Distribution of clinical risk factors for fracture in a Brussels cohort of postmenopausal women: The FRISBEE study and comparison with other major cohort studies

Objectives The estimation of fracture risk using clinical risk factors (CRFs) is of primary concern in osteoporosis management, but only some risk factors have been thoroughly evaluated and incorporated in predictive models. We have launched a large prospective study, the ‘Fracture Risk Brussels Epidemiological Enquiry’ (FRISBEE), to develop a new predictive model for osteoporotic fractures. The aims of this report are to describe the methodology of the FRISBEE study and to compare the distribution of CRFs in our cohort with those reported in other large studies. Study design FRISBEE is a new study that prospectively evaluates a cohort of 3560 post-menopausal women (aged 60–85 years) followed yearly for the occurrence of fragility fractures. Multiple validated CRFs, densitometry (DXA) values and intake of medication were systematically registered at baseline. The distribution of the FRISBEE CRFs has been compared with the distributions of CRFs in the cohorts used to develop the FRAX® model as well as in more recent cohorts. For these recent cohorts, we focused on CRFs not included in FRAX®. Results The most frequently encountered CRFs used in FRAX® were a prior fragility fracture (27.1%) and a parental history of hip fracture (13.4%). The prevalence of some CRFs not integrated in FRAX® was relatively high, such as the use of proton pump inhibitors (20.8%) and a history of fall(s) (19.7%). The prevalence of many CRFs was quite variable between cohorts; for example, the prevalence of ‘personal prior fragility fracture’ ranged from 9% to 51%. Conclusion We found considerable heterogeneity in the prevalence of CRFs between cohort studies. The impact of these differences on the predictive value of a particular CRF is unknown. We will construct a predictive model calibrated to the Belgian population. More importantly, the FRISBEE study should allow us to determine the predictive value of newly recognized CRFs in addition to the FRAX® algorithm to reliably estimate fracture risk.SCOPUS: ar.jinfo:eu-repo/semantics/inPres

Is the perfusion lung-scan still useful for the diagnosis approach towards lung embolism suspicion in the emergency department?

Objectives: Pulmonary embolism is a potentially fatal condition whose diagnosis requires helical CT scan or perfusion/ventilation scan. In emergency situations these techniques may be unavailable. The question was whether lung-perfusion scan alone could still be used as triage in an emergency department? Methods: This prospective study was performed when both helical CT scan and ventilation/perfusion scan were unavailable. During one year, 53 patients admitted to the emergency department and possibly suffering from pulmonary embolism had perfusion scan as first procedure. The referring emergency physician was thereafter asked whether the perfusion scan had an impact on patient's management and decision-making. The results of this examination were also compared to the final diagnosis at hospital's discharge. Results: Perfusion scan had an important impact in 39 patients (74%). Nine out of the 16 patients whose perfusion scan was interpreted as high probability for pulmonary embolism had pulmonary embolism as final diagnosis. None of the 14 patients with normal perfusion scan and none of the 23 patients with abnormal and equivocal perfusion scan had pulmonary embolism as final diagnosis. Conclusion: This study demonstrates that perfusion scintigraphiy used alone remains useful as it will allow the possibility to exclude embolism in more than 20% of the cases and as it will justify the initiation of appropriate treatment in about 30% of the cases. It also shows that perfusion scan has an important impact on patient's management in more than 70% of the cases. © 2007 Elsevier Masson SAS. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Comment les médecins nucléaires prennent-ils en compte les aspects éthiques dans la communication des résultats aux patients réalisant une TEP d'indication oncologique? Une étude nationale française

Objectif: There are no guidelines regarding the content of information to be delivered in nuclear medicine. This study aimed at describing practices of French nuclear medicine physicians concerning results communication to patients undergoing PETs for oncological indications. Methodes: A survey was performed among French nuclear medicine physicians using an electronic questionnaire. Resultats: The study included 250 nuclear medicine physicians. Their practices regarding communication of PET results to patients were heterogeneous: (1) pre- and/or post-PET consultations were systematic for 56%, adapted on a case-to-case basis for 35%, and never performed for 9% of respondents; (2) oral communication of results was systematic for 13%, adapted on a case-to-case basis for 63%, and never performed for 24% of respondents. Working in a private center, presence of post-PET consultations, being older and more years of experience were significantly associated with more oral communication of results. Finally, 80% of physicians admit that current recommendations are not clear enough. Conclusion: The heterogeneity of practices among French nuclear medicine physicians concerning communication of PET results to patients probably results from lack of clear recommendations. An inter-collegial, ethical, and multi-disciplinary reflection is needed to better guide nuclear medicine physicians in relation to the communication of results to patients suffering from serious disease.SCOPUS: sh.jinfo:eu-repo/semantics/publishe