tailieunhanh - báo cáo khoa học: " A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis | Little and Eccles Implementation Science 2010 5 80 http content 5 1 80 Implementation Science IMPLEMENTATION SCIENCE SYSTEMATIC REVIEW Open Access A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis Elizabeth A Little Martin P Eccles Abstract Background There is a large quality of care gap for patients with osteoporosis. As a fragility fracture is a strong indicator of underlying osteoporosis it offers an ideal opportunity to initiate investigation and treatment. However studies of post-fracture populations document screening and treatment rates below 20 in most settings. This is despite the fact that bone mineral density BMD scans are effective at identifying patients at high risk of fracture and effective drug treatments are widely available. Effective interventions are required to remedy this incongruity in current practice. Methods This study reviewed randomised controlled trials RCT involving fully qualified healthcare professionals caring for patients with a fragility fracture in all healthcare settings. Any intervention designed to modify the behaviour of healthcare professionals or implement a service delivery change was considered. The main outcomes were BMD scanning and osteoporosis treatment with anti-resorptive therapy. The electronic databases Medline and Embase were searched from 1994 to June 2010 to identify relevant articles in English. Post-intervention risk differences RDs were calculated for the main outcomes and any additional study primary outcomes the trials were meta-analysed. Results A total of 2814 potentially relevant articles were sifted 18 were assessed in full text. Nine RCTs evaluating ten interventions met the inclusion criteria for the review. All were from North America. Four studies focused on patients with a hip fracture three on fractures of the wrist distal forearm and two included several fracture sites