1362 ANTICHOLINERGIC PRESCRIBING HABITS AND ITS ASSOCIATIONS IN A COMMUNITY POPULATION OF PEOPLE LIVING WITH DEMENTIA

Introduction

Many commonly prescribed medications have inadvertent anticholinergic effects. People with Dementia (PwD) are more vulnerable to these effects and at risk of adverse outcomes, the risk being higher with a greater degree of anticholinergic exposure. We investigated prescribing patterns and Anticholinergic burden (ACB) in a cohort of community-dwelling older adults with dementia and aimed to explore the effect of ACB on cognition, mood, and quality of life(QoL).

Method

The medication and demographic information for 87 (39 female) community-dwelling PwD were obtained from Electronic Care Summaries. We used the German Anticholinergic Burden Scale (GABS) to measure ACB. Additionally, we investigated associations between ACB and cognitive (ADAS-Cog), functional (BADL) and QoL (DemQoL) assessments.

Results

28.7% of participants had a clinically significant score (ACB> 2). The most commonly prescribed medications with ACB were Lansoprazole(18.3%), Mirtazapine(12.6%) and Codeine(12.6%). ACB was higher in males and negatively correlated with age, r(87)=-.21,p=.03. There was no association between ACB and cognition, QoL, functional independence, and neuropsychiatric symptoms. Over six months, PLWD with no ACB had a greater negative change in neuropsychiatric symptoms[t(18)=2.27,p=.04] and functional independence[t(23)=-3.8,p=.001], indicating greater dependence and worsening neuropsychiatric symptoms.

Conclusion

A third of PLWD in the community had clinically significant ACB. No ACB was associated with worsening neuropsychiatric symptoms and functional dependence over a six-month period. Community prescribers should consider regular medication reviews with PLWD and carers to ensure medications are prescribed safely and appropriately.

Central quadriceps tendon for anterior cruciate ligament reconstruction. Part I: Morphometric and biomechanical evaluation

We examined the anatomic and biomechanical adequacy of the central quadriceps tendon as an alternative graft source for anterior cruciate ligament reconstruction. Morphometry was performed on 15 preserved and 6 fresh-frozen specimens. Biomechanical testing was performed on the six fresh-frozen specimens. We initially used a triple suture through the tendon construction, and then clamping directly on the tendon. Morphometry yielded the following measurements: length, 6.1 +/- 1.0 cm; width, 2.7 cm (range, 2.1 to 3.7); and thickness, 7 mm (range, 6.4 to 7.8). The thickness was 1.8 times that of the patellar tendon. Biomechanical testing showed that suture failure occurred at 692 +/- 181 N, and tendon failure occurred at 1075 +/- 449 N. The load to tendon failure was 1.36 times that of a comparable-width patellar tendon graft, although the difference was not statistically significant. The failure mode was primarily through partial or complete tendinous avulsion, with only one specimen failing at midsubstance. These findings show the central quadriceps graft is of sufficient size and strength to be used for anterior cruciate ligament reconstruction.

Meniscal injuries associated with acute anterior cruciate ligament tears in alpine skiers

We reviewed the records of 315 patients receiving an arthroscopically assisted stabilizing procedure for an acute anterior cruciate ligament injury incurred while alpine skiing to evaluate associated meniscal injuries. Meniscal injuries were classified by type, location, and treatment of the tear. Of the 317 knees operated on, all demonstrated an anterior cruciate ligament tear at arthroscopy. Ninety-eight percent of the injuries (310) were diagnosed within 3 days of injury, and 97% (307) were reconstructed within 28 days of injury. All tears occurred in the intrasubstance of the ligament; 32% were isolated injuries and 68% were combined with other injuries. In 159 patients with 170 meniscal tears 141 of the tears (83%) were lateral and 29 (17%) were medial. The injury triad of anterior cruciate ligament-medial collateral ligament-lateral meniscus was seen nine times as often as the anterior cruciate ligament-medial collateral ligament-medial mensicus combination.

Hex-nut loosening following compression instrumentation of the spine

Two cases of failure of compression instrumentation using the slotted hook and bushing (SHB) system due to back-off of the hex nut and loosening of the SHB. Laboratory tests on compression assemblies demonstrated that: hex-nut loosening can be produced in the laboratory by the cyclical loading of compression assemblies; crimping of the threads of the rod prevented hex-nut back-off and loosening of the SHB; crimping of the threads of the rod with the described rod crimper applied at a 90 degree angle did not damage the core of the rod or compromise its ability to withstand cyclical or tension loads; and crimping of the threads of the rod at angles other than 90 degrees damaged the core of the rod and significantly altered its ability to withstand cyclical loading. With subsequent clinical application of these principles, failure of compression instrumentation because of loosening of the SHB seems not to have been reported in the literature.