scholarly journals 327 The Impact of Implementation of Recommendations from the IFHD 2017 Annual Report in an Irish Model 3 Hospital

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Siofra Hearne ◽  
Hannah Smyth ◽  
Pheadra Monahan ◽  
Hugh McGowan ◽  
Shirley Timmins ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Bone Health ◽  
Annual Report ◽  
Health Assessment ◽  
Admission Rate ◽  
Rehabilitation Services ◽  
Discharge Destination ◽  
Older Person ◽  
Site Rehabilitation ◽  
The Impact

Abstract Background Hip fractures in the older person are associated with high mortality rates (NICE, 2011). Up to 40% of patients never regain their pre-fracture mobility, 10-20% never return to live at home. The Irish Hip Fracture Database (IHFD) National Report 2017 recommends appointment of an orthogeriatric consultant in this hospital to achieve IHFD standards 4 to 6. Methods We analysed a subset of HIPE data collected for the IHFD in patients over 60 years over a three month period from September – November 2017 and compare it to September – November 2018 after introduction of an orthogeriatric service. We looked at geriatrician review, bone health assessment, falls assessment, discharge destination, 30-day re-admission rate and mortality during admission. Results There were 45 hip fracture patients in each group. In the 2017 group, mean age was 79, female 64%; compared to mean age of 80, female 62.2% in 2018. In 2018, after the appointment of an orthogeriatrician, 95.6% of patients were seen by a geriatrician compared to 4.4% in 2017. In 2018, 97.7% received bone health assessment compared to 26.8% in 2017. In 2018 95.3% received specialist falls assessment, compared to 2.4% in 2017. Mean length of stay was 18 days in 2018 versus 13 days in 2017. 2.2% of patients were discharged to convalescence in 2018, 26.7% in 2017. 57.8% of patients were discharged to off-site rehabilitation in 2018 compared to 40% in 2017. 2.2% patients died during admission in 2018, 8.9% in 2017. In 2018, 6.7% of patients were readmitted within 30 days, 8.8% in 2017. Conclusion Provision of rapid Comprehensive Geriatric Assessment to all hip fracture patients, reduces falls and fracture risk. There is evidence of improvement in IHFD standards 4-6, mortality rate and 30-day readmission rate. Moreover, the orthogeriatric service has led to increased referral to rehabilitation services ensuring optimal functional recovery.

scholarly journals 279 Quality Improvement Audit on Bone Health Assessment and Secondary Prevention of Patients Discharged from an In-patient Rehabilitation Unit Post Fracture

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Pádraig Synnott ◽  
Michelle Brennan ◽  
Shaun O'Keeffe ◽  
Michelle Canavan
Keyword(s):  
Vitamin D ◽  
Bone Health ◽  
Health Assessment ◽  
Pharmacological Therapy ◽  
Prescribing Practices ◽  
Antiresorptive Therapy ◽  
Rehabilitation Unit ◽  
Life Years ◽  
Fracture Bone ◽  
Site Rehabilitation

Abstract Background Osteoporosis accounts for more disability-adjusted life years than many non-communicable diseases. Identification and treatment is important to reduce morbidity and mortality associated with further fracture.(1) National Osteoporosis Guideline Group recommends all patients with a fragility fracture should undergo a bone health assessment and commence pharmacological therapy if indicated.(2) Methods Electronic discharge summaries of all patients with a diagnosis of fracture discharged from an off-site rehabilitation unit from 1st January 2018 to 31st December 2018 were reviewed. Patient details, location and mechanism of fracture, bone health assessment and discharge prescription were assessed. Following data collection, an education session directed at NCHDs was performed and a discharge checklist prompting bone health review and consideration of pharmacological therapy was introduced. A re-audit was performed at 4 months to assess change following this intervention. Results 74 patients had a diagnosis of fracture. 4 were excluded as fracture resulted from high impact trauma. 100% had corrected calcium measured. 93%(n=65) had Vitamin D(OH) measured. 91%(n=64) had PTH measured. 55%(n=39) were discharged on calcium/vitamin D(OH) supplementation. 33%(n=23) were discharged on Vitamin D(OH) alone. 66%(n=46) were discharged on antiresorptive therapy: 28%(n=13) bisphosphonate, 67% (n=31) denosumab, 4% others. 33%(n=23) were not prescribed any bone protection on discharge. 4 had advanced chronic kidney disease. 6%(n=4) were discharged without calcium/Vitamin D or antiresorptive therapy. A re-audit from January to April 2019 of 15 patients post NCHD education has shown an increase in antiresorptive therapy prescription 86%(n=13) Conclusion Bone health assessment and prescribing practices of antiresorptive therapy in patients undergoing rehabilitation post fracture is sub-optimal. Education of non-consultant hospital doctors can substantially improve rates of antiresorptive therapy prescription.

Non attendance at a Bone Health Clinic following hip fracture

2014 ◽  
Author(s):  
Niamh Maher ◽  
Georgina Steen ◽  
Nessa Fallon ◽  
Rosaleen Lannon ◽  
Miriam Casey ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Bone Health ◽  
Health Clinic

scholarly journals Impact of Migrant Workers on Total Factor Productivity in Chinese Construction Industry

2019 ◽  
Vol 11 (3) ◽  
pp. 926 ◽  
Author(s):  
Gui Ye ◽  
Yuhe Wang ◽  
Yuxin Zhang ◽  
Liming Wang ◽  
Houli Xie ◽  
...  
Keyword(s):  
Construction Industry ◽  
Total Factor Productivity ◽  
Migrant Workers ◽  
Annual Report ◽  
Learning By Doing ◽  
Construction Sector ◽  
Factor Productivity ◽  
The Sustainable Development ◽  
Statistical Yearbook ◽  
The Impact

Total factor productivity (TFP) is of critical importance to the sustainable development of construction industry. This paper presents an analysis on the impact of migrant workers on TFP in Chinese construction sector. Interestingly, Solow Residual Approach is applied to conduct the analysis through comparing two scenarios, namely the scenario without considering migrant workers (Scenario A) and the scenario with including migrant workers (Scenario B). The data are collected from the China Statistical Yearbook on Construction and Chinese Annual Report on Migrant Workers for the period of 2008–2015. The results indicate that migrant workers have a significant impact on TFP, during the surveyed period they improved TFP by 10.42% in total and promoted the annual average TFP growth by 0.96%. Hence, it can be seen that the impact of migrant workers on TFP is very significant, whilst the main reason for such impact is believed to be the improvement of migrant workers’ quality obtained mainly throughout learning by doing.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

scholarly journals IoT-Based Patient Movement Monitoring: The Post-Operative Hip Fracture Rehabilitation Model

2021 ◽  
Vol 13 (8) ◽  
pp. 195
Author(s):  
Akash Gupta ◽  
Adnan Al-Anbuky
Keyword(s):  
Hip Fracture ◽  
Real Time ◽  
System Performance ◽  
Digital Health ◽  
Time Behavior ◽  
Functional Requirements ◽  
Rehabilitation Process ◽  
Rehabilitation Model ◽  
The Impact ◽  
Movement Monitoring

Hip fracture incidence is life-threatening and has an impact on the person’s physical functionality and their ability to live independently. Proper rehabilitation with a set program can play a significant role in recovering the person’s physical mobility, boosting their quality of life, reducing adverse clinical outcomes, and shortening hospital stays. The Internet of Things (IoT), with advancements in digital health, could be leveraged to enhance the backup intelligence used in the rehabilitation process and provide transparent coordination and information about movement during activities among relevant parties. This paper presents a post-operative hip fracture rehabilitation model that clarifies the involved rehabilitation process, its associated events, and the main physical movements of interest across all stages of care. To support this model, the paper proposes an IoT-enabled movement monitoring system architecture. The architecture reflects the key operational functionalities required to monitor patients in real time and throughout the rehabilitation process. The approach was tested incrementally on ten healthy subjects, particularly for factors relevant to the recognition and tracking of movements of interest. The analysis reflects the significance of personalization and the significance of a one-minute history of data in monitoring the real-time behavior. This paper also looks at the impact of edge computing at the gateway and a wearable sensor edge on system performance. The approach provides a solution for an architecture that balances system performance with remote monitoring functional requirements.

scholarly journals Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 722
Author(s):  
Yusuke Ito ◽  
Hidetaka Wakabayashi ◽  
Shinta Nishioka ◽  
Shin Nomura ◽  
Ryo Momosaki
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Nutritional Status ◽  
Logistic Regression Analysis ◽  
Short Form ◽  
Mini Nutritional Assessment ◽  
Functional Independence ◽  
Rehabilitation Ward ◽  
The Impact

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.

scholarly journals Effects of β-Cryptoxanthin on Improvement in Osteoporosis Risk: A Systematic Review and Meta-Analysis of Observational Studies

Foods ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 296
Author(s):  
Sun Jo Kim ◽  
Nguyen Hoang Anh ◽  
Nguyen Co Diem ◽  
Seongoh Park ◽  
Young Hyun Cho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Bone Health ◽  
Observational Studies ◽  
Meta Analysis ◽  
Random Effects Model ◽  
High Intake ◽  
Quantitative Evidence ◽  
Osteoporosis Risk ◽  
Reduced Risk

Many studies have analyzed the effects of β-cryptoxanthin (BCX) on osteoporosis and bone health. This systematic review and meta-analysis aimed at providing quantitative evidence for the effects of BCX on osteoporosis. Publications were selected and retrieved from three databases and carefully screened to evaluate their eligibility. Data from the final 15 eligible studies were extracted and uniformly summarized. Among the 15 studies, seven including 100,496 individuals provided information for the meta-analysis. A random effects model was applied to integrate the odds ratio (OR) to compare the risk of osteoporosis and osteoporosis-related complications between the groups with high and low intake of BCX. A high intake of BCX was significantly correlated with a reduced risk of osteoporosis (OR = 0.79, 95% confidence interval (CI) 0.70–0.90, p = 0.0002). The results remained significant when patients were stratified into male and female subgroups as well as Western and Asian cohorts. A high intake of BCX was also negatively associated with the incidence of hip fracture (OR = 0.71, 95% CI 0.54–0.94, p = 0.02). The results indicate that BCX intake potentially reduces the risk of osteoporosis and hip fracture. Further longitudinal studies are needed to validate the causality of current findings.

scholarly journals Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic

2021 ◽  
Vol 12 ◽  
pp. 215145932110066
Author(s):  
Naoko Onizuka ◽  
Lauren N. Topor ◽  
Lisa K. Schroder ◽  
Julie A. Switzer
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Healthcare System ◽  
Perioperative Complications ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Surgical Care ◽  
Admission Rate ◽  
System Response ◽  
Fragility Hip Fracture

Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

Sign in / Sign up

Export Citation Format

Share Document