Effects of chemotherapy prescription clinical decision-support systems on the chemotherapy process: A systematic review.

OBJECTIVE: To carry out a systematic review of studies assessing the effects of chemotherapy prescription clinical decision-support systems (CDSSs) on the chemotherapy process. METHODS: Articles published in English before May 1, 2017 and indexed in the PubMed and Embase databases were reviewed systematically. Studies that focused on the effects of chemotherapy prescription CDSSs on the chemotherapy process were included in this research and reviewed. RESULTS: 2283 articles were retrieved, of which 37 met the inclusion criteria. Twenty-seven of the included studies reported the effect of chemotherapy prescription CDSSs on medication errors, 18 studies focused on user satisfaction and system acceptance, 10 articles studied the effect of CDSSs on costs and care time and only 3 studies examined the impact on compliance with chemotherapy protocols. DISCUSSION AND CONCLUSION: In most of the studies, the use of CDSSs in chemotherapy prescription has reduced medication errors, especially dosage errors and has also reduced the time of chemotherapy process takes. However, in a few studies, the system has not been effective in reducing medication errors, has increased certain type of errors or has introduced new errors. Most of the software used has been specifically designed for the chemotherapy process and is intended to increase user satisfaction and system acceptance. There was not sufficient evidence on the effects of these systems on compliance with protocols and chemotherapy costs to draw firm conclusion. Higher quality studies are required to provide more evidence on the effects of CDSSs on medication errors, user satisfaction and system acceptance, costs, care time and compliance with protocols.

Association of -24CT, 1249GA, and 3972CT ABCC2 gene polymorphisms with methotrexate serum levels and toxic side effects in children with acute lymphoblastic leukemia.

Acute lymphoblastic leukemia patients after being treated with methotrexate, have differences in methotrexate serum levels and toxic side effects. One of the main determinants of these toxic side effects is the host pharmacogenetics. The aim of this study was to evaluate the association of -24CT, 1249GA, and 3972CT ABCC2 gene polymorphisms with serum levels, and toxic side effects of methotrexate in childhood acute lymphoblastic leukemia. Applying polymerase chain reaction and restriction fragment length polymorphism techniques, the prevalence of -24CT, 1249GA, and 3972CT ABCC2 gene polymorphisms was evaluated in 65 acute lymphoblastic leukemia patients. The relationship between polymorphisms and methotrexate serum levels and toxicities was studied. A reverse significant relationship was detected between 3972T allele carriers and hepatotoxicity (P = 0.01, OR = 0.25, 95% CI = 0.09-0.72). Also, 1249A allele carriers had increased rate of gastrointestinal toxicity (P = 0.05, OR = 3.47, 95% CI = 1.04-11.57). No significant relationship was detected between -24CT polymorphism and methotrexate toxic side effects. There was no significant relationship between these three polymorphisms and methotrexate serum levels. Genotyping for 3972CT and 1249GA ABCC2 gene variants maybe useful in acute lymphoblastic leukemia to optimize methotrexate therapy and reducing the associated toxicity.

Neuroblastoma in Iran: an experience of 32 years at a referral childrens hospital.

BACKGROUND: This survey aim was to evaluate the epidemiology and outcomes of neuroblastoma patients in one the most important children referral hospitals in Iran as a model from developing countries. MATERIALS AND METHODS: This retrospective, non-randomized analytic study was conducted on 219 newly diagnosed neuroblastoma cases. RESULTS: The age of patients ranged from 1-156 months with the average of 40.5±2.44, with a male/female ratio of 1.9/1. Of the total, 172 (78.5%) were children and 47 (21.5%) were infants The adrenals were the most common primary site (60%). Stage 4 at diagnosis accounted for about 54% of all enrolled patients. Infants had significantly better cumulative survival (85±8%) than children (33±7%) during the follow up period and the survival rate improved from 33±7% in 1974-1994 to 58±9% in 1995-2005. CONCLUSIONS: This study indicates that our patient population with neuroblastomas tends to have more advanced disease, perhaps with poor biologic markers, but our analysis shows that the outcomes have improved over 32 years although the overall survival of Iranian neuroblastoma patients is still lower than developed countries. Late diagnosis, inability to determine risk group during the years of study and using single protocol for all enrolled patients can be the reasons of lower survival rate.

Complications of ß-thalassemia intermedia in Iran during 1996-2010 (single-center study).

Patients with thalassemia intermedia (TI) experience many complications, of which the incidence varies greatly among cases. Considering the high prevalence of thalassemia in Iran, the study was carried out to determine the frequency of TI complications in Iranian patients and to find possible risk factors for each of them. Using the sampling method of "census," the authors included 153 patients who were seen in their tertiary hematology clinic with the diagnosis of TI during 1996-2010; an analytical cross-sectional study was performed and the data was analyzed by SPSS software using univariate and regression analyses. Mean age of the patients at the time of the study was 17.4 years and 36.5% were receiving transfusions (regularly or occasionally). Mean hemoglobin was 9.2 g/dL and mean serum ferritin was 858 ng/mL. Splenectomy was performed in 46.9% and it was correlated with age and the age at diagnosis in regression analysis. Cholelithiasis was found in 25.5% and was correlated with age and history of splenectomy. Pulmonary hypertension, detected in 23.5%, was correlated with thrombocytosis and mitral valve regurgitation in univariate analysis. Endocrine disease (hypogonadism, hypothyroidism, and adrenal insufficiency) was detected in 8% of the patients. In univariate analysis, endocrine disease was correlated with age of the patients. Regarding bone density of the spine, 53% of cases had osteoporosis. Thrombocytosis was present in 42% of patients and was correlated with their age. Since the severity of thalassemia intermedia vary greatly among patients, a careful evaluation of clinical, laboratory, and genetic aspects is necessary to differentiate TI in a patient at presentation. Moreover, TI patients should be carefully followed up for early detection and management of newly developed complications. The authors also suggest confirmatory controlled studies with larger sample sizes to assist in developing guidelines for surveillance and treatment of TI.

Acute lymphoblastic leukemia and hepatoblastoma in a family.

Acute lymphoblastic leukemia is the most common and hepatoblastoma is a rare malignancy diagnosed in children. Their report on an Iranian boy with acute lymphoblastic leukemia diagnosed at the age of 2 years; 20 months later his 10-month-old sister was referred to their hospital with hepatoblastoma. The occurrence of such two types of cancer is rare in a family.