Pharmaceutical care for patients with gynaecological malignancies in the outpatient setting : a pilot study

Pharmaceutical care in oncology aims at reducing treatment-related toxicity and improve patients’ quality of life. The objective of this pilot study was to develop a specific pharmaceutical care model for breast and ovarian cancer including patient counselling, optimisation of supportive medication and the implementation of a therapeutic algorithm for antiemetic prophylaxis. Additionally, it is the objective of this pilot study to assess the value and feasibility of therapeutic drug monitoring in outpatient settings for patients treated with antineoplastic agents, in particular carboplatin and its contribution to pharmaceutical care. Patients with breast or ovarian cancer treated with chemotherapy for the first time were included. The feasibility and outcome of this pharmaceutical care model was investigated using a prospective, multi-centred, sequential control group design. Quality of life (QoL) served as the primary endpoint. Patient satisfaction with the information on cancer treatment and the response to the antiemetic treatment were evaluated as secondary endpoints. The results regarding the health-related quality of life were difficult to interprete. Looking at the complete treatment period the global health status/QoL decreased in the control group in the median relatively to the baseline by 14% compared to only 6% in the intervention group by (p = 0.563, Mann-Whitney U-test). The quality of life could not be improved but stabilised in comparison to the control group. For certain symptom scales an improvement could be achieved (e.g. pain, constipation) which was not statistically significant. The global satisfaction with information on cancer treatment was significantly improved throughout the study (CG: median = 3.94, IG: median = 4.41, p = 0.014, Mann-Whitney U-test). Two of the 4 subscales also improved significantly. The patients’ perception of pharmacists much improved throughout the study. Only 15% of the patients in the control group described the pharmacist as one of their most important sources of information compared to 68.4% in the intervention group. This increase was statistically significant (p = 0.001, Mann-Whitney U-test). The strongest criterion to assess the success of the prevention of nausea and emesis is the complete response (CR) to the antiemetic treatment. Looking at the full treatment period for the intervention group an increase in the number of cycles with CR in emesis could be achieved (p = 0.155). The incidence of nausea could not be improved by the intervention. The monitoring of carboplatin confirmed results of previous earlier publications on this topic. In the median the achieved AUC differed from the target AUC by 21.7%. The doses necessary to achieve the target AUC would have needed to be in the mean 31.1% (SD 13.65%) higher than the actual dose given. This pilot study can be rated as an inital contribution to the development of pharmaceutical care models in oncology. Patients with breast and ovarian cancer seem to benefit from pharmaceutical care as demonstrated by improved clinical and subjective outcomes. The pharmaceutical care model was feasible and integrated in the daily routine. It was well accepted by patients and health care providers. The results of the TDM show a necessity to reconsider the individual dosing strategies for carboplatin in combination with paclitaxel. It proved to be feasible in the outpatient setting and was tolerated by the patients. In future pharmaceutical care research in oncology further effort should be made to develop improved outcome parameters which are capable of reflecting the impact of pharmaceutical care and allow conclusions on the quality of care. Additionally it should focus on additional aspects such as further patient needs, pharmacoeconomic aspects and standardisation for the integration into disease management programmes

Staged laser interstitial thermal therapy (LITT) treatments to left Insular low-grade glioma

BACKGROUND AND IMPORTANCE: Low-grade insular gliomas remain challenging tumors for aggressive resection because of the numerous functional and vascular structures surrounding them. Because of the potential morbidities associated with open surgical resection, less invasive techniques may confer a more optimal balance between cytoreduction and surgical complications. For this reason, we evaluated the use of laser interstitial thermal therapy (LITT) for resection of a dominant hemisphere oligodendroglioma World Health Organization (WHO) grade II in a 68-yr-old patient by use of multiple staged surgeries for its resection. CLINICAL PRESENTATION: Patient KK was a 68-yr-old female who was found to have a large, left-sided insular mass that was shown to be an oligodendroglioma WHO grade II, positive for codeletion 1p/19q and IDH1 mutant on biopsy. Over the course of 3 mo, KK underwent 2 stages of LITT, targeting different areas of the 5-cm tumor. The 60-d magnetic resonance imaging (MRI) demonstrated a reduction in size of the tumor from 5.2 × 3.3 × 2.4 cm to 3.6 × 1.9 × 1.4 cm. She returned for a second stage targeting the anterior portion of the tumor. KK did well postoperatively and went on to postsurgical chemoradiation. At the 2-yr follow-up, the lesion showed near resolution on MRI. CONCLUSION: This case report demonstrates successful use of LITT for staged surgeries to treat a left hemisphere-dominant insular lesion. This establishes the use of LITT as a viable, minimally invasive option to treat tumors that are difficult to access or pose concerns for increased morbidity through an open surgery

Beschreibung externer Komponenten zur Analyse und Optimierung von Softwaresystemen

Um Komponenten zu beschreiben, die einem Uebersetzer in einem Uebersetzungslauf nicht in Quelltext vorliegen, weil sie entweder als Bibliotheken von Drittanbietern nur in binaerer Form verfuegbar sind, oder weil der Uebersetzer aus Kapazitaetsgruenden ihren Quelltext nicht in einen Uebersetzungslauf mit einbeziehen kann, wurde eine Beschreibungssprache entwickelt. Mit ihr lassen sich wichtige Eigenschaften der extern Komponenten beschreiben und dem Uebersetzer zur Verfuegung stellen, so dass Programmanalysen das Verhalten von Fragmenten der externen Komponenten mit beruecksichtigen koennen

Endovascular treatment of an open cervical fracture with carotid artery tear

The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report

Minimising treatment-associated risks in systemic cancer therapy

Aim of the review To review the consequences of drug-related problems (DRP) in systemic cancer therapy and identify specific contributions of the pharmacist to minimise treatment-associated risks. Method Searches in PubMed, Embase and the Cochrane Library were conducted. Bibliographies of retrieved articles were examined for additional references. Only papers in English between 1980 and 2007 were included. Results In systemic cancer therapy there is an enormous potential for DRP due to the high toxicity and the complexity of most therapeutic regimens. The most frequently reported DRP can be classified into adverse effects, drug–drug interactions, medication errors, and non-adherence. Pharmacists have enhanced efforts to assure quality and safety in systemic cancer therapy together with other health care providers. In consequence, oncology pharmacy has evolved as a novel specialist discipline. The endeavour to merge and co-ordinate individual activities and services of the pharmacist has led to pharmaceutical care concepts which aim at offering novel solutions to the various DRP. Conclusion Pharmaceutical care for cancer patients should be developed within research projects and integrated into disease management programs in order to ensure broad implementation

Distribution and determinants of patient satisfaction in oncology with a focus on health related quality of life

<p>Abstract</p> <p>Background</p> <p>Cancer patients usually undergo extensive and debilitating treatments, which make quality of life (QoL) and patient satisfaction important health care assessment measures. However, very few studies have evaluated the relationship between QoL and patient satisfaction in oncology. We investigated the clinical, demographic and QoL factors associated with patient satisfaction in a large heterogeneous sample of cancer patients.</p> <p>Methods</p> <p>A cohort of 538 cancer patients treated at Cancer Treatment Centers of America^®(CTCA) was assessed. A patient satisfaction questionnaire developed in-house by CTCA was used. It covered the following dimensions of patient satisfaction: hospital operations and services, physicians and staff, and patient endorsements for themselves and others. QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30). The clinical, demographic and QoL factors were evaluated for predictive significance using univariate and multivariate logistic regression.</p> <p>Results</p> <p>The mean age of our patient population was 54.1 years (SD = 10.5, range 17-86), with a slight preponderance of females (57.2%). Breast cancer (n = 124) and lung cancer (n = 101) were the most frequent cancer types. 481 (89.4%) patients were "very satisfied" with their overall experience. Age and several QoL function and symptom scales were predictive of overall patient satisfaction upon univariate analysis. In the multivariate modeling, only those with a score above the median on the fatigue measure (i.e. worse fatigue) had reduced odds of 0.28 of being very satisfied (p = 0.03).</p> <p>Conclusion</p> <p>Patient fatigue, as reported by the QoL fatigue scale, was an independent significant predictor of overall patient satisfaction. This finding argues for special attention and programs for cancer patients who report higher levels of fatigue given that fatigue is the most frequently reported symptom in cancer patients.</p

An Analysis of Competing Stereotype Threat Theories

This paper investigates the literature on stereotype threat theory. Looking for an explanation for achievement gaps in standardized testing and mathematics, Claude Steele and Elliot Aronson conducted a study in 1995 which introduced the term “stereotype threat” to the psychological community. It was hypothesized by Steele and Aronson that stereotype threat is cause by the anxiety that results from a fear of conforming to a negative stereotype that directly affects an individual in a domain with which they identify. Stereotype threat can have extremely detrimental effects on individuals. Since the original study in 1995, numerous studies have been conducted to further address gender and racial achievement gaps. Some of the studies have yielded results in support of Steele’s theory, and some have called into questions certain aspects of Steele’s theory. This paper specifically analyses Steele’s theory and its ability to stand up against specific criticisms