Protective Effects of ß-Blockers on Bone in Older Adults with Dementia.

Increased ß-adrenergic receptor activity has been hypothesized to cause bone loss in those with dementia. We investigated the effect of long-term ß-blocker use on rate of bone loss in older adults with dementia. We used a linear mixed-effects model to estimate the relationship between long-term ß-blocker use and rate of bone loss in participants from the Health Aging and Body Composition study. Records of 1198 participants were analyzed, 44.7% were men. Among the men, 25.2% had dementia and 20.2% were on ß-blockers, while in the women, 22.5% had dementia and 16.6% received ß-blockers. In the 135 men with dementia, 23 were taking ß-blockers, while 15 of 149 women with dementia were using ß-blockers. In men with dementia, ß-blocker users had 0.00491 g/cm2 less bone mineral density (BMD) loss per year at the femoral neck (i.e., 0.63% less loss per year) than non-users (p < 0.05). No differences were detected in women with or without dementia and men without dementia. ß-blockers may be protective by slowing down bone loss in older men with dementia.

Improving patient safety through mandatory quality improvement (QI) education in a family medicine residency programme.

Although the American College of Graduate Medical Education (ACGME) requires that medical trainees acquire competencies in patient safety and quality improvement (QI), no standard curriculum exists. We envisaged that a sustainable QI curriculum would be a pragmatic way to improve residents' skills and competence in patient safety. Our aim was to develop and evaluate a patient safety-oriented QI curriculum in an established family medicine residency programme. A patient safety curriculum fulfilling ACGME requirements was developed and implemented in a family residency programme. The curriculum comprised didactics, self-paced online modules, experiential learning through individual QI projects, and mortality and morbidity conferences. The programme was evaluated using a survey at the end of its first year. We assessed knowledge on patient safety and QI, confidence in discussing safety concerns with peers, and ability to recognise safety gaps and initiate corrective actions. We also assessed the perception of the programme's relevance to the residents' training. All 36 residents participated, 19 completed the evaluation survey. Fifteen (79%) respondents reported learning more about the causes of medical errors, 42% could report safety concerns and 26% could recognise quality gaps. In addition, 58% felt the curriculum increased their confidence in discussing patient safety concerns with peers while 74% found the curriculum very relevant to their training. Some participants described the programme as 'very productive'. Embedding a QI curriculum into the ongoing residency training may be a realistic approach to training family medicine residents with no prior formal QI training.