This simple message of assessing the fall status in all

This simple message of assessing the fall status in all preoperative patients will hopefully be adopted in daily clinical practice. Early identification of patients at risk of postoperative falls may enable preventative measures to be implemented before surgery to decrease the risk of postoperative falls and the secondary associated morbidity and mortality. Falls services have been widely introduced throughout the National Health Service in the UK, however there is marked differences in the assessment and delivery according to region (). A systematic review of the current evidence assessed 159 trials reporting differing falls prevention strategies (). They found exercise programs, especially those focusing on personalised gait strength and balance retraining, were effective in decreasing the rate of falls by up to 25%. There are limitations of such exercise interventions with adherence and whether they potassium phosphate monobasic cost are a cost-effective strategy. Currently there is a multicentre randomised controlled trial being carried out to address these limitations (). There is limited data, if any, reporting the association of preoperative falls with functional decline and surgical complications. This would seem to be an area of significant importance in predicting the outcome of surgical interventions. From an orthopaedic aspect this single risk factor, of preoperative falls, if addressed may help improve the outcome of patients for example after total hip and knee replacements. At the very least to inform patients as part of the consent process who declare they are having falls that they may be at an increased risk of postoperative complications and may not achieve full functional benefit from their surgery. However, the paper by Kronzer et al. () does not break each surgical speciality down and report the functional outcome/decline or the specific associated complications. This may be the next step for future research to assess the independent effect of preoperative falls on the patient reported outcomes after surgery, for example after total hip and knee replacement, and the risk of postoperative complications (infection, fracture, etc.). Once this was established then the next step may be to assess whether preoperative interventions, such as physiotherapy, exercise programs, and/or medical optimisation, could improve the outcomes of the “at risk” patient. Kronzer and colleagues () should be congratulated on their original work, which will hopefully result in preoperative fall assessment becoming part routine clinical practice. This does however seem to be the beginning of a long line of investigation which may ultimately decrease the risk of postoperative falls and improve the surgical outcome of “at risk” patients. Disclosure
Development of the field of biorepository and biospecimen science has been shown to be a crucial tool for the development of biomarkers for health and disease and the development of testable hypotheses in clinical research (). The times when bio-specimens were tracked through laboratory notebooks and kept in a few freezers are over. Advances in epidemiology and omics science have led to a growth in national and international biobanks for regional healthy populations, or disease-specific populations of individuals to support large-scale research resources (). Specifically, the ease of processing blood derived plasma has favored the global spread of plasma biobanks. Plasma specimens lack the confounding factors associated with the cell release of proinflammatory cytokines and metabolites during clotting (), which has resulted in plasma being preferred over serum for protein abundance analyses (). Long-term stability of collected, stored plasma specimens is essential for longitudinal studies and for retrospective studies with specimens which have been for stored different periods. Large efforts have been made to collect carefully matched case and control cohorts, adjusting for non-disease related factors such as age and gender, or risk factors such as body mass index, weight and smoking. Also, plasma components have been found to change with storage time before separation and freezing, freezer storage time and number of freeze-thaw cycles (). While donor individual age has been shown to affect the plasma protein levels in many studies (), natural variables such as, time of day, weekday and general intra-individual variation which are also known to affect the variability and reproducibility of specimens stored in biobanks (), have not been previously studied for their contribution to the variability in large cohorts of specimens from biobanks. From monozygotic and dizygotic twin studies, it has been demonstrated that the levels of different plasma proteins show vastly different patterns of abundance variability among humans, and that genetic control and longitudinal variation affect protein levels and biological processes to different degrees (). However, the compounded heterogenic nature of genetic and environmental variables as well as changes in the circadian/seasonal cycles of protein levels affecting human plasma specimens available in biobanks has not allowed, as yet, the determination of the specific weight of these parameters in the context of protein stability in long-term stored plasma specimens.