The prevalence of low BMD in this population of renal transplant recipients was high. Parathyroid status was the only independent factor that correlated with low BMD at baseline and subsequent bone loss highlighting the critical role of this hormone in bone metabolism after renal transplant.

Objective. Limited information exists on the physical characteristics, bone mineral density (BMD), 25-hydroxyvitamin D [25(OH)D] levels and other biochemical parameters in patients with hip fractures in Asia. We aimed to explore whether these parameters differ between trochanteric and femoral neck (cervical) hip fractures in Singaporean patients.Methodology. 275 patients with osteoporotic hip fractures were evaluated. Multivariate regression models were used to investigate the relationship between physical characteristics, biochemical parameters, renal function, BMD and type of hip fracture.Results. The mean 25(OH)D level noted was 20.4 (8.1) ng/mL. Fifty percent of patients had levels less than 20 ng/mL. Patients with trochanteric fractures were heavier than those with cervical fractures (p=0.021). Logistic regression analysis showed that males were more likely to have trochanteric fractures (OR=1.79, 95% CI 1.03-3.11), and females with trochanteric fractures were older than those with cervical fractures (OR=0.97, 95% CI 0.94-1.00).Conclusion. Vitamin D deficiency was prevalent in half of our population of hip fracture patients. Trochanteric fractures were more common than cervical fractures in men and in older women. In contrast to findings noted in Caucasian populations, neither BMD nor other bone metabolic parameters examined were associated with the preferential occurrence of one type of osteoporotic hip fracture over the other.

The aim of this scholarly project was to implement and evaluate the efficacy of a tailored, multifaceted nursing educational program in prevention, early detection leading to early management of delirium in older adults aged 65 and above.Background: Delirium is a medical emergency which compromises patient safety due to its many negative consequences such as falls, prolonged hospitalisation, and increased use of restraints. Delirium is often missed or diagnosed late by physicians. As the frontline in patient care, nurses play an important role in early delirium detection and prevention. Therefore, educating nurses on delirium prevention and clinical application of a delirium screening tool is deemed necessary in caring for the elderly patients aged >65.Design: This was a three-phase study employing two-independent group pre-post design conducted at two mixed acute general medical/surgical wards in a large tertiary hospital. Methods: Phase 0 was to establish nurses' baseline knowledge of delirium, incidence of delirium, falls, restraint use, and length of stay amongst the eligible patients. Phase I was to implement the educational program which comprised of theoretical and practical components to the registered nurses in the two wards. Trained nurses then applied modified 4AT and delirium care bundle to eligible patients in Phase II.Results: Total of 61 nurses were involved in the training. There was significant improvement in nurses' knowledge of delirium after training, which was sustained at one month later. A total of 100 patients were recruited. The incidence of delirium was 8% in phase 0 and 6% in phase II. Patients with delirium had longer length of stay than patients without delirium. There was no significant difference in falls, restraint use and length of stay. Conclusions:A multifaceted delirium educational program improved nurses' knowledge in delirium screening and prevention. A longer study period for larger enrolment of patients is recommended to evaluate the longer term retention of knowledge and the effects on patient care.

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