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An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature124096
Source
Implement Sci. 2012;7:48
Publication Type
Article
Date
2012
Author
Courtney C Kennedy
George Ioannidis
Lora M Giangregorio
Jonathan D Adachi
Lehana Thabane
Suzanne N Morin
Richard G Crilly
Sharon Marr
Robert G Josse
Lynne Lohfeld
Laura E Pickard
Susanne King
Mary-Lou van der Horst
Glenda Campbell
Jackie Stroud
Lisa Dolovich
Anna M Sawka
Ravi Jain
Lynn Nash
Alexandra Papaioannou
Author Affiliation
Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. kennedyc@hhsc.ca
Source
Implement Sci. 2012;7:48
Date
2012
Language
English
Publication Type
Article
Keywords
Bone Density Conservation Agents - administration & dosage - therapeutic use
Calcium - administration & dosage
Dietary Supplements
Drug Utilization
Fractures, Bone - prevention & control
Homes for the Aged - organization & administration
Humans
Information Dissemination
Inservice training
Leadership
Long-Term Care - organization & administration
Nursing Homes - organization & administration
Ontario
Osteoporosis - prevention & control
Pilot Projects
Reminder Systems
Translational Medical Research - organization & administration
Vitamin D - administration & dosage - therapeutic use
Abstract
Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes.
The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed =800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (=800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel.
Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
Notes
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PubMed ID
22624776 View in PubMed
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Biglycan deficiency interferes with ovariectomy-induced bone loss.

https://arctichealth.org/en/permalink/ahliterature52066
Source
J Bone Miner Res. 2003 Dec;18(12):2152-8
Publication Type
Article
Date
Dec-2003
Author
Karina L Nielsen
Matthew R Allen
Susan A Bloomfield
Thomas L Andersen
Xiao-Dong Chen
Hans S Poulsen
Marian F Young
Anne-Marie Heegaard
Author Affiliation
Nordic Bioscience A/S, Herlev, Denmark. kln@nordicbioscience.com
Source
J Bone Miner Res. 2003 Dec;18(12):2152-8
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Animals
Bone Density
Carrier Proteins - metabolism
Female
Glycoproteins - metabolism
Male
Membrane Glycoproteins - metabolism
Mice
Mice, Inbred C57BL
Mice, Knockout
Models, Animal
Osteoclasts - physiology
Osteoporosis - prevention & control
Ovariectomy
Proteoglycans - deficiency
Receptors, Cytoplasmic and Nuclear - metabolism
Receptors, Tumor Necrosis Factor
Research Support, Non-U.S. Gov't
Abstract
Biglycan is a matrix proteoglycan with a possible role in bone turnover. In a 4-week study with sham-operated or OVX biglycan-deficient or wildtype mice, we show that biglycan-deficient mice are resistant to OVX-induced trabecular bone loss and that there is a gender difference in the response to biglycan deficiency. INTRODUCTION: Biglycan (bgn) is a small extracellular matrix proteoglycan enriched in skeletal tissues, and biglycan-deficient male mice have decreased trabecular bone mass and bone strength. The purpose of this study was to investigate the bone phenotype of the biglycan-deficient female mice and to investigate the effect of estrogen depletion by ovariectomy (OVX). MATERIALS AND METHODS: OVX or sham operations were performed on 21-week-old mice that were divided into four groups: wt sham (n = 7), wt OVX (n = 9), bgn-deficient sham (n = 10) and bgn-deficient OVX (n = 10). The mice were killed 4 weeks after surgery. Bone mass and bone turnover were analyzed by peripheral quantitative computed tomography (pQCT), biochemical markers, and histomorphometry. RESULTS AND CONCLUSIONS: In contrast to the male mice, there were only few effects of bgn deficiency on bone metabolism in female mice, showing a clear gender difference. However, when stressed by OVX, the female bgn knockout (KO) mice were resistant to the OVX-induced trabecular bone loss. The wt mice showed a decrease in trabecular bone mineral density by pQCT measurements, a decrease in trabecular bone volume (BV/TV), and an increase in mineral apposition rate. In contrast, no significant changes were detected in bgn KO mice after OVX. In addition, analysis of the bone resorption marker deoxypyridinoline showed no significant increase in the bgn KO OVX mice compared with bgn KO sham mice. Measurements of serum osteoprotegerin (OPG) and RANKL revealed increased levels of OPG and decreased levels of RANKL in the bgn KO mice compared with wt mice. In conclusion, the bgn deficiency protects against increased trabecular bone turnover and bone loss in response to estrogen depletion, supporting the concept that bgn has dual roles in bone, where it may modulate both formation and resorption ultimately influencing the bone turnover process.
PubMed ID
14672350 View in PubMed
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Bone densitometry: does the emperor have clothes?

https://arctichealth.org/en/permalink/ahliterature201493
Source
CMAJ. 1999 Jun 29;160(13):1822-3
Publication Type
Article
Date
Jun-29-1999
Author
A. Kazanjian
C. Green
K. Bassett
Source
CMAJ. 1999 Jun 29;160(13):1822-3
Date
Jun-29-1999
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Densitometry
Female
Humans
Middle Aged
Osteoporosis - prevention & control
Technology Assessment, Biomedical
Notes
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Comment On: CMAJ. 1998 Nov 17;159(10):1261-49861223
PubMed ID
10405665 View in PubMed
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[Bone density tests for results or just for testing?].

https://arctichealth.org/en/permalink/ahliterature171882
Source
Duodecim. 2005;121(19):2036-7
Publication Type
Article
Date
2005
Author
Harri Sievänen
Pekka Kannus
Author Affiliation
UKK-instituutti, tapaturma-ja osteoporoosiyksikkö, Tampere.
Source
Duodecim. 2005;121(19):2036-7
Date
2005
Language
Finnish
Publication Type
Article
Keywords
Absorptiometry, Photon - methods
Bone Density - physiology
Female
Finland
Humans
Male
Mass Screening
Osteoporosis - prevention & control - therapy
Sensitivity and specificity
PubMed ID
16300292 View in PubMed
Less detail
Source
CMAJ. 2011 Feb 8;183(2):226
Publication Type
Article
Date
Feb-8-2011
Author
Alban C Goddard Hill
Source
CMAJ. 2011 Feb 8;183(2):226
Date
Feb-8-2011
Language
English
Publication Type
Article
Keywords
Canada
Cost-Benefit Analysis
Health Policy
Humans
Mass Screening - economics - standards
Osteoporosis - prevention & control
Notes
Cites: CMAJ. 2010 Nov 23;182(17):1829-3020940235
Cites: CMAJ. 2010 Nov 23;182(17):1864-7320940232
PubMed ID
21324886 View in PubMed
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Breast Cancer Prevention Trial update.

https://arctichealth.org/en/permalink/ahliterature221325
Source
J La State Med Soc. 1993 Apr;145(4):147-9
Publication Type
Article
Date
Apr-1993
Author
M. Facundus
D. Lifsey
C G Kardinal
Author Affiliation
Ochsner Cancer Institute, New Orleans.
Source
J La State Med Soc. 1993 Apr;145(4):147-9
Date
Apr-1993
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - prevention & control
Canada
Coronary Disease - prevention & control
Female
Humans
Middle Aged
Osteoporosis - prevention & control
Risk factors
Tamoxifen - therapeutic use
United States
Abstract
In April 1992, the National Surgical Adjuvant Breast and Bowel Project and the National Cancer Institute launched the Breast Cancer Prevention Trial. This is the largest cancer prevention trial ever attempted. The Breast Cancer Prevention Trial will involve 16,000 high-risk women in the United States and Canada. Half will receive tamoxifen and half placebo. Currently, over 5,000 women have been enrolled in the Breast Cancer Prevention Trial. The Ochsner Community Clinical Oncology Program in New Orleans is coordinating the trial in Louisiana and Mississippi. Other participating centers in this area are located in Baton Rouge, Houma, and New Orleans East in Louisiana, and Biloxi, Gulfport, Hattiesburg, and Jackson in Mississippi.
PubMed ID
8486986 View in PubMed
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Building osteoporosis prevention into dental practice.

https://arctichealth.org/en/permalink/ahliterature124673
Source
J Can Dent Assoc. 2012;78:c29
Publication Type
Article
Date
2012
Author
Stacey Stewart
Rhona Hanning
Author Affiliation
Department ofHealth Studies and Gerontology, University of Waterloo. stacey.stewart@hotmail.com
Source
J Can Dent Assoc. 2012;78:c29
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Bone Density
Calcium, Dietary - administration & dosage
Canada
Female
Humans
Middle Aged
Osteoporosis - prevention & control
Postmenopause
Practice Management, Dental - organization & administration
Risk factors
Tooth Loss - prevention & control
Vitamin D - administration & dosage
Abstract
The National Report Card on Osteoporosis Care (2008) announced the need for comprehensive approaches to risk reduction and improvement in the early diagnosis of osteoporosis. Dental research has suggested that low systemic bone-mineral density also occurs in alveolar bone, and people with osteoporosis may have an increased risk of tooth loss. Whether or not a causal link exists, both conditions share similar modifiable risk factors, including a role for calcium and vitamin D. The purpose of this paper was to critically examine the role calcium and vitamin D play in the relationship between osteoporosis and the risk of tooth loss.
Scientific articles were obtained through PubMed, MEDLINE, CINAHL, AgeLine and Web of Science. Publications were restricted to those involving human subjects, and English-language articles on calcium and vitamin D. The search yielded 8 articles relating to osteoporosis and tooth loss that included calcium and vitamin D intake.
Despite methodological concerns, the evidence shows a relationship between osteoporosis and tooth loss for people who have an inadequate intake of calcium and vitamin D. Adequate calcium intake positively influences optimal peak bone mass and may also assist in tooth retention in later life.
The dental sector can assist with national prevention strategies for osteoporosis care.
PubMed ID
22558949 View in PubMed
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Calcium and vitamin D intakes in an adult Canadian population.

https://arctichealth.org/en/permalink/ahliterature152269
Source
Can J Diet Pract Res. 2009;70(1):21-7
Publication Type
Article
Date
2009
Author
Suzette Poliquin
Lawrence Joseph
Katherine Gray-Donald
Author Affiliation
CaMos Coordinating Centre, MUHC Research Institute, Royal Victoria Hospital, Montreal, QC.
Source
Can J Diet Pract Res. 2009;70(1):21-7
Date
2009
Language
English
Publication Type
Article
Keywords
Aged
Aging - physiology
Bone Density Conservation Agents - administration & dosage
Calcium - deficiency
Calcium, Dietary - administration & dosage
Canada - epidemiology
Cohort Studies
Cross-Sectional Studies
Dietary Supplements
Female
Food
Food, Fortified
Humans
Male
Middle Aged
Nutritional Requirements
Osteoporosis - prevention & control
Questionnaires
Vitamin D - administration & dosage
Vitamin D Deficiency - epidemiology
Abstract
Calcium and vitamin D intakes from food and supplements were estimated in Canadian men and women.
Calcium intakes from both diet and supplements and vitamin D intakes from fortified milk and supplements were estimated using cross-sectional data from 9423 randomly selected subjects aged 25 years or older, who were participating in a longitudinal study on osteoporosis. Subjects completed an abbreviated food frequency questionnaire administered by a trained interviewer between July 1995 and December 1997.
The mean (standard deviation) daily intake for calcium was estimated to be 1038 (614) mg for women and 904 (583) mg for men; for vitamin D, mean intakes were 5.6 (5.9) microg and 4.8 (5.5) microg for women and men, respectively.
Mean intakes for calcium and vitamin D in men and women under age 51 were close to the adequate daily intake levels. Older adults, however, may be at risk of deficiency.
PubMed ID
19261203 View in PubMed
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Changes in pattern of use, clinical characteristics and persistence rate of hormone replacement therapy among postmenopausal women after the WHI publication.

https://arctichealth.org/en/permalink/ahliterature168678
Source
Pharmacoepidemiol Drug Saf. 2007 Jan;16(1):17-27
Publication Type
Article
Date
Jan-2007
Author
Marie-Pascale Guay
Alice Dragomir
Danielle Pilon
Yola Moride
Sylvie Perreault
Author Affiliation
Faculty of Pharmacy, University of Montreal, Montreal, Canada.
Source
Pharmacoepidemiol Drug Saf. 2007 Jan;16(1):17-27
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Attitude to Health
Cohort Studies
Drug Prescriptions - statistics & numerical data
Drug Utilization Review - statistics & numerical data - trends
Estrogen Replacement Therapy
Female
Humans
Middle Aged
Osteoporosis - prevention & control
Patient Compliance - statistics & numerical data
Patient Dropouts
Publishing - statistics & numerical data
Quebec
Regression Analysis
Risk factors
Time Factors
Treatment Outcome
Women's health
Abstract
The WHI was stopped prematurely because of an increased risk of breast cancer, stroke and cardiovascular diseases (CVD) in the hormone replacement therapy (HRT) arm of the trial. Changes in the use of HRT are expected.
To assess the impact of the Women's Health Initiative (WHI) publication on the rate of HRT prescription, and the clinical characteristics and persistence rate of new users and its determinants.
From the RAMQ databases, the total numbers of HRT prescriptions, and of new HRT's users were calculated between 2 January 1998 and 31 May 2003. To assess the clinical characteristics of women, two retrospective cohorts of new HRT's users were constructed before (pre-WHI) and after (post-WHI) the WHI study publication. The persistence rate after 1 year of follow-up was estimated using a Kaplan-Meier analysis. Cox regression models were used to estimate the rate ratio of HRT cessation.
The total numbers of HRT users and of new users declined respectively by 28% and 50% in post-WHI. The standard dosage of HRT was significantly less used, while the proportion of women with risk factors of CVD or at very high risk of coronary artery disease (CAD) did not change. The rate of persistence in the pre-WHI cohort was 59% compared to 45% in the post-WHI (p
PubMed ID
16794994 View in PubMed
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Developing interprofessional collaboration: a longitudinal case of secondary prevention for patients with osteoporosis.

https://arctichealth.org/en/permalink/ahliterature120057
Source
J Interprof Care. 2013 Mar;27(2):161-70
Publication Type
Article
Date
Mar-2013
Author
Helene Victoria Hjalmarson
Bengt Ahgren
Margaretha Strandmark Kjölsrud
Author Affiliation
Division of Public Health Sciences, Department of Health and Environmental Sciences, University of Karlstad, Karlstad, Sweden. helene@kau.se
Source
J Interprof Care. 2013 Mar;27(2):161-70
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Cooperative Behavior
Humans
Interprofessional Relations
Longitudinal Studies
Organizational Case Studies
Osteoporosis - prevention & control
Patient care team
Program Development
Quality Improvement
Secondary Prevention
Sweden
Abstract
The aim of this study was to explore the development of interprofessional collaboration aiming to improve secondary prevention of osteoporosis by studying this topic expansively from the perspectives of different stakeholders. The method used was a longitudinal single case study with both qualitative and quantitative data sources. The findings elucidate that the bottom-up structure used triggers a freedom to act for the professionals and a changed leadership. Such an approach seems to make managers aware of the need for a horizontal organizational focus that, in this case, was crucial for developing interprofessional collaboration. Furthermore, the study shows that continuous feedback was central to motivate professionals to collaborate. Constructive feedback was created by interprofessional and patient-centered interaction skills, facilitated by confirming leadership promoting ability to recognize the efficacy of joint collaboration. The interprofessional collaboration resulted in an improved chain of care with increased transparency and collective control with benefits for both patients and providers. Outcomes at the system level showed an appreciable increase in patients investigated for osteoporosis: 88% were followed up in primary care and nearly half had improved their health behavior. The implementation of a bottom-up structure where leaders and professionals are developing interdependency, measuring collective performance and using feedback loops generated, in this case, motivational forces for interprofessional collaboration. It is reasonable to assume that these findings could be transferable to similar healthcare settings.
PubMed ID
23043549 View in PubMed
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47 records – page 1 of 5.