Multidisciplinary Educational Program to Standardize Education and Management of Immune-related Adverse Events: Review and Outcomes of a Single-institution Initiative.

Objectives: The use of immune checkpoint inhibitors (ICIs) as anticancer therapy across a variety of malignancies has led to durable efficacy in a subset of patients. However, associated side effects denoted immune-related adverse events (irAEs) have emerged and can result in substantial morbidity and mortality. Particularly early in the experience of using these agents, a lack of standardized education regarding irAEs among patients and clinical providers may have contributed to poor outcomes.

Preoperative Management of Gastrointestinal and Pulmonary Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement.

Perioperative medication management is integral to preoperative optimization but remains challenging because of a paucity of literature guidance. Published recommendations are based on the expert opinion of a small number of authors without collaboration from multiple specialties. The Society for Perioperative Assessment and Quality Improvement (SPAQI) recognized the need for consensus recommendations in this area as well as the unique opportunity for its multidisciplinary membership to fill this void.

Management of Hematologic Adverse Events Associated With Immune Checkpoint Inhibitors.

Immune checkpoint inhibitors target suppressor receptors, including cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed cell death ligand 1 (PD-L1). The activated T cells are not antigen specific; therefore, the blockade of the immune checkpoint may result in the development of autoimmune adverse events. The most common immune-related adverse events (irAEs) are rash, colitis, and endocrinopathies.

Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement.

Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus.

Management of Acute Pancreatitis Associated With Checkpoint Inhibitors.

Pancreatitis is a rare immune-related adverse event (irAE) associated with the use of immune checkpoint inhibitors (ICIs). It is more often associated with combined immunotherapy than by any single agent. Early signs of pancreatitis may only include elevation of lipase and amylase.

Cancer Constipation: Clinical Summary of the ONS Guidelines™ for Opioid-Induced and Non-Opioid-Related Cancer Constipation.

Constipation is a prevalent and distressing symptom affecting people with cancer. It may be a chronic condition, or it may be caused by the effects of the disease, its treatment, or the side effects of symptom management, including the use of opioids. These evidence-based guidelines can assist clinicians in the decision-making process, guiding patients to effective interventions to decrease the incidence and severity of constipation.

ONS Guidelines™ for Opioid-Induced and Non-Opioid-Related Cancer Constipation.

Purpose: This evidence-based guideline intends to support clinicians, patients, and others in decisions regarding the treatment of constipation in patients with cancer.

Methodologic Approach: An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of cancer-related constipation. Systematic reviews of the literature were conducted.

B-Cell Malignancies: The Use of Small Molecule Agents for Treatment and Management.

Hematologic B-cell malignancies, which have varying behavior patterns, disease processes, and treatment responses, include non-Hodgkin lymphoma, leukemias, and myeloma. Although monoclonal antibodies and other agents have led to dramatic advances in the treatment of B-cell malignancies, the development of small molecules have enhanced the ability to treat and manage these malignancies and their adverse events (AEs). Oncology nurses need to be educated on the unique side effects for each class of these agents so that they can administer interventions to prevent and manage AEs in patients.

Oxaliplatin: Detection and Management of Hypersensitivity Reactions.

Background: Oxaliplatin is used extensively for the treatment of gastrointestinal cancer and other malignancies, with increased frequency of use in recent years. Hypersensitivity reactions (HSRs) can pose a major problem in clinical practice because they can limit the use of oxaliplatin in the care of malignancies in which it has proven efficacy. Nurses play an integral role in the administration of oxaliplatin; therefore, they need to be well educated in the prevention, detection, and management of HSRs.

Post-acute Transitional Journey: Caring for Orthopedic Surgery Patients in the United States.

As the geriatric population in the United States continues to age, there will be an increased demand for total hip and total knee arthroplasties (THAs and TKAs). Older patients tend to have more comorbidities and poorer health, and will require post-acute care (PAC) following discharge. The most utilized PAC facilities following THA and TKA are skilled nursing facilities (SNFs), in-patient rehabilitation facilities (IRFs), and home with home health care (HHC).

Tranexamic acid use during total hip arthroplasty: A single center retrospective analysis.

Background: Tranexamic acid (TXA) is an antifibrinolytic agent that has shown promise in reducing blood loss during total hip arthroplasty (THA). Several studies have reported side effects of high-dose TXA administration, including myocardial infarction (MI), thromboembolic events, and seizures. These possible side effects have prevented the widespread adoption of TXA in the surgical community.

Perspectives of Post-Acute Transition of Care for Cardiac Surgery Patients.

Post-acute care (PAC) facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes, specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR) services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population.

Pathobiology and Diagnosis of Multiple Myeloma.

Objective: To understand the role of the genetic changes and bone marrow microenvironment on the development, progression, and staging of multiple myeloma (MM).

Data Sources: Peer-reviewed articles and clinical guidelines.

Conclusion: The acquisition of genetic changes and the bone marrow microenvironment in which myeloma cells develop both influence the pathogenic potential of these malignant cells and is reflected in staging of the disease, risk of progression, and predicted response to treatment.

Cancer-Related Pain Assessment: Monitoring the Effectiveness of Interventions.

Background: Cancer-related pain is a major health problem because of its magnitude, the subjective nature of the pain experience, and the complexity of the disease, making it difficult to assess and control. When assessment is not performed, poor pain control can result.
.

The Impact of Bariatric Surgery on Type 2 Diabetes Mellitus and the Management of Hypoglycemic Events.

Recent studies discussed the benefit of bariatric surgery on obese patients diagnosed with type 2 diabetes mellitus (T2DM). Several factors play an essential role in predicting the impact of bariatric surgery on T2DM, such as ABCD score (age, BMI, C-peptide, and duration of the disease), HbA1c, and fasting blood glucose, incretins [glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP)]. DiaRem score known to include factors such as age, HbA1c, medication, and insulin usage used to predict the remission of T2DM, but it has some limitations.

Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications.

Anesthetic Considerations for a Patient With Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome) Undergoing a Five-Box Thoracoscopic Maze Procedure for Atrial Fibrillation.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disorder involving the abnormal communication of vascular structures. HHT typically presents with recurrent epistaxis and telangiectasis of the nasal and buccal mucosa, tongue, and lips. More serious manifestations of this disease include cerebral, pulmonary, gastrointestinal, and hepatic arteriovenous malformations.

Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients.

Methicillin-resistant Staphylococcus aureus (MRSA) is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. Aggressive skin and soft-tissue infection may be caused by MRSA with potentially fatal complications.

Internet access and use by COPD patients in the National Emphysema/COPD Association Survey.

Background: Technology offers opportunities to improve healthcare, but little is known about Internet use by COPD patients. We tested two hypotheses: Internet access is associated with socio-demographic disparities and frequency of use is related to perceived needs.

Methods: We analyzed data from a 2007-2008 national convenience sample survey of COPD patients to determine the relationship between Internet access and frequency of use with demographics, socio-economic status, COPD severity, and satisfaction with healthcare.

Gender differences in symptoms and care delivery for chronic obstructive pulmonary disease.

Background: Morbidity and mortality for women with chronic obstructive pulmonary disease (COPD) are increasing, and little is known about gender differences in perception of COPD care.

Methods: Surveys were administered to a convenience sample of COPD patients to evaluate perceptions about symptoms, barriers to care, and sources of information about COPD.

Results: Data on 295 female and 273 male participants were analyzed.

Advances in the management of acute myeloid leukemia in older adult patients.

Purpose/objectives: To update oncology nurses on new developments in the care of older adult patients with acute myeloid leukemia (AML).

Data Sources: Clinical trial data, published guidelines, review articles, and conference proceedings.

Data Synthesis: Therapies for older adult patients with AML include cytarabine-based intensive-induction chemotherapy, investigational therapy, and supportive care.

Hospital income from patients managed through a center for microsurgery and complex reconstruction.

We analyzed a 3-year period of hospital income derived from patients managed through a Center for Microsurgery and Complex Reconstruction. Revenues for these 3 years were $1,505,748, $2,158,102, and $2,029,193, respectively. Profits were $487,322 (32%), $459,856 (21%), and $26,552 (1%) over the same period, with the last year's decrease in profits coinciding with increased costs at a time of administrative reorganization and practice disruptions in the university hospital.

Clinical insights into the safety and utility of the insulin tolerance test (ITT) in the assessment of the hypothalamo-pituitary-adrenal axis.

Objective: The insulin tolerance test (ITT) is the gold standard for assessing GH and cortisol production in pituitary disease. However, areas of uncertainty remain regarding its safety in older people, the optimal duration of the test and its performance in insulin resistant states. Whether basal cortisol concentration can reliably predict an adequate adrenal response to hypoglycaemia remains to be determined.

Overview of non-Hodgkin's lymphoma.

Objectives: To provide an overview of non-Hodgkin's lymphoma (NHL).

Data Sources: Review and research articles.

Conclusion: NHLs are divided primarily into two main categories based on their rate of growth: aggressive and indolent.