Integrated nutritional intervention in the elderly after hip fracture. A process evaluation

SummaryBackground & aimsWithin a multicentre randomized controlled trial aimed at improving the nutritional status and increase the speed of recovery of elderly hip fracture patients, we performed a process evaluation to investigate the feasibility of the intervention within the present Dutch health care system.MethodsPatients in the intervention group received nutritional counseling during 10 contacts. Oral nutritional supplements were advised as needed until three months after hip fracture surgery. The intervention was evaluated with respect to dieticians’ adherence to the study protocol, content of nutritional counseling, and patients’ adherence to recommendations given.ResultsWe included 66 patients (mean age of 76, range 55–92 years); 74% women. Eighty-three percent of patients received all 10 contacts as planned, but in 62% of the patients one or more telephone calls had to be replaced by face to face contacts. Nutritional counseling was complete in 91% of contacts. Oral nutritional supplementation was needed for a median period of 76 days; 75% of the patients took the oral nutritional supplements as recommended.ConclusionsNutritional counseling in elderly hip fracture patients through face to face contacts and telephone calls is feasible. However, individual tailoring of the intervention is recommended. The majority of hip fracture patients needed >2 months oral nutritional supplements to meet their nutritional requirements.The trial was registered at clincialtrails.gov as NCT00523575

Patients’ perceived health information needs in inflammatory arthritis: A systematic review

Objectives: To identify the breadth of the literature regarding patients’ perceived health information needs related to inflammatory arthritis care. Methods: A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO was performed to identify relevant articles (1990 -2016) examining patients’ perceived needs relating to health information in inflammatory arthritis. Data and themes were identified and categorised and risk of bias assessed. Results: Twenty nine studies (11 quantitative, 14 qualitative and 4 mixed methods) from 4121 identified articles were relevant for inclusion. Most focussed on rheumatoid arthritis. Key findings included: (1) Reasons for seeking health information often focussed on gaining ownership over their condition and facilitating self-management. (2) Demographic differences in information needs were inconsistent, but women and younger patients generally reported more needs. (3) Desired information content was broad, and included targeted and practical information covering disease treatment and psychosocial wellbeing. (4) Preferred information delivery method was consultation with a Rheumatologist; however group sessions had advantages for psychosocial issues while written information provided useful supplementation. (5) Barriers to meeting health information needs were around timely access. Conclusions: Patients with inflammatory arthritis have high information needs, desiring practical and individualised information. When developing strategies to meet patients’ information needs, aligning patient expectations with delivery methods that are accessible, cost-effective and flexible may help to optimize patient outcomes

Efficacy and cost-effectiveness of nutritional intervention in elderly after hip fracture: design of a randomized controlled trial

Background: Hip fracture patients often have an impaired nutritional status at the time of fracture, which can result in a higher complication rate, prolonged rehabilitation time and increased mortality. A study was designed to evaluate the effect of nutritional intervention on nutritional status, functional status, total length of stay, postoperative complications and cost-effectiveness. Methods: Open-labelled, multi-centre, randomized controlled trial in hip fracture patients aged 55 years and above. The intervention group receives dietetic counselling (by regular home visits and telephone calls) and oral nutritional supplementation for three months after surgery. The control group receives usual dietetic care as provided by the hospital. Outcome assessment is performed at three and six months after hip fracture. Discussion: Patient recruitment has started in July 2007 and has ended in December 2009. First results are expected in 2011. Trial registration: ClinicalTrials.gov NCT00523575Mechanical, Maritime and Materials Engineerin

Fast Track Program in Conversion Bariatric Surgery, as Safe as in Primary Bariatric Surgery?

Objectives Evaluate the safety of fast track (FT) surgery program in patients undergoing primary and revisional bariatric surgery (conversion from one procedure to another); identify limiting factors for early discharge and predictive factors for readmission. Methods This is a retrospective review of 730 consecutive morbidly obese patients who underwent bariatric surgery between January 2016 and December 2017. Fast track protocol was applied on all patients. Target discharge was after one-night stay. The primary end point is length of stay. The secondary end point is frequency of hospital contact after discharge, readmissions and reinterventions within 30 days. Results Primary procedures (n = 633) were banded Roux-en-Y gastric bypass (BRYGB, 79.3%), sleeve gastrectomy (10.7%), gastric band (4.7%) and others (5.3%). Mean age (+/- SD) was 44.32 +/- 11.26 years, and mean BMI (+/- SD) was 43.58 +/- 6.12 kg/m(2). Conversion procedures (n = 97) were gastric band to BRYGB (40.2%), or to adjustable BRYGB (39.2%), Mason to BRYGB (11.3%), sleeve to BRYGB (4.1%) and others (5.2%). Mean age (+/- SD) was 47.22 +/- 9.1 years, and mean BMI (+/- SD) was 37.9 +/- 7.27 kg/m(2). Mean LOS in primary patients was 1.3 +/- 0.99, and that in conversion patients was 1.5 +/- 1.4. Successful discharge at one night or less was achieved in 650 cases (573 primary and 77 conversion). After one-night discharge, incidence of contact to the hospital, readmission and reintervention was 23.9%, 5.9% and 1.9%, in the primary group and 31.2%, 13% and 5.2% in the conversion group. Conclusion One-night discharge in FT managed conversion procedures is safe, compared to primary procedures. It is associated with higher readmission rates; however, the postdischarge hospital contacts and surgical complications were not statistically significant different.</p

Surgical treatment of acromioclavicular dislocation associated with midshaft fracture of the ipsilateral clavicle

Acromioclavicular dislocation combined with a midshaft clavicle fracture is a rare traumatic shoulder problem. Various treatment options have been described in literature. We describe a new technique using a hook plate and coracoclavicular sling to replace the ruptured coracoclavicular ligaments in combination with plate osteosynthesis of the clavicle fracture. Furthermore, we provide a short overview of the few cases described in literature and their treatment options.

Conversion of Adjustable Gastric Banding to Adjustable Banded Roux-en-Y Gastric Bypass:Should We Leave the Band in Place?

Objective Laparoscopic adjustable gastric banding (LAGB) is rapidly becoming a deprecated bariatric procedure due to disappointing weight loss results and a high rate of band intolerance. Conversion to Roux-en-Y gastric bypass is a common revisional procedure after failed LAGB. The aim of this study was to evaluate the feasibility, safety, and risk profile of conversion to adjustable banded Roux-en-Y gastric bypass (ABRYGB).Methods A retrospective patient file review of all consecutive laparoscopic conversions of LAGB to ABRYGB 2008-2017. Pre/perioperative data, weight change, and long-/short-term complications were retrieved.Results Study population 98 patients. Mean BMI before revision was 40,15 kg/m(2). Most revisional procedures were performed for band intolerance and/or weight regain or weight loss failure. All procedures were performed laparoscopically. During follow-up, 16 bands had to be removed due to one of the following reasons: infection, anastomotic leakage, anastomotic peptic perforation, adhesions around the anastomosis, internal hernia around the tubing, adhesions to the tubing, tubing failure, and erosion of the band. Three of those bands were replaced with a non-adjustable Silastic (Minimizer) ring. In total, issues with tubing requiring an intervention were found in 20 patients after conversion to ABRYGB. Seven revisional procedures had to be performed for symptomatic internal hernias not related to the tubing and incidental internal hernias were found in another 7 procedures.Conclusion Although conversion of LAGB to ABRYGB is technically feasible, initially well-tolerated, and has good weight loss results, the number of additional procedures during follow-up is rather high, suggesting that leaving the band in place should not be advised.</p