Safe Chemotherapy Research Articles

Example of a Simulation Design in Nursing Education: Safe Chemotherapy Administration.

Chemotherapy is one of the treatment methods increasingly used in cancer. In this article, we aimed to share our simulation experiences within the scope of the elective course of Cancer Nursing in the Nursing Internship (4th year) program in the process of teaching safe chemotherapy administration methods. Simulation-based experience should be designed to attain specified educational goals and expected results as best as possible. Scenario implementation is based on the criteria of the International Nursing Association for Clinical Simulation and Learning standards. A biologically safe drug preparation cabin in the drug preparation room of a simulation center was used, and a medium-fidelity mannequin-based simulator evaluating the vital signs was utilized as the simulator during the simulation implementation. In the patient history prepared within the scope of the scenario, the students were expected to achieve goals. An analysis was performed by a trainer who followed attentively the implementation during the scenario. In the analysis stage, sessions including 8-10 students were held using the Promoting Excellence and Reflective Learning in Simulation. A checklist was used to evaluate the skill steps of the students objectively. It is thought that this simulation scenario maintained in accordance with the standards of best practice of the International Nursing Association for Clinical Simulation and Learning would guide the readers. The simulation is considered to be an effective method for safe medications, and it is recommended to plan different scenarios according to the levels of students.

Acyclic Retinoid Combined With Tenascin-C-derived Peptide Reduces the Malignant Phenotype of Neuroblastoma Cells Through N-Myc Degradation.

Despite intensive chemotherapy, the survival rates for high-risk neuroblastoma, most of which have MYCN amplification, remain low. Overexpression of N-myc oncoprotein promotes expression of cancer-associated properties. We recently found that combination of all-trans retinoic acid (ATRA) with the β1-integrin-activating peptide TNIIIA2 attenuated cancer-associated properties of neuroblastoma cells through N-Myc degradation. However, ATRA has serious side-effects and there are concerns about late adverse effects. The aim of this study was to examine the effects of the combination of acyclic retinoid (ACR) with TNIIIA2 on neuroblastoma. The effects of ACR and TNIIIA2 were examined by neuroblastoma cell proliferation and survival assays as well as by using a neuroblastoma xenograft model. The levels of N-Myc and cancer-associated malignant properties were assayed by western blot and colony formation assay, respectively. Combining ACR, which is clinically safe, with TNIIIA2 induced proteasomal degradation of N-Myc and reduction of neuroblastoma cell malignant properties. An in vivo experiment showed therapeutic potential. ACR-TNIIIA2 combination treatment may be efficacious and clinical safe chemotherapy for high-risk neuroblastoma.

Evaluation of outcome and prognostic factors in paediatric extraskeletal ewings sarcoma: A single institution experience.

e21507 Background: Ewing's sarcoma (ES) represent the most frequent small and round cell bone tumors of childhood and adolescence. Data on extraskeletal ewings sarcoma (EES) with uniform chemotherapy protocol are very minimal. We aimed to assess this aspect in our patients and identify prognostic factors in patients with extraskeletal ewings sarcoma. Methods: A retrospective analysis of data was done between January 2005 and January 2016. These paediatric EES patients who received chemotherapy with VAC-IE regimen were evaluated for their response, overall survival (OS) and Event free survival (EFS). The prognostic factors which influenced their overall survival were also analysed. Results: Fourty one paediatric EES patients were diagnosed at our institute out of which 31 patients received treatment at our hospital. 25.8% (8) were metastatic at presentation. The mean age was 12.37 years (1-18 years) with a predominant female preponderance 54.8%. The commonest site at presentation was presacral mass (7) and mass in the brain parenchyma (8). Rare sites of presentation as a nasal mass and parotid mass was seen in one patients each. 78% received chemotherapy with VAC-IE regimen. The ORR was 71% (8 CR + 9 PR). Toxicity was grade III neutropenia in 5 (20.8%). 8 patients received local RT. The 3 year OS and EFS in the localized EES were 55% and 39% and in metastatic EES were 35% and 24% respectively. Low hemoglobin (P = 0.05) and high LDH (P = 0.01) predicted inferior OS for the entire EES cohort on multivariate analysis. Conclusions: High LDH and low hemoglobin is associated with poor OS for patients with EES ewings sarcoma. VAC-IE is a very effective and a safe chemotherapy regimen and should be considered in patients with extraskeletal ewings sarcoma.

ChemoPalRx: Development and implementation of a chemotherapy mobile provider order entry system in a safety net hospital.

e18071 Background: Computerized provider order entry (CPOE) systems have been shown to enhance the safety and efficiency of prescribing chemotherapy over the handwritten ordering process. However, many institutions lack the financial ability, technological capability, or operational flexibility to invest in and implement such a system. In particular, Olive View-UCLA Medical Center (OVMC), a Los Angeles County safety net hospital, is among these institutions with unique restrictions that preclude the use of chemotherapy CPOE and mandate handwritten orders. Methods: In an effort to bridge the gap for safe chemotherapy prescribing, we aimed to develop and implement an effective, scalable, and sustainable chemotherapy provider order entry solution that was operationally sensitive to institutions without a chemotherapy CPOE. The solution was designed as a mobile application using Xcode, the integrative development environment of Apple Inc., with the Swift programing language. Results: On September 5th, 2018, we launched a free, chemotherapy provider order entry solution on the worldwide Apple App Store – ChemoPalRx. Using ChemoPalRx, providers can search, customize, and print common chemotherapy regimens in prescription format. Along with a reference library of over 120 order set and 450 medications, ChemoPalRx is equipped with the functions to automate dosage calculation, suggest pre-medications and safety parameters, and trigger alerts for missing prescribing information. As a quality improvement initiative, we implemented ChemoPalRx at OVMC. Implementation stages include obtaining administrative buy-in, consulting with multidisciplinary staffs, investing $100 USD for a prescription printer, and encouraging providers to download ChemoPalRx on their own mobile devices. An ongoing prospective cohort study is being conducted to determine ChemoPalRx effectiveness in reducing errors compared to handwritten orders. Conclusions: ChemoPalRx is developed to enhance the safety and efficiency of chemotherapy prescribing. Implementation of this mobile application is feasible in the safety-net hospital setting and has the potential to transform oncology practices globally.

105P - Safe chemotherapy for treating early breast cancer in G6PD-deficient patients

105P - Safe chemotherapy for treating early breast cancer in G6PD-deficient patients

Effects of Spondias mombin and Aspilia africana Aqueous Extracts on Rats with Monosodium Glutamate-Induced Leiomyoma

Uterine leiomyoma is commonly known as fibroid. Increased use of chemicals is believed to enhance its prevalence and monosodium glutamate is implicated. Fibroid is prevalent among black women with no known drug for its treatment. It is therefore necessary to determine a safer method for fibroid treatment. This work investigated effects of different aqueous extracts of Spondias mombin (hog plum) and Aspilia africana (wild sunflower) leaves on uterus and kidney cells of rats with monosodium glutamate (MSG)-induced fibroid. Twenty-eight rats used in this study were divided into four groups of seven rats each and acclimatized. Fibroid was induced on the Positive control, Groups III and IV, after daily ingestion of 750mg/kg body weight of MSG for 28 days. Negative control had no fibroid but the Positive control remained untreated. Groups III and IV were continuously ingested with same dose of MSG for the next 28 days with daily oral treatment using 250mg/kg body weight aqueous extracts of hog plum and wild sunflower, respectively. Histological examinations were performed on the 2nd and 4th weeks, respectively, on two rats from each group for the next 28 days. Results showed degenerated endometrial cells and preserved nephritic tissues after treatment with aqueous extracts of S. mombin leaves. There was mild hyperplasia of endometrial cells after treatment with extract of A. africana in the 2nd week which differed from the 4th week. MSG has nephrotoxic properties and aqueous extract of S. mombin alleviated MSG oxidative powers on rats’ endometrial cells. With continuous ingestion, A. africana aqueous extract better preserved rat’s endometrium from oxidizing action of MSG. These extracts could be used as safer chemotherapy in fibroid management.

Yeast Genome Screening and Methods for the Discovery of Metabolic Pathways Involved in a Phenotypic Response to Anticancer Agents.

The dramatic increase of cancer in the world drives the search for a new generation of drugs useful in effective and safe chemotherapy. In the postgenomic era the use of the yeast Saccharomyces cerevisiae as a simple eukaryotic model is required in molecular studies of biological activity of compounds that may be potential drugs in the future. The phenotype analysis of numerous deletion mutants (from the EUROSCARF collection) allows one to define the specific influence of tested compound on metabolism, stress generation and response of eukaryotic cell to stress. Moreover, it allows one to determine cell viability, design of new drugs and doses used in preclinical and clinical trials. Undoubtedly, this is also a good way to save the lives of many laboratory animals. Here we present a simple and cheap new approach to study the metabolic and stress response pathways in eukaryotic cells involved in the response to tested compounds (e.g., anticancer agents). The precise determination of biological activity mechanisms of tested compounds at the molecular level can contribute to the fast introduction of new cancer therapies, which is extremely important nowadays.

Survey of the Efficacy of Long-term and Successive Pharmaceutical Care in Outpatient Chemotherapy by Oncology Pharmacy Specialists

It is important that pharmacists ensure safe chemotherapy implementation. In addition to inspecting chemotherapeutic prescriptions according to patient condition and drug-drug interactions, the management of chemotherapy-induced adverse effects and associated pharmaceutical intervention is one of the most important responsibilities of pharmacists in medical care teams. In May 2016, an oncology pharmacist was set responsible for the specialized, long-term, and successive pharmaceutical care, including instructions about appropriate use of medication at an outpatient chemotherapy center. We evaluated the effectiveness of the continuous pharmaceutical care. The number of medication counseling and associated pharmaceutical interventions increased with time. Specifically, the number of pharmaceutical interventions (prescription questions and pharmaceutical proposals) was 745 (459 and 286, respectively) in the surveillance period, which significantly increased compared to that observed within the same duration before posting an oncology pharmacist. The adoption rate was approximately 70% for prescription questions and 98% for pharmaceutical proposals. We also found that approximately 70% of the proposals attenuated the painful symptoms. Furthermore, approximately 60% of all pharmaceutical interventions were established after the third visit; in particular, approximately 20% of the pharmaceutical proposals were suggested after the sixth visit, indicating that continuous medication counseling results in an increase in pharmaceutical proposals. In conclusion, long-term and successive pharmaceutical care by oncology pharmacy specialists in outpatient chemotherapy contributes to a safe and less onerous chemotherapy implementation, as it has been highly adopted, is effective in many cases, and has been proven to be important for risk management in chemotherapy.

Quality improvement interventions to reduce chemotherapy dose-modification ordering errors at a large academic medical center.

264 Background: Despite clear advantages of Electronic Health Records (EHR) systems for safe cancer chemotherapy administration, persistent opportunities exist to further reduce chemotherapy order errors. Unintended dose escalation orders of previously dose reduced chemotherapy were the most commonly reported “near-miss” medication safety events at our institution. This can lead to potential patient harm, delays in care, decreased patient satisfaction, reduced infusion room efficiency, and increased care team workload and decreased satisfaction. We sought to reduce chemotherapy order errors using interventions developed with process improvement techniques. Methods: Unintended dose escalation errors per month (the primary outcome measure) were identified through the hospital safety reporting system and by monitoring the EHR (EPIC) chemotherapy administration reports to identify dose escalations. All cases were confirmed with primary chart review. The pre-intervention baseline assessment period was 6/2017-11/2017, and the post intervention period was 12/2017-5/2018. Two interventions were selected: 1) Revision of the nursing chemotherapy checklist posted on all infusion room workstations for use prior to releasing chemotherapy orders; and 2) educating ordering providers and nurses about new EHR functionality to display prior and future chemotherapy orders. Statistical Process Control chart analysis was conducted with upper (UCL) and lower (LCL) control limits of 3 standard deviations. The primary aim was to reduce the number of chemotherapy errors by 50% in the post-intervention period. Results: The pre-intervention period averaged 3.83 chemotherapy ordering errors per month (UCL = 9.71, LCL = 0). The post-intervention period significantly reduced the average errors per month to 1.33 (UCL = 4.97, LCL = 0). The copy/forward feature in multi-day cycles was the most common source of unintended dose escalations. Conclusions: Implementation of the 2 interventions resulted in a 65% reduction of unintended dose modification errors. Based on successful results and positive staff feedback, we plan to roll out these interventions at additional satellite facilities.

Use and handling safety of Mini-Spike 2® chemo and puresite for safe chemotherapy compounding in a hospital pharmacy

We wanted to evaluate the impact of Mini-Spike 2® Chemo + Puresite (MSCP) use on contamination surface levels, professionals’ satisfaction and compounding time at pharmacy compared with Phaseal™.Presence of cyclophosphamide (CYP) and 5-fluorouracil (5FU) was evaluated at three sampling times: baseline; after a decontamination procedure and six months after MSCP use for CYP and 5FU compounding. Testing was carried out using an independent laboratory and wipe testing kit. To test compounding time, four different nurses followed the same compounding protocol with each device. We also developed a questionnaire to obtain feedback from the nurses.We did not find statistically significant differences in the median contamination surface levels between basal and final sampling time, CYP (0.140; 95% CI -1.135, 1.601), 5FU (−0.506; 95% CI -1.756, 0.287). We observed a difference of 10 s on compounding times between the two devices tested (p < 0.001) favoring MSCP. Finally, eight nurses answered the survey, with the best valued aspect as the aspiration/injection flow and resistance, and the worst value the comfort using Puresite and valve connection.MSCP maintains low surface contamination levels in our setting assuring compounding time standards. Satisfaction survey let us know which were the major advantages and disadvantages of the device

A self-targeting and controllable drug delivery system constituting mesoporous silica nanoparticles fabricated with a multi-stimuli responsive chitosan-based thin film layer

Surface modification and functionalization of nanomaterials have been adopted widely in devising smart drug delivery systems. This work examines the fabrication of multi-stimuli responsive surfaces on mesoporous silica nanoparticles (MSN) for environmentally sensitive site specific drug delivery with reduced risk of premature drug leakage. Chitosan cross-linked via disulfide bonds was applied to form a thin film on drug-loaded MSN, realizing a capsulation and stimuli-sensitive regulating gate membrane; that was further conjugated with folate for site specific targeting toward cancer cells. The chitosan thin film was very stable under neutral conditions and could effectively prevent drug leakage, but was sensitive to both pH and GSH stimulations to reach rapid drug release. Thus, drug release could be triggered by changes in such factors that are common to cancer cells. However, complete and accelerated release could only be realized when triggered simultaneously by both acidic pH and GSH. Moreover, tests with HepG-2 cells confirmed that folate-receptor mediated endocytosis successfully enhanced the cellular uptake of the nanoparticle and antitumor activity toward cancer cells. It is expected that this surface chemical modification strategy promises a powerful approach constructing smart drug delivery systems for efficient and safe chemotherapy.

PS02.101: PREOPERATIVE TREATMENT BASED ON THE DCF CHEMOTHERAPY AND SUPPORTIVE THERAPY FOR ESOPHAGEAL CANCER

Abstract Background The neoadjuvant chemotherapy using CDDP and 5-FU(CF) is the standard treatment for advanced esophageal cancer, defined as clinical stage II/III in Japan. However, more powerful chemotherapy has been required for the treatment of cases of cStageIII cases. In 2011, the combination treatment of CF and Docetaxel (DCF) was introduced for the treatment of those cases in our institute. DCF therapy increased chemotherapy remarkable cases. But, adverse events occur at high rates, including high myelosuppression. Therefore, it is necessary to ensure support by early intervention of supportive therapy so as not to exacerbate adverse events. We report about treatment outcome in preoperative DCF therapy cases. Methods We treated 128 esophageal cancer patients who underwent surgery following preoperative DCF therapy between 2011 and July 2017, and preoperative DCF was administered to 128 patients 2 course completely. The neoadjuvant chemotherapy regimen using DCF is Docetaxel:70mg/m2 (day1) + CDDP:70mg/m2 (day1) + 5-FU:700mg/m2 (day1–5). Results In the preoperative DCF group, overall response rate (over PR) was 51.5%. There were 37 cases in 128 cases of pathological tissue effect judgment for Grade 2 and 3. 14 cases of them (14cases/37cases:37.8%) had lymph node metastasis. Therefore it is necessary to control lymph node metastasis by surgery even in a remarkable group. Almost all patients experienced grade 4 adverse events, particularly neutropenia is a high frequency. From the start of chemotherapy, pretreatment of intraoral infection lesion and prevention and treatment of oral mucositis are performed. Considering the degree of myelosuppression during initial chemotherapy, in the second course, we actively administer G-CSF preparation. Conclusion A good prognosis can be expected if preoperative DCF therapy is effective. It is necessary to perform intensive and safe preoperative chemotherapy with appropriate supportive therapy intervention. Disclosure All authors have declared no conflicts of interest.

PS02.099: EFFORTS IN PROPHYLAXIS OF FEBRILE NEUTROPENIA IN DCF THERAPY FOR ESOPHAGEAL CANCER

Abstract Background DCF therapy (5-FU + CDDP + Docetaxel) for esophageal cancer is known to have strong anti-tumor effect but the incidence of bone marrow suppression (BMS) and febrile neutropenia (FN) after DCF therapy has been frequent and patients is often forced to reduce the dose of anti-cancer drug or discontinue of chemotherapy. We clarified the influence of prophylactic administration of a long-acting G-CSF, pegfilgrastim, in DCF therapy for esophageal cancer on the incidence of adverse events and anti-tumor effect. Methods From March, 2011 to July, 2017, 87 patients underwent DCF therapy (Docetaxel 60mg/m2 D1, CDDP 60mg/m2 D1, 5-FU 800mg/m2 D1–5) for esophageal squamous cell carcinoma above cStage II (33 patients administered pegfilgrastim, P group; 54 patients without pegfilgrastim, N group). We investigated the influence of pegfilgrastim on the incidence of adverse events in both groups according to CTCAE v4.0 grading system. And we investigated anti-tumor effects assessed by image examination in all patients and 47 surgically resected specimens. Results The incidence of leukocytopenia and neutropenia in P group were significantly lower than that in N group (15.2% vs 57.4%, P &lt; 0.001; 21.2% vs 64.8%, P &lt; 0.001, respectively). The incidence of FN in P group tended to be lower than that in N group (9.1% vs 20.4%, P = 0.233). Significantly more patients in N group suffered dose reduction or discontinuation of chemotherapy due to BMS or FN (30.3% vs 72.2%, P &lt; 0.001). Relative dose intensity of 5-FU in P group was significantly higher than that in N group (95.6% vs 82.5%, P = &lt; 0.001). In endoscopically evaluated response after 2 courses of DCF therapy, the reductive effects in the patients in P group significantly better than in those in N group (PR &lt; ; 78.1% vs 44.0%, P = 0.002). The overall response rate was also significantly better in the patients in P group than in those in N group (PR &lt; ; 60.6% vs 35.2%, P = 0.021). Histopathological responses in surgically resected tumor in P group tended to be better than N group (Grade 1b &lt; ; 47.1% vs 33.3%, P = 0.352). Conclusion DCF chemotherapy with prophylactic administration of pegfilgrastim may be an option for safe and effective chemotherapy for advanced esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Baited nanotraps for safer chemotherapy

Gold nanocage-oligonucleotide composites sequester cytoplasmic doxorubicin to protect noncancerous liver cells from chemotherapy-induced cytotoxicity.

Curcuminoid-loaded poly(methyl methacrylate) nanoparticles for cancer therapy.

Curcuminoids (Curs), oleoresins from Curcuma longa L., have known anticarcinogenic and anti-inflammatory properties, but high toxicity, poor aqueous solubility and susceptibility to degradation in body fluids are deterrents to their clinical administration. Poly(methyl methacrylate) nanoparticles (PMMA-NPs) are biocompatible and resilient and can entrap hydrophobic drugs. The present investigation is related to solubilizing Curs by incorporating them in these nanoparticles (NPs) and is related to a study comparing the anticarcinogenic effect of drug-loaded NPs with free Cur using lung cancer (A549) cell line. Freshly extracted oleoresins were post loaded in PMMA-NPs prepared using emulsion polymerization. The presence of the three components of oleoresins was confirmed by thin-layer chromatography. The size and morphology of void and loaded NPs were determined by dynamic light scattering, scanning electron microscopy and transmission electron microscopy. The NPs were spherical with diameters of 192.66±5 nm (void) and 199.16±5 nm (loaded). Drug loading and encapsulation efficiency were 6% and 93%, respectively. From the Fourier transform infrared spectroscopy spectra, the characteristic absorption vibration of poly(methyl methacrylate) and the bands at 1,383, 1,233 and 962 cm−1 for Cur moiety were observed. Drug release up to 10 days was estimated in buffer, saline and serum. The highest release of ~55% in ~3 days was noted in buffer that exhibited the highest bioavailability. The in vitro anticancer activity of loaded drug was evaluated up to 72 hours by MTT assay using A549 cell line. Cellular uptake of dye-loaded NPs was visualized within 30 minutes of incubation. The results revealed that the dose- and time-dependent cell death in case of loaded PMMA-NPs was comparable to that of free Cur. According to the study, the drug-loaded PMMA-NPs appear to be highly suitable for effective, localized and safe chemotherapy.

Nursing Staff Knowledge regarding Safe Chemotherapy Administration at Oncology Center in Kirkuk City

Chemotherapy drugs are wide range of therapeutic medication used in the managing of cancer diseases. Nursing staff prepare and administer chemotherapeutic drugs therefore they need more knowledge and competency in order to decrease adverse effect of the drugs to the cancer patients. Aim of the study: to assess nurses knowledge regarding safe chemotherapy administration at oncology center in Kirkuk city. A descriptive study was carried out from the period between 1st of February 2017 up to 1st of September 2017. A non-probability (purposive) sampling was used to select the sample. The study includes (40) nurses who works at the oncology center in Kirkuk city. For the purpose of the study a constructed questionnaire was designed. The data was collected through the utilization of self-administration technique. The data collection process was collected from the period of 1st of March 2017 up to the 1st April 2017. The data was analyzed through the application SPSS program version (20). The results revealed that the most study sample were between age group 18-23 year (40%), (65 %) were female, (62.5%) were nursing school graduate, (65%)of them were between (1-6) Years of experience, and (60%) were without Training Session. The study concluded that nurses' knowledge regarding to safe chemotherapy administration was inadequate, and also inadequate regarding general information to chemotherapy drugs. Chemotherapy safety administration standards should be applied for nurses that working in oncology center.

The use of gold nanorods as a new vaccine platform against schistosomiasis

Schistosomiasis is an important parasitic disease affecting >207 million people in 76 countries around the world and causing approximately 250,000 deaths per year. At present, the main strategy adopted for the control of schistosomiasis is the use of safe chemotherapy, such as praziquantel. However, the high rates of reinfection after treatment restrict the use of this treatment approach and assume the need for other forms of control such as vaccination. Sm29 is a protein that is localized in the Schistosoma mansoni tegument of adult worms and schistosomula and is considered a powerful vaccine candidate. Because of the chemical, physical and immunological characteristics of nanoparticles, nanocarriers have received increasing attention. In the field of nanotechnology, gold nanorods are considered potential vaccine carriers. In this study, we bound S. mansoni rSm29 protein to gold nanorods either directly or by cysteamine functionalization. When the worm burden was evaluated, the AuNRs-NH2-rSm29 group of immunized mice showed the best protection level (34%). Following AuNRs-NH2-rSm29 immunization, we observed a Th1 immunological response in mice with higher production of IFN-γ, mainly by CD4+ and CD8+ T cells. Furthermore, AuNRs-NH2-rSm29 could activate dendritic cells in vitro, enhancing MHCII and MHCI expression and the production of IL-1β in a NLRP3-, ASC- and Caspase-1-dependent manner. In summary, our findings support the use of nanorods as an immunization strategy in vaccine development against infectious diseases.

Janus Gold Nanoplatform for Synergetic Chemoradiotherapy and Computed Tomography Imaging of Hepatocellular Carcinoma.

There is a pressing need to develop nanoplatforms that integrate multimodal therapeutics to improve treatment responses and prolong the survival of patients with unresectable hepatocellular carcinoma (HCC). Mesoporous silica-coated gold nanomaterials have emerged as a novel multifunctional platform combining tunable surface plasmon resonance and mesoporous properties that exhibit multimodality properties in cancer theranostics. However, their reduced radiation-absorption efficiency and limited surface area hinder their further radiochemotherapeutic applications. To address these issues, we designed Janus-structured gold-mesoporous silica nanoparticles using a modified sol-gel method. This multifunctional theranostic nanoplatform was subsequently modified via the conjugation of folic acid for enhanced HCC targeting and internalization. The loaded anticancer agent doxorubicin can be released from the mesopores in a pH-responsive manner, facilitating selective and safe chemotherapy. Additionally, the combination of chemotherapy and radiotherapy induced synergistic anticancer effects in vitro and exhibited remarkable inhibition of tumor growth in vivo along with significantly reduced systematic toxicity. Additionally, the Janus NPs acted as targeted computed tomography (CT)-imaging agents for HCC diagnosis. Given their better performance in chemoradiotherapy and CT imaging as compared with that of their core-shell counterparts, this new nanoplatform designed with dual functionalities provides a promising strategy for unresectable HCC theranostics.

Determining the Virus Life-Cycle Stage Blocked by an Antiviral.

Among the members of the Arenaviridae family, Junín virus and Lassa virus represent important human health threats generating annual outbreaks of severe human hemorrhagic fever (HF) in endemic areas of Argentina and Western Africa, respectively. Given the lack of a specific and safe chemotherapy, the search for effective antiviral compounds is a continuous demanding effort. During the last two decades, academic research studies originated important results identifying novel molecules to be considered for further in vivo characterization. This chapter summarizes experimental in vitro approaches used to determine the possible mechanism of action of these antiviral agents.

Obstacles' And Facilitators Facing Safe Administration Of Chemotherapy by Oncology Nurses

Aim of the study : This study aimed to determine obstacles' and facilitators facing safe administration of chemotherapy by oncology nursing staff .  Material and methods : Study design: descriptive study design (qualitative) was used . Setting: the study was conducted at Tanta cancer center affiliated to Ministry of Health at El Garbeia Governorate Egypt. Sample: All (55) nurses working in oncology medical department at Tanta cancer center and administer chemotherapy. Tools: five tools  was used to conduct this study . Tool one :  Structured interview questionnaire: It was developed by the research after review of related literature. It was consisted of two parts : First part: Socio-demographic characteristics of oncology nurses and Second part: Level of knowledge needed about cytotoxic chemotherapy) by nurses .The total responses was summed up and classified into three levels,  high ,moderate &Low .  Tool Two Obstacles' facing nurses for safe administration of hazardous drug. It was developed by the researchers in Arabic & consisted of 13 open ended questions.Tool Three: : Modified Nurses attitude toward safe administration of hazardous drug for cancer patients (chemotherapy) questionnaire . It was adapted and translated into Arabic by the researchers. It was consisted of 18 items & included both positive and negative item statements  Tool Four: Modified Nurses anxiety and fear to administer hazardous drug for cancer patient questionnaires.It was adapted and translated into Arabic by the researchers. It consists of 18 items, the responses were 4 response Statements .Total anxiety scores: divided into three levels high , moderate and low according to scores ..Tool Five : Facilitators' of safe administration of hazardous drugs (cytotoxic chemotherapy : It was developed by the researchers in Arabic after review of related literature. It consisted of 13 open ended questions.Method : 1. Permission was obtained from head of oncology department at main Tanta University Hospital .2. Ten experts in the field of oncology, five oncology experts affiliated to Faculty of Medicine Tanta University and five nurses revised the tool for content validity. 3. Each nurses interviewed individually and participated to fulfill the questions in the five tools. 4. Ethical considerations: Consent was obtained from nurses after explanation of the research study aims and content. Confidentiality of data was ensured using code number instead of their names and withdrawal from the study was reserved. 5. Pilot study was carried out on 10% of the study sample 10 nurses  working in outpatient clinics and administer chemotherapy and not included in the sample to test tool feasibility and applicability and the required modification was done.  Results :Oncology nurses age was from 21-55 and have years of experiences from 0-30 year and more than two third of them married with deplume of secondary school level of education with no training courses about safe chemotherapy administration. Obstacles' for safe chemotherapy administration as perceived by nurses working in oncology department and administer chemotherapy according to priority ranking related to patient and as well as nurses were the first priority  while the last priority was related to hospital system of care delivery. Nurses attitude affect their behaviors to administer chemotherapy safely since slightly more than half 52% of nurses working in oncology had positive attitude toward safe administration of chemotherapy needed high level of knowledge and more than two third 76.36 % had moderate level of anxiety respectively and the more oncology nurses had positive attitude and more than two third 70.9% expressed they are in need to increased knowledge to be at high level the more they feel higher anxiety level to administer chemotherapy safely .Also facilitators for according to priority ranking, environmental factors especially quite wide space with sufficient illumination were the first priority followed by time of the shift and the last priority facilitors was hospital system .Conclusion and Recommendation Recommendations : Strategies to improve medication safety also need to be targeted at  specific multiple points in addition to oncology nurses attitudes and feelings toward safe chemotherapy administration which in respect shaping their behavior of cancer patients' care.