scholarly journals Osteoporosis Care After Hip Fracture: A Regional Healthcare System Experience

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A249-A249
Author(s):  
Ethan Thonn ◽  
Darin Ruanpeng
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Healthcare System ◽  
Primary Care Clinic ◽  
Pharmacologic Treatment ◽  
Osteoporosis Medication ◽  
Care Clinic ◽  
History Of ◽  
Osteoporosis Care

Abstract Background: Pharmacologic treatment is recommended to reduce risk of future fractures and possibly reduce mortality in patients with hip fracture. We investigated osteoporosis care after hip fracture at a regional comprehensive healthcare system to identify rates of pharmacologic treatment after hip fracture and barriers to treatment. Methods: We identified all patients admitted with a low impact hip fracture between 1/2017-12/2018. Follow-up clinical data was collected for a minimum of 16 months after hip fracture. Results: 208 patients were admitted with low impact hip fractures: 130 (62%) were female, mean age was 79.6 (SD 12.6), 24 (12%) were nursing home resident, and 117 (56%) had BMI <25 kg/m2. At the time of the fracture, 80% had polypharmacy, 42% used mobility aide, 24% had known osteoporosis, 22% had dementia/cognitive impairment, 20% has history of cancer, 20% had history of stroke, 19% had diabetes and 2% were on dialysis. Two hundred (96%) underwent surgery. Forty-three (20%) had vitamin D level checked, of this, 20 (46%) had level <30 ng/mL. Prior to admission prescription of vitamin D was 53% and calcium was 36%. Discharge prescription of vitamin D was 64% and calcium was 50%. Prior to fracture, 18/208 (9%) were prescribed osteoporosis medication and at 1 year following fracture, 26/192 (14%) were prescribed osteoporosis medication (11 new, 15 continuation of medication). For follow up, 114/192 (59%) were seen in orthopedics clinic, 61 (32%) in primary care clinic, 2 (1%) in endocrinology clinic and 99 (52%) in other clinics. Sixteen (8%) patients died during the hospitalization for hip fracture and 47 (22%) died within 1 year. Conclusions: Osteoporosis treatment after hip fracture is suboptimal and a model of care is needed to close this care gap.

scholarly journals Screening for Atrial Fibrillation in American Indian Adults in a Tribal Primary Care Clinic

2021 ◽  
Author(s):  
Stavros Stavrakis ◽  
Khaled Elkholey ◽  
Marty M. Lofgren ◽  
Zain U. A. Asad ◽  
Lancer D. Stephens ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
American Indian ◽  
Primary Care Clinic ◽  
Care Physician ◽  
Racial Groups ◽  
Unique Identifier ◽  
Care Clinic ◽  
Time Period ◽  
History Of

Background American Indian adults have a higher risk of atrial fibrillation (AF) compared with other racial groups. We implemented opportunistic screening to detect silent AF in American Indian adults attending a tribal health system using a mobile, single‐lead ECG device. Methods and Results American Indian patients aged ≥50 years followed in a tribal primary care clinic with no history of AF underwent a 30‐second ECG. A cardiologist overread all tracings to confirm the diagnosis of AF. After AF was confirmed, patients were referred to their primary care physician for initiation of anticoagulation. Patients seen over the same time period, who were not undergoing screening, served as controls. A total of 1019 patients received AF screening (mean age, 61.5±8.9 years, 62% women). Age and sex distribution of those screened was similar to the overall clinic population. New AF was diagnosed in 15 of 1019 (1.5%) patients screened versus 4 of 1267 (0.3%) patients who were not screened (mean difference, 1.2%; 95% CI, 0.3%–2.2%, P =0.002). Eight of 15 with new screen‐detected AF were aged <65 years. Those with screen‐detected AF were slightly older and had a higher CHA 2 DS 2 ‐VASc score than those without AF. Fourteen of 15 patients diagnosed with new AF had a CHA 2 DS 2 ‐VASc score ≥1 and initiated anticoagulation. Conclusions Opportunistic, mobile single‐lead ECG screening for AF is feasible in tribal clinics, and detects more AF than usual care, leading to appropriate initiation of anticoagulation. AF develops at a younger age in American Indian adults who would likely benefit from earlier AF screening. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03740477.

Primary Care Patients' Reactions to Mental Health Screening

1996 ◽  
Vol 26 (4) ◽  
pp. 431-441 ◽  
Author(s):  
Mark Zimmerman ◽  
David T. Lush ◽  
Neil J. Farber ◽  
Jon Hartung ◽  
Gary Plescia ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Psychiatric Treatment ◽  
Primary Care Clinic ◽  
Empirical Support ◽  
Medical Patients ◽  
Care Clinic ◽  
History Of ◽  
Primary Care Patients ◽  
High Level

Objective: The authors examined whether there is empirical support for the notion that medical patients are upset by being asked questions about psychiatric disorders. Method: Six hundred and one patients attending a primary care clinic completed the SCREENER—a newly developed, brief self-administered questionnaire that surveys a broad range of psychopathology. In addition, they completed a second questionnaire that assessed their attitudes toward the SCREENER. Results: We found a high level of acceptance by patients. The questions were judged easy to answer, and they rarely aroused significant negative affect. Fewer than 2 percent of the patients judged the questions difficult to answer, and fewer than 3 percent were “very much” embarrassed, upset, annoyed, or uncomfortable with the questions. Individuals with a history of psychiatric treatment and poorer current mental health reacted more unfavorably to the questionnaire. Conclusions: From the patient's perspective, it is feasible and acceptable to use self-administered questionnaires for routine screening of psychiatric problems in primary care settings.

scholarly journals Unusual presentation of vitamin D3-dependent rickets type II in a kitten

2020 ◽  
Vol 6 (1) ◽  
pp. 205511692091027
Author(s):  
Florent Duplan ◽  
Christina Maunder
Keyword(s):  
Vitamin D ◽  
Positive Response ◽  
Abdominal Distension ◽  
Response To Treatment ◽  
Type I ◽  
Type Ii ◽  
Different Types ◽  
History Of ◽  
Radiographic Changes

Case summary A 15-week-old kitten presented with a 1-month history of intermittent generalised tremors and abdominal distension. Hypocalcaemia associated with increased 1,25-vitamin D3 was consistent with vitamin D3-dependent rickets type II. The bone appearance on CT scan was most consistent with the changes typically seen with nutritional secondary hyperparathyroidism and less typical of the changes seen with rickets. Our patient had a positive response to high vitamin D3 therapy as it remained normocalcaemic 16 months after diagnosis, supporting the diagnosis of rickets. Relevance and novel information This case report is an unusual and interesting presentation of rickets in a kitten. Despite the characteristic vitamin D3 disturbance for rickets type II, the atypical radiographic changes have not been previously reported. In the literature, a positive response to treatment is not commonly seen or follow-up is short. Our case responded well to treatment and was followed for 16 months from the time of diagnosis. This emphasises that the pathophysiology of the condition is not well understood, and that different types of vitamin D3-dependent rickets type II may exist. Although the genetic defects responsible for some cases of rickets type I have been identified, this has still not been determined for rickets type II.

scholarly journals Vitamin D Intoxication in An Elderly: A Case Report

2019 ◽  
Vol 3 (4) ◽  
pp. 147-149
Author(s):  
Sahil Singh ◽  
Prernika Mittal ◽  
Ajay Sharma
Keyword(s):  
Vitamin D ◽  
Serum Vitamin ◽  
High Serum ◽  
Intravenous Fluids ◽  
Serum Vitamin D ◽  
Replacement Surgery ◽  
Vitamin D Intoxication ◽  
History Of ◽  
Very High

Vitamin D is a very common prescribed drug for numerous indications. Due to scarce knowledge and poor awareness of the various formulations, preparations and dosages of Vitamin D, there are many chances of prescription errors, medication errors, product use issue and undesirable adverse drug reactions. We hereby detail case of 70-year-old ex-army gentleman reported to us with a history of lethargy, confusion, reduced appetite and gait imbalance since few days with a history of knee replacement surgery 2 years back. Medical history was not of much relevance before it was revealed that he was getting cholecalciferol injection with a strength of 600000 IU once a week for few months. He was detected to have very high serum vitamin D level and hypercalcemia. He was started on intravenous fluids, diuretics and glucocorticoids. In a few days, after effective treatment, the patient was discharged in a recovering stage and advised to stop intake calcium and vitamin D in any form. At his last follow up, after a few months of discharge, he had totally recovered.

Implementation of a brief screening tool to identify needs of cancer survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23075-e23075 ◽  
Author(s):  
Allison L. McDonough ◽  
Yvonne Y. Lei ◽  
Dana Haggett ◽  
Rachel Jimenez ◽  
Katherine T. Johnston ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Primary Care Clinic ◽  
Qualitative Assessment ◽  
Plain Language ◽  
Convenience Sample ◽  
Care Clinic

e23075 Background: Innovation in health care delivery is needed to improve care for cancer survivors. We report a pragmatic study intended to evaluate our experience with adopting screening guidelines from the National Comprehensive Cancer Network (NCCN) to the routine care of breast cancer survivors in primary care and oncology follow up. Methods: We adapted the NCCN recommended screening questions into a plain language self-administered 1 page intake questionnaire. The tool was administered to a convenience sample of female breast cancer survivors in routine follow-up at an oncology or primary care clinic from September through December 2018. Domains included symptoms, lifestyle concerns, and financial issues. Frequency of concerns was assessed as “never”, “rarely”, “sometimes”, “very frequently” and “always”. We dichotomized results and evaluated feasibility of administration, prevalence of reported symptoms and qualitative assessment of burden as well as utility of the tool among participating clinicians. Results: 165 out of 169 patients offered the questionnaire participated (98%). Office staff provided the questionnaire at routine visits without notable impact on clinic flow. Most commonly endorsed concerns (sometimes or more) were: desire to improve fitness or nutrition (80%), worry about cancer recurrence (72%), and problems with sleep (57%). A majority also reported feeling nervous or worried (55%) and aches or pains in limbs or joints (55%). Several issues known to be underreported in clinic visits were endorsed including lack of satisfaction with sexual function (30% sometimes or more, 12% very often or always) and difficulty remembering things (47% sometimes or more, 13% very often or always). Among 7 participating clinicians, the tool was deemed useful and not burdensome. Several noted that it led to discussing issues that may not otherwise have been addressed. Suggestions included systematically identifying resources and strategies to address common issues and incorporating the tool into the electronic health record to increase utility. Conclusions: Screening for individual needs among survivors is feasible and efficient and may identify prevalent issues that otherwise can be missed in routine survivorship care.

377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A150-A150
Author(s):  
Cassandra Godzik ◽  
Adam Sorscher
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Sleep Medicine ◽  
Quality Metrics ◽  
Care Providers ◽  
National Guidelines ◽  
Daytime Functioning ◽  
Care Clinic

Abstract Introduction Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia. Methods We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months. Results Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%). Conclusion Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting. Support (if any) Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553

scholarly journals Injury Prevention Education in the Waiting Room of an Underserved Pediatric Primary Care Clinic

2018 ◽  
Vol 58 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Nikita Habermehl ◽  
Elizabeth Diekroger ◽  
Rina Lazebnik ◽  
Grace Kim
Keyword(s):  
Primary Care ◽  
Injury Prevention ◽  
Primary Care Clinic ◽  
The United States ◽  
Childhood Mortality ◽  
Pediatric Primary Care ◽  
Waiting Room ◽  
Care Clinic ◽  
Prevention Education

Unintentional injuries are the leading cause of childhood mortality in the United States. Study aims included educating families about injury prevention and improving satisfaction with the waiting room experience. Two hundred caregivers with young children in the waiting room of an underserved pediatric primary care clinic participated in brief individual education sessions and received a toolkit containing small safety items and content highlighting age-appropriate safety topics. Participants completed 2 follow-up surveys, and most caregivers (94%) reported learning new information about injury prevention and thought that the intervention resulted in a better waiting room experience (91%). Of those who completed the 2-week follow-up survey (84%), 93.5% made changes at home and 42.7% bought new safety equipment. Injury prevention education can be effectively provided in the waiting room of a pediatric primary care clinic by improving reported caregiver safety knowledge and behaviors as well as satisfaction with the waiting room experience.

Impact of Physician–Pharmacist Covisits at a Primary Care Clinic in Patients With Uncontrolled Diabetes

2018 ◽  
Vol 33 (3) ◽  
pp. 321-325
Author(s):  
Jasmine Peterson ◽  
April Hinds ◽  
Aida Garza ◽  
Jamie Barner ◽  
Lucas Hill ◽  
...  
Keyword(s):  
Care Delivery ◽  
Medication Management ◽  
Primary Care Clinic ◽  
Collaborative Management ◽  
Multicenter Cohort Study ◽  
Care Clinic ◽  
Uncontrolled Diabetes ◽  
Significant Difference ◽  
The Impact

Purpose: A popular method for enhancing medication management within a patient-centered medical home (PCMH) is the physician–pharmacist collaborative management (PPCM) model. To improve efficiency of health-care delivery within 4 federally qualified health centers (FQHCs), the PPCM model was implemented through coordinated physician–pharmacist covisits. Objective: To evaluate the impact of physician–pharmacist covisits on clinical outcomes among patients with uncontrolled diabetes. Methodology: This was a retrospective multicenter cohort study including adults (≥18 years old) with uncontrolled type 1 or type 2 diabetes (hemoglobin A1c [HbA1c] ≥ 8 %) who had at least one covisit between January 1, 2013, and October 1, 2016. The primary clinical metric was mean change in HbA1c from baseline to follow-up. Secondary outcomes included adherence to select American Diabetes Association (ADA) Standards of Medical Care. Results: A total of 106 patients were included in this analysis. Patients who were managed in the PPCM model experienced a significant decrease in mean change in HbA1c from baseline to follow-up (−1.75 [2.63], P < .001). There was no significant difference in the proportion of patients receiving recommended vaccinations or cardiovascular (CV) risk reduction medications. Conclusion: The results suggest that physician–pharmacist covisits may improve glucose control in patients with uncontrolled diabetes.

scholarly journals Prognostic Relevance of Circulating 25OHD Fractions for Early Recovery and Survival in Patients with Hip Fracture †

2018 ◽  
Vol 7 (8) ◽  
pp. 193 ◽  
Author(s):  
Erzsébet Toldy ◽  
Antal Salamon ◽  
Bernadette Kálmán ◽  
Katalin Ágota ◽  
Dániel Horváth ◽  
...  
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Mortality Rate ◽  
Predictive Factors ◽  
Functional Performance ◽  
Serum Levels ◽  
Early Recovery ◽  
Serum 25Ohd ◽  
History Of ◽  
Active Controls

The relation between vitamin-D (VD) status and healing after hip fracture had not been sufficiently addressed. Currently serum total 25-hydroxy-VD (t-25OHD) is the most widely used indicator of VD status. It is unclear whether free or bioavailable VD are better markers of 25OHD availability for tissues. Validity of overall cut-off values of t-25OHD is limited. Objectives: (1) Assess serum levels of circulating forms of 25OHD in patients with hip fracture (PwHF: N = 199) compared to active controls without history of fracture (N = 102); (2) determine relationship between 25OHD fractions and functional performance after surgery (FPAS) and survival. The t-25OHD; VD binding protein and albumin levels were measured. Comorbidities; lifestyle; FPAS and survival were recorded at seven months. VD deficiency occurred more frequently in PwHF than in controls (72% vs. 38%). Patients with better FPAS showed higher 25OHD in all fractions than with poor FPAS. Controlled by lifestyle; 25OHD levels were independent predictive factors (p < 0.001). Good FPAS values forecasted longer survival (OR: 6.5CI:3.2–13.3; p < 0.0001). All 25OHD forms showed a tendency to predict survival. Mortality rate decreased to 8% in individuals with t-25OHD levels of >22.6–39.5 nmol/L and increased to 14% with >40 nmol/L. These observations highlight the importance of serum 25OHD assessment and moderate VD substitution for healing and survival.

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