Comparison of lung aeration loss in open abdominal oncologic surgeries after ventilation with electrical impedance tomography-guided PEEP versus conventional PEEP: a pilot feasibility study

Background

Existing literature lacks high-quality evidence regarding the ideal intraoperative positive end-expiratory pressure (PEEP) to minimize postoperative pulmonary complications (PPCs). We hypothesized that applying individualized PEEP derived from electrical impedance tomography (EIT) would reduce the severity of postoperative lung aeration loss, deterioration in oxygenation, and PPC incidence.

Methods

A pilot feasibility study was conducted on 36 patients who underwent open abdominal oncologic surgery. The patients were randomized to receive individualized PEEP or conventional PEEP at 4 cm H2O. The primary outcome was the impact of individualized PEEP on changes in the modified lung ultrasound score (MLUS) derived from preoperative and postoperative lung ultrasonography. A higher MLUS indicated greater lung aeration loss. The secondary outcomes were the PaO2/FIO2 ratio and PPC incidence.

Results

A significant increase in the postoperative MLUS (12 ± 3.6 vs 7.9 ± 2.1, P < 0.001) and a significant difference between the postoperative and preoperative MLUS values (7.0 ± 3.3 vs 3.0 ± 1.6, P < 0.001) were found in the conventional PEEP group, indicating increased lung aeration loss. In the conventional PEEP group, the intraoperative PaO2/FIO2 ratios were significantly lower but not the postoperative ratios. The PPC incidence was not significantly different between the groups. Post-hoc analysis showed the increase in lung aeration loss and deterioration of intraoperative oxygenation correlated with the deviation from the individualized PEEP.

Conclusions

Individualized PEEP appears to protect against lung aeration loss and intraoperative oxygenation deterioration. The advantage was greater in patients whose individualized PEEP deviated more from the conventional PEEP.

Pattern of Care in Real-World Scenario on Advanced Epithelial Ovarian Cancer in a Tertiary Referral Oncology Centre in India - ISPSM Collaborative Study

The treatment of advanced epithelial ovarian cancer (EOC) has evolved over time. With advent of platinum-based chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC), there is a paradigm shift in the patterns of care with improved survival. In this study, we analysed our advanced EOC patients aiming to gain insights into the pattern of care. An ambispective study of 250 patients of advanced EOC was done from our prospectively maintained computerised database in the Department of Surgical Oncology, tertiary care referral centre from 2013 to 2020. We analysed the demographic profile, treatment patterns, and perioperative outcomes. In this study, there were 83.6% stage III and 16.4% stage IVA. There were 62 (24.8%) upfront and 112 (44.8%) in interval settings. There was a higher number of patients receiving neo-adjuvant chemotherapy. One hundred twenty-six (50.4%) underwent cytoreductive surgery (CRS) only and 124 (49.6%) underwent CRS and HIPEC. CC-0 was achieved in 84.4% and CC-1 in 15.6% patients. HIPEC programme was started in 2013. With advent of RCTs in HIPEC, there was a substantial increase in the number of patients receiving HIPEC from 2015 (n = 10), 2017 (n = 20) to 2019 (n = 41). We offer secondary CRS in a limited subset of patients, n = 76 (30.4%). There was 24.8% early and 8.4% late postop complications. We have median follow-up of 50 months with attrition rate of 4%. With practice changing updates, the treatment of advanced EOC has been evolving over time. Though the primary CRS followed by systemic therapy is the standard to date, there is change in pattern of care with neo-adjuvant chemotherapy followed by interval CRS and HIPEC because of various RCTs. The addition of HIPEC has acceptable morbidity and mortality. There is a definite learning curve and the team has to evolve as a whole. In a tertiary care referral centre from LMIC, good patient selection, logistics, and implementing recent advances will definitely add to improved survival.

Does the Nightmare of Distressing Complications of Groin Dissection Over with "River Flow" Incision? - Experience of 240 Dissections from Tertiary Referral Oncology Centre, India

OBJECTIVE

Groin dissection has been a nightmare for many surgeons due to its higher morbidity especially flap necrosis. Various modifications in incisions have been described in the literature to reduce the complications but with variable outcomes. By our novel "River Flow" incision technique, we have significantly reduced the procedure related complications without compromising onco surgical principles.

METHODS

A prospective longitudinal clinical observational study was designed after Institutional Ethical Committee clearance, aiming to minimize the rate of complications, especially flap necrosis. All patients who underwent unilateral/bilateral ilio-inguinal block dissection (IIBD) from January 2014 to December 2021 were included in the study. The "River Flow" incision was made and standard ilio-inguinal block dissection was performed. Flap viability, seroma formation, lymphedema, infection, etc. were observed and noted during hospitalization and on followup. Clavien- Dindo classification was used to grade the postoperative complications. We have taken our historical data of 235 groin dissections as a control and compared them with the results of the present study. It is one of the largest studies on groin dissection so far.

RESULTS

A total of 138 patients underwent 240 groin dissections. The most common diagnosis was carcinoma penis (44.9%) followed by carcinoma vulva (22.4%). Overall, the outcome of all groin dissections showed no postoperative mortality. None of the patients had complete flap necrosis. But in our historical data, the flap necrosis rate was 38%. The most common complication observed was seroma formation in 13.7% of cases followed by surgical site infection (6.52%). All the complications were managed conservatively. The postoperative stay of the patients was also significantly less. The median hospital stay was 3 days.

CONCLUSION

"River Flow" incision technique is a simple but effective novel surgical technique for therapeutic ILND for any surgical setup without the learning curve. It can avoid flap necrosis, and decrease morbidity significantly without compromising the onco surgical principle of standard groin dissection.

KEY WORDS

Groin dissection, skin necrosis, river flow incision.

Impact of age on the therapy-related characteristics and outcomes of testicular germ cell tumors at a tertiary care center in India

415

Background: Testicular germ cell tumors (t-GCTs) commonly present in age group 20-40 years (yrs). Older patients (pts) in many cancers have worse tolerance to therapy and outcomes. We examine herein the effect of older age in t-GCT pts. Methods: We conducted a chart-review-based retrospective analysis of pts of t-GCTs diagnosed and treated at our urogenital clinic from 2015-2021. Pts were divided into two groups: Age ≤40 years (Group A) and >40 years (Group B). Multivariable Cox regression models were constructed to analyze the prognostic value of older age while adjusting for measured confounders. Results: A total of 298 patients of t-GCT were identified; the median age was 30 yrs (interquartile range 24-37), 43.0% with intermediate or poor risk, 64.8% patients with non-seminomatous GCT (NSGCT), 250 pts in gp A and 48 in gp B. Baseline characteristics in both gps differed significantly with respect to the risk category, and seminoma histology, while there was no difference for performance status (ECOG ≥2), see table. Bleomycin, cisplatin, and etoposide (BEP) was the most common chemotherapy (226/262 pts), and use of BEP was not different in 2 gps (p=0.249). Grade III/IV adverse effect burden was greater in gp B vs gp A for febrile neutropenia, nausea/vomiting, and diarrhea, while infertility was more in gp A (Table). Outcomes in terms of markers normalization (163 vs 33, p=0.408) and radiological response (complete remission, 93 vs 20, p=0.205) did not differ. Median overall survival was not reached in both gps, and the hazard ratio for age >40 yrs was 1.91 (95% confidence interval 0.91-3.99, p =0.086), after adjusting for risk category, performance status, and response to therapy. Conclusions: Age does not deter the use of platinum-based therapy, which, although more toxic, has similar efficacy to younger pts of t-GCT. [Table: see text]

Evaluation of HE4 as a prognostic biomarker in uterine cervical cancer. Cancer Treat Res Commun 2023;34:100672. [PMID: 36525756 DOI: 10.1016/j.ctarc.2022.100672]

INTRODUCTION

Uterine cervical cancer (UCC) is the fourth most common health problem worldwide among women. Currently available biomarkers CA125, CA199, and CEA for diagnosis or prognostic evaluation of UCC have not got widespread acceptance.

METHOD

Whole blood samples of 64 patients with UCC were collected along with 63 healthy females and tested for serum levels of HE4 (sHE4). A cut-off value for positive result 64.0 pmol/L was set. Statistical analysis of different clinical variables was done.

RESULT

Serum level of HE4 has a significant role in the diagnosis of uterine cervical cancer. Its level increases with age, higher parity (P < 0.05), stage (P < 0.16), tumor size, and parametrial invasion. Negative result was seen with vaginal invasion, lymph node involvement & cases which had recurrence. Various histological types showed variable results. So the serum level of HE4 (sHE) level may play a role in the diagnosis & therapeutic monitoring of UCC. But the prognostic evaluation needs further studies.

CONCLUSION

sHE4 is useful in the diagnosis of cervical cancer, but its prognostic significance is under the question marks. It may be associated with higher values in higher stages. Higher parity of the patient is associated with higher level of HE4 in UCC.

Comprehensive Germline Genomic Profiling of Patients with Ovarian Cancer: A Cross-Sectional Study

Introduction Ovarian cancer is the third most common cancer among Indian women. The data on the hereditary predisposition of these cancers and the clinical outcomes of those with pathogenic mutations is meager in India.

Objective The aim of the current study was to analyze the germline-genetic profile, clinicopathological characteristics, and outcomes of patients with ovarian cancer who were referred for genetic counseling at our Institute.

Materials and Methods It was a cross-sectional observational study. Patients with histological diagnosis of carcinoma ovary at our institute who were referred for genetic counseling from July 2017 to June 2020 were included in the study. All patients underwent pretest counseling. Most patients underwent multigene panel testing with reflex multiplication ligation-dependent probe amplification for large genomic rearrangements, while some received testing for BRCA1 and BRCA2 only. The variants were classified as pathogenic or benign based on American College of Medical Genetics (ACMG) guidelines. Data regarding the demographic profile, clinical characteristics, histopathological findings, family history, treatment received, and outcomes were extracted from the medical record system files.

Results One hundred and one patients were referred to the genetic clinic and underwent genetic counseling. All patients were advised for genetic testing; however, only 72 (71%) underwent testing. A multigene panel testing was done in 51 (70%) patients, and only BRCA1 and BRCA2 genes were tested in 21 (30%). Among the 72 patients who underwent a genetic test, the median age was 47 years (range, 28–82). The most common histopathology was serous (90%), while 85% were diagnosed having stage 3 and 4 ovarian cancer. A pathogenic/likely pathogenic (P/LP) BRCA or non-BRCA mutation was detected in 32 (44%) patients. Six patients (8%) had a variant of unknown significance (VUS). Among P/LP mutations, 85% were in the BRCA gene (75% in BRCA1 and 10% in BRCA2), while 15% were in non-BRCA gene mutations (RAD51, PALB2, MER11, HMMR). Disease-free survival and overall survival were not different in mutation-positive and mutation-negative cohorts.

Conclusions We report 44% P/LP mutations in this selected cohort of patients with carcinoma ovaries. BRCA mutations constituted 85% of all the mutations, while 15% of mutations were in non-BRCA genes.

Leveraging epigenetics to enhance the efficacy of cancer-testis antigen: a potential candidate for immunotherapy

Ovarian cancer is the most lethal gynecological malignancy in women. The phenotype is characterized by delayed diagnosis, recurrence and drug resistance. Inherent immunogenicity potential, oncogenic function and expression of cancer-testis/germline antigen (CTA) in ovarian cancer render them a potential candidate for immunotherapy. Revolutionary clinical findings indicate that tumor antigen-mediated T-cell and dendritic cell-based immunotherapeutic approaches provide an excellent strategy for targeting tumors. Currently, dendritic cell vaccination for the treatment of B-cell lymphoma and CTA-based T-cell receptor transduced T-cell therapy involving MAGE-A4 and NY-ESO-1 are well documented and shown to be effective. This review highlighted the mechanical aspects of epigenetic drugs that can elicit a CTA-based humoral and cellular immune response and implicate T-cell and dendritic cell-based immunotherapeutic approaches.

Cytoreductive surgery plus HIPEC for advanced epithelial ovarian cancer: Analysis from a multicentric national Indian HIPEC registry of 1,470 patients—An ISPSM Collaborative study

5525

Background: Improved long-term results can be achieved in advanced epithelial ovarian cancer (EOC) patients using optimal cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: Indian society of peritoneal surface malignancy (ISPSM) is a registered body which maintains prospective data of 26 centers across India who perform CRS –HIPEC. From February 2017 until January 2022, 1470 patients with advanced EOC were treated with CRS-HIPEC. He general practice patterns and the oncological outcomes in terms of progression free survival (PFS) and overall survival (OS) & post-operative morbidity and mortality is reported. Results: Upfront (n = 156), interval (n = 645) and recurrent (n = 669) cytoreductions were performed based on the timeline at presentation. Mean age 54.5±10.74, PCI 13. 6±5.2, duration of surgery 10.6±1.h hrs. 36.4% had total peritonectomy, 12.7% had multivisceral resection, 41.8%had bowel resections and stoma rate was 7.4%. 60.3% had semiopen HIPEC, 83.1% used cisplatin for HIPEC and 83.1 % had HIPEC for 90 minutes. Overall G3-G5 morbidity was 25.4% with major ones being post-operative intra-abdominal collection (21.8%), electrolyte imbalance (16.4%), pulmonary (16.4%) followed by hematological (12.7%). Surgical morbidity was more in upfront cytoreduction group compared to interval group (20% versus 13.5%) and recurrent group (20% versus 15%), respectively. The 30 day mortality was 3.8%. With a median follow-up of 46 months, median PFS was 33 months in primary (upfront plus interval) group and 16 months in recurrent cytoreduction group. Median OS was not achieved in both primary and recurrent groups (4 year OS rates: 60 and 55%, respectively). Conclusions: This prospective database provides a collation and audit of the management of advanced epithelial ovarian cancer with CRS HIPEC in multiple centers registered under ISPSM. In advanced EOC patients, CRS plus HIPEC offers potential benefits in PFS and OS rates, with acceptable rates of morbidity and mortality and can be practiced even in resource constrained setting.

A proposal for changing nomenclature from pseudomyxoma peritonei (PMP) to abdomino-peritoneal mucinous carcinoma (APM) based on its long journey and experience from tertiary oncology center in India

Introduction

Pseudomyxoma peritonei (PMP) is a generalized term, usually known as “jelly belly” since 1884. Incidence is very low, 1–3 per million people per year. Because of its indolent nature, it is usually diagnosed at an advanced stage, thereby impacting the quality of life. The 5-year survival rate varies from 23 to 86% in world literature. Even 10 years and 20 years of survival have been described. With our experience, we like to propose rename of PMP as abdomino-peritoneal mucinous carcinoma (APM) as we strongly feel the time has come to specify the term and standardize the management strategy.

Methodology

In the premier institute of India and as a tertiary referral center, we experienced the maximum number of advanced cases of APM. From 2012 to 2021, we analyzed all the APM patients based on a prospectively maintained computerized database in the department of surgical oncology and found the reasons for renaming from this traditional one.

Results

We included a total of 87 patients who underwent surgical intervention. Thirty-five patients underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), and 52 patients underwent debulking. In CRS-HIPEC patients, CC-0 was achieved in 28 patients (80%), CC-1 in 4 patients (11.4%), and CC-2 in 3 patients (8.6%). Palliative intent HIPEC was done in 3 patients (8.6%). Clavien-Dindo grade III and IV morbidity was observed in 18.8% of patients with 90 days mortality of 5.7%.

Conclusion

With our long-term experience and advancement of scientific evidence, we like to propose a new name for PMP as APM. We strongly believe this paper will give a clear picture of this rare disease and standard management outlines.

Interplay between genome organization and epigenomic alterations of pericentromeric DNA in cancer

In eukaryotic genome biology, the genomic organization inside the three-dimensional (3D) nucleus is highly complex, and whether this organization governs gene expression is poorly understood. Nuclear lamina (NL) is a filamentous meshwork of proteins present at the lining of inner nuclear membrane that serves as an anchoring platform for genome organization. Large chromatin domains termed as lamina-associated domains (LADs), play a major role in silencing genes at the nuclear periphery. The interaction of the NL and genome is dynamic and stochastic. Furthermore, many genes change their positions during developmental processes or under disease conditions such as cancer, to activate certain sorts of genes and/or silence others. Pericentromeric heterochromatin (PCH) is mostly in the silenced region within the genome, which localizes at the nuclear periphery. Studies show that several genes located at the PCH are aberrantly expressed in cancer. The interesting question is that despite being localized in the pericentromeric region, how these genes still manage to overcome pericentromeric repression. Although epigenetic mechanisms control the expression of the pericentromeric region, recent studies about genome organization and genome-nuclear lamina interaction have shed light on a new aspect of pericentromeric gene regulation through a complex and coordinated interplay between epigenomic remodeling and genomic organization in cancer.

Hyperthermic intraperitoneal chemotherapy in locally advanced and recurrent ovarian carcinoma: surgical and oncological outcomes in the Indian public healthcare system

This study analyzed the surgical outcomes after initial implementation of a cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) program in government settings in India. Methods: Ovarian cancer patients undergoing cytoreductive surgery and HIPEC from May 2015 to April 2019 were identified from a prospectively maintained database. Treatment characteristics and surgical outcomes were analyzed. Results: The study identified 101 patients. The mean peritoneal cancer index (PCI) was 7 ± 6, with higher PCI scores in primary and recurrent cases. Major morbidities were recorded in 24.7% of patients. High PCI score, completeness of cytoreduction and major morbidities were independent predictors of overall survival in multivariate analysis. Conclusion: The application of HIPEC in limited-resource settings is feasible with acceptable major morbidities. This program should receive similar priority in government systems.

Oral metronomic chemotherapy for recurrent & refractory epithelial ovarian cancer: A retrospective analysis

Background & objectives:

Advanced epithelial ovarian cancer (EOC) is associated with dismal outcome and progression-free survival (PFS) shortens with each subsequent relapse. For patients with recurrent and platinum refractory disease, therapeutic options are limited. Oral metronomic therapy (OMT) is associated with symptomatic relief and stable response in a significant proportion of patients. We retrospectively evaluated the outcome of patients with EOC treated with OMT at a tertiary care hospital in north India.

Methods:

Between January 2011 to December 2017, 36 EOC patients received OMT. Patients’ median age was 50 yr (range, 38-81 yr) and they had received a median of two lines of prior chemotherapy. OMT regimen included a combination of cyclophosphamide, etoposide (VP-16) and celecoxib with or without pazopanib along with supportive care. Response rates and outcomes were ascertained using the Gynecological Cancer Intergroup Guidelines. The toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03.

Results:

The median CA-125 before initiating OMT was 160 U/ml (range, 42.23-5330 U/ml). The median interval between last chemotherapy and starting OMT regimen was 159 days (range, 1-1211 days). The overall response rate was 50 per cent. The median progression-free survival (PFS) was 8.2 months [95% confidence interval (CI): 5.03-10.33], and the median overall survival was 38 months (95% CI: 25.6-NR). Patients who received two lines of chemotherapy before OMT (P=0.052) and those who received pazopanib-based OMT (P=0.0513) had better PFS.

Interpretation & conclusions:

For patients with relapse and refractory EOC, OMT could be a reasonable option. A combination of oral etoposide (VP-16) and pazopanib needs further evaluation in a large number of patients in a randomized trial.

Xanthogranulomatous Orchitis Presenting as a Scrotal Mass in an Elderly Male: Malignancy or Mimicker?

Xanthogranulomatous inflammation is a rare, destructive pattern of inflammation, affecting different organs, that often produces a mass-like lesion, simulating malignancy. Although benign, it can coexist with malignancy. We, herein, report the case of a 60-year-old male patient, who presented with a testicular mass that was partly necrotic and showed heterogeneous enhancement on contrast study. Testicular tumor markers were normal. In view of clinicoradiological suspicion of a malignant cause, high inguinal orchidectomy was performed. However, histopathology showed features of a xanthogranulomatous orchitis with no evidence of any malignancy. Pathologists must be aware of this entity as definitive diagnosis requires histopathologic examination and adequate sampling must be done to rule out a coexistent malignancy.

Transfer of the methicillin resistance genomic island among staphylococci by conjugation

Methicillin resistance creates a major obstacle for treatment of Staphylococcus aureus infections. The resistance gene, mecA, is carried on a large (20 kb to > 60 kb) genomic island, staphylococcal cassette chromosome mec (SCCmec), that excises from and inserts site-specifically into the staphylococcal chromosome. However, although SCCmec has been designated a mobile genetic element, a mechanism for its transfer has not been defined. Here we demonstrate the capture and conjugative transfer of excised SCCmec. SCCmec was captured on pGO400, a mupirocin-resistant derivative of the pGO1/pSK41 staphylococcal conjugative plasmid lineage, and pGO400::SCCmec (pRM27) was transferred by filter-mating into both homologous and heterologous S. aureus recipients representing a range of clonal complexes as well as S. epidermidis. The DNA sequence of pRM27 showed that SCCmec had been transferred in its entirety and that its capture had occurred by recombination between IS257/431 elements present on all SCCmec types and pGO1/pSK41 conjugative plasmids. The captured SCCmec excised from the plasmid and inserted site-specifically into the chromosomal att site of both an isogenic S. aureus and a S. epidermidis recipient. These studies describe a means by which methicillin resistance can be environmentally disseminated and a novel mechanism, IS-mediated recombination, for the capture and conjugative transfer of genomic islands.

Shared borders: achieving the goals of interdisciplinary patient care

Definitions and components of interdisciplinary care, as well as means of implementing, reasons for adopting, and barriers to interdisciplinary care, are presented. A health care discipline is an area of knowledge and research that is critical to patient care. In multidisciplinary practice, each member of a clinical group practices with an awareness and tolerance of other disciplines. In interdisciplinary practice, members of a team actively coordinate care across disciplines. In an ideal interdisciplinary health care team, decisions are made by consensus and each discipline has an equal opportunity for input into decisions. To make the transition from multidisciplinary to interdisciplinary practice, all disciplines, rather than representing freestanding silos, must have shared borders that represent a common professional interest and knowledge base. Such a practice model will lead to an increased level of trust among professions and a deeper level of understanding about what each profession can contribute. Barriers to interdisciplinary practice include historical factors such as different philosophies of practice and professional training, logistics of team implementation, and resource limitation. To facilitate interdisciplinary practice, pharmacists must be competent, understand what a team is, provide leadership, be prepared to help develop drug therapy outcome objectives, project self-confidence, and demonstrate a readiness for interdisciplinary practice. Interdisciplinary care must be applied in a cost-effective way. Interdisciplinary patient care must be taught in professional schools and postgraduate training programs. Interdisciplinary patient care requires common values, a common vision, and an understanding of teamwork with the ultimate goal of serving the patient with wisdom.

Experience with an automated point-of-use unit-dose drug distribution system

Two years' experience with an automated, point-of-use unit-dose system at the University of California, San Diego Medical Center (UCSDMC) is described. Growing concerns about the efficiency and cost-effectiveness of the traditional unit-dose drug distribution system at UCSDMC, and the corresponding diversion of professional staff time from pharmaceutical care responsibilities, led us to investigate alternative systems. Criteria for a new system were developed and used in evaluating alternatives. Consideration was given to three possibilities: 1) improving the existing system, 2) automating the unit-dose cassette fill process, or 3) automating the final step in medication delivery at the nursing station. Based on the realization that our traditional unit-dose system was largely inefficient in today's hospital environment, it was concluded that the drug distribution system needed to be re-engineered in a way that simplified delivery and reduced waiting time. The Medstation Rx system marketed by the Pyxis Corporation (San Diego, CA) seemed to meet the need. During a 2-year period a Medstation Rx system was implemented in most of the hospital (in all but three specialty units) and evaluated. This system has resulted in several benefits, including a net savings in labor costs, a significant reduction in waiting time for first doses, and a reduction in dispensing errors. In the process, it was possible to minimize the disruption of pharmacists engaged in the direct provision of pharmaceutical care, thereby increasing their efficiency.

Planning for pharmaceutical care

The process for planning a pharmaceutical care practice model at the University of California-San Diego Medical Center (UCSDMC) is described. Pharmaceutical care is viewed as a health care need, analogous to medical care or dental care. Provision of such care requires that pharmacists have a generalist, rather than specialist, orientation and be held responsible for the outcomes of drug therapy. The scope of pharmaceutical care encompasses all treatment settings, emphasizing continuity of care from one setting to another. Its goal is to address the total pharmaceutical care needs of all patients. A pharmaceutical care task force was appointed to develop an overall plan for the implementation of the pharmaceutical care concept at UCSDMC. Several key practice elements were identified that served as the basis for the practice model. A three-week pilot study demonstrated the feasibility of implementing a pharmaceutical care program. An implementation plan was then developed. The program is currently being implemented. A long-range plan for implementing a pharmaceutical care practice model was developed through introspection, consensus building, and redirection of professional efforts.

Pulmonary function and morbidity in textile mill workers

The study was conducted in a large cotton textile mill in Surat City. A selected number of 278 employees were evaluated for social, anthropological and pulmonary functions. No parameters except the period of exposure to dust reduced pulmonary function; it was statistically significant in the case of vital capacity and maximum breathing capacity. Out of 23.94% pulmonary morbidity observed, the byssinosis rate was 1.62.

College of pharmacy-teaching hospital relationships: report of a survey

The results of surveys conducted by the American Association of Colleges of Pharmacy (AACP) and the American Society of Hospital Pharmacists (ASHP) to investigate the extent and causes of problems in relationships between colleges of pharmacy and the pharmacy departments in their affiliated teaching hospitals are presented. For the AACP study, questionnaires were mailed to either the dean or the pharmacy practice department chairman of all 72 colleges, and a telephone interview was subsequently conducted with most of them. For the ASHP study, interviews were conducted with 67 directors of pharmacy in the colleges' principal affiliated teaching hospitals. Problems identified by the colleges related to quality or extent of services and finances. Most directors of pharmacy stated that they derived benefit from their affiliation with a college of pharmacy. The relationship between colleges of pharmacy and their teaching hospitals is relatively healthy and generally better than expected.

Positions held by graduates of ASHP-accredited pharmacy residency programs

Current positions of graduates of ASHP-accredited residency programs were determined in an April 1983 survey of the directors of 154 ASHP-accredited residency programs. For each residency graduate (RG), respondents indicated one of 16 employment categories. Data were grouped according to number of years since completion of the residency. Responses were received from 122 directors (79%), representing 2522 RGs. The percentage of RGs in pharmacy directorships increased from 4% one to two years after graduation to 27% after 10 years. After 10 years, 49% were employed in institutional pharmacy practice and 80% in some health-related activity. Most RGs currently practice in institutional pharmacy settings or hold positions in other fields that enable them to build on their institutional pharmacy background.

Distribution accuracy of a decentralized unit dose system

Unit dose medication carts in a 500-bed university hospital were monitored for accuracy and completeness after delivery to the nursing station. The contents of the cart were compared with the nurse's patient medication record. Discrepancies were recorded for evaluation. All medication cart distribution errors found were analyzed to identify the source and were tabulated to determine error rate. Three major categories of errors were discovered: pharmacy technician errors not corrected by the pharmacist, errors associated with nurse's patient medication records, and errors resulting from lost orders.

Etiological factors of the Stevens-Johnson syndrome

Etiologic factors of the Stevens-Johnson syndrome, both drug-related and nondrug-related, are discussed. A description of the Stevens-Johnson syndrome as a symptom complex is presented. Available literature is reviewed and critiqued as to its contribution in helping to define the role of drugs as specific etiologic factors in the syndrome. A patient case history is presented to demonstrate the difficulty of determining the causative agent for the syndrome, and to emphasize the need for a complete drug history before specific agents are implicated. The need for caution and discretion in reporting and implicating agents without the availability of a complete patient history is discussed.