Postoperative Outcomes of Hip Fracture Surgery in Geriatric Patients on Clopidogrel or Warfarin at the Time of Surgery

BACKGROUND: The purpose of our study is to evaluate if surgical intervention in the setting of an elevated INR or continued use of clopidogrel lead to elevated post-operative mortality and/or morbidity compared to INR reversal or surgical delay. METHODS: We retrospectively reviewed 1,007 patients age \u3e 55 undergoing hip fracture fixation at our institution over a 10 year span. We placed patients into four groups based upon their anticoagulation status at the time of surgery. Descriptive statistics were utilized to evaluate for differences in mortality rates, blood loss, time to surgery, and wound complications. RESULTS: Comorbid conditions occurred at a higher rate in patients on an anticoagulant. There was found to be no difference (p\u3e.05) between all four groups in regards to units of blood transfused, net preoperative to post-operative hemoglobin change, 30 day mortality, wound infections, and post-operative thromboembolic events. Average time to surgery was less than two days for all groups. CONCLUSION: There was no statistically significant increase in local or systemic complications in patients who underwent surgery in the setting of an INR \u3e 1.5 or continued use of clopidogrel. Our study supports the finding that appropriate and attentive management of anticoagulants from the time of admission can minimize surgical delays and result in time to surgery in less than two days for patients with an elevated INR at the time of presentation with no effect on mortality or morbidity

Identifying Risk Factors for Significant Hyponatremia during Vasopressin Administration in Neonates

https://digitalcommons.unmc.edu/surp2023/1011/thumbnail.jp

Immediate vs Delayed Feedback in a Progressive Musculoskeletal E-module Case for Clinical Reasoning Development

PURPOSE: Educators are responsible for developing clinical reasoning skills in Physical Therapy (PT) students. Simulated virtual experiences allow specific skills, such as clinical reasoning, to be learned and tested (Holdsworth, 2016). PT students prefer a combination of learning from e-modules and lecture formats (Gardner, 2016). Feedback is a critical component for consolidated learning; however, there is no consensus on the best timing of feedback (Schute, 2008). The purpose was to evaluate the impact of immediate versus delayed feedback through an e-module in PT students\u27 accuracy in identifying the primary hypothesis, severity and irritability level for a virtual patient case. The secondary aim was to examine the longitudinal impact of the e-module by looking at the same outcome measures after a standardized patient (SP) simulation in addition to overall course grade METHODS: The e-module was designed to facilitate clinical reasoning by asking students to generate a hypothesis for the clinical case scenario, with subjective and objective examination results, then to determine the patient\u27s level of severity and irritability. Second year entry-level PT students were randomized to either receive immediate feedback throughout the case, or delayed feedback at the conclusion of the e-module. Fisher’s exact test was utilized to detect any difference between feedback groups’ performance on the e-module, SP simulation, or course grade, as well as any student demographic differences between groups. Students rated and qualitatively commented on satisfaction on learning activity. RESULTS: 53 students gave consent and participated in the study. There was no statistical difference between age, ethnicity, and prior experience between feedback groups. (p\u3e.05). Women were overrepresented in the immediate feedback group (p=.0473). There was no statistical association for identifying the correct hypothesis, severity, or irritability ratings between feedback groups for the e-module and SP simulation or between course grade performance and feedback group assignment. (p\u3e.05). The average student evaluation score was 8.59/10 on a scale (1 “not helpful at all” and 10 “incredibly helpful”) and qualitative comments were positive regardless of feedback timing. Students commented that the open-ended format of the hypothesis development questions challenged them more than a traditional multiple-choice exam format. CONCLUSIONS: Based on the results, the timing of feedback had no effect on outcomes in 2nd year PT students. Students in both groups valued the opportunity to learn and assess their clinical reasoning skills within the e-module. As students prepare for clinical practice, reducing the frequency of feedback allows students to test their knowledge, in a low-stakes environment, to help prepare for situations where they will not have immediate feedback available. More opportunities for students to practice clinical reasoning at their own pace, in a digital medium that is appealing to this generation of digital natives, could be valuable for preparing students for clinical education. UNMC E-Learning Gallery link to the immediate feedback version of the e-module: https://go.unmc.edu/elearning_immediate-feedbac

Determinants of Facilitated Health Insurance Enrollment for Patients With HIV Disease, and Impact of Insurance Enrollment on Targeted Health Outcomes.

BACKGROUND: The introduction of the Affordable Care Act (ACA) has provided unprecedented opportunities for uninsured people with HIV infection to access health insurance, and to examine the impact of this change in access. AIDS Drug Assistance Programs (ADAPs) have been directed to pursue uninsured individuals to enroll in the ACA as both a cost-saving strategy and to increase patient access to care. We evaluated the impact of ADAP-facilitated health insurance enrollment on health outcomes, and demographic and clinical factors that influenced whether or not eligible patients enrolled. METHODS: During the inaugural open enrollment period for the ACA, 284 Nebraska ADAP recipients were offered insurance enrollment; 139 enrolled and 145 did not. Comparisons were conducted and multivariate models were developed considering factors associated with enrollment and differences between the insured and uninsured groups. RESULTS: Insurance enrollment was associated with improved health outcomes after controlling for other variables, and included a significant association with undetectable viremia, a key indicator of treatment success (p \u3c .0001). We found that minority populations and unstably housed individuals were at increased risk to not enroll in insurance. CONCLUSION: The National HIV/AIDS Strategy calls for new interventions to improve HIV health outcomes for disproportionately impacted populations. This study provides evidence to prioritize future ADAP-facilitated insurance enrollment strategies to reach minority populations and unstably housed individuals

Rural–Urban Otolaryngologic Observational Workforce Analysis: The State of Nebraska

Objective To analyze the rural–urban access to otolaryngology (OHNS) care within the state of Nebraska. Design Cross-sectional study. Methods Counties in Nebraska were categorized into rural versus urban status based upon the 2013 National Center for Health Statistics urban–rural classification scheme with I indicating most urban and VI indicating most rural. The information on otolaryngologists was gathered utilizing the Health Professions Tracking System. Otolaryngologists were categorized based on the county of their primary and outreach clinic location(s). Travel burden was estimated using census tract centroid distance to the nearest clinic location, aggregated to county using weighted population means to determine the average county distance to the nearest otolaryngologist. Results Nebraska is a state with a population of 1.8 million people unequally distributed across 76,824 square miles, with rural counties covering 2/3 of the land area. Nebraska has 78 primary OHNS clinics and 70 outreach OHNS clinics distributed across 93 counties. More than half (54.8%) of the counties in Nebraska lacked any OHNS clinic. Overall, a statistically significant difference was found when comparing mean primary OHNS per 100,000 population and mean miles to a primary OHNS clinic with Level III counties being 5.17 linear miles from primary OHNS compared to Level V counties being 29.94 linear miles. Conclusion Overall, a clear discrepancy between rural and urban primary OHNS clinics in Nebraska can be seen visually and statistically with rural Nebraskans having to travel at least 5.5 times farther to primary OHNS clinics when compared to urban Nebraskans

Virtual Reality For Therapeutic Recreation In Dementia Hospice Care: A Feasibility Study

Purpose Feasibility study to explore virtual reality (VR) via wireless goggles as a therapeutic recreation for people with dementia on hospice (hPWD) To explore the acceptability of VR to hPWD To identify any problems and/or benefits associated with using VR as a form of therapeutic recreation in hPWD on hospicehttps://digitalcommons.unmc.edu/emet_posters/1002/thumbnail.jp