Park Nicollet Foundation

Pain may reduce stability and increase falls and subsequent fractures in older men. To examine the association between joint pain and any pain with falls, hip and non-spine fractures in older community-dwelling men. A cohort study. Analyses included 5,993 community-dwelling men aged ≥65 years from the MrOS cohort. Pain at hip, knee and elsewhere (any) was assessed by self-report. Men reported falls via questionnaires mailed 3× per year during the year following the baseline visit. Fractures were verified centrally. Mean follow-up time for fractures was 9.7 (SD 3.1) years. Logistic regression models estimated likelihood of falls and proportional hazards models estimated risk of fractures. Models were adjusted for age, BMI, race, smoking, alcohol use, medications use, co-morbidities and arthritis; fracture models additionally adjusted for bone mineral density. One quarter (25%, n = 1,519) reported ≥1 fall; 710 reported ≥2 falls in the year after baseline. In multivariate models, baseline pain at hip, knee or any pain increased likelihood of ≥1 fall and ≥2 falls over the following year. For example, knee pain increased likelihood of ≥1 fall (odds ratio, OR 1.44; 95% confidence interval, CI 1.25-1.65) and ≥2 falls (OR 1.75; 95% CI 1.46-2.10). During follow-up, 936 (15.6%) men suffered a non-spine fracture (n = 217, 3.6% hip). In multivariate models, baseline pain was not associated with incident hip or non-spine fractures. Any pain, knee pain and hip pain were each strong independent risk factors for falls in older men. Increased risk of falls did not translate into an increased risk of fractures.

Adherence to medications is central to successfully managing diabetes. Health coaching, which relies on frequent contact and ongoing intervention, has emerged in recent years as part of disease management initiatives and has been promoted as an effective method for improving health outcomes and patient compliance with medication. This study evaluated a 6-month worksite health coaching model to promote medication adherence. It assessed the effectiveness of tailoring health coaching for compliance with medication regimens among people with diabetes. The program was delivered through 3 face-to-face and 3 telephone consultations. Participants set goals promoting diabetes management at the end of each monthly consultation. The authors collected questionnaires from enrolled employees at baseline (n = 27) and from those who stayed in the program at completion of the intervention (n = 23). Using the ASK-20 SM for evaluation, the authors were able to significantly reduce the average number of barriers to medication adherence from pre (3.7) to post (2.2; P < .001) in those who completed the program. The results of this study suggest that health coaching combined with tools to help identify barriers increased medication adherence.

To determine the variability of indinavir pharmacokinetics in patients attending an outpatient clinic, and to explore relationships between indinavir exposure and antiviral effect. Open, formal pharmacokinetic evaluation. University-affiliated clinical research center. Forty-three adults infected with the human immunodeficiency virus (HIV) receiving therapy with indinavir and concomitant nucleoside reverse transcriptase inhibitors. Indinavir concentrations were measured after patients were observed taking an 800-mg oral dose, and pharmacokinetic parameters were determined using a one-compartment oral absorption model. Virologic and pharmacologic characteristics were compared in a subset of 23 patients who were protease inhibitor naive before receiving indinavir. Mean indinavir pharmacokinetics were similar to those reported previously. Significant intersubject variability in systemic exposure was observed in patients receiving the same dosage; the 8-hour area under the curve (AUC8) ranged from 5.4-68.0 microM x hour. In protease inhibitor-naive subjects, the indinavir AUC8 was statistically higher in those with undetectable plasma HIV RNA (30.7 microM x hr) versus detectable plasma HIV RNA (22.4 microM x hr, p=0.035). Measured concentrations 5 hours after the dose and extrapolated 8-hour concentrations were also significantly higher in patients with undetectable plasma HIV RNA (both p=0.007). Indinavir plasma concentrations were highly variable among patients receiving the same dosage. Patients with an undetectable plasma HIV RNA level who were protease inhibitor naive had statistically higher indinavir concentrations and slower oral clearance than the group with detectable HIV RNA. Relationships between indinavir concentrations and anti-HIV effect provide a basis for quantifying the pharmacologic contribution to the heterogeneity in therapeutic response.

Avulsion fractures of the ulnar collateral ligament of the thumb metacarpophalangeal joint (bony skier's thumb) may result in chronic instability with pain and weakness of pinch if improperly treated. Management requires an understanding of the relevant anatomy and careful clinical examination including stress testing. Undisplaced, or minimally displaced and stable fractures are treated conservatively, whereas displaced, rotated and unstable fractures require surgical treatment.