Cyclo-oxygenase 2 inhibitors: an important new drug classification.

The pharmacologic treatment of acute and chronic pain has evolved greatly over the last several decades. Notably, several new classifications of drugs have emerged to meet the growing demand of patients in pain and health care providers who attempt to assist them. This article describes 1 new classification, cyclo-oxygenase 2 inhibitors, and provides specifics about the 2 agents currently available via prescription.

Diagnostic imaging and biochemical markers of bone turnover.

The diagnosis and monitoring of osteoporosis has evolved markedly in the last several decades. Nurses caring for patients with osteoporosis and those working in prevention settings must have an understanding of the tools currently available to diagnose the disease and measure treatment response. The purpose of this article is to describe current diagnostic imaging techniques and biochemical markers of bone turnover in osteoporosis.

Women and coronary heart disease.

Coronary heart disease (CHD) is the leading cause of death in men and women in the United States. The incidence of CHD during midlife is lower in women than men, but the gap narrows with each decade. Because women have a longer life span than men, the absolute numbers of CHD deaths are roughly equal. Effective diagnosis of CHD in women requires the recognition of gender differences in presentation and pathogenesis. Women present with atypical symptoms and are less likely to have adequate primary prevention. This article discusses the differences between men and women in CHD and examines the assessment, diagnosis, and clinical management of CHD in women.

Hormonal decline in elderly men and male menopause.

Much has been written about female menopause, but hormonal decline in men indicative of a similar menopause is a relatively new concept. Hormonal decline in men is a gradual and often occult process. Many men do not experience noticeable symptoms, but those who do usually experience a decline in sexual desire and ability that may be attributed to aging. Some men may hide these symptoms. Hormonal replacements and herbal therapies may be helpful. Nurses must conduct careful histories and physical examinations to elicit disclosure of symptoms of hormonal decline in this population.

Osteoporosis and African-American women.

African-American women are missing from the list of risk factors for osteoporosis although over 300,000 currently have osteoporosis. Possible bone structure differences such as greater peak bone mass, a slower rate of bone loss after menopause, and better quality of bone microarchitecture in African-American women have not been supported by research. Approaches such as calcium intake, hormone replacement therapy, and medications which prevent and treat osteoporosis need to be undertaken.

HIV/AIDS and women.

Women are the fastest growing segment of people with acquired immunodeficiency syndrome (AIDS), yet they often receive this diagnosis when the disease is in its advanced stages. New therapies have caused human immunodeficiency virus (HIV) to become a chronic and treatable disease for many of those afflicted. Primary care providers must be cognizant of the initial symptoms to facilitate early diagnosis and prompt treatment for women with HIV. Early signs of HIV in women are subtle. Providers must consider a diagnosis of HIV in women who present with vaginal infections, abnormal pap smears, or sexually transmitted diseases that are unusually severe, recurrent, and resistant to treatment efforts. These signs and symptoms, along with a corroborating history, may be early clues to HIV. Primary care providers, in conjunction with HIV specialists, must strive to decrease the incidence, morbidity, and mortality of the disease in women.

Update on osteoporosis in elderly men.

Most nurses believe that osteoporosis is a problem of elderly women. Although the disease does occur primarily in women, aging men also are at risk. In fact, osteoporosis in elderly men typically causes greater morbidity and earlier mortality. Currently, no pharmacologic agents have been approved by the Food and Drug Administration to prevent or treat osteoporosis in this population. Several small clinical trials have been conducted in Europe, and several others are in progress in the United States. Geriatric nurses need to be aware of the risk of osteoporosis in elderly men and provide early counseling and prevention strategies.

Management of osteoporotic vertebral fracture pain.

Osteoporosis is an increasingly prevalent, chronic metabolic bone disease that can cause fractures of the distal radius, hip, and spine. Spinal fractures are the most common, and often the most debilitating, of osteoporotic fractures. Early recognition of these painful fractures can help to ease the burden. A variety of modalities can be used to manage vertebral fractures during both the acute and chronic stages. Nurses must be aware of the potential for osteoporosis to cause acute and chronic back pain. They can play an important role in early detection and appropriate pain management of patients with osteoporotic vertebral fractures.

Development and validation of the mini-osteoporosis quality of life questionnaire (OQLQ) in osteoporotic women with back pain due to vertebral fractures. Osteoporosis Quality of Life Study Group.

The objective of the study was to evaluate a shortened osteoporosis quality of life questionnaire (OQLQ) in osteoporotic women with back pain due to vertebral fractures. From the longer 30-item OQLQ (four to nine items per domain) we created the mini-OQLQ by choosing the two items with the highest impact in each of five domains (symptoms, physical function, activities of daily living, emotional function, leisure). We administered the OQLQ, the Sickness Impact Profile, the SF-36 and the Brief Pain Index to patients at baseline, after 2 weeks and after 6 months. The intraclass correlations between baseline and the 2-week follow-up for the five mini-OQLQ domains ranged from 0.72 to 0.86. Cross-sectional correlations between the domains of the mini-OQLQ and other health instruments were moderate to large (0.35-0.80) and greater than predicted. The mini-OQLQ items showed moderate to large correlations with items omitted from the shortened questionnaire (0. 44-0.88). Correlations between the OQLQ domains and the other three instruments were greater than those of the mini-OQLQ, and partial correlations between OQLQ items omitted from the mini-OQLQ and the other three instruments after considering mini-OQLQ items were substantial (0.19-0.71) and statistically significant. Sample sizes of less than 200 per group should be required to detect minimally important differences in parallel-group clinical trials. Longitudinal correlations between the mini-OQLQ and the other measures were often significant but generally lower than predicted (0.10-0.49). The partial correlations revealed that the omitted items explained a significant portion of the longitudinal variance in each domain. We conclude that in a selected group of patients with back pain caused by vertebral fractures, the mini-OQLQ demonstrated good discriminative and adequate evaluative properties. The mini-questionnaire should be useful in clinical settings.

Differential diagnosis of chest pain: a case report.

Chest pain in a common presenting complaint in many healthcare settings, including Gl settings. It may be caused by a variety of cardiac and noncardiac abnormalities. Nurses can play a critical role in the differential diagnosis of chest pain by obtaining a thorough history and conducting a directed physical examination. This article describes the differential diagnosis of chest pain through a case presentation.

Tai Chi as a method of fall prevention in the elderly.

Falls often lead to the fracture of bones in the elderly population. Fall incidence is increasing with the concomitant rise in the elderly population. Recently, some nontraditional methods of fall prevention have been explored. This article provides some background information about the ancient practice of Tai Chi as well as a brief review of the current literature exploring the effectiveness of Tai Chi in health promotion and fall prevention.

Screening calcaneal ultrasound and risk factors for osteoporosis among lesbians and heterosexual women.

We compared calcaneal ultrasound measurements (speed of sound [SOS], broadband ultrasound attenuation [BUA], and stiffness index [SI]) of lesbian and heterosexual women to examine the medical and lifestyle risk factors for osteoporosis in each group. This was an exploratory, community-based, cross-sectional study. Subjects were mailed food frequency, health, and physical activity questionnaires. Weight, height, and calcaneal ultrasound measurements were taken at one office visit. In communities in southern and eastern Maine, 71 lesbians and 77 heterosexual women between the ages of 30 and 50 with regular menses and in good general health were the subjects. Statistical analysis used t-tests and chi-square tests to evaluate differences between study groups. Linear regression models were used to evaluate risk factors for low calcaneal ultrasound measurements. There were no differences between the lesbian and heterosexual women in age, body mass index (BMI), exercise, calcium intake, alcohol use, or calcaneal ultrasound measurements. There was a positive association between BUA and both BMI and alcohol consumption (p < 0.01). Antidepressant use significantly reduced SOS and SI (p < 0.05). There were no differences in calcaneal ultrasound measurements between lesbian and heterosexual women. BMI was strongly and positively associated with BUA. Antidepressant use in both populations was associated with a significant reduction in calcaneal bone mass. Studies are needed to define the relationship of depression and its treatment to bone mineral density and the future risk of osteoporosis.

Diagnosis and management of hypothyroidism in pregnancy.

Hypothyroidism is not a common occurrence in pregnancy, but it is important that nurse practitioners recognize it early. Complications of hypothyroidism in pregnancy are pregnancy-induced hypertension, preeclampsia, abruptio placentae, low birth weight and stillbirth, and fetal distress in labor. Careful monitoring of pregnant women for hypothyroidism and correction with levothyroxine therapy can prevent these complications. During pregnancy, the thyroxine needs of women with hypothyroidism are increased, and their dosage of levothyroxine should be individualized. Nurse practitioners can provide holistic care to the woman with hypothyroidism to ensure optimal maternal and fetal health.

Health-related quality of life and participation in osteoporosis clinical trials.

Although osteoporosis affects millions of elderly women, the quality of their lives is extremely complex and is only recently being appreciated. We recently used a disease-specific Osteoporosis Quality of Life questionnaire (OQLQ) to measure quality of life for 105 elderly osteoporotic women, and reported that by path analysis, spinal fractures, health perception, and several sociodemographic factors accounted for 63% of the variance in quality of life. On the other hand, bone density, Colles fracture, hip fractures, pharmacologic agents, exercise, and several sociodemographic variables were not significant factors. Of particular note was the positive, indirect effect (via health perception and spinal fractures) that participation in a clinical trial (17.5% of the patients) had on life quality. In order to determine how involvement in a research study might affect health perception in this same cohort we examined OQLQ scores in the five domains of the OQLQ for the 18 post-menopausal osteoporotic women enrolled in two different phase III clinical trials with oral bisphosphonates and 87 osteoporotic women treated conventionally (estrogen, bisphosphonate, calcitonin, calcium/vitamin D) in our metabolic bone clinic. Research and clinical patients did not differ in age, femoral BMD, or number of spinal fractures. However, women in research trials had significantly greater aggregate OQLQ scores (5.67 versus 4.23, P < 0.0001) and perceived health (7.28 versus 5.85, P = 0.001) than clinical patients. These differences were highly significant (P < 0.001) for domains of quality of life including physical function, activities of daily living, symptoms, and leisure/ social activity and marginally significant for the emotional function domain (P = 0.05). Hence, by regression-based path analysis and subgroup analysis of cross-sectional data, participation in a clinical trial had a significant and positive impact on health-related quality of life. If these findings are confirmed by other studies, identifying those factors inherent in clinical studies that positively impact the lives of osteoporotic patients should become as important a priority as development of new therapies for this chronic disease.

Domains of health-related quality of life in elderly women with osteoporosis.

Osteoporotic spinal fractures can be painful, debilitating, and contribute to impaired HRQL of elderly women. The OQLQ is a validated disease-specific instrument developed to measure HRQL in women with spinal fracture caused by osteoporosis. Future intervention studies should test nursing interventions to decrease the burden of suffering for women with this increasingly prevalent, chronic disease.