Impact of an orthogeriatric collaborative care model for older adults with hip fracture in a community hospital setting.

Background: Studies have shown that the incidence of postoperative delirium, the hospital length of stay and time to surgery are reduced when older adults with a hip fracture are cared for by a multidisciplinary team providing comprehensive geriatric assessments. Most of these studies have been conducted in academic centres. We sought to determine if implementation of an orthogeriatric collaborative care model would improve key quality of care metrics in a community hospital setting. Methods: This retrospective pre- and postintervention single-site study was conducted in a community hospital in Ontario, Canada. We included consecutive patients aged 65 years or older who were admitted for a hip fracture between June 2015 and June 2017. In the intervention period, a new postoperative order set included a referral to a geriatrician for comprehensive geriatric assessment, with direct implementation of recommendations. Primary outcomes were the incidence of postoperative delirium and length of stay. Secondary outcomes included Health Quality Ontario's quality standards for hip fracture. Results: A total of 212 consecutive patients (95 in the preintervention group and 117 in the postintervention group) were included in the study. The incidence of postoperative delirium (26.3% v. 26.5%, p = 0.98) and length of stay (interquartile range 4-10 v. 5-10 d, p = 0.32) were similar in the preintervention and postintervention groups. There were improvements (p < 0.001) in the rates of asssessment of mental status, falls and bone health; identification of delirium prevention strategies; prescription of vitamin D or calcium or both; and recommendations for antiresorptive therapy. Despite systemic implementation of the orthogeriatric model, only 74.4% of patients in the postintervention group were seen by a geriatric medicine consultant. Conclusion: Although the implementation of an orthogeriatric collaborative care model for older adults with a hip fracture did not reduce the incidence of postoperative delirium or length of stay, there were improvements in the rates at which several other key quality standards for hip fracture care were met. Earlier proactive, comprehensive geriatric assessment in a community hospital setting will be the target for further quality improvement initiatives.

Contexte: Des études ont montré que l'incidence du délire postopératoire, la durée du séjour à l'hôpital et le temps d'attente avant la chirurgie sont réduits lorsque les personnes âgées présentant une fracture de la hanche reçoivent les soins d'une équipe multidisciplinaire qui réalise une évaluation gériatrique complète. La plupart de ces études ont été effectuées dans des centres universitaires. Nous souhaitions donc déterminer si l'intégration d'un modèle de soins orthogériatriques collaboratif améliorerait les principaux indicateurs de la qualité des soins dans les hôpitaux communautaires. Méthodes: Cette étude rétrospective comparant 2 groupes de patients avant et après la mise en oeuvre d'une intervention a été menée dans un seul hôpital communautaire en Ontario, au Canada. Nous avons inclus les patients consécutifs de 65 ans et plus admis pour une fracture de la hanche entre juin 2015 et juin 2017. Pendant la période d'intervention, un nouvel ensemble d'ordonnances postopératoires a été ajouté. Il comprenait l'aiguillage vers un gériatre pour une évaluation gériatrique complète et l'application directe des recommandations. Les principales issues à l'étude étaient l'incidence du délire postopératoire et la durée de l'hospitalisation. Les issues secondaires comprenaient le respect des normes de qualité relatives à la fracture de la hanche de Qualité des services de santé Ontario. Résultats: Au total, 212 patients consécutifs (95 dans le groupe préintervention et 117 dans le groupe postintervention) ont été inclus dans l'étude. L'incidence du délire postopératoire (26,3 % c. 26,5 %, p = 0,98) et la durée de l'hospitalisation (écart interquartile 4­10 jours c. 5­10 jours, p = 0,32) étaient similaires dans les 2 groupes. Il y a eu des améliorations (p < 0,001) dans le taux d'évaluation de l'état mental, des chutes et de la santé des os; dans l'intégration de stratégies de prévention du délire; dans la prescription de vitamine D ou de calcium, ou des deux; et dans les recommandations de traitement antirésorptif. Malgré l'adoption du modèle orthogériatrique dans l'ensemble du centre, seulement 74,4 % des patients du groupe postintervention ont eu une consultation en gériatrie. Conclusion: Bien que la mise en œuvre d'un modèle de soins orthogériatriques collaboratif chez les personnes âgées présentant une fracture de la hanche n'ait pas réduit l'incidence du délire postopératoire ou la durée de l'hospitalisation, il y a eu une amélioration du respect de plusieurs normes de qualité importantes relatives à ce type de fracture. L'évaluation gériatrique complète réalisée tôt, de manière proactive, dans les hôpitaux communautaires sera la cible d'initiatives d'amélioration de la qualité à venir.

How to conduct an annual literature update for top articles relevant to clinical practice in geriatrics: A scoping review.

BACKGROUND: Clinical educators in geriatrics are often tasked with presenting a literature update at annual conferences and scientific meetings, which is a highly regarded continuing medical education (CME) activity. Preparation of an annual literature update cannot rely on bibliometric analysis due to time lag and poor correlation between bibliometrics and expert opinion on clinical relevance. The methodology of how top research articles of the year are selected and presented is not often reported. METHODS: We conducted a scoping review for published reports of a curated selection of recent articles critically appraised for high impact to clinical practice in general geriatrics, published from 2010 to 2022. RESULTS: Six annual literature updates were included for study. Three updates detailed their article sources, ranging from a survey of clinicians, consulting seven individual journals, searching up to four bibliographic databases, scanning social media outlets, and reviewing previous literature updates. One update reported a detailed method of article selection and consensus development. Critical appraisal of articles followed a structured reporting of clinical context, methods, results, and a statement of clinical implication or bottom line. Three of the six updates' results were disseminated in an annual conference update and did not evaluate learning outcomes of the audience. We mapped the results on a four-step framework of article search, selection, critical appraisal, and dissemination of knowledge. CONCLUSIONS: Educators in geriatrics consult numerous article sources spanning multiple journals, databases, social media, and peer suggestions to create an annual literature update. The methodology of article search and selection is inconsistently described. In this exciting area of CME, we encourage educators to develop a framework for conducting annual literature updates in geriatrics and expand its scholarship.

Journal editors: How do their editing incomes compare?

Background: The work of journal editors is essential to producing high-quality literature, and editing can be a very rewarding career; however, the profession may not be immune to gender pay gaps found in many professions and industries, including academia and clinical medicine. Our study aimed to quantify remuneration for journal editors from core clinical journals, determine if a gender pay gap exists, and assess if there are remuneration differences across publishing models and journal characteristics. Methods: We completed an online survey of journal editors with substantial editing roles including section editors and editors-in-chief, identified from the Abridged Index Medicus "Core Clinical" journals in MEDLINE. We analyzed information on demographics, editing income, and journal characteristics using a multivariable partial proportional odds model for ordinal logistic regression. Results: There were 166 survey respondents (response rate of 9%), which represented editors from 69 of 111 journals (62%). A total of 140 fully completed surveys were analyzed (95 males and 45 females); 50 (36%) editors did not receive remuneration for editorial work. No gender pay gap and no difference in remuneration between editors who worked in subscription-based publishing vs. open access journals were detected. Editors who were not primarily health care providers were more likely to have higher editing incomes (adjusted odds ratio [OR] 2.96, 95% confidence interval [CI] 1.18-7.46). Editors who worked more than 10 hours per week editing earned more than those who worked 10 hours or less per week (adjusted OR 16.7, 95%CI 7.02-39.76). Conclusions: We were unable to detect a gender pay gap and a difference in remuneration between editors who worked in subscription-based publishing and those in open access journals. More than one third of editors surveyed from core clinical journals did not get remunerated for their editing work.

Mach-Zehnder interferometry in a strongly driven superconducting qubit.

We demonstrate Mach-Zehnder-type interferometry in a superconducting flux qubit. The qubit is a tunable artificial atom, the ground and excited states of which exhibit an avoided crossing. Strongly driving the qubit with harmonic excitation sweeps it through the avoided crossing two times per period. Because the induced Landau-Zener transitions act as coherent beamsplitters, the accumulated phase between transitions, which varies with microwave amplitude, results in quantum interference fringes for n = 1 to 20 photon transitions. The generalization of optical Mach-Zehnder interferometry, performed in qubit phase space, provides an alternative means to manipulate and characterize the qubit in the strongly driven regime.

Energy relaxation time between macroscopic quantum levels in a superconducting persistent-current qubit.

We measured the intrawell energy relaxation time tau(d) approximately 24 micros between macroscopic quantum levels in the double well potential of a Nb persistent-current qubit. Interwell population transitions were generated by irradiating the qubit with microwaves. Zero population in the initial well was then observed due to a multilevel decay process in which the initial population relaxed to lower energy levels during the driven transitions. The decoherence time, estimated from tau(d) within the spin-boson model, is about 20 micros for this configuration with a Nb superconducting qubit.