Effect of institution volume on mortality and outcomes in osteoporotic hip fracture care.

Hospitals that treat more patients with osteoporotic hip fractures do not generally have better care outcomes than those that treat fewer hip fracture patients. Institutions that do look after more such patients tend, however, to more consistently perform relevant health assessments. INTRODUCTION: An inveterate link has been found between institution case volume and a wide range of clinical outcomes; for a host of medical and surgical conditions. Hip fracture patients, notwithstanding the significance of this injury, have largely been overlooked with regard to this important evaluation. METHODS: We used the UK National Hip Fracture database to determine the effect of institution hip fracture case volume on hip fracture healthcare outcomes in 2019. Using logistic regression for each healthcare outcome, we compared the best performing 50 units with the poorest performing 50 institutions to determine if the unit volume was associated with performance in each particular outcome. RESULTS: There were 175 institutions with included 67,673 patients involved. The number of hip fractures between units ranged from 86 to 952. Larger units tendered to perform health assessments more consistently and mobilise patients more expeditiously post-operatively. However, patients treated at large institutions did not have any shorter lengths of stay. With regard to most other outcomes there was no association between the unit number of cases and performance; notably mortality, compliance with best practice tariff, time to surgery, the proportion of eligible patients undergoing total hip arthroplasty, length of stay delirium risk and pressure sore risk. CONCLUSIONS: There is no relationship between unit volume and the majority of health care outcomes. It would seem that larger institutions tend to perform better at parameters that are dependent upon personnel numbers. However, where the outcome is contingent, even partially, on physical infrastructure capacity, there was no difference between larger and smaller units.

Hip fractures sustained in hospital: comorbidities and outcome.

BACKGROUND: Guidelines on the management of hip fracture in the elderly focus on fractures suffered in the community. Between 4% and 7% of hip fractures occur in hospital. Mortality is higher in those who sustain hip fracture in hospital than those who sustain a fracture in the community. However, it is not known if sustaining a nosocomial fracture is an independent risk factor for a poor outcome. OBJECTIVE: To compare outcomes of hip fracture sustained in the community and sustained while in hospital for another reason. After adjusting for confounders, we sought to determine if sustaining a fracture in hospital was an independent risk factor for a poor outcome. METHODS: Using the National Hip Fracture Database, we identified all patients admitted to Leicester Royal Infirmary with hip fracture between July 2009 and February 2013. We extracted demographic data, details of comorbidity, and 30-day and long-term mortality. Age, gender, American Society of Anaesthesiologists (ASA) grade, time to surgery, and survival were compared between patients with hospital-acquired and those with community-acquired hip fracture. RESULTS: During the study period, 2987 patients were treated for hip fracture; 2984 were included in the study. Of these, 261 (8.7%) sustained the fracture while in hospital. Those who sustained the fracture in hospital were more commonly men (106/261 (41%)) than those with a community-acquired fracture (738/2723 (27%)) and had a worse ASA grade (III or IV, 215/230 (93%) vs 1647/2573 (64%)). Thirty-day mortality was higher in those with a hospital-acquired fracture (48/261 (18%)) than in those with a community-acquired fracture (212/2723 (7.8%)) (p<0.001). However, after adjustment for confounding variables, the association between hip fracture, in-hospital and 30-day mortality was not significant: OR 1.2 (95% CI 0.8 to 2.0), p=0.40. Longer-term mortality was associated with hip fracture in hospital after adjustment for confounding variables in multivariate proportional hazards regression: HR 1.5 (95% CI 1.2 to 1.8), p<0.001. CONCLUSIONS: Patients who sustain hip fractures in hospital are unsurprisingly sicker than those who sustain hip fractures in the community. Although being in hospital is not an independent risk factor, this easily identifiable group of patients are at particular risk of a poor outcome. We suggest that it might be appropriate to consider modifying the guidelines for treatment of hip fracture for this group in an attempt to improve outcome.

Non-whiplash soft tissue injuries following low-velocity impact collisions: A retrospective analysis.

Whiplash is the most common injury reported in low-velocity impact road traffic accidents, but claimants report a range of other soft tissue injuries and we looked at the prevalence of these and any patterns. We retrospectively reviewed reports from the medico-legal practice of an orthopaedic surgeon. We collected data on 609 claimants. Sixty-two per cent were women (p < 0.0001). Majority (90.3%) reported an injury to at least one other area than neck, and 48% of claimants reported shoulder pain. Hand/wrist injuries were almost exclusive to drivers (p = 0.0013). Those with knee injuries were older than those without (p = 0.001). There was a significant difference in the age of patients with different spinal injury patterns (p < 0.0001). Occupational status did not appear to influence the pattern of injuries (p = 0.06). Psychological symptoms were associated with a greater number of body parts injured (p < 0.01). Our data confirm a strong association between these soft tissue injuries and psychological symptoms.

Conjugation of quantum dots on carbon nanotubes for medical diagnosis and treatment.

Cancer is one of the leading causes of death worldwide and early detection provides the best possible prognosis for cancer patients. Nanotechnology is the branch of engineering that deals with the manipulation of individual atoms and molecules. This area of science has the potential to help identify cancerous cells and to destroy them by various methods such as drug delivery or thermal treatment of cancer. Carbon nanotubes (CNT) and quantum dots (QDs) are the two nanoparticles, which have received considerable interest in view of their application for diagnosis and treatment of cancer. Fluorescent nanoparticles known as QDs are gaining momentum as imaging molecules with life science and clinical applications. Clinically they can be used for localization of cancer cells due to their nano size and ability to penetrate individual cancer cells and high-resolution imaging derived from their narrow emission bands compared with organic dyes. CNTs are of interest to the medical community due to their unique properties such as the ability to deliver drugs to a site of action or convert optical energy into thermal energy. By attaching antibodies that bind specifically to tumor cells, CNTs can navigate to malignant tumors. Once at the tumor site, the CNTs enter into the cancer cells by penetration or endocytosis, allowing drug release, and resulting in specific cancer cell death. Alternatively, CNTs can be exposed to near-infrared light in order to thermally destroy the cancer cells. The amphiphilic nature of CNTs allows them to penetrate the cell membrane and their large surface area (in the order of 2600 m(2)/g) allows drugs to be loaded into the tube and released once inside the cancer cell. Many research laboratories, including our own, are investigating the conjugation of QDs to CNTs to allow localization of the cancer cells in the patient, by imaging with QDs, and subsequent cell killing, via drug release or thermal treatment. This is an area of huge interest and future research and therapy will focus on the multimodality of nanoparticles. In this review, we seek to explore the biomedical applications of QDs conjugated to CNTs, with a particular emphasis on their use as therapeutic platforms in oncology.