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Jassal S.K.,Primary Care Service | Jassal S.K.,University of California at San Diego | Wassel C.L.,University of Pittsburgh | Laughlin G.A.,University of California at San Diego | And 3 more authors.
Journal of Renal Nutrition | Year: 2015

Objectives: To determine whether a previously developed and externally validated equation using common variables (demographics and weight) that are important determinants of muscle mass to estimate 24-hour urine creatinine excretion rate (eCER) is associated with muscle mass and whether spot urine creatinine (UCr) provides similar estimates of muscle mass. Design: Observational cross-sectional cohort study. Setting: The Rancho Bernardo Study, San Diego, California. Subjects: A total of 1,371 Caucasian, middle class, community-dwelling older adults. Intervention: Morning spot UCr and fat-free mass (FFM) by dual-energy x-ray absorptiometry were measured. eCER was calculated: eCER (mg/day)=879.89+12.51 × weight (kilogram) - 6.19 × age+34.51 if black - 379.42 if female. Pearson correlation coefficients and linear regression were used to determine strengths of association of eCER and spot UCr with FFM. Results: Mean age was 70years, and 58% were women. eCER was strongly correlated with FFM (. r=0.95, P<.001), a correlation that was superior to that of spot UCr (. r=0.40, P<.001). Conclusions: An equation incorporating age, weight, sex, and race to estimate eCER is highly correlated with FFM in community-dwelling older persons and provides a more precise estimate than spot UCr. A simple screening tool for sarcopenia in older persons may allow interventions to maintain or improve muscle mass. Future studies should evaluate whether eCER predicts sarcopenia-related frailty and mortality in older persons. © 2015 . Source

Hudelson P.,University of Geneva | Dao M.D.,Primary Care Service | Perneger T.,University of Geneva | Durieux-Paillard S.,University of Geneva
PLoS ONE | Year: 2014

Background: International migration poses important challenges to European health care systems. The development of ''migrant friendly hospitals'' has been identified as a priority in both Europe and Switzerland.Methods: A multi-pronged initiative was developed at Geneva University Hospitals (HUG) to improve staff knowledge and use of existing ''migrant friendly'' resources. A self-administered questionnaire was sent pre and post-intervention to random samples of 4 major professional groups with direct patient contact at the HUG. The questionnaire assessed staff knowledge, attitudes and reported practices regarding the care of migrant patients.Results: Overall response rate was 51% (N = 1460) in 2010 but only 19% (N = 761) in 2013 owing to an institutionally imposed change in survey method. Despite these difficulties, and after adjusting for sample differences, we found that respondents in 2013 were significantly more likely to have received training in how to organize an appointment with an interpreter, how to work with an interpreter and about health and social services available for migrant patients. Respondents were also significantly more likely to have used several Migrant Friendly structures at the HUG. Use of, preference for and perceived skill at working with professional interpreters all improved, and respondents were both more likely to be encouraged by their supervisors to use professional interpreters, and less likely to be encouraged to look for alternative solutions for communicating with non francophone patients. Finally, 2013 respondents encountered fewer difficulties caring for migrant patients, although lack of time and language barriers continued to be the most important sources of difficulty.Conclusion: Our results suggest that an institution-wide information campaign may contribute to increased awareness and use of migrant friendly resources by clinical staff. Hospital commitment and financing, along with inter-departmental participation in all activities were important in creating and maintaining project visibility, and in contributing to a migrant friendly institutional culture. ©2014 Hudelson et al. Source

Naranjo A.,University of Las Palmas de Gran Canaria | Ojeda-Bruno S.,University of Las Palmas de Gran Canaria | Bilbao-Cantarero A.,University of Las Palmas de Gran Canaria | Quevedo-Abeledo J.C.,University of Las Palmas de Gran Canaria | And 2 more authors.
Osteoporosis International | Year: 2015

Summary: A fracture liaison service in Spain is able to maintain 73 % of the patients on antiresorptive 2 years after the fracture. Introduction: The purpose of this study was to evaluate the 2-year effectiveness of a program for the secondary prevention of fractures. Methods: Fragility fractures in patients over 50 attending the emergency room in our centre are captured by the recruitment system of a secondary prevention program. The unit is attended by a nurse, coordinated by two rheumatologists and with the collaboration of primary care consisted of a training program and annual meetings. The outcome of the program was analysed 2 years after implementation, including: (1) percentage of attendees/eligible; (2) percentage of attendees who start treatment with antiresorptive; (3) percentage of patients who retain treatment after 6, 12, 18 and 24 months; and (4) factors associated to adherence. Results: After 2 years of implementation, the program detected 1674 patients with fracture, of whom 759 finally entered the program (57 % of eligible). After 3 months, 82 % of patients prescribed an antiresorptive started treatment. After a year, 52 % of the patients in the program, 72 % of those of a prescribed treatment, were taking antiresorptives. Adherence at 24 months among those who had prescribed anti-fracture drugs was 73 %. Factors associated with adherence at 12 months were female sex (76 vs 45 %; p = 0.01) and previous treatment with antiresorptive (86 vs 68 %; p = 0.02). Conclusions: In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology seems effective in terms of recruitment of patients and adherence to treatment in the mid/long-term. © 2015, International Osteoporosis Foundation and National Osteoporosis Foundation. Source

Beste L.A.,Primary Care Service | Beste L.A.,Health Services Research and Development | Beste L.A.,University of Washington | Harp B.K.,Health Services Research and Development | And 6 more authors.
Digestive Diseases and Sciences | Year: 2015

Background: Two-thirds of patients with cirrhosis do not receive guideline-concordant liver care. Cirrhosis patients are less likely to receive recommended care when followed exclusively by primary care providers (PCPs), as opposed to specialty co-management. Little is known about how to optimize cirrhosis care delivered by PCPs. Aims: We conducted a qualitative analysis to explore PCPs’ attitudes and self-reported roles in caring for patients with cirrhosis. Methods: We recruited PCPs from seven Veterans Affairs facilities in the Pacific Northwest via in-service trainings and direct email from March to October 2012 (n = 24). Trained staff administered structured telephone interviews covering: (1) general attitudes; (2) roles and practices; and (3) barriers and facilitators to cirrhosis management. Two trained, independent coders reviewed each interview transcript and thematically coded responses. Results: Three overarching themes emerged in PCPs’ perceptions of cirrhosis patients: the often overwhelming complexity of comorbid medical, psychiatric, and substance issues; the importance of patient self-management; and challenges surrounding specialty care involvement and co-management of cirrhosis. While PCPs felt they brought important skills to bear, such as empathy and care coordination, they strongly preferred to defer major cirrhosis management decisions to specialists. The most commonly reported barriers to care included patient behaviors, access issues, and conflicts with specialists. Conclusions: PCPs perceive Veterans with cirrhosis as having significant medical and psychosocial challenges. PCPs tend not to see their role as directing cirrhosis-related management decisions. Educational efforts directed at PCPs must foster PCP empowerment and improve comfort with managing cirrhosis. © 2015, Springer Science+Business Media New York (Outside the USA). Source

Lazzari A.A.,Primary Care Service | Lazzari A.A.,Boston University | Lazzari A.A.,Harvard University | Dussault P.M.,Pharmacy Services | And 6 more authors.
Epilepsia | Year: 2013

Purpose To evaluate whether use of a bisphosphonate (risedronate) in addition to calcium and vitamin D in male veterans with epilepsy who were taking antiepileptic drugs (AEDs) long term can prevent the loss of bone mass (BMD, bone mineral density) associated with AED use compared to patients who were treated with a placebo plus calcium and vitamin D. As a secondary end point we studied the incidence of new morphometric vertebral and nonvertebral fractures. Methods Antiepileptic drug and osteoporosis prevention trial (ADOPT) was designed as a prospective 2-year double-blind, randomized placebo controlled study involving 80 male veterans with epilepsy who were being treated with AEDs such as phenytoin, phenobarbital, sodium valproate, or carbamazepine for a minimum of 2 years. All enrolled participants received calcium and vitamin D supplementation, and were randomized to risedronate or matching placebo. Total body, bilateral proximal femora, and anteroposterior (AP) lumbar spine BMDs in addition to morphometric lateral vertebral assessments (LVAs) were evaluated by a dual energy x-ray absorptiometry (DXA) instrument. Comparisons of BMDs were made between baseline, 1 year, and after 2 years of enrollment in the study. The incidence of new vertebral and nonvertebral fractures was secondary end point. Key Findings Of the 80 patients initially enrolled in the study, 53 patients completed the study. Baseline characteristics of the two groups were similar. At the end of the study, in the placebo plus calcium and vitamin D group, we observed a significant improvement in BMD at any of the evaluated sites when compared to their baseline scans in 69% (18/26) of the participants. In the risedronate plus calcium and vitamin D group, we observed significant improvement of BMDs in 70% (19/27) of the participants. At the end of the study, the risedronate group experienced a significant increase of BMD at the lumbar spine L1-4 (1.267-1.332 g/cm2), which was significantly larger than that seen in the placebo group) (1.229 g/cm2 vs. 1.245 g/cm 2; p = 0.0066).There were nonsignificant differences between the two groups regarding changes of total body BMD or at the proximal bilateral femora. Five new vertebral fractures and one nonvertebral fracture were observed only in the placebo group. Significance Calcium and vitamin D supplementation or calcium and vitamin D supplementation in addition to risedronate improved BMD in more than 69% of male veterans with epilepsy who were taking AEDs. In the group receiving risedronate plus calcium and vitamin D there was a significant improvement of BMD at the lumbar spine as compared to the placebo group, which also received calcium and vitamin D. The use of risedronate plus calcium and vitamin D prevented the incidence of new vertebral fractures and one nonvertebral fracture in this cohort. © Wiley Periodicals, Inc. © 2013 International League Against Epilepsy. Source

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