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1 Microscopic structure of normal and osteoporotic bone (a) Normal bone and (b) Osteoporotic bone (©Alan Boyde 2018 with permission)
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The speciality of orthogeriatric nursing has only recently emerged and is evolving rapidly. The recognition of the global burden of fragility fractures is growing and the recent call to action issued by the Fragility Fracture Network [1] has created momentum and further strengthened an expanding international network of nurses who continue to champ...
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... fracture is diagnosed by the symptoms and verified with X-rays [9]; these may be supplemented with MRI or CT to establish diagnosis. Most hip fractures occur in one of two locations; at the femoral neck or in the intertrochanteric region. The location of the fracture and the degree of displacement or impaction help determine the best treatment ( Fig. 5.1). In nearly all cases, surgery is the treatment of choice as this is the most effective way to manage pain and stabilise the fracture so that the patient can remobilise as soon as ...
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... from urinary incontinence; if urine is in contact with the skin for prolonged periods, it can lead to incontinenceassociated dermatitis (IAD), a type of irritant contact dermatitis caused by prolonged exposure of the skin to urine, faeces [3] or other fluids such as wound exudate and sweat. In combination, pressure, friction, shear and moisture ( Fig. 7.1) represent a group of extrinsic factors that healthcare workers need to modify when aiming to prevent skin damage. In addition to the extrinsic factors discussed above, patients are also vulnerable to tissue injury because of a complex interplay between a variety of intrinsic factors that affect the skin's innate ability to resist ...
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... of extrinsic factors that healthcare workers need to modify when aiming to prevent skin damage. In addition to the extrinsic factors discussed above, patients are also vulnerable to tissue injury because of a complex interplay between a variety of intrinsic factors that affect the skin's innate ability to resist external forces-tissue tolerance ( Fig. 7.1) [2]. These factors include coexisting health conditions such as those affecting the respiratory and circulatory system which result in diminished blood, oxygen and nutrition supply to the tissues. Pulmonary disease, cardiovascular disease and diabetes are common examples of such conditions. Health conditions that affect mobility such ...
Citations
... This co-working has led to value-based care in action and improvement in patient outcomes, patient and family experiences and clinical team members' work experience. The concept of interprofessional care is essential for ensuring that individuals' needs drive clinical care, and the incorporation of evidence-based practice is central to assessment and intervention [7]. ...
Caring for people following a fragility fracture is often a complex, medium- to long-term undertaking with several phases from acute care through to rehabilitation and secondary fracture prevention. Fragility fractures can have a substantial impact on older peoples’ longer term function, place of residence and quality of life, sometimes leading to long-term residential or end-of-life care.
Health professionals caring for patients following fragility fracture are required to provide evidence-based care and coordinate interdisciplinary care. Not all ‘care’ is provided by those professionals who are identified as nurses, and in the future the boundaries of care-giving roles are likely to be more flexible. For these reasons, this book, although focused on nursing (because a significant amount of fragility facture/orthogeriatric care is provided by them), aims to broaden its relevance to all healthcare professionals who provide care in any part of the world.
Avoiding the devastating impacts of fragility fractures drives the need to prevent fractures through secondary fracture prevention. This prevention care is lifelong and usually delivered and monitored by a primary care team including general practitioners, nurses, physiotherapists and other specialist practitioners. The pathway of care is, therefore, dynamic and involves the collaboration of many individuals and agencies.
Fragility fractures are important indicators that there may be undiagnosed osteoporosis that requires treatment to prevent further fractures. If left untreated, osteoporosis and associated bone fragility can, ultimately, lead to significant injuries such as hip or femoral fractures, which will require hospital admission and surgery, and severely threaten an individual’s health and well-being. This presents significant challenges for clinical teams in every care setting.
The aim of this chapter is to introduce the reader to orthogeriatric and fragility fracture care and to both familiarise them with the multiple topics covered in this book and support the interdisciplinary care team in achieving optimal recovery of independent function and quality of life, with no further fractures for all people with fragility fractures.
... Protocolos y registros locales. 7, [31][32][33][34][35] De calidad Sistemas dinámicos de comanejo cuyos resultados en indicadores claves del proceso de atención de pacientes mayores traumatológicos son mejores que los de otras vías. ...
¿Qué es "Ortogeriatría"?
¿Es lo mismo un "programa", una "unidad", un "servicio" de ortogeriatría"?
¿Qué modelos de atención en Ortogeriatría tienen la mejor evidencia?
¿Qué tipo de iniciativa ortogeriátrica puedo implementar?
¿Esposible clasificar los modelos de atención en Ortogeriatría para compararlos entre sí?
Estas y otras preguntas son abordadas y respondidas en este paper.
Comorbidity network analysis (CNA) is a technique in which mathematical graphs encode correlations (edges) among diseases (nodes) inferred from the disease co-occurrence data of a patient group. The present study applied this network-based approach to identifying comorbidity patterns in older patients undergoing hip fracture surgery. This was a retrospective observational cohort study using electronic health records (EHR). EHR data were extracted from the one University Health System in the southeast United States. The cohort included patients aged 65 and above who had a first-time low-energy traumatic hip fracture treated surgically between October 1, 2015 and December 31, 2018 (n = 1,171). Comorbidity includes 17 diagnoses classified by the Charlson Comorbidity Index. The CNA investigated the comorbid associations among 17 diagnoses. The association strength was quantified using the observed-to-expected ratio (OER). Several network centrality measures were used to examine the importance of nodes, namely degree, strength, closeness, and betweenness centrality. A cluster detection algorithm was employed to determine specific clusters of comorbidities. Twelve diseases were significantly interconnected in the network (OER > 1, p-value < .05). The most robust associations were between metastatic carcinoma and mild liver disease, myocardial infarction and congestive heart failure, and hemi/paraplegia and cerebrovascular disease (OER > 2.5). Cerebrovascular disease, congestive heart failure, and myocardial infarction were identified as the central diseases that co-occurred with numerous other diseases. Two distinct clusters were noted, and the largest cluster comprised 10 diseases, primarily encompassing cardiometabolic and cognitive disorders. The results highlight specific patient comorbidities that could be used to guide clinical assessment, management, and targeted interventions that improve hip fracture outcomes in this patient group.
Fragility fractures are pathological fractures that are the clinical outcome of osteoporosis, a major global public health problem, the cause of significant pain, distress and loss of independence for patients, and a significant challenge facing orthopaedic trauma services. This chapter provides an overview of the causes, prevention, care and management of the patient with any type of fragility fracture to assist the practitioner in providing skilled, high‐quality care. There are very few early signs of osteoporosis and the onset of the disease is usually asymptomatic so it is only recognised after a person sustains a fracture. Falls are the leading cause of hospitalisation of the over 65s and a third of older people fall annually. Frailty, falls and fractures are linked. Frailty increases the risk of morbidity and mortality in patients hospitalised with fragility fractures. Sarcopenia is a major component of frailty.
Fragility hip fracture is a fracture of the proximal femur involving the femoral neck or intertrochanteric region caused by low‐energy mechanisms of injury and low bone mass caused by osteoporosis. This chapter provides an overview of how best practice can be delivered for patients with fragility hip fracture. In many countries hip fracture is the most common reason for admission to orthopaedic trauma units. Orthogeriatric nursing requires a focus on the fundamentals of nursing care such as patient comfort, improving or maintaining quality of life, ensuring safety, empowerment and satisfaction. Hip fracture is painful and early surgical fracture fixation provides the most effective pain relief. Malnutrition is observed in a third of hospital inpatients and is directly associated with adverse outcomes and mortality. Constipation is a significant risk for patients following hip fracture and can lead to other complications, including fatal bowel obstruction.
Background
Real-time documentation is a novel process that changes nursing workflow; however, nurses’ experiences of real-time documentation are unknown.
Aim
This study aimed to explore nurses’ experiences with real-time documentation in an orthopaedic ward.
Design
This qualitative study took a phenomenological-hermeneutic approach.
Methods
Data were generated from three semi-structured focus group interviews with 18 nurses from an orthopaedic ward. Data analysis was based on Ricoeur's theory of narrative and interpretation and included naïve reading, structural analysis and critical interpretation and discussion.
Results
Five themes emerged from the structural analysis: (i) nurses were initially sceptical and outside of their comfort zone; (ii) implementation required support from the head nurse and other colleagues; (iii) increased time with patients led to better relationships, but nurses lacked time for reflection; (iv) increased patient involvement could also present challenges; (v) documentation became more integrated into orthopaedic nursing.
Conclusion
Real-time documentation improved orthopaedic nursing documentation and increased patient involvement. Nurses spent more time with patients, leading to better relationships, but they had decreased time with their colleagues and the opportunity to reflect. Real-time documentation leads to changes in workflow; thus, nurses should be provided with training and the opportunity to reflect.
