Articles: function.
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Review
Pre-operative co-morbidity and postoperative survival in the elderly: beyond one lunar orbit.
Mortality is a good measure of killing, but it is a poor measure of cure, palliation or the maintenance of function. Nevertheless, it has remained the primary metric of hospital care for 200 years. ⋯ This article discusses how disparate factors can usefully combine to generate an 'elderly' group with a monthly mortality in excess of 1% and a median life expectancy less than 3.5 years. A downloadable spreadsheet is provided that combines risk factors to generate mortality risks and their associated survival curves, emphasising the importance of looking beyond one postoperative month.
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Randomized Controlled Trial
Effect of low-dose oral prednisolone on symptoms and systemic inflammation in older adults with moderate to severe knee osteoarthritis: a randomized placebo-controlled trial.
To investigate the efficacy of 6 weeks of daily low-dose oral prednisolone in improving pain, mobility, and systemic low-grade inflammation in the short term and whether the effect would be sustained at 12 weeks in older adults with moderate to severe knee osteoarthritis (OA). ⋯ Low-dose oral prednisolone had both a short-term and a longer sustained effect resulting in less knee pain, better physical function, and attenuation of systemic inflammation in older patients with knee OA (ClinicalTrials.gov identifier NCT01619163).
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Comparative Study
Comparison of risk prediction scoring systems for ward patients: a retrospective nested case control study.
The rising prevalence of rapid response teams has led to a demand for risk-stratification tools that can estimate a ward patient's risk of clinical deterioration and subsequent need for intensive care unit (ICU) admission. Finding such a risk-stratification tool is crucial for maximizing the utility of rapid response teams. This study compares the ability of nine risk prediction scores in detecting clinical deterioration among non-ICU ward patients. We also measured each score serially to characterize how these scores changed with time. ⋯ ICU- and emergency room-based prediction scores can also be used to prognosticate risk of clinical deterioration for non-ICU ward patients. In addition, scoring models that take advantage of a score's change over time may have increased prognostic value over models that use only a single set of physiologic measurements.
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Observational Study
Vitamin D status and its association with season, hospital and sepsis mortality in critical illness.
Vitamin D plays a key role in immune function. Deficiency may aggravate the incidence and outcome of infectious complications in critically ill patients. We aimed to evaluate the prevalence of vitamin D deficiency and the correlation between serum 25-hydroxyvitamin D (25(OH) D) and hospital mortality, sepsis mortality and blood culture positivity. ⋯ Low 25(OH) D status is significantly associated with mortality in the critically ill. Intervention studies are needed to investigate the effect of vitamin D substitution on mortality and sepsis rates in this population.
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People with knee osteoarthritis (OA) report ongoing limitations in climbing stairs, even after total knee arthroplasty (TKA). The aim of this systematic review was to synthesise the available evidence of factors affecting stair climbing ability in patients with knee OA before and after TKA. ⋯ For people with knee OA there is evidence that some physical, demographic and psychosocial factors are related to stair-climbing ability. However, the evidence for similar relationships in the TKA population is scarce and needs more extensive research. Implications for Rehabilitation People with knee osteoarthritis experience difficulty when climbing stairs, and this remains challenging even after knee replacement. For people with knee osteoarthritis, a range of physical, demographic and psychosocial factors contribute to stair-climbing ability, however, evidence for similar relationships in the TKA population is scarce. Rehabilitation that is multi-faceted may be the best approach to improve stair-climbing in people with knee osteoarthritis.