Evidence-based management of patients with Colles' fractures in emergency departments: a case-based critical reflection

Application Effect of Case Management Mode Combined with ERAS in Elderly Patients with Hip Fracture

Objective

To explore the effect of the case management mode combined with enhanced recovery after surgery (ERAS) in elderly patients with hip fracture.

Methods

A total of 102 elderly hip fracture patients admitted to our hospital from June 2018 to December 2019 were selected. The patients with hip fracture were divided into the control group (n = 51) and the observation group (n = 51) by the random number table method. The control group adopts the conventional nursing mode, and the observation group adopts the case management mode combined with ERAS. The bed activity time, hospitalization time, total hospitalization expenses, and the satisfaction of patients were observed. The numeric rating scale (NRS) was used to assess the patient's pain before treatment and at 1, 3, and 5 days after treatment. The Harris score was used to assess the patient's joint motor function before treatment and at the 8th week after treatment. The perioperative complications of the two groups were compared.

Result

After treatment, the observation group was better than the control group in terms of out of bed activity time, hospitalization time, total hospitalization expenses, and the satisfaction of patients (P < 0.05). Before treatment, there was no significant difference in NRS scores between the two groups (P > 0.05). After treatment, the NRS scores of the two groups were lower than before treatment, and on days 1, 3, and 5 after treatment, the NRS scores of the observation group were lower than those of the control group (P < 0.05). Before treatment, there was no difference in the Harris score between the two groups (P > 0.05). At the 8th week after treatment, the Harris scores of the two groups were higher than those before treatment, and the Harris scores of the observation group were higher than those of the control group (P < 0.05). The total incidence of perioperative complications in the observation group (4/51) was lower than that in the control group (13/51) (P < 0.05).

Conclusion

The application of the case management mode combined with ERAS nursing in elderly patients with hip fracture can improve the clinical symptoms of patients, improve the therapeutic effect, and reduce the occurrence of complications, which is worthy of clinical application.

A novel mechanical chest compressor with rapid deployment in all population cardiopulmonary resuscitation

Cardiopulmonary resuscitation (CPR) resuscitates patients suffering from cardiac arrest. Mechanical chest compression CPR highlights the need for high CPR quality to facilitate survival and neurological recovery. However, current CPR devices cannot be used on pregnant women or infants. These devices’ long re-setup times interrupt CPR and can cause cerebral ischemia. This study designed a novel device with a crank-sliding mechanism. The polar coordinate system (r, θ, z) shortened the setup time and enabled adjustment without moving the patient. We compared our device with commercial products (e.g., LUCAS-2) by quantifying the compression pressure. Control groups for manual CPR of trained physicians and untrained citizens were recruited. We used Resusci Anne products as models. Our results indicated that our design exhibited performance similar to that of LUCAS-2 in adults (557.8 vs. 623.6 mmHg, p = 0.217) and met the current CPR standard guidelines. Notably, our device is applicable to pregnant women [565 vs. 564.5 (adults) mmHg, p = 0.987] and infants [570.8 vs. 564.5 (adults) mmHg, p = 0.801] without lowering the compression quality. The overall compression quality and stability of mechanical chest compression CPR were favorable to those of manual CPR. Our device provides an innovative prototype for the next generation of CPR facilities.