| 1. |
- Ekstrom, Wilhelmina, et al.
(författare)
-
Sex effects on short-term complications after hip fracture: a prospective cohort study
- 2015
-
Ingår i: Clinical Interventions in Aging. - 1178-1998 .- 1176-9092. ; 10, s. 1259-1266
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate potential sex differences and other factors associated with complications within 4 months after a hip fracture. Methods: A total of 1,915 patients. 65 years (480 men) with hip fracture were consecutively included in a prospective multicenter cohort study. A review of medical records and patient interviews according to a study protocol based on the Standardized Audit of Hip Fractures in Europe (SAHFE, RIKSHOFT) was performed. Sex differences in comorbidity according to the American Society of Anesthesiologists score and complications 4 months after a hip fracture were registered. Multivariate logistic regression analysis was performed to identify factors related to complications. Results: Male sex was associated with worse general health according to the American Society of Anesthesiologists classification (P=0.005) and with more comorbidities (P<0.001). Male sex emerged as a risk factor for developing pneumonia (P<0.001), and additionally, 18% of the men suffered from cardiac complications compared with 13% of the females (P=0.018). Female sex was predisposed for urinary tract infections, 30% vs 23% in males (P=0.001). Mortality was higher in the male vs female group, both within 30 days (15% vs 10%, P=0.001) and at 4 months (24% vs 14%, P=0.001). Conditions associated with pneumonia were male sex, pulmonary disease, and cognitive impairment. Cardiac complications were associated with delayed surgery and cardiovascular and pulmonary disease. Conclusion: Before surgery, men with hip fracture already have a poorer health status and higher comorbidity rate than women, thus resulting in a twofold increased risk of pneumonia. Cognitive dysfunction and pulmonary disease contributed to pneumonia in men. Delayed surgery seems to increase the risk for cardiac complications. It is important to consider the sex perspective early on together with cardiopulmonary comorbidity and cognitive dysfunction to be able to counteract serious complications that may lead to death.
|
|
| 2. |
- Hellström, Per M., et al.
(författare)
-
Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture : a pilot study
- 2017
-
Ingår i: BMC Anesthesiology. - : Springer Science and Business Media LLC. - 1471-2253 .- 1471-2253. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture. Methods: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55. Results: The mean gastric half-emptying time in the elderly study group was 53 +/- 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 +/- 4 (41-106) and 59 +/- 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture. Conclusion: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.
|
|
| 3. |
- Kelly-Pettersson, Paula, et al.
(författare)
-
Waiting time to surgery is correlated with an increased risk of serious adverse events during hospital stay in patients with hip-fracture : A cohort study.
- 2017
-
Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 69, s. 91-97
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hip fractures are common in the elderly and are associated with a high adverse event and mortality rate. Time to surgery is one of the major modifiable risk factors influencing adverse outcomes in hip-fracture patients. National guidelines and recommendations have been introduced which advocate specific time frames in which surgery should be performed i.e. within 24-48h. These time constraints have been arbitrarily set without being modelled on the linear assumption i.e. that risk increases continually over time and not within specific cut-off times.OBJECTIVES: To investigate how waiting time to surgery influenced the risk of serious adverse events in hip-fracture patients during the hospital stay and to examine how the risk increased over time.DESIGN: An observational single cohort study Participants 576 patients (72.4% females, mean [SD] age 82 [10]) years, with a hip fracture were included in the cohort study.METHODS: The outcomes of the study were the occurrence of serious adverse events during hospital stay, length of stay and one-year mortality. A structured medical record review was carried out to identify outcomes and mortality data was obtained from the Swedish National Death Registry. Waiting time to surgery was used as the exposure variable and age, sex, type of fracture, comorbidities using the American Society of Anaesthesiologists classification score and the presence of cognitive dysfunction were identified as confounders. A logistic regression analysis was performed to identify risk factors influencing outcomes.RESULTS: A total of 119 patients (20.6%) suffered 397 (range 1-5) serious adverse events during hospital stay. Every 10h of waiting time to surgery increased the risk of serious adverse events by 12% (odds ratio 1.12 [95% confidence interval 1.02-1.23]). We found no optimal cut-off times for waiting time to surgery. For every 24h of waiting time, the length of stay from surgery was increased by 0.6days (95% CI 0.1-1.1). We found no correlation between waiting time to surgery and one-year mortality.CONCLUSIONS: A large proportion of patients suffered from at least one serious adverse event after hip-fracture surgery and there are no safe limits for waiting time to surgery for hip-fracture patients. As the risk increases with every hour of waiting time, patients with higher American Society of Anesthesiologists classification scores, males and those with subtrochanteric fractures should be prioritized for surgery.
|
|
| 4. |
- Magnéli, Martin, et al.
(författare)
-
Validation of adverse events after hip arthroplasty : a Swedish multi-centre cohort study.
- 2019
-
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:3
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties.DESIGN: Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data.SETTING: 24 different hospitals in four major regions of Sweden.PARTICIPANTS: 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients.PRIMARY AND SECONDARY OUTCOME MEASURES: The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate.RESULTS: The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47).CONCLUSIONS: The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.
|
|
| 5. |
- Samuelsson, Bodil, et al.
(författare)
-
Nonverbal affect attunement in mentalization-based treatment for patients with borderline personality disorder
- 2018
-
Ingår i: Body, Movement and Dance in Psychotherapy: An International Journal for Theory, Research and Practice. - : Informa UK Limited. - 1743-2979 .- 1743-2987. ; 13:2, s. 100-113
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe and analyse the nonverbal affect attunement in relation to the verbal dialogue in mentalization-based treatment (MBT) for patients with borderline personality disorder (BPD). The therapists’ nonverbal affect attunement documented in five video recorded individual sessions in MBT, with five women, diagnosed with BPD, was analysed with part process analysis, a qualitative method developed for video recorded material. Four categories of nonverbal affect attunement were identified in the results: (1) nonverbal affect attunement that supports the therapeutic process; (2) nonverbal misattunement that supports the therapeutic process; (3) nonverbal misattunement that does not support the therapeutic process; (4) no nonverbal affect attunement that does not support the therapeutic process. The study suggests that making therapists more aware of the significance of nonverbal affect attunement could be supportive in helping patients to develop their ability to regulate affects and develop and stabilize the mentalizing ability.
|
|
| 6. |
- Wiinberg, Stig, et al.
(författare)
-
Questionnaire-based evaluation of mobile phone interference with medical-electrical equipment in Swedish hospitals
- 2017
-
Ingår i: Technology and Health Care. - 0928-7329. ; 25:4, s. 791-796
-
Tidskriftsartikel (refereegranskat)abstract
- National recommendations in Sweden recommend a safety distance of 3 meter (m) between mobile phones and medical-electrical (ME) equipment in hospitals. A questionnaire was used to investigate how often mobile phones were reported to interfere with ME products in clinical practice across Sweden. The results confirmed that ME equipment can be affected by mobile phone use but, the risk of the patient's outcome being affected were minimal; no cases were identified which led to injury or death. In conclusion, the results support recommendations for a general safety distance of 0.5 m between mobile phones and ME equipment in care environments.
|
|
