The addition of sodium thiosulphate to hyperthermic intraperitoneal chemotherapy with cisplatin in ovarian cancer.

Cisplatin based hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong recurrence free and overall survival of women with ovarian cancer who have responded to neoadjuvant chemotherapy. The aim of this study was to assess the impact of cytoreductive surgery with or without the addition of HIPEC on renal function. METHOD: This is a retrospective case-controlled study at a tertiary teaching hospital in Dublin, Ireland. All patients who had interval cytoreductive surgery (CRS) and HIPEC from October 2017 to October 2020 were included. A cohort of patients who had interval CRS without HIPEC were included as a control. Sodium thiosulphate (ST) was added to the HIPEC protocol in 2019. In order to assess the impact of ST as a renal protectant, renal function and post-operative outcomes were compared between the groups. RESULTS: Sixty patients who had interval CRS were included, thirty of whom received cisplatin-based HIPEC. Seven received cisplatin 50 mg/m2 without the addition of ST. Twenty three patients received cisplatin 100 mg/m2 and ST. There were no statistically differences in age, body mass index BMI, American society of anaesthesia score, estimated blood loss or peritoneal cancer index between the cohorts (p > 0.05). The only episode of acute kidney injury (AKI) was within the HIPEC cohort, after cisplatin 50 mg/m2 (without ST) and this was sustained at three months. In contrast, no patients within the CRS cohort or cisplatin 100 mg/m2 that received the addition of ST, sustained a renal injury and all had a creatinine within the normal range at three days post operatively. CONCLUSION: The renal toxicity associated with cisplatin HIPEC and major abdominal surgery can be minimised with careful preoperative optimisation, intra operative fluid management and attention to renal function. The addition of sodium thiosulphate is a safe and effective method to minimise toxicity and should be added to any cisplatin HIPEC protocol.

Simulating and predicting cellular and in vivo responses of colon cancer to combined treatment with chemotherapy and IAP antagonist Birinapant/TL32711.

Apoptosis resistance contributes to treatment failure in colorectal cancer (CRC). New treatments that reinstate apoptosis competency have potential to improve patient outcome but require predictive biomarkers to target them to responsive patient populations. Inhibitor of apoptosis proteins (IAPs) suppress apoptosis, contributing to drug resistance; IAP antagonists such as TL32711 have therefore been developed. We developed a systems biology approach for predicting response of CRC cells to chemotherapy and TL32711 combinations in vitro and in vivo. CRC cells responded poorly to TL32711 monotherapy in vitro; however, co-treatment with 5-fluorouracil (5-FU) and oxaliplatin enhanced TL32711-induced apoptosis. Notably, cells from genetically identical populations responded highly heterogeneously, with caspases being activated both upstream and downstream of mitochondrial outer membrane permeabilisation (MOMP). These data, combined with quantities of key apoptosis regulators were sufficient to replicate in vitro cell death profiles by mathematical modelling. In vivo, apoptosis protein expression was significantly altered, and mathematical modelling for these conditions predicted higher apoptosis resistance that could nevertheless be overcome by combination of chemotherapy and TL32711. Subsequent experimental observations agreed with these predictions, and the observed effects on tumour growth inhibition correlated robustly with apoptosis competency. We therefore obtained insights into intracellular signal transduction kinetics and their population-based heterogeneities for chemotherapy/TL32711 combinations and provide proof-of-concept that mathematical modelling of apoptosis competency can simulate and predict responsiveness in vivo. Being able to predict response to IAP antagonist-based treatments on the background of cell-to-cell heterogeneities in the future might assist in improving treatment stratification approaches for these emerging apoptosis-targeting agents.

Inhaled peppermint oil for postop nausea in patients undergoing cardiac surgery.

BACKGROUND: Postoperative nausea is a common occurrence that is very uncomfortable for patients and may result in complications including pain, strain at the surgical site, aspiration, and possible dehiscence. Antiemetics used to manage the nausea cause many adverse reactions, such as dysrhythmias and/or drowsiness resulting in an unwillingness to ambulate or perform deep-breathing exercises. LITERATURE REVIEW: Previous studies have reported a decrease in nausea following the use of peppermint oil. STUDY METHODOLOGY: Researchers obtained informed consent from 123 patients for this study; 34 (28%) of them experienced nausea and were offered a nasal inhaler that contained peppermint oil. RESULTS: The average nausea rating before the use of peppermint oil was 3.29 (SD, 1.0) on a scale of 0 to 5, with 5 being the greatest nausea. Two minutes later, the average nausea rating was 1.44 (SD, 1.3). Using paired t-tests, these differences were found to be statistically significant (P = 0.000). DISCUSSION: The researchers concluded that peppermint oil inhalation is a viable first-line treatment for nausea in postoperative cardiac surgery patients.

Reiki's effect on patients with total knee arthroplasty: A pilot study.

BACKGROUND: In the immediate postoperative period, managing postsurgical pain with pain medication can contribute to complications. A more effective approach might include a combination of pharmacologic and nonpharmacologic measures, such as Reiki therapy. PURPOSE: The purpose of this pilot study was to determine the impact of Reiki therapy on the pain perception of patients undergoing total knee arthroplasty (TKA) following Reiki sessions, satisfaction with Reiki therapy, satisfaction with the hospital experience overall, and pain medication use following surgery. WHAT IS REIKI?: Reiki is a technique for relaxation and stress reduction that also promotes healing. LITERATURE REVIEW: Reiki has been studied in women undergoing abdominal hysterectomies and in patients with cancer who were receiving chemotherapy. A review of 66 biofield therapy studies, including Reiki, suggested, "strong evidence for the effects of biofield therapy in the reduction of pain intensity in pain populations and moderate evidence for decreased pain in hospitalized patients." THEORETICAL FRAMEWORK: Martha Rogers's Theory of Unitary Human Beings formed the framework for this study. METHODS: The sample included 43 patients undergoing TKA, who were randomized into Reiki (N = 23) and non-Reiki (N = 20) groups. All subjects in this pilot study had unilateral TKA at the same hospital. Pain was assessed before and after Reiki therapy using the numeric rating scale in the preoperative area, postanesthesia care unit (PACU), and on each of 3 postoperative days. A questionnaire was distributed the day of discharge to measure satisfaction with Reiki and the hospital experience. RESULTS: All Reiki therapy sessions resulted in statistically significant reductions in pain, except those sessions in the PACU. Subjects receiving Reiki responded positively to questionnaires completed on the day of discharge. No statistically significant differences were found in pain medication use. DISCUSSION: Reiki may be an effective component in the management of surgical patients' postoperative pain. LIMITATIONS AND IMPLICATIONS: Subject numbers were limited due to the difficulty of meeting with the patients and obtaining informed consent. Due to the nature of Reiki therapy, the study was not blinded. Music played during Reiki therapy could have contributed to the effect experienced by the patients. Not all questionnaires were collected before patient discharge. RECOMMENDATIONS FOR FURTHER STUDIES: Future studies should include more subjects, control for music use during the Reiki session, and measure the length of time pain is decreased following Reiki treatments. UNANTICIPATED OUTCOMES: As a result of positive feedback and decreased pain ratings following Reiki sessions, a Reiki program has been established at the hospital. Ten nurses became trained and certified in Reiki.

Improving Nursing Knowledge of Alcohol Withdrawal: Second Generation Education Strategies.

Christiana Care Health System implemented a Care Management Guideline for Alcohol Withdrawal Symptom Management, which provided direction for inpatient screening for alcohol withdrawal risk, assessment, and treatment. Nurses educated on its use expressed confusion with the use of the assessment tools, pharmacokinetics, and pathophysiology of alcohol withdrawal and delirium tremens. Reeducation was provided by nursing professional development specialists. Pre- and postsurveys revealed that nurses were more confident in caring for patients with alcohol withdrawal.

Improving alcohol withdrawal outcomes in acute care.

CONTEXT: Excessive alcohol consumption is the nation's third leading cause of preventable deaths. If untreated, 6% of alcohol-dependent patients experience alcohol withdrawal, with up to 10% of those experiencing delirium tremens (DT), when they stop drinking. Without routine screening, patients often experience DT without warning. OBJECTIVE: Reduce the incidence of alcohol withdrawal advancing to DT, restraint use, and transfers to the intensive care unit (ICU) in patients with DT. DESIGN: In October 2009, the alcohol withdrawal team instituted a care management guideline used by all disciplines, which included tools for screening, assessment, and symptom management. Data were obtained from existing datasets for three quarters before and four quarters after implementation. Follow-up data were analyzed and showed a great deal of variability in transfers to the ICU and restraint use. Percentage of patients who developed DT showed a downward trend. MAIN OUTCOME MEASURES: Incidence of alcohol withdrawal advancing to DT and, in patients with DT, restraint use and transfers to the ICU. RESULTS: Initial data revealed a decrease in percentage of patients with alcohol withdrawal who experienced DT (16.4%-12.9%). In patients with DT, restraint use decreased (60.4%-44.4%) and transfers to the ICU decreased (21.6%-15%). Follow-up data indicated a continued downward trend in patients with DT. Changes were not statistically significant. Restraint use and ICU transfers maintained postimplementation levels initially but returned to preimplementation levels by third quarter 2012. CONCLUSION: Early identification of patients for potential alcohol withdrawal followed by a standardized treatment protocol using symptom-triggered dosing improved alcohol withdrawal management and outcomes.

Using the AUDIT-PC to predict alcohol withdrawal in hospitalized patients.

BACKGROUND: Alcohol withdrawal syndrome (AWS) occurs when alcohol-dependent individuals abruptly reduce or stop drinking. Hospitalized alcohol-dependent patients are at risk. Hospitals need a validated screening tool to assess withdrawal risk, but no validated tools are currently available. OBJECTIVE: To examine the admission Alcohol Use Disorders Identification Test-(Piccinelli) Consumption (AUDIT-PC) ability to predict the subsequent development of AWS among hospitalized medical-surgical patients admitted to a non-intensive care setting. DESIGN: Retrospective case­control study of patients discharged from the hospital with a diagnosis of AWS. All patients with AWS were classified as presenting with AWS or developing AWS later during admission. Patients admitted to an intensive care setting and those missing AUDIT-PC scores were excluded from analysis. A hierarchical (by hospital unit) logistic regression was performed and receiver-operating characteristics were examined on those developing AWS after admission and randomly selected controls. Because those diagnosing AWS were not blinded to the AUDIT-PC scores, a sensitivity analysis was performed. PARTICIPANTS: The study cohort included all patients age ≥18 years admitted to any medical or surgical units in a single health care system from 6 October 2009 to 7 October 2010. KEY RESULTS: After exclusions, 414 patients were identified with AWS. The 223 (53.9 %) who developed AWS after admission were compared to 466 randomly selected controls without AWS. An AUDIT-PC score ≥4 at admission provides 91.0 % sensitivity and 89.7 % specificity (AUC=0.95; 95 % CI, 0.94­0.97) for AWS, and maximizes the correct classification while resulting in 17 false positives for every true positive identified. Performance remained excellent on sensitivity analysis (AUC=0.92; 95 % CI, 0.90­0.93). Increasing AUDIT-PC scores were associated with an increased risk of AWS (OR=1.68, 95 % CI 1.55­1.82, p<0.001). CONCLUSIONS: The admission AUDIT-PC score is an excellent discriminator of AWS and could be an important component of future clinical prediction rules. Calibration and further validation on a large prospectivecohort is indicated.

The people in your neighborhood: impact of physician cohorting on nursing units.

In a study exploring the impact of a new physician practice model on staff's perceptions of their work environment, no statistically significant differences were found; however, some interesting results were obtained. Nurses should strive to improve working relationships not only with nurses and physicians, but also with members of the entire health care team and system.