"If only had I known":a qualitative study investigating a treatment of patients with a hip fracture with short time stay in hospital

Hip fractures are amongst the leading causes of admission to an orthopaedic ward. Systematized pathways with reduced admission time have become increasingly common as an essential tool for quality development and to improve efficiency in the hospital setting.  The aim of this study was to clarify if the patients feel empowered and able to perform self-care after short time stay in hospital (STSH) due to a hip fracture. The study used descriptive phenomenology to describe experiences of the pathway. Field studies were conducted in hospitals and in the patients' homes.  Interviews were performed with 10 patients recruited from two wards at a Danish University hospital, 4 family members and 15 health professionals from three hospitals.  The open attitude of reflective lifeworld research guided the analysis. The findings revealed that patients felt unprepared and insecure about their future, but also had a strong desire to be in charge of their own lives.  Of all the patients interviewed, none had any recollection of the information given to them by health professionals during their hospital admission. This study demonstrates that empowerment of patients with hip fractures is not adequately achieved in the pathway with STSH

Increased risk of revision in patients with non-traumatic femoral head necrosis

Peer reviewe

Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database

Background and purpose According to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65-74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA based on the NARA database, which has not been done previously.Patients and methods We determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression to assess survival and hazard ratios (HRs), with revision for any reason as endpoint and with adjustment for age, sex, diagnosis, and femoral head material.Results Spectron EF THA (89.9% (CI: 89.3-90.5)) and Elite THA (89.8% (CI: 89.0-90.6)) had the lowest 10-year survivorship. Lubinus (95.7% survival, CI: 95.5-95.9), MS 30 (96.6%, CI: 95.8-97.4), and C-stem THA (95.8%, CI: 94.8-96.8) had a 10-year survivorship of at least 95%. Lubinus (revision risk (RR)=0.77, CI: 0.73-0.81), Muller (RR =0.83, CI: 0.70-0.99), MS-30 (RR =0.73, CI: 0.63-0.86), C-stem (RR =0.70, CI: 0.55-0.90), and Exeter Duration THA (RR =0.84, CI: 0.77-0.90) had a lower risk of revision than Charnley THA, the reference implant.Interpretation The Spectron EF THA and the Elite THA had a lower implant survival than the Charnley, Exeter, and Lubinus THAs. Implant survival of the Muller, MS 30, CPT, and C-stem THAs was above the acceptable limit for 10-year survival.Peer reviewe

Increasing risk of prosthetic joint infection after total hip arthroplasty : 2,778 revisions due to infection after 432,168 primary THAs in the Nordic Arthroplasty Register Association (NARA)

WOS:000310015700004Background and purpose The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden). Materials and methods The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection as the endpoint. The effect of risk factors such as the year of surgery, age, sex, diagnosis, type of prosthesis, and fixation were assessed. Results 2,778 (0.6%) of the primary THAs were revised due to infection. Compared to the period 1995-1999, the relative risk (with 95% CI) of revision due to infection was 1.1 (1.0-1.2) in 2000-2004 and 1.6 (1.4-1.7) in 2005-2009. Adjusted cumulative 5-year revision rates due to infection were 0.46% (0.42-0.50) in 1995-1999, 0.54% (0.50-0.58) in 2000-2004, and 0.71% (0.66-0.76) in 2005-2009. The entire increase in risk of revision due to infection was within 1 year of primary surgery, and most notably in the first 3 months. The risk of revision due to infection increased in all 4 countries. Risk factors for revision due to infection were male sex, hybrid fixation, cement without antibiotics, and THA performed due to inflammatory disease, hip fracture, or femoral head necrosis. None of these risk factors increased in incidence during the study period. Interpretation We found increased relative risk of revision and increased cumulative 5-year revision rates due to infection after primary THA during the period 1995-2009. No change in risk factors in the NARA dataset could explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA.Peer reviewe

Countrywise results of total hip replacement An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database

Peer reviewe

Allogeneic blood transfusion and prognosis following total hip replacement: a population-based follow up study

<p>Abstract</p> <p>Background</p> <p>Allogeneic red blood cell transfusion is frequently used in total hip replacement surgery (THR). However, data on the prognosis of transfused patients are sparse. In this study we compared the risk of complications following THR in transfused and non-transfused patients.</p> <p>Methods</p> <p>A population-based follow-up study was performed using data from medical databases in Denmark. We identified 28,087 primary THR procedures performed from 1999 to 2007, from which we computed a propensity score for red blood cell transfusion based on detailed data on patient-, procedure-, and hospital-related characteristics. We were able to match 2,254 transfused with 2,254 non-transfused THR patients using the propensity score.</p> <p>Results</p> <p>Of the 28,087 THR patients, 9,063 (32.3%) received at least one red blood cell transfusion within 8 days of surgery. Transfused patients had higher 90-day mortality compared with matched non-transfused patients: the adjusted OR was 2.2 (95% confidence interval (CI): 1.2-3.8). Blood transfusion was also associated with increased odds of pneumonia (OR 2.1; CI: 1.2-3.8), whereas the associations with cardiovascular or cerebrovascular events (OR 1.4; CI: 0.9-2.2) and venous thromboembolism (OR 1.2; CI: 0.7-2.1) did not reach statistical significance. The adjusted OR of reoperation due to infection was 0.6 (CI: 0.1-2.9).</p> <p>Conclusions</p> <p>Red blood cell transfusion was associated with an adverse prognosis following primary THR, in particular with increased odds of death and pneumonia. Although the odds estimates may partly reflect unmeasured bias due to blood loss, they indicate the need for careful assessment of the risk versus benefit of transfusion even in relation to routine THR procedures.</p

Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

Background and purpose - Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year period, and compared it with that in THR patients with osteoarthritis (OA). Patients and methods - We identified 13,384 THRs in RA patients and 377,287 THRs in OA patients from 1995 through 2010 in a dataset from the Nordic Arthroplasty Register Association (NARA). Kaplan-Meier survival curves, with revision for infection as the endpoint, were constructed. Cox regression analyses were performed to calculate the relative risk (RR) of revision for infection adjusted for age, sex, fixation technique, and year of primary surgery. Results - RA patients had a 1.3 times (95% CI 1.0-1.6) higher risk of revision for infection. After 2001, this risk increased more for RA patients than for OA patients. During the first 3 months and from 8 years postoperatively, the risk of revision for infection was higher in RA patients with THRs fixated with antibiotic-loaded cement than in corresponding OA patients. Interpretation - We found a slightly higher overall risk of revision for infection in RA patients than in OA patients, but this difference was only present after 2001. In THRs with antibiotic-loaded cement, the risk of very early and late infections leading to revision was higher in RA patients than in OA patients.Peer reviewe

A Study On The Model Of Profit And Risk In Xiamen’s Commercial Banks

随着相对滞后的金融体制改革提上议事日程，金融业中的银行业的风险和效益的矛盾对立统一日益成为讨论的焦点、热点。加入WTO对金融业意味着拥有先进管理技术和经验的外资银行抢滩国内银行业务，其对国内中资银行的竞争和生存环境的影响是巨大且不可预测的。作者认为国内中资银行是缺乏效率的，为避免银行命脉被外资控制，国内中资银行不能讳疾忌医，而要以有容乃大、自省的态度积极寻求市场经济下的解决之道，最可取的莫过于解剖一只麻雀。 按照这一思路，本文选取了厦门8家经营较稳定的商业银行进行收益风险模式比较，为国内其他中资商业银行的经营管理提供实证参考。 第一章导言。对银行经营活动的一般特点进行描述。提出银行作为经济...Owing to the combination between banking and economics , influencing factor is increasingly complicated. Banker needs to design one macroanalysis model to logically judge different kinds of income chance and danger all banks faced with，through which banker may supply effective diagnose for banking operating management. The theses takes banking 'data in Xiamen as an example .It exists that huge c...学位：工商管理硕士院系专业：管理学院工商管理教育中心_工商管理硕士(MBA)学号：19981505

Seasonal changes in lipid composition and glycogen storage associated with freeze-tolerance of the earthworm, Dendrobaena octaedra

The earthworm, Dendrobaena octaedra, is a common species in the uppermost soil and humus layers of coniferous forests and tundra in temperate and subarctic regions. The species is freeze-tolerant and may survive several months in a frozen state. Upon freezing, glycogen reserves are rapidly converted to glucose serving as a cryoprotectant and fuel for metabolism. In the present study we investigated the induction of freeze-tolerance under field conditions, and sought to find relationships between temperature, glycogen and fat reserves, membrane phospholipid composition and the degree of freeze-tolerance. Freeze-tolerance was induced when worms had experienced temperatures below 5A degrees C for 2 weeks or more. Freeze-tolerance was linked to the magnitude of glycogen reserves, which also fluctuated with field temperatures being highest in autumn and winter. On the other hand fat reserves seemed not to be linked with freeze-tolerance at all. However, high glycogen alone did not confer freeze-tolerance; alterations in the membrane phospholipid fatty acid composition (PLFA) were also necessary in order to secure freeze-tolerance. The changes in PLFA composition were generally similar to changes occurring in other ectothermic animals during winter acclimation with an increased degree of unsaturation of the PLFAs