Patients with hip fracture who present anticoagulated with warfarin often require reversal of anticoagulation for safe hip fracture surgery. Vitamin K is typically administered for this, but requires 24–48 hours for maximal effect. These patients have an increased delay to surgery and increased mortality. Octaplex is a prothrombin complex concentrate (PCC) that reverses warfarin anticoagulation in less than an hour. This study assesses the effectiveness and safety of Octaplex for reversal of warfarin anticoagulation for hip fracture surgery.
Methods:
We reviewed the medical records of all patients with hip fracture in Calgary who received Octaplex between 2009 and 2015. Timing of admission, Octaplex administration and hip fracture surgery were recorded. Mortality and cardiac, thrombotic and orthopedic complications were assessed.
Results:
Median time from Octaplex administration to an international normalized ratio of 1.4 or lower was 1.1 hours. The median time from admission to surgery was 22 hours. Thirty-day mortality was 15.2%, with 4 cases of cardiac arrest and 1 respiratory arrest. Patients who received both Octaplex and fresh frozen plasma (FFP) had a lower rate of 30-day survival than those who received only Octaplex (95.7% v. 60.0%, p = 0.002).
Conclusion:
There were significant rates of cardiac events and 30-day mortality among patients who received Octaplex, but this is unsurprising in this population with multiple medical comorbidities. We caution against administrering both FFP and a PCC in patients for warfarin reversal. Octaplex is effective for rapidly reversing warfarin anticoagulation and reducing delays to hip fracture surgery. Further study comparing Octaplex to reversal using only vitamin K is required.
A representative sample of 855 Hong-Kong Chinese children aged 36–48 months were assessed using the BSQ and the PBCL. Good reliability for both instruments were found. For the BSQ and PBCL, 12.75% and 27.5% were above the cut-off points of 10+ and 12 + respectively and 5.9% were above both cut-off points. In the second stage, 234 subjects were recruited by stratified random sampling according to the results of the screening stage. A clinician interviewed the parent, child and teacher before making a diagnosis. The prevalence of behaviour disorder was: nil, 53.7%; dubious, 23.1 %; mild, 18.0%; moderate, 4.5%; and severe, 0.7%. There were significantly more boys in the categories mild, moderate and severe.
This paper presents the findings of the research on the various interventions implemented by Open
University Malaysia and their impact on its learners’ level of Engagement in the Online Community.
The intensity of the Online Community which is the result of the interventions was measured using four
variables: Learner-Learner, Learner-Tutor, Learner-Staff and Learner-Content interaction. These
variables were then correlated to two other variables; their level of Engagement and Commitment to
stay. Self-administered questionnaires were distributed to 1,500 undergraduate learners of Open
University Malaysia located throughout Malaysia. Results obtained from 1,116 respondents showed
that there was a strong correlation between Learner-Learner, Learner-Tutor, Learner-Staff, Learner-
Content, Engagement and Commitment to stay. Multiple regression analysis carried out showed that
the learners’ Engagement explains 72 percent of the variance of their Commitment to stay. This study
concurs with many previous researches that reducing the feelings of isolation of open and distance
learners can help increase their level of engagement and reduce their attrition. (Abstract by author)
Peningkatan kasus virus corona di Indonesia membuat jumlah kasus infeksi Covid-19 mencapai 2 juta. Tidak ada tanda-tanda penurunan, bahkan Indonesia menempati posisi ke-15 dunia sebagai negara dengan kasus Covid-19 tertinggi. Jadi kewajiban kita untuk menjaga protokol saat di luar rumah atau jika tidak perlu keluar rumah jika tidak ada kepentingan. Penerapan protokol kesehatan kini menjadi kunci wajib yang harus dipatuhi dengan tujuan agar pencegahan penyebaran virus Covid-19 dapat berkurang dan aktivitas di luar rumah menjadi lebih kecil. Oleh karena itu penyebarannya bahkan lebih kecil kemungkinannya. Penerapan protokol kesehatan tidak hanya berlaku di luar rumah seperti perusahaan, restoran, mall dan lain sebagainya, tetapi kita juga harus menerapkan protokol kesehatan di rumah agar saat keluar rumah kita tetap dalam keadaan sehat dan tidak menulari orang lain. jika kita sendiri yang terinfeksi, sebaliknya bagi perusahaan untuk menerapkan protokol kesehatan. agar perusahaan tetap dapat berjalan dengan lancar dan dapat menjual barang atau makanan. Perekonomian para pekerja tidak stabil karena pandemi ini, sehingga jika pemerintah memperketat regulasi, masyarakat harus ikut membantu kehidupan orang lain. Penerapan protokol Starsgym saat ini masih belum efektif, untuk itu kami memberikan masukan kepada Starsgym untuk menyediakan alat kesehatan sesuai protokol yang telah disusun oleh pemerintah. Dan juga dengan rutin melakukan penyemprotan disinfektan di seluruh area dan peralatan gym setiap hari disana. Kemudian memberikan peringatan kepada pelanggan untuk menggunakan masker dan juga menjaga jarak sesuai dengan peraturan pemerintah yang telah ditetapkan
Abstract Background The Alberta Bone and Joint Health Institute (ABJHI) has a comprehensive registry capturing clinical, demographic, and patient-reported outcome measures on all knee arthroplasties performed in the province of Alberta, Canada. This large database provides an opportunity to study the outcomes of total knee arthroplasties (TKA) in patients who underwent unilateral or bilateral procedures. Methods Pain and quality of life outcomes of 29,157 TKAs performed in 23,033 patients for knee osteoarthritis performed in Alberta, Canada from January 2013 to February 2020 were examined. This study: (1) investigates whether having both knees replaced results in better pain and quality of life outcomes than replacing only one knee (using multivariate analysis of variance) and (2) identifies if pain and quality of life outcomes impact the likelihood of needing surgery in the contralateral knee after a first TKA (using univariate and multivariate Cox proportional hazards models). Patient-reported outcomes were measured using questionnaires: the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to assess knee pain, and the EuroQol-5D-5L (EQ-5D) to assess quality of life. Results Patients who had surgery on both knees had approximately 5% better WOMAC (pain) and EQ-5D (quality of life) questionnaire scores 12 months post-surgery than those who had surgery on only one knee. Additionally, for every 1-point higher pre-operative WOMAC pain score (i.e., less pain) there was a 1% decreased likelihood of undergoing a contralateral TKA compared to a 46% decreased likelihood per 1-point improvement in quality of life. Dementia, back pain, and hospital readmission were associated with a 68%, 17%, and 44% decreased likelihood of contralateral TKA respectively. By contrast, patients with obesity were 36% more likely to undergo bilateral TKA (p < 0.05). Conclusions Preoperative knee pain and quality of life play a statistically significant role in determining which patients undergo bilateral TKA. Additionally, bilateral TKA resulted in better patient-reported outcomes compared to unilateral TKA. Though clinical significance cannot be drawn from the low response rates for the patient-reported outcomes, these findings provide a basis for future research on patient-reported outcomes within the Canadian healthcare system.
BackgroundThe Alberta Bone and Joint Health Institute (ABJHI) has a comprehensive registry capturing clinical, demographic, and patient-reported outcome measures on all knee arthroplasties performed in the province of Alberta, Canada. This large database provides an opportunity to study the outcomes of total knee arthroplasties (TKA) in patients who underwent unilateral or bilateral procedures. MethodsPain and quality of life outcomes of 29,157 TKAs performed in 23,033 patients for knee osteoarthritis performed in Alberta, Canada from January 2013 to February 2020 were examined. This study: (1) investigates whether having both knees replaced results in better pain and quality of life outcomes than replacing only one knee (using multivariate analysis of variance) and (2) identifies if pain and quality of life outcomes impact the likelihood of needing surgery in the contralateral knee after a first TKA (using univariate and multivariate Cox proportional hazards models). Patient-reported outcomes were measured using questionnaires: the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to assess knee pain, and the EuroQol-5D-5L (EQ-5D) to assess quality of life. ResultsPatients who had surgery on both knees had approximately 5% better WOMAC (pain) and EQ-5D (quality of life) questionnaire scores 12 months post-surgery than those who had surgery on only one knee. Additionally, for every 1-point higher pre-operative WOMAC pain score (i.e., less pain) there was a 1% decreased likelihood of undergoing a contralateral TKA compared to a 46% decreased likelihood per 1-point improvement in quality of life. Dementia, back pain, and hospital readmission were associated with a 68%, 17%, and 44% decreased likelihood of contralateral TKA respectively. By contrast, patients with obesity were 36% more likely to undergo bilateral TKA (p < 0.05). ConclusionsPreoperative knee pain and quality of life play a statistically significant role in determining which patients undergo bilateral TKA. Additionally, bilateral TKA resulted in better patient-reported outcomes compared to unilateral TKA. Though clinical significance cannot be drawn from the low response rates for the patient-reported outcomes, these findings provide a basis for future research on patient-reported outcomes within the Canadian healthcare system.
Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment.This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded.Interobserver agreement for the PAFF classification was excellent (kappa = 0.944; p < 0.001). On univariate analysis compared with controls, patients with PAFFs had higher mean body mass indices (28.6 kg/m2 (sd 8.9) vs 21.5 kg/m2 (sd 3.3); p = 0.009), longer durations of bisphosphonate therapy (median 5.5 years (IQR 3.2 to 10.6) vs 2.4 years (IQR 1.0 to 6.4); p = 0.04), and were less likely to be on alendronate (50% vs 94%; p = 0.02) with an indication of secondary osteoporosis (19% vs 0%; p = 0.049). Duration of bisphosphonate therapy was an independent predictor of PAFF on multivariate analysis (R2 = 0.733; p = 0.05). Following primary fracture management, complication rates were higher in PAFFs (9/16, 56%) than controls (5/17, 29%; p = 0.178) with a relative risk of any complication following PAFF of 1.71 (95% confidence interval (CI) 0.77 to 3.8) and of reoperation 2.56 (95% CI 1.3 to 5.2).AFFs do occur in association with prostheses. Longer duration of bisphosphonate therapy is an independent predictor of PAFF. Complication rates are higher following PAFFs compared with typical PFFs, particularly of reoperation and infection. Cite this article: Bone Joint J 2019;101-B:1285-1291.
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