Osteoporosis and fracture reduction in the primary care setting at GW MFA

Osteoporosis is a disorder characterized by deterioration in bone mass and bone architecture, leading to bone fragility and a predisposition to fracture. Among older patients, hip osteoporotic fractures are a major cause of morbidity, mortality, and health care costs. Currently, osteoporosis results in over 1.5 million fractures per year in the United States. With the aging of the population, the rate of fracture is expected to increase by 48% in the next 25 years, making the current fracture rate rise from 1.5 million to greater than 3 million fractures in the United States. Most osteoporotic fractures occur in women, primarily due to postmenopausal estrogen deficiency, leading to increased trabecular bone resorption. With osteoporosis becoming an increasingly significant public health burden, it is critically important to identify and treat at-risk patients. The focus of our QI project is to improve the rate of osteoporosis screening in the primary care setting for women equal to or greater than the age of 65, in accordance with the United States Preventive Services Task Force (USPSTF) recommendations. Specifically, we aim to increase the percentage of screening dual-energy x-ray absorptiometry (DXA) scan orders by a total of 10% for female patients age 65 or greater in the primary care setting through the use of education. Our initial PDSA cycles focused on collecting baseline data for two cohorts of residents to determine the percentage of patients in our study population who have existing or new DXA scan orders. Among the two cohorts of residents, we found a significant variability in the percentage of DXA scan orders (53% and 82.5%, respectively). Interventions included providing verbal reminders as well as email reminders and educational material regarding screening guidelines. In one of the resident cohorts, we see a 3% increase in percentage of new or existing DXA scan orders for a given week compared to baseline. With future PDSA cycles, we intend to incorporate education in the form of oral presentations, reminders, and encourage the use of documentation templates among resident cohorts with a low percentage of DXA scan orders

Extramedullary haematopoiesis presenting with cardiac tamponade in a patient with polycythaemia vera.

A 71-year-old man with a history of polycythaemia vera, diagnosed 4 years ago, presented to the emergency room with shortness of breath. A bedside echocardiogram revealed a large pericardial effusion with features concerning for pericardial tamponade. A left anterior thoracotomy and a pericardial window were emergently performed in the operating room and relieved the patient\u27s symptoms. Histology evaluation of the pericardial fragments and pericardial fluid revealed the presence of trilineage haematopoietic elements without any increase in the blasts. A bone marrow core biopsy revealed an increase in reticulin fibre and increase in the number of blasts of 5%-10%, whereas peripheral blood testing was positive for JAK2 V617F mutation. This case report reviews the literature for cases of extramedullary haematopoiesis associated with myeloproliferative neoplasms

Development of glandular models from human nasal progenitor cells.

Hyperplasia/hypertrophy of submucosal glands contributes to mucus overproduction in chronic diseases of the upper and lower respiratory tracts, especially in adult and pediatric chronic rhinosinusitis. Mechanisms that lead to glandular hyperplasia/hypertrophy are markedly understudied, reflecting a lack of in vitro model systems wherein airway epithelial progenitor cells differentiate into glandular cells. In this study, we developed and compared several in vitro three-dimensional systems using human nasal epithelial basal cells (HNEBCs) cultured by different methods on two types of extracellular matrices. We demonstrate that HNEBCs cultured on Matrigel (Corning, Tewksbury, MA) form glandular acini-like structures, whereas HNEBCs embedded in a collagen type I matrix form a network of tubules. Fibroblast-conditioned medium increases tubule formation in collagen type I. In contrast, HNEBCs cocultured with fibroblasts self-aggregate into organotypic structures with tubules and acini. These observations provide morphological evidence that HNEBCs are pluripotent and retain the capacity to differentiate into structures resembling specific structural components of submucosal glands depending on the extracellular matrices and culture conditions. The resultant models should prove useful in targeting cross-talk between epithelial cells and fibroblasts to decipher molecular mechanisms and specific signals responsible for the development of glandular hyperplasia/hypertrophy, which in turn may lead to new therapeutic strategies for chronic rhinosinusitis and other inflammatory respiratory diseases characterized by glandular hyperplasia/hypertrophy