Implementation of a Postfracture Care Program in a Private Hospital in Colombia.

PURPOSE: To describe the implementation of a postfracture care program in a private hospital in Colombia, the results achieved after the program's first year, and the challenges encountered. METHODS: A cross-sectional descriptive study of the first year's outcomes. The program was implemented following best practices described in the "Capture the Fracture" framework. We assessed the management of fractures before the launch of the program. A multidisciplinary group was established to collaborate on the diagnosis and treatment of patients with osteoporotic fractures. A full-time program coordinator was appointed. We analyzed the program's clinical outcomes and limitations. RESULTS: One-hundred and ninety patients were included in the study, with an average age of 76.7. Hip fracture was the most frequent one (33.6%). After the first year of implementing the program, 39.4% of patients received osteoporosis treatment, with an adherence rate of 73%. The incidence of subsequent falls was 5.8% and 1% for new fractures. CONCLUSIONS: The implementation of a program for patients' care with fragility fractures is challenging for healthcare institutions. The role of a full-time coordinator is critical for the proper operation of such programs.

[Evaluation with Doppler echocardiography of the Bjork-Shiley Monostrut prosthesis in the mitral position]. / Valutazione mediante ecocardiografia Doppler della protesi Björk-Shiley Monostrut in posizione mitralica.

The Doppler characteristics of Björk-Shiley Monostrut prostheses in mitral position were studied in 53 patients (35 women; 18 men; mean age 53.8 yrs). Valvular function was considered normal on the basis of clinical and echocardiographic evaluation. Mean follow-up after surgery was 23.9 +/- 12.0 months (range 9-53). M-mode, two-dimensional and colour flow mapping echo were performed in each patient. Transvalvular blood flow characteristics were examined by colour flow imaging whereas peak and mean gradient through the valve, pressure half-time and prosthetic area were calculated using continuous wave Doppler. In 84% of patients, colour flow mapping showed a transprosthetic flow with 2 jets; in 78% the jets were different: the main one was directed towards the free wall of left ventricle in 52% and towards the interventricular septum in 48%. Thus, the main jet direction was dependent on the spatial position of the prostheses and the orientation of the disc. In 16% a single jet flow was present during the whole diastole. CW Doppler showed the following parameters: peak velocity 1.6 +/- 0.3 m/s; peak gradient 10.7 +/- 3.9 mmHg; mean gradient 3.8 +/- 2.3 mmHg; pressure half-time 83.3 +/- 16.6 msec; prosthetic area 2.7 +/- 0.51 cm2. No statistically significant difference was found between different size prostheses. Our data show the excellent long term hemodynamic parameters of Björk-Shiley Monostrut mitral prosthesis and confirm the value of colour flow mapping in identifying normal transprosthetic flow profile.