Post-discharge use of assistive devices following hemiarthroplasty: comparison of fracture patients with or without hip precautions.

Purpose: To describe which types of assistive devices prescribed and actually used, either due to precautions or due to true functional reasons, after hip fracture-related hemiarthroplasty.Materials and methods: About 394 patients cluster-randomized 2010-2014 at a university hospital. Control group with standard postoperative precautions to reduce dislocations, mandatory assistive devices and knee brace for 6 weeks (in cognitively impaired) compared to non-precaution group with assistive devices only if needed. Postal questionnaire at 6 weeks and 3 months.Results: Both prescription and usage of reacher were higher in the precaution group. About 55% of patients with precautions was instructed to use stocking aids, 21% continued to do so. Significantly fewer without precautions, 11%, used it at 3 months. Raised toilet seat was used by ∼40% of all pre-fracture and was prescribed to 79% with precautions. It was unchanged at 42% in non-precaution group. Nevertheless, 64% in non-precaution group used a raised toilet both at 6 weeks and 3 months. The usage persisted around 70% in precaution group. Usage of raised chair/bed were similar, even if non-precaution patients was not prescribed such. In the precaution group, 102 were prescribed a knee brace, only 5 used it at 6 weeks.Conclusions: The use of assistive devices did not follow what was prescribed from the hospital, regardless of precautions or not. The use of higher furniture was similar regardless of precautions or not. Other devices were more common in the precaution group. The compliance of knee bracing was low, and bracing should not be standard-of-care.Implications for rehabilitationHemiarthroplasty is the most common treatment of displaced femoral neck fracture in elderly. Dislocation occur in 2 to 10% of these patients, and traditionally patients have been instructed to be careful when moving their leg and to use a number of assistive devices, in order to reduce the dislocation risk.The evidence base for such precautions is weak and occupational therapy and assistive devices may be costly. The current study shows that prescriptions and instructions from occupational therapists in hospital is more or less not follow after dismissal.Assistive devices should be prescribed based on the hip fracture patient's true functional needs, and not routinely or due to arthroplasty precautions.

Hip precautions not meaningful after hemiarthroplasty due to hip fracture. Cluster-randomized study of 394 patients operated with direct anterolateral approach.

AIMS: We aimed to compare two treatment regimes, one with and one without postoperative precautions in hemiarthroplasty patients, in terms of dislocation rate and patient-reported outcome. Direct lateral approach was used. PATIENTS AND METHODS: 394 patients were included in a cluster-randomized study 2010-2014. Depending on which ward they were admitted to, they were allotted to free rehabilitation (non-precaution group, NPG, n = 226) or our conventional regime with precautions and mandatory assistive equipment (precaution group, PG, n = 168). Patients were followed during hospital stay, at 6 weeks (postal questionnaire), 3 month (visit) and 6 months (reading of medical records) by means of function tests, health-related quality of life (EQ-5D) and other patient-reported outcome measures (PROM). RESULTS: One patient in each group had dislocation(s). We found no statistically significant differences regarding in-hospital-mortality, severe adverse events, EQ5D index or other PROM. In the NPG, rehabilitation personnel had significantly shorter work effort during hospital stay (p < 0.001). 7 in the NPG and 13 of the PG had reoperations (p = 0.038), 4 and 8 had deep infections, 3 and 5 periprosthetic fractures. CONCLUSION: Rehabilitation precautions are not needed for preventing dislocation when direct lateral approach is used. Without precautions, rehabilitation personnel implement significantly shorter work effort during hospital. We found no statistically significant differences regarding PROM and complications except for somewhat more reoperations in total in the precaution group.

[Herbal preparations have both effects and side effects. Widespread usage dictates knowledge among physicians]. / Ortmediciner har både effekter och biverkningar. Stor förbrukning kräver mer kunskap hos läkare.

The article gives a clinically oriented overview of the efficacy and safety of Ginkgo biloba, St. John's wort, ginseng, Echinacea, saw palmetto and kava based on American experiences. Clinical data support the efficacy for some of these drugs. None of them is free of adverse effects. Generally speaking, trials of herbal medicinal products have been too few, too small and too short. The lack of long-term studies is especially unfortunate since many of the drugs are used for a long time. The difference between American and Swedish legislation on herbal medicine products is described.

Otosclerosis: anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT.

OBJECTIVE: To assess the use of cone beam computed tomography (CBCT) compared with multi-slice computed tomography (MSCT) in otosclerosis, with special emphasis on middle- and inner-ear anatomy. STUDY DESIGN: Prospective study. PATIENTS: Twenty patients who underwent a stapedectomy 30 years ago were selected on the basis of bone conduction threshold values. Their mean age was 65 years (range, 48-76 yr). INTERVENTION: All patients underwent CBCT and MSCT with a slice thickness of 0.5 to 0.6 mm. MAIN OUTCOME MEASURES: Sixteen middle- and inner-ear anatomic structures and stapedial prostheses were analyzed by visual grading analysis. To assess critical reproduction and thereby the clinical applicability of CBCT, a dichotomization was made. Assessment of otosclerotic foci was performed using a grading system dividing the lesions in; (1) sole fenestral lesions, (2) retrofenestral lesions with or without fenestral lesions and (3) severe retrofenestral lesions. RESULTS: The 16 anatomic structures were clearly reproduced by both imaging techniques. However, there was an interobserver variation in judging the superiority of 1 method in favor of the other. Otosclerotic lesions were diagnosed in 80/95% using MSCT and 50/85% using CBCT (evaluators 1 and 2, respectively). Retrofenestral lesions were diagnosed in 5 of 10 of ears with severe-to-profound hearing loss, whereas no retrofenestral lesions were diagnosed in the 10 ears with mild-to-moderate hearing loss. The stapedial prostheses were adequately or very well reproduced by both methods. CONCLUSION: CBCT is a new imaging technique with a considerably lower radiation dose than conventional MSCT. Our study indicates that CBCT is suitable and, in many ways, equivalent to MSCT, for temporal bone imaging in otosclerosis.

Hemiarthroplasty for displaced femoral neck fracture: good clinical outcome but uneven distribution of occupational therapy.

PURPOSE: To assess rehabilitation, type of follow-up visits and outcome after bipolar hemiarthroplasty for femoral neck fracture. METHOD: Two hundred thirty-six consecutive patients with femoral neck fractures treated with hemiarthroplasty were followed for 30 months. RESULTS: One hundred sixty-eight (71%) were women, 175 (74%) over 80 years old and 53 (22%) were demented. Of 150 patients with available 3-month data, 7 patients (5%) had not regained their walking ability. Seventy (47%) were pain-free and 112 (75%) were back in their original habitat. A hip-related complication leading to a contact with the orthopaedic department occurred in 20 of all patients (8%), and 7 (3%) of these underwent a revision surgery. One hundred eighty-seven patients (79%) received occupational therapy (OT). Demented patients received OT more seldom (p < 0.001), as did patients aged 90 and older (p = 0.049). CONCLUSION: Due to the low rate of orthopaedic complications, these patients are now referred to their general practitioners, without any further follow-up at the orthopaedic department. Rehabilitation efforts are unevenly distributed. The need of increased rehabilitation efforts for demented or 'old old' patients is discussed.

A nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis: A qualitative study.

The aim of this study was to describe a nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic, inflammatory disease that attacks many joints, causing considerable functional restrictions for patients. Consequently, these patients are dependent on a wide variety of health-care services. A descriptive, qualitative design inspired by phenomenography was chosen. The conceptions were collected through interviews with 16 strategically selected patients with RA. Three descriptive categories comprising eight conceptions emerged: teaching (gaining insight and receiving information), regular review (receiving security, realizing regularity, and achieving accessibility), and attention (getting a holistic assessment, receiving coordinated care, and getting sufficient time). A nurse-led rheumatology clinic can be a source for empowering patients with RA to adopt new stances to alternative actions and achieve a higher level of faith in their own abilities.

A educação de pessoas com desordens do espectro autístico e dificuldades semelhantes de aprendizagem / Education for people with autistic espectrum disorders and similar learning disabilities

Este texto foi especialmente elaborado para orientar pais e professores de crianças, jovens e adultos autistas na tarefa de educá-los. E escrito, portanto, em linguagem absolutamente acessível, enfatizando aspectos essencialmente práticos da rotina da pessoa com autismo e dos que a circundam. A partir de explicações claras e objetivas sobre como a pessoa autista percebe o mundo, pensa, processa informações, e se comunica, a autora apresenta estratégias educacionais consistentes, que devem ser levadas em consideração no momento de se elaborar um plano educacional individualizado para a pessoa autista.