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Ymittos Athens, Greece

Guo S.,Alexandra Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand

Skin complications have been reported to be associated with tourniquet use. The UK Medical Devices Agency (MDA) recommends the use of a limb drape to act as underpadding to reduce these complications. Our hospital had traditionally used Velbands as an underpadding, but changed to limb drapes on the advice of the MDA. The purpose of this study is to establish whether Velbands are still a safe and cost-effective tourniquet underpadding. A prospective clinical study was performed on consecutive patients undergoing hand surgery over a four-month period. Patients were randomly allocated into one of two treatment groups. Group 1 using Velband as tourniquet underpadding and Group 2 using limb drapes as underpadding. All patients had identical tourniquets, tourniquet pressure and skin preparation agents. After surgery, the tourniquet was removed and the skin beneath the tourniquet was inspected for any skin reaction or damage. Each group included 50 patients. Skin was normal after tourniquet use in all cases and there was no difference between the two groups. Velband is still a safe and cost-effective tourniquet underpadding in hand surgery. Source

Feng L.,National University of Singapore | Nyunt M.S.Z.,National University of Singapore | Yap K.B.,Alexandra Hospital | Ng T.P.,National University of Singapore
Journal of the American Medical Directors Association

Objective: This study aimed to examine the cross-sectional and longitudinal relationships between physical frailty at baseline and depressive symptoms at baseline and at follow-up. Design: Four-year prospective study. Setting: Communities in the South East Region of Singapore. Participants: We analyzed data of 1827 older Chinese adults aged 55 and above in the Singapore Longitudinal Aging Study-I. Measurements: The frailty phenotype (based on Fried criteria) was determined at baseline, depressive symptoms (Geriatric Depression Scale ≥5) at baseline and follow-ups at 2 and 4years. Results: The mean age of the population was 65.9 (standard deviation 7.26). At baseline, 11.4% (n=209) had depressive symptoms, 32.4% (n=591) were prefrail and 2.5% (n=46) were frail. In cross-sectional analysis of baseline data, the adjusted odds ratios (OR)s and 95% confidence intervals controlling for demographic, comorbidities, and other confounders were 1.69 (1.23-2.33) for prefrailty and 2.36 (1.08-5.15) for frailty, (P for linear trend <.001). In longitudinal data analyses, prospective associations among all participants were: prefrail: OR=1.86 (1.08-3.20); frail: OR=3.09 (1.12-8.50); (P for linear trend=009). Among participants free of depressive symptoms at baseline, similar prospective associations were found: prefrail OR=2.26 (1.12-4.57); frail: OR=3.75 (1.07-13.16); (P for linear trend=009). Conclusion: These data support a significant role of frailty as a predictor of depression in a relatively younger old Chinese population. Further observational and interventional studies should explore short-term dynamic and bidirectional associations and the effects of frailty reversal on depression risk. © 2014 American Medical Directors Association, Inc. Source

Feng L.,National University of Singapore | Yap K.B.,Alexandra Hospital | Ng T.P.,National University of Singapore
American Journal of Geriatric Psychiatry

Objective: Among patients with chronic kidney disease (CKD), we investigated the prevalence of depressive symptoms, their impact on mortality and quality of life, and correlates of depressive symptoms. Design: Prospective cohort study, followed up to 4 years. Setting: General community. Participants: A total of 362 older adults with CKD (Stages 3 and 4 assessed from estimated glomerular filtration rate [eGFR]) drawn from the Singapore Longitudinal Aging Study cohort. Measurements: Scores on the Geriatric Depression Scale (GDS) and the prevalence of depressive symptoms (GDS -5) and other variables were assessed at baseline, and SF-12 quality of life (QOL) (at 2 years) and mortality determined from 4 years of follow-up. Results: Depressive symptoms were present in 13% of the participants at baseline, and were associated with poorer SF-12 QOL scores (up to 30 percentage point differences). There was a significant association between depressive symptoms and increased mortality risk (odds ratio: 3.17; 95% confidence interval: 1.17-8.61; c2 = 5.11; df = 1; p = 0.023), which was statistically significant in unadjusted analysis, but not in multivariate analysis that accounted for covariates (odds ratio: 2.62; 95% confidence interval: 0.77-8.89; c2 = 2.37; df = 1; p = 0.13). Baseline cognitive impairment, functional disability, and other chronic illness were significantly associated with both increasing GDS scores and depressive symptoms. No relationship between eGFR and depressive symptoms was observed. Conclusion: Depression among individuals with CKD was significantly associated with poorer quality of life, but not with increased mortality in predialysis CKD patients. More prospective studies are needed to establish the effects of depression on adverse CKD outcomes in predialysis CKD patients. © 2013 American Association for Geriatric Psychiatry. Source

Jewell D.P.,Alexandra Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand

Trapezio-metacarpal joint arthritis is common, affecting 7% of men and 15% of women. Numerous surgical techniques are described for this condition but it is not clear which is best. Eighty-six silicone trapezium replacements were assessed at an average of 46 months (six to 156 months) postoperatively for patient satisfaction, pain, key and power grip strength, range of motion, complications and disability with DASH score. Patient satisfaction was 92%. There was excellent pain reduction from 4.2 to 0.6 on a scale of 0 to 5. Strength was 72% and 84% of age-sex-matched normal data for key and power grips, respectively. The complication rate was low, with two cases of persistent pain. One resolved spontaneously, the other resolved following revision of the silicone implant. The average DASH score was 30. Silicone trapezium replacement is an effective operation that offers the patient good pain relief, strength and good function with few complications. Source

PURPOSE. To compare the effects of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients. METHODS. Records of 7 men and 17 women aged 68 to 93 (mean, 82) years who were on warfarin and underwent surgery for femoral neck fractures were reviewed. The time to surgery, complication rate, and mortality were recorded, as were the International Normalised Ratio (INR) on admission and the day of operation, as well as the dose, route, and time of administration of vitamin K for reversing the anticoagulation effect of warfarin. Patients were divided into 4 groups based on the warfarin reversal treatment. Group 1 (n=4) included patients who did not receive reversal treatment, as their admission INR was 1.5 or less. Group 2 (n=6) included patients who did not receive reversal treatment even though their INR was >1.6. Group 3 (n=5) included patients who received inappropriate reversal treatment (late or low-dose oral administration). Group 4 (n=9) included patients who received appropriate reversal treatment in terms of dose, route, and time of administration. RESULTS. Among the 4 groups, the mean INR was 2.2 (range, 1.3-4.6) on admission and 1.4 (range, 1.0-1.6) on the day of surgery. Group 1 was excluded from further analysis. Respectively in groups 2, 3, and 4, the mean times to surgery were 2.3, 2.6, and 1.2 days, and the complication rates were 67%, 20%, and 11%. CONCLUSION. Early administration of intravenous vitamin K for hip fracture patients on warfarin is recommended to ensure early operative management and avoid postoperative complications. Source

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