BackgroundAutomated dispensing cabinets (ADCs) were introduced in 2010 and 2012 at the Heart Hospital (HH) and National Center for Cancer Care and Research (NCCCR), both run by Hamad Medical Corporation in Qatar. These medication distribution systems provide computer-controlled storage, dispensing, and tracking of drugs at the point of care in patient care units. The purpose of this study was to assess nurses’ perceptions of and satisfaction with the use of ADCs at HH and NCCCR.MethodsA cross-sectional study was conducted in the two institutions in May and November 2012 using a piloted, validated, online, and anonymous questionnaire. The questionnaire consisted of four parts: nurses’ sociodemographic and practice characteristics, 21 questions about their perceptions, one question about their overall satisfaction, and one about the system’s ease of use. The self-administered survey was distributed to 503 nurses working at HH and NCCCR over three weeks using Survey Monkey®.ResultsThe survey response rate was 80 % (n = 403). No significant difference was found in perception scores between the two institutions (p = 0.06). Ninety-four percent (n = 378) of nurses agreed that the medication delivery system allowed them to do their job more safely, and 90 % (n = 363) nurses agreed that they now spent less time waiting for medication from the pharmacy than they did before the ADC system was introduced. Eighty seven percent (n = 349) nurses agreed that they were able to administer medication more efficiently with the ADC system. The overall satisfaction rate (either “very satisfied” or “satisfied”) for the two hospitals was 91 %.ConclusionsThe nurses’ perceptions of and levels of satisfaction with the ADC system were very good over the 6 months after complete implementation and integration at HH and NCCCR. ADCs appear to increase efficiency in the medication process and should therefore improve the quality of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-015-0121-7) contains supplementary material, which is available to authorized users.
Therapeutic drug monitoring data collected during routine clinical practice can provide a useful tool for understanding factors affecting methotrexate pharmacokinetics. Patient weight and hematocrit levels may play a clinically important role in determining methotrexate serum exposure and dosing requirements. Future prospective studies are needed to validate results of the developed model and evaluate its usefulness to predict methotrexate exposure and optimize dosing regimens.
The overall survival of patients with Chronic Myeloid Leukemia (CML) treated by using tyrosine kinase inhibitors (TKIs) is very close to that of the healthy population. However, little is known about the effect of specific measures such as intermittent fasting, especially during Ramadan period. A 3-year retrospective study was conducted to evaluate the effect of fasting on patients with CML receiving TKIs by evaluating certain clinical, hematological, and molecular parameters. A total of 49 patients were eligible, with a median age of 46 years (range: 22-86), of these 36 (73.5%) were males and 13 (26.5%) were females. Twenty-seven (55%) patients are Middle Eastern, while 16 (32.7%) from the Indian subcontinent, and 6 (12.3%) Africans. Imatinib was the most common TKI; used in 25 patients (51%). The mean White blood cells (WBCs), neutrophils, and BCR-ABL were found to be reduced after fasting compared to before and during with statistical difference. The use of TKIs while fasting did not result in significant changes in hematological nor BCR-ABL levels in our study. Patients who wish to practice intermittent fasting may be reassured in this regard, yet physicians can adopt the safe trial approach, where they allow the patients to fast, but with instructions such as when to break fasting.
Obesity is a chronic disease that is increasing in prevalence in adults, adolescents, and children and it is now considered to be a global epidemic. Current recommendation for treatment of Chronic Myeloid Leukemia (CML) does not take in consideration the weight of the patient with regard to doses of different Tyrosine Kinase Inhibitors. Obesity and obesity related surgeries are emerging and unmet needs. To shed the light into this special category of patients and we provide a strategy to treat morbid obesity with CML as well as obesity related surgeries like gastric band, sleeve gastrectomy in patients with CML. Five case scenarios were used to illustrate what is seen in real life: CML (CP) with class III obesity, CML (CP) with sleeve Gastrectomy, CML (CP) post gastric band CML with blast crisis each scenario were followed by proposal for treatment. Obesity and obesity related surgeries are emerging and unmet needs, the treatment of each should be individualized, and the TKI dose may needs to be adjusted in certain categories. The morbidity and mortality associated with being overweight (body mass index [BMI] of 25-29.9 kg/m 2) or obese (BMI of ≥ 30 kg/m 2) have been known to the medical profession for more than 2000 years. Obesity is a chronic disease that is increasing in prevalence in adults, adolescents, and children and it is now considered to be a global epidemic. 1 Body mass index (BMI) based classifications were originally based upon the associated risks of cardiovascular disease (CVD). The recommended classifications for BMI, adopted by the National Institutes of Health (NIH) and World Health Organization (WHO), 2,3 for Caucasian, Hispanic, and black individuals are: Underweight-<18.5 kg/m 2 Normal weight-≥18.5 to 24.9 kg/m 2 Overweight-≥25.0 to 29.9 kg/m 2 Obesity-≥30 kg/m 2 Class I-30.0-34.9 kg/m 2 Class II-35.0-39.9 kg/m 2 Class III-≥40 kg/m 2 (also referred to as severe, extreme, or massive obesity)
Background and Objectives: CML is a myeloproliferative neoplasm characterized by the dysregulated production and uncontrolled proliferation of mature and maturing granulocytes with fairly normal differentiation. It mainly affects adults, and is rarely seen in children. The average age at diagnosis of CML is around 64 years. There are few studies describing CML in adolescents and young adults. In Qatar we have one of the largest cohorts of adolescents and young adults with CML. This study aims to study this cohort and find out if there are any differences from older patients with CML. Methods: A retrospective analysis of 169 patients with CML treated at NCCCR over a 23-year period, 83 of them are younger than 40 years at diagnosis (adolescents and young adults) vs. 86 age 40 or older at diagnosis (controls). Comparison was done of all characteristics at diagnosis, including: gender, BMI, ethnicity, CBC parameters, spleen size, Sokal score, bone marrow findings, treatment modality, with response assessment using ELN guidelines. Results: Both groups were matched with regards to gender and ethnicity. Adolescents and young adults had higher WBC count and larger spleen on diagnosis compared to controls (174.1 vs. 142.2; and 18.0 vs. 15.6). 4 young patients presented in blast-phase vs. 1 in control group. 5 adolescents and young adults underwent allogeneic stem cell transplant vs. 1 patient in the control group. During a mean follow up of 70.7 months in adolescents and young adults vs. 72.7 months in the control group there were 2 deaths vs. 1 respectively. However, there were no other significant differences between the two groups, with regards to TKI used, or response at 1 year / latest assessment. Conclusions: Based on this data we may conclude that CML present more aggressively in adolescents and young adults as compared with older patients, however there is no difference in outcome. This might reflect different underlying etiology / better tolerance to treatment in the younger group. Table Disclosures No relevant conflicts of interest to declare.
IntroductionDue to the chronic nature of chelation therapy and the adverse consequences of iron overload, patient adherence to therapy is an important issue. Jadenu ® is a new oral formulation of deferasirox (Exjade ®) tablets for oral suspension. While Exjade® is a dispersible tablet that must be mixed in liquid and taken on an empty stomach, Jadenu ® can be taken in a single step, with or without a light meal, simplifying administration for the treatment of patients with chronic iron overload. This may significantly improve the compliance to treatment of patients with β-thalassemia major (BMT). The aim of this study was to evaluate the drug tolerability and the effects of chelation therapy on serum ferritin concentration, liver iron concentration (LIC) and biochemical profiles in patients with BMT and iron overload.Patients and MethodsTwelve selected adult patients BMT (mean age: 29 years; range:15–34 years) were enrolled in the study. All patients were on monthly regular red cell transfusion therapy to keep their pre-transfusional hemoglobin (Hb) level not less than 9 g/dL. They were on Exjade® therapy (30 mg/kg per day) for two years or more before starting Jadenu® therapy (14–28 mg/kg/day). The reason for shifting from Deferasirox® to Jadenu® therapy was lack of tolerability, as described by patients, such as nausea, vomiting, diarrhea, stomach pain. Most of them also reported that Deferasirox® was not palatable. Lab investigations included monthly urine analysis and measurement of their serum concentrations of creatinine, fasting blood glucose (FBG), serum ferritin, alkaline phosphatase (ALP), alanine transferase (ALT), aspartate transferase (AST) and albumin concentrations. LIC was measured using FerriScan ®. Thyroid function, vitamin D and serum parathormone, before and one year after starting Jadenu ® therapy, were also assessed.ResultsApart from some minor gastrointestinal complaints reported in 3 BMT patients that did not require discontinuation of therapy, other side effects were not registered during the treatment. Subjectively, patients reported an improvement in the palatability of Jadenu® compared to Exjade® therapy in 8 out of 12 BMT patients. A non-significant decrease in LIC measured by FerriScan® and serum ferritin levels was observed after one year of treatment with Jadenu®. A significant positive correlation was found between serum ferritin level and LIC measured by the FerriScan® method. LIC and serum ferritin level correlated significantly with ALT level (r = 0.31 and 0.45 respectively, p < 0.05). No significant correlation was detected between LIC and other biochemical or hormonal parameters.ConclusionsOur study shows that short-term treatment with Jadenu ® is safe but is associated with a non-significant decrease in LIC and serum ferritin levels. Therefore, there is an urgent need for adequately-powered and high-quality trials to assess the clinical efficacy and the longterm outcomes of new deferasirox formulation.
Patient: Male, 62Final Diagnosis: Chronic myeloid leukemiaSymptoms: Gastric polypsMedication: NilotinibClinical Procedure: —Specialty: HematologyObjective:Unusual or unexpected effect of treatmentBackground:Tyrosine kinase inhibitors (TKIs) are currently an important targeted drug class in the treatment of chronic myeloid leukemia (CML). Imatinib was the first approved TKI for CML in 2001. Nilotinib is a second-generation TKI, approved in 2007; it inhibits BCR-ABL, PDGFR, and c-KIT, and is 30 times more potent than imatinib. Tyrosine kinase enzymes are expressed in multiple tissues and are involved in several signaling pathways; they have been shown to have several off-target side effects.Case Report:We report a case of an elderly male with CML and no history of gastrointestinal diseases, treated with nilotinib, and developed recurrent gastric polyps after three years of treatment. We excluded common causes of gastric polyps and therefore considered nilotinib as a probable cause of recurrent gastric polyps.Conclusions:Recurrent gastric polyps could be a potential side effect of nilotinib treatment. Careful long-term monitoring of patients on TKI therapy is necessary and further long-term studies of TKI side effects are needed.
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