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Biomedical subjects

C R Kessenich

Publications and source records attributed to C R Kessenich.

At least 19 recordsLinked to original sources
PubMed2001

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.

Acute Disease↗
PubMed2001

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.

Clinical Trials as Topic↗
PubMed2001

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.

Absorptiometry, Photon↗
PubMed2000

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.

Acute Disease↗
PubMed1999

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.

Aged↗
PubMed1998

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.

Aged↗
PubMed1998

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.

Adult↗
PubMed1998

Health-related quality of life in osteoporosis.

The increasing prevalence and complexity of osteoporosis mandates that healthcare providers take a comprehensive view of the scientific investigation, treatment, and management of the disease. Despite recent pharmacologic advances, the enhancement of quality of life for patients with osteoporosis remains an elusive goal. The measurement of disease- specific quality of life in osteoporosis has recently improved with the development of three new tools specifically designed for this purpose. This paper provides an overview of the newly developed questionnaires along with some suggestions for the improvement of quality of life for this growing segment of the population.

Journal Article↗
PubMed1998

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.

Activities of Daily Living↗
PubMed1998

Onychomycosis: diagnosis and systemic treatment.

Onychomycosis, a persistent fungal infection affecting the toenails and fingernails, can interfere with standing, walking, and exercising. Associated physical impairments can result in paresthesia, pain, discomfort, and loss of manual dexterity. Patients may also suffer from loss of self-esteem and social interaction. A definitive diagnosis is crucial for effective treatment, because many other skin and nail disorders mimic onychomycosis. Diagnosis involves microscopic potassium hydroxide preparation, cultures, nail biopsy, and histologic analysis. Treatment can include topical and systemic antifungal therapies as well as nonpharmaceutical methods. This paper discusses pathophysiology, diagnosis, and treatment options for this common nail dystrophy, including the newer antifungal medications now available.

Antifungal Agents↗
PubMed1997

The pathophysiology and treatment of postmenopausal osteoporosis. An evidence-based approach to estrogen replacement therapy.

Osteoporosis is one of the most common and debilitating diseases of postmenopausal women. Recent advances in understanding the bone remodeling unit have clarified the pathophysiologic processes that contribute to bone loss after the onset of estrogen deprivation. Epidemiologic studies have suggested a protective effect from long-term estrogen replacement therapy on fracture risk. This article examines the key role estrogens play in bone remodeling and the current evidence that estrogen treatment in postmenopausal women reduces the likelihood of osteoporotic fractures.

Estrogen Replacement Therapy↗
PubMed1996

Comparative clinical pharmacology and therapeutic use of bisphosphonates in metabolic bone diseases.

The bisphosphonates are a class of synthetic compounds used in the treatment of various metabolic bone diseases, including hypercalcaemia of malignancy, Paget's disease, postmenopausal osteoporosis and corticosteroid-induced bone loss. Although there have been numerous studies comparing first, second and third generation bisphosphonates with placebo, there has been a paucity of comparative research investigating the effectiveness of these substances with other pharmacological agents. Still, the available evidence indicates that the bisphosphonates are well tolerated and effective therapeutic agents for various metabolic bone diseases. It seems certain that within the next 5 years, this class of drugs will emerge as one of the foremost options for treating Paget's disease and osteoporosis.

Absorption↗
PubMed1996

Update on pharmacologic therapies for osteoporosis.

Osteoporosis is an increasingly prevalent chronic and debilitating disease. It is a metabolic disorder characterized by decreased bone mass that subsequently leads to bone fractures. Osteoporotic fractures occur most commonly in the hip, spine, distal radius, and ribs. Historically, pharmacologic options for the treatment of osteoporosis have been limited to hormone replacement therapy, vitamins, and mineral supplements. These previous treatments have been effective for many patients with osteoporosis. However, for many other patients, treatment with hormone replacement therapy, calcium, and vitamin D has been contraindicated or ineffective. Recently, several newly developed medications have become available for the treatment of osteoporosis in the United States. These new therapies have expanded the choices of pharmacologic options for primary health care providers and their patients. Pharmacologic therapy coupled with individualized diet, exercise, and fracture prevention counseling can help to decrease the severity and consequences of osteoporosis for growing numbers of Americans.

Alendronate↗