Family physicians' personal and practice characteristics that are associated with improved utilization of bone mineral density testing and osteoporosis medication prescribing

Application of intelligent X-ray image analysis in risk assessment of osteoporotic fracture of femoral neck in the elderly

The paper focuses on establishing a risk assessment model of femoral neck osteoporotic fracture (FNOF) in the elderly population and improving the screening efficiency and accuracy of such diseases in specific populations. In literature research, the main risk factors of femoral neck osteoporosis (FNOP) in the elderly were studied and analyzed; the femur region of interest (ROI) and the hard bone edge segmentation model were selected from the X-ray digital image by using the image depth learning method. On this basis, the femoral trabecular score and femoral neck strength (FNS) in the set region were selected as the main evaluation elements, and the quantitative analysis method was established; an X-ray image processing method was applied to the feasibility study of FNOP and compared with dual-energy X-ray absorptiometry measurements of bone mineral density; Finally, the main risk factors of FNOP were selected and the prediction model of FNOP in the elderly population was established based on medical image processing, machine learning model construction and other methods. Some FNOP health records were selected as test samples for comparative analysis with traditional manual evaluation methods. The paper shows the risk assessment model of FNOF in the elderly population, which is feasible in testing. Among them, the artificial neural network model had a better accuracy (95.83%) and recall rate (100.00%), and the support vector machine prediction model had high specificity (62.50%). With the help of a machine learning method to establish the risk assessment model of FNOF for the elderly, one can provide decision support for the fracture risk assessment of the elderly and remind the clinic to give targeted interventions for the above high-risk groups in order to reduce the fracture risk.

Age at First Osteoporosis Screening Among Older Women and Men: Is Bone Mineral Density Measurement Ordered Timely?

BACKGROUND

US National Osteoporosis Foundation has specified age cut-offs for osteoporosis screening in older women and men.

OBJECTIVE

In this study, we investigated whether Turkish seniors undergo their first ever osteoporosis screening early, on time or late.

METHODS

We determined the age of older women and men at their first-time Bone Mass Densitometry (BMD) testing using the medical records of a geriatric outpatient unit. The timing of the BMD test was considered ''late'' when performed after the age of 65 and 70 in women and men, respectively. An "early" screening was defined as having a BMD measurement before these age cut-offs.

RESULTS

We included 481 individuals in the study (mean age: 74.5±6.5 years, women: 62%). On admission, around 18% of the sample could give no definite information and another 35% had never been assessed for osteoporosis. Among those with a past screening, 64.8% reported comorbid osteoporosis and 33% reported no osteoporosis. Mean age of the first-time BMD measurement was 67.4±7.7 years. The first-time BMD measurement was on time in 9.7%, early in 37.4% and late in 52.9% of the subjects. Half of the individuals with a self-reported osteoporosis diagnosis were non-osteoporotic on a new BMD ordered following the geriatric assessment. Multimorbidity (≥3), parental hip fracture, and smoking were the independent predictors of being early screened.

CONCLUSION

We found two-thirds of women and men unscreened for osteoporosis despite being indicated by age. Early and late screening were both prevalent. Self-reported osteoporosis diagnosis was mostly inconsistent with BMD testing in our sample.

Osteoporosis guideline awareness among Iranian family physicians: results of a knowledge, attitudes, and practices survey

AimThis study investigates the knowledge, attitudes, and practices (KAP) of family physicians in Iran, regarding osteoporosis and their experience with national osteoporosis guideline.

BACKGROUND

Osteoporosis is a relatively preventable, chronic and progressive disease. Family physicians play a crucial role in relieving the burden of care.

METHODS

This cross-sectional study was addressed at all qualified family physicians who registered at urban family physicians and referral system program. Data collection included demographics, professional experience, and knowledge of guidelines based on a standardized KAP questionnaire. Student's t-test was used to measure the associations between KAP scores and demographic, professional experience variables.FindingsThe response rate was 72% (540/750). Based on Bloom's cut off scale, family physicians knowledge and practice scores were in moderate level, and only 14 and 38.5% of them had good knowledge and practice, respectively. Attitude score was in good level, and 64.1% of participants had positive attitude. Mean score of knowledge and practice were higher significantly among family physicians that practice in public settings. Family physicians, who completed osteoporosis training courses, had higher attitude score (P=0.03). Only 23.5% of family physicians were aware of the existence of national osteoporosis guideline.

CONCLUSION

Although most family physicians believed in the importance of preventive measures, however, limited number of them had good knowledge and practice regarding osteoporosis and less than a quarter were aware of national guideline. This is a clear need to disseminate the guideline more effectively, make greater use of efficient training methods.

General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study

Background

Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease.

Methods

A national register-based cohort study was performed. All patients over 18 years receiving first-time prescriptions for medication targeting obstructive lung disease in 2008 were identified and detailed patient-specific data on sociodemographic status and spirometry tests were extracted. Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user.

Results

Partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40). We found a significant association between increasing general practitioner age and decreasing spirometry testing. This tendency was most pronounced among partnership practices, where doctors over 65 years had the lowest odds of spirometry testing (OR 0.25, CI 0.10-0.61). Training practice status was significantly associated with spirometry testing among single-handed practices (OR 1.40, CI 1.10-1.79).

Conclusion

Some of the variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease was associated with practice characteristics. This variation in performance may indicate a potential for quality improvement.