Degenerative lumbar changes have a statistically significant but small effect on trabecular bone score (TBS)-adjusted fracture risk (FRAX).

Trabecular bone score (TBS) assesses trabecular microarchitecture at the lumbar spine and was shown to improve fracture risk prediction compared to bone mineral density (BMD) alone. We investigated whether lumbar degenerative changes (DC) affect TBS and TBS-adjusted 10-year fracture risk assessment (tool) (FRAX) estimates. All patients who underwent BMD and TBS measurements via dual-energy X-ray absorptiometry at our institution between 1/7/2020 and 1/10/2020 were retrospectively evaluated. We identified all patients who had DC in 1 or 2 vertebrae (out of L1-L4) with a BMD T score > 1 unit higher than the remaining 2 to 3 adjacent vertebrae. TBS and BMD were compared between the vertebrae with and without DC. Change in TBS as well as FRAX estimates for major osteoporotic (MOP) and hip fractures after exclusion of the degenerative vertebrae were also determined. Of the 356 eligible patients, 94 met the inclusion criteria. The mean TBS of vertebrae without DC was not significantly different from that of L1 to L4 (1.31 ± 0.12 vs 1.32 ± 0.12, respectively, P = .11). The FRAX estimates after exclusion of the degenerative vertebrae were statistically significantly higher than for L1 to L4 for both MOP and hip fractures (P = .04 and P = .01, respectively). However, the differences were very small. The mean 10-year MOP FRAX estimate after exclusion of degenerative vertebrae was 7.67% ± 4.50% versus 7.55% ± 4.36% for L1 to L4 and the mean 10-year hip FRAX estimate after exclusion of degenerative vertebrae was 2.06% ± 2.01% versus 2.02% ± 1.98% for L1 to L4. Lumbar DC have a statistically significant but only small effect on TBS-adjusted FRAX making it unnecessary to exclude the degenerative vertebrae when computing TBS.

Qualitative evaluation of missed nursing care in neonatal intensive care units in a teaching hospital in Jordan.

PURPOSE: Missed nursing care (MNC) is a worldwide patient safety issue. However, little is known about MNC in neonatal intensive care units (NICU). The aim of this paper is to explore the elements and factors influencing the occurrence of MNC in the NICU in a teaching hospital in Amman, Jordan. DESIGN AND METHODS: The study used a qualitative descriptive design. Semi-structured interviews were conducted with NICU nurses. Purposeful sampling was used to select the participants and data collection was performed in the period August 2022 to September 2022. Data were analyzed using thematic analysis. RESULTS: The participants included 15 female nurses. The majority of the participants held a bachelor's degree in nursing. Five themes emerged from the analysis of data namely: (1) Conceptualizations of MNC (2) Missed care elements in the NICU (3) Reasons behind MNC in the NICU (4) Consequences of MNC and (5) Strategies to reduce the occurrence of MNC. Feeding,changing diapers, monitoring vital signs, and medication administrationwere identified as missed care elements in the NICU. CONCLUSIONS: The findings of this research may inform the development of interventions that may reduce missed care incidents in the NICU. PRACTICE IMPLICATIONS: Addressing staff shortages and the provision of necessary materials and equipment appear to be the key factors that may reduce the frequency of MNC. Thus, enhancing patient safety and quality healthcare in this challenging healthcare environment.