BACKGROUND: Despite changes in techniques and management, little has been published comparing hip replacement surgery over a three-decade time span. AIMS: To document change in the practice of hip arthroplasty in a large elective orthopaedic centre. METHODS: A retrospective analysis of 100 patients in 1979 and in 1999 comparing demographics, surgical approaches, blood loss, transfusion requirements, morbidity and length of stay. RESULTS: In 1999, males predominated, spinal anaesthesia had largely superceded general anaesthesia, the anterolateral approach had replaced the trans-trochanteric approach, osteoarthritis remained the main aetiology and the Charnley prosthesis remained the implant of choice. Average blood loss was higher in 1999 compared to 1979 (1,378 vs 1,225 ml) but all patients in 1979 were transfused with an average of 2.8 units while in 1999 one-third of patients were transfused with an average of 1.6 units (p<0.0001). Length of stay had fallen from 30.5 days in 1979 to 16.2 days in 1999 (p<0.0001). Thromboembolic complications fell from 13% to 2% (p=0.0083). CONCLUSION: The incidence of deep venous thrombosis (DVT), pulmonary embolus (PE) and length of hospital stay has fallen. Blood loss had changed little but fewer patients receive blood transfusion.

Aged↗

PubMedDate not supplied

A stage-of-change classification system based on actions and beliefs regarding dietary fat and fiber.

PURPOSE: The objectives of this study were to develop a stage-of-change classification system and to determine the degree to which various adult subgroups have adopted the behavioral changes necessary to achieve a low-fat and/or high-fiber diet as recommended by the Dietary Guidelines for Americans. DESIGN: The study used a mail survey randomly sent to 7110 adults. SETTING: The survey was conducted in 11 states and the District of Columbia. SUBJECTS: The random sample included males and females over age 18. Of the eligible respondents, 3198 (51.5%) were included in this analysis, with 2004 and 2066 unambiguously classified into stages of change for fat and fiber, respectively. MEASURES: Stage of change was defined by an algorithm based on self-reported intent and behaviors to limit fat and/or increase fiber. RESULTS: 45% of the respondents were classified as being in action/maintenance for fat and 38% for fiber. Women, older adults, individuals with advanced education, persons with diet-related chronic disease, people with higher levels of relevant nutrition knowledge and attitudes, and persons who indicated that health concerns were a primary influence on their diet were more likely to be in action/maintenance than other respondents. CONCLUSIONS: The algorithm in this study presents a model that more closely reflects the proportions of the adult population that have achieved low-fat diets and classifies a greater proportion in the preparation stage than classification systems in previous studies.

Adult↗