Pressure injuries during the SARS-CoV-2 pandemic: A retrospective, case-control study.

AIM OF STUDY: The main objective of this study was to ascertain whether severe alterations in hypoxemic, inflammatory, and nutritional parameters in patients diagnosed with SARS-CoV-2 infection were associated with the occurrence and severity of developed dependency-related injuries. The secondary objective was to determine whether there were prognostic factors associated with the occurrence and severity of developed dependency-related injuries during the SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective, single-centre, case-control study was conducted to compare SARS-CoV-2 patients who developed dependency-related injuries after the first 48 h after admission with a control group made up of SARS-CoV-2 patients without dependency-related injuries. The cases of the 1987 patients diagnosed with SARS-CoV-2 infection during the study period were reviewed. Data from 94 patients who developed dependency-related injuries and from 190 patients who did not develop them during hospital admission were analysed. RESULTS: High baseline dependency levels, prolonged hospital stays, and low oxygen saturation levels on arrival in emergency department triage were associated with the occurrence of dependency-related injuries among patients diagnosed with SARS-CoV-2 infection. CONCLUSIONS: SARS-CoV-2 infection can lead to complications such as dependency-related injuries. Although there are several non-modifiable variables associated with the occurrence of dependency-related injuries in these patients, it is essential to conduct further research and introduce consensus guidelines to reduce their incidence and prevalence.

The Meaning of Aggression Varies Across Culture: Testing the Measurement Invariance of the Refined Aggression Questionnaire in Samples From Spain, the United States, and Hong Kong.

Cultural differences in aggression are still poorly understood. The purpose of this article is to assess whether a tool for measuring aggression has the same meaning across cultures. Analyzing samples from Spain (n = 262), the United States (n = 344), and Hong Kong (n = 645), we used confirmatory factor analysis to investigate measurement invariance of the refined version of the Aggression Questionnaire (Bryant & Smith, 2001 ). The measurement of aggression was more equivalent between the Chinese and Spanish versions than between these two and the U.S. version. Aggression does not show invariance at the cultural level. Cultural variables such as affective autonomy or individualism could influence the meaning of aggression. Aggressive behavior models can be improved by incorporating cultural variables.

There's More Than Catastrophizing in Chronic Pain: Low Frustration Tolerance and Self-Downing Also Predict Mental Health in Chronic Pain Patients.

Among the potential range of irrational beliefs that could be used as predictors of physical and mental health, catastrophizing is the process that has received most attention in chronic pain research. Other irrational processes such as demandingness, low frustration tolerance, and self-downing have rarely been studied. The goal of this study was to explore whether this wider range of beliefs is associated with health in chronic pain patients beyond catastrophizing. A total of 492 chronic pain patients completed a measure of irrational beliefs, a measure of physical and mental health, and a numerical rating scale designed to assess pain intensity and interference. Irrational processes were more strongly associated with mental than with physical health. Low frustration tolerance and self-downing were found to be significantly related to mental health even after controlling for the effect of catastrophizing. Processes other than catastrophizing appear to have potentially important relationships with the mental health of people with chronic pain. These results may offer new intervention targets for practitioners.

Clinical practice guidelines: The good, the bad, and the ugly.

Clinical practices guidelines (CPGs) play a fundamental role in improving healthcare and patients' outcomes by helping clinicians make the best evidence-based decisions for their patients in a time-efficient manner. By following the available methods and criteria to create trustworthy CPGs, panel members can develop high-quality guidelines. However, despite the improvements over the years, CPGs are still subjected to biases and limitations, with conflicts of interest being the ugliest problem GCPs must face. In this review, we discuss the main characteristics of clinical practice guidelines, their pros and cons, and the future challenges they need to overcome.

Anterior Cruciate Ligament Reconstruction with Autologous Hamstring Single- versus Double-Bundle Graft: A Prospective Study with 10-Year Follow-up.

The purpose of the present study was to compare the clinical and subjective outcomes of anterior cruciate ligament (ACL) reconstruction using an autologous hamstring double bundle (DB) with a single bundle (SB) after a 10-year follow-up. A prospective comparative cohort study was performed of 47 consecutive patients with ACL rupture included between May 2006 and March 2008. Inclusion criteria were less than 2 years since the injury date, no previous surgery on the affected knee, and having closed growth plates. Patients were divided into two groups: (1) SB group (n = 25) and (2) DB group (n = 22). Patients underwent evaluation before surgery and at 1 and 10 years postoperatively. The clinical evaluation included the International Knee Documentation Committee (IKDC) Questionnaire, pivot shift test, and single hop test, as well as X-rays (anterior drawer X-rays on a Telos stress radiography). Range of motion (ROM) was assessed at 10-year follow-up. Both groups were similar in terms of baseline characteristics. Post hoc power analysis showed that among 30 and 226 patients would be needed for statistical significance, depending on the outcome. With the numbers available, no significant differences were observed in subjective IKDC, anterior stability (measured with Telos), and functional test outcomes (single hop test) between both groups at 1 and 10 years postoperatively. Regarding rotational instability (pivot-shift test), DB group was significantly superior (p = 0.002). Regarding ROM, no significant differences were observed between groups. No failure was registered in any of the groups. ACL reconstruction (ACLR) with an autologous hamstring, both with bundles and DB, shows overall better outcomes compared with the status before surgery. DB ACLR provides better rotational control of the knee, an outcome that is maintained after 10 years.

Is elective surgery during the COVID-19 pandemic safe? A multi-center prospective study in a high incidence area.

OBJECTIVE: The aim of this study was to describe the evolution of patients admitted for elective orthopaedic surgery during the immediate post-COVID-19 peak of the pandemic. METHODS: This is a multi-center, observational study conducted in 8 high complexity hospitals of Catalonia, one of the highest COVID-19 incidence areas in Spain. We included patients ≥18 years of age undergoing elective surgery (total knee or hip arthroplasty, knee or hip revision arthroplasty, shoulder or knee arthroscopy, hand or wrist surgery, forefoot surgery, or hardware removal) after the COVID-19 peak (between May 5th and June 30th, 2020). The main exclusion criterion was a positive result for SARS-CoV-2 PCR within the 7 days before the surgery. The primary outcomes were postoperative complications within 60 days (+/-30) or hospital readmission due to a COVID-19 infection. Following the recommendations of the International Consensus Group (ICM), elective surgeries were re-started when the nationwide lockdown was lifted. Before the surgery, patients were contacted by phone to rule out any exposure to confirmed COVID-19 cases, a reverse transcription-polymerase chain reaction (PCR) assay was performed in all patients 48-72 hours before hospital admission, and they were asked to maintain home confinement until the day of the surgery. RESULTS: 675 patients were included: 189 patients in the arthroplasty group (28%) and 486 in the ambulatory surgery group (72%). Mean [SD] age was 57.6 [15.3] years. The mean Charlson Comorbidity Index score was 2.21 (SD = 2.01, Min = 0, Max = 13). A total of 84 patients (12.75%) obtained an American Society of Anesthesiologists (ASA) score ≥ 3, showing no association between the ASA score and the risk of developing COVID-19 symptoms at follow-up (χ 2 (4) = 0.77, P = 0.94). The mean occupation rate of hospital beds for COVID-19 patients was 13% and the mean occupation rate of critical care beds for COVID-19 patients was 27% at the time of re-introducing elective surgeries. These were important rates to consider to decide when to reintroduce elective surgeries after lockdown. Surgical time, time of ischemia and intra-operative bleeding were not related with a higher risk of developing COVID-19 post-operatively (χ 2 (1) = 0.00, P = 0.98); (χ 2 (2) = 2.05, P = 0.36); (χ 2 (2) = 0.37, P = 0.83). Only 2 patients (0.3 %) presented with a suspected COVID-19 infection at follow-up. None of them presented with pneumonia or required confirmation by a reverse transcription PCR assay. Hospital re-admission was not needed for these patients. CONCLUSION: The risk of developing COVID-19 during the immediate post-COVID-19 peak in a region with a high incidence of COVID-19 has not been proved. These data suggest that elective orthopaedic surgeries can be resumed when assertive and strict protocols are followed.

Risk of Mortality for Proximal Femoral Fracture in Patients With and Without COVID-19. A Retrospective Cohort Study.

Background: SARS-CoV-2 (COVID-19) has resulted in a widespread loss of lives, morbidity, and major disruptions to the healthcare system. Hip fractures are an emergent condition which require early intervention to reduce increased risk of mortality and morbidity. Infection of SARS-CoV-2 may contribute to increased mortality due to the role of infection and immune response. This study investigated the impact of COVID-19 infection (defined by clinical symptoms) on mortality following proximal femoral fracture (PFF) repair procedures. Methods: This study was a retrospective cohort study. Data from the Premier Healthcare Database® was extracted for patients presenting for PFF during 2019 for control, and February 2020-September 2020 to represent a COVID time-period. Results: A total of N = 73 953 subjects were enrolled for the 2019 period, and a total of N = 34 842 subjects were enrolled for the COVID period. For the 2019 period, subjects who had a PFF procedure and who had flu/COVID-like illness had 2.47 (CI:2.11, 2.88) times the odds of mortality compared to those who did not have flu/COVID-like illness. Subjects who had a PFF procedure and who had flu/COVID-like illness during the COVID period had 2.85 times (CI:2.36, 3.42) the odds of mortality compared to those who did not have flu/COVID-like illness. For the COVID period, within subjects who did not have a PFF procedure, those with flu/COVID-like illness had increased odds of mortality compared to those who did not have flu/COVID-like illness (OR:2.26, CI:1.57, 3.21). Conclusions: Hip fractures present high risk for mortality and morbidity, where timely intervention is critical to improved outcomes. Presence of infection such as flu/COVID-like illness may influence mortality in patients undergoing hip fracture repair procedures. Consideration of infection status as a comorbidity is important to proper management and achieving optimal outcomes.

Comprehensive geriatric assessment among elderly people in a convalescence unit: a best practice implementation project.

AIM: The aim of this project was to audit the usual assessment practices employed when admitting patients to a convalescence unit on the outskirts of Barcelona, Spain. The project implemented strategies to improve evidence-based practice using the Joanna Briggs Institute methodology. The specific objectives of this project were (1) to improve completion of the comprehensive geriatric assessment (CGA) record, (2) to improve professionals' CGA knowledge, (3) to promote interdisciplinary work, (4) to improve tailored therapeutic plan generation by implementing evidence-based practice criteria within the instrument, and (5) to evaluate the records and action plans derived from the CGA. METHODS: Pre-/post-implementation audit methodology was used the Practical Application of Clinical Evidence System and Getting Research into Practice, and was developed in multiple phases. The implementation phase took 6 months. A sample of 34 consecutive admissions had their CGA patient records evaluated. Descriptive statistics were calculated. RESULTS: A total of 64 records (34 pre/30 post) were reviewed to assess CGA completion. The baseline audit results showed that only two audit criteria were higher than 50%, indicating poor knowledge about the concept of CGA and poor compliance with the current program. Following the implementation of the strategies, which included education and the development of a checklist, there was an improvement in all the criteria audited: the record was correctly completed in 67% of cases, and 80% of team members were knowledgeable and competent in CGA. CONCLUSION: Several barriers were identified at baseline, and various strategies were implemented to improve CGA compliance. The results show that the project increased awareness of the importance of a comprehensive assessment of the care that patients receive, resulting in better CGA completion.

Mortality Rates of Patients with Proximal Femoral Fracture in a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), in December 2019 in Wuhan, People's Republic of China, has developed into an unprecedented pandemic with enormous pressure on health-care providers around the world. A higher mortality rate has been described in older infected individuals. Patients with hip fracture are a particularly vulnerable population during this pandemic because older age is associated with a higher mortality rate. Our aim was to describe the early mortality rate and demographic variables in a hip fracture sample population in Spain during the coronavirus pandemic. METHODS: This is a multicenter, observational, retrospective, descriptive study. We collected data from 13 major hospitals in Spain from the beginning of the national state of alarm (declared on March 14, 2020, by the Spanish government) until the end of our study period on April 4, 2020. All patients who were ≥65 years of age, presented to the Emergency Department of the participating hospitals during this period with a diagnosis of proximal femoral fracture, and had a minimum follow-up of 10 days were included in the cohort. In addition to mortality, demographic and other potential prognostic variables were also collected. RESULTS: In this study, 136 patients with a hip fracture were included. Of these patients, 124 underwent a surgical procedure and 12 were managed nonoperatively. The total mortality rate was 9.6%. Sixty-two patients were tested for COVID-19, with 23 patients being positive. The mortality rate for these 23 patients was 30.4% (7 of 23 patients) at a mean follow-up of 14 days. The mortality rate was 10.3% (4 of 39) for patients who had been tested and had a negative result and 2.7% (2 of 74) for patients who had not been tested. Of the 12 patients who were managed nonoperatively, 8 (67%) died, whereas, of the 124 patients who were surgically treated, 5 (4%) died. Results differed among centers. CONCLUSIONS: There is a higher mortality rate in patients with a hip fracture and an associated positive test for COVID-19. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Attitudes do matter: The role of attitudes and personality in DUI offenders.

Several studies have related personality variables with antisocial behavior. Among antisocial behaviors, driving under the influence (DUI) has received growing attention in recent years, particularly in relation to the role of personality. However, it has been shown that personality alone is not sufficient to accurately predict DUI. As a result, there is growing interest in identifying other types of individual differences that might predict this behavior better, such as attitudinal variables. The aim of this study was to examine differences in personality dimensions and attitudes between a group of DUI offenders and a comparison group. Ninety-eight subjects were assessed: 51 subjects who had been convicted of a DUI offense following a diversion program, and 47 drivers without criminal records. Personality was measured with the NEO-Five Factor Inventory (NEO-FFI) and antisocial attitudes were assessed with the Jesness Inventory-Revised. Results indicated that offenders were more prone to show antisocial attitudes (p<.001) than comparisons. In terms of personality, there were no significant differences between the two groups. These findings suggest that attitudes may be useful predictors of DUI and should be taken into account in interventions designed to avoid recidivism.