Medical errors, affected sites, and adverse consequences among patients in the orthopaedic department: Does age matter?

Background: Orthopaedics have become the focus of research on patient safety due to the high incidence of medical errors. Previous studies were based on all orthopaedic patients and rarely conducted empirical analyses from the perspective of age. This study aimed to fill the academic gap in the age variable by comparing medical errors, affected sites, and adverse consequences in orthopaedic patients. Methods: This retrospective study included 329 litigation claims against orthopaedists using data from China Judgments Online. First, we performed computer crawling and screened 5,237 litigation documents using keywords, including medical errors. Second, 2,536 samples were retained through systematic random sampling, and 549 irrelevant cases were deleted after manual reading. Finally, three clinicians from different medical departments selected 329 incidents related to orthopaedics for further analysis, according to the description of the lawsuits. Three other professional orthopaedists evaluated the patients' ages, affected sites of medical errors, and adverse consequences. Results: The greatest number of medical errors was observed in the joints (30.43%) for all orthopaedic patients. However, adult patients (aged 18-60 years) were most susceptible to errors in the extremities (30.42%). A higher rate of complications was associated with a higher rate of morbidity/mortality for the corresponding patients. Medical errors correlated with complications occurred in the following sites: joints (15.38%), extremities (12.50%), spine (16.95%), multiple sites (15.38%), and hands and feet (14.81%). In addition to surgical errors, over 10% of all orthopaedic patients experienced missed diagnoses. The incidence of insufficient adherence to informed consent obligations was 13.5% among adult patients and was much higher in paediatric and older adults patients. When orthopaedic patients suffered from medical technical errors, iatrogenic mortality/morbidity would decrease by 0.3% for one unit increase in age. Conclusion: Dividing patients into different ages demonstrated diverse results in terms of medical errors and affected sites. Negligence in diagnosis and examination can be fatal factors that endanger safety, and complications may cause morbidity/mortality. When patients suffered from technical errors, age is inversely proportional to mortality/morbidity. Special attention needs to be paid to technical errors in the younger older adults population (60-64 years old), which has inspired implications in promoting aging and public health.

Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis.

Purpose: Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients. Methods: We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain. Results: This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), -2.11; 95% CI, -3.62 to -0.61], yoga (SMD, -1.76; 95% CI -2.72 to -0.81), Pilates exercise (SMD, -1.52; 95% CI, -2.68, to -0.36), and sling exercise (SMD, -1.19; 95% CI, -2.07 to -0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, -2.42; 95% CI, -3.81 to -1.03) and yoga (SMD, -2.07; 95% CI, -2.80 to -1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, -1.72; 95% CI, -2.91 to -0.53) and core or stabilization exercises (SMD, -1.04; 95% CI, -1.80 to -0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, -1.81; 95% CI, -2.78 to -0.83) and core or stabilization exercises (SMD, -1.13; 95% CI, -1.66 to -0.59) showed a better physical function improvement than no intervention provided. Conclusion: Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.

The Impact of Pets on Everyday Life for Older Adults During the COVID-19 Pandemic.

Purpose: The social and behavioral health of older adults is of particular concern during the COVID-19 pandemic. It is estimated that at least 50% of older adults in the U.S. have pets; while pets may be a source of support, they could also pose unique challenges during an already trying time. We aimed to investigate how pets impacted the everyday lives of older adults in the early stages of the COVID-19 pandemic. Methods: A large survey of U.S. pet owners (n = 2,068) was administered to assess the impact of relationships with pets during COVID-19 on human health and well-being. We conducted bivariate analyses to compare levels of social support, loneliness, pet attachment, and family income for a subset of older adults (ages 65 and older) with a younger comparison group (ages 18-64). Using thematic and content analysis, we analyzed two open-ended prompts from age 65+ respondents (n = 122): (1) the pros and cons of living with pets during the pandemic, and (2) advice for those living with pets in future pandemics. Results: Older adults, on average, reported lower levels of social support and less loneliness than respondents below age 65. There were no significant differences in strength of attachment to pets nor income between the younger and older respondents. For the open-ended prompt regarding pros and cons, we coded three emerging themes and related sub-themes: (1) pros (company; more time together; life purpose or meaning; love; support; stress relief; routine; distraction; exercise), (2) cons (general worry; potential for illness; limited participation; veterinary care access; obtaining supplies; difficulty meeting pet needs; financial concerns), and (3) no difference. Advice shared was coded into 13 themes/sub-themes: pets' health and welfare; make plans; veterinary information; treat pets like family; don't abandon pets; human health and well-being; stay calm; enjoy pets; keep routine; be careful of transmission; seek community resources; keep supplies stocked; and finances. Conclusions: Pets may fulfill some social and emotional needs for older adults during this particularly isolating event; equally important to consider are the challenges that may be precipitated by and/or exacerbated by this public health emergency.

Exploring the Association between Race and Health among Older Adults Who Are Incarcerated.

One of the little known ironies in the field of prison health is the notion that prison may actually have health-stabilizing effects for some groups. This study contributes to this line of inquiry by examining a variety of physical and mental health indicators among an older cohort of prisoners. Furthermore, this study's focus on race addresses a notable gap in the growing literature on older prisoner health. A cross-section of 625 males who were incarcerated residing in a northeastern state prison system was surveyed and data on self-reported health status and stress and individual demographics characteristics were collected. Univariate and multivariate logistic regressions were used to quantify racial differences with respect to self-reported stress after adjusting for potential confounders. Results suggest that Black men who are older and incarcerated appear to be more resilient than White men who are older. An association was found between race and self-reported stress though not statistically significant. Health status is a significant predictor of self-reported stress in univariate and multivariate analyses. Having ever committed a violent offense and having received mental health services (in and out patient) are statistically associated with self-reported stress. Black men who were older in this study appear to cope better with stress related to incarceration than White men who were older, which may in turn affect other physical and mental health outcomes. Future research is needed to address factors that stabilize health and reduce stress among a racially diverse, aging prison population.