Epidemiology of horse trauma: a literature review.

PURPOSE: Horses are used for many recreational and occupational activities. They are large, strong, temperamental, and unpredictable animals and people involved with them are at risk for injuries, from minor abrasions to severe injuries that may lead to death. This review reports on horse trauma in relation to the characteristics of injured equestrians, characteristics of horse trauma, and clinical outcomes. METHODS: A literature search was conducted from health-related electronic databases to identify studies from 2018 to 2023. The search returned 115 relevant full-text articles but after screening and assessment for eligibility, 39 were included in this review for a detailed examination of horse trauma epidemiology. Most studies were undertaken in the USA and the most used method was a retrospective review of hospital or trauma registry data. RESULTS: There have only been very slight changes in horse trauma numbers and outcomes over the past 5 years. Most injuries often follow falls and kicks. Females in their late-20 s to mid-30 s who are recreational equestrians are the group most represented in the data. The commonest injuries include fractures, and head, thoracic, and abdominal trauma. Most individuals with horse trauma were treated in the Emergency Department and discharged. For the equestrians who were admitted to hospital, around one-third required surgery. Mortality rates are very low. CONCLUSION: The popularity of occupational and recreational horse activities does not seem to wane and horse trauma continues to represent a significant concern for the health system. Health care workers need to be cognizant of the scope of trauma presentations as the mechanisms of injury can be complicated putting the equestrian at a high risk of associated injuries that may be life-threatening.

Pain Management in the Postoperative Period for People With Dementia: An Integrative Review.

Objective: With the increased global prevalence of older people with dementia, more will present for surgery over the coming decades. Therefore, the objective of this study was to synthesize the existing research about how pain in managed for people with dementia in the postoperative period and discuss the implications for clinical practice. Methods: For this integrative review, the Cumulative Index to Nursing and Allied Health literature, Medline/Pubmed, ProQuest, ERIC, and Health Source Nursing were searched to identify original empirical research published between 2000 and 2021. Tasks were divided between reviewers to ensure independent study selection, data extraction, and risk of bias assessment. Results: Eleven articles were eligible. The evidence is incompletely developed therefore the review focused on pain assessment, the types and amount of pain relief, that people with dementia receive less analgesia than people without dementia and the challenges for effective pain management. Most studies were surgery for hip fracture so there is scope to look at outcomes for other types of surgery. Analgesia was administered but it was noted that even over a 20-year period, people with dementia received less than cognitively intact people. Pain management could have a stronger evidence-base with more psychometric development of pain assessment tools. Challenges are due to the impaired ability of the person with dementia to communicate pain and that clinicians have difficulty understanding pain behavior in people with dementia. Conclusion: Adequate pain management for people with dementia in the postoperative period is important for a faster and better recovery.