Oral Chemotherapy: Safe Handling in the Home

Background: According to the National Institute for Occupational Safety and Health (2016), oral anticancer agents (OAC) are hazardous drugs (HD) and require the same safe handling interventions in the home setting as in controlled health care environments. The use of a safe handling checklist for OAC administration is a way nurses can provide safe handling education to patients and caregivers and assess for understanding and competency for critical tasks. Effective home management strategies outlining caregiver protections, proper storage, administration of OACs, spill clean-up, and waste disposal could reduce exposure risks to toxic agents. Objective: To present a safe-handling checklist and TIP sheet for health care providers to use when teaching patients and caregivers oral chemotherapy administration to prevent HD contamination. Methods: The author conducted a literature search in the CINAHL, Cochrane Library, and PubMed databases for research on the risks associated with OAC handling by patients and caregivers and to discover practical ways to address steps in the safe-handling process in a home environment. Findings: There is a need to develop standard work to ensure comprehensive patient and caregiver education with OAC handling. A checklist for patient education is a useful reference for nurses when teaching patients

USP\u3c800\u3e Compliance: A Hazardous Drug Safe-Handling Quality Improvement Project for Ambulatory Care Infusion Nurses

Problem: The U.S. Pharmacopeia (USP, 2016) Convention Chapter 800: Hazardous Drugs: Handling in Healthcare Settings took effect on December 1, 2019. According to Polovich and Olsen (2017), The implementation of the USP \u3c800\u3e Standards. will represent an important step forward to protect nurses and other potentially exposed healthcare workers (HCWs): (p.1). Context: The Doctor of Nursing Practice (DNP) project implemented a hazardous drug (HD) safe-handling personal protective equipment (PPE) toolkit in accordance to USP \u3c800\u3estandards and hospital policies at an ambulatory cancer infusion center to improve nurses\u27 adherence with PPE use. Interventions: The project consisted of (a) a safe-handling PPE toolkit, (b) a PPE observation tool, (c) an expert panel discussion, (d) a nurses\u27 skills session, (e) an online safe-handling survey, (f) an HD safe-handling checklist, and (g) a performance dashboard. Measures: Outcome measures included a (a) 90% or higher compliance rate with PPE use during hazardous drug administration and (b) sustained adherence to USP \u3c800\u3e standards and hospital policies by February 1, 2020. Results: A 90% compliance rate for PPE use during hazardous drug administration was achieved by February 1, 2020. Sustainability is at risk due to the COVID-19 pandemic and global PPE shortages, however, nurses were able to adapt to new processes to conserve vital resources and will be reassessed in six months. Conclusions: A systems-thinking approach to the implementation of USP\u3c800\u3e was successful in improving compliance and adherence to PPE use among ambulatory care infusion nurses

The Autobiographical Pack

This paper seeks to revisit and revise the autobiographical pact in light of current work done on companion species, especially dogs, by emphasizing that Donna Haraway’s foregrounding of becoming together and the importance of touch troubles Philippe Lejeune’s foundational concept. Lejeune postulates that the autobiographical pact presupposes that the name on the title page of a text matches the name of the author and, in so doing, assumes that the text is written and that the author is singularly constituted and human. But the co-constituting of canines and human beings as companion species call for a different theoretical approach to life narrative that will embody how co-constituting serves to get and have a life lived mutually as well as one which deemphasizes seeing in favor of the communicative touch that is central to the bond dogs and humans enjoy. The messiness of daily, tactile co-constituting challenges the distanced, looking at texts in ways that favors foregrounding mutual exchange via the touching of bodies, including their emissions, and zoe, the smallest form of life often considered as below the threshold of livable existence. To get at companion species co-constituting, I purpose that we revision and revisit the archives of our daily lives with companion species to think about how touch and the exchange of zoe between and among species necessitate a rewriting of touchstone life experiences, such as birth or death, and the narratives within which we have traditionally encased them. To do so would challenge the stranglehold of the visual on autobiographical theory and practice but it would also mean a reconceptualizing of theoretical constructs such as Lejeune’s autobiographical pact, which presupposes an easily negotiated correspondence among reader, author, and publisher with the reader’s experience paramount. However, the theory of the autobiographical pack displaces the reader in favor of co-constituting so that the reader must renegotiate his relationship to the pack

USP \u3c800\u3e Compliance: A Hazardous Drug Safe Handling PPE Toolkit for Infusion Nurses

Problem: Safety concerns have existed for more than 40 years about how hazardous drug (HD) exposure contributes to long- and short-term adverse health outcomes for healthcare workers (HCWs). Careless handling may cause toxic residues to infiltrate hospital environments and patient care areas, and can even be traced to patients’ homes. New government regulations will require healthcare organizations to minimize exposure risks to HCWs by fully implementing the U.S. Pharmacopeia (USP) Convention Chapter 800: Hazardous Drugs: Handling in Healthcare Settings (USP, 2016) on December 1, 2019. According to Polovich and Olsen (2017), “The implementation of the USP \u3c800\u3e Standards will represent an important step forward for nurses and other potentially exposed HCWs”. Context:The proposed Doctor of Nursing Practice (DNP) project will implement an HD safe-handling personal protective equipment (PPE) toolkit at an ambulatory cancer infusion center to improve nurses’ adherence with the USP \u3c800\u3e Standards and hospital policies addressing PPE use when handling, administering, and disposing of HD. Proposed Interventions: Interventions for this project will consist of (a) an HD safe-handling PPE toolkit for infusion nurses, (b) a PPE observation tool, (c) an expert panel discussion, (d) a nurses’ skills session, (e) safe-handling adherence between observation and self-assessment survey, (f) hazardous drug administration safe handling peer-to-peer checklist, and (g) a performance dashboard to display progress. Proposed Outcome Measures: Outcome measures include (a) 90% or higher compliance rates with PPE use and (b) sustained adherence to USP \u3c800\u3e Standards and hospital policies for safe HD handling to 100% by February 2020

Factors Influencing Training and Human Resource Development Certificate Programs in the United States.

The objectives of this study were to: describe training and human resource development (T&D/HRD) certificate programs in the United States, compare the demographic characteristics of certificate programs among academic groupings, and to determine the perceived degree of influence of various factors on the development of T&D/HRD certificate programs. A researcher designed questionnaire was administered to the population of U.S. institutions offering T&D/HRD certificate programs identified by the American Society for Training and Development (ASTD) 1990 Academic Directory. An 84.2% rate of return was received from the respondents in this study. Findings indicated that T&D/HRD certificate programs are more likely to be located in communities with an industrial base consisting of business services, finance, insurance, banking, or manufacturing. Almost two-thirds of the institutions offering T&D/HRD certificate programs offer graduate credit for program participants. When comparing the academic groupings of T&D/HRD certificate programs, more programs were found in business departments than in other departments. Most (59.4%) T&D/HRD certificate programs emphasize trainer roles and competencies equally. Factor analysis was used to determine the perceived influence of 53 factors that impact the development of T&D/HRD certificate programs. The top three factors perceived as having the most influence were: changed work environments, career development, and clientele of certificate programs

Hazardous Drug Administration in the Home Setting: Reducing Exposure Risks

Hazardous drug (HD) administration used to be contained in controlled-healthcare settings, however, the introduction of HDs for home administration has become a growing area of concern for home health agencies. The objectives of the Clinical Nurse Leader (CNL) project aims to improve homecare nurses\u27 knowledge of HDs and improve competency with personal protective equipment (PPE). The microsystem provides short-term homecare services for acute and chronically-ill patients. One team leader, two home infusion coordinators, and twelve registered infusion nurses participated in learning about exposure risks and PPE use with HD administration. Kotter\u27s 8-step change theory was used to develop behavior change strategies necessary to create a connection between emotion and the need for change. Education materials and PPE kits were developed specifically to address the needs of home care nurses and their patients. Teaching aids were developed with a health literacy team that included reviews by nurses, patients, and education experts. A literature review in the CINAHL, Cochrane Library, and PubMed databases provided articles rich with content about safe-handling practices withHD administration and exposure protection strategies. Themes that emerged from the project for future consideration included tracking exposed workers through a national database and improving data collection via electronic health records (EHR) used by homecare nurses at the point of care. While the goal of the project was to improve and sustain nurses\u27 knowledge and competency with PPE use to 95%, more education and hands-on practice will be required to achieve this worthy goal

Intervention with citrus flavonoids reverses obesity and improves metabolic syndrome and atherosclerosis in obese Ldlr \u3csup\u3e/\u3c/sup\u3e mice

Copyright © 2018 Burke et al. Obesity and its associated metabolic dysfunction and cardiovascular disease risk represent a leading cause of adult morbidity worldwide. Currently available pharmacological therapies for obesity have had limited success in reversing existing obesity and metabolic dysregulation. Previous prevention studies demonstrated that the citrus flavonoids, naringenin and nobiletin, protect against obesity and metabolic dysfunction in Ldlr/ mice fed a high-fat cholesterol-containing (HFHC) diet. However, their effects in an intervention model are unknown. In this report, we show that, in Ldlr/ mice with diet-induced obesity, citrus flavonoid supplementation to a HFHC diet reversed existing obesity and adipocyte size and number through enhanced energy expenditure and increased hepatic fatty acid oxidation. Caloric intake was unaffected and no evidence of white adipose tissue browning was observed. Reversal of adiposity was accompanied by improvements in hyperlipidemia, insulin sensitivity, hepatic steatosis, and a modest reduction in blood monocytes. Together, this resulted in atherosclerotic lesions that were unchanged in size, but characterized by reduced macrophage content, consistent with a more stable plaque phenotype. These studies further suggest potential therapeutic utility of citrus flavonoids, especially in the context of existing obesity, metabolic dysfunction, and cardiovascular disease

Prospectus, October 1, 1980

HAVE YOU REGISTERED TO VOTE YET? REGISTER THE PAINLESS WAY--ON CAMPUS; Election \u2780: The man behind the woman; Handicrafts taught to senior citizens; Got a pet peeve, gripe, or opinion? Write PROSPECTUS\u27 editor!; MMWW gives calendar of topics; Make Christmas gift decorations now; Student Government will hold O.RG.I.I. in Lounge; Record Enrollment: Fall enrollment sets new record; Activities set for Society; Insurance offered; No overdubbing results in very, very good record; Letters to the editor: Student wants late breakfast; Our Mistake!; Urbana student wins PC faculty wives\u27 $200; Park district has youth fall classes; Give Blood Today; Science You Can See: The chemistry of photography; Parkland student reps needed for committees; New officers named for Parkland\u27s PATH; Children\u27s art exhibit to be Oct. 4, 9-9, Market Place Mall; Arts activities and events need co-sponsors; PLATO proves very popular; Peptic ulcers October 7 topic; PCF to hear Christian teachers; Need it? Financial aid still available; CPA Accounting Careers Conference to be Nov. 15; Classifieds; Football/tennis intermurals begin; Champaign Park District organizes basketball league; PC Datebook; Jeff Dodson places second in LT gold invitational; Women\u27s V-ball record upped; PC baseball player wins; Gal Friday tries predicting; Fast Freddy Contesthttps://spark.parkland.edu/prospectus_1980/1019/thumbnail.jp

Peroxisome proliferator-activated receptor δ agonist GW1516 attenuates diet-induced aortic inflammation, insulin resistance, and atherosclerosis in low-density lipoprotein receptor knockout mice

OBJECTIVE - The peroxisome proliferator-activated receptor (PPAR) δ regulates systemic lipid homeostasis and inflammation. However, the ability of PPARδ agonists to improve the pathology of pre-established lesions and whether PPARδ activation is atheroprotective in the setting of insulin resistance have not been reported. Here, we examine whether intervention with a selective PPARδ agonist corrects metabolic dysregulation and attenuates aortic inflammation and atherosclerosis. APPROACH AND RESULTS - Low-density lipoprotein receptor knockout mice were fed a chow or a high-fat, high-cholesterol (HFHC) diet (42% fat, 0.2% cholesterol) for 4 weeks. For a further 8 weeks, the HFHC group was fed either HFHC or HFHC plus GW1516 (3 mg/kg per day). GW1516 significantly attenuated pre-established fasting hyperlipidemia, hyperglycemia, and hyperinsulinemia, as well as glucose and insulin intolerance. GW1516 intervention markedly reduced aortic sinus lesions and lesion macrophages, whereas smooth muscle α-actin was unchanged and collagen deposition enhanced. In aortae, GW1516 increased the expression of the PPARδ-specific gene Adfp but not PPARα- or γ-specific genes. GW1516 intervention decreased the expression of aortic proinflammatory M1 cytokines, increased the expression of the anti-inflammatory M2 cytokine Arg1, and attenuated the iNos/Arg1 ratio. Enhanced mitogen-activated protein kinase signaling, known to induce inflammatory cytokine expression in vitro, was enhanced in aortae of HFHC-fed mice. Furthermore, the HFHC diet impaired aortic insulin signaling through Akt and forkhead box O1, which was associated with elevated endoplasmic reticulum stress markers CCAAT-enhancer-binding protein homologous protein and 78kDa glucose regulated protein. GW1516 intervention normalized mitogen-activated protein kinase activation, insulin signaling, and endoplasmic reticulum stress. CONCLUSIONS - Intervention with a PPARδ agonist inhibits aortic inflammation and attenuates the progression of pre-established atherosclerosis. © 2013 American Heart Association, Inc

Ad-CD40L mobilizes CD4 T cells for the treatment of brainstem tumors

Diffuse Midline Glioma, formerly Diffuse Intrinsic Pontine Glioma (DIPG), is the deadliest pediatric brainstem tumor with median survival of less than one year. Here, we investigated 1) whether direct delivery of adenovirus expressing CD40L (Ad-CD40L) to brainstem tumors would induce immune-mediated tumor clearance and, 2) if so, whether therapy would be associated with a manageable toxicity due to immune-mediated inflammation in the brainstem. Methods Syngeneic gliomas in the brainstems of immune competent mice were treated with Ad-CD40L and survival, toxicity and immune profiles determined. A clinically translatable vector, whose replication would be tightly restricted to tumor cells, rAd-Δ24-CD40L, was tested in human patient-derived Diffuse Midline Gliomas and immunocompetent models. Results Expression of Ad-CD40L restricted to brainstem gliomas by pre-infection induced complete rejection, associated with immune cell infiltration, of which CD4+ T cells were critical for therapy. Direct intra-tumoral injection of Ad-CD40L into established brainstem tumors improved survival and induced some complete cures but with some acute toxicity. RNA-seq analysis showed that Ad-CD40L therapy induced neuroinflammatory immune responses associated with IL-6, IL-1β and TNF-α. Therefore, to generate a vector whose replication, and transgene expression, would be tightly restricted to tumor cells, we constructed rAd-Δ24-CD40L, the backbone of which has already entered clinical trials for Diffuse Midline Glioma. Direct intra-tumoral injection of rAd-Δ24-CD40L, with systemic blockade of IL-6 and IL-1β, generated significant numbers of cures with readily manageable toxicity. Conclusions Virus-mediated delivery of CD40L has the potential to be effective in treating Diffuse Midline Gliomas without obligatory neuroinflammation-associated toxicity