Dilute Intralesional 5-Fluorouracil for the Treatment of Squamous Cell Carcinomas and Keratoacanthomas: A Case Series.

BACKGROUND: Intralesional 5-fluorouracil (5-FU) is a promising, yet sparsely studied alternative to surgical treatment for nonmelanoma skin cancer (NMSC).1 Previous studies of intralesional 5-FU have reported concentrations ranging from 30 to 50 mg/mL. To the best of our knowledge, this case series represents the first reported use of intralesional 5-FU 10.0 mg/mL and 16.7 mg/mL for NMSC. METHODS: A retrospective chart review identified 11 patients who received intralesional 5-FU 10.0 mg/mL and 16.7 mg/mL for 40 cutaneous squamous cell carcinomas and 10 keratoacanthomas. We describe the characteristics of these patients and calculate the clinical clearance rate of dilute intralesional 5-FU therapy for NMSC at our institution. RESULTS: Dilute intralesional 5-FU successfully treated 96% (48/50) of the study lesions, providing complete clinical clearance in 82% (9/11) of patients across a mean follow-up time of 21.7 months. All patients tolerated their treatments well with no reported adverse effects or local recurrences. DISCUSSION: The use of more dilute preparations of intralesional 5-FU for NMSC may be a means of reducing cumulative dose and dose-dependent adverse reactions while maintaining clinical clearance. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.5058.

Nursing Care at the Time of Death: A Bathing and Honoring Practice.

PURPOSE/OBJECTIVES: To explore family members' experience of a bathing and honoring practice after a loved one's death in the acute care setting.
. RESEARCH APPROACH: A descriptive, qualitative design using a semistructured telephone interview script.
. SETTING: The Inpatient Adult Oncology Unit at Santa Barbara Cottage Hospital in California. 
. PARTICIPANTS: 13 family members who participated in the bathing and honoring practice after their loved one's death on the oncology unit.
. METHODOLOGIC APPROACH: Participants were selected by purposive sampling and interviewed by telephone three to six months after their loved one's death. Interviews using a semistructured script with open-ended questions were recorded, transcribed, verified, and analyzed using phenomenologic research techniques to identify common themes of experience.
. FINDINGS: 24 first-level themes and 11 superordinate themes emerged from the data. All participants indicated that the bathing and honoring practice was a positive experience and supported the grieving process. The majority found the practice to be meaningful and stated that it honored their loved one. Many expressed that the bathing and honoring was spiritually significant in a nondenominational way and that they hope it will be made available to all families of patients who die in the hospital. 
. CONCLUSIONS: After patient death, a bathing and honoring practice with family member participation is positive and meaningful, and it supports family members' initial grieving.
. INTERPRETATION: This study is a first step toward establishing specific nursing interventions as evidence-based practice that can be incorporated in routine nursing care for patients and families at the end of life.

Creating national standards from the point of care.

Every nurse leader is challenged to provide an infrastructure for patient care that facilitates the highest quality of patient care services, the adoption of innovative practices, and the satisfaction of caregivers. Nurses are expected to provide the best possible care to patients and their families in ways that are safe, respectful, timely, and appropriate, even if there is not a specific policy to support it-all within the scope of practice. The purpose of this article is to share an exemplar that illustrates an effective change dynamic as the framework for changing nursing practice. The exemplar describes a new approach for postmortem care that began with creative problem solving at the bedside and evolved to a nurse-led research study. Results from the study continue to be disseminated with the intention that the nursing intervention will become standard of care.