Costs of Digital Adherence Technologies for Tuberculosis Treatment Support, 2018-2021.

Digital adherence technologies are increasingly used to support tuberculosis (TB) treatment adherence. Using microcosting, we estimated healthcare system costs (in 2022 US dollars) of 2 digital adherence technologies, 99DOTS medication sleeves and video-observed therapy (VOT), implemented in demonstration projects during 2018-2021. We also obtained cost estimates for standard directly observed therapy (DOT). Estimated per-person costs of 99DOTS for drug-sensitive TB were $98 in Bangladesh (n = 719), $119 in the Philippines (n = 396), and $174 in Tanzania (n = 976). Estimated per-person costs of VOT were $1,154 in Haiti (87 drug-sensitive), $304 in Moldova (173 drug-sensitive), $452 in Moldova (135 drug-resistant), and $661 in the Philippines (110 drug-resistant). 99DOTS costs may be similar to or less expensive than standard DOT. VOT is more expensive, although in some settings, labor cost offsets or economies of scale may yield savings. 99DOTS and VOT may yield savings to local programs if donors cover infrastructure costs.

Insights into Permanent Encodings of Macroscopic Spike Patterns by Magnetic-Field-Directed Evaporative Self-Assembly from Ferrofluids.

Field-directed assembly has the potential to make large hierarchically ordered structures from nanoscale objects. Shear forces and optical, electric, and magnetic fields have been used for this purpose. Ferrofluids consist of magnetic nanoparticles hosted in mobile liquids. Though they exhibit rich structures and lattice patterns in response to an applied magnetic field, the patterns collapse when the field is removed. Recently, we adapted evaporation-induced self-assembly to obtain permanent encodings of the complex field response of magnetite nanoparticles in alkane media. The encodings are characterized by order that culminates in macrostructures comprising kinetically trapped spike patterns. The present work examines a number of variables that control pattern formation associated with this encoding. Control variables include applied magnetic field strength, magnetic field gradient, nanoparticle concentration, solvent evaporation conditions, and alkane solvent chain length. The pattern formation process is captured in six stages of evolution until the solvent host has evaporated and the pattern is permanently fixed. The macropatterns consist of hexagonal arrays that coexist with different pentagonal and heptagonal defects. The Voronoi entropy is calculated for different patterns that arise due to changes in the control parameters. Insight into order in the lattice patterns is achieved by extracting measurables like peak-to-peak spike wavelength, spike population, spike height, and base diameter from the patterns. The pattern measurables depend nonlinearly on the magnetic field gradient, solvent evaporation rate, and solvent chain length. Nanoparticle concentration does not impact the measurables significantly. Nonetheless, the results agree qualitatively with a linear expression for the critical magnetization and wavelength that explicitly contains the field gradient and surface tension.

Age-related asymmetry in anticipatory postural movements during unilateral arm movement and imagery.

Reaching movements of the arms are accompanied by anticipatory (APM) and compensatory postural motion (CPM) that counteract the resulting perturbations to body stability. Recent research has shown that these postural actions are also observable in the context of imagined arm movements. As motor imagery (MI) shares many neurophysiological and behavioral characteristics with physical movements, and MI training can affect subsequent performance, MI tasks provide a good setting for studying the anticipatory aspects of postural control. This study investigated APMs and CPMs of the head and hip of healthy young and older adults in the temporal vicinity of physical and imagined forward raises of the dominant and non-dominant arm. When MI of the dominant arm was self-initiated, both age groups showed APM in the anteroposterior plane. When the self-initiated MI was of the non-dominant arm, only the older group showed anteroposterior APM. The older group did not show APM when an expected arm movement (or MI) was made to an external signal. This suggests an age-related deficit in coordinating postural preparation with external events. Only the older group showed mediolateral APM, and only for dominant arm MI, indicating sensitivity to potential perturbation to the weaker, non-dominant side of the body. Overall, the older group showed more anticipatory postural motion at the head. Systematic APM for manual MI suggests that MI training may be an effective intervention for anticipatory postural control. An integrated model of postural support for executed and imagined limb movements is suggested.

Quantification of maximal power output in well-trained cyclists.

This study aimed to compare mechanical variables derived from torque-cadence and power-cadence profiles established from different cycle ergometer modes (isoinertial and isokinetic) and modelling procedures (second- and third-order polynomials), whilst employing a novel method to validate the theoretical maximal power output (Pmax). Nineteen well-trained cyclists (n = 12 males) completed two experimental sessions comprising six, 6-s maximal isoinertial or isokinetic cycling sprints. Maximal pedal strokes were extracted to construct power-cadence relationships using second- and third-order polynomials. A 6-s sprint at the optimal cadence (Fopt) or optimal resistance (Topt) was performed to assess construct validity of Pmax. No differences were found in the mechanical parameters when derived from isokinetic (Pmax = 1311 ± 415, Fopt = 118 ± 12) or isoinertial modes (Pmax = 1320 ± 421, Fopt = 116 ± 19). However, R2 improved (P < 0.02) when derived from isoinertial sprints. Third-order polynomial modelling improved goodness of fit values (Standard Error, adjusted R2), but derived similar mechanical parameters. Finally, peak power output during the optimised sprint did not significantly differ from the theoretical Pmax in both cycling modes, thus providing construct validity. The most accurate P-C profile can be derived from isoinertial cycling sprints, modelled using third-order polynomial equations.

Inter and intra-observer errors for postoperative total hip radiographic assessment using computer aided design.

Plain radiographic assessment of primary total hip arthroplasty following surgery remains to be the commonest radiological assessment. The current paper, studies the accuracy and concordance between observers reviewing these radiographs. A prospective radiographic and medical note review of ten patients who underwent total hip replacement for primary osteoarthritis, with a mean age of 69 years. Early and 6 weeks postoperative x-rays were assessed for hip profile and version profile using computer aided design (CAD) by two observers on two different occasions. The observers were Orthopaedic surgeons who perform arthroplasty of the hip. The results were analyzed statistically. Dimensions, including Femoral offset, medial offset and ilioischial offset showed a high degree of inter- film and intra-film correlation, with inter-class cor- relation (ICC) over 0.8. Except of the intra-film correlation of ilioischial offset measured on the post- operative films (p=0.067) by the first rater, all the intra and inter film correlation were significantly over the benchmark of 0.6. In terms of stem alignment, cup inclination and cup version, the intra-film correlation by rater n°2 ranges from 0.574 to 0.975 and were significantly over the benchmark of 0.6, except in the case of cup inclination measured on the 6 th​ week follow-up ; meanwhile the intra-film correlation by rater n°1 ranges from 0.581 to 0.819 and none were significantly over the benchmark of 0.6. The inter-rater reliability and inter-film correlation showed a dichotomy of results among different dimensions of the measurement. Dimensions of femoral offset, medial offset and ilioischial offset showed a substantial degree of reliability in terms of inter-rater reliability, inter-film correlation, and intra-rater/film reliability.

Age-related differences in postural adjustments during limb movement and motor imagery in young and older adults.

Recent research has shown that systematic postural adjustments occur during periods of manual motor imagery (MI), but the timing (anticipatory or reactive) and directionality (against or in the direction of arm extension) of these postural motions relative to individual manual actions or imagery are not well understood. This study analyzed the anteroposterior hip and head motion of healthy young and older participants, while they imagined bilateral arm raises under self-initiated or environmentally triggered performance conditions. When MI was self-initiated, both age groups showed significant forward postural motion during the second prior to MI initiation. When MI (or physical arm movement) was environmentally triggered, however, older people did not show anticipatory forward postural motion, but did show compensatory backward head motion. These results suggest that manual MI is indeed accompanied by anticipatory postural motion, but this anticipation is attenuated in older people when they do not have control over the timing of manual movement onset.

Project Gatekeeper: An Entrance Control System Embedded Radiation Detection Capability for Security Applications.

Threat assessments continue to conclude that terrorist groups and individuals as well as those wanting to cause harm to society have the ambition and increasing means to acquire unconventional weapons such as improvised nuclear explosive devices and radiological disposal devices. Such assessments are given credence by public statements of intent by such groups/persons, by reports of attempts to acquire radioactive material and by law enforcement actions which have interdicted, apprehended or prevented attempts to acquire such material. As a mechanism through which to identify radioactive materials being transported on an individual's person, this work sought to develop a detection system that is of lower-cost, reduced form-factor and more covert than existing infrastructure, while maintaining adequate sensitivity and being retrofittable into an industry standard and widely utilised Gunnebo Speed Gate system. The system developed comprised an array of six off-set Geiger-Muller detectors positioned around the gate, alongside a single scintillator detector for spectroscopy, triggered by the systems inbuilt existing IR proximity sensor. This configuration served to not only reduce the cost for such a system but also allowed for source localisation and identification to be performed. Utilising the current setup, it was possible to detect a 1 µSv/h source carried into the Speed Gate in all test scenarios, alongside locating and spectrally analysing the material in a significant number.

Perceptual Errors Support the Notion of Masking by Object Substitution.

Two experiments examined the effect of object substitution masking (OSM) on the perceptual errors in reporting the orientation of a target. In Experiment 1, a four-dot trailing mask was compared with a simultaneous-noise mask. In Experiment 2, the four-dot and noise masks were factorially varied. Responses were modelled using a mixture regression model and Bayesian inference to deduce whether the relative impacts of OSM on guessing and precision were the same as those of a noise mask, and thus whether the mechanism underpinning OSM is based on increasing noise rather than a substitution process. Across both experiments, OSM was associated with an increased guessing rate when the mask trailed target offset and a reduction in the precision of the target representation (although the latter was less reliable across the two experiments). Importantly, the noise mask also influenced both guessing and precision, but in a different manner, suggesting that OSM is not simply caused by increasing noise. In Experiment 2, the effects of OSM and simultaneous-noise interacted, suggesting the two manipulations involve common mechanisms. Overall results suggest that OSM is often a consequence of a substitution process, but there is evidence that the mask increases noise levels on trials where substitution does not occur.

Clinical Aspects of Type 3 Long-QT Syndrome: An International Multicenter Study.

BACKGROUND: Risk stratification in patients with type 3 long-QT syndrome (LQT3) by clinical and genetic characteristics and effectiveness of ß-blocker therapy has not been studied previously in a large LQT3 population. METHODS: The study population included 406 LQT3 patients with 51 sodium channel mutations; 391 patients were known to be event free during the first year of life and were the focus of our study. Clinical, electrocardiographic, and genetic parameters were acquired for patients from 7 participating LQT3 registries. Cox regression analysis was used to evaluate the independent contribution of clinical, genetic, and therapeutic factors to the first occurrence of time-dependent cardiac events (CEs) from age 1 to 41 years. RESULTS: Of the 391 patients, 118 (41 males, 77 females) patients (30%) experienced at least 1 CE (syncope, aborted cardiac arrest, or long-QT syndrome-related sudden death), and 24 (20%) suffered from LQT3-related aborted cardiac arrest/sudden death. The risk of a first CE was directly related to the degree of QTc prolongation. Cox regression analysis revealed that time-dependent ß-blocker therapy was associated with an 83% reduction in CEs in females (P=0.015) but not in males (who had many fewer events), with a significant sex × ß-blocker interaction (P=0.04). Each 10-ms increase in QTc duration up to 500 ms was associated with a 19% increase in CEs. Prior syncope doubled the risk for life-threatening events (P<0.02). CONCLUSIONS: Prolonged QTc and syncope predispose patients with LQT3 to life-threatening CEs. However, ß-blocker therapy reduces this risk in females; efficacy in males could not be determined conclusively because of the low number of events.

Inhibition of TRPM8 channels reduces pain in the cold pressor test in humans.

The transient receptor potential (subfamily M, member 8; TRPM8) is a nonselective cation channel localized in primary sensory neurons, and is a candidate for cold thermosensing, mediation of cold pain, and bladder overactivity. Studies with TRPM8 knockout mice and selective TRPM8 channel blockers demonstrate a lack of cold sensitivity and reduced cold pain in various rodent models. Furthermore, TRPM8 blockers significantly lower body temperature. We have identified a moderately potent (IC50 = 103 nM), selective TRPM8 antagonist, PF-05105679 [(R)-3-[(1-(4-fluorophenyl)ethyl)(quinolin-3-ylcarbonyl)amino]methylbenzoic acid]. It demonstrated activity in vivo in the guinea pig bladder ice water and menthol challenge tests with an IC50 of 200 nM and reduced core body temperature in the rat (at concentrations >1219 nM). PF-05105679 was suitable for acute administration to humans and was evaluated for effects on core body temperature and experimentally induced cold pain, using the cold pressor test. Unbound plasma concentrations greater than the IC50 were achieved with 600- and 900-mg doses. The compound displayed a significant inhibition of pain in the cold pressor test, with efficacy equivalent to oxycodone (20 mg) at 1.5 hours postdose. No effect on core body temperature was observed. An unexpected adverse event (hot feeling) was reported, predominantly periorally, in 23 and 36% of volunteers (600- and 900-mg dose, respectively), which in two volunteers was nontolerable. In conclusion, this study supports a role for TRPM8 in acute cold pain signaling at doses that do not cause hypothermia.

School wellness policy implementation: insights and recommendations from two rural school districts.

Although school wellness policies have the potential to transform school environments, relatively little has been written about postadoption policy implementation and evaluation (policy to practice). The authors report results of a research study that examined the implementation of school wellness policies in two school districts in northern New Mexico. Through nine key informant interviews with administrators and two focus groups with students, they found that physical activity and nutrition policies were implemented inconsistently in both districts. Study participants identified facilitating factors (e.g., champions, grant funding) and barriers (e.g., competitive food sales, lack of clarity about responsibility for policy enforcement) to policy implementation. Participants also provided recommendations to improve policy implementation, including wellness policy training for school personnel and parents, improving the taste, nutritional value of, and choices in cafeteria food; and involving the community health council to promote community understanding and support of the policies. This study underscores the need to identify and address factors involved in the successful implementation of school wellness policies, looking at schools in the larger context of their communities. It also serves as an example of the potential for communities, schools, and others to work together to address a locally identified health priority.

A drift diffusion model analysis of age-related impact on multisensory decision-making processes.

Older adults (OAs) are typically slower and/or less accurate in forming perceptual choices relative to younger adults. Despite perceptual deficits, OAs gain from integrating information across senses, yielding multisensory benefits. However, the cognitive processes underlying these seemingly discrepant ageing effects remain unclear. To address this knowledge gap, 212 participants (18-90 years old) performed an online object categorisation paradigm, whereby age-related differences in Reaction Times (RTs) and choice accuracy between audiovisual (AV), visual (V), and auditory (A) conditions could be assessed. Whereas OAs were slower and less accurate across sensory conditions, they exhibited greater RT decreases between AV and V conditions, showing a larger multisensory benefit towards decisional speed. Hierarchical Drift Diffusion Modelling (HDDM) was fitted to participants' behaviour to probe age-related impacts on the latent multisensory decision formation processes. For OAs, HDDM demonstrated slower evidence accumulation rates across sensory conditions coupled with increased response caution for AV trials of higher difficulty. Notably, for trials of lower difficulty we found multisensory benefits in evidence accumulation that increased with age, but not for trials of higher difficulty, in which increased response caution was instead evident. Together, our findings reconcile age-related impacts on multisensory decision-making, indicating greater multisensory evidence accumulation benefits with age underlying enhanced decisional speed.

Bifidobacterium longum 1714 improves sleep quality and aspects of well-being in healthy adults: a randomized, double-blind, placebo-controlled clinical trial.

Stress and sleep are linked with overall well-being. Bifidobacterium longum 1714 has been shown to influence stress responses and modulate neural responses during social stress, and influence sleep quality during examination stress in healthy adults. Here, we explored the ability of this strain to alter sleep quality in adults using subjective and objective measures. Eighty-nine adults (18-45y) with impaired sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI) and with a global score ≥ 5 were randomized to receive B. longum 1714 or placebo daily for eight weeks. Assessing the effect of the strain on PSQI global score was the primary objective. Secondary objectives assessed sleep quality and well-being subjectively and sleep parameters using actigraphy objectively. While PSQI global score improved in both groups, B. longum 1714 significantly improved the PSQI component of sleep quality (p < 0.05) and daytime dysfunction due to sleepiness (p < 0.05) after 4 weeks and social functioning (p < 0.05) and energy/vitality (p < 0.05) after 8 weeks, compared to placebo. No significant effect on actigraphy measures were observed. The 1714 strain had a mild effect on sleep, demonstrated by a faster improvement in sleep quality at week 4 compared to placebo, although overall improvements after 8 weeks were similar in both groups. B. longum 1714 improved social functioning and increased energy/vitality in line with previous work that showed the strain modulated neural activity which correlated with enhanced vitality/reduced mental fatigue (ClinicalTrials.gov: NCT04167475).

Genomic attributes of airway commensal bacteria and mucosa.

Microbial communities at the airway mucosal barrier are conserved and highly ordered, in likelihood reflecting co-evolution with human host factors. Freed of selection to digest nutrients, the airway microbiome underpins cognate management of mucosal immunity and pathogen resistance. We show here the initial results of systematic culture and whole-genome sequencing of the thoracic airway bacteria, identifying 52 novel species amongst 126 organisms that constitute 75% of commensals typically present in heathy individuals. Clinically relevant genes encode antimicrobial synthesis, adhesion and biofilm formation, immune modulation, iron utilisation, nitrous oxide (NO) metabolism and sphingolipid signalling. Using whole-genome content we identify dysbiotic features that may influence asthma and chronic obstructive pulmonary disease. We match isolate gene content to transcripts and metabolites expressed late in airway epithelial differentiation, identifying pathways to sustain host interactions with microbiota. Our results provide a systematic basis for decrypting interactions between commensals, pathogens, and mucosa in lung diseases of global significance.

A model for calculating the mechanical demands of overground running.

An energy-based approach to quantifying the mechanical demands of overground, constant velocity and/or intermittent running patterns is presented. Total mechanical work done (Wtotal) is determined from the sum of the four sub components: work done to accelerate the centre of mass horizontally (Whor), vertically (Wvert), to overcome air resistance (Wair) and to swing the limbs (Wlimbs). These components are determined from established relationships between running velocity and running kinematics; and the application of work-energy theorem. The model was applied to constant velocity running (2-9 m/s), a hard acceleration event and a hard deceleration event. The estimated Wtotal and each sub component were presented as mechanical demand (work per unit distance) and power (work per unit time), for each running pattern. The analyses demonstrate the model is able to produce estimates that: 1) are principally determined by the absolute running velocity and/or acceleration; and 2) can be attributed to different mechanical demands given the nature of the running bout. Notably, the proposed model is responsive to varied running patterns, producing data that are consistent with established human locomotion theory; demonstrating sound construct validity. Notwithstanding several assumptions, the model may be applied to quantify overground running demands on flat surfaces.

Best Current Practice and Research Priorities in Active Surveillance for Prostate Cancer-A Report of a Movember International Consensus Meeting.

BACKGROUND: Active surveillance (AS) is recommended for low-risk and some intermediate-risk prostate cancer. Uptake and practice of AS vary significantly across different settings, as does the experience of surveillance-from which tests are offered, and to the levels of psychological support. OBJECTIVE: To explore the current best practice and determine the most important research priorities in AS for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: A formal consensus process was followed, with an international expert panel of purposively sampled participants across a range of health care professionals and researchers, and those with lived experience of prostate cancer. Statements regarding the practice of AS and potential research priorities spanning the patient journey from surveillance to initiating treatment were developed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Panel members scored each statement on a Likert scale. The group median score and measure of consensus were presented to participants prior to discussion and rescoring at panel meetings. Current best practice and future research priorities were identified, agreed upon, and finally ranked by panel members. RESULTS AND LIMITATIONS: There was consensus agreement that best practice includes the use of high-quality magnetic resonance imaging (MRI), which allows digital rectal examination (DRE) to be omitted, that repeat standard biopsy can be omitted when MRI and prostate-specific antigen (PSA) kinetics are stable, and that changes in PSA or DRE should prompt MRI ± biopsy rather than immediate active treatment. The highest ranked research priority was a dynamic, risk-adjusted AS approach, reducing testing for those at the least risk of progression. Improving the tests used in surveillance, ensuring equity of access and experience across different patients and settings, and improving information and communication between and within clinicians and patients were also high priorities. Limitations include the use of a limited number of panel members for practical reasons. CONCLUSIONS: The current best practice in AS includes the use of high-quality MRI to avoid DRE and as the first assessment for changes in PSA, with omission of repeat standard biopsy when PSA and MRI are stable. Development of a robust, dynamic, risk-adapted approach to surveillance is the highest research priority in AS for prostate cancer. PATIENT SUMMARY: A diverse group of experts in active surveillance, including a broad range of health care professionals and researchers and those with lived experience of prostate cancer, agreed that best practice includes the use of high-quality magnetic resonance imaging, which can allow digital rectal examination and some biopsies to be omitted. The highest research priority in active surveillance research was identified as the development of a dynamic, risk-adjusted approach.

Periprosthetic bone remodeling after 12 years differs in cemented and uncemented hip arthroplasties.

BACKGROUND: Different patterns of stress shielding may lead to differences in periprosthetic bone preservation around cemented and uncemented hips in the long term? QUESTIONS/PURPOSES: The purpose of this study is to compare the difference in periprosthetic bone density between cemented Charnley total hip and uncemented hydroxyapatite-coated Furlong THAs at a minimum followup of 12 years (mean, 16 years; range, 12-24 years). METHODS: We studied a cohort of 17 patients who had bilateral THAs with a cemented Charnley THA on one side and an uncemented Furlong hydroxyapatite-coated THA on the other side. At a minimum followup of 12 years, Harris and Oxford hip scores were used to determine the function, and dual-energy x-ray absorptiometry was used to quantify bone mineral density adjacent to the prosthesis. The results of the dual-energy x-ray absorptiometry scan for cemented and uncemented hips were analyzed using paired-sample two-tailed t-tests. To compare the Harris hip scores, a nonparametric Wilcoxon test was used. RESULTS: Bone mineral density was higher on the uncemented Furlong side in Gruen Zones 2, 3, 5, and 6 of the proximal femur and DeLee and Charnley Zone 1 of the acetabulum. In all other zones, there was no difference. Comparison of Harris and Oxford hip scores showed no differences between the two hips. CONCLUSION: Bone density is better preserved around the uncemented hydroxyapatite-coated Furlong stem compared with the Charnley cemented stem. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Patient opinion regarding patient-centered medical home fundamentals.

OBJECTIVES: Although conceptually there is agreement on how the Patient-Centered Medical Home (PCMH) should be organized, there is little information regarding which PCMH components are the most important to patients. METHODS: An anonymous, voluntary survey was administered to patients at three US academic medical centers. Questions sought opinions regarding the National Committee for Quality Assurance's key components and essential elements of the PCMH. Analysis of the survey responses was conducted using SAS version 9.1. RESULTS: A total of 780 surveys were returned. Patients expressed believing strongly that the ability to coordinate care, help patients to manage their own disease, and track laboratory results were the most important aspects of a PCMH office. There were no differences in response to the survey according to age, sex, race, or site. Patients listed care coordination, patient self-management, and improved access to care as the top priority attributes of a PCMH. CONCLUSIONS: Patients were consistent in their opinions that care coordination, access, and patient self-management were the most important elements of a PCMH.

Probability distribution for energy of saturated broadband ocean acoustic transmission: results from Gulf of Maine 2006 experiment.

The probability distribution of ocean-acoustic broadband signal energy after saturated multipath propagation is derived using coherence theory. The frequency components obtained from Fourier decomposition of a broadband signal are each assumed to be fully saturated with energy spectral density that obey the exponential distribution with 5.6 dB standard deviation and unity scintillation index. When the signal bandwidth and measurement time are larger than the correlation bandwidth and correlation time, respectively, of its energy spectral density components, the broadband signal energy obtained by integrating the energy spectral density across the signal bandwidth then follows the Gamma distribution with a standard deviation smaller than 5.6 dB and a scintillation index less than unity. The theory is verified with broadband transmissions in the Gulf of Maine shallow water waveguide in the 300 to 1200 Hz frequency range. The standard deviations of received broadband signal energies range from 2.7 to 4.6 dB for effective bandwidths up to 42 Hz, while the standard deviations of individual energy spectral density components are roughly 5.6 dB. The energy spectral density correlation bandwidths of the received broadband signals are found to be larger for signals with higher center frequencies and are roughly 10% of each center frequency.

Perioperative multimodal optimisation in patients undergoing surgery for fractured neck of femur.

INTRODUCTION: Enhanced Recovery after Surgery protocols are associated with reduced length of stay and morbidity in patients undergoing major surgery. The aim of this audit was to assess the impact of a multimodal optimisation protocol in patients admitted with fractured neck of femur. PATIENTS AND METHODS: A multimodal optimisation protocol was introduced for the care of patients with proximal femoral fractures. The short-term effects of the optimised perioperative care programme was assessed and compared with the conventional perioperative care before the intervention. RESULTS: A total of 232 patients were included in this audit, 117 optimised care and 115 conventional care. Patients were similar with regards to age, gender, domicile, mental status and the type of operation. The optimised group suffered from fewer post-operative complications (36 out of 117 vs 48 out of 115, P = 0.04, Chi square test). There was no significant difference between two groups with regards to the length of hospital stay and 30-day mortality. CONCLUSION: Multimodal optimisation may be associated with a decline in post-operative morbidity in patients with proximal hip fracture. It does not have any significant impact on the length of hospital stay and 30-day mortality.