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Age, diabetes and smoking in lower limb amputation for arterial occlusive disease.

https://arctichealth.org/en/permalink/ahliterature48911
Source
Acta Orthop Scand. 1983 Jun;54(3):383-8
Publication Type
Article
Date
Jun-1983
Author
E. Liedberg
B M Persson
Source
Acta Orthop Scand. 1983 Jun;54(3):383-8
Date
Jun-1983
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Amputation
Arterial Occlusive Diseases - complications - surgery
Comparative Study
Diabetes Complications
Epidemiologic Methods
Female
Hip Fractures - surgery
Humans
Leg
Male
Middle Aged
Prospective Studies
Research Support, Non-U.S. Gov't
Smoking
Sweden
Abstract
The increased number of amputations for arterial occlusive disease noted in western countries is only partly explained by increasing numbers of the elderly. A prospective analysis of the influence of diabetes and smoking habits was therefore carried out. In 1978-81, 188 lower limb amputees in Lund were examined and classified as non-smokers, ex-smokers, light smokers and heavy smokers. These figures were compared with corresponding figures among age-correlated controls and to a group of hip fracture patients. The material was divided into men and women and into non-diabetics and diabetics. Smokers had much lower mean age at amputation. Out of 188 amputees only 23 were not either a diabetic, a smoker or 80 years or more. The population study indicates a correlation between smoking and amputation for ichaemia. The coincident increase in cigarette consumption in Sweden is illustrated and it is suggested that smoking should be noted as routinely as diabetes at amputations.
PubMed ID
6858657 View in PubMed
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Analgesics in postoperative care in hip fracture patients with dementia - reported by nurses.

https://arctichealth.org/en/permalink/ahliterature268599
Source
J Clin Nurs. 2014 Nov;23(21-22):3095-106
Publication Type
Article
Date
Nov-2014
Author
Maija Rantala
Sirpa Hartikainen
Tarja Kvist
Päivi Kankkunen
Source
J Clin Nurs. 2014 Nov;23(21-22):3095-106
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Acetaminophen - administration & dosage
Adult
Aged
Aged, 80 and over
Analgesics - administration & dosage
Analgesics, Opioid - administration & dosage
Attitude of Health Personnel
Cross-Sectional Studies
Dementia
Drug Administration Schedule
Female
Finland
Hip Fractures - surgery
Humans
Male
Middle Aged
Pain, Postoperative - drug therapy - nursing
Postoperative Care - nursing
Surveys and Questionnaires
Abstract
To describe the analgesic use in hip fracture patients with dementia during the first two postoperative days as reported by nurses.
Nurses play a pivotal role in treating postoperative pain in patients with dementia and monitoring the effects of administered analgesics.
Cross-sectional descriptive questionnaire study in seven university hospitals and 10 central hospitals in Finland.
The study was conducted from March until May in 2011 in Finland. For this analysis, the focus was on the sample of nurses (n = 269) who were working in orthopaedic units. Analgesics were classified according to the Anatomical Therapeutic Chemical Classification System. Nonparametric tests were applied to find out the significant differences between analgesic use and different hospitals.
Paracetamol and strong opioids administered orally or parenterally seemed to be the most typical of postoperatively used types of analgesics in patients with dementia. Nonsteroidal anti-inflammatory analgesics and weak opioids were also commonly reported to be in use. There were no statistically significant differences between hospitals in typical daily doses. The majority of the nurses reported that the primary aim of postoperative pain management in hip fracture patients with dementia was 'slight pain, which does not prevent normal functioning' (72%).
The pharmacological postoperative pain treatment in acute care was commonly based on the use of strong opioids and paracetamol in hip fracture patients with dementia. The reported use of transdermal opioids and codeine combination warrants further examination. Further studies are also needed to find out whether the pain is appropriately and adequately treated.
Transdermal opioids and codeine combination may not be relevant analgesics for acute pain management in older adults. It is important to create a balance between sufficient pain relief and adverse effects of analgesics to allow early mobilisation and functional recovery.
PubMed ID
24476197 View in PubMed
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[Anesthesia and postoperative care--increased need for supplies].

https://arctichealth.org/en/permalink/ahliterature241910
Source
Lakartidningen. 1983 May 11;80(19):2051-3
Publication Type
Article
Date
May-11-1983

Budget impact analysis of warfarin reversal therapies among hip fracture patients in Finland.

https://arctichealth.org/en/permalink/ahliterature268284
Source
Drugs R D. 2015 Mar;15(1):155-62
Publication Type
Article
Date
Mar-2015
Author
Timo Purmonen
Soili Törmälehto
Niina Säävuori
Hannu Kokki
Source
Drugs R D. 2015 Mar;15(1):155-62
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - adverse effects
Blood Coagulation Factors - administration & dosage - economics
Budgets
Female
Finland
Health Care Costs
Hip Fractures - surgery
Humans
International Normalized Ratio
Male
Plasma
Time Factors
Vitamin K - administration & dosage - economics
Warfarin - adverse effects - antagonists & inhibitors
Abstract
Hip fractures require operation within 36-48 h, and they are most common in the elderly. A high International Normalized Ratio should be corrected before surgery. In the current study, we analyzed the budget impact of various warfarin reversal approaches.
Four reversal strategies were chosen for the budget impact analysis: the temporary withholding of warfarin, administration of vitamin K, fresh frozen plasma (FFP), and a four-factor prothrombin complex concentrate (PCC).
We estimated that, annually, 410 hip fracture patients potentially require warfarin reversal in Finland. The least costly treatment was vitamin K, which accounted for €289,000 in direct healthcare costs, and the most costly treatment option was warfarin cessation, which accounted for €1,157,000. In the budget impact analysis, vitamin K, PCC and FFP would be cost-saving to healthcare compared with the current treatment mix.
The various warfarin reversal strategies have different onset times, which may substantially impact the subsequent healthcare costs.
Notes
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PubMed ID
25749804 View in PubMed
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A Canadian survey of prophylactic antibiotic use among hip-fracture patients.

https://arctichealth.org/en/permalink/ahliterature200129
Source
Infect Control Hosp Epidemiol. 1999 Nov;20(11):752-5
Publication Type
Article
Date
Nov-1999
Author
D. Zoutman
L. Chau
J. Watterson
T. Mackenzie
M. Djurfeldt
Author Affiliation
Department of Pathology, Queen's University, Kingston, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 1999 Nov;20(11):752-5
Date
Nov-1999
Language
English
Publication Type
Article
Keywords
Antibiotic Prophylaxis - statistics & numerical data - utilization
Canada
Data Collection
Hip Fractures - surgery
Humans
Orthopedics
Retrospective Studies
Surgical Wound Infection - prevention & control
Abstract
To study how surgical prophylactic antibiotics (SPAs) were utilized in the perioperative management of surgery for hip fractures.
Retrospective chart review of randomly selected medical records.
Twenty-two hospitals (teaching, nonteaching, community, and large urban referral centers) from across Canada.
Patients admitted in 1990 with a diagnosis of hip fracture.
Complete medical records of 438 patients were examined; 352 cases who underwent surgical repair of a fractured hip with insertion of prosthetic material were included in analysis. Perioperative SPA use was assessed by abstracting the agent(s) chosen, dosages, time given with respect to the incision, and duration of postoperative use. Fourteen patient and process-of-care variables related to SPA were examined.
247 (70%) of 352 cases did not receive a dose of SPA 2 hours preoperatively. Ten percent of preoperative SPA was administered either too early or during the procedure. In 91 (39%) of 231 cases receiving SPA, the first dose was not administered until the end of the procedure. Preoperative SPA consisted of a parenteral first-generation cephalosporin for 94% of cases. SPAs were continued more than 24 hours postoperatively in 78% of cases. Lack of a written order for SPA, being a nonteaching hospital, and shorter duration of surgical procedure were predictive of failure to receive SPA in an effective manner.
Most hip-fracture-surgery patients did not receive effective antibiotic prophylaxis as required to prevent serious wound infections. This important variable can be included for surveillance, so that corrective measures can be taken to assure effective prophylactic antibiotic administration.
PubMed ID
10580626 View in PubMed
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Changing methods of hip fracture osteosynthesis in Sweden. An epidemiological enquiry covering 46,900 cases.

https://arctichealth.org/en/permalink/ahliterature221316
Source
Acta Orthop Scand. 1993 Apr;64(2):173-4
Publication Type
Article
Date
Apr-1993
Author
I. Sernbo
H. Fredin
Author Affiliation
Lund University, Department of Orthopedics, Malmö General Hospital, Sweden.
Source
Acta Orthop Scand. 1993 Apr;64(2):173-4
Date
Apr-1993
Language
English
Publication Type
Article
Keywords
Bone Nails
Bone Screws
Fracture Fixation, Internal - methods - trends
Hip Fractures - surgery
Hip Prosthesis
Humans
Questionnaires
Sweden
Abstract
An enquiry covering all hospitals in Sweden operating on hip fractures was conducted in 1990. The results were compared with enquiries from 1982 and 1985. In cervical hip fractures the use of single nail has almost disappeared in favor of 2 LIH hook pins and, lately, the Uppsala subchondral screws. Primary hip prosthesis is the ultimate method of choice in Sweden. Among trochanteric hip fracture the Ender nail has almost totally been replaced by a sliding screw and plate device.
PubMed ID
8498179 View in PubMed
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[Clinical experience with a custom-made hip prosthesis developed in Norway]

https://arctichealth.org/en/permalink/ahliterature78757
Source
Tidsskr Nor Laegeforen. 2007 Feb 15;127(4):432-4
Publication Type
Article
Date
Feb-15-2007
Author
Svenningsen Svein
Author Affiliation
Ortopedisk avdeling, Sørlandet sykehus Arendal, Serviceboks 605, 4809 Arendal. svein.svenningsen@sshf.no
Source
Tidsskr Nor Laegeforen. 2007 Feb 15;127(4):432-4
Date
Feb-15-2007
Language
Norwegian
Publication Type
Article
Keywords
Adult
Arthroplasty, Replacement, Hip
Female
Femur - surgery
Follow-Up Studies
Hip Dislocation - surgery
Hip Fractures - surgery
Hip Prosthesis
Humans
Legg-Perthes Disease - surgery
Male
Middle Aged
Norway
Osteoarthritis, Hip - surgery
Prospective Studies
Prosthesis Design
Treatment Outcome
Abstract
BACKGROUND: A custom-made hip prosthesis is developed at St.Olav s Hospital and the Norwegian University of Science and Technology (NTNU) in Trondheim. The purpose was to design an uncemented stem for optimal fit of the proximal femur to achieve secure fixation and optimal strain distribution to the bone. A customized hip prosthesis permits reconstruction of the normal joint mechanism, including reconstruction of leg length, a physiological hip centre and a normal lever arm for the major hip muscles. 6 years of experience with the device at the orthopaedic department at Sørlandet Hospital, Arendal is presented. MATERIAL AND METHOD: 43 hips in 37 patients were operated. Median time of observation was 3 years (3 months-6 years). The patients' age was on average 49 years. 70% of the hips had hip dysplasia. The patients were followed prospectively, both clinically and radiologically for up to 6 years (median 3 years). RESULTS:The operations were performed as planned in all patients with an average operation time of 96 minutes. We have had no re-operations, no post-operative dislocations of the operated hips and no infections. No components have loosened and no patient has complained of thigh pain. One patient had a per-operative femoral fissure that was treated with cerclage, and one patient had an affection of nervus ischiadicus. The mean Harris hip score was 49 pre- and 97 post-operation . INTERPRETATION: Our experience with the Norwegian custom-made hip prosthesis is promising and confirms the good results from the Trondheim group.
PubMed ID
17304270 View in PubMed
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A comparison of surgical delays in directly admitted versus transferred patients with hip fractures: opportunities for improvement?

https://arctichealth.org/en/permalink/ahliterature105170
Source
Can J Surg. 2014 Feb;57(1):40-3
Publication Type
Article
Date
Feb-2014
Author
Sagar J Desai
Janak Patel
Hussein Abdo
Abdel-Rahman Lawendy
David Sanders
Author Affiliation
From Western University, London, Ont.
Source
Can J Surg. 2014 Feb;57(1):40-3
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Fracture Fixation
Hip Fractures - surgery
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Ontario
Organizational Policy
Outcome and Process Assessment (Health Care)
Patient Admission
Patient transfer
Quality Indicators, Health Care
Retrospective Studies
Time Factors
Trauma Centers - organization & administration
Abstract
The increasing incidence of hip fractures in our aging population challenges orthopedic surgeons and hospital administrators to effectively care for these patients. Many patients present to regional hospitals and are transferred to tertiary care centres for surgical management, resulting in long delays to surgery. Providing timely care may improve outcomes, as delay carries an increased risk of morbidity and mortality.
We retrospectively reviewed the cases of all patients with hip fractures treated in a single Level 1 trauma centre in Canada between 2005 and 2012. We compared quality indicators and outcomes between patients transferred from a peripheral hospital and those directly admitted to the trauma centre.
Of the 1191 patients retrospectively reviewed, 890 met our inclusion criteria: 175 who were transferred and 715 admitted directly to the trauma centre. Transfer patients' median delay from admission to operation was 93 hours, whereas nontransfer patients waited 44 hours (p
Notes
Cites: JAMA. 2004 Apr 14;291(14):1738-4315082701
Cites: J Trauma. 1995 Aug;39(2):261-57674394
Cites: J Bone Joint Surg Am. 1995 Oct;77(10):1551-67593064
Cites: J Bone Joint Surg Am. 2005 Mar;87(3):483-915741611
Cites: J Bone Joint Surg Br. 2005 Mar;87(3):361-615773647
Cites: Rheum Dis Clin North Am. 2006 Nov;32(4):617-2917288968
Cites: Int Orthop. 2008 Feb;32(1):13-817219213
PubMed ID
24461225 View in PubMed
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Compliance with national guidelines for antibiotic prophylaxis in hip fracture patients: a quality assessment study of 13 329 patients in the Norwegian Hip Fracture Register.

https://arctichealth.org/en/permalink/ahliterature305852
Source
BMJ Open. 2020 05 20; 10(5):e035598
Publication Type
Journal Article
Date
05-20-2020
Author
Tom Lian
Eva Dybvik
Jan-Erik Gjertsen
Håvard Dale
Marianne Westberg
Lars Nordsletten
Wender Figved
Author Affiliation
Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway tom.t.lian@gmail.com.
Source
BMJ Open. 2020 05 20; 10(5):e035598
Date
05-20-2020
Language
English
Publication Type
Journal Article
Keywords
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis - standards
Arthroplasty, Replacement, Hip
Clindamycin - therapeutic use
Female
Guidelines as Topic - standards
Hip Fractures - surgery
Hospitals
Humans
Male
Norway
Qualitative Research
Registries
Abstract
We assessed compliance with new guidelines for prophylactic antibiotics in hip fracture surgery in Norway introduced in 2013.
The data from the Norwegian Hip Fracture Register was used to assess the proportion of antibiotics given according to the national guidelines.
All hospitals in Norway performing hip fracture surgery in the period from 2011 to 2016.
We studied 13 329 hemiarthroplasties (HAs) for acute hip fracture.
Type and timing between first and last dose of prophylactic antibiotics compared with the national guidelines.
Before the guidelines were introduced, the recommended drugs cephalotin or clindamycin was used in only 86.2% of all HAs. In 2016, one of the two recommended drugs was administered in 99.2% of HAs. However, hospitals' adaption of the recommended administration of the two drugs improved slowly, and by the end of the study period, only three out of five HAs were performed with the correct drug administered in the correct manner. We found major differences in compliance between hospitals.
The change towards correct administration of antibiotic prophylaxis was varied both when investigating university and non-university hospitals. We suggest that both hospital leaders and the national Directorate of Health need to investigate routines for better dissemination of information and education to involved parties. Strong leadership concerning evidence-based guidelines on antibiotic prophylaxis in surgery may take away some autonomy from executing healthcare professionals, but will result in better patient care and antibiotic stewardship.
PubMed ID
32439694 View in PubMed
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48 records – page 1 of 5.