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Kow RY, Low CL, Abbas AA, Zulkifly AH. Bibliometric Analysis of Malaysian Orthopaedic Journal using Scopus Database. Malays Orthop J 2024; 18:1-9. [PMID: 39130504 PMCID: PMC11315949 DOI: 10.5704/moj.2407.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/05/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction The Malaysian Orthopaedic Journal (MOJ) (ISSN 1985-2533 / 2232-111X) is the official publication of the Malaysian Orthopaedic Association (MOA) and the ASEAN Orthopaedic Association (AOA). In May 2007, MOA published the first standalone issue of MOJ with the aim of disseminating new knowledge and providing updates in orthopaedics, trauma and musculoskeletal research. Since then, MOJ has grown significantly, achieving indexing in numerous databases and attaining a 2nd Quartile (Q2) rank in the Scopus database in 2022. This bibliometric analysis aims to explore the trends and distribution of articles published in MOJ. Materials and Methods Bibliometric data for MOJ was extracted from the SCOPUS database, covering the years from its indexing to 2022. Information such as authors, country, document type, author's keywords, citations, and other parameters were extracted using the bibliometrix package in the R Studio software. The data were then presented in tables and illustrative graphs using the same software. Results A total of 305 articles were retrieved from the Scopus database during the study period. Two-thirds of the articles were original articles and review articles. The highest number of citations received by an article is 56, and top ten articles in MOJ were authored by researchers from seven different countries, highlighting the journal's diversity. Despite receiving submissions from various countries, there is minimal collaboration between authors of different countries. Keywords such as "covid-19" and "pandemic" dominate the authors' keyword section due to the once-in-a-life-time COVID-19 which during the study period, resulting in numerous publications related to this issue. Conclusion This bibliometric analysis reviews all the articles indexed in the Scopus database and provides insight into the contributors' information and the trends in orthopaedic research. By identifying the lack of collaboration between countries, it is hoped that this analysis can inspire more orthopaedic surgeons and researchers to collaborate and produce high-quality publications.
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Affiliation(s)
- R Y Kow
- Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University Malaysia, Kuantan, Malaysia
| | - C L Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, Malaysia
| | - A A Abbas
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Universiti Malaya, Kuala Lumpur, Malaysia
| | - A H Zulkifly
- Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University Malaysia, Kuantan, Malaysia
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Muhamad Jamil NK, Naina Mohamed I, Mokhtar SA, Leong JF, Kamudin NAF, Muhammad N. Barriers to osteoporosis management and adherence to Clinical Practice Guideline: a comparative study between tertiary East Coast hospitals and a Fracture Liaison Services (FLS)-accredited hospital in Malaysia. Arch Osteoporos 2024; 19:49. [PMID: 38864939 DOI: 10.1007/s11657-024-01407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
This study compares osteoporosis management between tertiary East Coast hospitals and a FLS-accredited hospital in Malaysia. It identifies significant barriers and highlights the superior performance of FLS in areas like timely treatment initiation and treatment monitoring. The insights are crucial for improving osteoporosis management strategies. INTRODUCTION Osteoporosis management poses a substantial healthcare challenge, necessitating effective strategies and Clinical Practice Guidelines (CPG) adherence. METHODS The study employed a self-administered online questionnaire via Google Forms. Orthopedic clinicians from all study sites were invited to participate via messaging platforms. A total of 135 participants completed the questionnaire and the data was proceeded to statistical analyses. RESULTS The study identified significant barriers, including inadequate knowledge of current osteoporosis guidelines and medications (p = 0.014), limited choice of anti-osteoporosis medication (p < 0.001), insufficient post-fracture care staff (p < 0.001), patients' financial constraints due to socioeconomic status (p = 0.027), and lack of doctor-patient time (p = 0.042). FLS demonstrated superior performance in CPG adherence in areas such as clinical diagnosis of osteoporosis without BMD assessment (p = 0.046), timely treatment initiation (p < 0.001), treatment monitoring using BMD (p = 0.004), reassessment treatment after 3-5 years of bisphosphonate therapy (p = 0.034) and considering anabolic agents in very high-risk patients (p = 0.018). CONCLUSION The findings highlight an essential opportunity for improvement and emphasize the necessity for robust strategies and strict adherence to Clinical Practice Guidelines (CPG), especially within tertiary East Coast hospitals. The exemplary efficacy demonstrated by the FLS model strongly advocates for its broader integration across multiple hospitals, promising substantial advancements in osteoporotic patient care outcomes throughout Malaysia.
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Affiliation(s)
- Nur Khadijah Muhamad Jamil
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia
- Pharmacology Department, Faculty of Medicine, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud, 20400, Kuala Terengganu, Terengganu, Malaysia
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Sabarul Afian Mokhtar
- Department of Trauma and Orthopedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Juzaily Fekry Leong
- Department of Trauma and Orthopedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Nur Azree Ferdaus Kamudin
- Department of Orthopedics, Faculty of Medicine, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud, 20400, Kuala Terengganu, Terengganu, Malaysia
| | - Norliza Muhammad
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Lim WX, Khor HM, Lee JK, Ong T. Fracture Liaison Service and Its Role in Secondary Fracture Prevention in Malaysia: A Scoping Review. Malays Orthop J 2023; 17:1-6. [PMID: 37583523 PMCID: PMC10425002 DOI: 10.5704/moj.2307.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Fragility fractures, which occur after a low-trauma injury, increases with advancing age. Such fracture doubles the life-time risk of sustaining another fracture. This risk is highest in the immediate 18 months after the index fracture. However, most patients do not receive the appropriate risk assessment and intervention to reduce this risk. A coordinated model of care termed Fracture Liaison Service (FLS) has been reported to address this treatment gap. Materials and methods This scoping review aims to explore the potential role and delivery of FLS services in Malaysia. Scientific and non-scientific sources relevant to FLS were identified from electronic bibliographic databases, specialist journals and relevant websites. Findings were categorised into themes and presented narratively. Results FLS services remain concentrated in the Klang Valley. Even within FLS services, many do not have extensive coverage to risk assess all fracture patients. These services are multidisciplinary in nature where there are links between different departments, such as orthopaedics, osteoporosis expertise, bone densitometry, rehabilitation, falls services and primary care. FLS was able to increase the number of people undergoing fracture risk assessment and treatment. The importance of FLS was highlighted by local experts and stakeholders. Its implementation and delivery are supported by a number of national guidelines. Conclusion FLS is central to our national efforts to reduce the impending fragility fracture crisis in the coming years. Continued effort is needed to increase coverage within FLS services and across the country. Training, awareness of the problem, research, and policy change will support this endeavour.
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Affiliation(s)
- W X Lim
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - H M Khor
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - J K Lee
- Department of Orthopaedics, Beacon Hospital, Kuala Lumpur, Malaysia
| | - T Ong
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Anwarali Khan MH, Kow RY, Ramalingam S, Sofian A, Ho JPY, Jaharan Singh KS, Jaya Raj J, Ganthel Annamalai K, Mohamad F. Outcomes of Geriatric Hip Fractures in a Tertiary Referral Center in Malaysia During the COVID-19 Pandemic. Cureus 2023; 15:e40479. [PMID: 37456372 PMCID: PMC10349682 DOI: 10.7759/cureus.40479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction With the advancing age of the population, there are an increasing number of patients with geriatric hip fractures. Despite the advancement of surgical knowledge and improvement of implant designs to treat geriatric hip fractures, mortality and morbidity remain high among these frail patients. In conjunction with the COVID-19 pandemic, the collateral damage dealt to these patients remains unknown as scarce resources are funneled to deal with the pandemic. This study is geared to investigate the surgical outcomes of patients with geriatric hip fractures who were admitted during the initial phase of the COVID-19 pandemic. Methods This retrospective study was carried out at Hospital Kuala Lumpur, the largest public hospital in the capital of Malaysia, from March 1, 2020, to March 1, 2021. All patients of age 60 years and above were screened for suitability. Only patients who had undergone surgical intervention during the study period were included in this study. Patients' demographic data, mechanism of injury, waiting time for surgery, type of surgery, complications and ambulatory status were obtained from the medical records. Univariate analysis was performed to determine the factors associated with complications as well as the post-operative ambulatory status of the patients. Results A total of 52 patients were included in this study, with a median age of 72 years. The majority of the patients were Chinese (n=21, 40.4%). This was followed by Malay and Indian (n=14, 26.9% each) and other ethnicity (n=3, 5.8%). More than three-quarters of the patients had a trivial injury such as a fall due to a miss-step (n=16, 30.8%) and slip (n=16, 30.8%) and a fall due to dizziness (n=8, 15.4%). Only 12 patients (23.1%) sustained hip fractures due to trauma. The median time to surgery for these patients was 5 days (interquartile range: 4 days). Most of these patients underwent total hip replacement (n=30, 57.7%). This was followed by unipolar hemiarthroplasty (n=11, 21.2%), bipolar hemiarthroplasty (n=10, 19.2%) and internal fixation (n=1, 1.9%). Among these patients, six of them had documented complications. There were periprosthetic joint infection (n=2, 3.8%), dislocation (n=2, 3.8%), hematoma formation (n=1, 1.9%) and seroma (n=1, 1.9%). Six months after the surgery, most of the patients were able to ambulate, albeit some patients required walking aid such as walking stick and walking frame. Univariate analysis showed that all the factors were not associated with the complications and the post-operative ambulatory status of the patients. Conclusion The incidence of geriatric hip fractures remains high during the COVID-19 pandemic despite the movement control order (MCO) being enforced in Malaysia. With prompt surgical intervention, most of the patients can regain ambulatory status, albeit with a walking aid.
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Affiliation(s)
- Mohammed Harris Anwarali Khan
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, MYS
- Department of Orthopaedics, Seberang Jaya Hospital, Seberang Jaya, MYS
| | - Ren Yi Kow
- Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | | | - Azlan Sofian
- Department of Orthopaedic Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, MYS
| | - Jade Pei Yuik Ho
- Department of Orthopaedic Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, MYS
| | | | - Jeffrey Jaya Raj
- Department of Orthopaedic Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, MYS
| | | | - Fazir Mohamad
- Department of Orthopaedic Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, MYS
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Lim HT, Khor HM, Chandrasekaran CK, Singh S, Adnan YK, Draman MR, Ong T. Process mapping of hip fracture orthogeriatric care: Experience from a tertiary hospital in Malaysia. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2023. [DOI: 10.1177/22104917231161830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Early surgical repair and mobilization postoperatively is associated with improved outcomes for older people with hip fractures. A process mapping exercise was performed to identify the delivery of this aspect of care in a tertiary center. Methods: Analysis was done on electronic health record data of those ≥65 years who had surgery over a 3-month period. Barriers to surgery within 48 h of admission, and mobilized within the day after surgery were identified. Results: Fourty-two patients had surgery where the majority were female, had an average age of 78 years, frail, and multimorbid. 10/42 (23.8%) and 9/42 (21.4%) patients were operated on and mobilized early. Eighteen (42.9%) patients had pre-operative cardiology assessment and 19 patients (45.2%) had pre-operative echocardiogram. None led to a change in the surgical management plan. Other reasons for the delay to early surgery included the need for further medical optimization, financial constraints, blood transfusion, and being on antiplatelet/anticoagulant. Barriers to early mobilization postoperatively were lack of weekend service, delayed referral to therapists, pain, hypotension, anemia, and delirium. Conclusions: Streamlining referrals, agreed clinical pathways, consolidating multidisciplinary involvement, and continuous audit would address the barriers identified in delivering early surgical repair and mobilization post-operatively.
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Affiliation(s)
- Hong Tak Lim
- Geriatric Medicine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Geriatric Medicine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - C.S. Kumar Chandrasekaran
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Orthopedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Simmrat Singh
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Orthopedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Yohan Khirusman Adnan
- Department of Orthopedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Rusdi Draman
- Department of Orthopedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Terence Ong
- Geriatric Medicine Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Ho JPY, Wong AYF, Ong LH, Rutel A, Abdullah S, Jaffar MSA, Bong CH, Tan KT, Rao RP, Kamaruddin F. Mobility and Hip Function Among Geriatric Patients With Displaced Neck of Femur Fractures Treated With Arthroplasty. Geriatr Orthop Surg Rehabil 2023; 14:21514593231164245. [PMID: 36923160 PMCID: PMC10009023 DOI: 10.1177/21514593231164245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background Neck of femur fractures result in impaired function for older people. Despite surgery, many patients experience a decrease in functional level and poorer health status after the injury. The objectives of this study were (1) to determine the short-term mobility and hip function of geriatric patients who underwent hip replacement surgery for a displaced neck of femur fracture in our local population and (2) to identify factors which affect the functional outcome of these patients. Methods Patients aged 60 years and above, who were admitted for neck of femur fracture from January 2017 to December 2020, and treated surgically with arthroplasty, were included. Information on patient demography, comorbidities, perioperative data, mobility, hip function and complications were retrospectively collected. Outcome measures used were independent ambulation and recovery of pre-fracture mobility at 1 year after surgery while hip function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain, stiffness, and physical function scores. Factors associated with these outcomes were analyzed. Results 168 patients with a mean age of 75.2 (SD 8.4) years met the inclusion criteria. 32.1% of patients regained their pre-fracture mobility and 59.6% remained independent 1 year after surgery. Logistic regression analysis identified age, gender, surgical procedure, and time to surgery as significant contributors to recovery of pre-fracture mobility. Older age and increasing requirement for postoperative ambulatory aid resulted in worse WOMAC total and physical function scores. No significant differences were observed in patient-reported hip function between those who had a total hip arthroplasty and those who had a hemiarthroplasty. Conclusion Most geriatric patients with displaced neck of femur fractures did not regain pre-fracture mobility despite surgical treatment with arthroplasty.
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Affiliation(s)
- Jade Pei Yuik Ho
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Amy Yoke Foong Wong
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Lik Han Ong
- Department of Orthopaedic Surgery, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Ankimtay Rutel
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Sabaruddin Abdullah
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | | | - Chun Haw Bong
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Kean Tee Tan
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Reuben Prashant Rao
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Faris Kamaruddin
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
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Khor HM, Tan MP, Kumar CS, Singh S, Tan KM, Saedon NB, Ong T, Chin AV, Kamaruzzaman SB, Hasmukharay K, Zakaria MIB, Teh HX, Tan FC, Chong PY. Mobility and mortality outcomes among older individuals with hip fractures at a teaching hospital in Malaysia. Arch Osteoporos 2022; 17:151. [PMID: 36447075 DOI: 10.1007/s11657-022-01183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022]
Abstract
UNLABELLED The challenges of hip fracture care in Malaysia is scarcely discussed. This study evaluated the outcomes of older patients with hip fracture admitted to a teaching hospital in Malaysia. We found that one in five individuals was no longer alive at one year after surgery. Three out of five patients did not recover to their pre-fracture mobility status 6 months following hip fracture surgery. PURPOSE With the rising number of older people in Malaysia, it is envisaged that the number of fragility hip fractures would also increase. The objective of this study was to determine patient characteristics and long-term outcomes of hip fracture in older individuals at a teaching hospital in Malaysia. METHODS This was a prospective observational study which included consecutive patients aged ≥ 65 years old admitted to the orthopedic ward with acute hip fractures between March 2016 and August 2018. Patient socio-demographic details, comorbidities, pre-fracture mobility status, fracture type, operation and anesthesia procedure, and length of stay were recorded. Post-fracture mobility status was identified at 6 months. Cox proportional hazard analysis was used to assess the risk of death in all patients. RESULTS 310 patients (70% women) with the mean age of 79.89 years (SD 7.24) were recruited during the study period. Of these, 284 patients (91.6%) underwent surgical intervention with a median time to surgery of 5 days (IQR 3-8) days. 60.4% of patients who underwent hip fracture surgery did not recover to their pre-fracture mobility status. One year mortality rate was 20.1% post hip fracture surgery. The independent predictor of mortality included advanced age (hazard ratio, HR = 1.05, 95% CI = 1.01-1.08; p = 0.01), dependency on activities of daily living (HR = 2.08, 95% CI = 1.26-3.45; p = 0.01), and longer length of hospitalization (HR = 1.02, 95% CI = 1.01-1.04; p < 0.01). CONCLUSION One in 5 individuals who underwent hip fracture surgery at a teaching hospital in Kuala Lumpur was no longer alive at one year. A systematic approach to hip fracture management is crucial to improve outcomes and restore pre-fracture function of this vulnerable group of patients.
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Affiliation(s)
- Hui Min Khor
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - C Sankara Kumar
- Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Simmrat Singh
- Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kit Mun Tan
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Terence Ong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ai-Vyrn Chin
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Kejal Hasmukharay
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mohd Idzwan Bin Zakaria
- Academic Unit Trauma and Emergency, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hui Xin Teh
- Department of Medicine, Hospital Sultan Ismail, Jalan Mutiara Emas Utama, Taman Mount Austin, Johor Bahru, Johor, Malaysia
| | - Fang Chin Tan
- Department of Medicine, Hospital Seberang Jaya, Jalan Tun Hussein Onn, Seberang Jaya, Permatang Pauh, Pulau Pinang, Malaysia
| | - Poh Yong Chong
- Parkcity Medical Centre, No. 2, Jalan Intisari Perdana, Desa Parkcity, Kuala Lumpur, Malaysia
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Mitchell PJ, Chan DCD, Lee JK, Tabu I, Alpuerto BB. The global burden of fragility fractures - what are the differences, and where are the gaps. Best Pract Res Clin Rheumatol 2022; 36:101777. [PMID: 36089481 DOI: 10.1016/j.berh.2022.101777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current burden of fragility fractures is enormous, and it is set to increase rapidly in the coming decades as humankind enters a new demographic era. The purpose of this review is to consider, in different settings: • The human and economic toll of fragility fractures. • Risk factors for fragility fractures. • Current acute management of fragility fractures. • Current care gaps in both secondary and primary fracture prevention. A summary of global, regional, and national initiatives to improve the quality of care is provided, in addition to proposals for the research agenda. Systematic approaches to improve the acute care, rehabilitation and prevention of fragility fractures need to be developed and implemented rapidly and at scale in high-, middle- and low-income countries throughout the world. This must be an essential component of our response to the ageing of the global population during the remainder of the current United Nations - World Health Organization "Decade of Healthy Ageing".
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Affiliation(s)
- Paul James Mitchell
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Australia; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Synthesis Medical NZ Limited, Pukekohe, New Zealand.
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Changde St, Taipei, 100, Taiwan.
| | - Joon-Kiong Lee
- Beacon Hospital, 1, Jalan 215, Section 51, Off Jalan Templer, 46050, Petaling Jaya, Selangor, Malaysia.
| | - Irewin Tabu
- Department of Orthopaedics, University of the Philippines - Philippine General Hospital, Manila, Philippines; Institute on Aging-National Institutes of Health, UP Manila, Philippines.
| | - Bernardino B Alpuerto
- Department of Orthopaedics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
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9
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Thiam CN, Khor HM, Pang GHM, Lim WC, Shanmugam T, Chandrasekaran CSK, Singh S, Zakaria MIB, Ong T. Hip fracture management in the emergency department and its impact on hospital outcomes: a retrospective cross-sectional analysis. Eur Geriatr Med 2022; 13:1081-1088. [PMID: 35567676 DOI: 10.1007/s41999-022-00654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The emergency department (ED) plays an important role in initiating early treatment for hip fractures and ensuring prompt transfer to orthopaedic wards. This study reported on the care delivered in a tertiary centre ED in Malaysia and the association between time spent in ED with hospital outcomes. METHODS Patients aged ≥ 65 years with fragility hip fractures and seen by the geriatric team were recruited. Data were collected on patient characteristics, key time points for treatment and hospital outcomes. Median time in ED was used to dichotomise long and short waiting time. RESULTS 447 patients were recruited. The mean (SD) age was 80.5 (7.0) years and 69.8% were women. 74.9% were prescribed analgesia within 30 min. Median (Q1,Q3) time to diagnostic imaging was 27.0 (24.0-43.0) minutes, clinician confirmation of fracture was 83.0 (49.0-129.0) minutes, and time in ED was 4.8 (3.5-6.9) h. A weekday, weekend, in-hour or out-of-hour admission did not demonstrate a difference in the time important care was delivered. Patients who spent ≥ 5 h in ED had more cardiac events (4.6 vs 10.1%, p = 0.023) and more spent ≥ 14 days in hospital (17.5 vs 29.0%, p = 0.004) compared to those < 5 h. No significant increase in inpatient complications (43.5 vs 34.6%, p = 0.054), length of stay (median, 8 vs 7 days, p = 0.119), care home discharge (5.3 vs 4.6%, p = 0.772), or in-hospital death (6.3 vs 4.2%, p = 0.313) were observed. CONCLUSION Time to early hip fracture pain relief and diagnosis was adequate in this ED. Time ≥ 5 h in ED was associated with cardiac events and 2 weeks or more inpatient stay.
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Affiliation(s)
- Chiann Ni Thiam
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.,Department of General Medicine, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.,Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Gordon Hwa Mang Pang
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.,Department of General Medicine, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Wan Chieh Lim
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.,Department of General Medicine, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Tharshne Shanmugam
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia
| | - C Sankara Kumar Chandrasekaran
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.,Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Simmrat Singh
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.,Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Idzwan Bin Zakaria
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.,Academic Unit Trauma and Emergency, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Terence Ong
- University Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia. .,Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Ji X, Li Z, Wang W, Chen J. Downregulation of long non-coding RNA PVT1 enhances fracture healing via regulating microRNA-497-5p/HMGA2 axis. Bioengineered 2021; 12:8125-8134. [PMID: 34592894 PMCID: PMC8806978 DOI: 10.1080/21655979.2021.1987099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fragility fracture is a common and serious complication of osteoporosis. Abnormal expression of long non-coding RNAs is closely related to orthopedic diseases and bone metabolism. In the study, the role of lncRNA PVT1 during fracture healing, and the potential mechanism were explained. In the present study, 80 cases with fragility fracture were collected, serum samples were also collected at 7, 14, 21 days after standardized fixation therapy. qRT-PCR was applied for the measurement of mRNA levels. hFOB1.19 cells were recruited for the cell experiments, and the cell viability and apoptosis were detected. Luciferase reporter gene assay was performed for target gene confirmation. It was found that the level of PVT1 increased gradually, while miR-497-5p showed a downward trend over time in both intra-articular and hand fracture patients, and the changes reached a significant level at 21 day after treatment. In vitro experiments demonstrated that PVT1 knockdown promoted cell proliferation and inhibited cell apoptosis in HFOB1.19 cells. LncRNA PVT1 acts as a competing endogenous RNA (ceRNA) of miR-497-5p, and the influence of PVT1 knockdown on HFOB1.19 cell proliferation and apoptosis was reversed by miR-497-5p inhibition. HMGA2 is the target gene of miR-497-5p. It was concluded that LncRNA PVT1 silencing may enhance fracture healing via mediating miR-497-5p/HMGA2 axis.
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Affiliation(s)
- Xiang Ji
- Department of Hand and Foot Trauma Surgery, Qingdao Central Hospital, Qingdao, China
| | - Zhiqing Li
- Department of Emergency Surgery, Qingdao Central Hospital, Qingdao, China
| | - Wei Wang
- Department of Second Oncology Radiotherapy, Qingdao Central Hospital, Qingdao, China
| | - Jun Chen
- Department of Hand and Foot Trauma Surgery, Qingdao Central Hospital, Qingdao, China
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