Outcomes following surgical management of femoral neck fractures in elderly dialysis-dependent patients.

INTRODUCTION: Proximal femur fractures are one of the most common fractures observed in dialysis-dependent patients. Given the large comorbidity burden present in this patient population, more information is needed regarding post-operative outcomes. The goal of this study was to assess morbidity and mortality following operative fixation of femoral neck fractures in the dialysis-dependent elderly. METHODS: The full set of medicare data from 2005 to 2014 was retrospectively analyzed. Elderly patients with femoral neck fractures were selected. Patients were stratified based on dialysis dependence. Post-operative morbidity and mortality outcomes were compared between the two populations. Adjusted odds were calculated to determine the effect of dialysis dependence on outcomes. RESULTS: A total of 320,629 patients met the inclusion criteria. Of dialysis-dependent patients, 1504 patients underwent internal fixation and 2662 underwent arthroplasty. For both surgical cohorts, dialysis dependence was found to be associated with at least 1.9 times greater odds of mortality within 1 and 2 years post-operatively. Blood transfusions within 90 days and infections within 2 years were significantly increased in the dialysis-dependent study cohort. Dialysis dependence alone did not contribute to increased mechanical failure or major medical complications. CONCLUSION: Regardless of the surgery performed, dialysis dependence is a significant risk factor for major post-surgical morbidity and mortality after operative treatment of femoral neck fractures in this population. Increased mechanical failure in the internal fixation group was not observed. The increased risk associated with caring for this population should be understood when considering surgical intervention and counseling patients.

Technology induced error and usability: the relationship between usability problems and prescription errors when using a handheld application.

This paper describes an innovative approach to the evaluation of a handheld prescription writing application. Participants (10 physicians) were asked to perform a series of tasks involving entering prescriptions into the application from a medication list. The study procedure involved the collection of data consisting of transcripts of the subjects who were asked to "think aloud" while interacting with the prescription writing program to enter medications. All user interactions with the device were video and audio recorded. Analysis of the protocols was conducted in two phases: (1) usability problems were identified from coding of the transcripts and video data, (2) actual errors in entering prescription data were also identified. The results indicated that there were a variety of usability problems, with most related to interface design issues. In examining the relationship between usability problems and errors, it was found that certain types of usability problems were closely associated with the occurrence of specific types of errors in prescription of medications. Implications for identifying and predicting technology-induced error are discussed in the context of improving the safety of health care information systems.

The relationship of usability to medical error: an evaluation of errors associated with usability problems in the use of a handheld application for prescribing medications.

This paper describes an innovative approach to the evaluation of a handheld prescription writing application. Participants (10 physicians) were asked to perform a series of tasks involving entering prescriptions into the application from a medication list. The study procedure involved the collection of data consisting of transcripts of the subjects who were asked to "think aloud" while interacting with the prescription writing program to enter medications. All user interactions with the device were video and audio recorded. Analysis of the protocols was conducted in two phases: (1) usability problems were identified from coding of the transcripts and video data (2) actual errors in entering prescription data were also identified. The results indicated that there were a variety of usability problems, with most related to issues of ease of use. In addition, other problems were identified which were related to limitations of the content of the program. In examining the relationship between usability problems and errors, it was found that certain types of usability problems were closely associated with the occurrence of specific types of errors in prescription of medications. Implications for the improvement of safety of health care information systems are discussed.