“Prejuvenation” 6 Things Millennials Can Do to Maintain Their Youth

www.drmanishshah.com

Many people in their 20’s are stressed out about high post college student loan debt requiring side hustles to pay it off. They’re noticing tired eyes and premature wrinkles as they turn to filters to optimize their social media photos. There is pressure to keep up with celebrities their age not to mention the countless millennial “social media influencers” who are setting the new standard for beauty and youth. Bottomline, millennials are stressed, and they don’t want to look it. Dr. Manish Shah, a Denver, Colorado Board-Certified Plastic Surgeon who specializes in facial plastic surgery urges the under 30 crowd not to overdo it with expensive treatments and procedures that can actually make them look older and put them further into debt.

Here is Dr. Shah’s of 6 things millennials can do to maintain their youth.

1. Use sunblock every day.

“The best way to make sure your face is protected from the sun is to use a daily moisturizer with SPF of no less than 30,” explains Dr. Shah. He also suggests applying creams to your neck and chest to postpone wrinkling and sagging in these areas. “The sun protection done daily in your 20’s will pay off greatly in your 40’s,” he says.

2. Get your Vitamin C.

“Vitamin C is a huge collagen booster and it also reduces pores and brightens skin, and these are the exact things women in their late 30’s and 40’s complain about most,” he reveals. Foods such as cantaloupe, mango, pineapples, oranges, grapefruits, and berries are all packed with this antioxidant which, when eaten regularly does wonders to sustain a youthful glow.

3. Ditch the fast food and eat more fish.

Those late night post partying fries and pizza are to be expected and at 25 are difficult to avoid. Perhaps your metabolism can handle it, for now. Offset these weekend indulgences by eating fish during the week. “Fish oil has fatty acids can erase early wrinkles you may notice. It prevents inflammation which can only make wrinkles more noticeable and deeper over time. Many millennials who are picky eaters and avoid seafood can get Omega-3’s via supplements but getting it directly from eating fish is best,” Dr. Shah suggests.

4. Quit smoking.

Nothing will age you quicker than smoking. “It is possible for a 25-year-old to look 8-5 years younger, within just 3 months after quitting smoking. This number increases after age 30. Women over age 40 who don’t smoke typically look up to a decade younger than their counterparts who still smoke,” says Dr. Shah. There are a gazillion reasons to quit smoking. Linking it to vanity is a pretty powerful motivator.

5. Decrease your sugar intake.

You really want to start getting mindful about your sugar intake in your 20’s for many different reasons. “Sugars and carbohydrates are a beauty killer because they are pro-inflammatory. Pasta, ketchup, candy, ice cream, and fruit juices are often dietary staples for those under 30. Any inflammation in the body will show up on the face in the form of adult acne, sagging and wrinkling not to mention sallow skin tone,” warns Dr. Shah.

6. Maintain your glow with facials and peels.

While many millennials are starting off with “Baby Botox” which can postpone wrinkling, Botox isn’t cheap. It also can be a “gateway” treatment which leads to lip injections and fillers that often have a reverse effect making younger women appear older, cautions Dr. Shah. “Lasers and peels have come very far, offer an excellent solution for sun damage, skin texture, pores, acne scarring and cell turnover to stimulate collagen growth.

Dr. Shah concludes that millennials who get into a good solid habit of taking care of themselves both inside and out, will create a lifestyle of longevity. “Millennials raised by mothers who may have had breast implants, Botox and lip injections may feel that getting things “done” is normal. This is exactly why I am always very honest when advising patients under 25 on procedures they’re considering.”

About Dr. Manish Shah

Plastic Surgeon Colorado | Dr. Manish Shah, M.D. | Denver https://drmanishshah.com/ 

Manish Shah, M.D., F.A.C.S. is board-certified by the American Board of Plastic Surgery and member of the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery and the International Society of Aesthetic Plastic Surgery. After completing his formal plastic surgery training in Plastic and Reconstructive Surgery at the Univ. of Tennessee College of Medicine, he moved to New York City and was selected for the prestigious Aesthetic Surgery Fellowship at Manhattan Eye, Ear, and Throat Hospital. He underwent extensive, advanced training in aesthetic surgery of the face, breasts, and body at the hands of some of the most renowned cosmetic surgeons in the world. Dr. Shah is one of only a select few plastic surgeons in the country who have undergone formal post-graduate training in aesthetic surgery.

Dr. Shah’s specialties include revision facial aesthetic surgery, rhinoplasty (“nose reshaping”), and aesthetic surgery of the breast (breast augmentation, breast lift, breast reduction). He is, however, well-trained in all areas of aesthetic surgery. Dr. Shah’s aim is to obtain a natural appearing transformation that complements the real you!

Expert Advisory Group Releases Report on Assisted Dying and Mental Disorders

Report includes recommendations and cautions

TORONTO, Feb. 13, 2020 /CNW/ - Following comprehensive review of the available evidence, the Expert Advisory Group (EAG) on Medical Assistance in Dying (MAiD) released a report today cautioning that evolving assisted dying policies must not put the lives of Canadians who live with mental illness at risk.  MAiD in Canada is for medical conditions with irreversible decline, yet unlike other medical conditions mental illnesses can never be predicted to be irremediable.

"The evidence shows it's impossible to predict irremediability of mental illnesses," said Dr. K. Sonu Gaind, the Toronto psychiatrist who coordinates the EAG.  "Society would think people were being helped to die with MAiD to relieve suffering from an irremediable illness, but in reality we would be ending their lives because of loneliness, poverty, and all sorts of other life suffering... lives of people who could get better.  I don't think Canadians would support that sort of discrimination."

Mark Henick, one of the EAG members with lived experience of mental illness and depression for over 20 years, lets people know he "absolutely" would have taken the option of assisted dying in the past, if it had been available.  He points out that while mental illnesses are remediable, receiving MAiD for mental illness is not.  "My suicidal-self wouldn't believe my well-self now," Henick said, "but that's exactly why I'm so glad that I didn't have access to an irremediable solution to my suffering.  I would have lost out on so much that I then never imagined could someday be possible, but now am very, very grateful for life.  Everybody deserves that opportunity."

The EAG report highlights the need to set evidence-based policies and not discriminatorily ignore the realities of mental illness.  Canada's MAiD laws should acknowledge the worldwide evidence that mental illnesses cannot be identified as being irremediable, and should also contain proper safeguards against ambivalent wishes to die to ensure society doesn't take the lives of non-dying people who would have enjoyed continued life.

Read the report and recommendations at www.eagmaid.org 

The Expert Advisory Group (EAG) on Medical Assistance in Dying (MAiD) consists of individuals with extensive Canadian and international experience with MAiD policy and practices, and mental health and illness issues.  The EAG includes members of the Council of Canadian Academies (CCA) expert panels on MAiD, and additionally those with lived experience/expertise of mental illness.Our purpose: To provide expert, evidence-based advice to guide MAiD policy

SOURCE Expert Advisory Group on Medical Assistance in Dying

Ontario Medical Association Statement on Dr. Jennifer Kagan and Daughter Kiera Kagan

TORONTO, Feb. 12, 2020 /CNW/ - This is a sad week for doctors across Ontario. One of our own has lost a young child, four-year old Keira, under dramatic and public circumstances. Dr. Jennifer Kagan, mother to Keira and nine-month old Joseph, is a palliative care physician in Brampton. Keira's body was recovered yesterday. The cause of death is currently under investigation.   

I hope we can all take a moment to hold our fellow physician, Dr. Kagan, in our hearts, thoughts and prayers during this tragic time. She describes Keira as a spunky, resilient little girl who wanted to change the world. 

While there remain many questions to be answered, we are aware that Dr. Kagan and her husband, Phil Viater were actively pursuing legal means to protect Keira from what they perceived as threats to Keira's safety. 

Despite following appropriate legal channels and using resources many women don't have in challenging custody battles, the legal system forced Dr. Kagan to leave Keira in the care of her biological father. The weekend of February 7-9, 2020 was the last weekend he was to have Keira in his care before potentially losing unsupervised access. 

"I did not end up like Elana, but I couldn't save my precious daughter," Dr. Kagan is quoted as saying, a reference to Dr. Elana Fric – a physician victim of intimate partner violence.  Keira's mother is hoping Keira's memory and story can bring about system change.

Today, let us come together and embrace our own who are suffering: Dr. Kagan and her family, and other physician colleagues who may be struggling to protect themselves and their families. For those who wish to contribute, a gofundme account is online here.  

About the OMA

The Ontario Medical Association represents Ontario's 43,000 plus physicians, medical students and retired physicians, advocating for and supporting doctors while strengthening the leadership role of doctors in caring for patients. Our vision is to be the trusted voice in transforming Ontario's health-care system. 

SOURCE Ontario Medical Association

Honda Canada Foundation Launches New Partnership to Support Canadians with Cancer

Ten Honda Odyssey minivans donated to the Canadian Cancer Society Wheels of Hope transportation program

TORONTO, Feb. 11, 2020 /CNW/ - Today, the Honda Canada Foundation (HCF) announced a donation of 10 Honda Odyssey minivans that will be used as part of the Canadian Cancer Society Wheels of Hope transportation program. Over the next two years, the special fleet of vehicles will alleviate some of the challenges people with cancer face every day in the GTA, Cornwall, Winnipeg, Prince Albert and Calgary, by getting them to and from their life-saving treatment both safely and comfortably.

More than 1,800 volunteers in Ontario, Alberta, Saskatchewan and Manitoba devote their time to driving people with cancer to and from their treatments. Without the Wheels of Hope program, these passengers would need to find costly transportation to their appointments or even miss their treatments entirely due to unreliable transit. An estimated 8,300 Canadians rely on the service however, prior to today's donation, those without access to a vehicle were unable to become Wheels of Hope drivers. With Honda's contribution of 10 Odyssey minivans, prospective volunteers with a valid driver's license can get involved in a cause they are passionate about.  

"The Canadian Cancer Society is an organization making a real difference in communities across the country, which is something the Honda Canada Foundation wholeheartedly supports," said Dave Jamieson, Chair of the Honda Canada Foundation. "Knowing that these vehicles will be used in such a kind and compassionate way is as inspiring as it is rewarding."         

Honda will also cover the cost of insurance and maintenance for the 10 minivans for the duration of the partnership. 

"Getting to treatment can be difficult for anyone who isn't physically well enough to drive themselves, use public transportation or able to afford the cost of travel so this partnership with the Honda Canada Foundation goes a long way in solving these challenges," Interim Director of Corporate Partnerships, Susanna Tyson. "Adding these vehicles to our program will unlock new volunteer opportunities allowing us to serve even more of the people who count on us throughout the year."

Facts about the Canadian Cancer Society Wheels of Hope program:

• Wheels of Hope is active in four provinces - Ontario, Alberta, Manitoba and Saskatchewan 
• In these regions, the Odyssey minivans will transport an estimated 2,500 passengers with cancer to and from their medical appointments 
• During the two-year partnership, the 10 Odyssey minivans will make approximately 50,000 trips combined 
• In total, all Honda Odyssey Wheels of Hope edition minivans will clock an estimated 250,000 km over the next two years 
• In 2019, over 200,000 trips were offered to people with cancer by volunteer drivers

Anyone interested in volunteering with the Wheels of Hope program can fill out an online registration form here.

About the Honda Canada Foundation
Established in 2005, the Honda Canada Foundation (HCF) aims to enable the realization of dreams through various annual philanthropic activities and funding to non-profit registered charities across Canada where Honda customers and associates live, work and play. The HCF focuses on four key pillars – family, environment, engineering and education – and each year more than $2 million is disbursed to groups in need. More than six million Canadians have benefited from Honda Canada and Honda Canada Foundation funded charitable programs. For more information, please visit www.hondacanadafoundation.ca.

About Canadian Cancer Society
The Canadian Cancer Society (CCS) is the only national charity that supports Canadians with all cancers in communities across the country. No other organization does what we do; we are the voice for Canadians who care about cancer. We fund groundbreaking research, provide a support system for all those affected by cancer and advocate to governments for important social change. 

Help us make a difference. Call 1-888-939-3333 or visit cancer.ca today. 

SOURCE Honda Canada Inc.

Four Ways to Keep Your Resolutions 

CHICAGO —Award-winning Career and Lifestyle Coach, Neha O’Rourke, has prepared four tips to help keep your New Year’s resolutions:

Tip #1 STAY REALISTIC

Take away the heavy-ness of your new year's resolution by changing the goals that may take a little more time or discipline to nail down. If you fall off the wagon — whatever wagon we’re talking about here, you can get right back on by changing the timeline, data, or habits. 

For example: 

• If you’ve barely hit the gym in the last year, then saying you’re going to go 5 times a week isn’t realistic. 
• Take the time to really assess what’s going to be realistic and attainable for you. Remember – any action, no matter how big or small means you’re going in the right direction and are closer to your goal than you were before. 

Tip #2 CELEBRATE THE WINS

New Year's resolutions focus on what needs to change, but we don’t reflect on the progress we’ve made in the last year! 

There’s always something that we could be doing and sometimes that feeling can be overwhelming, which is why we need to acknowledge and celebrate our wins throughout the year. Similarly to making resolutions, you should be celebrating those accomplishments on a more frequent basis. 

There’s actual science behind how your thoughts are creating your reality and gratitude can manifest incredible things. 

Tip #3 EVALUATING YOUR HAPPINESS AND GOALS THROUGHOUT THE YEAR

If you think about it, it is inefficient to go an entire year without reflecting on how things are going and what needs to change. Assessing our lives at the end of each year is just not conducive to living our best lives. 

Rather than only looking at it once a year, figure out a more frequent cadence that works for you. For me, that’s monthly. I like to reflect on what’s making me happy, what’s bringing me down and what I want to achieve. 

Tip #4 DIG A LITTLE DEEPER 

I’d like to add to your new year's resolutions by asking you to consider the fact that the average American spends 90,000 hours working – ahem: over 10 years of your life simply working! 

Chances are, there’s a reason you haven’t made your desired change already. Maybe you haven’t made it to the gym because you’re working late every night. In that case, your goal might actually be to set boundaries at work so you get some time to make it to the gym. 

By thinking about the root of the issue, you’re positioning yourself to be successful at achieving your resolution. 

—————

Neha O’Rourke is the Founder and Career Coach at Somewhere In Between Coaching, a coaching company that empowers women around the country and across industries in designing a career and life they love. Since founding Somewhere In Between, Neha has served hundreds of women in avoiding career burnout through her signature 1:1 career coaching programs, research-based blog series, and public appearances. She was recently named “20 on the Rise” in the coaching category by Honeybook and Rising Tide Society. 

At the Starting Line: 4 Tips for First-Time Runners

Running is an amazing pastime that can help you burn calories, strengthen your cardiovascular system, and even boost your cognitive health. If you have decided to start running for the first time, then you will need to come up with a solid training plan and invest in a few key products.

Start Slow

One of the most common mistakes that new runners make is pushing themselves to the limit every single day. Unfortunately, putting out max exertion every training session is probably going to result in chronic injuries. Even if it doesn’t result in injuries, you’ll likely find that your motivation and excitement to keep going quickly burns out. 

That is why many experts suggest that you establish a baseline and then come up with a long-term training plan. That plan should slowly increase your strength and endurance without putting your health at risk.

Don’t Forget to Cross-Train

While running is going to be excellent for your health, propelling yourself forward only strengthens a few specific muscle groups. Over time, those who only exercise by running could begin to develop muscle imbalances, which is going to increase their risk of injury. At least one or two days a week, you should do exercises that are going to strengthen your lower back, hamstrings, arms, and shoulders.

Fix Your Diet

Becoming a better running will be nearly impossible if you don’t properly fuel yourself. The occasional cheat meal is perfectly fine for most people, but the vast majority of your diet should be comprised of nutrient-dense foods that are going to provide you with protein, healthy fats, and complex carbohydrates. Sticking to a relatively strict diet will give you more energy during your runs and help you recover much faster between your training sessions.

Invest in the Right Gear

Wearing the proper gear will make your runs much more enjoyable and will greatly reduce your risk of becoming injured. Luckily, it doesn’t require a lot of specific gear, and much of it is up to personal preference. The most important thing is good running shoes. 

In addition to having an excellent pair of shoes, you might also want to invest in a comfortable pair of men’s running shorts with pockets. High-quality shorts will prevent chafing and give you a place to store your phone, energy gels, and any other items that you will be taking with you, which will make your runs a little more convenient. For running in the summer, you are also going to need sunglasses, a hat, and some sunscreen.

Throughout your running career, you are sure to deal with at least a few injuries, and those issues should never be ignored. Many of the injuries that runners are prone to can easily be taken care of as long as they are diagnosed and treated in their earliest stages.

Ontario Sets New Record Highs for Organ Donation and Transplantation in 2019

TORONTO, Feb. 11, 2020 /CNW/ - In 2019, Ontario set new records for the most organs donated and transplanted in a single year: there were 1,386 organ transplants and 684 deceased and living organ donors, a 13% increase over the previous year. Trillium Gift of Life Network achieved record-breaking results across its internationally-renowned organ and tissue donation and transplant system due to a combination of expanded protocols, innovative treatments and effective leading practices.

"More Ontarians than ever before gave and received the gift of life last year thanks to the collaboration among our forward-thinking hospital partners, dedicated stakeholder groups and hard-working staff," said Ronnie Gavsie, CEO and President of Trillium Gift of Life Network. "These achievements inspire us to do more. We will continue to work with fervor toward a day when no Ontarian dies on the wait list due to a lack of an organ or tissue."

Higher transplant numbers are partly attributable to technological and medical advancements that allow for the transplantation of organs from donors who historically would have been excluded due to prior medical conditions – these donors accounted for 21% of all organ transplants in 2019. Transplants of healthy and suitable organs from donors with hepatitis C, for example, can now safely occur, expanding the pool of potential donors and decreasing wait times for recipients on the list. There was a 41% increase of donors with hepatitis C in 2019 as compared to 2018, and a 39% increase in transplants from these donors.

In recent years, Trillium Gift of Life Network streamlined the province's tissue recovery system and established new initiatives. This included the consolidation of ocular and multi-tissue recovery and the launch of a tissue referral program with emergency medical service responders, both of which have contributed to the record numbers in tissue donation. In 2019, there was a new milestone of 281 multi-tissue donations, with a remarkable 81% increase of skin donors from the previous year. 

"Organ and tissue donations and transplants play an important role in saving and enhancing the lives of many Ontarians," said Christine Elliott, Ontario's Deputy Premier and Minister of Health. "This is an incredible achievement led by Trillium Gift of Life Network. Through their collaborative work with our health system partners, Ontario has made significant strides in organ and tissue donations and transplants that will help more patients and families access the life-saving procedures."

Ontario's established leading-practices, such as routine notification, which requires hospitals and referring partners to report all potential organ and tissue donation cases to Trillium Gift of Life Network, led to a record 7,901 organ referrals and 33,585 tissue referrals in 2019. Additionally, Trillium Gift of Life Network's trained Organ and Tissue Donation Coordinators and referring partners approached 1,341 families to discuss the option of organ and tissue donation after their loved one died and a remarkable 816 families agreed to the gift of life through organ donation. 

Registration has a strong connection to donation.  When a potential donor has formally registered to be an organ and tissue donor, families almost always proceed with donation. In the absence of registration, families only consent half the time. There has been a steady increase in the percentage of organ donors who were formally registered, and 2019 had the highest percentage at 51%. Trillium Gift of Life Network's robust public awareness and education campaign emphasizes the importance of registering to be an organ and tissue donor and encourages all Ontarians to do so. Currently, more than 4.2 million Ontarians, or 34% of the eligible population, have registered for organ and tissue donation.

Trillium Gift of Life Network consistently explores new ways to expand donation opportunities. In 2016, organ donation was integrated as part of quality end-of-life care for individuals receiving the provision of medical assistance in dying (MAID). 

"We congratulate Trillium Gift of Life Network on their record-breaking year. Their continued commitment to advancing leading practices to increase donations and transplants is remarkable," said Dr. Beatriz Domínguez-Gil, Director General of Spain´s Organización Nacional de Trasplantes (ONT), the world's leader in organ donation.

There are more than 1,600 people across Ontario waiting to receive a life-saving organ transplant. Every three days, someone dies while waiting. Learn more about how organ donation can help to save a life by visiting www.beadonor.ca. 

Trillium Gift of Life Network
Trillium Gift of Life Network is the Government of Ontario agency responsible for planning, promoting, coordinating and supporting organ and tissue donation and transplantation across the province and for continually improving the system so that more lives can be saved. 

SOURCE Trillium Gift of Life Network

Vildagliptin’s affordability will provide competitive advantage to Eris and Cipla in crowded Indian diabetes market, says GlobalData

Novartis has recently sold its anti-diabetic drug vildagliptin (branded as Zomelis, Vysov and Vysov M) to Ahmedabad-based Eris Lifesciences and Mumbai-based pharmaceutical major Cipla Ltd, in India. The orally active, potent and selective dipeptidyl peptidase -4 (DPP-4) inhibitor’s patent has expired in India leading to increased affordability of vildagliptin. Product acquisition and increased affordability of vildagliptin will provide a competitive advantage to both the companies in a market crowded with several players, says GlobalData, a leading data and analytics company.

According to GlobalData’s upcoming report, ‘Type 2 Diabetes – Global Drug Forecast and Market Analysis to 2028’, the Indian type 2 diabetes (T2D) market, similar to other major markets, is mature and crowded with both expensive branded therapies and inexpensive generics. With an estimated diagnosed prevalent T2D population of about 90 million by 2028, approximately 80% of which are treated using anti-diabetics, India has a burgeoning T2D market with a robust and competitive pipeline.

The main drivers of market growth will be the dramatic increase in disease prevalence, and physicians' efforts to delay disease progression and reduce the costly burden of diabetic complications through the use of combination therapies and novel branded drugs.

Prashant Khadayate, Pharma Analyst at GlobalData, says: “The Indian diabetes market is highly competitive and price sensitive. Companies are always on the lookout for ways to differentiate themselves in this crowded market. Vildagliptin has shown good traction in the Indian market and patent expiry of vildaglitpin in the Indian market will increase the affordability and will lead to easier access.”

Earlier, Zomelis was sold in India by Abbott under a license from Novartis. On the other hand, Cipla was co-marketing vildagliptin in agreement with Novartis under brand names Vysov and Vysov M (vildagliptin and metformin).

As per Q2 FY’20 results, Eris Lifesciences was ranked third in terms of the number of prescriptions within the Indian diabetology segment. In FY’19, the company’s overall leading brand Glimisave (glimepiride) generated sales of INR2,212m (US $32.5m*). Tendia (tenegliptin) and Cyblex (gliclazide) are the other leading diabetic brands of Eris Lifesciences which generated sales of INR598m (US$8.8m*) and INR396m (US$5.8m*), respectively. 

In contrast, Cipla views diabetes as a main therapeutic area of focus, due to the large market opportunity in India. In the past, the company has collaborated with Eli Lilly to market and distribute Basaglar (insulin glargine), with Janssen to market canagliflozin under brand name Prominad and with Mannkind USA to market inhaled insulin Afrezza, which is in clinical development. Cipla will be responsible to get the regulatory approval for Afrezza in India.

Khadayate concludes: “Eris Lifesciences has already emerged as one of the key players in the diabetes market through its leading brands. Sales from its diabetes portfolio makes up approximately 25% of total company sales, as witnessed in FY’19, whereas Cipla’s diabetes portfolio accounted for only 2% of total company sales in FY’18-19. However, both companies continue to be committed to bringing effective and life-changing anti-diabetic drugs to an ever-growing diabetic population in India.  in India and innovator vildagliptin brands acquisition will provide a competitive edge over the vildagliptin generics.”

*Converted currency from INR to US$ based on 2018 average rate

Real world evidence shows accelerated surgery in patients with hip fracture has substantial benefits

HAMILTON, ON, Feb. 9, 2020 /CNW/ - Canadian researchers have discovered that accelerated time to surgery – within an average of 6 hours after a hip fracture diagnosis – resulted in a lower risk of delirium and urinary tract infections, moderate to severe pain, faster mobilization, and a shorter length of hospital stay compared to standard care – when surgery occurred an average of 24 hours after a hip fracture diagnosis.

The HIP Fracture Accelerated Surgical TreaTment And Care tracK (HIP ATTACK) Trial, presented on Sunday at the Orthopaedic Research Society (ORS) 2020 Annual Meeting and published in The Lancet, was led by researchers of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences (HHS) in Hamilton, Canada. HIP ATTACK involved 2,970 people at 69 sites in 17 countries. 

Ten years ago, Dr. Devereaux - principal investigator of the HIP ATTACK trial, as well as senior scientific lead of PHRI's perioperative and surgery program, professor of medicine at McMaster, and cardiologist with HHS - was consulted to manage a 73-year-old female with a hip fracture who also had an elevated blood test (troponin) demonstrating heart injury. The referring doctor told Dr. Devereaux the patient's heart issue had to be treated before surgery for her hip fracture could occur. Despite the best of intentions, with the medical treatment Dr. Devereaux provided based on current practice at that time, the patient died before she was able to undergo surgery for her hip fracture.

Upon reflecting on this case, Dr. Devereaux wondered if the prevailing dogma regarding the need to medically optimize patients before hip fracture surgery was the wrong approach. He contacted Dr. Mohit Bhandari, co-principal investigator of HIP ATTACK and an orthopedic surgeon in Hamilton, to get his perspective on the case. Dr. Bhandari told Dr. Devereaux that observational studies suggested that shorter time to surgery may prevent death and major complications in patients with a hip fracture. Based on this evidence, they initiated a large randomized controlled trial to understand the effects of accelerated surgery in patients with a hip fracture.  

Accelerated surgery did not result in a reduction in death or a collection of major complications; however, patients randomized to accelerated surgery had a lower risk of delirium, urinary tract infection, moderate to severe pain, and were faster to stand, mobilize, and go home compared to patients randomized to standard care. Among patients who had an elevated blood test (troponin) demonstrating heart injury when they presented to the hospital with their hip fracture, accelerated surgery lowered the risk of death compared to standard care.

• "Hip fracture—as distinct from hip replacement for arthritis—is a medical emergency that kills many older people who would otherwise enjoy many more productive years of life. This study represents a decade of high-quality medical research and very committed patient partners to answer a very important practical question," said Karim Khan, Scientific Director of Canadian Institutes of Health Research Institute (CIHR) of Musculoskeletal Health and Arthritis, said. "It is now clear that in many cases, one would want to have hip fracture surgery inside 6 hours if at all possible. The challenge will be for health systems to deliver this ideal scenario. We must also remember that hip fractures can be prevented—strength and balance training work reduce falls and medication may be indicated for those at risk because of previous osteoporotic fracture."
  
  
• "Hip fractures are a common cause of presentations to over-crowded emergency departments in Canada. Many of these patients languish while awaiting surgical repair and develop complications such as delirium, over-sedation, and poor outcomes," said Dr. Brian Rowe, Scientific Director of CIHR's Institute of Circulatory and Respiratory Health and a practicing emergency physician in Edmonton. "This collaborative multi-national research, supported by a number of health funders, provides firm evidence of the need to prioritize hip surgery to improve the health of patients and reduce the burden on the health care system." 
  
  
• "Patients find waiting for hip fracture surgery undesirable because they are forced to lie flat in a bed, go without food, and they are either in pain or receiving pain medications that commonly have negative side effects," said Dr. Mohit Bhandari, co-principal investigator of HIP ATTACK and an orthopedic surgeon in Hamilton. 
  
  
• "This trial demonstrates that accelerated surgery for a hip fracture is feasible, safe, and reduces the risk of delirium, urinary tract infection, moderate to severe pain, and length of hospital stay," said Dr. Flavia Borges, the Project Officer of HIP ATTACK and a general internist in Hamilton. 
  
  
• "The lower risk of death with accelerated surgery, in patients who had evidence of a heart injury at the time of hospital admission, challenges the dogma of medical optimization before surgery. Further research should explore the benefits of accelerated surgery in this high-risk group," said Dr. P.J. Devereaux, principal investigator of the HIP ATTACK trial, as well as senior scientific lead of PHRI's perioperative and surgery program, professor of medicine at McMaster, and cardiologist with HHS.

The main funding for the HIP ATTACK trial came from the Canadian Institutes of Health Research, the Ontario Strategy for Patient Oriented Research Support Unit, and the Ontario Ministry of Health and Long-Term Care.

SOURCE Population Health Research Institute