Identification of mortality predictors in elderly patients with a hip fracture

Prelomi kuka u starih, kao najozbiljnija komplikacija osteoporoze, upravo zbog visoke incidence, povezanog morbiditeta, visokog stepena invalidnosti, produžene hospitalizacije i velikih troškova lečenja, kao i posledično visokih stopa mortaliteta, imaju ogroman zdravstveni i društveno-ekonomski značaj. Shodno podacima iz savremene literature, identifikovane su velike geografske varijacije u učestalosti preloma kuka širom sveta, a sve u zavisnosti od razvijenosti zemlje, kulturoloških razlika i drugih relevantnih faktora. Iako je hirurška intervencija kamen temeljac u lečenju povređenih, postoji dovoljno dokaza da su kliničko stanje pre preloma i perioperativno upravljanje ovim stanjem, od ključnog značaja za funkcionalni oporavak i krajnji ishod. Osoba sa prelomom kuka se karakteriše time da je nosilac hroničnih, multisistemskih, više ili manje kontrolisanih bolesti (sa prosekom od 3,7 komorbiditeta), sa visokim procentom kognitivnih oštećenja, i korišćenja multimedikamenatozne terapije. Uprkos napretku u lečenju preloma kuka, postoje mnogi faktori koji se moraju uzeti u obzir prilikom odlučivanja šta bi trebalo da bude optimalan tretman za svakog pacijenta ponaosob. Potvrđena je direktna veza između preloma kuka i mortaliteta, od kada se smatra jednim od vodećih uzroka smrti kod starije populacije. Najveći rizik od razvoja smrtnog ishoda je u periodu neposredno posle preloma, i povećava se 2 do 10 puta u odnosu na opštu populaciju sličnih karakteristika. Najveći deo ove smrtnosti upravo se dešava u prvih 3-6 meseci nakon samog preloma kuka. Utvrđeno je postojanje jakih dokaza za ove prediktore koji utiču na smrtnost pacijenata posle preloma kuka. Izolovani su sledeći faktori: pol, starost, broj komorbiditeta, tip i lokacija preloma, psihički i funkcionalni status pre preloma, ASA (American Society of Anesthesiologists) skor, hemodinamski poremećaji, vrsta tretmana (hirurgija ili konzervativa), vrsta hirurške tehnike, operativno kašnjenje, anemija, pojava komplikacija (respiratorna, kardiološka insuficijencija, tromboembolija, elektrolitni i metabolički poremećaji, infekcije). Doprinos ove studije ogleda se u detaljnoj analizi i utvrđivanju potencijalnog značaja ispitivanih faktora (prediktora) za nastanak smrtnog ishoda kod pripadnika populacije sa pomenutom zdravstvenom problematikom, kako u pojedinačnom slučaju, tako i u kombinaciji sa drugim potencijalnim prediktorima. Proistekli rezultati istraživanja svakako će omogućiti znatno preciznije i potpunije razumevanje faktora koji predisponiraju razvoj smrtnog ishoda kod starijih pacijenata sa prelomom kuka, a time biti i od praktičnog značaja u kreiranju strategije primene preventivnih (optimizacija hemodinamskih, kardio-respiratornih, metaboličkih, bubrežnih funkcija, prevencija delirijuma, prevencija dekubitalnih ulkusa, tromboembolijskih komplikacija...) i pravovremenih korektivnih mera za sprečavanje razvoja ozbiljnih komplikacija i posledičnog smrtnog ishoda, tako da je ova studija deo identifikacione strategije.Due to its high incidence and accompanying morbidity, a high degree of disability, prolonged hospitalization, high costs of treatment, and high mortality rates, hip fracture in the elderly, as the most serious complication of osteoporosis, is of great health and socio-economic importance. According to modern literature, large geographical variations in the frequency of hip fractures worldwide have been identified, all depending on the country's development, cultural differences and other relevant factors. Although surgical intervention is a cornerstone in the treatment of injuries, there is sufficient evidence that the clinical condition before the fracture and the perioperative management of this condition is crucial for a functional recovery and the final outcome. Patients with a hip fracture are characterized by the fact that they have chronic, multisystemic, more or less controlled diseases (with an average of 3.7 comorbidities), a high percentage of cognitive impairments, and are on multidrug therapy. Despite advances in the treatment of hip fracture, there are many factors that must be considered when deciding what should be the optimal treatment for each patient individually. A direct link between hip fracture and mortality has been confirmed since it started to be considered one of the leading causes of death in the older population. The greatest risk of developing a fatal outcome is in the period immediately after the fracture, and is 2 to 10 times bigger in relation to the general population of similar characteristics. The bulk of this mortality occurs in the first 3-6 months after the hip fracture. Strong evidence has been established for the following predictors that affect the mortality of patients with a hip fracture: sex, age, number of comorbidities, type and location of fractures, psychological and functional status before the fracture, ASA (American Society of Anaesthesiologists) score, hemodynamic disorders, type of treatment (surgery or conservative), type of surgical technique, anemia, complications (respiratory complications, cardiac insufficiency, thromboembolism, electrolyte and metabolic disorders, infections). The contribution of this study lies in detailed analysis and establishment of the potential significance of the investigated factors (predictors) for the occurrence of the fatal outcome in the population with the given health problem, both in the individual case and in combination with other potential predictors. The results of the research will certainly provide a much more precise and complete understanding of the factors that predispose the development of the fatal outcome in elderly patients with a hip fracture, and thus be of practical importance in creating a strategy for preventive measures (optimization of haemodynamic, cardio-respiratory, metabolic, and renal functions, delirium prevention, prevention of decubital ulcers, thromboembolic complications, etc.) and for timely corrective measures aiming to prevent the development of serious complications and consequent death. In that sense, this study is part of the identification strategy

Digital technologies as support to healthcare systems in promotion of health and prevention of disease: raising awareness as an aim of communications

The paper analyzes the approach to one very important phenomenon in the modern environment, which is defined as digital transformation in the healthcare system. The increasing influx of digital technologies into business processes leads to the point where the provision of healthcare services can no longer be viewed only in traditional frameworks, but it is necessary to look at the unlimited options of digital technologies, digital content and digital communications in the provision of healthcare services. The needs of the healthcare system and certain changes resulting from the development of communication and information technologies such as the Internet, social networks, mobile applications, etc. require organized work on the implementation of a strategy for new ways of doing business in healthcare. Health information and early screening awareness of oncological diseases increase the motivation for active participation of people in the implementation of preventive measures, treatments and rehabilitation.U radu se analizira pristup veoma važnom fenomenu u savremenom okruženju koji se definiše kao digitalna transformacija u zdravstvenom sistemu. Sve veći upliv digitalnih tehnologija u poslovne procese dovodi do toga da se pružanje zdravstvenih usluga više ne može posmatrati samo u tradicionalnim okvirima već je neophodno sagledati i neograničene mogućnosti digitalnih tehnologija, digitalnih sadržaja i digitalnih komunikacija u pružanju zdravstvenih usluga. Potrebe zdravstvenog sistema i promene koje nastaju razvojem komunikacionih i informacionih tehnologija poput interneta, društvenih mreža, mobilnih aplikacija i sl. zahtevaju organizovan rad na sprovođenju strategije za implementiranje novih načina poslovanja u zdravstvu. Informisanost o zdravlju i podizanje svesti o ranom skriningu onkoloških bolesti povećavaju motivisanost za aktivno učešće u sprovođenju preventivnih mera, lečenju i rehabilitaciji

Bio-psycho-social concept of ageing

The paper focuses thematically on one of the essential issues of human existence, a complex and a mysterious phenomenon of ageing. The old people with their biological and psychological features, with their social position and other aspects, are the inexhaustible source of professional research of doctors and sociologists. As opposed to the usual pessimistic attitude of ageing and the old age, the paper points, within the humanist and social work frame, to man's awareness of overcoming the transience of human existence by cultivating a sense and a beauty of life. By elaborating on the concept of ageing, the authors stress the length and the quality of life, which could be advanced by the interaction of three groups of factors: social engagement and participation, the reduction of illness and the improvement of the high level of psychological and mental functions

Central venous catheter as vascular approach in patients with acute liver insufficiency

Liver cirrhosis is complex pathological condition which may arise due to different etiological factors. Due to improper functioning of the liver all other processes in the organism are compromised; besides, complications of cirrhosis are multiple and life threatening. When caring for patients with liver cirrhosis, especially for patients with complicated diseases, well-trained nurses and technicians have central role in providing assistance tophysicians. Stabilization of emergency patients with acute hepatic failure (AHF) is also major challenge. Treatment of these patients is complex, and frequently there is a necessity to provide safe venous access with central venous catheter (CVC). Appropriate use of the CVC contributes to faster recovery of patients with AHF and shorten their stay in the intensive care unit

The impact of gender differences on mortality in elderly patients after hip fracture

Background/Aim. Hip fracture is one of the leading causes of death in elderly population. We evaluated the impact of gender differences on mortality rate in elderly patients with hip fracture. Methods. The study included all hospitalized elderly patients (aged over 65 years) with hip fracture during 2013. The patients were classified into four risk groups in accordance with institutional Şişli Etfal risk factor assessment scale ISERFAS to estimate postoperative mortality. Clinical, laboratory and risk score results were gender matched between survived and deceased patients. Hospital mortality was monitored as well as mortality at intervals of three and six months. The prediction effect of gender and overall risk variables on mortality rate were determined by univariate and multivariate logistic regression analyses. Results. The complete sample included 434 female and 163 male patients. Average age of men was 77.95 years and 79.18 years for women. Femoral neck fracture was more often seen in women (44.5%), but with no statistically significant difference (p = 0.57). Significant difference between the genders in relation to the risk score values was determined (p = 0.024). It was observed that the values of risk score was lower in the female patients and higher in the male patients. Cumulative mortality was 6% during hospital stay, 17.8% after three months and 25% after six months, respectively. In-hospital and six months after the hip fracture, the mortality rates were similar in both genders. The mortality rate was significantly higher in male patients (p = 0.035) three months after the hip fracture. The overall risk observed at all mortality intervals was a significant predictor by itself (p = 0.000). Independent gender prediction effect disappeared in joint effects of patients’ overall risk. Conclusion. Gender can be defined as a significant mortality predictor in patients with hip fracture. A risk assessment system to estimate postoperative mortality for hip fractures would be helpful in planning treatment for each patient. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007