Fragility fractures due to osteoporosis are a major cause of disability or premature death in older adults. Those at highest risk are patients who have already suffered one fragility fracture; they are at twice the risk of suffering a future fracture compared to others who have not fractured.
Nevertheless health care systems around the world are failing to identify and treat these patients, leaving them exposed to debilitating and life-threatening secondary fractures.
Based on evidence from numerous global studies, a new report, ‘Capture the Fracture: A Best Practice Framework and Global Campaign to Break the Fragility Fracture Cycle’ (1), sets 13 achievable standards for best practice in implementing fracture liaison services (FLS) worldwide, in a broad range of health-economic environments.
The report has been published in the peer-reviewed journal ‘Osteoporosis International’ and is endorsed by the International Osteoporosis Foundation (IOF) Committee of Scientific Advisors. It is available at link.springer.com/article/10.1007/s00198-013-2348-z
Fracture Liaison Systems help reduce the burden of fragility fractures:
Professor Cyrus Cooper, Chair of the IOF Committee of Scientific Advisors (CSA) emphasized the importance of systematic and coordinated secondary prevention care: ‘Coordinator-based FLS have been shown to close the gap in secondary fracture prevention care, ensuring that fragility fracture sufferers receive appropriate assessment and intervention to reduce future fracture risk.’
The best practice framework sets the foundation for ‘Capture the Fracture’, a multi-stakeholder initiative led by the International Osteoporosis Foundation. The initiative hopes to drive change so that secondary fracture prevention becomes a reality around the world.
The new initiative aims to:
　

The hormone-releasing Mirena coil intrauterine device (IUD) is a better treatment for heavy menstrual periods than other conventional medical approaches, according to results of a major clinical trial led by scientists from the Universities of Nottingham and Birmingham.
 
The findings of the ECLIPSE study, funded by the National Institute for Health Research (NIHR) are widely expected to change standard clinical practice.

Heavy periods, or menorrhagia, affect the lives of large numbers of women aged 25-50 years, accounting for many GP consultations and 20 per cent of gynaecological referrals in the UK. Yet to date there has been limited evidence to help women and doctors make informed choices about treatments.

The ECLIPSE trial compared the clinical effectiveness of the levonorgestrel-releasing intrauterine system (also known as LNG-IUS or the Mirena contraceptive coil) with other medical treatments on offer in primary care.
 
A total of 571 women, consulting their GPs for heavy menstrual bleeding, agreed to be randomly assigned to LNG-IUS or to another standard medical treatment, such as tranexamic acid, mefanamic acid, combined estrogen and progestogen or progestogen only.
 
Over two years, patient reported outcomes improved more with LNG-IUS than with other treatments, including women

Researchers at the University of Southampton have completed a project that will enable surgeons to fit joint replacements with longer, optimised lifespans. The MXL project uses computational modelling to define the mechanics of an artificial joint

The ‘near-death experience’ reported by cardiac arrest survivors worldwide may be grounded in science, according to research at the University of Michigan Health System.
University of Michigan researchers George Mashour, M.D., Ph.D. and Jimo Borjigin, Ph.D., provide the first scientific framework for near-death experiences.
Whether and how the dying brain is capable of generating conscious activity has been vigorously debated.
A U-M study shows shortly after clinical death, in which the heart stops beating and blood stops flowing to the brain, rats display brain activity patterns characteristic of conscious perception.
‘This study, performed in animals, is the first dealing with what happens to the neurophysiological state of the dying brain,’ says lead study author Jimo Borjigin, Ph.D., associate professor of molecular and integrative physiology and associate professor of neurology at the University of Michigan Medical School.
‘It will form the foundation for future human studies investigating mental experiences occurring in the dying brain, including seeing light during cardiac arrest,’ she says.
Approximately 20 percent of cardiac arrest survivors report having had a near-death experience during clinical death. These visions and perceptions have been called ‘realer than real,’ according to previous research, but it remains unclear whether the brain is capable of such activity after cardiac arrest.
‘We reasoned that if near-death experience stems from brain activity, neural correlates of consciousness should be identifiable in humans or animals even after the cessation of cerebral blood flow,’ she says.
Researchers analysed the recordings of brain activity called electroencephalograms (EEGs) from nine anaesthetised rats undergoing experimentally induced cardiac arrest.
Within the first 30 seconds after cardiac arrest, all of the rats displayed a widespread, transient surge of highly synchronised brain activity that had features associated with a highly aroused brain.
Furthermore, the authors observed nearly identical patterns in the dying brains of rats undergoing asphyxiation.
‘The prediction that we would find some signs of conscious activity in the brain during cardiac arrest was confirmed with the data,’ says Borjigin, who conceived the idea for the project in 2007 with study co-author neurologist Michael M. Wang, M.D., Ph.D., associate professor of neurology and associate professor of molecular and integrative physiology at the U-M.
‘But, we were surprised by the high levels of activity,’ adds study senior author anesthesiologist George Mashour, M.D., Ph.D., assistant professor of anesthesiology and neurosurgery at the U-M. ‘ In fact, at near-death, many known electrical signatures of consciousness exceeded levels found in the waking state, suggesting that the brain is capable of well-organised electrical activity during the early stage of clinical death.

To improve patient safety, hospitals should randomly test physicians for drug and alcohol use in much the same way other major industries in the United States do to protect their customers. The recommendation comes from two Johns Hopkins physicians and patient safety experts.
In addition, the experts say, medical institutions should take a cue from other high-risk industries, like airlines, railways and nuclear power plants, and mandate that doctors be tested for drug or alcohol impairment immediately following an unexpected patient death or other significant event.
‘Patients might be better protected from preventable harm. Physicians and employers may experience reduced absenteeism, unintentional adverse events, injuries, and turnover, and early identification of a debilitating problem,’ write authors Julius Cuong Pham, M.D., Ph.D., an emergency medicine physician at The Johns Hopkins Hospital, and Peter J. Pronovost, M.D., Ph.D., director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality. Gregory E. Skipper, M.D., of the drug and alcohol treatment center Promises, in Santa Monica, CA. also contributed.
Pham, Pronovost and Skipper note that ‘mandatory alcohol-drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine,’ even though physicians are as susceptible to alcohol, narcotic and sedative addiction as the general public. (A sentinel event is an incident which results in death or serious physical harm.)
The authors recommend in their commentary that hospitals take a number of steps as a model to address this overlooked patient safety issue. They are:
— Mandatory physical examination, drug testing or both, before a medical staff appointment to a hospital. This already occurs in some hospitals and has been successful in other industries.
— A program of random alcohol-drug testing.
— A policy for routine drug-alcohol testing for all physicians involved with a sentinel event leading to patient death.
— Establishment of testing standards by a national hospital regulatory or accrediting body. The steps could be limited to hospitals and their affiliated physicians at this time, since hospitals have the infrastructure to conduct adverse event analysis and drug testing, note the authors. Hospitals also have the governing bylaws to guide physician conduct and an existing national accrediting body, The Joint Commission, the authors add.
In cases in which a physician is found to be impaired, a hospital could ‘suspend or revoke privileges and, in some cases, report this to the state licensing board,’ the authors write. Impaired physicians would undergo treatment and routine monitoring as a condition for continued licensure and hospital privileges.
‘Patients and their family members have a right to be protected from impaired physicians,’ argue the authors in the JAMA commentary. ‘In other high-risk industries, this right is supported by regulations and surveillance. Shouldn