The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study.

INTRODUCTION: Hip fracture patients are fragile, and the majority fail to fully recover to their pre-fracture functional level, resulting in an increase in institutionalization. We aimed to investigate risk factors for being dependent at discharge and for failure to return to independent living 12 months after a hip fracture. MATERIALS AND METHODS: From 2011 to 2017, all surgically treated hip fracture patients admitted from their own homes were included in this prospective cohort study. Patient characteristics were registered, including age, sex, lifestyle, comorbidities, pre-fracture New Mobility Score (NMS), biochemical measures, fracture type, and surgical method. Dependency was measured at discharge using a cumulated ambulatory score (CAS < 6) and the timed-up-and-go test (TUG > 20 s). At 12 months, patients were interviewed regarding residence, NMS, and care needs. Multivariable logistic regression was used, reporting odds ratio (OR) with 95% confidence intervals (CI). RESULTS: A total of 2006 patients were included in the study with data regarding their hospital stay and discharge. In all, 1342 patients underwent follow-up at 12 months. The risk factors found to be associated with dependency at discharge were mostly static. Modifiable variables associated with dependency at discharge (CAS < 6) were hypoalbuminemia (OR: 1.94, 95% CI 1.38-2.71), not having been mobilized to standing within 24 h (OR: 1.88, 95% CI 1.12-3.15), and general anesthesia (OR: 1.35, 95% CI 1.07-1.71). Failure to return to independent living at 12 months was found in 10% of the patients, and was primarily associated with patient characteristics and proxy variables for comorbidities, but also with dependency at discharge (CAS < 6). CONCLUSIONS: Mobilizing patients to standing within 24 h from hip fracture surgery was vital in maximizing short-term functional recovery. Failure to return to independent living was seen in the frailest patients. However, the majority remained in their own home with little increase in care needs.

Active clinical issues at discharge predict readmission within 30 days and one year following hip fracture surgery.

AIM: To investigate the impact of delay in surgery for medical causes and active clinical issues (ACIs) on 30-day readmission for medical causes after hip fracture surgery. FINDINGS: ACIs were associated with readmissions following hip fracture surgery; however, no association between readmissions and reasons for delaying surgery was found. MESSAGE: Further studies into ACIs and reasons for delaying surgery are warranted to make more tailor-made treatment plans for patients with hip fracture.

Comparison of the clinical presentation across two waves of COVID-19: a retrospective cohort study.

BACKGROUND: Only a few studies have performed comprehensive comparisons between hospitalized patients from different waves of COVID-19. Thus, we aimed to compare the clinical characteristics and laboratory data of patients admitted to the western part of Denmark during the first and second waves of COVID-19 in 2020. Furthermore, we aimed to identify risk factors for critical COVID-19 disease and to describe the available information on the sources of infection. METHODS: We performed a retrospective study of medical records from 311 consecutive hospitalized patients, 157 patients from wave 1 and 154 patients from wave 2. The period from March 7 to June 30, 2020, was considered wave 1, and the period from July 1st to December 31, 2020, was considered wave 2. Data are presented as the total study population, as a comparison between waves 1 and 2, and as a comparison between patients with and without critical COVID-19 disease (nonsurvivors and patients admitted to the intensive care unit (ICU)). RESULTS: Patients admitted during the first COVID-19 wave experienced a more severe course of disease than patients admitted during wave 2. Admissions to the ICU and fatal disease were significantly higher among patients admitted during wave 1 compared to wave 2. The percentage of patients infected at hospital decreased in wave 2 compared to wave 1, whereas more patients were infected at home during wave 2. We found no significant differences in sociodemographics, lifestyle information, or laboratory data in the comparison of patients from waves 1 and 2. However, age, sex, smoking status, comorbidities, fever, and dyspnea were identified as risk factors for critical COVID-19 disease. Furthermore, we observed significantly increased levels of C-reactive protein and creatinine, and lower hemoglobin levels among patients with critical disease. CONCLUSIONS: At admission, patients were more severely ill during wave 1 than during wave 2, and the outcomes were worse during wave 1. We confirmed previously identified risk factors for critical COVID-19 disease. In addition, we found that most COVID-19 infections were acquired at home.

Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic.

BACKGROUND: Healthcare workers' (HCWs) adherence to hand hygiene is vital in combatting COVID-19 in hospitals. We aimed to investigate HCWs hand hygiene compliance before and during the COVID-19 pandemic and hypothesised that hand hygiene compliance would increase during the pandemic. METHODS: We conducted a prospective observational study in three medical departments at the Regional Hospital of West Jutland, Denmark from April 2019 to August 2020. A total of 150 HCWs participated before the COVID-19 pandemic and 136 during the pandemic. Hand hygiene observations were assessed using an automated hand hygiene monitoring system. Students unpaired t-test was used to assess differences in hand hygiene compliance rates in each department. RESULTS: Comparison analyses showed, that hand hygiene compliance in department A and B was significantly higher before the COVID-19 pandemic than during the pandemic; a 7% difference in department A and a 5% difference in department B. For department C, the total hand hygiene compliance was unchanged during the pandemic compared to before. CONCLUSION: The COVID-19 pandemic did not raise hand hygiene compliance. Further studies are needed to verify these findings and further identify barriers to hand hygiene compliance among HCWs.

Malnutrition, poor function and comorbidities predict mortality up to one year after hip fracture: a cohort study of 2800 patients.

PURPOSE: Despite extensive research, a complete understanding of factors influencing mortality risk after hip fractures is lacking. Previous research has focused on static risk factors; however, to improve outcomes, attention should be directed towards risk factors that may be optimised. The present study aimed to investigate the association of 19 risk factors with mortality among patients with hip fracture treated according to a well-defined guideline. METHODS: The study was a retrospective analysis of a large prospective patient cohort with all consecutive patients surgically treated for a hip fracture from January 2011 to December 2017 included (n = 2800). Variables were obtained from patient records and the Holstebro Hip Fracture Database comprising prospectively registered data on demographics, comorbidity, malnutrition (low Body Mass Index (BMI) or albumin) and hospital stay (including fracture and surgical data, biochemistry, mobilisation and discharge). Outcomes were 30-day and one-year mortality. RESULTS: Patients were predominantly female (66%); median age 81.6 years. Overall mortality was 9% at 30 days and 24% at one year. Age ≥ 75 years, male gender, nursing home residence, cognitive impairment, American Society of Anesthesiologists (ASA) score ≥ 3, BMI < 20 kg/m2, albumin < 35 g/l, creatinine ≥ 100 µmol/l, a low New Mobility Score and no mobilisation were all associated with increased mortality at 30 days and one year. CONCLUSION: In addition to non-modifiable risk factors, comorbidities (expressed as high ASA score and creatinine), malnutrition, and failure to achieve early post-operative mobilisation were associated with increased short and long-term mortality among patients with hip fracture: these are potentially modifiable. The effect of optimisation interventions warrants further research.

Patients' experiences of being treated by an interprofessional student team compared with uniprofessional treatment by residents supported by nurses: a case study.

Clinical experience, preferably interprofessional, is an important part of health professionals' undergraduate training. In recent years, more and more patient treatment has been moving to outpatient clinics with research suggesting hat this shift is not compromising students' learning outcomes. The purpose of this study was to explore orthopedic outpatients' perceived experiences of being treated by an interprofessional student team consisting of one medical and one nursing student versus being treated by a resident doctor supported by nurses in a uniprofessional setup. We performed an exploratory single case study with two embedded units: 1) a quantitative part with a survey (n = 89) including seven questions and 2) a qualitative part with interviews (n = 46). In the questionnaire, three of the seven questions revealed a significant difference in favor of the student teams. However, the qualitative part of the study did not indicate any differences between the groups. In this study, patients' experiences in an orthopedic outpatient clinic were not influenced by being treated by interprofessional student teams compared to normal patient pathway with registrars and nurses working uniprofessionally. This information is important in designing and implementing student curriculums with clinical training in outpatient clinics. Furthermore, the interprofessional student team can undertake unassisted consultations with selected patients with indirect supervision from the supervisors, making the clinical setting realistic for the students. However, in this teaching model, feedback to the students relies only on the students' written patient records; even if patient satisfaction is high, structured observation of student performance may be necessary as a supplementary teaching tool. This may be incorporated in future studies of patient-student relations in clinical training in an outpatient setting.

[Compulsive treatment in a psychiatry--an economic evaluation of participation in the Breakthrough model]. / Tvang i psykiatrien--undersøgelse af resurseforbrug ved deltagelse i gennembrudsprojektet.

BACKGROUND: By use of the Breakthrough Series Collaborative a national quality project was launched in Denmark in 2004. The purpose was to improve the quality of compulsive treatment. Due to participation in the project the psychiatric ward at Herning Hospital reduced the frequency and duration of compulsive treatment significantly compared to 2003. The objective of this study was to evaluate changes in costs per discharged patient and bed-day before and after the intervention. To illustrate quality improvements beyond the purpose of the national project the consumption of antipsychotics was included in the evaluation. MATERIALS AND METHODS: Specification of working hours per discharged patient and bed-day and an average hourly rate for a nurse provide the basis for the valuation. The cost of antipsychotics is based on an average daily use per discharged patient and bed-day. The monetary unit is Danish Kroner. RESULTS: The wage costs per discharged patient were 18,487 before and 19,010 after the intervention. Per bed-day the costs were 2,642 and 2,679, respectively. Medicine costs per discharged patient were 198 before and 148 after the intervention while the costs per bed-day were 28 and 21, respectively. CONCLUSION: This evaluation of costs shows that it is possible to develop and implement quality improvements without increasing costs. A decrease in medicine costs indicates that the effect reaches further than the quality in compulsive treatment.