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Biomedical subjects

M J Holechek

Publications and source records attributed to M J Holechek.

13 recordsLinked to original sources
PubMed1996

Risk of foot complications in long-term diabetic patients with and without ESRD: a preliminary study.

OBJECTIVE: The purpose of this preliminary study was to generate hypotheses for future research about the relationship between ESRD and foot complications in patients with long-term diabetes. DESIGN: A cross-sectional prevalence study was conducted comparing a sample of long-term diabetic patients with ESRD to a sample of long-term diabetic patients without ESRD. SAMPLE/SETTING: A convenience sample of 132 patients with long-term diabetes (> 15 years), with (N = 60) and without (N = 72) ESRD, was selected from ambulatory care settings and dialysis units. METHODS: Data were collected by chart audit, structured interview, and physical examination. RESULTS: Foot complications were greater in individuals with diabetes and ESRD (25%) than in diabetic individuals without ESRD (10%) (p = 0.02). Neither neuropathy, past or current smoking, race, gender, nor age were significantly associated with current foot complications (either current infection, ulcer, gangrene, or amputation). CONCLUSIONS: Research is needed to better understand foot complications in persons with long-term diabetes and ESRD so that the effectiveness of nursing and medical interventions to stabilize or prevent foot complications can be evaluated.

Adult↗
PubMed1992

Renal physiology series: Part 2 of 8. Glomerular filtration and renal hemodynamics.

The formation of urine is a process that begins with glomerular filtration and is greatly influenced by changes in renal hemodynamics. Selective filtration of the blood is possible because of the unique characteristics of the glomerulus and renal circulation. Many factors interact to maintain a consistent blood flow, allowing filtration and urine formation to continue despite systemic changes in blood pressure. Factors that impact on renal hemodynamics include the autoregulatory mechanism, the renin-angiotensin mechanism, eicosanoids, kinins, the sympathetic nervous system, catecholamines, antidiuretic hormone, dopamine, histamine, endothelin, endothelium-derived relaxing factor, and atrial natriuretic peptide. Knowledge of the effects of these factors will allow the nephrology nurse to predict, identify, and assist in the treatment of clinical conditions that can alter renal hemodynamics and glomerular filtration.

Glomerular Filtration Rate↗
PubMed1991

Medication review: FK 506.

Overall, the absolute rate of clinical rejection in FK 506 patients is only slightly lower than with current standard therapies, but fewer steroid boluses, steroid recycles, and OKT 3 courses were needed as compared to CyA patients. FK 506 has not significantly affected allograft or patient survival or the incidence of infection as compared to CyA. It does have the benefit of allowing for the potential elimination or reduction in dose of azathioprine and prednisone. The majority of information available on FK 506 is generated by the sole human clinical trial site in Pittsburgh. Far more data from other clinical trial sites will be essential to finalize information on dosing, side effects, and drug monitoring for renal transplant recipients. The role of FK 506 in renal transplantation has yet to be well defined. The frequency and severity of side effects produced by this drug will be major determinants in its long-term usefulness for renal transplant recipients.

Anti-Bacterial Agents↗
PubMed1991

Medication review: fluconazole.

Fluconazole is an antifungal agent available for the treatment of oropharyngeal and esophageal candida and cryptococcal meningitis. It has been found to be equal to or more efficacious than amphotericin B in treating oral and esophageal candidiasis and in providing maintenance therapy for cryptococcal meningitis. It still remains to be seen if it can be equally effective in treating acute cryptococcal infections and systemic candidiasis. In these fungal infections, amphotericin B remains the clinically proven drug of choice. To its advantage, it does not cause acute renal failure, bone marrow depression, or suppress corticosteroid production which are significant drawbacks to other available agents. It is a drug with great promise for its specific indications, but more studies in renal failure and organ transplant patients are needed to firmly establish its efficacy in these populations.

Fluconazole↗
PubMed1991

Epoetin alfa for predialysis and AZT-treated HIV-positive patients.

PROCRIT is an exogenous form of erythropoietin now marketed for use in anemic predialysis patients and AZT-treated HIV-positive patients. It is the same preparation as epogen. It will be up to the physician to determine which form of the drug is prescribed for each patient. Cost issues will probably be a deciding factor as the products are identical. Key differences to keep in mind are that predialysis patients will have to come in to the clinic two or three times a week for injections as they are are not on dialysis and that payment issues could be a problem.

Anemia↗
PubMed1991

Medication review: an alternative phosphate binder--calcium acetate.

Calcium acetate is a potent phosphate binder that causes fewer problems with hypercalcemia and elevated serum aluminum concentrations than other calcium salt or aluminum-binding agents. It exceeds calcium carbonate in its binding ability and is not expensive. These advantages make it an attractive alternative to many of the standard phosphate-binding regimens.

Acetates↗
PubMed1990

Case management of the anemic patient. Focus on blood pressure and rHuEPO therapy.

As the use of Epoetin alfa to treat the anemia of chronic renal failure (CRF) expands, nurses play an ever-increasing role in patient monitoring and control. One area that relies heavily on nurses is blood pressure monitoring. Clinical trials with Epoetin alfa in hemodialysis patients indicate that its use may be associated with the onset or aggravation of elevated blood pressure as the hematocrit level increases. Because high blood pressure is a risk factor for left ventricular hypertrophy and cardiovascular mortality in this patient population, use of an agent that may cause high blood pressure requires careful monitoring. As the following two cases reports illustrate, sufficient data to provide better insight into the clinical aspects of this potential problem have now been accumulated.

Adult↗
PubMed1989

Management of anemia using recombinant human erythropoietin in patients on chronic hemodialysis.

Most hemodialysis patients experience symptomatic anemia related to their chronic renal failure that can limit physical activities, interfere with rehabilitation, and negatively affect the quality of life. Preliminary studies of the newly developed recombinant human erythropoietin (rHuEPO) have revealed that this drug can correct the anemia of chronic renal failure and alleviate many of its related symptoms. This article reviews the pathophysiology of this anemia, discusses rHuEPO, describes the nursing care of patients receiving rHuEPO, and considers future implications and areas for nursing research.

Anemia↗