Class of 2012 Abstract / Specific Aims: To compare and evaluate the therapies prescribed, the incidence of adverse drug events, and the time to clinical cure in transplant patients with a cytomegalovirus (CMV) infection at an academic medical center before and during the foscarnet nationwide shortage. Methods: This study was a retrospective chart review to compare CMV treatment prescribed and clinical outcomes in pediatric and adult transplant patients at an academic medical center. Transplant patients were evaluated over a 16 month time period between December 2009 and March 2011. The average dose (mg/kg) and prevalence ganciclovir, foscarnet, and cidofovir prescribed in transplant patients with CMV infection were evaluated. Additionally, the incidence of adverse drug events including acute renal dysfunction and myelosuppression were characterized. Main Results: There were 30 subjects diagnosed with CMV disease during the evalutaion period. Of all of the patients treated for CMV before the shortage, 79% received ganciclovir, 43% received foscarnet, and 21% received cidofovir. Following the shortage in September 2010, the usage of the antiviral agents changed to 100%, 25%, and 13% respectively. Overall the usage of ganciclovir increased while the usage of foscarnet decreased when there was a shortage of medication. Conclusions: The antiviral prescribing patterns changed significantly during the foscarnet shortage. The average dose and incidence of ganciclovir increased which likely contributed to serious adverse events. Due to the limited amount of patients treated for CMV and the short time frame, clinical cure could not be determined at this time. Drug shortages are a serious problem and significantly influence patient outcomes.

Class of 2012 Abstract / Specific Aims: The primary aim of this study was to determine the incidence of posaconazole and voriconazole concentration monitoring that occurs in transplant patients receiving antifungal prophylaxis therapy. The secondary aim was to determine whether voriconazole and posaconazole serum concentrations were used for dose adjustments. Methods: Patients status post either a liquid or solid organ transplant over the age of 1 year who received invasive fungal infection prophylaxis with either posaconazole or voriconazole between the dates of February 1, 2010 through January 31, 2011 while admitted to academic medical center were included in this descriptive retrospective study. This study has been approved by the Institutional Review Board. Data collected on each subject included demographic information, type of transplant, posaconazole or voriconazole concentrations, and duration and dosage adjustments. Main Results: 54 subjects were identified who received either voriconazole or posaconazole for fungal prophylaxis after transplant. For subjects who were prescribed posaconazole (N = 8), concentration monitoring was performed in 50% of subjects and 0% of posaconazole dose adjustments were based on concentrations. For subjects who were prescribed voriconazole, concentration monitoring and dose adjustments based on voriconazole concentrations were performed in 20% and 78% of subjects respectively. Adverse outcomes associated with the use of antifungal therapy were reported in 0% of the posaconazole therapy group and 17% of the voriconazole therapy group. Conclusions: Both posaconazole and voriconazole concentrations were obtained from patients who were receiving antifungal therapy for invasive fungal infection prophylaxis. Adjustments of prophylactic doses are not well characterized.

Class of 2012 Abstract / Specific Aims: The primary aim of this study was to determine the incidence of posaconazole and voriconazole concentration monitoring that occurs in transplant patients receiving antifungal prophylaxis therapy. The secondary aim was to determine whether voriconazole and posaconazole serum concentrations were used for dose adjustments. Methods: Patients status post either a liquid or solid organ transplant over the age of 1 year who received invasive fungal infection prophylaxis with either posaconazole or voriconazole between the dates of February 1, 2010 through January 31, 2011 while admitted to academic medical center were included in this descriptive retrospective study. This study has been approved by the Institutional Review Board. Data collected on each subject included demographic information, type of transplant, posaconazole or voriconazole concentrations, and duration and dosage adjustments. Main Results: 54 subjects were identified who received either voriconazole or posaconazole for fungal prophylaxis after transplant. For subjects who were prescribed posaconazole (N = 8), concentration monitoring was performed in 50% of subjects and 0% of posaconazole dose adjustments were based on concentrations. For subjects who were prescribed voriconazole, concentration monitoring and dose adjustments based on voriconazole concentrations were performed in 20% and 78% of subjects respectively. Adverse outcomes associated with the use of antifungal therapy were reported in 0% of the posaconazole therapy group and 17% of the voriconazole therapy group. Conclusions: Both posaconazole and voriconazole concentrations were obtained from patients who were receiving antifungal therapy for invasive fungal infection prophylaxis. Adjustments of prophylactic doses are not well characterized.

Class of 2016 Abstract / Objectives: The purpose of this study was to evaluate if fluconazole 200 mg is an acceptable alternative to the fluconazole 400 mg for fungal prophylaxis in allogenic hematopoietic stem cell patients. Lower fluconazole doses will decrease cost of therapy and may reduce adverse events associated with higher doses. Methods: This study was a retrospective chart review conducted at the Arizona Cancer Center. A total of 58 patients qualified for the study. Primary endpoints were number of days on fluconazole 200 mg and type and number of fungal infections that occurred within 1 year post transplant. Results: Out of the fifty-eight patients who qualified for the study, only eight patients had a breakthrough fungal infection while on 200 mg (13.7%) after one year. Three of those eight were identified as having systemic fungal infections (5.2%). Conclusions: Fluconazole 200 mg is a reasonable low-cost and low side effect alternative to fluconazole 400 mg for antifungal prophylaxis in allogenic hematopoietic stem cell patients.

The diploma thesis deals with the issues of nursing care and the nurse?s position in the complex process of transplantation. Transplantation treatment becomes more important in the course of time. There are such situations that there is no other choice of restoring and saving the health of the sick person but to transplant. The complex process of transplantation is a chain of successive operations in which not only many doctors but also other medical and paramedical staff are involved and they constantly interact not only with the patient. Classically, the largest group in providing patient care is general nurses who assume the responsibility for the direct provision of nursing care, work independently and are responsible for the care provided. Their work requires a deep knowledge of the branch and many professional activities without suppressing their original mission. Today?s nurse is a full member of the team and the doctor?s partner in practicing his or her profession. The theoretical part deals comprehensively with the issues of the removal of organs especially from deceased donors, their transplantation and legislation in the Czech Republic and especially with the role of a nurse which she has in this process. An objective of the research survey was to map whether a nurse really felt to be the doctor?s partner in this challenging branch of providing nursing care and what their attitudes towards practicing their own profession in this branch were and to map the extensiveness of their knowledge and educational opportunities in these issues. Another objective was to map the attitudes of patients themselves towards care in the transplantation treatment process. In the research survey a quantitative method was used and applied by distributing questionnaires to general nurses working at a department of transplantation medicine. The results of the questionnaire survey were processed to create well-arranged tables. The qualitative part of the research survey was carried out through interviews with patients who are in the transplantation treatment process. The interviews were processed in writing and the results were summarized in mind maps.

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