Nutritional Therapy in Older Patients With Hip Fractures Undergoing Rehabilitation: A Systematic Review and Meta-Analysis.

OBJECTIVE: Older people with hip fractures are often undernourished, which adversely affects their functional prognosis. A previous review reported that oral multinutritional supplements may prevent complications after hip fracture surgery. However, it is unclear whether interventions that combine rehabilitation and nutritional therapy have prognostic benefits. The objective of this study was to determine whether nutritional therapy is effective for patients with hip fractures undergoing rehabilitation. DESIGN: Systematic literature review and meta-analysis. SETTING AND PARTICIPANTS: Randomized controlled trials involving patients at least 65 years of age with hip fracture undergoing rehabilitation with or without nutritional therapy. Older patients with hip fractures undergoing rehabilitation were included. METHODS: A systematic literature search using 5 databases (PubMed, Cochrane Central Register of Controlled Trials, EMBASE, WHO ICTRP, and Ichu-shi Web) was conducted in December 2018 and identified all randomized controlled trials. Outcome variables include mortality, complications, activities of daily living, quality of life, and muscle strength. RESULTS: Of the 1431 studies found, 10 met the inclusion criteria, involving a total of 1119 patients. Four studies reported mortality, 5 studies reported complications, and 4 studies reported grip strength. Nutritional therapy showed a significant reduction in mortality [relative risk (RR) 0.61, 95% confidence interval (CI) 0.39, 0.93; I2 = 0%] and complications (RR 0.67, 95% CI 0.44, 1.03; I2 = 79%), and improved grip strength (mean difference = 2.01, 95% CI 0.81, 3.22; I2 = 0%). The effects of nutritional therapy on activities of daily living, quality of life, and knee extension strength are unknown. The majority of studies were assessed as low quality. CONCLUSIONS AND IMPLICATIONS: Our study showed that the combination of rehabilitation and nutritional therapy for older patients with hip fractures reduced mortality and postoperative complications and enhanced grip strength, although the quality of the evidence was low. A well-designed controlled study is needed for further investigation.

Successful treatment of hypersensitivity pneumonitis caused by Grifola frondosa (Maitake) mushroom using a HFA-BDP extra-fine aerosol.

We successfully treated a patient with occupational hypersensitivity pneumonitis (HP) caused by Grifola frondosa (Maitake) mushroom spore with an extra-fine aerosol corticosteroid; beclomethasone dipropionate (BDP) dissolved in hydrofluoroalkane-134a (HFA). A 49-year-old woman developed respiratory symptoms 3 months after beginning work on a mushroom farm. She was diagnosed as HP based on radiological and serological findings. Oral prednisolone therapy improved her HP and she returned to the same farm. Her HP relapsed after 5 months, and daily 400 microg of HFA-BDP was administered with gradual improvement. An extra-fine particle inhaled corticosteroid might reach appropriate alveoli to be effective therapy for mild HP.