Choi, S. W., Chang, L., Hanauer, D. A., Shaffer-Hartman, J., Teitelbaum, D., Lewis, I., . . . Niedner, M. F. (2013). Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods. Pediatric Blood and Cancer, 60, 262–269.
To investigate the effects of the implementation of a central line catheter care bundle on infection rates.
A working group comprised of physicians specializing in pediatric hematology-oncology, infectious diseases, anesthesiology, and surgery, as well as infection-control professionals, a phlebotomy service leader, and several nursing leaders, was formed to focus on improvement in central line-associated blood stream infection (CLABSI) rates. Team members were educated in quality improvement for a four-month period and developed techniques to improve the safety culture, identify best practices for insertion and line maintenance, and disseminate information to clinical care providers. A catheter care bundle was implemented, including proper hand hygiene, dressing change frequency, skin cleansing with chlorhexidine, tubing changes at least every 96 hours, chlorhexidine used for bathing, and standards for central line entry. Pre- and postimplementation data were analyzed at six months from the beginning of the effort and at 17 months.
This was a descriptive observational study.
Self-reported adherence to catheter bundle care was more than 90% in most areas. Lowest compliance areas were bathing practices and “all or none” (compliance with everything) areas in the first six months. These both improved to more than 85% at 17 months. The preintervention CLABSI rate was 5.55% in patients undergoing bone marrow transplantation (BMT) and 1.81% in non-BMT patients. Postintervention CLABSI rates were 2.96% in BMT patients and 1.04% in non-BMT patients (p < 0.04). Patient safety culture survey results reflected improvement; however, sample sizes were small with low response rates, and comparisons were not statistically significant.
Findings showed that the institutional initiative used here was effective in reducing CLABSI rates.
Comprehensive institutional initiatives can improve quality of care. Catheter care bundle implementation was effective in reducing overall CLABSI rates as measured here. Results showed that it took time to achieve improvement in compliance with all aspects of catheter care.
Choi, C.H., Kim, M.K., Park, J.Y., Yoon, A., Kim, H.J., Lee, Y.Y., . . . Bae, D.S. (2014). Safety and efficacy of aprepitant, ramosetron, and dexamethasone for chemotherapy-induced nausea and vomiting in patients with ovarian cancer treated with paclitaxel/carboplatin. Supportive Care in Cancer, 22(5), 1181–1187.
To evaluate the efficacy of aprepitant, ramosetron, and dexamethasone 20 mg on chemotherapy-induced nausea and vomiting (CINV) in women with ovarian cancer receiving paclitaxel/carboplatin
On day 1, one hour before chemotherapy, patients received 125 mg oral aprepitant, 0.6 mg IV ramosetron, and 20 mg IV dexamethasone (over 30 minutes). On days 2 and 3, patients received 80 mg aprepitant. Vomiting episodes and use of rescue therapy were recorded for 120 hours after chemotherapy was administered. A daily Visual Analog Scale was completed on the first five mornings after chemotherapy. Rescue medications were permitted throughout the study, and type of medication was at the treating physicians' discretion.
Prospective, nonrandomized trial
98.8% of patients had CR in the acute phase, 89.4% in the delayed phase, and 89.4% overall. Patients over age 55 had a significantly higher rate of CR (97.8%) than those younger than 55 (80%) (p = 0.011). 95.3% of patients experienced no vomiting in the overall phase, and 91.8% took no rescue medications in the overall phase. Overall CR (89.4%) achieved in cycle 1 was maintained in cycles 2–6. Four hundred and sixty cycles were analyzed for adverse events. Results are as follows: ≥ 1 adverse event occurred in 179 (38.9%) cycles, drug-related adverse events occurred in 35 (7.6%) cycles, and serious adverse events occurred in 10 (2.2%) cycles. No patients discontinued therapy due to adverse events.
The combination of aprepitant, ramosetron, and dexamethasone for CINV is highly effective in the acute and delayed phases after chemotherapy administration. CR is achieved by a high number of patients for the six days following chemotherapy.
Nurses can educate patients on the available pharmacologic options to control CINV, including the combination of aprepitant, ramosetron, and dexamethasone.
Cho, H.K., Jeong, Y.M., Lee, H.S., Lee, Y.J., & Hwang, S.H. (2015). Effects of honey on oral mucositis in patients with head and neck cancer: A meta-analysis. The Laryngoscope, 125, 2085–2092.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: None stated
Administration of Honey Versus Control (Mucositis-Related Adverse Effects)
This study demonstrated the potential efficacy of honey administration in the prevention of oral mucositis and weight loss during radiotherapy and chemotherapy in patients with head and neck cancer.
Cho, S.Y., Lee, D.G., Choi, S.M., Choi, J.K., Lee, H.J., Kim, S.H., . . . Min, W.S. (2015). Posaconazole for primary antifungal prophylaxis in patients with acute myeloid leukaemia or myelodysplastic syndrome during remission induction chemotherapy: A single-centre retrospective study in Korea and clinical considerations. Mycoses, 58, 565–571.
To examine the incidence and outcomes related to the treatment of invasive fungal infection (IFI) with posaconazole versus fluconazole prophylaxis
Records of patients undergoing remission induction chemotherapy were reviewed for data collection. Results of those who received fluconazole versus posaconazole antifungal prophylaxis were compared. Both agents were begun 1–2 days prior to chemotherapy and continued until the patients' absolute neutrophil count (ANC) was > 500/mm3.
The incidence of breakthrough IFIs and the use of empirical antifungal treatment were lower in those who received posaconazole (p < 0.001). Overall, IFI-related mortality was 1.9% in the posaconazole group compared to 12.1% in the fluconazole group (p = 0.028). No difference existed between groups in overall survival.
The findings suggest that posaconazole was more effective than early generation azoles for antifungal prophylaxis in at-risk patients with cancer.
The findings suggest that newer azoles may be more effective for antifungal prophylaxis in at-risk patients with cancer.
Chu-Hui-Lin Chi, G., Young, A., McFarlane, J., Watson, M., Coleman, R.L., Eifel, P.J., . . . Richardson, M. (2015). Effects of music relaxation video on pain and anxiety for women with gynaecological cancer receiving intracavitary brachytherapy: A randomised controlled trial. Journal of Research in Nursing, 20, 129–144.
To determine the effect of watching a music relaxation video on pain and anxiety in women diagnosed with gynecological cancer who were undergoing intra-cavitary brachytherapy
A music relaxation video was played four times for a total of 120 minutes during the first 44 hours of brachytherapy treatment, with monitoring of pain scores, opioid consumption, and perceived anxiety scores compared to usual nursing care during the same time period.
Women in the intervention group reported less pain. There was no difference in levels of opioid consumption between the intervention and control groups. Participants in the music viewing group indicated significantly reduced anxiety levels in analysis (p = 0.001).
Nurses and other medical personnel should consider using music relaxation videos to help reduce pain and anxiety during intracavitary brachytherapy and other procedures that may be uncomfortable. The intervention is non-invasive, with beneficial effects.
This non-invasive intervention could be nurse-driven without a physician’s order. Women undergoing brachytherapy must lie still in a shielded isolation room for 2-3 days with limitations on visitors, resulting in physical and psychological discomforts, including pain. This study shows that pain experiences may be lessened with music relaxation videos.
Chi, N., Demiris, G., Lewis, F.M., Walker, A.J., & Langer, S.L. (2016). Behavioral and educational interventions to support family caregivers in end-of-life care. American Journal of Hospice and Palliative Medicine, 33, 894–908.
STUDY PURPOSE: To collect, review, and report on the current evidence on behavioral and educational interventions used to support family caregivers of patients who are receiving end-of-life care
TYPE OF STUDY: Systematic review
PHASE OF CARE: End-of-life care
APPLICATIONS: Palliative care
Educational and behavioral interventions for caregivers of patients with advanced cancer at the end of life appear to be effective. They are difficult to study because of high attrition rates, in part because of the point in the illness trajectory in which one is asked to participate. However, increasing evidence supports that these types of interventions will benefit caregiver competence and well-being. Ongoing study is needed to identify more specifics about the interventions, what makes them successful, and the methods of delivery, the timing, and the dose, as well as what outcomes should be measured and with what instruments. Perhaps some consistency should be developed. The cost-effectiveness of interventions should be considered as well.
Educational and behavioral interventions for caregivers appear to be helpful in improving caregiver outcomes, with statistical improvement seen in a variety of caregiver domains. The type of intervention strategy used seems to influence the specificity and breadth of outcomes influenced, with some showing more results on competence and knowledge and others expanding beyond competence and knowledge to include an additional impact on the emotional well-being and quality of life of the caregiver. All three types of interventions appear to have positive impact. Care must be taken when choosing an intervention, considering what outcome is desire.
Chiu, L., Chow, R., Popovic, M., Navari, R.M., Shumway, N.M., Chiu, N., . . . DeAngelis, C. (2016). Efficacy of olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): A systematic review and meta-analysis. Supportive Care in Cancer, 24, 2381–2392.
STUDY PURPOSE: To evaluate the effectiveness of olanzapine compared to other antiemetic regimens for preventative and breakthrough chemotherapy-induced nausea and vomiting (CINV). A secondary objective is to evaluate the effectiveness of 5 mg compared to 10 mg olanzapine for the prevention of CINV.
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Elder care
Efficacy of Acute Phase: Olanzapine was statistically superior to non-olanzapine regimens for emesis (RR = 1.10, 95% CI [1.03, 1.17]) but not nausea. The 10 mg olanzapine was statistically superior to a non-olanzapine regimen for emesis and nausea.
Efficacy of Delayed Phase: Olanzapine was statistically superior to standard antiemetic regimens for emesis (RR = 1.31, 95% CI [1.14, 1.52]) and for nausea (RR = 1.50, 95% CI [1.15, 1.97]). The 10 mg olanzapine was statistically superior to a non-olanzapine regimen for emesis (RR = 1.31, 95% CI [1.11, 1.54]) and nausea (RR = 1.50, 95% CI [1.15, 1.97]).
Efficacy Overall: Olanzapine was statistically superior to standard anti-emetic regimens for emesis (RR = 1.41, 95% CI [1.18, 1.68]) and for nausea (RR 1.53, 95% CI [1.18, 1.97]). Olanzapine 5 mg and 10 mg were both statistically superior for emesis, and 10 mg strength was superior for nausea. No studies were available for nausea with 5 mg.
Efficacy of Breakthrough: Only emesis (not nausea) was available for analysis, and olanzapine showed superiority (RR = 2.09, 95% CI [1.63, 2.68]) to non-olanzapine regimens.
Olanzapine is effective in treating emesis at all time points and is effective in treating nausea in the delayed phase. More studies are needed to determine the most effective dosing.
Olanzapine should be used as an adjunct medication for the treatment of acute chemotherapy related vomiting, breakthrough vomiting, and delayed CINV.
Chiu, H.Y., Shyu, Y.K., Chang, P.C., & Tsai, P.S. (2016). Effects of acupuncture on menopause-related symptoms in breast cancer survivors: A meta-analysis of randomized controlled trials. Cancer Nursing, 39, 228–237.
STUDY PURPOSE: To use meta-analysis technique to examine the short-term and intermediate-term effects of acupuncture on menopause-related symptoms, particularly on hot flashes, in breast cancer survivors
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
Acupuncture produced small-size effects on reducing hot-flash frequency and the severity of menopause-related symptoms. This effect did not persist even one to three months on hot-flash frequency and severity.
Acupuncture and sham control procedures might offer a short-term reduction in the severity and frequency of hot flashes, but more research with larger longer studies is needed.
Chiusolo, P., Salutari, P., Sica, S., Scirpa, P., Laurenti, L., Piccirillo, N., & Leone, G. (1998). Luteinizing hormone-releasing hormone analogue: Leuprorelin acetate for the prevention of menstrual bleeding in premenopausal women undergoing stem cell transplantation. Bone Marrow Transplantation, 21, 821–823.
Low-dose leuprorelin acetate (Lupron®) 3.75 mg given subcutaneously at least 30 days prior to transplant conditioning regimen and the second injection given 28 days after the first
Mean duration of thrombocytopenia was 28 days; only one patient developed menstrual bleeding during this time. No side effects related to leuprorelin acetate were noted.
Chiu, H.Y., Chiang, P.C., Miao, N.F., Lin, E.Y., & Tsai, P.S. (2014). The effects of mind-body interventions on sleep in cancer patients: A meta-analysis of randomized controlled trials. Journal of Clinical Psychiatry, 75, 1215–1223.
PHASE OF CARE: Multiple phases of care
The primary outcome was a change in a sleep parameters. The results of the meta-analysis indicated that MBIs had a medium effect size on the improvement of sleep quality, and this effect persisted up to three months after treatment. The weighted mean effect size was -0.43 (95% CI, -0.24 to -0.62), and the long-term effect size (up to three months) was -0.29 (95% CI, -0.52 to -0.06). The sensitivity analysis revealed that MBIs had a significant effect on sleep (g = -0.33, p < 0.001). The moderating effects of components of the intervention, methodologic features, subject characteristics, and the quality of the studies on the relationship between MBIs and sleep were not found (all p values > 0.05). The main interventions used in included studies in which yoga and mindfulness-based stress reduction were employed. Some studies involved the use of meditation, hypnosis, or sleep hygiene interventions. Yoga interventions yielded an effect size similar to that of other individual interventions (g = -0.40, p = 0.71).
This meta-analysis suggested that MBIs yield a medium effect size on sleep quality, and its effects are maintained for up to three months.
Although there was a comprehensive review of the literature, the selection criteria may have limited the studies included in the review, and the search strategies may have influenced the articles obtained. Only RCTs with MBIs reporting improved sleep outcomes may have been published, and studies with negative results may have been missed, causing a publication bias. Analysis was only done across all studies, which had substantially different interventions, some of which included cognitive behavioral therapy, which is shown to be effective in sleep improvement. The validity of calculating results across studies with very different interventions is questionable. Different methods of measurement were used in some studies as well. The included studies all lacked attention control.
The findings of this meta-analysis support the implementation of MBIs into multimodal approaches to managing sleep quality in patients with cancer; however, it should be recognized that this pooled analysis was done across specific interventions that were very different from each other, and there are multiple limitations that affect the strength of these conclusions.