Outcome of nonoperative treatment for hip fractures in elderly patients: A systematic review of recent literature

Many studies have shown that surgical management still leads to the best outcomes in elderly patients with hip fractures, with some studies showing non-inferiority of nonsurgical management as compared to surgery in fragility fractures. Evidence-based guidelines on whether to operate on these patients are lacking. A systematic literature search was conducted regarding outcomes of nonoperatively treated hip fractures in elderly patients with various comorbidities. A structured literature review of multiple databases (PubMed, Web of Science, EMBASE, and Cochrane library) referenced articles from 2000 to 2020. A total of 596 patients from 11 published studies were identified. Mean age was 83.3 years. Overall 328 (69.7%) complications occurred in 470 patients with nonsurgical treatment. Pneumonia and urinary tract infections were the most common complications which occurred in 53 (16.1%) and 46 (14.0%) patients, respectively. Hip fracture patients who were treated nonoperatively had a higher in-hospital (17.1% vs. 4.4%; p < 0.001), 30-day (31.4% vs. 10.2%; p < 0.001), and 1-year (48.5% vs. 19.9%; p < 0.001) mortality compared to a matched group of operatively treated patients ( n = 1464). Of the 110 patients whose reported cause of death was nonoperative care, 44 (40%) was due to pneumonia. Patients with nonoperative treatment following hip fracture were associated with substantially higher complication and mortality compared with patients who were treated operatively. Our study will help health-care providers and caregivers to enable more informed decision-making for families and patients confronted with a hip fracture.

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A Hospitalist-Led Fracture Liaison Service Improves Care of Hip Fracture Patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.490 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A241-A241

Author(s):

Anne Drabkin ◽

Micol Sara Rothman ◽

Goold Audrey ◽

Yasui Robin ◽

Mancini Diana

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Primary Care Providers ◽

The United States ◽

Fracture Liaison Service ◽

Care Providers ◽

Osteoporosis Care ◽

Fracture Liaison

Abstract Background: Osteoporosis care traditionally falls to outpatient primary care providers despite the fact that over 300,000 elderly patients are hospitalized yearly with hip fractures in the United States. Internal medicine hospitalists are often involved in the co-management of their care on surgical teams and are skillful in osteoporosis recognition and management. Objective: A hospitalist-led Fracture Liaison Service (FLS) was established to provide improved care of hospitalized patients with hip fractures. Methods: A retrospective evaluation of inpatient and post-discharge management of patients admitted with low-impact hip fractures was performed before (8/17-2/18) and after (8/19 - 2/20) launch of the hospitalist Fracture Liaison Service (H-FLS). Results: Eighty-nine patients were admitted with a hip fracture in post-launch period compared to 73 admitted prior. 74% vs 11% of eligible patients (based on adequate renal function and vitamin D stores) were discharged with anti-osteoporosis medications (p<0.001), 82% vs 38% were discharged with vitamin D/calcium supplements (p<0.001), 22% vs 5% underwent a DXA scan after discharge (p<0.05) and 65% vs 0% were referred to outpatient osteoporosis-specific care at discharge (p<0.001). Conclusion: A hospitalist-led FLS is a unique approach to osteoporosis care that significantly improved quality metrics for elderly patients with osteoporotic hip fractures including initiation of anti-osteoporosis medication and bone density imaging. Outpatient follow-up data are needed to evaluate adherence to this initial management over time.

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The Relationship Between Fragility Fractures and Pain Experience: A Systematic Review

Frontiers in Medicine ◽

10.3389/fmed.2021.609318 ◽

2021 ◽

Vol 8 ◽

Author(s):

Pei-En Chen ◽

Ching-Wen Chien ◽

Tao-Hsin Tung

Keyword(s):

Systematic Review ◽

Health Care Providers ◽

Fragility Fractures ◽

Current Evidence ◽

Cochrane Library ◽

Clinical Consequence ◽

Care Providers ◽

Pain Experience ◽

Limited Range Of Motion ◽

The Relationship

Purpose: This systematic review is conducted to explore the relationship between fragility fractures and pain experience.Methods: We searched for relevant studies on Pubmed, Embase, Web of Science, and the Cochrane library without restrictions on language from inception until February 4th, 2021. The risk of bias and methodological quality was evaluated using the Newcastle-Ottawa Scale and ROBINS-I tool.Results: Twenty-one studies were included in this systematic review. The so-called study reported participants with continuous post-fracture pain. The included studies showed that post- fractured pain can decrease with time, however, the continual pain can last at least 1 year even longer, and some participants would need to self-manage pain. Moreover, the limited range of motion was considered as a factor that might distress the normal development of daily activities.Conclusions: The current evidence could not fully support that pain continues to influence patients' lives after a fragility fracture. However, it still showed the pain might come with fracture. The findings also could be useful to help health care providers better recognize and manage this clinical consequence of fractures. Nonetheless, future large-scale longitudinal studies will be required to evaluate the long-term effects of pain in fragility fractures.

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Elderly Patients with Pertrochanteric Hip Fracture: In Hospital Care

Journal of Orthopedics & Bone Disorders ◽

10.23880/jobd-16000190 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-8

Author(s):

Faour Martín O

Keyword(s):

Health Care ◽

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Cost Reduction ◽

Hospital Care ◽

Scientific Evidence ◽

Clinical Results ◽

Fracture Management ◽

Care Of Elderly

Objective: To evaluate the improvement in the care of elderly patients hospitalized due to pertrochanteric hip fractures. Methods: A comparative study of two cohorts of patients admitted due to pertrochanteric hip fractu re before (2010) and after the application of in hospital management protocols (2018). The intervention consisted in the implementation of multidisciplinary measures during hospitalization based on current scientific evidence. An evaluation of the clinical results was performed, as well as the health care impact. Results: The characteristics of patients admitted for hip fracture in 2010 (216 patients) and 2018 (205 patients) were similar in age, sex, Barthel index and the Charlson abbreviated index. In 2018 patients had more comorbidity. A significant reduction of preoperative stay and overall stay in the cohort of 2018 was achieved. Detection of delirium, malnutrition and anaemia was higher in 2018, and a reduced incidence of infection and a better function al efficiency was achieved in this period. Conclusion: The introduction of measures for the improvement of the pertrochanteric hip fracture management reduces hospitalization with consequent cost reduction. Unification of criteria among professionals may b e an opportunity for better clinical results and reduction of complications.

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Health Problems of Elderly Patients attending Combined Military Hospital, Dhaka

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i1.41008 ◽

2017 ◽

Vol 13 (1) ◽

pp. 8-12

Author(s):

SM Humayun Kabir ◽

Md Ziaul Islam ◽

Masuda Begum ◽

Masud Ahmed ◽

Mohammad Mohsin ◽

...

Keyword(s):

Elderly Patients ◽

Health Care Providers ◽

Family Income ◽

Sampling Technique ◽

Armed Forces ◽

The Elderly ◽

Health Problems ◽

Military Hospital ◽

Care Providers ◽

Cross Sectional

Introduction: Health problems of elderly are an emerging health burden throughout the world. Bangladesh is currently undergoing a demographic transition and the proportion of the population of 60 years and older is increasing rapidly. Health care providers and policymakers are highly concerned with this burning issue. Objective: To know the disease pattern among the elderly patients in Combined Military Hospital, Dhaka. Materials and Methods: This cross-sectional study was carried out from July 2015 to June 2016 among 152 elderly patients above 60 years of age admitted in Combined Military Hospital (CMH), Dhaka Cantonment. Data were collected by face-to-face interview with semi-structured questionnaire and checklist following purposive sampling technique. Analysis of data was done by Statistical Package for Social Science (SPSS, version 20.0). Results: Mean age of the elderly was 72.06±4.56 years with the range of 60-80 years and majority (90.8%) of the elderly was male. Out of total 152 elderly patients, by occupation majority (31.6%) were in the business group followed by 30.3% in the retired group and 9.2 % in the housewife group. Average monthly family income was BDT 17927.63±7360.75 with the range of BDT 6000-35000. With initial complaints elderly patients reported to doctors in private chamber (38.2%), private hospital (25.6%) and Govt hospital (5.9%). Among all of the elderly patients, majority (21.1%) had Diabetes Mellitus followed by Rheumatoid Arthritis (17.6%), Asthma (12.5%), Cataract (11.2%), ENT problem (6.6%), Malignancy (5.9%) and Benign Enlargement of Prostate 8(5.3%). Conclusion: The number of elderly people is expanding rapidly; it also presents multifaceted health problems and thus creates unique challenges for the national healthcareservices. Early identification of problem and ensuring the availability of health with economic and social support can have a control over the elderly health problems. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 8-12

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

PeerJ ◽

10.7717/peerj.10683 ◽

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.

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Health-related needs and barriers for forcibly displaced women: a systematic review

10.21203/rs.2.11059/v1 ◽

2019 ◽

Author(s):

Jenny Jesuthasan ◽

Zara Witte ◽

Sabine Oertelt-Prigione

Keyword(s):

Health Care Providers ◽

Cochrane Library ◽

Care Providers ◽

Culturally Sensitive Care ◽

Barriers To Access ◽

Innovative Methodology ◽

Health Related ◽

Unequal Access ◽

Available Information ◽

Specific Health

Abstract Introduction Women represent a large proportion of the currently internationally displaced individuals. Due to gender roles, care duty, educational and economic imbalance their experiences and vulnerability during flight and relocation differ from that of men and children. The currently available information about their specific health-related needs and barriers to access is scarce and scattered. Methods We searched PubMed, Medline, EMBASE, Cochrane Library and Scopus to identify publications that explored the unique experiences of female refugees between 1 January 2008 and 30 June 2018. Publications needed to address the health needs of refugees, asylum seekers or displaced individuals, include at least 50% women in their study and employ a user-centered perspective, i.e. focus on the perspective of displaced individuals themselves and not health care providers. A framework of themes was identified and applied to all publications. Results We identified 1945 publications of which 13 could be included in the present review. Twelve of these publications employed qualitative and/or innovative methodology (e.g. ethnographies, index cards, photovoice). We identified five broad categories of health-related needs (immediate healthcare, communication, sultural/spiritual, social, economic), which are further detailed. Conclusions A concerted action providing information and culturally-sensitive care, while supporting language acquisition and economic empowerment is essential to improving the health status of female refugees. Transformative interventions need to address multiple axes of unequal access for female refugees to increase participation and overall health.

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Genital hygiene behaviors and practices: A cross-sectional descriptive study among antenatal care attendees

Journal of Public Health in Africa ◽

10.4081/jphia.2019.746 ◽

2019 ◽

Vol 10 (1) ◽

Author(s):

Patrick Martial Nkamedjie Pete ◽

Rodrigue Mabvouna Biguioh ◽

André Gael Bita Izacar ◽

Sali Ben Béchir Adogaye ◽

Cecile Nguemo

Keyword(s):

Pregnant Women ◽

Health Care Providers ◽

Descriptive Study ◽

Care Providers ◽

Cross Sectional ◽

Vaginal Douching ◽

Hygiene Practices ◽

Tract Infections ◽

Genital Hygiene ◽

Antiseptic Solutions

The female genital tracts harbor a wide variety of microorganisms’ knowns as microflora mostly constituted by lactobacilli, involved in the healthy state of the vagina without causing infection. Urinary tract infections (UTI) are frequent in pregnant women due to physiological and anatomical changes that occur during pregnancy. These infections can result to disabilities or serious health problems both for the mother and the new-born. Vaginal douching has been reported among risky practices associate with UTIs. However, this remains debatable and contradictory when other studies report the benefit effects of vaginal cleaning in infection prevention. The aim of this study was to assess pregnant women behaviors and practices regarding genital hygiene. This was a cross sectional descriptive study conducted on exhaustive sample of pregnant women coming for antenatal visits in Lafé Sub-divisional Hospital (SDH) and Baleng Catholic Health Center (BCHC) between 16 and 30 September 2013. Data were collected using a paper based standardized questionnaire directly self-administered after obtain a free consent. Overall, 80 pregnant women were enrolled. The majority of them had attended at least primary education (97.5%; n=78/80) and many were lived in couple (81.25%; n=65/80). Almost one on three participants identified antenatal consultation (ANC) as a key element to be taken into account by pregnant women. 70.1% (n=56/80) of women declared wearing undergarments in cotton. Regarding the daily vaginal douching behaviors, the majority (76.3%; n=61/80) of participants used the recommended gynecological measure, while the remaining use self-prescribed measures. Both genital parts (vulva area and vagina) were cleaned and use of water was mostly cited (63.8%; n=51/80). Almost one participant on four (n=29/80) use antiseptic solutions for genital cleaning. Antiseptic solutions were associated with water in 34.5% of cases (n=10/29), and in 65.5% (n=19/29) of cases it was used only for the vagina. Our findings suggest that knowledge and genital hygiene cleaning practices are acceptable among our study population. Risky practices such as use of antiseptic solutions and synthetic underwear’s were reported. Skills of health care providers on good hygiene practices for pregnant should be improved and community-based communication strategies need to be implemented to reach all women of child bearing age.

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Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-019-1249-4 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Kassahun Gebeyehu Yazew ◽

Chanyalew Worku Kassahun ◽

Amare Wondim Ewnetie ◽

Habtamu Kerebih Mekonen ◽

Endalamaw Salilew Abagez

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Congestive Heart Failure ◽

Health Care Providers ◽

Recovery Rate ◽

Severe Acute Malnutrition ◽

Meta Analysis ◽

Acute Malnutrition ◽

Cochrane Library ◽

Care Providers

Abstract Background Severe acute malnutrition affects more than 20 million children. Africa is pointed out as a region where the problem is highly prevalent. There were individual studies on the recovery rate and its determinants among children with severe acute malnutrition in Ethiopia. But, there is no national pooled estimate. Therefore, this systematic review and meta-analysis aimed to estimate the recovery rate and determinants among children with severe acute malnutrition admitted to the therapeutic feeding unit in Ethiopia. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed in this study. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, and EMBASE. The statistical analysis was conducted using STATA version-11 software. The pooled prevalence was estimated with 95% confidence intervals using a random-effects model. Result A total of 12 studies were included with 2658 participants in the analysis. The overall pooled estimated recovery rate among children with severe acute malnutrition admitted to the inpatient therapeutic feeding unit in Ethiopia was 72.02 % (CI, 64.83, 79.22%). In the subgroup analysis, the highest estimate (80.29%) was observed in studies conducted in Oromia regional state, while 68.63% was observed in studies Southern Nation Nationality of people region 68.63%. Children who had no congestive heart failure were 4.88 times (OR, 4.88; 95% CI, 2.246, 10.586) more likely to recover than their counterparts. Conclusion The recovery rate among severe acute malnourished children on the therapeutic feeding unit in Ethiopia lied within the international minimum sphere. Hence, health care providers shall strengthen the management of severe acute malnutrition and management other co-morbidities like congestive heart failure. Systematic review registration PROSPERO CRD42019119124

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Epidemiology of gastroesophageal reflux disease in Iran: a systematic review and meta-analysis

BMC Gastroenterology ◽

10.1186/s12876-020-01417-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mohammad Karimian ◽

Hassan Nourmohammadi ◽

Majid Salamati ◽

Mohammad Reza Hafezi Ahmadi ◽

Fatemeh Kazemi ◽

...

Keyword(s):

Systematic Review ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Health Care Providers ◽

Reflux Disease ◽

Meta Analysis ◽

Iranian Population ◽

Cochrane Library ◽

Care Providers ◽

Online Databases

Abstract Background Gastroesophageal reflux disease (GERD), which leads to acid reflux into the esophagus, is a common gastrointestinal disorder. Several studies have shown the prevalence of GERD in Iranian population, but their evidence is contradictory. Therefore, the present study was conducted to investigate the epidemiology of GERD in Iran. Methods The entire steps of this systematic review and meta-analysis were based on the MOOSE protocol, and the results were reported accordance with the PRISMA guideline. This review is registered on PROSPERO (registration number: CRD42020142861). To find potentially relevant published articles, comprehensive search was done on international online databases Scopus, Science Direct, EMBASE, PubMed/Medline, CINAHL, EBSCO, Cochrane Library, Web of Science, Iranian online databases and the Google Scholar search engine in June 2019. Cochran test and I2 index were used to assess the heterogeneity of the studies. Data were analyzed using Comprehensive Meta-Analysis software ver. 2. The significance level of the test was considered to be P < 0.05. Results The daily, weekly, monthly, and overall prevalence of GERD symptoms in Iranian population was 5.64% (95%CI [confidence interval]: 3.77–8.35%; N = 66,398), 12.50% (95%CI: 9.63–16.08%; N = 110,388), 18.62% (95%CI: 12.90–26.12%; N = 70,749) and 43.07% (95%CI: 35.00–51.53%; N = 73,189), respectively. The daily, weekly, monthly, and overall prevalence of heartburn in Iranian population was 2.46% (95%CI: 0.93–6.39%; N = 18,774), 9.52% (95%CI: 6.16–14.41%; N = 54,125), 8.19% (95%CI: 2.42–24.30%; N = 19,363) and 23.20% (95%CI: 13.56–36.79%; N = 26,543), respectively. The daily, weekly, monthly, and overall prevalence of regurgitation in Iranian population was 4.00% (95%CI: 1.88–8.32%; N = 18,774), 9.79% (95%CI: 5.99–15.60%; N = 41,140), 13.76% (95%CI: 6.18–44.31%; N = 19,363) and 36.53% (95%CI: 19.30–58.08%; N = 21,174), respectively. The sensitivity analysis for prevalence of all types GERD, heartburn and regurgitation symptoms by removing a study showed that the overall estimate is still robust. Conclusion The present meta-analysis provides comprehensive and useful information on the epidemiology of GERD in Iran for policy-makers and health care providers. This study showed a high prevalence of GERD in Iran. Therefore, effective measures on GERD-related factors such as lifestyle can be among the health policies of Iran.

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A Closer Look at the 2015 Beers Criteria

Journal of Pharmacy Practice ◽

10.1177/0897190016663072 ◽

2016 ◽

Vol 30 (4) ◽

pp. 419-424 ◽

Cited By ~ 10

Author(s):

Rebecca L. Salbu ◽

Judith Feuer

Keyword(s):

Elderly Patients ◽

Health Care Providers ◽

Clinical Judgment ◽

The Elderly ◽

Specific Information ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Care Providers ◽

Inappropriate Medications ◽

Made In

The Beers Criteria identifies potentially inappropriate medications for patients who are 65 years of age and older. Initially published in 1991, the criteria have been updated multiple times, most recently in 2015. The Beers Criteria is a tool designed to alert health-care providers to the potential harms of specific medications so they may better tailor therapeutic regimens for their elderly patients. The expert panel of the 2015 update made changes to a number of previous recommendations and provided 2 new tables on select drug interactions and select medications requiring renal dose adjustments. The purpose of this review is to provide additional details and rationale behind selected noteworthy changes within the 2015 criteria. Specific information is provided on the changes in recommendations for the use of nitrofurantoin, antiarrhythmics, nonbenzodiazepine receptor agonist hypnotics, antipsychotics, and proton pump inhibitors in the elderly. Additional comparisons are made between the 2012 recommendations and newer recommendations made in the 2015 update, along with rationale for the change. This review will allow practitioners to apply the 2015 Beers Criteria and integrate their clinical judgment when evaluating and selecting drug therapy for elderly patients.

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