Search

Background: A well-known complication of having hip alloplasty surgery is dislocation of the prothesis. This affects 2%-4% of the patients, and 75% of the dislocations occur within the first year after surgery. The aim of our study was to gain knowledge about the clinical considerations underlying the choice of anaesthesia for, and treatment of, patients with dislocated hips by specialists in anaesthesiology and orthopaedic surgery.Methods: We used semi-structured group interviews of specialists in anaesthesiology and orthopaedic surgery. An interview guide was developed and pilot tested before the group interviews. In total, 25 specialists participated, recruited from two university hospitals in Denmark. Data saturation was reached after seven group interviews. Inductive content analysis was used in the data analysis.Results: We identified four overall themes, describing essential considerations made by the specialists: "Adhering to the principle of minimal intervention", "Ensuring patient safety through optimal working conditions", "Organisational considerations" and "Pain induced gastric retention".Conclusion: Our study illustrates different clinical considerations made by specialists in anaesthesiology and orthopaedic surgery in relation to the treatment of patients with dislocated hips. Our results hope to promote mutual understanding in joint clinical decision-making in relation to patients with dislocated hips as well as to inspire less-experienced anaesthesiologists and orthopaedic surgeons. Additionally, our results suggest a set of "rules of thumb" for how jointly to decide on the repositioning site of the patient during the procedure. [ABSTRACT FROM AUTHOR]

OBJECTIVES Patients undergoing hip fracture surgery have a 10 times increased risk of stroke compared with the general population. We aimed to evaluate the association between the CHA2DS2‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke/TIA [transient ischemic attack]/systemic embolism (2 points), vascular disease, age 65‐74 years, and female sex) score and the risk of stroke, thromboembolism, and all‐cause mortality in patients with hip fracture with or without atrial fibrillation (AF). DESIGN Nationwide prospective cohort study. SETTING Danish hospitals. PARTICIPANTS Subjects were all incident hip fracture patients in Denmark age 65 years and older with surgical repair procedures between 2004 and 2016 (n = 78,096). Participants were identified using the Danish Multidisciplinary Hip Fracture Registry. MEASUREMENTS We calculated incidence rates, cumulative incidences, and hazard ratios (HRs) with 95% confidence intervals (CIs) by CHA2DS2‐VASc score, stratified on AF history. RESULTS: The cumulative incidence of ischemic stroke 1 year after hip fracture increased with ascending CHA2DS2‐VASc score, and it was 1.9% for patients with a score of 1 and 8.6% for patients with a score above 5 in the AF group. Corresponding incidences in the non‐AF group were 1.6% and 7.6%. Compared with a CHA2DS2‐VASc score of 1, adjusted HRs were 5.53 (95% CI = 1.37‐22.24) among AF patients and 4.91 (95% CI = 3.40‐7.10) among non‐AF patients with a score above 5. A dose‐response–like association was observed for all cardiovascular outcomes. All‐cause mortality risks and HRs were substantially higher for all CHA2DS2‐VASc scores above 1 in both the AF group and the non‐AF group. CONCLUSION: Among patients with hip fracture, a higher CHA2DS2‐VASc score was associated with increased risk of stroke, thromboembolism, and death. This finding applied both to patients with and without AF. Patients with high CHA2DS2‐VASc scores had almost similar absolute risks for cardiovascular outcomes, irrespective of AF. J Am Geriatr Soc 68:1698‐1705, 2020. [ABSTRACT FROM AUTHOR]

Background: The prevalence of constipation in the general population is 2–28%. Patients with constipation report symptoms of abdominal pain, bloating, nausea, straining to defecate and general discomfort. Strategies for preventing constipation include laxatives, exercise and increased fluid and fibre intake, but life style adjustments, such as exercise, eating more fibres and drinking more fluids, were not considered a solution by older patients. Previous studies have shown that actively involving patients through individualised care and support increases patients’ outcome. Aim: To test the efficacy of a nursing intervention based on active patient involvement including individualised nursing care plans and daily dialogues for patients with hip fractures in preventing constipation after surgery. Methods: A quasi‐experimental design was applied. Inclusion criteria hip fracture needing surgery, understand Danish. Exclusion criteria dementia, gastrointestinal disease. A total of 186 patients were included and 155 completed. An admission interview including Constipation Risk Assessment Scale was undertaken. On that basis an individualised nursing care plan was made. At admission, discharge and 30 days after surgery constipation, intake of fibres and fluid were measured. The Bristol Stool Scale and Rasmussen's scale were used to measure constipation. Patients in the control group received standard care of the ward. Results: After 30 days constipation rates for patients in the intervention group were significantly lower than for patients in the control group (p = 0.042). The fibre intakes and fluid intakes were significantly higher in the intervention group (p ≤ 0.001). The effect of liquid intake was statistically significant (OR = 1.1, 95% CI: 1.0–1.2). Likewise, the effect of fibre intake was statistically significant; the odds of constipation decreased with increasing fibre intake (OR = 0.4, 95% CI: 0.2–0.8). Conclusion: Patients with hip fractures that were actively involved in their own care in preventing constipation were significantly less constipated 30 days after surgery than control patients. Increases in fluid and fibre intakes had significant effects on reducing the risk of developing constipation. [ABSTRACT FROM AUTHOR]

Background A European Union Commission report in 2015 concluded that the concept of patient involvement refers specially to the right of patients to have a central position in the healthcare process (EU Commission 2012, ). Recent research suggests that patient involvement after hip replacement is a very effective strategy in older adults with regard to improving walking ability and reducing pain and thereby lessening loss of physical, mental and social aspects of the quality of life. The growing number of older adults all over the world will increase the need for hip surgery. Hypothesis Older adults' involvement in own rehabilitation improves their health and quality of life after hip replacement. Aim To involve and coach older adults with a hip replacement to self-care after early discharge in transition between hospital and home. Population Empirical data were collected by carrying out three randomised clinical trials ( RCT) focusing on self-rated health and involvement of patients undergoing total hip replacement in three Danish orthopaedic clinics. Based on power calculation, 260 patients (mean age 67.5 years) were invited to participate. In this third study in 2010-2013, patients were randomised to either an intervention group or a control group. Methodology Randomised clinical trials ( RCT). Questionnaire SF-36 a generic tool measuring patients' self-rated health status and quality of life. All patients filled out SF-36 before surgery and again 3, 6, 9 and 12 months after surgery. Patients in the intervention group had an additional follow-up 1, 3 and 7 weeks after discharge by nurses from orthopaedic clinic in hospital. The nurses used a semi-structured interview guide as intervention model to coach, counsel and involve patients to improve their self-care and planned rehabilitation after hip replacement. Results Older adults benefit through involvement based on an intervention model of expectations, measurement of self-rated health and quality of life. The results of the randomised trials one and two documented that patients' self-rated health status in the intervention group reached their habitual level 3 months after hip replacement vs. 9 months in the control group. Since our working hypothesis 'patient involvement in own rehabilitation improves health and quality of life after hip replacement' was found valid, our ambition is now based on results from this third study to contribute to further research and development within patient involvement. Relevance to clinical practice To follow new evidence-based research, results concluded that walking ability is very necessary in order to increase physical activity to benefit the health of older adults and prevent disease. [ABSTRACT FROM AUTHOR]