Abstract
Background
The management and care of older patients with multiple health problems is demanding and complex. Interprofessional and intraprofessional collaboration has the potential to ...improve both the efficiency and the quality of care for these patients. However, it has proven difficult to demonstrate the efficacy of this approach in terms of objective patient-related outcomes. Recently, a care model with interprofessional and intraprofessional care was started, the Intensive Collaboration Ward (ICW). This ward combines
inter
professional care and
intra
professional care for older patients with multiple health problems. The aim of this study was to evaluate the effects of ICW care in older patients with multiple health problems.
Methods
This retrospective cohort study evaluated the effects on patients outcomes. This was done by comparing patients of the new model, the ICW (ICW group), to a historical cohort of comparable patients who would have been eligible for the ICW (control group). Outcomes were medical consultations, allied health professional consultations, radiological procedures, waiting time for radiological procedures, change in primary treating specialty, length of hospital stay, readmission rate, and mortality rate. Linear and logistic regression analyses were performed, adjusted for baseline differences.
Results
The ICW group required significantly fewer medical consultations than the control group. Calls to specialists from the emergency room decreased significantly, but there was no change in in-person consultations on the ER. 51% of control patients had ≥ 1 in-hospital consultation compared to 21% of ICW patients (
p
< 0.05). Patients in the ICW group received significantly more consultations with allied health professionals and more often had a change in primary treating specialty.
Conclusions
Interprofessional and intraprofessional clinical collaboration on the ICW reduced in-hospital consultations and increased allied health professionals’ consultations. This approach may decrease fragmentation of care and provide more integrated, efficient and patient centered care. This may improve the overall care of older patients with multiple health problems.
Patients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1-3 days after surgery. With this relatively short length of hospital stay, a patient's self-management ...is a crucial factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity, and the passive mode of communication used to convey it.
This study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about their recovery through the app. In addition, physical functioning, quality of life, ability to perform physiotherapy exercises and daily self-care activities, satisfaction with information, perceived involvement by the hospital, and health care consumption were also assessed.
A multicenter randomized controlled trial was performed in five Dutch hospitals. In total, 213 patients who had undergone elective, primary, unilateral TKR participated. All patients had access to an app for their smartphone and tablet to guide them after discharge. The intervention group could unlock day-to-day information by entering a personal code. The control group only received weekly, basic information. Primary (level of pain) and secondary outcomes (physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for physical functioning and quality of life, which were measured at baseline and at four weeks after discharge. Data was analyzed using Student t tests, chi-square tests, and linear mixed models for repeated measures.
In total, 114 patients were enrolled in the intervention group (IG) and 99 in the control group (CG). Four weeks after discharge, patients in the IG performed significantly better than patients in the CG on all dimensions of pain: pain at rest (mean 3.45 vs mean 4.59; P=.001), pain during activity (mean 3.99 vs mean 5.08; P<.001) and pain at night (mean 4.18 vs mean 5.21; P=.003). Additionally, significant differences were demonstrated in favor of the intervention group for all secondary outcomes.
In the four weeks following TKR, the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption compared to standard patient education. Given the rising number of TKR patients and the increased emphasis on self-management, we suggest using an app with timely postoperative care education as a standard part of care.
Netherlands Trial Register NTR7182; https://www.trialregister.nl/trial/6992.
Background and purpose: To date, the value of culture results after debridement, antibiotics, and implant retention (DAIR) for early (suspected) prosthetic joint infection (PJI) as risk indicators in ...terms of prosthesis retention is not clear. At the 1-year follow-up, the relative risk of prosthesis removal was determined for culture-positive and culture-negative DAIR patients after primary total hip or knee arthroplasty. The secondary aim of this work was to explore differences in patient characteristics, infection characteristics, and outcomes between these two groups. Methods: A retrospective regional registry study was performed in a group of 359 patients (positive cultures: n=299; negative cultures: n=60) undergoing DAIR for high suspicion of early PJI in the period from 2014 to 2019. Differences in patient characteristics, the number of deceased patients, and the number of subsequent DAIR treatments between the culture-positive and culture-negative DAIR groups were analysed using independent t tests, Mann-Whitney U tests, Pearson's chi-square tests, and Fisher's exact tests. Results: The overall implant survival rate following DAIR was 89 %. The relative risk of prosthesis removal was 7.4 times higher (95 % confidence interval (CI) 1.0-53.1) in the culture-positive DAIR group (37 of 299, 12.4 %) compared with the culture-negative DAIR group (1 of 60, 1.7 %). The culture-positive group had a higher body mass index (p=0.034), a rate of wound leakage of 10 d (p=0.016), and more subsequent DAIR treatments (p=0.006). Interpretation: As implant survival results after DAIR are favourable, the threshold to perform a DAIR procedure for early (suspected) PJI should be low in order to retain the prosthesis. A DAIR procedure in the case of negative cultures does not seem to have unfavourable results in terms of prosthesis retention.
The original version of this article unfortunately contained a mistake. The presentation of Figure 1 was incorrect. The correct version of Figure 1 is given in the following page.
Background and purpose Bones used in mechanical studies are frequently harvested from human cadavers that have been embalmed in a buffered formaldehyde solution. It has been reported that ...formaldehyde fixation or freezing hardly affects the mechanical properties of bone after a storage period of several weeks. However, human cadaver bones are usually stored for longer periods of time before use. We therefore investigated the effects of long-term embalming or freezing on the mechanical properties of cortical bone.
Methods After 5 different storage periods (ranging from 0 to 12 months), goat femora and humeri were used to evaluate the effect of embalming and freezing on torsion, and on bending stiffness and strength. The effect on hardness and bone mineral density (BMD) was also evaluated.
Results Even after 1 year, no statistically significant differences could be found in stiffness, strength, and energy absorption when we compared embalmed or frozen bones to a fresh reference group. In addition, although we found no significant change in BMD, there appears to be a tendency to increasing hardness.
Interpretation We found that there was no effect on the mechanical properties of bone after storage periods of 1 year. We conclude that embalmed or frozen bones can safely be used for mechanical testing, at least for storage periods of up to one year.
Studies based on pharmacy medication records have shown suboptimal adherence and persistence of osteoporosis treatment with oral bone sparing drugs (OBSD). Little is known about adherence and ...persistence of OBSD treatment in primary care. We assessed adherence and persistence of OBSD use of patients in general practices and identified associated factors.
Using electronic medical records, adherence and persistence of newly prescribed treatment with OBSD in patients from 16 general practices was retrospectively assessed. The Medication Possession Ratio (MPR) was calculated as a proxy for adherence (MPR > 75%), persistence rates were estimated using survival analysis. Determinants of adherence and persistence using logistic regression and Cox regression analysis were assessed.
OBSD treatment was initiated in 957 patients. Seventy-five percent and 45% of the patients persisted OBSD treatment for one and five years, respectively. Being adherent in the first year decreased the risk of long-term non-persistence hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.3-0.57; P < 0.001. Patients receiving the majority of their prescriptions by a specialist tended to be more non-persistent (HR 1.37; 96%; CI 0.96-1.94; P = 0.08). Adherence was 62.5% in the first year and 60.8% in the overall treatment period. Non-adherence was associated with the specialist being the main prescriber odds ratio (OR) 3.76; 95% CI 2.43-5.82; P < 0.001 and younger age (<65 years, OR 1.44; 95% CI 1.01-2.08; P = 0.04).
Older age of the patients and the GP prescribing the majority of medication were associated with better adherence and persistence. Good adherence in the first prescription year was associated with better persistence.
Abstract Objectives To describe the association between participants’ person-related potential predictor variables and cumulative compliance with interventions for preventing ankle sprains: ...neuromuscular training, wearing an ankle brace, and a combined training and bracing. Design Secondary analysis of compliance data from a randomized controlled trial (RCT) comparing measures preventing ankle ligament injuries. Methods Ordinal regression with a backward selection method was used to obtain a descriptive statistical model linking participants’ person-related potential predictor variables with the monthly cumulative compliance measurements for three interventions preventing ankle ligament injuries. Results Having had a previous ankle injury was significantly associated with a higher compliance with all of the preventive measures trialed. Overall compliance with bracing and the combined intervention was significantly lower than the compliance with NM training. Per group analysis found that participating in a high-risk sport, like soccer, basketball, and volleyball, was significantly associated with a higher compliance with bracing, or a combined bracing and NM training. In contrast, participating in a high-risk sport was significantly associated with a lower per group compliance with NM training. Conclusions Future studies should include at least registration of previous ankle sprains, sport participation (high- or low-risk), experience in NM training, and hours of sport exposure as possible predictors of compliance with interventions preventing ankle sprains. Practitioners should take into account these variables when prescribing preventive neuromuscular training or bracing.
Modern health care focuses on shared decision making (SDM) because of its positive effects on patient satisfaction, therapy compliance, and outcomes. Patients' knowledge about their illness and ...available treatment options, gained through medical education, is one of the key drivers for SDM. Current patient education relies heavily on medical consultation and is known to be ineffective.
This study aimed to determine whether providing patients with information in a subdivided, categorized, and interactive manner via an educational app for smartphone or tablet might increase the knowledge of their illness.
A surgeon-blinded randomized controlled trial was conducted with 213 patients who were referred to 1 of the 6 Dutch hospitals by their general practitioner owing to knee complaints that were indicative of knee osteoarthritis. An interactive app that, in addition to standard care, actively sends informative and pertinent content to patients about their illness on a daily basis by means of push notifications in the week before their consultation. The primary outcome was the level of perceived and actual knowledge that patients had about their knee complaints and the relevant treatment options after the intervention.
In total, 122 patients were enrolled in the control group and 91 in the intervention group. After the intervention, the level of actual knowledge (measured on a 0-36 scale) was 52% higher in the app group (26.4 vs 17.4, P<.001). Moreover, within the app group, the level of perceived knowledge (measured on a 0-25 scale) increased by 22% during the week within the app group (from 13.5 to 16.5, P<.001), compared with no gain in the control group.
Actively offering patients information in a subdivided (per day), categorized (per theme), and interactive (video and quiz questions) manner significantly increases the level of perceived knowledge and demonstrates a higher level of actual knowledge, compared with standard care educational practices.
International Standard Randomized Controlled Trial Number ISRCTN98629372; http://www.isrctn.com/ISRCTN98629372 (Archived by WebCite at http://www.webcitation.org/73F5trZbb).
Abstract Purpose Consultations for forefoot pain are frequent in primary care, but scientific support of treatment options is scarce. The purpose of this study is to investigate the effect of ...podiatric treatment vs standardized advice on proper shoe characteristics and fit of shoes by means of an information leaflet for people aged 50 years and older with forefoot pain in primary care. Methods In this randomized controlled trial, 205 participants aged 50 years and older with hindering nontraumatic forefoot pain have been recruited at their general practitioner's office. Exclusion criteria were treatment of forefoot problem of less than 6 months' duration before inclusion, rheumatoid arthritis, and diabetic neuropathy or having pain considered not to be musculoskeletal (eg, warts). Participants received shoe advice by means of an information leaflet or podiatric care. Foot pain, foot-related dysfunction, general health, and social participation were assessed by means of questionnaires every 3 months for 1 year. Using multilevel analysis, we analyzed results at the level of (1) outcome measures, (2) the individual, and (3) the general practitioner. Results No differences were found between the 2 treatment groups. Both intervention groups showed an improvement over time in foot pain and foot-related dysfunction. Conclusion This study found that shoe advice provided to patients consulting their general practitioner for forefoot pain and symptom relief resulted in outcomes similar to treatment outcomes in patients consulting a podiatrist. Based on these results, primary care physicians should be cautious when referring a patient to a podiatrist; instead, they should start by providing advice on proper characteristics and fit of shoes.
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