Interventions for Adherence Improvement in the Primary Prevention of Cardiovascular Diseases:Expert Consensus Statement

In primary prevention for cardiovascular diseases, there are significant barriers to adherence including freedom from symptoms, long latency for therapeutic benefits, life-long duration of treatment, and need for combined lifestyle changes. However, to implement more systematic approaches, the focus on adherence improvement needs to be shifted away from patient factors to the effects of the treatment team and healthcare system. In addition to conventional educational approaches, more patient-oriented approaches such as patientcentered clinical communication skills, counseling using motivational strategies, decisionmaking by patient empowerment, and a multi-disciplinary team approach should be developed and implemented. Patients should be involved in a program of self-monitoring, self-management, and active counseling. Because most effective interventions on adherence improvement demand greater resources, the health care system and educational or training system of physicians and healthcare staff need to be supported for systematic improvement.

Retrograde Intramedullary Nailing for Distal Femur Fracture with Osteoporosis

BACKGROUND: The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. METHODS: Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and managed with retrograde intramedullary nailing were retrospectively reviewed. Cement augmentation was used in four patients, shape memory alloy was used in eight patients and both were used in one patient. All patients were followed up for more than 2 years. Radiologic alignments. were scored and Tegner and the Lysholm activity score was used for a functional assessment. RESULTS: The average time to clinical union was 13 weeks (range, 10 to 15 weeks). In 12 of our cases, the total alignment scores were excellent. At the last follow-up, the mean range of motion was 116degrees (range, 110degrees to 125degrees). The average functional score at postoperative 1 year was 2.6 (range, 1 to 5). CONCLUSIONS: Retrograde intramedullary nailing is a good surgical option for distal femur fracture with osteoporosis. Cement augmentation and shape memory alloy can also be used for added mechanical stability. This surgical technique is very useful for distal femur fracture with osteoporosis as it promotes fracture healing and early rehabilitation.

The Efficacy of the Treatment of Thoracolumbar Spine Fractures with Short-segment Posterior Instrumentation and Fusion

PURPOSE: To evaluate the safety and usefulness of the short-segment posterior instrumentation and fusion in the treatment of thoracolumbar spine fractures. MATERIALS AND METHODS: Forty-two patients were treated by short-segment pedicle screw instrumentation and fusion between Oct. 1998. and Jan. 2004 by single surgeon. All patients were treated posteriorly and all the pedicle screws are monoaxial. Intraoperative rod bending and fixation technique was used to reduce the collapsed vertebral body and correct the kyphotic angle. The follow up duration is mean 2.1 year (1~6 year). The mean age is 40.2 year (18~60 year) old. The fractures were classified by Denis' classification and Load-Sharing Classification. Preoperative and postoperative changes of kyphotic angle and vertebral body height were measured. Denis' Pain Score and Work scales, Frankel neurologic grade were obtained during follow-up evaluation for patients. RESULTS: All the cases got solid bony union. Mean Load-Sharing Score was 7.3. Clinical results were good. The mean kyphotic angle was preoperatively 14.5 degree, immediate postoperatively 7.5 degree, and last follow up 9.2 degree. The mean anterior vertebral heights s were 60.8% preoperatively, 83.4% immediate postoperatively, and 79.5% last follow up. There was only one case of screw breakage but no revision operation due to loss of reduction. All the cases showed satisfactory clinical results. CONCLUSION: This study suggest that short-segment instrumentation and fusion using pedicle screw system for thoracolumbar spine fractures could lead to good results, if comminution of vertebral body is considered in the selection of approach.