Hip fractures in the elderly individuals are a complex problem. Our objective was to determine whether orthogeriatric treatment is effective in terms of reducing length of hospital stay, morbidity, ...and mortality of elderly patients with a hip fracture compared with orthopedic (traditional) treatment. From July 2009 to May 2011, patients older than 65 years with a hip fracture were followed prospectively. They were co-treated by geriatric and orthopedic teams. This cohort was compared with a retrospective cohort followed from January 2007 to June 2009 that was managed by the orthopedic surgery team only. Epidemiology, pre- and postoperative hematocrit, and renal function were registered. Also, in-hospital and distant mortality data (determined by consulting the national registry), mortality-associated factors, postoperative complications, hospital stay length, and transfers to other services were registered. One hundred and eighty-three patients in the retrospective group and 92 in the prospective group were included in this study with a median follow-up of 26 months (interquartile range: 13-41). The average age was 84 years and 74% of patients were female. Intertrochanteric fracture accounted for 51% of the cases. There was no difference between groups with regard to hospital stay length, hematocrit at discharge, in-hospital mortality, long-term survival, or transfers to internal medicine or the intensive care unit. It did show differences in the transfer to the intermediate care unit, prolonged hospitalizations (>20 days), and diagnosis of delirium and anemia requiring transfusion. In the present study, orthogeriatric treatment is slightly more effective than traditional treatment in terms of morbidity, but there is no difference in hospital stay length or mortality. Further studies and longer follow-up are needed to draw more conclusions.
In this article, we address the following question: how should clinical environments be designed to promote learning opportunities for clinicians? We develop an ecologically-informed account of ...learning opportunities informed by Gibson’s influential ecological theory of perception (Gibson, 1977, 1979). The so-called ‘push-pull’ account is proposed as a framework in which we can conceptualise how affordances are formed and actioned across different areas of clinical practice. We develop an account of health-care-related affordances that is discussed in relation to surgical training with a particular emphasis in terms of how skills are acquired in the use of robotic surgical techniques. Our primary focus is on the performative aspects of surgical performative process. We situate the current discussion in relation to a broader discussion about skills development in the context of healthcare as well as the future design of clinical spaces.
Hunting for a cause of painful diplopia Stevens, Sarah L; Schweitzer, Daniel
Medical journal of Australia,
October 2018, Letnik:
209, Številka:
7
Journal Article
Background
Distinguishing a benign enchondroma from a low-grade chondrosarcoma is a common diagnostic challenge for orthopaedic oncologists. Low interrater agreement has been observed for the ...diagnosis of cartilaginous neoplasms among radiologists and pathologists, but, to our knowledge, no study has evaluated inter- and intraobserver agreement among orthopaedic oncologists grading these lesions using initial clinical and imaging information. Determining such agreement is important since it reflects the certainty in the diagnosis by orthopaedic oncologists. Agreement also is important as it will guide future treatment and prognosis, considering that there is no gold standard for diagnosis of these lesions.
Questions/Purposes
(1) to determine inter- and intraobserver agreement among a multinational panel of expert orthopaedic oncologists in diagnosing cartilaginous neoplasms based on their assessment of clinical symptoms and imaging at diagnosis. (2) To describe the most important clinical and imaging features that experts use during the initial diagnostic process. (3) To determine interobserver agreement for proposed initial treatment strategies for cartilaginous neoplasms by this panel of evaluators.
Methods
Thirty-nine patients with intramedullary cartilaginous neoplasms of the appendicular skeleton of various histopathologic grades were selected and classified as having benign, low-grade malignant, or intermediate- or high-grade malignant neoplasms by 10 experienced orthopaedic oncologists based on clinical and imaging information. Additionally, they chose the three most important clinical or imaging features for the diagnosis of these neoplasms, and they proposed a treatment strategy for each patient. The Kappa coefficient (κ) was used to determine inter- and intraobserver agreement.
Results
Inter- and intraobserver agreements were only fair to good, κ = 0.44(95% CI, 0.41–0.48) and κ = 0.62 (95% CI, 0.52–0.72), respectively. The three factors most frequently identified as helpful in making the diagnosis by our panel were cortical involvement in 65% of evaluations (253/390), neoplasm size in 51% (198/390), and pain in 50% (194/390). The interobserver agreement for the proposed initial treatment strategy after diagnosis was poor (κ = 0.21; 95% CI, 0.18–0.24).
Conclusions
This study showed barely fair interobserver and fair to good intraobserver agreement for grading of intramedullary cartilaginous neoplasms by orthopaedic oncologists using initial clinical and imaging findings. These results reflect the insufficient guidance interpreting clinical and imaging features, and the limitations of the systems we use today when making these diagnoses. In the same way, they generate concern for the implications that this may have on different treatment strategies and the future prognosis of our patients. Future studies should build on these observations and focus on clarifying our criteria of diagnosis so that treatment recommendations are standardized regardless of the treating institution or oncologist.
Level of Evidence
Level III, diagnostic study.
Objectives
To examine workload, thermal discomfort and heat‐related symptoms among healthcare workers (HCWs) in an Australian ED during the COVID‐19 pandemic.
Methods
A cross‐sectional study design ...was employed among HCWs in an ED at a metropolitan hospital in Brisbane, Australia. Respondents provided demographic information including their self‐reported age, sex, height, weight, role (e.g. doctor, nurse), and whether they wore personal protective equipment (PPE) during their shift, rated as either Full PPE, Partial PPE, or usual uniform or scrubs. The workload of HCWs was assessed with the National Aeronautics and Space Administration's task load index (NASA‐TLX). Thermal discomfort was evaluated using scales from the International Organisation for Standardisation. Responders rated their subjective heat illness using the Environmental Symptoms Questionnaire.
Results
Fifty‐nine HCWs completed the survey (27 male, 31 female, one prefer not to answer). Overall workload from the NASA‐TLX was 64.6 (interquartile range IQR 56.5–73.3) for doctors, 72.5 (IQR 63.3–83.3) for nurses and 66.7 (IQR 58.3–74.17) for other staff, representing moderate to high ratings. Eighty‐one percent reported thermal sensation to be slightly warm, warm, or hot, and 88% reported being uncomfortable, ranging from slightly to extremely. Ninety‐seven percent reported at least one heat‐strain symptom. More than 50% reported light‐headedness or headache and approximately 30% reported feeling dizzy, faint, or weak.
Conclusions
ED HCWs experience thermal discomfort when wearing PPE. Combined with their workloads, HCWs experienced symptoms related to heat strain. Therefore, careful consideration should be given to managing heat strain among HCWs when wearing PPE in an ED.
This cross‐sectional study surveyed healthcare workers' (HCWs) thermal discomfort, workload, and heat‐related symptoms when wearing personal protective equipment (PPE). ED HCWs experience thermal discomfort, moderate to high workloads, and symptoms related to heat strain when wearing PPE. Therefore, careful consideration should be given to managing heat strain among HCWs when wearing PPE in an ED.
Purpose: To compare the debonding/crack initiation strength (D/CIS) of a low‐fusing pressable leucite‐based glass ceramic (PC) fused to metal to a feldspathic porcelain (FP) fused to metal.
Materials ...& Methods: As per ISO 9693:1999, 40 rectangular metal specimens (25.0 mm × 0.5 mm × 3.0 mm) were prepared. Twenty of the specimens were cast in a base metal nickel‐chromium alloy (BA), and 20 were cast in a noble metal palladium‐silver alloy (NA). Ten randomly selected NA and BA alloy specimens had FP applied. The remaining 10 NA and BA alloy specimens had ash‐free wax patterns applied, the metal‐wax complexes invested, and were pressed with a PC. The dimensions of the ceramic specimens were 8.0 mm × 1.0 mm × 3.0 mm, creating a combined metal‐ceramic complex thickness of 1.5 mm. All specimens were subject to a three‐point bending test at a crosshead speed of 1.5 mm/min. Fracture loads were recorded in Newtons and D/CISs calculated by the formula τb=k×Ffail.
Results: Mean D/CISs, measured in MPa (standard deviations): NA‐FP 32.56 (4.62), NA‐PC 30.23 (5.06), BA‐FP 30.98 (4.41), and BA‐PC 31.81 (3.48). A two‐way ANOVA (p > 0.05) did not demonstrate significant difference between groups.
Conclusion: The debonding/crack initiation strength of a low‐fusing pressable leucite‐based glass ceramic fused to metal was equivalent to that of a feldspathic porcelain fused to metal.
Examining how heat affects people with Parkinson’s disease is essential for informing clinical decision-making, safety, well-being, and healthcare planning. While there is evidence that the ...neuropathology associated with Parkinson’s disease affects thermoregulatory mechanisms, little attention has been given to the association of heat sensitivity to worsening symptoms and restricted daily activities in people with this progressive disease. Using a cross-sectional study design, we examined the experiences of people diagnosed with Parkinson’s disease in the heat. Two-hundred and forty-seven people completed an online survey (age: 66.0 ± 9.2 years; sex: male = 102 (41.3%), female = 145 (58.7%)), of which 195 (78.9%) reported becoming more sensitive to heat with Parkinson’s disease. Motor and nonmotor symptoms worsened with heat in 182 (73.7%) and 203 (82.2%) respondents, respectively. The most commonly reported symptoms to worsen included walking difficulties, balance impairment, stiffness, tremor, fatigue, sleep disturbances, excess sweating, difficulty concentrating, and light-headedness when standing. Concerningly, over half indicated an inability to work effectively in the heat, and nearly half reported that heat impacted their ability to perform household tasks and social activities. Overall, heat sensitivity was common in people with Parkinson’s disease and had a significant impact on symptomology, day-to-day activities and quality of life.
Summary Objective To report clinical results of patients treated with closed reduction and percutaneous iliosacral screw fixation for unstable pelvic ring fractures. Materials and methods ...Retrospective study using medical records, images and late clinical assessment of all patients treated in our centre with percutaneous iliosacral screw fixation for unstable pelvic ring fractures, with a minimum follow-up of 12 months. Seventy-three patients with a mean age of 40.3 years old (range 14–70 years) were treated between July 1998 and December 2005. Seventy-one patients were included. Fractures types included 10 AO type B and 61 AO type C injuries. Forty-two patients had associated injuries. Mean follow-up was 31 months (12–96). Functional status was assessed using Majeed's grading score for pelvic fractures at final follow-up. Results Sixty-nine patients obtained a satisfactory initial reduction. Two patients had transitory postoperative neurological deficit. Five patients presented hardware failure. Fifteen patients developed sacroiliac osteoarthritis during follow-up. Good and excellent functional results were observed in 66 patients at final follow-up. Five patients had bad results, one due to infection of an anterior pelvic plate and the others due to painful refractory sacroiliac osteoarthritis that required a sacroiliac fusion. Sixty-one (86%) patients were able to return to pre-injury occupation. Conclusions Good clinical results with a low and predictable rate of complications can be expected using closed reduction and percutaneous iliosacral screw fixation for unstable pelvic ring fractures.
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