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Bone Marrow Procedures

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CLEVELAND CLINIC'S PROCEDURE NOW STANDARD (September 1, 2010)

" For many years, the standard methods of performing bone marrow procedures in

patients with varying bone densities have remained unchanged. This is despite

the fact that the manual method of performing bone trephine biopsies has

significant limitations, including patient discomfort, needle-related adverse

events, and operator dependence.

" The new and developing field of intraosseous medicine is finally bringing

much-needed change to bone marrow procedures. Intraosseous (IO) vascular access

was commonly used by World War II medics to resuscitate soldiers dying from

hemorrhagic shock. The technique of infusing fluids and drugs into patients in

trauma and resuscitative situations via IO space fell out of favor once the war

ended. But in the 1980s, a pediatrician from the Cleveland Clinic observed IO

being used during a cholera epidemic in India, and the technique became standard

in pediatric advanced life support. " Please note that entire article can be

seen at the following website:

http://tinyurl.com/25j344p

___________________________

August 10, 2010 GLEEVEC WILL BECOME GENERIC DRUG IN 2015

" Imatinib (Gleevec), the first-line standard of care in chronic myeloid

leukemia, will become a generic drug in 2015, so the race is on to find a second

generation of tyrosine kinase inhibitors (TKIs) that can do the job just as

well. Dasatinib (Sprycel) and nilotinib (Tasigna) have demonstrated benefits as

second-line therapies, but could they be frontrunners as first-line therapy as

well? New studies would seem to support that theory, although longer patient

follow-up and, of course, cost considerations will ultimately determine whether

dasatinib and nilotinib are up to the task.

" Imatinib has changed the treatment of CML, " said Hagop Kantarjian, MD, a

professor and chair of the leukemia department at the M.D. Cancer

Center in Houston. " However, there are about 2% to 4% of patients every year who

develop resistance or toxicities that require different therapies, and this is

where the new generation of TKIs [could] have a significant role: in managing

imatinib failure. "

" Dr. Kantarjian led a study that evaluated the efficacy and safety of dasatinib

compared with imatinib. A second study, the ENESTnd trial, compared nilotinib

with imatinib (see " CML patients' molecular response to nilotinib continues to

deepen over time " ). For the dasatinib study, 519 patients with newly diagnosed

CML were randomized to dasatinib (100 mg) or imatinib (400 mg) for one year.

" Complete cytogenetic response (CCyR) and major molecular response (MMR) were

used to evaluate efficacy. The primary endpoint was confirmed CCyR, defined as

CCyR on two consecutive analyses (ASCO 2010 abstract LBA6500; N Engl J Med

362:2260-2270, 2010). " There is always more at:

http://tinyurl.com/22q7zep

Did you know that over 1 billion URL's are transformed into tiny URL's every

month? Just go to www.tinyurl.com and it is transposed in less than a minute.

___________________________________

HAND HYGIENE (can never be stressed enough and not practiced by some medical

professionals. They should wash their hands upon entering and existing the

patient's room or office visit.

" Hand hygiene has proven to be one of the most effective ways to prevent the

transmission of infection. Friese and Lee nicely review the significance of hand

hygiene as well as the appropriate hand-washing technique. Hand hygiene cannot

be emphasized enough, however; despite the knowledge that hand-washing decreases

the risk of infection, clinicians are not always compliant in washing their

hands before and after patient contact. Furthermore, most oncology patients are

outpatient and it is critical that nurses educate patients about the importance

of hand hygiene for themselves and their close contacts. "

http://tinyurl.com/25ymq6w

_____________________________

FOOD BORNE ILLNESSES LAX IN INSTITUTIONS

" In the 1970s, research established that foods, particularly fresh fruits and

vegetables, contain Escherichia coli, Pseudomonas aeruginosa, and other

gram-negative bacilli.[6] These observations led to the implementation of

dietary restrictions for neutropenic cancer patients, commonly referred to as a

low microbial or “neutropenic” diet. Nearly all healthcare institutions surveyed

in the 2000s recommended a neutropenic diet to their patients, and the most

common recommendation was to avoid uncooked fruits and vegetables. "

" In one study, 30% of 23 outpatients were noncompliant with the neutropenic

diet and infection rates were similar in compliant and noncompliant

patients.[12] Another small trial showed no difference in the rate of febrile

neutropenia between patients who were randomly assigned to a US Food and Drug

Administration. " –

http://tinyurl.com/25ymq6w

__________________________

fyi,

Lottie Duthu

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