Nursing Week’s Articles: 08/05/2009 – 08/12/2009
Wednesday, August 19th, 2009Dronedarone for atrial fibrillation: a new therapeutic agent
Patel PD et al. – Atrial fibrillation is the most common of the serious cardiac rhythm disturbances and is responsible for substantial morbidity and mortality. Dronedarone is a multichannel blocker and, like amiodarone, possesses both a rhythm and a rate control property in atrial fibrillation.
What’s new in prostate cancer screening and prevention?
Klein EA – Prostate cancer is extremely common but causes death in only a minority of men in whom it develops, facts that raise issues regarding screening and treatment morbidity. Two large trials of screening with prostate–specific antigen (PSA) measurements came to seemingly opposite conclusions. Furthermore, a large trial of selenium and vitamin E found that these agents have no value as preventive agents.
* An elevated PSA level lacks specificity as a test for prostate cancer, but PSA measurements can be useful in combination with clinical risk factors or to measure changes in PSA over time.
* Rather than relying on PSA screening alone, we should stratify the risk of prostate cancer on the basis of race, age, PSA level, family history, findings on digital rectal examination, whether the patient has ever undergone a prostate biopsy, and whether the patient is taking finasteride (Proscar). A simple online tool is available to do this.
* There is no PSA level below which the risk of cancer is zero.
* Finasteride has been found in a randomized trial to decrease the risk of prostate cancer, but vitamin E and selenium supplements have failed to show a benefit.
* In spite of some recent studies, or perhaps because of them, we still are unsure about how best to screen for and prevent prostate cancer. Two large trials of screening with prostate–specific antigen (PSA) measurements came to seemingly opposite conclusions.1,2 Furthermore, a large trial of selenium and vitamin E found that these agents have no value as preventive agents.
How menopause affects oral health, and what we can do about it
Buencamino MCA et al. – After menopause, women become more susceptible to periodontal disease. The authors believe the problem is due in large part to estrogen deficiency with resulting bone loss and inflammatory processes. Osteoporosis and periodontal disease are best diagnosed early so that treatment can be started sooner and fractures and tooth loss can be prevented. This article reviews the published studies of the association between menopause and periodontal disease, specifically, the effects of hormonal changes, osteoporosis, and bisphosphonate use on the periodontal status of postmenopausal women. The authors will highlight the interrelationship of dental health and postmenopausal health and underscore the need for cross–communication and patient referral between physicians and dentists.
Current trends in the treatment of hepatic encephalopathy
Al Sibae MR et al. – More recent data supports the benefits of rifaximin used solely and as an additional agent with fewer side effects than neomycin or metronidazole. Newer therapies being investigated in humans with clinical promise include nitazoxanide, the molecular adsorbent recirculating system (MARS), L–ornithine phenylacetate, sodium benzoate, and/or sodium phenylacetate and Kremezin.
