ABSTRACT
BACKGROUND: Hip fractures are devastating injuries, with high health and social care costs. Despite national standards and guidelines, substantial variation persists in hospital delivery of hip fracture care and patient outcomes. This qualitative study aimed to identify organisational processes that can be targeted to reduce variation in service provision and improve patient care. METHODS: Interviews were conducted with 40 staff delivering hip fracture care in four UK hospitals. Twenty-three anonymised British Orthopaedic Association reports addressing under-performing hip fracture services were analysed. Following Thematic Analysis of both data sources, themes were transposed onto domains both along and across the hip fracture care pathway. RESULTS: Effective pre-operative care required early alert of patient admission and the availability of staff in emergency departments to undertake assessments, investigations and administer analgesia. Coordinated decision-making between medical and surgical teams regarding surgery was key, with strategies to ensure flexible but efficient trauma lists. Orthogeriatric services were central to effective service delivery, with collaborative working and supervision of junior doctors, specialist nurses and therapists. Information sharing via multidisciplinary meetings was facilitated by joined up information and technology systems. Service provision was improved by embedding hip fracture pathway documents in induction and training and ensuring their consistent use by the whole team. Hospital executive leadership was important in prioritising hip fracture care and advocating service improvement. Nominated specialty leads, who jointly owned the pathway and met regularly, actively steered services and regularly monitored performance, investigating lapses and consistently feeding back to the multidisciplinary team. CONCLUSION: Findings highlight the importance of representation from all teams and departments involved in the multidisciplinary care pathway, to deliver integrated hip fracture care. Complex, potentially modifiable, barriers and facilitators to care delivery were identified, informing recommendations to improve effective hip fracture care delivery, and assist hospital services when re-designing and implementing service improvements.
Subject(s)
Delivery of Health Care , Hip Fractures , Humans , Hip Fractures/surgery , HospitalsABSTRACT
Apart from the physical effects of Covid-19, psychological effects are seen as well in the general population. In pregnant females, psychological impact leads to adverse pregnancy and neonatal outcomes. Due to limited data, the mental health of COVID-19 positive pregnant patients is not clear especially in relation to isolation in hospital, treatment, time and mode of delivery. Objective: To determine and compare frequency of anxiety and depression in pregnant women with and without COVID-19. Material and Methods: It was a comparative cross-sectional study that was conducted in the department of Obstetrics and Gynaecology, SGRH, Lahore. 60 pregnant females were enrolled and underwent nasopharyngeal swab for PCR and had HRCT to determine Covid-19 status. HADS was applied on all pregnant females to assess depression and anxiety and findings were subjected to statistical analysis. Results: The mean age, gestational age, anxiety scores and depression scores were 29.93±4.15, 31.1±6.28, 10.56±3.29 and 10.02±2.72 respectively. There were 60% Covid positive pregnant females, depression was present in 31.7% and anxiety was present in 65% females. Comparison of pregnant females with or without Covid infection in terms of depression and anxiety using independent T-test revealed that anxiety was significantly associated with Covid positive status (p=0.032), however, no significant association was seen between depression and covid status (p=0.641) (table 3). Conclusion: Covid-19 was frequently seen in pregnant females and was significantly associated with high frequency of anxiety. Depression was less commonly seen and was not significantly associated with Covid-19 infection.
ABSTRACT
In Mexico, the fragility fractures (FF) represent a public health problem;recent reports state rates of almost 2,000 cases for every 100,000 inhabitants with an expected sevenfold increase by 2050 (Clark.P- 2005). Hip fracture cases will go up from 155,875 to 226,886 in 2050 (5.2 to 7.2 timesmore than those registered in 2005) (Johansson.H-2011). According to ICUROS-Mx study mortality after FF was 20.2%. Quality of life after FF is affected significantly (Borgstrom.F-2013). The costs related with the handling of nonpharmacological low bone mass (osteopenia), osteoporosis and FF are high in our country;they reach over 5,191 million (MXP) in 2010 and $ 7,575 million pesos in 2020 (Carlos.F-2013). TheMexican health care system comprises two sectors: public and private, offers coverage to 82.2% of the 119.5 million inhabitants registered in that year. An example is Instituto Mexicano del Seguro Social (IMSS) Victoriode- la-Fuente-Narváez where the traumatology unit alone will require a budget greater than 315,000,000 million (MXP) per year as per 2050 forecasts. We show the direct costs derived from the most frequent FF according to the Group Related Diagnosis (GRP) published in 2017 by the IMSS with costs updated to 2020 (Gilma.A-2014). Fracture Liaison Services (FLS) with a worldwide successful experience for the care of FF patients offer diverse and feasible models enable to adapt to different Health Systems settings. The aim of this review is to put forward the possible implementation of the International Osteoporosis Foundation (IOF) Capture the Fracture® program) in Mexico. The initial experience in the implementation of the Capture the Fracture program in diverse Mexican institutions shows us that this program is feasible of being adapted for being implemented in countries with fragmented health system such as Mexico. The fishbone diagram below (Figure 1) lists the barriers impacting the development of FLSs inMexico. These barriers include a series of factors required for an effective and efficient FLS. All these factors were exacerbated by the COVID-Sars2. Conclusion: Fragility fractures represent a health problem in Mexico and in the world. This study reviews and puts forward the implementation of FLS as a feasible and cost-effective alternative in health institutions in our country.
ABSTRACT
Background/Introduction: The European Registry for Rare Bone and Mineral Conditions (EuRR-Bone) was founded in April 2020 and is the affiliated registry of the European Reference Network for Rare Bone Diseases (ERN BOND). Purpose: As bone and mineral conditions are seen by a variety of specialists there is a close connection with the European Registries for Rare Endocrine Conditions (EuRRECa) and its affiliated ERN Rare Endocrine Diseases (Endo-ERN). EuRR-Bone is open not only to centres within these ERNs but also to others and consists of a core registry for all cases and an e-reporting registry for new cases. Methods: The latter is accomplished via an electronic reporting platform, e-REC (e-Reporting of Rare Conditions), a light touch approach that does not collect personally identifiable information. Unique IDs for reported cases are generated instantaneously and emailed to users to be stored locally at reporting centres. Data are available to all collaborators following approval by the joint Data Access Committee of EuRRECa and EuRR-Bone. Results: Until July 2020, 12 centres from 9 different countries joined, of which 5 are ERN BOND members and 10 are Endo-ERN members. A total of 23 adults and 20 children were newly diagnosed with a Bone and Mineral condition. Amongst adults, the most frequently reported conditions were fibrous dysplasia and PTH independent hypercalcemia, while in children pseudohypoparathyroidism and osteogenesis imperfecta were the most reported. Since April 2020, the e-REC platform is also being used to capture the occurrence of a new COVID19 infection in a patient with an existing bone or mineral condition. Conclusion(s): e-REC is a promising tool enabling clinical networks to objectively map conditions and related activity, providing a better understanding of the occurrence of the rare bone and mineral conditions.