Orthopaedic Ward Research Articles

‘SHOULD WE SEND THE HEAD?’ INCIDENCE OF PATHOLOGICAL NECK OF FEMUR FRACTURES: A ONE-YEAR RETROSPECTIVE OVERVIEW

Neck of femur fracture (NOF#) is the commonest reason for admission to an orthopaedic ward with 70-75,000 cases each year in the UK1. The femoral head is often sent to pathology if there is clinical suspicion of a malignant cause. There is limited evidence in the literature to support the efficacy of this2. The purpose of this project was to study the incidence of femoral head pathology analysis in NOF # patients with a background of malignancy and evaluate the impact this investigation has on guiding future management.Retrospective analysis of all neck of femur fractures admitted to the Queen Elizabeth University Hospital between 01/01/2021 and 31/12/2021. The electronic notes were accessed and for patients with past medical history of malignancy, it was confirmed whether femoral head or bone reamings were sent to pathology, resultant findings and the impact on subsequent management.In 2021, 784 patients were admitted to the QEUH with a NOF#. Of these, 770 (98.2%) underwent operative management, 138 (17.3%) of whom had a past medical history (PMH) of malignancy. Intra-operative pathology was sent from 19 (13.7%) of these 138 patients. No malignant cells were found in 13 (69%) samples, and in 6 (31%), the known active malignancy was confirmed. In all cases where samples were sent for pathology, none caused any change in management.In this retrospective study, pathological investigations in NOF# patients with a PMH of malignancy had no impact on further management. The authors would not advocate for sending pathology results in this cohort group.

THE POTENTIAL EFFECTS OF AN ADAPTED NURSING DISCHARGE PLAN AMONG PATIENTS WITH HIP FRACTURES IN HOSPITAL MELAKA, MALAYSIA

Background: Patients with hip fractures frequently face the problem of a longer stay in the ward after surgery and being readmitted, falls, and being unable to carry out daily activities after discharge from the hospital. A nursing discharge plan is widely recognised as one of the strategies for addressing these issues. In Malaysia, however, it is unknown for patients with hip fractures. As a result, this study was carried out to investigate the impact of nursing discharge planning on patients with hip fractures in Hospital Melaka, Malaysia. Methods: A total of 58 patients aged 50 years and above in the orthopaedic ward of Hospital Melaka were randomised using sealed envelopes to the intervention group (n = 29) and the control group (n = 29). The intervention group received an adapted nursing discharge plan with health education activities in the form of pamphlets and oral instructions within 24 hours of ward admission until discharge while the control group received routine discharge practices. Demographic data were taken from the study subjects while clinical data and length of stay in the ward were taken from the subjects’ medical records before discharge. After one month discharged, data for ward readmission rate and drop rate were taken from the subject's medical records while data for the subject's daily life activities were obtained through telephone calls using The Barthel Index survey form. Results: The results of the study showed that the intervention group had a shorter ward stay (U = 254.00, p = 0.008) and a higher level of independence than the control group (U = 205.00, p = 0.001). The control group had 100% of subjects who were not able to be independent in daily activities of life compared to 75.9% of the intervention group (p <0.05). Conclusion: A nursing discharge plan including a health education component starting from the patient's admission to the ward until before the discharge should be considered in the nursing practice. It could facilitate better discharge outcomes for patients with hip fractures.

THE POTENTIAL EFFECTS OF AN ADAPTED NURSING DISCHARGE PLAN AMONG PATIENTS WITH HIP FRACTURES IN HOSPITAL MELAKA, MALAYSIA

Background: Patients with hip fractures frequently face the problem of a longer stay in the ward after surgery and being readmitted, falls, and being unable to carry out daily activities after discharge from the hospital. A nursing discharge plan is widely recognised as one of the strategies for addressing these issues. In Malaysia, however, it is unknown for patients with hip fractures. As a result, this study was carried out to investigate the impact of nursing discharge planning on patients with hip fractures in Hospital Melaka, Malaysia. Methods: A total of 58 patients aged 50 years and above in the orthopaedic ward of Hospital Melaka were randomised using sealed envelopes to the intervention group (n = 29) and the control group (n = 29). The intervention group received an adapted nursing discharge plan with health education activities in the form of pamphlets and oral instructions within 24 hours of ward admission until discharge while the control group received routine discharge practices. Demographic data were taken from the study subjects while clinical data and length of stay in the ward were taken from the subjects’ medical records before discharge. After one month discharged, data for ward readmission rate and drop rate were taken from the subject's medical records while data for the subject's daily life activities were obtained through telephone calls using The Barthel Index survey form. Results: The results of the study showed that the intervention group had a shorter ward stay (U = 254.00, p = 0.008) and a higher level of independence than the control group (U = 205.00, p = 0.001). The control group had 100% of subjects who were not able to be independent in daily activities of life compared to 75.9% of the intervention group (p <0.05). Conclusion: A nursing discharge plan including a health education component starting from the patient's admission to the ward until before the discharge should be considered in the nursing practice. It could facilitate better discharge outcomes for patients with hip fractures.

Establishment and validation of a nomogram for progression to diabetic foot ulcers in elderly diabetic patients.

Many diabetic patients develop and progress to diabetic foot ulcers, which seriously affect health and quality of life and cause great economic and psychological stress, especially in elderly diabetic patients who often have various underlying diseases, and the consequences of their progression to diabetic foot ulcers are more serious and seriously affect elderly patients in surgery. Therefore, it is particularly important to analyze the influencing factors related to the progression of elderly diabetic patients to diabetic foot, and the column line graph prediction model is drawn based on regression analysis to derive the influencing factors of the progression of elderly diabetic patients to diabetic foot, and the total score derived from the combination of various influencing factors can visually calculate the probability of the progression of elderly diabetic patients to diabetic foot. The influencing factors of progression deterioration to diabetic foot in elderly diabetic patients based on LASSO regression analysis and logistics regression analysis, and the column line graph prediction model was established by statistically significant risk factors. The clinical data of elderly diabetic patients aged 60 years or older in the orthopedic ward and endocrine ward of the Third Hospital of Shanxi Medical University from 2015-01-01 to 2021-12-31 were retrospectively analyzed and divided into a modeling population (211) and an internal validation population (88) according to the random assignment principle. Firstly, LASSO regression analysis was performed based on the modeling population to screen out the independent influencing factors for progression to diabetic foot in elderly diabetic patients; Logistics univariate and multifactor regressions were performed by the screened influencing factors, and then column line graph prediction models for progression to diabetic foot in elderly diabetic patients were made by these influencing factors, using ROC (subject working characteristic curve) and AUC (their area under the curve), C-index validation, and calibration curve to initially evaluate the model discrimination and calibration. Model validation was performed by the internal validation set, and the ROC curve, C-index and calibration curve were used to further evaluate the column line graph model performance. Finally, using DCA (decision curve analysis), we observed whether the model could be used better in clinical settings. (1) LASSO (Least absolute shrinkage and selection operator) regression analysis yielded a more significant significance on risk factors for progression to diabetic foot in elderly diabetic patients, such as age, presence of peripheral neuropathy, history of smoking, duration of disease, serum lactate dehydrogenase, and high-density cholesterol; (2) Based on the influencing factors and existing theories, a column line graph prediction model for progression to diabetic foot in elderly diabetic patients was constructed. The working characteristic curves of subjects in the training group and their area under the curve (area under the curve = 0.840) were also analyzed simultaneously with the working characteristic curves of subjects in the external validation population and their area under the curve (area under the curve = 0.934), which finally showed that the model was effective in predicting column line graphs; (iii) the C-index in the modeled cohort was 0.840 (95%CI: 0.779-0.901) and the C-index in the validation cohort was 0.934 (95%CI: 0.887-0.981), indicating that the model had good predictive accuracy; the calibration curve fit was good; (iv) the results of the decision curve analysis showed that the model would have good results in clinical use; (v) it indicated that the established predictive model for predicting progression to diabetic foot in elderly diabetic patients had good test efficacy and helped clinically screen the possibility of progression to diabetic foot in elderly diabetic patients and give personalized interventions to different patients in time.

Purple urine bag syndrome: An unusual presentation of urinary tract infection

Introduction: Purple urine bag syndrome is a rare clinical entity characterized by purple discoloration of the urinary catheter and urinary drainage bag in chronically catheterized patients. Though it can be alarming to patients and clinicians, it is considered benign but can indicate an underlying urinary tract infection. Case Series: The first case was a 68-year-old woman with multiple comorbidities who was admitted to the orthopedic ward with a close fracture of the neck of the right femur. She was bedridden and had an indwelling urethral catheter. Her urine bag was noticed to stain purplish 22 days after bladder catheterization. Urine culture showed a heavy mixed growth. A change of urinary catheter and drainage bag led to a resolution of the condition. The second case was a 58-year-old male who was admitted on account of decompensated liver cirrhosis from chronic hepatitis C virus infection. He also had quadriparesis due to a traumatic cervical spine injury, urine retention, and constipation. On day 24 of his admission, his urine bag was stained with a purplish hue. A urine culture grew Klebsiella oxytoca. The urine bag remained clear and contained amber-colored urine after catheter changes and antibiotic treatment for cystitis. Conclusion: Purple urine bag syndrome can be alarming to the patient and caregiver who need to be reassured of its benign nature. Urine culture would identify any associated infection. Good catheter care, control of risk factors including constipation and antibiotic treatment for symptomatic urinary tract infection leads to the resolution of the discoloration.

Effect of Nursing Care Regarding Postoperative Complications among Diabetic Patients after Hip Replacement Surgery

Background: The total hip arthroplasty surgery is an effectiveness intervention to improve patients function with osteoarthritis. This surgery is usually done for patients who aged more than 60 years and are associated with uncontrolled pain or hopeless damage hip joints. The effect of diabetes disease at post-surgical time, influencing on wounds healing process and promoting sores formation which lead to a complex of nursing care performance for patients has a big challenge, to deal with patients and their family feeling to help them to promote independence. Objective: This study aimed to evaluate the nursing management for diabetic patients undergoing surgical total hip replacement. Materials and Methods: A case–control study design applied on diabetic patients with a hip operation after fractured hip at orthopedic wards at Al-Rabea and Ninevah private hospitals in Mosul city. The study was conducted from September 10, 2022 until December 10, 2022. Postoperative nursing care provided to the control group was the daily common nursing care management in our hospitals, whereas that provided to the study group depended on a special standard nursing care management protocol. Results: Evaluation of postoperative disorders and complications showed a positive direction in decreasing their occurrence after depending on a special standard nursing care management protocol. Conclusions: The study concludes that all the postoperative complication may be relieved after total hip replacement as any surgical intervention if the orthopedic nursing staff applied the standard tool for nursing care management.

Colonization of patients hospitalized at orthopedic department of tertiary hospital in Uganda with extended-spectrum beta-lactamase-producing enterobacterales

BackgroundBeta-lactamase production remains the most contributing factor to beta-lactam resistance. Extended-Spectrum Beta-Lactamase-Producing Enterobacterales (ESBL-PE) are associated with risk factors both in hospital and community settings.ObjectivesTo assess the incidence and risk factors for intestinal carriage of ESBL-PE among patients admitted to orthopedic ward of Mulago National Referral Hospital, and to analyze the acquisition of ESBL-PE during hospital stay and associated factors.MethodsWe screened 172 patients aged 18 years old and above who got admitted to the orthopedic ward of Mulago National Referral Hospital between May to July 2017. Stool samples or rectal swabs were collected at admission, every 3 days until fourteen days and screened for ESBL-PE. Data on demographic status, antibiotic use, admission and travel, length of hospital stay, hygiene practices and drinking boiled water were analyzed by logistic regression and cox regression model.ResultsAt admission, 61% of patients showed intestinal ESBL-PE carriage. Co- resistance was common but no Carbapenem resistance was detected. Of the ESBL-PE negative, 49% were colonized during hospitalization. On admission, prior antibiotic use was significantly associated with carriage, but none was associated with acquisition during hospitalization at p-value < 0.05.ConclusionCarriage of ESBL-PE on admissions and acquisition at orthopedic ward of Mulago Hospital were high, and dissemination into the community are of substantial concern. We suggested refinement of empirical treatment based on risk stratification, and enhanced infection control measures that target health care workers, patients and attendants.

Prevalence of pressure ulcer and related factors in orthopaedic wards: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to provide an overview of the prevalence of pressure ulcers (PU) in orthopaedic wards. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Prevalence", "Pressure ulcer", "Pressure sore", and "Orthopaedics" from the earliest to February 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. Finally, 11 studies were included in the final analysis. The results indicated that the prevalence of PU in orthopaedic departments was 18% (ES: 0.18, 95% CI: 0.10-0.26, Z= 4.53, I2 : 99.09%). Although the odds ratio of PU was lower in men than women, it was not statistically significant (OR: 0.91, 95% CI: 0.74-1.11, Z= 0.95, I2 : 17.4%, P= .34). Also, results showed the prevalence of PU was higher among studies with a sample size of more than 200 (ES: 0.19, 95% CI: 0.10-0.28, Z= 4.07, I2 : 99.1%), Europe region (ES: 0.20, 95% CI: 0.14-0.26, Z= 6.7, I2 : 93.0%) and prospective design (ES: 0.23, 95% CI: 0.18-0.27, Z= 9.47, I2 : 83.3%) when compared with other sub-groups. In sum, considering the 18% prevalence of PU in the orthopaedic department, it is recommended to focus on detecting risk factors and design interventions to reduce PU in the patients admitted orthopaedic department.

Total Knee Arthroplasty in Patients with Parkinson's Disease: A Critical Analysis of Available Evidence

Aim: To determine the significance of total knee arthroplasty in patients with Parkinson's disease. Study design: Retrospective study. Place and duration of study: Department of Orthopaedics, Sahara Medical College, Narowal and CMH Kharian Medical College Kharian from 1st July 2020 to 30th September 2022. Methodology: Fifty patients suffered from Parkinson disease which was already diagnosed and the patients attended the Orthopaedic Ward for knee arthroplasty were included. Patients were then followed up till 12 weeks for the clinical analysis of the preoperative and postoperative outcomes of the procedure. Western-Ontario and McMaster-Universities Osteoarthritis Index, Short Form Health Survey-scale, physical component-summary as well as mental-component summary were used for the critical analysis of the patients underwent knee arthroplasty. Knee Society-Score and Knee Society-Function Score determined the deformity, stability, pain and functional analysis. Results: The mean age of the cases was 66.91 ± 6.62 years. There were more females than males in this study with a comparative percentage of 20% vs 80% respectively. There were 60% left knee arthroplasty with 22% in grade IV. Range of motion as well as stability of the patients was also improved. SF-12 also showed a significant improvement in the Physical component-summary and mental-component summary levels. There was a reduction in pain and stiffness analyzed through Western-Ontario and McMaster-Universities Osteoarthritis Index scoring and more flexion as analyzed by range of motion. Conclusion: There is better scoring of patients from pre to postoperative state although still towards lower side and with poor motor functional outcomes. Key words: Ganglion, Neurodegenerative, Arthroplasty, Significance, Analysis

Technique of tension band wiring in patella fracture management-our experience

: Fractures of the patella account for about 1% of all skeletal injuries. Displaced patella fractures often result in disruption of the extensor mechanism of the knee. Open reduction and internal fixation is the recommended treatment to restore the extensor mechanism Tension band wiring (TBW) technique using K-wires and stainless steel wires is the most commonly used. The purpose of this study is to study surgical outcome of patella fractures treated with, tension band wiring (TBW) technique and functional outcome of patella fractures treated with TBW technique. It is a Retrospective study of 21 patients carried out from July 2019 to February 2021 admitted to orthopedic ward at our institution. All patients underwent same surgical technique and similar postoperative and physiotherapy protocol. Bostman scoring system was used to perform functional assessment.: In our study there were 14 males and 7 females. Fracture union was achieved in all patients. The mean bostman score was 26.54 at the final follow up.we had 4 complications 1 superficial infection of the surgical wound, 1 knee stiffness and 2 cases of symptomatic implant. We had 8 excellent, 9 good and 4 satisfactory result.: Tension band wiring technique for transverse patella fractures can be a very good option with effective fixation method and relatively easy surgical procedure.

Nurses’ perceptions of screening for delirium in the Post Anaesthesia Care Unit and orthopaedic surgical wards: A qualitative study

Purpose: The aims of this study were to explore nurses’ perceptions of the usability and clinical utility of two screening tools for delirium detection in the Post Anaesthesia Care Unit (PACU) and orthopaedic surgical wards settings, and to identify nurses’ decisions about patient care delivery based on delirium assessment outcomes. The tools studied were the 3D-CAM and 4AT – the three-minute diagnostic interview for CAM (Confusion assessment method) delirium and the 4 ‘A’s test, respectively.

Outcome of intertrochanteric fracture managed with proximal femoral nail antirotation 2

Background: Intertrochanteric fracture is a common condition seen in elderly population which is managed with operative procedure in the department of orthopedics. The proximal femoral nail antirotation (PFNA) system was developed by the AO/ASIF in 2004 for this fracture that provides optimal anchoring and stability when the implant is inserted into the osteoporotic bone. The main characteristic of the implant is the use of a single blade with a large surface area and insertion of the blade compacts the cancellous bone. Aims and Objectives: The aim of the study was to study the functional outcome of intertrochanteric fracture managed with PFNA2. Materials and Methods: The prospective and observational study was conducted in patients diagnosed with intertrochanteric fracture admitted in orthopedic ward, Western Regional Hospital, Pokhara. Pre- and post-operative fracture alignment, Harris hip score (HHS), post-operative complications were taken into account. Results: Out of 55 cases taken into study, 36 (65.45%) were male and 19 (34.55%) were female. Maximum number of patients allocated in our study falls in 71–80 years group (29%) with least number in age group of 90 years or more (1.9%). Right-sided intertrochanteric fracture were 27 (49%) and left side involved were 28 (51%). Twenty-eight (51%) falls in Type II and 27 (49%) falls in Type III Boyd and Griffin intertrochanteric fractures. There was a marked improvement in fracture alignment after the operation with various parameters taken into consideration. Pre-operative HHS was 5.52±5.38 (Poor) and immediately after the procedure, it was 30.41±3.04 (Poor), 89.86±3.59 (Good) at 6 months, and 95.56±1.257 (Excellent) at 12 months. One case had blade cut out at immediate post-operative period, eight cases had surgical site infection, and five cases had GT fracture. Conclusion: This study showed that PFNA2 is an effective operative procedure in management of intertrochanteric fractures by achieving better fixation through bone impaction especially in osteoporotic bone.

Spinal Epidural Abscess: Early Suspicion in Emergency Department Using C-Reactive Protein and Erythrocyte Sedimentation Rate Tests.

Spinal epidural abscess (SEA) is an uncommon but serious differential diagnosis of acute spinal pain with high paralysis and mortality rate. This study aims to provide local data on its bioclinical characteristics and evaluate potential strategies to enhance its diagnostic rate in accident and emergency department (AED). A retrospective case study from 2013 to 2019 was conducted in United Christian Hospital. SEA cases were classified as study group, spinal pain due to non-SEA cases were classified as control group. Data collected from study group included symptoms, radiological diagnosis, microbiological culture, treatment, and outcome. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of both groups were compared to analyze their diagnostic power. In the study group (n = 42), 93% of patients had spinal pain, 55% had fever, 60% had neurological deficits, and only 26% had the classic triad on presentation. Seventy-four percent of patients presented with spinal cord or cauda equina compression in their first magnetic resonance imaging. Mortality rate was 23.8%, and paralysis rate was 7.1%. Diagnostic accuracy in AED was 12%. Admission to orthopedic ward (n = 23) resulted in a significantly lower mean time-to-imaging (4.39 days vs. 14.58 days) and mean time-to-treatment (6.56 days vs. 16.9 days) as compared to other specialties. The area under curves of CRP and ESR were 0.893 and 0.874 respectively, the optimal threshold levels were 45.9 mg/L (sensitivity 82.9%, specificity 79%) and 59.5 mm/hr (sensitivity 87.2%, specificity 80.4%), respectively. Diagnosis of SEA in emergency department based on clinical symptomatology is not reliable due to low incidence of the classic triad, despite a more advanced disease on presentation. We proposed incorporating CRP and ESR tests into evaluation of patients with spinal pain since both tests demonstrated excellent discriminative power in diagnosing SEA.

Implementing PERFECT-ER with Plan-Do-Study-Act on acute orthopaedic hospital wards: Building knowledge from an implementation study using Normalization Process Theory.

Delivering care to growing numbers of patients with increasingly 'complex' needs is currently compromised by a system designed to treat patients within organizational clinical specialties, making this difficult to reconfigure to fit care to needs. Problematic experiences of people with cognitive impairment(s) admitted to hospitals with a hip fracture, exemplify the complex challenges that result if their care is not tailored. This study explored whether a flexible, multicomponent intervention, adapting services to the needs of this patient group, could be implemented in acute hospital settings. We used action research with case study design to introduce the intervention using a Plan-Do-Study-Act (PDSA) model to three different hospital sites (cases) across England. The qualitative data for this paper was researcher-generated (notes from observations and teleconference meetings) and change agent-generated (action plans and weekly reflective reports of change agents' activities). Normalization Process Theory (NPT) was used to analyze and explain the work of interacting actors in implementing and then normalizing (embedding) the intervention across contexts and times. Data analysis was abductive, generating inductive codes then identified with NPT constructs. Across the three cases, change agents had to work through numerous implementation challenges: needing to make sense of the intervention package, the PDSA model as implementation method, and their own role as change agents and to orientate these within their action context (coherence). They had to work to encourage colleagues to invest in these changes (cognitive participation) and find ways to implement the intervention by mobilising changes (collective action). Finally, they created strategies for clinical routines to continue to self-review, reconfiguring actions and future plans to enable the intervention to be sustained (reflexive monitoring). Successful implementation of the (PERFECT-ER) intervention requires change agents to recognize and engage with local values, and then to enable its fit with practice and wider contextual goals. A context of constant change fragments normalization. Thus, sustaining practice change over time is fragile and requires change agents to continue a recursive two-way sense-making process. This enables implementation and normalization to re-energize and overcome barriers to change.

HIP FRACTURES IN THE OLDER ADULT: ORTHOPAEDIC AND GERIATRIC SHARED CARE MODEL IN SOUTHLAND: A FIVE-YEAR FOLLOW-UP AUDIT

Fractures of the neck of femur are common in the older adult with significant morbidity and mortality rates. This patient cohort is associated with frailty and multiple complex medical and social needs requiring a multidisciplinary team to provide optimal care. The aim of this study was to assess the outcomes at 5 years following implementation of a collaborative service between the Orthopaedic and Geriatric departments of Southland Hospital in 2012.Retrospective data was collected for patients aged 65 years and older who were admitted with a fragility hip fracture. Data was collated for 2011 (pre-implementation) and 2017 (post-implementation). Demographics and ASA scores were recorded. We assessed 30-day and 1-year mortality, surgical data, length of stay and complications.There were 74 patient admissions in 2011 and 107 in 2017. Mean age at surgery was 84.2 years in 2011 and 82.6 years in 2017 (p&gt;0.05). Between the 2011 and 2017 groups there has been a non-significant reduction in length of stay on the orthopaedic ward (9.8 days vs 7.5 days, p=0.138) but a significant reduction in length of stay on the rehabilitation ward (19.9 vs 9 days, p&lt;0.001). There was a significant decrease in frequency of patients with a complication (71.6% vs 57%, p=0.045) and a marginal reduction in number of complications (p=0.057). Through logistic regression controlling for age, sex and ASA score, there was a reduction in the odds of having a complication by 12% between 2011 and 2017 (p&lt;0.001). There was no difference in mortality between the groups.The orthogeriatric model of care at Southland Hospital appears to have reduced both the frequency of complications and length of stay on the rehabilitation ward 5 years after its implementation. This is the first study in New Zealand demonstrating medium-term post-implementation follow-up of what is currently a nationally accepted standard model of care.

A prospective randomized control trial of topical tranexamic acid used in elderly patients with femoral neck fractures treated with hemiarthroplasty

Background: Geriatric hip fracture patients frequently suffer femoral neck injuries. The advantage of using TXA topically over the IV route is that maximum concentration of the drug is attained at the wound/surgical site with minimal systemic side effects of drug and also it is easy to administer locally. Aim of current study was fragmented necks of the femur can be treated with Tranexamic acid to reduce postoperative blood loss. Methods: Over the course of 20 months from June 2020 to December 2021, the orthopaedics department at SMS Hospital, Jaipur, conducted this study. A total of 174 patients (87 in each group) of age &gt;60 years, presenting with neck of the femur in orthopaedics wards were enrolled in this study. Results: Compared to the control group, the case group experienced 408 ml more blood loss, which was treated with tranexamic acid. In cases and controls, transfusion was necessary for 31 and 41 patients, respectively. Conclusions: One dosage of topical tranexamic acid may be given to an older patient undergoing bipolar hemiarthroplasty for a fractured femoral neck in order to minimize post-operative blood loss.

Development and Validation of the Infection Prevention Appraisal Scale.

It has been emphasized that future studies aimed at improving adherence to infection prevention guidelines should focus on beliefs in, e.g., self-efficacy. Reliable situation specific measures are needed to measure the phenomenon of self-efficacy, but there seems to be few valid scales available that are suitable for measuring one's belief in self-efficacy regarding infection prevention measures. The purpose of the study was to develop a unidimensional appraisal scale to capture nurses' beliefs in their abilities to practice medical asepsis in care situations. When creating the items, evidence-based guidelines for preventing healthcare-associated infections were used together with Bandura's guide for constructing self-efficacy scales. Face validity, content validity, and concurrent validity were tested in various samples of the target population. Furthermore, dimensionality was evaluated on data collected from 525 registered nurses and licensed practical nurses recruited from the medical, surgical, and orthopaedic wards of 22 Swedish hospitals. The Infection Prevention Appraisal Scale (IPAS) consists of 14 items. Face and content validity were endorsed by target population representatives. The exploratory factor analysis suggested unidimensionality, and the internal consistency was good (Cronbach's alpha 0.83). The total scale score correlated with the General Self-Efficacy Scale, as expected, and supported concurrent validity. The Infection Prevention Appraisal Scale demonstrates sound psychometric properties supporting a unidimensional measure of self-efficacy to medical asepsis in care situations.

Phenotypic Detection of AmpC \(\beta\)-lactamase Producing Escherichia coli among Patients in Hospital Wards

Background and Objectives: AmpC β-lactamase producing Escherichia coli has emerged in hospital environments as an important health issue that is of a global health concern as drug-resistant pathogenic bacteria that has evolved into strains that are resistant to many classes of antibiotics. However, awareness of the prevalence of AmpC β-lactamase producing microorganisms such as E. coli could be very valuable for achieving more accurate epidemiological results, as well as controlling their spread in the different hospital wards.&#x0D; Methodology: A total of four hundred (400) clinical samples comprising of two hundred and seventy-nine (279) urine samples and one hundred and Twenty-one (121) wound samples were collected from patients in different ward at AE-FUTHA. The clinical samples were analyze using standard microbiological culture and identification of Escherichia coli. Detection of phenotypic AmpC β-lactamases production was performed using Cefoxitin-Cloxacillin Double-Disk Synergy Test (CC-DDST). Antibiotic susceptibility studies of AmpC β-lactamases producing Escherichia coli was determined using the Kirby–Bauer disk diffusion method and the results were construed using the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints.&#x0D; Results: Phenotypic AmpC β-lactamases producing E. coli accounted overall prevalence rate of 94.1%. The frequency of AmpC β-lactamases producing E. coli in urine samples were 57(93.4%) comprising of high occurrence rate in Surgical ward 15(100%) followed by medical ward 24(88.9%) but also accounted for overall prevalence rate of 38(95.0%) in wound samples consisting of 9(100 %) from children ward and medical ward 10(100%) followed by Orthopedic ward 13(86.7%) with the least prevalence rate. The AmpC β-lactamases producing E. coli exhibited high percentage of resistance within the range of 50-100% against ceftriaxone, ceftazidime, cefepime, azetronam, Trimethoprim-Sulfamethoxazole Ticarcillin-clavulanic acid but were susceptible to ofloxacin 70.0%, Imipenem 83.3% and amikacin 100%.&#x0D; Conclusion: The findings of this study is a proof of the occurrence of AmpC β-lactamase producing Escherichia coli among patients admitted to hospital wards and there’s an urgent need for controlling and managing the development of MDR genotype strain. Moreover, to prevent the spread of resistance among AmpC β-lactamase producing Escherichia coli to other strains and improve the effectiveness of antibiotics, it is suggested to establish a precise schedule for antibiotic use in each region based on their antibiotic resistance pattern.

Association between Body Mass Index, Abdominal Obesity, and Body Size with Hip and Femoral Fractures in the Elderly

Background: The risk of bone fractures, particularly hip fractures is increasing in the elderly. One of the known factors for predicting fractures is body mass index (BMI) and abdominal obesity. Thus, this study aimed to determine the association between obesity (general and abdominal) with femoral and hip fractures according to gender and age. Methods: In this descriptive cross-sectional study, 100 patients with femoral or hip fractures admitted to the orthopedic ward of Khatam Al-Anbia Hospital in Zahedan were selected between March 2018 and May 2019. Waist circumference (WC), wrist circumference, BMI, and body size were measured. A P-value of &lt;0.05 was considered as statistical significant. All the analyses were performed by SPSS software version 21. Results: The highest rate of hip fracture was observed in people aged over 70 years (61.9%, P &lt; 0.01). The highest rate of hip and femoral fractures were observed in individuals with BMI &lt; 23 kg/m2 (P &lt; 0.001) and taller people (&gt;167 cm) (P &lt; 0.0001). The risk of fractures decreased with increasing WC (P &lt; 0.01). Approximately half of those with hip fractures (52.4%) and femoral fractures (51.9%) had small size. Conclusion: On the basis of our findings, taller height, lower BMI and smaller body size have been suggested as potential contributions to the risk of femoral and hip fractures. It is suggested that abdominal fat may be protective against the risk of hip and femoral fractures at older ages, which requires further research.

Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study.

Drug-resistant bacteria are one of the main reasons of deaths worldwide. One of the significant groups of these bacteria are carbapenemase-producing Enterobacteriaceae (CPE). The goal of this cross-sectional study was the identification and hierarchisation of selected risk factors of CPE colonisation. To achieve that goal, we examined 236 patients for the presence of CPE using the standard method of anal swabs. The patients were divided into three groups: hospitalised patients; those chronically dialysed; those requiring home care. A very thorough medical interview was conducted for comorbidities. A statistical analysis relationship between comorbidities and locations of the patient's stay with the positive result of the culture was investigated. A significant relationship was demonstrated between the positive result of the culture and confirmed dementia, heart failure, connective tissue diseases, and established irregularities in the level of leukocytes. No significant relationship was demonstrated with the remaining comorbidities considered in the study. Afterwards these factors were compared for importance for the assessment of risk of a positive swab result-the biggest importance was found in establishing connective tissue disease. Next were dementia, abnormal values of leukocytes, heart failure, and at the end, stay at the orthopaedics ward. Conclusions: The study identified asymptomatic carriers of CPE, which demonstrates the need for further studies in order to identify infection risk factors. The connective tissue diseases are the most important variable which enable the prediction of CPE colonisation-the next ones are dementia, abnormal values of leukocytes, heart failure, and stay at the orthopaedics ward.