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Konishi T, Sasabuchi Y, Matsui H, Tanabe M, Seto Y, Yasunaga H. Long-Term Risk of Being Bedridden in Elderly Patients Who Underwent Oncologic Surgery: A Retrospective Study Using a Japanese Claims Database. Ann Surg Oncol 2023; 30:4604-4612. [PMID: 37149549 PMCID: PMC10319666 DOI: 10.1245/s10434-023-13566-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Although functional outcomes are important in surgery for elderly patients, the long-term functional prognosis following oncologic surgery is unclear. We retrospectively investigated the long-term, functional and survival prognosis following major oncologic surgery according to age among elderly patients. METHODS We used a Japanese administrative database to identify 11,896 patients aged ≥ 65 years who underwent major oncological surgery between June 2014 and February 2019. We investigated the association between age at surgery and the postoperative incidence of bedridden status and mortality. Using the Fine-Gray model and restricted cubic spline functions, we conducted a multivariable, survival analysis with adjustments for patient background characteristics and treatment courses to estimate hazard ratios for the outcomes. RESULTS During a median follow-up of 588 (interquartile range, 267-997) days, 657 patients (5.5%) became bedridden and 1540 (13%) died. Patients aged ≥ 70 years had a significantly higher incidence of being bedridden than those aged 65-69 years; the subdistribution hazard ratios of the age groups of 70-74, 75-79, 80-84, and ≥ 85 years were 3.20 (95% confidence interval [CI], 1.53-6.71), 3.86 (95% CI 1.89-7.89), 6.26 (95% CI 3.06-12.8), and 8.60 (95% CI 4.19-17.7), respectively. Restricted cubic spline analysis demonstrated an increase in the incidence of bedridden status in patients aged ≥ 65 years, whereas mortality increased in patients aged ≥ 75 years. CONCLUSIONS This large-scale, observational study revealed that older age at oncological surgery was associated with poorer functional outcomes and higher mortality among patients aged ≥ 65 years.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Harman H, Walton TJ, Chan G, Stott P, Ricketts DM, Rogers BA. Predicting 30-day mortality after hip fracture: the G4A calibrated prognostic tool. Hip Int 2022; 32:820-825. [PMID: 33755498 DOI: 10.1177/1120700021998959] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Proximal femoral fracture is common with a high mortality (7% mortality at 30 days). Accurate determination of mortality risk allows better consenting, clinical management and expectation management. Our study aim was to develop a prognostic tool to predict 30-day mortality after proximal femoral fracture, among patients treated within a dedicated hip fracture unit. MATERIALS AND METHODS We collected data from our hospital concerning 2210 patients with 2287 proximal femoral fractures. The clinical parameters of 97 patients who died within 30 days of surgery were analysed. We used logistic regression to determine if the parameters' relationship with 30-day mortality was statistically significant or not. The statistically significant parameters were used to create a prognostic model for predicting 30-day mortality. RESULTS The 5 independent predictors of 30-day mortality were gender, age, admission source, preoperative Abbreviated Mental Test Score (AMTS) and American Society of Anesthesiologists Score (ASA). The highest risk was for males >85 years, admitted from institutional care, with low preoperative mental test score and high ASA grade. Using these predictors, we formulated the G4A score. The Hosmer-Lemeshow 'goodness of fit' test showed good concordance between observed and predicted mortality rates. CONCLUSIONS We recommend the use of the G4A score to predict 30-day mortality after surgery for proximal femoral fracture, particularly within dedicated hip fracture units. Further research is needed to establish whether the findings of this study are applicable on a national scale.
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Affiliation(s)
- Holly Harman
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Thomas J Walton
- Trauma and Orthopaedic Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Gareth Chan
- Trauma and Orthopaedic Department, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Philip Stott
- Trauma and Orthopaedic Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David M Ricketts
- Trauma and Orthopaedic Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Benedict A Rogers
- Trauma and Orthopaedic Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Lin W, Tian X, Lu X, Ma D, Wu Y, Hong J, Yan R, Feng G, Cheng Z. Prediction of Bedridden Duration of Hospitalized Patients by Machine Learning Based on EMRs at Admission. Comput Inform Nurs 2021; 40:251-257. [PMID: 34723871 DOI: 10.1097/cin.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Being bedridden is a frequent comorbid condition that leads to a series of complications in clinical practice. The present study aimed to predict bedridden duration of hospitalized patients based on EMR at admission by machine learning. The medical data of 4345 hospitalized patients who were bedridden for at least 24 hours after admission were retrospectively collected. After preprocessing of the data, features for modeling were selected by support vector machine recursive feature elimination. Thereafter, logistic regression, support vector machine, and extreme gradient boosting algorithms were adopted to predict the bedridden duration. The feasibility and efficacy of above models were evaluated by performance indicators. Our results demonstrated that the most important features related to bedridden duration were Charlson Comorbidity Index, age, bedridden duration before admission, mobility capability, and perceptual ability. The extreme gradient boosting algorithm showed the best performance (accuracy, 0.797; area under the curve, 0.841) when compared with support vector machine (accuracy, 0.771; area under the curve, 0.803) and logistic regression (accuracy, 0.765; area under the curve, 0.809) algorithms. Meanwhile, the extreme gradient boosting algorithm had a higher sensitivity (0.856), specificity (0.650), and F1 score (0.858) than that of support vector machine algorithm (0.843, 0.589, and 0.841) and logistic regression (0.852, 0.545, and 0.839), respectively. These findings indicate that machine learning based on EMRs at admission is a feasible avenue to predict the bedridden duration. The extreme gradient boosting algorithm shows great potential for further clinical application.
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Affiliation(s)
- Weijie Lin
- Author Affiliations: College of Information Science & Electronic Engineering (Messrs Lin, Lu, and Ma and Dr Cheng), Department of Neurology, Second Affiliated Hospital, School of Medicine (Ms Tian), and Department of Surgery, Zhejiang University Hospital (Ms Wu), and Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine (Mr Hong and Drs Yan and Feng), Zhejiang University, Hangzhou, China
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Goopy S, Suva C, Hayden KA, Silversides H, Palova K. Activities and programmes that support the emotional wellness and well-being of refugees, immigrants and other newcomers within settlement agencies: a scoping review protocol. BMJ Open 2020; 10:e033377. [PMID: 32938589 PMCID: PMC7497533 DOI: 10.1136/bmjopen-2019-033377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Obstacles to successful settlement-social isolation, language hardship, issues with employment, housing questions, transportation, barriers to health, education and government service access-all potentially play a role in emerging physical and mental health problems. The objective of this scoping review is to map the available evidence in order to provide an overview of the services and resources offered to refugees, immigrants and other newcomers by settlement agencies to support emotional wellness and well-being. METHODS AND ANALYSIS The protocol to be followed for this scoping review is based on the Joanna Briggs Institute to provide a map of the current and emergent literature, and examine the extent, range and nature of this literature. The proposed scoping review will also identify the gaps in research pertaining to the emotional wellness of refugees, immigrants and other newcomers as well as summarise and disseminate research findings and provide direction for future reviews. Key databases for this scoping review include APA PsycINFO, Medline, Embase, Cumulative Index of Nursing and Allied Health Literature Plus, Academic Search Complete, and Education Research Complete. The database search start and end dates for this scoping review will be from inception to July 2020. The article searches will take place between August and October 2020. ETHICS AND DISSEMINATION Ethics is not required as the research will not involve human or animal subjects. The research is a scoping review, and thus relies on published and grey literature studies and documents. The findings of this proposed scoping review will be disseminated through future publications as well as presentations to relevant stakeholders, including immigrant serving agencies. We anticipate that this scoping review will identify gaps in research pertaining to the emotional wellness of refugees, immigrants and other newcomers. The results of this review will be the first comprehensive recent survey of emotional wellness practices employed by settlement agencies.
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Affiliation(s)
- Suzanne Goopy
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Cesar Suva
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Research and Program Development, The Immigrant Education Society, Calgary, Alberta, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | | | - Katerina Palova
- Research and Program Development, The Immigrant Education Society, Calgary, Alberta, Canada
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What is a reasonable rate for specific osteoporosis drug therapy in older fragility fracture patients? Arch Osteoporos 2020; 15:20. [PMID: 32088765 DOI: 10.1007/s11657-020-0690-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Osteoporosis is the most common condition contributing to 95% of fractures in older patients hospitalized for fracture treatment. Despite the significant impact of fragility fractures on patient morbidity and mortality, efforts in optimizing osteoporotic treatment and prevention remain inadequate. In contrast, in patients with limited life expectancy, withholding specific osteoporosis drug treatment appears reasonable. The threshold between under- and overtreatment is still unclear. METHODS In 2016, we implemented a fracture liaison service (FLS) for 18 months to improve the quality of osteoporosis care. We collected prospectively the patient's history, current treatment for osteoporosis, and risk factors for fragility fractures using a standardized protocol. Recommendations for drug therapy are discussed during the interdisciplinary ward round. The primary outcome parameter was a recommendation for specific osteoporosis drug treatment. We included 681 patients (mean age 82.5 years, 502 (73.7%) females). The inclusion criteria were the following: age of 70 years or older, admission to geriatric fracture center between April 2016 and December 2018. RESULTS Based on our data, specific osteoporosis drug therapy was recommended in 467 (68.6%) patients. Six hundred fifty-one (95.6%) patients received vitamin D3, and 546 (80.2%) calcium. After adjustment, only age (every 5 years, OR 0.57; 95% CI 0.45-0.72; p < 0.0001), cognitive impairment (OR 0.41; 95% CI 0.23-0.74; p = 0.003), pre-fracture mobility (OR 1.54; 95% CI 1.34-1.75; p < 0.0001), and living in a nursing home (OR 0.52; 95% CI 0.27-0.99; p = 0.049) remained as independent predictors for an indication of specific osteoporosis drug therapy. CONCLUSION We found a higher rate of recommendations for specific osteoporosis drug therapy compared with usual treatment rates in literature. Though in some cases withholding of specific osteoporosis drug therapy seems reasonable, the main proportion of fragility fracture patients is undertreated. Our results could be a benchmark for the quality of osteoporosis care in older fragility fracture patients treated in a geriatric fracture center.
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Dovjak P, Föger-Samwald U, Konrad M, Bichler B, Pietschmann P. Secondary confounders of osteoporotic hip fractures in patients admitted to a geriatric acute care department. Z Gerontol Geriatr 2014; 48:633-40. [PMID: 25421255 DOI: 10.1007/s00391-014-0821-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 08/27/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND With respect to the pathogenesis of osteoporosis, primary and secondary forms of the disease can be distinguished. It has been recognized that the incidence of primary and secondary osteoporosis differs in women and men. OBJECTIVE The aim of the present study was to assess the incidence and gender distribution of factors contributing to osteoporosis in older hip fracture patients. METHODS In this cross-sectional study 404 patients with hip fractures and controls referred to an acute geriatric care department over a period of 15 months were included. The medical history was recorded and blood samples were analyzed for routine laboratory parameters. RESULTS A total of 249 patients with hip fractures and 155 matched controls were studied. The Tinetti test and the Barthel index were found to show highly significant differences in both groups mainly because of the postoperative state of patients with fractures. Vitamin D deficiency was found in 94.1% of male fracture patients and 94.6% of female fracture patients. On average 2.4 secondary contributors of osteoporosis were present in male fracture patients versus 2.9 in male controls and 2.3 in female fracture patients versus 2.3 in female controls. For most parameters no significant gender differences of possible secondary contributors to osteoporosis were found. Secondary osteoporosis was diagnosed in all male fracture patients and in 56.2% of all female fracture patients. CONCLUSION Based on the findings of this study it is recommended that hip fracture patients should be assessed for secondary contributors of osteoporosis. Although the overall distribution of secondary contributors was similar in women and men, the prevalence of secondary osteoporosis was higher in men.
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Affiliation(s)
- Peter Dovjak
- Department of Geriatric Acute Care, Salzkammergut-Klinikum Gmunden, Miller von Aichholzstraße 49, 4810, Gmunden, Austria.
| | - Ursula Föger-Samwald
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Spitalsgasse 23, 1090, Vienna, Austria
| | - Maarit Konrad
- Department of Geriatric Acute Care, Salzkammergut-Klinikum Gmunden, Miller von Aichholzstraße 49, 4810, Gmunden, Austria
| | - Bernhard Bichler
- Department of Geriatric Acute Care, Salzkammergut-Klinikum Gmunden, Miller von Aichholzstraße 49, 4810, Gmunden, Austria
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Spitalsgasse 23, 1090, Vienna, Austria
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Abstract
As musculoskeletal disorders are a common cause of emergency department visits in the United States, it is vital for nurses and nurse practitioners to understand the decision rules for ordering imaging tests when triaging patients with musculoskeletal complaints. Proper knowledge and command of selecting the most appropriate imaging for these frequent emergency department presentations will help reduce costs, decrease ionizing radiation exposure, and increase patient throughput. This article reviews the current evidence-based literature for musculoskeletal imaging in the emergency department and discusses the epidemiology, etiology, management, and prevention of the most common musculoskeletal disorders.
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Branco K, Crane J. Religiousness, Coping Styles, and Situational Optimism Among Nursing Home Residents. JOURNAL OF RELIGION, SPIRITUALITY & AGING 2014. [DOI: 10.1080/15528030.2013.807485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wall M, Lohfeld L, Giangregorio L, Ioannidis G, Kennedy CC, Moser A, Papaioannou A, Morin SN. Fracture risk assessment in long-term care: a survey of long-term care physicians. BMC Geriatr 2013; 13:109. [PMID: 24138565 PMCID: PMC3853074 DOI: 10.1186/1471-2318-13-109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/19/2013] [Indexed: 11/21/2022] Open
Abstract
Background The majority of frail elderly who live in long-term care (LTC) are not treated for osteoporosis despite their high risk for fragility fractures. Clinical Practice Guidelines for the diagnosis and management of osteoporosis provide guidance for the management of individuals 50 years and older at risk for fractures, however, they cannot benefit LTC residents if physicians perceive barriers to their application. Our objectives are to explore current practices to fracture risk assessment by LTC physicians and describe barriers to applying the recently published Osteoporosis Canada practice guidelines for fracture assessment and prevention in LTC. Methods A cross-sectional survey was conducted with the Ontario Long-Term Care Physicians Association using an online questionnaire. The survey included questions that addressed members’ attitudes, knowledge, and behaviour with respect to fracture risk assessment in LTC. Closed-ended responses were analyzed using descriptive statistics and thematic framework analysis for open-ended responses. Results We contacted 347 LTC physicians; 25% submitted completed surveys (81% men, mean age 60 (Standard Deviation [SD] 11) years, average 32 [SD 11] years in practice). Of the surveyed physicians, 87% considered prevention of fragility fractures to be important, but a minority (34%) reported using validated fracture risk assessment tools, while 33% did not use any. Clinical risk factors recommended by the OC guidelines for assessing fracture risk considered applicable included; glucocorticoid use (99%), fall history (93%), age (92%), and fracture history (91%). Recommended clinical measurements considered applicable included: weight (84%), thyroid-stimulating hormone (78%) and creatinine (73%) measurements, height (61%), and Get-Up-and-Go test (60%). Perceived barriers to assessing fracture risk included difficulty acquiring necessary information, lack of access to tests (bone mineral density, x-rays) or obtaining medical history; resource constraints, and a sentiment that assessing fracture risk is futile in this population because of short life expectancy and polypharmacy. Conclusion Perceived barriers to fracture risk assessment and osteoporosis management in LTC have not changed recently, contributing in part to the ongoing care gap in osteoporosis management. Our findings highlight the importance to adapt guidelines to be applicable to the LTC environment, and to develop partnerships with stakeholders to facilitate their use in clinical practice.
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Affiliation(s)
- Michelle Wall
- McGill University Health Center Research Institute, Montreal, Canada.
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Khong TP, de Vries F, Goldenberg JSB, Klungel OH, Robinson NJ, Ibáñez L, Petri H. Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States. Calcif Tissue Int 2012; 91:24-31. [PMID: 22566242 PMCID: PMC3382650 DOI: 10.1007/s00223-012-9603-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
Benzodiazepine use increases the risk of falls and has been associated with an increased risk of hip fractures. Our aim was to estimate the possible population impact of the use of benzodiazepines on the rate of hip fracture in France, Germany, Italy, Spain, the United Kingdom, and the United States. We conducted a literature review to estimate the pooled relative risk (RR) for hip fractures and use of benzodiazepines. Prevalence rates of benzodiazepine use in 2009 were calculated for each country using the IMS MIDAS database and three public databases in Denmark, the Netherlands, and Norway. Both the RR and prevalence rates were used for calculation of population attributable risks (PARs) of hip fractures associated with benzodiazepine use. The literature review showed an increased risk of hip fractures in benzodiazepine users (RR = 1.4, 95 % CI 1.2-1.6). Rate of benzodiazepine use showed considerable differences between countries, ranging from 4.7 % to 22.3 % of population ever in a 1-year period. These are reflected in results for the PARs; estimated attributions of benzodiazepines to the rate of hip fractures were 1.8 %, 95 % CI 1.1-2.6 (Germany); 2.0 %, 95 % CI 1.2-2.8 (United Kingdom); 5.2 %, 95 % CI 3.2-7.3 (Italy); 7.4 %, 95 % CI 4.5-10.0 (France); 8.0 %, 95 % CI 4.9-11.0 (United States); and 8.2 %, 95 % CI 5.1-12.0 (Spain). PAR estimates suggest that the potential attribution of benzodiazepine use on the population rate of hip fractures in the five specified European countries and the United States varies between 1.8 % and 8.2 %. During the next phase of the IMI-PROTECT study, a comparison with individual patient data will show whether this approach is valid.
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Affiliation(s)
- T. P. Khong
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands
- Epidemiology and Patient Reported Outcomes, Roche Products Limited, Shire Park, 6 Falcon Way, Welwyn Garden City, AL7 1TW UK
| | - F. de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J. S. B. Goldenberg
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands
- Epidemiology and Patient Reported Outcomes, Roche Products Limited, Shire Park, 6 Falcon Way, Welwyn Garden City, AL7 1TW UK
| | - O. H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands
| | - N. J. Robinson
- Epidemiology and Patient Reported Outcomes, Hoffman-La Roche, Building 663, Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Luisa Ibáñez
- Department of Pharmacology, Therapeutics and Toxicology, Foundation of the Catalan Institute of Pharmacology (FICF), Autonomous University of Barcelona, Barcelona, Spain
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - H. Petri
- Epidemiology and Patient Reported Outcomes, Roche Products Limited, Shire Park, 6 Falcon Way, Welwyn Garden City, AL7 1TW UK
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Greenspan S, Nace D, Perera S, Ferchak M, Fiorito G, Medich D, Zukowski K, Adams D, Lee C, Saul M, Resnick N. Lessons learned from an osteoporosis clinical trial in frail long-term care residents. Clin Trials 2011; 9:247-56. [PMID: 22157987 DOI: 10.1177/1740774511430516] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although osteoporosis affects women of all ages, the impact is most pronounced in frail residents in long-term care. Nevertheless, few interventional trials have been performed in this population, and few data on therapeutic alternatives are available in this cohort. PURPOSE We describe the challenges and lessons learned in developing and carrying out a trial in frail long-term-care residents. METHODS The Zoledronic acid in frail Elders to STrengthen bone (ZEST) study was designed to examine the safety and efficacy of a single-dose therapy for osteoporosis in frail residents in long-term care in the Pittsburgh area. Women with osteoporosis who were 65 years of age and older and currently not on therapy were randomized in a blinded fashion to intravenous zoledronic acid or placebo. Follow-up of each participant was planned for 2 years. All participants received appropriate calcium and vitamin D supplementation. RESULTS Seven hundred and thirty-three contacts were made with long-term care residents of nine participating facilities. Of 252 women screened, 181 were eligible, enrolled, and randomized. Multiple barriers to research in long-term-care facilities were encountered but overcome with direct communication, information sessions, in-service trainings, and social events. Lessons learned included designing the study in a manner that avoided placing an additional burden on an already overcommitted facility staff, a two-stage consent process to separate screening from randomization, and a flexible examination schedule to accommodate residents while obtaining the necessary outcome measurements. Furthermore, a mobile unit accessible to participants containing state-of-the-art dual x-ray absorptiometry (DXA), assessment for vertebral fractures, and phlebotomy equipment allows all assessments to be performed on-site at each facility. Serious adverse events are collected from affiliated hospitals in real time with a novel electronic surveillance system. LIMITATIONS The major limitation is selection of outcomes that can be assessed at participating facilities and do not require transport of participants to hospitals or clinics. CONCLUSIONS Clinical research for osteoporosis can be successfully and safely performed with frail residents in long-term care facilities. Lessons learned from this study may inform future investigations among frail elderly residents of these facilities.
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Affiliation(s)
- Sl Greenspan
- Division of Endocrinology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Biver E, Borg S, Chopin F, Hoppé E, Morel G, Cortet B. Male osteoporosis: Who should be treated and how? Joint Bone Spine 2011; 78 Suppl 2:S202-7. [DOI: 10.1016/s1297-319x(11)70005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fisher A, Martin J, Srikusalanukul W, Davis M. Bisphosphonate use and hip fracture epidemiology: ecologic proof from the contrary. Clin Interv Aging 2010; 5:355-62. [PMID: 21228901 PMCID: PMC3010171 DOI: 10.2147/cia.s13909] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Indexed: 11/23/2022] Open
Abstract
AIM The objective of this article is to evaluate the relationship between the changes in prescriptions of antiosteoporotic drugs (mainly the rapid fall in the use of bisphosphonates [BPs]) and standardized hip fracture (HF) rates over the period 2005-2008 in the Australian Capital Territory (ACT). METHODS Annual sex- and age-specific HF rates (per 100,000 population) were determined and standardized using the Australian 2006 population census. Data on the annual prescriptions of BPs (mainly alendronate and risedronate), strontium ranelate, and hormone replacement therapy were obtained from the Australian Pharmaceutical Benefits Scheme (PBS) and Repatriation Australian Pharmaceutical Benefits Scheme (RPBS) databases. RESULTS In the ACT, the peak annual number of prescriptions for BPs was observed in 2006. Following reports linking osteonecrosis of the jaw with BP use, the number of BP prescriptions dropped by 14% in 2007-2008 compared with 2005, when the lowest HF rates were recorded. The reduction in BP prescriptions coincided with increased HF rates in females in 2007 (+22.6%) and in 2008 (+25.2%) compared with 2005; in males, HF incidence declined by 6.6% and 16.7%, respectively. The proportion of filled prescriptions for strontium ranelate, risedronate, and alendronate in 2007-2008 was 1:8.4:15.5, indicating that BPs were the dominant antiosteoporotic drugs. There was an inverse statistically significant relationship between the total annual number of BP prescriptions and standardized HF incidence rates for the 10-year period 1999-2008. CONCLUSION Although currently there is no clear understanding of factors contributing to changing HF epidemiology, the available evidence suggests that much of the decline in HF rates is due to the use of BPs. The fall in the use of BPs is associated with an increase in HF rates in females, indicating that BPs should still be considered the first-line medications for the prevention and treatment of osteoporosis. Our results need to be confirmed in other populations and countries.
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Affiliation(s)
- Alex Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
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Lau AN, Ioannidis G, Potts Y, Giangregorio LM, Van der Horst ML, Adachi JD, Papaioannou A. What are the beliefs, attitudes and practices of front-line staff in long-term care (LTC) facilities related to osteoporosis awareness, management and fracture prevention? BMC Geriatr 2010; 10:73. [PMID: 20929589 PMCID: PMC2958961 DOI: 10.1186/1471-2318-10-73] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 10/08/2010] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Compared to the general elderly population, those institutionalized in LTC facilities have the highest prevalence of osteoporosis and subsequently have higher incidences of vertebral and hip fractures. The goal of this study is to determine how well nurses at LTC facilities are educated to properly administer bisphosphonates. A secondary question assessed was the nurse's and PSW's attitudes and beliefs regarding the role and benefits of vitamin D for LTC patients. METHODS Eight LTC facilities in Hamilton were surveyed, and all nurses were offered a survey. A total 57 registered nurses were surveyed. A 21 item questionnaire was developed to assess existing management practices and specific osteoporosis knowledge areas. RESULTS The questionnaire assessed the nurse's and personal support worker's (PSWs) education on how to properly administer bisphosphonates by having them select all applicable responses from a list of options. These options included administering the drug before, after or with meals, given with or separate from other medications, given with juice, given with or without water, given with the patient sitting up, or finally given with the patient supine. Only 52% of the nurses and 8.7% of PSWs administered the drug properly, where they selected the options: (given before meals, given with water, given separate from all other medications, and given in a sitting up position). If at least one incorrect option was selected, then it was scored as an inappropriate administration. Bisphosphonates were given before meals by 85% of nurses, given with water by 90%, given separately from other medication by 71%, and was administered in an upright position by 79%. Only 52% of the nurses and 8.7% of PSWs surveyed were administering the drug properly. Regarding the secondary question, of the 57 nurses surveyed, 68% strongly felt their patients should be prescribed vitamin D supplements. Of the 124 PSWs who completed the survey, 44.4% strongly felt their patients should be prescribed vitamin D supplementation. CONCLUSION Bisphosphonates are quite effective in increasing the bone mineral density of LTC patients, and may reduce fracture rates, but it is only effective if properly administered. In our study, proper administration of bisphosphonate therapy was less than optimal. In summary, although the education of health providers has improved since the mid-1990's, this area still requires further attention and the subject of future quality assurance research.
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Affiliation(s)
- Arthur N Lau
- Division of Rheumatology and Department of Medicine, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada
| | - George Ioannidis
- Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yelena Potts
- St Joseph's Healthcare, Hamilton, Ontario, Canada
| | | | - Mary-Lou Van der Horst
- Division of Geriatrics and Department of Medicine, Hamilton Health Science and McMaster University, Hamilton, Ontario, CIHR -Eli Lilly Chair Osteoporosis and Fracture Prevention, Canada
| | - Jonathan D Adachi
- Division of Rheumatology and Department of Medicine, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Division of Geriatrics and Department of Medicine, Hamilton Health Science and McMaster University, Hamilton, Ontario, CIHR -Eli Lilly Chair Osteoporosis and Fracture Prevention, Canada
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Crilly RG, Tanner DA, Kloseck M, Chesworth BM. Hip fractures in long-term care: is the excess explained by the age and gender distribution of the residents? J Aging Res 2010; 2010:291258. [PMID: 21152198 PMCID: PMC2989715 DOI: 10.4061/2010/291258] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 05/30/2010] [Accepted: 06/21/2010] [Indexed: 11/21/2022] Open
Abstract
Introduction. This study compares hip fracture rates in Long Term Care (LTC) residents with those in the community to determine if their high rate of fracturing reflects the extreme age and predominantly female nature of that population. Methods. Hospital discharge data in London Ontario (population 350,000) and Statistics Canada data were used to correct the hip fracture rate in the LTC setting for age and gender. Results. The risk of hip fracture is 1.8 times greater in LTC than in the community for people of similar age and gender. The rate in women is 1.5 times higher whereas in men it is 4.3 times higher. In the oldest residents, the risk in men exceeds that of women in LTC. Conclusion. The high hip fracture rate in LTC is not just a reflection of the age and predominantly female nature of this population. The oldest men in LTC are a particularly high risk group, deserving more attention.
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Affiliation(s)
- Richard G. Crilly
- Division of Geriatric Medicine, Parkwood Hospital, 801 Commissioners Road East, London, ON, Canada N6C 5J1
| | - David A. Tanner
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada N6A 5B9
| | - Marita Kloseck
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada N6A 5B9
| | - Bert M. Chesworth
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada N6A 5B9
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Ranhoff A, Solheim L. Omfattende bruddskader etter kramper. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:2012. [DOI: 10.4045/tidsskr.10.0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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