A single postdischarge telephone call by an occupational therapist does not reduce the risk of falling in women after hip fracture: a randomized controlled trial.

BACKGROUND: Post-discharge telephone calls to reinforce targeted recommendations for fall prevention have scarcely been investigated in hip-fracture survivors. AIM: To assess the effectiveness of a single telephone call by an occupational therapist in reducing the proportion of fallers (primary endpoint) and improving the adherence to targeted recommendations for fall prevention (secondary endpoint) after hospital discharge in hip-fracture women. DESIGN: Randomized controlled trial. SETTING: Post-acute rehabilitation hospital and community (post-discharge). POPULATION: We randomized 169 of 228 women with a fall-related fracture of the hip. Data for analyses were available for 153 women (78 from the intervention group and 75 controls). METHODS: All the women underwent a multidisciplinary program targeted at fall prevention during post-acute inpatient rehabilitation. Additionally, the intervention group received a telephone call by an occupational therapist to reinforce the targeted recommendations for fall prevention at a median of 18 days after discharge. The outcomes were assessed at a six-month follow-up. RESULTS: Eleven of the 78 women (14.1%) from the intervention group, and 10 of the 75 (13.3%) from the controls sustained at least one fall during the follow-up (relative risk=1.06; 95% CI from 0.48 to 2.34). The mean adherence to the recommendations for fall prevention was 75.1% in the intervention group and 71.2% in the controls (between group difference 3.9; 95% CI from -3.4 to 11.3; P=0.29). CONCLUSION: Our study does not support a post-discharge telephone call to reinforce the recommendations for fall prevention in hip-fracture women. CLINICAL REHABILITATION IMPACT: We contribute to elucidate one aspect of multidisciplinary fall-prevention strategies in hip-fracture survivors.

Effects of soil tillage on Tuber magnatum development in natural truffières.

Tuber magnatum Pico, the Italian white truffle, commands the highest prices of any truffle. Despite its commercial value, it is the only edible European truffle which has not yet been successfully cultivated. Because of this, it is essential to safeguard natural truffières and to identify cultural practices to maximize their productivity. Soil tillage is successfully and extensively used in black truffle cultivation to enhance productivity, but its effects are not known on the development of T. magnatum. A recently developed real-time PCR assay was applied to evaluate the effects of tillage (10-15 cm depth) on T. magnatum mycelium in two different natural truffle grounds located in Tuscany and Emilia-Romagna. Tillage effects on bulk density, ectomycorrhizal fungal communities, and ascoma production were also assessed. Tilling significantly increased the quantity of T. magnatum mycelium which seemed to be related to an increase in soil porosity by up to 34%, and the diversity of ectomycorrhizal fungal communities. On the contrary, no significant effects were found on ascoma production. The results highlight that real-time PCR is the most reliable method for evaluating the effects of cultural practices on the development of T. magnatum in soil avoiding long-term studies on fruiting body production.

Presentation, diagnosis, and medical management of heart failure in children: Canadian Cardiovascular Society guidelines

Pediatric heart failure (HF) is an important cause of morbidity and mortality in childhood. This article presents guidelines for the recognition, diagnosis, and early medical management of HF in infancy, childhood, and adolescence. The guidelines are intended to assist practitioners in office-based or emergency room practice, who encounter children with undiagnosed heart disease and symptoms of possible HF, rather than those who have already received surgical palliation. The guidelines have been developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and are accompanied by practical Recommendations for their application in the clinical setting, supplemented by online material. This work does not include Recommendations for advanced management involving ventricular assist devices, or other device therapies.

Adherence to recommendations for fall prevention significantly affects the risk of falling after hip fracture: post-hoc analyses of a quasi-randomized controlled trial.

BACKGROUND: Few studies focused on fall prevention in hip-fracture survivors. AIM: To investigate the role of adherence to targeted recommendations on both home environment and behaviors in affecting the hazard of falling after a fall-related hip fracture. DESIGN: Post-hoc analysis of a quasi-randomized controlled trial. SETTING: Post-acute rehabilitation hospital. POPULATION: Ninety-five of 119 women living in the community with a fall-related fracture of the hip. METHODS: We assessed home hazard of falling and suggested targeted modifications of home environment and behaviors in activities of daily living to prevent falls during inpatient rehabilitation. Falls were recorded at a six-month follow-up during a pre-planned home visit. RESULTS: Nineteen of the 95 women sustained at least one fall during the six-month follow-up. Women with > 2 uncorrected risk factors had a significantly higher risk of falling than those with 0-2 risk factors; the odds ratio adjusted for four confounders was 4.58 (95%CI 1.472-4.250; P=0.009). Adherence to recommendations for fall prevention was negatively associated with fall risk. The adjusted odds ratio for a ten percent increase in adherence rate was 0.749 (95%CI 0.594-0.945; P=0.015). CONCLUSION: Uncorrected environmental and behavioral risk factors and poor adherence to targeted recommendations for fall prevention significantly predicted the risk of falling in community-dwelling women who sustained a fall-related hip fracture. CLINICAL REHABILITATION IMPACT: Fall-risk assessment should be performed during inpatient rehabilitation following a fall-related hip fracture. Improving adherence to targeted recommendations emerges as a major goal to prevent falls in hip-fracture survivors.

Ambulatory monitoring of the sudden death of an adolescent with hypertrophic cardiomyopathy.

Sudden death is an important cause of mortality in hypertrophic cardiomyopathy. Several mechanisms have been proposed, but ambulatory monitoring of the event has rarely occurred. The case of an adolescent girl with congenital hypertrophic cardiomyopathy and arthrogryposis multiplex congenita is presented. Despite appropriate therapy and severe activity limitation, the patient's condition progressively worsened. The patient died suddenly in her sleep, one month after a myocardial myomectomy for subaortic stenosis. The fortuitous ambulatory electrocardiographic (ECG) monitoring of the event recorded polymorphic ventricular tachycardia degrading into ventricular fibrillation. Retrospective review of previous ambulatory ECG revealed the presence of nonsustained ventricular tachycardia, a predictive determinant for sudden death, and atrioventricular node dysfunction. However, the patient had never reported symptoms during the dysrhythmias. The pathological specimen showed an unexpected old apical infarction scar, suggesting that her preoperative cardiac status was worse than suspected. In summary, the mechanism of sudden death in this patient was revealed by ambulatory ECG monitoring, and the involvement of neural and myocardial factors are proposed.

[Birth control]. / Il controllo delle nascite.

PIP: The mechanism of conception and the various types of contraceptive methods and devices, their effectiveness, side effects, and contraindications are briefly described. The review includes coitus interruptus, the rhythm method, the basal temperature method, prophylactics (condom and diaphragm), vaginal spermicides, IUDs and oral contraceptives. Oral contraceptives are described in greater detail. They are regarded as highly effective; their side effects include some positive ones, such as normalization of the menstrual cycle, and extensive data appear to rule out any correlation between their use and a greater incidence of cancer of the uterus and breast. There are, however, contraindications e.g., in cases of predisposition to thromboem bolism, liver diseases, heart diseases, diabetes and related conditions, kidney diseases, and genital conditions such as fibroma and cysts. However, all of these conditions can be diagnosed by tests and medical examination prior to prescribing oral contraceptives. It is concluded that oral contraceptives are highly effective and side effects are not much more serious than those of many other drugs currently in widespread use.^ieng