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Backman C, Vaillancourt E, Chabot C, Joanisse J. Description of a Nurse Practitioner-Led Orthogeriatric Model of Care: A Health Record Review. Orthop Nurs 2024; 43:262-269. [PMID: 39321435 DOI: 10.1097/nor.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
Older adults often present with multiple comorbidities and face significant postoperative complications. This study aimed to describe the role of Nurse Practitioner (NP)-led orthogeriatric services in managing hip fracture patients. We conducted a review of health records of older adults with hip and proximal femoral fractures between July 2017 and June 2018, presenting descriptive statistics on patient characteristics, surgical outcomes, and the involvement of orthogeriatric services. A total of 197 participants were included, with a majority being female (n = 132; 67.0%). Most patients (53.8%; n = 106) had between five and nine pre-existing conditions. Among the 192 patients who underwent surgery, 69.8% (n = 134) experienced up to four surgical complications. The Nurse Practitioner provided care to 89.1% (n = 163) of the patients within the orthogeriatric service, with half of the patients (n = 82) requiring at least five NP interventions to manage complex pre- and postoperative needs. Refining the NP-led model could potentially help reduce the burden on physicians and surgeons in treating complex medical conditions, especially in settings where geriatricians may not be readily available.
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Affiliation(s)
- Chantal Backman
- Chantal Backman RN, MHA, PhD, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
- Emma Vaillancourt, RN, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
- Chantal Chabot, RN, MScN, NP, Hôpital Montfort, Ottawa, ON, Canada
- John Joanisse, MD, Institut du Savoir Montfort, Ottawa, ON, Canada; Hôpital Montfor, Ottawa, ON, Canada K1K 0T2
| | - Emma Vaillancourt
- Chantal Backman RN, MHA, PhD, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
- Emma Vaillancourt, RN, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
- Chantal Chabot, RN, MScN, NP, Hôpital Montfort, Ottawa, ON, Canada
- John Joanisse, MD, Institut du Savoir Montfort, Ottawa, ON, Canada; Hôpital Montfor, Ottawa, ON, Canada K1K 0T2
| | - Chantal Chabot
- Chantal Backman RN, MHA, PhD, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
- Emma Vaillancourt, RN, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
- Chantal Chabot, RN, MScN, NP, Hôpital Montfort, Ottawa, ON, Canada
- John Joanisse, MD, Institut du Savoir Montfort, Ottawa, ON, Canada; Hôpital Montfor, Ottawa, ON, Canada K1K 0T2
| | - John Joanisse
- Chantal Backman RN, MHA, PhD, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
- Emma Vaillancourt, RN, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
- Chantal Chabot, RN, MScN, NP, Hôpital Montfort, Ottawa, ON, Canada
- John Joanisse, MD, Institut du Savoir Montfort, Ottawa, ON, Canada; Hôpital Montfor, Ottawa, ON, Canada K1K 0T2
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Crowe S, Spence BG, Colley P. Enhancing orthopedic care: The impact of introducing nurse practitioners. Int J Orthop Trauma Nurs 2024; 54:101123. [PMID: 39053149 DOI: 10.1016/j.ijotn.2024.101123] [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: 04/10/2024] [Revised: 07/17/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Orthopedic surgery constitutes a significant portion of surgical interventions globally, driven by aging populations (Spence et al., 2019). Nurse practitioners (NPs) have emerged as essential team members in orthopedic surgery, offering expertise and advanced training. PURPOSE This paper describes a practice development initiative that saw the integration of NPs to the orthopedic team to provide postoperative care to patients undergoing hip and knee arthroplasty procedures. METHODS Aggregate data was collected from electronic health records and from online surveys. RESULTS Using descriptive and inferential statistics our data analysis revealed significant improvements post-NP implementation. Monthly surgeries increased by 41.6%, indicating enhanced access to care. The average length of stay decreased statistically for both hip and knee surgeries (p < 0.001), resulting in substantial cost savings and streamlined resource utilization. The readmission rate post-discharge also decreased by 41.6%, reflecting improved continuity of care facilitated by NPs. Surveys among healthcare staff demonstrated positive feedback regarding NP integration, highlighting improved accessibility, bed utilization, and timely treatment of medical issues. CONCLUSION This study underscores the multifaceted benefits of NP integration in orthopedic care, including enhanced patient outcomes, improved healthcare efficiency, and positive impacts on the healthcare team dynamics. Continued investment in NP programs in orthopedic settings is crucial for further optimizing care delivery and patient outcomes. Advocating for the expansion of the NP role in orthopedic surgery will contribute to elevating the standard of care in this specialty.
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Affiliation(s)
- Sarah Crowe
- Fraser Health Authority, Suite 400, Central City Tower 13450 102nd Avenue, Surrey, B.C., V3T 0H1, Canada.
| | - Brittany G Spence
- Burnaby Hospital, Fraser Health Authority, Suite 400, Central City Tower 13450 102nd Avenue, Surrey, B.C., V3T 0H1, Canada
| | - Pamela Colley
- Fraser Health Authority, Suite 400, Central City Tower 13450 102nd Avenue, Surrey, B.C., V3T 0H1, Canada
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Thomas L, Hadfield N, Munt R. Patient experience during their joint replacement journey: The role of the Orthopaedic Nurse Practitioner. Int J Orthop Trauma Nurs 2024; 54:101106. [PMID: 38768543 DOI: 10.1016/j.ijotn.2024.101106] [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: 03/17/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The benefits of the Nurse Practitioner role in acute care are known however, the patient's experience of having an Orthopaedic Nurse Practitioner involved in their joint replacement care is unknown. AIM This study aimed to explore the experience of patients undergoing a hip or knee joint replacement who had an Orthopaedic Nurse Practitioner involved in their care. METHODS This study used a qualitative descriptive design using semi-structured interviews with eleven participants. Data were analysed using Braun and Clark's six step reflexive thematic analysis framework. RESULTS Four themes emerged from the thematic analysis: 1) Information sharing and education; 2) Support throughout the journey; 3) Coordination of care, and 4) Reassurance. CONCLUSION The role of the Orthopaedic Nurse Practitioner in supporting participants throughout their joint replacement journey provided benefits for the patient's health and recovery.
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Affiliation(s)
- Lesley Thomas
- Central Adelaide Local Health Network, South Australia, Australia.
| | - Nicole Hadfield
- Central Adelaide Local Health Network, South Australia, Australia.
| | - Rebecca Munt
- Central Adelaide Local Health Network, South Australia, Australia.
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Neumann N, Peter F, Lenz R, Höhmann U, Knecht C, Heitmann D. [Advanced practice nurses in geriatric traumatology : A scoping review]. Z Gerontol Geriatr 2024; 57:302-307. [PMID: 37851091 DOI: 10.1007/s00391-023-02243-7] [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: 06/16/2023] [Accepted: 08/23/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Older and very old persons have an increased risk of traumatic injuries as well as comorbidities and multimorbidities. The standardized workflow in hospitals can increase the occurrence of typical geriatric complications, such as challenging behavior and delirium, which can result in highly complex care situations. The application of advanced practice nurses (APN) is an international response to such challenges. In Germany, the scientifically based development of APN has so far lagged behind the international standard. METHOD For this scoping review, a systematic search in the databases PubMed and CINAHL and a supplementary hand search was conducted for the period 2010-2022. RESULTS Tasks and role profiles for the scope of practice of APN in geriatrics and traumatology already exist in the literature. There is a lack of scientifically proven tasks and role profiles for APN in geriatric traumatology in the literature. DISCUSSION Based on the current state of research it is not yet possible to derive specific tasks and role profiles for APN in geriatric traumatology. The transferability of tasks and profiles from geriatrics and traumatology seem to be possible. The development of tasks and role profiles for geriatric traumatology APN requires further research, especially to identify the specific needs of geriatric traumatology patients.
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Affiliation(s)
- Naomi Neumann
- Evangelische Hochschule Rheinland-Westfalen-Lippe, Protestant University of Applied Sciences, Bochum, Deutschland.
| | - Frederike Peter
- Evangelische Hochschule Rheinland-Westfalen-Lippe, Protestant University of Applied Sciences, Bochum, Deutschland
| | - Reinhard Lenz
- Evangelische Hochschule Rheinland-Westfalen-Lippe, Protestant University of Applied Sciences, Bochum, Deutschland
| | - Ulrike Höhmann
- Universität Witten/Herdecke, Fakultät für Gesundheit, Department für Humanmedizin, Witten, Deutschland
| | | | - Dieter Heitmann
- Evangelische Hochschule Rheinland-Westfalen-Lippe, Protestant University of Applied Sciences, Bochum, Deutschland
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Pelletier B, Hoyt A. The Orthopaedic NP Workforce: Results From a Nationally Representative Survey. Orthop Nurs 2024; 43:32-40. [PMID: 38266262 DOI: 10.1097/nor.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Although a growing number of nurse practitioners (NPs) are practicing in orthopaedics, little is known about the workforce. The aim of this study was to estimate the size of the orthopaedic NP workforce, compare it with the workforce of primary care NPs, and investigate the interaction effect specialty NP practice and physician relationships have on NP role perception. We selected licensed, practicing orthopaedic and primary care NPs from the 2018 National Sample Survey of Registered Nurses and compared demographics, education, experience, functional autonomy, and job outcomes. Nationally, 2,796 NPs described their specialty as orthopaedics. Compared with primary care NPs, they spent 27% more time on care coordination, were half as likely to have their own patient panel, and were most likely to say that their NP education was fully utilized when in a collaborative relationship with physicians. Differences between orthopaedic and primary care NPs may call for reform of Consensus Model that currently places specialty practice outside its regulatory network.
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Affiliation(s)
- Brittany Pelletier
- Brittany Pelletier, AGPCNP-BC, ATC, Comprehensive Rehab Consultants, Boston, MA
- Alex Hoyt, PhD, RN, Associate Professor, School of Nursing, MGH Institute of Health Professions, Boston, MA
| | - Alex Hoyt
- Brittany Pelletier, AGPCNP-BC, ATC, Comprehensive Rehab Consultants, Boston, MA
- Alex Hoyt, PhD, RN, Associate Professor, School of Nursing, MGH Institute of Health Professions, Boston, MA
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Ayoub A, Zombre I, Backman C, Chantal C, Bédard D, Joanisse J. Staff perspectives of a nurse practitioner-led orthogeriatric model of care in a large academic hospital: A mixed methods study. Int J Orthop Trauma Nurs 2023; 49:101015. [PMID: 36989585 DOI: 10.1016/j.ijotn.2023.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Research has shown that models of care involving geriatric care in orthopedics decrease hospitalizations, mortality, length of stay and post-operative complications. This article presents an example of a nurse practitioner-led orthogeriatric model of care in a large academic hospital in Ontario. The overall goal was to explore staff perspectives regarding the nurse practitioner-led orthogeriatric model of care. METHODS We conducted a mixed methods approach consisting of an online questionnaire, semi-structured interviews, and a focus group with staff. RESULTS Questionnaire of staff showed overall support for functions of the NP within the model. Interviews with healthcare providers, and leadership as well as one focus group with orthopedic surgeons showed that despite the lack of formal awareness of the NP-led orthogeriatric model of care, staff felt that the model provided better care for the geriatric hip fracture population. CONCLUSION In the current context of geriatricians' shortages to provide post-surgical care to geriatric patients, the staff described that geriatric care of hip fracture patients can be well accomplished by a NP. Further improvement efforts to create better awareness of the NP-led orthogeriatric model among the care team is needed.
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Shared governance council to engage advanced practice registered nurses in a hospital setting. J Am Assoc Nurse Pract 2023; 35:163-169. [PMID: 36454953 DOI: 10.1097/jxx.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Health care organizations use advanced practice registered nurses (APRNs) to expand patient access and support high-quality care. However, turnover, often exacerbated by inadequate engagement, has steep financial and experiential costs. LOCAL PROBLEM The project site, a large urban academic institution with quaternary care capabilities, employs more than 300 APRNs to provide patient care. Due to variations in hiring entity, leadership structure, and organizational visibility, efforts to maintain APRN engagement were complex. In addition, inconsistencies in standardization of clinical, credentialing, and privileging procedures created organizational risk. METHODS Quality improvement principles informed the implementation of a shared governance council for APRNs that included nurse practitioners and certified registered nurse anesthetists. Data were collected pre and postintervention using validated engagement questions. INTERVENTION Implementation of a shared governance council to support the organizational engagement of APRNs through decisional involvement in professional practice issues. RESULTS Analysis included the percentage of change in aggregate scores and the Wilcoxon rank-sum test to obtain p values of the 2 independent samples. There was an 8.9% increase in aggregate postintervention scores and statistical improvement in measures of quality improvement involvement. CONCLUSION Participation in the shared governance council increased APRN engagement through enhanced opportunities to communicate professional and clinical practice issues, decisional involvement, and collaboration. Statistically significant improvements in quality improvement involvement values potentially affirm the council's role in facilitating work environment improvements. Potential long-term gains include improved job satisfaction, retention, and organizational cost savings.
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Maymi M, Madden M, Bauer C, Reuter-Rice K. Acute Care Pediatric Nurse Practitioner: The 2018 Practice Analysis. J Pediatr Health Care 2022; 36:e11-e21. [PMID: 34836734 DOI: 10.1016/j.pedhc.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study informed an update of the Certified Pediatric Nurse Practitioner - Acute Care (CPNP-AC) examination content outline. METHOD A descriptive analysis of a survey completed in 2018 by 373 pediatric nurse practitioners (PNP) practicing as an acute care role (AC). RESULTS Respondents were primarily females aged 25 to 34 years (35.4%) and formally educated as AC PNPs (84.2%) and held the CPNP-AC credential (98.9%). Most respondents (83.6%) practiced in urban areas and spent 84% of their time in direct patient care with 74% working in inpatient settings. The majority (87%) worked in subspecialty practice such as critical care (18.5%) and cardiac intensive care (12.3%). DISCUSSION This is the fourth practice analysis of the AC PNP role that demonstrates continuous evolution in clinical practice, educational preparation, and subspecialty practice distribution.
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Marley MA, Lambers A, Marley I, Welthy L, Seymour H. The Tyranny of Distance: How Hospital Transfer Affects Time to Surgery for Hip Fracture Patients. Cureus 2022; 14:e22662. [PMID: 35371764 PMCID: PMC8964482 DOI: 10.7759/cureus.22662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction In Western Australia, vast distances between hospitals can limit a patient’s access to timely surgical intervention. The aim was to examine the effect of patient location on outcomes. Methods Hip fracture data from all operative cases at the major Western Australian hospitals between 2015 and 2019 was retrospectively reviewed. A total of 5691 patients were separated into three groups based on hospital of first presentation - directly to the operative hospital (metropolitan), a hospital less than 2.5 hours by road from the operative centre (outer-metropolitan), or requiring transfer by air (rural). Impact of location on time to surgery, length of stay and 30-day and 120-day mortality was analysed. Results The mean time to surgery was 26.7 hours for metropolitan patients, 37.0 hours for outer-metropolitan, and 42.6 hours for rural patients. Outer-metropolitan patients were less likely to reach surgery within 48 hours than metropolitan patients (80.2% vs 91.5%, p<0.001), with even lower rates for rural patients (66.8%, p<0.001). Acute length of stay was longer for rural patients compared to outer-metropolitan (7.2 vs 5.8 days) and metropolitan patients (5.5 days) (p<0.001). There was no significant difference in 30-day or 120-day mortality for outer-metropolitan or rural patients compared to metropolitan patients despite requiring transfer. However, when considered as a whole group there was an increased 120-day mortality with increased time to surgery. Overall mortality was 8.7% at 30 days and 17.3% at 120 days. Conclusion Patients presenting outside the metropolitan area with a hip fracture have a longer time to surgery and longer length of stay. Delay for outer-metropolitan patients is disproportionately longer than transit time alone and may provide opportunities for improvement.
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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 Z, Chen X, Chen Y, Yang L, Wang H, Jiang W, Liu S, Liu Y. Association between admission serum calcium and hemoglobin in older patients with hip fracture: a cross-sectional study. Eur Geriatr Med 2021; 13:445-452. [PMID: 34595738 DOI: 10.1007/s41999-021-00569-2] [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: 07/30/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Serum calcium ion is an essential cofactor in the coagulation cascade, and low calcium concentration is associated with more bleeding in many diseases. This study aimed to describe the prevalence of hypocalcaemia, and investigate the correlation between calcium and hemoglobin (Hb) level in older patients with hip fracture. METHODS From our established hip fracture database, patients were consecutively included between January 2014 and December 2020. Serum calcium concentration was corrected for albumin level, and hypocalcaemia was defined as corrected calcium below the lower limit of reference range (< 2.11 mmol/L), and further sub-grouped into mild hypocalcaemia (1.90-2.11 mmol/L) and severe hypocalcaemia (< 1.90 mmol/L). Pearson correlation, scatter plots and partial correlation analyses were performed to evaluate the associations between various factors and Hb level. RESULTS A total of 1032 older patients with hip fracture were finally included (mean age 79.2 years, 66.0% female). At admission, the mean serum corrected calcium and Hb levels were 2.14 mmol/L and 11.0 g/dL. Overall, the prevalence of hypocalcaemia and anemia were 39.5% and 71.6%, respectively. After adjusting for all variables, low serum calcium concentration was positively associated with low Hb level in the total study (partial correlation r = 0.13, P < 0.001), as well as in patients with femur neck fracture (partial correlation r = 0.16, P = 0.001) and intertrochanteric fracture (partial correlation r = 0.13, P = 0.003). CONCLUSION Hypocalcaemia was common in older patients with hip fracture, and independently and positively associated with low Hb level. Further study on causal relationship between calcium and Hb level in older patients with hip fracture is necessary.
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Affiliation(s)
- Zhicong Wang
- Orthopedic Center of Deyang City, Department of Orthopedic Surgery, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Xi Chen
- Orthopedic Center of Deyang City, Department of Orthopedic Surgery, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Yan Chen
- Orthopedic Center of Deyang City, Department of Orthopedic Surgery, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Ling Yang
- Orthopedic Center of Deyang City, Department of Orthopedic Surgery, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Hong Wang
- Orthopedic Center of Deyang City, Department of Orthopedic Surgery, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Wei Jiang
- Orthopedic Center of Deyang City, Department of Orthopedic Surgery, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Shuping Liu
- Orthopedic Center of Deyang City, Department of Orthopedic Surgery, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China.
| | - Yuehong Liu
- Orthopedic Center of Deyang City, Department of Orthopedic Surgery, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China.
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Dehanne F, Gourdin M, Devleesschauwer B, Bihin B, Van Wilder P, Mareschal B, Leclercq P, Pirson M. Cost-DALY comparison of hip replacement care in 12 Belgian hospitals. BMJ Open Qual 2021; 10:bmjoq-2020-001263. [PMID: 34580082 PMCID: PMC8477339 DOI: 10.1136/bmjoq-2020-001263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/13/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In view of the expected increase in expenditure on hip replacement treatment in Belgium, the complication rate and potential waste reduction, as estimated by the Organisation for Economic Cooperation and Development, we are not yet in a position to assess the efficiency of hip replacement treatment in Belgian hospitals. This objective study uses a cost-disability-adjusted life years (DALYs) ratio to propose a comparison of hip replacement surgery among 12 Belgian hospitals. METHODS Our study seeks to innovate by proposing an interhospital comparison that simultaneously integrates the weighting of quality indicators and the costs of managing a patient. To this end, we associated a DALY impact with each patient safety indicator, readmission and mortality outcome. We then compared hospitals using both costs and DALYs adjusted to their case mix index. The adjusted values (costs and DALYs) were obtained by relating the observed value to the predicted value obtained from the linear regression model. RESULTS We registered a total of 246.5 DALYs for the 12 hospital institutions, the average cost (SD) of a stay being €8013 (€4304). Our model allowed us to identify hospitals with observed values higher than those predicted. Out of the 12 hospitals evaluated, 4 need to reduce costs and DALYs impacts, 6 have to improve one of the two factors and 2 appear to have good results. The costs for the worst performing hospitals can rise to over €150 000. CONCLUSION Evaluating the rates of patient safety indicators, associated with cost, is a prerequisite for quality and cost improvement efforts on the part of managers and practitioners. However, it appears essential to evaluate the entire care chain using a comparable unit of measurement. The hospital's case mix index must also be considered in benchmarking to avoid drawing the wrong conclusions. In addition, other indicators, such as the patient's perception of the actual results, should be added to our study.
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Affiliation(s)
- Fabian Dehanne
- General Management, CHU UCL Namur, Yvoir, Belgium .,ESP, ULB, Bruxelles, Belgium
| | | | | | - Benoit Bihin
- General Management, CHU UCL Namur, Yvoir, Belgium
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Hunt-O'Connor C, Moore Z, Patton D, Nugent L, Avsar P, O'Connor T. The effect of discharge planning on length of stay and readmission rates of older adults in acute hospitals: A systematic review and meta-analysis of systematic reviews. J Nurs Manag 2021; 29:2697-2706. [PMID: 34216502 DOI: 10.1111/jonm.13409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/30/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
AIM To examine the effectiveness of discharge planning on length of stay and readmission rates among older adults in acute hospitals. BACKGROUND Discharge planning takes place in all acute hospital settings in many forms. However, it is unclear how it contributes to reducing patient length of stay in hospital and readmission rates. METHODS Seven systematic reviews were identified and examined. All of the systematic reviews explored the impact of discharge planning on length of stay and readmission rates. RESULTS A limited meta-analysis of the results in relation to length of stay indicates positive finding for discharge planning as an intervention (MD = -0.71(95% CI -1.05,-0.37; p = .0001)). However, further analysis of the broader findings in relation to length of stay indicates inconclusive or mixed results. In relation to readmission rates both meta-analysis and narrative analysis point to a reduced risk for older people where discharge planning has taken place (RR = 0.78 (95% CI: 0.72, 0.84; p = .00001)). The ability to synthesize results however is severely hampered by the diversity of approaches to research in this area. IMPLICATIONS FOR NURSING MANAGEMENT It is unclear what impact discharge planning has on length of stay of older people. Indeed, while nurse mangers will be interested in gauging this impact on throughput and patient flow, it is questionable if length of stay is the correct outcome to measure when studying discharge planning as good discharge planning may increase length of stay. Readmission rates may be a more appropriate outcome measure but standardization of approach needs to be considered in this regard. This would assist nurse managers in assessing the impact of discharge planning processes.
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Affiliation(s)
- Caroline Hunt-O'Connor
- St James's Hospital, Dublin, Ireland.,RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland
| | - Zena Moore
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Lida Institute, Shanghai, China.,Faculty of Medicine and Health Sciences, UGent, Ghent University, Ghent, Belgium.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Declan Patton
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda Nugent
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia
| | - Pinar Avsar
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Tom O'Connor
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Lida Institute, Shanghai, China.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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14
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Abstract
BACKGROUND The aims of this article are to examine the scope of practice differences between physician assistant and nurse practitioner providers, to identify financial cost and benefits, and to posit the impact of physician extenders on plastic surgery practices. METHODS A review of the literature was performed using the PubMed database. Key words included "plastic surgery AND physician extender AND cost," "plastic surgery AND physician assistant AND cost," and "plastic surgery AND nurse practitioner AND cost." Secondarily, a search was performed for plastic surgery-related specialties of maxillofacial surgery, orthopedic surgery, and otolaryngology. Inclusion criteria consisted of any study design measuring the financial benefits associated with integrating physician extenders. RESULTS The PubMed search yielded 91 articles. Eight articles were ultimately included, of which four (plastic, maxillofacial, and orthopedic) discussed the impact of physician assistants and four (orthopedic and otolaryngology) discussed the impact of nurse practitioners. All eight studies demonstrated that integration of physician assistants and nurse practitioners into practices was associated with a net financial gain even after taking into account their overall costs, along with other outcomes such as productivity or time involvement. CONCLUSIONS As the number of physician extenders continues to grow, especially in subspecialties, plastic surgeons should be aware of their roles and the potentially positive impact of these providers, their respective training, and their quantifiable financial impact toward a plastic surgery practice. Both physician assistants and nurse practitioners appear to have a positive effect on costs in plastic surgery and plastic surgery-related practices.
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15
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Batty J. An evaluation of the role of the advanced nurse practitioner on an elective orthopaedic ward from the perspective of the multidisciplinary team. Int J Orthop Trauma Nurs 2021; 41:100821. [PMID: 33518437 DOI: 10.1016/j.ijotn.2020.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
AIM To evaluate the role of the advanced nurse practitioner on an elective orthopaedic ward from the perspective of the multidisciplinary team. BACKGROUND The development of advanced practice roles worldwide has been influenced by an ageing population with complex needs. There is evidence that these roles can have a positive impact in hospital settings, but little is known about the role of the ANP in an elective orthopaedic ward. DESIGN A qualitative evaluation study (n = 10). METHODS A purposive sample of 4 junior doctors and 6 nurses working on an elective orthopaedic ward was recruited. Participants were interviewed individually using semi-structured interviews. FINDINGS There were three overarching themes found from the analysis: 1) role identity, 2) a valued member of the team, and value-added care. The ANPs were identified as being part of the medical team, while their nursing background was valued. They provided continuity and clinical expertise to the ward team. They were perceived as being supportive and as working closely with the ward team. CONCLUSIONS The ANPs were perceived to deliver effective, person-centred care. The evaluation adds to the recognition that the ANP has a unique identity. The study adds to the limited literature on ANPs working on elective orthopaedic wards.
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Affiliation(s)
- Jane Batty
- Trauma and Orthopaedic Department, Great Western Hospital, Marlborough Road, Swindon, SN3 6BB, UK.
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16
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O'Rourke N. The orthopaedic nurse practitioner: Breaking tradition to fill gaps in care delivery through varied scopes of practice. Int J Orthop Trauma Nurs 2021; 44:100843. [PMID: 33478826 DOI: 10.1016/j.ijotn.2020.100843] [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: 05/03/2020] [Revised: 11/29/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Musculoskeletal conditions are the world's fourth largest burden of disease, accounting for more than 50% of chronic health conditions in the population aged >50 years (Briggs et al., 2016). This increasing burden is due to a progressively overweight, sedentary and ageing population and is often poorly recognised as a priority globally in an under-resourced health care system. This article reviews the current literature to identify where Orthopaedic Nurse Practitioners (ONPs) currently fill gaps in care delivery through varied scopes of practice in musculoskeletal trauma, degenerative disease, tumour and bone health. The varied scopes of practice include, fracture management, surgical assisting, performing surgical and/or advanced clinical procedures, prescribing treatment for bone health, conducting home visits and managing ONP led outpatient clinics. The article will outline current ONP roles in orthopaedic trauma, pain management, fragility hip fractures, osteoporosis, bone and soft tissue sarcoma and surgical assisting which effectively address long waiting lists, gaps in care delivery and reduce costs currently being managed by the health care system. METHOD A brief search of the literature published from January 2008-January 2020 on CINAHL, Cochrane Library, MEDLINE, Joanna Briggs Institute, Ovid, PubMed, Embase and Pro Quest databases was undertaken using key words Orthopaedic Nurse Practitioner, Advanced Practice Nurse (APN), musculoskeletal health, bone health, nurse-led and nurse specialist. CONCLUSION ONPs offer an innovative, viable and cost-effective solution to providing comparable, effective and efficient care with varied scopes of practice and valuable experience in both the inpatient and outpatient settings.
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17
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Allsop S, Morphet J, Lee S, Cook O. Exploring the roles of advanced practice nurses in the care of patients following fragility hip fracture: A systematic review. J Adv Nurs 2020; 77:2166-2184. [PMID: 33320350 DOI: 10.1111/jan.14692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022]
Abstract
AIM This study aimed to explore the role and impact of advanced practice nurses (APNs) in care of patients following fragility hip fracture by systematically reviewing the available evidence. REVIEW DESIGN Systematic review. DATA SOURCES A search of the databases Ovid Medline, CINAHL, Embase, Emcare, Cochrane Library, and Google Scholar was conducted from January-February 2019. METHOD This systematic review adhered to The PRISMA Statement. Study selection was managed using the Covidence software platform and quality was assessed using JBI Critical appraisal tools. Studies included adults >18 years and described the role and impact of APNs in care of patients following fragility hip fracture on clinical and non-clinical outcomes. RESULTS There were 19 papers identified that met the inclusion/exclusion criteria. Quality was graded as moderate to low risk of bias. Six characteristics of APNs were identified: (1) coordination; (2) collaboration; (3) education; (4) assessment, investigation and treatment recommendations; (5) discharge planning, support and follow up; and (6) documentation. Overall mortality and LOS improved when characteristics of the APN role were present. CONCLUSION Key findings from this systematic review showed: (1) The APN title and role are not clearly defined, but characteristics of the APN role are evident; (2) characteristics of APNs promote the delivery of best practice hip fracture care and have a positive impact on mortality and LOS; and (3) innovative service delivery models involving APNs should be considered to address future projections of hip fracture rates and improve outcomes. IMPACT This systematic review provides evidence of the role characteristics of APNs in fragility hip fracture and the impact of the role on outcomes. Findings from this research could be used to develop service delivery models using APNs to care for patients following fragility hip fracture and to inform practice where APN roles may improve outcomes for other patient cohorts.
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Affiliation(s)
- Sharon Allsop
- Nursing & Midwifery, Monash University, Frankston, Vic, Australia.,Peninsula Health, Frankston, Vic, Australia
| | - Julia Morphet
- Nursing & Midwifery, Monash University, Frankston, Vic, Australia
| | - Susan Lee
- Nursing & Midwifery, Monash University, Frankston, Vic, Australia
| | - Olivia Cook
- Nursing & Midwifery, Monash University, Frankston, Vic, Australia
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18
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Fülling T, Bula P, Defèr A, Bonnaire FA. Dresdener Network Osteoporosis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:438-446. [PMID: 32428959 DOI: 10.1055/a-1149-9588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE On a global scale the main focus of traumatological therapy lies in the treatment of unintentional injuries or victims of violence. People of all ages and through all economic groups can be affected. Due to demographic change in Western industrial countries, however, this focus increasingly shifts towards fragility fractures. In Europe osteoporosis is the most common bone disease in advanced age. Secondary prevention programs like the Fracture Liaison Service (FLS) are becoming increasingly prevalent, especially in Anglo-American health care systems. In German orthopedic and trauma wards and hospitals, however, the FLS is still relatively uncommon. This article will examine the question whether secondary prevention programs like FLS need to be established in the German health care system. This study aims at finding out, whether in the area of a medium sized German city there is a difference regarding the initiation of osteoporosis diagnosis and therapy between the regular aftercare by the general practitioner or the orthopedic surgeon and the aftercare by a specialist trained in osteology (Osteologe). MATERIALS AND METHODS For the open, randomized prospective study 70 patients with low energy fractures were recruited, who were older than 60 years and have been treated in our department. RESULTS 58 out of 70 patients have completed the study, which amounts to a follow-up of 82.9%. Limited mobility and a high degree of organizational effort were the main reasons for early termination of the study. While in the group with regular aftercare, only 2 out of 29 patients received a specific osteoporosis treatment, in group who were directly transferred to a specialist trained in osteology 17 out of 29 patients received specific treatment. After re-evaluation of group with regular aftercare in 21 out of 29 cases a specific osteoporosis treatment was recommended. CONCLUSIONS It could be established that there is a significant diagnosis and treatment gap regarding the aftercare of patients with fractures caused by osteoporosis between general practitioners or orthopedic surgeons on the one hand and the specialists trained in osteology on the other hand. To improve the aftercare of fracture patients, cross sectoral networks with a background in geriatrics and orthopedic-trauma surgery like a FLS need to be established in the German healthcare system.
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Affiliation(s)
- Tim Fülling
- Department of Trauma, Reconstructive and Hand Surgery, Dresden Municipal Hospital
| | - Philipp Bula
- Department of Trauma and Reconstructive Surgery, Orthopaedic, Plastic, Aesthetic and Hand Surgery, Gutersloh Municipal Hospital
| | | | - Felix Alois Bonnaire
- Department of Trauma, Reconstructive and Hand Surgery, Dresden Municipal Hospital
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19
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Zychowicz ME. A Day in the Life: Advanced Practice Nurses Providing Care to Patients with Musculoskeletal Conditions: Preparation, Role, and Impact. Nurs Clin North Am 2020; 55:163-174. [PMID: 32389251 DOI: 10.1016/j.cnur.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurse practitioners (NPs) play an increasingly greater role in the delivery of orthopedic patient care. NPs practice in a wide variety of orthopedic settings having a significant positive impact on orthopedic care delivery. Few formal educational outlets exist for training NPs for orthopedic care. Many new orthopedic NPs rely on continuing education and an apprenticeship model of learning "on the job" with their surgeon counterparts. This article describes the preparation, role, and impact that today's NPs have on orthopedic care delivery.
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Affiliation(s)
- Michael E Zychowicz
- Orthopedic NP Specialty, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA.
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20
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Boman E, Duvaland E, Gaarde K, Leary A, Fagerström L. Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies. J Adv Nurs 2020; 76:1069-1076. [DOI: 10.1111/jan.14299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- Department of Nursing Åland University of Applied Sciences Mariehamn Finland
| | | | - Kim Gaarde
- Drammen Hospital Vestre Viken HF Drammen Norway
| | - Alison Leary
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- School of Health and Social Care London South Bank University London UK
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- Faculty of Education and Welfare Studies Åbo Akademi University Vaasa Finland
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21
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Risk factors and complications contributing to mortality in elderly patients with fall-induced femoral fracture: A cross-sectional analysis based on trauma registry data of 2,407 patients. Int J Surg 2019; 66:48-52. [DOI: 10.1016/j.ijsu.2019.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/26/2019] [Accepted: 04/14/2019] [Indexed: 11/22/2022]
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22
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Möllers T, Stocker H, Wei W, Perna L, Brenner H. Length of hospital stay and dementia: A systematic review of observational studies. Int J Geriatr Psychiatry 2019; 34:8-21. [PMID: 30260050 DOI: 10.1002/gps.4993] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Hospitalizations of people with dementia (PWD) are often accompanied by complications or functional loss and can lead to adverse outcomes. Unsystematic findings suggest an influence of comorbidities on the extent of differences in the length of hospital stay (LOS). This systematic review aimed to identify and evaluate all studies reporting LOS in PWD as compared to PwoD in general hospitals. METHODS A systematic review of observational studies using PubMed and ISI Web of Knowledge. Inclusion criteria comprised original studies written in English or German, assessment of diagnosis of dementia, measurement of LOS, and comparison of people with and without dementia. RESULTS Fifty-two of 60 studies reported a longer hospitalization time for PWD compared to PwoD. The extent of the difference in LOS varied between and within countries as well as by type of primary morbidity (eg, injuries, cardiovascular diseases). The range of the LOS difference for studies without restriction to a primary morbidity was -2 to +22 days after matching or adjustment for a variable number and selection of potentially relevant covariates. For studies with injuries/fractures/medical procedures and infectious/vascular disease as the primary morbidity, the range was -2.9 to +12.4 and -11.2 to +21.8 days, respectively. CONCLUSIONS The majority of studies reported a longer hospitalization of PWD compared to PwoD. Length of hospital stay seems to be influenced by a variety of medical, social, organizational factors, including reasons for hospital admission, whose role should be explored in detail in further research.
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Affiliation(s)
- Tobias Möllers
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Stocker
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Wenjia Wei
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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23
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Taylor MA, Parekh SG. Optimizing Outpatient Total Ankle Replacement from Clinic to Pain Management. Orthop Clin North Am 2018; 49:541-551. [PMID: 30224015 DOI: 10.1016/j.ocl.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Outpatient total ankle arthroplasty is a potential significant source of cost savings. The ability to institute an effective outpatient total ankle program depends on appropriate patient selection, surgeon experience with total ankle replacement, addressing preoperative patient expectations, the involvement of an experienced multidisciplinary care team including experienced anesthesiologists, nurse navigators, recovery room nursing staff and physical therapists, and most importantly, such a program requires complete institutional logistical support.
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Affiliation(s)
- Michel A Taylor
- Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Fuqua School of Business, 100 Fuqua Drive, Durham, NC 27708, USA; North Carolina Orthopedic Clinic, 3609 Southwest Durham Drive, Durham, NC 27707, USA.
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