PAROXETINE AND IMPROVEMENT OF VISUAL HALLUCINATIONS IN PATIENTS WITH DEMENTIA WITH LEWY BODIES
PAROXETINE AND IMPROVEMENT OF VISUAL HALLUCINATIONS IN PATIENTS WITH DEMENTIA WITH LEWY BODIES
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帕罗西汀与路易体痴呆患者幻视的改善
DOI：
--
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发表时间：
2005
影响因子：
6.3
通讯作者：
P. Harmer
中科院分区：
文献类型：
--
作者：
Fuzhong Li;K. Fisher;P. Harmer
致编辑：我们想提请您注意一个重要但可预防的骨骼健康和医疗保健提供困境，我们相信可以通过简单，低成本的干预来改善。1982年，马约诊所的研究人员报告说，既往低创伤或脆性骨折史与随后发生髋部骨折的相对风险为1.3相关，这可能低估了风险。作为回应，美国和加拿大的国家指南强调，低创伤骨折不应仅仅接受骨科治疗，还应促使家庭医生评估骨质疏松症风险并进行适当管理。尽管这是骨质疏松二级预防的理想机会，但许多出版物强调了前哨骨折后的持续低调查率（20%）。接受适当治疗的患者更少，凸显了“知识-护理差距”。在迄今为止最大的一系列腕关节骨折的回顾中，只有23%的“高危”患者接受了骨质疏松症的治疗，而一项对大型数据库的回顾性研究报告称，只有9.8%的女性和2.9%的男性接受了骨质疏松症的筛查。另一项研究表明，筛查这些“哨兵骨折”将使髋部骨折减少9%。尽管越来越多的人意识到这个问题，很少有对照研究测试干预措施，以改善诊断和管理。最近有一些出版物测试了旨在改变医生执业模式的干预措施。最近，一个简单的四部分干预使用诊断/管理问卷和计数“骨质疏松症最佳实践”提供的家庭医生与手腕脆性骨折的患者进行了测试。自愿参加本研究的参与者被分配到两组之一（干预组或对照组）。干预组的每位参与者都收到了一张信息表，解释她或他患有诊断为骨质疏松症的低创伤骨折，要求从正在管理骨折的整形外科医生那里拿一封信给家庭医生，提醒她或他最近的低创伤骨折，并在4至6周时进行电话随访，以提醒参与者去看她或他的家庭医生。干预的第四个要素是整形外科医生向家庭医生发出传真，特别要求全科医生评估和管理骨质疏松症。在对照组中，研究人员没有向参与者提供任何有关骨质疏松症风险的额外信息。对照组患者接受常规护理，定义为医院工作人员对骨折进行治疗，并定期通知家庭医生骨折和任何随访计划。两组在6个月时通过电话进行诊断管理问卷调查。本问卷是专门为确定骨质疏松症调查率和骨质疏松症的“最佳实践”，由2002年骨质疏松症共识的建议。最初的桡骨远端骨折“WristWatch "研究扩展到包括肱骨骨折。62名受试者入组本研究（36名对照组和26名干预组）。(See参与者特征见表1。在这个多成分的质量改善干预的病人教育和医生报警系统，73%的参与者在干预组进行了骨质疏松症的调查。绝对差异为54%，相对危险度为3.8（95%置信区间5 1.9-7.6）。同样，干预组的骨质疏松症调查显著较高（P <0.001）。很容易推测，这项研究至少有两种方法可以转化为临床实践。骨科医生对家庭医生的随访记录中包含的常规命令将确保患者和家庭医生能够得到最佳的骨质疏松症护理。或者，医疗工作者可以在潜在的风险患者和医疗服务之间进行联络，以启动护理途径（骨折联络服务）。一组提供者在其临床实践中测试了这种模式，指定的团队成员进行病例发现并启动适当的调查。这对于资金充足的大型设施来说是一种有效的服务。虽然可以将其视为标准，但仍有一些人和地区无法获得此类服务。虽然目前的研究表明，家庭医生调查骨质疏松症的风险患者时，骨科医生提示他们这样做，未来的研究可以调查使用临床路径，使用其他卫生专业人员的专业知识（例如，物理治疗师，护士）在骨折诊所或急诊室
To the Editor: We would like to draw your attention to an important but preventable bone health and healthcare delivery dilemma that we believe can be improved with a simple, low-cost intervention. In 1982, researchers at the Mayo Clinic reported that history of a previous low-trauma or fragility fracture was associated with a 1.3 relative risk of subsequent hip fracture and this was likely an underestimation of the risk. In response, national guidelines in the United States and Canada emphasized that low-trauma fractures should not merely be treated orthopedically, but should also prompt a family physician evaluation to assess osteoporosis risk and manage it appropriately. Despite this ideal opportunity for secondary prevention of osteoporosis, numerous publications have highlighted the continual low investigation ( 20%) rates after a sentinel fracture. Even fewer patients received adequate therapy, highlighting the ‘‘knowledge-care gap.’’ In a review of the largest series of wrist fractures to date, only 23% of ‘‘at risk’’ patients were treated for osteoporosis, whereas one study reported from a retrospective review of a large database that only 9.8% of the women and 2.9% of the men were screened for osteoporosis. Yet another study suggests that screening for these ‘‘sentinel fractures’’ would reduce hip fractures 9%. Despite increasing awareness of this problem, few controlled studies have tested interventions to improve diagnosis and management. There have been recent publications that have tested interventions aimed at changing physician practice patterns. Recently, a simple four-part intervention using a diagnosis/management questionnaire and counting ‘‘osteoporosis best practices’’ offered by the family physician to patients with a wrist fragility fracture was tested. Participants who volunteered for this study were allocated into one of two groups (intervention or control). Each participant in the intervention group received an information sheet explaining that she or he had suffered a low-trauma fracture diagnostic of osteoporosis, a request to take a letter from the orthopedic surgeon who was managing the fracture to show to the family physician alerting her or him to the recent low-trauma fracture, and a follow-up telephone call at 4 to 6 weeks to remind the participant to visit her or his family physician. The fourth element of the intervention was a facsimile from the orthopedic surgeon to the family physician specifically requesting general practitioner assessment and management of osteoporosis. In the control group, participants were not given any additional information on risk of osteoporosis by the researchers. Control group patients received usual care, defined as treatment for the fracture by the hospital staff and routine notification to the family physician of the fracture and any follow-up plans. Both groups were telephoned at 6 months to administer the diagnosis management questionnaire. This questionnaire was developed specifically to ascertain the osteoporosis investigation rate and osteoporosis ‘‘best practices’’ as recommended by the 2002 Osteoporosis Consensus. The original distal radius fracture ‘‘WristWatch’’ study was expanded to include humeral fractures. Sixty-two participants were enrolled in this study (36 control and 26 intervention). (See Table 1 for participant characteristics.) In this multicomponent quality-improvement intervention of a patient-education and physician-alerting system, 73% of participants in the intervention group were investigated for osteoporosis. The absolute difference was 54%, and the relative risk was 3.8 (95% confidence interval5 1.9–7.6) Once again, investigation for osteoporosis was significantly higher in the intervention group (Po.001). It is tempting to speculate that there might be at least two ways that this study could be translated into clinical practice. Standing orders contained within the orthopedic surgeon’s follow-up note to the family physician would ensure that patients and family physicians instigate optimum osteoporosis care. Alternatively, a healthcare worker could liaise between potential patients at risk and the healthcare services to initiate the care pathway (fracture liaison service). One group of providers tested such a model in their clinical practice, and a designated team member performed case finding and initiated appropriate investigation. This can be an effective service for larger facilities with adequate funding. Although it can be seen as the criterion standard, there are people and regions who are not able to access such services. Although the current study showed that family physicians investigated at-risk patients for osteoporosis when an orthopedic surgeon prompted them to do so, future studies could investigate the use of clinical pathways that use the expertise of other health professionals (e.g., physical therapist, nurse) at the fracture clinic or emergency
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影响因子：
37.8
作者：
Levine, BD;Zuckerman, JH;deFilippi, CR
通讯作者：
deFilippi, CR
科尔斯骨折和随后的髋部骨折风险。
影响因子：
4.2
作者：
Owen,RA;Melton3rd,LJ;Ilstrup,DM;Johnson,KA;Riggs,BL
通讯作者：
Riggs,BL
老年人外伤累犯。
DOI：
10.1097/00005373-199612000-00002
发表时间：
1996
期刊：
The Journal of trauma
影响因子：
--
作者：
Gubler,KD;Maier,RV;Davis,R;Koepsell,T;Soderberg,R;Rivara,FP
通讯作者：
Rivara,FP
影响因子：
4.3
作者：
Hausdorff, JM;Rios, DA;Edelberg, HK
通讯作者：
Edelberg, HK