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Pimentel G, Cruz A, Lavareda Baixinho C, Loureiro M, Fernandes S, Ferreira RJO, Marques A. Assessment of rehabilitation nurses' knowledge and results of nurse educational programme (C2F) regarding osteoporosis and fragility fractures. Int J Orthop Trauma Nurs 2024; 54:101120. [PMID: 39059025 DOI: 10.1016/j.ijotn.2024.101120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Providing adequate care for the person with a fragility fracture is essential to prevent recurrences. A key strategy involves training by improving nursing care in the fields of osteoporosis and fragility fractures. However, in Portugal, there is no report on the level of knowledge of nurses, nor experimental studies on how to improve it. OBJECTIVE The study aimed to assess the knowledge of Rehabilitation Nurses in Portugal on osteoporosis and fragility fractures. Additionally, it sought to evaluate the impact of a specific educational programme on nurses' knowledge. METHODS In Phase I, a cross-sectional study involved 452 participants, utilizing a 26-question knowledge test. In Phase II, a quasi-experimental study included 42 nurses from 28 hospitals, subjected to a 30-h hybrid educational programme. The program comprised 9 online (2 h 30 min each) and 2 live sessions, covering assessment, pharmacological and non-pharmacological treatment, monitoring, project planning, consultations, and outcome indicators measurement. A before-and-after programme knowledge test was administered. RESULTS Phase I revealed an average knowledge score of 69.6%. In Phase II, there was a significant improvement with programme (70.4% vs. 85.8%, p < 0.01). Specialized nurses performed better than non-specialized nurses (80% vs. 75%, p = 0.011), and those from orthopaedic services showed the greatest improvement (92% vs. 83%, p = 0.014). CONCLUSIONS Rehabilitation Nurses in Portugal have room to improve their knowledge of osteoporosis and fragility fractures. The hybrid educational programme proved effective in improving nurses' knowledge, especially among specialist and orthopaedic service nurses. We hope that this knowledge can be translated into continuous improvement in healthcare provision.
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Affiliation(s)
- Georgina Pimentel
- Rheumatology Department, Unidade Local de Saúde de Coimbra, Coimbra, Portugal; Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal.
| | - Arménio Cruz
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal.
| | - Cristina Lavareda Baixinho
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal.
| | - Maria Loureiro
- Cardiothoracic Departament, Unidade Local de Saúde de Coimbra, Coimbra, Portugal; ICBAS - School of Medicine and Biomedical Sciences - U.Porto, CINTESIS - Center for Health Technology and Services Research, Portugal.
| | | | - Ricardo J O Ferreira
- Rheumatology Department, Unidade Local de Saúde de Coimbra, Coimbra, Portugal; Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal; Environmental Health Institute (ISAMB), Medicine School of University of Lisbon, Lisbon, Portugal; Centre for Nursing Research (NIE), Unidade Local de Saúde de Coimbra, a clinical unit of the Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; TERRA Associated Laboratory, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Andréa Marques
- Rheumatology Department, Unidade Local de Saúde de Coimbra, Coimbra, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal.
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Song M, Wang Y, Jiang Y, Pi H, Lyu H, Gao Y. Risk factors for subsequent fractures in hip fracture patients: a nested case-control study. J Orthop Surg Res 2024; 19:348. [PMID: 38867268 PMCID: PMC11167847 DOI: 10.1186/s13018-024-04833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The risk factors for subsequent fractures following an initial hip fracture are not entirely understood. This study examined the clinical characteristics of hip fracture patients to identify potential risk factors associated with a higher risk of experiencing subsequent fractures. METHODS We conducted a nested case-control study using data from the Chinese PLA General Hospital Hip Fracture Cohort between January 2008 and March 2022. The cases were individuals who experienced subsequent fractures following an initial hip fracture. Each case was matched with up to 2 controls who did not develop subsequent fractures. Important clinical factors were compared across groups, including traditional fracture risk factors and potential risk factors (e.g., comorbidities, falls risk, physical impairment, calcium or vitamin D use, and anti-osteoporosis medications). Conditional logistic regression analyses were used to evaluate the impact of these clinical features as potential risk factors for subsequent fractures. RESULTS A total of 96 individuals who suffered from subsequent fractures were matched with 176 controls. The median time between the initial hip fracture and the subsequent fracture was 2.1 years. The overall proportion of patients receiving anti-osteoporosis treatment after initial hip fracture was 25.7%. In the multivariable regression analysis, living in a care facility (OR = 3.78, 95%CI: 1.53-9.34), longer hospital stays (OR = 1.05, 95%CI: 1.00-1.11), and falls after discharge (OR = 7.58, 95%CI: 3.37-17.04) were associated with higher odds of subsequent fractures. CONCLUSIONS This study showed that living in a care facility, longer hospital stays, and falls after discharge may be independent risk factors for repeat fractures following an initial hip fracture. These findings could be used to identify and manage patients at high risk of subsequent fractures.
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Affiliation(s)
- Mi Song
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of nursing, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Yilin Wang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Yu Jiang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Hongying Pi
- Military Health Service Training Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Houchen Lyu
- Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Yuan Gao
- Department of nursing, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
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Goubar A, Martin F, Sackley C, Foster N, Ayis S, Gregson C, Cameron I, Walsh N, Sheehan K. Development and Validation of Multivariable Prediction Models for In-Hospital Death, 30-Day Death, and Change in Residence After Hip Fracture Surgery and the "Stratify-Hip" Algorithm. J Gerontol A Biol Sci Med Sci 2023; 78:1659-1668. [PMID: 36754375 PMCID: PMC10460557 DOI: 10.1093/gerona/glad053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND To develop and validate the stratify-hip algorithm (multivariable prediction models to predict those at low, medium, and high risk across in-hospital death, 30-day death, and residence change after hip fracture). METHODS Multivariable Fine-Gray and logistic regression of audit data linked to hospital records for older adults surgically treated for hip fracture in England/Wales 2011-14 (development n = 170 411) and 2015-16 (external validation, n = 90 102). Outcomes included time to in-hospital death, death at 30 days, and time to residence change. Predictors included age, sex, pre-fracture mobility, dementia, and pre-fracture residence (not for residence change). Model assumptions, performance, and sensitivity to missingness were assessed. Models were incorporated into the stratify-hip algorithm assigning patients to overall low (low risk across outcomes), medium (low death risk, medium/high risk of residence change), or high (high risk of in-hospital death, high/medium risk of 30-day death) risk. RESULTS For complete-case analysis, 6 780 of 141 158 patients (4.8%) died in-hospital, 8 693 of 149 258 patients (5.8%) died by 30 days, and 4 461 of 119 420 patients (3.7%) had residence change. Models demonstrated acceptable calibration (observed:expected ratio 0.90, 0.99, and 0.94), and discrimination (area under curve 73.1, 71.1, and 71.5; Brier score 5.7, 5.3, and 5.6) for in-hospital death, 30-day death, and residence change, respectively. Overall, 31%, 28%, and 41% of patients were assigned to overall low, medium, and high risk. External validation and missing data analyses elicited similar findings. The algorithm is available at https://stratifyhip.co.uk. CONCLUSIONS The current study developed and validated the stratify-hip algorithm as a new tool to risk stratify patients after hip fracture.
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Affiliation(s)
- Aicha Goubar
- School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Finbarr C Martin
- School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Catherine Sackley
- School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Nadine E Foster
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Salma Ayis
- School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and University of Sydney, Ryde, New South Wales, Australia
| | - Nicola E Walsh
- Centre for Health and Clinical Research, University of the West of England Bristol, Bristol, UK
| | - Katie J Sheehan
- School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
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Miedico M, Quattrini F, Attardo SE, Marchioni M, Bassi MC, Lucenti E, Sarli L, Guasconi M. The use of skin traction in the adult patients with proximal femur fracture. What are the effects, advantages and disadvantages? A scoping review. Int J Orthop Trauma Nurs 2023; 49:101004. [PMID: 36878122 DOI: 10.1016/j.ijotn.2023.101004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Hip surgery is normally the chosen therapy for proximal femur fractures. Surgery within 24-48 h after hip fracture is recommended, but surgery may not always be performed promptly. Consequently, skin-traction is applied to reduce complications. The purpose of this review is to assess both advantages and disadvantages of skin traction. METHODS A scoping review was conducted. The research question was: which are the effects of skin traction, its advantages and disadvantages in adult patients with proximal femur fractures hospitalised in orthopaedic wards? The search was done in the databases PubMed, CINAHL, Cochrane, Embase, DOAJ, ClinicalTrials.gov and OpenDissertation. RESULTS 9 records were included, skin traction effects were summarised in 7 categories: pain, pressure sores, comfort and relaxation, thromboembolism, damage from adhesive, complications and quality of care. The possible advantage is pain reduction between 24 and 60 h, the possible disadvantage is skin damage. DISCUSSION AND CONCLUSION The routine use of skin traction does not appear recommended, but more consistent evidence is necessary to make clinic decisions. Future RCTs could focus on the effects of skin traction 24-60 h after hospitalisation and before surgery.
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Affiliation(s)
- Melania Miedico
- "Azienda Unità Sanitaria Locale di Piacenza", Piacenza, Italy
| | - Fabrizio Quattrini
- "Azienda Unità Sanitaria Locale di Piacenza", Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy
| | | | | | - Maria Chiara Bassi
- "Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia", Reggio Emilia, Italy
| | - Enrico Lucenti
- "Azienda Unità Sanitaria Locale di Piacenza", Piacenza, Italy
| | - Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Massimo Guasconi
- "Azienda Unità Sanitaria Locale di Piacenza", Piacenza, Italy; University of Parma, Department of Medicine and Surgery, Parma, Italy.
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Li H, Hu Y, Gan L, Wang Y. Observation of the clinical effectiveness of evidence-based nursing for patients with a vertebral osteoporotic fracture. J Back Musculoskelet Rehabil 2022; 36:517-523. [PMID: 36404532 DOI: 10.3233/bmr-220161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An osteoporotic fracture (OPF) can significantly affect patients' activities of daily living (ADLs). OBJECTIVE This study observed the effects of evidence-based nursing (EBN) on the occurrence of postoperative complications and ADLs in patients with a vertebral OPF. METHODS A total of 90 patients with vertebral OPF were divided into two groups. The conventional orthopedic nursing method was conducted for the control group, and the EBN model was delivered for the observation group. RESULTS Differences in the Barthel index (BI) score on the first day of admission were not statistically significant between the two groups. The BI scores on the day before discharge, compared with the day of admission, had improved in both groups. The BI score on the day before discharge was 83.67 ± 6.94 in the observation group, and the difference was statistically significant (P< 0.05) compared with the control group (76.56 ± 6.89). The rate of satisfaction with nursing in the observation group (100.0%) was significantly higher than in the control group (82.2%) (P< 0.05). The incidence of postoperative complications in the observation group (2.2%) was significantly lower than in the control group (24.4%) (P< 0.05). CONCLUSIONS The implementation of EBN in patients with vertebral OPF improved the postoperative ADLs, reduced the incidence of postoperative complications, and improved the patients' satisfaction with nursing.
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Affiliation(s)
- Hui Li
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ying Hu
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lin Gan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - YiXuan Wang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Application of Multimode Health Education Combined with Humanistic Care in Pain Management of Patients with Femoral Fracture and Its Influence on VAS Score. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1242481. [PMID: 34938419 PMCID: PMC8687774 DOI: 10.1155/2021/1242481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Objective To explore the application of multimode health education combined with humanistic care in pain management of patients with femoral fracture and its influence on VAS score. Methods A total of 120 patients with femoral fracture admitted in our hospital (May 2017–May 2021) were selected as the research objects. The patients who received routine health education were included into the routine group, and the patients who received multimode health education combined with humanistic care were included into the combined group, with 60 cases in each group. The pain management effect of the two groups was compared after nursing intervention. Results No significant difference was found in age, BMI, fracture sites, gender, education degree, and residence between the two groups (P > 0.05). The awareness rate of health knowledge of the combined group was as high as 93.33%, which was obviously higher than that of the routine group (P < 0.05). Compared with the routine group, excellent rates of sitting durability and joint range of motion in the combined group were obviously higher (P < 0.05), and poor rates of sitting durability and joint range of motion in the combined group were obviously lower (P < 0.05). Compared with the routine group, VAS scores of the combined group at 1 d, 2 d, and 3 d after admission and at 1 d, 2 d, and 3 d after surgery were remarkably lower (P < 0.05). Compared with the routine group, compliance of exercise, medical waist belt using, and working posture of the combined group 1 week, 1 month, and 6 months after surgery was obviously higher (P < 0.05). Compared with the routine group, the scores of Rasmussen and Johner-Wruhs of the combined group 6 months after surgery were conspicuously higher (P < 0.05). Conclusion The application of multimode health education combined with humanistic care in pain management of patients with femoral fracture can effectively relieve pain, improve the awareness rate of health knowledge, promote the recovery of lower limb function, and enhance the prognosis of quality of life for patients.
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Wang M, Liang H, Cui L. Clinical practice of Best Practice Nursing Care Standards for Older Adults with Fragility Hip Fracture: A propensity score matched analysis. Appl Nurs Res 2021; 62:151491. [PMID: 34814995 DOI: 10.1016/j.apnr.2021.151491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fragility hip fracture (FHF) is a significant cause of morbidity and mortality in older adults. In 2018, Best Practice Nursing Care Standards for Older Adults with Fragility Hip Fracture (NSOF) were released by The International Collaboration of Orthopaedic Nursing (ICON). However, there are only limited clinical data about the application of this standard in clinical practice in China. AIMS To determine the clinical practice effect of the NSOF. METHODS A retrospective single-centre cohort study was performed from January 2016 to June 2020. Patients were divided into the standardized nursing care group (SN group) and the conventional nursing care group (CN group) depending on whether they were cared for according to the NSOF criteria. The propensity score matched (PSM) analysis was conducted in this study. The perioperative and follow-up outcomes between the two groups were analyzed. RESULTS A total of 204 patients diagnosed with FHF were included in the study. After a 1:1 matching, 56 cases were identified in the SN group as well as the CN group. Patients in the SN group had significantly shorter preoperative wait times for surgery (17.4 ± 4.6 vs. 24.4 ± 7.6 h, p < 0.05) and a higher proportion of individuals performing exercise within 24 h after surgery (94.6% vs. 66.1%, p < 0.05). Notably, patients in the SN group also had a significantly shorter length of stay than those in the CN group (9.4 ± 3.1 vs. 14.2 ± 5.1 days, p < 0.05). At the 6-month follow-up, the incidence of refracture was significantly lower (3.6% vs. 14.3%, p < 0.05), and the timed up and go mobility index was improved in the SN group compared to the CN group (20.3 ± 1.7 vs. 24.6 ± 2.2 s, p < 0.05). CONCLUSION This study showed that application of the NSOF resulted in a significant improvement in the treatment of older adults patients with FHF.
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Affiliation(s)
- Meng Wang
- Department of Traditional Chinese Medicine, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, China
| | - Hongyin Liang
- Department of General Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, China
| | - Lin Cui
- Department of Orthopedic, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, China.
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Delirium Triage Screen/Brief Confusion Assessment Method in Adult Orthopaedic and Hematological Patients: A Validation Study. Orthop Nurs 2021; 40:16-22. [PMID: 33492905 DOI: 10.1097/nor.0000000000000726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Delirium in the hospitalized orthopaedic patient is associated with numerous negative outcomes. Assessing for the presence of delirium using an accurate and reliable tool is essential. However, the number of validated screening tools is limited. The purpose of this study was to validate and test the reliability of the Delirium Triage Screening and brief Confusion Assessment Method (DTS/bCAM) to screen for delirium in non-intensive care (ICU) orthopaedic and hematological patients. This was a prospective, observational study. Seventy-six delirium assessments were completed on 19 orthopaedic patients and 10 hematological patients. The clinical nurse performed the DTS/bCAM during every 12-hour shift. Within 2 hours of this assessment, a research investigator performed both the DTS/bCAM and the Confusion Assessment Method (CAM). Each patient had a maximum of three assessments by a research investigator. Interrater reliability for the clinical nurse and the researcher was measured through comparison of positive and negative DTS/bCAM results. Validity was measured by comparing the matched DTS/bCAM and CAM results, both performed by the researcher. The DTS/bCAM and CAM results had 100% agreement. Two patients (7%) screened positive for delirium. Sensitivity of the DTS/bCAM was 100% (95% CI [15.8-100]) and specificity was 100% (95% CI [95.1, 100]). There was 86% agreement (43/50) between the clinical nurse and the researcher for the DTS/bCAM. In adult orthopaedic and hematological patients not receiving intensive care, the DTS/bCAM may be a valid, reliable, and rapid screening tool for delirium.
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Nursing in the Orthogeriatric Setting. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-48126-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Erickson KLB. Innovations in Care of the Elderly Hip Fracture Patient; a Nightmare No More. Nurs Clin North Am 2020; 55:149-161. [PMID: 32389250 DOI: 10.1016/j.cnur.2020.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hip fractures that occur in the elderly population continue to be a growing problem in communities. In this particular population, people 65 years and older, patients often have multiple comorbidities. These comorbidities cause challenges for a patient's optimization preoperatively and throughout the continuum of care. Although unplanned and traumatic, hip fracture patients can benefit from care organized in a comprehensive and standardized way. Having a hip fracture program that is driven by a multidisciplinary team approach has proved to decrease length of stay and promote positive outcomes for patients.
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Nutritional care of the older orthopaedic patient - A nursing priority and a collaborative effort. Int J Orthop Trauma Nurs 2020; 37:100775. [PMID: 32345530 DOI: 10.1016/j.ijotn.2020.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Archibald MM, Lawless M, Gill TK, Chehade MJ. Orthopaedic surgeons' perceptions of frailty and frailty screening. BMC Geriatr 2020; 20:17. [PMID: 31948387 PMCID: PMC6966824 DOI: 10.1186/s12877-019-1404-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/22/2019] [Indexed: 01/13/2023] Open
Abstract
Background Over the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts. Methods We used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior Consultants, and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation. Results Orthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used. Conclusions There is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.
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Affiliation(s)
- Mandy M Archibald
- for the Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia. .,University of Manitoba, College of Nursing, 99 Curry Pl, Winnipeg, MB, R3T 2M6, Canada. .,Flinders University, College of Nursing and Health Sciences, Bedford Park, SA, 5042, Australia.
| | - Michael Lawless
- for the Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia.,Flinders University, College of Nursing and Health Sciences, Bedford Park, SA, 5042, Australia
| | - Tiffany K Gill
- Adelaide Medical School, South Australian Health and Medical Research Institute, Level 7, North Tce, Adelaide, SA, 5000, Australia
| | - Mellick J Chehade
- for the Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia.,Discipline of Orthopaedics & Trauma, Royal Adelaide Hospital, The University of Adelaide, Level 4 Bice Building, Adelaide, SA, 5005, Australia
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Larsson G, Strömberg U, Rogmark C, Nilsdotter A. Cognitive status following a hip fracture and its association with postoperative mortality and activities of daily living: A prospective comparative study of two prehospital emergency care procedures. Int J Orthop Trauma Nurs 2019; 35:100705. [PMID: 31324592 DOI: 10.1016/j.ijotn.2019.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Early assessment of hip fracture patients' cognitive function is important for preventing pre- and postoperative complications. The aim of this study was twofold: (1) to assess prehospital cognitive function in hip fracture patients and establish whether cognitive status differs pre- and postoperatively between prehospital fast track care (PFTC) and the traditional emergency department (ED) pathway and (2) whether preoperative cognitive function is associated with postoperative mortality and activities of daily living (ADL) ability. METHODS Three hundred and ninety one hip fracture patients were prospectively included. The Short Portable Mental Status Questionnaire (SPMSQ) was used prehospital, at the orthopaedic ward and three days postoperatively. ADL was followed up after four months. RESULTS No difference in patients' cognitive function was observed between PFTC and ED. Four-month mortality was 37% for patients with dementia, 21% for those with cognitive impairment and 10% for patients without cognitive impariment. Only 26% of patients with dementia and 47% with cognitive impairment had full ADL ability, compared with 70% of patients with intact cognitive function (p < 0.001). CONCLUSION PFTC did not influence hip fracture patients' cognitive function. Patients with prehospital cognitive impairment had a poor outcome in terms of mortality and ADL, indicating the need for special care interventions.
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Affiliation(s)
- Glenn Larsson
- Department of Ambulance and Prehospital Care, Region Halland, Sweden; Department of Orthopaedics, Lund University, Sweden.
| | - Ulf Strömberg
- Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Sweden; Skane University Hospital, Malmö, Sweden
| | - Anna Nilsdotter
- Department of Orthopaedics, Lund University, Sweden; Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden
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Brent L, Hertz K, Costa M. Fragility fracture: A global call to action. Int J Orthop Trauma Nurs 2019; 32:1-2. [DOI: 10.1016/j.ijotn.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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