A Delphi consensus on the management of Spanish patients with osteoporosis at high risk of fracture: OSARIDELPHI study.

The OSARIDELPHI study evaluated the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. The results provide expert-based recommendations for prevention, diagnosis, and treatment related to fracture risk. Therefore, the study facilitates clinical decision-making for managing this patient's profile. PURPOSE: To evaluate the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. METHODS: A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with assessments on a 9-point Likert scale. Item selection was based on acceptance by ≥ 66.6% of panel experts and the agreement of the scientific committee. In round 2, the same panelists evaluated non-consensus items in round 1. RESULTS: A total of 80 panelists participated in round 1; of these, 78 completed the round 2 survey. In round 1, 122 items from 4 dimensions (definition of fracture risk: 11 items, prevention and diagnosis: 38 items, choice of treatment: 24 items, and treatment-associated quality of life: 49 items) were evaluated. The consensus was reached for 90 items (73.8%). Panelists agreed that categorizing high risk, very high risk, or imminent risk determines secondary prevention actions (97.5%). Experts agreed that treatment with bone-forming drugs should be considered in case of a very high risk of fracture, and a sequential change to antiresorptive drugs should be made after 1-2 years (97.5%). Panelists also recommended corrective action plans for non-adherent patients to improve adherence (97.5%). A total of 131 items were finally accepted after round 2. CONCLUSION: This Delphi study provides expert-based recommendations on clinical decision-making for managing patients with osteoporosis at high risk of fracture.

Una aportación más sobre la intervención geriátrica en el anciano ingresado por fractura de cadera / One more contribution to Geriatric intervention in older people hospitalised due to hip fracture

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Trastorno del control de impulsos asociado a agonistas dopaminérgicos en la enfermedad de Parkinson. A propósito de un caso / Impulse control disorders associated with dopaminergic agonists in Parkinson's disease. Case report

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Déficit de vitamina D en una cohorte de pacientes mayores de 69 años con fractura de fémur atendidos en la Unidad Geriátrica de Agudos del Hospital de Igualada / Vitamin D deficiency in a cohort of patients over 69 years with femoral fracture admitted to an Acute Geriatric Unit of Hospital Igualada

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El proceso de la fractura de fémur: algunas consideraciones más / No disponible

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Fractura de fémur: aspectos rehabilitadores / No disponible

La fractura de fémur es una de las patologías más prevalentes y que provoca una importante morbimortalidad y discapacidad en los pacientes atendidos en los servicios de rehabilitación hospitalarios. El abordaje de la misma ha de ser interdisciplinario, debiendo existir una estrecha relación entre los servicios de urgencias, geriatría, cirugía ortopédica y traumatología y rehabilitación con el objetivo de realizar intervenciones que permitan obtener resultados más eficaces y eficientes. Los servicios de rehabilitación deben garantizar un tratamiento integral de la fractura de fémur. La prevención de los dos factores que predisponen a la misma como son las caídas y la osteoporosis, con intervenciones basadas fundamentalmente en la promoción de la actividad física y el ejercicio terapeútico. El tratamiento rehabilitador del paciente afecto de fractura de fémur ha de tener como objetivo fundamental el recuperar la capacidad de deambulación previa. Para realizar una correcta planificación se deberán tener en cuenta aspectos relacionados con la situación previa del paciente como las enfermedades concomitantes, el grado de funcionalidad y la situación sociofamiliar. Los programas se iniciarán de forma precoz, en el postoperatorio inmediato, estimulando la carga y deambulación en las fases tempranas con el objeto de minimizar las complicaciones de la inmovilización(AU)

A fractured femur is one of the most prevalent diseases and causes significant morbidity-mortality and disability in patients in hospital rehabilitation services. The same approach must be interdisciplinary and should be a close relationship between the emergency services, geriatrics, orthopedics and rehabilitation with the aim of developing interventions that can produce more effective and efficient results. Rehabilitation services should ensure a comprehensive treatment of hip fracture. The prevention of the two factors that predispose to it as are the falls and osteoporosis, mainly based interventions in promoting physical activity and therapeutic exercise. The rehabilitative treatment of the patient suffering from a fractured femur has a fundamental aim recover to walking. For proper planning should take into account issues related to the previous situation of the patient and concomitant diseases, the degree of functionality and social and family situation. The program is initiated early, in the immediate postoperative period, stimulating the load and walking in the early stages in order to minimize(AU)

¿Qué hacer y qué no a lo largo del proceso demencial? Diálogo y ayuda / What should be done and not done throughout the process of dementia? Dialogue and aid

La demencia es un potente predictor de dependencia que hace que sean esas personas las que vivan más años con discapacidad. Es la enfermedad crónica que mayor dependencia ocasiona a los 12, a los 24 y a los 36 meses de su evolución, por delante de otras enfermedades discapacitantes, como el ictus, la enfermedad de Parkinson o las enfermedades cardiovasculares. Somos muchos los que conocemos las consecuencias devastadoras de las demencias, pero pocos sabemos reconocer los síntomas en las fases iniciales. Para poder combatir este hecho es necesario promover una mayor información pública y una mayor formación a los profesionales de la salud. Es necesario avanzar en 3 campos para poder desarrollar una mejor atención en las distintas fases evolutivas de las demencias: considerar la demencia como una prioridad de salud pública, combatir la creencia equívoca de que no se puede hacer nada para los pacientes diagnosticados de demencia y, finalmente, no por ello menos importante, saber reconocer la demencia incipiente. Decir que las personas con demencia reciben con menor frecuencia atención paliativa de confort que aquellos pacientes diagnosticados de cáncer a pesar de compartir, claramente, la necesidad de cuidados en fases avanzadas de la enfermedad y a pesar de ser demandada frecuentemente por familiares y cuidadores. A forma de resumen, decir que podemos actuar y mejorar en el diagnóstico precoz de la enfermedad, de la misma forma que lo podemos hacer en las distintas fases evolutivas de la demencia y, así, poder retardar y/o minimizar la dependencia y, finalmente, mejorar las medidas de confort al final de la enfermedad (AU)

Because dementia is a powerful predictor of dependence, people with this disease are those that live longest with disability. Dementia is the chronic disease provoking the greatest dependence at 12, 24, and 36 months after diagnosis, ahead of other diseases such as stroke, Parkinson's disease and cardiovascular disease. Many of us are aware of the devastating consequences of dementia, but few know how to recognize the symptoms in the initial phases. To rectify this situation, increased public information and training for health professionals is required. To improve the care of the distinct phases of dementia, progress must be made in three areas: dementia must be considered a public health priority, the erroneous belief that nothing can be done for patients with a diagnosis of dementia must be combatted and, finally, no less importantly, knowledge of how to recognize incipient dementia must be acquired. People with dementia less frequently receive palliative care than patients with cancer, despite clearly sharing the need for care in the advances stages of the disease and frequent requests by relatives and carers. In summary, action can be taken to improve the early diagnosis of dementia and the care of the distinct phases of the disease, thus delaying and/or minimizing dependency. Finally, comfort measures at the end stage can be improved (AU)

[What should be done and not done throughout the process of dementia? Dialogue and aid]. / ¿Qué hacer y qué no a lo largo del proceso demencial? Diálogo y ayuda.

Because dementia is a powerful predictor of dependence, people with this disease are those that live longest with disability. Dementia is the chronic disease provoking the greatest dependence at 12, 24, and 36 months after diagnosis, ahead of other diseases such as stroke, Parkinson's disease and cardiovascular disease. Many of us are aware of the devastating consequences of dementia, but few know how to recognize the symptoms in the initial phases. To rectify this situation, increased public information and training for health professionals is required. To improve the care of the distinct phases of dementia, progress must be made in three areas: dementia must be considered a public health priority, the erroneous belief that nothing can be done for patients with a diagnosis of dementia must be combatted and, finally, no less importantly, knowledge of how to recognize incipient dementia must be acquired. People with dementia less frequently receive palliative care than patients with cancer, despite clearly sharing the need for care in the advances stages of the disease and frequent requests by relatives and carers. In summary, action can be taken to improve the early diagnosis of dementia and the care of the distinct phases of the disease, thus delaying and/or minimizing dependency. Finally, comfort measures at the end stage can be improved.