Review : Utilization of dimethyl sulfoxide for treating anthracycline extravasation

Objective. To review the literature available on the use of dimethyl sulfoxide (DMSO) to treat anthracy cline extravasation.

Data Sources. English-language literature was gathered using Medline, EMBASE International Phar maceutical Abstracts, CINAHL, and references from bibliographies.

Study Selection. Studies selected for review included controlled animal studies and any available human studies, including case reports and case series. All studies must have used DMSO in the treatment of an anthracycline extravasation.

Data Extraction. Data extracted from animal studies included the animal model used; method of doxorubicin and DMSO administration; ulcer out come ; and statistical significance. Individual case re ports and case series were abstracted for the anti neoplastic agent extravasated; associated symptoms; DMSO administration; concurrent therapies; and short- and long-term results (symptoms, functional damage).

Data Synthesis. One of six animal studies indi cated a significant difference in peak lesion size and area under the curve between DMSO and control. However, local cooling resulted in less toxicity as compared with DMSO, and the time to ulcer healing was actually prolonged in the DMSO-treated group. Clinical experience with DMSO has resulted in no surgical intervention and no residual function impair ment after anthracycline extravasation.

Conclusion. The controversial animal data and the lack of controlled clinical experience with DMSO should preclude its use as the sole initial therapy of anthracycline extravasations. A comparison study be tween topical DMSO and local cooling versus local cooling alone would aid in determining the true benefit of DMSO in the treatment of anthracycline extravasation.

Variables impacting an academic pharmacy career choice

OBJECTIVES

To identify the variables associated with an academic pharmacy career choice among the following groups: final professional-year doctor of pharmacy (PharmD) students, pharmacy residents, pharmacy faculty members within the first 5 years of academic employment, and clinical pharmacy practitioners.

METHODS

A cross-sectional design Web-based survey instrument was developed using the online tool SurveyMonkey. The survey link was distributed via e-mail and postcards, and data were collected anonymously. Quantitative analyses were used to describe the 2,494 survey respondents and compare their responses to 25 variables associated with an academic pharmacy career choice. Logistic regression models were used to predict the motivators/deterrents associated with an academic pharmacy career choice for each participant group.

RESULTS

Across all participant groups, the potential need to generate one's salary was the primary deterrent and autonomy, flexibility, and the ability to shape the future of the profession were the primary motivators. Final-year pharmacy students who considered a career in academic pharmacy were significantly deterred by grant writing. The overall sample of participants who considered an academic pharmacy career was more likely to be motivated by the academic environment and opportunities to teach, conduct professional writing and reviews, and participate in course design and/or assessment.

CONCLUSIONS

This study demonstrates specific areas to consider for improved recruitment and retention of pharmacy faculty. For example, providing experiences related to pharmacy academia, such as allowing student participation in teaching and research, may stimulate those individuals' interest in pursuing an academic pharmacy career.

Collaborative drug therapy management by pharmacists--2003

Since publication of the initial ACCP position statement on CDTM by pharmacists in 1997, the public, government, and much of the health care community at large have come to better appreciate the growing complexity of providing effective and safe drug therapy in today's health care environment. Increased interest in the issues of cost and quality of drug use is evident in the increasing coverage of the issue in the lay press and professional literature. This represents real progress, as well as real opportunity, for pharmacists. It also heightens the potential for a better understanding of the vital role that pharmacists can play in addressing these concerns. The percentage of patients who take several drugs for chronic diseases will continue to increase. Based on current trends, the number of patients who lack adequate access to care, or who receive either suboptimal, inappropriate, or unnecessarily expensive drug therapy for their acute and chronic diseases, will increase. Even as financial and human resources are increasingly strained within the current health care system, costs will continue to rise unless changes are made. Fortunately, qualified pharmacists are prepared, capable, and willing to help address a significant portion of these challenges. The public, many health care providers, some legislators, and a few insurers now recognize that pharmacists, because of their education and training in drug therapy, are well positioned both to accept additional responsibility for patient care and to provide services that make a real difference in health care quality and outcomes. The health care programs administered by the U.S. Public Health Service, the armed forces, and the Veterans Health Administration, as well as 38 states, now support pharmacist participation in CDTM. Pharmacists, working in an interdisciplinary structure with physicians and other health care providers, have demonstrated that they can improve the effectiveness, efficiency, and safety of drug therapy by providing CDTM. It is time to incorporate this valuable professional skill of the contemporary pharmacist as a core component of the delivery of health care services.

Cancer-related issues for women

Tobacco and diet account for almost two-thirds of all cancer-related deaths and are among the most correctable risk factors. Up to 35% of cancer-related deaths could be avoided if appropriate screening measures were used. Research on the use of vaccines to treat or prevent cancer has intensified. Pharmacists can play a major role in women's health by acting as patient advocates, serving as referral sources, and recommending supportive care.

Transdermal fentanyl in the management of cancer pain in ambulatory patients: an open-label pilot study

We performed an open-label pilot study to define analgesic efficacy, acceptability, and toxicity of transdermal fentanyl in an ambulatory population of patients with cancer pain. Our 7-day study included 35 patients, all of whom had failed a trial of an opioid analgesic conventionally used for moderate pain. Patients received either a 25 micrograms/hr or 50 micrograms/hr fentanyl transdermal patch depending on prior opioid dose. Pain was measured daily utilizing visual analogue (VAS) and categorical (CAT) scales. Hours of nighttime sleep, quality of life, toxicities, and use of rescue medication were also assessed. There was a 24%-29% reduction in mean VAS and CAT pain scores as compared with the baseline and a 25% increase in mean hours of nighttime sleep. Fifty-nine percent of those patients responding (46% of all study patients) were satisfied to very satisfied with the analgesia provided by transdermal fentanyl. Six percent of all study patients were not at all satisfied with the pain relief obtained. Toxicities were similar to those seen with other opioids. No patient developed severe sedation or respiratory depression. The 25-50 micrograms/hr patch appears to be a safe starting dosage in ambulatory patients previously receiving opioids conventionally used for moderate pain.

Hepatic artery chemoembolization therapy for hepatic tumors

Patients with hepatocellular carcinomas who undergo chemoembolization therapies require skilled perioperative nursing care that addresses their knowledge deficits about chemoembolization techniques, their anxieties related to chemoembolization procedures and adverse effects, and their impaired mobility resulting from the presence of arterial lines and the progression of the cancer. Perioperative nursing participation in chemoembolization procedures is an example of the expanded role of today's OR nurse.

Randomized placebo-controlled evaluation of hydrazine sulfate in patients with advanced colorectal cancer

PURPOSE

Hydrazine sulfate is a controversial agent that was originally studied in cancer patients approximately 20 years ago. Based on a series of recent trials that suggested that this drug might have utility in cancer patients, we conducted this study.

PATIENTS AND METHODS

Patients with metastatic colorectal cancer were randomized to receive hydrazine sulfate or placebo in a double-blinded manner. Protocol patients did not concurrently receive any other systemic antineoplastic treatment.

RESULTS

There were 127 assessable patients entered onto this clinical trial. Data from the study showed trends both for poorer survival and for poorer quality of life (QL) in the hydrazine group. There were no significant differences in the two study arms with regard to anorexia or weight loss.

CONCLUSION

This trial failed to demonstrate any benefit for hydrazine sulfate.

Aminoglycoside forecasting in neutropenic patients with cancer

To validate the population pharmacokinetic parameters of aminoglycoside disposition in patients with cancer, a retrospective evaluation of predictive performance of a Bayesian program was performed in 155 patients from 1986 to 1989 who received amikacin, gentamicin or tobramycin. Each patient received 1 of the 3 drugs and had initial drug concentration determination, with a second set of drug concentrations drawn < or = 14 days after the initial dose. Predictions of 64 amikacin, 144 gentamicin and 102 tobramycin concentrations were generated using 1-compartment model pharmacokinetic parameters, serum creatinine values, patients' dosage history and demographic data. The mean (+/- SD) observed (and predicted) serum concentrations for amikacin were 18.9 +/- 14.8 mg/L (17.2 +/- 14.1 mg/L); for gentamicin were 4.49 +/- 3.58 mg/L (4.26 +/- 3.33 mg/L) and for tobramycin were 4.52 +/- 3.70 mg/L (4.05 +/- 3.49 mg/L) [p > 0.05]. Results demonstrated minimal bias with a mean error in gentamicin concentrations of -0.236 (95% CI -0.533: 0.0613). Significant (p < 0.05) under prediction occurred in concentrations of tobramycin [-0.474 mg/L (95% CI -0.842: -0.0107)] and amikacin [-1.77 mg/L (95% CI -3.42: -0.114)]. Good precision is indicated by a mean squared error for gentamicin of 3.35 mg/L (95% CI 1.70: 4.99) and for tobramycin of 3.64 mg/L (95% CI 1.83: 5.44). Fair precision is demonstrated by amikacin [46.1 mg/L (95% CI 27.3: 65.0)]. Similar results were shown in a separate peak/trough analysis. These data indicate that aminoglycoside pharmacokinetics in patients with cancer can be predicted with minimal bias and good precision using a Bayesian forecasting program for gentamicin and tobramycin.

The safety and effectiveness of long-term warfarin therapy in an anticoagulation clinic

Whenever long-term anticoagulation is prescribed, the risks of such therapy must be evaluated accurately. Whether these risks are influenced by the duration of therapy, the indication for therapy, patient demographics and social habits, or the use of an anticoagulation clinic is controversial. This study examined the occurrence rates of major hemorrhage, minor hemorrhage, and thromboembolic events among an inception cohort of 82 patients receiving long term-warfarin therapy in an anticoagulation clinic. During 199.34 patient-years of observation, there were 4 major hemorrhages (0.0201/patient-year), 31 minor hemorrhages (0.1555/patient-year), and 7 thromboembolic events (0.0351/patient-year). Although each type of event tended to occur during the first 6 months of therapy, this trend was not statistically significant. Failure to demonstrate statistically significant influence of any of the evaluated variables may have been due to the unusually low rate of complications, a finding that may reflect the safety of anticoagulant therapy when managed by a specialized clinic.

Evaluation of factors associated with stability of anticoagulation therapy

Eighty-two patients receiving long-term warfarin therapy provided 199.34 patient-years of data that were evaluated to determine if certain variables could identify those who might be monitored safely at less frequent intervals. Most patient demographics, social habits, medical histories, indications for anticoagulation, and concurrent therapy were not useful in discriminating between patients with stable (n = 67) and unstable (n = 15) anticoagulation. A few trends were noted, but they failed to achieve statistical significance. Patients who never achieved stability (the unstable group) tended to be younger than those who did (p 0.13). Among the stable patients, those with a diagnosis of deep vein thrombosis or pulmonary embolus, or with elevated alanine aminotransferase values, were significantly more likely to require a dosage change. The probability of requiring a dosage change at monthly visits did not correlate with the time required to become stable, but it did correlate inversely with the duration of stable anticoagulation. This probability declined from almost 16% when monitoring frequency was first extended to monthly intervals to less than 8% at 2 months of stable anticoagulation, and tended to decline further with longer periods of stable therapy. Of the 67 patients who became stable, 23 did not require a dosage change during an average of 526 days of follow-up. Among the 44 stable patients who required a dosage change, the mean time to the change was 250 days after becoming stable. Few complications occurred, almost all of them early in therapy.(ABSTRACT TRUNCATED AT 250 WORDS)