Are people in residential care entitled to receive rehabilitation services following hip fracture? Views of the public from a citizens' jury

Walking self-confidence and lower levels of anxiety are associated with meeting recommended levels of physical activity after hip fracture: a cross-sectional study

PURPOSE

To explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture.

MATERIALS AND METHODS

Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis determined factors associated with meeting physical activity thresholds related to positive health outcomes: 4,400 and 7,100 daily steps. Explanatory variables were: walking self-confidence; falls self-efficacy; depression; anxiety; co-morbidities; previous gait aid use; nutritional status; age; and gender.

RESULTS

Forty-three participants (20%) met the lower threshold of ≥4,400 to <7,100 steps and thirty participants (14%) met the upper threshold of ≥7,100 steps. Walking self-confidence was positively associated with meeting higher physical activity thresholds (adjusted odds ratio [AOR] 1.32: 95% CI 1.11 to 1.57, p = 0.002). Age (AOR 0.93: 95% CI 0.89 to 0.98, p = 0.003), DASS-21 anxiety score (AOR 0.81: 95% CI 0.69 to 0.94, p = 0.008) and comorbidity index score (AOR 0.52: 95% CI 0.36 to 0.72, p < 0.001) were negatively associated with meeting higher physical activity thresholds.

CONCLUSION

Walking self-confidence and anxiety are potentially modifiable factors associated with meeting physical activity thresholds related to positive health outcomes after hip fracture.

The role of depression in the association between mobilisation timing and live discharge after hip fracture surgery: Secondary analysis of the UK National Hip Fracture Database

PURPOSE

The aim was to compare the probability of discharge after hip fracture surgery conditional on being alive and in hospital between patients mobilised within and beyond 36-hours of surgery across groups defined by depression.

METHODS

Data were taken from the National Hip Fracture Database and included patients 60 years of age or older who underwent hip fracture surgery in England and Wales between 2014 and 2016. The conditional probability of postsurgical live discharge was estimated for patients mobilised early and for patients mobilised late across groups with and without depression. The association between mobilisation timing and the conditional probability of live discharge were also estimated separately through adjusted generalized linear models.

RESULTS

Data were analysed for 116,274 patients. A diagnosis of depression was present in 8.31% patients. In those with depression, 7,412 (76.7%) patients mobilised early. In those without depression, 84,085 (78.9%) patients mobilised early. By day 30 after surgery, the adjusted odds ratio of discharge among those who mobilised early compared to late was 1.79 (95% CI: 1.56-2.05, p<0.001) and 1.92 (95% CI: 1.84-2.00, p<0.001) for those with and without depression, respectively.

CONCLUSION

A similar proportion of patients with depression mobilised early after hip fracture surgery when compared to those without a diagnosis of depression. The association between mobilisation timing and time to live discharge was observed for patients with and without depression.

IMPAACT: IMproving the PArticipAtion of older people in policy decision-making on common health CondiTions - a study protocol

INTRODUCTION

Rapid population ageing is a demographic trend being experienced and documented worldwide. While increased health screening and assessment may help mitigate the burden of illness in older people, issues such as misdiagnosis may affect access to interventions. This study aims to elicit the values and preferences of evidence-informed older people living in the community on early screening for common health conditions (cardiovascular disease, diabetes, dementia and frailty). The study will proceed in three Phases: (1) generating recommendations of older people through a series of Citizens' Juries; (2) obtaining feedback from a diverse range of stakeholder groups on the jury findings; and (3) co-designing a set of Knowledge Translation resources to facilitate implementation into research, policy and practice. Conditions were chosen to reflect common health conditions characterised by increasing prevalence with age, but which have been underexamined through a Citizens' Jury methodology.

METHODS AND ANALYSIS

This study will be conducted in three Phases-(1) Citizens' Juries, (2) Policy Roundtables and (3) Production of Knowledge Translation resources. First, older people aged 50+ (n=80), including those from traditionally hard-to-reach and diverse groups, will be purposively recruited to four Citizen Juries. Second, representatives from a range of key stakeholder groups, including consumers and carers, health and aged care policymakers, general practitioners, practice nurses, geriatricians, allied health practitioners, pharmaceutical companies, private health insurers and community and aged care providers (n=40) will be purposively recruited for two Policy Roundtables. Finally, two researchers and six purposively recruited consumers will co-design Knowledge Translation resources. Thematic analysis will be performed on documentation and transcripts.

ETHICS AND DISSEMINATION

Ethical approval has been obtained through the Torrens University Human Research Ethics Committee. Participants will give written informed consent. Findings will be disseminated through development of a policy brief and lay summary, peer-reviewed publications, conference presentations and seminars.

The Efficacy of Rehabilitation Nursing Interventions on Patients with Open Lower Limb Fractures

Objective

The study aims to analyze the efficacy of rehabilitation nursing interventions on patients with open lower limb fractures.

Methods

From June 2020, patients who received RNI (observation group) were included and compared with patients who received routine nursing interventions (control group). The efficacy of different nursing modes was compared with several indicators.

Results

One hundred patients were included in this study, 50 in each group. The baseline characteristics were not significantly different between the groups. Regarding the emotional scores, the Self-Rating Anxiety Scale (SAS) score (26.98 vs 43.47), and Distress Management Screening Measure (DMSM) score (8.01 vs 12.85) in the observation group were significantly lower than those in the control group, both P < 0.05. Regarding the postoperative related indexes, the postoperative pain score (10.13 vs 15.53), fracture healing time (6.32 vs 10.86 weeks), and postoperative complications rate (0 vs 12%) in the observation group were all significantly lower than those in the control group, all P < 0.05. Regarding the quality of life scores, the WHOQOL-100 score (94.12 vs 83.13) and PSQI score (6.43 vs 10.36) were both significantly better in the observation group, with both P < 0.05.

Conclusion

Patients with open lower limbs who received RNI can help patients reduce postoperative anxiety and stress, promote postoperative rehabilitation and improve their quality of life.

Diagnostic accuracy of circulating microRNA in hepatitis B virus-related hepatocellular carcinoma: a meta-analysis based on Asian data

BACKGROUND AND AIM

Hepatitis B virus (HBV) is the main risk factor for hepatocellular carcinoma (HCC). We performed a meta-analysis based on Asian data to evaluate the diagnostic accuracy of circulating microRNA as a non-invasive biomarker in the diagnosis of HBV-related HCC.

METHODS

A comprehensive literature search (updated to May 12, 2021) in PubMed, Embase, Web of Science, Wanfang Database, and China National Knowledge Infrastructure (CNKI) was performed to identify eligible studies. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUC) for diagnosing HBV-related HCC were pooled in this meta-analysis. Subgroup analysis was performed to explore heterogeneity, and Deeks' funnel plot was used to assess publication bias.

RESULTS

19 articles including 32 studies were included in the current meta-analysis. The overall sensitivity, specificity, PLR, NLR, DOR and AUC were 0.83 (95% CI: 0.79 - 0.87), 0.78 (95% CI: 0.73 - 0.83), 3.9 (95% CI: 3.0 - 4.9), 0.21 (95% CI: 0.16 - 0.27), 18 (95% CI: 12 - 27) and 0.88 (95% CI: 0.85 - 0.91), respectively. Subgroup analysis shows that miRNA clusters with a large sample size showed better diagnostic accuracy. Although there is no publication bias, it still has some limitations.

CONCLUSIONS

Circulating miRNAs could serve as a potential non-invasive biomarker in diagnosing of HBV-related HCC in Asian populations.

Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens' Jury

BACKGROUND

Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked 'What considerations are important to include in a model of care of brain injury rehabilitation?'

METHODS

Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days.

RESULTS

Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made.

CONCLUSION

Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term.

PATIENT AND PUBLIC CONTRIBUTION

As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.