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Yakushiji K, Fujita K, Tabuchi Y, Matsunaga-Myoji Y, Tanaka S, Mawatari M. Long-term health-related quality of life of total hip arthroplasty patients and cost-effectiveness analysis in the Japanese universal health insurance system. Jpn J Nurs Sci 2023; 20:e12537. [PMID: 37088471 DOI: 10.1111/jjns.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023]
Abstract
AIM Total hip arthroplasty can effectively improve patients' motility with end-stage osteoarthritis. This study aimed to: (1) compare gradual changes in utility values with total hip arthroplasty and estimated values without; (2) evaluate total hip arthroplasty cost-effectiveness; and (3) evaluate cost-effectiveness by age, diagnosis, and comorbidity. METHODS Patients who underwent total hip arthroplasty between January 2008 and December 2009 were included. Patients completed the EuroQol preoperatively and at 1, 3, 5 and 7 years postoperatively. To derive the quality-adjusted life years gained, a utility score was obtained from the EuroQol item scores and combined with 7 years, and estimates were obtained by discounting the postoperative 1-year utility value at an annual rate of 2%-4%. Mixed-effects regression models were used to compare the estimated and the measured utility values. RESULTS Mean total cost was 1,921,849 yen, and quality-adjusted life years gain score was 1.746 with per cost as 1,100,715 yen. Compared with actual measurements, the estimated values from 1 to 7 years post-surgery differed significantly, and interaction was observed. Regarding age, the older the patient, the higher the cost per quality-adjusted life years. Patients with lower preoperative physical function had higher quality-adjusted life years gains, while the cost per quality-adjusted life years was lower. CONCLUSIONS Total hip arthroplasty was cost-effective. Compared with actual measurements, the estimated utility values from 1 to 7 years post-surgery significantly differed. Even among older patients and those with impaired preoperative physical functions, its cost was lower than patients' willingness to pay in Japan.
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Affiliation(s)
- Kanako Yakushiji
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kimie Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Yuriko Matsunaga-Myoji
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satomi Tanaka
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ewens B, Seaman K, Whitehead L, Towell-Barnard A, Young M. A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults. BMC Nurs 2021; 20:202. [PMID: 34666763 PMCID: PMC8525041 DOI: 10.1186/s12912-021-00692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/23/2021] [Indexed: 11/11/2022] Open
Abstract
Background Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge of delirium amongst clinicians caring for patients at high risk of developing delirium and to determine whether education can improve clinical assessment of delirium. Methods Two hundred and forty-six case notes were audited before and 149 were reviewed after the education intervention and implementation of a delirium screening tool. Clinicians at the hospital were invited to complete a questionnaire on knowledge of delirium. The questionnaire was based on a validated tool which contained 39 questions about delirium. The questionnaire also contained 28 questions on delirium knowledge. Additional questions were included to gather demographic information specific to the hospital. Descriptive statistics, chi square and independent t-tests were conducted to test for differences in knowledge between the pre and post periods. The Squire Checklist Reporting Guidelines for Quality Improvement Studies informed the preparation of the manuscript. Results The audit demonstrated that the use of a cognitive assessment tool overall increased from 8.5% in pre education to 43% in the post education period. One hundred and fifty-nine staff completed the questionnaire in total, 118 the pre and 41 post. The knowledge subscale score was high pre and post education and no statistically significant difference was observed. The greatest increase in knowledge was related to knowledge of the risk factors subscale. The increase in knowledge (6.8%) was statistically significant. Conclusion An interprofessional approach to delirium education was effective in not only increasing awareness of the factors associated with this syndrome but also increased the use of a delirium assessment tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00692-2.
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Affiliation(s)
- Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Michelle Young
- Joondalup Health Campus, Cnr Grand Boulevard and Shenton Avenue, Joondalup, WA, 6027, Australia
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Hino K, Nomoto M, Endo E, Watanabe A, Sakamoto O, Takahashi Y. Effect of a Psychiatric Department Liaison Team on Patient Treatment and Outcomes. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200628-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tamune H. Delirium-informed care in emergency departments: Diagnosis and beyond. Am J Emerg Med 2020; 38:1684-1685. [DOI: 10.1016/j.ajem.2019.158460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022] Open
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Abstract
BACKGROUND Most older adults with hip fracture surgery experience functional decline (FD), causing devastating outcomes. However, few studies have examined the effects of nursing interventions to reduce FD for them. PURPOSE The aim of the study was to evaluate an individualized transitional care program (ITCP) to reduce FD for older adults with hip arthroplasty. METHODS The study was quasiexperimental, with a nonequivalent control group design. A total of 37 participants scheduled for hip arthroplasty were recruited-21 in the experimental and 16 in the control group. FINDINGS Two weeks following surgery (i.e., just prior to discharge), the ITCP group displayed less fear of falling than the usual care group. Moreover, the experimental group displayed objectively less FD with increased activities of daily living and Timed Up and Go scores, 6 weeks after hip arthroplasty. CONCLUSIONS This study provides evidence of the effectiveness of nurse-led rehabilitative practices to reduce FD in older adults with hip arthroplasty. CLINICAL RELEVANCE The ITCP promoted individual physical functioning for older adults with hip arthroplasty. This study results can aid healthy transitions of elderly patients with other various diseases.
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Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures. Arch Orthop Trauma Surg 2019; 139:347-354. [PMID: 30519735 DOI: 10.1007/s00402-018-3086-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objective of the current study was to evaluate the effect of a quality management system on treatment and care delivery of proximal femoral fractures. Specifically, our hypothesis was that the "plan-do-check-act (PDCA)" philosophy of the ISO 9001 quality management system results in a continuous improvement process. METHODS 1015 proximal femoral fractures were prospectively included into a hip fracture database over a 5-year period, after a restructuring process with implementation of clinical pathways and standard operation procedures. A close and structured ortho-geriatric co-management (certified ortho-geriatric center) was the basis for treatment. ISO 9001 certification was granted for the first time in 2012. Procedural and patient outcome parameters were analyzed by year and evaluated statistically using SPSS 25.0. RESULTS In both categories (procedural and outcome) significant changes could be detected during the 5-year period, e.g., significant reduction of time to surgery for the first 2 years, improvement in discharge management, and reduction of surgical complications. However, no significant changes could be demonstrated for mortality or internal complications such as pneumonia, urinary tract infections, or postoperative delirium. However, the incidence of the latter was already on a very low level at the onset of the quality improvement process. CONCLUSION We could show a relevant and continuous improvement of several quality indicators during a 5-year period after implementation of a quality management system based on the PDCA philosophy for the treatment of proximal femoral fractures in elderly patients. However, other parameters (internal complications, cost-effectiveness, etc.) need our close attention in the future.
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Which orthopaedic trauma patients need psychiatry consultation? A single institution pilot survey study. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hendlmeier I, Bickel H, Hessler JB, Weber J, Junge MN, Leonhardt S, Schäufele M. [Dementia friendly care services in general hospitals : Representative results of the general hospital study (GHoSt)]. Z Gerontol Geriatr 2017; 51:509-516. [PMID: 29110137 DOI: 10.1007/s00391-017-1339-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mostly model projects report on special care services and procedures for general hospital patients with cognitive impairment. The objective of this study was to determine the frequency of special care services and procedures in general hospitals on the basis of a representative cross-sectional study. METHODS From a list of all general hospitals in southern Germany we randomly selected a specified number of hospitals und somatic wards. The hospitals were visited and all older patients on the selected wards on that day were included in the study. Information about care services and their utilization was collected with standardized instruments. RESULTS A total of 33 general hospitals and 172 wards participated in the study. The patient sample included 1469 persons over 65 (mean age 78.6 years) and 40% of the patients showed cognitive impairments. The staff reported that the most frequent measures for patients with cognitive impairments concerned patients with wandering behavior (63.1%), efforts to involve the patients' relatives to help with their daily care (60.1%), conducting nonintrusive interviews to identify cognitive impairments (59.9%), allocation to other rooms (58%) and visual aids for place orientation of patients (50.6%). In accordance with earlier studies our results show that other dementia friendly services implemented in pilot projects were rare. The existing special services for patients with cognitive impairment were rarely used by the patients or their relatives. DISCUSSION The results demonstrate the urgent need to improve special care services and routines for identification of elderly patients with cognitive impairment and risk of delirium in general hospitals.
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Affiliation(s)
- Ingrid Hendlmeier
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.
| | - Horst Bickel
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Johannes Baltasar Hessler
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Joshua Weber
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.,Hochschule für Soziale Arbeit Olten, Fachhochschule Nordschweiz, Olten, Schweiz
| | - Magdalena Nora Junge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Sarah Leonhardt
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland
| | - Martina Schäufele
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.
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Rizk P, Morris W, Oladeji P, Huo M. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery. Geriatr Orthop Surg Rehabil 2016; 7:100-5. [PMID: 27239384 PMCID: PMC4872181 DOI: 10.1177/2151458516641162] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms.
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Affiliation(s)
- Paul Rizk
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William Morris
- Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Philip Oladeji
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Huo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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