Classification system for primary care provider eConsults about medications for older adults with frailty.

BACKGROUND: Providing primary care for people with frailty can be challenging due to an increased risk of adverse outcomes and use of potentially inappropriate medications which may exacerbate characteristics of frailty. eConsult is a service where primary care providers can receive timely specialist advice for their patients through a secure web-based application. We aimed to develop a classification system to characterize medication-focused eConsult questions for older adults with frailty and assess its usability. METHODS: A classification system was developed and refined over three cycles of improvement through a cross-sectional study of 35 cases categorized as medication-focused from cases submitted in 2019 for patients aged 65 or older with frailty through the Champlain BASE eConsult service (Ontario, Canada). The final classification system was then applied to each case. RESULTS: The classification system contains 5 sections: (1) case descriptives; (2) intent and type of question; (3) medication recommendations and additional information in the response; (4) medication classification; and (5) potentially inappropriate medications. Among the 35 medication-focused cases, the most common specialties consulted were endocrinology (9 cases, 26%) and cardiology (5 cases, 14%). Medication histories were available for 29 cases (83%). Many patients were prescribed potentially inappropriate medications based on explicit tools (AGS Beers Criteria®, STOPPFall, Anticholinergic Cognitive Burden Scale, ThinkCascades) yet few consults inquired about these medications. CONCLUSION: A classification system to describe medication-related eConsult cases for patients experiencing frailty was developed and applied to 35 eConsult cases. It can be applied to more cases to identify professional development opportunities and enhancements for eConsult services.

Exercise affects protein utilization in healthy children.

Although health initiatives promote increased physical activity in children, the physiologic outcomes have not been well characterized. This investigation examined the effects of programmed aerobic exercise on protein metabolism in children (n = 7; mean +/- SEM: 9.14 +/- 0.46 y old; weight, 32.1 +/- 1.6 kg; height, 138 +/- 2.5 cm; and body mass index, 16.21 +/- 0.36 kg/m(2) ) using (15)N-glycine methodology. Boys (n = 5) and girls (n = 2) walked (5 d/wk, 3.2-6.4 km/d) for 6 wk. Criterion measures taken at baseline (Pre) and after the exercise program (Post) included anthropometric data, dietary assessment, nitrogen balance, nitrogen flux (Q), protein synthesis (PS), protein breakdown (PB) and net protein balance [(Net) = PS - PB]. After the walking program, there were no significant changes in body weight, fat-free mass or percentage of body fat, whereas height increased (P < 0.01). Energy and protein intakes were constant throughout the study. Nitrogen balance was significantly more positive Post than Pre (P < 0.05). There was a significant decrease in Q (P < 0.0001) with corresponding decreases in PS (P < 0.001) and PB (P < 0.01). These data provide the first evidence that programmed aerobic exercise alters whole-body protein utilization in healthy, nonobese children. Longitudinal studies are required to further examine changes in protein metabolism associated with increased physical activity in this population. In addition, findings suggest a need to evaluate nutrient requirements for healthy, physically active boys and girls.