Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 19 de 19
Filtrar
Mais filtros

Base de dados
País/Região como assunto
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Osteoporos Int ; 34(6): 1011-1035, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37014390

RESUMO

INTRODUCTION: Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE: A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS: A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION: Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.


Assuntos
Fraturas do Quadril , Osteoporose , Humanos , Canadá/epidemiologia , Fraturas do Quadril/cirurgia , Fraturas do Quadril/complicações , Osteoporose/complicações , Osteoporose/terapia , Indicadores de Qualidade em Assistência à Saúde , Resultado do Tratamento
2.
Calcif Tissue Int ; 95(5): 405-12, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25209972

RESUMO

Subtrochanteric atypical femoral fractures (AFFs) have been reported in patients on osteoporosis therapy (bisphosphonates and denosumab). In 2010, and again in 2013, the ASBMR AFF Task Force developed strict diagnostic criteria for AFFs. This is the first study using these criteria to define the prevalence of AFFs in Canada. This study is a retrospective review of all adult patients (April 2002-March 2013) with an ICD 10 code for hip, femoral or subtrochanteric fracture, from two referral hospitals in Alberta, Canada. All identified as isolated subtrochanteric fractures were further evaluated by chart review, prescription review and examination of radiographs. Of 349 subjects, 79 had isolated subtrochanteric fractures. Of the 70 cases of subtrochanteric fractures that were radiographically assessed (9 films unavailable), 41 fulfilled ASBMR 2013 AFF criteria. The remaining subjects had subtrochanteric fractures but did not meet the ASBMR criteria to qualify as AFFs. There were 11 AFFs in 2012/2013, giving a rate of AFFs of 1.42 per 100,000 50 + year adults, compared to a rate of 103.47 per 100,000 50+ year adults for typical hip fractures. Isolated subtrochanteric fractures are rare. They cannot reliably be identified by ICD coding alone. In this study, only 59 % of all isolated subtrochanteric/femoral shaft fractures fulfilled the ASBMR task force criteria for true AFFs. The rate of typical hip fractures was substantially higher than the rate of AFFs, defined by ASBMR diagnostic criteria.


Assuntos
Fraturas do Fêmur/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Conservadores da Densidade Óssea/efeitos adversos , Estudos de Coortes , Difosfonatos/efeitos adversos , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
3.
Age Ageing ; 43(6): 877-9, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24950689

RESUMO

Dysphagia is a common problem in the elderly patient. Palato-pharyngo-laryngeal myoclonus, however, is a rare cause of this. We report a case of a 78-year-old man with dysphagia due to palato-pharngo-laryngeal myoclonus that was ultimately managed conservatively with a good functional outcome.


Assuntos
Transtornos de Deglutição/etiologia , Deglutição , Doenças da Laringe/complicações , Doenças da Boca/complicações , Mioclonia/complicações , Doenças Faríngeas/complicações , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/dietoterapia , Transtornos de Deglutição/fisiopatologia , Humanos , Doenças da Laringe/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Doenças da Boca/diagnóstico , Mioclonia/diagnóstico , Doenças Faríngeas/diagnóstico , Fatores de Risco , Resultado do Tratamento
4.
Front Nutr ; 10: 1126534, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37415915

RESUMO

COVID-19 infection causes cognitive changes in the acute phase, but also after apparent recovery. Over fifty post (long)-COVID symptoms are described, including cognitive dysfunction ("brain fog") precluding return to pre-COVID level of function, with rates twice as high in females. Additionally, the predominant demographic affected by these symptoms is younger and still in the workforce. Lack of ability to work, even for six months, has significant socio-economic consequences. This cognitive dysfunction is associated with impaired cerebral glucose metabolism, assessed using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), showing brain regions that are abnormal compared to age and sex matched controls. In other cognitive conditions such as Alzheimer's disease (AD), typical patterns of cerebral glucose hypometabolism, frontal hypometabolism and cerebellar hypermetabolism are common. Similar FDG-PET changes have also been observed in post-COVID-19, raising the possibility of a similar etiology. Ketone bodies (B-hydroxybutyrate, acetoacetate and acetone) are produced endogenously with very low carbohydrate intake or fasting. They improve brain energy metabolism in the face of cerebral glucose hypometabolism in other conditions [mild cognitive impairment (MCI) and AD]. Long-term low carbohydrate intake or prolonged fasting is not usually feasible. Medium chain triglyceride (MCT) is an exogenous route to nutritional ketosis. Research has supported their efficacy in managing intractable seizures, and cognitive impairment in MCI and AD. We hypothesize that cerebral glucose hypometabolism associated with post COVID-19 infection can be mitigated with MCT supplementation, with the prediction that cognitive function would also improve. Although there is some suggestion that post COVID-19 cognitive symptoms may diminish over time, in many individuals this may take more than six months. If MCT supplementation is able to speed the cognitive recovery, this will impact importantly on quality of life. MCT is readily available and, compared to pharmaceutical interventions, is cost-effective. Research shows general tolerability with dose titration. MCT is a component of enteral and parenteral nutrition supplements, including in pediatrics, so has a long record of safety in vulnerable populations. It is not associated with weight gain or adverse changes in lipid profiles. This hypothesis serves to encourage the development of clinical trials evaluating the impact of MCT supplementation on the duration and severity of post COVID-19 cognitive symptoms.

5.
Can Geriatr J ; 26(4): 493-501, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38045877

RESUMO

Background: Sarcopenia is associated with increased morbidity and mortality. Clinically, sarcopenia can be overlooked, especially in obesity. Sarcopenia diagnostic criteria include muscle mass (MM) and function assessments. Muscle function can be readily assessed in a clinic setting (grip strength, chair stand test). However, MM requires dual-energy X-ray absorptiometry (DXA) Body Composition (BC) or other costly tools, not readily available. Methods: Observational cohort pilot study of independently mobile, community dwelling older adults, comparing MM using two office-based, direct-to-consumer bioimpedance (BIA) scales (Ozeri® [manufactured in China] and OMRON® [OMRON HBF-510® Full Body Sensor, Shiokoji Horikawa, Kyoto, Japan] to DXA. The OMRON differs from the Ozeri scale because the OMRON also includes hand sensors. The European Working Group on Sarcopenia in Older People (EWGSOP) DXA or BIA low MM diagnostic cut-offs were used to classify participants as having low or normal MM. Results: Fifty participants: 11 men, 39 women. Forty-two completed DXA. Age 75.8 yrs [67-90]. 81% obese based on body fat cut-offs. With DXA [ASM/height2], 15 had low MM. Using BIA [mmass/height2], 7 with Ozeri, and 27 with OMRON, had low MM. Positive predictive value for low MM versus DXA (as the gold standard) for Ozeri was 73.3% and OMRON was 92.8%. Good correlation between BIA scales and DXA for body fat estimates. Conclusions: OMRON captured all low MM participants identified by DXA plus all on DXA diagnostic borderline. Prevalence of obesity was high. Clinically, sarcopenic obese is the most difficult phenotype, as obesity masks low muscle mass. Low cost, readily available, direct-to-consumer BIA BC scales, especially with hand sensors, provide immediate, reliable information on muscle and fat mass. This can prompt appropriate investigation and/or intervention for sarcopenia or sarcopenic obesity.

6.
J Patient Exp ; 10: 23743735231151537, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36687165

RESUMO

Catch a Break (CaB) is a secondary fracture prevention program that uses medical understandings of osteoporosis to assess first fractures and determine appropriateness for secondary fracture prevention. In this study, we interviewed CaB program participants to identify the understandings that patients themselves used to make sense of first fractures and the osteoporosis suggestion as cause. Semi-structured interviews were conducted with female and male participants of the CaB program in Canada. An interpretive practice approach was used to analyze the data. A random sample of 20 individuals, 12 women, and eight men all aged 50 years and over participated. First fractures were produced as meaningful in the context of osteoporosis only for seniors of very advanced age, and for people of any age with poor nutrition. The trauma events that led to a first fracture were produced as meaningful only if perceived as accidents, and having an active lifestyle was produced as beneficial only for mental health and well-being unrelated to osteoporosis. Cultural knowledge shapes, but does not determine, how individuals make sense of their health and illness experiences. Risk prevention program designers should include patients on the design team and be more aware of the presumptive knowledge used to identify individuals at risk of disease.

7.
Alzheimers Dement (N Y) ; 8(1): e12259, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35310527

RESUMO

Introduction: Cerebral glucose and insulin metabolism is impaired in Alzheimer's disease (AD). Ketones provide alternative energy. Will medium chain triglyceride (MCT) oil, a nutritional source of ketones, impact cognition in AD? Methods: This was a 6-month randomized, double-blind, placebo-controlled, crossover study, with 6-month open-label extension in probable AD subjects, on stable medications. MCT dose was 42 g/day, or maximum tolerated. Cognition was assessed with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Cognigram®. Results: Twenty subjects, average age 72.6 years, 45% women, 70% university educated had baseline MMSE 22.6/30 (10-29); MoCA 15.6/30 (4-27); baseline Cognigram® Part 1: 65-106, Part 2: 48-107. Average MCT oil consumption was 1.8 tablespoons/day (25.2 g, 234 kcal). Eighty percent remained stable or improved. Longer MCT exposure and age > 73, resulted in higher final MMSE (P < .001) and Cognigram® 1 scores. Discussion: This is the longest duration MCT AD study to date. Eighty percent had stabilization or improvement in cognition, and better response with 9-month continual MCT oil.

8.
Arch Osteoporos ; 16(1): 136, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535837

RESUMO

Catch a Break staff conducting the organizational work of delivering secondary fracture prevention screening conversations drew on cultural and organizational resources to determine eligibility of individuals. They encountered and navigated their way through interactional troubles as they requested participation, assessed trauma risk, and provided lifestyle information. PURPOSE: We investigated delivery of a population-based type C fracture liaison service for non-hip fractures. The purpose of this study was to examine accounts of how osteoporosis health risk screening interactions were delivered. METHODS: A pre-determined sample of 5 organizational representatives (program staff) were interviewed by telephone. We analyzed the qualitative data through the lens of interpretive inquiry, informed by discourse analysis, to examine staff's "talk" about conducting the program risk screening conversations. RESULTS: A dominant finding emerging from CAB staff's accounts of program delivery was the conversational work required to include only those individuals deemed appropriate for the program while managing the survey interaction. Staff talked about specific examples of interactional troubles they experienced as barriers to the smooth and successful risk screening conversation. They drew on cultural and organizational resources as interpretive frameworks to make decisions about individuals and groups at risk and in need of further investigation. They drew on larger ideas about ageism and genderism, judging as inappropriate for participation the oldest old adults, men involved in high risk occupations, and adults aged 50 to 70. Staff also employed interactional resources useful in managing problems in the conversation during the request to participate, trauma risk assessment, and lifestyle/health information provision sequences of the risk screening call. CONCLUSION: We uncovered areas in the screening interaction that were talked about by staff as problematic to achieving the program objective of identifying and enrolling individuals in the secondary fracture prevention program. By highlighting areas for improvement in program delivery, this study may help to reduce the interactional troubles staff negotiate as they deliver this type of program.


Assuntos
Osteoporose , Fraturas por Osteoporose , Adulto , Idoso de 80 Anos ou mais , Humanos , Masculino , Programas de Rastreamento , Fraturas por Osteoporose/prevenção & controle , Medição de Risco , Prevenção Secundária
9.
Clin Nutr ESPEN ; 32: 8-15, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31221295

RESUMO

BACKGROUND: Malnutrition and sarcopenia are common in older adults. A new clinical syndrome has been suggested - the Malnutrition Sarcopenia Syndrome (MSS) - that may provide improved management, by highlighting two older adult conditions that can interact in a cumulative way to affect functional independence and health outcomes. This paper evaluates the published literature reporting data on both nutrition and sarcopenia evaluation simultaneously in the population studied, and creates a diagnostic algorithm. METHODS: An inclusive, systematic literature search was done for articles including a simultaneous standardised evaluation of sarcopenia and nutritional status, from 1990-date. Sarcopenic status needed to be evaluated using accepted guidelines published by international guideline committees which include a functional muscle evaluation and a quantitative evaluation using bioimpedence assay or dual energy X-ray absorptiometry. Nutritional status needed to evaluated with a standardised, validated nutritional screening tool that was not disease specific. RESULTS: 11 studies met these criteria. They differed in their methodology for screening both sarcopenia and nutritional issues. They differed as to the population studied (community versus institutionalised versus hospitalised). CONCLUSIONS: No one methodology was consistent for evaluation of sarcopenia or malnutrition. The concept of the Malnutrition Sarcopenia Syndrome intuitively makes sense to clinicians. This opinion paper suggests a possible clinical approach. The management and interventions for both conditions are likely to have considerable overlap. There needs to be some consensus on how to evaluate it, in order to be able to accurately interpret the impact of interventions that may be undertaken for one or both conditions simultaneously.


Assuntos
Idoso Fragilizado , Desnutrição/diagnóstico , Avaliação Nutricional , Sarcopenia/diagnóstico , Idoso , Humanos , Estado Nutricional , Síndrome
10.
Clin Rheumatol ; 27(9): 1191-4, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18607671

RESUMO

Canadian Consensus guidelines regarding appropriate use of nonsteroidal anti-inflammatory drugs (NSAID) were recently published. This study was done to evaluate the application of these guidelines on NSAID practice patterns in frail elderly patients referred to a specialist Geriatric Assessment Clinic. A retrospective chart review was undertaken of referrals who were currently prescribed NSAIDs. Data were captured on age, sex, weight, diagnoses, medications and dosages, indication for NSAID treatment, lying BP (as assessed in the clinic) and recent serum creatinine result. Creatinine clearance was subsequently calculated use the Cockcroft-Gault equation. Complete data were available on 107 patients (68% women, average age 80.6 years). Thirty percent were on a traditional NSAID, the remainder were on a Coxib. Concomitant aspirin was prescribed in 37%. Cytoprotection was being used in 38% and did not increase appreciably in patients with additional risk factors for GI toxicity, i.e., concomitant aspirin usage (35%), and history of GI toxicity (48%). Sixty-seven were taking anti-hypertensive medications, although more than two thirds of these patients were uncontrolled. Newly diagnosed hypertension was present in 19.6%. Calculated creatinine clearance revealed moderate to severe renal impairment in 79% of subjects, although serum creatinine was only elevated in 18%. In total, 70% of subjects were found to have relative or absolute risk factors for NSAID therapy. Given the high prevalence of potential contraindications to anti-inflammatory drug usage in this study, we advocate the dissemination and application of these guidelines in geriatric patients in an attempt to reduce potential morbidity and mortality.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Idoso de 80 Anos ou mais , Canadá , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Feminino , Guias como Assunto , Humanos , Masculino
11.
Arch Intern Med ; 167(19): 2110-5, 2007 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-17954806

RESUMO

BACKGROUND: Patients who survive hip fracture are at high risk of recurrent fractures, but rates of osteoporosis treatment 1 year after sustaining a fracture are less than 10% to 20%. We have developed an osteoporosis case manager intervention. The case manager educated patients, arranged bone mineral density tests, provided prescriptions, and communicated with primary care physicians. The intervention was compared with usual care in a randomized controlled trial. METHODS: We recruited from all hospitals that participate in the Capital Health system (Alberta, Canada), including patients 50 years or older who had sustained a hip fracture and excluding those who were receiving osteoporosis treatment or who lived in a long-term care facility. Primary outcome was bisphosphonate therapy 6 months after fracture; secondary outcomes included bone mineral density testing, appropriate care (bone mineral density testing and treatment if bone mass was low), and intervention costs. RESULTS: We screened 2219 patients and allocated 220, as follows: 110 to the intervention group and 110 to the control group. Median age was 74 years, 60% were women, and 37% reported having had previous fractures. Six months after hip fracture, 56 patients in the intervention group (51%) were receiving bisphosphonate therapy compared with 24 patients in the control group (22%) (adjusted odds ratio, 4.7; 95% confidence interval, 2.4-8.9; P < .001). Bone mineral density tests were performed in 88 patients in the intervention group (80%) vs 32 patients in the control group (29%) (P < .001). Of the 120 patients who underwent bone mineral density testing, 25 (21%) had normal bone mass. Patients in the intervention group were more likely to receive appropriate care than were patients in the control group (67% vs 26%; P < .001). The average intervention cost was $50.00 per patient. CONCLUSION: For a modest cost, a case manager was able to substantially increase rates of osteoporosis treatment in a vulnerable elderly population at high risk of future fractures.


Assuntos
Administração de Caso , Fraturas do Quadril , Osteoporose/prevenção & controle , Idoso , Alberta , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/etiologia , Qualidade da Assistência à Saúde , Resultado do Tratamento
12.
Clin Rheumatol ; 24(5): 535-8, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16010447

RESUMO

The objective of this study was to evaluate the knowledge, awareness, utilization, and satisfaction of patients with different treatment modalities for osteoarthritis (OA). Patients with a diagnosis of OA of the knee or hip who had attended a rheumatology referral clinic over the preceding 2 years were eligible. A six-page self-administered questionnaire was mailed to them. Responses were anonymous. One hundred and six completed questionnaires were returned. The average age of the respondents was 64 years and included 71 females. Ninety-four percent of respondents had at least 8 years of formal education, and 75% had had OA for at least 5 years. Seventy-five percent successfully defined OA. The majority had heard of most treatment modalities. Seventy-one percent had tried cyclooxygenase-2 inhibitors (COXIBs), 79% analgesics, and 56% physiotherapy. Twenty-six percent had had surgery for their OA. Of those that had tried the various treatment options, the most satisfaction occurred with surgery, pool therapy, walking aids, and narcotic analgesics. Fifty-five percent found traditional nonsteroidal anti-inflammatory drugs (NSAIDs) helpful and 65% benefited from the COXIBs. Treatment reported as providing the most improvement in function was surgery, followed by steroid injections, COXIB therapy, and traditional NSAIDs. Treatment modalities providing the most symptomatic improvement were surgery, followed by COXIBs and steroid injections. When treatment options were compared, their rank ordering differed when considering overall satisfaction, functional improvement, and symptomatic relief. The participants in this study were well informed as to the nature of their disease and its treatment. A wide number of therapies had been tried, most of which were well tolerated. According to patient perception, those undergoing surgical treatment had the best improvement in symptoms and function. For those using anti-inflammatories (NSAIDs or COXIBs) improvement occurred in >50%, though this was less than for physiotherapy and analgesics. Based on this cohort of patients, treatments that were rated highly (such as surgery) were not necessarily those that were the most widely experienced. Conversely, those therapies that were the most widely accessed (such as analgesics) were not necessarily those that provided the maximum perceived benefit. We conclude that in the continued absence of specific disease-modifying therapies for OA, multiple therapeutic options need to be explored to address individual patient's functional and symptomatic needs.


Assuntos
Osteoartrite , Educação de Pacientes como Assunto , Satisfação Pessoal , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Feminino , Humanos , Osteoartrite/patologia , Osteoartrite/psicologia , Osteoartrite/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários
13.
J Am Med Dir Assoc ; 5(6): 377-81, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15530175

RESUMO

OBJECTIVES: Low bone mineral density (BMD) is a major risk factor for osteoporotic fracture. The gold standard measurement of BMD, central dual-energy x-ray absorptiometry (DXA), requires transportation to a radiologic facility, patient agility and cooperation. For those with severe cognitive impairment, this is not realistic; hence, central BMD is seldom measured. The objectives were to evaluate the use of calcaneal BMD measurement (by qualitative ultrasound), the prevalence of osteoporosis diagnosis (based on calcaneal BMD), and treatment in individuals with severe cognitive impairment. DESIGN: This is a point prevalence descriptive study. Calcaneal BMD was measured using a Sahara sonometer (Hologic). Cognition (Mini Mental Status Examination), mobility (Berg balance scale, timed up-and-go), and chart audit were also undertaken. SETTING: This study was conducted at four dementia long-term care facilities (122 beds) in Edmonton, Alberta, Canada. PARTICIPANTS: Forty long-term care residents participated in this study with an average MMSE of 10 (range, 0-25). MEASUREMENTS: One hundred percent of study subjects cooperated with calcaneal ultrasound measurement. RESULTS: Based on calcaneal BMD measurement using recommended cutoffs, 92.5% were at high risk for osteoporosis or osteopenia and 5% were at moderate risk. One participant (2.5%) had a normal calcaneal BMD measurement. Calcium supplementation occurred in 32% of the high-risk group, 50% of the moderate-risk group, and 100% of the normal group. One (2.5%) participant was on hormone replacement therapy, and 12% were taking etidronate. CONCLUSIONS: Calcaneal ultrasound measurement could be a useful tool to assess BMD in cognitively impaired nursing home residents.


Assuntos
Densidade Óssea , Calcâneo/diagnóstico por imagem , Transtornos Cognitivos/complicações , Fraturas Ósseas/etiologia , Deficiência Intelectual/complicações , Osteoporose/diagnóstico por imagem , Pessoas com Deficiência Mental/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Doenças Ósseas Metabólicas/diagnóstico por imagem , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Feminino , Fraturas Ósseas/prevenção & controle , Humanos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Osteoporose/complicações , Osteoporose/epidemiologia , Osteoporose/prevenção & controle , Análise de Regressão , Medição de Risco/métodos , Fatores de Risco , Ultrassonografia
14.
Healthc Q ; 7(2): 49-53, 2, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15088332

RESUMO

As the population ages, and there is more pressure on acute and long-term care services, governments will continue to search for ways to save healthcare dollars. Home care has been touted as an alternative to long-term care; however, not enough is known about quality of care and patient outcomes.


Assuntos
Fraturas do Quadril/reabilitação , Serviços de Assistência Domiciliar , Avaliação de Resultados em Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Alberta , Estudos de Coortes , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino
16.
Clin Rheumatol ; 28(6): 723-7, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19240980

RESUMO

Efficacy of hip protector pads to prevent hip fracture is controversial. This study was done to evaluate two comparable groups for fracture risk. Two matched cohorts of long-term care residents in Canada, assessing the efficacy of hip protector pads. Evaluation included demographics, medications/diagnoses, cognition (Mini Mental Status Examination (MMSE)), balance (Berg), bone mineral density (calcaneal ultrasound), falls/injuries at baseline and completion. Of the 58 participants, there were two confirmed hip fractures (8%) in the hip pad (one while wearing the pad) and eight (24%) in the control groups. But baseline demographics showed significant differences between hip pad (25) and control groups (33) in MMSE, Berg and osteoporosis treatment, all being less in the hip pad group. This persisted at completion, with a higher mortality in the hip pad group. Baseline differences predisposed the hip pad group to a higher fracture risk, but there were fewer hip fractures in this group. Small numbers, multifactorial nature of hip fractures and the inability to control for many of these variables in the real world make efficacy of hip protector pads difficult to confirm. Hip protector pads should be offered as part of the osteoporosis management of frail elderly, especially in those unable/unwilling to take pharmacotherapy.


Assuntos
Fraturas do Quadril/prevenção & controle , Equipamentos de Proteção , Idoso , Idoso de 80 Anos ou mais , Canadá , Estudos de Coortes , Feminino , Seguimentos , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
17.
Arch Intern Med ; 169(1): 25-31, 2009 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-19139320

RESUMO

BACKGROUND: In a randomized trial of patients with hip fractures, we previously demonstrated that a hospital-based case manager could increase rates of appropriate osteoporosis treatment to 51% compared with 22% for usual care (P < .001). Alongside that trial, we conducted an economic analysis. METHODS: Patients with hip fractures were randomized to usual care (n = 110) or a case manager (n = 110) and followed up for 1 year. Time-motion studies were used to determine intervention costs. From a third-party health care payer perspective and over the patient's remaining lifetime, a Markov decision-analytic model was constructed to determine cost-effectiveness of the intervention compared with usual care. Costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. RESULTS: The intervention cost CaD $56 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients case managed, 6 fractures (4 hip fractures) were prevented, 4 quality-adjusted life-years were gained, and CaD $260 000 was saved by the health care system. Irrespective of the number of patients case managed, the intervention reached a break-even threshold within 2 years. The intervention dominated usual care over the entire spectrum of 1-way sensitivity analyses and was cost-saving in 82% of probabilistic model simulations. CONCLUSIONS: Compared with usual care, we found that using a case manager for patients with hip fractures increased rates of appropriate osteoporosis treatment. The intervention dominated usual care, and the analysis suggests that systems implementing an intervention similar to ours should expect to see a reduction in fractures, gains in life expectancy, and substantial cost savings. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00175175.


Assuntos
Administração de Caso/economia , Redução de Custos , Custos de Cuidados de Saúde , Fraturas do Quadril/cirurgia , Osteoporose/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/fisiologia , Análise Custo-Benefício , Difosfonatos/uso terapêutico , Feminino , Seguimentos , Fixação Intramedular de Fraturas/economia , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/economia , Fraturas do Quadril/mortalidade , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Osteoporose/tratamento farmacológico , Probabilidade , Qualidade de Vida , Radiografia , Valores de Referência , Taxa de Sobrevida , Resultado do Tratamento
18.
Arthritis Rheum ; 61(2): 209-15, 2009 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-19177538

RESUMO

OBJECTIVE: We previously demonstrated that a case manager intervention improved osteoporosis (OP) treatment within 6 months of hip fracture compared with usual care. The second phase of the randomized trial compared a less intensive intervention, facilitated bone mineral density (BMD) testing, with usual care and the case manager intervention. METHODS: We initially randomized 220 hip fracture patients to either an OP case manager intervention or usual care. After completing the original trial at 6 months postfracture, usual care patients were reallocated to facilitated BMD testing; BMD tests were arranged and results sent to primary care physicians. Main outcomes (bisphosphonate treatment, BMD tests, receipt of appropriate care) were reascertained 1 year following hip fracture and compared with outcomes achieved by the OP case manager intervention and usual care. RESULTS: Compared with usual care, facilitated BMD testing increased testing from 29% to 68% (P < 0.001), bisphosphonate use from 22% to 38% (P < 0.001), and receipt of appropriate care from 26% to 45% (P < 0.001). The more intensive (70 versus 30 minutes) and expensive ($56 versus $24 Canadian per patient) OP case manager intervention led to significantly higher bisphosphonate use (54% versus 38%; P = 0.03), receipt of appropriate care (71% versus 45%; P < 0.001), and more BMD testing (80% versus 68%; P = 0.06) than usual care followed by facilitated BMD testing. CONCLUSION: Compared with usual care, 2 different inexpensive interventions resulted in significant increases in appropriate management of OP after hip fracture. The magnitude of improvements achieved was directly related to the intensity of the interventions.


Assuntos
Densidade Óssea , Administração de Caso , Fraturas do Quadril/reabilitação , Osteoporose/tratamento farmacológico , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Procedimentos Clínicos , Difosfonatos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde
19.
Osteoporos Int ; 14(9): 722-7, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12904833

RESUMO

This study examined post-fracture osteoporosis drug treatment in hip fracture patients and the association of treatment with mortality and morbidity. Pre- and post-fracture demographic/health information was collected on a cohort of hip fracture patients aged 65+ years. Post-fracture administrative data on prescription drug use and health care utilization was linked to the cohort data. Five classes of osteoporosis drugs were available during the study period: hormone replacement therapy (HRT), bisphosphonates (BSP), calcitonin, selective estrogen receptor modulators (SERMs) and vitamin D(3) (Rocaltrol). Pre-fracture, 38 of 449 patients (8%) were on osteoporosis medications. Post-fracture, 81 of 356 patients (23%) were treated; 63 of these patients were untreated prior to fracture. Both treated and untreated patients had similar rates of subsequent hip fracture (6% and 4%, respectively) and Colles fracture (2%). Regardless of treatment status, patients were also equally likely to be hospitalized, both in the short-term (28% in treated, 27% in untreated) and in the long-term (43% versus 37%). However, mortality was significantly lower in the treated group. The lower mortality in the treated group, combined with the knowledge that antiresorptive drugs reduce fractures and increase bone density, merit undertaking a randomized trial to confirm our findings that antiresorptive therapy should be considered in all patients post-hip fracture.


Assuntos
Fraturas do Quadril/etiologia , Osteoporose/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Calcitonina/administração & dosagem , Calcitriol/administração & dosagem , Continuidade da Assistência ao Paciente , Difosfonatos/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Terapia de Reposição de Estrogênios , Feminino , Seguimentos , Humanos , Masculino , Osteoporose/complicações , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Análise de Sobrevida , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA