A case of cetuximab-induced radiation recall skin dermatitis and review of the literature

Radiation recall presents as an acute inflammatory reaction triggered by systemic therapy, usually chemotherapy, and is typically limited to an area that was previously irradiated. Radiation recall reactions are generally self-limiting and most commonly occur in the skin. Many systemic agents have been described to elicit a radiation recall reaction, but the exact pathogenesis is largely unknown. Here, we describe the first reported case of radiation recall dermatitis following cetuximab. While cetuximab is associated with other skin reactions, oncologists should not exclude radiation recall dermatitis as a potential complication of cetuximab infusion in patients with prior radiation, and special attention should be paid to the pattern of skin changes both in terms of location and chronology.

Treatment of moist desquamation for patients undergoing radiotherapy

Moist desquamation occurs in approximately 36% of patients who receive radiation therapy and is associated with severe opioid-resistant pain and discomfort. Moist desquamation is typically at its worst within 1 to 3 weeks after treatment conclusion and resolves over a period of 6 weeks. Herein, we present a therapeutic pearl for the treatment of moist desquamation based on methods from the burn literature, with the goal of helping patients who undergo radiation therapy for breast cancer and other indications.

Preventing secondary exposure to women from men applying a novel nestorone/testosterone contraceptive gel

BACKGROUND

Testosterone (T)/Nestorone (NES) combination gel is a potential transdermal male contraceptive that suppresses gonadotropins and spermatogenesis. Transfer of transdermal T from men to women can be prevented by washing or covering application sites with clothing.

OBJECTIVES

We hypothesized that showering or wearing a shirt over gel application sites would prevent secondary exposure of T and NES to a woman after close skin contact.

MATERIALS AND METHODS

Twelve healthy male and 12 healthy female participants were recruited. Men applied T/NES 62 mg/8 mg gel to their shoulders and upper arms. Two hours after application, female partners rubbed the application site for 15 min. Exposure in the female partner was assessed under three conditions: a shirt covered the application site; the man showered prior to skin contact; or without intervention to reduce transfer. Serum T and NES concentrations were measured by LC-MS/MS in serial blood samples for 24 h after gel exposure.

MAIN OUTCOMES

Change in female serum T and NES levels as measured by average concentration over 24 h (C_avg ).

RESULTS

Median female serum T C_avg was 23.9 ng/dL (interquartile range, 19.3, 33.9) with the shirt barrier and 26.7 ng/dL (20.7, 33.9) after showering, which was higher than baseline 20.9 ng/dL (16.7, 25.0), both p < 0.03) but lower than without intervention (58.2 ng/dL [30.9, 89.1], both p < 0.01). Female serum NES C_avg and maximum concentration were below the lower limit of quantification with the shirt barrier and after showering, but increased without intervention in six of 12 women (maximum concentration <60 pg/mL). Men had lower average serum NES levels after showering (47 pg/ml [20, 94] compared to no intervention (153.3 pg/mL [51, 241], p < 0.02).

CONCLUSION

Secondary transfer of T and NES occurs after intensive skin contact with the gel application site. Secondary transfer is decreased by a shirt barrier or showering before contact.

Power in partnership

This paper focuses on the meaning and process of collaboration, particularly in the area of research and clinical practice. Much has been written about the existing gaps between research and the practice of nursing; however, action research is one mechanism that allows these elements to be drawn together. Research developed through collaborative participation has the potential to harness the energy, enthusiasm and talents of nurses at different levels and practice into a cohesive group motivated to achieve professional development and quality practice goals. Action research that is built on the philosophy of a quality within the process and significance of the group can lead to effective practice in nursing. Power can be found in partnership.

Scholarly/research activities in nursing administration: some issues

Despite an increasing commitment to expanding scholarly/research activities within the discipline of nursing and the overwhelming agreement on its value, scholarship progress has been relatively slow within the subdiscipline of nursing administration. The vast majority of nurse administrators are preoccupied with strategic and operational management and give limited attention to nursing scholarly/research activities. Nurse administrators appear to have embraced the idea of research and scholarship but perhaps have yet to become widely involved. This paper explores some of the issues related to scholarship/research activities in nursing administration.

Evaluations in mental health services: some methodological considerations

Most health organizations evaluate policies and programmes periodically. Mental health services, without exception, also need to examine their established practices with particular concern about their propriety and effectiveness. As mental health services are coming under increasing pressure to function as self-evaluating organizations that carefully link planning, service delivery and assessment, choices must be made regarding which evaluative strategies are most relevant to the development of mental health services. This paper examines some of the methodological issues in the outcome evaluations in mental health services.

Case study of learning milieux: the modifying effect of the workplace

In examining the clinical environment that may influence the first-year college graduate's attitudes toward continuing learning, four case studies were conducted in hospitals within the Illawarra Area Health Service, New South Wales. The exploratory research attempts to determine the extent to which desired educational changes occur and where improvements could be made to the educational process. This paper reports the research findings.

Continuing nursing education: some issues

In nursing, a commitment to continuing education appears to be a relatively new concept. There have always been nurses who are continuing learners throughout their professional lives. Too often, this is incidental, rather than planned. There appears to be a need to re-examine current approach in continuing nursing education.

Student competence profile: the Wollongong approach

The difficulty in developing clinical assessment tools for the clinical evaluation of nursing students which will motivate the students is a problem faced by all nurse educators. At the University of Wollongong, New South Wales, the lecturing staff in the new Diploma of Applied Science (Nursing) programmes have formulated a Student Competence Profile (SCP) for the clinical evaluation of students. This SCP, which they describe here, has been organized to reflect the objectives of the course curriculum.

Multi-dimensional approach: a task for curriculum development

Curriculum development is an issue of continuing concern to nurse educators. For the planning model to be effective, it must be compatible with, and actually facilitate, the implementation of the particular programme or practice that is to be used. In nursing, the process of curriculum construction is predominantly influenced by the linear approach. This planning model which has taken over nursing education at all levels and in all content areas seems neutral, but it is not. It carries with it a particular value position on human nature. This paper examines the value position of the linear model and its limitation, and proposes a multi-dimensional model as a possible alternative.

Aftercare residential facility for ex-psychiatric patients--the Australian and American perspectives

The decline in the number of inpatients in psychiatric hospitals over the last decade has resulted in a strong demand for community based mental health services, and a search for alternative accommodation for ex-psychiatric patients. However, for any comprehensive planning for residential services for ex-psychiatric patients to be effective, there must be a recognition of the variety of patient needs and resources and the range of service models available. This paper attempts to review aftercare residential facilities in America and Australia, to identify the underlying care philosophy and to propose various supervision approaches.