scholarly journals Differences in hip fracture care in Europe: a systematic review of recent annual reports of hip fracture registries

2021 ◽  
Author(s):  
Maic Werner ◽  
Christian Macke ◽  
Manfred Gogol ◽  
Christian Krettek ◽  
Emmanouil Liodakis
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Functional Decline ◽  
Annual Reports ◽  
Cochrane Library ◽  
Fracture Care ◽  
Keywords Hip Fracture ◽  
Keywords Hip ◽  
Process And Outcome ◽  
Process Measurements

Abstract Purpose Hip fractures are of growing interest due to their increasing number, subsequent functional decline and high institutionalization rate of patients, mortality, and costs. Several process measurements are essential for hip fracture care. To compare and improve these, hip fracture registries in Europe became popular. This systematic review aims to describe the differences between hip fracture registries in Europe as well as the differences in hip fracture treatment between countries. Methods A systematic search using the keywords “hip fracture” AND “national” AND “database OR audit OR registry OR register” was performed in PubMed, Embase and Cochrane Library according to PRISMA guidelines till 3rd December 2020. Recent annual reports of identified hip fracture registries in Europe were additionally identified in June 2021. Comparisons of most common case-mix, process and outcome measurements were performed. Results 11 registries in Europe were identified. Differences were observed regarding inclusion criteria of the different registries. Comparison of the different registries was difficult due to differences in the way to report measurements. While mortality rates differed substantially between countries, most of the process measurements met recommendations according to recent guidelines. Conclusion Hip fracture registries were a valid tool to compare hospitals within one country. However, a comparison between registries of different countries should have also been easily possible. For this, the registries need to make their data easily accessible and further unify their way of measuring and reporting.

scholarly journals The association of fracture risk in atrial fibrillation patients and long-term anticoagulant therapy category: a systematic review and meta-analysis

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e10683
Author(s):  
Jun Chen ◽  
Lingchun Lyu ◽  
Jiayi Shen ◽  
Chunlai Zeng ◽  
Cheng Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Hip Fractures ◽  
Observational Studies ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hip Fracture Risk ◽  
Significant Difference

Objective Our study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. Methods We searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893). Results We included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin. Conclusion The meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.

scholarly journals Effectiveness of acute geriatric unit care on functional decline and process outcomes among older adults admitted to hospital with acute medical complaints: a protocol for a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e050524
Author(s):  
Íde O’Shaughnessy ◽  
Katie Robinson ◽  
Margaret O'Connor ◽  
Mairéad Conneely ◽  
Damien Ryan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Meta Analysis ◽  
Functional Decline ◽  
Index Admission ◽  
Research Centre ◽  
Cochrane Library ◽  
Process Outcomes

IntroductionOlder adults are clinically heterogeneous and are at increased risk of adverse outcomes during hospitalisation due to the presence of multiple comorbid conditions and reduced homoeostatic reserves. Acute geriatric units (AGUs) are units designed with their own physical location and structure, which provide care to older adults during the acute phase of illness and are underpinned by an interdisciplinary comprehensive geriatric assessment model of care. This review aims to update and synthesise the totality of evidence related to the effectiveness of AGU care on clinical and process outcomes among older adults admitted to hospital with acute medical complaints.DesignUpdated systematic review and meta-analysisMethods and analysisMEDLINE, Cumulative Index of Nursing and Allied Health Literature, Controlled Trials in the Cochrane Library and Embase electronic databases will be systematically searched from 2008 to February 2021. Trials with a randomised design that deliver an AGU intervention to older adults admitted to hospital for acute medical complaints will be included. The primary outcome measure will be functional decline at discharge from hospital and at follow-up. Secondary outcomes will include length of stay, cost of index admission, incidence of unscheduled hospital readmission, living at home (the inverse of death or institutionalisation combined; used to describe someone who is in their own home at follow‐up), mortality, cognitive function and patient satisfaction with index admission. Title and abstract screening of studies for full-text extraction will be conducted independently by two authors. The Cochrane risk of bias 2 tool will be used to assess the methodological quality of the included trials. The quality of evidence for outcomes reported will be assessed using the Grading of Recommendations Assessment, Development and Evaluations framework. A pooled meta-analysis will be conducted using Review Manager, depending on the uniformity of the data.Ethics and disseminationFormal ethical approval is not required as all data collected will be secondary data and will be analysed anonymously. The authors will present the findings of the review to a patient and public involvement stakeholder panel of older adults that has been established at the Ageing Research Centre in the University of Limerick. This will enable the views and opinions of older adults to be integrated into the discussion section of the paper.PROSPERO registration numberCRD42021237633.

scholarly journals Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Zhanyu Yang ◽  
Jiangdong Ni ◽  
Ze Long ◽  
Letian Kuang ◽  
Yongquan Gao ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Antiplatelet Therapy ◽  
Hip Fractures ◽  
Meta Analysis ◽  
Platelet Aggregation Inhibitors ◽  
Early Surgery ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
Hip Fracture Surgery ◽  
Keywords Hip

Abstract Background: Hip fractures are common and account for a large proportion of orthopaedic surgical admissions in elderly patients. However, determining the timing for surgery has been controversial for patients who develop with hip fractures while on antiplatelet treatment. Methods: Computerized databases for studies published from the inception date to January 2020, including the Cochrane Library, PubMed (Medline), EMBASE, Web of Science TM , ClinicalTrials, ClinicalKey and Google Scholar, were searched using the keywords “Hip AND Fracture”, “Antiplatelet”, “Antithrombocyte”, “Platelet aggregation inhibitors”, “Aspirin”, “Plavix”, and “Clopidogrel”. Results: In total, 2328 initial articles were identified. Twenty-four studies with 5423 participants were ultimately included in our analysis. Early surgery was associated with an increased transfusion rate in the antiplatelet group compared to the non-antiplatelet group (OR = 1.21; 95% CI, 1.01 to 1.44; p = 0.03). Early surgery for hip fracture patients on antiplatelet therapy was associated with a greater decrease in haemoglobin compared to delayed surgery (WMD = 0.75; 95% CI, 0.50 to 1.00; p < 0.001). However, early surgery appeared to decrease the length of hospitalization (WMD = -6.05; 95% CI, -7.06 to -5.04; p < 0.001) and mortality (OR = 0.43; 95% CI, 0.23 to 0.79; p = 0.006). Conclusion: It is unnecessary to delay surgery to restore platelet function when patients with hip fractures receive antiplatelet therapy. Furthermore, early surgery can significantly reduce mortality and hospital stay, which is conducive to patient recovery. Future randomized trials should determine whether the results are sustained over time.

scholarly journals Systematic review protocol: an assessment of the post-approval challenges of autologous CAR-T therapy delivery

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026172
Author(s):  
Ching Lam ◽  
Edward Meinert ◽  
Celine-Lea Halioua-Haubold ◽  
Alison Carter ◽  
Aidong Yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systems Engineering ◽  
Grey Literature ◽  
Annual Reports ◽  
Cochrane Library ◽  
Car T ◽  
Registration Number ◽  
Critical Appraisal Skills ◽  
Meta Analyses ◽  
Google Search

IntroductionFollowing recent regulatory approvals of two chimeric antigen receptor T-cell (CAR-T) therapies, the field now faces a number of post-approval challenges. These challenges are in some respects defined and, in others, uncertain due to the nascence of the field. At present, information pertaining to such post-approval challenges are scattered in various previous reviews or raised in singular papers reporting experience in working with the therapy. This systematic review is designed to evaluate and summarise the post-approval challenges for robust delivery of CAR-T therapies to inform future work on the optimisation of CAR-T delivery to patients.Methods and analysisWe will search Medline, EMBASE (OvidSP), BIOSIS & Web of Science, Cochrane Library, ICER database, NICE Evidence Search, CEA Registry, WHOLIS WHO Library and Scopus for studies published between 2014 and the present. In addition, a Google search for grey literature such as bioprocess blog posts, opinion pieces, press releases and listed companies involved in CAR-T development annual reports will be conducted. Two authors will independently screen the titles and abstracts identified from the search and accept or reject the studies according to the study inclusion criteria and any discrepancies will be discussed and resolved. The quality of the selected literature will be assessed using theCritical Appraisal Skills Programme(CASP) Systematic Review checklist and grey literature will be assessed using the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist. Data from eligible publications will be categorised using a flowchart and extracted using a data abstraction form. Qualitative and quantitative analysis of the post-approval challenges of CAR-T therapies will be conducted based on the results attained.Ethics and disseminationThe executed study will be published in a peer-reviewed journal in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The findings from this review will be used to inform the development of an optimisation model for robust delivery of CAR-T therapies using a systems engineering approach.Trial registration numberCRD42018109756.

scholarly journals Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Bang Yu Xu ◽  
Shi Yan ◽  
Lian Leng Low ◽  
Farhad Fakhrudin Vasanwala ◽  
Sher Guan Low
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Grip Strength ◽  
Hip Fractures ◽  
Functional Outcomes ◽  
Medical Condition ◽  
Hand Grip Strength ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Hand Grip

Abstract Background Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. Methods We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Results We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. Conclusions This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.

scholarly journals Quality indicators for hip fracture care, a systematic review

2018 ◽  
Vol 29 (9) ◽  
pp. 1963-1985 ◽  
Author(s):  
S.C. Voeten ◽  
P. Krijnen ◽  
D.M. Voeten ◽  
J.H. Hegeman ◽  
M.W.J.M. Wouters ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Quality Indicators ◽  
Fracture Care

Outcomes in Multidisciplinary Team-based Approach in Geriatric Hip Fracture Care: A Systematic Review

2020 ◽  
Vol 28 (3) ◽  
pp. 128-133 ◽  
Author(s):  
Jay N. Patel ◽  
David S. Klein ◽  
Swathy Sreekumar ◽  
Frank A. Liporace ◽  
Richard S. Yoon
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Multidisciplinary Team ◽  
Fracture Care ◽  
Geriatric Hip Fracture

scholarly journals Integrated Hip Fracture Care Pathway (IHFCP): reducing complications and improving outcomes

2021 ◽  
Author(s):  
L Heyzer ◽  
R Ramason ◽  
JADC Molina ◽  
WWL Chan ◽  
YL Chen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Outcome Measures ◽  
Average Length ◽  
Care Pathway ◽  
Post Discharge ◽  
Fracture Care ◽  
Fragility Hip Fracture ◽  
Average Length Of Stay ◽  
Process And Outcome

Introduction: Hip fractures in elderly people are increasing. A five-year Integrated Hip Fracture Care Pathway (IHFCP) was implemented at our hospital for seamlessly integrating care for these patients from admission to post discharge. We aimed to evaluate how IHFCP improved process and outcome measures in these patients. Methods: A study was conducted over a five-year period on patients with acute fragility hip fracture who were managed on IHFCP. The evaluation utilised a descriptive design, with outcomes analysed separately for each of the five years of the programme. First-year results were treated as baseline. Results: The main improvements in process and outcome measures over five years, when compared to baseline, were: (a) increase in surgeries performed within 48 hours of admission from 32.5% to 80.1%; (b) reduced non-operated patients from 19.6% to 11.9%; (c) reduced average length of stay at acute hospital among surgically (from 14.0 ± 12.3 days to 9.9 ± 1.0 days) and conservatively managed patients (from 19.1 ± 22.9 to 11.0 ± 2.5 days); (d) reduced 30-day readmission rate from 3.2% to 1.6%; and (e) improved Modified Functional Assessment Classification of VI to VII at six months from 48.0% to 78.2%. Conclusion: The IHFCP is a standardised care path that can reduce time to surgery, average length of stay and readmission rates. It is distinct from other orthogeriatric care models, with its ability to provide optimal care coordination, early transfer to community hospitals and post-discharge day rehabilitation services. Consequently, it helped to optimise patients’ functional status and improved their overall outcome.

Characteristics of the Frequency-Following Response to Speech in Neonates and Potential Applicability in Clinical Practice: A Systematic Review

2020 ◽  
Vol 63 (5) ◽  
pp. 1618-1635
Author(s):  
Céline Richard ◽  
Mary Lauren Neel ◽  
Arnaud Jeanvoine ◽  
Sharon Mc Connell ◽  
Alison Gehred ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cochrane Library ◽  
Neurodevelopmental Outcomes ◽  
Frequency Following Response ◽  
Ovid Medline ◽  
Published Evidence ◽  
Mesh Terms ◽  
Potential Applicability ◽  
Clinical Potential

Purpose We sought to critically analyze and evaluate published evidence regarding feasibility and clinical potential for predicting neurodevelopmental outcomes of the frequency-following responses (FFRs) to speech recordings in neonates (birth to 28 days). Method A systematic search of MeSH terms in the Cumulative Index to Nursing and Allied HealthLiterature, Embase, Google Scholar, Ovid Medline (R) and E-Pub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Web of Science, SCOPUS, COCHRANE Library, and ClinicalTrials.gov was performed. Manual review of all items identified in the search was performed by two independent reviewers. Articles were evaluated based on the level of methodological quality and evidence according to the RTI item bank. Results Seven articles met inclusion criteria. None of the included studies reported neurodevelopmental outcomes past 3 months of age. Quality of the evidence ranged from moderate to high. Protocol variations were frequent. Conclusions Based on this systematic review, the FFR to speech can capture both temporal and spectral acoustic features in neonates. It can accurately be recorded in a fast and easy manner at the infant's bedside. However, at this time, further studies are needed to identify and validate which FFR features could be incorporated as an addition to standard evaluation of infant sound processing evaluation in subcortico-cortical networks. This review identifies the need for further research focused on identifying specific features of the neonatal FFRs, those with predictive value for early childhood outcomes to help guide targeted early speech and hearing interventions.

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