Functional Predictors for Home Discharge after Hip Fracture in Patients Living in Sloped Neighborhoods or Islands: An 8-Year Retrospective Cohort Study

Functional predictors of home discharge after hip fractures have been widely reported; however, no study has considered the geographical features surrounding patients’ homes. This study aimed to identify home discharge predictors and determine the cutoff points required for home discharge of patients living in sloped neighborhoods or islands. A total of 437 postoperative hip fracture patients were included and classified into the flat, slope, and island groups according to their residential area before the fracture. Multivariate logistic regression analysis was used to identify significant home discharge predictors, and receiver-operating characteristic analysis to calculate cutoff values. In all the groups, the functional independence measure-motor score was a significant home discharge predictor, with cutoff values of 69 for the flat group and 65 points for the slope and island group. In the slope group, the 6-minute walking distance (odds ratio, 1.02; 95% confidence interval, 1.01–1.04) and revised Hasegawa dementia scale score (odds ratio, 1.06; 95% confidence interval, 1.01–1.12) were also identified as predictors, with cutoff values of 150 m and 18 points, respectively. The outcomes required for home discharge after hip fracture differ depending on the neighborhood terrain, especially for patients living in areas with many slopes and stairs.

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Organisational Determinants and Consequences of Diagnostic Discrepancy in Emergency Departments: A National Study of Consecutive Episodes Between 2008-2016

10.21203/rs.3.rs-131975/v1 ◽

2020 ◽

Author(s):

Line Stjernholm Tipsmark ◽

Børge Obel ◽

Tommy Andersson ◽

Rikke Søgaard

Keyword(s):

Emergency Department ◽

Hip Fracture ◽

Observational Study ◽

Confidence Interval ◽

Odds Ratio ◽

Healthcare Sector ◽

National Study ◽

Common Phenomenon ◽

Mixed Effect ◽

Mixed Effect Models

Abstract Background Diagnostic discrepancy (DD) is a common phenomenon in healthcare, but little is known about its organisational determinants and consequences. Thus, the aim of the study was to evaluate this among selected emergency department (ED) patients. Method We conducted an observational study including all consecutive ED patients (hip fracture or erysipelas) in the Danish healthcare sector admitted between 2008 and 2016. DD was defined as a discrepancy between discharge and admission diagnoses. Episode and department statistics were retrieved from Danish registers. We conducted a survey among all Danish EDs (m=21) to inform organisational determinants. To estimate the results while adjusting for episode- and department-level heterogeneity, we used mixed effect models of ED organisational determinants and 30-day readmission, 30-day mortality and episode costs (2018-DKK) of DDs. ResultsDD was observed in 2,308 (3.3%) of 69,928 hip fracture episodes and 3,206 (8.5%) of 37,558 erysipelas episodes. The main organisational determinant of DD was senior physicians being employed at the ED (hip fracture: odds ratio (OR) 2.74, 95% confidence interval (CI) 2.15-3.51; erysipelas: OR 3.29, 95% CI 2.65-4.07). However, 24-hour presence of senior physicians (hip fracture) and availability of external senior physicians (both groups) were negatively associated with DD. DD was associated with increased 30-day readmission (hip fracture, mean 9.45% vs 13.76%, OR 1.46, 95% CI 1.28-1.66, p<0.001) and episode costs (hip fracture, 61,681 DKK vs 109,860 DKK, log cost 0.58, 95% CI 0.53-0.63, p<0.001; erysipelas, mean 20,818 DKK vs 56,329 DKK, log cost 0.97, 95% CI 0.92-1.02, p<0.001) compared with episodes without DD. Conclusion DD affects outcomes, and particular organisational characteristics seem to be associated with DD. Yet, the complexity of organisations and settings warrant further studies into these associations.

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Lateral and Posterior Approaches in Hemiarthroplasty

Scandinavian Journal of Surgery ◽

10.1177/1457496917748226 ◽

2018 ◽

Vol 107 (3) ◽

pp. 260-268 ◽

Cited By ~ 5

Author(s):

M. T. Hongisto ◽

M. S. Nuotio ◽

T. Luukkaala ◽

O. Väistö ◽

H. K. Pihlajamäki

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Confidence Interval ◽

Living Arrangements ◽

Odds Ratio ◽

Posterior Approach ◽

Hip Dislocation ◽

Lateral Approach ◽

Mobility Aids ◽

Neck Fracture

Purpose: Hemiarthroplasty is a common treatment for patient with a fragility displaced femoral neck fracture. We compared lateral and posterior approaches with respect to need for mobility aids, mobility level, living arrangements, pain, hip dislocation, and survival 12 months after hip fracture. Methods: A total of 393 fragility femoral neck fracture patients aged 65 years or more who underwent hemiarthroplasty were observed for 12 months. Patient information was collected on admission, during hospitalization, and by telephone interview 1 year after the hip fracture. A total of 269 patients were included in the final analysis. Results: At 1 year after hip fracture, more patients undergoing hemiarthroplasty with the posterior approach (22%) survived without mobility aids compared to those with the lateral approach (12%; p = 0.026). Multivariate logistic regression analysis revealed that the need for mobility aids 1 year after hip fracture was significantly predicted by the use of mobility aids before the fracture (odds ratio = 13.46, 95% confidence interval = 4.29–42.25), age ≥85 years (odds ratio = 3.85, 95% confidence interval = 1.09–13.44), male sex (odds ratio = 3.59, 95% confidence interval = 1.05–12.22), and lateral approach (odds ratio 2.73, 95% confidence interval 1.15–6.50). The posterior approach resulted in four (3.4%) dislocated hips, compared with none by the lateral approach. Survival, mobility level, pain in the operated hip, and living arrangements 1 year postoperatively were not significantly different between groups. Conclusion: Hemiarthroplasty using a lateral approach predisposed to the need for ambulatory aids 1 year after hip fracture. The posterior approach, however, predisposed to hip dislocation. Patient selection must be considered when deciding the appropriate surgical approach.

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Retrospective Investigation of Factors Influencing Time-dependent Changes in Serum Magnesium Levels in Patients Receiving Cetuximab

10.21203/rs.3.rs-443200/v1 ◽

2021 ◽

Author(s):

Kaito Yamashiro ◽

Atsushi Hirata ◽

Ryosuke Ota ◽

Fumihiko Ogata ◽

Takehiro Nakamura ◽

...

Keyword(s):

Confidence Interval ◽

Magnesium Oxide ◽

Serum Sodium ◽

Odds Ratio ◽

Magnesium Deficiency ◽

Serum Magnesium ◽

Multivariate Logistic Regression Analysis ◽

Serum Levels ◽

Time Dependent ◽

Baseline Serum

Abstract Background: Cetuximab causes electrolyte abnormalities, such as hypomagnesemia, hypokalemia, and hypocalcemia. However, little is known about the relationships between the onset of hypomagnesemia, patient background before administration, and time-dependent changes in serum magnesium levels. Therefore, we examined the patient backgrounds that influenced the onset of hypomagnesemia and the time-dependent changes in serum magnesium levels in patients receiving cetuximab. Methods: A retrospective study was performed to investigate patients with advanced or recurrent colorectal cancer or head and neck cancer, treated with a cetuximab regimen from 2012 to 2020 at Kindai University Nara Hospital. In total, 52 patients who met the inclusion criteria were enrolled in this study. Results: The serum magnesium levels tended to decline with an increasing number of cetuximab administrations. After two administrations of cetuximab, the serum magnesium level was significantly lower in the hypomagnesemia group than in the non-hypomagnesemia group (p < 0.001). The multivariate logistic regression analysis revealed that the baseline serum sodium levels (odds ratio: 0.729, 95% confidence interval: 0.552–0.963) and the combination of magnesium oxide tablet (odds ratio: 0.997, 95% confidence interval: 0.995–0.999) were one of the independent factors for hypomagnesemia. These results indicated that the two administrations of cetuximab may cause magnesium deficiency even if the serum levels are within the normal range. Additionally, hyponatremia before administration may be an indicator of serum magnesium levels after administration of cetuximab.Conclusion: Cetuximab-induced hypomagnesemia may be predicted using baseline serum sodium levels, and hypomagnesemia may be prevented by administration of magnesium oxide tablets. Our findings provided new evidence for the management of serum magnesium levels in patients receiving cetuximab.

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Postoperative Spinal Subdural Lesions Following Lumbar Spine Surgery: Prevalence and Risk Factors

Asian Spine Journal ◽

10.4184/asj.2017.11.5.793 ◽

2017 ◽

Vol 11 (5) ◽

pp. 793-803 ◽

Cited By ~ 2

Author(s):

Yukitaka Nagamoto ◽

Shota Takenaka ◽

Hiroyuki Aono

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Confidence Interval ◽

Spine Surgery ◽

Odds Ratio ◽

Protective Factor ◽

Multivariate Logistic Regression Analysis ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Mr Images

<sec><title>Study Design</title>Retrospective case–control study</sec><sec><title>Purpose</title>To clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery.</sec><sec><title>Overview of Literature</title>Because SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery.</sec><sec><title>Methods</title>We conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis.</sec><sec><title>Results</title>Postoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; <italic>p</italic><0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; <italic>p</italic>=0.002).</sec><sec><title>Conclusions</title>The prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.</sec>

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Peripheral artery disease is associated with frailty in chronic hemodialysis patients

Vascular ◽

10.1177/1708538118756690 ◽

2018 ◽

Vol 26 (4) ◽

pp. 425-431 ◽

Cited By ~ 4

Author(s):

Michihiro Okuyama ◽

Hidemi Takeuchi ◽

Haruhito A Uchida ◽

Yuki Kakio ◽

Yuka Okuyama ◽

...

Keyword(s):

Confidence Interval ◽

Peripheral Artery Disease ◽

Odds Ratio ◽

Ankle Brachial Index ◽

Multivariate Logistic Regression Analysis ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Disease Group ◽

Peripheral Artery ◽

Artery Disease

Objectives The clinical condition of frailty is a common problem in the elderly population. However, the relationship between peripheral artery disease and frailty in hemodialysis patients remains unknown. The aim of this study was to identify the relationships between peripheral artery disease and frailty in Japanese chronic hemodialysis patients. Methods A total of 362 chronic hemodialysis patients who regularly visited six institutions were enrolled. To evaluate frailty, the modified Fried’s frailty phenotype adjusted for Japanese were used. Peripheral artery disease was defined as ankle-brachial index <0.9. Results Of 362 patients, 62 patients (17.1%) were categorized as peripheral artery disease group and 300 patients (82.9%) as Non-peripheral artery disease group. The prevalence of frailty in the peripheral artery disease group was significantly higher than in the Non-peripheral artery disease group (34% vs. 18%, P = 0.0103). Non-shunt side grip strength was significantly stronger in the Non-peripheral artery disease group (23.6 kg vs. 17.0 kg, P < 0.0001). Thigh circumferences were also significantly larger in the Non-peripheral artery disease group (41.7 cm vs. 39.7 cm, P = 0.0054). A multivariate logistic regression analysis demonstrated that the factors independently associated with peripheral artery disease were as follows: frailty (odds ratio = 2.06, 95% confidence interval 1.09–3.89) and myocardial infarction (odds ratio = 3.74, 95% confidence interval 2.05–6.83). Conclusions It is concluded that peripheral artery disease is closely associated with frailty in hemodialysis patients.

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Hospital staff participation in a national hip fracture audit: facilitators and barriers

Archives of Osteoporosis ◽

10.1007/s11657-019-0652-8 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Stijn C. Voeten ◽

Leti van Bodegom-Vos ◽

J. H. Hegeman ◽

Michel W.J.M. Wouters ◽

Pieta Krijnen ◽

...

Keyword(s):

Hip Fracture ◽

Data Collection ◽

Confidence Interval ◽

Odds Ratio ◽

Clinical Audit ◽

Hospital Staff ◽

Active Participation ◽

Structured Interviews ◽

Intention To Participate ◽

Facilitators And Barriers

Abstract Summary To ensure meaningful results in a clinical audit, as many hospitals as possible should participate. To optimise participation, the data collection process should either be performed by additional staff or be automated. Active participation may be promoted by offering relevant external parties insight into the actual quality of care. Purpose The aim of the study was to identify which facilitators and barriers experienced by hospital staff are associated with participation in the ongoing nationwide multidisciplinary Dutch Hip Fracture Audit (DHFA). Methods A survey including questions about the respondents’ characteristics, hospital level of participation and factors of influence on DHFA participation was sent to hip fracture surgeons. The factors were based on results of semi-structured interviews held with hospital staff involved in hip fracture care. Univariable and multivariable logistic regression analyses were used to establish which respondent characteristics and factors were associated with participation and active participation (≥ 80% of patients registered) in the DHFA. Factors significantly increasing the (active) participation in the DHFA were classified as facilitators, and factors significantly decreasing the (active) participation in the DHFA as barriers. Results One hundred nine surgeons filled out the questionnaire. The factors most agreed on were availability of staffing capacity for data collection and automated data import. A lower intention to participate was associated with being an academic surgeon (odds ratio, 0.15; 95% confidence interval, 0.04–0.52) and an orthopaedic surgeon (odds ratio, 0.30; 95% confidence interval, 0.10–0.90). Data sharing with relevant external parties was associated with active participation (odds ratio, 3.19; 95% confidence interval, 1.14–8.95). Conclusions To improve participation in a nationwide clinical audit, it seems that the data collection should either be performed by additional staff or be automated. Active participation is facilitated if audit data is made available to other parties, such as insurers, healthcare authorities or policymakers.

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Relationship between Self-Reported Sleep Duration and Risk of Anemia: Data from the Korea National Health and Nutrition Examination Survey 2016–2017

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094721 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4721

Author(s):

Min-Young Chun ◽

Jeong-hoon Kim ◽

Ju-Seop Kang

Keyword(s):

Confidence Interval ◽

Postmenopausal Women ◽

Sleep Duration ◽

National Health ◽

Odds Ratio ◽

Family Income ◽

Reference Group ◽

Multivariate Logistic Regression Analysis ◽

Nutrition Examination Survey ◽

Health And Nutrition

The importance of sleep has been gaining more and more attention nowadays. It has been widely studied that some major health issues, such as cardiovascular diseases or mortality, are closely related to the extreme ends of sleep durations. Anemia is one of the health problems in modern society. In this study, we aimed to find a relationship between anemia occurrence and sleep duration. Data of 11,131 Korean adults aged 19 years or older were recruited from the 2016–2017 Korea National Health and Nutrition Examination Survey and analyzed in this cross-sectional study. ‘Anemia’ was defined in this study by hemoglobin level of <13 g/dL in men and <12 g/dL in women. Selected data were sorted into five groups by sleep duration: <5 h, 5 h ~ <6 h, 6 h ~ <8 h, 8 h ~ <9 h, and ≥9 h per day. We performed multivariate logistic regression analysis to assess the relationship between sleep duration and risk of anemia after adjusting for covariates including age, gender, family income level, education level, physical activity, cigarette smoking, and alcohol usage. Other factors were assessed in the analysis, such as depression, hypertension, diabetes, dyslipidemia, stroke, coronary artery disease, malignancy, stress level, and body mass index (BMI). We found that sleep duration of <5 h was related to high risk of anemia (odds ratio = 1.87; 95% confidence interval = 1.01–3.49, sleep duration of 6 h ~ <8 h as the reference group). Also, sleep duration of ≥9 h was related to lower risk of anemia in most premenopausal women after adjusting for covariates (odds ratio = 0.61; 95% confidence interval = 0.38–0.96, sleep duration of 6 h ~ < 8 h as the reference group). Male individuals with sleep durations of <5 h (odds ratio = 2.01; 95% confidence interval =1.05–3.84) and of ≥9 h (odds ratio = 2.48; 95% confidence interval =1.63–3.81) had a significantly higher risk of anemia without covariate adjustment. Postmenopausal women with sleep durations of ≥9 h had a significantly higher risk of anemia (odds ratio =2.02; 95% confidence interval =1.33–3.08) without adjusting for covariates. However, the associations became statistically insignificant after adjusting for age and covariates in both men and postmenopausal women. In conclusion, we found significant associations between extreme ends of sleep duration and risk of anemia in premenopausal Korean women. However, we did not observe strong associations between self-reported sleep duration and anemia risk in men or postmenopausal women.

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Multiple-Type Human Papillomavirus (HPV) Infections: A Cross-Sectional Analysis of the Prevalence of Specific Types in 309,000 Women Referred for HPV Testing at the Time of Cervical Cytology

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31829e9fb4 ◽

2013 ◽

Vol 23 (7) ◽

pp. 1295-1302 ◽

Cited By ~ 40

Author(s):

Elizabeth Louise Dickson ◽

Rachel Isaksson Vogel ◽

Robin L. Bliss ◽

Levi S. Downs

Keyword(s):

Human Papillomavirus ◽

Confidence Interval ◽

Odds Ratio ◽

Negative Relationship ◽

Multivariate Logistic Regression Analysis ◽

Multiple Infections ◽

Hpv Testing ◽

Entire Sample ◽

Hpv Types ◽

Multiple Type

ObjectivesTo determine the frequency of multiple-type cervical human papillomavirus (HPV) infections, and whether any types are involved in multiple-type infections more or less frequently than might be expected if these infections occur randomly.MethodsIn this retrospective analysis of type-specific HPV testing, results from women 18 to 65 years old with samples collected between July 2007 and May 2011 were considered.Multivariate logistic regression analysis was used to model the presence of each of the 24 most prevalent HPV types, adjusting for one other HPV type, age, laboratory region, and age-by-region interactions.ResultsHuman papillomavirus infection was present in 74,543 (24.1%) of 309,471 women and 65,492 (21.1%) were positive for one of the top 24 most prevalent HPV types. The most common HPV type was type 16, occurring in 4.1% of the entire sample. A total of 14,181 women were positive for 2 or more HPV types (4.6% of entire sample and 19.0% of HPV-positive sample). Two-way HPV type comparisons were analyzed. Types 52, 53, 81, and 83 were more likely to occur in multiple infections with other types; and types 16, 58, and 66 were less likely to occur in multiple infections with other types. Human papillomavirus types 72 and 81 have the strongest positive relationship (odds ratio, 5.2; 95% confidence interval, 3.6–7.4). Human papillomavirus types 33 and 66 have the strongest negative relationship (odds ratio, 0.4; 95% confidence interval, 0.2–0.6).ConclusionsIn this population, multiple-type HPV infections were present in 4.6% of all women. Our findings suggest that there may be both competitive and cooperative interactions between HPV types.

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A data visualisation method for assessing exposure misclassification in case-crossover studies: the example of tricyclic antidepressants and the risk of hip fracture in older people

BMC Medical Research Methodology ◽

10.1186/s12874-021-01230-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael J. Leach ◽

Elizabeth E. Roughead ◽

Nicole L. Pratt

Keyword(s):

Hip Fracture ◽

Confidence Interval ◽

Crossover Study ◽

Odds Ratio ◽

Tricyclic Antidepressants ◽

Data Visualisation ◽

Exposure Misclassification ◽

Case Crossover ◽

Crossover Studies ◽

Control Window

Abstract Background The case-crossover design is suited to medication safety studies but is vulnerable to exposure misclassification. Using the example of tricyclic antidepressants and the risk of hip fracture, we present a data visualisation tool for observing exposure misclassification in case-crossover studies. Methods A case-crossover study was conducted using Australian Government Department of Veterans’ Affairs claims data. Beneficiaries aged over 65 years who were hospitalised for hip fracture between 2009 and 2012 were included. The case window was defined as 1–50 days pre fracture. Control window one and control window two were defined as 101–150 and 151–200 days pre fracture, respectively. Patients were stratified by whether exposure status changed when control window two was specified instead of control window one. To visualise potential misclassification, each subject’s tricyclic antidepressant dispensings were plotted over the 200 days pre fracture. Results The study population comprised 8828 patients with a median age of 88 years. Of these subjects, 348 contributed data to the analyses with either control window. The data visualisation suggested that 14% of subjects were potentially misclassified with control window one while 45% were misclassified with control window two. The odds ratio for the association between tricyclic antidepressants and hip fracture was 1.18 (95% confidence interval = 0.91–1.52) using control window one, whereas risk was significantly increased (odds ratio = 1.43, 95% confidence interval = 1.11–1.83) using control window two. Conclusions Exposure misclassification was less likely to be present with control window one than with an earlier control window, control window two. When specifying different control windows in a case-crossover study, data visualisation can help to assess the extent to which exposure misclassification may contribute to variable results.

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Does Health Care Insurance Affect Outcomes after Traumatic Brain Injury? Analysis of the National Trauma Databank

The American Surgeon ◽

10.1177/000313481007601019 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1108-1111 ◽

Cited By ~ 15

Author(s):

Rodrigo F. Alban ◽

Cherisse Berry ◽

Eric Ley ◽

James Mirocha ◽

Daniel R. Margulies ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Injury Severity ◽

Unit Length ◽

Multivariate Logistic Regression Analysis ◽

National Trauma ◽

Severe Tbi

Increasing evidence indicates insurance status plays a role in the outcome of trauma patients; however its role on outcomes after traumatic brain injury (TBI) remains unclear. A retrospective review was queried within the National Trauma Data Bank. Moderate to severe TBI insured patients were compared with their uninsured counterparts with respect to demographics, Injury Severity Score, Glasgow Coma Scale score, and outcome. Multivariate logistic regression analysis was used to determine independent risk factors for mortality. Of 52,344 moderate to severe TBI patients, 41,711 (79.7%) were insured. Compared with the uninsured, insured TBI patients were older (46.1 ± 22.4 vs 37.3 ± 16.3 years, P < 0.0001), more severely injured (ISS > 16: 78.4% vs 74.4%, P < 0.0001), had longer intensive care unit length of stay (6.0 ± 9.4 vs 5.1 ± 7.6, P < 0.0001) and had higher mortality (9.3% vs 8.0%, P < 0.0001). However, when controlling for confounding variables, the presence of insurance had a significant protective effect on mortality (adjusted odds ratio 0.89; 95% confidence interval: 0.82-0.97, P = 0.007). This effect was most noticeable in patients with head abbreviated injury score = 5 (adjusted odds ratio 0.7; 95% confidence interval: 0.6-0.8, P < 0.0001), indicating insured severe TBI patients have improved outcomes compared with their uninsured counterparts. There is no clear explanation for this finding however the role of insurance in outcomes after trauma remains a topic for further investigation.

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