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Comorbidities in Hip Fracture: Costs & Improving Care Delivery

More than 250,000 hip fractures occur annu­ally in the United States, and the incidence is expected to increase among the elderly as society continues to outlive previous generations. Hip fractures have a significant impact on health-related quality of life and are a major source of healthcare expenditures, and almost all result in hospitalization and surgery. They also often result in nursing home admission, long-term dis­ability, and extended periods of rehabilitation. Patients with hip fractures frequently present with comorbid illnesses, including many chronic diseases. “In addition to increasing resource uti­lization, the presence of several comorbidities has been identified as a strong preoperative risk factor for death in patients with hip fractures,” says Kevin P. Black, MD. A New Large-Scale Analysis of Hip Fracture Previous research has examined comorbidities and hospitalization costs for hip fracture in the elderly, but these studies have been conducted on a small scale. In the January 4, 2012 Journal of Bone and Joint Surgery, Dr. Black and colleagues had a larger-scale study published that aimed to gain a better understanding of the coexist­ing medical conditions that impact the cost of treating patients with hip fractures. “A better understanding of the impact of comorbidities on inpatient costs and length of stay may advance the discussion on appropriate reimbursement for patients with hip fractures and multiple comor­bidities,” says Dr. Black. “It may also lead us to the development of strategies to better manage comorbidities in this patient population.” Hospital discharge information was gathered from an AHRQ report that included data from more than 1,000 hospitals in 40 states. For the more than 32,000 patients involved in the study,...

Managing Thyroid Disease During Pregnancy

The effects of pregnancy on the thyroid gland are profound. The gland is required to produce a 50% increase in thyroxine (T4) and triiodothyronine (T3). While a healthy thyroid should respond well to pregnancy, women with limited thyroidal reserve or iodine deficiency who become pregnant can develop hypothyroidism. “Women in high-risk groups need to be tested as early as possible for hypothyroidism during the first trimester.” Knowledge about the interaction between the thyroid gland and pregnancy has exploded over that last 15 to 20 years. In response to the emerging data, the American Thyroid Association (ATA) recently created clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and postpartum. They were published in the October 2011 issue of Thyroid. Pregnancies At-Risk for Thyroid Disease According to the ATA guidelines, about 10% of pregnant women are thyroid peroxidase (TPO)-antibody positive but have normal thyroid function. These women have a two- to four-fold increased risk of miscarriage when compared with women who don’t have the antibody. Among women without the antibody but with slightly elevated thyrotropin (TSH) levels, the risk of miscarriage is increased by 60% when compared with women without hypothyroidism. Women with either the TPO antibody or mild hypothyroidism are also at risk for preterm delivery. The 10% of all women who are TPO-antibody positive have a 50% chance of developing postpartum thyroiditis. Thyroid Screening Recommendations Women in high-risk groups need to be tested as early as possible for hypothyroidism during the first trimester, according to the ATA guidelines. These groups include (but are not limited to) women: With a history of thyroid dysfunction or prior thyroid...
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