Didemnin B is a depsipeptide derived from a Caribbean tunicate (sea squirt) that has demonstrated antineoplastic activity against a variety of murine tumor models, including the L1210 and P388 leukemia, the B16 melanoma, and M5076 sarcoma cell lines. Based on these data, we designed a phase II trial in which 15 patients with measurable, unresectable colorectal cancer were treated with Didemnin B at an initial dosage of 3.47 mg/m2 over 30 minutes administered by intravenous infusion every 28 days; the dosage was altered in accordance with the toxicity observed, with only one patient requiring a dosage reduction for pronounced nausea and vomiting. No hematologic or nonhematologic toxicity developed. No complete or partial responses were observed. These results do not compare favorably with results of treatments using other single agents or combinations that are currently available for the treatment of advanced colorectal cancers. However, because of the tolerable levels of toxicity experienced by in our patients, it is possible that an insufficient dose of the medication was delivered. We concluded that Didemnin B is not active against of colorectal cancers at the dosage and schedule at which it was administered in this study.
Informal feedback from patients, as well as metrics on use of the space, indicates that the gym is well received and frequently used. Limitations include the absence of a designated physical therapy technician to supervise individual activity, which may limit patient access when a staff member is unavailable. The cost associated with the implementation of such space may be offset by benefits to patients, including enhanced conditioning, quality of life, and time to discharge, as evidenced in the literature.
In response to this trend, a team was developed to plan and implement a Quality Improvement (QI) project addressing the process for administration and drug monitoring for patients receiving these drugs by implementing the Institute for Healthcare Improvement (IHI) model for QI. The IHI model utilizes the Plan-Do-Study-Act process in which a series of small tests of change are implanted to achieve desired results. The team established the standard nursing practice as administration of tacrolimus or cyclosporine through the white lumen of the tunneled CVC and lab draws for drug monitoring through the red lumen of the tunneled CVC. BMT nurses were informed of the new standard practice during twice daily safety huddles. Nurses were instructed to remember the standard as "red for blood" meaning to draw from the red lumen. Since implantation of this standard practice there have been zero reported line contaminations.
practitioners (NP) screen all donors and determine eligibility based on a history and physical, review of a Health History Questionnaire (HHQ), and various diagnostic tests. The Foundation for the Accreditation of Cellular Therapy (FACT), set standards of operation to promote quality medical and laboratory practice in hematopoietic transplantation and other cellular therapy products. Adherence to the FACT standards helps to ensure donor eligibility thereby reducing the risks of transmissible diseases. The HHQ guides the NP in determining donor eligibility. A retrospective chart review of 46 medical records from January 2011 through December 2011 revealed the rate of accuracy of 60% in determining donor eligibility based upon FACT criteria. All donors (46) were deemed as eligible; however, only 28 met FACT criteria for eligibility. Eighteen patients were ineligible; yet they were medically acceptable to donate. Reasons for ineligibility included: a missing or incomplete HHQ, a tattoo within a year, donor lived in Europe. NPs were re-educated regarding FACT criteria and how to use the HHQ when determining eligibility. A tool provided a guideline for the NPs highlighting special considerations for donors that would make them potentially ineligible. Following these interventions, the rate of accuracy improved to 84%. From June 2012 to September 2012, 19 medical records were reviewed 16 met FACT criteria for eligibility. By re-educating NPs about FACT guidelines, NPs were able to utilize the HHQ as a crucial step in their assessment process and improve the rate of accuracy in determining donor eligibility thus improving donor screening.
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