Geriatric rehabilitative care after fractures of the proximal femur: one year follow up of a randomised clinical trial.

Abstract

We investigated the use of amniocentesis performed at eight to 14 weeks' gestation as a possible alternative to chorionic villus sampling. Patients, methods, and results Samples of amniotic fluid were taken from 40 gestation, and the mean time to the cells being harvested was 12 6 days. In contrast only 17 (68%) of the 25 samples taken at eight to 11 weeks yielded a result. One sample taken at 13 weeks' gestation yielded a female karyotype, whereas the fetal parts revealed a male karyotype; the sample was subsequently identified as maternal urine. The mean volume of amniotic fluid obtained was 13 9 ml (range 1-40 ml). CommentAll 15 samples taken at 12-14 weeks' gestation yielded a result. The mean time to cells being harvested in this group (12-6 days) compared favourably with the current mean of 11 days for the samples obtained routinely at [16][17][18][19] weeks that are processed by our laboratory. Culture of all the 5 ml aliquots obtained at 12-14 weeks was successful. Thus a 10 ml sample would provide two cultures, which are necessary for the interpretation of equivocal results and in case of microbial infection.In one case, a urine sample was obtained at 13 weeks' gestation from an obese patient in whom imaging was poor. In a clinical environment sampling would not have been attempted, and this patient would have been recalled later.Our results show that amniocentesis from as early as 12 weeks' gestation can provide sufficient material for cytogenetic diagnosis and could be offered as an alternative to current methods of prenatal diagnosis. Furthermore, the procedure could be carried out by doctors already familiar with the technique, using existing resources. Patients must, however, be advised that the risks of this procedure are unknown. Preliminary reports from the United States suggest that early amniocentesis is safer than chorionic villus sampling.24 Further evaluation, preferably by means of a randomised trial, is urgently needed. We are continuing our investigation of amniocentesis before 12 weeks with the aim of bringing the procedure forward into the first trimester of pregnancy.We acknowledge contributions to the study from Mr N Fisk, Mr P Reginald, Mr M Michel, and Mrs R Rebello.

Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia

“…Kennie et al found that women with hip fracture who were admitted to a geriatric ward after surgery had a shorter median stay and were less likely to be discharged into institutional care than women who remained on an orthopaedic ward 30. After one year the mortality was lower and more patients were living independently 31. However, the patients in the control group were older and had more severe cognitive impairment than those in the intervention group.…”

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

“…Standardised care pathways designed and rolled out to meet these demands have shown inconsistent results for patient benefit and functional improvements. 23,121,128,157,238,239 When they were reported to improve patients' functional outcomes 46,95,100,102,140,155,218,237 or quality of life, 100,144 or to reduce morbidity or mortality, 100,124 the trade-off was usually a longer hospital stay, leading to increased cost and resource implications. 124,155 One element that was important in attaining better outcomes was discharge planning that took into account patients' self-care information and education needs.…”

“…Multidisciplinary care pathways have improved patient care and functional outcomes 46,102,155,237 and quality of life 144 and reduced morbidity or mortality, 124,159 but their successful execution requires the completion of successive steps by a chain of professionals. Non-completion or partial completion of tasks in the pathway led to delays in patient care and the risk of litigation.…”

Musculoskeletal rehabilitation after hip fracture: a review

“…The methods used in these studies differed considerably in aims, interventions, and outcomes, producing inconsistent and conflicting results [43][44][45][46]. According to a recent meta-analysis, there is no conclusive evidence that co-ordinated multidisciplinary inpatient rehabilitation is more effective than conventional hospital care (no rehabilitation professionals involved) for older patients with hip fracture [47].…”