A pilot study of a trial of tight control of blood pressure during hip fracture surgery in older people

2016 ◽  
Author(s):  
Iain Moppett
Keyword(s):  
Blood Pressure ◽  
Hip Fracture ◽  
Pilot Study ◽  
Older People ◽  
Tight Control ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
R. Gamberale ◽  
C. D’Orlando ◽  
S. Brunelli ◽  
R. Meneveri ◽  
P. Mazzola ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Frailty Index ◽  
Pathophysiological Mechanisms ◽  
Hip Fracture Surgery ◽  
Endothelial Dysfunctions ◽  
Fracture Surgery ◽  
Pathophysiologic Mechanisms

Abstract Background Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. Methods Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient’s functional status at discharge, using the Cumulated Ambulation Score. Discussion This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.

On-table decision-making in intracapsular hip fracture surgery: mid-term results of a pilot study

2016 ◽  
Vol 136 (7) ◽  
pp. 913-919 ◽  
Author(s):  
Maximilian J. Hartel ◽  
Shahab Maafi Mandani ◽  
Jakob Nuechtern ◽  
Norbert Stiel ◽  
Wolfgang Lehmann ◽  
...  
Keyword(s):  
Decision Making ◽  
Hip Fracture ◽  
Pilot Study ◽  
Hip Fracture Surgery ◽  
Intracapsular Hip Fracture ◽  
Mid Term Results ◽  
Fracture Surgery

Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study

2006 ◽  
Vol 50 (4) ◽  
pp. 437-442 ◽  
Author(s):  
N. B. Foss ◽  
D. S. Christensen ◽  
M. Krasheninnikoff ◽  
B. B. Kristensen ◽  
H. Kehlet
Keyword(s):  
Hip Fracture ◽  
Pilot Study ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals A pilot study examining the impact of exercise training on skeletal muscle genes related to the TLR signaling pathway in older adults following hip fracture recovery

2017 ◽  
Vol 122 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Alec I. McKenzie ◽  
Robert A. Briggs ◽  
Katherine M. Barrows ◽  
Daniel S. Nelson ◽  
Oh Sung Kwon ◽  
...  
Keyword(s):  
Gene Expression ◽  
Older Adults ◽  
Skeletal Muscle ◽  
Hip Fracture ◽  
Pilot Study ◽  
Exercise Training ◽  
Muscle Function ◽  
Tlr Signaling ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Older adults after hip fracture surgery experience progressive muscle atrophy and weakness, limiting full recovery. Further understanding of the molecular mechanisms in muscle with adaptation to exercise training in this vulnerable population is necessary. Therefore, we conducted a pilot study to investigate the skeletal muscle inflammatory and ceramide biosynthesis gene expression levels associated with the toll-like receptor (TLR) pathway before (Pre) and following a 3-mo multicomponent exercise training program in older adults (3M, 4F; 78.4 ± 13.3 yr; 25.5 ± 2.3 kg/m2) ~4 mo after repair from hip fracture (HipFx). Vastus lateralis biopsies from the surgical limb were obtained before (Pre) and after training. Molecular end points and muscle function data were also compared with matched nonexercise healthy controls (CON). As a follow-up analysis, we evaluated specific sphingolipid pools in HipFx and CON muscle. Following training, quadriceps cross-sectional area, strength, and 6-min walk (6MW) increased in the surgical limb ( P < 0.05). Additionally, MYD88, TAK1, NFKB1, IL6, SPT2, and CERS1 gene expression decreased after training ( P ≤ 0.05), but some remained elevated above CON levels. Interestingly, MYD88 mRNA was inversely correlated to quadriceps CSA, strength, and 6MW. Finally, muscle dihydroceramides and phosphoceramides in HipFx were lower than CON at Pre ( P ≤ 0.05), but after training differences from CON were removed. Together, our pilot data support that exercise training alters skeletal muscle inflammation and ceramide metabolism associated with TLR signaling in older adults recovering from hip fracture surgery and may be related to improvements in muscle function recovery. NEW & NOTEWORTHY These pilot data demonstrate that 3 mo of exercise training in older adults recovering from hip fracture surgery was able to mitigate skeletal muscle gene expression related to inflammation and ceramide metabolism while also improving surgical limb lean tissue, strength, and physical function.

Diabetes Mellitus and Gender Have a Negative Impact on the Outcome of Hip Fracture Surgery—A Pilot Study

2019 ◽  
Vol 38 (4) ◽  
pp. 834-842 ◽  
Author(s):  
Adam S. Galbraith ◽  
Clara Sanz‐Nogués ◽  
Sharon Glynn ◽  
Cynthia M. Coleman ◽  
Colin Murphy
Keyword(s):  
Diabetes Mellitus ◽  
Hip Fracture ◽  
Pilot Study ◽  
Negative Impact ◽  
Hip Fracture Surgery ◽  
And Gender ◽  
Fracture Surgery

Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people

2006 ◽  
Vol 36 (11) ◽  
pp. 1635-1645 ◽  
Author(s):  
RICHARD C. OUDE VOSHAAR ◽  
SUBE BANERJEE ◽  
MIKE HORAN ◽  
ROBERT BALDWIN ◽  
NEIL PENDLETON ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Hip Fracture ◽  
Older People ◽  
Cognitive Functioning ◽  
Outcome Measures ◽  
Functional Recovery ◽  
Fear Of Falling ◽  
Hip Fracture Surgery ◽  
The Impact ◽  
Fracture Surgery

Background. Depression and cognitive functioning have a negative impact on functional recovery after hip fracture surgery in older people, and the same has been suggested for pain and fear of falling. These variables, however, have never been studied together, nor has the timing of psychiatric assessment been taken into account.Method. Two parallel, randomized controlled trials were undertaken aiming to prevent and treat depression after hip fracture surgery in older people. Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms (15-item Geriatric Depression Scale, GDS), pain (Wong–Baker pain scale), cognitive functioning (Mini-mental State Examination, MMSE) and fear of falling (Modified Falls Efficacy Scale, MFES) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months. Main outcome measures were performance-based measures (up-and-go test, gait test, functional reach) and the self-report Sickness Impact Profile (SIP) questionnaire to assess the impact of the hip fracture on activities of daily living (ADL).Results. Two hundred and ninety-one patients participated and outcome measures for 187 (64%) patients were available at 6 months. All mental health variables interfered with functional recovery. However, in the final multivariate model, cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery, whereas pain and depressive symptoms were no longer significant.Conclusion. Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.

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