Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.046
Filtrar
1.
Int J Health Plann Manage ; 36(5): 1445-1464, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34519092

RESUMO

BACKGROUND: Studies have found that optimised care chain (OCC) can promote the recovery of hip fracture patients. Fast track (FT) has been widely proven to play a good role, but there is no systematic review report. METHODS: We conducted a comprehensive search and obtained search data as of April 2020. These included randomised controlled trials (RCTs) and cohort trials (CTs). We applied the research input Review Manager 5.3 for data synthesis, and used Stata 12.0 for meta- regression analysis. RESULTS: This review reported 2200 hip fractures. Our analysis showed that OCC can reduce complications and 1-year mortality, and shorten the length of stay (LOS). After dividing the complications into bed-related complications and other complications, OCC has advantages in reducing bed-related complications, but has no significant effect on other complications. For the conventional care group, the secondary outcome of the OCC group showed there was no significant difference in duration of surgery, and the rest were significantly improved. Subgroup analysis between green channel (GC) and FT showed a shorter LOS for GC. CONCLUSIONS: This meta-analysis suggests that the use of OCC in China promotes rehabilitation in elderly patients with hip fractures, that FT and GC are similar in effect in China, and that GC shows a greater advantage in reducing LOS.


Assuntos
Fraturas do Quadril , Idoso , China , Fraturas do Quadril/terapia , Humanos , Tempo de Internação
2.
Ned Tijdschr Geneeskd ; 1652021 09 02.
Artigo em Holandês | MEDLINE | ID: mdl-34523843

RESUMO

Integrated orthogeriatric treatment, led by a nurse practitioner, is an important step forward in the improvement of care for older people with a hip fracture. In this paper we reflect on the study of Van Leendert et al. Their main findings are similar to the literature with a significantly reduced 1-year mortality rate in the orthogeriatric group compared to the standard care group. However, there are some remarks to be made regarding the patient characteristics that are unbalanced in favor of the orthogeriatric group, with an overrepresentation of a certain type of fracture, indicating potentially more vulnerable patients in the standard care group. Although a significant step forward, we also address that still face major challenges, that technology might be an enabler for further improvement but that it might also be time to introduce a new perspective on recovery that makes better use of the dynamics of the system.


Assuntos
Serviços de Saúde para Idosos , Fraturas do Quadril , Idoso , Fraturas do Quadril/terapia , Humanos , Tempo de Internação
3.
Orthop Clin North Am ; 52(4): 297-304, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538342

RESUMO

The direct anterior approach (DAA) is gaining popularity in primary total hip arthroplasty (THA). Although DAA has demonstrated many advantages over other surgical approaches, periprosthetic femur fractures (PPFF) rates continue to be higher. Femoral stem designs that allow for easier insertion via a DAA may contribute to the higher rates of fracture seen in this approach. Certain stem designs and fixation methods may reduce the risk of PPFF via a DAA in primary THA.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fixação de Fratura/métodos , Fraturas do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/cirurgia , Desenho de Prótese/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Cimentos Ósseos , Cimentação , Fraturas do Quadril/etiologia , Fraturas do Quadril/terapia , Humanos , Fraturas Periprotéticas/etiologia , Reoperação
4.
Isr Med Assoc J ; 23(8): 475-478, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392620

RESUMO

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic had enormous impact on many aspects of our society, including huge medical, social, and economic challenges. OBJECTIVES: To evaluate the impact of the first wave of the COVID-19 pandemic and the related movement restrictions on the incidence of hip fractures in different age groups. METHODS: This single center retrospective observational study included all patients over 60 years old admitted to our hospital with the diagnosis of hip fracture during March and April 2020. Exclusion criteria were periprosthetic or pathologic fractures and multitrauma. We collected the same data on all patients with hip fractures admitted during March and April of 2018 and 2019. RESULTS: Mean patient age increased from 81.7 to 85.0 years. Only two of 49 patients tested positive for COVID-19. The data show a decrease of 38% in fracture load, but a striking decrease of 85% and 59% among sexagenarians and septuagenarian, respectively. There was no decrease among nonagenarians. Early mortality, both at 30 days and 90 days, was twice as common during the pandemic. However, stratification by age group demonstrated that the risks of early mortality were the same as previous years. Mean waiting time for surgery decreased from 27.5 to 18.9 hours. Patient discharge to home over a rehabilitation facility increased from 9% to 17. CONCLUSIONS: The COVID-19 pandemic affected the epidemiology of hip fractures in the elderly. The incidence of fractures and age distribution were significantly different from other years. Discharge destinations were also affected. The management of hip fracture patients was not compromised.


Assuntos
COVID-19 , Fraturas do Quadril , Administração dos Cuidados ao Paciente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Fraturas do Quadril/mortalidade , Fraturas do Quadril/reabilitação , Fraturas do Quadril/terapia , Humanos , Incidência , Controle de Infecções/métodos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/tendências , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação
5.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371911

RESUMO

BACKGROUND: The aim of this work was to assess whether the muscle thickness and echogenicity were associated with dysphagia, malnutrition, sarcopenia, and functional capacity in acute hospital admission for a hip fracture. METHODS: Observational study that assessed nutritional status by Global Leadership Initiative on Malnutrition, risk of dysphagia and sarcopenia by European Working Group on Sarcopenia in Older People and Barthel functional index. We measured muscle thickness and echogenicity of masseter, bicipital, and quadriceps rectus femoris (RF) and vastus intermedius (VI) by ultrasound. RESULTS: One hundred and one patients were included in the study (29.7% sarcopenia and 43.8% malnutrition). Logistic regression models adjusted for age, sex, and body mass index showed an inverse association of the masseter thickness with both sarcopenia (OR: 0.56) and malnutrition (OR: 0.38) and quadriceps with sarcopenia (OR: 0.74). In addition, patients at high risk of dysphagia had lower masseter thickness (p: 0.0001) while patients able to self-feeding had thicker biceps (p: 0.002) and individuals with mobility on level surfaces higher thickness of biceps (p: 0.008) and quadriceps (p: 0.04). CONCLUSION: Thickness of the masseter was associated with risk of dysphagia, biceps with the ability to self-feed, and that of the quadriceps RF-VI with mobility.


Assuntos
Composição Corporal , Fraturas do Quadril/terapia , Hospitalização , Desnutrição/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Estado Nutricional , Sarcopenia/diagnóstico por imagem , Ultrassonografia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Estado Funcional , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Humanos , Pacientes Internados , Masculino , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Músculo Esquelético/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco , Sarcopenia/epidemiologia , Sarcopenia/fisiopatologia , Espanha/epidemiologia
7.
Arch Osteoporos ; 16(1): 103, 2021 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-34176022

RESUMO

PURPOSE: Orthogeriatrics is a team approach that aims to provide adequate and timely intervention for individuals suffering from fragility fractures, particularly hip fractures. These patients are mostly the frailest older adults. The aim of orthogeriatrics is to re-gain functionality as early as possible and to decrease disability and mortality. Some developed countries have established orthogeriatric services, while many others, including Turkey, have so far not. Here, to identify areas for improvement, we outline the status of the orthogeriatrics in older adults in Turkey. METHODS: We present clear calls for action, emphasizing possible and noteworthy areas for improvement. RESULTS: Our proposals include the need for an easily applied, short version of comprehensive geriatric assessment; appropriate laboratory testing on admission; paracetamol with a special emphasis in its dosings and clues for state-of-the-art analgesic management; the essential need to introduce oral nutritional supplementation, irrespective of nutritional status; the need for vitamin D commencement, in almost all patients; and starting osteoporosis treatment in fracture hospitalization, whenever appropriate. Last but not least, the ever-increasing prerequisite to establish "fracture liaison services" is stipulated. CONCLUSION: We suggest that our recommendations offer great potential in Turkey, for the improvement of frail fracture patients' care. We call the other countries that do not have established orthogeriatric lines to model our approach to improve the management of fracture patients globally.


Assuntos
Serviços de Saúde para Idosos , Fraturas do Quadril , Fraturas por Osteoporose , Idoso , Idoso Fragilizado , Fraturas do Quadril/terapia , Hospitalização , Humanos , Fraturas por Osteoporose/terapia , Turquia
8.
Injury ; 52(7): 1851-1860, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33985752

RESUMO

BACKGROUND: Hip fracture is a common serious injury in older people and reducing readmission after hip fracture is a priority in many healthcare systems. Interventions which significantly reduce readmission after hip fracture have been identified and the aim of this review is to collate and summarise the efficacy of these interventions in one place. METHODS: In a rapid review of systematic reviews one reviewer (ELS) searched the Ovid SP version of Medline and the Cochrane Database of Systematic Reviews. Titles and abstracts of 915 articles were reviewed. Nineteen systematic reviews were included. (ELS) used a data extraction sheet to capture data on interventions and their effect on readmission. A second reviewer (RK) verified data extraction in a random sample of four systematic reviews. Results were not meta-analysed. Odds and risk ratios are presented where available. RESULTS: Three interventions significantly reduce readmission in elderly populations after hip fracture: personalised discharge planning, self-care and regional anaesthesia. Three interventions are not conclusively supported by evidence: Oral Nutritional Supplementation, integration of care, and case management. Two interventions do not affect readmission after hip fracture: Enhanced Recovery pathways and comprehensive geriatric assessment. CONCLUSIONS: Three interventions are most effective at reducing readmissions in older people: discharge planning, self-care, and regional anaesthesia. Further work is needed to optimise interventions and ensure the most at-risk populations benefit from them, and complete development work on interventions (e.g. interventions to reduce loneliness) and intervention components (e.g. adapting self-care interventions for dementia patients) which have not been fully tested yet.


Assuntos
Fraturas do Quadril , Readmissão do Paciente , Idoso , Fraturas do Quadril/terapia , Humanos , Alta do Paciente , Autocuidado , Revisões Sistemáticas como Assunto
9.
Eur J Health Econ ; 22(6): 873-885, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33813666

RESUMO

BACKGROUND: Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients. METHODS: This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a hip fracture in 2014, and were treated in hospitals providing OGCM (OGCM group) or standard care (control group). Health care costs from payer and societal perspective, life years gained (LYG) and cost-effectiveness were investigated within 1 year. We applied weighted gamma and two-part models, and entropy balancing to account for the lack of randomisation. We calculated incremental cost-effectiveness ratios (ICER) and employed the net-benefit approach to construct cost-effectiveness acceptability curves. RESULTS: 14,005 patients were treated in OGCM, and 10,512 in standard care hospitals. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The ICER equalled €52,378.12/ LYG from payer and €75,703.44/ LYG from societal perspective. The probability for cost-effectiveness would be 95% if the willingness-to-pay was higher than €82,000/ LYG from payer, and €95,000/ LYG from societal perspective. CONCLUSION: Survival improved in hospitals providing OGCM. Costs were found to increase, driven by inpatient and long-term care. The cost-effectiveness depends on the willingness-to-pay. The ICER is likely to improve with a longer follow-up.


Assuntos
Fraturas do Quadril , Seguro de Assistência de Longo Prazo , Idoso , Análise Custo-Benefício , Custos de Cuidados de Saúde , Fraturas do Quadril/terapia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos
10.
J Korean Med Sci ; 36(13): e87, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33821594

RESUMO

BACKGROUND: The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data. METHODS: This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA. RESULTS: In the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (P > 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12-1.87; P = 0.004) and 1.65-fold (aRR; 95% CI, 1.43-1.91; P < 0.001), respectively, compared to past non-users. CONCLUSION: In THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery.


Assuntos
Analgésicos Opioides/efeitos adversos , Artroplastia de Quadril , Transtornos Relacionados ao Uso de Opioides/etiologia , Adolescente , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Bases de Dados Factuais , Feminino , Fraturas do Quadril/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/mortalidade , Dor Pós-Operatória/tratamento farmacológico , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tramadol/efeitos adversos , Tramadol/uso terapêutico , Adulto Jovem
11.
Arch Osteoporos ; 16(1): 63, 2021 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-33829364

RESUMO

Individual process indicators often do not enable the benchmarking of hospitals and often lack an association with outcomes of care. The composite hip fracture process indicator, textbook process, might be a tool to detect hospital variation and is associated with better outcomes during hospital stay. PURPOSE: The aim of this study was to determine hospital variation in quality of hip fracture care using a composite process indicator (textbook process) and to evaluate at patient level whether fulfilment of the textbook process indicator was associated with better outcomes during hospital stay. METHODS: Hip fracture patients aged 70 and older operated in five hospitals between 1 January 2018 and 31 December 2018 were included. Textbook process for hip fracture care was defined as follows: (1) assessment of malnutrition (2) surgery within 24 h, (3) orthogeriatric management during admission and (4) operation by an orthopaedic trauma certified surgeon. Hospital variation analysis was done by computing an observed/expected ratio (O/E ratio) for textbook process at hospital level. The expected ratios were derived from a multivariable logistic regression analysis including all relevant case-mix variables. The association between textbook process compliance and in-hospital complications and prolonged hospital stay was determined at patient level in a multivariable logistic regression model, with correction for patient, treatment and hospital characteristics. In-hospital complications were anaemia, delirium, pneumonia, urinary tract infection, in-hospital fall, heart failure, renal insufficiency, pulmonary embolism, wound infection and pressure ulcer. RESULTS: Of the 1371 included patients, 753 (55%) received care according to textbook process. At hospital level, the textbook compliance rates ranged from 38 to 76%. At patient level, textbook process compliance was significantly associated with fewer complications (38% versus 46%) (OR 0.66, 95% CI 0.52-0.84), but not with hospital stay (median length of hospital stay was 5 days in both groups) (OR 1.01, 95% CI 0.78-1.30). CONCLUSION: The textbook process indicator for hip fracture care might be a tool to detect hospital variation. At patient level, this quality indicator is associated with fewer complications during hospital stay.


Assuntos
Fraturas do Quadril , Indicadores de Qualidade em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/terapia , Hospitalização , Hospitais , Humanos , Tempo de Internação
12.
Artigo em Inglês | MEDLINE | ID: mdl-33809573

RESUMO

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms "hip fracture", "geriatric assessment", "second hip fracture", "surgery", "perioperative management" and "orthogeriatric care", in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.


Assuntos
Serviços de Saúde para Idosos , Fraturas do Quadril , Idoso , Fraturas do Quadril/terapia , Hospitalização , Hospitais , Humanos , Tempo de Internação
13.
Aging Clin Exp Res ; 33(6): 1439-1452, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33821467

RESUMO

As many as one out of three fragility fractures occur in older men and the outcome of major osteoporotic fractures, in particular hip fractures, is worse in men than in women. Osteoporosis in older men is thus an important threat to the quality of life of individual patients and a considerable burden for society. However, only a small minority of older men with high or very high fracture risk are receiving therapy. This does not need to be so as tools for fracture risk assessment are available and several drugs have been approved for treatment. Nevertheless, the evidence base for the management of osteoporosis in older men remains limited. This narrative review summarises the evidence for older men on the burden of osteoporosis, the pathophysiology of fragility fractures, the clinical presentation, diagnosis and risk assessment, the patient evaluation, and the non-pharmacological and pharmacological management.


Assuntos
Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Idoso , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/terapia , Humanos , Masculino , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/prevenção & controle , Qualidade de Vida , Medição de Risco , Fatores de Risco
14.
BMC Geriatr ; 21(1): 224, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794804

RESUMO

BACKGROUND: This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS: This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS: Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS: The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION: Netherlands Trial Register: NTR5695 (7 March 2016).


Assuntos
Acidentes por Quedas , Cognição , Fraturas do Quadril , Acidentes por Quedas/prevenção & controle , Idoso , Medo , Estudos de Viabilidade , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/psicologia , Fraturas do Quadril/terapia , Humanos , Países Baixos/epidemiologia , Estudos Prospectivos
15.
Age Ageing ; 50(5): 1744-1750, 2021 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-33710294

RESUMO

BACKGROUND: Hip fractures are a major cause of mortality and disability in frail older adults. Therefore, orthogeriatrics has been embraced to improve patient outcomes. With the optimal template of orthogeriatric care still unknown, and to curtail rising healthcare expenditure we implemented a nurse practitioner-led orthogeriatric care program (NPOCP). The objective was to evaluate NPOCP by measuring 3-month and 1-year mortality, compared to usual care (UC). In addition, length of stay (LOS) and location of hospital discharge were reported. METHODS: An anonymised data set, of hip fracture patients (n = 300) who presented to Maastricht University Medical Centre, the Netherlands, a level-1 trauma centre, was used. NPOCP was implemented on one of two surgical wards, while the other ward received UC. Patient allocation to these wards was random. RESULTS: In total, 144 patients received NPOCP and 156 received UC. In the NPOCP, 3-month and 1-year mortality rates were 9.0% and 13.9%, compared to 24.4% and 34.0% in the UC group (P < 0.001). The adjusted hazard ratio (aHR) for 3-month (aHR 0.50 [95%CI: 0.26-0.97]) and 1-year mortality (aHR 0.50 [95%CI: 0.29-0.85]) remained lower in NPOCP compared to UC. Median LOS was 9 days [IQR 5-13] in patients receiving UC and 7 days [IQR 5-13] in patients receiving NPOCP (P = 0.08). Thirty-eight (27.5%) patients receiving UC and fifty-seven (40.4%) patients receiving NPOCP were discharged home (P = 0.023). CONCLUSION: Implementation of NPOCP was associated with significantly reduced mortality in hip fracture patients and may contribute positively to high-quality care and improve outcomes in the frail orthogeriatric population.


Assuntos
Fraturas do Quadril , Profissionais de Enfermagem , Idoso , Seguimentos , Idoso Fragilizado , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/terapia , Humanos , Tempo de Internação
16.
BMC Geriatr ; 21(1): 208, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33765935

RESUMO

BACKGROUND: The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL). METHODS: This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery. RESULTS: Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points. CONCLUSIONS: Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.


Assuntos
Atividades Cotidianas , Fraturas do Quadril , Serviço Hospitalar de Emergência , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/terapia , Hospitalização , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Soc Sci Med ; 274: 113611, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33685757

RESUMO

Many studies indicate huge regional and hospital-level differences in health care performance. In order to increase health system efficiency, it is important to know the reasons behind the differences and analyse the effects of those factors that can be affected by health policy. The aim of this study is to evaluate and compare various organisational factors and health policy interventions in the performance of the care of hip fracture patients in Finland. We analysed the relationship between organisational factors (hospital volume, regional concentration of treatments) and performance. The focus is also on the effects of two macro-level organisational changes (integration of production of all health and social services in one provider) and two micro-level interventions (integrated patient pathway interventions, aiming to discharge patients as soon as possible). Our results indicate that macro-level integration of the production or financing of health and social services, bigger hospital volumes, and the concentration of the acute phase of care in fewer hospitals within hospital districts were not consistently related to efficiency in the care of hip fracture patients. Instead, efficiency can be increased using micro-level interventions aiming to coordinate patient pathways at the patient group level.


Assuntos
Fraturas do Quadril , Atenção à Saúde , Finlândia , Política de Saúde , Fraturas do Quadril/terapia , Hospitais , Humanos
18.
Can J Surg ; 64(2): E211-E217, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33769005

RESUMO

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.


Assuntos
Delírio/prevenção & controle , Avaliação Geriátrica , Fraturas do Quadril/cirurgia , Tempo de Internação/estatística & dados numéricos , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/terapia , Hospitais Comunitários , Humanos , Masculino , Modelos Teóricos , Período Pós-Operatório , Estudos Retrospectivos
19.
J Orthop Sports Phys Ther ; 51(2): 62, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33522381

RESUMO

Hip fractures become more common as people age. If they occur when someone is 65 years of age or older, there are a number of things that can ensure a good outcome. Once hip fractures are treated, usually by surgery, rehabilitation begins. This should include physical therapy. The JOSPT published a clinical practice guideline titled "Physical Therapy Management of Older Adults With Hip Fracture" in the February 2021 issue. In this Perspectives for Patients article, we share what the experts found and what it means for you or someone for whom you may be caring. J Orthop Sports Phys Ther 2021;51(2):62. doi:10.2519/jospt.2021.0502.


Assuntos
Fraturas do Quadril/terapia , Modalidades de Fisioterapia , Idoso , Humanos , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto
20.
J Orthop Sports Phys Ther ; 51(2): 60-61, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33522382

RESUMO

Hip fracture is a leading cause of morbidity in people aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Individuals recovering from hip fracture are at high risk for muscle weakness, fear of falling, limitations in mobility and self-care, and loss of autonomy, which can last for months after surgery. They also have a higher risk of mortality compared to people who have not had such a fracture. Published in the February 2021 issue of the JOSPT, clinical practice guidelines (CPGs) for hip fracture summarize the best available evidence on outcome measures and the interventions to be implemented after hip fracture. J Orthop Sports Phys Ther 2021;51(2):60-61. doi:10.2519/jospt.2021.0501.


Assuntos
Fraturas do Quadril/terapia , Modalidades de Fisioterapia , Idoso , Medicina Baseada em Evidências , Humanos , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...