Evaluation of a patient self-medication program in allogeneic hematopoietic stem cell transplantation.

INTRODUCTION: Patients admitted for allogeneic hematopoietic stem cell transplantation (allo-HSCT) are discharged with multiple new medications. At our institution, a new patient Self Medication Program (SMP) was implemented on the allo-HSCT units. An SMP allows patients to practice self-administration of medications in a controlled environment before discharge. We assessed the impact of the SMP on patient medication knowledge, self-efficacy, adherence, and safety. Patient and staff satisfaction with the SMP was also explored. METHODS: Participants in the SMP group received medication counseling by a pharmacist and self-managed their medications with nursing supervision until discharge. Participants in the pre-SMP group received medication counseling by a pharmacist at discharge. All participants completed a Medication Knowledge and Self-Efficacy Questionnaire before discharge and at follow-up. Safety endpoints were assessed for SMP participants. RESULTS: Twenty-six patients in the pre-SMP group and 25 patients in the SMP group completed both questionnaires. Median knowledge scores in the pre-SMP group versus the SMP group were 8.5/10 versus 10/10 at discharge (p = 0.0023) and 9/10 versus 10/10 at follow-up (p = 0.047). Median self-efficacy scores were 38/39 in the pre-SMP group versus 39/39 in the SMP group at both discharge and follow-up (pdischarge = 0.11, pfollow-up = 0.10). The SMP was associated with at least 1 medication event in 7 participants, but no medication incidents. Patient and staff surveys showed a positive perceived value of the SMP. CONCLUSION: Our results demonstrate that the SMP is associated with durable, improved medication knowledge, a trend towards improved self-efficacy, and largely positive perceptions among both staff and patient participants.

Efficacy and cost analysis of eltrombopag in thrombocytopenia and poor graft function post allogeneic hematopoietic cell transplantation.

Eltrombopag has shown efficacy in the treatment of thrombocytopenia and poor graft function (PGF) after allogeneic hematopoietic cell transplantation (HCT) in retrospective observational studies, but is not approved for this indication. The cost of this drug is also a major concern in publicly funded health care systems. We collected data about patients who received eltrombopag for thrombocytopenia or PGF after HCT. Post-HCT thrombocytopenia, PGF, and eltrombopag response were defined as per previously published criteria. Primary outcome was treatment efficacy and secondary outcome was cost comparison between estimated treatment cost prior to and after initiation of eltrombopag. Seventeen patients (males 70.6%; median age = 58) received eltrombopag. Isolated thrombocytopenia was present in 11.8% (n = 2) patients while PGF was present in 88.2% (n = 15) of patients. After 8 weeks of treatment at the maximum dose of 150 mg orally daily, overall response rate (ORR) was seen in 76.5% (13/17) of patients: complete response (CR) in 10/13 patients and partial response (PR) in 3/13 patients. The use of eltrombopag was associated with an overall decrease in the total weekly care costs (5021 vs 2,524 CA$; P = 0.04). Thus, Eltrombopag is an efficacious and possibly cost-effective therapy for thrombocytopenia and PGF after allogeneic HCT.

Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit.

At our institution, tacrolimus is used as a second-line agent for the prevention and treatment of graft-versus-host-disease in the allogeneic hematopoietic stem cell transplantation (HSCT) unit after patients have experienced a serious or intolerable adverse event to cyclosporine. As per our standard practice, tacrolimus is administered via 2-h intermittent IV infusions (IIVs) every 12 h rather than continuous IV infusion. Shorter infusion times are cautioned due to concerns of higher rates of nephrotoxicity, neurotoxicity and infusion-related reactions, although there is a paucity of data to support this claim. Our primary objective was to evaluate the safety of a 2-h IIV of tacrolimus in an adult HSCT population. We retrospectively reviewed the charts of 104 patients who received tacrolimus by IIV (3574 doses; median = 22, range 1-158, IQR = 28) from 2002 to 2016. Primary outcomes collected include rates of nephrotoxicity, neurotoxicity and infusion-related reactions. One (0.9%) grade 2 infusion-related reaction occurred and resolved without discontinuation of tacrolimus. Of 16 incidences (13.6%) of nephrotoxicity, all but 10 (8.5%) cases resolved. Precipitating factors for nephrotoxicity unrelated to tacrolimus were identified in all 10 cases. There were 41 incidences (35%) of neurotoxicity, of which, 8 (6.8%) were considered serious. All neurotoxicity reverted to baseline or resolved completely. We propose that a 2-h IIV of tacrolimus is a safe method of administration in the adult HSCT setting.

Pharmacist's Role in Improving Medication Safety for Patients in an Allogeneic Hematopoietic Cell Transplant Ambulatory Clinic.

BACKGROUND: Patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT), supported by complex drug regimens, are vulnerable to drug therapy problems (DTPs) at interfaces of care after discharge from hospital and may benefit from timely pharmacy interventions and education. OBJECTIVE: To determine the effect on medication safety of, as well as potential barriers to, incorporating a pharmacist in the multidisciplinary team of an allo-HCT clinic. METHODS: Two pharmacists rotated to attend the allo-HCT clinic of a tertiary care, university-affiliated cancer centre between January and June 2010 (coverage for 1 of 3 clinic days per week). For every patient who was seen by a pharmacist, all discharge medications were reconciled from the inpatient ward to the clinic. The pharmacists' primary task was to perform medication reconciliation and to identify and resolve DTPs. The pharmacists also provided medication education to patients and pharmacy consultations to clinic staff. Working with the outpatient pharmacy, the pharmacists helped to clarify prescriptions and drug coverage issues. Medication discrepancies identified and interventions performed by the pharmacists were recorded and were later graded for clinical significance by a panel of clinicians. Patient and staff satisfaction surveys were conducted at random during the study period. Barriers to the flow of patient care and other operational issues were documented. RESULTS: The 2 pharmacists saw a total of 35 patients over 100 visits. They identified a total of 50 medication discrepancies involving 17 (49%) of the patients and 70 DTPs involving 23 (66%) of the patients. Thirty-one of the 70 DTPs resulted directly from a medication discrepancy. Twenty (95%) of the 21 unintentional medication discrepancies and 7 (70%) of the 10 undocumented intentional medication discrepancies were graded as clinically significant or moderately significant. Satisfaction surveys completed by patients and clinic staff yielded positive responses supporting pharmacists' participation. CONCLUSIONS: Pharmacists working as part of the multidisciplinary team identified and resolved medication discrepancies, thereby improving medication safety at the allo-HCT clinic.

CONTEXTE: Les patients subissant une greffe allogénique de cellules souches hématopoïétiques (GACSH), appuyée par un traitement médicamenteux complexe, sont vulnérables aux problèmes pharmacothérapeutiques lors de changement de milieu de soins après avoir reçu leur congé de l'hôpital et pourraient tirer profit d'interventions et de conseils pharmaceutiques en temps opportun. OBJECTIF: Déterminer les répercussions sur la sécurité des médicaments de la participation d'un pharmacien et les obstacles potentiels à sa participation à l'équipe multidisciplinaire d'une unité clinique de GACSH. MÉTHODES: Deux pharmaciens se sont relayés pour se joindre à l'équipe de l'unité clinique de GACSH d'un centre de cancérologie tertiaire affilié à une université, entre janvier et juin 2010 (participation à une des trois journées par semaine d'ouverture de l'unité clinique). Pour chaque patient qu'il a rencontré, le pharmacien a comparé les médicaments prescrits au départ de l'hôpital au schéma pharmacothérapeutique adopté à l'unité de GACSH. La principale tâche des pharmaciens était d'effectuer un bilan comparatif des médicaments et de détecter et de résoudre tout problème pharmacothérapeutique. Les pharmaciens devaient également fournir des conseils sur les médicaments aux patients et des consultations au personnel de l'unité clinique. En collaboration avec la pharmacie externe, le pharmacien aidait à clarifier les ordonnances et à préciser les modalités de remboursement des médicaments. Les divergences médicamenteuses relevées par les pharmaciens et les interventions effectuées par ceux-ci ont été consignées, puis dans un second temps classées par un panel de cliniciens selon leur importance clinique. Des sondages sur la satisfaction des patients et du personnel ont été effectués au hasard pendant la période de l'étude. Les obstacles au bon déroulement des soins aux patients et d'autres problèmes de fonctionnement ont été cernés et consignés. RÉSULTATS: Les deux pharmaciens ont vu 35 patients en tout au cours de 100 visites. Ils ont détecté un total de 50 divergences médicamenteuses touchant 17 (49 %) des patients et 70 problèmes pharmacothérapeutiques touchant 23 (66%) des patients. Trente-et-un de ces 70 problèmes pharmacothérapeutiques étaient directement attribuables à une divergence médicamenteuse. Vingt (95 %) des 21 divergences non intentionnelles et 7 (70 %) des 10 divergences intentionnelles non consignées ont été classées comme étant significatives ou modérément significatives sur le plan clinique. Les sondages sur la satisfaction remplis par les patients et le personnel de l'unité ont dégagé des réponses favorables à la participation des pharmaciens. CONCLUSIONS: Les pharmaciens qui ont participé à l'équipe multidisciplinaire ont détecté et résolu des divergences médicamenteuses, améliorant ainsi la sécurité des médicaments à l'unité de GACSH. [Traduction par l'éditeur].

[The proliferating ability inhibited by energy controllable steep pulse in breast cancer cell line and its mechanism].

This was a study aimed to observe the proliferating ability inhibited by energy controllable steep pulse (ECSP) and to detect the expression of gene with relation to the proliferating ability of the tumor in breast cancer cell line; the possible mechanisms were also addressed. Human breast cancer cell line MDA-MB-231 was treated with ECSP; the apoptosis and the expression of tumor suppressor gene--Rb genes and E2F1 genes in ECSP group and control group were detected by TUNEL staining and Reverse Transcripitional PCR respectively. ECSP was found to inhibit the proliferating ability of breast cancer cells markedly, the cell amount in ECSP group decreased and the TUNEL positive cells increased obviously, compared to control; 24 hours after treatment the expression of Rb genes mRNA increased, whereas the expression of E2F1 mRNA decreased. These findings indicate that the proliferating ability of breast cancer cells can be inhibited by ECSP markedly, the apoptosis of breast cancer cell can be induced by ECSP, and the Rb genes and E2F1 genes may be involved in the course.