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Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus
The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.
Journal Article
CONTAINMENT OF A NEW ADMINISTRATION SYSTEM FOR HAZARDOUS DRUGS
Clinicians are regularly exposed to hazardous drugs (HDs). Existing protective equipment may be more effective during drug preparation than administration. USP 800 now requires the use of Closed System Transfer Devices (CSTDs) during HD administration. A new closed administration system for minimizing exposure of healthcare professionals to HDs was recently marketed. The objective was to evaluate the efficacy of the ChemfortTM CADM system in preventing HD release during administration. Containment was assessed upon the first and final (10th) connection cycle at both beginning and end of shelf-life (four different test groups). The principles of the NIOSH 2015 containment performance draft protocol! were followed: isopropanol (IPA) is the drug surrogate; acceptance criterion is <1.0 ppm IPA vapor concentration inside a closed chamber. Three tasks were developed to mimic administration and subsequent disconnection of three different combinations of CADM components. The Bag Adaptor Ghemfort™ Port is the required partner of each of the other three CADM components: Closed Adaptor Spike Port (task 1); Closed Y-inline Set (task 2); and Closed Secondary IV Set (task 3). In each task, a 500 ml IV bag containing 70% IPA was connected in series with the tested components and placed inside a closed chamber, which was sealed and connected to a Fourier-transform infrared spectroscopy gas analyzer in a closed circuit. Inside the chamber, administration was simulated, and IPA levels were monitored during the task and for at least 30 minutes afterwards. Each task was repeated four times per test group. The relevant result for each repetition was the highest increase in IPA vapor concentration reached over the course of the task, relative to the average background levels before commencement of that task. IPA concentrations observed for all components in all test groups were well below the acceptance criterion of 1.0 ppm. CSTDs are well-adopted in pharmacy, but less during administration. USP 800 requires use of CSTDs for administration. A new closed administration system was evaluated according to a NIOSH methodology. Results show that CADM prevents the escape of hazardous aerosols and vapors and that new administration systems could potentially raise the safety standard for clinicians to that already adopted in pharmacies.
Journal Article
CT Colonography for Radiographers
This book explains every aspect of the role of radiographers in performing CT colonography (CTC) and interpreting CTC images with the aim of enabling radiographers to extend the scope of their practice.
eBook
Treatment Outcomes of HER2-Directed Therapy in Patients With HER2-Positive Non-metastatic Breast Cancer in Low-Resource Settings
Introduction This study aimed to evaluate treatment outcomes of human epidermal growth factor receptor 2 (HER2)-directed therapies in patients with non-metastatic HER2-positive breast cancer treated in a low-resource setting. Specifically, we assessed the impact of dual blockade (trastuzumab and pertuzumab), trastuzumab alone, or no HER2-targeted therapy on rates of residual disease, pathological complete response (pCR), progression-free survival (PFS), and overall survival (OS). Methods We conducted a retrospective cohort study at Shaukat Khanum Memorial Cancer Hospital, including 299 patients with non-metastatic HER2-positive breast cancer treated with neoadjuvant chemotherapy and either dual HER2 blockade, trastuzumab alone, or no HER2-targeted therapy due to financial constraints. Patient demographics, clinical features, treatments, and outcomes were analyzed using descriptive statistics, chi-square tests, and Kaplan-Meier survival analysis. Results The median age at diagnosis was 45.7 years (standard deviation±8.9). A majority of patients were premenopausal (n=222; 74.2%), and the majority presented with a palpable lump (n=275; 91.9%). Tumors were mainly located in the left (n=149; 49.8%) or right breast (n=147; 49.2%), with bilateral involvement in 3 (1.0%) cases. Invasive ductal carcinoma was the predominant histology (n=275; 91.9%), with estrogen receptor and progesterone receptor positivity observed in 185 (61.9%) and 179 (59.9%) patients, respectively. Grade III tumors were observed in 156 (52.2%) cases, and most tumors were T2 stage (n=236; 78.9%) with axillary nodal involvement in 232 (77.6%). Patients receiving dual HER2 blockade achieved a pCR in 45 (54.9%) of 82 cases, compared to 51 (45.9%) of 111 with trastuzumab alone, and 39 (36.8%) of 106 with no HER2 therapy (p=0.046). The docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP) regimen had the highest pCR rate in 19 (65.5%) of 29 patients (p<0.001). Grade III tumors were associated with higher pCR than Grade II (n=96; 56.5% vs. n=39; 30.2%; p<0.001). At 60 months, PFS was 236 (79.0%) overall, highest in the dual blockade group (n=73; 89.0%), followed by trastuzumab (n=96; 86.5%) and no HER2 therapy (n=69; 65.1%). OS at 60 months was 271 (90.6%), highest in the dual blockade group (n=78; 95.1%), then trastuzumab (n=102; 91.9%) and no HER2 therapy (n=79; 74.5%). Achieving pCR was associated with improved PFS and OS. Differences in both outcomes across groups were statistically significant (p<0.001). Conclusion Dual HER2 blockade significantly improved pCR, PFS, and OS in non-metastatic HER2-positive breast cancer. These findings support the inclusion of HER2-targeted agents in standard neoadjuvant treatment, even in resource-limited settings. Addressing barriers to access remains essential to improving global outcomes in breast cancer care.
Journal Article