Mayo Clinic proceedings
-
Mayo Clinic proceedings · Nov 2008
Comparative StudyUse of renal function measurements for assessing fracture risk in postmenopausal women.
To determine whether factors associated with moderate chronic kidney disease can be used to independently predict fracture risk in postmenopausal white women by analyzing the effect of adding renal function measurements to traditional risk factors (eg, age, body weight, bone mineral density) for fracture risk assessment. ⋯ The addition of serum creatinine concentration, creatinine clearance rate, or estimated glomerular filtration rate does not improve fracture risk prediction in postmenopausal white women who have moderate chronic kidney disease. This result can be partly explained by the fact that important risk factors for decreased renal function (eg, advanced age, lower body weight) are already accounted for in most fracture prediction models.
-
Mayo Clinic proceedings · Oct 2008
ReviewDevelopment of peripheral opioid antagonists' new insights into opioid effects.
The recent approval by the US Food and Drug Administration of 2 medications--methylnaltrexone and alvimopan--introduces a new class of therapeutic entities to clinicians. These peripherally acting mu-opioid receptor antagonists selectively reverse opioid actions mediated by receptors outside the central nervous system, while preserving centrally mediated analgesia. Methylnaltrexone, administered subcutaneously, has been approved in the United States, Europe, and Canada. ⋯ Clinical and laboratory studies performed during the development of these drugs have indicated that peripheral receptors mediate other opioid effects, including decreased gastric emptying, nausea and vomiting, pruritus, and urinary retention. Laboratory investigations with these compounds suggest that opioids affect fundamental cellular processes through mechanisms that were previously unknown. These mechanisms include modifications of human immunodeficiency virus penetration, tumor angiogenesis, vascular permeability, and bacterial virulence.
-
Mayo Clinic proceedings · Oct 2008
Comparative StudyPhysicians' preferences and attitudes about end-of-life care in patients with an implantable cardioverter-defibrillator.
Clinical guidance is deficient regarding deactivation of implantable cardioverter-defibrillators (ICDs) in patients with terminal illnesses. We hypothesized that many physicians are apprehensive about discussing ICD deactivation with their dying patients. Thus, we conducted an anonymous survey of all the physicians in the Department of Medicine at Unity Health System in Rochester, NY. ⋯ Forty physicians (46%) either thought it was illegal or were not sure if it was legal to deactivate an ICD in these circumstances. However, if reassured about the legality of discontinuing ICD therapy, 79 (91%) of these same respondents said that they would be willing to discuss voluntary ICD deactivation with their dying patients. With increased knowledge about managing the withdrawal of this potentially life-prolonging therapy, physicians are likely to become more skilled at caring for dying patients with an ICD.