Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients with gastrointestinal (GI) risk (QI #1 NSAID-PPI) and avoid oral NSAIDs in chronic kidney disease (CKD) stage G4 or G5 (QI #2 NSAID-CKD). METHODS: This retrospective study included index primary care clinic visits for knee OA at our health system in 2019. The validation cohort consisted of a random sample of 60 patients. The remainder were included in the expanded cohort. Analysis of structured data extracts was validated against chart review of clinic visit notes (validation cohort) and estimated QI adherence (expanded cohort). RESULTS: Among 60 patients in the validation cohort, analysis of data extracts was validated against chart review for QI #1 NSAID-PPI (100% sensitivity and 91% specificity) and QI #2 NSAID-CKD (100% accuracy). Among 335 patients in the expanded cohort, 44% used NSAIDs, 27% used PPIs, 73% had elevated GI risk, and only 2% had CKD stage 4 or 5. Twenty-one percent used NSAIDs and had elevated GI risk but were not using PPIs. Therefore, adherence to QI #1 NSAID-PPI was 79% (95% CI, 74-83%). No patients with CKD stage 4 or 5 used NSAIDs. Therefore, adherence to QI #2 NSAID-CKD was 100%. CONCLUSION: A substantial proportion of knee OA patients with GI risk factors did not receive PPI with NSAID therapy during primary care visits.

Quality indicators for osteoarthritis pain management in the primary care setting.

BACKGROUND: Development of valid and feasible quality indicators (QIs) is needed to track quality initiatives for osteoarthritis pain management in primary care settings. METHODS: Literature search identified published guidelines that were reviewed for QI extraction. A panel of 14 experts was assembled, including primary care physicians, rheumatologists, orthopedic surgeons, pain specialists, and outcomes research pharmacists. A screening survey excluded QIs that cannot be reliably extracted from the electronic health record or that are irrelevant for osteoarthritis in primary care settings. A validity screening survey used a 9-point Likert scale to rate the validity of each QI based on predefined criteria. During expert panel discussions, stakeholders revised QI wording, added new QIs, and voted to include or exclude each QI. A priority survey used a 9-point Likert scale to prioritize the included QIs. RESULTS: Literature search identified 520 references published from January 2015 to March 2021 and 4 additional guidelines from professional/governmental websites. The study included 41 guidelines. Extraction of 741 recommendations yielded 115 candidate QIs. Feasibility screening excluded 28 QIs. Validity screening and expert panel discussion excluded 73 QIs and added 1 QI. The final set of 15 prioritized QIs focused on pain management safety, education, weight-management, psychological wellbeing, optimizing first-line medications, referral, and imaging. CONCLUSION: This multi-disciplinary expert panel established consensus on QIs for osteoarthritis pain management in primary care settings by combining scientific evidence with expert opinion. The resulting list of 15 prioritized, valid, and feasible QIs can be used to track quality initiatives for osteoarthritis pain management.

The eating disorder examination questionnaire for adults from the Mexican general population: Reliability and validity.

The Eating Disorder Examination Questionnaire is a widely used self-report questionnaire for eating disorders. An Eating Disorder Examination Questionnaire model that is not lacking in relevant content has been supported in three different samples, but existing studies on this model present shortcomings regarding generalizations to the general population. Therefore, the general purpose of the current research was to test the reliability and interpretation validity of the Eating Disorder Examination Questionnaire 6.0 scores in adults of both sexes from the Mexican general population. After translating, adapting, and assessing the Eating Disorder Examination Questionnaire 6.0 in the target population through three pilot studies, we conducted two independent studies. In Study 1, 684 women and 433 men aged 18-83 participated, whereas in Study 2, 591 women and 382 men aged 18-86 did it. They answered the Eating Disorder Examination Questionnaire 6.0 and a measure of either body dissatisfaction (Study 1) or self-esteem (Study 2). According to confirmatory factor analyses, the 14-item Eating Disorder Examination Questionnaire model that we tested fit acceptably for the four samples (two female, two male) and was invariant across sex. All 14-item Eating Disorder Examination Questionnaire 6.0 scores were reliable according to Cronbach's alpha and McDonald's omega, except for only one factor score in men. Pearson's correlations of the 14-item Eating Disorder Examination Questionnaire 6.0 scores with body dissatisfaction and self-esteem were positive and negative, respectively. This new Latin American Spanish translation of the Eating Disorder Examination Questionnaire 6.0 works broadly as expected and provides evidence to extend the generalization of previous studies to the general population. Thus, the present translation of the Eating Disorder Examination Questionnaire 6.0 may be a valuable tool in the field of eating disorders for researchers and practitioners studying or serving Latin American Spanish speakers of either sex from the general population.

Acceso vascular para hemodiálisis: injerto arterio-arterial, Humero-humeral: presentación de un caso / Vascular access for hemodialysis: arterio-arterial graft, from proximal brachial artery to distal brachial artery: report of a case

Objetivo: Reportar la experiencia de nuestro servicio en el manejo de un paciente multiabordado, para lograr un acceso vascular para hemodiálisis, cuando las posibilidades descritas en la literatura se han agotado. Material y métodos: Paciente femenina de 73 años, con cavidad no útil para diálisis, que durante el lapso de 3 años, fue sometida a más de 20 abordajes para lograr una vía de acceso vascular para hemodiálisis en cuello, miembros superiores y miembros inferiores. Finalmente se le realizó un puente arterial humero-humeral, terminolateral, con politetrafluoroetileno. Resultados: La paciente durante el lapso de seis meses, se ha hemodializado satisfactoriamente a través del puente arterio-arterial, sin ninguna complicación. Conclusión: La realización de un puente arterio-arterial, con material sintético, como vía de acceso vascular para hemodiálisis ha demostrado ser útil y una opción cuando las vías descritas en la literatura se han agotado. Este caso constituye el inicio de un protocolo para valorar la utilidad, vida media, complicaciones y riesgos a largo plazo.