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3 results on '"P. Iglar"'

1. Understanding health advocacy in family medicine and psychiatry curricula and practice: A qualitative study.

Author

Sophie Soklaridis, Carrie Bernard, Genevieve Ferguson, Lisa Andermann, Mark Fefergrad, Kenneth Fung, Karl Iglar, Andrew Johnson, Morag Paton, and Cynthia Whitehead

Subjects
Medicine, Science
Abstract

BACKGROUND:We explored understanding and experiences of health advocacy among psychiatry and family medicine residents and faculty and the implications for clinical care and teaching through the lens of relationship-centred care. METHODS:This qualitative study was conducted in the psychiatry and family medicine departments at a large urban university. We interviewed 19 faculty members and conducted two focus groups with 18 residents. Semi-structured questions explored the relational meaning of health advocacy, how residents and faculty learned about the role and ethical considerations involved in incorporating advocacy work into clinical practice within a relationship-centred care framework. RESULTS:Four themes emerged from the interviews and focus groups: 1) health advocacy as an extension of the relationship to self; 2) health advocacy and professional boundaries in the physician-patient relationship; 3) health advocacy within a team-based approach; and 4) health advocacy and the physician-community/organization relationship. Participants described implications for practice of the challenges of health advocacy, including perceived institutional risks, professional boundaries and the appropriation of patient voice. CONCLUSIONS:Our study provides insights into the relational complexities of the health advocate role in residency curriculum and clinical practice. All participants described health advocacy as a broad spectrum of actions that are guided by relationships among patients, health care professionals and communities. Our analysis revealed that some challenges that participants identified with a health advocacy role could be addressed by anchoring the role within a specific theoretical framework. This would better enable us to create a culture of advocacy in the training and development of physicians.

Published
2018
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2. Surgery alters parameters of vitamin D status and other laboratory results

Author

Matthew W. Squire, Kirk J. Hogan, Douglas B. Coursin, J. Heiner, Neil Binkley, Joan M. Lappe, Diane Krueger, P. Iglar, Patrice Watson, and Richard L. Illgen

Subjects
Male, Vitamin, medicine.medical_specialty, Arthroplasty, Replacement, Hip, Endocrinology, Diabetes and Metabolism, Urinary system, Osteoporosis, 030209 endocrinology & metabolism, Urine, Osteoarthritis, Hip, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, medicine, Vitamin D and neurology, Humans, False Positive Reactions, Postoperative Period, Prospective Studies, 030212 general & internal medicine, Vitamin D, Aged, Aged, 80 and over, Postoperative Care, Hip fracture, Creatinine, Hip Fractures, business.industry, Middle Aged, Vitamin D Deficiency, medicine.disease, Surgery, chemistry, Orthopedic surgery, Female, business, Biomarkers, Osteoporotic Fractures
Abstract

Fracture liaison services often perform laboratory testing, but these results may be altered by surgery. In 40 hip arthroplasty patients, many laboratory parameters of bone health relevance were reduced by 8-22% on the first post-operative day. Laboratory results obtained in the immediate post-surgery interval do not reliably ascertain baseline status.As secondary causes of osteoporosis are common, fracture liaison services often perform laboratory testing in the immediate post-fracture interval. We hypothesized that laboratory results obtained shortly after surgery may not accurately ascertain baseline status. If true, such alterations might confound subsequent fracture prevention efforts.Patients undergoing elective total hip arthroplasty were studied as a surrogate for hip fracture patients. Blood and urine were obtained 2 weeks before surgery, before anesthetic induction, on post-operative day one, and 6 weeks after surgery. Serum total and free 25-hydroxyvitamin D (25(OH)D), vitamin D-binding protein (DBP), calcium, creatinine, albumin (Alb), alkaline phosphatase (ALP), plasma hemoglobin (Hgb) and urinary DBP/creatinine ratio (UDBP/Cr) were measured.Forty volunteers (28 women; 12 men) with mean age of 65.7 [8.7] years were studied. Laboratory results were stable from 2 weeks before to the day of surgery. On the first day after surgery, total 25(OH)D, DBP, calcium, creatinine, ALP, and Alb declined 8-22% (p 0.0001); free 25(OH)D and Hgb declined by 8 and 15% (p 0.01), respectively; and UDBP/Cr increased 32% (p 0.01). Using a 25(OH)D30 ng/mL threshold, vitamin D inadequacy prevalence increased from 38% before surgery to 68% the day after (p 0.001). All laboratory values returned to baseline at 6 weeks after surgery.Laboratory values are reduced immediately following elective total hip arthroplasty. Testing at that time does not accurately ascertain baseline status and may lead to elevated estimates of vitamin D inadequacy, incorrect interventions, and misallocation of healthcare resources.

Published
2016

3. Surgery Alters Parameters of Vitamin D Status and Other Laboratory Results of Relevance to Fracture Liaison Services

Author

P. Watson, K. Hogan, R. Ilgen, D. Coursin, Neil Binkley, P. Iglar, Matthew W. Squire, J. Heiner, Joan M. Lappe, and Diane Krueger

Subjects
medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, Physical therapy, medicine, Vitamin D and neurology, Radiology, Nuclear Medicine and imaging, Orthopedics and Sports Medicine, Relevance (information retrieval), business, Laboratory results, Surgery
Published
2016

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