Improving the Pharmacologic Management of Patients after Osteoporotic Hip Fractures

Abstract Background Osteoporotic hip fractures have become an increasingly common healthcare burden with significant morbidity and mortality in the geriatric population. Pharmacological management of the underlying osteoporosis is critical. Our objective is to determine the percentage of patients older than 65 who receive pharmacologic treatment of osteoporosis within six months after a fragility fracture at Cabell Huntington Hospital. Methods Data was extracted from medical records for patients age 65 or older who sustained a hip fracture during June 2013 - March 2015. Patients who received any form of pharmacologic treatment within six months after their fractures were identified. All analyses were performed using SAS version 9.3 (SAS Institute, Cary, North Carolina). Results Among the 193 patients who met the inclusion criteria, 26% (n=50) received pharmacologic treatment within six months after fracturing versus 74% (n=143) who did not receive any type of pharmacologic therapy after the fracture. Female was the predominant gender in pharmacologic treatment group (74% vs 71%). Mean age was 81 years old in both groups (81±9 vs 82±8), mean BMI was 25 in both groups (25±5 vs 25±6). There was no significant difference in pharmacologic management when the patients were stratified according to age group. Conclusion Patients were pharmacologically undertreated after an osteoporotic hip fracture, regardless of the age of fracture presentation. Due to potential benefits of pharmacologic treatment after osteoporotic hip fracture, treatment should be initiated prior to discharge, if possible. If this is not feasible for the patient, specific and detailed instructions should be given to the patient’s primary care physician, or endocrinologist if medically complicated, for initiating therapy and proper management of the patient

Optimizing quality of care by patient satisfaction for the department of Orthopaedics - A survey study

Introduction: Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) has provided a standardized survey method in order to evaluate the patient’s satisfaction on the care they are provided. While overall patient satisfaction is clearly a multidimensional concept, the HCAHPS survey covers 8 domains of health care. This study tries to identify and establish the main determinants to patient’s level of satisfaction during their visit to Cabell Huntington Hospital Orthopaedics department. Methods: Data was collected from surveys handed in 3 consecutive months; June, July and August of 2013. Sixteen questions were selected from HCAHPS that were appraised to be relevant for the use in orthopaedics department. The main dependent questions that allowed patients to rate their overall satisfaction were (1) how much is the patient likely to recommend the department is and (2) how would they rate their overall satisfaction in their visits. We then studied each of the other 14 questions (independent questions) the patients were made to answer and how much they determined the overall patient satisfaction. We also divided the questionnaire into those questions the health care provider had control over (modifiable) and those where that were not under their control (non-modifiable). Data was then gathered and step-wise multi variable regression analysis was performed. All analyses were performed using SAS version 9.3. Results: 1138 patients answered the survery. The independent questions that had the maximum impact on the overall patient satisfaction was whether the nurses treated them with respect (OR = 11.5, 95% CI 3.1-43.12. Conclusion: We determined that how the nurses treat the patients and whether the doctors listened to their patients carefully had the highest impact on determining patient’s overall satisfaction and their likelihood of recommending the doctors to their relatives or friends respectively. Our study depicts the patients’ experience of their visit to the orthopedic office is dependent on a variety of factors, which can be modified by the healthcare providers in order to improve the patient’s satisfaction

Trauma Team Activation for Geriatric Trauma at a Level II Trauma Center: Are the Elderly Under-triaged?

Abstract Geriatric patients often sustain life-threatening injuries from minor trauma. A growing body of research suggests that these patients are often under-triaged in the emergency setting.The purpose of this research was to evaluate whether or not geriatric trauma patients are under-triaged at a community based level II trauma center. 1434 trauma patients over the age of 65 presenting from 2010-2015 were retrospectively reviewed from the Cabell Huntington Hospital trauma registry and analyzed for age, gender, arrival type, ED response, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), injury cause, ICD-9 diagnosis codes, and mortality. Under-triage and over-triage rates were determined using the Cribari method (under-triage = ISS ≥ 16 without full trauma team activation [TTA]; Over-triage = ISS ≤ 15 with full TTA). The under-triage rate was 9.5% (132/1393) with the majority of under-triaged patients having head trauma (n=423). There were 371 head trauma patients with a recorded GCS and analysis shows those with a GCS ≥ 13 had a 1.2% mortality risk (n=326; ISS 10.2), but that risk drastically increases to 60% with GSC ≤ 12 (n=45; ISS 21.5). Of the 45 patients with GSC ≤ 12, only 4% had priority 1 TTA using the current protocol (2/45). The American College of Surgeons-Committee of Trauma (ACS-COT) recommends an acceptable under-triage rate of \u3c 5%. In order to improve geriatric care and reduce under-triage rates, we recommend that an age-based criteria be added to our TTA protocol at our community based Level II trauma center: priority 1 TTA for all patients 65 years or older sustaining head trauma with a GCS ≤ 12 or suspicion of intracranial hemorrhage

Improving the Pharmacologic Management of Patients after Osteoporotic Hip Fractures

Background Osteoporotic hip fractures have become an increasingly common healthcare burden with significant morbidity and mortality in the geriatric population. Pharmacological management of the underlying osteoporosis is critical. Our objective is to determine the percentage of patients older than 65 who receive pharmacologic treatment of osteoporosis within six months after a fragility fracture at Cabell Huntington Hospital. Methods Data was extracted from medical records for patients age 65 or older who sustained a hip fracture during June 2013 - March 2015. Patients who received any form of pharmacologic treatment within six months after their fractures were identified. All analyses were performed using SAS version 9.3 (SAS Institute, Cary, North Carolina). Results Among the 193 patients who met the inclusion criteria, 26% (n=50) received pharmacologic treatment within six months after fracturing versus 74% (n=143) who did not receive any type of pharmacologic therapy after the fracture. Female was the predominant gender in pharmacologic treatment group (74% vs 71%). Mean age was 81 years old in both groups (81±9 vs 82±8), mean BMI was 25 in both groups (25±5 vs 25±6). There was no significant difference in pharmacologic management when the patients were stratified according to age group. Conclusion Patients were pharmacologically undertreated after an osteoporotic hip fracture, regardless of the age of fracture presentation. Due to potential benefits of pharmacologic treatment after osteoporotic hip fracture, treatment should be initiated prior to discharge, if possible. If this is not feasible for the patient, specific and detailed instructions should be given to the patient’s primary care physician, or endocrinologist if medically complicated, for initiating therapy and proper management of the patient

Orthopaedic Surgeon Density in West Virginia

Abstract West Virginia (WV) has many healthcare disparities and access barriers. For bone and joint disorders, WV has some of the highest rates of musculoskeletal problems, including the highest reported rate of adult arthritis in the nation (36.2%). We hypothesized that WV has one of the lowest Orthopaedic surgeon densities in the country, which can negatively impact the delivery of musculoskeletal care. Using the WV Board of Medicine practitioner databank, the Veterans Administration practitioner data, and national Orthopaedic surgeon census data, we demonstrated a considerably low Orthopaedic surgeon density in WV (7.71/100,000 population versus the national average of 8.51/100,000 population) with 54% of our counties (n=30) having no Orthopaedic surgeons. This data is currently being used to further determine the appropriate allocation of resources to help improve access to specialized orthopaedic care for our state

Cellular Senescence and Their Role in Liver Metabolism in Health and Disease: Overview and Future Directions

Chronic liver disease has globally risen mainly due to a prevalent hepatitis C virus (HCV) infection rate and an epidemic of obesity. It is estimated by the year 2030, 2.2 billion people around the world will be overweight and 1.1 billion people will be obese. Diabetes and obesity are the main risk factors for the development of the metabolic syndrome and in the liver of non-alcoholic fatty liver disease (NAFLD) which could progress to non-alcoholic fatty steatohepatitis (NASH) related cirrhosis and liver malignancy. At present there is not effective therapy for NASH besides loss of weight and exercise. Furthermore, optimal management of HCC with curative intent includes resection or liver transplantation. Nevertheless, these therapies are limited because the degree of liver dysfunction or the medical conditions at the time of diagnosis and the scarcity of available liver grafts. The role of cellular lipid management and metabolism in human health and disease is taking a center stage. The present overview articulates the current pathophysiology of fatty liver disease under the aging processes, potential biological markers of liver disease diagnosis and progression and future therapies

Pyomyositis mistaken for septic hip arthritis in children: the role of MRI in diagnosis and management

Septic arthritis is an orthopaedic emergency which requires timely management to prevent joint destruction and poor outcome. Differentiating septic arthritis from transient synovitis in pediatric patients is aided by the use of Kocher criteria which have excellent sensitivity but lack specificity. In addition to these two disorders, primary pyomyositis is bacterial infection of skeletal muscle that most commonly affects children. Patients present with pain, swelling, fever, and elevated inflammatory markers which mimics septic arthritis. If left untreated, pyomyositis can lead to abscess formation and sepsis. Due to potential for nearly identical presentations of septic arthritis and pyomyositis, differentiation of these two disorders can be aided with the use of MRI which has a high sensitivity for detecting muscle edema and abscess formation. In this case series, we discuss the use of MRI to assist with the diagnosis of pyomyositis versus septic arthritis. The authors advocate the use of MRI in questionable or complicated cases of septic arthritis or where synovial fluid aspiration is unable to be obtained promptly

The Effects of Obesity on Outcomes in Trauma Injury: Overview of the Current Literature

Obesity has reached epidemic proportions and is now considered a chronic disease by the National Institute of Health (NIH) in the West. Its impact on trauma outcomes is of particular interest with several studies presenting conflicting information. The present overview suggests a strong association between obesity and injury severity, hospital length of stay (LOS), intensive care unit (ICU) admission, pattern of injury, rate of complications and mortality. The nature of the observations may relate to an underlying physiological state of the obese patient and its associated comorbidities with a constant heightened inflammatory state aggravated by the second hit on an injury

Trauma Team Activation for Geriatric Trauma at a Level II Trauma Center: Are the Elderly Under-triaged?

Geriatric patients often sustain life-threatening injuries from minor trauma. A growing body of research suggests that these patients are often under-triaged in the emergency setting.The purpose of this research was to evaluate whether or not geriatric trauma patients are under-triaged at a community based level II trauma center. 1434 trauma patients over the age of 65 presenting from 2010-2015 were retrospectively reviewed from the Cabell Huntington Hospital trauma registry and analyzed for age, gender, arrival type, ED response, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), injury cause, ICD-9 diagnosis codes, and mortality. Under-triage and over-triage rates were determined using the Cribari method (under-triage = ISS ≥ 16 without full trauma team activation [TTA]; Over-triage = ISS ≤ 15 with full TTA). The under-triage rate was 9.5% (132/1393) with the majority of under-triaged patients having head trauma (n=423). There were 371 head trauma patients with a recorded GCS and analysis shows those with a GCS ≥ 13 had a 1.2% mortality risk (n=326; ISS 10.2), but that risk drastically increases to 60% with GSC ≤ 12 (n=45; ISS 21.5). Of the 45 patients with GSC ≤ 12, only 4% had priority 1 TTA using the current protocol (2/45). The American College of Surgeons-Committee of Trauma (ACS-COT) recommends an acceptable under-triage rate of < 5%. In order to improve geriatric care and reduce under-triage rates, we recommend that an age-based criteria be added to our TTA protocol at our community based Level II trauma center: priority 1 TTA for all patients 65 years or older sustaining head trauma with a GCS ≤ 12 or suspicion of intracranial hemorrhage

Orthopaedic Surgeon Density in West Virginia

West Virginia (WV) has many healthcare disparities and access barriers. For bone and joint disorders, WV has some of the highest rates of musculoskeletal problems, including the highest reported rate of adult arthritis in the nation (36.2%). We hypothesized that WV has one of the lowest Orthopaedic surgeon densities in the country, which can negatively impact the delivery of musculoskeletal care. Using the WV Board of Medicine practitioner databank, the Veterans Administration practitioner data, and national Orthopaedic surgeon census data, we demonstrated a considerably low Orthopaedic surgeon density in WV (7.71/100,000 population versus the national average of 8.51/100,000 population) with 54% of our counties (n=30) having no Orthopaedic surgeons. This data is currently being used to further determine the appropriate allocation of resources to help improve access to specialized orthopaedic care for our state