The risk of fall injury in relation to commonly prescribed medications among older people--a Swedish case-control study.

BACKGROUND: Older people not only consume more medication but they also represent a group at high risk for adverse effects such as injurious falls. This study examines the association between the medications most commonly prescribed to older people in Sweden and fall injuries. METHODS: This is a population-based, matched, case-control study of 64 399 persons aged ≥ 65 years in Sweden admitted to hospital because of a fall injury between March 2006 and December 2009, and four controls per case matched by gender, date of birth and place of residence. The prevalence of the 20 most commonly prescribed medications was compiled for the 30-day period before the index date. The association between those medications and injurious falls was estimated with odds ratios and corresponding 95% confidence intervals using conditional logistic regression. RESULTS: Ten of the top 20 most commonly prescribed medications, and in particular the three medications affecting the central nervous system (CNS), significantly increased the risk of fall injuries (highest for opioids and antidepressants) but not the seven cardiovascular ones, who had a protective effect (lowest for angiotensin converting enzyme inhibitors and selective calcium channel blockers). CONCLUSIONS: The adverse effect of several commonly prescribed medications may seriously threaten their positive effects on the well-being and quality of life of older people. Their association with injurious falls is of particular concern as falls are prevalent and often leading to severe consequences. This needs to be acknowledged so physicians and patients can make informed decisions when prescribing and using them.

3D-imaging of the knee with an optimized 3D-FSE-sequence and a 15-channel knee-coil.

OBJECTIVES: To evaluate the clinical usefulness of an optimized 3D-Fast-Spin-Echo-sequence (3D-SPACE) in combination with a 15-channel knee-coil for 3D-imaging of the knee at 3T. METHODS: 15 volunteers and 50 consecutive patients were examined at 3 T with fat-saturated moderately T2-weighted 3D-SPACE (Voxel-size (VS): 0.6 mm×0.5 mm×0.5 mm/acquisition-time (AT) 10:44 min) using a 15-channel knee-coil. Flip angle optimization and radial k-space reordering were applied. Signal- and contrast-to-noise-ratios (SNR, CNR) were compared to non-optimized 3D-SPACE (8-channel knee-coil) and conventional 2D-FSE (VS: 0.4 mm×0.4 mm×3 mm/total AT: 12 min). Two radiologists independently rated depiction of internal knee structures and assessed detection and depiction of cartilage and meniscus abnormalities compared to conventional 2D-FSE-sequences. Sensitivity and specificity were calculated for a subgroup with arthroscopy as reference standard. Statistical analysis was performed with paired t-tests, confidence intervals and weighted-κ-coefficients. RESULTS: SNR and CNR particularly of fluid/cartilage of optimized 3D-SPACE were significantly higher (p<0.05) than of the non-optimized 3D-sequence and conventional 2D-sequence. Blurring and image inhomogeneity were reduced in the optimized sequence. The thin slice-thickness was beneficial for depiction of problematical anatomical structures such as meniscal roots. 3D-SPACE showed significantly higher diagnostic confidence (p<0.05) for diagnosis of cartilage lesions of the femoral trochlea. Overall sensitivity and specificity of 3D-SPACE and 2D-FSE for cartilage lesions was 82.3%/80.2% and 79.4%/84.2% and 100%/86.4% and 92.3%/81.8% for meniscus lesions. CONCLUSIONS: Optimized 3D-SPACE provides significantly higher signal and contrast compared to conventional 2D-FSE, particularly for fluid and cartilage, leading to improved diagnostic confidence, particularly in problematic areas, such as the femoral trochlea.

3D-MRI of the ankle with optimized 3D-SPACE.

PURPOSE: To assess the use of 3-dimensional (3D) MR imaging of the ankle with the 3D-turbo-spin-echo-sequence 3D-"Sampling Perfection with Application optimized Contrast using different flip angle Evolutions" (SPACE), as compared with 2-dimensional-turbo-spin-echo-sequence. MATERIAL AND METHODS: After internal review board's approval and informed consent, 15 healthy volunteers and 45 consecutive patients were examined at 3 T with isotropic fat-saturated moderately T2-weighted 3D-SPACE (voxel size: 0.6(3) mm(3)/acquisition time: 6:43 minutes) featuring radial k-space reordering for optimized contrast. Signal- and contrast-to-noise ratios (SNR; CNR, respectively) were calculated with the subtraction method. Using free 3D reconstructions, 2 radiologists independently assessed depiction of cartilage, ligaments, and tendons, as well as detection and grading of abnormalities of these structures (5-point Likert scale) compared with conventional 2-dimensional-TSE-sequences (voxel size: 0.4 × 0.4 × 3 mm(3)/total acquisition time: 11 minutes). Statistical analysis was performed with Wilcoxon signed rank tests, 95% and 99% confidence intervals and weighted κ coefficients. RESULTS: SNR and CNR of fluid/cartilage were significantly higher for 3D-SPACE (P < 0.05). The isotropic voxel size facilitated improved depiction of the medial and lateral ankle ligaments with significant differences for the calcaneofibular ligament and the anteromedial ligament complex (P < 0.05). In the patient cohort, cartilage and spring ligaments were also significantly better depicted (P < 0.05). However, there were no significant differences in the number or in the diagnostic confidence of detected cartilage, ligament, or tendon abnormalities. Interreader correlation was good (κ = 0.69-0.71) for both sequences. The correlation between the 2 sequences was excellent (κ = 0.84-0.85). CONCLUSION: 3D-SPACE allows 3D acquisition and assessment of the ankle and facilitates depiction of the complex ankle anatomy at sufficient SNR and CNR.