Drug-Induced Hypophosphatemia: Current Insights.

Phosphate is actively involved in many important biochemical pathways, such as energy and nucleic acid metabolism, cellular signaling, and bone formation. Hypophosphatemia, defined as serum phosphate levels below 2.5 mg/dL (0.81 mmol/L), is frequently observed in the course of treatment with commonly used drugs, such as diuretics, bisphosphonates, antibiotics, insulin, and antacids. Furthermore, this undesired effect may complicate the use of several novel medications, including teriparatide, denosumab, parenteral iron, and antiviral and antineoplastic agents. This review addresses drug-associated hypophosphatemia, focusing on underlying mechanisms and the most recent knowledge on this topic, in order to increase the insight of clinicians, with reference to early diagnosis and appropriate management.

Hyponatremia in Acute Stroke Patients: Pathophysiology, Clinical Significance, and Management Options.

BACKGROUND: Hyponatremia is frequent in acute stroke patients, and it is associated with worse outcomes and increased mortality. SUMMARY: Nonstroke-related causes of hyponatremia include patients' comorbidities and concomitant medications, such as diabetes mellitus, chronic kidney disease, heart failure, and thiazides. During hospitalization, "inappropriate" administration of hypotonic solutions, poor solute intake, infections, and other drugs, such as mannitol, could also lower sodium levels in patients with acute stroke. On the other hand, secondary adrenal insufficiency due to pituitary ischemia or hemorrhage, syndrome of inappropriate antidiuretic hormone secretion, and cerebral salt wasting are additional stroke-related causes of hyponatremia. Although it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke, the restoration of the volume depletion remains the cornerstone of treatment in hypovolemic hyponatremia. In case of hyper- and euvolemic hyponatremia, apart from the correction of the underlying cause (e.g., withdrawal of an offending drug), fluid restriction, administration of hypertonic solution, loop diuretics, and vasopressin-receptor antagonists (vaptans) are among the therapeutic options. Key Messages: Hyponatremia is frequent in patients with acute stroke. The plethora of underlying etiologies warrants a careful differential diagnosis which should take into consideration comorbidities, concurrent medication, findings from the clinical examination, and laboratory measurements, which in turn will guide management decisions. However, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke.

Hyponatremia-Inducing Drugs.

In clinical practice, several medications such as diuretics, psychotropic drugs, and anticonvulsants have been reported to be a frequent cause of hyponatremia. Drugs may cause hyponatremia either by affecting the homeostasis of sodium and water (e.g., diuretics) or by altering the water homeostasis as a consequence of the syndrome of inappropriate secretion of antidiuretic hormone. On the contrary, drugs commonly prescribed in everyday clinical practice, including proton pump inhibitors, antibiotics, angiotensin-converting enzyme inhibitors, hypoglycemic agents and, amiodarone, have been infrequently 'incriminated' as causes of hyponatremia. Therefore, in the diagnostic approach of patients with low serum [Na+] levels, meticulous history taking and recording of pharmacotherapy is warranted to identify potentially culprit medications. Taking into account the adverse outcomes associated with even mild hyponatremia (i.e., impaired cognition, falls and fractures, mortality), recognition of drug-induced hyponatremia is of vital importance, while responsible agents should be discontinued and "re-challenge" should be avoided by informing the patient and involved caregivers.

Assessment of quality of life in adolescent patients with cancer and adolescent survivors of childhood cancer.

PURPOSE: The aim of the study was to assess the quality of life (QoL) of adolescents with cancer and survivors of childhood cancer as well as the effect of various demographic factors upon it. DESIGN AND METHODS: The sample of the study included 82 adolescents aged 13-20 years who had been diagnosed with any type of cancer. Twenty-six of them received treatment and 56 survivors of childhood cancer had successfully completed their treatment. Data collection lasted from July 2010 to December 2012 in Children's Hematology-Oncology Unit in Athens. For data collection, Minneapolis-Manchester Quality Questionnaire of Life Instrument was used. The assessment of the QoL of adolescents undergoing treatment was performed with three measurements and that of the survivors with one. RESULTS: The QoL of adolescent patients did not significantly change during treatment and they showed a satisfactory QoL. Boys scored higher than girls (z = -1.78, p = .04 in psychological function and t = 2.27, p = .02 in body image) as far as QoL in social relations is concerned (z = -2.79, p = .002 in first measurement and z = -2.31, p = .01 in second measurement). Scores on the scale for the QoL of survivors of childhood cancer who completed treatment was 3.91. Survivors showed a higher QoL than the adolescent patients. CONCLUSIONS: This research has shown that the studied population scored a sufficient QoL, especially survivors of childhood cancer ones. Moreover, their QoL seemed to be influenced by the stage of treatment, the type of cancer, sex, age, family support, and their level of education.

Physician and nursing perceptions concerning interprofessional communication and collaboration.

The aim of the study was to investigate the physician and nursing perceptions regarding communication and collaboration as well as the factors that may influence these activities. A self-administered questionnaire survey was sent to a random sample of 93 physicians and 197 nurses based in two large public hospitals in Athens, Greece. Descriptive statistics, t-test and chi square test were performed with the SPSS 19.0 statistical package. Years of experience, the size of the clinic, the university degree and the postgraduate studies were found to be significant factors according to nurses' view (p < 0.05). For the physicians, age, sex, years of experience and the size of clinic affected the communication and collaboration with the nursing staff significantly (p < 0.05). In summary, these findings suggest that nurses and physicians do not share the same views concerning the effectiveness of their communication and nurses' role in the decision-making process of the patients' care. The most important barrier for the establishment of good relations between these professions, according to the physicians, was that they did not recognize the nurses' professional role. The study also indicated that the absence of interprofessional collaboration may result in a higher possibility of errors and omissions in patients' care. Therefore, in everyday practice, both nurses and physicians should acknowledge the importance of their effective communication and they should develop and implement interprofessional teamwork interventions to improve collaboration. Moreover, nurses have to constantly consolidate their role in the decision process and patients' care, especially in countries with limited interprofessional collaboration culture. In addition, factors that improve physicians' attitudes toward collaboration and effective communication should be further explored.

The opinion of Greek parents on the advantages and disadvantages of the outpatient pediatric oncology setting.

PURPOSE OF THE RESEARCH: The aim of this study was to assess parental opinions on the advantages and disadvantages of a pediatric oncology outpatient setting in comparison to the inpatient oncology ward. METHODS AND SAMPLE: The sample of the study consisted of 104 parents whose children were diagnosed and treated for pediatric cancer. The survey took place at the Pediatric Oncology Wards, as well as their respective outpatient settings of the two General Children's Hospitals in Athens, Greece from May 2010 to August 2010. KEY RESULTS: According to parents' view the outpatient setting was preferable due to the maintenance keeping of their daily routine (x(2) = 75.9, p = 0.000), maintaining the family life (x(2) = 90.1, p = 0.000) and young patients' participation in activities (x(2) = 25.6, p = 0.000). Moreover, young patients were more happy, less anxious and less scared when they were attending in the daily clinic (x(2) = 25.9, p = 0.000). CONCLUSIONS: According to parents' view, the outpatient setting has many advantages. The judgment of children and parents on the services offered by the Pediatric Oncology Unit overall, in both inpatient and outpatient setting can give the necessary feedback to improve the qualitative provided care.