Knowledge expectations of surgical orthopaedic patients: a European survey

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research

The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture

© 2018 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (November 2018) in accordance with the publisher’s archiving policyThe purpose of this document is to provide nurses who care for older adults with fragility hip fracture with a framework to promote safe and optimal care for this vulnerable population. The successful application of the standards of care contained in this document requires clinical expertise and evidence-supported decision-making in order to maximize patient outcomes. In 2012, 2013 a two part consensus document published in the International Journal of Orthopaedic and Trauma Nursing entitled “Acute nursing care of the older adult with fragility hip fracture: an international perspective” was developed by nursing leaders from seven countries across 3 continents who delineated the recommended care standards for this group of patients (Maher et al., 2012; Maher et al., 2013)

Διερεύνηση της ύπαρξης συσχέτισης μεταξύ της ενδυναμωτικής εκπαίδευσης ασθενών που υποβάλλονται σε ολική αρθροπλαστική γόνατος ή ισχίου και των αποτελεσμάτων απο την επέμβαση

INTRODUCTION: The aging of the population leads to an increase of the frequency of impairments, such as arthritis, and, consequently, to an increase of the frequency of planned orthopaedic surgeries, such as Total Joint Arthroplasty – TJA (of hip or knee). TJA constitutes a very frequent surgical operation in developed countries, with beneficial short-term and long-term results. The education of orthopaedic patients is an important parameter of nursing care and has been correlated to positive health outcomes. AIM: The exploration of the knowledge and information that patients expect to receive when they are undergoing TJA, of the knowledge they receive, as well as of the way that knowledge correlates to their recovery and rehabilitation. METHODS: A descriptive longitudinal observational and correlational study was conducted in three phases: prior to the operation, at discharge from the hospital and at six months after the operation. Data was gathered from patients undergoing TJA of the hip or knee in three General Hospitals in Attica region. The instruments for the collection of the data included the Hospital Patient’s Expected and Received Knowledge Scales, the Access to Knowledge Scale, the Quality of Recovery Scale, the EQ5D Health Questionnaire, the Patient Satisfaction from Care Scale, the Pain Care Scale, a list of questions about the patient’s contacts with healthcare professionals after the operation and about the total financial cost, and the Health Opinion Survey Krantz. The ethical principles for medical research involving human subjects of Helsinki (2004) were applied during the whole study. An analysis of the data with methods of descriptive statistics and parametrical procedures was conducted. RESULTS: The mean age of the patients’ sample was 72,32 years. In their majority patients were women (71,3%), graduates of elementary school (76,1%), without professional education (80,4%), retired (57,9%), and with at least one chronic condition (65,1%). Also, most of the patients were undergoing TJA of the knee (60,3%), and for the first time (67,5%). Patients reported high expectations for knowledge acquisition, mainly in the functional and biophysiological dimensions of empowering education. However, their needs for knowledge, as evaluated with the Hospital Patient’s Received Knowledge Scale, were not adequately covered both at their discharge from the hospital and at six months after the operation. Patients’ expectations were at a greater part covered in the functional and biophysiological dimensions. Independent variables, such as age, were not correlated to patients’ Expected and Received Knowledge, while the gender was also not correlated to knowledge expectations, although women wanted to receive more knowledge in comparison with men. An interesting finding of the study is that the results in the Health Opinion Survey Krantz were not correlated to patients’ Expected Knowledge; thus, although the patients through their answers in the particular questionnaire reported to receive information and to participate in care passively, they expected to receive knowledge about their care. Patients were mostly satisfied from the nursing staff’s professionalism and from the care they received, but less satisfied from the time that the nursing staff devoted to them. Patients who had more access to knowledge also received more knowledge. Patients’ Received Knowledge was correlated also to patients’ satisfaction with care, meaning that the patients who received more knowledge were at the same time more satisfied from the care they received during their hospitalization. The results in the Patient Satisfaction from Care Scale and from the Access to Knowledge Scale were correlated to the pain that patients experienced during their hospitalization. Also, there was a correlation between the Pain Care Scale and the patients’ Received Knowledge, meaning that the patients who received more knowledge also reported that their pain had been more sufficiently treated. Finally, it is worthy of mentioning that patients’ health- related quality of life was substantially improved at six months after the operation, while it was significantly correlated to Received Knowledge at the six months interval. CONCLUSION: Patients in the present study reported high expectations about their education and that their educational needs were not fully covered, a fact that hinders their empowerment. At the same time, patient education represents an important, independent and individualized nursing intervention and the attempts for its promotion will certainly contribute to the enhancement of Nursing within the Greek society. In the future it of particular importance for the patients to be offered many choices about their education and this initiative must derive from the nurses.ΕΙΣΑΓΩΓΗ: Η γήρανση του πληθυσμού οδηγεί σε αύξηση της συχνότητας εμφάνισης νόσων φθοράς, όπως η αρθρίτιδα, και συνεπακόλουθα, σε αύξηση του αριθμού των προγραμματισμένων ορθοπαιδικών επεμβάσεων, όπως η Ολική Αρθροπλαστική - ΟΑ (ισχίου ή γόνατος). Η ΟΑ αποτελεί μία πολύ συχνή χειρουργική επέμβαση στις αναπτυγμένες χώρες, με ευεργετικά βραχυπρόθεσμα και μακροπρόθεσμα αποτελέσματα. Η εκπαίδευση των ασθενών με ορθοπαιδικά προβλήματα υγείας αποτελεί απαραίτητη παράμετρο της νοσηλευτικής φροντίδας και έχει συσχετισθεί με θετικές εκβάσεις υγείας. ΣΚΟΠΟΣ της μελέτης ήταν η διερεύνηση των γνώσεων και πληροφοριών που αναμένουν να λάβουν οι ασθενείς που υποβάλλονται σε ΟΑ, των γνώσεων που λαμβάνουν, καθώς επίσης και του τρόπου που αυτές οι γνώσεις σχετίζονται με την ανάρρωση και την αποκατάστασή τους. ΜΕΘΟΔΟΛΟΓΙΑ: Πρόκειται για μία περιγραφική μελέτη επισκόπησης και συσχέτισης, με διαχρονική παρακολούθηση σε τρεις χρονικές στιγμές: πριν από την επέμβαση, κατά την έξοδο από το νοσοκομείο και έξι μήνες μετά. Τα εμπειρικά δεδομένα συλλέχθηκαν από ασθενείς που υποβλήθηκαν σε ΟΑ γόνατος ή ισχίου σε τρία Γενικά Νοσοκομεία της Αττικής. Τα εργαλεία συλλογής των δεδομένων που χρησιμοποιήθηκαν στη μελέτη ήταν το Ερωτηματολόγιο Προσδοκώμενης και Προσληφθείσας Γνώσης του ασθενή, η Κλίμακα Πρόσβασης στη Γνώση για τον ασθενή, η Κλίμακα Ποιότητας Ανάρρωσης του Ασθενή, το Ερωτηματολόγιο ποιότητας ζωής του ασθενή (EQ5D), η Κλίμακα Ικανοποίησης των Ασθενών από τη Φροντίδα Υγείας, η Κλίμακα του Πόνου του Ασθενή, μία λίστα ερωτήσεων σχετικών με τις επαφές του ασθενή μετά τη χειρουργική επέμβαση με επαγγελματίες υγείας και το συνολικό οικονομικό κόστος και το Ερωτηματολόγιο Απόψεων για την Υγεία Krantz. Σε όλη τη διάρκεια της μελέτης ακολουθήθηκαν οι αρχές της Διακήρυξης του Ελσίνκι (2004). Πραγματοποιήθηκε ανάλυση των δεδομένων με μεθόδους περιγραφικής στατιστικής και παραμετρικές δοκιμασίες. ΑΠΟΤΕΛΕΣΜΑΤΑ: Η μέση ηλικία των ασθενών του δείγματος ήταν 72,32 έτη. Στην πλειονότητά τους οι ασθενείς ήταν γυναίκες (71,3%), απόφοιτοι του δημοτικού ή λιγότερο (76,1%), χωρίς επαγγελματική εκπαίδευση (80,4%), συνταξιούχοι (57,9%), και με τουλάχιστον ένα χρόνιο νόσημα (65,1%). Επίσης, οι περισσότεροι ασθενείς υποβλήθηκαν σε ΟΑ γόνατος (60,3%) και για πρώτη φορά (67,5%). Οι ασθενείς παρουσίασαν υψηλές προσδοκίες για πρόσληψη γνώσεων, ιδιαίτερα στη λειτουργική και τη βιοσωματική διάσταση της εκπαίδευσης ενδυνάμωσης. Οι ανάγκες, όμως, των ασθενών για γνώση, όπως μετρήθηκαν με την Κλίμακα Προσληφθείσας Γνώσης κατά την έξοδό τους από το νοσοκομείο και στο διάστημα των έξι μηνών μετά την επέμβαση, δεν καλύφθηκαν επαρκώς. Περισσότερο καλύφθηκαν οι προσδοκίες των ασθενών στη λειτουργική και τη βιοσωματική διάσταση. Ανεξάρτητες μεταβλητές, όπως π.χ. η ηλικία, δεν συσχετίστηκαν με την Προσδοκώμενη και την Προσληφθείσα Γνώση των ασθενών, ενώ και το φύλο δεν συσχετίστηκε με τις προσδοκίες σχετικά με τη γνώση, αν και οι γυναίκες επιθυμούσαν περισσότερη εκπαίδευση σε σύγκριση με τους άνδρες. Ένα ενδιαφέρον εύρημα της μελέτης είναι ότι τα αποτελέσματα της Κλίμακας Απόψεων για την Υγεία Krantz δεν συσχετίστηκαν με την Προσδοκώμενη Γνώση και, επομένως, αν και οι ασθενείς στο συγκεκριμένο ερωτηματολόγιο έδειξαν παθητικότητα στην πρόσληψη πληροφοριών και στη συμμετοχή στη φροντίδα, προσδοκούσαν ωστόσο να λάβουν γνώσεις για τα ζητήματα της φροντίδας τους. Οι ασθενείς ήταν περισσότερο ικανοποιημένοι από τον επαγγελματισμό του νοσηλευτικού προσωπικού και με τη φροντίδα που έλαβαν, ενώ λιγότερο ικανοποιημένοι ήταν από το χρόνο που αφιέρωνε το νοσηλευτικό προσωπικό σε αυτούς. Οι ασθενείς που είχαν μεγαλύτερη πρόσβαση στη γνώση έλαβαν και περισσότερες γνώσεις. Οι Προσληφθείσες Γνώσεις των ασθενών συσχετίστηκαν, επίσης, με την ικανοποίηση των ασθενών από τη φροντίδα, δηλαδή οι ασθενείς που έλαβαν περισσότερες γνώσεις ήταν και περισσότερο ικανοποιημένοι από τη φροντίδα κατά την παραμονή τους στο νοσοκομείο. Τα αποτελέσματα στην Κλίμακα Ικανοποίησης από τη Φροντίδα και την Κλίμακα Πρόσβασης στη Γνώση συσχετίστηκαν με τον πόνο που βίωσαν οι ασθενείς κατά την παραμονή τους στο νοσοκομείο. Επίσης, υπήρξε συσχέτιση ανάμεσα στην Κλίμακα Πόνου και τις Προσληφθείσες Γνώσεις των ασθενών, δηλαδή οι ασθενείς που έλαβαν περισσότερες γνώσεις ανέφεραν πως και ο πόνος τους αντιμετωπίστηκε αποτελεσματικότερα. Αξίζει, τέλος, να σημειωθεί πως η ποιότητα της ζωής των ασθενών που οφείλεται στην υγεία βελτιώθηκε πολύ στο διάστημα των έξι μηνών μετά την επέμβαση, ενώ συσχετίστηκε στατιστικά σημαντικά με την Προσληφθείσα Γνώση στο διάστημα των έξι μηνών. ΣΥΜΠΕΡΑΣΜΑ: Οι ασθενείς στην παρούσα μελέτη έδειξαν ότι είχαν μεγάλες προσδοκίες για την εκπαίδευσή τους και ότι οι ανάγκες τους αυτές δεν καλύφθηκαν πλήρως, γεγονός που δυσκολεύει την ενδυνάμωσή τους. Παράλληλα, η εκπαίδευση του ασθενή αποτελεί σημαντική, ανεξάρτητη και εξατομικευμένη νοσηλευτική παρέμβαση και οι προσπάθειες για προαγωγή της είναι σίγουρο ότι θα συμβάλουν στην αναβάθμιση του ρόλου της Νοσηλευτικής στην ελληνική κοινωνία. Στο μέλλον είναι σημαντικό να προσφέρονται στους ασθενείς πολλές επιλογές σε ό,τι αφορά στην εκπαίδευση και η πρωτοβουλία πρέπει να ξεκινά από τους νοσηλευτές

Predictive factors for in-hospital stay and complications after hip fracture

Background: There are a number of factors, such as preoperative Length Of hospital Stay (LOS), that effect treatment outcomes following proximal hip fracture. Much of this is not completely understood. Objective: To determine whether co-morbidities, complications and patients' abnormal laboratory findings at admission have an effect on LOS and related complications during hospitalization for hip fracture treatment in a Greek hospital. Design: Prospective observational descriptive study. Setting: A high volume orthopedic ward of a general hospital in Greece, from March to October 2008. Patients: In total, 253 consecutive patients hospitalized for hip fracture treatment in an orthopedic ward of a large Greek hospital were included in the study. All complications, LOS and parameters of clinical history and treatment were recorded. Results: The mean age of the sample was 79.68. years. Only 29.3% of the patients were operated within the first 2. days, as the mean preoperative LOS was 3.71. days, leading to a total LOS of 9.68. days. Preoperative LOS increases somewhat in patients with heart failure and previous cerebrovascular accident. LOS increases when patients present with cardiac complications, respiratory complications, fever and anemia. Complications correlate with the type of patients' co-morbidities. Abnormal laboratory findings at admission correlate to the type of preoperative complications. Discussion: LOS, mortality and complication rates in the study hospital are comparable to the findings reported in the literature. © 2011 Elsevier Ltd

Diabetes-Related Distress and Associated Characteristics in Patients With Type 2 Diabetes in an Urban Primary Care Setting in Greece

Background: Diabetes-related distress (DRD) is a common psychological issue of people living with diabetes. International guidelines advise to take DRD into consideration in diabetes care but evidence for Greece is scarce. In the present study we aimed to estimate the frequency of DRD as assessed by Diabetes Distress Scale (DDS) and to examine its connections with clinical and sociodemographic characteristics among patients with type 2 diabetes mellitus (T2D) in urban primary care (PC) in Greece. Methods: This descriptive survey included adults with a diagnosis of T2D of at least six months under medication treatment attending a novel, public urban PC unit. Patients with other forms of diabetes, dementia, and psychosis were excluded. Patients were screened for DRD with DDS instrument and correlations were made between DRD and clinical and sociodemographic characteristics. Results: In 135 eligible participants the frequency of moderate to high levels of DRD (DDS ≥ 2) was 24.4% and of high levels of DRD (DDS ≥ 3) was 7.4%. Emotional burden (EB) subscale was significantly correlated with younger age, insulin use, duration of insulin use, and the number of insulin injections per day. Longer diabetes duration showed significant correlation with DDS total, EB, and regimen distress. Participants with lower income, sedentary lifestyle, micro-vascular complications, more episodes of hypoglycaemia, and higher levels of glycated haemoglobin (HbA1c) experienced significantly higher distress. Conclusion: DRD screening is important in urban PC and in more susceptible patients as those on more insulin injections per day, with longer diabetes duration, higher levels of HbA1c, lower income, sedentary lifestyle, and more episodes of hypoglycaemia. © The Author(s) 2020

Use of ASEPSIS scoring method for the assessment of surgical wound infections in a Greek orthopaedic department

Background: In Greece there is no systematic assessment of surgical wounds with the use of a validated instrument, while the ASEPSIS scoring method has been widely used internationally. Aim: To examine the frequency of wound infections and their correlations both with patient background factors, as well as surgery factors, with the use of ASEPSIS. Methods: In this prospective, observational study, participants undergoing orthopaedic surgeries in a large hospital in Greece were assessed during hospitalisation and the first month after discharge using the ASEPSIS wound assessment tool. The principles of the Declaration of Helsinki were applied. Non-parametric statistical analyses were performed using SPSS 20.0. Results: In total, 111 patients participated; nearly half (49.5%) had a total ASEPSIS score of “0”. Almost 3 out of 4 patients (76.6%) had an ASEPSIS score under or equal to “10” (satisfactory healing) and only 3.6% had a minor or severe surgical wound infection. The ASEPSIS score was only positively correlated to longer surgery duration and longer postoperative stay. Discussion: The frequency of surgical wound infections in orthopaedic patients in Greece is comparable to that described in the literature. ASEPSIS could be used for assessing patients and as a performance indicator in Greek orthopaedic departments. © 2018 Elsevier Lt

Health-related quality of life of patients with severe heart failure: A cross-sectional multicentre study

Background: Heart failure is a serious chronic syndrome that is accompanied by significant physical and psychological burdens, resulting in poor quality of life. Aim: To assess the quality of life of patients with severe heart failure and its correlation with patient demographic, socio-economic and clinical characteristics. Method: We studied 199 patients with heart failure who were hospitalized in the Cardiology Department of three general hospitals of Greece during a 1-year period. Demographic and socio-economic data were obtained using a short questionnaire, while clinical data were obtained from medical record review. The assessment of the patients' quality of life was performed using Minnesota Life with Heart Failure Questionnaire (MLWHFQ). Findings: The mean MLWHFQ score was 62.7 (±20.3). Significantly lower quality of life was found in patients with diabetes mellitus (Coefficient beta (β) = 11.4; 95% Confidence Interval (CI), 5.2-17.5), hypertension (β = 10.3; CI, 1.4-19.1), chronic renal failure (β = 13.9; CI, 5.9-21.9), chronic respiratory failure (β = 11.2; CI, 4.7-17.7), cancer (β = 12.3; CI, 2.3-22.4), psychiatric disease (β = 10.5; CI, 0.6-20.4) and those patients who were classified in New York Heart Association class IV (β = 10.6, CI = 4.1-17.0). Conclusions: The average score of the MLWHFQ was high, and this reflects the poor quality of life of patients. Higher scores in specific patient groups show the negative influence of these factors in quality of life. The holistic care of patients with heart failure by a multidisciplinary team of healthcare professionals could improve their quality of life. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science

Emotions of orthopaedic arthroplasty patients a european survey

METHODS: This was a pre/post-observational study examining patients' emotions before and during elective knee or hip replacement surgery for osteoarthritis in seven European Union countries to identify factors related to better emotional status at discharge. INSTRUMENTS: In addition to demographic data, information was collected on quality of life (EuroQoL five-dimension questionnaire), hospital expectations (Knowledge Expectations of Hospital Patients Scale), symptoms, and experienced emotions. ANALYSIS: Total negative emotions scores at baseline and discharge were transformed into median values. Multivariate analysis identified the baseline factors related to better emotional status at discharge. RESULTS: Patients (n = 1,590), mean age 66.7 years (SD = 10.6), had a significant reduction in the frequency of total negative emotions at discharge as compared with baseline. The multivariate model showed better health status (odds ratio [OR] = 1.012; p = .004), better emotional status at baseline (≥24 points), and shorter duration of hospital stay (OR = 0.960; p = .011) as independent factors associated with better emotional status at discharge (OR = 4.297; p = .001). CONCLUSIONS: Patients undergoing elective knee or hip replacement surgery for osteoarthritis improve their emotional status during hospitalization, with fewer negative emotions at discharge. Good emotional status, feeling of higher health status at baseline, and shorter hospitalization were independently associated with better emotional status at discharge. © 2020 Lippincott Williams and Wilkins. All rights reserved