This document lists over 100 authors and their affiliations who are members of the European Union Geriatric Medicine Society (EUGMS) Falls and Fracture Interest Group or the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), Osteoporosis Research and Information Group (GRIO), and International osteoporosis Foundation (IOF). The authors are from various universities, hospitals, and research institutions in Europe, North America, Asia, and other parts of the world. They are involved in research related to falls, fractures, osteoporosis, and bone health in older adults. The document provides contact information for each author such as their department
The document summarizes the goals and activities of Aviesan, the French Alliance for Life and Health Sciences. It aims to optimize scientific foresight, facilitate research clusters, and promote national projects. It represents major French research organizations and operates through 10 thematic institutes. It also maintains a catalog of 237 French health databases and supports several large research projects and infrastructures through funding from "Investments for the future", totaling billions of euros over 10 years.
Olivier Carle is a French anesthesiologist who currently works as a consultant in anesthesia and intensive care at the University Hospital of Grenoble in France. He received his medical degree in 1999 and has since obtained additional post-graduate degrees in various fields including medical engineering, anesthesia and intensive care, and pediatric anesthesia. His clinical responsibilities involve anesthesia consultations and management for both adults and children, including those requiring difficult airways, neonatal surgery, and acute pain management. He also engages in teaching and research activities.
The Center for Information Technology Renato Archer a unit of the Ministry of Science and Technology, (CTI/MCT-Campinas-SP), is coordinating a research project involving several Brazilian universities and several international. The research project GESITI/Hospital has the purpose of mapping out the management of systems (IS) and information technology (IT) in hospitals, in order to identify their needs and demands, prospecting for unfolding, perform publications and, mainly, generate a Integrated Research Report (IRR) with a focus on, also, a Report Research Roadmap (RRR). This IRI/RRR should be used as decision making support by public and/or private managers
Currently, the research is being carried out by eighteen universities: sixteen Brazilian, one Mexican and one Portuguese. An important initial result of this research work, which makes use of the Interpretative (or Introspective) Methodology, will be the generation in Brazil of an unprecedented database regarding hospital management and, from which several important information will be extracted. From the local information, obtained via reports where the research has been carried out (each local includes the average of results obtained in five (5) hospitals), it becomes possible to undertake local decision making. However, the main purpose of the project is the preparation of a RPI/RRR for national decision-making support. This RPI/RRR should have a integrated comparative analyzes based on all locals results (participants from Brazil & International), for a better decision-making on issues of interest to managers regarding the better efficiency and effectiveness of hospital management, public and/or private.
Although has not been directly mentioned, the final result, ultimate, from the research should be a significant improvement on the hospital management and on the decision-making. These results must reflect on peoples more satisfied regarding a better health care.
This document summarizes the findings of analyzing whole genome sequences from 560 breast cancer samples. It identified 93 cancer genes with probable driver mutations. Some non-coding regions had high mutation frequencies but most had distinctive structural features causing elevated mutation rates rather than harboring driver mutations. Mutation signature analysis was also extended to genome rearrangements, revealing 12 substitution signatures and six rearrangement signatures. Three rearrangement signatures associated with defective homologous recombination DNA repair, one with defective BRCA1 function and another with defective BRCA1 or BRCA2 function. The causes of the third signature are unknown.
- Professor Mariano Anderle and Ms. Carlotta Colli from the Italian Embassy in Vietnam and Ho Chi Minh City visited the University of Medicine & Pharmacy in Ho Chi Minh City.
- The University of Medicine & Pharmacy aims to develop translational medicine to apply biological research advances to patient care for untreated illnesses in Vietnam.
- The new Biomedicine Program will train biomedical researchers and doctors in basic and clinical research with the goal of creating a biotech industry in Vietnam.
Who 2019-n cov-corticosteroids-2020.1-engCIkumparan
This document provides recommendations from the WHO on the use of corticosteroids for the treatment of COVID-19. It recommends the use of systemic corticosteroids for patients with severe or critical COVID-19 based on moderate certainty evidence showing benefits. It conditionally recommends against the use of corticosteroids for non-severe COVID-19 based on low certainty evidence. The document was developed in collaboration with experts and reviews evidence on corticosteroid use from multiple clinical trials. It provides the background, methods, evidence and practical considerations regarding the recommendations.
This document provides an agenda for a health care conference being held over two days in Chamonix, France. The conference will feature roundtable discussions, interviews, and presentations on topics related to health systems and health care innovation in Europe and the United States. Speakers will discuss issues like the costs and value of health care, principles for efficient systems, the future of national health services, population health improvement, performance measurement, and the pricing of innovations. Attendees will include experts from France, the UK, Germany, Belgium, Switzerland, and the United States.
The document summarizes the goals and activities of Aviesan, the French Alliance for Life and Health Sciences. It aims to optimize scientific foresight, facilitate research clusters, and promote national projects. It represents major French research organizations and operates through 10 thematic institutes. It also maintains a catalog of 237 French health databases and supports several large research projects and infrastructures through funding from "Investments for the future", totaling billions of euros over 10 years.
Olivier Carle is a French anesthesiologist who currently works as a consultant in anesthesia and intensive care at the University Hospital of Grenoble in France. He received his medical degree in 1999 and has since obtained additional post-graduate degrees in various fields including medical engineering, anesthesia and intensive care, and pediatric anesthesia. His clinical responsibilities involve anesthesia consultations and management for both adults and children, including those requiring difficult airways, neonatal surgery, and acute pain management. He also engages in teaching and research activities.
The Center for Information Technology Renato Archer a unit of the Ministry of Science and Technology, (CTI/MCT-Campinas-SP), is coordinating a research project involving several Brazilian universities and several international. The research project GESITI/Hospital has the purpose of mapping out the management of systems (IS) and information technology (IT) in hospitals, in order to identify their needs and demands, prospecting for unfolding, perform publications and, mainly, generate a Integrated Research Report (IRR) with a focus on, also, a Report Research Roadmap (RRR). This IRI/RRR should be used as decision making support by public and/or private managers
Currently, the research is being carried out by eighteen universities: sixteen Brazilian, one Mexican and one Portuguese. An important initial result of this research work, which makes use of the Interpretative (or Introspective) Methodology, will be the generation in Brazil of an unprecedented database regarding hospital management and, from which several important information will be extracted. From the local information, obtained via reports where the research has been carried out (each local includes the average of results obtained in five (5) hospitals), it becomes possible to undertake local decision making. However, the main purpose of the project is the preparation of a RPI/RRR for national decision-making support. This RPI/RRR should have a integrated comparative analyzes based on all locals results (participants from Brazil & International), for a better decision-making on issues of interest to managers regarding the better efficiency and effectiveness of hospital management, public and/or private.
Although has not been directly mentioned, the final result, ultimate, from the research should be a significant improvement on the hospital management and on the decision-making. These results must reflect on peoples more satisfied regarding a better health care.
This document summarizes the findings of analyzing whole genome sequences from 560 breast cancer samples. It identified 93 cancer genes with probable driver mutations. Some non-coding regions had high mutation frequencies but most had distinctive structural features causing elevated mutation rates rather than harboring driver mutations. Mutation signature analysis was also extended to genome rearrangements, revealing 12 substitution signatures and six rearrangement signatures. Three rearrangement signatures associated with defective homologous recombination DNA repair, one with defective BRCA1 function and another with defective BRCA1 or BRCA2 function. The causes of the third signature are unknown.
- Professor Mariano Anderle and Ms. Carlotta Colli from the Italian Embassy in Vietnam and Ho Chi Minh City visited the University of Medicine & Pharmacy in Ho Chi Minh City.
- The University of Medicine & Pharmacy aims to develop translational medicine to apply biological research advances to patient care for untreated illnesses in Vietnam.
- The new Biomedicine Program will train biomedical researchers and doctors in basic and clinical research with the goal of creating a biotech industry in Vietnam.
Who 2019-n cov-corticosteroids-2020.1-engCIkumparan
This document provides recommendations from the WHO on the use of corticosteroids for the treatment of COVID-19. It recommends the use of systemic corticosteroids for patients with severe or critical COVID-19 based on moderate certainty evidence showing benefits. It conditionally recommends against the use of corticosteroids for non-severe COVID-19 based on low certainty evidence. The document was developed in collaboration with experts and reviews evidence on corticosteroid use from multiple clinical trials. It provides the background, methods, evidence and practical considerations regarding the recommendations.
This document provides an agenda for a health care conference being held over two days in Chamonix, France. The conference will feature roundtable discussions, interviews, and presentations on topics related to health systems and health care innovation in Europe and the United States. Speakers will discuss issues like the costs and value of health care, principles for efficient systems, the future of national health services, population health improvement, performance measurement, and the pricing of innovations. Attendees will include experts from France, the UK, Germany, Belgium, Switzerland, and the United States.
Liotta, ussai s, illario m (2018). frailty as the future core business of pub...About Silvia Ussai
Frailty as the Future Core Business of Public Health:
Report of the Activities of the A3 Action Group of the
European Innovation Partnership on Active and
Healthy Ageing (EIP on AHA)
This document provides a summary of Dr. Jérôme LARCHÉ's background and qualifications. It outlines his medical education and experience as an internist, intensivist, and head of an intensive care unit. It also details his research focusing on bacteriophages and antibiotic resistance. Additionally, it lists his political science education and experience analyzing security, conflicts, and civil-military relations. The document serves to introduce Dr. LARCHÉ's extensive medical and policy expertise.
This document presents the 2010 classification criteria for rheumatoid arthritis (RA) developed by a joint working group from the American College of Rheumatology and European League Against Rheumatism. The new criteria focus on identifying factors in patients newly presenting with undifferentiated inflammatory synovitis that are associated with persistent and/or erosive disease. Classification as definite RA requires synovitis in at least one joint, no alternative diagnosis, and a score of 6 or higher based on the number and site of involved joints, serologic abnormalities, elevated acute-phase response, and symptom duration. This redefines RA by focusing on earlier disease features associated with persistence rather than late-stage features.
Mechanical signals inhibit growth of a grafted tumor in vivo proof of conceptRemy BROSSEL
We apply the principles of physical oncology (or mechanobiology) in vivo to show the effect of a “constraint field” on tumor growth.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152885
Infectious diseases account for a significant portion of global mortality, particularly in developing countries. New pathogens are emerging and spreading rapidly, while multidrug-resistant pathogens are a growing problem. A multidisciplinary approach is needed to address infectious disease challenges. This document outlines the agenda for the 3rd International Research Meeting on microbiology and infectious diseases, highlighting France's major research institutions in this area and the scientific sessions to be covered.
1) Anaesthesiology has a key role in patient safety for surgical procedures and other vulnerable situations. Around 230 million patients undergo anaesthesia yearly, with 7 million developing complications and 1 million dying.
2) Leaders in anaesthesiology societies agree that patients have a right to safe care. Key goals include endorsing international safety standards, educating patients, providing appropriate resources, improving education, and developing safe drugs and equipment.
3) Specific aims are that all institutions providing anaesthesia comply with monitoring standards, have safety protocols, comply with sedation standards, support the WHO checklist, collect safety data, and contribute to audits and reporting.
Contents lists available at ScienceDirectInternational JouAlleneMcclendon878
Contents lists available at ScienceDirect
International Journal of Orthopaedic and Trauma Nursing
journal homepage: www.elsevier.com/locate/ijotn
Prevention of heel pressure ulcers among adult patients in orthopaedic
wards: an evidence-based implementation project
Siew Yi Koha, Hui Ling Yeoa, Mien Li Gohb,∗
aUniversity of Orthopaedic Cluster, National University Hospital, Singapore
b Evidence Based Nursing Unit, National University Hospital, Singapore
A B S T R A C T
Background: Immobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a
Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels.
Aims: The evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel
pressure ulcers.
Methods: The project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs
Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and
involved a sample consisting of 30 adult patients.
Results: Nurses’ compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking
heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project
resulted in more than 50% reduction in stage one heel pressure ulcers.
Conclusion: The implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.
Background
Pressure ulcers are a common and perpetual problem in healthcare
settings worldwide (Corbett et al., 2017). Pressure ulcers (PUs), also
known as pressure injury or bed sores, are areas of necrotic soft tissue,
that usually occur over bony prominences (Ministry of Health [MOH]
Nursing Clinical Practice Guidelines, 2001; Sussman and Bates-Jensen,
2007; Smeltzer et al., 2010). They usually develop when skin is sub-
jected to shear, friction and prolonged unrelieved pressure. Many areas
in the human anatomy are susceptible to PUs, for instance occiput,
sacrum, elbow and heel (Smeltzer et al., 2010).
There are six classifications of PUs (National Pressure Ulcer
Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan
Pacific Pressure Injury Alliance, 2014). Stage one PU presents as
non-blanching discoloration of intact skin, often in red, blue or
purplish hues. Stage two PUs involve partial thickness loss of
dermis with a shallow wound or intact blister. An ulcer progresses
to stage three when there is full thickness tissue loss, accompanied
by undermining or tunneling. Full thickness tissue loss with ex-
posed bone ...
This document presents guidelines for the treatment of allergic rhinitis within the German health system. It was developed by a collaboration of German and international medical organizations and experts based on the internationally recognized ARIA guidelines. The integrated care pathways outlined aim to improve care for allergic rhinitis and asthma patients through a digitally-enabled, personalized approach. Allergic diseases affect over 30 million people in Germany and represent a significant health burden. Early treatment of hay fever is emphasized to reduce the risk of asthma development. The guidelines seek to better implement evidence-based care through structured, multidisciplinary care plans.
This document provides a summary of Jacques Duranteau's professional background and qualifications. It includes details about his current position as Professor in Anesthesiology and Intensive Care and Head of the Neurosurgical and Surgical Intensive Care Unit of Bicêtre Hospital University Paris XI. It also lists his education, areas of research interest, publications, and professional affiliations.
The current pandemic shows us what happens if pathogens become easily transmissible from human to human, even if the mortality rate of a virus is relatively low. In view of this fact, it is almost unbelievable that since more than ten years, highly risky “gain-of-function” experiments are being conducted in various research labs where dangerous pathogens, such as avian influenza viruses and SARS-type viruses, are being adapted to human cells so that they ultimately become dangerous, i.e. potentially pandemic pathogens. Such experiments are ongoing – even with much more dangerous types of viruses – and, at least partially funded by taxpayers’ money. It is the responsibility of scientists worldwide to raise awareness about these huge risks among politicians and among the general public. A group of 50 scientists from different scientific disciplines and from various countries in Europa, America, Asia, Australia and New Zealand have drafted and signed the „Hamburg Declaration 2022“ with the goal of a worldwide ban of „gain-of-function” research with potentially pandemic pathogens as well as its supervision and continuous monitoring by an independent international regulatory agency. This Declaration follows the spirit of the “Göttinger Declaration of 1957” devoted to the threat by nuclear weapons
The document describes a retrospective case series of 10 patients with post-traumatic radioulnar synostosis who were treated using a triple therapy combination of preoperative radiotherapy, resection of heterotopic ossification and insertion of an anconeus interposition flap, and postoperative indomethacin. All 10 patients reported excellent postoperative Mayo elbow performance scores and significant improvements in range of motion compared to preoperatively. One patient experienced a complication that resolved with follow-up. The triple therapy combination was found to provide good functional outcomes and prevent recurrence of radioulnar synostosis.
Use of Tumor Markers in Liver, Bladder, Cervical, and Gastric CancersLAB IDEA
This chapter discusses tumor markers for liver cancer. Liver cancer, or hepatocellular carcinoma, is a major cause of cancer death worldwide. Early detection is important for effective treatment but many cases are asymptomatic and detected late. The guidelines evaluate tumor markers like alpha-fetoprotein for surveillance of high-risk patients and diagnosis of liver cancer, noting their limitations. Recommendations are provided on the appropriate use of tumor markers in conjunction with imaging for managing liver cancer.
RCT on base tie in lap appendecomy.pptxadnanhabib31
This study aimed to compare outcomes of different techniques for closing the appendix stump during laparoscopic appendectomy (L-APPE). In a randomized clinical trial, 180 patients undergoing L-APPE for uncomplicated acute appendicitis were assigned to have their appendix stump closed using an endoloop, Hem-o-lok clips, or stapler. The stapler group had a significantly longer operative time and higher rate of intraoperative complications compared to the other groups. Postoperative complication rates were low across groups but costs were highest for the stapler technique. Hem-o-lok clips resulted in the shortest operative time and lowest costs, making them a reasonable option for appendix stump closure during L-
Jean Michel Hovsepians is a 29-year-old orthopedic surgeon from Venezuela currently completing a sports medicine fellowship in Munich, Germany. He received his medical degree from Universidad Central de Venezuela in 2010 and completed orthopedic residencies in Venezuela and Germany. His clinical and research interests include shoulder and elbow surgery and sports medicine. He is pursuing research on biomechanics of the Latarjet procedure and stemless shoulder prostheses.
This document discusses delirium in the ICU. It begins with definitions of delirium and discusses its high prevalence among ICU patients, up to 70%. The pathophysiology is not fully understood but may involve disturbances in neurotransmitters like acetylcholine. Precipitants include medications, infections, metabolic disturbances and physical immobilization. Diagnosis involves tools like the Confusion Assessment Method. Management prioritizes prevention, treating underlying causes, and supportive care with low-dose short-acting medications as needed to manage severe symptoms.
The document discusses the Swiss Personalized Health Network (SPHN) initiative. The main goal of SPHN is to establish nationwide interoperability of biomedical information to advance personalized health research in Switzerland. SPHN coordinates various projects and nodes across universities and hospitals. It expects that tens of millions of human genomes will be sequenced by 2022, over 80% in healthcare settings. SPHN is coordinating standards and managing data through its Data Coordination Center to enable integrated research using diverse real-world data sources.
The document provides instructions for requesting writing assistance from a website. It outlines a 5-step process: 1) Create an account with a password and email. 2) Complete a 10-minute order form providing instructions, sources, and deadline. 3) Review bids from writers and select one based on qualifications. 4) Review the completed paper and authorize payment if satisfied. 5) Request revisions to ensure satisfaction, with a refund offered for plagiarized work.
Political Science Research Paper Outline. Free PoliticaKarla Adamson
False. Cultural relativism and moral relativism are not exactly the same. Cultural relativism is the view that cultural practices and beliefs should be understood based on the cultural context from which they arise rather than being judged against the standards of another culture. Moral relativism is the view that moral truths are relative to the culture or society holding them rather than being absolute. So cultural relativism focuses on understanding other cultures, while moral relativism focuses on whether moral claims can be objectively true or false.
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Liotta, ussai s, illario m (2018). frailty as the future core business of pub...About Silvia Ussai
Frailty as the Future Core Business of Public Health:
Report of the Activities of the A3 Action Group of the
European Innovation Partnership on Active and
Healthy Ageing (EIP on AHA)
This document provides a summary of Dr. Jérôme LARCHÉ's background and qualifications. It outlines his medical education and experience as an internist, intensivist, and head of an intensive care unit. It also details his research focusing on bacteriophages and antibiotic resistance. Additionally, it lists his political science education and experience analyzing security, conflicts, and civil-military relations. The document serves to introduce Dr. LARCHÉ's extensive medical and policy expertise.
This document presents the 2010 classification criteria for rheumatoid arthritis (RA) developed by a joint working group from the American College of Rheumatology and European League Against Rheumatism. The new criteria focus on identifying factors in patients newly presenting with undifferentiated inflammatory synovitis that are associated with persistent and/or erosive disease. Classification as definite RA requires synovitis in at least one joint, no alternative diagnosis, and a score of 6 or higher based on the number and site of involved joints, serologic abnormalities, elevated acute-phase response, and symptom duration. This redefines RA by focusing on earlier disease features associated with persistence rather than late-stage features.
Mechanical signals inhibit growth of a grafted tumor in vivo proof of conceptRemy BROSSEL
We apply the principles of physical oncology (or mechanobiology) in vivo to show the effect of a “constraint field” on tumor growth.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152885
Infectious diseases account for a significant portion of global mortality, particularly in developing countries. New pathogens are emerging and spreading rapidly, while multidrug-resistant pathogens are a growing problem. A multidisciplinary approach is needed to address infectious disease challenges. This document outlines the agenda for the 3rd International Research Meeting on microbiology and infectious diseases, highlighting France's major research institutions in this area and the scientific sessions to be covered.
1) Anaesthesiology has a key role in patient safety for surgical procedures and other vulnerable situations. Around 230 million patients undergo anaesthesia yearly, with 7 million developing complications and 1 million dying.
2) Leaders in anaesthesiology societies agree that patients have a right to safe care. Key goals include endorsing international safety standards, educating patients, providing appropriate resources, improving education, and developing safe drugs and equipment.
3) Specific aims are that all institutions providing anaesthesia comply with monitoring standards, have safety protocols, comply with sedation standards, support the WHO checklist, collect safety data, and contribute to audits and reporting.
Contents lists available at ScienceDirectInternational JouAlleneMcclendon878
Contents lists available at ScienceDirect
International Journal of Orthopaedic and Trauma Nursing
journal homepage: www.elsevier.com/locate/ijotn
Prevention of heel pressure ulcers among adult patients in orthopaedic
wards: an evidence-based implementation project
Siew Yi Koha, Hui Ling Yeoa, Mien Li Gohb,∗
aUniversity of Orthopaedic Cluster, National University Hospital, Singapore
b Evidence Based Nursing Unit, National University Hospital, Singapore
A B S T R A C T
Background: Immobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a
Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels.
Aims: The evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel
pressure ulcers.
Methods: The project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs
Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and
involved a sample consisting of 30 adult patients.
Results: Nurses’ compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking
heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project
resulted in more than 50% reduction in stage one heel pressure ulcers.
Conclusion: The implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.
Background
Pressure ulcers are a common and perpetual problem in healthcare
settings worldwide (Corbett et al., 2017). Pressure ulcers (PUs), also
known as pressure injury or bed sores, are areas of necrotic soft tissue,
that usually occur over bony prominences (Ministry of Health [MOH]
Nursing Clinical Practice Guidelines, 2001; Sussman and Bates-Jensen,
2007; Smeltzer et al., 2010). They usually develop when skin is sub-
jected to shear, friction and prolonged unrelieved pressure. Many areas
in the human anatomy are susceptible to PUs, for instance occiput,
sacrum, elbow and heel (Smeltzer et al., 2010).
There are six classifications of PUs (National Pressure Ulcer
Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan
Pacific Pressure Injury Alliance, 2014). Stage one PU presents as
non-blanching discoloration of intact skin, often in red, blue or
purplish hues. Stage two PUs involve partial thickness loss of
dermis with a shallow wound or intact blister. An ulcer progresses
to stage three when there is full thickness tissue loss, accompanied
by undermining or tunneling. Full thickness tissue loss with ex-
posed bone ...
This document presents guidelines for the treatment of allergic rhinitis within the German health system. It was developed by a collaboration of German and international medical organizations and experts based on the internationally recognized ARIA guidelines. The integrated care pathways outlined aim to improve care for allergic rhinitis and asthma patients through a digitally-enabled, personalized approach. Allergic diseases affect over 30 million people in Germany and represent a significant health burden. Early treatment of hay fever is emphasized to reduce the risk of asthma development. The guidelines seek to better implement evidence-based care through structured, multidisciplinary care plans.
This document provides a summary of Jacques Duranteau's professional background and qualifications. It includes details about his current position as Professor in Anesthesiology and Intensive Care and Head of the Neurosurgical and Surgical Intensive Care Unit of Bicêtre Hospital University Paris XI. It also lists his education, areas of research interest, publications, and professional affiliations.
The current pandemic shows us what happens if pathogens become easily transmissible from human to human, even if the mortality rate of a virus is relatively low. In view of this fact, it is almost unbelievable that since more than ten years, highly risky “gain-of-function” experiments are being conducted in various research labs where dangerous pathogens, such as avian influenza viruses and SARS-type viruses, are being adapted to human cells so that they ultimately become dangerous, i.e. potentially pandemic pathogens. Such experiments are ongoing – even with much more dangerous types of viruses – and, at least partially funded by taxpayers’ money. It is the responsibility of scientists worldwide to raise awareness about these huge risks among politicians and among the general public. A group of 50 scientists from different scientific disciplines and from various countries in Europa, America, Asia, Australia and New Zealand have drafted and signed the „Hamburg Declaration 2022“ with the goal of a worldwide ban of „gain-of-function” research with potentially pandemic pathogens as well as its supervision and continuous monitoring by an independent international regulatory agency. This Declaration follows the spirit of the “Göttinger Declaration of 1957” devoted to the threat by nuclear weapons
The document describes a retrospective case series of 10 patients with post-traumatic radioulnar synostosis who were treated using a triple therapy combination of preoperative radiotherapy, resection of heterotopic ossification and insertion of an anconeus interposition flap, and postoperative indomethacin. All 10 patients reported excellent postoperative Mayo elbow performance scores and significant improvements in range of motion compared to preoperatively. One patient experienced a complication that resolved with follow-up. The triple therapy combination was found to provide good functional outcomes and prevent recurrence of radioulnar synostosis.
Use of Tumor Markers in Liver, Bladder, Cervical, and Gastric CancersLAB IDEA
This chapter discusses tumor markers for liver cancer. Liver cancer, or hepatocellular carcinoma, is a major cause of cancer death worldwide. Early detection is important for effective treatment but many cases are asymptomatic and detected late. The guidelines evaluate tumor markers like alpha-fetoprotein for surveillance of high-risk patients and diagnosis of liver cancer, noting their limitations. Recommendations are provided on the appropriate use of tumor markers in conjunction with imaging for managing liver cancer.
RCT on base tie in lap appendecomy.pptxadnanhabib31
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Jean Michel Hovsepians is a 29-year-old orthopedic surgeon from Venezuela currently completing a sports medicine fellowship in Munich, Germany. He received his medical degree from Universidad Central de Venezuela in 2010 and completed orthopedic residencies in Venezuela and Germany. His clinical and research interests include shoulder and elbow surgery and sports medicine. He is pursuing research on biomechanics of the Latarjet procedure and stemless shoulder prostheses.
This document discusses delirium in the ICU. It begins with definitions of delirium and discusses its high prevalence among ICU patients, up to 70%. The pathophysiology is not fully understood but may involve disturbances in neurotransmitters like acetylcholine. Precipitants include medications, infections, metabolic disturbances and physical immobilization. Diagnosis involves tools like the Confusion Assessment Method. Management prioritizes prevention, treating underlying causes, and supportive care with low-dose short-acting medications as needed to manage severe symptoms.
The document discusses the Swiss Personalized Health Network (SPHN) initiative. The main goal of SPHN is to establish nationwide interoperability of biomedical information to advance personalized health research in Switzerland. SPHN coordinates various projects and nodes across universities and hospitals. It expects that tens of millions of human genomes will be sequenced by 2022, over 80% in healthcare settings. SPHN is coordinating standards and managing data through its Data Coordination Center to enable integrated research using diverse real-world data sources.
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The document discusses two short stories by Nikolai Gogol, "The Nose" and "The Overcoat", that end with a balance of power rather than a happy ending. In "The Nose", a man's nose rises to a higher social rank than him before returning to his face. In "The Overcoat", a man's coat, a symbol of power, is stolen after he saves to buy a new one, leaving him powerless, though he later steals a coat from a man he feels is responsible. Both stories show the rise and fall of power before ending in a similar balance of power as the beginning.
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This document provides instructions for completing a scholarship application process in 5 steps:
1. Create an account and provide login credentials.
2. Complete a 10-minute order form providing instructions, sources, deadline, and attach a sample for writing style imitation.
3. Review bids from writers and choose one based on qualifications, history, and feedback, then pay a deposit to start the assignment.
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The characters of Romeo and Mercutio in Shakespeare's Romeo and Juliet serve as foils to each other. While Romeo is a romantic lover who expresses his love through words, Mercutio is cynical about love and sees it as insignificant. He encourages Romeo to have casual sex instead of pursuing a serious relationship. Mercutio also seems jealous of Romeo's love for Juliet. The two characters present contrasting views of love and relationships that underscore major themes in the play.
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The document discusses the enforcement of rules in American football by organizations like the NFL and NCAA. It notes that rules have gradually changed over the years to make the game safer and less violent. However, some argue this has made football too soft compared to the past. New rules like targeting bans certain tackles and leads to more penalties being called, which slows down defenses and reduces exciting big hits. While safety was the goal, some feel the rule changes have negatively impacted the game.
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The passage discusses how the horror genre shifted in the late 1980s/early 1990s to portray serial killers as humans living among society rather than masked figures. This changed the "Final Girl" character, exemplified by Clarice Starling in Silence of the Lambs, who must face internal rather than external threats. By confronting more psychologically complex villains, these films explored how violence relates to sexuality in a way that still resonates with audiences today.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
A Comprehensive Fracture Prevention Strategy In Older Adults The European Union Geriatric Medicine Society (EUGMS) Statement
1. Corresponding author: H. Blain, Pôle de Gériatrie, Centre Antonin-Balmes, CHU de Montpellier, 39, avenue Charles-Flahault, 34395
Montpellier Cedex 5, France. Tel: +33 4 67 33 99 57. h-blain@chu-montpellier.fr.
*For the EUGMS Falls and Fracture Interest Group: Marta Neira Alvarez, Department of Geriatric Medicine of Infanta, Sofia
University Hospital. S S Reyes. Madrid, Spain. (marta.neira@yahoo.es); Cedric Annweiler, Department of Neuroscience, Division of
Geriatric Medicine, Angers University Hospital; University Memory Clinic; UPRES EA 4638, University of Angers, UNAM, Angers,
France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of
Western Ontario, London, Ontario, Canada. (CeAnnweiler@chu-angers.fr); Pierre Louis Bernard, UFR-STAPS, Université
Montpellier, EA 2991 EuroMov, Montpellier, France. (pbernard@univ-montp1.fr); Natalie Beswetherick, OBE MBA FCSP, Chartered
Society of Physiotherapy, London, UK. (beswetherickn@csp.org.uk); Heike A. Bischoff-Ferrari, Department. of Geriatrics and Aging
Research, University Hospital Zurich and University of Zurich, Switzerland; ESCEO/IOF. (Heike.Bischoff@usz.ch); Frédéric Bloch,
Department of Gerontology, Hopital Broca (AP-HP), and University Paris-Descartes, EA 4468, Paris, France.
(frederic.bloch@brc.aphp.fr); Jacques Boddaert, Unit of Peri-Operative Geriatric care, Geriatric Department Pitié-Salpêtrière Hospital,
CNRS UMR8256 Pierre et Marie Curie University, UPMC Paris 6, France. (jacques.boddaert@psl.aphp.fr); Marc Bonnefoy,
Department of Geriatrics, Groupement Hospitalier Sud – HCL Université Claude Bernard, Unité INSERM 1060 69495, Pierre-Bénite
Cedex, France. (marc.bonnefoy@chu-lyon.fr); Isabelle Bourdel-Marchasson, Clinical Gerontology Department, CHU Bordeaux,
RMSB, UMR 5536, CNRS, Bordeaux University, France. (isabelle.bourdel-marchasson@chu-bordeaux.fr); Ana Capisizu, University
of Medicine and Pharmacy «Carol Davila» Geriatric Department - «St Luke» Hospital, Bucharest, Romania.
(anacapisizu@yahoo.com); Hélène Che, Département de rhumatologie, Pole Os et articulations, Hopital Lapeyronie Université de
Montpellier, Montpellier, France. (h-che@chu-montpellier.fr); João Gorjão Clara, Geriatric University Unit, Instituto de Medicina
Preventiva, Faculdade de Medicina da Universidade de Lisboa, Portugal. (gorjaoclara@gmail.com); Bernard Combe, Département de
rhumatologie, Pole Os et articulations, Hopital Lapeyronie Université Montpellier I, Montpellier, France; Société Française de
Rhumatologie. (b-combe@chu-montpellier.fr); Didier Delignieres, UFR-STAPS, Université Montpellier, EA 2991 EuroMov,
Montpellier, France. (didier.delignieres@univ-montp1.fr); Patrik Eklund, Department of Computing Science, Umeå University,
SE-90187 Umeå, Sweden. (pe@fourcomp.com); Marielle Emmelot-Vonk, Department of Geriatrics, University Medical Centre
Utrecht, The Netherlands. (M.H.EmmelotVonk@umcutrecht.nl); Ellen Freiberger, Institute for Biomedicine of Aging, Nürnberg,
Germany. (ellen.freiberger@fau.de); Jean-Bernard Gauvain, Court Séjour Gériatrique, CHR Orléans, France; GRIO. (jean-
bernard.gauvain@chr-orleans.fr); Nandu Goswami, Institute of Physiology, Medical University of Graz, Austria.
(nandu.goswami@medunigraz.at); Nick Guldemond, University Medical Centre Utrecht, The Netherlands,
(N.A.Guldemond@umcutrecht.nl); Álvaro Casas Herrero, F.E.A Geriatría Complejo Hospitalario Navarra, Pamplona, Spain.
(alvaro.casas.herrero@navarra.es); Marie-Eve Joël, Université Paris-Dauphine, Paris, France. (Marie-Eve.Joel@dauphine.fr); Anna
Björg Jónsdóttir, Department of Geriatric Medicine The National University Hospital of Iceland, Reykjavík –Iceland.
(annabjon@landspitali.is); Gilles Kemoun, Laboratoire EA 6314, Université de Poitiers, Institut de Recherche sur le Handicap et le
Vieillissement, Paris, France. (gilles.kemoun@wanadoo.fr); Istvan Kiss, Division Section of Geriatrics, 2nd Department of Internal
Medicine, Semmelweis University, Budapest, Hungary (ikiss@enternet.hu); Helgi Kolk, Department of Traumatology and
Orthopaedics, Tartu University Hospital, Estonia. (Helgi.Kolk@kliinikum.ee); Marek L Kowalski, Department of Immunology,
Rheumatology and Allergy, Medical University of Lodz, Poland. (Marek.Kowalski@csk.am.lodz.pl); Štefan Krajcík, Geriatric
department, Slovak Medical University, Bratislava, Slovakia. (skrajcik@szu.sk); Yesim Gökçe Kutsal, Director of Hacettepe
University Research Center of Geriatric Sciences, Turkey. (ygkutsal@gmail.com); Fulvio Lauretani, University Hospital of Parma,
Parma, Italy. (flauretani@ao.pr.it); J rat Macijauskien , Department of Geriatrics, Medical Academy, Lithuanian University of Health
Sciences; Kaunas, Lithuania. (jurate.macijauskiene@lsmuni.lt); Marte Mellingsæter, Akershus University hospital, Norway.
(cmelling@online.no); France Mourey, Inserm 1093 UFR santé université Bourgogne Franche-Comté, France. (france.mourey@u-
bourgogne.fr); Fati Nourashemi, Gérontopôle de Toulouse, France. (nourhashemi.f@chu-toulouse.fr); Csaba Nyakas, Semmelweis
University, Faculty of Health Sciences, Research Unite for Behavioral Physiology, Budapest, Hungary. (nyakas@tf.hu); François
Puisieux, Département de Gériatrie, CHU de Lille, France. (Francois.puisieux@chru-lille.fr); Patrick Rambourg, Pôle de pharmacie,
CHU Montpellier, France. (p-rambourg@chu-montpellier.fr); Alfonso González Ramírez, Working Group of Osteoporosis, Falls and
Fractures of the Spanish Geriatrics Society; Unit of Geriatrics - Universitary Hospital of Salamanca, Spain. (alfonsogr@segg.es);
Kilian Rapp, Department of Geriatrics and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
(Kilian.Rapp@rbk.de); Yves Rolland, Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de
Toulouse; Unité Mixe de Recherche, Institut National de la Santé et de la Recherche Médicale 1027, University of Toulouse III,
Toulouse, France. (rolland.y@chu-toulouse.fr); Jesper Ryg, Department of Geriatric Medicine, Odense University Hospital,
Department of Clinical Research, University of Southern Denmark. (Jesper.Ryg@rsyd.dk); Opinder Sahota, Department of
Orthogeriatric Medicine & Consultant Physician, QMC, Nottingham University Hospitals NHS Trust, UK.
(opinder.sahota@nuh.nhs.uk); Sanne Snoeijs , Department of care demand of the chronically ill and disabled International
Comparative Health Services Research, Utrecht, The Netherlands. (s.snoeijs@nivel.nl); Yannick Stephan, EA 4556 Dynamic of
Human Abilities and Health Behaviors, University of Montpellier, France. (yannick.stephan@univ-montp1.fr); Eric Thomas,
Departement de rhumatologie, Pole Os et articulations, Hopital Lapeyronie, Université de Montpellier, Montpellier, France. (e-
thomas@chu-montpellier.fr); Chris Todd, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
(Chris.Todd@manchester.ac.uk); Jonathan Treml, Co-Chair British Geriatrics Society Falls and Bone Health Section. Department of
Geriatric Medicine, Queen Elizabeth Hospital, Birmingham UK. (Jonathan.Treml@uhb.nhs.uk).
**For the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), Osteoporosis Research
and Information Group (GRIO), and International osteoporosis Foundation (IOF): Rick Adachi, St. Joseph’s Hospital, Western
University, London, Ontario, Canada; IOF. (jd.adachi@sympatico.ca); Donato Agnusdei, Skeletal Diseases, Eli Lilly and Co., Italy;
IOF. (donato@lilly.com); Jean-Jacques Body, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; ESCEO/IOF. (jean-
jacques.body@chu-brugmann.be); Olivier Bruyère, Department of Public Health, Epidemiology and Health Economics, University of
Liège, Liège, Belgium; ESCEO/IOF. (olivier.bruyere@ulg.ac.be); Peter Burckardt, Hirslanden Bois Cerf, Lausanne, Switzerland;
ESCEO/IOF. (pburckhardt@eva-basel.ch); Jorge B. Cannata-Andia, Bone and Mineral Research Unit , Hospital Universitario Central
J Nutr Health Aging. Author manuscript; available in PMC 2016 November 03.
Published in final edited form as:
J Nutr Health Aging. 2016 ; 20(6): 647–652. doi:10.1007/s12603-016-0741-y.
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2. A COMPREHENSIVE FRACTURE PREVENTION STRATEGY IN
OLDER ADULTS: THE EUROPEAN UNION GERIATRIC MEDICINE
SOCIETY (EUGMS) STATEMENT
H. BLAIN1, T. MASUD2, P. DARGENT-MOLINA3, F.C. MARTIN4, E. ROSENDAHL5, N. VAN
DER VELDE6, J. BOUSQUET7, A. BENETOS8, C. COOPER9, J.A. KANIS10, J.Y.
de Asturias, Universidad de Oviedo , Oviedo , Spain; ESCEO/IOF. (cannata@hca.es); John Carey, Department of Rheumatology,
Galway University Hospitals, Galway, Republic of Ireland National University of Ireland Galway, Galway, Republic of Ireland;
ESCEO/IOF. (john.carey@hse.ie) Dinh-Chen Chan, Department of Gerontology and Geriatrics, National Taiwan University Hospital,
Taipei, Taiwan; Department of Internal Medicine, National Taiwan; IOF. (dingchengchan@ntu.edu.tw); Thierry Chevalley, Division of
Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland; ESCEO/IOF (thierry.chevalley@hcuge.ch)
Martine Cohen-Solal, Inserm U1132 & USPC Paris-Diderot, Department of rheumatology, Hôpital Lariboisière, France; GRIO.
(martine.cohen-solal@inserm.fr); Bess Dawson-Hughes, Jean Mayer United States Department of Agriculture Human Nutrition
Research Center on Aging at Tufts University, Boston, MA, USA; IOF. (bess.dawson-hughes@tufts.edu); Elaine M Dennison, NIHR
Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton, Southampton, UK;
ESCEO/IOF (emd@mrc.soton.ac.uk); Jean-Pierre Devogelaer, Department of Rheumatology, Saint-Luc University Hospital,
Université Catholique de Louvain, Brussels, Belgium; ESCEO/IOF. (devogelaer@ruma.ucl.ac.be); Patrice Fardellone, Department of
Rheumatology, Hôpital Nord,; INSERM U1088, Amiens, France; GRIO. (fardellone.patrice@chu-amiens.fr); Jean-Marc Féron
(Department of Orthopaedic and Trauma Surgery. Saint Antoine Hospital. UPMC-Sorbonne Universités. Paris, France; GRIO. (jean-
marc.feron@aphp.fr); Adolfo Diez Perez, Department of Internal Medicine, Hospital del Mar, Director of the Bone and Joint Research
Unit at the Municipal Institute of Medical Research, Barcelona, Spain, ESCEO/IOF. (adiez@imas.imim.es); Dieter Felsenberg, Centre
for Muscle and Bone Research, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany; ESCEO/IOF.
(dieter.felsenberg@charite.de); Claus Glueer, Universitatsklinikum Schleswig-Holstein , Kiel, Germany; ESCEO/IOF
(glueer@rad.uni-kiel.de); Nocholas Harvey, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16
6YD, UK; ESCEO/IOF. (nch@mrc.soton.ac.uk); Mickael Hiligsman, Department of Health Services Research, School for Public
Health and Primary Care (CAPHRI), Maastricht University,, The Netherlands; ESCEO/IOF. (m.hiligsmann@maastrichtuniversity.nl);
Muhammad Kassim Javaid, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, University of
Oxford, Oxford, UK, ESCEO/IOF. (kassim.javaid@ndorms.ox.ac.uk); Niklas Rye Jörgensen, Research Center for Ageing and
Osteoporosis, Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark; Institute of
Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark, ESCEO/IOF (niklas@dadlnet.dk); David
Kendler, University of British Columbia, Vancouver, Canada; IOF. (davidkendler@gmail.com); Marius Kraenzlin, University Hospital
Basel, Petersgraben, Basel, Switzerland; ESCEO/IOF. (marius.kraenzlin@unibas.ch); William D Leslie, College of Medicine,
University of Manitoba, Winnipeg, Manitoba, Canada; IOF. (bleslie@sbgh.mb.ca); E. Michael Lewiecki, New Mexico Clinical
Research & Osteoporosis Center, Albuquerque, NM, USA; IOF. (mlewiecki@gmail.com); Toshitaka Nakamura, National Center for
Global Health and Medicine, Tokyo 162-8655, Japan; IOF (t-nak@utopia.ocn.ne.jp) Alexandra Papaioannou, Department of
Medicine, McMaster University , Hamilton, ON , Canada; IOF. (papaioannou@hhsc.ca); Christian Roux, Department of
Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Paris Descartes
University, INSERM U1153, Paris, France; ESCEO/GRIO/IOF. (christian.roux@aphp.fr); Stuart Silverman, Cedars-Sinai Medical
Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA, IOF. (stuarts@bhillsra.com); Manuel Sosa Henriquez Research
Group into Osteoporosis and Mineral Metabolism, University of Las Palmas de Gran Canaria, Spain; Bone Metabolism Unit, Internal
Medicine Service, University Insular Hospital, Las Palmas de Gran Canaria, Spain; ESCEO/IOF. (msosa@ono.com); Thierry Thomas
hôpital de Bellevue, Saint-Etienne, France; Groupe de Recherche et d’Information sur les Osteoporoses, ESCEO/GRIO//IOF.
(thierry.thomas@chu-st-etienne.fr); Samual Vasikaran School of Pathology and Laboratory Medicine, University of Western Australia,
Nedlands, WA, 6009, Australia; IOF. (samuel.vasikaran@health.wa.gov.au); Nelson B. Watts, Mercy Health Osteoporosis and Bone
Health Services Clinical Trial Center.), Cincinnati, Ohio, USA; IOF. (nelson.watts@uc.edu); Georges Weryha, CHU de Nancy, service
d’endocrinologie, 54500 Vandœuvre-lès-Nancy, France ; GRIO. (g.weryha@chu-nancy.fr); Valérie Bousson, Service de Radiologie
Ostéoarticulaire, Hôpital Lariboisière, Paris, France; GRIO. (valerie.bousson@aphp.fr); Véronique Breuil, Nice University Hospital,
Pasteur 2 Hospital, Department of Rheumatology; UMR E-4320 TIRO-MATOs CEA/iBEB, Nice Sophia Antipolis University, France;
GRIO (breuil.v@chu-nice.fr); Laure Chapuis, Service de rhumatologie, 35500 Vitré, France; GRIO. (laure.chapuis@wanadoo.fr);
Michel Laroche, Centre de Rhumatologie, CHU Purpan, Toulouse; GRIO. (laroche.m@chu-toulouse.fr); Erick Legrand, Service de
rhumatologie, CHU Angers, France ; GRIO. (ErLegrand@chu-angers.fr); Eric Lespessailles, Service de Rhumatologie - CHR Orléans
- La Source, France; GRIO. (eric.lespessailles@chr-orleans.fr); Jacques Morel, Département de rhumatologie, Pole Os et articulations,
Hopital Lapeyronie Université Montpellier I, Montpellier, France; Société Française de Rhumatologie. (j-morel@chu-montpellier.fr)
Disclosure of interest: The authors declare that they have no conflicts of interest concerning this article.
Ethical standard: Participants provided by e-mail their written consent to participate in this study. Ethics committees/IRBs were not
involved in this consent procedure.
This article is being published concurrently by Aging Clinical and Experimental Research, European Geriatric Medicine, and Journal
of nutrition, health & aging”.
BLAIN et al. Page 2
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3. REGINSTER11, R. RIZZOLI12, B. CORTET13, M. BARBAGALLO14, K.E. DREINHÖFER18, B.
VELLAS15, S. MAGGI16, T. STRANDBERG17, FOR THE EUGMS FALLS AND FRACTURE
INTEREST GROUP, THE INTERNATIONAL ASSOCIATION OF GERONTOLOGY AND
GERIATRICS FOR THE EUROPEAN REGION (IAGG-ER), THE EUROPEAN UNION OF
MEDICAL SPECIALISTS(EUMS)*, THE FRAGILITY FRACTURE NETWORK (FFN), THE
EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS
AND OSTEOARTHRITIS (ESCEO), and THE INTERNATIONAL OSTEOPOROSIS
FOUNDATION (IOF)
1Department of Internal Medicine and Geriatrics, Montpellier University hospital; EA 2991
Movement To Health, Euromov, Montpellier University; MacVia-LR, EIP-AHA reference Site;
France 2Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust
Nottingham, United Kingdom 3INSERM, U1153, ORCHARD Team, Centre of Research in
Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris,
France; EUGMS 4Department of Ageing and Health, Guy’s and St Thomas’ NHS Trust, London,
UK 5Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy,
Umeå, Sweden 6Geriatrics Department Academisch Medisch Centrum Geriatrie, Amsterdam,
The Netherlands 7Respiratory Diseases Department, Montpellier University hospital; Inserm
U1018, Villejuif; MacVia-LR, EIP-AHA reference Site; France 8Department of Geriatrics,
University Hospital of Nancy, Inserm, U1116, CIC-P 1433, Université de Lorraine, France 9MRC
Lifecourse Epidemiology Unit, University of Southampton, UK; NIHR Musculoskeletal Biomedical
Research Unit, University of Oxford, Oxford, UK, ESCEO/IOF 10WHO Collaborative Centre for
Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10
2RX, UK 11Department of Public Health, Epidemiology and Health Economics, University of
Liege, CHU Sart Tilman B23, 4000 Liège, Belgium 12Service of Bone Diseases, Geneva
University Hospitals and Faculty of Medicine, Geneva, Switzerland 13Hôpital Roger Salengro, Lille
France 14Geriatric Unit, University of Palermo, Italy 15Gérontopôle, Institute of Ageing, University
Hospital Toulouse, France 16National Research Council, Aging Branch, Institute of Neuroscience,
Padova, Italy 17University of Helsinki, and Helsinki University Central Hospital, Helsinki; University
of Oulu, Center for Life Course Health Research, Oulu, Finland 18Dept. for muskuloskeletal
Rehabilitation, Prevention and Health Service Research Center for Sport Science and Sport
Medicine (CSSB) Center for Musculoskeletal Sugery (CMSC) Charité, Universitätsmedizin Berlin;
Dept. of Orthopedics and Traumatology Medical Park Berlin, Germany ; Fragility Fracture
Network, Germany
Abstract
Prevention of fragility fractures in older people has become a public health priority, although the
most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest
Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society
(EUGMS), in collaboration with the International Association of Gerontology and Geriatrics for
the European Region (IAGG-ER), the European Union of Medical Specialists (EUMS), the
International Osteoporosis Foundation - European Society for Clinical and Economic Aspects of
Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in
relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone
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4. fragility, and the place of combined falls and fracture liaison services for fracture prevention in
older people.
Keywords
Falls; fragility fracture; older people; prevention; position statement
Introduction
Three quarters of all vertebral and non-vertebral fractures occur among adults aged 65 years
or older and over three quarters of hip fractures occur in people aged 75 or over (1). The
major influence of ageing on fracture risk is mainly due to the strong impact of age and age-
related conditions on bone strength and fall risk (2, 3). Although fractures of the hip are the
most serious and costly fractures, those at the spine, pelvis, distal femur, proximal tibia,
proximal humerus, and ribs are also major fractures, associated with excess morbidity and
mortality, increased hip fracture risk, decreased quality of life, and high health care costs (4–
8). With the global growth of the older population, prevention of fractures has become an
international public health priority (4, 9, 10). The most appropriate and cost-effective
strategy to prevent major fractures in older people however remains a hotly debated topic
(11–14). In the present statement, the Interest Group on Falls and Fracture Prevention of the
European Union Geriatric Medicine Society (EUGMS), in collaboration with the
International Association of Gerontology and Geriatrics for the European Region (IAGG-
ER), the European Union of Medical Specialists (EUMS), the International Osteoporosis
Foundation - European Society for Clinical and Economic Aspects of Osteoporosis and
Osteoarthritis, outlines its views on the main points in the current debate.
Primary and secondary prevention related to falls
In adults, falls occur predominantly in older people. In populations over age 65, a third of
community-dwelling people fall at least once per year and in those aged 80 years or more a
non-vertebral fractures result from a fall (2, 3). Around 10% of falls result in a fracture (17,
18) and 2% in a hip fracture (19). The efficacy of falls prevention interventions to reduce
fractures is debated (13, 14), in part because it depends on the fall risk profile of people and
the type of intervention program (20, 21).
There is no international consensus for assessing the fall risk profile of older people, even if
it is well understood that people at higher risk of future falls are those aged 75 or older, those
who have fallen during the previous 12 months or those who have fear of falling or
significant gait, muscle strength, or balance problems (16, 22–28). The fall risk profile is
also dependent on the setting and some other factors, including cognitive impairment which
may be associated with increased risk-taking. Even though balance, gait, and muscle
function decline increases the risk of falling, the relationship is not completely linear since
those with most problems (i.e. bedridden) usually have a lower falls risk, similar to those
without such problems, presumably due to low exposure to risk (29).
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5. Notwithstanding the lack of consensus in assessing fall risk profile, there is rather consistent
evidence in subjects with low to moderate falls risk, usually community dwelling, that
multicomponent exercise programs, including progressive, challenging and regular exercises
designed to improve balance, muscle strength, and protective responses in case of
destabilisation, are effective in the reduction of serious falls and non-vertebral fractures (21,
24, 30, 31). The studies are however insufficiently powered to demonstrate a significant
effect on hip fracture risk (21, 24, 30). Single interventions including treatment of some
vision problems or carotid sinus hypersensitivity, vitamin D supplementation in deficient
patients, gradual withdrawal of psychotropic medication, or improving the safety of indoor
activities and outdoor walking environments are also effective for suitable patient groups in
the prevention of falls, but the effect on fracture risk is not clear (21, 32, 33). Multifactorial
interventions, a combination of interventions linked to the individual’s risk profile, seem no
more effective in preventing falls than single targeted interventions (e.g. community exercise
or fall prevention programs) (21, 34).
In people at high risk of falls single targeted interventions seem less effective, e.g. in older
nursing home residents, the only single intervention that has reduced falls is vitamin D
supplementation (20). Other interventions have been ineffective or inconsistent for falls
although the rate of recurrent falls may be reduced (35). A multifactorial and
interprofessional approach, determined by individual assessment of functional, medical, and
social concerns, may be a more appropriate strategy to prevent falls in older people at high
risk of falling (20, 22–34, 36). Moreover, this tailored approach (37) may provide
opportunities to address previously unidenti ed health problems (e.g. impaired cognition,
diabetes, Parkinson’s disease, osteoporosis) (9, 38), conferring bene ts beyond falls
prevention (39, 40). People at high risk of fall are most often frail patients (40) and
multifactorial approach in this population has been shown to improve the ability to live
safely and independently (41).
Taken together, the EUGMS supports 1) the set-up of a working group that would develop
consensus international operational definitions and diagnostic criteria for assessing the risk
of falling to be used in clinical practice as well as in research studies, 2) the 2010 American
Geriatrics Society / British Geriatrics Society joint guideline urging practitioners to screen,
at least annually, older patients for risk of falling (42), 3) that above evidenced-based
measures, especially evidence-based community exercise fall prevention programs, should
be widely available to prevent non-vertebral fractures in older people at low or moderate risk
of falling (9), and 4) that people at high risk should be able to access individually tailored
multifactorial measures based on a comprehensive geriatric assessment. EUGMS
recommends continued and expanded provision of evidence based fall prevention
programmes such as those being promoted by ProFouND (www.profound.eu.org).
Primary and secondary prevention related to bone health
It is widely recognized that lifestyle measures (regular weight-bearing exercises, balanced
diet, including calcium intake, avoiding smoking and excessive alcohol consumption) and
measures aimed at reducing adverse effects on bone of drugs and diseases, including renal
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6. diseases, have to be recommended throughout life in everyone. They are beneficial in
optimizing skeletal development (43–46) and limiting bone loss during adulthood (47).
Whereas there are well established definitions of osteoporosis (13, 14), there is much current
debate on what is the target population that may potentially benefit from treatments acting
on bone metabolism (TABM) (13, 14, 48–51).
Osteoporosis is currently defined by bone densitometry (densitometry osteoporosis) when
the bone mineral density (BMD) is 2.5 SD or more below that of the mean level for a young-
adult reference population (T-score ≤
-2.5 at the lumbar spine or the hip, or at the distal
radius when the hip and lumbar spine cannot be measured or are unusable or
uninterpretable) (52–54). Aortic calcification and osteoarthrosis that increase progressively
with age may be a source of accuracy error in the measurement of lumbar spine BMD in
older people (55, 56). However, for a given BMD, the risk of major fractures depends on
other risk factors for bone fragility, of which age is the most important one, which are taken
into account in different fracture prediction tools such as the most used FRAX® tool
(www.shef.ac.uk.FRAX) or the Garvan Fracture Risk calculator (www.garvan.org.au/bone-
fracture) or the Q-fracture Risk Calculator (www.qfracture.org). Fragility fracture risk
should therefore take into account not only BMD but also other risk factors of bone fragility,
by using fracture prediction tools, and falls risk (57). Since falls and osteoporosis are
independent risk factors of non-vertebral fractures, osteoporosis should induce bone fragility
but also in patients at risk of falls and vice versa (58). The prevalence of osteoporosis
detected by DXA BMD measurement is high in fallers with sarcopenia, impaired mobility,
and weight loss, which are risk factors for both falls and osteoporosis (58).
A fracture is considered a fragility or low energy fracture when it is the result of a minimal
trauma, such as a fall from a standing height or less. However, a fall from standing height
without any protective response generates an amount of energy which is at least 10 times the
energy required to fracture the proximal femur of an elderly woman (59). Diagnosis of
fragility fracture should therefore be set after a careful comprehensive assessment including
1) Fracture mechanism consideration (energy of the trauma) and 2) bone strength estimate,
based on bone mineral density (BMD), considering that densitometry osteoporosis is
observed in around 60% and 40% hip fractured women and men, respectively (60), fracture
type (comminuted or not, for example) and operator’s subjective assessment of bone quality
in the case of surgery.
The cost-effectiveness of the pharmacological approach of treating osteoporosis (and
therefore on searching for osteoporosis by Dual-Energy X-Ray Absorptiometry (DXA)) is
also debated (13). However, several licensed TABM have shown their ability to prevent
major fractures in people (most often women) with a T-score ≤
-2.5 at the spine or the hip
(raloxifene has only been shown effective in preventing vertebral fractures) (14, 61) or after
a hip fracture (61). Relative risk reductions of spine and non-vertebral fractures by TABM in
subjects with bone densitometry diagnosed osteoporosis are 40–60% and 20–40%,
respectively (14, 61). Number-Needed-to-Treat (NNT) to prevent a fracture is lower in
people at high risk of fractures, and especially in those with prior fragility fractures (13, 37,
61–73).
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7. Taken together, EUGMS supports recommendations that 1) osteoporosis should be
ascertained by DXA, at best combined with vertebral fracture assessment (VFA) or
radiography examination to detect vertebral fractures, in individuals at risk of fracture, i.e. at
risk of falling (58) or at risk of bone fragility (history of fracture, low body weight, parental
history of hip fracture, use of glucocorticoids, excessive alcohol consumption, diseases with
bone adverse effects) (74), 2) TABM should be considered after a careful assessment of the
benefit/risk ratio in patients at high risk of fracture, i.e. with a prior fragility fracture or in
those with densitometry diagnosed osteoporosis associated with other risks factors of
fractures, assessed both by fracture prediction scores and risk of falling 3) TABM should not
be initiated when the life expectancy is less than 6–12 months, the minimum time needed for
drugs to be effective in fracture prevention (66).
EUGMS recommends that prospective studies be conducted in non-selected older people
(particularly in those aged over 80 years) to determine if this strategy is effective,
considering that age and health status may modify compliance to treatments and the
Number-to-Treat/Number-Needed-to-Harm (NNH) of TABM (61).
Fracture Liaison Services and screening for spine fragility
As the diagnosis of fragility fracture and the assessment of benefit/risk ratio of the above
measures is complex, EUGMS recommends that patients aged 65 years or older with
vertebral or non-vertebral fractures should be referred to a fracture liaison service (FLS) (as
proposed by the International Osteoporosis Foundation in the Capture the Fracture initiative)
(75), which should be linked to or have strong input from geriatric medicine services
(combined fall and fracture liaison service). Such an approach will allow commencement of
appropriate interventions and ensure locally agreed arrangements for follow-up of patients.
This model of care has been shown to be cost-effective (76, 77).
EUGMS emphasizes that vertebral compression fractures are common, and often
unrecognized in older people. X-ray examination should be more systematically performed
in older patients with back pain, significant height loss (e.g. 5 cm or more), or significant
incident kyphosis. Radiologists should be encouraged to report on the presence or absence
of vertebral deformities as “fractures” when assessing chest radiographs so as to identify
patients who need referral to the combined fall and fracture liaison services (78), as these are
mostly fragility fractures in older people (53).
Conclusion
EUGMS advocates a comprehensive and multidisciplinary fracture prevention strategy in
individuals aged 65 or older requiring: 1) Better education for both older people and health
care professionals with regards to general lifestyle and medical measures to optimize bone
health and prevent falls; 2) Improved knowledge about screening and optimizing
management of older people with bone fragility or high risk of falling in primary and
community care as well as institutional settings; and 3) Strong collaboration between
fracture liaison services, geriatric medicine departments (combined falls and fracture liaison
services) and primary care. Policy makers will need to play a major role in developing
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8. community and institutional programs on falls prevention, to establish falls and fracture
liaison services and appropriate pathways for fracture prevention that include both
assessment and management of fallers and optimising medical management in those with
bone fragility to reduce fracture risk.
The EUGMS believes strongly that the focus for fracture prevention should not be polarised
into either falls prevention or improving bone health camps. Rather the ideal strategy should
be on optimising bone health, especially in those with bone fragility, in addition to
implementing measures to prevent falls.
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