BACKGROUND: Hip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India. METHODS: A total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year. RESULTS: The average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up. CONCLUSIONS: Elderly hip fracture has a high risk of mortality (14%–58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.
Aged ; Aged, 80 and over ; Comorbidity ; Follow-Up Studies ; Fracture Fixation ; Hip Fractures ; Hip ; Hospitals, Military ; Humans ; Hypertension ; India ; Length of Stay ; Lost to Follow-Up ; Mortality ; Postoperative Complications ; Rehabilitation ; Specialization ; Veterans ; Walkers ; Walking

PURPOSE: This study was performed to analyze the potential impact of cement use and favorable pre-injury activity on clinical outcomes of bipolar hemiarthroplasty (BHA) compared with total hip arthroplasty (THA) in elderly patients with femoral neck fractures. MATERIALS AND METHODS: Systematic review and meta-analysis of 12 clinical studies (5 randomized controlled trials and 7 comparative studies). Subgroup analysis was performed based on type of fixation method (cemented vs. cementless) and in the patient with independent ambulation, respectively. RESULTS: A significantly higher dislocation rate was observed in patients treated with THA compared with those treated with BHA in individuals capable of independent ambulation before injury (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.62; P=0.05, Z=1.98). Also, the dislocation rate was significantly higher in patients treated with cemented THA compared with those treated with cemented BHA (OR, 0.18; 95% CI, 0.05–0.62; P=0.006, Z=2.73). EQ-5D was significantly higher in those treated with cemented THA compared with patients treated with cemented BHA. Lastly, HHS was significantly higher in patients treated with cementless THA compared with those treated with cementless BHA. CONCLUSION: An increase in the dislocation rate was observed when THA was performed in elderly patients with femoral neck fracture and who were pre-injury independent walkers. In addition, cemented THA was associated with a higher dislocation rate compared with cemented BHA. However, the dislocation rate in those treated with cementless THA were similar to patients treated with cementless BHA. With regards to functional score, THA was superior to BHA in both cementless and cemented fixation.
Aged ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Butylated Hydroxyanisole ; Dislocations ; Femoral Neck Fractures ; Femur Neck ; Hemiarthroplasty ; Humans ; Methods ; Walkers ; Walking

BACKGROUND: Osteolytic metastasis is a common destructive form of metastasis, in which there is an increased bone resorption but impaired bone formation. It is hypothesized that the changed mechanical properties of tumor affected bone cells could inhibit its mechanosensing, thus contributing to differences in bone remodeling. METHODS: Here, atomic force microscopy indentation on primary bone cells exposed to 50% conditioned medium from Walker 256 (W) carcinoma cell line or its adaptive tumor (T) cells was carried out. Nitric oxide levels of bone cells were monitored in response to low-magnitude, high-frequency (LMHF) vibrations. RESULTS: A stronger sustained inhibitive effect on bone cell viability and differentiation by T cells as compared to that of its cell line was demonstrated. This could be attributed to the higher levels of transforming growth factor-β1 (TGF-β1) in the T-conditioned medium as compared to W-conditioned medium. Bone cell elastic moduli in W and T-groups were found to decrease significantly by 61.0% and 69.6%, respectively compared to control and corresponded to filamentous actin changes. Nitric oxide responses were significantly inhibited in T-conditioned group but not in W-conditioned group. CONCLUSIONS: It implied that a change in cell mechanical properties is not sufficient as an indicator of change in mechanosensing ability. Moreover, inhibition of phosphoinositide 3-kinase/Akt downstream signaling pathway of TGF-β1 alleviated the inhibition effects on mechanosensing in T-conditioned cells, further suggesting that growth factors such as TGF-β could be good therapeutic targets for osteoblast treatment.
Actins ; Bone Neoplasms ; Bone Remodeling ; Bone Resorption ; Cell Line ; Cell Survival ; Culture Media, Conditioned ; Elastic Modulus ; Intercellular Signaling Peptides and Proteins ; Microscopy, Atomic Force ; Neoplasm Metastasis ; Nitric Oxide ; Osteoblasts ; Osteogenesis ; Sensitivity Training Groups ; T-Lymphocytes ; Vibration ; Walkers

PURPOSE: The purpose of this article was to identify and define concepts of post-traumatic growth of family caregivers of cancer patients. METHODS: This study was conducted according to the method of Walker and Avant (2005)'s, focusing on research articles and books published from 2000 to 2017. RESULTS: There were five attributes of the concept: personal growth, reinforcing relationships with others, understanding of others, finding meaning of care, and gratitude for life. Furthermore, antecedents were as follows: cancer diagnosis of a family member, cancer severity, role acceptance of caregiver, caregiving related burden, self-esteem, and hope. The consequences, therefore, were promoting patient' s posttraumatic growth and psychological well-being, increased the quality of life, health related habits change, balance of life, satisfaction of life, and continuation of care. CONCLUSION: Knowing the factors of posttraumatic growth in nursing can be used to devise an intervention to enhance the posttraumatic growth of family caregivers of cancer patient, which can then be applied to a variety of nursing areas.
Caregivers ; Diagnosis ; Hope ; Humans ; Methods ; Nursing ; Quality of Life ; Walkers

PURPOSE: This study was done to analyze and clarify the concept of empathy in nursing. METHODS: Using the concept analysis framework of Walker & Avant 68 articles about empathy were selected for this study. RESULTS: Defining attributes of empathy included recognizing others' perspective and thought, understanding others' emotion, and communicating with them. The antecedents of empathy included contact with patients, respect and trust for patients, a certain level of cognitive ability, and communication skills. Consequences of empathy were increasing patient self-understanding, self-awareness as a therapeutic subject and improving quality of nursing. The concept was clarified through presentation of model, borderline, related, and contrary cases. CONCLUSION: The results of this study are meaningful in that the concept and attributes of empathy are explored in the area of nursing. Also, based on results of this study, development of standardized tools to measure patient-perceived empathy and measure the three attributes of empathy is recommended as well as the development of educational programs to enhance empathy.
Empathy ; Humans ; Nursing ; Walkers

PURPOSE: The purpose of this study was to identify the attributes, antecedents, and consequences of nurse's work interruptions. METHODS: Walker and Avant's concept analysis method was used to analyze this concept. Relevant articles published before August 2018 were searched through MEDLINE, CINAHL, EMBASE, KISS, and RISS databases using “interruption,” “work or task,” and “nurse” as keywords. RESULTS: The attributes of work interruption by nurses were as follows: 1) new tasks to do; 2) cognitive transition of work priorities; 3) loss of work continuity; 4) tasks to be resumed. The antecedents of work interruption were intrusion of unplanned events, internal and external factors that result in nurses forgetting their original intentions, an unpredictable work environment, and cultural climate where interruptions are considered as a part of the work process. The consequences of work interruption were decline in job satisfaction, trigger of work errors, lengthening of work completion time, decline in work productivity, increase in work stress, and delay of transferring needed information in a timely manner. CONCLUSION: The results of this study provide basic data to reduce the negative consequences of nurses' work interruptions, and contribute to expanding the knowledge necessary for improving patients' safety and nurses' performance.
Climate ; Efficiency ; Intention ; Job Satisfaction ; Methods ; Walkers ; Work Performance

PURPOSE: The aim of this study was to explore the attributes, antecedents, and consequences of patient-centered care (PCC) for older adults with multimorbidity in acute care hospitals.METHODS: The concept analysis performed by Walker and Avant was used to analyze PCC. Fifteen studies from the literature related to PCC appear in systematic literature reviews in the fields of theology, medicine, psychology, and nursing.RESULTS: PCC in acute care hospitals was defined according to the five attributes of ‘maintaining patient autonomy’, ‘empowering self-care’, ‘individualized and relationship-based care’, ‘shared decision-making’, and ‘creating a homelike environment’. Antecedents of PCC were found to be a respect for patients' preferences, qualifications of the nursing staff, care coordination and integration, and organizational support. Consequences of effective PCC were a functional status; health-related quality of life; satisfaction with care, mortality, and medical costs from the perspective of the patient and family; and quality of care and therapeutic relationships from nurses' viewpoints.CONCLUSION: PCC as defined by the results of this study will contribute to the foundation of institutionalization and the creation of a safe and healthy acute care hospital culture focused on patients' preferences and values.
Adult ; Comorbidity ; Humans ; Institutionalization ; Mortality ; Nursing ; Nursing Staff ; Patient-Centered Care ; Psychology ; Quality of Life ; Theology ; Walkers

PURPOSE: The purpose of this study was to identify the attributes, antecedents, and consequences of the transition of simulation-based learning (SBL) in nursing schools.METHODS: The study was conducted in accordance with Walker and Avant's conceptual analysis process. We searched MEDLINE, CINAHL, EMBASE, Google Scholar, and RISS (Korean Education and Research Information Service) databases, resulting in nine studies for an in-depth review.RESULTS: The attributes of transition of SBL include (1) preparing for a professional role, (2) practicing in a real clinical setting, and (3) progressing toward expected competency. Antecedents of the concept include novice status, changing roles, clinical experience in controlled settings, and expected competency in the clinical setting.CONCLUSION: The transition of SBL includes the important feature of progression toward expected competency. Further research is needed to identify graduate nurses' experiences during this transition to establish a strategy for improving it and developing a measurement tool that reflects attributes of the concept.
Education ; Learning ; Nursing ; Professional Role ; Schools, Nursing ; Walkers

PURPOSE: This study was to identify and define the concept of a facilitator and specific attributes for providing basic data on simulation nursing education. METHODS: Using Walker and Avant's (2005) criteria that identify the attributes, antecedents, and consequences of facilitators in simulation nursing education, the findings of research articles published from 2001 to 2017 were reviewed. RESULTS: There were three aspects of the facilitator concept in simulation nursing education: (1) continuous support throughout the entire simulation process; (2) skilled progress based on clinical expertise; (3) guidance for learners to actively understand and reflect on the situation. CONCLUSION: This concept analysis helps us to better understand better facilitators in simulation nursing education.
Education, Nursing ; Nursing Theory ; Nursing ; Patient Simulation ; Walkers

PURPOSE: An axillary crutch is the most commonly used assistive device in foot and ankle patients who require nonweightbearing. On the other hand, its use frequently induces axillary or wrist pain and critical neurovascular injuries have been reported in several studies. This study compared the clinical outcomes of patients using the knee walker and axillary crutch. MATERIALS AND METHODS: A retrospective analysis was performed comparing the utility of a knee walker and axillary crutch as a nonweightbearing ambulatory aid for 62 foot and ankle patients treated between November 2016 and March 2018. A comparative study of the two orthosis could be performed because all the patients temporarily used an axillary crutch before or after the use of a knee walker. A demographic study and comparative analysis based on the visual analogue scale (VAS) satisfaction score (0~100), complications, and fall down history were evaluated. Furthermore, under the assumption of having retreatment, their preference of orthosis between the knee walker and axillary crutch was investigated. RESULTS: The mean age of the patients was 36.5 and the mean duration of ambulation with a knee walker and axillary crutch were 5.2 and 2.4 weeks. The VAS satisfaction score of the knee walker and crutch was 88.8 and 27.5, respectively (p < 0.05). The most frequent complications of the knee walker and crutch were ipsilateral knee pain (6 cases) and axillary or wrist pain (56 cases), respectively. No case of falling down occurred during knee walker ambulation, but there were two cases of crutch ambulation. Fifty-eight patients (93.5%) preferred the knee walker and four patients (6.5%) preferred a crutch. CONCLUSION: Compared to the axillary crutch, the knee walker afforded lower complication and higher satisfaction. Most patients preferred the knee walker to a crutch. Therefore, the knee walker is an efficient and safe orthosis for foot and ankle patients who require nonweightbearing.
Accidental Falls ; Ankle* ; Foot* ; Hand ; Humans ; Knee* ; Orthotic Devices ; Retreatment ; Retrospective Studies ; Self-Help Devices ; Walkers* ; Walking ; Wrist