6 research outputs found
Use of human GH in elderly patients with accidental hip fracture
OBJECTIVE: To investigate whether early intervention with recombinant
human growth hormone (hGH) after hip fracture improves functional recovery
and long-term outcome. SUBJECTS AND METHODS: Functional recovery after hip
fracture is often incomplete. The catabolic situation that develops after
the hip fracture accident, and a state of malnutrition either pre-existing
or developing after surgery, are main contributing factors for the poor
clinical outcome. hGH has been used to promote anabolism in a variety of
clinical catabolic situations. The study design was randomized,
double-blind and placebo-controlled. A total of 111 patients older than 60
years with an accidental hip fracture (mean age 78.5+/-9.1 (s.d.) years)
were randomized to receive either hGH (20 microg/kg per day) or placebo
for a period of 6 weeks, starting within 24 h after the hip fracture
accident. Thereafter patients were followed up for an additional period of
18 weeks. Efficacy was assessed by comparing the changes in the Barthel
Index score of activities of daily living and in a patient's living
situation between the hGH- and the placebo-treated subjects. RESULTS:
Eighty-five (78.5%) patients completed the first 8 weeks of the study and
76 (68.5%) the entire study period of 24 weeks. When split according to
age, a trend was found that for patients older than 75 years the changes
in Barthel Index score from baseline were less in the hGH group than in
the placebo group (-18.6+/-18 vs -28.1+/-26) at 6 weeks after surgery
(P<0.075). There was an overall trend to a higher rate of return to the
pre-fracture independent living situation in the hGH group than in the
placebo group. Analysis by age revealed a significantly higher proportion
of hGH- than placebo-treated patients returning to the pre-fracture living
situation for subjects older than 75 years (93.8 vs 75.0%, P=0.034). hGH
treatment increased IGF-I values to levels in the range of those of normal
subjects of 50-60 years of age. CONCLUSIONS: A 6 week treatment with hGH
(20 microg/kg per day) of otherwise healthy patients after an accidental
hip fracture may be of benefit if given to subjects older than 75 years of
age. The rate of return to the pre-fracture living situation in subjects
of this age treated with hGH was significantly increased when compared
with the placebo-treated group. The treatment intervention was well
tolerated and no safety issues were recorded
Prediction of torsional failure in 22 cadaver femora with and without simulated subtrochanteric metastatic defects: a CT scan-based finite element analysis
BACKGROUND: In metastatic bone disease, prophylactic fixation of impending long bone fracture is preferred over surgical treatment of a manifest fracture. There are no reliable guidelines for prediction of pathological fracture risk, however. We aimed to determine whether finite element (FE) models constructed from quantitative CT scans could be used for predicting pathological fracture load and location in a cadaver model of metastatic bone disease. MATERIAL AND METHODS: Subject-specific FE models were constructed from quantitative CT scans of 11 pairs of human femora. To simulate a metastatic defect, a transcortical hole was made in the subtrochanteric region in one femur of each pair. All femora were experimentally loaded in torsion until fracture. FE simulations of the experimental set-up were performed and torsional stiffness and strain energy density (SED) distribution were determined. RESULTS: In 15 of the 22 cases, locations of maximal SED fitted with the actual fracture locations. The calculated torsional stiffness of the entire femur combined with a criterion based on the local SED distribution in the FE model predicted 82% of the variance of the experimental torsional failure load. INTERPRETATION: In the future, CT scan-based FE analysis may provide a useful tool for identification of impending pathological fractures requiring prophylactic stabilization
Agreement of general practitioners with the guideline-based stepped-care strategy for patients with osteoarthritis of the hip or knee: A cross-sectional study
Background: To improve the management of hip or knee osteoarthritis (OA), a multidisciplinary guideline-based stepped-care strategy (SCS) with recommendations regarding the appropriate non-surgical treatment modalities and optimal sequence for care has been developed. Implementation of this SCS in the general practice may be hampered by the negative attitude of general practitioners (GPs) towards the strategy. In order to develop a tailored implementation plan, we assessed the GPs' views regarding specific recommendations in the SCS and their working procedures with regard to OA. Methods. A survey was conducted among a random sample of Dutch GPs. Questions included the GP's demographical characteristics and the practice setting as well as how the management of OA was organized and whether the GPs supported the SCS recommendations. In particular, we assessed GP's views regarding the effectiveness of 14 recommended and non-recommended treatment modalities. Furthermore, we calculated their agreement with 7 statements based on the SCS recommendations regarding the sequence for care. With a linear regression model, we identified factors that seemed to influence the GPs' agreement with the SCS recommendations. Results: Four hundred fifty-six GPs (37%) aged 30-65 years, of whom 278 males (61%), responded. Seven of the 11 recommended modalities (i.e. oral Non-Steroidal Anti-Inflammatory Drugs, physical therapy, glucocorticoid intra-articular injections, education, lifestyle advice, acetaminophen, and tramadol) were considered effective by the majority of the GPs (varying between 95-60%). The mean agreement score, based on a 5-point scale, with the recommendations regarding the sequence for care was 2.8 (SD = 0.5). Ten percent of the variance in GPs' agreement could be explained by the GPs' attitudes regarding the effectiveness of the recommended and non-recommended non-surgical treatment modalities and the type of practice. Conclusion: In general, GPs support the recommendations in the SCS. Therefore, we expect that their attitudes will not impede a successful implementation in general practice. Our results provide sev
Tromboembolische complicaties na totale heuparthroplastiek : een onderzoek naar de profylactische waarde van laag-gedoseerde pre- en postoperatieve orale anticoagulantia
Medisch-technische ontwikkelingen gedurende de afgelopen 25 jaar
hebben het mogelijk gemaakt een pijnlijk en verstijfd gewricht met een
grate kans van slagen te vervangen door een nieuw gewricht in de vorm
van een prothese.
De heup is thans het meest vervangen gewricht. In Nederland werden in
1984 meer dan 10.000 totale heuparthroplastieken verricht.Bij het merendeel van deze operaties werden een acetabulumprothese van polyethyl een
en een kophalsprothese van een metaallegering met acrylcement gefixeerd.
Een scherpe indicatiestelling, een geestelijke en lichamelijke voorbereiding
van de (veelal bejaarde} patient, een optimale operatietechniek, een zonodig individueel aangepast revalidatieschema, en leefregels
voor de langere termijn dragen er mede toe bi j dat globaal 90% van de
ingebrachte heupprotheses na 10 jaar nag probleemloos functioneert.
Zowel het gebied van de endoprothesiologie in engere zin als dat van de
verankeringstechnieken is nag volop in beweging, en een hoger succespercentage
in de toekomst is niet uitgesloten.
De meest gevreesde complicatie na een totale heuparthroplastiek is
een infectie random de prothese. Preoperatief onderzoek naar potentiele
infectiebronnen (zeals urineweginfecties) en behandeling daarvan, peroperatieve
antibiotische bescherming en het gebruik van een kiemvrije
operatiekamer kunnen het infectiepercentage tot ongeveer een procent
reducere
Effect of stepped care on health outcomes in patients with osteoarthritis: An observational study in Dutch general practice
Abstract
Background
A stepped care strategy (SCS) to improve
adequate healthcare use in patients with
osteoarthritis was developed and implemented
in a primary care region in the Netherlands.
Aim
To assess the association between care that
is in line with the SCS recommendations and
health outcomes.
Design and setting
Data were used from a 2-year observational
study of 313 patients who had consulted their
GP because of osteoarthritis.
Method
Care was considered ‘SCS-consistent’ if al