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Delirium in orthopaedic

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https://www.readbyqxmd.com/read/29054389/optimizing-surgical-quality-datasets-to-care-for-older-adults-lessons-from-the-american-college-of-surgeons-nsqip-geriatric-surgery-pilot
#1
Julia R Berian, Lynn Zhou, Melissa A Hornor, Marcia M Russell, Mark E Cohen, Emily Finlayson, Clifford Y Ko, Thomas N Robinson, Ronnie A Rosenthal
BACKGROUND: Surgical quality datasets can be better tailored toward older adults. The American College of Surgeons (ACS) NSQIP Geriatric Surgery Pilot collected risk factors and outcomes in 4 geriatric-specific domains: cognition, decision-making, function, and mobility. This study evaluated the contributions of geriatric-specific factors to risk adjustment in modeling 30-day outcomes and geriatric-specific outcomes (postoperative delirium, new mobility aid use, functional decline, and pressure ulcers)...
September 28, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28475261/impact-of-the-orthopaedic-nurse-practitioner-role-on-acute-hospital-length-of-stay-and-cost-savings-for-patients-with-hip-fracture-a-retrospective-cohort-study
#2
Linda L Coventry, Sharon Pickles, Michelle Sin, Amanda Towell, Margaret Giles, Kevin Murray, Diane E Twigg
AIMS: To compare acute hospital length of stay and cost-savings for patients with hip fracture before and after commencement of the Orthopaedic Nurse Practitioner and identify variables that increase length of stay in hospital. BACKGROUND: Globally, hip fractures are associated with significant morbidity and mortality. Whilst the practical benefits of the Orthopaedic Nurse Practitioner have been anecdotally shown, an analysis showing the cost-saving benefits has yet to be published...
November 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28466701/care-of-patients-with-dementia-in-an-acute-trauma-and-orthopaedics-unit
#3
Gillian McCorkell, Deirdre Harkin, Victoria McCrory, Mary Lafferty, Vivien Coates
Aim To increase awareness of the needs of patients with dementia in the trauma and orthopaedics unit of one acute hospital, and to collaborate with staff on the unit to identify ways of improving the care experienced by these patients and their families. Method An action research approach was used and three action research cycles were completed. Data were obtained retrospectively for 20 patients with dementia who were admitted to the unit for treatment. Deficiencies in the care of these patients were identified and related to communication, pain management and the recognition of delirium...
May 3, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28421731/intraoperative-dexmedetomidine-sedation-reduces-the-postoperative-agitated-behavior-in-elderly-patients-undergoing-orthopedic-surgery-compared-to-the-propofol-sedation
#4
Hyun-Jung Shin, Bon-Wook Koo, Seung-Uk Bang, Jin-Hee Kim, Jung-Won Hwang, Sang-Hwan DO, Hyo-Seok Na
BACKGROUND: Postoperative agitation or confusion is one of the symptoms of hyperactive delirium in elderly patients. We retrospectively evaluated the incidence of postoperative abnormal psychomotor behavior in elderly surgical patients according to the use of different intraoperative sedative agents: dexmedetomidine vs. propofol. METHODS: The medical records of 855 elderly patients, who underwent orthopedic surgery with regional anesthesia between July 2012 and September 2015, were divided into two groups, the dexmedetomidine group (N...
October 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28407199/comprehensive-geriatric-assessment-for-prevention-of-delirium-after-hip-fracture-a-systematic-review-of-randomized-controlled-trials
#5
REVIEW
Lynn Shields, Victoria Henderson, Robert Caslake
OBJECTIVES: To assess the efficacy of comprehensive geriatric assessment (CGA) in prevention of delirium after hip fracture. DESIGN: Systematic review and metaanalysis. SETTING: Ward based models on geriatrics wards and visiting team based models on orthopaedics wards were included. PARTICIPANTS: Four trials (three European, one U.S.; 973 participants) were identified. Two assessed ward-based, and two assessed team-based interventions...
July 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28349412/evaluating-outcomes-for-older-patients-with-parkinson-s-disease-or-dementia-with-lewy-bodies-who-have-been-hospitalised-for-hip-fracture-surgery-potential-impact-of-drug-administration
#6
Marie Enemark, Mette Midttun, Kristian Winge
INTRODUCTION: People with Parkinson's disease (PD) are at risk of falling and have an increased risk of complications and prolonged recovery during hospitalisation. OBJECTIVE: The aim of this study was to investigate the rate of complications and recovery related to a hip fracture in patients with PD. METHODS: All patients with PD or dementia with Lewy bodies (DLB) and a hip fracture who were admitted from January 2013 through June 2014 (18 months) to the Department of Orthopaedics, Copenhagen University Hospital, Herlev, Denmark were evaluated...
May 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28128699/surgical-results-and-complications-of-anterior-decompression-and-fusion-as-a-revision-surgery-after-initial-posterior-surgery-for-cervical-myelopathy-due-to-ossification-of-the-posterior-longitudinal-ligament
#7
Seiichi Odate, Jitsuhiko Shikata, Tsunemitsu Soeda, Satoru Yamamura, Shinji Kawaguchi
OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL...
April 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27554319/baseline-vulnerability-and-inpatient-frailty-status-in-relation-to-adverse-outcomes-in-a-surgical-cohort
#8
H-S Lin, N M Peel, R E Hubbard
This study aimed to derive measures of baseline vulnerability and inpatient frailty in elderly surgical patients and to study their association with adverse post-operative outcomes. Data from comprehensive geriatric assessment of 208 general surgical and orthopaedic patients aged 70 and over admitted to four acute hospitals in Queensland, Australia, were analysed to derive a baseline and inpatient Frailty Index (FI). The association of these indices with adverse outcomes was examined in logistic regression...
2016: Journal of Frailty & Aging
https://www.readbyqxmd.com/read/27235526/the-influence-of-a-history-of-clinical-depression-on-peri-operative-outcomes-in-elective-total-shoulder-arthroplasty-a-ten-year-national-analysis
#9
B Mollon, S A Mahure, D Y Ding, J D Zuckerman, Y W Kwon
AIMS: Depression can significantly affect quality of life and is associated with higher rates of medical comorbidities and increased mortality following surgery. Although depression has been linked to poorer outcomes following orthopaedic trauma, total joint arthroplasty and spinal surgery, we wished to examine the impact of depression in elective total shoulder arthroplasty (TSA) as this has not been previously explored. PATIENTS AND METHODS: The United States Nationwide Inpatient Sample (NIS) was used to identify patients undergoing elective TSA over a ten-year period...
June 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27147696/rethinking-orthopaedic-decision-making-for-frail-patients-with-hip-fracture-commentary-on-an-article-by-marilyn-heng-md-frcsc-et-al-abnormal-mini-cog-is-associated-with-higher-risk-of-complications-and-delirium-in-geriatric-patients-with-fracture
#10
COMMENT
https://www.readbyqxmd.com/read/27147687/abnormal-mini-cog-is-associated-with-higher-risk-of-complications-and-delirium-in-geriatric-patients-with-fracture
#11
COMMENT
Marilyn Heng, Caitlin E Eagen, Houman Javedan, Jennifer Kodela, Michael J Weaver, Mitchel B Harris
BACKGROUND: The Mini-Cog test is a validated and simple tool to screen for dementia. The purpose of this study was to investigate the relationship of cognitive impairment as measured by Mini-Cog testing as a predictor for in-hospital complications and mortality in geriatric patients with fracture. METHODS: From 2011 to 2014, patients who were seventy years of age or older, had a fracture, and were admitted to co-managed orthopaedic trauma and geriatrics services embedded at two Level-I trauma centers were enrolled in our study...
May 4, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/26999246/three-different-outcomes-in-older-community-dwelling-patients-receiving-intermediate-care-in-nursing-home-after-acute-hospitalization
#12
J F Abrahamsen, C Haugland, R M Nilsen, A H Ranhoff
OBJECTIVES: To evaluate the recovery and outcome of older communitydwelling patients admitted to intermediate care (IC) in nursing homes after acute hospitalization, and to compare patients who were able and unable to return directly to their own homes. DESIGN: Prospective, observational, cohort study conducted between June 2011 and 2014. SETTING: A 19- bed IC unit in a nursing home with increased multidisciplinary staffing. PARTICIPANTS: A total of 961 community-dwelling patients, ≥70 years of age, considered to have a rehabilitation potential and no major cognitive impairment or delirium, transferred from internal medicine, cardiac, pulmonary and orthopaedic hospital departments...
April 2016: Journal of Nutrition, Health & Aging
https://www.readbyqxmd.com/read/26967259/interventions-for-preventing-delirium-in-hospitalised-non-icu-patients
#13
REVIEW
Najma Siddiqi, Jennifer K Harrison, Andrew Clegg, Elizabeth A Teale, John Young, James Taylor, Samantha A Simpkins
BACKGROUND: Delirium is a common mental disorder, which is distressing and has serious adverse outcomes in hospitalised patients. Prevention of delirium is desirable from the perspective of patients and carers, and healthcare providers. It is currently unclear, however, whether interventions for preventing delirium are effective. OBJECTIVES: To assess the effectiveness of interventions for preventing delirium in hospitalised non-Intensive Care Unit (ICU) patients...
March 11, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26253332/prevention-of-delirium-pod-for-older-people-in-hospital-study-protocol-for-a-randomised-controlled-feasibility-trial
#14
RANDOMIZED CONTROLLED TRIAL
John Young, Francine Cheater, Michelle Collinson, Marie Fletcher, Anne Forster, Mary Godfrey, John Green, Shamaila Anwar, Suzanne Hartley, Claire Hulme, Sharon K Inouye, David Meads, Gillian Santorelli, Najma Siddiqi, Jane Smith, Elizabeth Teale, Amanda J Farrin
BACKGROUND: Delirium is the most frequent complication among older people following hospitalisation. Delirium may be prevented in about one-third of patients using a multicomponent intervention. However, in the United Kingdom, the National Health Service has no routine delirium prevention care systems. We have developed the Prevention of Delirium Programme, a multicomponent delirium prevention intervention and implementation process. We have successfully carried out a pilot study to test the feasibility and acceptability of implementation of the programme...
August 8, 2015: Trials
https://www.readbyqxmd.com/read/26074478/enhanced-rehabilitation-and-care-models-for-adults-with-dementia-following-hip-fracture-surgery
#15
REVIEW
Toby O Smith, Yasir A Hameed, Jane L Cross, Catherine Henderson, Opinder Sahota, Chris Fox
BACKGROUND: Hip fracture is a major fall-related injury which causes significant problems for individuals, their family and carers. Over 40% of people with hip fracture have dementia or cognitive impairment, and their outcomes after surgery are poorer than those without dementia. It is not clear which care and rehabilitation interventions achieve the best outcomes for these people. OBJECTIVES: (a) To assess the effectiveness of models of care including enhanced rehabilitation strategies designed specifically for people with dementia following hip fracture surgery compared to usual care...
2015: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/25844284/age-related-surgical-outcomes-of-laminoplasty-for-cervical-spondylotic-myelopathy
#16
Takafumi Maeno, Shinya Okuda, Tomoya Yamashita, Tomiya Matsumoto, Ryoji Yamasaki, Takenori Oda, Motoki Iwasaki
Study Design Retrospective clinical study. Objective To investigate the age-related surgical outcomes of laminoplasty. Methods One hundred patients who underwent an en bloc laminoplasty for cervical spondylotic myelopathy from 2004 to 2008 and were followed for at least 1 year were included in this study. The clinical outcomes were assessed with the Japanese Orthopaedic Association (JOA) score. Acquired points (postoperative JOA score minus preoperative JOA score) were also calculated. To investigate the age-related effect for laminoplasty, two analyses were conducted: (1) the correlation between age and clinical outcome; and (2) the clinical outcomes by decade...
April 2015: Global Spine Journal
https://www.readbyqxmd.com/read/25785620/gentle-persuasive-approaches-introducing-an-educational-program-on-an-orthopaedic-unit-for-staff-caring-for-patients-with-dementia-and-delirium
#17
Anne Pizzacalla, Maureen Montemuro, Esther Coker, Lori Schindel Martin, Leslie Gillies, Karen Robinson, Heather Pepper, Jeff Benner, Joanna Gusciora
Gentle Persuasive Approaches in Dementia Care (GPA), a curriculum originally designed for long-term care, was introduced into an acute care setting. This person-centered approach to supporting and responding to persons with behaviors associated with dementia was shown to be applicable for staff on an orthopaedic surgery unit where they had reported significant challenges and care burdens when faced with behaviors such as shouting, explosiveness, and resistance to care. Staff confidence in their ability to care for persons with behaviors increased after attending the 1-day GPA workshop, and they reported being highly satisfied with the curriculum, found it to be applicable to their practice, indicated that it was also useful for patients with delirium, and would recommend it to others...
March 2015: Orthopaedic Nursing
https://www.readbyqxmd.com/read/25402484/interrelationship-of-postoperative-delirium-and-cognitive-impairment-and-their-impact-on-the-functional-status-in-older-patients-undergoing-orthopaedic-surgery-a-prospective-cohort-study
#18
Chih-Kuang Liang, Chin-Liang Chu, Ming-Yueh Chou, Yu-Te Lin, Ti Lu, Chien-Jen Hsu, Liang-Kung Chen
BACKGROUND: The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. METHOD: This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery...
2014: PloS One
https://www.readbyqxmd.com/read/25099538/effectiveness-of-rehabilitation-in-the-home-service
#19
Sneha Bharadwaj, David Bruce
OBJECTIVES: Rehabilitation in the home (RITH) services increasingly provide hospital substitution services. This study examines clinical outcomes in a large metropolitan RITH service in Western Australia. METHODS: The 2010 database of Fremantle Hospital RITH service was interrogated to identify the clinical profile of cases, length of stay (LOS) and clinical outcomes. Negative outcomes included death or unexpected hospital readmission. Multiple logistic regression modelling was used to explore associations with negative outcomes...
November 2014: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/24651145/using-implementation-science-to-facilitate-evidence-based-practice-changes-to-promote-optimal-outcomes-for-orthopaedic-patients
#20
Sandra L Powrie, Diane Danly, Cynthia F Corbett, Janet Purath, Alice Dupler
Implementation Science is a relatively new field that focuses on discovering strategies to reduce the gap between research and practice. The revised Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to evaluate implementation of an evidence-based project that was designed to reduce the impact of delirium on hospitalized, older, orthopaedic patients. Interventions used in the pilot project were compared with the core elements of the PARIHS framework: evidence, context, facilitation, and successful implementation...
March 2014: Orthopaedic Nursing
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