Reply separately to two of your classmates article critique’s posts (See attached classmates posts, post#1 and post#2). 

– Use at least two scholarly references per peer post. 

The expectation is not that you “agree” or “disagree” with your peers but that you develop a reply post with information that is validated via citations to encourage learning and to bring your own perspective to the conversation.

Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the other one is the reply to my other peer Post #2.


MINUMUM 350-Words per replies.

Note: My background for you to have as a reference: I am currently enrolled in the Advance Nurse Practitioner Program, I am a Registered Nurse, I work at a Psychiatric Hospital.





Discussion Post – Week 4

Sickle Cell Anemia

Jennifer Pike

The purpose of this discussion post is to critique a research article focused on the treatment of Sickle Cell Anemia (SCA) with Hydroxyurea. SCA is attributed to an inherited characteristic that leads to the formation of abnormal hemoglobin, referred to as hemoglobin S (HbS) (Hubert & VanMeter, 2018). There are over 300,000 infants born each year worldwide with sickle cell anemia, it is an autosomal recessive disease. The clinical manifestations of SCA can include hemolytic anemia, vaso-occlusive crisis, and bacterial susceptibility that can have a lasting impact on many of the organs (Becker et al., 2019). Many of the signs and symptoms of SCA do not appear until a child is around 12 months of age when their fetal hemoglobin has been replaced by the HbS, the amount of hemoglobin that is replaced by HbS determines how severe the illness will be (Hubert & VanMeter 2018). One of the medications used for the treatment of SCA is Hydroxyurea which when effective for an individual is able to reduce the frequency of vaso-occlusive episodes and prolong the lifespan.

The article titled, “Optimizing Hydroxyurea Treatment for Sickle Cell Disease Patients: The Pharmacokinetic Approach,” the article was published in the Journal of Clinical Medicine in October 2019. The authors include Charlotte Nazon, Amelia-Naomi Sabo, Guillaume Becker, Jean-Marc Lessinger, Veronique Kemmel, and Catherine Paillard. The purpose of the article presented is to optimize and encourage the use of Hydroxyurea in SCA patients by showing the efficacy in reducing the frequency of vaso-occlusive episodes, hospitalizations, need for blood transfusions, and overall improved quality of life. The authors used a method of dose increasing in order to reach optimal level of treatment.

The participants of the study were patients with SCA that were under 20 years of age and being treated with Hydroxyurea currently by the authors hospital of affiliation between February and May 2018. The sample size consisted of 9 patients that were on Hydroxyurea for multiple vaso-occlusive events or acute chest syndrome. According to the researchers most of the participants in the study had already been on Hydroxyurea for more than four years with a daily dose of 12.9 to 24.6 mg/kg/day. Plasma samples of the participant was collected at pre-determined times including, pre-dose, at 10 minutes, 20 minutes, 1 hour, 2 hour, 4 hour, and the 6 hour mark after dosing of the patients usual dose. The levels of neutrophil count, reticulocyte count and platelet count were monitored in order to ensure maximum dose tolerance could be reached without the risk of toxicity.

None of the patients in the study we

Journal of

Clinical Medicine


Optimizing Hydroxyurea Treatment for Sickle Cell
Disease Patients: The Pharmacokinetic Approach

Charlotte Nazon 1, Amelia-Naomi Sabo 2,3, Guillaume Becker 3,4, Jean-Marc Lessinger 2,
Véronique Kemmel 2,3,* and Catherine Paillard 1,5,*

1 Hôpitaux Universitaires de Strasbourg, Centre de compétence pour les maladies constitutionnelles du
globule rouge et de l’érythropoïèse, Service d’hématologie oncologie pédiatrique, Avenue Molière,
67200 Strasbourg, France; [email protected]

2 Laboratoire de Pharmacologie et Toxicologie Neurocardiovasculaire, Faculté de Médecine, 11 rue Humann,
67085 Strasbourg, France; [email protected] (A.-N.S.);
[email protected] (J.-M.L.)

3 Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Laboratoire de Biochimie et Biologie
Moléculaire, Avenue Molière, 67200 Strasbourg, France; [email protected]

4 Hôpitaux Universitaires de Strasbourg, Service de la Pharmacie, Avenue Molière, 67200 Strasbourg, France
5 Laboratoire d’ImmunoRhumatologie Moléculaire, INSERM UMR_S 1109, LabEx Transplantex, Fédération

de Médecine Translationnelle de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg Cedex, France
* Correspondence: [email protected] (V.K.); [email protected] (C.P.);

Tel.: +33-(0)-3-88-12-75-33 (V.K.); +33-(0)-3-88-12-88-23 (C.P.)

Received: 21 August 2019; Accepted: 11 October 2019; Published: 16 October 2019

Abstract: Background: Hydroxyurea (HU) is a FDA- and EMA-approved drug that earned an
important place in the treatment of patients with severe sickle cell anemia (SCA) by showing its
efficacy in many studies. This medication is still underused due to fears of physicians and families
and must be optimized. Methods: We analyzed our population and identified HU pharmacokinetic
(PK) parameters in order to adapt treatment in the future. Working with a pediatric population,
we searched for the most indicative sampling time to reduce





Chapter 11: Lymphedema

The purpose of this paper is to discuss lymphedema and critique an article on the topic. Lymphedema is when there is an obstruction in the lymphatic vessels that cause the tissues in the extremities to swell (Hubert & Vanmeter, 2018). This also allows for accumulation of lymph in the tissues as well. Commonly, this disorder is congenital and may involve the lymph nodes along with the vessels (Hubert & Vanmeter, 2018). It can also be caused by blockage of the lymph vessels due to parasitic worms (Hubert & Vanmeter, 2018). When the lymph states to build up in the body, the more the extremity swells (Huber & Vanmeter, 2018). As lymphedema continues to progress over time, the extremity becomes enlarged, firm and painful (Hubert & Vanmeter, 2018). Lymphedema can be chronic as well, which leads to frequent infection (Hubert & Vanmeter, 2018). According to Johns Hopkins Medicine (2020), lymphedema can occur after cancer surgery when lymph nodes are removed.

Authors Rebecca J. Tsai, Leslie K. Dennis, Charles F. Lynch, Linda G. Snetselaar, Gideon K. D. Zamba, Carol Scott-Conner published an article on lymphedema after breast cancer entitled “Lymphedema following breast cancer: The importance of surgical methods and obesity” Published to Front Women’s Health in 2018. The purpose of the article is to discuss the research that the authors have conducted on the association between developing lymphedema after cancer surgery and personal risk factors (Tsai et al., 2018). This research will allow for them to better understand if there are certain factors that make a person more at risk for developing lymphedema after cancer surgery. The literature was drawn from a systemic approach. This is because it focuses on a specific question and critically appraises all relevant research. The review focuses on cause and effect meaning how does one issue effect the other. In this case, the authors are correlating developing lymphedema after surgery and certain risk factors that can affect this. Tsai et al. (2018) identify concern that the measures of the study are from subject self-reporting. The authors feel that there can be issues with self-reporting because the patients do not always participate until the end of the study.

The aim of the study is to understand if there is a correlation between arm lymphedema and certain personal risk factors (Tasi et al., 2018). To achieve an accurate study, the authors used a population-based cohort design. This allows for better understanding of the research for this specific population of women. The sample was obtained in Iowa from 2004 to 2010. Tsai et al. (2018) states that the women who met the criteria, completed a short telephone interview about their lymphedema status, arm activities, demographics and chronic condit

Lymphedema following breast cancer: The importance of
surgical methods and obesity

Rebecca J. Tsai, PhDa,*, Leslie K. Dennis, PhDa,b, Charles F. Lynch, MD, PhDa, Linda G.
Snetselaar, RD, PhD, LDa, Gideon K.D. Zamba, PhDc, and Carol Scott-Conner, MD, PhD,

aDepartment of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.

bDivision of Epidemiology and Biostatistics, College of Public Health, University of Arizona,
Tucson, AZ, USA.

cDepartment of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA.

dDepartment of Surgery, College of Medicine, University of Iowa, Iowa City, IA, USA.


Background: Breast cancer-related arm lymphedema is a serious complication that can
adversely affect quality of life. Identifying risk factors that contribute to the development of

lymphedema is vital for identifying avenues for prevention. The aim of this study was to examine

the association between the development of arm lymphedema and both treatment and personal

(e.g., obesity) risk factors.

Methods: Women diagnosed with breast cancer in Iowa during 2004 and followed through 2010,
who met eligibility criteria, were asked to complete a short computer assisted telephone interview

about chronic conditions, arm activities, demographics, and lymphedema status. Lymphedema was

characterized by a reported physician-diagnosis, a difference between arms in the circumference

(> 2cm), or the presence of multiple self-reported arm symptoms (at least two of five major arm

symptoms, and at least four total arm symptoms). Relative risks (RR) were estimated using

logistic regression.

Results: Arm lymphedema was identified in 102 of 522 participants (19.5%). Participants treated
by both axillary dissection and radiation therapy were more likely to have arm lymphedema than

treated by either alone. Women with advanced cancer stage, positive nodes, and larger tumors

along with a body mass index > 40 were also more likely to develop lymphedema. Arm activity

level was not associated with lymphedema.

*Correspondence and Reprints to: Rebecca Tsai, National Institute for Occupational Safety and Health, 4676 Columbia Parkway,
R-17, Cincinnati, OH 45226. [email protected]. Phone: (513)841-4398. Fax: (513) 841-4489.
Authorship contribution
All authors contributed to the conception, design, drafting, revision, and the final review of this manuscript.

Competing interest

Conflicts of Interest and Source of Funding: This study was funded by the National Cancer Institute Grant Number: 5R03CA130031.
All authors do not declare any conflict of interest.
All authors do not declare any