Chemotherapy extravasation injuries beyond the immediate stage: A series of 15 cases treated according to a preset surgical algorithm based on time of presentation.

Chemotherapy extravasation can cause severe harm. There is a lack of evidence-based standardization on the surgical management of such injuries beyond the immediate stage. In an algorithm connecting presentation time post-injury with surgical treatment could help standardize future treatment. This study prospectively validated a preset standardized surgical algorithm based on presentation time in a consecutive series between October 2017 and October 2020. Chemotherapeutic agent, site and extent of injury, type of surgery and outcome at a minimum of 6 months' follow-up were collected. Seven thousand six hundred twelve individuals received chemotherapy during that period; 15 patients suffered extravasation injuries, 2 of whom were referred from outside our hospital. This algorithm distinguished: A) beyond the immediate stage and up to 2 days, treated with saline subcutaneous washout (SCWO) and vacuum-assisted closure (VAC) dressing; B) 2 to 5 days, open surgical decompression and VAC dressing; C) 5 to 10 days, non-operative management with surveillance; and D) more than 10 days, radical necrotic excision with or without VAC dressing and tissue reconstruction. In 2 patients in Group A and 3 patients in Group B, all vesicant symptoms resolved. Five of the 6 patients in Group C (3 vesicant, 3 non-vesicant) did not progress into necrosis or infection, and 1 case of vesicant extravasation progressed to a localized ulcer beyond this period and, as surgery was refused, led to a chronic ulcer with stiffness; 2 cases of non-vesicant extravasation developed a recall phenomenon but resolved after the third cycle. Of the 4 patients in Group D, all vesicant, 2 were treated with no complications, 1 had complex regional pain syndrome (CRPS) due to late presentation, and 1, referred with necrotizing fasciitis, underwent above-elbow amputation but died due to septic shock. This study demonstrated a uniform surgical approach in a series of 15 cases; larger studies are still needed to validate the efficacy of this protocol in reducing morbidity. LEVEL OF EVIDENCE: IV.

Peer-assisted Learning: Intensity-modulated Radiotherapy Transition in Developing Countries.

Intensity-modulated radiotherapy (IMRT) is not widely used in developing countries due to technical challenges and a lack of expertise and resources. We outline head and neck cancer IMRT implementation challenges and highlight how improvised solutions allowed successful IMRT transition in Jordan. This article showcases a 'peer-assisted learning' model, promoting IMRT transition in other developing countries. Unlike the 'top-down' approach, this model is uncommonly addressed in oncology journals. Developing countries could benefit from this article to enhance the adoption of modern radiotherapy technology.

Reliability testing of the Pedestrian and Bicycling Survey (PABS) method.

BACKGROUND: The Pedestrian and Bicycling Survey (PABS) is a questionnaire designed to be economical and straightforward to administer so that it can be used by local governments interested in measuring the amount and purposes of walking and cycling in their communities. In addition, it captures key sociodemographic characteristics of those participating in these activities. METHODS: In 2009 and 2010 results from the 4-page mail-out/mail-back PABS were tested for reliability across 2 administrations (test-retest reliability). Two versions--early and refined--were tested separately with 2 independent groups of university students from 4 universities (N = 100 in group 1; N = 87 in group 2). Administrations were 7 to 9 days apart. RESULTS: Almost all survey questions achieved adequate to excellent reliability. CONCLUSIONS: Transportation surveys have not typically been tested for reliability making the PABS questionnaire an important new option for improving information collection about travel behavior, particularly walking and cycling.