Antineoplastics
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PharmacoEconomics & Outcomes News 454 - 5 Jun 2004 Evaluating quality of care: how does the VA measure up? Assessing quality of care via clinical measures converted from practice guidelines is a "young technology that requires further evaluation before it can achieve its full role in improving patient care", say US- based researchers. They critically evaluated the colorectal cancer screening performance measure used by the US Department of Veterans Affairs (VA) to assess quality of care at each of its medical centres. Analysis of medical records for patients audited for colorectal screening in 2002 revealed "several pitfalls" associated with converting practice guidelines into performance measures, note the researchers. Indeed, the illness severity of the sample population audited for colorectal cancer screening adherence was not considered by the VA, consequently screening was targeted "to patients who were much sicker than the healthy volunteers who participated in randomized trials of screening", they contend. In addition, high target screening rates appeared to be set without considering the fact that many patients (42% of those audited) were tested for "diagnostic rather than screening purposes", the researchers say. A third pitfall the researchers identified was that patient preferences or clinician judgement were not taken into account in the development of the measure. The quality of screening could be better measured through considering "thoughtful decision making that includes prognosis and patient preferences", the researchers suggest. These potential issues seem especially important given the recent Institute of Medicine recommendation to apply many VA performance measurement and reporting practices to "the US health care system as a whole", contend the researchers. Walter LC, et al. Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure. JAMA: the Journal of the American Medical Association 291: 2466-2470, No. 20, 26 May 2004 800973503 1 PharmacoEconomics & Outcomes News 5 Jun 2004 No. 454 1173-5503/10/0454-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1373 - 15 Oct 2011
SAntineoplastics
Leucopenia, neutropenia and thrombocytopeniain an elderly patient: case report
A 71-year old man with metastatic gastric cancerreceived adjuvant chemotherapy in 4-week cycles,consisting of the following: epirubicin 27 mg/m2 andcarboplatin 400 mg/m2 on day 1, etoposide 70 mg/m2 ondays 1–3 and fluorouracil 330 mg/m2 on days 1–5 [routesnot stated]. After one cycle, he developed grade2 leucopenia, as well as grade 4 neutropenia andthrombocytopenia. He also developed a grade 1 loss ofappetite. He received supportive therapy, and hischemotherapy regimen doses were reduced to 75% in hissecond cycle. Fluorouracil administration was shortened todays 1–4 from the third cycle at the patient’s request[outcome not stated]. He completed 6 cycles, andremained in remission 4 years later at follow up.Inagaki H, et al. A case of gastric small cell carcinoma with metastatic livertumors responding to adjuvant chemotherapy. Gan to Kagaku Ryoho 37:1953-1956, No. 10, Oct 2010 [Japanese; summarised from a translation] -Japan 803061240
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Reactions 15 Oct 2011 No. 13730114-9954/10/1373-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
