Current therapies for recurrent or progressive high-grade gliomas (HGG, WHO grade 3-4) produce a 6-month progression-free survival of only 10-25%. Migration and invasion by HGG is mediated in part by matrix metalloproteases (MMPs) which promote remodeling of the extracellular matrix. Several HIV protease inhibitors (HIVPI) decrease the expression of MMPs in astrocytes and microglia. Given these mechanisms of antitumor activity of HIVPI, we evaluated the efficacy of ritonavir/lopinavir, a combination HIVPI, in patients with progressive or recurrent HGG in an open label phase II trial. Nineteen patients were treated in this study. Patients received ritonavir/lopinavir (400 mg/100 mg) orally twice daily. All patients were treated until progression of disease or unacceptable toxicity. A complete response was seen in one patient (5%). Three patients (16%) had stable disease as the best response. Fifteen patients (79%) had progressive disease. The 6-month progression free survival (PFS(6)) was 11% (2 of 19 patients). Ritonavir/lopinavir was well tolerated in patients with heavily pretreated refractory HGG, and no grade 3 or 4 toxicity was seen. The activity at the dose and schedule used in this study, however, was modest and the study did not meet its efficacy endpoint.

Purpose: Provide advanced practice nurses (APNs) with tools and guidance on spiritual assessment for advance care planning(ACP); to review the literature on the connectedness between spiritual assessment and ACP; and to discuss implications for the APN in application of these concepts with a case study. Data sources: Selected research and clinical articles. Conclusions: There is a disconnect between what patients have expressed as their wishes regarding end‐of‐life care (EOLC) and what occurs. Spiritual beliefs and values impact patients' and families' decisions regarding EOLC, but if not discussed in advance, most wishes, especially dying at home, do not occur. Implications for practice: Incorporating spiritual assessment in a holistic assessment, it is possible to assist patients and families prior to crisis in sorting out patients' wishes with respect to EOLC during clinic visits. With the use of a simple mnemonic to guide spiritual assessment, the APN can bridge the gap between what the patient wants and what care is received at end of life.

Glutaraldehyde is considered a high-level surgical disinfectant commonly used in the United States in gastrointestinal lab environments. Glutaraldehyde requires proper ventilation when used as glutaraldehyde vapors are known irritants to the skin, eyes, nose, and lungs without proper ventilation in the work environment. Vapor concentration is the unit of measurement for the environmental presence of glutaraldehyde. Safe levels of glutaraldehyde vapor concentrations are a significant issue in the work environment. The American Conference of Governmental Hygienists has established and reported safe and allowable limits for vapor concentration of glutaraldehyde. Unfortunately, uncontrolled glutaraldehyde exposure in selected work environments is contributing to occupational asthma. Environmental exposure to glutaraldehyde has been linked to respiratory sensitization of the workers exposed and suggests the need for safe work environments anywhere glutaraldehyde is in use. Gastrointestinal labs use high-level disinfectants like glutaraldehyde to safely and thoroughly disinfect endoscopic instruments and accessories; however, there are worker-safety considerations relevant to glutaraldehyde use. The purpose of this article is to identify and describe clinical issues and challenges associated with worker safety and proper ventilation of glutaraldehyde in a gastrointestinal environment. A multidisciplinary problem-solving approach for use in identification and intervention for glutaraldehyde exposure and safety recommendations related to glutaraldehyde use as a high-level disinfectant in one gastroenterology lab environment will be highlighted.