Management of chemotherapy hypersensitivity reactions and desensitization: An SGO clinical practice statement.

OBJECTIVE: The goal of this practice statement is to help members and their multidisciplinary teams recognize infusion reactions and hypersensitivity reactions in the clinical setting. It will provide recommendations to help guide response to reactions and desensitization when appropriate, to promote safe use of chemotherapeutic agents among all providers in the delivery process. METHODS: A multi-disciplinary team of healthcare professionals from the Society of Gynecologic Oncology Education Committee collaborated to review peer reviewed literature and guidelines to develop a practice statement on the management of chemotherapy hypersensitivity reactions and desensitization regimens. RESULTS: There is always potential for a patient to have a reaction to any medication, with both infusion reactions and hypersensitivity reactions potentially occurring in the treatment of gynecologic cancers. Premedication to prevent reactions should be given at least prior to infusion for regimens that include the most common agents associated with reactions. At the time when reaction is occurring it might be difficult to distinguish between an infusion reaction versus true hypersensitivity given the similarities in signs and symptoms, therefore it is important that orders to manage reactions be included in every chemotherapy order set so the infusion nurse can provide immediate interventions while waiting for the provider to arrive to assess the patient. Desensitization is a potential option to allow the patient to continue to receive the offending agent. While a variety of desensitization regimens have been presented in the literature, the goal is to minimize steps and variability to decrease opportunity for errors during chemotherapy preparation or administration. CONCLUSION: Incorporating a review of the literature and clinical experience from the SGO Education Committee, this paper provides an overview of current approaches for prevention and management of reactions to commonly used chemotherapy agents for gynecologic cancers.

Ureteroarterial fistula.

The authors intended to perform a comprehensive review of the literature pertaining to ureteroarterial fistulae and apply the findings to a case. A comprehensive literature search was performed using the Keywords: ureter, artery and fistula. The available articles printed in or translated to English were analysed for overall trends. The results were then compared with the case of a patient (index patient). Review of the literature reveals that 57% of all ureteroarterial fistulae form in women at an average age of 58. The most common presenting complaint is haematuria. There appears to be a shift in management from primarily open surgical to primarily angiographic. The known risk factors are: vascular pathology, malignancy, prior radiation and indwelling stents. While 98% of all cases have at least one known risk factor, only 41% had two or more. We report an additional case of this rare condition, and review the present literature.

The optokinetic cervico reflex during simulated helicopter flight.

INTRODUCTION: The optokinetic cervico reflex (OKCR) is a recently hypothesized, visually driven reflex that serves to stabilize the image of the external horizon on the retina during roll maneuvers in high-performance aircraft. Although reported anecdotally, head tilt during helicopter flight has not been studied formally. Such research is required to determine the full impact and significance that it may have on the flying performance of a rotary-wing aviator. OBJECTIVE: The aim of this study was to investigate the relationship between horizon position and the perception of orientation and, thus, to generate vital information to assess whether OKCR plays an important role in spatial disorientation. HYPOTHESIS: Pilots of rotary-wing aircraft will exhibit the OKCR. METHODS: A UH-60 flight simulator study, with 20 volunteer pilots participating, was performed to examine the effects of this reflex during day flight and during flight with night vision goggles (NVGs). RESULTS: The results confirm that the OKCR occurs during simulated helicopter flight, both with and without NVGs. As with previous studies, head roll increased during flight under visual meteorological conditions in relation to an increasing aircraft roll angle up to a maximum sustainable level and then remained constant. Head roll did not occur during flight under instrument meteorological conditions. CONCLUSION: The presence of the OKCR will impact rotary-wing operations. Various aspects are discussed, and recommendations are made for future research.

An evaluation of the British Army spatial disorientation sortie in U.S. Army aviation.

BACKGROUND: Following didactic instruction, most aircrew are able to experience some of the disorienting illusions and limitations of the orientation senses in a variety of ground-based devices. In order to reinforce instruction in spatial disorientation (SD) within the environment in which they operate, British Army Air Corps helicopter pilots also receive an airborne demonstration of the limitations of their orientation senses prior to rotary-wing instrument flight training. The objective of this assessment was to determine whether the SD demonstration sortie would be an effective adjunct in training aircrew in SD in the U.S. Army. METHODS: There were 45 aviators and training personnel who experienced the sortie and gave their opinion in questionnaires. RESULTS: The following conclusions were made: the maneuvers performed in the SD demonstration sortie, and the sortie overall, were extremely effective at demonstrating the limitations of the orientation senses; the SD sortie attracted a significantly higher rating in its effectiveness to train aviators in SD than all the currently available methods; the introduction of the sortie into the initial flight training syllabus would be a distinct enhancement to the SD training of aviators and associated personnel; and the introduction of the sortie into refresher training in field units would also be an advantage. CONCLUSION: Other services are encouraged to consider this enhancement to the SD training of aviators.

Flight simulator evaluation of a novel flight instrument display to minimize the risks of spatial disorientation.

BACKGROUND: Spatial disorientation (SD) in flight remains a major source of attrition. Many SD accidents would occur regardless of the instrument display in use, since the aircrew are simply not looking at the instruments. However, there are a number of accidents which might be amenable to improved instrument displays. In an attempt to improve maintenance and reattainment of correct orientation with a reduced cognitive workload, a novel instrument display has been developed. This paper describes an assessment of the display in a UH-60 helicopter flight simulator. HYPOTHESIS: This study tested the hypothesis that during instrument flight and recovery from unusual attitudes, the novel display permits a more accurate maintenance and reestablishment of flight parameters than the standard flight instruments. METHODS: There were 16 male aviators who flew a simulated instrument flight profile and recovery from unusual attitudes using both the standard flight instruments and the novel display. The two display formats were tested both with and without a secondary task. RESULTS: When compared with the standard instruments, both control of flight parameters and recovery from unusual attitudes were significantly improved when using the novel display. Analysis of the secondary task scores showed that cognitive workload was reduced when using the novel display compared with the standard instruments. CONCLUSIONS: Results from all aspects of the assessment indicated benefits of the new display. Future testing should be carried out during real flight, and the display should be further developed to be used in a head-up or helmet-mounted device.