Describing care delivery by healthcare professionals to older patients with hip fracture in acute hospital settings: an observational study

Hip fracture (HF) in older patients is associated with a high six-month mortality rate. Several clinical conditions may affect outcome, including baseline characteristics, co-existing acute illnesses, perioperative factors, and postoperative complications. Our primary objective was to estimate the respective effect of these four domains on six-month mortality after HF. A retrospective observational study using a monocentric cohort of older patients was conducted. All patients ≥ 70 years old admitted to the emergency department for HF and hospitalized in our perioperative geriatric care unit from June 2009 to September 2018 were included. Among 1015 included patients, five (0.5%) were lost to follow-up, and 1010 were retained in the final analysis (mean age 86 ± 6 years). The six-month mortality rate was 14.8%. The six-month attributable mortality estimates were as follows: baseline characteristics (including age, gender, comorbidities, autonomy, type of fracture): 62.4%; co-existing acute illnesses (including acute events present before surgery that could result from the fracture or cause it): 0% (not significantly associated with six-month mortality); perioperative factors (including blood transfusion and delayed surgery): 12.3%; severe postoperative complications: 11.9%. Baseline characteristics explained less than two-thirds of the six-month mortality after HF. Optimizing patients care by improving management of perioperative factors and thus decreasing postoperative complications, could reduce by a maximum of one quarter of the six-month mortality rate after HF.

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Post-hospital care pathway for individuals with hip fracture: what is the optimal setting and rehabilitation intensity? An observational study

Disability and Rehabilitation ◽

10.1080/09638288.2021.1897692 ◽

2021 ◽

pp. 1-8

Author(s):

Mattia Morri ◽

Cristiana Forni ◽

Monica Guberti ◽

Paolo Chiari ◽

Alessia Pecorari ◽

...

Keyword(s):

Hip Fracture ◽

Observational Study ◽

Hospital Care ◽

Care Pathway ◽

Optimal Setting

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Consent in pregnancy - an observational study of ante-natal care in the context of Montgomery: all about risk?

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03574-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jacqueline A. Nicholls ◽

Anna L. David ◽

Joseph Iskaros ◽

Dimitrios Siassakos ◽

Anne Lanceley

Keyword(s):

Qualitative Research ◽

Observational Study ◽

Pregnant Women ◽

Social Factors ◽

Healthcare Professionals ◽

Effective Interaction ◽

Clinical Decision ◽

Place Of Birth ◽

Clinical Risk ◽

In Pregnancy

Abstract Background How to best support pregnant women in making truly autonomous decisions which accord with current consent law is poorly understood and problematic for them and their healthcare professionals. This observational study examined a range of ante-natal consultations where consent for an intervention took place to determine key themes during the encounter. Methods Qualitative research in a large urban teaching hospital in London. Sixteen consultations between pregnant women and their healthcare professionals (nine obstetricians and three midwives) where ante-natal interventions were discussed and consent was documented were directly observed. Data were collectively analysed to identify key themes characterising the consent process. Results Four themes were identified: 1) Clinical framing - by framing the consultation in terms of the clinical decision to be made HCPs miss the opportunity to assess what really matters to a pregnant woman. For many women the opportunity to feel that their previous experiences had been ‘heard’ was an important but sometimes neglected prelude to the ensuing consultation; 2) Clinical risk dominated narrative - all consultations were dominated by information related to risk; discussion of reasonable alternatives was not always observed and women’s understanding of information was seldom verified making compliance with current law questionable; 3) Parallel narrative - woman-centred experience – for pregnant women social factors such as the place of birth and partner influences were as or more important than considerations of clinical risk yet were often missed by HCPs; 4) Cross cutting narrative - genuine dialogue - we observed variably effective interaction between the clinical (2) and patient (3) narratives influenced by trust and empathy and explicit empowering language by HCPs. Conclusion We found that ante-natal consultations that include consent for interventions are dominated by clinical framing and risk, and explore the woman-centred narrative less well. Current UK law requires consent consultations to include explicit effort to gauge a woman’s preferences and values, yet consultations seem to fail to achieve such understanding. At the very least, consultations may be improved by the addition of opening questions along the lines of ‘what matters to you most?’

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Markers of renal function at admission and mortality in hip fracture patients - a single center prospective observational study

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.1080/00365513.2021.1884892 ◽

2021 ◽

pp. 1-7

Author(s):

Magnus H. Jonsson ◽

Anna Åkesson ◽

Ami Hommel ◽

Anders Grubb ◽

Peter Bentzer

Keyword(s):

Renal Function ◽

Hip Fracture ◽

Observational Study ◽

Prospective Observational Study ◽

Single Center

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Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

The Ultrasound Journal ◽

10.1186/s13089-021-00230-w ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Luigi Vetrugno ◽

Enrico Boero ◽

Elena Bignami ◽

Andrea Cortegiani ◽

Santi Maurizio Raineri ◽

...

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Observational Study ◽

Elderly Patients ◽

Fracture Fixation ◽

Frail Elderly ◽

Statistical Power ◽

Lung Ultrasound ◽

Preoperative Evaluation ◽

Cardiac Complications

Abstract Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.

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Knee Extension Strength Measures Indicating Probable Sarcopenia Is Associated with Health-Related Outcomes and a Strong Predictor of 1-Year Mortality in Patients Following Hip Fracture Surgery

Geriatrics ◽

10.3390/geriatrics6010008 ◽

2021 ◽

Vol 6 (1) ◽

pp. 8

Author(s):

Morten Tange Kristensen ◽

Signe Hulsbæk ◽

Louise Lohmann Faber ◽

Lise Kronborg

Keyword(s):

Hip Fracture ◽

Strong Predictor ◽

Knee Extension ◽

Acute Hospital ◽

Cut Points ◽

Knee Extension Strength ◽

Hip Fracture Surgery ◽

Hand Grip ◽

Health Related ◽

Fracture Surgery

To examine if knee-extension strength (KES) measures indicating probable sarcopenia are associated with health-related outcomes and if KES and hand grip strength (HGS) measures are associated with 1-year mortality after hip fracture. Two groups of older patients with hip fracture had either HGS (n = 32) or KES (n = 150) assessed during their acute hospital stay. Cut-points for HGS (<27 kg for men and <16 kg for women), and cut-points for maximal isometric KES (non-fractured limb), being the lowest sex-specific quintile (<23.64 kg for men and <15.24 kg for women), were used to examine association with health-related outcomes and 1-year mortality. Overall, 1-year mortality was 12.6% in the two strength groups, of which 47% (HGS) and 46% (KES) respectively, were classified as probable sarcopenia. Probable sarcopenia patients (KES) had lower prefracture function, performed poorly in mobility measures and expressed a greater concern of falling compared to their stronger counterparts. Hazard ratio for 1-year mortality was 2.7 (95%CI = 0.49–14.7, p = 0.3) for HGS and 9.8 (95%CI = 2.2–43.0, p = 0.002) for KES for probable sarcopenia patients compared to those not. Sex-specific KES measures indicating sarcopenia is associated with health-related outcomes and a strong predictor of 1-year mortality after hip fracture.

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Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.09.025 ◽

2020 ◽

Author(s):

Michael P. Cary ◽

Farica Zhuang ◽

Rachel Lea Draelos ◽

Wei Pan ◽

Sathya Amarasekara ◽

...

Keyword(s):

Machine Learning ◽

Palliative Care ◽

Hip Fracture ◽

Older Patients ◽

Learning Algorithms ◽

Machine Learning Algorithms

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289 Detection of Falls in Older Patients by Medical Professionals on Admission to Hospital: An Audit

Age and Ageing ◽

10.1093/ageing/afz103.183 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Emily Buckley ◽

Mazen Alalawi

Keyword(s):

Practice Guidelines ◽

Older Patients ◽

Best Practice ◽

Acute Hospital ◽

Medical Professionals ◽

Medical Patients ◽

Screening Questionnaire ◽

Best Practice Guidelines ◽

Audit Data ◽

History Of

Abstract Background A history of a previous fall is one of the best predictors of future falls, increasing its risk 3-fold. The Health Service Executive (HSE) best practice guidelines recommend that all patients aged over 65 years in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the fall-frequency, context and characteristics. The aim of this audit was to increase falls recognition by medical professionals following the implementation of a falls screening questionnaire into the admission proforma of an acute hospital. Methods This was a clinical audit. Data was collected on 29 consecutive patients aged > 65 who were admitted via the emergency department of an acute hospital over a 6 day period. Data on falls was collected using the medical admissions hospital proforma during the first 72 hours. Following the initial audit, a new proforma containing a falls screening questionnaire (as per best practice guidelines) was introduced and an information session provided on its use. A re-audit of 17 admitted medical patients was then completed over the next 72 hours. Results The initial audit highlighted poor assessment of falls with only 3 (25%) patients being screened at admission. 1 (33%) had a fall; described as mechanical. Following introduction of a falls screening questionnaire into the admission proforma, a re-audit showed a significant increase, with 58% of admissions now being screened. Of these, 40% had fallen in the last year: 75% of falls were mechanical and 25% due to other causes. Conclusion This audit shows that falls in this patient population was largely unrecognised by medical professionals. Following implementation of a screening questionnaire, significant improvements were made. This audit concludes that implementation of a falls screening questionnaire into the medical admissions proforma is an effective method in identifying falls in older patients admitted to hospital.

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