The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures

<p>Abstract</p> <p>Background</p> <p>Whether reducing time-to-surgery for elderly patients suffering from hip fracture results in better outcomes remains subject to controversial debates.</p> <p>Methods</p> <p>As part of a prospective observational study conducted between January 2002 and September 2003 on hip-fracture patients from 268 acute-care hospitals all over Germany, we investigated the relationship of time-to-surgery with frequency of post-operative complications and one-year mortality in elderly patients (age ≥65) with isolated proximal femoral fracture (femoral neck fracture or pertrochanteric femoral fracture). Patients with short (≤12 h), medium (> 12 h to ≤36 h) and long (> 36 h) times-to-surgery, counting from the time of the fracture event, were compared for patient characteristics, operative procedures, post-operative complications and one-year mortality.</p> <p>Results</p> <p>Hospital data were available for 2916 hip-fracture patients (mean age (SD) in years: 82.1 (7.4), median age: 82; 79.7% women). Comparison of groups with short (n = 802), medium (n = 1191) and long (n = 923) time-to-surgery revealed statistically significant differences in a few patient characteristics (age, American Society of Anesthesiologists ratings classification and type of admission) and in operative procedures (total hip endoprosthesis, hemi-endoprosthetic implants, other osteosynthetic procedures). However, comparison of these same groups for frequency of postoperative complications revealed only some non-significant associations with certain complications such as post-operative bleeding requiring treatment (early surgery patients) and urinary tract infections (delayed surgery patients). Both unadjusted rates of one-year all-cause mortality (between 18.1% and 20.5%), and the multivariate-adjusted hazard ratios (HR for time-to-surgery: 1.04; p = 0.55) showed no association between mortality and time-to-surgery.</p> <p>Conclusion</p> <p>Although this study found a trend toward more frequent post-operative complications in the longest time-to-surgery group, there was no effect of time-to-surgery on mortality. Shorter time-to-surgery may be associated with somewhat lower rates of post-operative complications such as decubitus ulcers, urinary tract infections, thromboses, pneumonia and cardiovascular events, and with somewhat higher rates of others such as post-operative bleeding or implant complications.</p

Multistable Solitons in the Cubic-Quintic Discrete Nonlinear Schr\"odinger Equation

We analyze the existence and stability of localized solutions in the one-dimensional discrete nonlinear Schr\"{o}dinger (DNLS) equation with a combination of competing self-focusing cubic and defocusing quintic onsite nonlinearities. We produce a stability diagram for different families of soliton solutions, that suggests the (co)existence of infinitely many branches of stable localized solutions. Bifurcations which occur with the increase of the coupling constant are studied in a numerical form. A variational approximation is developed for accurate prediction of the most fundamental and next-order solitons together with their bifurcations. Salient properties of the model, which distinguish it from the well-known cubic DNLS equation, are the existence of two different types of symmetric solitons and stable asymmetric soliton solutions that are found in narrow regions of the parameter space. The asymmetric solutions appear from and disappear back into the symmetric ones via loops of forward and backward pitchfork bifurcations.Comment: To appear Physica D. 23 pages, 13 figure

Optical, magneto-optical properties and fiber-drawing ability of tellurite glasses in the TeO2-ZnO-BaO ternary system

The presented work is focused on the optical and magneto-optical characterization of TeO2-ZnO-BaO (TZB) tellurite glasses. We investigated the refractive index and extinction coefficient dispersion by spectroscopic ellipsometry from ultraviolet, 0.193 um, up to mid infrared, 25 um spectral region. Studied glasses exhibited large values of linear (n632 = 1.91-2.09) and non-linear refractive index (n2 = 1.20-2.67x10-11 esu), Verdet constant (V632 = 22-33 radT-1m-1) and optical band gap energy (Eg = 3.7-4.1 eV). The materials characterization revealed that BaO substitution by ZnO leads (at constant content of TeO2) to an increase in linear and nonlinear refractive index as well as Verdet constant while the optical band gap energy decreases. Fiber drawing ability of TeO2-ZnO-BaO glassy system has been demonstrated on 60TeO2-20ZnO-20BaO glass with presented mid infrared attenuation coefficient. Specific parameters such as dispersion and single oscillator energy, Abbe number, and first-/ third-order optical susceptibility are enclosed together with the values of magneto-optic anomaly derived from the calculation of measured dispersion of the refractive index

Multistable Solitons in Higher-Dimensional Cubic-Quintic Nonlinear Schroedinger Lattices

We study the existence, stability, and mobility of fundamental discrete solitons in two- and three-dimensional nonlinear Schroedinger lattices with a combination of cubic self-focusing and quintic self-defocusing onsite nonlinearities. Several species of stationary solutions are constructed, and bifurcations linking their families are investigated using parameter continuation starting from the anti-continuum limit, and also with the help of a variational approximation. In particular, a species of hybrid solitons, intermediate between the site- and bond-centered types of the localized states (with no counterpart in the 1D model), is analyzed in 2D and 3D lattices. We also discuss the mobility of multi-dimensional discrete solitons that can be set in motion by lending them kinetic energy exceeding the appropriately crafted Peierls-Nabarro barrier; however, they eventually come to a halt, due to radiation loss.Comment: 12 pages, 17 figure

Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle

Summary The International Osteoporosis Foundation (IOF) Capture the Fracture Campaign aims to support implementation of Fracture Liaison Services (FLS) throughout the world. Introduction FLS have been shown to close the ubiquitous secondary fracture prevention care gap, ensuring that fragility fracture sufferers receive appropriate assessment and intervention to reduce future fracture risk. Methods Capture the Fracture has developed internationally endorsed standards for best practice, will facilitate change at the national level to drive adoption of FLS and increase awareness of the challenges and opportunities presented by secondary fracture prevention to key stakeholders. The Best Practice Framework (BPF) sets an international benchmark for FLS, which defines essential and aspirational elements of service delivery. Results The BPF has been reviewed by leading experts from many countries and subject to beta-testing to ensure that it is internationally relevant and fit-for-purpose. The BPF will also serve as a measurement tool for IOF to award ‘Capture the Fracture Best Practice Recognition’ to celebrate successful FLS worldwide and drive service development in areas of unmet need. The Capture the Fracture website will provide a suite of resources related to FLS and secondary fracture prevention, which will be updated as new materials become available. A mentoring programme will enable those in the early stages of development of FLS to learn from colleagues elsewhere that have achieved Best Practice Recognition. A grant programme is in development to aid clinical systems which require financial assistance to establish FLS in their localities. Conclusion Nearly half a billion people will reach retirement age during the next 20 years. IOF has developed Capture the Fracture because this is the single most important thing that can be done to directly improve patient care, of both women and men, and reduce the spiralling fracture-related care costs worldwide.</p