scholarly journals Experience of medical care which is provided to patients of older age groups with a hip fracture in Yaroslavl region

2020 ◽  
pp. 154-158
Author(s):  
M. V. Belov ◽  
K. Yu. Belova ◽  
A. A. Degtyarev ◽  
O. B. Ershova
Keyword(s):  
Hip Fracture ◽  
Medical Care ◽  
Hip Fractures ◽  
High Efficiency ◽  
Low Energy ◽  
Falls Prevention ◽  
Care Hospital ◽  
Osteoporosis Therapy ◽  
Secondary Fracture ◽  
Number Of Patients

Hip fractures are severe and life-threatening injuries with huge social, medical and economic consequences and a high mortality rate. The article is devoted to the organization of medical care in older patients group who received a hip fracture due to osteoporosis. Based on the experience of the Yaroslavl emergency medical care hospital n.a. N.V. Solovyov we analyze how the providing of medical care for these patients has changed over the past 10 years. A whole range of measures was introduced to ensure timely hospitalization, round-the-clock examination, availability of free metal structures, therapeutic support and early rehabilitation of patients. The result of these measures was the reduction in hospital mortality from 9.66% to 1.44%, the increase of operational activity from 71% to 92%, and the increase of the number of patients operated on within 48 hours from 0.3% to 82%. In addition, patients with low-energy fractures need implementing measures of falls prevention and prescription of the treatment for osteoporosis. These approaches help to reduce the frequency of further low-energy fractures and mortality of these patients. For this purpose, the secondary fracture prevention service (FLS) was created in this hospital. The service organized an active patients’ identification, fractures and falls risk assessment, prescription of osteoporosis therapy, recommendation of non-drug measures and physical training, and development of a plan for further monitoring of the patient. These approaches allowed to achieve high efficiency of the service: identification up to 97% in patients with fracture, prescription of drug therapy to 78% of patients. Thus, the introduction of a whole range of measures has significantly improved the quality indicators of medical care for patients with hip fractures.

scholarly journals The use of Plan-Do-Study-Act (PDSA) cycle in perfection of fracture liaison service work

2020 ◽  
Vol 22 (2) ◽  
pp. 4-13
Author(s):  
Ksenia Y. Belova ◽  
Olga B. Ershova
Keyword(s):  
Medical Care ◽  
Best Practice ◽  
Fracture Prevention ◽  
Falls Prevention ◽  
Effective Control ◽  
Care Organization ◽  
Care Hospital ◽  
Osteoporosis Therapy ◽  
Secondary Fracture ◽  
Pdsa Cycle

Background: Secondary fracture prevention services (FLS) have been established around the world during several last years. However, due to the differences of medical care organization in different regions, it is difficult to offer a unified approach of the structure and separate components of such services, which could be used everywhere. It is recommended to apply the Plan-Do-Study-Act (PDSA) cycle to evaluate the FLS in the institution. Aim: To study the application of the PDSA cycle in the optimization of FLS working in Yaroslavl. Materials and methods: We evaluated the effectiveness of FLS organization which was created in the Emergency medical care hospital n.a. N. V. Solovyov at two stages of its development: at the first stage we worked using the principle by referral of a traumatologist, at the second stage we used a dedicated coordinator. We used the questionnaire Best Practice framework for assessment. We also used PDSA cycle to analyze and evaluate the effectiveness of FLS organization. Results: At the stage by referral of a traumatologist we revealed problems with patients identification, timing of assessment after a fracture, low frequency of initiation of osteoporosis therapy, lack of a falls prevention system and problems with a database. After the analysis and revealing shortcomings weve made several changes in the organization of our FLS. First of all we introduced a dedicated coordinator-nurse in the staff of FLS.The following analysis showed that significant improvements had been made in all revealed directions. The following application of the PDSA cycle again identified several issues of FLS organization requiring improvement. Conclusion: Thus, the use of the PDSA cycle during the organization of FLS is a tool of effective control and establishment of an effective care system for patients with low-energy fractures.

scholarly journals Vertebral fractures as a precursor to potential hip fractures in elderly women

2021 ◽  
Author(s):  
Xuan Wu ◽  
Xiang-xu Chen ◽  
Li-yong Bai ◽  
Hui Chen ◽  
Yun-feng Rui
Keyword(s):  
Hip Fracture ◽  
Vertebral Fracture ◽  
Hip Fractures ◽  
Vertebral Fractures ◽  
Elderly Women ◽  
Statistical Significance ◽  
Osteoporosis Treatment ◽  
Low Energy ◽  
Functional Training ◽  
Number Of Patients

Abstract Objective: The purpose of this study was to investigate the kind of low-energy fracture which is a precursor of hip fracture in the elderly, and to suggest the importance of osteoporosis treatment and gait training for fall prevention after this low-energy fracture to prevent the occurrence of secondary hip fracture. Methods: From January 2017 to December 2020, a total of 564 patients who underwent surgical treatment for hip fractures were admitted to the Zhongda Hospital affiliated to Southeast University. Baseline information including gender, age, diagnosis and type of low-energy fracture before hip fracture were collected. FRAX score, the number of patients received functional training and the number of patients received anti-osteoporosis treatment were analyzed. Results: There were180 male patients and 384 female patients in the total 564 patients. The number of male patients with low-energy fractures before hip fracture was 28, including hip fracture (8 cases), vertebral fracture (8 cases) and humeral fracture (7 cases), and radial fracture (5 cases). The number of female hip fracture patients with a low-energy fracture before fracture was 62, containing vertebral fracture (31 cases), hip fracture (15 cases), radial fracture (9 cases) and humeral fracture (7 cases). It was found that vertebral fractures were the most frequent low-energy fractures that preceded hip fractures in elderly women compared to other low-energy fractures. It was showed that the 10-year probability of hip fracture and other site fractures was significantly higher in the group with lumbar fractures and other site fractures than those in the group without fractures assessed by using the FRAX measurement system. There were no statistical significance among the three groups of patients who underwent functional training and anti-osteoporosis treatment. We could not find statistical significance among the three groups of patients who underwent functional training and anti-osteoporosis treatment. Conclusion: Vertebral fracture is a precursor of hip fracture in elderly women. In face of the vertebral fractures, surgeons, especially orthopedic surgeons, should pay extra attention to the treatment of osteoporosis and anti-fall functional training.

scholarly journals Assessment and Early Management of Pain in Hip Fractures: The Impact of Paracetamol

2018 ◽  
Vol 9 ◽  
pp. 215145931880644 ◽  
Author(s):  
Ján Dixon ◽  
Fiona Ashton ◽  
Paul Baker ◽  
Karl Charlton ◽  
Charlotte Bates ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Pain Control ◽  
Patient Comfort ◽  
Central Feature ◽  
Significant Finding ◽  
Early Management ◽  
Intravenous Paracetamol ◽  
Number Of Patients ◽  
The Impact

Introduction: As the number of patients sustaining hip fractures increases, interventions aimed at improving patient comfort and reducing complication burden acquire increased importance. Frailty, cognitive impairment, and difficulty in assessing pain control characterize this population. In order to inform future care, a review of pain assessment and the use of preoperative intravenous paracetamol (IVP) is presented. Materials and Methods: Systematic review of preoperative IVP administration in patients presenting with a hip fracture. Results: Intravenous paracetamol is effective in the early management of pain control in the hip fracture population. There is a considerable decrease in use of breakthrough pain medications when compared with other pain relief modalities. Additionally, IVP reduces the incidence of opioid-induced complications, reduces length of stay, and lowers mean pain scores. Another significant finding of this study is the poor administration of all analgesics to patients with hip fracture with up to 72% receiving no prehospital analgesia. Discussion: The potential benefits of IVP as routine in the early management of hip fracture-related pain are clear. Studies of direct comparison between analgesia regimes to inform optimum bundles of analgesic care are sparse. This study highlights the need for properly constructed pathway-driven comparator studies of contemporary analgesia regimes, with IVP as a central feature to optimize pain control and minimize analgesia-related morbidity in this vulnerable population.

scholarly journals Observation on the risk of falling and self-efficacy in elderly patients with hip fracture

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Zongyou Mou ◽  
Ke Song ◽  
Jinquan Guo
Keyword(s):  
High School ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Self Efficacy ◽  
School Education ◽  
High School Education ◽  
Risk Of Falling ◽  
Post Surgery ◽  
Number Of Patients

Objectives:To study the risk of falling and self-efficacy in elderly patients with hip fracture. Methodology: Forty elderly patients with hip fractures that were caused by falling were admitted into our hospital from April 2018 to April 2019, and were enrolled into this study. All patients were assessed by using the Morse Fall Scale (MFS) and Falls Efficacy Scale(FES).The basic situation of the patients with hip fractures caused by falling and the scores of MFS and FES before and after falling were evaluated. Results: Results showed that the number of patients with femoral neck fractures accounted for 70% out of all patients, and the number of patients with intertrochanteric fractures accounted for the remaining30%of the patients. The number of patients with academic qualification below primary school is 16, the number of patients with middle high school education is 11 and the number of patients with high school education and above is 13. Slipping is the cause of hip fracture that accounted for the most in patients, followed by outing activities, whereas least patients with hip fractures was caused by falling in nursing home. There were 29 patients’ whoused crutches or walking aids and this number was more than that of those who required the devices. After the MFS and FES analyses, the results (scores of MFS and FES) showed that the risk before the fall was lower. In contrast, the risk of fracture and post-surgery after the fall was greatly increased. Conclusion: The elderly patients with hip fractures were found to have increased risk of falling and thus, these patients require good care.

Improving outcomes after hip fracture at a safety net hospital with a standardised hip fracture protocol

2020 ◽  
pp. 112070002091933
Author(s):  
Anthony V Christiano ◽  
Hannah C Elsevier ◽  
Salman Sarker ◽  
George Agriantonis ◽  
David Joseph ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Safety Net ◽  
Management Service ◽  
Protocol Implementation ◽  
Time To Surgery ◽  
Number Of Patients ◽  
Safety Net Hospital ◽  
Urban Safety

Introduction: standardised protocols for the care of geriatric hip fractures demonstrate improved patient outcomes with decreased cost. The purpose of this study is to evaluate outcomes of a standardised hip fracture protocol at an urban safety-net hospital. Methods: All trauma patients presenting to our urban safety-net hospital are included in a trauma database and inpatient outcomes recorded. A hip fracture protocol was introduced at our institution in 2015, which depended on admission to a monitored setting due to the absence of a geriatric co-management service. The database was queried to identify patients surgically treated for a geriatric hip fracture in the 3 years prior to protocol implementation (2012–2014) and patients treated in the 3 years following protocol implementation (2016–2018). Demographics, time to surgery, inpatient complications, and length of stay were compared between groups. Results: A total of 633 patients treated operatively for isolated hip fractures were identified, 262 patients in the 2012–2014 pre-protocol cohort, and 371 patients in the 2016–2018 protocol cohort. Following implementation of a hip fracture protocol the number of patients admitted to a surgical service increased from 198 (76%) to 348 (94%, p < 0.005) with the number of patients being admitted to a monitored setting increasing from 40 (15%) to 83 (22%, p = 0.026). The time to surgery was reduced to 2.75 days ( p = 0.054). The complication rate fell from 23% to 4% ( p < 0.0005). Length of stay was significantly reduced from 13.2 days to 12 days ( p = 0.045). Conclusions: A hip fracture protocol including admission to a monitored setting can be effectively implemented at an urban safety-net hospital where geriatric co-management is not available. This resulted in a decrease in complications and length of stay. Additional interventions are required to decrease average time to surgery below 36 hours.

scholarly journals IMPACT-Scot report on COVID-19 and hip fractures

2020 ◽  
Vol 102-B (9) ◽  
pp. 1219-1228 ◽  
Author(s):  
Andrew J. Hall ◽  
Nicholas D. Clement ◽  
Luke Farrow ◽  
Alasdair M. J. MacLullich ◽  
Graham F. Dall ◽  
...  
Keyword(s):  
Platelet Count ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Area Under The Curve ◽  
Clinical Predictors ◽  
Time To Surgery ◽  
Patient Demographics ◽  
Number Of Patients ◽  
American Society ◽  
American Society Of Anesthesiologists

Aims The primary aim was to assess the independent influence of coronavirus disease (COVID-19) on 30-day mortality for patients with a hip fracture. The secondary aims were to determine whether: 1) there were clinical predictors of COVID-19 status; and 2) whether social lockdown influenced the incidence and epidemiology of hip fractures. Methods A national multicentre retrospective study was conducted of all patients presenting to six trauma centres or units with a hip fracture over a 46-day period (23 days pre- and 23 days post-lockdown). Patient demographics, type of residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, operation, American Society of Anesthesiologists (ASA) grade, anaesthetic, length of stay, COVID-19 status, and 30-day mortality were recorded. Results Of 317 patients with acute hip fracture, 27 (8.5%) had a positive COVID-19 test. Only seven (26%) had suggestive symptoms on admission. COVID-19-positive patients had a significantly lower 30-day survival compared to those without COVID-19 (64.5%, 95% confidence interval (CI) 45.7 to 83.3 vs 91.7%, 95% CI 88.2 to 94.8; p < 0.001). COVID-19 was independently associated with increased 30-day mortality risk adjusting for: 1) age, sex, type of residence (hazard ratio (HR) 2.93; p = 0.008); 2) Nottingham Hip Fracture Score (HR 3.52; p = 0.001); and 3) ASA (HR 3.45; p = 0.004). Presentation platelet count predicted subsequent COVID-19 status; a value of < 217 × 109/l was associated with 68% area under the curve (95% CI 58 to 77; p = 0.002) and a sensitivity and specificity of 63%. A similar number of patients presented with hip fracture in the 23 days pre-lockdown (n = 160) and 23 days post-lockdown (n = 157) with no significant (all p ≥ 0.130) difference in patient demographics, residence, place of injury, Nottingham Hip Fracture Score, time to surgery, ASA, or management. Conclusion COVID-19 was independently associated with an increased 30-day mortality rate for patients with a hip fracture. Notably, most patients with hip fracture and COVID-19 lacked suggestive symptoms at presentation. Platelet count was an indicator of risk of COVID-19 infection. These findings have implications for the management of hip fractures, in particular the need for COVID-19 testing. Cite this article: Bone Joint J 2020;102-B(9):1219–1228.

scholarly journals Epidemiology of hip fracture in Botswana

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
M. Kebaetse ◽  
S. Nkhwa ◽  
M. Mogodi ◽  
J. Masunge ◽  
Y. P. Gureja ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Chart Review ◽  
Population Based ◽  
Men And Women ◽  
Patient Chart ◽  
Number Of Patients ◽  
The Republic ◽  
Age And Sex ◽  
Population Based Survey

Abstract Summary A retrospective population-based survey in the Republic of Botswana determined the incidence of fractures at the hip over 3 years. The estimated number of such fractures nationwide for 2020 was 103 and is predicted to increase. Objective This article describes the epidemiology of hip fractures in the Republic of Botswana. Methods A retrospective patient chart review was conducted to identify from hospital registers the number of patients diagnosed with hip fracture in 2009, 2010, and 2011. Age- and sex-specific incidence of hip fracture was determined from which lifetime probabilities and future projections for hip fracture were calculated. Results The incidence of hip fracture was low and comparable to rates reported from Tunisia. The remaining lifetime risk of hip fracture at the age of 50 years in men and women was 1.4 and 1.1%, respectively. The incidence of hip fracture suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2020 was 103 and is predicted to increase by more than threefold to 372 in 2050. Conclusion The hip fracture rates can be used for healthcare planning. Additionally, these data can be used to create a FRAX model to help guide decisions about treatment.

scholarly journals IMPROVEMENT OF MUNICIPAL OUTPATIENT ACTIVITY ON THE BASIS OF LEAN TECHNOLOGIES

2020 ◽  
Vol 8 (4) ◽  
pp. 481-494
Author(s):  
V.A. Evdakov ◽  
◽  
A.M. Allenov ◽  
G.B. Artemyeva ◽  
D.P. Lvova ◽  
...  
Keyword(s):  
Medical Care ◽  
Outpatient Clinic ◽  
Swot Analysis ◽  
High Efficiency ◽  
Lean Production ◽  
Outpatient Setting ◽  
Medical Organization ◽  
Number Of Patients ◽  
Standard Operating ◽  
Flow Map

Background. The world practice shows a high efficiency of lean production technologies both in the industrial and in social sectors. This determines the relevance of the research devoted to the analysis of the results of implementing a process approach based on the concept of lean produc-tion, in improving the activities of an outpatient medical organization. Aim. To identify resources of a municipal outpatient clinic in improvement of organization and effectiveness of realization of prophylactic programs, organization of work with patients and conduct of technological processes. Materials and Methods. To determine the aims of strategic development of a medical organiza-tion and identify the key trends for improvements on the basis of the concept of lean technolo-gies, SWOT analysis was used. A full-design study was conducted for assessment of the results of introduction of the concept of lean production in the period from January 2019 to December 2019, the respective parameters of the activity of an outpatient clinic were acquired and pro-cessed. The results obtained were compared with analogous results of 2018. Results. Introduction of the lean production concept helped to increase the availability of outpa-tient care, reduce the waiting time for examination and visiting medical specialists, improve the effectiveness of the health Center, increase the number of patients examined under preventive programs (+14.1%) from the planned level in comparison with the previous reporting period, from 83.0% in 2018 to 97.1% in 2019. A new form of public notification, the information flow map, has been developed and put into practice, and new standard operating maps (SOC) and standard operating procedures (SOP) have been developed and implemented. Improvement in the provision of medical care in the outpatient setting based on the concept of lean production has significantly improved several parameters of the organization: the coverage of the population with prophylactic medical examination (+14.1%) in comparison with the previous year, attraction of more individuals of the working age to the prophylactic examination: in the group of 21-39 years of age (+25.9%), in the group of 40-60 years of age (+18.9%). Conclusions. The results obtained confirm effectiveness of the concept of lean production in the improvement of the processes of medical organization providing medical care to the population in the outpatient setting. The block of presented approaches and tools of lean production may be used with taking into account adaptation to individual operating processes in a particular medical organization.

scholarly journals Educational program for orthopedic surgeons’ influences for osteoporosis

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1438-1443
Author(s):  
Huafeng Zhuang ◽  
Shufeng Lin ◽  
Yizhong Li ◽  
Siqing Cai ◽  
Peiwen Wang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Educational Program ◽  
Trained Group ◽  
Mineral Density ◽  
Education Programs ◽  
Osteoporosis Therapy ◽  
Orthopedic Surgeons ◽  
Turnover Markers ◽  
The Impact

Abstract Background In this retrospective study, we studied the impact of educational osteoporosis program on the rates of bone mineral density (BMD) assessment and bone turnover markers (BTM) and drug medications in the patients with hip fracture. Methods This retrospective research enrolled 651 patients aged ≥50 years who experienced hip fractures from January 2013 to December 2015. We recorded whether patients had received BMD assessment, BTM measurement, and anti-osteoporosis therapy during the period of hospitalization. Orthopedic surgeons were classified into the trained group and the untrained group. The rates of BMD assessment, BTM measurement, and anti-osteoporosis medications in the patients with hip fracture were compared between the trained group and the untrained group. Results BMD assessment was performed in 109/220 patients in the trained group and 142/431 patients in the untrained group. BTM measurements were performed in 130 patients in the trained group and 124 patients in the untrained group. Forty eight patients in the trained group and 63 patients in the untrained group received bisphosphonate medications. Conclusions Although the rates of BMD assessment, BTM measurement, and bisphosphonate use in the patients after hip fractures are still insufficient, education programs help to improve the situation.

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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