Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country.

Purpose: This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures. Patients and Methods: Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs). Results: The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration. Conclusion: The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.

Correlation Between Rotator Cuff Tear in Thai Urban Elderly Population and Vitamin D Deficiency.

Background The benefits of vitamin D encompass the augmentation of rotator cuff healing, the enhancement of bone mineral density (BMD), and the fortification of skeletal muscle strength. The vitamin D deficiency in Asian countries appears to be more severe compared to their Western counterparts. This study aims to ascertain the relationship between rotator cuff tears and vitamin D levels in the urban Thai elderly demographic. Our hypothesis posits that vitamin D deficiency will exhibit an association with the occurrence of rotator cuff tears. Materials and methods A prospective clinical trial conducted at a single tertiary was carried out to assess the patients experiencing shoulder pain who were aged 60 years or older. All participants were tested of blood specimens for calciferol concentration and magnetic resonance imaging (MRI). The duration between blood sample collection and magnetic resonance imaging (MRI) did not exceed a two-week window. The assessment of fatty degeneration in the supraspinatus, infraspinatus, and subscapularis muscles, as well as tear dimensions and cartilage thickness, was conducted using magnetic resonance imaging within the outpatient clinic. Results The analysis of serum vitamin D levels within a cohort comprising 59 subjects produced significant observations, indicating that 20.03% of the participants manifested a deficiency in vitamin D and 44.07% exhibited insufficiency in vitamin D levels. There was no observed correlation between serum vitamin D levels and various patient parameters, including age (P = .99), body mass index (P = 0.31), tear size (P = 0.41), cartilage thickness at different locations on the humeral head (superior, middle, inferior, and total) (P = 0.31, 0.40, 0.26, 0.20, respectively), degree of fatty infiltration of the rotator cuff (P = 0.81), and severity of the rotator cuff condition (P = 0.13). A significant positive correlation was established between rotator cuff tear size and both the severity of the rotator cuff condition (P < 0.001) and the degree of fatty infiltration of the cuff (P < 0.001). Conclusion A negative correlation is observed between serum vitamin D levels and various parameters, including tear size, fatty infiltration, cartilage thickness, and the severity of rotator cuff tears within the elderly urban Thai population. To affirm these findings, it is imperative to conduct additional research and integrate vitamin D assessments into the management strategies for aging populations with rotator cuff conditions.

The prevalence and risk factors of sarcopenia among Thai community-dwelling older adults as defined by the Asian Working Group for Sarcopenia (AWGS-2019) criteria: a cross-sectional study.

BACKGROUND: This study aimed to determine the prevalence and risk factors for sarcopenia and severe sarcopenia among urban community-dwelling adults in Thailand, using the Asian Working Group for Sarcopenia (AWGS-2019) criteria. METHODS: This cross-sectional study comprising 892 older adults aged > 60 years analyzed data from a cohort study (Bangkok Falls study; 2019-2021). The appendicular skeletal muscle mass was evaluated using the Bioelectrical Impedance Analysis (BIA) method. Physical performance and muscle strength were evaluated using the five-time sit-to-stand and handgrip strength tests, respectively. Logistic regression was used to determine the factors associated with sarcopenia. RESULTS: The prevalence rates of sarcopenia and severe sarcopenia were 22.2% and 9.4%, respectively. Age ≥ 70 years (adjusted odds ratio (aOR), 2.40; 95% confidence interval (CI), 1.67-3.45), body mass index (BMI) of < 18.5 kg/m2 (aOR, 8.79; 95% CI, 4.44-17.39), Mini Nutritional Assessment (MNA) score of < 24 (aOR, 1.75; 95% CI, 1.24-2.48), and a six-item cognitive screening test score of ≥ 8 (aOR, 1.52; 95% CI, 1.08-12.15) were associated with sarcopenia. Likewise, age ≥ 70 years, BMI < 18.5 kg/m2, and an MNA score of < 24 predicted severe sarcopenia. CONCLUSION: One-third of the urban community-dwelling older Thai adults had sarcopenia or severe sarcopenia. The age ≥ 70 years, low BMI, and inadequate nutrition increased the risk of both sarcopenia and severe sarcopenia while impaired cognitive functions predicted only sarcopenia in this population.

Hand-held navigation may improve accuracy in minimally invasive total knee arthroplasty: a prospective randomized controlled trial.

INTRODUCTION: A novel hand-held navigation combines gyroscopes, accelerometers and a secure local wireless channel to guide the distal femoral and proximal tibial cutting positions by displaying to the surgeon directly on the pods within the surgical field. No previous study has reported on its accuracy. MATERIALS AND METHODS: A prospective randomized controlled trial was performed to compare radiographic outcomes in minimally invasive surgery total knee arthroplasty (MIS-TKA) with (40 patients, 40 knees) and without (40 patients, 40 knees) the novel hand-held navigation. RESULTS: The use of hand-held navigation resulted in fewer outliers (> ± 3° malalignment) in all frontal alignment: the hip-knee-ankle, the femoral component, and the tibial component. Tibial slope was also better achieved with the navigation. Femoral component flexion was not significantly different. Operation time and bone cutting time with the navigation were not longer than those without. Blood loss from drainage was not significantly different. CONCLUSION: The hand-held navigation improves accuracy for mechanical alignment and positioning of the prosthesis without additional surgical time.

Low-level laser therapy with a wrist splint to treat carpal tunnel syndrome: a double-blinded randomized controlled trial.

The efficacy of low-level laser therapy (LLLT) was evaluated in a total of 66 patients with mild to moderate carpal tunnel syndrome (CTS) with a double-blinded randomized controlled study. The patients were randomly assigned into two groups. Group I received 15 sessions of a gallium-aluminum-arsenide laser treatment at a dosage of 18 J per session over the carpal tunnel area with neutral wrist splint. Group II received placebo laser therapy with neutral wrist splint. The patients were evaluated with the following parameters: (1) clinical parameters which consisted of visual analog scale, symptom severity scale, functional status scale, and pinch strength and grip strength before the treatment and at 5- and 12-week follow-ups and (2) electroneurophysiological parameters from nerve conduction study which were evaluated before the treatment and at 12-week follow-up. Fifty nine patients (112 hands: unilateral CTS = 6 hands and bilateral CTS = 106 hands) completed the study. Both groups I and II had n = 56 hands. Improvements were significantly more pronounced in the LLLT-treated group than the placebo group especially for grip strength at 5- and 12-week follow-ups. At 12-week follow-up, distal motor latency of the median nerve was significantly improved in the LLLT group than the placebo group (p < 0.05). LLLT therapy, as an alternative for a conservative treatment, is effective for treating mild to moderate CTS patients. It can improve hand grip strength and electroneurophysiological parameter with a carry-over effect up to 3 months after treatment for grip strength of the affected hands.