Development of a prognostic model to predict post-operative mobility of patients with fragility hip fractures: a retrospective cohort study.

INTRODUCTION: Older adults with fragility hip fractures have high 1-year mortality and significant functional loss. This study aimed to identify the factors that predict the post-operative ambulatory prognosis of patients with fragility hip fracture. METHODS: A total of 233 patients who were consecutively admitted with fragility hip fracture to the orthopaedic unit of an acute hospital in Hong Kong between March and July 2016, were included in this retrospective observational cohort study. The outcome variable was the binary classification of whether patients could or could not walk independently without assistance for more than10 m at the time of discharge from hospital to community. The prognostic model was developed by using multivariate logistic regression. RESULTS: Eighty-nine (38.2%) patients could walk independently upon discharge. The statistically significant factors that affected walking independence on discharge were age (Odds Ratio [OR] = 0.93), Charlson Comorbidity Index (OR = 0.67), baseline Mini-Mental Status Examination score (OR = 1.15) and pre-fracture mobility (p = 0.012). Patients who walked unaided before the fracture had a better prognosis than patients requiring a stick walker (OR = 0.57), quadripod walker (OR = 0.28) or frame walker (OR = 0.12). The area under the ROC curve was 0.848. CONCLUSIONS: The model provides healthcare professionals with evidence to personalize the rehabilitation regime according to the patient's age, comorbidity, baseline cognitive function and pre-fracture mobility.

A Pilot Randomized, Controlled Study of Nanocrystalline Silver, Manuka Honey, and Conventional Dressing in Healing Diabetic Foot Ulcer.

Nanocrystalline silver (nAg) and Manuka honey (MH) dressing have increasing popularity for treating diabetic foot ulcer (DFU). This study was an open-label randomized controlled trial with three parallel groups' design in examining the preliminary effectiveness of nAg against MH and conventional dressing in healing DFU in terms of ulcer healing, ulcer infection, and inflammation. 31 participants (11 in the nAg group, 10 in the MH group, and 10 in the convention group) diagnosed with type 2 diabetes were enrolled. Wound cleaning, debridement, and topical dressing application were performed according to the group allocation in each visit at weeks 1, 2, 3, 4, 6, 8, 10, and 12. The results found that the proportions of complete ulcer healing were 81.8%, 50%, and 40% in the nAg, MH, and conventional groups, respectively. The ulcer size reduction rate was potentially higher in the nAg group (97.45%) than the MH group (86.21%) and the conventional group (75.17%). In bacteriology, nAg showed a greater rate of microorganism reduction although it was not significant. To conclude, nAg alginate was potentially superior to MH and conventional dressing in healing diabetic foot ulcer in terms of ulcer size reduction rate.

The Anti-Inflammatory and Antibacterial Action of Nanocrystalline Silver and Manuka Honey on the Molecular Alternation of Diabetic Foot Ulcer: A Comprehensive Literature Review.

Honey and silver have been used since ancient times for treating wounds. Their widespread clinical application has attracted attention in light of the increasing prevalence of antibiotic-resistant bacteria. While there have been a number of studies exploring the anti-inflammatory and antibacterial effects of manuka honey and nanocrystalline silver, their advantages and limitations with regard to the treatment of chronic wounds remain a subject of debate. The aim of this paper is to examine the evidence on the use of nanocrystalline silver and manuka honey for treating diabetic foot ulcers through a critical and comprehensive review of in vitro studies, animal studies, and in vivo studies. The findings from the in vitro and animal studies suggest that both agents have effective antibacterial actions. Their anti-inflammatory action and related impact on wound healing are unclear. Besides, there is no evidence to suggest that any topical agent is more effective for use in treating diabetic foot ulcer. Overall, high-quality, clinical human studies supported by findings from the molecular science on the use of manuka honey or nanocrystalline silver are lacking. There is a need for rigorously designed human clinical studies on the subject to fill this knowledge gap and guide clinical practice.