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Komoda H, Morita D, Nakayama T, Iwase T. Idiopathic normal pressure hydrocephalus possibly affects the occurrence of proximal femoral fracture. Orthop Traumatol Surg Res 2023; 109:103545. [PMID: 36623705 DOI: 10.1016/j.otsr.2023.103545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023]
Abstract
AIMS The clinical triad of idiopathic normal pressure hydrocephalus (iNPH) includes gait disturbance, dementia, and urinary incontinence. These symptoms are also frequently observed in patients with proximal femoral fracture (PFF). The aim of this study was to investigate the relationship between PFF and iNPH retrospectively. PATIENTS AND METHODS Of the130 patients over 80-years-old with PFF included in this study, 48 were assigned to the PFF group. Forty-eight patients with peripheral vertigo matched with the PFF group for age and sex were included in the control group. We compared the Evans' index (EI), which is a head computed tomography finding of iNPH, and the percentages of patients with EI>0.3 between the two groups. The PFF group was further divided into two subgroups depending on whether EI was higher or lower than 0.3 (the higher or lower subgroup, respectively). We compared the patient's gait abilities before PFF, causes of PFF, cognitive functions, and occurrence of urinary incontinence between both groups. RESULTS The mean value of EI in the PFF group was significantly higher than that in the control group (PFF group, 0.301; control group, 0.284; p=0.008). The percentages of patients with EI>0.3 in the PFF and control groups were 62.5% and 35.4%, respectively (p=0.014). In subgroup analyses, the gait ability before injury was worse in the higher subgroup than that in the lower subgroup and was prominent among individuals who could walk only with human assistance (p=0.018). There were no significant differences in other parameters. CONCLUSION Elderly patients with PFF may have underlying idiopathic normal pressure hydrocephalus. LEVEL OF EVIDENCE III; case-control comparative study.
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Affiliation(s)
- Hidenori Komoda
- Department of Orthopedic surgery, Hamamatsu medical center, Shizuoka, Japan
| | - Daigo Morita
- Department of Orthopedic surgery, Hamamatsu medical center, Shizuoka, Japan.
| | - Teiji Nakayama
- Department of Neurosurgery, Hamamatsu medical center, Shizuoka, Japan
| | - Toshiki Iwase
- Department of Orthopedic surgery, Hamamatsu medical center, Shizuoka, Japan
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2
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Holvik K, Ellingsen CL, Solbakken SM, Finnes TE, Talsnes O, Grimnes G, Tell GS, Søgaard AJ, Meyer HE. Cause-specific excess mortality after hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). BMC Geriatr 2023; 23:201. [PMID: 36997876 PMCID: PMC10064567 DOI: 10.1186/s12877-023-03910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Information on cause of death may help appraise the degree to which the high excess mortality after hip fracture reflects pre-existing comorbidities or the injury itself. We aimed to describe causes of death and cause-specific excess mortality through the first year after hip fracture. METHODS For studying the distribution of causes of death by time after hip fracture, we calculated age-adjusted cause-specific mortality at 1, 3, 6 and 12 months in patients hospitalized with hip fracture in Norway 1999-2016. Underlying causes of death were obtained from the Norwegian Cause of Death Registry and grouped by the European Shortlist for Causes of Death. For estimating excess mortality, we performed flexible parametric survival analyses comparing mortality hazard in patients with hip fracture (2002-2017) with that of age- and sex matched controls drawn from the Population and Housing Census 2001. RESULTS Of 146,132 Norwegians with a first hip fracture, a total of 35,498 (24.3%) died within one year. By 30 days post-fracture, external causes (mainly the fall causing the fracture) were the underlying cause for 53.8% of deaths, followed by circulatory diseases (19.8%), neoplasms (9.4%), respiratory diseases (5.7%), mental and behavioural disorders (2.0%) and diseases of the nervous system (1.3%). By one-year post-fracture, external causes and circulatory diseases together accounted for approximately half of deaths (26.1% and 27.0%, respectively). In the period 2002-2017, cause-specific one-year relative mortality hazard in hip fracture patients vs. population controls ranged from 1.5 for circulatory diseases to 2.5 for diseases of the nervous system in women, and correspondingly, from 2.4 to 5.3 in men. CONCLUSIONS Hip fractures entail high excess mortality from all major causes of death. However, the traumatic injury of a hip fracture is the most frequently reported underlying cause of death among older patients who survive less than one year after their fracture.
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Affiliation(s)
- Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, P. O. Box 222, Skøyen, Oslo, 0213, Norway.
| | - Christian Lycke Ellingsen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Siri Marie Solbakken
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, P. O. Box 222, Skøyen, Oslo, 0213, Norway
| | - Trine Elisabeth Finnes
- Department of Endocrinology, Innlandet Hospital Trust, Hamar, Norway
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Ove Talsnes
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
- Department of Orthopedics, Innlandet Hospital Trust, Elverum, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne-Johanne Søgaard
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, P. O. Box 222, Skøyen, Oslo, 0213, Norway
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, P. O. Box 222, Skøyen, Oslo, 0213, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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Does a bicycle accident as the cause of proximal femur fracture indicate that geriatric co-management is superfluous? A retrospective cohort study. Eur Rev Aging Phys Act 2023; 20:3. [PMID: 36864405 PMCID: PMC9979461 DOI: 10.1186/s11556-023-00315-6] [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: 11/08/2022] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Deployment of geriatric care would be more sustainable if we could limit geriatric co-management to older hip fracture patients who benefit most from it. We assumed that riding a bicycle is a proxy of good health and hypothesized that older patients with a hip fracture due to a bicycle accident have a more favorable prognosis than patients whose hip fracture was caused by another type of accident. METHODS Retrospective cohort study of hip fracture patients ≥ 70 years admitted to hospital. Nursing home residents were excluded. Primary outcome was length of hospital stay (LOS). Secondary outcomes were delirium, infection, blood transfusion, intensive care unit stay and death during hospitalization. The group with a bicycle accident (BA) was compared to the non-bicycle accident (NBA) group using linear and logistic regression models, with correction for age and sex. RESULTS Of the 875 patients included, 102 (11.7%) had a bicycle accident. BA patients were younger (79.8 versus 83.9 years, p < 0.001), less often female (54.9 versus 71.2%, p = 0.001) and lived independently more often (100 versus 85.1%, p < 0.001). Median LOS in the BA group was 0.91 times the median LOS in the NBA group (p = 0.125). For none of the secondary outcomes the odds ratio favored the BA group, except for infection during hospital stay (OR = 0.53, 95%CI 0.28-0.99; p = 0.048). CONCLUSIONS Although older hip fracture patients who had a bicycle accident appeared more healthy than other older hip fracture patients, their clinical course was not more favorable. Based on this study, a bicycle accident is not an indicator that geriatric co-management can be omitted.
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Yau L, Soutter K, Ekegren C, Hill KD, Ashe M, Soh SE. Adherence to Exercise Programs in Community-Dwelling Older Adults Postdischarge for Hip Fracture: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2022; 103:1827-1838.e2. [PMID: 35143745 DOI: 10.1016/j.apmr.2022.01.145] [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: 09/30/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether older adults adhere to exercise programs after discharge for hip fracture and how adherence relates to exercise program characteristics and intervention efficacy. DATA SOURCES Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, Embase, Physiotherapy Evidence Database, Web of Science, SPORTDiscus, PsycINFO, PubMed, and Ovid MEDLINE were searched from inception to August 2020. STUDY SELECTION Randomized controlled trials of exercise interventions in adults older than 60 years with a surgically managed hip fracture that provided a measure of adherence were selected by 2 independent reviewers. DATA EXTRACTION Data were extracted independently by 1 reviewer and cross-checked by a second reviewer for accuracy. Risk of bias was assessed with 2 tools: a customized checklist was used to examine sources of bias and ambiguity for adherence data, and the Cochrane Risk of Bias tool was used to assess the interval validity of studies. DATA SYNTHESIS Seventeen trials with 1850 participants (mean age, 78.8 years) were included in the review. The pooled estimate of adherence to exercise programs post hip fracture was 0.88 (95% CI, 0.78-0.95). Programs that were more than 6 months in duration were associated with a decrease in adherence (odds ratio, 0.29; 95% CI, 0.11-0.77). However, increased adherence was not associated with improvements in functional outcomes. None of the other program characteristics were associated with improvements in functional outcomes. CONCLUSIONS Adherence to exercise programs after hip fracture appears to be high and may be related to program duration. However, there is a need for a standardized approach to measure and report adherence data in future studies to determine whether exercise adherence is associated with improvements in function for this population.
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Affiliation(s)
- Lucinda Yau
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Kate Soutter
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Christina Ekegren
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Maureen Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Physiotherapy, Monash University, Melbourne, Australia.
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Prommik P, Tootsi K, Veske K, Strauss E, Saluse T, Kolk H, Märtson A. Isolated greater trochanter fracture may impose a comparable risk on older patients' survival as a conventional hip fracture: a population-wide cohort study. BMC Musculoskelet Disord 2022; 23:394. [PMID: 35477499 PMCID: PMC9044808 DOI: 10.1186/s12891-022-05336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, IGT’s effect on mortality is unknown, and its best management strategies are unclear. This study aims to compare these patient populations, their acute- and post-acute care, physical and occupational therapy use, and up to three-year mortality. Methods This retrospective cohort study is based on population-wide data of Estonia, where routine IGT management is non-operative and includes immediate weight-bearing as tolerated. The study included patients aged ≥ 50 years with a validated index HF or IGT diagnosis between 2009–2017. The fracture populations’ acute- and post-acute care, one-year physical and occupational therapy use and three-year mortality were compared. Results A total of 0.4% (50/11,541) of included patients had an IGT. The baseline characteristics of the fracture cohorts showed a close resemblance, but the IGT patients received substantially less care. Adjusted analyses showed that the IGT patients’ acute care was 4.5 days [3.4; 5.3] shorter they had 39.2 percentage points [25.5; 52.8] lower probability for receiving post-acute care, and they had 50 percentage points [5.5: 36]] lower probability for receiving physical and occupational therapy. The IGT and HF patients’ mortality rates were comparable, being 4% and 9% for one month, 28% and 31% for one year, and 46% and 49% for three years, respectively. Crude and adjusted analyses could not find significant differences in their three-year mortality, showing a p-value of 0.6 and a hazard ratio of 0.9 [0.6; 1.3] for the IGT patients, retrospectively. Conclusions Despite IGT being a relatively minor injury, the evidence from this study suggests that it may impose a comparable risk on older patients’ survival, as does HF due to the close resemblance of the two fracture populations. Therefore, IGT in older patients may signify an underlying need for broad-based medical attention, ensuring need-based, ongoing, coordinated care. Trial registration Retrospectively registered.
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Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia.
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Karin Veske
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Eiki Strauss
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Toomas Saluse
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, L. Puusepa 8, 50406, Tartu, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, L. Puusepa 8, 50406, Tartu, Estonia
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6
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Prommik P, Tootsi K, Saluse T, Märtson A, Kolk H. Nonoperative hip fracture management practices and patient survival compared to surgical care: an analysis of Estonian population-wide data. Arch Osteoporos 2021; 16:101. [PMID: 34173061 DOI: 10.1007/s11657-021-00973-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED A notable proportion of hip fracture patients receive nonoperative management, but such practice is seldom analysed. Although highly variable reasons underpin hip fracture nonoperative management, none of these practices conclusively outweigh the superiority of operative management. Nonoperative management should be only considered when surgery is not an option. PURPOSE Reasons underpinning hip fracture (HF) nonoperative management (NOM) are seldom analysed. This study aims to identify the reasons behind NOM and assess the accuracy of these decisions using these patients' survival compared with those treated with operative management (OM). METHODS This is a retrospective cohort study based on population-wide administrative health data, including patients aged ≥ 50 with an index HF diagnosis between January 2009 and September 2017. NOM patients were subgrouped according to their expected prognoses, and their survival up to 36 months was compared with those treated surgically. RESULTS From a total of 11,210 included patients, 6.8% (766) received NOM. Varying reasons lead to NOM, dividing them further into five distinct subgroups: (I) 46% NOM decision due to poor expected prognosis with OM; (II) 29% NOM decision due to poor expected prognosis for mixed reasons; (III) 15% NOM decision due to good expected prognosis with NOM; (IV) 8.0% NOM decision due to patient's refusal of OM; and (V) 1.3% NOM decision due to occult HF. Only poor prognosis and patients who refused OM (I, II, IV) had worse survival than OM patients. However, a relatively high proportion of the poor prognosis patients survived 1 year (29%). CONCLUSION Although there was high variability in reasons underpinning HF NOM, none of these practices conclusively outweigh OM's superiority. NOM should be considered with utmost care and only for patients for whom OM is out of the question - well-defined medical unfitness or carefully considered refusal by understanding the increased mortality risk.
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Affiliation(s)
- Pärt Prommik
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia.
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia.
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Tartu, Estonia.
| | - Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
| | - Toomas Saluse
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
| | - Helgi Kolk
- Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia
- Traumatology and Orthopaedics Clinic, Tartu University Hospital, Tartu, Estonia
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7
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A bibliometric analysis of orthogeriatric care: top 50 articles. Eur J Trauma Emerg Surg 2021; 48:1673-1682. [PMID: 34114053 PMCID: PMC9192394 DOI: 10.1007/s00068-021-01715-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
Background Population is ageing and orthogeriatric care is an emerging research topic. Purpose This bibliometric review aims to provide an overview, to investigate the status and trends in research in the field of orthogeriatric care of the most influential literature. Methods From the Core Collection databases in the Thomson Reuters Web of Knowledge, the most influential original articles with reference to orthogeriatric care were identified in December 2020 using a multistep approach. A total of 50 articles were included and analysed in this bibliometric review. Results The 50 most cited articles were published between 1983 and 2017. The number of total citations per article ranged from 34 to 704 citations (mean citations per article: n = 93). Articles were published in 34 different journals between 1983 and 2017. In the majority of publications, geriatricians (62%) accounted for the first authorship, followed by others (20%) and (orthopaedic) surgeons (18%). Articles mostly originated from Europe (76%), followed by Asia–pacific (16%) and Northern America (8%). Key countries (UK, Sweden, and Spain) and key topic (hip fracture) are key drivers in the orthogeriatric research. The majority of articles reported about therapeutic studies (62%). Conclusion This bibliometric review acknowledges recent research. Orthogeriatric care is an emerging research topic in which surgeons have a potential to contribute and other topics such as intraoperative procedures, fractures other than hip fractures or elective surgery are related topics with the potential for widening the field to research.
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Dakhil S, Thingstad P, Frihagen F, Johnsen LG, Lydersen S, Skovlund E, Wyller TB, Sletvold O, Saltvedt I, Watne LO. Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials. BMC Geriatr 2021; 21:208. [PMID: 33765935 PMCID: PMC7992808 DOI: 10.1186/s12877-021-02152-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL). Methods This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery. Results Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points. Conclusions Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.
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Affiliation(s)
- Shams Dakhil
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frede Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lars Gunnar Johnsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Orthopedic Trauma Unit, Department of Orthopedic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Stian Lydersen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Sletvold
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Leiv Otto Watne
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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9
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Prieto-Moreno R, Ariza-Vega P, Ortiz-Piña M, Ashe MC, Romero-Ayuso D, Kristensen MT. Translation, Reliability and Validity of the Spanish Version of the Modified New Mobility Score (NMS-ES). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E723. [PMID: 33467712 PMCID: PMC7830379 DOI: 10.3390/ijerph18020723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
The New Mobility Score (NMS) is an easy to administer self-report measure of functional ability, and is used worldwide as a hip fracture (HF) score, but a Spanish version does not exist. The aim of the study is to translate NMS into Spanish, and to measure its inter-rater reliability, internal consistency, and concurrent validity in a sample of Spanish speaking patients with HF. A reliability and validity study with a sample of 60 adults, 65 years or older (46 women and 14 men; mean age 81.7 years) with a hip fracture admitted consecutively to the acute trauma service of the Health Campus Hospital of Granada. The participants were interviewed during the first week after surgery by an occupational therapist or a physiotherapist. The statistical test used for analysis were: Cronbach's α coefficient, McNemar-Bowker test, Bland-Altman plot, Spearman´s Rho, and Mann-Whitney U test. The Cronbach's α coefficient was 0.90. No inter-rater systematic differences were found. We noted significant associations between the Spanish Version of the Modified New Mobility Score (NMS-ES) and selected health outcomes: Age, cognition, pre-fracture function, and basic mobility. The NMS-ES is a reliable and valid instrument to assess pre-injury functional levels for patients with HF in Spanish speaking countries.
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Affiliation(s)
- Rafael Prieto-Moreno
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sport, University of Granada, 18011 Granada, Spain;
| | - Patrocinio Ariza-Vega
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (M.O.-P.); (D.R.-A.)
- Biohealth Research Institute, Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, 18016 Granada, Spain
| | - Mariana Ortiz-Piña
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (M.O.-P.); (D.R.-A.)
| | - Maureen C. Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Dulce Romero-Ayuso
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (M.O.-P.); (D.R.-A.)
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research—Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark;
- Institute of Clinical Medicine, University of Copenhagen, 2200 Nørrebro, Denmark
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10
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Bell JJ, Pulle RC, Lee HB, Ferrier R, Crouch A, Whitehouse SL. Diagnosis of overweight or obese malnutrition spells DOOM for hip fracture patients: A prospective audit. Clin Nutr 2020; 40:1905-1910. [PMID: 32994070 DOI: 10.1016/j.clnu.2020.09.003] [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] [Received: 10/29/2018] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS Crude diagnostic parameters such as BMI limit recognition of malnutrition in overweight and obese patients. This study applied a robust malnutrition diagnostic measure to investigate whether malnutrition impacts clinical outcomes in overweight or obese hip fracture inpatients. METHODS A prospective, consecutive 12-month audit of inpatients admitted to a dedicated hip fracture unit with a BMI of ≥25 for surgical intervention. Univariate and logistic regression analyses were performed to investigate the relationship of demographics (age, gender), comparative measures (type of fracture, Charlson Comorbidity Index (CCI) on admission, time to surgery, type of surgery and anaesthesia, nutrition status) and outcome measures (delirium, time to mobilise post-operatively, length of stay, 12-month mortality). Malnutrition was defined using the International Classification of Diseases, Tenth Revision - Australian Modification protein-energy malnutrition criteria. RESULTS 127 overweight or obese hip fracture patients for surgical intervention were included in analyses. Patients were predominantly older females (median 81.0, range 48-97 years; 66.9%). Malnutrition prevalence was not infrequent (18.3%) despite the median BMI of 28.3 (range 25.0-63.9). Mortality at 12-months (17.3%) was lower than routinely reported across broader hip fracture populations. Logistic regression modelling demonstrated that malnutrition increased the likelihood of 12-month mortality (OR: 4.47, 95% CI 1.27-15.77; p = 0.020), post-operative delirium (OR: 3.64, 95% CI 1.00 to 13.33; p = 0.051), and delayed post-operative mobility (OR: 3.29, 95% CI 1.05 to 10.31; p = 0.041), in overweight or obese hip fracture patients. Length of stay demonstrated poor association with all predictor measures. CONCLUSION Hip fracture patients who are both overweight or obese, and malnourished, have significantly and substantially worse clinical outcomes than their well-nourished, albeit overweight or obese, counterparts. Comprehensive nutrition assessment measures should be applied to all hip fracture inpatients to ensure appropriate clinical nutrition care is appropriately directed.
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Affiliation(s)
- Jack J Bell
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, 4072, Australia.
| | - Ranjeev C Pulle
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Hui Bing Lee
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia
| | - Rebecca Ferrier
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Alisa Crouch
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Sarah L Whitehouse
- Orthopaedic Research Unit, The Prince Charles Hospital and Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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11
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Rasmussen B, Nielsen CV, Uhrenfeldt L. Being active 1½ years after hip fracture: a qualitative interview study of aged adults' experiences of meaningfulness. BMC Geriatr 2020; 20:263. [PMID: 32727376 PMCID: PMC7391487 DOI: 10.1186/s12877-020-01666-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 07/22/2020] [Indexed: 01/29/2023] Open
Abstract
Background Being active is vital and a source of well-being. However, 18 months after hip fracture (HF), progress seems to have come to a halt. Aged adults may feel vulnerable, experiencing ongoing dependency and limited possibilities for socializing. How they experience the meaningfulness of being active during these circumstances is unknown. The aim of this study was to explore experiences of the meaningfulness of being active for aged adults 18 months after HF. Methods A phenomenological-hermeneutic methodology based on the philosophies of Heidegger and Gadamer was applied. Data were collected using individual interviews conducted in participants’ homes. The study was part of a longitudinal study, and three former interviews helped build trusting relationships with participants and focus the semi-structured interview guide. An existential theory of well-being and suffering considering health to be a balancing of mobility and dwelling was applied. Participants were nine aged adults 65 years or older with pre-fracture dependency included in the study 18 months earlier while still in hospital after HF. The interpretation was a process of analyzing data by moving between the parts and the whole as a means of gaining a deeper understanding and continuously testing pre-understandings. The analysis followed five steps: a) getting a sense of the whole b) delineating and condensing meaning units, c) interpreting meaning units, d) relating to study purpose, and e) developing themes and sub-themes. Results Two main themes emerged. The main-theme “Feeling the continuity of life “had four sub-themes: “Gratitude for present possibilities, ““Connected with earlier life-experience, ““Thoughtfully managing vulnerability, “and “Belonging with other people. “The main-theme “Feeling vulnerable “had two sub-themes: “Thwarted “and “Sad and regretting lost continuity in life.“. Conclusions Eighteen months after HF, aged adults seem to be struggling on their own to be active in meaningful ways. To maintain hope, relieve the strain in everyday life, and maintain a sense of safety and self-confidence, they may need help. However, to avoid suffering, there is a need to balance additional training and a struggle for progress with well-being experiences in terms of feeling gratitude, restoring a sense of normality, and feeling kinship with other people.
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Affiliation(s)
- Birgit Rasmussen
- Department of Physio and Occupational Therapy, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Bartholinsallé 2, 8000, Aarhus C, Denmark.,DEFACTUM, Aarhus, Central Denmark Region, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Lisbeth Uhrenfeldt
- Faculty of Nursing and Health Science, Nord University, Universitetsalléen 11, 8049, Bodø, Norway
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12
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Leer-Salvesen S, Dybvik E, Ranhoff AH, Husebø BL, Dahl OE, Engesæter LB, Gjertsen JE. Do direct oral anticoagulants (DOACs) cause delayed surgery, longer length of hospital stay, and poorer outcome for hip fracture patients? Eur Geriatr Med 2020; 11:563-569. [PMID: 32361891 PMCID: PMC7438280 DOI: 10.1007/s41999-020-00319-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/31/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The perioperative consequences of direct oral anticoagulants (DOACs) in hip fracture patients are not sufficiently investigated. The primary aim of this study was to determine whether DOAC-users have delayed surgery compared to non-users. Secondarily, we studied whether length of hospital stay, mortality, reoperations and bleeding complications were influenced by the use of DOAC. METHODS The medical records of 314 patients operated for a hip fracture between 2016 and 2017 in a single trauma center were assessed. Patients aged < 60 and patients using other forms of anticoagulation than DOACs were excluded. Patients were followed from admission to 6 months postoperatively. Surgical delay was defined as time from admission to surgery. Secondary outcomes included length of hospital stay, transfusion rates, perioperative bleeding loss, postoperative wound ooze, mortality and risk of reoperation. The use of general versus neuraxial anaesthesia was registered. Continuous outcomes were analysed using Students t test, while categorical outcomes were expressed by Odds ratios. RESULTS 47 hip fracture patients (15%) were using DOACs. No difference in surgical delay (29 vs 26 h, p = 0.26) or length of hospital stay (6.6 vs 6.1 days, p = 0.34) were found between DOAC-users and non-users. DOAC-users operated with neuraxial anaesthesia had longer surgical delay compared to DOAC-users operated with general anaesthesia (35 h vs 22 h, p < 0.001). Perioperative blood loss, transfusion rate, risk of bleeding complications and mortality were similar between groups. CONCLUSION Hip fracture patients using DOAC did not have increased surgical delay, length of stay or risk of reported bleeding complications than patients without anticoagulation prior to surgery. The increased surgical delay found for DOAC-users operated with neuraxial anaesthesia should be interpreted with caution.
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Affiliation(s)
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anette H Ranhoff
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Chronic Diseases and Aging, Norwegian Institute of Public Health, Oslo, Norway.,Diakonhjemmet Hospital, Oslo, Norway
| | | | - Ola E Dahl
- Innlandet Hospital Trust, Elverum, Norway.,Thrombosis Research Institute, London, UK
| | - Lars B Engesæter
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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13
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Dokken I, Brovold T, Hesseberg K. Reliability and validity of the Norwegian-language version of the elderly mobility scale in older hospitalised patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1857. [PMID: 32627335 DOI: 10.1002/pri.1857] [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: 10/31/2019] [Revised: 05/14/2020] [Accepted: 05/23/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE Reliable and valid assessment tools are needed to evaluate and predict physical function in older hospitalised patients. The purpose of this study was to determine the reliability and validity of the Norwegian-language version of the Elderly Mobility Scale (EMS-N) for use with geriatric patients. METHODS Fifty patients admitted to a medical ward in a hospital in Norway were included. The inclusion criteria were acute hospital admission because of medical issues, age ≥65 years and referred to a physiotherapist for a physical function review. The original version of the Elderly Mobility Scale (EMS) was translated from English to Norwegian before initiating this study. EMS-N was tested for internal consistency, test-retest reliability and criterion validity by using the short physical performance battery (SPPB) as the gold standard. Internal consistency was measured by Cronbach's alpha. Test-retest reliability was estimated by linear weighted kappa and the intra-class correlation coefficient (ICC). RESULTS The mean age of participants was 82 (range 65-95). The main admission diagnoses were acute functional decline (64%, n = 32) or acute infection (26%, n = 13). Internal consistency was estimated at 0.88. Test-retest reliability: six of the seven EMS-N items showed very good consistency, and the last item showed good consistency, ICC was estimated at 0.99. The standard error of measurement (SEM) reflected the absolute reliability, calculated at 0.52. The minimal detectable change (MDC) was calculated with 95 and 90% confidence intervals at 1.44 and 1.21, respectively. Criterion validity was calculated by a correlation analysis of the EMS-N and the SPPB. The rho value was estimated as 0.75, which corresponds to a high correlation and indicated good criterion validity. DISCUSSION EMS-N exhibited good internal consistency and good to very good test-retest reliability and criterion validity. EMS can safely be used as an assessment tool for hospitalised geriatric patients.
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Affiliation(s)
| | - Therese Brovold
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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14
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Smith A, Moon T, Pak T, Park B, Urman RD. Preoperative Anemia Treatment With Intravenous Iron in Patients Undergoing Major Orthopedic Surgery: A Systematic Review. Geriatr Orthop Surg Rehabil 2020; 11:2151459320935094. [PMID: 32637197 PMCID: PMC7323265 DOI: 10.1177/2151459320935094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Based upon the Third National Health and Nutrition Examination Survey data, iron deficiency anemia is the cause of at least 20% of cases of anemia in adults over the age of 65. This is especially relevant in patients undergoing major orthopedic surgery as substantial perioperative blood loss is possible, leading to a high rate of allogeneic blood transfusion in total hip replacements, total knee replacements, and hip fracture repairs. Significance The results of this systematic review may be of interest to clinicians and hospital administrators evaluating the clinical efficacy and cost effectiveness of intravenous (IV) iron administration prior to major orthopedic surgery. Materials and Methods The original studies considered for this review included patients who were over 18 years of age, undergoing major orthopedic surgery, and who received an IV iron treatment in the preoperative setting. A total of 1083 articles were identified and reviewed. After removing duplicates, 1031 publications were screened, and 105 full-text studies were assessed for eligibility. A total of 98 were excluded and 7 articles remained which met the criteria for this review. The primary outcome examined in the included studies was the allogeneic blood transfusion rate. The secondary areas of interest were changes in serum hemoglobin, morbidity and mortality, length of stay, and cost effectiveness. Results This systematic review found little evidence that IV iron therapy is effective at reducing transfusion in patients undergoing major orthopedic surgery. Conclusions We do not recommend preoperative IV iron therapy for all patients scheduled for major orthopedic surgery.
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Affiliation(s)
- Aaron Smith
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tiffany Moon
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taylor Pak
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian Park
- Department of Anesthesiology, Perioperative Pain and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative Pain and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Harvard Medical School, Boston, MA, USA
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15
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High variability in hip fracture post-acute care and dementia patients having worse chances of receiving rehabilitation: an analysis of population-based data from Estonia. Eur Geriatr Med 2020; 11:581-601. [PMID: 32564341 DOI: 10.1007/s41999-020-00348-5] [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] [Received: 01/09/2020] [Accepted: 06/07/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Rehabilitation is a fundamental part of hip fracture (HF) care; however, the best strategies are unclear. This study maps index HF patients' post-acute care (PAC) in Estonia and compares the PAC of patients with and without a diagnosis of dementia. METHODS A retrospective cohort study was conducted using validated population-based data from the Estonian Health Insurance Fund using inclusion criteria: age ≥ 50 years, International Classification of Diseases code (S72.0-2) indicating HF between 1 January 2009 and 30 September 2017, and the survival of PAC. The presence of dementia diagnosis was based on the 10th revision of the International Classification of Diseases codes. RESULTS A total of 8729 patients were included in the study, 11% of whom had a dementia diagnosis. The PAC of HF patients varied from extensive to no care: 8.7% received combined inpatient and outpatient care; 59% received hospital care (13% had a length of stay (LOS) > 6 weeks; 33% had LOS between 2-4 weeks, 14% had LOS < 2 weeks); 4% received only community-based care; 28% received no PAC. Physical therapy (PT) was received by 56% of patients and by 35% of those with dementia diagnosis. Dementia patients had 1.5-fold higher odds of not receiving PT. CONCLUSION In Estonia, the PAC after index HF varies from extensive to no care, and the provision of PT is limited and unequal, affecting dementia patients in particular. Thus, there is an urgent need to standardise index HF PAC by reviewing the resources of PT and developing effective rehabilitation practices.
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16
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Hagen G, Magnussen J, Tell G, Omsland T. Estimating the future burden of hip fractures in Norway. A NOREPOS study. Bone 2020; 131:115156. [PMID: 31760216 DOI: 10.1016/j.bone.2019.115156] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The incidence rate of hip fractures seems to be declining in many western countries. However, due to the ageing of the population, the number of fractures may still be on the rise. No papers so far have quantified the future burden of hip fractures in terms of both health loss (as measured in disability adjusted life years DALY) and costs. The purpose of this paper is to assess the future health and economic burden of hip fractures. METHODS We collected population projections from Statistics Norway up until the year 2040. The medium projection was used for the base case analysis. Fracture rates for 2008 were estimated based on information from the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) hip fracture database (NORHip), which includes information about all hip fractures in Norway. Future fracture rate was assumed to decline by 0.7% per year in the base case. We used the same assumptions as the global burden of disease project on years of remaining life and disability weights. Cost of hip fracture was based on the published literature. In sensitivity analyses, we assessed the impact of changing underlying assumptions on demographic change, development in hip fracture rate, assumed life expectancy and choice of disability weights. RESULTS Assuming a medium population growth and a continued decline in fracture rate, our estimates indicate that health lost to hip fractures will approximately double, from 32,850 DALYs in 2020 to 60,555 in 2040. Over the same period, costs are estimated to increase by 65%. Sensitivity analyses indicate that estimates are highly sensitive to assumptions on both population growth, fracture rate development, disability weights and assumed life expectancy. CONCLUSION The burden of hip fractures in terms of DALYs lost and cost incurred is likely to increase even if the fracture rate continues to decline.
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Affiliation(s)
- Gunhild Hagen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Jon Magnussen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Grethe Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone Omsland
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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17
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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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18
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Gallardo P, Clavel O. FRACTURA DE CADERA Y GERIATRÍA, UNA UNIÓN NECESARIA. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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19
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Kristoffersen MH, Dybvik E, Steihaug OM, Bartz-Johannesen CA, Martinsen MI, Ranhoff AH, Engesæter LB, Gjertsen JE. Validation of orthopaedic surgeons' assessment of cognitive function in patients with acute hip fracture. BMC Musculoskelet Disord 2019; 20:268. [PMID: 31153373 PMCID: PMC6545206 DOI: 10.1186/s12891-019-2633-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About one fourth of patients with hip fracture have cognitive impairment. These patients are at higher risk of surgical and medical complications and are often excluded from participating in clinical research. The aim of the present study was to investigate orthopaedic surgeons' ability to determine the cognitive status of patients with acute hip fracture and to compare the treatment given to patients with and without cognitive impairment. METHODS The cognitive function of 1474 hip fracture patients reported by the orthopaedic surgeons to the nationwide Norwegian Hip Fracture Register was compared with data registered in quality databases in two hospitals with orthogeriatric service on the same patients. Cognitive function registered in the quality databases was determined either by the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or by pre-fracture diagnosis of dementia. The information registered in the quality databases was defined as the reference standard. Cognitive function in the Norwegian Hip Fracture Register was reported as: Chronic cognitive impairment? "Yes", "Uncertain" or "No" by the orthopaedic surgeons. Sensitivity, specificity, negative and positive predictive values for chronic cognitive impairment reported to the Norwegian Hip Fracture Register by the orthopaedic surgeons was calculated. Baseline data and treatment of hip fractures in patients with and without cognitive impairment in the Norwegian Hip Fracture Register were compared. RESULTS Orthopaedic surgeons reported chronic cognitive impairment in 31% of the patients. Using documented dementia or IQCODE > 4.0 as the reference, this assessment of cognitive impairment by the orthopaedic surgeons had a sensitivity of 69%, a specificity of 90%, a positive predictive value of 78%, and a negative predictive value of 84% compared to information registered in the two hospital quality databases. There were no differences in type of hip fracture or type of surgical treatment by cognitive function. CONCLUSION The treatment of hip fractures was similar in patients with chronic cognitive impairment and cognitively well-functioning patients. The surgeons had an acceptable ability to identify and report chronic cognitive impairment in the peri-operative period, indicating that the Norwegian Hip Fracture Register is a valuable resource for future registry-based research also on hip fracture patients with chronic cognitive impairment.
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Affiliation(s)
- Målfrid Holen Kristoffersen
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway.
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway.
| | - Eva Dybvik
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway
| | | | | | | | - Anette Hylen Ranhoff
- Diakonhjemmet Hospital, Postboks 23 Vindern, N 0319, Oslo, Norway
- Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway
| | - Lars Birger Engesæter
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway
| | - Jan-Erik Gjertsen
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway
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20
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Harris MJ, Brovman EY, Urman RD. Clinical predictors of postoperative delirium, functional status, and mortality in geriatric patients undergoing non-elective surgery for hip fracture. J Clin Anesth 2019; 58:61-71. [PMID: 31100691 DOI: 10.1016/j.jclinane.2019.05.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 01/28/2023]
Abstract
STUDY OBJECTIVE To identify modifiable preoperative factors that might influence the morbidity and mortality associated with non-elective, inpatient hip fracture surgeries in the geriatric surgical population. DESIGN Retrospective database analysis from the American College of Surgeons National Surgical Quality Improvement Program Geriatric Surgery Pilot Project. SETTING Inpatient, perioperative. PATIENTS Geriatric patients undergoing surgery. INTERVENTIONS Non-elective hip repair surgery. MEASUREMENTS Preoperative demographic, medical, surgical, and anesthetic variables; post-operative rates of delirium, decline in functional status, and 30-day mortality. MAIN RESULTS The 1261 patients in this study were predominantly female (74%), white (89%), and non-Hispanic (92%). Ages were distributed across groups from 65 to over 90 years. Most patients were categorized as American Society of Anesthesiologists Physical Status class 3 (64%). General anesthesia (57%) was the most common anesthetic, followed by spinal (38%). Preoperative functional status was recorded in 79% as independent in activities of daily living (ADLs). About one third of patients had baseline dementia. Post-operatively, 42% experienced delirium, and most patients required partial or total assistance with ADLs (72% and 12%, respectively). Reoperation was required in 2.8% of cases. Mortality at 30 days was 5.0%. In the multivariable analysis, risk factors associated with post-operative delirium included dementia and lack of competency to sign consent. In the analysis for postoperative decline in functional status, the major risk factor was a history of falls, while emergently performed surgery was protective. The analysis for mortality at thirty days was under-powered. CONCLUSIONS Hip fractures remain a major source of morbidity in geriatric patients. Baseline dementia and inability to sign surgical consent are significant risk factors for adverse outcomes after hip fractures and should be considered in the informed consent process. Data from this study and currently ongoing randomized trials will help guide reductions in morbidity and mortality in this population.
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Affiliation(s)
- Mark J Harris
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Richard D Urman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States of America.
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21
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Interdisciplinary care of hip fractures.: Orthogeriatric models, alternative models, interdisciplinary teamwork. Best Pract Res Clin Rheumatol 2019; 33:205-226. [PMID: 31547979 DOI: 10.1016/j.berh.2019.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hip fractures are common among older people, and the prognosis is serious in terms of mobility, independence in daily life activities, and cognition, with 42% of patients never achieving the same function as before the fracture. Norway has the highest incidence of hip fractures, and the important tasks are to improve patient care and prevent new fractures. The aim was to develop Norwegian Guidelines for Interdisciplinary Care for Hip Fractures, which included models of care, organization, and clinical issues. These guidelines were based on review of the literature, including existing guidelines such as the NICE guidelines, as well as clinical experience of the members of the group, where consensus was reached after discussions. The guidelines focus on interdisciplinary patient management through a clinical pathway from admission to discharge. Here, we will present a shortened and internationally adapted version of these guidelines, which has newly been released.
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22
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Ariza-Vega P, Ortiz-Piña M, Mora-Traverso M, Martín-Martín L, Salazar-Graván S, Ashe MC. Development and Evaluation of a Post-Hip Fracture Instructional Workshop for Caregivers. J Geriatr Phys Ther 2019; 43:128-136. [PMID: 30913137 DOI: 10.1519/jpt.0000000000000230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE A hip fracture is an unexpected traumatic event. Caregivers of patients with an acute hip fracture have only short time to learn the new skills of postoperative care and handling of the patient. This sudden responsibility changes the life of the caregivers who perceive a higher level of preoccupation about the care of their family member/friend. The objective of this study was to develop and test feasibility for a post-hip fracture inpatient instructional workshop for caregivers of older adults with hip fracture and to establish their knowledge of hip fracture recovery and perceptions of the utility and satisfaction with the workshop. METHODS This 2-part study was conducted at the University Hospital of Granada, Spain, from September 2016 to April 2017. We invited caregivers of patients (60 years of age or older) hospitalized for a surgically treated fall-related hip fracture to attend an informational and skill development hospital-based workshop (60-90 minutes in duration) on postdischarge management strategies. Following the workshop, we invited caregivers to complete a questionnaire to obtain their knowledge about care after hip fracture and their perceived concerns. Furthermore, we requested that they provide feedback on workshop utility and satisfaction (0-10 points) and suggestions for improving the workshop. RESULTS AND DISCUSSION We delivered 42 workshops over an 8 month period. One hundred three caregivers attended the sessions and enrolled in the study, mean (SD) age: 52.1 (12.8) years. Sixty-nine percent of the caregivers were women. Caregivers' main concern was apprehension for delivering physical care to their family member/friend (75%), followed by lack of time (42%). Caregivers who were employed were 3.16 times as likely to be concerned about time availability to provide care for their family member/friend. The median (Q1, Q3) of both workshop utility and satisfaction was 10 (10, 10), minimum-maximum: 7 to 10. CONCLUSIONS Caregivers in this study stated that the workshop was useful and satisfactory. Because caregivers play such a vital role in recovery after hip fracture, providing knowledge and skill development as part of health care delivery may support more person-centered care.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital of Granada, Granada, Spain; Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain; and PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
| | - Mariana Ortiz-Piña
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Susana Salazar-Graván
- Orthopaedic Surgery and Traumatology Service, Health Campus Hospital, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada; and Centre for Hip Health and Mobility, Vancouver, Canada
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Ariza-Vega P, Mora-Traverso M, Ortiz-Piña M, Ashe MC, Kristensen MT. Translation, inter-rater reliability, agreement, and internal consistency of the Spanish version of the cumulated ambulation score in patients after hip fracture. Disabil Rehabil 2019; 42:2766-2771. [PMID: 30907173 DOI: 10.1080/09638288.2019.1577499] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose: To translate the Cumulated Ambulation Score into Spanish, and to examine its inter-rater reliability, agreement and internal consistency.Materials and Methods: Two occupational therapists independently used the Spanish version of the Cumulated Ambulation Score (three activities scored from 0-2 points) to assess 60 consecutive patients with hip fracture within the first post-surgery week at a traumatology service of a public hospital. We used linear weighted kappa (κ) statistics to determine inter-rater reliability, percent agreement to assess measurement error, Cronbach's α coefficient to establish the internal consistency, and the McNemar-Bowker test to evaluate for systematic between-rater differences.Results: The κ was ≥ 0.83 for the three individual activities and the total score, the percent agreement was ≥ 0.87, and Cronbach's α was 0.89 with no observed systematic between-rater difference.Conclusions: This study provides evidence for almost perfect inter-rater reliability, excellent internal consistency, and high percent agreement of the Spanish version of the Cumulated Ambulation Score. Due to the strong psychometric properties, and its ease of use, we suggest it be used in Spanish speaking countries to assess early basic mobility status of patients with hip fracture until independence is reached.Implications for rehabilitationThe Spanish version of the Cumulated Ambulation Score is a reliable outcome measure to assess basic mobility of patients with hip fracture.We suggest the Spanish version of the Cumulated Ambulation Score be used in Spanish speaking settings to indicate small changes in basic mobility of patients with hip fracture until an independent level is reached.The Spanish version of the Cumulated Ambulation Score can be used with a high reliability by experienced and inexperienced occupational therapists, corresponding to the already established reliability when used by physicians and physiotherapists.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain.,Department of Physiotherapy, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | | | - Maureen Celeste Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen, Denmark.,Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
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Abstract
A high proportion of patients with fragility fracture, mainly hip fracture, have a variable degree of comorbidity and show some degree of dependence in basic or more complex activities of daily living. Evaluating these patents following the geriatric concept of frailty, about one third of hip fracture patients may be categorised as frail with high risk of poor outcomes and prolonged length of stay, one third as not frail, and about one third with an intermediate condition. Due to the high vulnerability, combined with the hip fracture event and surgical repair procedures, a multidisciplinary approach that includes geriatric competencies becomes essential to improve short and long-term outcomes after hip fracture. A key element of an effective process of care is a true co-managed approach that applies quality standards and provides a fast-track pathway of care, minimises the time the patient spends in bed, and reduces postoperative complications by means of standardised procedures. The occurrence of a fragility fracture is the strongest risk factor for a subsequent fracture. Moreover, frail subjects have a further risk of fracture due to high risk of falls - related to loss of muscle mass, multiple illnesses, impaired balance and weakness. Thus, effective secondary prevention strategies are essential to reduce morbidity and mortality after hip fracture, and they are currently a standard task of orthogeriatric care. Fracture liaison services (FLS) are probably the most efficient way of addressing secondary prevention including the assessment of both bone health and falls risk. Therefore, the optimal management of frail patients with fragility fracture includes both orthogeriatric care and FLS, which are complementary to each other. Orthogeriatric collaboration is also powerful in influencing healthcare policy. British experience as well as that in Ireland, Australia and New Zealand, have shown that when two widely disparate specialisms say the same thing, they may achieve a fundamental shift in attitudes and behaviour of both managers and clinicians. Furthermore, a continuous real-time audit, at national level, is a powerful driver for change and better standards of care.
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Torvinen-Kiiskinen S, Tolppanen AM, Koponen M, Tanskanen A, Tiihonen J, Hartikainen S, Taipale H. Editorial: let's take a break from studying the PPI-fracture association-Authors' reply. Aliment Pharmacol Ther 2018; 47:1544-1545. [PMID: 29878435 DOI: 10.1111/apt.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- S Torvinen-Kiiskinen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - A-M Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern, Kuopio, Finland
| | - M Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - A Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - J Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - S Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - H Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Bielza R, Fuentes P, Blanco Díaz D, Moreno RV, Arias E, Neira M, Birghilescu AM, Sanjurjo J, Escalera J, Sanz-Rosa D, Thuissard IJ, Gómez Cerezo JF. [Assessment of clinical complications and their associated factors in hip-fracture patients in an Acute Geriatric Orthopaedic Unit]. Rev Esp Geriatr Gerontol 2018; 53:121-127. [PMID: 29486947 DOI: 10.1016/j.regg.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/13/2017] [Accepted: 01/04/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence of clinical complications in hip fracture (HF) patients is high and variable due to their heterogeneous nature. The aim of the study was to assess the clinical complications and their associated factors in HF patients admitted to the Orthopaedic Geriatric Unit of a 283 bed University Hospital. An average of 200 HF patients is attended yearly. MATERIAL AND METHODS A prospective, observational and analytical study was conducted on 383 consecutive patients admitted to the unit during the years 2013 and 2014. Clinical complications were defined according to recommendations supported by the AOTrauma Network (International Network of Traumatologists for the Study of Osteosynthesis). RESULTS A total of 273 patients (71.28%) showed some clinical complication. The main ones were, delirium (55.4%), renal failure (15.4%), and cardiac complications (12.3%). An ASA III-IV score of OR = 1.962 (95% CI; 1.040-3.704, P=.038), lower Barthel index at discharge (b = -3.572, 95% CI -0.866 to -0.104, P=.01), the increase in pre-operative stay (OR = 1.165, 95% CI 1.050-1.294, P=.004) and an increased length of stay (b = 2.663, 95% CI 3.522-0.325; P<.001) were factors associated with clinical complications. CONCLUSIONS Delirium, renal failure, and cardiac complications were the most frequent complications according the new recommendations. An ASA III-IV score, worse functional status at discharge, prolonged pre-operative period, and increased length of stay, were risk factors associated with clinical complications. Cardiac, pulmonary, and gastrointestinal complications were the main causes of mortality in the unit.
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Affiliation(s)
- Rafael Bielza
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España.
| | - Paola Fuentes
- Servicio de Geriatría, Hospital Naval A. Nef, Escuela de Medicina sede Viña del Mar, Facultad de Medicina, Universidad Andrés Bello, Viña del Mar, Valparaíso, Chile
| | - David Blanco Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Ricardo Vicente Moreno
- Servicio de Rehabilitación, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Estefanía Arias
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Marta Neira
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Ana M Birghilescu
- Área de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Jorge Sanjurjo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Javier Escalera
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - David Sanz-Rosa
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Israel J Thuissard
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Jorge F Gómez Cerezo
- Servicio de Medicina Interna-Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Departamento Clínico, Escuela de Biomedicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
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Mobility one week after a hip fracture – can it be predicted? Int J Orthop Trauma Nurs 2018; 29:3-9. [DOI: 10.1016/j.ijotn.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 10/09/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
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CORR Insights®: The Rothman Index is Associated With Postdischarge Adverse Events After Hip Fracture Surgery in Geriatric Patients. Clin Orthop Relat Res 2018; 476:1007-1009. [PMID: 29668557 PMCID: PMC5916620 DOI: 10.1097/01.blo.0000532689.78005.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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C. Ashe M, L. Ekegren C, M. Chudyk A, Fleig L, K. Gill T, Langford D, Martin-Martin L, Ariza-Vega P. Telerehabilitation for community-dwelling middle-aged and older adults after musculoskeletal trauma: A systematic review. AIMS MEDICAL SCIENCE 2018. [DOI: 10.3934/medsci.2018.4.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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30
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Nouraei MASc H, M. Chudyk A, L. Cook W, Guy P, Brasher P, H. Puyat J, C Ashe M. Recovery of physical function after hip fracture: Analysis of secondary outcomes from a randomized controlled trial. AIMS MEDICAL SCIENCE 2018. [DOI: 10.3934/medsci.2018.3.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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C. Ashe M, Merali K, Edwards N, Schiller C, M. Hanson H, Fleig L, M. Khan K, L. Cook W, A. McKay H. Integrating research into clinical practice for hip fracture rehabilitation: Implementation of a pragmatic RCT. AIMS MEDICAL SCIENCE 2018. [DOI: 10.3934/medsci.2018.2.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zusman EZ, Dawes MG, Edwards N, Ashe MC. A systematic review of evidence for older adults' sedentary behavior and physical activity after hip fracture. Clin Rehabil 2017; 32:679-691. [PMID: 29169245 DOI: 10.1177/0269215517741665] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesize evidence on older adults' sedentary behavior and physical activity during rehabilitation and recovery for hip fracture (1) across the care continuum and (2) from clinical interventions. DESIGN We conducted a systematic review of peer-reviewed publications using CINAHL, Embase, Ovid MEDLINE, PsycINFO, and SportDiscus (last search: 17 October 2017). STUDY SELECTION We included studies that measured sedentary behavior and physical activity of older adults with hip fracture using activity monitors (e.g. accelerometers). We identified literature at Level 1 (title and abstract) and Level 2 (full text), and conducted forward and backward searches. We assessed observational studies' adherence to reporting guidelines and intervention studies' risk of bias. RESULTS We included 14 studies (882 participants). Four studies reported sedentary behavior data, while all studies reported information on physical activity. Settings included hospital, rehabilitation centers, and the community. Nine studies were observational; five were experimental design. Older adults had excessive sedentary time (>10 hours/day) and low physical activity. Participants' average upright time differed across settings. During hospital stay, it ranged 16-52 minutes/day, while in the community, it ranged 51-261 minutes/day. Data from five interventions reported on physical activity change: two studies increased between 14 and 27 minutes/day. Another study reported participants accumulated 6994 steps/day at the end of the intervention, but for two other interventions, activity was below 5000 steps/day. CONCLUSION Based on available evidence, older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery.
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Affiliation(s)
- Enav Z Zusman
- 1 Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada.,2 Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
| | - Martin G Dawes
- 2 Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
| | - Nicola Edwards
- 1 Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
| | - Maureen C Ashe
- 1 Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada.,2 Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
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Association of comprehensive geriatric assessment with quality-related care practices during implementation and development of an orthogeriatric hip fracture program. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pajulammi HM, Pihlajamäki HK, Luukkaala TH, Jousmäki JJ, Jokipii PH, Nuotio MS. The Effect of an In-Hospital Comprehensive Geriatric Assessment on Short-Term Mortality During Orthogeriatric Hip Fracture Program-Which Patients Benefit the Most? Geriatr Orthop Surg Rehabil 2017; 8:183-191. [PMID: 29318079 PMCID: PMC5755836 DOI: 10.1177/2151458517716516] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/24/2017] [Accepted: 05/27/2017] [Indexed: 11/16/2022] Open
Abstract
Aims To examine the association of patient-related factors with the effect of an in-hospital comprehensive geriatric assessment (CGA) on hip fracture mortality. Methods Population-based, prospective data were collected on 1425 consecutive hip fracture patients aged ≥65 in a central hospital providing orthogeriatric service. Outcome was mortality at 1 month after hip fracture associated with receiving versus not receiving CGA. Results Of the patients receiving CGA compared to those who did not, 8.5% versus12.0% had died within 1 month of the hip fracture (P = .028). In the age- and sex-adjusted Cox proportional hazards model, CGA was associated with a decreased risk of 1-month mortality in patients aged 80 to 89 years (hazard ratio [HR] 0.46, 95% confidence interval [CI]: 0.29-0.73), females (HR: 0.57, 95% CI: 0.38-0.86), having American Society of Anesthesiologists (ASA) score 1 to 3 (HR: 0.60, 95% CI: 0.37-0.99), taking 4 to 10 daily medications (HR: 0.59, 95% CI: 0.38-0.91), with a diagnosis of memory disorder (HR: 0.50, 95% CI: 0.29-0.88), with an estimated glomerular filtration rate <30 mL/min/1.73m2 (HR: 0.28, 95% CI: 0.10-0.76), or living in an assisted living accommodation (HR: 0.40, 95% CI: 0.21-0.76). Conclusion Several modifiable and patient-related factors were associated with decreased risk of 1-month mortality when CGA was performed during hospitalization for hip fracture. Between "younger and fitter" and "oldest and frailest," there is a large group of hip fracture patients whose survival can be improved by in-hospital CGA.
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Affiliation(s)
- Hanna M Pajulammi
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Harri K Pihlajamäki
- Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland.,University of Tampere, Seinäjoki, Finland
| | - Tiina H Luukkaala
- Research and Innovation Center, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - Janne J Jousmäki
- Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pekka H Jokipii
- Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Complications after hip fracture surgery: are they preventable? Eur J Trauma Emerg Surg 2017; 44:573-580. [PMID: 28795198 PMCID: PMC6096618 DOI: 10.1007/s00068-017-0826-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/31/2017] [Indexed: 01/22/2023]
Abstract
Purpose Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention. Methods Prospective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality. Results The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97–2.35) and delay in surgery (OR 3.16; 95% CI 1.43–6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality. Conclusion The overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.
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Bernstein J, LeBrun D, MacCourt D, Ahn J. Presumed consent: licenses and limits inferred from the case of geriatric hip fractures. BMC Med Ethics 2017; 18:17. [PMID: 28235413 PMCID: PMC5324244 DOI: 10.1186/s12910-017-0180-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/17/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hip fractures are common and serious injuries in the geriatric population. Obtaining informed consent for surgery in geriatric patients can be difficult due to the high prevalence of comorbid cognitive impairment. Given that virtually all patients with hip fractures eventually undergo surgery, and given that delays in surgery are associated with increased mortality, we argue that there are select instances in which it may be ethically permissible, and indeed clinically preferable, to initiate surgical treatment in cognitively impaired patients under the doctrine of presumed consent. In this paper, we examine the boundaries of the license granted by presumed consent and use the example of geriatric hip fracture to build an ethical framework for understanding the doctrine of presumed consent. DISCUSSION The license to act under presumed consent requires three factors: patient incapacity, clinical urgency and clarity on the correct course of action. All three can apply to geriatric hip fracture. The typical patient frequently lacks capacity. Delays in initiating surgical treatment are associated with markedly increased mortality rates. Last, there appears to be consensus that surgery is the preferred treatment. Nonetheless, because there is a window of safe delay during which treating physicians can stabilize the patient, address reversible causes of cognitive impairment and identify surrogate decision makers, presumed consent should be invoked only as a method of last resort. CONCLUSIONS A medical situation need not be characterized by risk of imminent and certain death for presumed consent to be relevant. Rather, there are two distinct windows that must be considered: the time interval in which action may be delayed without danger, and the time interval needed to obtain a better form of consent. Presumed consent is appropriate only when the latter exceeds the former.
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Affiliation(s)
| | | | | | - Jaimo Ahn
- University of Pennsylvania, Philadelphia, USA
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Ruths S, Baste V, Bakken MS, Engesæter LB, Lie SA, Haugland S. Municipal resources and patient outcomes through the first year after a hip fracture. BMC Health Serv Res 2017; 17:144. [PMID: 28209152 PMCID: PMC5314693 DOI: 10.1186/s12913-017-2087-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip fractures represent major critical events for older people, and put huge demands on economic and personnel resources. Most hip fracture patients are in need of postoperative rehabilitation services. Through the Coordination Reform, the municipalities in Norway were given increased responsibility for community-based treatment and rehabilitation after surgery. The purpose of this study was to examine associations between municipal resources and patient outcomes through the first year after a hip fracture, focusing on survival and health-related quality of life. METHODS We conducted a nationwide cohort study on people experiencing a hip fracture in 2011-2012 in Norway, with a 1-year follow-up. We obtained data on date of hip fracture, demographics, total morbidity (ASA) score, health-related quality of life (EQ-5D-3 L), date of death if applicable, municipality of residence (Norwegian Hip Fracture Register), date of hospital readmission due to complications (Norwegian Patient Register), and information on municipalities' characteristics (Municipality-State-Reporting). RESULTS The study population comprised 15,757 patients, mean age 80.8 years, 68.6% women. All-cause mortality was 8.6% at 30 days, and 25.3% at 12 months. Mortality was lower in the municipalities with the highest overall staff time for rehabilitation. A high proportion of the population aged 80+, was associated with low rates of self-reported anxiety/depression 12 months after surgery, as well as higher general health scores (EQ-5D VAS). There were no other differences in outcome according to rehabilitation resources, when comparing municipalities with the highest and lowest staffing. CONCLUSION The study revealed no substantial impact of municipal resources on survival and health-related quality of life through the first year after a hip fracture. To evaluate major organizational changes and allocate resources according to best practice, there is a need to monitor health outcomes and use of resources over time through reliable measures, including variables related to coordination between services.
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Affiliation(s)
- Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | | | | | - Lars Birger Engesæter
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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Ritchie CS, Kelley AS, Stijacic Cenzer I, Smith AK, Wallhagen ML, Covinsky KE. High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture. J Pain Symptom Manage 2016; 52:533-538. [PMID: 27521282 PMCID: PMC5357076 DOI: 10.1016/j.jpainsymman.2016.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 06/27/2016] [Accepted: 07/29/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care. OBJECTIVES Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture. METHODS Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression. RESULTS Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls. CONCLUSIONS A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.
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Affiliation(s)
- Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Jewish Home of San Francisco Center for Research on Aging, San Francisco, California, USA.
| | - Amy S Kelley
- Icahn School of Medicine at Mount Sinai, New York, New York and the James J Peters VA Medical Center, Bronx, New York, USA
| | - Irena Stijacic Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA
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Gomes ECC, Marques APDO, Leal MCC, Barros BPD. [Factors associated with the danger of accidental falls among institutionalized elderly individuals: an integrative review]. CIENCIA & SAUDE COLETIVA 2016; 19:3543-51. [PMID: 25119093 DOI: 10.1590/1413-81232014198.16302013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/16/2013] [Indexed: 11/22/2022] Open
Abstract
The scope of this research is to identify the major risk factors associated with accidental falls among the elderly. It involves an integrative review of the literature between 2002 and 2012 in English and Portuguese. The selection of articles was based on the following key words in the Lilacs, Medline and BDENF databases: accidental falls, homes for the elderly and health services. In the final sample 19 articles were selected, of which 11 were national and 8 were international. They indicate that the major factors related to the risk of accidental falls in Homes for the Elderly are: being female, being diagnosed with chronic disease, treatment with benzodiazepine, earlier cases of accident falls, and mobility restriction. The research reveals that architectonic and furniture inadequacies in Homes for the Elderly may be predisposing factors for accidental falls. Analysis of the articles reveals the need for further longitudinal studies and, consequently, enhanced monitoring of the conditions of the functional capacity of the elderly, especially the risks related to falls, considered one of the leading causes of death among institutionalized elderly individuals.
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Bowers TM, Parker MJ. Assessment of outcome after hip fracture: development of a universal assessment system for hip fractures. SICOT J 2016; 2:27. [PMID: 27259572 PMCID: PMC4893153 DOI: 10.1051/sicotj/2016018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/20/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of the study was to refine current evaluation systems used to assess outcome after a hip fracture and to devise a simple and practical system to assess all hip fracture patients. METHODS Three continuous scales were defined for pain, mobility and functional independence. These were all found to have an acceptable degree of inter-observer agreement. The pre-fracture mobility and independence scores were related to the one-year mortality for a consecutive series of 381 patients. RESULTS Scores for mobility and functional independence were highly predictive of mortality (p < 0.0001). CONCLUSIONS It is recommended that the outcome after hip fracture should be standardised to these principle outcomes of pain, regain of mobility and independence and mortality. These scores can be use to assess progress and identify those who may require additional assessment or intervention.
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Affiliation(s)
| | - Martyn J. Parker
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Peterborough City Hospital, Edith Cavell Campus Bretton Gate Peterborough Cambridgeshire
PE3 9GZ UK
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A Short Battery for Predicting Rehabilitation Success After Hip Fracture Surgery in the Elderly. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stenqvist C, Madsen CM, Riis T, Jørgensen HL, Duus BR, Lauritzen JB, van der Mark S. Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture. Geriatr Orthop Surg Rehabil 2016; 7:67-73. [PMID: 27239379 PMCID: PMC4872179 DOI: 10.1177/2151458515625296] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months for patients with hip fracture. The secondary outcome is mortality for home dwellers and nursing home inhabitants. Materials and Methods: This is a retrospective clinical cohort study with an historic control group including all patients with hip fracture admitted from 2007 to 2011. Patients with hip fracture are registered in a local database, and data are retrieved retrospectively using the Danish Civil Registration Number. Results: We included 993 patients in the intervention group and 989 patients in the control group. A univariate analysis showed only significantly decreased mortality inhospital 6.3% vs 3.1% (P = .009) after orthogeriatrics. However, when adjusting for age, gender, and American Society of Anaesthesiologists (ASA) score in a multivariate analysis, including all patients with hip fracture, we find significantly reduced mortality inhospital (odds ratio [OR] 0.35), after 30 [OR 0.66] and 90 days [OR 0.72] and 1 year [OR 0.79]). When using a univariate analysis for home-dwelling patients, we found significantly reduced mortality inhospital (8.3-2.0%, P < .0001), after 30 days (12.2-6.8%, P = .004) and 90 days (20.5-13.0%, P = .002). One-year mortality was not significant. Patients from nursing homes had no significant decreasing mortality at any point of time in the univariate analysis. Conclusion: We have shown significant decreases for inhospital, 30 day, 90 day, and 1-year mortality after implementation of orthogeriatric service at Bispebjerg Hospital when adjusting for age, gender, and ASA score. Future trials should include frail patients with other fracture types who can benefit from orthogeriatrics.
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Affiliation(s)
- Charlotte Stenqvist
- Department of Orthopedic Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Medom Madsen
- Department of Orthopedic Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Troels Riis
- Department of Orthopedic Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Benn Rønnow Duus
- Department of Orthopedic Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jes Bruun Lauritzen
- Department of Orthopedic Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Susanne van der Mark
- Department of Orthopedic Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Martinsen MI, Valland H, Solheim LF, Holvik K, Ranhoff A. A restrictive policy for red blood cell transfusion in older hip fracture patients: experiences from a patient register. BMC Res Notes 2016; 9:75. [PMID: 26860849 PMCID: PMC4746927 DOI: 10.1186/s13104-016-1885-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 01/22/2016] [Indexed: 01/25/2023] Open
Abstract
Background Allogeneic red blood cell transfusions (ABT) are common in older hip fracture patients. Recent research supports a restrictive transfusion policy. The aim was to study variation in hemoglobin (Hb) concentration, and clinical outcomes in these patients. Results Cross-sectional study with one-year follow-up in an orthogeriatric unit. Data were obtained from a quality register with demographic and medical information collected by an interdisciplinary team. 106 (22 %) of the 491 patients admitted from September 2011 throughout September 2012 (76 % women, mean age 85 years) received ABT. When given ABT, 80 % had Hb <80 g/l and mean Hb was 78 g/l. Mean Hb, regardless ABT, showed variation from 125 g/l (±16) on admission to 106 g/l (±17), 101 g/l (±16) and 102 g/l (±14) on 1st, 3rd and 5th postoperative day respectively. Patients with per-/subtrochanteric fractures more often received ABT than those with femur neck fractures (p < 0.001), 70 % of the patients receiving ABT had a per-/subtrochanteric fracture. Patients who received ABT were older, had more chronic diseases and lower mean Hb throughout the hospital stay. Length of stay was longer (median 7 vs. 6 days, p = 0.01), and medical complications more common. In-hospital and 30-day mortalities were similar in patients given ABT and in those who were not, but 1-year mortality was higher among patients who were given ABT (p = 0.008). Conclusions Hb had a tendency to fall during the three first days after surgery and seemed to be stabilized on day 5. Patients who received ABT had poorer health, but not significantly higher short-term mortality. This study demonstrates a restrictive transfusion policy.
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Affiliation(s)
| | - Haldor Valland
- Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway.
| | | | - Kristin Holvik
- Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway. .,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Anette Ranhoff
- Department of Medicine, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
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Prevalence of delirium in geriatric rehabilitation in Israel and its influence on rehabilitation outcomes in patients with hip fractures. Int J Rehabil Res 2015; 38:233-7. [DOI: 10.1097/mrr.0000000000000121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fracture. J Am Med Dir Assoc 2015; 16:661-7. [DOI: 10.1016/j.jamda.2015.03.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 12/28/2022]
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Sáez López P, Sánchez Hernández N, Paniagua Tejo S, Valverde García JA, Montero Díaz M, Alonso García N, Freites Esteve A. [Clinical pathway for hip fracture patients]. Rev Esp Geriatr Gerontol 2015; 50:161-167. [PMID: 25559411 DOI: 10.1016/j.regg.2014.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. PURPOSE To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. MATERIAL AND METHODS A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. RESULTS Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. CONCLUSION The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact.
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Affiliation(s)
- Pilar Sáez López
- Unidad de Geriatría, Complejo Asistencial de Ávila, Ávila, España.
| | | | | | | | - Margarita Montero Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España
| | - Noelia Alonso García
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España
| | - Alfonso Freites Esteve
- Servicio de Cardiología. Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Pajulammi HM, Pihlajamäki HK, Luukkaala TH, Nuotio MS. Pre- and perioperative predictors of changes in mobility and living arrangements after hip fracture--a population-based study. Arch Gerontol Geriatr 2015; 61:182-9. [PMID: 26043958 DOI: 10.1016/j.archger.2015.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 05/16/2015] [Accepted: 05/19/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE OF THE RESEARCH Examining pre- and perioperative predictors of changes in mobility and living arrangements after hip fracture. MATERIALS AND METHODS Population-based prospective data were collected on 1027 hip fracture patients aged ≥65. The outcomes were decreased vs. same or improved mobility level and need for more supported vs. same or less supported living arrangements 1 year after hip fracture. The independent variables were age, gender, body mass index, American Society of Anesthesiologists score, diagnosis of memory disorder, mobility level and living arrangements, fracture type, delay to surgery and urinary catheter removal during acute hospitalization. THE PRINCIPAL RESULTS Multivariate logistic regression analysis revealed the prefracture mobility level of walking outdoors (OR=0.47, 95% CI 0.30-0.75) or indoors (OR=0.25, 95% CI 0.09-0.72) assisted to be associated with a smaller decrease in mobility level. Non-independent mobility level (OR=2.74, 95% CI 1.70-4.41) was associated with the need of more supported living arrangements. Living in assisted living accommodations (OR=0.23, 95% CI 0.12-0.44) was associated with less need for more supported living arrangements. Removal of the urinary catheter showed a protective association on both decline in mobility level (OR=0.45; 95% CI 0.29-0.70) and moving to a more supported living arrangement(OR=0.49,95% CI 0.31-0.77. MAJOR CONCLUSIONS Worsening of mobility was significant for independent mobilizers. Prefracture impaired mobility was associated with the need of more supported living arrangements. Living in an assisted living accommodation protected against institutionalization. The findings emphasize the importance of a prompt removal of the urinary catheter after hip fracture.
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Affiliation(s)
- Hanna M Pajulammi
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland.
| | - Harri K Pihlajamäki
- Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland; University of Tampere, Mediwest, Koskenalantie 16, 60220 Seinäjoki, Finland
| | - Tiina H Luukkaala
- Science Center, Pirkanmaa Hospital District, PL 2000, 33521 Tampere, Finland; School of Health Sciences, University of Tampere, 33014 University of Tampere, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland
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BAKKE HK, DEHLI T, WISBORG T. Fatal injury caused by low-energy trauma - a 10-year rural cohort. Acta Anaesthesiol Scand 2014; 58:726-32. [PMID: 24773521 PMCID: PMC4171781 DOI: 10.1111/aas.12330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 12/20/2022]
Abstract
Background Death after injury with low energy has gained increasing focus lately, and seems to constitute a significant amount of trauma-related death. The aim of this study was to describe the epidemiology of deaths from low-energy trauma in a rural Norwegian cohort. Methods All deaths from external causes in Finnmark County, Norway, from 1995 to 2004 were identified retrospectively through the Norwegian Cause of Death Registry. Deaths caused by hanging, drowning, suffocation, poisoning, and electrocution were excluded. Trauma was categorised as high energy or low energy based on mechanism of injury. All low-energy trauma deaths were then reviewed. Results There were 262 cases of trauma death during the period. Low-energy trauma counted for 43% of the trauma deaths, with an annual crude death rate of 13 per 100,000 inhabitants. Low falls accounted for 99% of the injuries. Fractures were sustained in 89% of cases and head injuries in 11%. Ninety per cent of patients had pre-existing medical conditions, and the median age was 82 years. Death was caused by a medical condition in 85% of cases. Fifty-two per cent of the patients died after discharge from the hospital. Conclusion In this cohort, low-energy trauma was a significant contributor to trauma related death, especially among elderly and patients with pre-existing medical conditions.
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Affiliation(s)
- H. K. BAKKE
- Anaesthesia and Critical Care Research Group Faculty of Health Sciences University of Tromsø Tromsø Norway
- Department of Surgery Mo i Rana Hospital Helgeland Hospital Trust Mo i Rana Norway
| | - T. DEHLI
- Department of Gastrointestinal Surgery University Hospital of North Norway Tromsø Tromsø Norway
| | - T. WISBORG
- Anaesthesia and Critical Care Research Group Faculty of Health Sciences University of Tromsø Tromsø Norway
- Department of Anaesthesiology and Intensive Care Finnmark Health Trust Hammerfest Hospital Hammerfest Norway
- Norwegian Trauma Competency Service Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
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Nyman SR, Ballinger C, Phillips JE, Newton R. Characteristics of outdoor falls among older people: a qualitative study. BMC Geriatr 2013; 13:125. [PMID: 24245830 PMCID: PMC3835551 DOI: 10.1186/1471-2318-13-125] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/12/2013] [Indexed: 12/02/2022] Open
Abstract
Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.
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Affiliation(s)
- Samuel R Nyman
- Bournemouth University Dementia Institute and Psychology Research Centre, School of Design, Engineering & Computing, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK.
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Mézière A, Paillaud E, Belmin J, Pariel S, Herbaud S, Canouï-Poitrine F, Le Thuaut A, Marty J, Plaud B. Delirium in older people after proximal femoral fracture repair: Role of a preoperative screening cognitive test. ACTA ACUST UNITED AC 2013; 32:e91-6. [DOI: 10.1016/j.annfar.2013.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/06/2013] [Indexed: 11/30/2022]
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