Effectiveness of home based intervention program in reducing mortality of hip fracture patients: A non-randomized controlled trial

PurposeThe study was done to investigate whether a postoperative intervention program is effective in reducing mortality and improving mobility in two comparative hip fracture patients over one year postoperatively.MethodsA non-randomized controlled trial study with an intervention group of hip fracture patients and historical control group with 12 months follow up.One hundred twenty four admitted hip fracture patients to the Trauma Unit of Assiut University Hospitals, aged 50 years and older were included from 1st July to 31st December 2014. They were divided into 64 and 60 patients as intervention and control groups respectively. Weight, height and bone mineral density were measured and baseline characteristics were taken. The intervention was a postoperative care program in the form of education sessions with an explanatory leaflet on discharge for nutrition and physical exercise program at home. Follow up phone calls were done at 3 months, 6 months and one year postoperatively by one assessor. Physical mobility was assessed by 24 items Western Ontario And McMaster Universities Osteoarthritis Index (WOMAC).ResultsMortality was significantly higher in the control group, WOMAC score was significantly better among intervention group through follow up. By multivariate Cox survival analysis, advancing age, no intervention, osteoporosis, postoperative complications, chest infections and heart attacks were significant predictors for mortality.ConclusionA significant improvement in mobility and reduction of mortality was achieved by application of a postoperative care program that could be incorporated into the hip fracture patients' care pathway.     

Waist‐to‐hip ratio and mortality in heart failure

Aims

A higher body mass index (BMI) is associated with better survival in heart failure (HF) patients, also known as the obesity paradox. However, BMI does not account for body composition. We therefore analysed the association between abdominal fat, measured via waist‐to‐hip ratio (WHR), BMI and all‐cause mortality in patients with HF.

Methods and results

For this analysis, 1738 patients from the Scottish BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT‐CHF) validation study were included. Patients without waist and hip measurements were excluded. WHR was defined as waist circumference/hip circumference, divided into tertiles and split for sex. A linear regression of principal components from an extensive panel of biomarkers was performed to provide insight in the pathophysiology behind a higher WHR. In total, 1479 patients were included, of which 33% were female and mean age was 75 ±11 years. A higher WHR was independently associated with a higher BMI, a higher prevalence of diabetes and higher New York Heart Association functional class. There was a significant interaction between sex and WHR on its association with mortality (P <0.001). In women, a higher WHR was associated with a higher mortality risk [hazard ratio (HR) 2.23, 95% confidence interval (CI) 1.37–3.63; P =0.001], whereas no significant association was found in men (HR 0.87, 95% CI 0.63–1.20; P = 0.409). We found a strong association between a higher WHR and elevated markers of inflammation and MAPK cascade in women, while these associations were less profound in men.

Conclusions

A higher WHR was associated with a higher risk of death in female but not in male HF patients. These findings challenge the obesity paradox, and suggest that fat deposition is pathophysiologically harmful and may be a target for therapy in female patients with HF.     

One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality:role of the multidisciplinary approach

BACKGROUND:Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers.This,however,is a major undertaking in most patients and is associated with a significant morbidity and mortality.A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis,resection rate,mortality and morbidity.We undertook the study to assess the effect of this approach on diagnosis,resection rates and s...     

Carotid sinus syndrome in an unselected population of eight hundred consecutive patients with syncope. Prevalence and clinical profile.

Carotid sinus syndrome (CSS) is frequently underdiagnosed in patients with unexplained syncope or falls. The goal of our study was to assess the value of carotid sinus massage (CSM) in an unselected population with syncope, in the supine position and after prolonged orthostasis. We observed 824 consecutive patients with unexplained syncope referred to our Autonomic Laboratory between October and October 2000 (36 months). For the analysis we studied only patients aged over 42 years (the age of the youngest patient with CSS). One hundred and eight normal healthy subjects served as the control group. CSM was performed after beat-by-beat blood pressure and continuous electrocardiographic monitoring, during supine rest and after prolonged (45 min) orthostasis on a motor-driven tilt table (HTT). Three hundred and eighty-six patients were selected (all more than 42 years old and with unexplained syncope). Six of them were excluded because of contraindication to CSM. Seventy-five patients (20%) had CSS (28% cardioinhibitory type, 22% pure vasodepressor response and 50% mixed type). Forty patients had CSS diagnosed in the supine position and 35 only after HTT. The response type was similar in both positions. The control group had only one positive response after HTT. CSS was more prevalent in males (66/9). We concluded that in an elderly population CSS is a frequent cause of syncope or unexplained falls, particularly in men. CSM in the supine position is 100% specific but only 53% sensitive. Syncope centers should perform CSM with continuous blood pressure monitoring and after prolonged orthostasis.     

Estimating influenza‐associated mortality in New Zealand from 1990 to 2008

This study used Poisson regression modelling to estimate influenza‐associated mortality in New Zealand for 1990–2008. Inputs were weekly numbers of deaths and influenza and RSV isolates. Seasonal influenza was associated with an average of 401 medical deaths annually from 1990 to 2008, a rate of 10·6 (95% CI: 7·9, 13·3) per 100 000 persons per year, which is 17 times higher than recorded influenza deaths. The majority (86%) of deaths occurred in those 65 years and over. There was no clear decline in influenza‐associated mortality in this age group over the course of the study period.     

Brachial‐ankle pulse wave velocity,but not ankle‐brachial index,predicts all‐cause mortality in patients with diabetes after lower extremity amputation

We examined whether brachial‐ankle pulse wave velocity (baPWV) and ankle‐brachial pressure index (ABI) are predictors for mortality in diabetic patients after lower extremity amputation. This was an observational historical cohort study of 102 Japanese diabetic patients after first non‐traumatic lower extremity amputation, with a mean age of 63 years (standard deviation 12 years). The end‐point was all‐cause mortality. During the mean follow‐up period of 3.3 years, 44 patients reached the end‐point. In both univariate and multivariate analyses, baPWV (m/s) (hazard ratio [HR] 1.05 and 1.04, both P < 0.01, respectively), but not ABI (HR 0.38 and 0.89, P = 0.08 and 0.86, respectively), was a significant predictor for the end‐point. When baPWV (above or below the median [21.8 m/s]) and ABI (normal [0.9–1.4] or not) were analyzed as categorical variables, the results were similar. In conclusion, baPWV, but not ABI, might be a predictor for all‐cause mortality in diabetic patients after lower extremity amputation.