Gastrointestinal stromal tumors, version 2.2014.

Gastrointestinal stromal tumors (GIST) are the most common soft tissue sarcoma of the gastrointestinal tract, resulting most commonly from KIT or platelet-derived growth factor receptor α (PDGFRα)-activating mutations. These NCCN Guideline Insights highlight the important updates to the NCCN Guidelines for Soft Tissue Sarcoma specific to the management of patients with GIST experiencing disease progression while on imatinib and/or sunitinib.

Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients.

Background: Data on the risk factors and clinical course of hungry bone syndrome are lacking in dialysis and renal transplant patients who undergo parathyroidectomy. In this study, we aimed to assess the risks and clinical course of hungry bone syndrome and calcium repletion after parathyroidectomy in dialysis and renal transplant patients.

Methods: We performed a retrospective review of parathyroidectomies performed at The Nebraska Medical Center.

Common controversies in the management of gallbladder cancer.

Gallbladder cancer is a rare and lethal malignancy. Most patients are best served at high-volume centers of excellence, where they are likely to receive evidence-based care derived from a multidisciplinary approach. Surgical resection is recommended for early-stage disease, whereas if the disease is unresectable, the treatment options include biliary drainage, gemcitabine-based combination chemotherapy, fluoropyrimidine chemoradiation, clinical trial enrollment, or best supportive care.

Melanoma, version 4.2014.

The NCCN Guidelines for Melanoma provide multidisciplinary recommendations for the management of patients with melanoma. These NCCN Guidelines Insights highlight notable recent updates. Dabrafenib and trametinib, either as monotherapy (category 1) or combination therapy, have been added as systemic options for patients with unresectable metastatic melanoma harboring BRAF V600 mutations.

Soft tissue sarcoma, version 2.2014.

These NCCN Guidelines Insights highlight the important updates to the NCCN Guidelines for Soft Tissue Sarcoma (STS) specific to the role of radiation therapy in the management of patients with retroperitoneal/intra-abdominal STS. The guidelines have also included recommendations for genetic testing and counseling for patients with a clinical and/or family history of genetic cancer syndromes associated with a predisposition for the development of STS.

Practice Management Training in the PGY1 Residency Year: Best Practices From Two Nationwide Surveys.

Purpose: The development of future pharmacy leaders is vital to the advancement of our profession. Postgraduate year 1 (PGY1) residency training requires residents to exercise leadership and practice management skills. Two national surveys were conducted to describe the current state of practice management experiences and elucidate best practice recommendations.

Outcomes of hematopoietic cell transplantation for diffuse large B cell lymphoma transformed from follicular lymphoma.

There are limited data on the outcomes of autologous or allogeneic hematopoietic cell transplantation (HCT) in diffuse large B cell lymphoma transformed from follicular lymphoma. We analyzed transplantation outcomes in 141 subjects with biopsy-proven diffuse large B-cell lymphoma transformed from follicular lymphoma reported to the Center for International Blood and Marrow Transplant Research between 1990 and 2009. Two groups were identified: autologous HCT (auto-HCT; n = 108) and allogeneic HCT (allo-HCT; n = 33).

Kidney cancer, version 2.2014.

These NCCN Guidelines Insights highlight treatment recommendations and updates specific to the management of patients with advanced non-clear cell carcinoma included in the 2014 version of the NCCN Clinical Practice Guidelines in Oncology for Kidney Cancer.

Optimal z-axis scanning parameters for gynecologic cytology specimens.

Background: The use of virtual microscopy (VM) in clinical cytology has been limited due to the inability to focus through three dimensional (3D) cell clusters with a single focal plane (2D images). Limited information exists regarding the optimal scanning parameters for 3D scanning.

Aims: The purpose of this study was to determine the optimal number of the focal plane levels and the optimal scanning interval to digitize gynecological (GYN) specimens prepared on SurePath™ glass slides while maintaining a manageable file size.

Beneficial role for supplemental vitamin D3 treatment in chronic urticaria: a randomized study.

Background: Observational reports have linked vitamin D with chronic urticaria, yet no randomized controlled trial has been conducted.

Objective: To determine whether high-dose vitamin D supplementation would decrease Urticaria Symptom Severity (USS) scores and medication burden in patients with chronic urticaria.

Methods: In a prospective, double-blinded, single-center study, 42 subjects with chronic urticaria were randomized to high (4,000 IU/d) or low (600 IU/d) vitamin D3 supplementation for 12 weeks.

Adolescent and young adult oncology, version 2.2014.

The NCCN Guidelines Insights on Adolescent and Young Adult (AYA) Oncology discuss the fertility and endocrine issues that are relevant to the management of AYA patients with cancer. Fertility preservation should be an essential part in the treatment of AYA patients with cancer. The NCCN Guidelines recommend discussion of fertility preservation and contraception before the start of treatment.

Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle.

Objective: The debilitating and persistent effects of ICU-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle into everyday practice.

Design: Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012.

Prostate cancer, version 1.2014.

The NCCN Guidelines for Prostate Cancer provide multidisciplinary recommendations on the clinical management of patients with prostate cancer. This report highlights notable recent updates. Radium-223 dichloride is a first-in-class radiopharmaceutical that recently received approval for the treatment of patients with symptomatic bone metastases and no known visceral disease.

Chronic Myelogenous Leukemia, Version 1.2014.

The 2014 NCCN Clinical Practice Guidelines in Oncology for Chronic Myelogenous Leukemia recommend quantitative reverse-transcription polymerase chain reaction (QPCR) standardized to International Scale (IS) as the preferred method for monitoring molecular response to tyrosine kinase inhibitor (TKI) therapy. A BCR-ABL1 transcript level of 10% or less (IS) is now included as the response milestone at 3 and 6 months. Change of therapy to an alternate TKI is recommended for patients with BCR-ABL1 transcript levels greater than 10% (IS) at 3 months after primary treatment with imatinib.

Ovarian cancer, version 2.2013.

These NCCN Guidelines Insights focus on the major updates to the 2013 NCCN Guidelines for Ovarian Cancer. Four updates were selected based on recent important updates in the guidelines and on debate among panel members about recent clinical trials. The topics include 1) intraperitoneal chemotherapy, 2) CA-125 monitoring for ovarian cancer recurrence, 3) surveillance recommendations for less common ovarian histopathologies, and 4) recent changes in therapy for recurrent epithelial ovarian cancer.

Redefining parenthood: surviving the death of a child.

Background: Although dying children are often aware of their impending death, parents are reluctant to communicate with their dying child about death.

Objective: The objective of this study was to examine how parents of children in the advanced stage of a life-threatening disease trajectory communicated about death.

Methods: Using grounded theory methods, data were collected via interviews with 18 parents of children who had died of an advanced life-threatening disease.

Acute myeloid leukemia, version 2.2013.

These NCCN Guidelines Insights summarize several key updates to the NCCN Guidelines for Acute Myeloid Leukemia and discuss the clinical evidence that support the recommendations. The updates described in this article focus on the acute promyelocytic leukemia (APL) section, featuring recommendations for additional induction/consolidation regimens in patients with low- or intermediate-risk APL, and providing guidance on maintenance strategies for APL.

Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines.

These NCCN Guidelines Insights focus on nutrition and supportive care for patients with head and neck cancers. This topic was a recent addition to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers. The NCCN Guidelines Insights focus on major updates to the NCCN Guidelines and discuss the new updates in greater detail.

Older adults' views about "Managing Your Medications" booklet.

The objectives were to evaluate Managing Your Medications (MYM) booklet to improve medication management. Mailed packets, including MYM booklet and 4-page survey assessing comprehensibility, communicative effectiveness, and usefulness, were sent to a random sample of 250 older adults. The survey included perceptions of booklet, how to disseminate, and respondent's health history.

Development of a postexposure biologic treatment algorithm on a medical center campus.

Objective: To describe the development of an easily accessible online biologic exposure algorithm to guide postexposure medical evaluation and treatment of medical research personnel and health care workers in a Midwest medical center campus.

Methods: We describe the steps involved in the creation of a biologic exposure algorithm from design through implementation.

Results: One point of contact allows phone evaluation and immediate triage, providing effective and timely medical care for exposed employees as well as important guidance for clinicians.