Lower rates of mortality, readmission and reoperation in patients receiving acupuncture after hip fracture: a population-based analysis

Background: Studies on the effects of acupuncture on mortality and complication rates in hip fracture patients are limited by small sample size and short follow-up time. We aimed to assess the associations of acupuncture use with mortality, readmission and reoperation rates in hip fracture patients using a longitudinal population-based database. Methods: A retrospective matched cohort study was conducted using data for the years 1996–2012 from Taiwan’s National Health Insurance Research Database. Hip fracture patients were divided into an acupuncture group consisting of 292 subjects who received at least 6 acupuncture treatments within 183 days of hip fracture, and a propensity score matched “no acupuncture” group of 876 subjects who did not receive any acupuncture treatment and who functioned as controls. The two groups were compared using survival analysis and competing risk analysis. Results: Compared to non-treated subjects, subjects treated with acupuncture had a lower risk of overall death (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.24–0.73, p = 0.002), a lower risk of readmission due to medical complications (subdistribution HR (sHR): 0.64, 95% CI: 0.44–0.93, p = 0.019) and a lower risk of reoperation due to surgical complications (sHR: 0.62, 95% CI: 0.40–0.96, p = 0.034). Conclusion: This is the first study to suggest that postoperative acupuncture in hip fracture patients is associated with significantly lower mortality, readmission and reoperation rates compared with those of matched controls.

Download Full-text

Comprehensive Geriatric Care to Improve Mobility after Hip Fracture: An RCT

Gerontology ◽

10.1159/000510903 ◽

2020 ◽

Vol 66 (6) ◽

pp. 542-548

Author(s):

Wendy L. Cook ◽

Penelope M.A. Brasher ◽

Pierre Guy ◽

Stirling Bryan ◽

Meghan G. Donaldson ◽

...

Keyword(s):

Hip Fracture ◽

Small Sample Size ◽

Controlled Trial ◽

Geriatric Care ◽

Small Sample ◽

Community Dwelling ◽

Post Discharge ◽

Mobility Performance ◽

Discharge Care ◽

Comprehensive Geriatric Care

Background: Comprehensive geriatric care (CGC) for older adults during hospitalization for hip fracture can improve mobility, but it is unclear whether CGC delivered after a return to community living improves mobility compared with usual post-discharge care. Objective: To determine if an outpatient clinic-based CGC regime in the first year after hip fracture improved mobility performance at 12 months. Methods: A two-arm, 1:1 parallel group, pragmatic, single-blind, single-center, randomized controlled trial at 3 hospitals in Vancouver, BC, Canada. Participants were community-dwelling adults, aged ≥65 years, with a hip fracture in the previous 3–12 months, who had no dementia and walked ≥10 m before the fracture occurred. Target enrollment was 130 participants. Clinic-based CGC was delivered by a geriatrician, physiotherapist, and occupational therapist. Primary outcome was the Short Physical Performance Battery (SPPB; 0–12) at 12 months. Results: We randomized 53/313 eligible participants with a mean (SD) age of 79.7 (7.9) years to intervention (n = 26) and usual care (UC, n = 27), and 49/53 (92%) completed the study. Mean 12-month (SD) SPPB scores in the intervention and UC groups were 9.08 (3.03) and 8.24 (2.44). The between-group difference was 0.9 (95% CI –0.3 to 2.0, p = 0.13). Adverse events were similar in the 2 groups. Conclusion: The small sample size of less than half our recruitment target precludes definitive conclusions about the effect of our intervention. However, our results are consistent with similar studies on this population and intervention.

Download Full-text

34 Discharge After Hip Fracture Surgery by Mobilisation Timing: Secondary Analysis of the UK National Hip Fracture Database

Age and Ageing ◽

10.1093/ageing/afab029.13 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i7-i11

Author(s):

A Goubar ◽

O Almilaji ◽

F C Martin ◽

C Potter ◽

G D Jones ◽

...

Keyword(s):

Hip Fracture ◽

Average Rate ◽

Small Sample Size ◽

Small Sample ◽

Competing Risk ◽

Hospital Death ◽

Early Mobilisation ◽

Hip Fracture Surgery ◽

Risk Of Death ◽

Fracture Surgery

Abstract Background To maximise the benefits of hip fracture surgery the National Institute for Health and Care Excellence Clinical Guideline recommends mobilisation on the day after hip fracture surgery based a low to moderate quality trial with a small sample size. There is a need to generate additional evidence to support early mobilisation as a new UK Best Practice Tariff (BPT). Objective To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30-days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death. Method We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between January 2014 and December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 hours of surgery) and those mobilised late accounting for potential confounders and the competing risk of in-hospital death. Results 106,722 (79%) of patients first mobilised early. The average rate of discharge was 60.1 (95% CI 59.8–60.5) per 1,000 patient days, varying from 65.2 (95% CI 64.8–65.6) among those who mobilised early to 44.5 (95% CI 43.9–45.1) among those who mobilised late, accounting for the competing risk of death. By 30-days postoperatively, the crude and adjusted odds ratios of discharge were 2.26 (95% CI 2.2–2.32) and 1.93 (95% CI 1.86–1.99) respectively among those who first mobilised early compared to those who mobilised late, accounting for the competing risk of death. Conclusion Early mobilisation led to a near two fold increase in the adjusted odds of discharge by 30-days postoperatively. We recommend inclusion of mobilisation within 36 hours of surgery as a new UK BPT to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.

Download Full-text

New findings on protected and strictly protected species confirm the value of the prime hoverfly area network

Zbornik Matice srpske za prirodne nauke ◽

10.2298/zmspn1835063j ◽

2018 ◽

pp. 63-71

Author(s):

Marina Jankovic ◽

Marija Milicic ◽

Dimitrije Radisic ◽

Dubravka Milic ◽

Ante Vujic

Keyword(s):

Protected Areas ◽

Species Distribution ◽

Species Distribution Models ◽

Small Sample Size ◽

Small Sample ◽

Area Network ◽

Distribution Models ◽

Environmental Pressures ◽

New Findings ◽

Using Data

With environmental pressures on the rise, the establishment of pro?tected areas is a key strategy for preserving biodiversity. The fact that many species are losing their battle against extinction despite being within protected areas raises the question of their effectiveness. The aim of this study was to evaluate established Priority Hoverfly Areas (PHAs) and areas that are not yet but could potentially be included in the PHA network, using data from new field surveys. Additionally, species distribution models have been created for two new species recognized as important and added to the list of key hoverfly species. Maps of potential distribution of these species were superimposed on maps of protected areas and PHAs to quantify percentages of overlap. The results of this study are not statisti?cally significant, which could be influenced by a small sample size. However, the results of species distribution models and the extent of overlap with PHAs confirm the utility of these expert-generated designations.

Download Full-text

The Association Between Pleural Empyema and Peripheral Arterial Disease in Younger Patients: A Retrospective National Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.621330 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tzu-Yuan Wang ◽

Hsin-Hung Chen ◽

Chun-Hung Su ◽

Sheng-Pang Hsu ◽

Chun-Wei Ho ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Pleural Empyema ◽

Arterial Disease ◽

Population Based ◽

Rank Test ◽

Research Database ◽

Increased Risk ◽

Using Data ◽

Peripheral Arterial

Background: To investigate the relationship between pleural empyema (PE) and peripheral arterial disease (PAD).Methods: We conducted a retrospective cohort study using data from the National Health Institute Research Database. Univariable and multivariable Cox's proportional hazard regressions were performed to investigate the association between PE and the risk of PAD. Kaplan–Meier method and the differences were assessed using a log-rank test.Results: The overall incidence of PAD was higher in the PE cohort than in the non-PE cohort (2.76 vs. 1.72 per 1,000 person-years) with a crude hazard ratio (HR) of 1.61 [95% confidence interval (CI) = 1.41–1.83]. After adjustment for age, gender, and comorbidities, patients with PE were noted to be associated with an increased risk of PAD compared with those without PE [adjusted HR (aHR) = 1.18, 95% CI = 1.03–1.35]. Regarding the age-specific comparison between the PE and non-PE cohorts, PAD was noted to be significantly high in the ≤ 49 years age group (aHR = 5.34, 95% CI = 2.34–10.1). The incidence of PAD was higher in the first 2 years, with an aHR of 1.35 (95% CI = 1.09–1.68) for patients with PE compared with those without PE.Conclusion: The risk of PAD was higher if patients with PE were younger than 49 years and within the 2-year diagnosis of PE.

Download Full-text

Association of Consecutive Influenza Vaccinations and Pneumonia: A Population-Based Case-Control Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16061078 ◽

2019 ◽

Vol 16 (6) ◽

pp. 1078

Author(s):

Liang-Tsai Yeh ◽

Chi-Ho Chan ◽

Shun-Fa Yang ◽

Han-Wei Yeh ◽

Ying-Tung Yeh ◽

...

Keyword(s):

Influenza Vaccination ◽

Case Control Study ◽

Conditional Logistic Regression ◽

Population Based ◽

Case Control ◽

Research Database ◽

Conditional Logistic Regression Analysis ◽

Using Data ◽

Influenza Vaccinations ◽

Control Study

The purpose of this study was to investigate whether individuals receiving influenza vaccines have a lower risk of pneumonia. A nationwide population-based case-control study was conducted using data from the National Health Insurance Research Database in Taiwan. We enrolled 7565 patients each in pneumonia and non-pneumonia groups after diagnosis of patients with chronic pulmonary disease, and these patients were individually age and sex matched in a 1:1 ratio. Using conditional logistic regression analysis, adjusted odds ratios (aORs) were estimated in patients who received influenza vaccination and those who had not previously had pneumonia. Moreover, we also analyzed the interval between vaccination and the onset of pneumonia and the number of vaccinations received by patients. This was compared with patients who never received influenza vaccination. Patients who had received influenza vaccination and had been vaccinated for two consecutive years (aOR = 0.85, confidence interval (CI) = 0.79–0.93 and aOR = 0.75, CI = 0.67–0.85, respectively) showed lower rates of pneumonia occurrence by 15–25%. In conclusion, influenza vaccination significantly reduces the occurrence of pneumonia, especially in individuals who receive vaccination in consecutive years.

Download Full-text

Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

BMJ Open ◽

10.1136/bmjopen-2017-016992 ◽

2017 ◽

Vol 7 (9) ◽

pp. e016992 ◽

Cited By ~ 8

Author(s):

Shu-Man Lin ◽

Shih-Hsien Yang ◽

Hung-Yu Cheng ◽

Chung-Chao Liang ◽

Huei-Kai Huang

Keyword(s):

Cohort Study ◽

Health Insurance ◽

Hip Fracture ◽

National Health Insurance ◽

National Health ◽

Population Based ◽

Research Database ◽

Matched Cohort ◽

Matched Cohort Study

ObjectivesThis study aimed to investigate the association between thiazide use and the risk of hip fracture after stroke.SettingA population-based, propensity-matched cohort study was conducted on the basis of Taiwan’s National Health Insurance Research Database.ParticipantsPatients with newly diagnosed ischaemic stroke between 2000 and 2011 were included. After propensity score matching, 7470 patients were included, of whom 3735 received thiazides and 3735 did not.Outcome measuresHRs for developing hip fractures within 2 years after stroke were calculated using Cox proportional hazards regression model with adjustments for sociodemographic and coexisting medical conditions.ResultsOverall, patients using thiazides after stroke had a lower risk of hip fracture than those not using thiazides (8.5 vs 13.9 per 1000 person-years, adjusted HR=0.64, 95% CI 0.46 to 0.89, p=0.007). Further sensitivity analysis based on the duration of thiazide use revealed that the risk of hip fracture tended to decrease as the duration of exposure of thiazides increased. However, the effect was significant only in patients with long-term use of thiazides (using thiazides for >365 days within 2 years after stroke), with a 59% reduction in the risk of hip fracture when compared with patients not using thiazide (adjusted HR=0.41, 95% CI 0.22 to 0.79, p=0.008).ConclusionsThe long-term use of thiazides is associated with a decreased risk of hip fracture after stroke.

Download Full-text

Acupuncture in Subacute Stroke: No Benefits Detected

Physical Therapy ◽

10.2522/ptj.20110138 ◽

2013 ◽

Vol 93 (11) ◽

pp. 1447-1455 ◽

Cited By ~ 12

Author(s):

Yi Zhu ◽

Lixia Zhang ◽

Gang Ouyang ◽

Dianhuai Meng ◽

Kailin Qian ◽

...

Keyword(s):

Physical Therapy ◽

Motor Function ◽

Small Sample Size ◽

Randomized Study ◽

Theoretical Background ◽

Scalp Acupuncture ◽

Small Sample ◽

Acupuncture Group ◽

Rehabilitation Centers ◽

Subacute Stroke

Background There is debate concerning the effect of acupuncture on rehabilitation following stroke, with key reviews unable to find evidence of benefit. This lack of evidence may be due to poor study design, small sample size, and insufficient theoretical background. Objective The present study was designed to determine whether acupuncture combined with conventional physical therapy improves motor function and activities of daily living in patients with subacute stroke compared with conventional physical therapy alone. Design A multicenter, single-blinded, randomized study was conducted. Setting Four rehabilitation centers in the Jiangsu province of China participated in this study. Patients One hundred eighty-eight patients with subacute stroke admitted to the hospital were randomized into an acupuncture group and a conventional rehabilitation group. Interventions A combination of body and scalp acupuncture was used for 3 months in the acupuncture group. All patients underwent conventional stroke rehabilitation. Measurements The Fugl-Meyer Assessment (FMA) and Barthel Index (BI) were performed at baseline and at 1, 3, and 6 months after inclusion in the study. Results No statistically significant differences were found at baseline between the groups. No statistically significant differences were found between the groups using the FMA motor scores and the BI scores at baseline or at 1, 3, or 6 months. Significant improvements were found in each group following treatment. Conclusions In patients with subacute stroke, the addition of body and scalp acupuncture to a regimen of conventional physical therapy does not result in further improvement in either motor function or ADL beyond the effect of conventional physical therapy alone.

Download Full-text

In-hospital mortality among electroconvulsive therapy recipients: A 17-year nationwide population-based retrospective study

European Psychiatry ◽

10.1016/j.eurpsy.2016.12.005 ◽

2017 ◽

Vol 42 ◽

pp. 29-35 ◽

Cited By ~ 4

Author(s):

C.-S. Liang ◽

C.-H. Chung ◽

C.-K. Tsai ◽

W.-C. Chien

Keyword(s):

Hospital Mortality ◽

Electroconvulsive Therapy ◽

Scientific Evidence ◽

Population Based ◽

National Database ◽

Research Database ◽

Taiwan National Health Insurance ◽

Hospital Stays ◽

Psychiatric Conditions ◽

Using Data

AbstractBackgroundElectroconvulsive therapy (ECT) remains irreplaceable in the treatment of several psychiatric conditions. However, evidence derived using data from a national database to support its safety is limited. The aim of this study was to investigate in-hospital mortality among patients with psychiatric conditions treated with and without ECT.MethodsUsing data from the Taiwan National Health Insurance Research Database from 1997 to 2013, we identified 828,899 inpatients with psychiatric conditions, among whom 0.19% (n = 1571) were treated with ECT.ResultsWe found that ECT recipients were more frequently women, were younger and physically healthier, lived in more urbanized areas, were treated in medical centers, and had longer hospital stays. ECT recipients had lower odds of in-hospital mortality than did those who did not receive ECT. Moreover, no factor was identified as being able to predict mortality in patients who underwent ECT. Among all patients, ECT was not associated with in-hospital mortality after controlling for potential confounders.ConclusionECT was indicated to be safe and did not increase the odds of in-hospital mortality. However, ECT appeared to be administered only on physically healthy but psychiatrically compromised patients, a pattern that is in opposition with the scientific evidence supporting its safety. Moreover, our data suggest that ECT is still used as a treatment of last resort in the era of modern psychiatry.

Download Full-text

System and Neural Network Analysis of Economic and Financial Development – A case study of Dubai and rest of UAE

International Review of Advances in Business Management and Law ◽

10.30585/irabml.v1i1.72 ◽

2018 ◽

Vol 1 (1) ◽

pp. 51-67

Author(s):

Genanew B Worku ◽

Ananth Rao

Keyword(s):

Neural Network ◽

Financial Development ◽

Small Sample Size ◽

Core Competencies ◽

Business Environment ◽

Small Sample ◽

Factors Affecting ◽

Jel C32 ◽

Using Data ◽

Start Ups

The study examines the factors affecting the economic and financial development by applying Zellner’s seemingly unrelated regressions (SURE) and Neural Network techniques. It applies multivariate and neural network frameworks for analysing the GDP of Dubai and rest of UAE using data for 2001–2015. The study shows that there exists positive interdependencies between Dubai and rest of UAE economies. This signifies that the core competencies across various sectors in Dubai and rest of UAE economies need to be promoted further to have overall diversified impact on UAE economy. The positive sizable impact of the finance sector in Dubai and negative sizable impact in the rest of the UAE provide many opportunities for designing diversification programs for sustained economic development of the entire UAE economy. The small sample size, non-availability of detailed sectoral data in four of the seven emirates constrained the scope of the study for generalization to other economies in the Middle East. The study findings are crucial for identifying structural reforms, to strengthen competitiveness and accelerate private sector-led job creation for nationals, potential on further opening up foreign direct investment (FDI), improving selected areas of the business environment, and easing access to finance for start-ups and SMEs in both the economies. JEL: C32, C52, D85, N15, N25

Download Full-text

Neoadjuvant bevacizumab: Surgical complications of mastectomy with and without reconstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1100 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1100-1100

Author(s):

Kari Joanne Kansal ◽

Laura Stewart Dominici ◽

Sara M. Tolaney ◽

Steven J. Isakoff ◽

Ian E. Krop ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Therapy ◽

Surgical Complications ◽

Small Sample Size ◽

Small Sample ◽

P Value ◽

Data Sets ◽

Complication Rates ◽

Similar Time ◽

Time Period

1100 Background: Neoadjuvant therapy is commonly used in operable breast cancer. We prospectively evaluated the surgical complications in a cohort of patients who underwent mastectomy following neoadjuvant doxorubucin hydrochloride/cyclophosphamide/paclitaxel (AC/T) plus bevacizumab and compared the rate of complications to a matched cohort of neoadjuvant AC/T without bevacizumab. Methods: One hundred patients with HER2-negative breast cancer enrolled in a single-arm trial of neoadjuvant AC/T plus bevacizumab (cohort 1), 60 of these patients underwent mastectomy and were matched with 59 patients who received standard neoadjuvant AC/T (cohort 2) over a similar time period in the same healthcare system. All patients underwent mastectomy with or without reconstruction. Fisher’s exact tests were used to compare complication rates, with a p<0.05 was considered significant. Results: Patients were matched well in terms of demographics. The overall complication rate was 33% in cohort 1 and 31% in cohort 2 (P-value=0.84; Table). In cohort 1, 7 of 23 (30%) patients who underwent immediate expander/implant reconstruction had complications, including 2 patients who had explantation of their reconstructions. In cohort 2, 0 of 8 (0%) had complications (p value=0.15). Conclusions: Nearly a third of patients undergoing neoadjuvant therapy with AC/T with or without bevacizumab developed a postoperative complication after mastectomy. The use of bevacizumab was not associated with a significant increase in surgical complications, although this is a non-randomized data with a small sample size. As larger data sets become available with the use of neoadjuvant bevacizumab with mastectomy, further refinement may be necessary. [Table: see text]

Download Full-text