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

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.