on MRS.
Adult↗