Predictors of outcomes after internal fixation of periprosthetic femoral hip fractures Subgroup analysis of the peri-implant and peri-prosthetic fractures Spanish registry (PIPPAS).

PURPOSE: To identify risk factors predisposing patients to poor outcomes after fixation of periprosthetic hip fractures around femoral stems. METHODS: Prospective multicentre cohort study of fractures around a hip replacement stem managed by internal fixation. The primary outcome was one-year mortality, while secondary outcomes were local complications and healthcare burden-related outcomes (nursing facility utilization and hospital length of stay). RESULTS: One-year mortality was 16.2%. Age-adjusted Charlson Comorbidity Index score (OR=1.17; 95%CI=1.03-1.33)), Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) score (OR=1.16; 1.06-1.28), prosthetic dysfunction (OR=1.90; 1.00-3.61), and postoperative medical complications (OR=1.97; 1.06-3.68) were predictors of mortality. Patients with prior prosthetic dysfunction, lower Pfeiffer SPMSQ scores, Vancouver A fractures, and fractures fixed only using cerclages were at higher risk of local complications, which occurred in 9.3% of cases. Medical (OR=1.81; 1.05-3.13) and local complications (OR=5.56; 2.42-3.13) emerged as consistent risk factors for new institutionalization. Average hospitalization time was 13.9±9.2 days. Each day of fixation delay led to an average 1.4-day increase in total hospitalization. CONCLUSION: Frail periprosthetic hip-fracture patients with poorer functional status, dysfunctional replacements, and postoperative complications are at increased risk of mortality. Postoperative complications are more common in patients with dysfunctional arthroplasties, Vancouver A fractures, and fixation using cerclages alone. Postoperative complications were the most consistent predictor of higher healthcare resource utilization.

[Eligibility of schizophrenia inpatients to participate in clinical trials]. / Elegibilidad de pacientes con esquizofrenia ingresados en una unidad de hospitalización psiquiátrica para participar en ensayos clínicos.

INTRODUCTION: This study assesses the potential eligibility of patients admitted to a psychiatric hospitalisation unit to take part in the major clinical trials based on schizophrenia treatment in clinical practice (CATIE, CUtLASS and EUFEST). MATERIAL AND METHODS: A retrospective evaluation by consulting the medical records of 241 subjects (59.8% males and 40.2% females, mean age 39.7±13.0 years), admitted consecutively over one year to psychiatric hospitalisation unit with a diagnosis of schizophrenia or another psychosis. The influence of the factors involved in the non-eligibility in each of the clinical trials is analysed using logistic regression analysis. RESULTS: Only 20.7%, 22.3%, and 22.5% of patients with schizophrenia or another psychosis would be eligible to participate in the CATIE, CUtLASS and EUFEST studies, respectively. The main factors involved in the non-eligibility were polytherapy with anti-psychotics (2 or more) (Odds Ratio (OR): 7.64, 95% confidence interval (CI): 3.06-19.06, P<.001), mental retardation (OR: 16.67, 95% CI: 1.75-166.67, P=.014), and resistance, intolerance or contraindication to any of the anti-psychotics of the study (OR: 3.68, 95% CI: 1.13-11.99, P=.030). CONCLUSIONS: Three out of every four patients with schizophrenia or another psychosis admitted to a psychiatric hospitalisation unit are not represented in the major clinical trials on schizophrenia treatment.

Fobia a tragar: plan de cuidados en la infancia y adolescencia / Choking phobia: Care plan in Children and Adolescents

Las alteraciones alimentarias son un problema frecuente en la edad pediátrica. La fobia a tragar se caracteriza por miedo a atragantarse al ingerir comida, líquidos o pastillas. Aunque es un trastorno considerado menor y de baja prevalencia, en estos últimos años se ha observado un aumento de su incidencia en la etapa infantil y juvenil. En el análisis de 4 casos atendidos en nuestro hospital de día por esta fobia específica, se establece la valoración y los cuidados necesarios para su tratamiento y solución, en colaboración con los demás profesionales implicados y la familia. Es de destacar el importante rol que posee enfermería en el tratamiento de este trastorno psicológico, en los dispositivos de hospitalización parcial, para la correcta aplicación del plan terapéutico, el establecimiento de vínculos robustos y de confianza con la familia y el propio usuario, así como en la motivación para el cambio terapéutico por parte de todo el núcleo familiar. Es indispensable la inclusión del trastorno en el diagnóstico diferencial de los trastornos de alimentación en la infancia y su conocimiento por parte de los profesionales comunitarios, con la finalidad de poder establecer un adecuado tratamiento precoz que mejore los resultados terapéuticos (AU)

Eating disorders are a common problem in childhood. Swallowing phobia is characterised by fear of choking on having consumed food, liquids or tablets. Although they are considered a minor disorder and have low prevalence, there has been an increase in its incidence in children and adolescents in the past few years. The analysis of four cases treated in our day hospital for this specific phobia provides an assessment and the care necessary for its treatment and solution, in collaboration with other professionals and the family The importance of the role that nurses have in the treatment of this psychological disorder is emphasised, as well admission to Day Units, the correct application of the treatment plan, the establishment of robust and reliable links with the family and the patient, and the motivation for therapeutic change by the whole family. It is essential to include the disorder in the differential diagnosis of eating disorders in children, as well as knowledge of this by community workers, in order to establish adequate early treatment to improve therapeutic outcomes (AU)

[Choking phobia: care plan in children and adolescents]. / Fobia a tragar: plan de cuidados en la infancia y adolescencia.

Eating disorders are a common problem in childhood. Swallowing phobia is characterised by fear of choking on having consumed food, liquids or tablets. Although they are considered a minor disorder and have low prevalence, there has been an increase in its incidence in children and adolescents in the past few years. The analysis of four cases treated in our day hospital for this specific phobia provides an assessment and the care necessary for its treatment and solution, in collaboration with other professionals and the family. The importance of the role that nurses have in the treatment of this psychological disorder is emphasised, as well admission to Day Units, the correct application of the treatment plan, the establishment of robust and reliable links with the family and the patient, and the motivation for therapeutic change by the whole family. It is essential to include the disorder in the differential diagnosis of eating disorders in children, as well as knowledge of this by community workers, in order to establish adequate early treatment to improve therapeutic outcomes.

Intervención enfermera en el plan terapéutico familiar de la anorexia nerviosa / Nursing intervention in the family treatment plan for anorexia nervosa

Una de las principales intervenciones que enfermería realiza en el tratamiento de los trastornos de conducta alimentaria se establece en la psicoeducación familiar, aspecto indispensable en la mayoría de tratamientos en Salud Mental. Este artículo describe y analiza las dificultades familiares expresadas en el cumplimiento del plan terapéutico establecido para los pacientes ingresados por anorexia nerviosa (AN) en el Hospital de Día de adolescentes de Salud Mental, de la Corporació Sanitària Parc Taulí, durante el año 2009. Así mismo, se recopilan datos sobre las intervenciones profesionales realizadas con la familia por parte de la enfermera asignada a esta unidad, con la finalidad de agruparlas y categorizarlas, para facilitar posteriormente la intervención enfermera en estos casos. Se incluyen en este plan de cuidados un total de 10 familias correspondientes a los 10 pacientes ingresados con diagnóstico de AN para el período estudiado. En todos los casos las pacientes son mujeres adolescentes que han recibido tratamiento previo, desde un dispositivo ambulatorio, con respuesta parcial o nula al tratamiento. Las dificultades familiares expresadas se han agrupado en cinco categorías a partir del análisis de su contenido: problemas para la elaboración de una dieta equilibrada, problemas para el manejo emocional/conductual de la paciente, problemas por inexistencia de hábitos alimentarios familiares previos, problemas por escaso control y supervisión familiar, y problemas por negativa/incumplimiento general de las pautas establecidas. Se proponen para estas categorías distintas intervenciones individuales específicas, desarrolladas e implementadas en el plan de cuidados de enfermería, y se evalúan los resultados de dichas intervenciones (AU)

One of the main nursing interventions in the treatment of eating disorders is family psycho-education, an essential aspect of mental health treatment. This article describes and analyses the difficulties families expressed in the performance of a treatment plan for patients hospitalised for anorexia nervosa (AN) in the adolescent Day Hospital of Mental Health, of the Corporació Sanitària Parc Taulí, during 2009. Data was also collected data on professional interventions, performed by the nurse assigned to this unit, in order to group and categorise them, and as an aid to nursing intervention. A total of 10 families of the 10 patients admitted with a diagnosis of AN were included in the study period. In all cases, the patients were young women who had received treatment before in an Outpatient Unit, with partial or no response to the treatment. The difficulties expressed by the families were grouped into five categories from content analysis: problems in preparing a balanced diet, problems as they are unable to handle the behaviour and emotions of the patient, problems because as there are no previous family eating habits, problems because there is no family control or supervision, and problems with the established guidelines. Specific individualised interventions are proposed for developing and promoting a nursing care plan, and assessing the results (AU)

[Nursing intervention in the family treatment plan for anorexia nervosa]. / Intervención enfermera en el plan terapéutico familiar de la anorexia nerviosa.

One of the main nursing interventions in the treatment of eating disorders is family psycho-education, an essential aspect of mental health treatment. This article describes and analyses the difficulties families expressed in the performance of a treatment plan for patients hospitalised for anorexia nervosa (AN) in the adolescent Day Hospital of Mental Health, of the Corporació Sanitària Parc Taulí, during 2009. Data was also collected data on professional interventions, performed by the nurse assigned to this unit, in order to group and categorise them, and as an aid to nursing intervention. A total of 10 families of the 10 patients admitted with a diagnosis of AN were included in the study period. In all cases, the patients were young women who had received treatment before in an Outpatient Unit, with partial or no response to the treatment. The difficulties expressed by the families were grouped into five categories from content analysis: problems in preparing a balanced diet, problems as they are unable to handle the behaviour and emotions of the patient, problems because as there are no previous family eating habits, problems because there is no family control or supervision, and problems with the established guidelines. Specific individualised interventions are proposed for developing and promoting a nursing care plan, and assessing the results.

Deterioro funcional en ancianosingresados en un hospitalsin unidades geriátricas / Functional impairment in elderly inpatients in a hospital without geriatric units

Introducción: El aumento de la población de personasmayores de 65 años hace cada vez más frecuente su ingresoen los hospitales. La estancia hospitalaria en unidadesde hospitalización convencionales puede llevaraparejado el deterioro de la capacidad funcional en losancianos. Objetivos. Establecer el perfil del paciente ancianoatendido en las Unidades de Medicina Interna delComplejo Hospitalario de Jaén. Analizar los resultadosde la hospitalización en personas mayores en términosde variación de la capacidad funcional al alta respectodel ingreso. Identificar qué variables influyen en la variaciónde esa capacidad funcional de los ancianos hospitalizadosen un centro sin unidades geriátricas. Métodos.Estudio prospectivo observacional en tres unidadesde hospitalización de medicina interna de un hospitaluniversitario de la red pública de Andalucía. Se ha incluidouna muestra de 190 pacientes ancianos hospitalizados.Las variables recogidas fueron: demográficas, (..) (AU)

Introduction: Increased population of elderly people is becomingmore frequent admission to hospitals of people olderthan 65 years. Hospital stay in conventional units can leadto functional worsening in the elderly. Aim: To identify theprofile of elderly patients treated in the Internal MedicineHospital of Jaén. To analyze variation in functional abilityof elderly people following admission to inpatient units of apublic hospital. To identify variables that influence thechanges in the functional ability of elderly inpatients inhospitals without geriatric units. Methods: Prospective observationalstudy in 3 units of internal medicine units in ahospital belonging to the Andalusian Health Service. Asample of 190 hospitalized elderly patients has been included.Variables related to demographic, hospitalization andfunctional ability using Barthel Index, were reported.Results: Hospitalization in internal medicine units did nothelp to improve functional ability in older people; rather,they had a negative effect, promoting functional worsening (..) (AU)

[Usefulness and difficulties for the elaboration of the nursing discharge report, according to Hospital de Fuenlabrada (Spain) nursing group]. / Utilidad y dificultades para la realización del informe de enfermería al alta hospitalaria según las enfermeras del Hospital de Fuenlabrada.

OBJECTIVE: To evaluate the utility and difficulty of writing the nursing discharge report perceived by nurses working in the hospitalization unit of the Fuenlabrada Hospital in Spain. METHOD: We performed a cross-sectional, descriptive study in all nurses working in hospitalization units in the Fuenlabrada Hospital (Madrid) in the last trimester of 2006. A questionnaire was used to collect sociodemographic variables, variables related to perceived utility of the report in general and variables measuring the difficulty of completing the report. The questionnaires were delivered to the hospitalization units and collected personally. For the statistical analysis, the chi-square test and Student's t-test and/or analysis of variance were used. The SPSS/PC statistical package, version 12.0, was used. RESULTS: Seventy-four completed questionnaires were obtained (57.4 % of the population analyzed). Of the nurses surveyed, 61 (82.4 %) considered the report to be useful in assuring continuity of care and 57 nurses (77 %) thought it useful in providing information to the patients. In total, 60 nurses (82.1 %) considered the report's structure to be not very suitable or unsuitable. CONCLUSIONS: Nurses' satisfaction with the report is high. The report is seen as effective in assuring continuity of care and as useful to patients. However, the report's structure should be improved.

Plantilla de enfermería y demanda de cuidados de ancianos hospitalizados, ¿son suficientes los recursos? / Nursing staff and care needs in hospitalized elders, are there enough resources?

Introducción: El aumento de la población de personas mayoresde 65 años hace cada vez más frecuente su ingreso enlos hospitales. El tiempo de estancia hospitalaria de los ancianossuele ser más prolongado que el del resto de pacientes.Objetivo: Analizar la capacidad de prestación de cuidadosde 3 unidades de hospitalización de un hospital público ycompararla con la demanda de cuidados de los ancianos.Métodos: Estudio prospectivo observacional en 3 unidadesde hospitalización de medicina interna de un hospital universitariode la red pública de Andalucía (España). Se ha incluidouna muestra de 190 pacientes ancianos hospitalizados.Las variables recogidas fueron: demográficas, relacionadascon la hospitalización, demanda de cuidados y capacidadde prestación de cuidados de la plantilla de enfermería. Losdatos se han obtenido del sistema de información del hospital,del conjunto mínimo básico de datos de pacientes y porobservación directa mediante el método de nivel de cuidados(MNC). Resultados: La edad media de los ancianos hospitalizadosfue de 77,4 años, con 21,1% de mayores de 85años. La estancia media fue de 15,68 días. La estimación dela capacidad de prestación de cuidados de la plantilla de en fermería fue de 2,8 horas/paciente/día (con un índice de enfermerastituladas del 60%). A partir de la medición de nivelesde dependencia, la demanda de cuidados media de losancianos fue de 4,9 horas/paciente/día. Esta diferencia suponeun déficit anual de 51 profesionales de enfermería en laplantilla de las 3 unidades de hospitalización. Los factoresque influyen en la demanda de cuidados de los ancianos sonla edad, días de estancia hospitalaria, el diagnóstico médico yel destino del paciente al alta. También se encuentra una relacióncon la presencia de un familiar acompañando al paciente(cuidador familiar). Los cuidados básicos representanun 65,7% del total de cuidados requeridos. Conclusiones:La proporción de ancianos frágiles ingresados en los hospitalesestá en aumento. La demanda de cuidados de los ancianoses mayor que la capacidad de provisión de la plantilla deenfermería del hospital, lo cual genera un déficit que tieneque ser asumido por los cuidadores familiares

Introduction: The increase in the elders’ population makesmore and more frequent its admittance in hospitals. Thehospital stay of the elder patients is usually longer than therest of patients. Aim: To analyze the care delivery capacityin 3 units of the hospital and to compare it with the needsfor care of the elders. Methods: Observational and prospectivestudy in 3 Internal medicine units in an universityhospital belonging to the Andalusian Health Service(Spain). A sample of 190 hospitalized elders has been included.Variables reported were: demographics, hospitalization-related, needs for care and care delivery capacity of thenursing staff. Data were extracted by the Hospital informationsystem, the minimum basic set of data and by directobservation applying the method of level of care. Results:The median age of the elders was 77.4 years, a21.1% of the patients were older than 85 years. The hospitalstay was 15.68 days as average. The nursing staf has acare delivery capacity of 2.8 hours/patient/day (with askill-mix of RN 60%). According to the dependence level,the need for care of the elders was 4.9 hours/patient/day, asaverage. This gap means a lack of 51 nurses each year, among the 3 units. Factors influencing the needs for care ofelders were: age, hospital stay, medical diagnosis and dischargedestination. There is a relation also with the presenceof a relative accompanying to the patient (family caregiver).The proportion of basic care was a 65.7% of the totalamount of care. Conclusions: The rate of frail elders inthe hospitals is increasing. The needs for care of the eldersare higher than capacity for care delivery of nursing staff,so a shortage is created that can be taken up by family caregivers (AU)