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Delirium in orthopaedic

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...
January 27, 2017: Journal of Neurosurgery. Spine
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
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
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
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
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
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
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
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
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
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
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
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
Ernst J Müller, Ingeborg Gerstorfer, Peter Dovjak, Bernhard Iglseder, Georg Pinter, Walter Müller, Katharina Pils, Peter Mikosch, Michaela Zmaritz, Monique Weissenberger-Leduc, Markus Gosch, Heinrich W Thaler
In patients with hip fractures, in order to reduce the high number of general complications and those associated with the specific treatment, the functional loss and cognitive impairment, implementation of co-ordinated, multidisciplinary treatment pathways, and rehabilitation, is mandatory. The imminent treatment of proximal femoral fracture consists of major orthopaedic surgery in most cases (total or partial hip arthroplasty, osteosynthesis). After the diagnosis of a hip fracture, an adequate pain medication should be initiated...
October 2013: Wiener Medizinische Wochenschrift
Amanda Griffiths, Alec Knight, Rowan Harwood, John R F Gladman
BACKGROUND AND OBJECTIVE: in the UK, two-thirds of patients in general hospitals are older than 70, of whom half have dementia or delirium or both. Our objective was to explore doctors, nurses and allied health professionals' perceptions of their preparation to care for confused older patients on general hospital wards. METHODS: : using a quota sampling strategy across 11 medical, geriatric and orthopaedic wards in a British teaching hospital, we conducted 60 semi-structured interviews with doctors, nurses and allied healthcare professionals and analysed the data using the Consensual Qualitative Research approach...
July 2014: Age and Ageing
Jennifer B Seaman, Judith A Erlen
As the U.S. population ages, the proportion of hospitalized patients older than 65 years will continue to increase with a significant number likely to have some degree of cognitive impairment. Because of the high rate of falls-related traumatic injury among older adults, many will require orthopaedic services. These patients may have multiple comorbidities and are at increased risk for complications. Varying degrees of cognitive impairment in combination with possible postoperative complications including delirium places these patients at risk for decreased decisional capacity and can create ethical dilemmas during the provision of bedside care...
September 2013: Orthopaedic Nursing
Konstantin V Grigoryan, Houman Javedan, James L Rudolph
OBJECTIVES: Hip fractures are common, morbid, and costly health events that threaten independence and function of older patients. The purpose of this systematic review and meta-analysis was to determine if orthogeriatric collaboration models improve outcomes. DATA SOURCES: Articles in English and Spanish languages were searched in the electronic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and the Cochrane Registry from 1992 to 2012...
March 2014: Journal of Orthopaedic Trauma
Go Ito, Kousuke Kanemoto
In Japan, indications for opioid analgesics, once exclusively used as pain killers for patients suffering from malignant cancer, have been expanded for a wide range of pain. Herein we report a patient with opioid-induced delirium associated with the administration of buprenorphine patches that was well below the indicated therapeutic range limit. An 82-year-old woman was referred to us from an orthopaedic practitioner for uncontrollable behavioural problems apparently caused by the beginning of dementia; the patient had gradually developed disorientation, visual hallucinations, and delusions...
June 2013: Psychogeriatrics: the Official Journal of the Japanese Psychogeriatric Society
Lucy E Bradshaw, Sarah E Goldberg, Sarah A Lewis, Kathy Whittamore, John R F Gladman, Rob G Jones, Rowan H Harwood
BACKGROUND: two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission. METHODS: a follow-up study of 250 patients aged over 70 admitted to 1 of 12 wards (geriatric, medical or orthopaedic) of an English acute general hospital with a co-morbid mental health problem and followed up at 180 days...
September 2013: Age and Ageing
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