Objective: The purpose of this study was to define the incidence of chemotherapy-induced nausea and vomiting (CINV) in newly diagnosed cervical cancer patients receiving cisplatin and radiation treatment; and to determine if the granisetron transdermal patch (Sancuso<sup>®</sup>) would be appropriate to recommend as part of standard antiemetic regimen for the cisplatin radiation chemotherapy order set. Methods: This is a retrospective case-controlled study of cervical cancer patients receiving cisplatin chemotherapy with radiation (cisXRT); comparing patients receiving the granisetron transdermal patch to matched patients receiving oral 5HT3 blockers. All patients prescribed cisXRT between September 15th 2008 and November 30, 2011 were identified using pharmacy dispensing records. Patients were included if they received at least a partial dose of cisXRT and Sancuso<sup>®</sup> patch as standard antiemetic prophylaxis prior to cisXRT for cervical cancer treatment. Exclusion criteria included concomitant investigational agents, biotherapy and/or chemotherapy agents; prior chemotherapy; or incomplete or restricted medical records. Patients will be matched based on age. Patients were matched 3:1 (oral:patch). A total of 404 patients that received and completed cisXRT were identified utilizing an existing de-identified database from previous study were reviewed to evaluate parameters of interest. Results: A total of 285 patients’ medication records were reviewed for Sancuso<sup>®</sup> use, and 47 were identified. Of these 47 charts only five patient cases met eligibility criteria to be included in the study. All five patients that received the granisetron patch had at least three known risk factors for nausea. The nausea/vomiting in these patients did not worsen after receiving the Sancuso<sup>®</sup> patch, and four out of five had subjective improvement. CINV was unrelated to changes in laboratory values or incidence of other toxicity and was not dose-related. Conclusions: While no definitive conclusions could be drawn from this retrospective analysis, the limited data suggests that patients’ nausea and vomiting did not worsen after receiving the Sancuso<sup>®</sup> patch, and four out of five patients had subjective improvement. The challenges met and limitations identified justify the need for a prospective study that is now underway to control other contributing variables and evaluate overall efficacy of the granisetron patch for controlling CINV in patients receiving cisplatin plus radiation
INTRODUCTION: There are currently no standardized methods of handoff between Labor & Delivery (L&D) and Neonatology teams for neonatology-attended deliveries. Communication breakdown occurs in approximately 70% of sentinel events resulting in perinatal mortality or permanent disability. Barriers to effective patient handoffs include confusion over role clarity, transferring unnecessary information, time constraints, and room volume. Standard communication in the delivery room could reduce communication variability and promote safer care. Our goal was to evaluate if standardized handoffs between the L&D and Neonatology teams in unplanned neonatology-attended cesarean deliveries would result in more complete and efficient transfer of critical patient information. METHODS: Members of the L&D and Neonatology teams were surveyed to determine critical areas of patient handoff in neonatology attended cesarean deliveries. Survey results were utilized to determine areas that required change for subsequent Plan-Do-Study-Act worksheets. Reliability of the process was assessed by Neonatology response respiratory therapists who submitted a separate observational survey. RESULTS: Over a 3 month period, 38 deliveries were assessed. The following transfer of critical information was identified: Obstetrician to Neonatologist - gestational age, single versus multiple gestation, presence of meconium, fetal heart rate abnormalities, fetal anomalies, and reason for the call. Whereas Neonatologist to Obstetrician - APGAR score, gender, birth weight, resuscitative measures, and disposition of infant. Both the L&D and Neonatology teams reported that a streamlined handoff process improved workflow and team satisfaction (15 and 16% positive increase, respectively). CONCLUSION: Standardization of handoffs and role identification improve communication of critical information between L&D and Neonatology teams.
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