RESUMEN
OBJECTIVES: To determine the proportion of untreated women who reported receiving treatment after incident fracture and to identify factors that predict treatment across an international spectrum of individuals. DESIGN: Prospective observational study. Self-administered questionnaires were mailed at baseline and 1 year. SETTING: Multinational cohort of noninstitutionalized women recruited from 723 primary physician practices in 10 countries. PARTICIPANTS: Sixty thousand three hundred ninety-three postmenopausal women aged 55 and older were recruited with a 2:1 oversampling of women aged 65 and older. MEASUREMENTS: Data collected included participant demographics, medical history, fracture occurrence, medications, and risk factors for fracture. Anti-osteoporosis medications (AOMs) included estrogen, selective estrogen receptor modulators, bisphosphonates, calcitonin, parathyroid hormone, and strontium. RESULTS: After the first year of follow-up, 1,075 women reported an incident fracture. Of these, 17% had started AOM, including 15% of those with a single fracture and 35% with multiple fractures. Predictors of treatment included baseline calcium use (P = .01), baseline diagnosis of osteoporosis (P < .001), and fracture type (P < .001). In multivariable analysis, women taking calcium supplements at baseline (odds ratio (OR) = 1.67) and with a baseline diagnosis of osteoporosis (OR = 2.55) were more likely to be taking AOM. Hip fracture (OR = 2.61), spine fracture (OR = 6.61), and multiple fractures (OR = 3.79) were associated with AOM treatment. Age, global region, and use of high-risk medications were not associated with treatment. CONCLUSION: More than 80% of older women with new fractures were not treated, despite the availability of AOM. Important factors associated with treatment in this international cohort included diagnosis of osteoporosis before the incident fracture, spine fracture, and to a lesser degree, hip fracture.
Asunto(s)
Fracturas Óseas/epidemiología , Osteoporosis Posmenopáusica/tratamiento farmacológico , Anciano , Distribución de Chi-Cuadrado , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
The University of Arkansas for Medical Sciences (UAMS) is planning interprofessional training in electronic health records (EHRs) and medical informatics. Training will be integrated throughout the curricula and will include seminars on broad concepts supplemented with online modules, didactic lectures, and hands-on experiences. Training will prepare future health professionals to use EHRs, evidence-based medicine, medical decision support, and point-of-care tools to reduce errors, improve standards of care, address Health Insurance Portability and Accountability Act requirements and accreditation standards, and promote appropriate documentation to enable data retrieval for clinical research. UAMS will ensure that graduates are ready for the rapidly evolving practice environment created by the HITECH Act.
Asunto(s)
Educación de Pregrado en Medicina , Registros Electrónicos de Salud/organización & administración , Bibliotecas Médicas/organización & administración , Informática Médica/educación , Facultades de Medicina/organización & administración , American Recovery and Reinvestment Act , Arkansas , Competencia Clínica , Habilitación Profesional , Curriculum , Técnicas de Apoyo para la Decisión , Registros Electrónicos de Salud/legislación & jurisprudencia , Humanos , Informática Médica/legislación & jurisprudencia , Informática Médica/organización & administración , Sistemas de Atención de Punto/organización & administración , Estados UnidosRESUMEN
The authors report on a national survey of administrators and program specialists at 43 state vocational rehabilitation (VR) agencies concerning the impact of federal employment legislation and rehabilitation policies on the provision of services to consumers who are deaf or hard of hearing. The article focuses on 5 initiatives enacted to enhance efforts to help people with disabilities achieve competitive employment and self-sufficiency: the Workforce Investment Act of 1998, Order of Selection policies established by state agencies, Interagency Agreements between VR and postsecondary programs, the Comprehensive System of Personnel Development, and the Ticket to Work and Work Incentives Improvement Act of 1999. The article concludes with a summary of state agencies' priorities and needs in regard to technical assistance to enhance the provision of VR services.