ABSTRACT
Background/Purpose: As a result of the COVID-19 pandemic, changes in data collection methods have been introduced in research to ensure continuity despite physical distancing and lockdown restrictions. Our objective was to compare differences in physical and mental health of older adults participating in falls research using data collection methods pre-covid-19 pandemic (face-to-face) and during the pandemic (hybrid). Method(s): Individuals aged 60 years and over with at least one fall in the past 12 months, and controls with no history of falls in the past 12 months were recruited. Pre-pandemic, individuals were interviewed face-to-face exclusively, those interviews after the start of the pandemic were conducted virtually with physical assessments conducted face-to-face to minimize physical contact. Cognitive status, physical performance, psychological status, quality of life, physical activity, and social participation were measured. Result(s): Of the 145 participants of similar socio-demographic backgrounds, 69 were interviewed face-to-face, while 76 were assessed using a hybrid method. Differences were observed in presence of fall characteristics, with fewer fallers seeing a doctor and more fallers attending the emergency department after the start of the pandemic. After adjustment for baseline differences, participants interviewed using hybrid status had lower depression scores (OR (95%CI)=0.29(0.14-0.61)) and stress scores (OR(95%CI)=0.33(0.15-0.72)), but greater fear of falling (OR(95%CI)=2.16(1.04-4.48)) and reduced social participation (OR(95%CI)=2.64(1.20-5.79)). Conclusion(s): Alterations in data collection methods to overcome pandemic restrictions should take into consideration potential differences in individuals who agree to participate as well as the influence of major life events on the psychological status of participants. Copyright © 2022, Full Universe Integrated Marketing Limited. All rights reserved.
ABSTRACT
Introduction: Preoperative carbohydrate loading in Enhanced Recovery After Surgery (ERAS) is an independent predictor of postoperative outcomes. By reducing the impact of surgical stress response, fasting-induced insulin resistance is modulated. As a clear fluid, consuming whey protein-infused carbohydrate is safe up to 2 hours preoperatively. Widely practiced in abdominal surgeries, its implementation in hip fracture surgeries is yet to be recognized. Methods: We aim to identify the feasibility of preoperative carbohydrate loading in hip fracture surgery and assess its clinical effects. A randomized controlled, open labelled trial in patients ≥ 65 years old without diabetes mellitus, has hip fracture was conducted in University Malaya Medical Centre between November 2020 and May 2021. Intervention: Carbohydrate loading (Resource-Nestle®) with 100g on the day before surgery and 50g up to 2 hours preoperatively versus standard preoperative fasting. Results: Thirty ASA 1-3 patients (carbohydrate loading and control, n = 15 each), mean age 79 years (SD±8.5), mean body mass index 23.8 (SD±3.5kg/m2) were recruited. Analysis for feasibility of carbohydrate loading (n = 15) demonstrated attrition rate of 20%, n = 3 (one participant completed the drinks but operation was postponed and two patients were not served the third drink by ward staff). Otherwise, patients were 100% compliant with no adverse events reported. 26 randomized participants were analyzed for secondary outcomes (intervention n = 12, control n = 14). There was no significant difference among groups in the postoperative nausea and vomiting, pain score, fatigue level and muscle strength assessed at 24-48 hours postoperatively. Conclusion: COVID-19 pandemic had interrupted recruitment resulting in a small number of participants. Nevertheless, this study demonstrated that implementation of preoperative carbohydrate loading is feasible for hip fracture surgeries without complications but requires careful coordination among surgical, anaesthetic and nursing teams. An adequately powered randomized controlled study is needed to examine the full benefits of preoperative carbohydrate loading in this group of patients.
ABSTRACT
Introduction: COVID-19 has led to a change in the health-seeking behaviour and the delivery of healthcare. Globally, fragility fracture admissions have reduced by 0-54% depending on location. When Malaysia implemented the third movement control order on 3 May 2021 in response to increasing COVID-19 cases, the number of orthopaedic beds in the University Malaya Medical Centre was reduced from over a hundred to twenty-eight. To date, the impact of COVID-19 on fragility fracture admission in Malaysia is unknown. This study aims to investigate the relationship between COVID-19 cases and fragility fracture admissions to a tertiary hospital in Malaysia. Methods: This retrospective study was conducted from April to June 2021 in the University Malaya Medical Centre. The patients admitted to the University Malaya Medical Centre with fragility fractures between April and June 2021 were identified and compared to the corresponding periods in 2018. Patients <50 years old and those who had fractures due to cancer were excluded. The relationship between the total number of COVID-19 cases per week and weekly fragility fractures admissions were determined. Results: A total of 406,479 COVID-19 cases were reported over 3 months (April, n = 63,213;May, n = 163,644;June, n = 179,622). Fifty-five patients [mean age (78.9±8.6), female (44/55,80%), hip fractures (36/55,65.5%)] were admitted in April-June 2021, which was a 35.3% reduction when compared to the same period in 2018 [n = 85, mean age (75.1±9.9), female (62/85,72.9%), hip fractures (53/85,62.4%)], although no significant difference was found between the baseline characteristics. However, both fragility fracture and hip fracture admissions were found to be negatively correlated (r =-0.76 and r =-0.75) with the COVID-19 cases (P < 0.01). Twelve (12/51,23.5%) patients admitted in 2021 due to post-fall fragility fractures presented to the hospital more than a day after their injury. The proportion of patients with delayed presentation (>1 day post-fall) increased over the study period (April = 5/26, 19.2%;May = 3/13, 23.1%;June = 4/12, 33.3%). Conclusion: There was a reduction in fragility fracture admissions during the COVID outbreak in Malaysia. There might be a rebound in cases after the COVID crisis is over, reorganising medical services may be warranted to ensure effective fracture care delivery.