| 1. |
|
|
| 2. |
- Wennberg, Pär, 1972-, et al.
(författare)
-
Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures - effects on cognition
- 2019
-
Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 19:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Impaired cognition is a major risk factor for perioperative delirium. It is essential to provide good pain control in patients with hip fractures and especially important in patients with severely impaired cognitive status, as they receive less pain medication, have poorer mobility, poorer quality of life and higher mortality than patients with intact cognition. The purpose of this study was to examine the association between preoperative pain management with nerve blocks and cognitive status in patients with hip fractures during the perioperative period. Methods One hundred and twenty-seven patients with hip fractures participating in a double-blind, randomised, controlled trial were included in this study. At hospital admission, a low-dose fascia iliaca compartment block (FICB) was administered as a supplement to regular analgesia. Cognitive status was registered on arrival at hospital before FICB and on the first postoperative day using the Short Portable Mental Status Questionnaire. Results Changes in cognitive status from arrival at hospital to the first postoperative day showed a positive, albeit not significant, trend in favour of the intervention group. The results also showed that patients with no or a moderate cognitive impairment received 50% more prehospital pain medication than patients with a severe cognitive impairment. FICB was well tolerated in patients with hip fractures. Conclusion Fascia iliaca compartment block given to patients with hip fractures did not affect cognitive status in this study. Patients with a cognitive impairment may receive inadequate pain relief after hip fracture and this discrimination needs to be addressed in further studies.
|
|
| 3. |
- Caesar, Ulla, 1964, et al.
(författare)
-
Delayed and cancelled orthopaedic surgery; are there solutions to reduce the complex set of problems? A systematic literature review.
- 2021
-
Ingår i: International journal of clinical practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 75:9
-
Tidskriftsartikel (refereegranskat)abstract
- Unexpected cancellations of, and delays to, orthopaedic surgery have adverse effects, with a negative impact on hospital performance and undesirable patient outcomes. As cancellations and delays are common, finding measures to prevent them is a matter of urgency.The present systematic review conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and the Cochrane Handbook. Peer-reviewed studies reporting on cancellations or delays in patients requiring emergency orthopaedic or planned orthopaedic surgery that compared care action/intervention with no action or traditional care were included. The Grading of Recommendations Assessment, Development and Evaluation used to assess the quality of evidence of the results from the included studies. The objective of the present study was systematically to search and review the literature for qualitative evidence of factors that might reduce cancellations of and delays to orthopaedic surgical procedures.The electronic search yielded 1209 studies and eight articles were included in the performed quality assessment. The heterogeneity of the studies and the lack of calculations and statistics in the studies resulted in no meta-analysis. The result of the quality assessment indicated that the evidence ranked from low to very low across the different outcomes. The main limiting factor, which was the reason for a decrease in quality in some outcomes, was the study designs, which were non-randomised control or retrospective approach. The interventions in the included studies could help to support a reduction in the risk of cancelled and delayed orthopaedic procedures.This systematic literature review has revealed important evidence to help reduce the risk of cancelled and delayed orthopaedic procedures associated with a variety of care action exposures. They include a fast-track pathway, pre-operative guidelines and telephone contact with patients prior to surgery, as well as careful consideration of additional pre-operative tests.
|
|
| 4. |
- Caesar, Ulla, 1964
(författare)
-
Delayed and cancelled orthopaedic surgery; Causes and consequences
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extended waiting time, over-booked waiting lists and cancelled and delayed surgical procedures are realities for some patients treated at orthopaedic clinics in Sweden. This situation affects the prioritisation procedures for both emergency and elective surgery and results in even longer waiting lists, not only for planned patients, but for emergencies as well. Methods: Studies I and III were retrospective, observational, single-centre studies with data collected from the hospital’s registers. The aim was to evaluate and describe the number and reasons of delays and cancellations, as well as the waiting times. Study I included 17,625 elective patients over a period of five years and Study III, of 36,017 emergency patients over seven years. The design in Study II was qualitative, aimed to elucidate lived experiences of patients being cancelled of replacement surgery. The 10 interviews were analysed by phenomenological hermeneutic method. Study IV was a systematic review of literature in evidence of factors used to reduce cancellations and delays of orthopaedic procedures. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook were used as guidelines. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence in the included studies. Results: In Study I, 39% of all patients received at least one, some several cancellations. The most common reasons were various patient-related factors 33%. The median waiting time for those cancelled once was 54 days. In Study III, 24% of all patients scheduled for emergency surgeries were delayed, 80% of these were organisational reasons; 21% of all delays were rescheduled within 24 hours, whilst 41% waited more than 24 hours up to three days. In Study II the comprehensive analyses revealed that the participants described their feelings as not being the chosen one and thereby feeling rejected. And described the cancellation using words with connotations to physical pain, like feeling hurt. The relationship between the participant and the health-care provider appeared to be damaged by the cancellation. Study IV included eight articles. The analysis indicated that the evidence was ranked from low to very low across the different studies. The main limiting factor, also the reason for a decrease in quality, was the designs. Conclusion: In Study I more than a third of the patients had their surgery cancelled and in Study III almost one-fourth had their emergency surgery re-scheduled. One possible way of influencing the high rate of the elective patients’ cancellations, might be to involve them more in the overall planning of the care process. In Study III the results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays negatively affect patient outcomes. The result in Study II is promising first step towards building a better understanding on patients experiences of having a surgical procedure cancelled. These new evidence gives possibilities to reflect, develop and improve care. Study IV revealed items that might be useful to help reduce the risk of cancelled and delayed orthopaedic procedures.
|
|
| 5. |
- Caesar, Ulla, et al.
(författare)
-
Incidence and root causes of cancellations for elective orthopaedic procedures : a single center experience of 17,625 consecutive cases.
- 2014
-
Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 8:24
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery.METHODS: The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once.RESULTS: Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations.CONCLUSIONS: In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process.
|
|
| 6. |
- Larsson, Maria E H, 1969, et al.
(författare)
-
Patients' views on responsibility for the management of musculoskeletal disorders - A qualitative study.
- 2009
-
Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 10:1
-
Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Musculoskeletal disorders are very common and almost inevitable in an individual's lifetime. Enabling self-management and allowing the individual to take responsibility for care is stated as desired in the management of these disorders, but this may be asking more than people can generally manage. A willingness among people to take responsibility for musculoskeletal disorders and not place responsibility out of their hands or on employers but to be shared with medical professionals has been shown. The aim of the present study was to describe how people with musculoskeletal disorders think and reason regarding responsibility for prevention, treatment and management of the disorder. METHODS: Individual interviews with a strategic sample of 20 individuals with musculoskeletal disorders were performed. The interviews were tape-recorded, transcribed verbatim and analysed according to qualitative content analysis. RESULTS: From the interviews an overarching theme was identified: own responsibility needs to be met. The analysis revealed six interrelated categories: Taking on responsibility, Ambiguity about responsibility, Collaborating responsibility, Complying with recommendations, Disclaiming responsibility, and Responsibility irrelevant. These categories described different thoughts and reasoning regarding the responsibility for managing musculoskeletal disorders. Generally the responsibility for prevention of musculoskeletal disorders was described to lie primarily on society/authorities as they have knowledge of what to prevent and how to prevent it. When musculoskeletal disorders have occurred, health care should provide fast accessibility, diagnosis, prognosis and support for recovery. For long-term management, the individuals described themselves to be responsible for making the most out of life despite disorders. CONCLUSION: No matter what the expressions of responsibility for musculoskeletal disorders are, own responsibility needs to be met by society, health care, employers and family in an appropriate way, with as much or as little of the "right type" of support needed, based on the individual's expectations.
|
|
| 7. |
- Nilsson, Martin, 1966, et al.
(författare)
-
Competitive physical activity early in life is associated with bone mineral density in elderly Swedish men
- 2008
-
Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 19:11, s. 1557-1566
-
Tidskriftsartikel (refereegranskat)abstract
- In this population-based study of 75-year-old men (n = 498), we investigated the association between physical activity (PA) early in life and present bone mineral density (BMD). We demonstrate that a high frequency of competitive sports early in life is associated with BMD at several bone sites, indicating that increases in BMD following PA are preserved longer than previously believed. Introduction Physical activity (PA) increases bone mineral density (BMD) during growth. It is unclear if the positive effects remain at old age. In this study, we aimed to determine if PA early in life was associated with BMD in elderly men. Methods In this population-based study, 498 men, 75.2 +/- .3 (mean +/- SD) years old, were included. BMD was assessed using DXA. Data concerning lifetime PA, including both competitive (CS) and recreational sports (RS), and occupational physical load (OPL), were collected at interview. Results Subjects in the highest frequency group of CS in the early period (10-35 years), had higher BMD at the total body (4.2%, p < 0.01), total hip (7.0%, p < 0.01), trochanter (8.7%, p < 0.01), and lumbar spine (7.9%, p < 0.01), than subjects not involved in CS. A stepwise linear regression model showed that frequency of CS in the early period independently positively predicted present BMD at the total body (beta=0.12, p < 0.01), total hip (beta=0.11, p < 0.01), trochanter (beta=0.12, p < 0.01), and lumbar spine (beta=0.11, p=0.01). Conclusions We demonstrate that PA in CS early in life is associated with BMD in 75-year-old Swedish men, indicating that increases in BMD following PA are preserved longer than previously believed.
|
|
| 8. |
|
|
| 9. |
- Wennberg, Pär, 1972-, et al.
(författare)
-
Pre-operative pain management with nerve block in patients with hip fractures : a randomized, controlled trial.
- 2019
-
Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241 .- 1878-1292. ; 33, s. 35-43
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Pain management in patients with hip fractures is a major challenge for emergency care. The objective of this study was to evaluate whether the supplementation of pre-operative analgesia with low-dose fascia iliaca compartment block (FICB) compared with placebo would improve pain relief in patients with hip fractures.METHODS: A double-blind, randomized, controlled trial was conducted on 127 patients. At hospital admission, a low-dose FICB was administered to patients with hip fractures as a supplement to regular pre-operative analgesia. Patients with and without cognitive impairment were included. The instruments used were a visual analogue scale (VAS), a numerical rating scale and a tool for behavior related pain assessment. The primary endpoint was the change in reported pain on movement from hospital admission to two hours after FICB.RESULTS: The intervention group showed improved pain management by mean VAS score for pain on movement compared with the control group (p = 0.002).CONCLUSIONS: Our results support the use of low-dose FICB as a pain-relieving adjuvant to other analgesics when administered to patients with a hip fracture.
|
|
