Seasonal Variations and Common Places of Hip Fractures in Elderly Patients: Nine Year Consecutive Survey

Background@#Fall prevention is important for reducing hip fractures. The aim of this study was to determine the relationship between variables related to hip fractures according to sex and season. @*Methods@#This study included patients admitted for fragility hip fractures between 2012 and 2021. Patients were interviewed by a junior resident before discharge. Data on sex, age, diagnosis, osteoporosis treatment, direction, voiding problems, ambulatory function, seasons, weather, time of day, place, location, floor condition, activity during fall, and perceived reason for fall were collected and analyzed. @*Results@#A total of 1,118 patients were included (279 males and 839 females). In both sexes, indoor falls were prevalent throughout all seasons, but males showed a higher proportion of outdoor falls, especially in winter during cloudy or snowy weather. Rooms and walking were the most common locations and activities during falls. The poor ambulatory function was associated with a higher prevalence of indoor falls. Osteoporosis treatment rates were low and did not differ according to Koval stage. Winter was associated with higher osteoporosis non-treatment group. Urgency/incontinence in female patients caused a higher proportion of falls during the evening time. @*Conclusions@#Strategies for indoor fall prevention and vigilant osteoporosis diagnosis and treatment are important for all seasons, especially for frail elderly patients. Outdoor fall prevention emphasized for male patients, and education around nighttime falls should be provided for female patients with voiding dysfunction.

Relationship between Low Muscle Strength, and Protein Intake: A Preliminary Study of Elderly Patients with Hip Fracture

Background@#The purpose of the present study was to assess the daily protein uptake and its relationship with sarcopenia, as defined by the Asian Working Group for Sarcopenia (AWGS), among elderly patients with hip fractures. @*Methods@#Forty-seven elderly patients with hip fractures were enrolled in this retrospective observational study. The main outcome measures included protein uptake, muscle mass, and grip strength for sarcopenia in elderly patients. Sarcopenia was diagnosed according to AWGS. Wholebody densitometry was used to measure skeletal muscle mass, and muscle strength was evaluated using handgrip testing. @*Results@#Of 47 patients with hip fractures (12 men and 35 women), 37 (79%) patients exhibited insufficient protein intake (range, 0.01-0.588 g/kg/day), and 10 (21%) patients exhibited excessive protein intake (range, 1.215-2.121 g/kg/day). The mean daily protein intake was 56.5 g (range, 7.2–136.0 g). Prevalence of low muscle strength (handgrip strength <18 kg in women and <26 kg in men) was detected in 13 (37%) women and 8 (67%) men (P=0.076). Sarcopenia (lower muscle mass and lower muscle strength) was detected in 9 (26%) women and 6 (50%) men (P=0.119). Although lower protein intake was marginally associated with sarcopenia (P=0.189), it was significantly associated with lower grip strength (P=0.042). @*Conclusions@#The present study demonstrated that insufficient protein intake in elderly patients with hip fractures was common, and lower protein intake was significantly associated with lower muscle strength.

Renal Recovery from Severe Acute Kidney Injury Requiring Renal Replacement Therapy / 대한신장학회지

PURPOSE: Acute tubular necrosis (ATN) is a serious complication in critically ill patients. This study investigated the renal outcome of severe ATN requiring RRT and prognostic factors for renal recovery. METHODS: Between January 2000 and May 2008, surviving patients with presumed ATN requiring dialysis were analyzed retrospectively. Patients with pre-existing chronic kidney disease and other causes of ARF rather than ATN were excluded. Primary outcomes were complete renal recovery (CR) and dialysis withdrawal. CR was defined as a return to basal serum creatinine level or creatinine <1.5 mg/dL (male) or <1.3 mg/dL (female) without dialysis. RESULTS: Of one hundred twenty two patients, 79 (65%) patients were male. The mean age was 54+/-16 years and 87 patients (71%) received continuous renal replacement therapy. 55% had ischemic ATN, 29% had septic ATN, and 16% had nephrotoxic ATN. Mean duration of dialysis was 12 (6-29) days. Dialysis withdrawal rate at 30 days and at 60 days after initiation of dialysis were 51% and 77 %, respectively. CR at 60 days after initiation was 50%. Multivariate analysis revealed that older age (per year, Hazard ratio (HR)=0.981, 95% Confidence interval (CI) 0.963 to 0.999), ischemic ATN (vs. toxic ATN, HR=0.481, 95% CI 0.238 to 0.974),and longer duration of oliguria (per day, HR=0.979, 95 % CI 0.962 to 0.996) were independent prognostic factors of renal recovery. CONCLUSION: Young age and short duration of oliguria were favorable factors for renal recovery from ATN requiring dialysis. The cause of ATN might be also an independent prognostic factor.

The Effect of Education in Reducing Catheter-related Urinary Tract Infections in Intensive Care Units at a University Hospital / 병원감염관리

BACKGROUND: Urinary tract infections (UTIs) are the most frequent nosocomial infections and are frequently associated with indwelling urinary catheters. It is known that adherence to standard infection control measures for urinary catheters can reduce UTIs in hospitals. This study was performed to evaluate the effect of education in reducing catheter-related UTIs (CR-UTIs) in intensive care units (ICUs) of a university hospital. METHODS: CR-UTIs were prospectively monitored for all patients with indwelling urinary catheters in ICUs from July 2006 through December 2007. Recommendations based on previously known guidelines for catheter insertion, catheter management, and specimen collection to prevent CR-UTIs were formulated and educated in March 2007. Knowledge and adherence level were evaluated before and after educating healthcare workers about the recommendations using questionnaire. Changes in knowledge and adherence level before and after education were compared by Chi-square test. Changes in the rate of CR-UTIs and urinary catheter utilization ratios were also analyzed by Fisher's exact test. RESULTS: After education, knowledge level of and adherence level to most of the recommendations were improved significantly. The rate of CR-UTIs significantly decreased by 48% from 7.43/1,000 catheter-days before intervention to 3.87/1,000 catheter-days after intervention (P=0.02). CONCLUSION: Surveillance for nosocomial infections and education for standard infection control measures are very important in preventing CR-UTIs in ICUs.