Search

Background: The incidence of hip fractures and subtrochanteric fractures in particular is increasing, along with the globally expanding aging population. Intramedullary nailing remains the 'gold standard' of their treatment. Blood loss can be a result of the original trauma, but also secondary to the subsequent surgical insult, especially during the reaming of the intramedullary canal. Objectives: The aim of our study was to report on the blood loss and incidence of blood transfusion in patients presenting with a subtrochanteric fracture treated with intramedullary nailing. Most importantly, we aim to identify factors associated with the need for transfusion within the first 48 h post‐operatively. Methods: Following institutional board approval, 431 consecutive patients (131 males; age: 79.03 years old, SD 13.68 years) presenting in a Level 1 Trauma Centre with a subtrochanteric fracture treated with an intramedullary nail were retrospectively identified, over an 8‐year period. Exclusion criteria included patients with high energy injuries, pathological fractures, primary operations at other institutions and patients lost to follow‐up. To identify risk factors leading to increased risk of transfusion, we first compared patients requiring intra‐operative transfusion or transfusion during the first 48 h post‐operatively against those who did not require transfusion. This was then followed by multivariate regression analysis adjusted for confounding factors to identify the most important risk factors associated with need for transfusion within the first 48 h post‐operatively. Results: Incidence of blood transfusion was 6.0% pre‐operatively, compared to 62.7% post‐operatively. A total of 230 patients (52.3%) required either intra‐operative transfusion or transfusion during the first 48 h following surgery. Patients having a transfusion within the first 48 h post‐operatively had a higher incidence of escalation in their care (p = 0.050), LOS (p = 0.015), 30‐day (p = 0.033) and one‐year mortality (p = 0.004). Multivariate regression analysis adjusted for confounding factors identified that the most important association of a need for transfusion within the first 48 post‐operative hours was a pre‐operative Hb <100 g/L (OR 6.64); a nail/canal ratio <70% (OR 3.92), followed by need for open reduction (OR 2.66). Fracture involving the lesser trochanter was also implicated with an increased risk (OR 2.08). Additionally, pre‐operative moderate/severe renal impairment (OR 4.56), as well as hypoalbuminaemia on admission (OR 2.10) were biochemical predictors of an increased risk of transfusion. Most importantly, the need for transfusion was associated with an increase in 30‐day mortality (OR 12.07). Conclusion: Several patient, fracture and surgery related factors are implicated with an increased risk for transfusion within the first 48‐h post‐operatively. Early identification, and where possible correction of these factors can potentially reduce blood loss and risk of transfusion, along with all the associated sequelae and mortality risk. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Experiencing mental health stigma during adolescence can exacerbate mental health conditions, reduce quality of life and inhibit young people’s help-seeking for their mental health needs. For young people, education and contact have most often been viewed as suitable approaches for stigma reduction. However, evidence on the effectiveness of these anti-stigma interventions has not been consistent. This systematic review evaluated the effectiveness of interventions to reduce mental health stigma among youth aged 10–19 years. The review followed Cochrane and PRISMA guidelines. Eight databases were searched: PubMed, PsycINFO, MEDLINE, Web of Science, Scopus, EMBASE, British Education Index and CNKI. Hand searching from included studies was also conducted. Randomised controlled trials and experimental designs that included randomised allocation to interventions and control groups were included in the review. Narrative synthesis was employed to analyse the results. A meta-analysis was conducted to determine the effectiveness of included interventions. Twenty-two studies were included in the review. Eight studies reported positive effects, 11 studies found mixed effects and 3 studies reported no effect on indicators of mental health stigma among youth. Seven of the effective studies were education-based. Eleven studies were suitable for meta-analysis, and the multivariate meta-analytic model indicated a small, significant effect at post-intervention (d = .21, p < .001), but not at follow-up (d = .069, p = .347). Interventions to reduce stigma associated with mental health conditions showed small, short-term effects in young people. Education-based interventions showed relatively more significant effects than other types of interventions. [ABSTRACT FROM AUTHOR]

Recruiting lay people from the neighbourhoods of target communities as Community Health Educators (CHEs) is an increasingly popular strategy for health interventions in the UK. CHEs are assumed to have a distinct advantage in reaching 'difficult to reach' groups by virtue of their network membership. However, results obtained from a recent intervention study [Chiu (2002). Straight talking: Communicating breast screening information in primary care. Leeds: Nuffield Institute for Health, University of Leeds] raised concerns about the much-asserted efficacy of networks and suggested that neighbourhood was a contextual factor that would potentially affect the results of health interventions. In addition, it suggested that the concept of social networks and other related concepts i.e. 'social embeddedness', 'social capital', and 'neighbourhoods' that underpin CHE interventions needed to be better understood. In order to examine these concepts in relation to CHE interventions, we conducted a pilot study involving 53 CHEs (26 White, 27 Black and Minority Ethnic) in seven health organisations across the UK. The CHEs took part in focus group interviews to explore their perceptions of social networks and neighbourhood. Quantitative information on their personal networks was also mapped using three proformas. This paper explores CHEs' networks with a specific focus on the concept of 'social embeddedness' and the effect of neighbourhood. Implications of these findings on the effectiveness of intervention are discussed. Keywords: Social networks; Neighbourhood; Embeddedness; Health intervention; Community health educators; UK

Selected Poems By James Applewhite Duke University Press, 2005 184 pp. Paper $18.95 It's remarkable how often the national poetry establishment fails to celebrate the many fine southern poets writing [...]