NeuRA Magazine #26

New report

NEW REPORT REVEALS OSTEOPOROSIS CARE GAP

Professor Jacqueline Close, Geriatrician and Co-Chair of the Australian and New Zealand Hip Fracture Registry (ANZHFR) based at NeuRA with Orthopaedic surgeon Professor Ian Harris, recently released findings from the 2018 Hip fracture Registry that showed Australia is still significantly behind other countries in closing the osteoporosis care gap.

Data from the report produced by the Australian and New Zealand Hip Fracture Registry, based at NeuRA, shows only 25 per cent of hip fracture patients leave hospital on active treatment for osteoporosis and only 24 per cent of hospitals provide individualised written information on prevention of future falls and fractures.

“There are huge opportunities to further improve hip fracture care including the prevention of future falls and fractures. Strong evidence exists to support treatment of osteoporosis in this population yet all too frequently we fail to offer treatments which can impact on people’s lives,” said Professor Close.

Professor Harris said hospitals are now sharing their waiting times from arrival to surgery, helping to generate a more transparent snapshot of performance against a national standard.

“Currently the most common delay for people waiting more than 48 hours for surgery is access to operating theatre time. This is something we must address,” said Professor Harris.

Professor Harris, Orthopaedic Surgeon and Co-Chair of the ANZHFR, said data is a powerful driver of change in the health system. “The Registry is run by clinicians for clinicians and provides hospitals with real-time performance data, allowing them to see how they perform against other hospitals.”

Although the incidence of minimal trauma hip fracture has decreased over time, the actual number of hip fractures continues to increase due to the rising number of older adults. Current projections suggest that by 2022 there will be more than 30,000 hip fractures each year with a projected cost of $1.126 billion. Minimal trauma fractures are relatively common in people aged 50 and over.

It is estimated that, for Australians in this age group, one in four men and two in five women will experience a minimal trauma fracture. A hip fracture is one of the most serious types of minimal trauma fracture. In 2015-16, approximately 22,000 people aged 50 and over were hospitalised for a minimal trauma hip fracture with the need for hospitalisation highest for those aged over 85.

Women were one and a half times more likely than men to be admitted to hospital with a hip fracture.

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Abdominal muscle stimulation to improve bowel function in spinal cord injury

Bowel complications, resulting from impaired bowel function, are common for people living with a spinal cord injury (SCI). As a result, people with a SCI have high rates of bowel related illness, even compared with those with other neurological disorders. This includes high rates of abdominal pain, constipation, faecal incontinence and bloating. These problems lower the quality of life of people with a SCI and place a financial burden on the health system. A treatment that improves bowel function for people with a SCI should reduce illness, improve quality of life and lead to a large cost saving for health care providers. Bowel problems have traditionally been managed with manual and pharmacological interventions, such as digital rectal stimulation, enemas, and suppositories. These solutions are usually only partially effective, highlighting the need for improved interventions. The abdominal muscles are one of the major muscle groups used during defecation. Training the abdominal muscles should improve bowel function by increasing abdominal pressure. During our previous Abdominal FES research with people with a SCI, we observed that Abdominal FES appeared to lead to more consistent and effective bowel motion. However, this evidence remains anecdotal. As such, we are going to undertake a large randomised controlled trial to investigate the effectiveness of Abdominal FES to improve the bowel function of people with a SCI. This study will make use of a novel measurement system (SmartPill, Medtronic) that can be swallowed to measure whole gut and colonic transit time. We will also assess whether Abdominal FES can change constipation-related quality of life and the use of laxatives and manual procedures, as well as the frequency of defecation and the time taken. A positive outcome from this study is likely to lead to the rapid clinical translation of this technology for people living with a SCI.
PROJECT