X-Ray Film under Artificial Intelligence Algorithm in the Evaluation for Nursing Effect of Gamma Nail Internal Fixation in Elderly Patients with Intertrochanteric Fracture of Femur.

The aim of this work was to explore the effects of Gamma nail internal fixation for intertrochanteric fracture of femur by X-ray film classification and recognition method based on artificial intelligence algorithm. The study subjects were 100 elderly patients with intertrochanteric fracture of femur admitted to hospital. The cases were diagnosed as elderly (over 60 years old) femoral intertrochanteric fractures by X-ray or CT. They were divided into two groups, with 50 persons in each group: one group used the X-ray film evaluation image guidance based on the artificial intelligence algorithm (research group), and the other group did not use algorithmic guidance (control group). The results showed that the segmentation effect of the proposed algorithm was similar to the gold standard segmentation result, indicating that the algorithm was effective and feasible in the segmentation of fractures and bones. The global level set algorithm was set as the control. The ultimate measurement accuracy (UMA) value of the algorithm group was (1.77 ± 0.22), and the UMA value of the global level set algorithm group was (3.42 ± 0.36), indicating that the image processed by the algorithm group had obvious numerical effect, high accuracy, and good retention of details. The operation time, intraoperative blood loss, incision length, hospital stay, weight-bearing time, and fracture healing time of the two groups were all better than those of the control group. One month after surgery, the Harris score of the algorithm group was 67, and that of the control group was 51, with a 16-point difference between the two groups (p < 0.05). The patient had less pain and fast recovery speed, indicating that it was a good way to treat elderly intertrochanteric fractures with the nursing effect of X-ray Gamma nail internal fixation based on an artificial intelligence algorithm. The artificial intelligence algorithm not only can be applied to the Gamma nail internal fixation of elderly patients with intertrochanteric fractures but also can be applied to the X-ray image processing of other fractures and other surgical methods to provide effective treatment for fracture patients.

Factors associated with the successful removal of indwelling urinary catheters post-operatively in the fragility hip fracture patient.

INTRODUCTION: Patients presenting to hospital with a fragility hip fracture are routinely catheterized in the emergency department. Studies have found that the duration of catheterization is the greatest and most important risk factor for developing a urinary tract infection. Whilst there is a considerable body of evidence around correct techniques for insertion of urinary catheters, there appears to be little evidence as to the timing of their removal. AIM OF THE STUDY: To describe the current practice of indwelling catheter (IDC) removal post operatively in the fragility hip fracture patient and to identify factors associated with the successful removal of IDCs post operatively in the same cohort of patients. METHODS: This study was a retrospective cohort analysis of patients admitted to a large, tertiary hospital with an established ortho-geriatric model of care. RESULTS: Aperient regime was the only factor that appeared to have a significant impact on the successful IDC removal. The patient commenced on the aperient regime was three times more likely to have an unsuccessful IDC removal than the patient on a limited or no aperient regime. CONCLUSION: This study highlights the need for redesigning care that is patient focused, evidence-based, effective and efficient. The argument that a patient's bowel is required to be emptied prior to the successful removal of an IDC appears to be false, as in this study it was not identified as a predictor of successful IDC removal. A prospective clinical trial may be the next step forward in developing a clinical guideline for the successful removal of IDCs in the fragility hip fracture patient and/or surgical patient. Nurses have a crucial role to play in contributing to evidence-based practice and are continually challenged to do so.

Risk of Nursing Home Admission After Femoral Fracture Compared With Stroke, Myocardial Infarction, and Pneumonia.

OBJECTIVE: To analyze the burden of institutionalizations after femoral fracture and compare it with other "catastrophic" disease entities like stroke, myocardial infarction, or pneumonia. DESIGN/SETTING/PARTICIPANTS: Routine data of 414,000 hospitalized German patients aged 66 years and older were used to calculate institutionalization risks after femoral fracture, stroke, myocardial infarction, pneumonia or a combined group of "all other hospitalizations." MEASUREMENTS: Institutionalization was defined as nursing home admission within 6 months after discharge from hospital. Age- and sex-specific incidence and incidence rates of institutionalization were calculated. To compare the risk of institutionalization between the disease entities, age-standardized rates were computed and proportional hazards models were applied. In-house mortality and mortality after discharge from hospital were also calculated. RESULTS: The risk of institutionalization increased exponentially with age in all disease entities. For example, the risk of institutionalization after femoral fracture increased from 3.6% in women aged 65 to 69 years to 34.8% in women aged 95 years and older. The highest institutionalization rates were observed in patients with stroke, followed by femoral fracture, pneumonia, and myocardial infarction. In men, the age-standardized risk of institutionalization was almost as high after femoral fracture as after stroke (7.5% vs 8.0%). In contrast to myocardial infarction and pneumonia, femoral fracture and stroke were more likely to be followed by institutionalization rather than death. CONCLUSION: Femoral fractures result in high burden of institutionalizations. Prevention of falls, diagnosis and treatment of osteoporosis, and high-quality rehabilitation are challenges to tackle the burden of institutionalization in these patients in the future.

Benzodiazepinas en ancianos: a propósito de un caso / Benzodiazepines in aged patients: a case report

Las benzodiazepinas son los fármacos hipnótico-sedantes más consumidos, sobre todo entre la población geriátrica. En la presente publicación se describe el caso clínico de un paciente que ha sufrido una caída con consecuencia de rotura de fémur y que se encontraba en tratamiento con dos benzodiazepinas a dosis mayores a las recomendadas para ancianos, en el momento de sufrir la caída. Dichos fármacos fueron ketazolam y lorazepam, a dosis de 30 mg y 5 mg, respectivamente. Recalcamos la importancia de prestar especial atención a la dosificación de estos fármacos en los ancianos y de seguir las recomendaciones de elegir benzodiazepinas de vida media corta o ultracorta, a la menor dosis posible y durante el menor periodo de tiempo necesario

Benzodiazepines are the most consumed sedative-hypnotic drugs, especially among geriatric population. In this publication, we report the case of a patient who suffered a fall and broked his femur and who was treated with two benzodiazepines at higher doses tan recommended for elderly patients, at the time of suffering the fall. Such drugs were ketazolam and lorazepam, prescribed at 30 mg/ day and 5 mg/day respectively. We emphasize the need of pay special attention to the dosage of these drugs in the elderly and to follow the recommendations of choicing those ones of short or ultrashorthalf-life, at the lowest dose possible and for the shortest time necessary

[Andrea's story]. / La storia di Andrea.

First-hand accounts of illness experiences provide important insights for other patients and their carers and can be a powerful tool for patient information and professional education. Andrea was ran over by a motor-bike while he was carried by bike and reported a complicated femur fracture. Three different representations of the story are reported and confronted: the bold chronicle of events, that sets the scenery and time sequence; Andrea's mother point of view on what happened after the accident, and during the course of the illness; and Andrea's story, told with his words and drawings. The methodological comments offered as discussion, stress how the collection of relevant patients stories can be a valuable research resource because it can offer a broad perspective which cannot be obtained by other means.

The potential for elderly suicide. . . Is health care missing it?

Assessment of elderly patients at risk for suicide, presents a unique challenge in healthcare. Assessment of residents entering long term care facilities does not end once they are admitted. Learning to identify the warning signs and situations that can precede "silent suicide" requires extraordinary sensitivity (Simon, 1989). A case study is utilized to review some of the most common risk factors for suicide in the elderly population. The impact on elderly people when they must leave their homes, is highlighted in the discussion of"relocation stress" (Harkulich, 1992) The reason why healthcare workers could misinterpret the signs and symptoms of potential elderly suicide is also included.

[Fracture of the proximal third of the femur. II]. / Fractura del tercio proximal del fémur (y II) postoperatorio.

The second of a two part series dealing with fractures of the femur. Postoperative health care is the focus of this article, with special attention paid to possible complications and what effect they might have on the patient's quality of life. Specific nursing care plans and procedures help prepare the patient to confront their disability in the best physical and psychological state possible.

[Fracture of the proximal third of the femur. 1. Preoperative measures]. / Fractura del tercio proximal del fémur (I). Preoperatorio.

Fractures of the proximal third of the femur occur in great numbers, especially among the over 65 population. Due to the serious nature of these injuries it is imperative that nurses have specific procedures and care plans to deal with them. The authors approach this topic in a two part series: the first part deals with the preoperative period, and the second part looks at postoperative care.

South Dakota statewide Nursing Minimum Data Set Project.

The elements of the Nursing Minimum Data Set (NMDS) were collected manually from 188 medical records in eight acute care facilities. These eight facilities represent 54 per cent of the beds in South Dakota. The purpose of the study was to describe discharge destination, nursing diagnoses, nursing interventions, and nursing resource utilization for patients with fractured femur with pinning. The sample was primarily female (69.1 per cent), with a mean age of 78.5 years. Most (84.0 per cent) patients were transferred to another facility, with 46.2 per cent going to extended care facilities. The most frequent nursing diagnoses were comfort (89.9 per cent) and physical mobility (59.6 per cent). Interventions were classified using the 16-category classification scheme developed by Werley and Lang. The most frequently recorded types of interventions were in the category of monitoring and/or surveillance (16.7 per cent of 7,555 interventions), whereas emotional support and/or counseling was much less frequent (3.0 per cent of 7,555). Discharge planning was the most frequent nursing intervention in the category of coordination and collaboration of care (54.8 per cent of 188 patients). Documentation systems have been structured to accommodate technical tasks on flow sheets, for example. Nursing resource utilization was the most difficult, and also presently the least meaningful, NMDS element to collect because each facility has different staffing, different patient classification systems, and no prescribed method for collecting these data. Manual data collection is time-consuming and expensive and therefore not recommended.

Care of the school-aged child in 90/90 traction.

Children in the school-aged period are those most likely to sustain a fractured femur. One method of treatment for this age group is immobilization of the fracture in 90/90 traction. Specific needs of these children are discussed, and related nursing problems are identified. The physiologic and psychosocial aspects of nursing care are also addressed. Emphasis is placed on the developmental tasks inherent in this age group. Mastery of illness and hospitalization are central issues for the school-aged child and can be facilitated through the efforts of nursing and hospital staff. A therapeutic play program is also a beneficial adjunct to treatment and nursing care.