Interdisciplinary care of hip fractures.

Ranhoff, Anette Hylen; Saltvedt, Ingvild; Frihagen, Frede; Ræder, Johan; Maini, Sameer; Sletvold, Olav

doi:10.1016/j.berh.2019.03.015

Cited by 29 publications

(17 citation statements)

References 67 publications

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“…Traumatology care dropped but 3 weeks after the lockdown rose again. If negative, patients were hospitalized in the Covid-free surgical ward and followed the standard treatment protocol (64). Of major concern 30-day mortality among hip fracture patients during the first 30 days of the pandemic increased.…”

Section: Clinical Findings: a Glance From The Specialistsmentioning

confidence: 99%

The Many Faces of Covid-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy

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Baisi

Banderali

et al. 2021

Front. Public Health

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In March 2020, northern Italy became the second country worldwide most affected by Covid-19 and the death toll overtook that in China. Hospital staff soon realized that Covid-19 was far more severe than expected from the few data available at that time. The Covid-19 pandemic forced hospitals to adjust to rapidly changing circumstances. We report our experience in a general teaching hospital in Milan, the capital of Lombardy, the most affected area in Italy. First, we briefly describe Lombardy's regional Covid-19-related health organizational changes as well as general hospital reorganization. We also provide a multidisciplinary report of the main clinical, radiological and pathological Covid-19 findings we observed in our patients.

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Section: Clinical Findings: a Glance From The Specialistsmentioning

confidence: 99%

The Many Faces of Covid-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy

Priori

Baisi

Banderali

et al. 2021

Front. Public Health

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“…A recently implemented national guideline for the treatment of hip fracture patients defines new standards of care ( 46 ). This includes a systematic screening for geriatric syndromes and the involvement of geriatricians which has been recommended and evaluated internationally ( 47 ). The potential of this approach to meet the risks of malnutrition needs to be analyzed in future studies.…”

Section: Discussionmentioning

confidence: 99%

Malnutrition is associated with six-month mortality in older patients admitted to the emergency department with hip fracture

et al. 2023

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BackgroundHip fractures in older people are a common health problem often associated with malnutrition that might affect outcomes. Screening for malnutrition is not a routine examination in emergency departments (ED). This analysis of the EMAAge study, a prospective, multicenter cohort study, aimed to evaluate the nutritional status of older patients (≥ 50 years) with hip fracture, factors associated with malnutrition risk, and the association between malnutrition and the six-months mortality.MethodsRisk of malnutrition was evaluated using the Short Nutritional Assessment Questionnaire. Clinical data as well as data on depression and physical activity were determined. Mortality was captured for the first six months after the event. To assess factors associated with malnutrition risk we used a binary logistic regression. A Cox proportional hazards model was used to assess the association of malnutrition risk with six-month survival adjusted for other relevant risk factors.ResultsThe sample consisted of N = 318 hip fracture patients aged 50 to 98 (68% women). The prevalence of malnutrition risk was 25.3% (n = 76) at the time of injury. There were no differences in triage categories or routine parameters measured in the ED that could point to malnutrition. 89% of the patients (n = 267) survived for six months. The mean survival time was longer in those without malnutrition risk (171.9 (167.1–176.9) days vs. 153.1 (140.0–166.2) days). The Kaplan Meier curves and the unadjusted Cox regression (Hazard Ratio (HR) 3.08 (1.61–5.91)) showed differences between patients with and patients without malnutrition risk. In the adjusted Cox regression model, risk of death was associated with malnutrition risk (HR 2.61, 1.34–5.06), older age (70–76 years: HR 2.5 (0.52–11.99); 77–82 years: HR 4.25 (1.15–15.62); 83–99 years: HR 3.82 (1.05–13.88)) and a high burden of comorbidities (Charlson Comorbidity Index ≥3: HR 5.4 (1.53–19.12)).ConclusionRisk of malnutrition was associated with higher mortality after hip fracture. ED parameters did not differentiate between patients with nutritional deficiencies and those without. Therefore, it is particularly important to pay attention to malnutrition in EDs to detect patients at risk of adverse outcomes and to initiate early interventions.

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“…International and national guidelines are based on evidence-based recommendations for the care of patients with a hip fracture. They emphasize intensity of physiotherapy, screening for cognitive impairment, fall risk prevention and efforts to minimize the risk of delirium to improve patient outcomes [9,35,[37][38][39][40][41][42][43]. Moreover, several guidelines have also incorporated standardized detailed assessment tools for mobility and ADL [37,44].…”

Section: Care Pathways and Toolsmentioning

confidence: 99%

“…This has resulted in a relatively standardized surgical procedure followed by perioperative care during the in-hospital stay of several days to weeks [ 8 ]. Furthermore, it has led to incorporating inpatient comprehensive geriatric assessment and the introduction of orthogeriatric care units, which has proved to decrease mortality [ 9 , 10 ]. These evidence-based practices have been incorporated into guidelines for standardized care and subsequently translated into clinical care pathways [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Geriatric rehabilitation care after hip fracture

et al. 2023

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Purpose After acute hospital admission, patients with a hip fracture are frequently discharged to skilled nursing homes providing geriatric rehabilitation (GR). There are few evidence-based studies regarding specific treatment times and assessments during GR. This study aims to provide a description of care for hip fracture patients during GR in the Netherlands. Methods Descriptive study analyzing the care pathways from GR facilities, regarding healthcare professionals involved, allocated treatment time per profession, total length of rehabilitation stay, and assessment instruments. Based on the reimbursement algorithm (diagnostic treatment combination = DBCs), of 25 patients, the registered actual treatment time per profession was calculated. Results The care pathways pivoted on three groups of health care professionals: medical team (MT), physiotherapy (PT), and occupational therapy (OT). There was some discrepancy between the allocated time in the care pathways and the calculated mean actual treatment time from the DBCs. First week: MT 120–180 min, DBC 120 (SD: 59) minutes; PT 120–230 min, DBC 129 (SD: 58) minutes; and OT 65–165 min, DBC 93 (SD: 61) minutes. From week two onwards, MT 15–36 min, DBC 49 (SD: 29) minutes; PT 74–179 min, DBC 125 (SD: 50) minutes; and OT 25–60 min, DBC 47 (SD: 44) minutes. Dieticians, psychologists, and social workers were sporadically mentioned. There was heterogeneity in the assessment and screening tools. Conclusions It is difficult to define current standard care in GR after hip fracture in the Netherlands due to the diversity in care pathways and large practice variation. This is a problem in conducting randomized effectiveness research with care provided as control. Trial register and date of registration NL7491 04-02-2019.

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Interdisciplinary care of hip fractures.

Cited by 29 publications

References 67 publications

The Many Faces of Covid-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy

The Many Faces of Covid-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy

Malnutrition is associated with six-month mortality in older patients admitted to the emergency department with hip fracture

Geriatric rehabilitation care after hip fracture

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