International Journal of Orthopaedic and Trauma Nursing最新文献

英文中文

Validity and reliability of the Danish version of the Hospital Anxiety and Depression Scale (HADS) in patients with major lower extremity amputations: A psychometric study. 丹麦版医院焦虑抑郁量表（HADS）在下肢主要截肢患者中的效度和信度：一项心理测量学研究

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2025-01-10 DOI: 10.1016/j.ijotn.2025.101157

Charlotte Abrahamsen, Ulla Riis Madsen, Ann Pia Søe Jensen, Karin Bundgaard, Charlotte Myhre Jensen, Pia Kjær Kristensen

Background: Patients undergoing major lower extremity amputation (LEA) due to vascular disease face an increased risk of post-surgery anxiety and depression. The Hospital Anxiety and Depression Scale (HADS), widely used to identify anxiety and depressive symptoms, has been translated into Danish, but its content validity has not previously been tested in LEA patients. This study aims to test the validity and reliability of HADS in this population.

Method: This methodological study involved cognitive interviews with 10 major LEA patients to assess content validity and HADS responses from 100 patients to evaluate the floor and ceiling effects, construct validity, and internal consistency reliability. Data were collected from seven orthopedic departments across Denmark.

Results: In this hospital-based study, 20% had anxiety symptoms and 18% had depressive symptoms before discharge. Patients found the questionnaire relevant but had concerns about the one-week timeframe and the comprehensibility of certain items ("butterflies in the stomach" in item 9 and the term "things" in items 2 and 12). Floor effects were present across all items, with no ceiling effects. Confirmatory factor analysis supported both the original two-factor and a three-factor structure. Internal consistency reliability was good for both subscales.

Conclusion: This study supports the validity and reliability of the Danish version of HADS for assessing anxiety and depression in patients with major lower extremity amputation (LEA). The questionnaire serves as a valuable tool for addressing psychosocial challenges, enabling patients to reflect on their mental health and recognize potential symptoms needing medical attention in the future.

背景：由于血管疾病而接受下肢大截肢（LEA）的患者面临着术后焦虑和抑郁的风险增加。医院焦虑和抑郁量表（HADS），广泛用于识别焦虑和抑郁症状，已翻译成丹麦语，但其内容效度尚未在LEA患者中进行过测试。本研究旨在检验HADS在该人群中的效度和信度。方法：采用认知访谈法对10例主要LEA患者进行内容效度评估，对100例患者的HADS反应进行下限效度、结构效度和内部一致性信度评估。数据从丹麦的七个骨科部门收集。结果：在这项以医院为基础的研究中，20%的患者在出院前有焦虑症状，18%的患者有抑郁症状。患者认为问卷是相关的，但对一周的时间框架和某些项目的可理解性（项目9中的“胃里的蝴蝶”和项目2和12中的术语“事物”）有顾虑。地板效果出现在所有项目中，没有天花板效果。验证性因子分析支持原来的两因素和三因素结构。两个分量表的内部一致性信度均较好。结论：本研究支持丹麦版HADS评估重度下肢截肢（LEA）患者焦虑和抑郁的有效性和可靠性。问卷是解决心理社会挑战的宝贵工具，使患者能够反思自己的心理健康状况，并认识到未来需要医疗照顾的潜在症状。

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引用次数: 0

Barriers and facilitators for improving oral anticoagulant medication adherence in lower extremity deep venous thrombosis patients after spinal surgery: A qualitative study using the COM-B model. 脊柱术后下肢深静脉血栓患者口服抗凝药物依从性改善的障碍和促进因素：一项使用COM-B模型的定性研究

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-12-27 DOI: 10.1016/j.ijotn.2024.101155

Xiaoyu Wu, Huaqin Wang, Ya Tan, Xiaoju Tan, Xinge Zhao, Xiaoling Liu, Wenli Wang

Background: Deep venous thrombosis (DVT) of the lower extremity causes a major disease burden globally. Currently, oral anticoagulant therapy is used as the first-line treatment of DVT, however, medication non-adherence remains a serious problem for postoperative spinal surgery patients whose DVT incidence is at a high level.

Aims: To explore barriers and facilitators affecting patient oral anticoagulant medication adherence, based on guidance using the COM-B model.

Methods: This study was a qualitative study using a descriptive research design with in-depth and semi-structured interviews. Data were analyzed adopting traditional content analysis methods.

Results: Based on the COM-B theoretical model, we identified 9 barriers and facilitators from capability, opportunity, and motivation domains.

Conclusions: Patients were confronted with barriers from capability, opportunity, and motivation domains, which were not isolated but interrelated. Future interventions should incorporate facilitators and barriers to address medication adherence issue with a holistic approach at multiple levels.

背景：下肢深静脉血栓形成（DVT）是全球范围内的主要疾病负担。目前，口服抗凝治疗是DVT的一线治疗方法，但对于DVT发生率较高的脊柱术后患者，药物依从性仍然是一个严重的问题。目的：基于COM-B模型的指导，探讨影响患者口服抗凝药物依从性的障碍和促进因素。方法：本研究采用定性研究，采用深度访谈和半结构化访谈的描述性研究设计。数据分析采用传统的内容分析方法。结果：基于COM-B理论模型，我们从能力、机会和动机三个方面确定了9个障碍和促进因素。结论：患者面临着能力、机会和动机领域的障碍，这些障碍不是孤立的，而是相互关联的。未来的干预措施应结合促进因素和障碍，以多层次的整体方法解决药物依从性问题。

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引用次数: 0

Editorial February 2025 issue - Authors Prof Rebecca Jester and Paul McLiesh. 社论2025年2月号-作者丽贝卡·杰斯特教授和保罗·麦克利什。

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-12-25 DOI: 10.1016/j.ijotn.2024.101156

引用次数: 0

Corrigendum to "Patient participation in orthopaedic care-a survey on hip surgery patients' preferences for and experiences of engagement in their health and healthcare" [Int. J. Orthop. Trauma Nurs. 54 (2024) 101118]. “患者对骨科护理的参与——髋关节手术患者对其健康和保健的偏好和参与经验的调查”的勘误表[Int。j . .。创伤护理，54(2024)101118。

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-12-06 DOI: 10.1016/j.ijotn.2024.101154

Patricia Sköld, Maria Hälleberg-Nyman, Eva Joelsson-Alm, Ann Catrine Eldh

引用次数: 0

Literature reviews – External fixation pin site infections: Solutions, screws and Kwires 文献综述-外固定针部位感染：解决方案，螺钉和钢丝

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-11-28 DOI: 10.1016/j.ijotn.2024.101152

Sonya Clarke, Shareena Bibi Mohd Arif, Carmen Queiros

引用次数: 0

Postoperative delirium in geriatric orthopedic and trauma patients: Care begins preoperatively! 老年骨科和创伤患者术后谵妄：护理从术前开始！

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-11-23 DOI: 10.1016/j.ijotn.2024.101143

Lynn Haslam-Larmer , Shirin Vellani

Delirium is a common and serious neuropsychiatric syndrome affecting older adults, particularly after surgery. It manifests in three forms: hypoactive, hyperactive, and mixed, with symptoms ranging from lethargy and inattention to agitation and confusion. Delirium is often misdiagnosed or overlooked, especially in its hypoactive form, which can delay treatment and worsen patient outcomes. Distinguishing delirium from dementia is crucial, as delirium is typically reversible with prompt intervention.

This article, presented in a case study format, explores the assessment and management of delirium in postoperative patients, highlighting the use of validated tools such as the Delirium Elderly at Risk (DEAR) and the Confusion Assessment Method (CAM). Early identification of at-risk patients and timely screening are critical for improving outcomes. Non-pharmacological interventions, including reorientation, sleep hygiene, sensory aids, early mobilization, and family involvement, play a vital role in preventing and managing delirium.

The article emphasizes the importance of nurses in detecting early signs of delirium and implementing preventative measures. A multidisciplinary approach, integrating ongoing screening, patient-centered care, and non-pharmacological strategies, is essential for reducing the incidence and severity of delirium. Early detection and appropriate management can significantly improve recovery and reduce long-term complications, promoting better outcomes in older adults undergoing surgery.

谵妄是一种常见且严重的神经精神综合征，影响着老年人，尤其是手术后的老年人。它有三种表现形式：低活性、高活性和混合型，症状从嗜睡、注意力不集中到躁动和精神错乱不等。谵妄经常被误诊或忽视，尤其是低度谵妄，这会延误治疗并恶化患者的预后。本文以病例研究的形式探讨了术后患者谵妄的评估和管理，重点介绍了谵妄老人风险（DEAR）和意识混乱评估方法（CAM）等有效工具的使用。早期识别高危患者和及时筛查对于改善预后至关重要。文章强调了护士在发现谵妄早期征兆和实施预防措施方面的重要性。要降低谵妄的发生率和严重程度，必须采取多学科方法，将持续筛查、以患者为中心的护理和非药物治疗策略结合起来。及早发现并采取适当的管理措施可以大大改善患者的恢复情况并减少长期并发症，从而为接受手术的老年人带来更好的治疗效果。

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引用次数: 0

Older patients' experiences of shared decision-making when choosing treatment for their distal radius fracture; A qualitative study 老年患者在选择桡骨远端骨折治疗方法时的共同决策经验；定性研究

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-11-19 DOI: 10.1016/j.ijotn.2024.101153

Louise Marie Nøhr , Ane Simony , Charlotte Abrahamsen

Objective

This study aims to understand how older patients experience shared decision-making (SDM) when making decisions about the treatment of their distal radius fracture (DRF).

Methods

An exploratory qualitative study was designed using individual in-person and telephone interviews. Twelve DRF patients were recruited during their first follow-up visit to a Danish outpatient clinic, with ten of them participating in interviews. Data was analysed using content analysis.

Results

Three themes emerged: 1) An acute situation, 2) Considerations influencing the treatment choice and 3) The treatment decision.

Conclusion

In conclusion, our study represents a pioneering effort in reporting the use of Shared Decision Making in fracture management. The sudden onset of DRF proved to be highly distressing for the patients. Providing SDM material to patients in the Emergency department (ED) aimed to empower them and prepare them for their subsequent outpatient clinic visit. However, its effectiveness varied. The demeanour of doctors played a crucial role in shaping patient experiences.

本研究旨在了解老年患者在对桡骨远端骨折（DRF）的治疗做出决定时，如何体验共同决策（SDM）。丹麦一家门诊部在首次复诊时招募了 12 名桡骨远端骨折患者，其中 10 人参加了访谈。结果出现了三个主题：1）急性情况；2）影响治疗选择的考虑因素；3）治疗决定。结论总之，我们的研究开创性地报告了共同决策在骨折管理中的应用。事实证明，DRF 的突然发生给患者带来了极大的痛苦。在急诊科（ED）向患者提供共同决策材料，旨在增强他们的能力，为随后的门诊就诊做好准备。然而，其效果参差不齐。医生的言行举止对患者的体验起着至关重要的作用。

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引用次数: 0

Long-term maintenance of a fragility fracture initiative 长期坚持脆性骨折倡议。

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-11-15 DOI: 10.1016/j.ijotn.2024.101144

Christopher K. Sullivan , Kristine Kocjan , Trevor Tompane , Jennifer Smith , Benjamin M. Wheatley

Introduction

Fragility fractures are common and have an increased chance of refracture and mortality. A process improvement project was initiated including standardized orders to improve treatment of osteoporosis-related fractures. The primary objective was to determine the implementation and maintenance of this process over time. Secondary objectives were to determine the refracture and mortality risk before and after implementation.

Methods

A retrospective cohort of fragility fractures treated during the 6 months prior and 6 months after implementation and for one year 6 years after implementation of the process. We measured the proportion of patients who received DEXA scans, osteoporosis laboratory blood tests, Vitamin D/Calcium supplementation, Primary Care follow-up, refracture, and 6-year mortality.

Results

There was a significant improvement in interventions obtained immediately after process improvement implementation. At 6-years the proportion of interventions obtained had declined and were not significantly different from pre-implementation except laboratory blood tests ordered which remained significantly improved. Mortality risk was significantly lower in the 6 months after process improvement implementation (24% vs 10%; p = 0.027). There was no significant difference in refracture in our cohort (18% vs 19%; p = 0.675).

Discussion

Our process improvement project showed significant improvement in interventions being performed and decreased mortality but were unable to sustain high levels of intervention. We suggest that high surgeon and resident turnover limited our ability to maintain the process improvement project over time. This study supports orthopedic surgeons implementing an osteoporosis treatment protocol for fragility fractures and the importance of continued re-education and re-implementation of process improvement protocols.

导言脆性骨折是一种常见病，会增加再骨折和死亡率。为改善骨质疏松症相关骨折的治疗，我们启动了一项流程改进项目，其中包括标准化医嘱。首要目标是确定该流程的实施情况和长期保持情况。次要目标是确定实施前后的骨折和死亡率风险：方法：对实施前 6 个月和实施后 6 个月以及实施后 6 年内接受治疗的脆性骨折患者进行回顾性队列研究。我们测量了接受 DEXA 扫描、骨质疏松症实验室血液检测、维生素 D/钙补充剂、初级保健随访、再骨折和 6 年死亡率的患者比例：结果：实施流程改进后，干预措施立即得到明显改善。6 年后，获得干预的比例有所下降，与实施前相比没有显著差异，但实验室血液化验除外，后者仍有明显改善。流程改进实施后 6 个月内的死亡率风险明显降低（24% 对 10%；P = 0.027）。我们队列中的骨折率没有明显差异（18% vs 19%; p = 0.675）：讨论：我们的流程改进项目显示，介入治疗的实施有了明显改善，死亡率也有所下降，但却无法维持高水平的介入治疗。我们认为，外科医生和住院医师的高流动率限制了我们长期维持流程改进项目的能力。本研究支持骨科医生针对脆性骨折实施骨质疏松症治疗方案，以及持续再教育和再实施流程改进方案的重要性。

{"title":"Long-term maintenance of a fragility fracture initiative","authors":"Christopher K. Sullivan , Kristine Kocjan , Trevor Tompane , Jennifer Smith , Benjamin M. Wheatley","doi":"10.1016/j.ijotn.2024.101144","DOIUrl":"10.1016/j.ijotn.2024.101144","url":null,"abstract":"<div><h3>Introduction</h3><div>Fragility fractures are common and have an increased chance of refracture and mortality. A process improvement project was initiated including standardized orders to improve treatment of osteoporosis-related fractures. The primary objective was to determine the implementation and maintenance of this process over time. Secondary objectives were to determine the refracture and mortality risk before and after implementation.</div></div><div><h3>Methods</h3><div>A retrospective cohort of fragility fractures treated during the 6 months prior and 6 months after implementation and for one year 6 years after implementation of the process. We measured the proportion of patients who received DEXA scans, osteoporosis laboratory blood tests, Vitamin D/Calcium supplementation, Primary Care follow-up, refracture, and 6-year mortality.</div></div><div><h3>Results</h3><div>There was a significant improvement in interventions obtained immediately after process improvement implementation. At 6-years the proportion of interventions obtained had declined and were not significantly different from pre-implementation except laboratory blood tests ordered which remained significantly improved. Mortality risk was significantly lower in the 6 months after process improvement implementation (24% vs 10%; p = 0.027). There was no significant difference in refracture in our cohort (18% vs 19%; p = 0.675).</div></div><div><h3>Discussion</h3><div>Our process improvement project showed significant improvement in interventions being performed and decreased mortality but were unable to sustain high levels of intervention. We suggest that high surgeon and resident turnover limited our ability to maintain the process improvement project over time. This study supports orthopedic surgeons implementing an osteoporosis treatment protocol for fragility fractures and the importance of continued re-education and re-implementation of process improvement protocols.</div></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":"56 ","pages":"Article 101144"},"PeriodicalIF":1.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Corrigendum to “The effectiveness of prophylactic closed incision negative pressure wound therapy compared to conventional dressings in the prevention of periprosthetic joint infection post hip and knee revision arthroplasty surgery: A systematic review” [Int. J. Orthopaed. Trauma Nurs. 53 (2024) 101048] 预防性闭合切口负压伤口疗法与传统敷料相比在预防髋关节和膝关节翻修关节置换术后假体周围感染方面的有效性：53 (2024) 101048]。

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-11-01 DOI: 10.1016/j.ijotn.2024.101125

Tracy Morgan , Tamara Page , Zaneta Smith

引用次数: 0

A qualitative study of older adults: The difficulties and needs of returning home after hip fractures 一项针对老年人的定性研究：髋部骨折后重返家园的困难和需求。

IF 1.5 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-11-01 DOI: 10.1016/j.ijotn.2024.101141

Paula Rocha , Cristina Lavareda Baixinho , Maria Adriana Henriques

Background

Falls and consequent fractures are an increasing problem among older adults, with low rates of return to previous functional condition and a substantial risk of subsequent falls. This scenario points to the need for an improved response to this population's needs.

Objective

To define the difficulties and needs felt by older adults with hip fractures when returning home.

Methods

This was a descriptive and exploratory qualitative study. Semi-structured interviews were conducted with hip fracture patients who had been submitted to surgery and who were treated at a hospital in the central region of Portugal. Bardin's content analysis was used to analyze the data. Content analysis was carried out with the support of MAXQDA® Analytic pro 2022 software.

Results

The analysis of the results of the 15 interviews yielded three categories related to the difficulties perceived by hip fracture patients on returning home: functional limitations; pain; and emotional management. Regarding the needs felt, the following categories emerged: resources/help with activities of daily living; capacity-building for the return home; and information.

Conclusions

The needs and difficulties of older adults with hip fractures on returning home are multiple and variable. Knowledge of these aspects can significantly enhance the standardized actions of nurses in this area of intervention, contributing to the improvement of continuity of care and ensuring a safe transition.

背景：在老年人中，跌倒和随之而来的骨折是一个日益严重的问题，其功能恢复率很低，而且再次跌倒的风险很大。这种情况表明，需要更好地满足这一人群的需求：方法：这是一项描述性和探索性研究：这是一项描述性和探索性的定性研究。我们对在葡萄牙中部地区一家医院接受手术治疗的髋部骨折患者进行了半结构化访谈。数据分析采用了 Bardin 内容分析法。内容分析在 MAXQDA® Analytic pro 2022 软件的支持下进行：通过对 15 个访谈结果的分析，得出了与髋部骨折患者回家后所感受到的困难有关的三个类别：功能限制、疼痛和情绪管理。在感受到的需求方面，出现了以下类别：日常生活活动的资源/帮助；重返家园的能力建设；信息：患有髋部骨折的老年人在返回家中时的需求和困难是多种多样的。对这些方面的了解可以大大加强护士在这一干预领域的标准化行动，有助于改善护理的连续性并确保安全过渡。

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