No abstract

SummaryWe systematically reviewed the observational associations of anaemia with outcomes and the effects of interventions to increase haemoglobin concentrations following hip fracture in older people. Anaemia on hospital admission was associated with increased mortality, relative risk 1.64 (95% CI 1.47-1.82), p < 0.0001. After adjustment for co-morbidities, the association of anaemia with increased mortality remained in four of eight observational studies. There was no association of postoperative transfusion with mortality after adjusting for covariates. Transfusion at 80 g.l À1 vs 100 g.l À1 increased acute myocardial infarction, relative risk 1.67 (95% CI 1.01-2.77), p = 0.05. Transfusion threshold was not associated with differences in other outcomes. There were insufficient high-quality studies to inform pre-operative blood transfusion or the use of peri-operative iron or erythropoietin. Studies for most interventions recruited too few participants to determine effects on infections, mortality or function.

Video-conferencing equipment was set up in Scotland in response to the increased pressure faced by the child and adolescent mental health services (CAMHS), and the need for specialist services to be accessible to, and harmonize with, 'mainstream' health services. Three sites were linked to the inpatient service in Edinburgh. Data were collected via questionnaires and diary logs. During a 24-month study, a total of 65 adolescents were admitted for inpatient care, of whom only five had their cases reviewed and monitored in a total of 20 teleconsultations. Adolescents and their carers involved in the study expressed great satisfaction with telemedicine and were keen to use it. Clinicians were resistant to telemedicine, with consequently low levels of utilization. Our results suggest that managers may be unwilling to re-allocate funding away from staffing, even where these costs are small and represent considerable improvements in the process of care for patients. Widespread integration of telemedicine to CAMHS is likely to be hard to achieve.

High velocity low amplitude thrust (HVLAT) or manipulation is commonly used for the treatment of back pain. This critical review of the proposed mechanisms of action was based on a database search using the keywords: spinal manipulation, low back pain, osteopathy, physiotherapy and chiropractic. Three proposed mechanisms were highlighted -biomechanical, muscular reflexogenic, and neurophysiological. There is evidence of a mechanical gapping of the facet joints during manipulation, although the clinical significance of this is not clear. There is also evidence to support the theory that HVLAT techniques evoke spinal stretch reflexes resulting in a brief muscle contraction possibly followed by a period of reduced muscle activity. The papers also provide support for the anti-nociceptive treatment effects of HVLAT and this would have obvious benefit to the patient. In conclusion, there is support in the literature for each of the mechanisms, but it is clear that more research is needed to further our understanding of the mechanisms underlying spinal manipulation.