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Laird C, Williams KA, Benson H. Perceptions and practices of aged care pharmacists regarding osteoporosis management: a qualitative study. Int J Clin Pharm 2023; 45:913-921. [PMID: 37162657 PMCID: PMC10366014 DOI: 10.1007/s11096-023-01586-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/25/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Osteoporosis is a common but sub-optimally managed disease among aged care residents. Although pharmacists are one of the key healthcare providers responsible for osteoporosis medication management there is limited research on their involvement. AIM This study explored the perceptions and practices of Australian pharmacists regarding osteoporosis management for aged care residents. METHOD Semi-structured interviews were conducted with aged care pharmacists. Interviews were recorded, transcribed, and analysed using a constructivist grounded theory approach. RESULTS Twenty-one aged care pharmacists were interviewed. Three main themes were identified: osteoporosis is highly prevalent but given low priority, factors affecting pharmacists' management of osteoporosis, and optimism for the future role of pharmacists in osteoporosis management. The complexity of aged care residents' healthcare needs and the silent, insidious nature of osteoporosis contribute to the low priority it is afforded. Barriers identified by pharmacists included their current practice model, limited access to residents' medical histories and difficulties accessing bone mineral density (BMD) testing. Interdisciplinary collaboration and education regarding osteoporosis management were seen as facilitators. Pharmacists were optimistic that an embedded practice model would improve their capacity to influence osteoporosis management. CONCLUSION The high prevalence and low priority of osteoporosis in the aged care setting presents pharmacists with an opportunity to improve medication management and reduce fracture risk. Barriers to osteoporosis management identified by pharmacists can be addressed by interdisciplinary collaboration and education. Pharmacists being embedded in aged care could enable more opportunities to contribute to the interdisciplinary team and become champions of osteoporosis management.
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Affiliation(s)
- Catherine Laird
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Kylie A Williams
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
| | - Helen Benson
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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MAHDAVIAZAD HAMIDEH, KESHTKAR VAHID, EMAMI MOHAMMADJAFAR, KARGARSHOUROKI ZEINAB, VOSOUGHI AMIRREZA. Osteoporosis guideline awareness among Iranian nurses: results of a knowledge and attitudes survey. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E415-E420. [PMID: 34604582 PMCID: PMC8451363 DOI: 10.15167/2421-4248/jpmh2021.62.2.1738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
Introduction Osteoporosis is a chronic and progressive disease associated with gradual bone loss and elevated risk of fracture. Role of health care professional especially nurses in lowering burden of osteoporosis via patients and public education is critical. Current study conducted to evaluate knowledge and attitude regarding osteoporosis among the nurses in orthopedic wards and their experience with national clinical osteoporosis guideline. Methods A cross-sectional study was conducted from August to December 2016 among all nurses in orthopedic ward of hospitals affiliated to Shiraz University of Medical Sciences. The 23- item self-administered scale consisted of knowledge and attitude questions were used. Moreover, data regarding participation in osteoporosis training courses and awareness of the national osteoporosis clinical guideline were collected as a measure of nurses’ experience with guideline. The gathered data were analyzed using SPSS (V. 16), student t-test was used to compare total knowledge and attitude scores between categorical demographic and professional data. Pearson test was used to calculate the correlation between total knowledge and attitude scores and years of practice. A p-value < 0.05 was considered statistically significant. Results From total of 160 nurses, 143 of them completed the questionnaire (response rate: 89.3%). The total mean ± SD knowledge and attitude scores were 11.60 ± 3.10 and 3.47 ± 0.92 respectively. Six nurses (4.2%) had participated in osteoporosis training courses after graduation, and 39 (27.3%) had been aware of the national osteoporosis clinical guideline. Knowledge and attitude scores among nurses who practice in private hospitals was higher than those practices in the teaching hospitals. These differences were statistically significant based on student t-test. According to Pearson correlation coefficient, there was positive and significant correlation between nurses’ knowledge and attitude score (Correlation coefficient: 0.199, p-value = 0.037). Conclusion Our findings reveal that nurses’ knowledge and attitude regarding osteoporosis was not satisfactory. Most of them were not aware of national osteoporosis clinical guideline and had not participated in osteoporosis training courses after their graduation. We need more empowered nurses to lowering burden of osteoporosis and its consequences in the future.
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Affiliation(s)
- HAMIDEH MAHDAVIAZAD
- Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Hamideh Mahdaviazad, Assistant Professor of Community and Preventive Medicine, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, 7193634154 Shiraz, Iran - Tel.: +98-711-32302830 - Fax: +98-711-32302830 - E-mail: /
| | - VAHID KESHTKAR
- Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MOHAMMAD JAFAR EMAMI
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - ZEINAB KARGARSHOUROKI
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - AMIR REZA VOSOUGHI
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kang DW, Wang SM, Um YH, Na HR, Kim NY, Han K, Lee CU, Lim HK. Differential Risk of Incident Fractures Depending on Intensity and Frequency of Physical Activity According to Cognitive Status: A Nationwide Longitudinal Study. Front Med (Lausanne) 2020; 7:572466. [PMID: 33364244 PMCID: PMC7753209 DOI: 10.3389/fmed.2020.572466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Previous studies have demonstrated an increased risk of fractures in subjects with various degrees of cognitive impairments. Recently, there has been growing recognition of the vital effect of physical activity (PA) on delay and prevention of fractures in older adults. Objectives: This study aimed to evaluate the optimal intensity and frequency of PA needed to prevent fractures in cognitively preserved older adults (CP), participants with subjective cognitive decline (SCD), and dementia patients using a large-scale nationwide cohort study. Methods: Data from a nationwide health screening program for individuals at the transitional age of 66 years were used in this study. A total of 968,240 subjects was enrolled, followed from 2007 to 2014, and classified as CP (n = 759,874), SCD (n = 195,365), or dementia group (n = 13,001). Adjusted hazard ratios (aHRs) by demographic and known risk factors for fractures were evaluated to identify the impact of various frequency and intensity PA on the occurrence of hip, vertebral, and limb fractures. Results: In CP participants, the most noticeable reduction of hip and vertebral fracture risk was shown in those performing vigorous-intensity PA at least three times per week. In the SCD group, the risk decrement in hip and vertebral fractures was most prominent in subjects who performed multiple-intensity PAs at least three times a week regardless of intensity. In the dementia group, only high-frequency walking and high-frequency & multiple-intensity PA decreased the risk of hip fractures compared with absence of PA. Conclusion: These findings suggest a role for various PA intensity and frequency levels to prevent hip and vertebral fractures according to cognitive status. Further study is needed to validate the effects of PA intensity and frequency proposed in this study on fractures according to cognitive status.
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Affiliation(s)
- Dong Woo Kang
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sheng-Min Wang
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yoo Hyun Um
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Hae-Ran Na
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Nak-Young Kim
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Chang Uk Lee
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Kook Lim
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Papaioannou A, Ioannidis G, McArthur C, Hillier LM, Feldman S, Giangregorio L, Jaglal S, Jain R, Van der Horst ML, Adachi J. Preventing Fractures in Long-Term Care: Translating Recommendations to Clinical Practice. J Am Med Dir Assoc 2020; 22:36-42. [PMID: 32800745 DOI: 10.1016/j.jamda.2020.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
The Ontario Osteoporosis Strategy for long-term care (LTC) aims to support fracture risk-reduction. LTC specific recommendations for fracture prevention were developed in 2015. This article describes the use of the Knowledge-to Action framework to guide the development and application of research evidence on fracture prevention in older adults. Knowledge translation activities highlighted fractures as a significant source of morbidity in LTC, significant gaps in fracture risk assessment and treatment, and barriers and facilitators to guideline implementation. Multifaceted knowledge translation strategies, targeting staff in LTC homes in Ontario, Canada to support fracture guideline implementation have included education, audit and feedback, team-based action planning, and engagement of LTC residents, their families, and health professionals. Provincial administrative databases were accessed to monitor fracture rates between 2005 and 2015. Our research has identified enablers and barriers to knowledge use such as limited knowledge of osteoporosis, fracture risk, and prevention. Province-wide over a 10-year period, hip fracture rates in LTC decreased from 2.3% to 1.9%, and any fracture rates decreased from 4% to 3.6%. This body of work suggests that multifaceted knowledge translation initiatives are feasible to implement in LTC and can improve the uptake of clinical recommendations for fracture prevention. A key aspect of our fracture prevention knowledge translation activities has been the full engagement of key stakeholders to assist in the co-development and design of knowledge translation products.
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Affiliation(s)
- Alexandra Papaioannou
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada.
| | - George Ioannidis
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada
| | - Caitlin McArthur
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada
| | | | - Sid Feldman
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; Baycrest Health Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Lora Giangregorio
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; University of Waterloo, Waterloo, Ontario, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Susan Jaglal
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Ravi Jain
- Osteoporosis Canada, Toronto, Ontario, Canada
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Applying vibration in early postmenopausal osteoporosis promotes osteogenic differentiation of bone marrow-derived mesenchymal stem cells and suppresses postmenopausal osteoporosis progression. Biosci Rep 2019; 39:BSR20191011. [PMID: 31406012 PMCID: PMC6722487 DOI: 10.1042/bsr20191011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/29/2019] [Accepted: 08/08/2019] [Indexed: 02/05/2023] Open
Abstract
We aimed to evaluate whether applying low magnitude vibration (LMV) in early postmenopausal osteoporosis (PMO) suppresses its progression, and to investigate underlying mechanisms. Rats were randomly divided into Sham (Sham-operated), Sham+V, OVX (ovariectomized), OVX+E2 (estradiol benzoate), OVX+V (LMV at 12–20 weeks postoperatively), and OVX+Vi (LMV at 1–20 weeks postoperatively) groups. LMV was applied for 20 min once daily for 5 days weekly. V rats were loaded with LMV at 12–20 weeks postoperatively. Vi rats were loaded with LMV at 1–20 weeks postoperatively. Estradiol (E2) rats were intramuscularly injected at 12–20 weeks postoperatively once daily for 3 days. The bone mineral densities (BMDs), biomechanical properties, and histomorphological parameters of tibiae were analyzed. In vitro, rat bone marrow-derived mesenchymal stem cells (rBMSCs) were subjected to LMV for 30 min daily for 5 days, or 17β-E2 with or without 1-day pretreatment of estrogen receptor (ER) inhibitor ICI 182,780 (ICI). The mRNA and protein expresion were performed. Data showed that LMV increased BMD, bone strength, and bone mass of rats, and the effects of Vi were stronger than those of E2. In vitro, LMV up-regulated the mRNA and protein expressions of Runx2, Osx, Col I, and OCN and down-regulated PPARγ, compared with E2. The effects of both LMV and E2 on rBMSCs were inhibited by ICI. Altogether, LMV in early PMO suppresses its progression, which is associated with osteogenic differentiation of rBMSCs via up-regulation of ERα and activation of the canonical Wnt pathway. LMV may therefore be superior to E2 for the suppression of PMO progression.
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Senderovich H, Tang H, Belmont S. The Role of Exercises in Osteoporotic Fracture Prevention and Current Care Gaps. Where Are We Now? Recent Updates. Rambam Maimonides Med J 2017; 8:RMMJ.10308. [PMID: 28786812 PMCID: PMC5548111 DOI: 10.5041/rmmj.10308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The primary non-pharmacological management recommended for patients with osteoporosis (OP) is exercise, but whether it should be high-force, resistive, or other means can be obscure. OBJECTIVE To describe the role of exercises in osteoporotic fracture prevention, identify effects and potential risks of high-force exercises, detect the optimal exercises to combat OP, and explore the challenges that might arise from interventions. METHODS A search on MEDLINE and Cochrane databases was conducted on the role of exercises in preventing osteoporotic fractures from 1989 onwards, leading to 40 results, including op-ed pieces, qualitative studies, randomized clinical trials (RCTs) (n=5), and RCT follow-up studies (n=1). Articles deemed relevant to the objectives were analyzed and summarized. Data on effects of vitamin D and calcium supplementation were later gathered from different sources as well. RESULTS High-intensity, resistive strength training provided the maximum benefit in increasing bone mineral density (BMD) levels, muscle mass, and reduction in fractures, while posture and balance exercises only improved mobility. High-force exercises did not increase fractures and were associated with increases in BMD. Interventions including exercises, vitamin D, and calcium intake had limited effect when used as single interventions, while vitamin D and calcium may potentially cause increases of cardiovascular events. CONCLUSION A long-term regular exercise program designed to improve postural stability, mobility, and mechanical efficiency, alongside an increased vitamin D and dietary calcium intake, is most effective in preventing OP and reducing osteoporotic fractures.
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Affiliation(s)
- Helen Senderovich
- Geriatrics & Palliative Care & Pain Medicine, Baycrest Health Sciences, Assistant Professor, University of Toronto, Department of Family and Community Medicine, Division of Palliative Care, Toronto, Canada
- To whom correspondence should be addressed. E-mail:
| | - Henry Tang
- Baycrest Health Sciences, Toronto, Canada
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Kennedy CC, Ioannidis G, Thabane L, Adachi JD, O’Donnell D, Giangregorio LM, Pickard LE, Papaioannou A. Osteoporosis prescribing in long-term care: impact of a provincial knowledge translation strategy. Can J Aging 2015; 34:137-48. [PMID: 25850439 PMCID: PMC5104546 DOI: 10.1017/s0714980815000057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study described prescribing trends before and after implementing a provincial strategy aimed at improving osteoporosis and fracture prevention in Ontario long-term care (LTC) homes. Data were obtained from a pharmacy provider for 10 LTC homes in 2007 and 166 homes in 2012. We used weighted, multiple linear regression analyses to examine facility-level changes in vitamin D, calcium, and osteoporosis medication prescribing rates between 2007 and 2012. After five years, the estimated increase in vitamin D, calcium, and osteoporosis medication prescribing rates, respectively, was 38.2 per cent (95% confidence interval [CI]: 29.0, 47.3; p < .001), 4.0 per cent (95% CI: -3.9, 12.0; p = .318), and 0.2 per cent (95% CI: -3.3, 3.7; p = .91). Although the study could not assess causality, findings suggest that wide-scale knowledge translation activities successfully improved vitamin D prescribing rates, although ongoing efforts are needed to target homes with low uptake.
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Affiliation(s)
- Courtney C. Kennedy
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - George Ioannidis
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University
- St Joseph’s Healthcare – Hamilton
| | - Jonathan D. Adachi
- Department of Medicine, McMaster University
- St Joseph’s Healthcare – Hamilton
- Alliance for Better Bone Health Chair in Rheumatology
| | | | | | - Laura E. Pickard
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
- Eli Lilly Canada Chair in Osteoporosis
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Kennedy CC, Ioannidis G, Thabane L, Adachi JD, Marr S, Giangregorio LM, Morin SN, Crilly RG, Josse RG, Lohfeld L, Pickard LE, van der Horst ML, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A. Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Trials 2015; 16:214. [PMID: 25962885 PMCID: PMC4431601 DOI: 10.1186/s13063-015-0720-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/13/2015] [Indexed: 01/02/2023] Open
Abstract
Background Few studies have systematically examined whether knowledge translation (KT) strategies can be successfully implemented within the long-term care (LTC) setting. In this study, we examined the effectiveness of a multifaceted, interdisciplinary KT intervention for improving the prescribing of vitamin D, calcium and osteoporosis medications over 12-months. Methods We conducted a pilot, cluster randomized controlled trial in 40 LTC homes (21 control; 19 intervention) in Ontario, Canada. LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider. Participants were interdisciplinary care teams (physicians, nurses, consultant pharmacists, and other staff) who met quarterly. Intervention homes participated in three educational meetings over 12 months, including a standardized presentation led by expert opinion leaders, action planning for quality improvement, and audit and feedback review. Control homes did not receive any additional intervention. Resident-level prescribing and clinical outcomes were collected from the pharmacy database; data collectors and analysts were blinded. In addition to feasibility measures, study outcomes were the proportion of residents taking vitamin D (≥800 IU/daily; primary), calcium ≥500 mg/day and osteoporosis medications (high-risk residents) over 12 months. Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes. Results At baseline, 5,478 residents, mean age 84.4 (standard deviation (SD) 10.9), 71% female, resided in 40 LTC homes, mean size = 137 beds (SD 76.7). In the intention-to-treat analysis (21 control; 19 intervention clusters), the intervention resulted in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D (odds ratio (OR) 1.82, 95% confidence interval (CI): 1.12, 2.96) and calcium (OR 1.33, 95% CI: 1.01, 1.74), but not for osteoporosis medications (OR 1.17, 95% CI: 0.91, 1.51). In secondary analyses, excluding seven nonparticipating intervention homes, ORs were 3.06 (95% CI: 2.18, 4.29), 1.57 (95% CI: 1.12, 2.21), 1.20 (95% CI: 0.90, 1.60) for vitamin D, calcium and osteoporosis medications, respectively. Conclusions Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement. Trial Registration ClinicalTrials.gov: NCT01398527. Registered: 19 July 2011.
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Affiliation(s)
- Courtney C Kennedy
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - George Ioannidis
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Lehana Thabane
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Jonathan D Adachi
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Sharon Marr
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Lora M Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Suzanne N Morin
- McGill University, 845Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada.
| | - Richard G Crilly
- Western University, Parkwood Hospital, 801 Commissioners Road East, London, ON, N6C 5 J1, Canada.
| | - Robert G Josse
- University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Lynne Lohfeld
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Laura E Pickard
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | | | - Glenda Campbell
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Jackie Stroud
- Medical Pharmacies Group Limited, 590 Granite Crt, Pickering, ON, L1W 3X6, Canada.
| | - Lisa Dolovich
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Anna M Sawka
- University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Ravi Jain
- Osteoporosis Canada, Suite 301, 1090 Don Mills Road, Toronto, ON, M3C 3R6, Canada.
| | - Lynn Nash
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Alexandra Papaioannou
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Division of Geriatrics, Department of Medicine, McMaster University, Geriatric Education and Research in Aging Sciences (GERAS) Centre, St. Peter's Hospital, Room 151, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada.
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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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Santini D, Bertoldo F, Dell'Aquila E, Cecchini I, Fregosi S, Bortolussi P. The Italian cross-sectional survey of the management of bone metastasis: ZeTa study. J Bone Oncol 2012; 1:35-9. [PMID: 26909253 PMCID: PMC4723326 DOI: 10.1016/j.jbo.2012.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 04/26/2012] [Accepted: 04/28/2012] [Indexed: 11/04/2022] Open
Abstract
Background Several studies have emphasized the importance of the maintenance of bone health in a comprehensive cancer care. However, no survey about approach to bone metastasis care is currently available. The ZeTa study provides a picture of the Italian oncologists' therapeutics habits in this area, in a real clinical-practice scenario. Design This study was based on online questionnaire-based interviews to Italian oncologists that included 145 questions. The aim was to collect information on the treatment of bone metastasis, the current use of bisphosphonates, the awareness of guidelines and the concerns about ONJ, the use of vitamin D supplementation. Results 445 oncologists were contacted, 283 agreed to participate. The results show that the current management of bone metastasis is still sub-optimal, as the recommendations from current clinical guidelines are not completely followed by all specialists. Conclusions This survey highlights the urgent need to improve management of bone metastasis in cancer patients.
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Affiliation(s)
- Daniele Santini
- Oncologia Medica, University Campus Biomedico, Roma, Rome, Italy
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11
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Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD, Thabane L, Morin SN, Crilly RG, Marr S, Josse RG, Lohfeld L, Pickard LE, King S, van der Horst ML, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A. An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Implement Sci 2012; 7:48. [PMID: 22624776 PMCID: PMC3533817 DOI: 10.1186/1748-5908-7-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/24/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes. METHODS AND DESIGN The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel. DISCUSSION Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
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Affiliation(s)
- Courtney C Kennedy
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - George Ioannidis
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lora M Giangregorio
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Suzanne N Morin
- Department of Medicine, Division of General Internal Medicine, MUHC-Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Richard G Crilly
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Parkwood Hospital, 801 Commissioners Rd. East, London, Ontario, N6C 5J1, Canada
| | - Sharon Marr
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Robert G Josse
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lynne Lohfeld
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Laura E Pickard
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Susanne King
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Mary-Lou van der Horst
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Glenda Campbell
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Jackie Stroud
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Anna M Sawka
- Department of Medicine, Division of Endocrinology and Metabolism, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 1090 Don Mills Road, Suite 301, Toronto, Ontario, M3C 3R6, Canada
| | - Lynn Nash
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
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