Guided LearNiNG Keywords Paget’s disease Bone Long-term conditions
Paget’s disease 2: exploring diagnosis, This article provides advice on diagnosing Paget’s disease and outlines management options
Author Name and qualifications [abstract
character styles]
is job title/place of work [Abstract
Author Anne Sutcliffe, BSc, DN, HV,
effective than risedronate (reid et al, 2005). LearNiNG objecTiVes
RGN, is healthcare and education officer,
Both zoledronic acid and pamidronate can AbstrAct Name [Abstract character style] (2008)
cause acute phase reactions. oral treatment Article title [Abstract paragraph style]. Nursing Times
AbstrAct Sutcliffe, A. (2009) Paget’s
1. Know the different ways of
can be prescribed in primary care but may [Abstract NT character style]; 104: 4, 33–34.
lead to gastrointestinal problems and some Abstract text [Abstract paragraph style].
patients find the dosing regimen restrictive. 2. Understand drug treatments for
crossHead ParagraPH styLe - 1 Line sPace Nursing Times; 105: 7, 14–15.
nurses have a key role in explaining drug This is the second of a two-part unit on Body 1st para paragraph style for first paragraph and include indigestion and nausea and patients Body indent paragraph style for subsequent and clinical features of the condition. This several sites are involved (eastell, 1999). prescribed for a set period of time, for subhead paragraph style - line space above associated with liver disease and, if this is present, it may be appropriate to measure Body 1st para paragraph style for first paragraph and specialist centres, urine tests may be used risedronate in a different dose is prescribed Body indent paragraph style for subsequent managed in primary care or as outpatients. to assess disease activity. once treatment for osteoporosis, so it is vital to check the However, inpatient care may be necessary if has been given, alkaline phosphatase level right regimen is used. For details on oral and Bullet list texts is in Body 1st para paragraph style, surgery is needed, there are doubts about decreases. repeating the blood test is a iV drugs, see tables 1 and 2 in Portfolio the bullet is Bullet list character style – use pointer tool the diagnosis or a patient has marked pain. way of measuring response to therapy.
Primary care nurses and those in relevant Bullet list texts is in Body 1st para paragraph style, specialties should have basic knowledge of performed, particularly if malignant changes phosphatase level generally decreases, with the bullet is Bullet list character style – use pointer tool prescribed drug therapy and surgical options.
patients treated with zoledronic acid (reid, Bullet is followed by an n-space (shift apple n) 2006). it may be useful to perform a blood test after six months to reassure patients Paget’s disease may present with obvious have bone pain localised to an affected site. that treatment has been successful. drug signs or symptoms or may be an incidental in the absence of pain, selby et al (2002) effectiveness can also be measured in terms Final paragraph has an endstop n – from character finding of investigating other conditions. the diagnosis can usually be confirmed by considered to prevent further complications about three months after starting treatment.
X-ray showing bone enlargement, cortical but there is a lack of consensus on this.
Extra info at the end of an article goes in Body text thickening and sclerotic changes in affected Bisphosphonates, oral or intravenous, are effective in reducing bone pain in Paget’s italics chracter style with a bullet (e.g. ‘This article was bones. X-rays can also show fractures and commonly used. these bind to the surface disease, patients may have complications shortlisted in the Innovations category of the NT Awards) of hydroxyapatite crystals within bone and such as deformity and osteoarthritis that do isotope bone scans are more sensitive in trigger the death of osteoclasts, which cause not respond well to them. these patients the increased bone turnover. oral therapy may require analgesic and anti-inflammatory licensed in the uK includes risedronate, take them regularly. non-pharmacological X-rays or scans will usually be unnecessary risedronate being the most potent and usually physiotherapy and transcutaneous electrical 2006). Pamidronate and zoledronic acid (the nerve stimulation (tens), are used for pain since Paget’s disease is associated with most recent drug) are given intravenously. control, but effectiveness of this is based on anecdotal reports, not rigorous assessment. reported no significant difference between raised in active disease. serum alkaline the effects of different bisphosphonates on phosphatase is usually elevated in 85% of pain control (miller et al, 1999; siris et al, although few patients need surgery, surgical patients with untreated Paget’s disease and generally this level will be highest when shown that zoledronic acid was slightly more complications has improved quality of life. NT 24 February 2009 Vol 105 No 7
For more nursing practice information log on to and NT Clinical and Archive This arTicle has been doUble-blind Peer-reviewed WWW.
allowed correction of complex deformities.
osteoarthritis. other indications include eastell, r. (1999) Biochemical markers of
fracture fixation, osteotomy to correct bone bone turnover in Paget’s disease of bone. deformity, and surgery to correct spinal treated medically. on rare occasions, spinal stenosis or to resect a malignant tumour. decompression may be performed to relieve symptomatic arthritis of the hip needing Graham, j., Harris, w.H. (1971) Paget’s
arthroplasty occurs in approximately 10% of a malignant lesion in a pagetic bone is a disease involving the hip joint. Journal of patients with Paget’s disease (graham and Bone and Joint Surgery (Br); 53: 650–659.
Harris, 1971). most studies on outcomes of condition. surgical resection aiming for wide total joint arthroplasty have reported similar margin is recommended but the outcome is Miller, P.d. et al (1999) a randomised,
double-blind comparison of risedronate and
results to those achieved in patients without etidronate in the treatment of Paget’s the condition but surgery at this site may be grade of the tumour, delay in diagnosis, etidronate study group. American Journal deformity and altered bone quality (Parvizi et al, 2006). in addition to normal surgical risks, there is a slight increased risk of heterotopic Parvizi, j. et al (2006) surgical management
ossification (formation of bone outside the of Paget’s disease of bone. Journal of Bone skeleton) and non-union of the trochanter.
minimise this risk, patients are usually given and Mineral Research; 21 (suppl 2): 75–82.
bisphosphonate treatment before surgery. it patients with Paget’s disease because of is vital that fluid balance and blood loss are reid, i.r. (2006) Zoledronate: efficacy and
monitored carefully post-operatively.
safety. Journal of Bone and Mineral healing may be more protracted. in femoral neck fractures treated with internal fixation, non-union is common so the best option in reid, i.r. et al (2005) comparison of
these patients is prosthetic replacement.
a single infusion of zoledronic acid with osteotomy is occasionally used if there is risedronate for Paget’s disease. New marked deformity, fissure fractures and pain appear beneficial but they have not been England Journal of Medicine; 353: specific problems such as limb shortening selby, P.L. et al (2002) guidelines on the
external fixation, such as spatial frames and and deformity may be helped by shoe raises management of Paget’s disease of bone. Following surgery, patients may also need to consider adaptations in the home, such siris, e.s., roodman, d.G. (2006) Paget’s
disease of bone. in: Favus, m.J. et al (eds) Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Washington, dc: american society for Bone Portfolio Pages can be filed in
classic hallmarks of long-term conditions. your professional portfolio as
it is inveterate, caused by non-reversible siris, e.s. et al (1996) comparative study of
evidence of your learning and
pathology, may leave residual disability and can need a long period of supervision professional development.
Journal of Clinical Endocrinology and They contain learning activities
Metabolism; 81: 3, 961–967.
that correspond to the learning
objectives in this unit, presented
about the possibility of future complications in a convenient format for
including fracture and deformity. some are you to print out or work through
about aspects of care. to fulfil this role, it is effects of medication or may have unrealistic essential to focus on the individual’s needs, on screen.
offer accurate information and advice and For the Portfolio Pages
liaise with other health and social care corresponding to this unit, log
disease and, if this becomes chronic, it may on to, click
lead to anxiety, social isolation and failure of Both patients and healthcare professionals NT clinical and Archive then
can obtain useful information and advice click Guided Learning
as part of a wider healthcare team, nurses from the Paget’s association (see Portfolio may assume the key role of counsellor to Pages on for details). n NT 24 February 2009 Vol 105 No 7


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HALTON  ASTHMA  PROTOCOL  Recognition of Committee Members: The following are thanked for their dedication and expertise in developing the Halton Asthma Protocol for the Public and Catholic elementary and secondary schools in the Halton Region. Co-Chairs: Bob Soroko, Halton Catholic District School Board Jacki Oxley, Halton District School Board Rebecca Lewis, Public Health

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