Older hip fracture patients: three groups with different needs

BACKGROUND: Norway, and particularly Oslo, has the highest reported incidence of hip fractures in the world. It is increasingly common to care for older hip fracture patients in orthogeriatric units where orthopaedic care is combined with interdisciplinary geriatric care. The characteristics and needs of older hip fracture patients are poorly described. The aim of this paper is to describe the characteristics of these patients in order to better understand their need for care and rehabilitation. METHODS: This is an observational study based on a quality register for all patients 65+ years in an orthogeriatric unit who are operated for a hip fracture. The unit covers 250,000 inhabitants in Oslo. Patient data were collected in the aim of quality control. The quality database includes demographic, medical, and functional data collected from routine assessment by the interdisciplinary team. RESULTS: From January 2007 to September 2009, 1010 patients, included 241 (24%) from long-term care institutions, were enrolled in the database. Mean age was 85.1 years (SD 7.1), 76% were female, and 83% had experienced an indoor fall. Chronic diseases were registered in 88%, and 38% of the community-dwelling patients had pre-fracture cognitive impairment defined as IQCODE-SF > 3.6. Complications were observed in 51% of the patients, of which the most common were a need for blood transfusion, delirium, and urinary tract infections. Post-operative orthopaedic infections were rare (3.1%). Patients from long-term care were older, (87 vs. 84 years, p < 0.001), more had American Society of Anaesthesiologists (ASA) score >/= 3 (67% vs. 48%, p < 0.001) and a higher number of chronic medical conditions (mean 2.2 vs. 1.6, p < 0.001). Among community-dwelling patients, those who had fallen indoors were older, more often female, had ASA score >/= 3, chronic medical conditions, impairment in pre-fracture ADL and cognitive function, and more complications during hospital stay. CONCLUSIONS: Older hip fracture patients in this orthogeriatric unit may be divided into three groups; patients who are relatively fit and have experienced outdoors falls (17%), frail community-dwelling patients who have fallen indoors (59%), and patients from long-term care institutions (24%). Different caring pathways are needed for these groups

Photochromic mechanism in oxygen-containing yttrium hydride thin films: An optical perspective

Oxygen-containing yttrium hydride thin films exhibit photochromic behavior: Transparent thin films reversibly switch from a transparent state to a photodarkened state after being illuminated with UV or blue light. From optical spectrophotometry and ellipsometry measurements of the transparent state and photodarkened state, it is concluded that the photochromic effect can be explained by the gradual growth, under illumination, of metallic domains within the initial wide-band-gap semiconducting lattice. This conclusion is supported by Raman measurements

Detectability of the degree of freeze damage in meat analytic-tool depends on selection

Novel freezing solutions are constantly being developed to reduce quality loss in meat production chains. However, there is limited focus on identifying the sensitive analytical tools needed to directly validate product changes that result from potential improvements in freezing technology. To benchmark analytical tools relevant to meat research and production, we froze pork samples using traditional (−25 °C, −35 °C) and cryogenic freezing (−196 °C). Three classes of analyses were tested for their capacity to separate different freeze treatments: thaw loss testing, bioelectrical spectroscopy (nuclear magnetic resonance, microwave, bioimpedance) and low-temperature microscopy (cryo-SEM). A general effect of freeze treatment was detected with all bioelectrical methods. Yet, only cryo-SEM resolved quality differences between all freeze treatments, not only between cryogenic and traditional freezing. The detection sensitivity with cryo-SEM may be explained by testing meat directly in the frozen state without prior defrosting. We discuss advantages, shortcomings and cost factors in using analytical tools for quality monitoring in the meat sector

Editorial: Semantic Algorithms in the Assessment of Attitudes and Personality

Editorial on the Research Topic Semantic Algorithms in the Assessment of Attitudes and Personalit

The bodily presence of significant others: Intensive care patients' experiences in a situation of critical illness

This study is about intensive care patients and the bodily presence of significant others. The aim of the study is to inquire and understand the patients experience of the body in relation to their significant others during critical illness. Open, unstructured, in-depth interviews with six former intensive care patients provide the data for the study. The phenomenological–hermeneutical analysis points to a theme among ICU patients' experience of conflict between proximity and distance during the bodily presence of their relations. Patients experience different and conflicting forms of responses to the presence of their significant others. Patients experience significant positive confirmation but also negation through this presence. In the ICU situation, the reactions of significant others appear difficult to deal with, yet the physical presence is significant for establishing a sense of affinity. Patients seek to take some responsibility for themselves as well as for their relatives, and are met with a whole spectrum of reactions. Intensive care patients experience the need to be actively, physically present, which often creates sharp opposition between their personal needs and the needs of their significant others for active participation

The implications of autonomy: Viewed in the light of efforts to uphold patients dignity and integrity

This article focuses on Danish patients’ experience of autonomy and its interplay with dignity and integrity in their meeting with health professionals. The aim is to chart the meanings and implications of autonomy for persons whose illness places them in a vulnerable life situation. The interplay between autonomy and personal dignity in the meeting with health care staff are central concepts in the framework. Data collection and findings are based on eight qualitative semi-structured interviews with patients. Patients with acute, chronic, and life threatening diseases were represented including surgical as well as medical patients. The values associated with autonomy are in many ways vitalising, but may become so dominant, autonomy seeking, and pervasive that the patient's dignity is affected. Three types of patient behaviour were identified. (1) The proactive patient: Patients feel that they assume responsibility for their own situation, but it may be a responsibility that they find hard to bear. (2) The rejected patient: proactive patients take responsibility on many occasions but very active patients are at risk of being rejected with consequences for their dignity. (3) The knowledgeable patient: when patients are health care professionals, the patient's right of self-determination was managed in a variety of ways, sometimes the patient's right of autonomy was treated in a dignified way but the opposite was also evident. In one way, patients are active and willing to take responsibility for themselves, and at the same time they are “forced” to do so by health care staff. Patients would like health professionals to be more attentive and proactive

Insects as Stem Engineers: Interactions Mediated by the Twig-Girdler Oncideres albomarginata chamela Enhance Arthropod Diversity

Background: Ecosystem engineering may influence community structure and biodiversity by controlling the availability of resources and/or habitats used by other organisms. Insect herbivores may act as ecosystem engineers but there is still poor understanding of the role of these insects structuring arthropod communities. Methodology/Principal Findings: We evaluated the effect of ecosystem engineering by the stem-borer Oncideres albomarginata chamela on the arthropod community of a tropical dry forest for three consecutive years. The results showed that ecosystem engineering by O. albomarginata chamela had strong positive effects on the colonization, abundance, species richness and composition of the associated arthropod community, and it occurred mainly through the creation of a habitat with high availability of oviposition sites for secondary colonizers. These effects cascade upward to higher trophic levels. Overall, ecosystem engineering by O. albomarginata chamela was responsible for nearly 95 % of the abundance of secondary colonizers and 82 % of the species richness. Conclusions/Significance: Our results suggest that ecosystem engineering by O. albomarginata chamela is a keystone process structuring an arthropod community composed by xylovores, predators and parasitoids. This study is the first to empirically demonstrate the effect of the ecosystem engineering by stem-boring insects on important attributes o

Der Konflikt in Afghanistan : Historischer und gesellschaftlicher Hintergrund, Evolution und Lageentwicklung – ein Positionspapier

This study is part of a larger project, the aim of which is to elucidate “mental health nurses” attitudes towards their patients'. In this study, nurses' and patients' attitudes are described from the perspective of both parties using a qualitative approach. The informants were selected from a rehabilitation unit for young adults, below 40, suffering from psychosis at a psychiatric clinic that provides acute psychiatric care. The informant group consisted of three dyads: three patients with various diagnoses and three nurses with primary responsibility for the patients' daily care. The aim of this particular study was to extend our preliminary understanding of nurses' attitudes towards psychiatric patients in the context of psychiatric in-patient care, by elucidating the patient's “inner” picture of her/his past, present and future and the nurse's picture of the same patient's past, present and future. Data were collected and analysed using a phenomenological-hermeneutic approach and the narrative picturing technique. For each picture and group, 15 related sub-themes emerged, on the basis of which six themes were formulated. The findings show that the nurses overrate their own importance when it comes to the patient's well-being on the ward. All the nurses emphasize confirmation and safety as the basis of their nursing care, while in the patient's picture the nurses represent a replication of childhood demands, which probably means that nursing care risks becoming a continuation of the patient's childhood estrangement