Recent Advances in Management of Cancer Treatment-induced Bone Loss (CTIBL) in Patients with Breast or Prostate Cancer

PURPOSE: Bone loss resulting from cancer treatment is an emerging problem among cancer survivors. However, the mechanism and treatment of cancer treatment-induced bone loss (CTIBL) is not fully understood. The purpose of this article was to review the recent advances in CTIBL. METHODS: A comprehensive review of the literature was conducted. RESULTS: Risk factors for CTIBL that are unique to or commonly found in cancer survivors include chemotherapy-induced menopause, anti-estrogen and anti-androgen therapies, gonadotropin-releasing hormone suppression of gonadal function, and use of glucocorticoids. Assessment of CTIBL is performed using dual X-ray absorptiometry testing for measurement of BMD levels, Fracture Risk Assessment Tool, and bone turnover markers. Initial strategies for prevention of CTIBL include lifestyle modifications such as exercise, an adequate intake of calcium and vitamin D, avoiding tobacco use, and limiting alcohol intake. Pharmacologic therapy should be considered for patients at high risk for bone loss or fracture. CONCLUSIONS: Prevention of CTIBL may be the best way to decrease morbidity and financial costs associated with osteoporosis and/or fractures. Oncology nurses should be well prepared to identify cancer survivors at risk of CTIBL, and to provide them with education regarding prevention and treatment of CTIBL.

Comparisons of the Prognostic Predictors of Traumatic Brain Injury According to Admission Glasgow Coma Scale Scores-Based on 1- and 6-month Assessments / 간호학회지

PURPOSE: The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. METHODS: The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. RESULTS: The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. CONCLUSIONS: The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation METHODS: This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.