Use of granulocyte colony-stimulating factor in patients with chemotherapy-induced neutropaenia

Background: Febrile neutropaenia (FN) and resultant infections are the major cause of treatment-related morbidity and mortality in patients receiving chemotherapy. Clinical practice guidelines recommend the use of granulocyte colony-stimulating factors (G-CSF) to reduce the risk of FN and ensuing complications in patients receiving chemotherapy. Despite these recommendations, inappropriate usage of G-CSF has been reported. Aim: To assess prescribing patterns and adherence to international guidelines of G-CSF in adult patients with chemotherapy-induced neutropaenia (CIN) at the haematology oncology wards of the Dr George Mukhari Academic Hospital (DGMAH) and compliance to guidelines. Methods: Medical records of adult patients who received G-CSF were reviewed retrospectively between 01 January 2018 and 31 July 2018. Results: Of the 128 patient files screened, 57 cases met the inclusion criteria. Duration of treatment with G-CSF was not in accordance with guidelines in more than 50% of the patients and in 43.86%, G-CSF dosing deviated from recommended guidelines. Conclusion: The study demonstrated over-prescribing of G-CSF due to either increased doses or duration of G-CSF therapy. Although prescribed for the correct indication, the dosage was often too high or the duration was too long, even once an acceptable neutrophil nadir count was reached. Interventions to optimise the use of G-CSF are required and the pharmacist may play a role in this regard. Contribution: The administration of the correct doses of G-CSF can reduce both the severity and duration of neutropaenia. Over-prescribing and incorrect dosing may contribute to patient morbidity and add to the financial burden of healthcare

Radiation exposure of radiographers who handle 18F-fluorodeoxyglucose for positron emission tomography at a hospital in Pretoria, South Africa

18F-fluorodeoxyglucose (18F-FDG) is used in most diagnostic applications of Positron Emission Tomography (PET). It has high annihilation energy of 511 keV, which results in potentially high radiation doses for staff. This study investigated radiographer radiation exposure during receipt, administration and scanning of patients with 18F-FDG. The objectives were to monitor the radiographers’ radiation levels throughout the handling of 18F-FDG; determine the radiation dose per radiographer per patient handling event and identify procedures which pose the greatest risk for radiation exposure. The study was quantitative, observational and prospective. Six radiographers’ work flow was tracked over time and the measured radiation doses were logged with electronic pocket dosimeters. The radiation dose per radiographer per event in the patient handling process was determined. The sample consisted of 1858 events, which were documented successfully. Events which posed the greatest risk for excessive radiation exposure were identified. The event in the patient handling process which lead to the highest radiation exposure was radiopharmaceutical injection, resulting in an average dose of 49.79 nSv/s. Radiographer 2 received the highest radiation dose per second (32.80 nSv/s) in her execution of the patient handling process and radiographer 3 the lowest, with 4.60 nSv/s. The average daily dose for the radiographers included in the study does not imply overexposure, but if the higher daily doses were extrapolated to yearly doses, half of the radiographers would be over the permitted annual limit.Keywords: 18F-fluorodeoxyglucose (18F-FDG), radiographer, radiation exposure

Spotlight : the status of radiopharmacy in Africa

DATA AVAILABILITY : This is a spotlight so no data driven research has been done. No questionnaires has been used. The data included are all from reviewing current literature as well as the experience of the authors on the article.No abstract available.https://link.springer.com/journal/403362024-09-14hj2024Nuclear MedicineSDG-03:Good heatlh and well-bein