Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators.

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.

Factors associated with the development of impulse compulsive disorders in Parkinson patients.

OBJECTIVE: The aim of this study is to identify the prevalence of impulse compulsive disorder (ICD) in Parkinson's disease (PD) patients and to study potential associative factors that may be related to the onset of ICD while on parkinsonian medications. METHOD: The study was conducted in two parts. In Part A, the prevalence of ICD in 140 PD patients was first assessed, followed by identifying any common variables that may be associated with the development of ICD. Finally, using a detailed chart review, Part B of the study examined the prevalence of ICD in all patients who presented with identical risk factors gathered in Part A. RESULTS: Of the 140 patients, 8 patients developed symptoms of ICD. Seven of these patients were found to have five common variables that included gender (males), stages 1-2 of PD, young onset of PD, maximum dosage of the drug and the use of dopamine agonists (DAs). Of the 140 patients, 22 patients fit the above-mentioned five criteria and of those 22 patients, 33% developed symptoms of ICD. CONCLUSION: The use of DA therapy in the treatment of PD patients should be carefully monitored, especially in younger male patients who exhibit early signs of parkinsonian symptoms. As such, it is crucial for physicians to adjust DA dosages while also seeking alternative treatments to avoid the risk of ICD while on DAs.

Improving Transitions of Care between the Intensive Care Unit and General Internal Medicine Ward. A Demonstration Study.

Background: In-hospital transfers such as from the intensive care unit (ICU) to the general internal medicine (GIM) ward place patients at risk of adverse events. A structured handover tool may improve transitions from the ICU to the GIM ward. Objective: To develop, implement, and evaluate a customized user-designed transfer tool to improve transitions from the ICU to the GIM ward. Methods: This was a pre-post intervention study at a tertiary academic hospital. We developed and implemented a user-designed, structured, handwritten ICU-to-GIM transfer tool. The tool included active medical issues, functional status, medications and medication changes, consulting services, code status, and emergency contact information. Transfer tool users included GIM physicians, ICU physicians, and critical care rapid response team nurses. An implementation audit and mixed qualitative and quantitative analysis of pre-post survey responses was used to evaluate clinician satisfaction and the perceived quality of patient transfers. Results: The pre-post survey response rate was 51.8% (99/191). Respondents included GIM residents (58.5%), ICU rapid response team physicians and nurses (24.2%), and GIM attending physicians (17.2%). Less than half of clinicians (48.8%) reported that the preintervention transfer process was adequate. Clinicians who used the transfer tool reported that the transfer process was improved (93.3% vs. 48.8%, P = 0.03). Clinician-reported understanding of medication changes in the ICU increased (69.2% vs. 29.1%, P = 0.004), as did their ability to plan for a safe hospital discharge (69.2% vs. 31.0%, P = 0.01). However, only 64.2% of audited transfers used the tool. Frequently omitted sections included home medications (missing in 83.4% of audits), new medications (33.3%), and secondary diagnosis (33.3%). Thematic analysis of free-text responses identified areas for improvement including clarifying the course of ICU events and enhancing tool usability. Conclusion: A user-designed, structured, handwritten transfer tool may improve the perceived quality of patient transfers from the ICU to the GIM wards.

DOPA-sparing strategy in the treatment of young onset Parkinson's disease.

CONTEXT: Late onset Parkinson's disease (LOPD) is a neurodegenerative disorder afflicting individuals of ages 60 and older. However, 5-10% of cases can begin earlier between the ages 20 to 40, and are classified as young onset Parkinson disease (YOPD). AIM: In turn, this study aims to observe the trend in the choice of drug administered to patients with both YOPD and LOPD, with particular emphasis on this trend in its relation to the practice background of the neurologist. SETTINGS AND DESIGN: A cross-sectional study was conducted in a community based Parkinson's disease and movement disorder clinic. STATISTICAL ANALYSIS USED: Using a retrospective chart review data was obtained and analysed. RESULTS: The results showed that 83% of general neurologists prescribed levodopa to their patients with YOPD, whereas movement-disorder specialists took a different approach altogether. They opted not to use levodopa and, in its stead, prescribed a mixture of alternate drugs.