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1.
Clin Exp Rheumatol ; 34(2): 247-53, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26940788

RESUMEN

OBJECTIVES: To estimate the proportion of patients with very severe osteoporosis (those covered by the reimbursement criteria of the Italian National Health Service) experiencing new vertebral and non-vertebral fragility fractures in the first 24 months of a new anti-osteoporosis treatment. METHODS: Prospective observational study in men and post-menopausal women (aged > 21 years) initiating anti-osteoporosis treatment for very severe osteoporosis. Eligibility was based on teriparatide (TPD) reimbursement criteria in Italy: incident of vertebral or hip fracture during anti-resorptive treatment (minimum 1 year), or at least three prevalent severe vertebral fractures, or two prevalent severe vertebral fractures and a historical proximal hip fracture. Incidence of new clinical vertebral and non-vertebral fractures was documented by original x-rays and/or radiological reports, and a post-hoc analysis compared data from the TPD monotherapy population versus the total treated group. RESULTS: Overall, 767 patients (mean age 72.8 years, 90.7% women) were enrolled in the study, of whom 628, 538, 419 and 424 attended visits at 6, 12, 18 and 24 months, respectively. The most commonly prescribed therapy was TPD (single-agent; 64.5%), then bisphosphonates and other anti-resorptives (33.3%). A combination of different oral treatments was given to 22.5% of the patients. Overall treatment adherence at 24 months was 65.7%. In a post-hoc analysis, the overall incidence of new clinical vertebral and non-vertebral fractures in the total treated population was, respectively, 4.7% and 2.3% in the first 6 months; 1.8% and 1.6% in the 6-12 month period; 2.9% and 1.4% in the 12-18 month period; and 2.2% and 1.0% in the 18-24 month period. CONCLUSIONS: In patients with very severe osteoporosis, the risk of new vertebral and non-vertebral fractures declined after the first 6 months and remained low throughout the study.


Asunto(s)
Cumplimiento de la Medicación , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Teriparatido/uso terapéutico
2.
AORN J ; 113(2): 138-145, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33534151

RESUMEN

As the coronavirus disease 2019 (COVID-19) pandemic spread around the world, the US Surgeon General called for the cancellation of elective surgeries. At a large academic medical center in the Northeast, there was a resulting surplus of perioperative nurses who were deployed to inpatient units in need of skilled nursing care for a surge of COVID-19 patients. To prepare them for deployment to inpatient units, perioperative leaders developed a core curriculum to ensure that the OR nurses possessed the skills and knowledge required to successfully care for patients outside the OR with the same level of care and compassion that they provided to perioperative patients. The leaders employed available resources at the hospital to design and implement the course in a short amount of time. This article describes the development of a curriculum for OR nurses to manage a surging patient volume on inpatient units because of the COVID-19 pandemic.


Asunto(s)
COVID-19/enfermería , Curriculum , Capacitación en Servicio , Rol de la Enfermera , Enfermería Perioperatoria , SARS-CoV-2 , Humanos
3.
AORN J ; 111(3): 289-300, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32128762

RESUMEN

Hazardous drug (HD) use in the perioperative environment poses unique challenges and risks for exposure that can have adverse consequences for perioperative personnel. The United States Pharmacopeial Convention has implemented new standards to address the safe handling and administration of HDs by health care workers. To comply with these standards and minimize perioperative personnel's occupational exposure to HDs, a multidisciplinary team at an academic medical center in Boston that was performing an increased number and variety of operative and other invasive procedures using antineoplastic agents updated their protocol for the safe use of HDs in the OR. This article discusses HDs and the risks they pose to health care workers and outlines the new HD safety protocol for the OR that was part of a performance improvement plan to ensure compliance with new standards and staff member safety in the perioperative setting.


Asunto(s)
Protocolos Clínicos , Sustancias Peligrosas/uso terapéutico , Medicamentos bajo Prescripción/uso terapéutico , Boston , Sustancias Peligrosas/administración & dosificación , Humanos , Exposición Profesional/prevención & control , Quirófanos/métodos , Equipo de Protección Personal , Medicamentos bajo Prescripción/administración & dosificación , Administración de la Seguridad
4.
Appl Immunohistochem Mol Morphol ; 15(1): 70-6, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17536311

RESUMEN

Several studies indicate that cyclooxygenase-2 (COX-2) is overexpressed in human malignancies, where it produces high levels of prostaglandins and contributes to tumor growth. In this study we have analyzed the expression of COX-2 in a series of 48 skeletal osteosarcomas of different subtypes by immunohistochemistry. In addition, we examined the effects of the specific COX-2 inhibitor Celecoxib on the growth of the human osteosarcoma cell line SaOS-2. Immunoreactivity for COX-2 was observed in 39 out of 48 tumors (81.2%), 30 (76.9%) of which showed a moderate or diffuse immunostaining. Considering the group of 42 primary osteosarcomas, COX-2 immunoreactivity was significantly higher in high grade osteosarcomas, where moderate or diffuse expression was detected in 23 out of 32 cases (71.8%), than in low grade osteosarcomas, where moderate or diffuse expression was detected in 2 out of 10 cases (20%) (P = 0.008, Fisher exact test). In addition, low COX-2 expression was always associated with a good response to chemotherapy (5 out of 5 cases), whereas moderate or diffuse COX-2 expression was associated with a good response in 11 out of 20 cases (55%) (P = 0.12, Fisher exact test). In SaOS-2 osteosarcoma cells, which express COX-2, treatment with Celecoxib determined inhibition of cell proliferation and induction of apoptosis. These results indicate that COX-2 is expressed at high levels in high grade osteosarcomas and support the use of COX-2 inhibitors to improve both the tumor response to chemotherapy and the outcome of osteosarcoma patients.


Asunto(s)
Ciclooxigenasa 2/análisis , Osteosarcoma/enzimología , Apoptosis/efectos de los fármacos , Biopsia , Celecoxib , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Humanos , Inmunohistoquímica , Osteosarcoma/tratamiento farmacológico , Osteosarcoma/patología , Pirazoles/farmacología , Sulfonamidas/farmacología
5.
Menopause ; 13(3): 451-61, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16735942

RESUMEN

OBJECTIVE AND DESIGN: A cross-sectional segregation analysis of polymorphisms in the estrogen receptor (ER) genes (Pvull and Xbal in ERalpha, and Alul in ERAbeta with bone mineral density in the lumbar spine and forearm and with lipid profile was performed in 1098 postmenopausal women. Additionally, in a subpopulation of 280 women, who completed 1 year of treatment with estrogen plus progestin, the association between genotypes and the response to treatment in both plasma lipids and bone was investigated. In another untreated subpopulation of 443 women, genotype influence on the prevalence of vertebral fractures and on annual rate of bone loss during a mean follow-up period of 11 years was estimated. RESULTS: Baseline plasma lipids, bone mineral density, annual rate of bone loss and prevalence of spinal fractures were not significantly associated with polymorphisms in the ERbeta gene. The ERA polymorphism was significantly associated with bone loss from the distal forearm (P = 0.04) but not with bone loss from the spine. After 1 year of treatment with hormone therapy there was also a significant association between the ERbeta polymorphism and the response in total cholesterol (P = 0.02); while the ERalpha gene polymorphisms did not significantly influence the response to hormone therapy. CONCLUSIONS: In a large white population of postmenopausal women, ERalpha gene polymorphisms were not associated with bone mineral density or lipid profile at baseline or after hormone therapy. Conversely, the ERbeta genotype appeared to segregate with bone loss from the forearm and to modulate the decrease in total cholesterol during hormone therapy.


Asunto(s)
Receptor alfa de Estrógeno/genética , Receptor beta de Estrógeno/genética , Terapia de Reemplazo de Estrógeno , Osteoporosis Posmenopáusica/tratamiento farmacológico , Osteoporosis Posmenopáusica/genética , Densidad Ósea , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , ADN/análisis , Dinamarca/epidemiología , Femenino , Antebrazo , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Humanos , Vértebras Lumbares , Persona de Mediana Edad , Osteoporosis Posmenopáusica/sangre , Polimorfismo Genético , Triglicéridos/sangre
6.
AORN J ; 101(4): 404-12; quiz 413-5, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25835006

RESUMEN

Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care.


Asunto(s)
Errores Médicos/prevención & control , Enfermería Perioperatoria/organización & administración , Garantía de la Calidad de Atención de Salud , Humanos , Cultura Organizacional , Enfermería Perioperatoria/normas , Evaluación de Procesos, Atención de Salud
7.
Maturitas ; 47(1): 39-45, 2004 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-14706764

RESUMEN

OBJECTIVE: In postmenopausal women, we investigated if the response in bone mineral density (BMD) was associated with the response in the atherogenic lipid profile during hormone replacement therapy. METHODS: We performed an exploratory, post-hoc analysis of data from a prospective double-blind placebo-controlled trial. Healthy postmenopausal women were randomised into five groups, each receiving different combinations of 17 beta-estradiol and gestodene or placebo. A total of 133 women completed the study. The study period was 3 years. The response in bone mass was expressed as the percentage change in BMD from baseline calculated by linear regression from semi-annual measurements. The change in lipid profile was evaluated as the average of three mid-cycle and end-cycle values in percentage from baseline in order to account for cyclic changes during sequential hormone therapy. RESULTS: A significant correlation between the increase in BMD of the spine and hip and forearm with the decrease in serum low density lipoprotein (LDL) and cholesterol was found. Additionally, the decrease in atherogenic lipids correlated significantly with the response in biochemical bone markers for resorption and formation. CONCLUSION: In conclusion, our study shows that it is the same women who have a favourable response in BMD as in the lipid-profile during hormone replacement therapy (HRT). The association is most likely driven by a common response in FSH to exogenous estradiol therapy. This indicates that common denominators for the response to HRT exist. Further studies are needed to explore and identify such predictors.


Asunto(s)
Densidad Ósea/efectos de los fármacos , LDL-Colesterol/efectos de los fármacos , Terapia de Reemplazo de Estrógeno , Osteoporosis Posmenopáusica/prevención & control , Biomarcadores/sangre , Biomarcadores/orina , Dinamarca , Método Doble Ciego , Estradiol/farmacocinética , Estradiol/uso terapéutico , Terapia de Reemplazo de Estrógeno/métodos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Norpregnenos/farmacocinética , Norpregnenos/uso terapéutico , Osteoporosis Posmenopáusica/tratamiento farmacológico , Progestinas/farmacocinética , Progestinas/uso terapéutico , Estudios Prospectivos , Análisis de Regresión , Resultado del Tratamiento
8.
Expert Rev Endocrinol Metab ; 3(4): 503-511, 2008 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30290437

RESUMEN

Estrogens behave as protective agents on the development of colorectal cancer, and hormonal-replacement therapy is associated with an increased survival rate in women with this disease, indicating that estrogenic therapy correlates with a better prognosis. The protective effect of estrogens on Fcolorectal cancer development and progression is presumably related to the expression of estrogen receptors in colon mucosa, with the estrogen receptor-ß isoform being the predominant one. This observation suggests that estrogen receptor-ß could have an inhibitory effect on colorectal cancer cell proliferation and a regulatory effect on colonic mucosa cell growth, opening the discussion on a pharmacologic approach to colorectal cancer prevention and therapy based on estrogenic compounds.

9.
Curr Med Res Opin ; 24(9): 2609-15, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18687167

RESUMEN

INTRODUCTION: Polymorphisms of genes encoding enzymes of the mevalonate pathway could modulate the response to amino-bisphosphonate treatment in postmenopausal osteoporosis. RESEARCH DESIGN AND METHODS: A characterisation of 234 Danish osteoporotic postmenopausal women (as part of the Prospective Epidemiological Risk Factors study (PERF)), treated for at least 2 years with amino-bisphosphonates, with respect to the adenosine/cytosine (A/C) rs2297480 farnesyl pyrophosphate synthase (FDPS) gene polymorphism, was carried out by PCR-based enzymatic digestion and quantitative PCR allelic discrimination on genomic DNA extracted from blood leukocytes. The association between these polymorphism genotypes and the response of spine and femur bone mineral density (BMD) and of biochemical bone biomarkers to treatment with amino-bisphosphonates was statistically examined. RESULTS: FDPS polymorphism did not show any relationship to baseline spinal and femoral BMD in Danish postmenopausal women. BMD response to treatment with amino-bisphosphonates was similar in the AA and the AC genotypes, while the CC genotype showed a lower BMD response to 2-year-treatment with amino-bisphosphonates at all examined skeletal sites (p=0.60 at the spine and p=0.59 at the femur). Interestingly, after 2 years of treatment the response of urinary Cross-laps to amino-bisphosphonates treatment was significantly (p<0.05) lower in the CC genotype when compared to both the AC and AA genotypes. Even the response of serum osteocalcin was lower in the CC genotype, but without reaching a statistical significance (p=0.65). CONCLUSIONS: Danish postmenopausal women with osteoporosis bearing the homozygous CC genotype for rs2297480 FDPS polymorphism showed a decreased response of bone turnover markers to amino-bisphosphonate therapy, when compared to the heterozygous AC and to the homozygous AA genotypes. Further investigation on larger and different populations, together with polymorphism functional studies are required to confirm these data.


Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Geraniltranstransferasa/genética , Polimorfismo Genético , Posmenopausia , Anciano , Densidad Ósea , Remodelación Ósea , Femenino , Genotipo , Humanos , Persona de Mediana Edad
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