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Despite enhanced pharmacologic therapies for osteoporosis prevention and treatment, hip fractures remain an important individual and public health problem. Since the mean age of the population continues to increase, it is likely that management of hip fracture will become even more pertinent. In this study, Kannus and associates report on the use of a hip protector (specifically, KPY Hip Protector, Respecta, Helsinki, Finland) worn to reduce the effect of trauma upon the hip. Each patient in the treatment group (n = 653) wore bilateral 19 cm conical padded hip protectors daily.
During the study period, compliance with the device was a modest 48% (i.e., treatment group participants actually wore the devices only half the days). Nonetheless, almost three-quarters of the falls that occurred in this group happened while wearing protectors. There were 13 treatment group patients who had a hip fracture vs. 67 control subjects (relative hazard = 0.4). Similarly, the pelvic fracture rate was halved by use of the hip protector, despite the fact that some fractures occurred in the treatment group while they were not wearing their protectors. Adverse reactions attributable to wearing the protectors were few and generally inconsequential. Protective padding, for those willing to use it, offers an effective preventive for hip fracture.
Kannus P, et al. N Engl J Med 2000; 343:1506-1513.
As demonstrated by both randomized and observational studies, the mortality rate of colorectal cancer (CRC) is reduced by fecal occult blood testing (FOBT). The favorable effect of FOBT upon CRC mortality has been attributed to earlier stage of tumor at time of detection, surgical excision of tumors, and removal of premalignant lesions. This report details the results at 18 years of follow-up for participants in the Minnesota Colon Cancer Control Study (n = 46,551), which used annual, biennial, or "usual care" for FOBT screening. Persons with any positive FOBT were offered colonoscopy.
The cumulative incidence of CRC in both screening groups was significantly (17-20%) less than in the control group. Mandell and colleagues challenge the theory suggested by others that mortality reduction is a consequence of chance tumor detection at colonoscopy; they suggest that it is the sensitivity of FOBT testing that is responsible for the improved outcome. No significant difference was found between yearly vs. every two years of FOBT screening.
Mandell JS, et al. N Engl J Med 2000; 343:1603-1607.
Short-term outcome after transient ischemic attack (TIA) has been a topic investigated in only a few settings. Confirmation of TIA diagnosis may be contentious, since seizure, syncope, migraine, and other etiologies can be mistaken for TIA. This study evaluated persons presenting to emergency departments (EDs) in a single health maintenance organization over one year with a diagnosis of TIA (n = 1707).
Within 90 days after presentation to the ED, 10.5% of patients suffered a completed stroke. Although TIA patients who received anticoagulation at discharge from the ED were subsequently more likely to suffer a completed stroke, it has been suggested that perhaps those individuals were perceived to have been at greater stroke risk at the time of ED presentation. A favorable trend toward stroke reduction was seen in antiplatelet recipients (e.g., aspirin, ticlopidine). Five items were determined to be independent risk factors for stroke within 90 days: age older than 60, diabetes, TIA enduring over 10 minutes, weakness with TIA, and speech impairment with TIA.
Johnston SC, et al. JAMA 2000;284: 2901-2906.