Incidence and risk factors for hip fracture in elderly patients undergoing lumbar spine surgery: a nationwide database study with 11-year follow-up.

Impaired functional movement may occur after spinal surgery, which increases risk of fall episode and hip fracture. Patients with long-segment thoracolumbar spine fusions had a significantly higher risk of hip fracture than those with only discectomies. Fall prevention is necessary due to the highly increased hip fracture risk. INTRODUCTION: Spinal surgeries are performed to treat spondylolisthesis, fractures, scoliosis, or other deformities. Impaired balance mechanisms and functional movement may occur after spinal surgery. Fall episodes may cause hip fractures, which have negative impacts on quality of life and increase mortality. The incidence of hip fracture after spinal surgery is still unknown. The aim of this study was to examine the association between various types of spinal surgeries and hip fractures in the elderly by using a nationwide database. We hypothesized that the spinal surgeries may increase hip fracture risk in the elderly. METHODS: We used the National Health Insurance Research Database (NHIRD) to identify 3345 patients undergoing spinal surgery and a random dataset to identify 6690 age-, sex- and Charlson comorbidity index (CCI)-matched controls to compare the incidence of hip fractures in an 11-year follow-up period. We also enrolled 82,730 patients with spinal surgeries from the inpatient dataset to investigate the impact of different types of spinal surgeries. RESULTS: Patients who received spinal surgeries had higher risks of hip fractures, especially patients aged 60 to 79 years and female patients. The patients with long-segment thoracolumbar spinal fusions had a significantly higher risk of hip fracture than those with only discectomies. Short segmental lumbar spine fusions also slightly increased the risk of hip fracture compared with discectomies. CONCLUSION: Fall prevention for the elderly undergoing lumbar spinal surgery is necessary due to the highly increased hip fracture risk.

The assessment of the ulnar nerve at the elbow by ultrasonography in children.

We evaluated the morphological changes to the ulnar nerve of both elbows in the cubital tunnel by sonography in a total of 237 children, of whom 117 were aged between six and seven years, 66 between eight and nine years, and 54 between ten and 11 years. We first scanned longitudinally in the extended elbow and then transversely at the medial epicondyle with the elbow extended to 0 degrees . We repeated the scans with the elbow flexed at 45 degrees , 90 degrees , and 120 degrees . There were no significant differences in the area of the ulnar nerve, but the diameter increased as the elbow moved from extension to flexion in all groups. More importantly, the ulnar nerve was subluxated anteriorly on to the medial epicondyle by 1.5% to 1.9% in extended elbows, by 5.9% to 7.9% in those flexed to 45 degrees , by 40.0% to 44% in those flexed to 90 degrees , and by 57.4% to 58.1% in those flexed to 120 degrees , depending on the age group. Sonography clearly and accurately showed the ulnar nerve and was useful for localising the nerve before placing a medial pin. Because the ulnar nerve may translate anteriorly onto the medial epicondyle when the elbow is flexed to 90 degrees or more, it should never be overlooked during percutaneous medial pinning.

A baseline study of pediatric dialysis in Texas.

This study provides a cross-sectional view of the management of 94 Texas children with end-stage renal disease in 1996 and serves as a point of comparison for future changes in management practice. Data collected in 6 pediatric and 18 adult dialysis facilities in Texas revealed that a greater proportion of younger pediatric patients received peritoneal dialysis (PD). Patients on PD had a significantly lower serum albumin level than those on hemodialysis (HD). HD and PD patients were 2.3 and 1.7 standard deviation scores (SDS) below the average height of the age- and gender-matched populations, respectively. There was no significant difference in hematocrit, use of growth hormone, parathyroid hormone level, weight SDS, or bone age by treatment modality. However, patients dialyzed in pediatric facilities were more likely to receive growth hormone and to be regularly evaluated for Tanner stage and bone age than those in adult facilities. Measurement of creatinine clearance as a measure of adequacy of PD in young children was not a common practice. Instead pediatric nephrologists tended to rely more on anthropometric measurements, developmental maturation, and serum albumin to assess adequacy. Opportunities remain to maximize the growth potential and to develop standards for the adequacy of dialysis in the younger patient.

Reducing staff turnover: a case study of dialysis facilities.

A multivariate logistic analysis of 42 Texas dialysis facilities indicated that younger, white, short tenure, an LVN/LPN, with less support from family and friends for emotional concerns, and less supervisor support significantly increased the likelihood of turnover (p < or = .05) in dialysis facilities. The high annual staff turnover of these dialysis facilities increases costs and impedes the delivery of quality patient care. Managerial strategies to increase staff retention are suggested.

Renal dietitians' perspective: identification, prevalence, and intervention for malnutrition in dialysis patients in Texas.

OBJECTIVE: Determine the prevalence of malnutrition per facility standards; examine interventions used to treat malnutrition; and share experiences, concerns, and solutions to problems in the management of malnutrition in dialysis patients in Texas. DESIGN: Structured survey questionnaires. SETTING: 196 outpatient hemodialysis (HD) and 86 peritoneal dialysis (PD) programs in End-Stage Renal Disease (ESRD) Network of Texas, Inc. PARTICIPANTS: Renal dietitians who worked in Texas dialysis facilities that treated chronic, outpatient adult, and pediatric ESRD patients on HD or PD. MEASIRES: Criteria used to identify malnourished patients, prevalence of malnutrition in dialysis recipients, prevalence and types of interventions used to manage malnourished patients, and participation in quality management activities among renal dietitians. RESULTS: For facilities that treated both HD and PD patients in 1996: (1) a significantly greater proportion of PD patients were identified as malnourished than HD patients; (2) facilities that had a high percentage of malnourished HD patients also had a high percentage of malnourished PD patients; (3) a significantly greater proportion of PD patients received commercial nutrition supplements than HD patients; and (4) use of tube feedings, intradialytic parenteral nutrition, intraperitoneal parenteral nutrition, and total parenteral nutrition among HD and PD patients decreased significantly from the past to the current survey year. Renal dietitians shared their experiences, concerns and solutions to problems in the management of malnutrition in this population. CONCLUSION: Results indicate a need to improve the nutritional status of malnourished dialysis patients, to increase consideration of tube feedings as viable nutrient delivery routes, and to maximize involvement of renal dietitians in the quality management process. With the cooperative effort of staff, care givers, patients, and family, early identification and appropriate interventions may improve the nutritional status and quality of life of dialysis patients. This is a US government work. There are no restrictions on its use.

Review of nursing turnover research, 1977-1996.

Turnover represents a major problem for health care services in terms of cost and quality of care given. As a result, turnover has been the subject of a large number of investigations. However, the variety of study populations, research methodologies, and inconsistent definitions and measurements of turnover lead to difficulties when attempting to compare studies. The purpose of this paper is to present: (1) a summary of turnover study methods and procedures, and (2) a summary of socio-demographic, organizational, and social support factors associated with turnover of nursing staff.