Prise en charge de l’ostéoporose dans les unités de courte durée gériatriques
Bibliographic record
Abstract
OBJECTIF Identifier dans les guides de pratique canadiens et americains sur la prise en charge de l’osteoporose, les recommandations applicables aux personnes âgees vulnerables admises en unite de courte duree geriatrique (UCDG). TYPE D’ETUDE Delphi modifie selon la methode RAND/UCLA. CONTEXTE Les membres du panel d’experts proviennent de diverses regions du Quebec. PARTICIPANTS Le panel est compose de 6 medecins, 5 pharmaciens et 3 nutritionnistes reconnus par leurs pairs pour leur expertise en UCDG. METHODE Onze recommandations emanant de lignes directrices nord-americaines ont ete soumises au panel d’experts afin d’identifier les plus appropriees pour la prise en charge de l’osteoporose en UCDG. Le degre d’accord de chaque expert avec les recommandations et le degre d’accord entre les experts ont servi a en evaluer la pertinence. RESULTATS Un consensus a ete atteint pour chacune des 11 recommandations. Sept recommandations ont ete jugees appropriees dans le contexte de la prise en charge de l’osteoporose aupres de personnes âgees vulnerables admises en UCDG. La mesure de la densite osseuse en tant que parametre de suivi est la seule recommandation jugee inappropriee dans ce contexte. Les experts sont demeures incertains par rapport a 3 recommandations: le depistage systematique de l’osteoporose par la mesure de la densite minerale osseuse, le depistage ou l’evaluation systematique des facteurs de risque de fractures et la prevention pharmacologique aupres des personnes âgees vulnerables ayant un risque accru de fracture. CONCLUSION Certaines recommandations emises dans les lignes directrices nord-americaines semblent moins appropriees pour la prise en charge de l’osteoporose chez les personnes âgees vulnerables admises en UCDG. Les recommandations retenues dans cette etude pourraient s’averer utiles pour standardiser les interventions prodiguees a cette clientele ainsi que pour evaluer la conformite de la pratique actuelle. ### OBJECTIVE To identify the recommendations in Canadian and American clinical practice guidelines for the management of osteoporosis that are applicable to vulnerable, older patients in short-term geriatric units (STGU). ### DESIGN Modified Delphi approach according to the RAND/UCLA method. ### SETTING A panel of experts from various regions of Quebec. ### PARTICIPANTS The panel consisted of 6 physicians, 5 pharmacists, and 3 nutritionists recognized by their peers for their expertise in STGU. ### METHODS Eleven recommendations from the North American guidelines were submitted to a panel of experts who were asked to identify those most appropriate for the management of osteoporosis in STGU. Each expert’s level of agreement with the recommendations and the experts’ general level of agreement were used to determine the relevance of the recommendations. ### FINDINGS The experts reached a consensus on each of the 11 recommendations. Seven recommendations were deemed appropriate for the management of osteoporosis in vulnerable, older patients in STGU. Bone mineral density measurement as a parameter for follow-up was the only recommendation deemed inappropriate in this context. The experts remained uncertain about 3 recommendations: systematic screening for osteoporosis by bone mineral density measurement; systematic screening or evaluation of the risk factors for fractures; and pharmacologic prevention in vulnerable, older patients with an increased risk of fracture. ### CONCLUSION Some of the recommendations issued in the North American recommendations appear to be less appropriate for managing osteoporosis in vulnerable, older patients in STGU. The recommendations retained in this study could be used to standardize interventions for these patients and to determine the extent to which current practice follows the recommendations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.060 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".