Regression of brain metastases from breast carcinoma after chemotherapy with bendamustine.

PURPOSE: Bendamustinehydrochloride (bendamustine) is an alkylator with anticipated antimetabolic activity. It has shown activity in malignant lymphoma and breast cancer. Up to now there are no reports about the activity of bendamustine in the treatment of brain metastases. We report on a 38-year-old woman with brain metastases from breast cancer. The first diagnosis of an invasive ductal, hormone receptor negative breast cancer was made in October 1997, stage pT1c pN2 (11/11)cM0 - G3. After lumpectomy and resection of axillary lymph nodes, the patient received adjuvant chemo- and radiotherapy. Twenty six months after the first diagnosis, bone metastases occurred and were treated with radiotherapy. One month later, multiple liver metastases developed which were treated with trastuzumab and paclitaxel. Four months later, progress of the liver metastases and malignant infiltration of bone marrow with thrombopenia occurred. METHODS: Chemotherapy with bendamustine at a dose of 150 mg/m(2) on day 1 and 2 was initiated. Two days later, the patient suffered from central facial palsy and subsequent computed tomography (CT) revealed three brain metastases in the frontal, parietal and occipital region. Because of the advanced liver metastases with clinical and laboratory signs of liver insufficiency and the reduced performance status of the patient, chemotherapy with bendamustine was continued and no local treatment of the brain metastases was performed. RESULTS: After two courses of bendamustine, ultrasound showed regression of the liver metastases. Liver enzymes decreased, platelets increased, and the patient's performance status improved. Additionally, two of the three brain metastases were no longer detectable by CT, the third had decreased compared to the time of diagnosis. CONCLUSION: To the best of our knowledge, this is the first report describing major activity of bendamustine in cerebral metastases. Thus, it may be considered as another therapeutic strategy against metastatic brain cancer. However, this finding warrants further investigation in clinical trials.

Documentation with MDS Section M: Skin Condition.

The Minimum Data Set is designed to be the assessment instrument used in all long-term-care facilities receiving federal funds for Medicare and Medicaid. However, Section M: Skin Condition is one of the most challenging sections to complete when trying to match the Minimum Data Set documentation with the true clinical picture. If wounds are not adequately assessed and documented, outcomes of care cannot be evaluated, and treatment and prevention plans will be inadequate. This may result in less than optimal outcomes and possible lawsuits for inadequate care against both the caregiver and facility. The purpose of this article is to provide examples of medical record documentation necessary to support the Minimum Data Set assessment.

Examining the nutritional status of independently living elderly.

As more and more people age, the idea of quality, not just quantity, of life becomes increasingly important. Healthcare professionals and community planners need to look at programs aimed at keeping the elderly as healthy as possible for as long as possible. To accomplish this, having a profile of the needs of this population in all possible settings is important. The purpose of this study was to examine wellness behaviors and nutrition in a group of independently living elderly. Wellness behaviors and health practices were generally positive in this study. However, the author identified several areas of deficiencies including performing breast and testicular self-examinations, staying asleep, medication use, exercising and weight maintenance, and eating (dietary patterns). Healthcare professionals need to take nutrition seriously. Although poor nutrition is a risk factor for pressure ulcers, delays wound healing, and increases mortality when someone is ill, effects of poor nutrition are often overlooked when the person is healthy and active. Results of this study show that health professionals need to include nutritional assessment as an important component of any examination in community, acute care, and long-term care settings.

Examination of care-planning needs for elderly newly admitted to an acute care setting.

This study examined characteristics of elderly people newly admitted to an acute care setting who should be included in routine care planning. The mean serum albumin for the 137 participants was 3.0 g/dL, and 75% (n = 102) needed assistance with activity/transfer and going up stairs. Of the participants, 32.4% (n = 44) experienced some degree of either fecal or urinary incontinence. Use of the nutritional, functional, and cognitive profile developed from this study will enable nurses and medical personnel to better plan care to prevent functional decline and improve nutritional status during hospitalization of elderly patients.

A conceptual model of pressure ulcer prevalence: MDS+ items and nutrition.

A conceptual model was developed examining all items in the Minimum Data Set (MDS) as well as serum albumin. This model uses direct and indirect relationships for pressure ulcer prevalence to more adequately plan care, and is suggested as an alternative method of assessment and care planning for pressure ulcer risk. Examination of risk factors using the conceptual model developed will allow nurses to plan individualized care in a cost-effective manner. Linking the MDS to day-to-day care will strengthen its importance in individualized care planning and care provision. Understanding common problems with MDS administration will improve the accuracy of the MDS and will provide a solid basis for nurses to use when making care decisions.

MDS+ items not contained in the pressure ulcer RAP associated with pressure ulcer prevalence in newly institutionalized elderly.

All federally funded facilities are required to use the Minimum Data Set Plus (MDS+) for functional assessment of their residents. Within the MDS+ there are 18 specific conditions addressed through Resident Assessment Protocols (RAPs). The purpose of this study was to determine if MDS+ items not included in the pressure ulcer RAP correlated with pressure ulcer prevalence in newly institutionalized elderly. Additionally, this study examined whether the addition of nutritional status information to the correlated items increased association with pressure ulcer prevalence. Data were collected through a retrospective chart review of 990 residents over age 65 at eight nursing homes. Pressure ulcer prevalence was 33.2%. Nineteen of 59 non-RAP MDS+ items were correlated with pressure ulcer prevalence. Logistic regression determined that 10 MDS+ items predicted pressure ulcer prevalence in 28.88% of the subjects. Including serum albumin in the logistic model increased the predictability for pressure ulcer prevalence to 36.3%. Results of this study demonstrate the strong association between nutrition and pressure ulcer prevalence and the need to revise the pressure ulcer RAP.

Construct validity of Minimum Data Set items within the context of the Braden Conceptual Schema.

The Minimum Data Set Plus (MDS+) is used by all federally-funded long-term care facilities to assess residents and plan their care. Eighteen conditions, known as Resident Assessment Protocols (RAPs) including a pressure ulcer RAP, require a written care plan by staff. Consequently, it is important to determine if the operational definitions from the MDS+ are consistent with theoretical constructs from a conceptual schema representative of pressure ulcer risk. Examination of construct validity shows that not all of the variables in the Braden Conceptual Schema are adequately operationalized by the MDS+ or the pressure ulcer RAP. Physiologic markers of nutritional status and friction/shear are not included in the MDS+. Sensory perception is included in the MDS+ but not the pressure ulcer RAP. If the MDS+ pressure ulcer RAP is to be used to plan care and assess risk, then all items should be included. The purpose of this article is to examine the construct validity between the operational definitions of risk factors from the MDS+ and pressure ulcer RAP with theoretical constructs from the Braden Conceptual Schema.

MDS+ RAP items associated with pressure ulcer prevalence in newly institutionalized elderly: study I.

All federally funded facilities are required to use the Minimum Data Set Plus (MDS+) for functional assessment of their residents. Within the MDS+ there are 18 specific conditions addressed through Resident Assessment Protocols (RAPs). There is a RAP for pressure ulcers but the validity of the pressure ulcer RAP items has not been documented. The purpose of this study was to determine which pressure ulcer RAP items correlate with pressure ulcer prevalence in newly institutionalized elderly and whether inclusion of nutritional status information to the correlated RAP items increases association with pressure ulcer prevalence. Data were collected through a retrospective chart review of 990 residents over age 65 at 8 nursing homes. Five pressure ulcer RAP items were predictive of pressure ulcer prevalence 19.76% of the time. When nutritional status markers were added in a logistic regression, pressure ulcers were correctly predicted 32.3% of the time. In clinical practice, the pressure ulcer RAP needs to include nutritional status information to accurately reflect pressure ulcer risk.