Preventive Strategies for Patients at Risk of Medication-related Osteonecrosis of the Jaw

2015 ◽  
Vol 27 (4) ◽  
pp. 527-536 ◽  
Author(s):  
Reginald H. Goodday
Keyword(s):  
At Risk ◽  
Osteonecrosis Of The Jaw ◽  
Preventive Strategies ◽  
Patients At Risk

Contrast-Induced Nephropathy: Pathophysiology and Preventive Strategies

2013 ◽  
Vol 33 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Ann L. Jorgensen
Keyword(s):  
At Risk ◽  
Oxygen Free Radicals ◽  
Renal Perfusion ◽  
Evidence Based ◽  
Preventive Strategies ◽  
Prevention Strategies ◽  
Contrast Induced Nephropathy ◽  
Patients At Risk ◽  
Flow Through ◽  
Hospital Acquired

Contrast-induced nephropathy is the third most common cause of hospital-acquired renal failure, after decreased renal perfusion and nephrotoxic medications. Identification of patients at risk and implementation of preventive strategies can decrease the incidence of this nephropathy. Prevention strategies focus on counteracting vasoconstriction, enhancing blood flow through the nephron, and providing protection against injury by oxygen free radicals. Knowledge of the adverse effects associated with infusion of contrast media, identification of patients at risk for contrast-induced nephropathy, and application of evidence-based prevention strategies allow nurses to assist in the prevention of contrast-induced nephropathy.

scholarly journals The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Olga Di Fede ◽  
Vera Panzarella ◽  
Rodolfo Mauceri ◽  
Vittorio Fusco ◽  
Alberto Bedogni ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
At Risk ◽  
Primary Prevention ◽  
Osteonecrosis Of The Jaw ◽  
Antiangiogenic Agents ◽  
New Paradigm ◽  
Dental Management ◽  
Patients At Risk

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typologies and timing of dental treatments (e.g., before, during, or after the drug administration). The aim of this paper is to describe the new paradigm by the Italian Society of Oral Pathology and Medicine (SIPMO) on preventive dental management in patients at risk of MRONJ, prior to and during/after the administration of the aforementioned ONJ-related drugs. In reducing the risk of MRONJ, dentists and oral hygienists are key figures in applying a correct protocol of primary prevention for pre-treatment and in-treatment patients. However, the necessity of a multidisciplinary standardized approach, with a sustained dialogue among specialists involved, should be always adopted in order to improve the efficacy of preventive strategies and to ameliorate the patient’s quality of life.

scholarly journals POS1104 THE DEVELOPMENT AND VALIDATION OF A RISK STRATIFICATION QUESTIONNAIRE TO SCREEN FOR MEDICATION RELATED OSTEONECROSIS OF THE JAW RISK IN OSTEOPOROTIC PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 832.2-832
Author(s):  
Y. El-Miedany ◽  
M. El Gaafary ◽  
M. Toth ◽  
S. Bahlas ◽  
W. Hassan ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Oral Health ◽  
Risk Stratification ◽  
Great Majority ◽  
Osteonecrosis Of The Jaw ◽  
Complete Healing ◽  
Dental Procedure ◽  
Risk Minimisation ◽  
Patients At Risk

Background:Given the gaps in knowledge that exist in relation to risk stratification for osteonecrosis of the jaw (ONJ) amongst patients treated with anti-resorptive agents, there is a high need for an evidence-based measure which would facilitate the identification of those patients at higher risk of ONJ development; particularly, most of the available advice is empirically based.Objectives:to develop a valid self-administered questionnaire to facilitate risk stratification and risk minimisation of medication related ONJ in osteoporotic patients treated with anti-resorptive agents.Methods:Development of ONJ risk assessment questionnaire (ONRAQ) followed 5 stages: 1. Review of the literature to Identify the risk factors associated with medication related ONJ. 2. Item pool development: a list of the main risk factors was compiled. Rare or uncommon factors were excluded. 3. A questionnaire was developed. This was based on the idea that the questions should be straight forward and as clear as possible. 4. Pre-testing of the questionnaire. 5. Validation of the questionnaire by comparing the patients answers with their medical records. Patients at risk were advised to seek dental assessment and the dental report was evaluated. The last prescription was reviewed to verify the current medications. 157 patients were invited to participate and were prospectively monitored for 5-years to assess for the incidence of medication related ONJ. Advice was given regarding how to maintain good dental hygiene to prevent dental disease and to ensure that any dental interventions that are considered necessary are carried out as conservative and preservative as possible. Comprehensibility of the model sections was also assessed.Results:Stages 1 and 2 identified the risk factors chosen for the questionnaire. These risk factors were stratified into 4 sections: Personal, Dental and oral health, current medications and associated comorbidities. Stage 3 led to the development of the 27 items questionnaire. Personal: 3 risk factors (age, elevated BMI and smoking), Dental and oral health (11 risk factors), current medications (3 risk factors) and associated comorbidities (10 risk factors). Analysis of the answers provided by 126 patients, who completed the study, age range 58-82 years revealed that the mean time to answer the questionnaire was 1.9 + 0.153 minutes. The ONRAQ has shown a strong validity when compared to the patients’ data record (range 0.89-0.97). All patients rated the questionnaire as easily comprehensible. Comprehensibility of the various questionnaire sections ranged between 96.1% and 98.2% denoting that all the questions were well understood by the great majority of patients. 11/126 (8.7%) had a dental procedure in the past 6-months, 13/126 (10.3%) were advised to stop smoking. Whereas 20/126 (20.6%) had associated comorbidities. Risk stratification led to the advice to start oral bisphosphonates/ denosumab rather than IV zoledronate for patients at moderate risk (comorbidities, personal, medication). Treatment was postponed till complete healing for those with recent history of invasive dental procedure (high risk). No ONJ was identified after 5-years of follow up.Conclusion:Results of this questionnaire revealed that the ONRAQ is valid screening questionnaire. It can be implemented, as a risk minimisation measure, in standard practice. The questionnaire was able to identify patients at risk of developing medication related osteonecrosis of the jaw and facilitate the prospective risk management of ONJ.Disclosure of Interests:None declared.

1678: Identifying Patients at Risk for Benign Versus Life Shortening Postoperative Prostate-Specific Antigen Failure

2005 ◽  
Vol 173 (4S) ◽  
pp. 455-455
Author(s):  
Anthony V. D’Amico ◽  
Ming-Hui Chen ◽  
Kimberly A. Roehl ◽  
William J. Catalona
Keyword(s):  
At Risk ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Patients At Risk
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