Putting the Brakes on Breaks: Osteoporosis Screening and Fracture Prevention.

INTRODUCTION: This prospective study sought to implement a screening tool to identify and risk stratify at-risk patients for osteoporosis and evaluate patient knowledge of osteoporosis and fragility fractures in an orthopedic trauma clinic affiliated with a level 1 trauma academic center. METHODS: Of 297 eligible patients, 291 were screened and risk stratified. Patients completed an osteoporosis screening questionnaire and were risk stratified. Lifestyle advice was given to patients at low fracture risk. A dual-energy X-ray absorptiometry scan was ordered for patients at intermediate fracture risk. A referral was initiated for treatment to a bone health specialist in high fracture risk patients. Twenty patients completed a knowledge-based pretest/posttest. RESULTS: A total of 291 patients were screened, which represented 97.7% of patients over the age of 50. Of those patients, 165 (56.7%) patients met criteria for further osteoporosis evaluation as they were considered either intermediate or high risk for future fractures. One hundred thirty-six (82.4%) patients were referred for bone mineral density evaluation. For the knowledge-based evaluation portion, patients had a 33% gain in knowledge (P = .0004). The largest knowledge deficit identified pertained to osteoporosis risk factors and lifestyle management. DISCUSSION: The use of an osteoporosis screening questionnaire in the orthopedic trauma clinic produced clinically significant improvement in identification of at-risk patients. A lack of knowledge regarding osteoporosis and fragility fractures was found to exist among these patients. CONCLUSION: The implementation of an osteoporosis screening tool to identify, risk stratify, and treat patients with osteoporosis and related fragility fractures can be successfully integrated into a busy clinical practice.

Early recognition of malnutrition in the older adult: a quality improvement project using a standardized nutritional tool.

PURPOSE: The purpose of this project was to identify the nutritional status of older adults in a primary care setting by using a standardized nutritional tool and to improve clinical outcomes by implementing appropriate interventions. METHODS: A retrospective chart review of 50 records was conducted prior to any intervention to document what was being done before the use of a standardized nutritional tool. Clinic staff was instructed on the Mini Nutritional Assessment tool. After implementing the tool, a chart review was conducted on 25 participants. RESULTS: Prior to implementing the tool, data showed that 42% of the patients' charts recorded a body mass index and there was no documentation of any nutritional concerns. After the implementation of the standardized tool, data showed 40% of the older adult patients had normal nutritional status, 56% were at risk, and 4% were malnourished. Furthermore, 100% of records continued to show no documentation of any nutritional interventions. CONCLUSION: Data suggest that many older adult patients are at risk or have malnourishment that is unrecognized. Documentation of nutritional interventions needs to be evaluated and recorded.

Exploring Death Anxiety and Burnout Among Staff Members Who Work In Outpatient Hemodialysis Units.

Outpatient hemodialysis unit staff members are at risk for psychological stress, including death anxiety, unresolved grieving, and burnout, due tofrequent interactions with chronically ill patients who have a high mortality rate. Experiencing death anxiety and burnout may impair the ability to build interpersonal relationships, decrease job satisfaction, and impact quality of patient care. A quantitative study to evaluate the effect of educational classes on the level of death anxiety and burnout among hemodialysis caregivers revealed a decrease in participants' level of death anxiety and a decrease in emotional exhaustion in one area that was directly related to the work environment Information from the study can be used to decrease psychological stress through education and support for staff members who work in the hemodialysis unit environment.