Management of hip fractures in older people in Beijing: a retrospective audit and comparison with evidence-based guidelines and practice in the UK

2015 ◽  
Vol 27 (2) ◽  
pp. 677-681 ◽  
Author(s):  
M. Tian ◽  
X. Gong ◽  
S. Rath ◽  
J. Wei ◽  
L. L. Yan ◽  
...  
Keyword(s):  
Older People ◽  
Hip Fractures ◽  
Evidence Based ◽  
Retrospective Audit ◽  
The Uk ◽  
Evidence Based Guidelines

scholarly journals Peripheral Intravenous Cannula Usage in the Emergency Department

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Adam K Stanley ◽  
Ashton Barnett-Vanes ◽  
Matthew J Reed
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Regional Variation ◽  
Evidence Based ◽  
Failure Rates ◽  
Intravenous Cannula ◽  
Hospitalised Patients ◽  
The Uk ◽  
Evidence Based Guidelines

Over a billion Peripheral Intra-Venous Cannulas (PIVC) are used globally every year with at least 25 million sold annually in the UK.1,2 The NHS spends an estimated £29m of its annual acute sector budget on PIVC procurement3 and around 70% of all hospitalised patients require at least one PIVC during their stay.4 Despite their extensive and routine use, PIVC failure rates are reported as high as 50-69%.5-7 In addition, many PIVCs remain unused following insertion, particularly in the Emergency Department (ED).8,9 The risk factors for PIVC failure are not well understood and the literature has found extensive regional variation in practice when it comes to PIVC insertion and management.1,7,10 While various technologies have been developed to address these issues, there remains a need for standardised, evidence-based guidelines.

Deprescribing in older people

2020 ◽  
Vol 81 (1) ◽  
pp. 1-9 ◽  
Author(s):  
M Sinead O'Mahony ◽  
Anita Parbhoo
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Older People ◽  
Adverse Drug Events ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Pharmacological Management ◽  
International Evidence ◽  
Evidence Based Guidelines

Polypharmacy and multimorbidity are both currently rising. The number of medicines taken is the single biggest predictor of adverse drug events. Deprescribing is an approach to managing polypharmacy and reducing adverse outcomes. Multiple international evidence-based guidelines are emerging to promote discontinuation of high-risk medications, and use of alternative medical and non-pharmacological management. This review outlines the evidence base behind deprescribing, and suggests some pragmatic approaches to decision making around medication review.

scholarly journals Evidence-based clinical practice guidelines on the management of pain in older people – a summary report

2020 ◽  
pp. 204946372097615
Author(s):  
Margaret Dunham ◽  
Patricia Schofield ◽  
Roger Knaggs
Keyword(s):  
Health Care ◽  
Older People ◽  
Severity Of Illness ◽  
Evidence Based ◽  
Therapeutic Approaches ◽  
Pharmacological Interventions ◽  
Care Plans ◽  
Individualised Care ◽  
Evidence Based Guidelines ◽  
Routine Assessment

Objective: The objective of this study is to develop an update of the evidence-based guidelines for the management of pain in older people. Design: Review of evidence since 2010 using a systematic and consensus approach is performed. Results: Recognition of the type of pain and routine assessment of pain should inform the use of specific environmental, behavioural and pharmacological interventions. Individualised care plans and analgesic protocols for specific clinical situations, patients and health care settings can be developed from these guidelines. Conclusion: Management of pain must be considered as an important component of the health care provided to all people, regardless of their chronological age or severity of illness. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with adverse effects of treatment and the potential for drug interactions.

scholarly journals Current practice in the assessment and management of acute diabetes-related foot complications

2007 ◽  
Vol 31 (2) ◽  
pp. 217 ◽  
Author(s):  
Rebecca L Jessup ◽  
Anita A Spring ◽  
Aspa Grollo
Keyword(s):  
Length Of Stay ◽  
Clinical Guidelines ◽  
Current Practice ◽  
Glycated Haemoglobin ◽  
Evidence Based ◽  
Outpatient Services ◽  
Foot Complications ◽  
Retrospective Audit ◽  
Acute Diabetes ◽  
Evidence Based Guidelines

A retrospective audit of client histories from 1 April 2004 to 31 March 2005 was conducted. Assessment, investigations on admission, management, length of stay and outcomes were assessed and compared with evidence-based guidelines. A total of 62 clients with 115 admissions were identified. The finding that HBA1c (glycated haemoglobin) levels were measured on admission 50% of the time suggested there is significant variability in assessment, investigation and management of acute diabetes-related foot complications. There is a need to better utilise evidence-based clinical guidelines, and for greater emphasis on linking individuals who are at risk of hospitalisation into appropriate outpatient services to improve outcomes.

From gut feeling to evidence base: drivers and barriers to the development of health care for older people

2015 ◽  
Author(s):  
Paul V. Knight
Keyword(s):  
Older People ◽  
Evidence Base ◽  
Evidence Based ◽  
The Past ◽  
Key Points ◽  
Provision Of Services ◽  
The Uk ◽  
Complex Scenario ◽  
Care For Older People ◽  
Do So

Key points• Major advances in medicine, policy, and services for older people have been made over the past fifty years.• The numbers of older people in the UK and elsewhere are increasing and will continue to do so.• This increase has concomitant sociological, medical, and economic challenges that need to be met because they affect the provision of services at all levels.• These challenges are occurring at a time when resources are becoming scarcer and budgets shrinking.• Governments are faced with orchestrating infrastructure and policy in this demanding and complex scenario.• Managers are attempting to do more with less.• Clinicians and other medical professionals are trying to base treatments on sound evidence-based strategies.• There is recognition of the need to include older people and the general public in these processes.• Research may provide us with information that can help resolve these problems.

scholarly journals Identifying Disparities in the Management of Hip Fractures Within Europe: A Comparison of 3 Health-Care Systems

2019 ◽  
Vol 10 ◽  
pp. 215145931987294 ◽  
Author(s):  
Cliodhna E. Murray ◽  
Andreas Fuchs ◽  
Heide Grünewald ◽  
Owen Godkin ◽  
Norbert P. Südkamp ◽  
...  
Keyword(s):  
Health Care ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Care Pathway ◽  
Health Care Systems ◽  
Standards Of Care ◽  
Evidence Based ◽  
Care Hospital ◽  
Care Systems ◽  
The Uk

Introduction: This study investigates the management of hip fractures in a German maximum care hospital and compares these data to evidence-based standard and practice in 180 hospitals participating in the UK National Hip Fracture Database (NHFD) and 16 hospitals participating in the Irish Hip Fracture Database (IHFD). This is the first study directly comparing the management of hip fractures between 3 separate health-care systems within Europe. Methods: Electronic medical data were collected retrospectively describing the care pathway of elderly patients with a hip fracture admitted to a large trauma unit in the south of Germany “University Hospital Freiburg” (UHF). The audit evaluated demographics, postoperative outcome, and the adherence to the 6 “Blue Book” standards of care. These data were directly compared with the data from the UK NHFD and the IHFD acquired from 180 and 16 hospitals, respectively. Results: At 36 hours, 95.8% of patients had received surgery in UHF, compared to 71.5% in the NHFD and 58% of patients in the IHFD. The rate of in-hospital mortality was 4.7% compared to 7.1% in the NHFD and 5% in the IHFD. The mean average acute length of stay was 13.4 days compared to 16.4 days in the NHFD and 20 days in the IHFD. Reoperation rates are 3.3% compared to 1% in the NHFD and 1.1% in the IHFD; 50.5% of patients were discharged on bone protection medication, compared to 47% in the IHFD and 79.3% in the UK NHFD. Discussion: Despite uniformly acknowledged evidence-based treatment guidelines, the management of hip fractures remains heterogeneous within Europe. Conclusion: These data show that different areas of the hip fracture care pathway in Germany, England, and Ireland, respectively, show room for improvement in light of the growing socioeconomic burden these countries are expected to face.

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