Quality and effectiveness of osteoporosis treatment decision aids: a systematic review and environmental scan.

Decision aids (DAs) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. We searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial's risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA, and discuss plans for development of a new DA. We identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM, and increased accuracy of patients' perceived fracture risk compared with controls. Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients' own needs and risk. Using a systematic review and environmental scan, we identified 11 decision aids to inform patient decisions about osteoporosis treatment and 6 studies evaluating their effectiveness. Use of decision aids increased accuracy of risk perception and shared decision-making but the decision aids themselves fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development.

[Body composition in chronic kidney disease patients and haemodialysis]. / Composición corporal en pacientes con insuficiencia renal crónica y hemodiálisis.

BACKGROUND: Nutritional alterations are highly prevalent among patients with chronic kidney diseases stage 5 who receive haemodialysis therapy. Body composition alterations are directly related to an increased morbidity and mortality. Nutritional assessment represents a cardinal intervention oriented to improve the outcome and survival in chronic renal patients. OBJECTIVE: To evaluate body composition in a mexican population with chronic kidney disease stage 5 and haemodialysis therapy. METHODS: Prospective, descriptive and transversal study. Free fatty mass (FFM) and fatty mass (FM) were evaluated by means of bioelectric impedance (BIE), anthropometrics measures (MPA) and dual-energy x-ray absorptiometry (DEXA). RESULTS: 20 patients were evaluated (12 females and 8 males). Mean age was 51.9 +/- 19.3 years. Mean weight was 59.5 +/- 10.5 kg and mean body mass index was 24.9 +/- 3.1 kg/m(2). Mean FFM values were 42.4 +/- 8.6 kg (MPA), 43.6 +/- 8.9 kg (DEXA) y 42.8 +/- 10.2 kg (IBE). Mean FM values: 17.2 +/- 6.2 kg (MPA), 15.9 +/- 6.9 kg (DEXA) and 16.9 +/- 6.9 kg (IBE). Correlation coefficients between the three methods were: FFM, 0.982 (MPA vs IBE), 0.963 (MPA vs DEXA) y 0.947 (IBE vs DEXA). Fatty mass: 0.975 (MPAvs IBE), 0.925 (MPA vs DEXA) y 0.898 (IBE vs DEXA). CONCLUSION: In the studied population, fatty mass was increased and FFM was within the reference ranges. There was not evidence of protein malnutrition. MPA and BIE are practical and useful tools to evaluate body composition in mexican chronic kidney disease patients who receive haemodialysis therapy. The results obtained by means of MPA and BIE correlated with results obtained by DEXA.

[Assessment of nutritional status in a Mexican population of adult patients with rheumatoid arthritis]. / Evaluación del estado nutricio en una población mexicana de pacientes adultos con artritis reumatoide.

BACKGROUND: Rheumatoid arthritis (RA) represents a life-long chronic inflammatory process frequently associated to potential multiorganic complications. Cardiovascular diseases and nutritional alterations are increased in AR populations and represent potential factors that alter negatively the disease course and prognosis. PURPOSE: To evaluate nutritional status from a Mexican AR population, including body composition, anthropometrics and dietary patterns. MATERIAL AND METHODS: There were included 100 RA outpatients from a regional rheumatic centre located in San Luis Potosi México. Nutritional assessment included anthropometric evaluation, bioelectrical impedance analysis (BIA) and dietary patterns evaluation. RESULTS: 100 RA out-patients were included. Mean age was 47.6 +/- 13.3 years, with a mean disease course of 10.18 +/- 9.02. 79% of patients were in RA functional class II and 21% in class III. Average body mass index 26.8 +/- 4.4 kg/m2 According to body mass index categories, 65% patients were within the range of overweight and obesity and 2% of patients were undernourished. Mean waist circumference 86.7 +/- 11.1 cm, 34% of patients showed waist circumference values over the limits established for the definition of metabolic syndrome. Lean body mass was diminished in 48% patients. Body fat mass estimated by anthropometry and BIA was increased in 94 patients (94%). DIETARY PARAMETERS: Mean energy intake was 26.4 +/- 8.2 kcal/kg. There was qualitative nutritional inadequacy in 90 patients (90%). Protein intake was optimal in all the patients. CONCLUSION: Nutritional alterations are highly prevalent in Mexican RA population; our study showed freefat mass depletion, low caloric intake, dietary inadequate parameters and fat mass increments as the more prevalent findings. Nutritional assessment and nutritional strategies are recommended as potential measures to improve RA clinical course and prognosis.

[Nutritional support in a pregnant woman with brain death. Case report and literature review]. / Apoyo nutricio en una mujer embarazada y con muerte cerebral. Informe de un caso y revisión de la literatura.

The occurence of brain death in pregnancy represents a catastrophic entity although infrequent. The aims of continue medical management are focused in a double purpose: to preserve intrauterine product's life and fetal maturation until delivery and to consider the mother as a potential organ donor. Ethical considerations together with gestational age, fetal well being and relatives' wishes are cardinal for continuing medical support. Modern critical care units allow us to obtain favourable results, supported in scientifical reports that describe successful outcomes. Nutritional aspects plays a cardinal role in the medical management, allowing to preserve the mother's organs' viability and also to preserve fetal intrauterine growth and development.

Spontaneous calcific cerebral emboli from calcified aortic valve stenosis.

Calcific cerebral emboli (CE) are a rare complication of calcified aortic valve stenosis (CAS). These emboli usually result from diagnostic manoeuvres (e.g. left heart catheterization) or from therapeutic procedures (e.g. heart valve surgery). Spontaneous calcific emboli are exceptional. We present the cases of two subjects known to have CAS who presented with acute neurological disorders suggesting strokes. In both subjects CT scans of the skull and brain provided a diagnosis of spontaneous CE by showing calcium-dense dots located on vessels or within the cerebral parenchyma. Additional examinations enabled us to determine the origin (heart or carotid artery) of these emboli. The finding of spontaneous cerebral CE is a very strong argument in favour of surgical valve replacement in these patients.