Identifying clinically relevant groups of hip fracture patients at risk of adverse outcomes by using classification tree analysis

Being active after hip fracture; older people's lived experiences of facilitators and barriers

Hip fracture (HF) incidents can severely restrict the activity and well-being of older people. While participation in activities may be related to lived experiences of meaningfulness, the aim of this study was to explore facilitators and barriers for being active as experienced by older people during the first six months after HF. The study used a phenomenological-hermeneutic methodology informed by the philosophies of Heidegger and Gadamer. Two men and 11 women with reduced functioning prior to the HF were interviewed 2 weeks (n=13) and again 6 months (n=11) after discharge. Referring to own pre-understanding including a theoretical framework of well-being, a method of meaning condensation was applied to structure the data. A deeper understanding was gradually achieved through a movement between the parts and the wholes. Two themes emerged: (1) "Inner dialogue and actions" with the sub-themes "Inner driving forces" and "Inner limitations"; (2) "Struggling and Striving" with the sub-themes "Building relationships" and "Considering complications and conditions". We conclude that facilitators for older people to experience well-being while being active involve meaningful relationships with other people, a sense of own identity and being at peace and may be influenced by relationships with staff, physical surroundings, public health services, and health problems.

Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis

BACKGROUND

Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery.

OBJECTIVES

The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.

DESIGN

Randomised controlled trial with cost-effectiveness analysis.

SETTING

The study was carried out at an orthopaedic department at a Swedish University Hospital.

METHODS

One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge.

RESULTS

Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI -6.9-11.6%) The patients in the intermittent catheterisation group were more often catheterised (p<0.001) and required more bladder scans (p<0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p<0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.

CONCLUSIONS

Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.