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: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Purpose The complication profile following repeat 90Y-radioembolization (RE) is not well understood, and repeat RE is sometimes avoided because of concerns for RE-induced liver disease (REILD) and liver toxicity. The purpose of this study was to examine the incidence of REILD and liver toxicity following repeat 90Y-RE and to identify potential risk factors. Methods A retrospective analysis of patients undergoing repeat RE to the same hepatic lobe between 2013 and 2018 was performed. Baseline factors were evaluated as predictors of liver toxicity, mortality, and REILD, which was defined as the presence symptomatic ascites or jaundice in the absence of biliary obstruction within 8 weeks following RE. Post-RE complications were graded according to the Common Terminology Criteria for Adverse Events version 5. Results A total of 39 patients underwent repeat RE with 14 (35.9%) experiencing Common Terminology Criteria for Adverse Events toxicity of grade 2 or greater, 3 (10.3%) grade 3, and no grade 4 or greater. A Model for End Stage Liver Disease score of 8 or greater was associated with grade 2 toxicity or greater (26.7% vs 75%; P = 0.013). Only 3 patients (7.7%) experienced REILD due to symptomatic ascites without jaundice. Greater than 2 REs were associated with a greater rate of 6-month mortality (12% vs 58.3%, P = 0.003), 12-month mortality (28% vs 75%, P = 0.007), and REILD (0% vs 21.4%, P = 0.016). Age, sex, microsphere type, cirrhosis, Child-Pugh, and Eastern Cooperative Oncology Group status were not significantly associated with complications, REILD, or survival. Conclusions Repeat 90Y-RE appears to be well tolerated with a low rate of high-grade adverse events and REILD.

Purpose. This study aims to identify clinical and imaging prognosticators associated with the successful bridging or downstaging to liver transplantation (LT) in patients undergoing Yttrium-90 radioembolization (Y90-RE) for hepatocellular carcinoma (HCC). Methods. Retrospectively, patients with Y90-RE naïve HCC who were candidates or potential candidates for LT and underwent Y90-RE were included. Patients were then divided into favorable (maintained or achieved Milan criteria (MC) eligibility) or unfavorable (lost eligibility or unchanged MC ineligibility) cohorts based on changes to their MC eligibility after Y90-RE. Penalized logistic regression analysis was performed to identify the significant baseline prognosticators. Results. Between 2013 and 2018, 135 patients underwent Y90-RE treatment. Among the 59 (42%) patients within MC, LT eligibility was maintained in 49 (83%) and lost in 10 (17%) patients. Within the 76 (56%) patients outside MC, eligibility was achieved in 32 (42%) and unchanged in 44 (58%). Among the 81 (60%) patients with a favorable response, 16 (20%) went on to receive LT. Analysis of the baseline characteristics revealed that lower Albumin-Bilirubin score, lower Child–Pugh class, lower Barcelona Clinic Liver Cancer stage, HCC diagnosis using dynamic contrast-enhanced imaging on CT or MRI, normal/higher albumin levels, decreased severity of tumor burden, left lobe HCC disease, and absence of HBV-associated cirrhosis, baseline abdominal pain, or fatigue were all associated with a higher likelihood of bridging or downstaging to LT eligibility ( p ’s < 0.05). Conclusion. Certain baseline clinical and tumor characteristics are associated with the successful bridging or downstaging of potential LT candidates with HCC undergoing Y90-RE.

Purpose: A dedicated IVC filter clinic has been shown to have a positive impact on retrieval rates. In this study, we aim to evaluate the long-term impact of a dedicated inferior vena cava filter (IVCF) clinic on IVCF retrieval rates and technical success of IVCF retrieval. We hypothesize that technical success and retrieval rates have improved with institution of a dedicated clinic. Materials: A dedicated IVCF clinic was established at our institution in 1/2009; data has been prospectively collected form this date forward. Patients with IVCFs placed at our institution between 1/2000-12/2008 were retrospectively studied. We compared retrieval rates, technical success of retrieval, and use of advanced retrieval techniques in the pre-and post-clinic groups utilizing Fisher's exact test.Pearson correlation was used to analyze post-clinic change in retrieval rates and use of advanced techniques. Significance was accepted at po0.05. Results: From 1/2000-12/2008, 1219 filters were placed, 369 retrievable (30.3%). In the post-clinic period from 1/2009-8/ 2016, 1696 filters were placed, 1129 retrievable (66.6%). Retrieval rates in the pre-and post-clinic groups were 35% (n ¼ 126) and 65.6% (n ¼ 741), respectively (po0.0001). Retrieval rates increased significantly through the post-clinic period (p ¼ 0.003). Technical success rate in the pre-clinic period was 84.6% (126/149) vs 98.4% (741/753) in the postclinic period (po0.0001). Advanced techniques were used in 15.8% (n ¼ 119) of removal attempts in the post-clinic period; they were not used in the pre-clinic period, and increased significantly through the post clinic period (p ¼ 0.01). Conclusions: The establishment of a dedicated IVCF clinic has had a significant, positive longitudinal impact on retrieval rates, validating previously published approaches to clinical management of patients with IVCF. Technical success of retrieval has increased as well, along with use of advanced retrieval techniques. Dedicated personnel in an IVC filter clinic may improve retrieval rates through expertise with advanced techniques.