Fracture liaison services in Ireland-how do we compare to international standards?

In this first na tional survey of public hospitals in The Republic of Ireland, we found fracture liaison services (FLS) to be heterogeneous, limited in many cases and poorly supported. A national strategy is urgently needed to support the implementation and operation of an FLS, and thus help reduce the burden of fragility fractures for patients and the healthcare system. INTRODUCTION: Fragility/low-trauma fractures are a global concern, whose incidence is rising as the population ages. Many are preventable, and people with a prior fragility fracture are at particularly high risk of further fractures. This patient group is the target of the International Osteoporosis Foundation (IOF) Capture the Fracture campaign, advocating global adoption of fracture liaison services (FLS), with the aim of preventing secondary fragility fractures. We wished to determine the current availability and standards of an FLS in Ireland, ahead of the launch of a National FLS database. METHODS: We devised a questionnaire encompassing the thirteen IOF standards for an FLS and asked all 16 public hospitals with an orthopaedic trauma unit in Ireland, to complete for the calendar year 2019 in patients aged ≥ 50 years. RESULTS: All sites returned the questionnaire, i.e. 100% response rate. Nine hospitals stated that they have an FLS, additionally one non-trauma hospital running a FLS responded, and were included. These 10 FLS had identified and managed 3444 non-hip fractures in the year 2019. This figure represents 19% of the expected non-hip fragility fracture numbers occurring annually in Ireland. Implementation of the IOF standards was very variable. All sites reported being inadequately resourced to provide a high-quality service necessary to be effective. CONCLUSION: The existence and functioning of FLS in Ireland are heterogeneous and suboptimal. A national policy to support the implementation of this programme in line with international standards of patient care is urgently needed.

The Patient's Second Hip Fracture - One in Ten.

Introduction The number of fragility hip fractures (>60 years) are estimated to triple/quadruple by 2050. It is estimated that the prevalence of patient's contralateral hip fractures (HF2s) will increase also. Methods Single hospital, Retrospective review, 2013-2017, Radiograph review, n = 822. Results Management of patient's 2nd hip fractures accounted for 10.5% of all hip fracture surgeries. ~50% occurred within 3 years of the 1st hip fracture. There was no statistically significant difference in discharge destination, length-of-stay or mortality between the HF1 and HF2 cohorts. Discussion Patients with HF2s comprised a significant and stable proportion of all hip fractures treated. We advocate for the provision of a Fracture Liaison Service in each of the 16 hip fracture operating hospitals in Ireland to optimise the secondary prevention of hip fractures.

Factors affecting parenting stress among biologically vulnerable toddlers.

Parenting a child with, or at risk for, a developmental delay or disability can be stressful. Abidin's parenting stress model was used as a framework to examine how several maternal, child, and family factors predict parent stress outcomes. Stepwise regression models revealed that maternal and child factors were significant contributors to parenting stress. However, family factors (income and family functioning) were not retained. Parenting stress was lower when child (cognitive and adaptive ability) and maternal (depression and child care competence) characteristics were more positive. Child cognitive ability was a strong contributor to total parenting stress and two parenting stress subscales. Findings suggest that these parents need stress lowering interventions such as supportive child care, respite relief, and a child behaviour-focused program.

Effective delivery of neonatal stabilization education using videoconferencing in Manitoba.

We compared face-to-face and videoconference delivery of an education programme for health professionals on the subject of neonatal stabilization skills. A pre-test/post-test control group design was used to compare knowledge acquisition and satisfaction between the two modalities. There were no statistically significant differences between delivery modalities for knowledge acquisition. Both groups showed significant gains in knowledge when pre- and post-test scores were compared. Responses to most of the items in a survey of satisfaction with the course did not differ significantly between the two groups. Face-to-face participants expressed higher levels of comfort in interacting with the presenter, and those in the videoconference group were more willing to receive the course via videoconference in the future. Videoconferencing provided an effective and acceptable way of delivering neonatal stabilization skills.

Cocaine: effects of in utero exposure on the fetus and neonate.

In North America, an increasing number of babies are prenatally exposed to cocaine, yet the implications of cocaine use during pregnancy are not fully understood. The effects of cocaine are exerted primarily by its influence on aminergic receptors in the central and peripheral nervous systems. Developmental, physiological, and behavioral problems in infants and children are likely outcomes of maternal cocaine abuse, but these findings are confounded by concomitant use of other drugs such as marijuana and cocaine and by factors such as time, dosage, and route of cocaine intake. Different screening options exist for cocaine and its metabolites, including sampling of neonatal urine, hair and meconium need to be considered, as do the sensitivity and the ethical implications of such testing. Clinical management of cocaine-exposed infants requires attention to several issues, including: central nervous system irritation, cardiac anomalies, apnea, and feeding difficulties, as well as infant safety and follow-up postdischarge. Early detection and intervention remain the primary objectives of caring for cocaine-exposed infants.

The thymus gland.

This article reviews the embryology, physiology, and pathophysiology of the thymus. The anatomy of this lymphoid organ, the significance of the presence or absence of the thymus radiographically, and the role of the thymus in immunity are also reviewed. Finally, the pathologic presentation of thymic hypoplasia (DiGeorge syndrome) is discussed. Despite advances in modern science, little was known about the thymus, one of the body's key organs in the immune system, until 1961, when Dr. Jacques Miller performed thymectomies in mice. Then it became evident that the thymus played a key role in the body's defense against infection. Since that time, researchers have continued to examine the role of the thymus from fetal life through adulthood.

Neonatal cancer: a clinical perspective.

The diagnosis of a neonatal malignancy, while rare, requires complex knowledgeable care from members of the health care team. The neonatal intensive care nurse plays an important role on that team. The types of malignancies found in neonates differ from those in older children, as do the neonate's responses to treatment. A review of the presentation, diagnosis, and management of the more common types of neonatal malignancies provides the context for consideration of the nurse's role in providing specialized care to neonates with cancer.

Advanced practice nursing in Canada: has the time really come?

Nurse practitioners in Canada have experienced many of the problems facing those in the UK. In this paper, first presented at this year's meeting of the Commonwealth Nurses' Federation, the authors explain the events.

Porcine liver esterase-catalyzed enantioselective hydrolysis of a prochiral diester into its optically pure (S)-ester acid, a precursor to a growth hormone secretagogue.

A limited screen of several commercially-available and internally-produced lipases and esterases identified porcine liver esterase as a suitable biocatalyst for the enantioselective hydrolysis of a diester into its (S)-ester acid with high optical purity (99%). This (S)-ester acid is a precursor to an experimental growth hormone secretagogue. After identifying xanthan gum as the best emulsifier and optimizing the reaction conditions, hydrolysis rates of 1 g/l.h and final (S)-ester acid (ee > 99%) titers of about 8.5 g/l were routinely achieved. This process supported the production of preparative amounts of optically pure (S)-ester (ee > 99%) with a high reaction yield of 82%. Upon purification, the (S)-ester was successfully used in the subsequent synthetic steps to yield the growth hormone secretagogue.

NMR solution structure of a cytoplasmic surface loop of the human red cell anion transporter, band 3.

The membrane domain of the human red cell anion transport protein, band 3, is too large to be studied by solution nuclear magnetic resonance spectroscopy (NMR), and its amphiphilic nature requires the use of detergents for solubilization. An alternative approach is to divide the protein into smaller (trans-membrane or surface loop) domains for NMR study. We report the structure of a 46-residue synthetic peptide that corresponds to the cytoplasmic surface loop connecting the putative 12th and 13th trans-membrane spans (residues 796-841) in the 14 span model of band 3. This peptide was shown by circular dichroism (CD) to be 38% helical in 30% trifluoroacetic acid. Two regions of helix (one close to the N-terminus of the peptide and one close to the C-terminus of the peptide) were identified by NMR. Long-range nuclear Overhauser effect (NOE) cross-peaks showed the two helices to be in near proximity. The helices were separated by a proline-rich loop that exhibited local order but was mobile with respect to the rest of the peptide. We discuss how the NMR structure of this loop fits the current models of band 3 structure and topology and the results of recent mutagenesis experiments. A cyclic version of this peptide was synthesized and studied by CD, but NMR studies were not possible due to the low solubility of this peptide.

Interpretation of neonatal blood gases, Part II: Disorders of acid-base balance.

Timely and accurate interpretation of blood gases is of paramount importance in providing comprehensive neonatal care. Disorders of acid-base balance may evolve quickly in respiratory problems or develop over time with metabolic imbalances. In many cases, the interpretation of acid-base disorders may be complicated by the mixed metabolic and respiratory origins of the disorder. An overview of the underlying physiology of acid-base balance and oxygen transport helps the nurse understand the causes and subsequent treatments of the various disorders. Such an overview was presented in part I of this series (Vol. 16, No. 5). This article presents a discussion of the four basic types of acid-base disorders. A systematic plan for blood gas evaluation is presented, along with several case studies illustrating the principles of blood gas analysis.

Effect of personal hygiene on blood lead levels of workers at a lead processing facility.

The relationship between personal hygiene and blood lead levels was tested at a lead processing facility. During the workers' semiannual respirator fit test, when they were confident their hands were clean, the amount of lead on their right hands was measured. Samples were obtained by cleaning one entire hand with a wiping towel treated with a proprietary mixture of alcohol, surfactants, and ethylenediaminetetraacetic acid. Wipe samples were analyzed for total lead and then compared with the worker's blood lead level. Each worker's personal habits at rest were also observed. Workers with more than 1 year's experience had a significantly positive correlation between lead on the hand tested and their blood level. The study strongly suggests that lead on the skin ultimately enters the bloodstream. The route of entry was not investigated. Personal habits of the workers with high blood lead levels were observed to include actions that would quickly contaminate their hands shortly after washing.

Interpretation of neonatal blood gases, Part I: Physiology and acid-base homeostasis.

Accurate interpretation of blood gases is paramount in clinical management in the NICU. This interpretation should be based on a sound understanding of acid-base physiology. Acid-base homeostasis depends on a series of complex chemical reactions controlled by the kidneys and the lungs. The maintenance of a blood pH within the narrow range required for normal cellular reactions requires a balance between acid production and excretion. Somewhat separate but equally important to blood gas interpretation is an understanding of oxygen transport. Included in this is the relationship between oxygen and hemoglobin. This article, the first in a two-part series, discusses the physiology of acid-base balance and oxygen transportation. The second article provides an approach for systematic interpretation of blood gases.

Neonatal personnel in Canada.

Although the need for trained personnel to care for neonates with complex needs is recognized, there has been no systematic analysis of present or future personnel requirements. The Canadian Paediatric Society's Neonatal-Perinatal Medicine Section sponsored a symposium on neonatal personnel, inviting four Canadian experts to address issues related to future needs. Areas addressed included neonatal nurse practitioners providing increased patient care in some parts of the country as resident involvement in neonatal intensive care decreases, the extended roles of other health care personnel and increased direct patient care by neonatologists. There is no approved method to determine personnel needs, but paediatric department heads have indicated that the number of neonatologists needed is substantially greater than available funding allows. Considering economic factors and the need to educate perinatal care providers, it is important to assess present and future needs to ensure that quality care can be provided.

Bacterial and fungal infections in the neonate.

Despite tremendous advances in technology, sepsis remains a major threat in neonatal intensive care. The incidence of neonatal infection ranges from 7.3 to 16 per 1,000 live births. Nurses play an important role in the recognition and treatment of the septic infant. An understanding of the classification, epidemiology, and signs and symptoms of bacterial and fungal sepsis will better position the nurse to identify the infant at risk for sepsis and to initiate supportive care.