| 1. |
- Hommel, Ami, et al.
(författare)
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A study of a pathway to reduce pressure ulcers for patients with a hip fracture
- 2007
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Ingår i: Journal of Orthopaedic Nursing. - : Elsevier. - 1361-3111 .- 1873-4839 .- 1878-1241. ; 11:3-4, s. 151-159
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Tidskriftsartikel (refereegranskat)abstract
- Due to an ageing population the numbers of patients with hip fractures are increasing. They often suffer from concomitant diseases and are therefore prone to be affected by complications such as pressure ulcers. The prevention of pressure ulcers among patients with a hip fracture is crucial. The aim of this study was to improve the quality of care and patient safety in patients with a hip fracture. A new evidence based clinical pathway was introduced to prevent hospital acquired pressure ulcers. Furthermore, the purpose was to bring attention to pressure ulcer prevention and to facilitate changes in clinical practice to improve quality of care and patient safety. A total of 478 patients with a hip fracture were consecutively included between April 2003 and March 2004. The new evidence based clinical pathway was introduced on October 1st 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article. In the intervention group, hospital acquired pressure ulcers decreased by 50% (p < 0.007). It is possible to reduce the development of hospital acquired pressure ulcers among elderly patients with a hip fracture even though it is not possible to eliminate the effect of factors such as increased age and the patients’ medical status which are often the two main risk factors.
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| 2. |
- Hommel, Ami, et al.
(författare)
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Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year
- 2008
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Ingår i: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 39:10, s. 1164-1174
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Tidskriftsartikel (refereegranskat)abstract
- Hip fractures are a major cause of hospital stay among the elderly, and result in increased disability and mortality. In this study from 1 April 2003 to 31 March 2004, the influence of optimised treatment of hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year were investigated. Comparisons were made between the first 210 patients in the period and the last 210 patients, who followed the new clinical pathway introduced at the University Hospital in Lund, Sweden. Early surgery, within 24h, was not associated with reduced mortality, but was significantly associated with reduced length of stay (p<0.001). Significantly more cases of osteosynthesis for femoral neck fracture were reoperated compared with all other types of surgery (p<0.001) when reoperations with extraction of the hook pins in healed fractures were excluded. Mortality was significantly higher among men than women at 4 (p=0.025) and 12 (p=0.001) months after fracture and among medically fit patients with administrative delay to surgery compared with patients with no delay (p<0.001).
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| 3. |
- Hommel, Ami, et al.
(författare)
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Nutritional status among patients with hip fracture in relation to pressure ulcers
- 2007
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Ingår i: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 26:5, s. 589-596
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims Patients with a hip fracture often have a poor nutritional status that is associated with increased risk of complications, morbidity and mortality. The aim of this study was to investigate the effects of an improved care intervention in relation to nutritional status and pressure ulcers. An intervention of best practices for patients with hip fracture was introduced, using the available resources effectively and efficiently with a not too complicated or expensive intervention. Methods A quasi-experimental study of 478 patients consecutively included between April 1, 2003 and March 31, 2004. A new evidence-based clinical pathway was introduced on October 1, 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article. Results The total number of patients with a hospital-acquired pressure ulcer was in the intervention group, 19 patients, and in the control group, 39 patients (p=0.007). No patient younger than 65 years developed a pressure ulcer. There were no statistical significant differences between the groups with respect to blood biochemical variables at inclusion. Patients in the control group had higher arm muscle circumference (AMC) (p=0.05), calf circumference (CC) (p=0.038) and body mass index (BMI) (p=0.043) values. Abnormal anthropometrical tests of BMI, triceps skin fold (TSF) <10th percentile and AMC <10th percentile were found in 12 patients in the control group and in 4 patients in the intervention group. None of the 4 patients in the intervention group developed pressure ulcers. However, 2 of the 12 patients in the control group were affected. Conclusions It is possible to reduce the development of hospital-acquired pressure ulcers among elderly patients with a hip fracture even though they have poor prefracture nutritional status. Results in this study indicate the value of the new clinical pathway, as number of patients who have developed pressure ulcers during their stay in hospital has been reduced by 50%.
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| 4. |
- Björkman Björkelund, Karin
(författare)
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Acute Confusional State in Elderly Patients with Hip Fracture. Identification of risk factors and intervention using a prehospital and perioperative management program
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract The overall aim of this thesis was to increase knowledge about underlying causes and perioperative risk factors of Acute Confusional State (ACS) in elderly patients with hip fracture and to investigate the effect of a multi-factorial intervention program in order to decrease the number of patients who develop ACS. The aim in paper I was to describe elderly patients with hip fracture on the basis of the American Society of Anesthesiologists’ ASA classification system and to identify preoperative risk factors in relation to the postoperative outcome measured up to 4-months after surgery. The aim in paper II was to identify perioperative risk factors in relation to postoperative outcome up to 4-months after surgery. In paper III the aim was to critically examine the Organic Brain Syndrome (OBS) Scale using the criteria and guidelines formulated by the Scientific Advisory Committee of the Medical Outcomes Trusts (SAC) for the evaluation of assessment instruments; and to investigate its relevance and suitability for use in various clinical settings. In paper IV the aim was to investigate whether an implementation of a multi-factorial intervention program including prehospital, pre-, intra- and postoperative treatment and care can reduce the incidence of acute ACS among elderly patients with hip fracture, lucid at admission to hospital. Design: In paper I and II a descriptive, cohort design was used, using data prospectively registered, and data retrospectively collected from medical records and nursing charts. The design used in study III was a two-stage strategy for identifying and reviewing scientific papers. In study IV a quasi-experimental, nonequivalent comparison group design was used. Results: In paper I risk factors for a poorer 4-month’s survival after hip fracture found were ‘ASA-status 3 and 4’, ‘more extensive fractures’, ‘age ≥85’, ‘male sex’, and ‘dependency in living.’ Mortality within 4-months was significantly associated with ‘ASA status 3 and 4’, ‘age ≥85 years’, ‘male sex’, ‘dementia diagnosis’, ‘Short Mental Status Questionnaire (SPMSQ) score <8 correct answers’, ‘prescribed drugs ≥4’, ‘hemoglobin <100 g/L’, ‘creatinine >100 micromol/L’, ‘dependency in living’, ‘unable to walk alone’, and ‘fracture other than undisplaced intracapsular’. In paper II significant perioperative risk factors for a poorer recovery and survival after hip fracture were ‘oxygen saturation (SpO2) <90 %’, ‘fasting time ≥12 hours’, and ‘blood transfusion ≥1 unit ’. ‘SpO2 <90 %’, and ‘blood transfusion ≥1’ unit were factors significantly associated with postoperative confusion, in-hospital complications and/or death within 4-months after hip fracture. A ‘postoperative hemoglobin <100 g/L’ was also significantly associated with postoperative confusion and in-hospital complications. In paper III the result showed that the OBS Scale in many aspects satisfies the requirements formulated by the SAC, but there is a need for additional evaluation, especially with regard to different forms of reliability, and the translation and adaptation to other languages. In paper IV the incidence of ACS was reduced by 64 % in the intervention group (29 of 131) compared to the control group (45 of 132) (p=0.031). Patients developing ACS had significantly higher levels of serious complications and 30-day mortality compared to patients without ACS. Conclusion: Elderly patients acutely admitted to hospital due to a hip fracture often suffer from increased morbidity. The incidence of complications is high in this patient group. It is of great importance that patients at risk of developing postoperative complications such as ACS are identified and treated promptly in order to prevent complications. Patient’s baseline characteristics, such as high age, number of prescribed drugs, or functional status are not possible to affect. On the other hand, factors such as oxygen saturation in blood, anemia, fluid balance, pain, or the length of fasting time are possible to intervene already at an early stage.
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| 5. |
- Björkman Björkelund, Karin, et al.
(författare)
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Factors at admission associated with 4 months outcome in elderly patients with hip fracture.
- 2009
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Ingår i: AANA Journal. - 0094-6354. ; 77:1, s. 49-58
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Mortality within 4 months was significantly associated with ASA physical status 3 and 4, age 85 years or older, male sex, dementia diagnosis, fewer than 8 correct answers on the Short Portable Mental Status Questionnaire, 4 or more prescribed drugs, hemoglobin level less than 100 g/L, creatinine level more than 100 micromol/L, dependency in living, inability to walk alone, and fracture other than undisplaced intracapsular. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.
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| 6. |
- Björkman Björkelund, Karin, et al.
(författare)
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Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.
- 2010
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; Apr 7, s. 678-688
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (>/=65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test. Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.
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| 7. |
- Björkman Björkelund, Karin, et al.
(författare)
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The influence of perioperative care and treatment on the 4-month outcome in elderly patients with hip fracture.
- 2011
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Ingår i: AANA Journal. - 0094-6354. ; 79:1, s. 51-61
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to identify perioperative risk factors associated with postoperative outcome up to 4 months after surgery in elderly patients with hip fracture. Data were collected prospectively through the Swedish National Hip Fracture, the local Acute and Emergency, and Anesthesia registers, and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Perioperative risk factors predicting death within 4 months after surgery were fasting time of 12 or more hours and blood transfusion of 1 U or more. Risk factors predicting postoperative confusion were postoperative oxygen saturation less than 90% and fasting time 12 hours or longer. Risk factors predicting in-hospital complications were transfusion of 1 or more units of blood, preoperative oxygen saturation less than 90%, and fasting time 12 hours or more. Risk factor predicting length of stay longer than 10 days was blood transfusion of 1 U or more. To minimize morbidity and mortality, providers should increase efforts to optimize the patients' oxygen saturation and hemoglobin level and reduce fasting time and waiting time for surgery.
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| 8. |
- Björkman Björkelund, Karin, et al.
(författare)
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The Organic Brain Syndrome (OBS) scale: a systematic review.
- 2006
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 21:3, s. 210-222
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Forskningsöversikt (refereegranskat)abstract
- Background/Objective The Organic Brain Syndrome (OBS) Scale was developed to determine elderly patients' disturbances of awareness and orientation as to time, place and own identity, and assessment of various emotional and behavioural symptoms appearing in delirium, dementia and other organic mental diseases. The aim of the study was to examine the OBS Scale, using the eight criteria and guidelines formulated by the Scientific Advisory Committee of the Medical Outcomes Trust (SAC), and to investigate its relevance and suitability for use in various clinical settings. Method Systematic search and analysis of papers (30) on the OBS Scale were carried out using the criteria suggested by the SAC. Results: The OBS Scale in many aspects satisfies the requirements suggested by the SAC: conceptual and measurement model, reliability, validity, responsiveness, interpretability, respondent and administrative burden, alternative forms of administration, and cultural and language adaptations, but there is a need for additional evaluation, especially with regard to different forms of reliability, and the translation and adaptation to other languages. Conclusions The OBS Scale is a sensitive scale which is clinically useful for the description and long-term follow-up of patients showing symptoms of acute confusional state and dementia. Although the OBS Scale has been used in several clinical studies there is need for further evaluation. Copyright (c) 2006 John Wiley & Sons, Ltd.
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| 9. |
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| 10. |
- Hommel, Ami, et al.
(författare)
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A study of a pathway to reduce pressure ulcers for patients with a hip fracture
- 2007
-
Ingår i: Journal of Orthopaedic Nursing. - : Elsevier BV. - 1361-3111 .- 1878-1292 .- 1873-4839. ; 11:3-4, s. 151-159
-
Tidskriftsartikel (refereegranskat)abstract
- Due to an ageing population the numbers of patients with hip fractures are increasing. They often suffer from concomitant diseases and are therefore prone to be affected by complications such as pressure ulcers. The prevention of pressure ulcers among patients with a hip fracture is crucial. The aim of this study was to improve the quality of care and patient safety in patients with a hip fracture. A new evidence based clinical pathway was introduced to prevent hospital acquired pressure ulcers. Furthermore, the purpose was to bring attention to pressure ulcer prevention and to facilitate changes in clinical practice to improve quality of care and patient safety. A total of 478 patients with a hip fracture were consecutively included between April 2003 and March 2004. The new evidence based clinical pathway was introduced on October 1st 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article. In the intervention group, hospital acquired pressure ulcers decreased by 50% (p < 0.007). It is possible to reduce the development of hospital acquired pressure ulcers among elderly patients with a hip fracture even though it is not possible to eliminate the effect of factors such as increased age and the patients’ medical status which are often the two main risk factors.
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