RESUMEN
In spite of being a public health problem of pandemic proportions, osteoporosis continues to be underdiagnosed and undertreated especially in older adults with fragility fractures. Confirmation of this hypothesis resulted in the development of a novel Fracture Liaison Service (Rush FLS). Results of the first 12 months of operation revealed that patients with confirmed fragility fracture do not have a timely diagnosis at fracture occurrence or treatment of their disease. The Rush FLS is an effective fracture liaison model. INTRODUCTION: Determining the prevalence of undiagnosed and untreated osteoporosis in fragility fracture patients, either admitted to an academic tertiary care center or treated and discharged from the center's emergency department to be followed in the endocrinology bone clinic, using an innovative, educational, low-cost, physician-run Fracture Liaison Service (FLS). METHODS: An automated alert was integrated into the electronic medical record at Rush University Medical Center (RUMC), triggered by historical and/or acute fracture(s) in patients 50 years or older, in patients that were either admitted to the hospital or in patients evaluated in the emergency department and discharged to be followed in the endocrinology bone clinic. We report the results of the first 12 months of operation in patients admitted to the hospital. RESULTS: First acute fragility fracture(s) were identified in 36% (80/223), only historical fragility fracture(s) in 28% (63/223) and both acute and historical fragility fracture(s) in 36% (80/223). The cumulative subgroup with historical fragility fractures with/without new fractures included 67% (96/143) without a previous diagnosis of osteoporosis. First acute fragility fracture group included 83.8% (67/80) without a previous diagnosis of osteoporosis. Rush FLS "captured missed opportunities" in 73.1% (163/223) of previously undiagnosed and 77.1% (172/223) of previously untreated osteoporosis patients. Dual-energy x-ray absorptiometry (DXA) prior to FLS consult was confirmed in 30% (67/223). Vitamin D deficiency (25-hydroxy vitamin D < 20 ng/ml) in 41.9% (78/186) including undetectable levels in 16.6% (31/186) and secondary hyperparathyroidism in 43.3% (78/180) were the most common laboratory confirmed secondary etiologies for bone loss. CONCLUSIONS: This study reported undiagnosed, uninvestigated, and untreated osteoporosis in the majority of fragility fracture patients seen by the Rush FLS in the first 12 months of operation.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Atención a la Salud/organización & administración , Osteoporosis/diagnóstico , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Adulto , Anciano , Chicago , Estudios Transversales , Registros Electrónicos de Salud , Servicio de Urgencia en Hospital/organización & administración , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Prevención Secundaria/métodos , Prevención Secundaria/organización & administraciónRESUMEN
This study investigated 2 sanitizer formulations and compared them with hydrogen peroxide (H(2)O(2)). Formulation number 1 contained citric acid and sodium dodecylbenzene sulfonate (SDBS). Formulation number 2 contained SDBS, citric, lactic, phosphoric acids, and benzoic acid. Low concentration levels of the sanitizers (1.0% for formulation 1 and 0.5% for formulation 2) were compared with 35% H(2)O(2) for their efficacies on Escherichia coli, Listeria innocua, and Saccharomyces cerevisiae inoculated onto low-density polyethylene (LDPE) films and metal cans at room temperature (23 +/- 1 degrees C) and 40 degrees C. The results showed that both formulations 1 and 2 required >120 s to sanitize both materials from microbial populations at room temperature, while <15 s was needed for the H(2)O(2). Except for formulation 1 on the E. coli inoculated LDPE film surface, the sanitizers completely eliminated the bacterial populations on both materials in 60 s at 40 degrees C. In general, the formulations were more effective for reduction of the microbial numbers on the can material when compared with the LDPE film. The E. coli showed greater tolerance for the sanitizers when exposed to the process conditions in this study. All sanitizers completely eliminated the test organisms in