scholarly journals Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance

2021 ◽  
Author(s):  
G. Hampson ◽  
M. Stone ◽  
J. R. Lindsay ◽  
R. K. Crowley ◽  
S. H. Ralston
Keyword(s):  
Clinical Care ◽  
Fragility Fractures ◽  
Osteoporosis Treatment ◽  
Healthcare Services ◽  
Urgent Care ◽  
Health Concern ◽  
Care Pathways ◽  
Long Term Conditions ◽  
Treatment Pathways ◽  
Diagnosis And Management

AbstractIt is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.

scholarly journals ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2—care pathways, treatment, and follow-up

2021 ◽  
Author(s):  
◽  
Colin Baigent ◽  
Stephan Windecker ◽  
Daniele Andreini ◽  
Elena Arbelo ◽  
...  
Keyword(s):  
Practical Knowledge ◽  
Current Knowledge ◽  
Healthcare Providers ◽  
Care Pathways ◽  
The Novel ◽  
Treatment Pathways ◽  
Diagnosis And Management ◽  
Narrative Literature ◽  
Narrative Literature Review ◽  
Cv Disease

Abstract Aims Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. Methods and results A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. Conclusion This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.

Priming Primary Care Physicians to Treat Osteoporosis After a Fragility Fracture: An Integrated Multidisciplinary Approach

2013 ◽  
Vol 40 (5) ◽  
pp. 703-711 ◽  
Author(s):  
Sophie Roux ◽  
Michèle Beaulieu ◽  
Marie-Claude Beaulieu ◽  
François Cabana ◽  
Gilles Boire
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Fragility Fractures ◽  
Osteoporosis Treatment ◽  
Care Gap ◽  
Intention To Treat ◽  
Frequency Of Contact ◽  
Male Sex

Objective.To evaluate 2 incremental levels of intervention designed to increase initiation of osteoporosis treatment by primary care physicians (PCP) following fragility fractures (FF).Methods.Women and men over age 50 years were screened for incident FF in fracture clinics, and eligible outpatients were randomly assigned to standard care (SC) or to either minimal (MIN) or intensive (INT) interventions. The MIN and INT interventions were intended to educate and motivate both patients and PCP, but differed in their frequency of contact and information content. Delivery of osteoporosis medication was confirmed with pharmacists. Treatment rates were analyzed using an intention-to-treat approach.Results.At inclusion, 74.3% of 881 outpatients with FF were untreated. Followup at 12 months was completed in 92.3% of patients. Up to 90% of patients treated at inclusion remained treated at 12 months. Among patients who initially were untreated, 18.8% in the SC group, 40.4% in the MIN, and 53.2% in the INT groups were treated at 12 months. Change in treatment rates (adjusted for age and initial treatment) increased significantly after both MIN and INT. Only the INT intervention significantly increased treatment rates in patients with previous fractures. Negative predictors of change in treatment status included non-major FF, age younger than 65 years, and male sex.Conclusion.Both interventions significantly increased initiation of osteoporosis treatment. Our multidisciplinary intervention builds on existing first-line structures and uses minimal specialized resources. Iterative and systematic interventions in the context of clinical care may modify the approach of PCP to osteoporosis management after FF and narrow the care gap in the long term.

The Pharmacist's Role in Developing Diabetes Clinical Care Pathways and Diabetes Patient-Focused Care Plans

1997 ◽  
Vol 10 (6) ◽  
pp. 374-378
Author(s):  
Jodie J. Cardenas
Keyword(s):  
Clinical Practice ◽  
Chronic Disease ◽  
Clinical Care ◽  
Cost Effective ◽  
Healthcare Services ◽  
Diabetes Patient ◽  
Care Pathways ◽  
Management Tools ◽  
Healthcare Market ◽  
Care Plans

Diabetes is a serious, chronic disease affecting an estimated 16 million Americans with total costs in excess of $92 billion a year. A changing healthcare market is creating demand for coordinated, standardized methods of optimizing both outcomes and resource utilization. Diabetes clinical care pathways (DCCPs) and diabetes patient-focused care plans (DPFCPs) are valuable management tools used to coordinate the delivery of clinically appropriate, cost-effective, interdisciplinary diabetes healthcare services. This article identifies the characteristics of DCCPs and DPFCPs, and describes the pharmacist's role in their development and use in clinical practice.

scholarly journals Innovative Strategies to Facilitate Patient-Centered Research in Multiple Chronic Conditions

2021 ◽  
Vol 10 (10) ◽  
pp. 2112
Author(s):  
Tullika Garg ◽  
Courtney A. Polenick ◽  
Nancy Schoenborn ◽  
Jane Jih ◽  
Alexandra Hajduk ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Clinical Care ◽  
Intervention Development ◽  
Healthcare Services ◽  
Multiple Chronic Conditions ◽  
Patient Centered ◽  
Older Americans ◽  
Innovative Strategies ◽  
Department Of Health ◽  
Innovative Methods

Multiple chronic conditions (MCC) are one of today’s most pressing healthcare concerns, affecting 25% of all Americans and 75% of older Americans. Clinical care for individuals with MCC is often complex, condition-centric, and poorly coordinated across multiple specialties and healthcare services. There is an urgent need for innovative patient-centered research and intervention development to address the unique needs of the growing population of individuals with MCC. In this commentary, we describe innovative methods and strategies to conduct patient-centered MCC research guided by the goals and objectives in the Department of Health and Human Services MCC Strategic Framework. We describe methods to (1) increase the external validity of trials for individuals with MCC; (2) study MCC epidemiology; (3) engage clinicians, communities, and patients into MCC research; and (4) address health equity to eliminate disparities.

Dresdener Network Osteoporosis

2020 ◽  
Author(s):  
Tim Fülling ◽  
Philipp Bula ◽  
Alexander Defèr ◽  
Felix Alois Bonnaire
Keyword(s):  
Health Care ◽  
Secondary Prevention ◽  
Health Care Systems ◽  
Trauma Surgery ◽  
Specific Treatment ◽  
Fragility Fractures ◽  
Osteoporosis Treatment ◽  
Prevention Programs ◽  
Global Scale ◽  
Limited Mobility

Abstract Purpose On a global scale the main focus of traumatological therapy lies in the treatment of unintentional injuries or victims of violence. People of all ages and through all economic groups can be affected. Due to demographic change in Western industrial countries, however, this focus increasingly shifts towards fragility fractures. In Europe osteoporosis is the most common bone disease in advanced age. Secondary prevention programs like the Fracture Liaison Service (FLS) are becoming increasingly prevalent, especially in Anglo-American health care systems. In German orthopedic and trauma wards and hospitals, however, the FLS is still relatively uncommon. This article will examine the question whether secondary prevention programs like FLS need to be established in the German health care system. This study aims at finding out, whether in the area of a medium sized German city there is a difference regarding the initiation of osteoporosis diagnosis and therapy between the regular aftercare by the general practitioner or the orthopedic surgeon and the aftercare by a specialist trained in osteology (Osteologe). Materials and Methods For the open, randomized prospective study 70 patients with low energy fractures were recruited, who were older than 60 years and have been treated in our department. Results 58 out of 70 patients have completed the study, which amounts to a follow-up of 82.9%. Limited mobility and a high degree of organizational effort were the main reasons for early termination of the study. While in the group with regular aftercare, only 2 out of 29 patients received a specific osteoporosis treatment, in group who were directly transferred to a specialist trained in osteology 17 out of 29 patients received specific treatment. After re-evaluation of group with regular aftercare in 21 out of 29 cases a specific osteoporosis treatment was recommended. Conclusions It could be established that there is a significant diagnosis and treatment gap regarding the aftercare of patients with fractures caused by osteoporosis between general practitioners or orthopedic surgeons on the one hand and the specialists trained in osteology on the other hand. To improve the aftercare of fracture patients, cross sectoral networks with a background in geriatrics and orthopedic-trauma surgery like a FLS need to be established in the German healthcare system.

Abstract 047: Using Geospatial Data To Eliminate Disparities In Covid-19 Testing

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Gregory W Heath ◽  
Tim Moreland ◽  
Shannon Stephenson ◽  
Jesse A Houser ◽  
Colleen Schmitt
Keyword(s):  
Community Health Centers ◽  
Effective Means ◽  
Age Distribution ◽  
Healthcare Services ◽  
Health Concern ◽  
Behavioral Risk ◽  
Local Health ◽  
Social Vulnerability Index ◽  
First Case ◽  
Black Residents

Introduction: The first case of COVID-19 in Chattanooga/Hamilton County, Tennessee (CHC) was identified on March 13, 2020. By early April, 51 RT-PCR confirmed cases were identified, with white, non-Hispanic males and females representing 82% (41/51) of positive cases and remaining cases representing black residents (18%; 9/51). That few people from racial/ethnic minorities were being tested became a key public health concern. We hypothesized that local mapping of health-related data would identify regions where individuals at greater risk for COVID-19 live and work and have limited access to testing and healthcare services. Methods: The CDC 500 Cities data was used to generate layered maps of prevalence estimates for cardiovascular disease, type 2 diabetes mellitus, chronic lung disease, and the behavioral risk factors of physical inactivity and obesity. Layers also included the CDC Social Vulnerability Index, age distribution, gender, race, ethnicity, and zip codes. Maps were shared with intersectoral collaborators representing the black and Hispanic/Latinx communities who provided specific neighborhood information to the maps. Collaborators included hospital systems, the local health department, community health centers, the private sector, and non-profit organizations. Maps were used to identify geographic sites for mobile and strategic testing within communities at higher risk for the spread of the coronavirus. Specific diverse neighborhoods along with worksites were then provided with testing beginning in early May and ongoing. Results: Strategic and mobile testing beginning in early May increased three-fold the number of identified new cases of COVID-19. Seventy percent (652/932) of these positive tests were among ethnically Hispanic/Latinx and 16% (149/932) among black residents. Positive tests continued to increase at a greater rate among Hispanic/Latinx and black residents compared with white residents through the months of May-July (68/10K vs. 2.6/10K, OR = 4.85, 95% CI 2.66, 9.02). Conclusions: This example of inter-sectoral collaboration, data sharing, and data use through strategic mapping of vulnerable populations for COVID-19 was an effective means to enhance COVID-19 testing and identification of positive cases throughout CHC. This expanded partnering resulting in targeted testing may be a useful approach among similar communities and subsequent outbreaks.

Prescribing practice: an overview of the principles

2021 ◽  
Vol 30 (17) ◽  
pp. 1016-1022
Author(s):  
Aby Mitchell ◽  
Reuben Pearce
Keyword(s):  
Hospital Admissions ◽  
Healthcare Services ◽  
Valuable Resource ◽  
Long Term Conditions ◽  
Legal Principles ◽  
Nurse Prescribing ◽  
Prescribing Practice ◽  
Hospital Stays

Nurse prescribing has become a well-established aspect of advanced clinical practice working alongside key NHS principles and drivers to address the increasing complexities in patient care and the demands on the health service. Prescribing practice is governed by ethical and legal principles to ensure a holistic patient-centred approach. It has been recognised as a valuable resource that could effectively transform healthcare services to reduce hospital admissions and long hospital stays and improve the quality of life for patients with long-term conditions and multiple comorbidities. This article will provide an overview of prescribing practice.

scholarly journals Step by step development of clinical care pathways for older cancer patients: Necessary or desirable?

2007 ◽  
Vol 43 (15) ◽  
pp. 2170-2178 ◽  
Author(s):  
Maruscha de Vries ◽  
Julia C.M. van Weert ◽  
Jesse Jansen ◽  
Valery E.P.P. Lemmens ◽  
Huub A.A.M. Maas
Keyword(s):  
Cancer Patients ◽  
Clinical Care ◽  
Care Pathways ◽  
Older Cancer Patients

scholarly journals Why did the children stop coming? Reasons for paediatric emergency department attendance decrease during the first wave of the COVID-19 pandemic in the United Kingdom: A qualitative study

2021 ◽  
Author(s):  
Matthew Breckons ◽  
Sophie Thorne ◽  
Rebecca Walsh ◽  
Sunil Bhopal ◽  
Stephen Owens ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
United Kingdom ◽  
Substantial Reduction ◽  
Healthcare Services ◽  
Urgent Care ◽  
List Type ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Health Messaging

AbstractObjectiveTo explore parent’s experiences and views relating to their use of children’s emergency healthcare services during the Covid-19 pandemic.DesignQualitative telephone interview study using in-depth interviews, based on the principles of grounded theory. Recorded, transcribed verbatim, managed in NVivo version 12, analysed by thematic analysis.SettingNorth East England, United Kingdom.ParticipantsParents of children aged 0-8 years.FindingsThree major themes emerged from the interview data: Risk to children and families, Sources of Information, and Making Healthcare-seeking Decisions. These themes encompassed a range of intellectual and emotional responses in the way that parents interpreted information related to Covid-19, and their sense of responsibility towards family and wider society.ConclusionsTogether these themes aid understanding of the changes in paediatric emergency department attendances reported in the early months of the Covid-19 pandemic in the UK. The analysis suggests that public health messaging directed at those seeking urgent care for children may be inadequate and lead to adverse consequences, the impacts of which require further study and refinement.What is known about the subjectFollowing lockdown, there was a substantial reduction in the number of children taken to unscheduled medical care across the countryDelays in presentation can impact on children’s healthIt is not known what parents’ views are on accessing emergency health services in a pandemic situationWhat this study addsParents had to weigh up a number of information sources before deciding on whether to take their child to hospitalPublic health messaging directed at those seeking urgent care for children may lead to a reduction in use of emergency healthcare servicesFuture lockdowns should implement focussed strategies, optimising use of emergency healthcare services, whilst avoiding harm.

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