scholarly journals Early Mobility After Fragility Hip Fracture: A Mixed Methods Embedded Case Study

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Catherine Donnelly ◽  
Mohammad Auais ◽  
Kevin Woo ◽  
Vincent DePaul
Keyword(s):  
Hip Fracture ◽  
Healthcare Provider ◽  
Functional Decline ◽  
System Level ◽  
Physical Factors ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Time In Bed ◽  
Embedded Case Study

Abstract BackgroundFollowing a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of loss of ambulation. Participating in early mobility activities can decrease the overall length of hospital stay and aid in re-establishing a patients’ functional status. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory prior to their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade.MethodsA descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from hip fracture repair. Data from multiple sources provided an understanding of mobility activity initiation and patient participation.ResultsActivity monitor data from eighteen participants demonstrated a mean sedentary time of 23.18h. Median upright time was 24 min, and median number of steps taken was 30. Qualitative interviews from healthcare providers and patients identified two main categories of themes; factors that are external to the person (system, healthcare provider team, environment) and factors that are unique to the person (psychological and physical factors). Discussion There are multi-level factors that require consideration with implementation of best practice interventions, namely, systemic, healthcare provider related, and patient related. Recommendations are being sustained at the system level, and the unit has embraced a strong interdisciplinary approach. At the micro level, patients identify several factors influencing their participation, which ultimately demonstrates successful uptake of recommendations.ConclusionsThe study reports several variables to be important considerations for facilitating early mobility. Communicating mobility expectations and addressing physical and psychological readiness are essential. Our findings can be used to develop meaningful patient centred interventions to address these barriers.

scholarly journals Early mobility after fragility hip fracture: a mixed methods embedded case study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Catherine Donnelly ◽  
Mohammad Auais ◽  
Kevin Woo ◽  
Vincent DePaul
Keyword(s):  
Hip Fracture ◽  
Healthcare Provider ◽  
Functional Decline ◽  
Healthcare Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Increased Risk ◽  
Poor Outcomes ◽  
Embedded Case Study

Abstract Background Following a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of ambulation loss. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory before their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade. Methods A descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from hip fracture repair. Data from multiple sources provided an understanding of mobility activity initiation and patient participation. Results Activity monitor data from eighteen participants demonstrated a mean sedentary time of 23.18 h. Median upright time was 24 min, and median number of steps taken was 30. Qualitative interviews from healthcare providers and patients identified two main categories of themes; themes external to the person and themes unique to the person. We identified four factors that can influence mobility; a patient’s pre-fracture functional status, cognitive status, medical unpredictability, and preconceived notions held by healthcare providers and patients. Conclusions There are multi-level factors that require consideration with implementation of best practice interventions, namely, systemic, healthcare provider related, and patient related. An increased risk of poor outcomes occurs with compounding multiple factors, such as a patient with low pre-fracture functional mobility, cognitive impairment, and a mismatch of expectations. The study reports several variables to be important considerations for facilitating early mobility. Communicating mobility expectations and addressing physical and psychological readiness are essential. Our findings can be used to develop meaningful healthcare provider and patient-centred interventions to address the risks of poor outcomes.

scholarly journals A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Kevin Woo ◽  
Mohammad Auais ◽  
Catherine Donnelly ◽  
Vincent DePaul
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Hip Fracture ◽  
Health Care Providers ◽  
Care Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Fracture Function ◽  
Practice Gaps

Abstract Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. The aim of this project was to identify evidence to practice gaps in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery.Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included.Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment.Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

scholarly journals A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Kevin Woo ◽  
Mohammad Auais ◽  
Catherine Donnelly ◽  
Vincent DePaul
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Hip Fracture ◽  
Health Care Providers ◽  
Care Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Fracture Function ◽  
Practice Gap

Abstract Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. Objective To identify if there is an evidence to practice gap in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery. Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included. Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment. Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

scholarly journals Case Study Application of an Ethical Decision-Making Process for a Fragility Hip Fracture Patient

2019 ◽  
Vol 22 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Lynn Haslam ◽  
Vincent DePaul
Keyword(s):  
Decision Making ◽  
Hip Fracture ◽  
Health Care Providers ◽  
Ethical Decision ◽  
Surgical Repair ◽  
Ethical Decision Making ◽  
Care Providers ◽  
Term Care ◽  
Fragility Hip Fracture

In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministry of Health and Long Term Care has implemented strategies to reduce surgical wait times and improve outcomes in target areas. These best practice standards advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. The majority of patients are good candidates for surgical repair; however, for some patients, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice. Patients and families face a dif-ficult and hurried decision, often with no time to voice their concerns, or with little-to-no information on which to guide their choice. Similarly, health-care providers may experience moral distress or hesitancy to articulate other options, such as palliative care.  Is every fragility fracture a candidate for surgery, no matter what the outcome? When is it right to discuss other options with the patient? This article examines a case study via an application of a framework for ethical decision-making.

scholarly journals Early mortality outcomes of patients with fragility hip fracture and concurrent SARS-CoV-2 infection

2021 ◽  
Vol 2 (5) ◽  
pp. 314-322
Author(s):  
Harry Alcock ◽  
Eleanor Ann Moppett ◽  
Iain Keith Moppett
Keyword(s):  
Decision Making ◽  
Hip Fracture ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Early Mortality ◽  
Informed Decision ◽  
System Level ◽  
Informed Decision Making ◽  
Fragility Hip Fracture ◽  
The Impact

Aims Hip fracture is a common condition of the older, frailer person. This population is also at risk from SARS-CoV-2 infection. It is important to understand the impact of coexistent hip fracture and SARS-CoV-2 for informed decision-making at patient and service levels. Methods We undertook a systematic review and meta-analysis of observational studies of older (> 60 years) people with fragility hip fractures and outcomes with and without SARS-CoV-2 infection during the first wave of the COVID-19 pandemic. The primary outcome was early (30-day or in-hospital) mortality. Secondary outcomes included length of hospital stay and key clinical characteristics known to be associated with outcomes after hip fracture. Results A total of 14 cohort and five case series studies were included (692 SARS-CoV-2 positive, 2,585 SARS-CoV-2 negative). SARS-CoV-2 infection was associated with an overall risk ratio (RR) for early mortality of 4.42 (95% confidence interval (CI) 3.42 to 5.82). Early mortality was 34% (95% CI 30% to 38%) and 9% (95% CI 8% to 10%) in the infected and noninfected groups respectively. Length of stay was increased in SARS-CoV-2 infected patients (mean difference (MD) 5.2 days (3.2 to 7.2)). Age (MD 1.6 years (0.3 to 2.9)); female sex (RR 0.83 (95% CI 0.65 to 1.05)); admission from home (RR 0.51 (95% CI 0.26 to 1.00)); presence of dementia (RR 1.13 (95% CI 0.94 to 1.43)); and intracapsular fracture (RR 0.89 (95% CI 0.71 to 1.11)) were not associated with SARS-CoV-2 infection. There were statistically, but not clinically, significantly greater Nottingham Hip Fracture Scores in infected compared with non-infected patients (MD 0.7 (0.4 to 0.9)). Conclusion SARS-CoV-2 infection is associated with worse outcomes after hip fracture. This is not explained by differences in patient characteristics. These data can be used to support informed decision-making and may help track the impact of widespread adoption of system-level and therapeutic changes in management of the COVID-19 pandemic. Cite this article: Bone Jt Open 2021;2(5):314–322.

scholarly journals A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Kevin Woo ◽  
Mohammad Auais ◽  
Catherine Donnelly ◽  
Vincent DePaul
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hip Fracture ◽  
Functional Ability ◽  
Care Providers ◽  
Systematic Method ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Practice Gap

Abstract BackgroundA fragility hip fracture is a serious injury in older adults. After experiencing a fracture, a large percentage of patients do not regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the usage of these early mobility recommendations by health care providers within our institution. An evidence-to-practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence-to-practice gap. There were two aims of this project; to describe early mobility activities undertaken on one post surgical unit and b) to identify if there is an evidence-to-practice gap.MethodsAt a large tertiary centre in Toronto, Ontario, medical records from one calendar year were abstracted for older adults (≥65 years of age) recovering from fragility hip fracture repair. Data regarding demographics, co-morbidities, surgery type, post-operative mobility activities, and any post-operative complications were collected. Primary outcomes were evidence of early mobility activities and a comparison to Health Quality Ontario recommendations for fragility hip fracture care.ResultsBetween 11% - 50% of patients are not participating in early mobility activities. By postoperative day five only two patients had walked over 50 metres. Those with low pre-fracture functional ability and a cognitive impairment consistently experienced lower rates of participation compared to patients with a high pre-fracture functional ability and no cognitive impairment. Chi-square tests and regression analysis did not reveal any significant associations with variables.ConclusionsThere is very limited participation in early mobility activities after surgery. The study was unable to identify any significant relationships between several variables that may impact participation. This chart review identified the processes that have been sustained and highlights potential areas for future interventions.

Ties to the outside: An exploration of faculty interactions with external organizations

2018 ◽  
Vol 4 (1) ◽  
pp. 295-313 ◽  
Author(s):  
Karley A Riffe
Keyword(s):  
Study Design ◽  
Financial Constraints ◽  
Academic Discipline ◽  
Faculty Members ◽  
Faculty Work ◽  
Case Study Design ◽  
Low Resource ◽  
Faculty Interactions ◽  
Embedded Case Study

Faculty work now includes market-like behaviors that create research, teaching, and service opportunities. This study employs an embedded case study design to evaluate the extent to which faculty members interact with external organizations to mitigate financial constraints and how those relationships vary by academic discipline. The findings show a similar number of ties among faculty members in high- and low-resource disciplines, reciprocity between faculty members and external organizations, and an expanded conceptualization of faculty work.

Evaluating The Effectiveness Of Problem-Based Learning (Pbl) Implemented In The Textile Engineering Course - A Case Study On Ahsanullah University Of Science And Technology, Bangladesh

2014 ◽  
Vol 1 (1) ◽  
pp. 111-114
Author(s):  
Lal Mohan Baral ◽  
Ramzan Muhammad ◽  
Claudiu Vasile Kifor ◽  
Ioan Bondrea
Keyword(s):  
Engineering Students ◽  
Science And Technology ◽  
Problem Based Learning ◽  
Professional Life ◽  
System Level ◽  
Teaching Tool ◽  
Technical Problems ◽  
Empirical Survey ◽  
Undergraduate Programs

AbstractProblem-based learning as a teaching tool is now used globally in many areas of higher education. It provides an opportunity for students to explore technical problems from a system-level perspective and to be self-directed life-long learner which is mandatory for equipping engineering students with the skill and knowledge. This paper presents a case study illustrating the effectiveness of implemented Problem-based learning (PBL) during five semesters in the undergraduate programs of Textile Engineering in Ahsanullah University of Science and Technology (AUST). An assessment has been done on the basis of feedback from the students as well as their employers by conducting an empirical survey for the evaluation of PBL impact to enhance the student's competencies. The Evaluations indicate that students have achieved remarkable competencies through PBL practices which helped them to be competent in their professional life.

Kajian Sosiolinguistik Penggunaan Alih Kode di Media Sosioal

2020 ◽  
Author(s):  
Iftitahul Kamaliyah
Keyword(s):  
Embedded Case Study

Kajian mengenai Soisolinguistik memang sangat menarik untuk dibahas. Dengan beraneka ragam suku, bahasa, dan budaya mengakibatkan munculnya masyarakat Indonesia yang kedwibahasaan. Sebagai objek dari sosiolinguistik, bahasa tidak dipandang sebagai bahasa, melainkan dilihat dipandang sebagai sarana interaksi atau komunikasi di dalam masyarakat (Chaer dan Agustina,2010:3). Sebagai sarana komunikasi di dalam masyarakat, bahasa menitik beratkan pada penggunanan yang bertujuan membuat komunikasi antara penutur dan lawan tutur dapat berkomunikasi dengan baik walaupun dilakukan secara kedwibahasaan. Penelitian ini bertujuan untuk mengetahui serta mendeskripsikan penggunaan alih kode di media sosial Instagram dan Twitter. Serta untuk mengetahui alasan munculnya alih kode pada media sosial. Penelitian ini menggunakan metode kualititatif deskriptif, dikarenakan memiliki tujuan untuk mendeskripsikan, menjelasakan serta memaparkan data dengan sedetail mungkin. Penelitian berfokus pada penggunaan alih kode di media sosial. Apabila ditinjau berdasarkan sifat kasusnya, termasuk dalam studi kasus tunggal terpancang (embedded case study). Sumber data penelitian ini didapatkan melalui dokumen-dokumen tertulis yang diunggah di berbagai media sosial seperti Instagram dan twitter. Dalam teknik pengumpuan data, menggunakan metode observasi dan studi dokumen.

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