International Journal of Orthopaedic and Trauma Nursing最新文献_第6页

Level of implementation of pain management and early mobilization strategies to prevent delirium in geriatric trauma patients: A mixed-methods study 老年创伤患者预防谵妄的疼痛管理和早期动员策略的实施水平：一项混合方法研究。

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-02-01 DOI: 10.1016/j.ijotn.2023.101050

Maryline Beaudoin , Etienne L. Belzile , Céline Gélinas , David Trépanier , Marcel Émond , Marc-Aurèle Gagnon , Mélanie Bérubé

Background

Pain management and early mobilization strategies are recommended in clinical practice guidelines for the prevention of delirium in older adults. However, available data on the implementation of these strategies in trauma are limited.

Aims

To describe the use of pain management and early mobilization strategies in older adults at a level I trauma center, as well as the facilitators and barriers to their implementation.

Methods

A convergent mixed methods study was used. Quantitative data were collected from sixty medical records. Qualitative data was collected through a focus group with healthcare providers to explore their perspectives regarding the use of the target practices and on barriers and facilitators to their implementation. Descriptive statistics were calculated, and a thematic analysis using an inductive and deductive interpretative descriptive approach was undertaken.

Results

A question on the presence/absence of pain was the most frequently documented pain assessment method. Pain assessment was poorly documented. Frequencies of non-opioid and opioid administrations were similar, but non-pharmacological strategies were not widely used. The first mobilization was performed quickly and was most commonly to a chair. The focus group discussion confirmed many of the data collected in the medical records. Barriers to implementing the targeted strategies were primarily related to organizational context and facilitation processes.

Conclusions

Areas for improvement were identified including pain assessment, the use of non-pharmacological pain management strategies and ambulation as a mobilization strategy. Our findings will serve as a starting point for optimizing and adapting practices for geriatric trauma patients and evaluating their impact.

背景：预防老年人谵妄的临床实践指南建议采用疼痛管理和早期动员策略。然而，关于在创伤中实施这些策略的现有数据有限。目的：描述一级创伤中心老年人疼痛管理和早期动员策略的使用情况，以及实施这些策略的推动者和障碍。方法：采用收敛混合方法研究。从60份病历中收集了定量数据。通过与医疗保健提供者组成的焦点小组收集定性数据，以探讨他们对目标实践的使用以及实施目标实践的障碍和促进因素的看法。对描述性统计数据进行了计算，并采用归纳和演绎的解释性描述性方法进行了专题分析。结果：关于疼痛是否存在的问题是最常见的疼痛评估方法。疼痛评估记录不足。非阿片类和阿片类给药的频率相似，但非药理学策略没有得到广泛使用。第一次动员进行得很快，最常见的是坐在椅子上。焦点小组讨论证实了医疗记录中收集的许多数据。执行有针对性的战略的障碍主要与组织背景和促进进程有关。结论：确定了需要改进的领域，包括疼痛评估、非药物疼痛管理策略的使用以及作为动员策略的步行。我们的研究结果将作为优化和调整老年创伤患者实践并评估其影响的起点。

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引用次数: 0

Literature reviews 文献综述

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-02-01 DOI: 10.1016/j.ijotn.2023.101058

Mary Drozd, Carmen Queiros, Shareena Bibi Mohd Arif

引用次数: 0

Sustainability in Orthopaedic and Trauma Nursing 骨科和创伤护理的可持续性

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2024-01-18 DOI: 10.1016/j.ijotn.2024.101082

Rebecca Jester

引用次数: 0

A path analysis investigation into menopausal osteoporosis, sarcopenia risk, and their impact on sleep quality, depressive symptoms and quality of life 更年期骨质疏松症、肌肉疏松症风险及其对睡眠质量、抑郁症状和生活质量影响的路径分析研究

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2023-12-27 DOI: 10.1016/j.ijotn.2023.101080

Hui-Ling Lai , Chun-I Chen , Yu-Ching Lin , Liu-Chun Lu , Chiung-Yu Huang

Purpose

The objective was to investigate the relationships among disease characteristics, sarcopenia risk, bone function, sleep quality, depressive symptoms, and health-related quality of life in menopausal women. Additionally, we also examined the potential mediating role of coping in the relationship between these factors and health outcomes for individuals with osteoporosis.

Methods

In a cross-sectional approach, 201 participants were referred by a physician from the Family Medicine Department during their outpatient visits at a general hospital in Southern Taiwan. Data collection involved structured one-on-one interviews, and the analysis included descriptive and inferential statistics, along with a structural equation modeling.

Results

The participants' bone function was strongly positively related to coping, physical and mental quality of life (QOL), and negatively related to sleep quality and depressive symptoms. The duration of osteoporosis was positively related to pain, sarcopenia risk, sleep quality, but negatively related to bone function, physical and mental QOL. This structural framework explains 36% of the variance in depressive symptoms, 25% in sleep disturbances, 54% in mental QOL, and 72% in physical QOL. The best-fit structural equation modeling showed that physical function, exercise, sarcopenia, pain, and coping were significant predictors of depressive symptoms, with coping acting as a mediator in these relationships.

Conclusion

Individuals who employed more active coping strategies exhibited fewer depressive symptoms, better sleep quality, and superior physical and mental QOL. Further, individuals with osteoporosis had lower pain levels, less sarcopenia risk, and higher engaged in exercise presentation improved physical and mental QOL. Future longitudinal research holds the promise of providing deeper insights into these complex relationships.

目的研究更年期女性的疾病特征、肌肉疏松症风险、骨功能、睡眠质量、抑郁症状以及与健康相关的生活质量之间的关系。此外，我们还研究了应对措施在这些因素与骨质疏松症患者健康结果之间的潜在中介作用。方法采用横断面方法，在台湾南部一家综合医院门诊就诊时，由家庭医学科医生转介 201 名参与者。结果参与者的骨功能与应对能力、身体和精神生活质量（QOL）密切正相关，而与睡眠质量和抑郁症状呈负相关。骨质疏松症的持续时间与疼痛、肌肉疏松症风险和睡眠质量呈正相关，但与骨功能、身体和精神生活质量呈负相关。该结构框架可解释抑郁症状中 36% 的变异、睡眠障碍中 25%的变异、心理 QOL 中 54% 的变异以及身体 QOL 中 72% 的变异。最佳拟合结构方程模型显示，身体功能、运动、肌肉疏松症、疼痛和应对是抑郁症状的重要预测因素，而应对是这些关系的中介。此外，骨质疏松症患者的疼痛程度较低、患肌肉疏松症的风险较小、参与运动的人数较多，这些都改善了他们的身心健康。未来的纵向研究有望更深入地揭示这些复杂的关系。

{"title":"A path analysis investigation into menopausal osteoporosis, sarcopenia risk, and their impact on sleep quality, depressive symptoms and quality of life","authors":"Hui-Ling Lai , Chun-I Chen , Yu-Ching Lin , Liu-Chun Lu , Chiung-Yu Huang","doi":"10.1016/j.ijotn.2023.101080","DOIUrl":"https://doi.org/10.1016/j.ijotn.2023.101080","url":null,"abstract":"<div><h3>Purpose</h3><p>The objective was to investigate the relationships among disease characteristics, sarcopenia risk, bone function, sleep quality, depressive symptoms, and health-related quality of life in menopausal women. Additionally, we also examined the potential mediating role of coping in the relationship between these factors and health outcomes for individuals with osteoporosis.</p></div><div><h3>Methods</h3><p>In a cross-sectional approach, 201 participants were referred by a physician from the Family Medicine<span><span> Department during their outpatient visits at a general hospital in Southern Taiwan. Data collection involved structured one-on-one interviews, and the analysis included descriptive and inferential statistics, along with a </span>structural equation modeling.</span></p></div><div><h3>Results</h3><p>The participants' bone function was strongly positively related to coping, physical and mental quality of life (QOL), and negatively related to sleep quality and depressive symptoms. The duration of osteoporosis was positively related to pain, sarcopenia risk, sleep quality, but negatively related to bone function, physical and mental QOL. This structural framework explains 36% of the variance in depressive symptoms, 25% in sleep disturbances, 54% in mental QOL, and 72% in physical QOL. The best-fit structural equation modeling showed that physical function, exercise, sarcopenia, pain, and coping were significant predictors of depressive symptoms, with coping acting as a mediator in these relationships.</p></div><div><h3>Conclusion</h3><p>Individuals who employed more active coping strategies exhibited fewer depressive symptoms, better sleep quality, and superior physical and mental QOL. Further, individuals with osteoporosis had lower pain levels, less sarcopenia risk, and higher engaged in exercise presentation improved physical and mental QOL. Future longitudinal research holds the promise of providing deeper insights into these complex relationships.</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":"52 ","pages":"Article 101080"},"PeriodicalIF":1.4,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433513","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

Patient-reported outcomes the first thirty days after fast-track primary total hip arthroplasty. A prospective cohort study using a web-based registration tool for postoperative follow-up 快速初级全髋关节置换术后前三十天的患者报告结果。使用网络登记工具进行术后随访的前瞻性队列研究

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2023-12-22 DOI: 10.1016/j.ijotn.2023.101079

Janne Kristin Hofstad , Jomar Klaksvik , Pål Klepstad , Kari Hanne Gjeilo , Kjeld Søballe , Tina Strømdal Wik

Introduction

The documentation on patient reported outcomes the first weeks at home following total hip arthroplasty (THA) is sparse. Length of hospital stay after THA is substantially reduced. Therefore, knowledge on whether patients are managing their own postoperative rehabilitation early after discharge is important, in order to give the patients realistic preoperative information, to modify expectations and enable patients to monitor their own rehabilitation process.

Methods

Eighty-two THA patients were included in a prospective cohort study. Patient-reported outcomes were collected twice a week thirty days postoperatively using a web-based registration tool. Numeric rating scales (0–10) for pain, function, and quality of life, EQ-5D, and the use of opioids were registered. Four weeks postoperatively a telephone interview were conducted. Pain, EQ5D and hip specific physical function score (HOOS-PS) were recorded preoperatively, at three- and twelve-months follow-up.

Results

Pain was maintained the first days after hospital discharge. From day 0 to day 30, pain decreased from 4.0 (SD 2.23) to 2.3 (SD 1.75), function improved from 4.4 (SD 2.06) to 7 (SD 1.57), quality of life improved from 6.3 (SD 2.69) to 7.8 (SD 1.47), and EQ-5D improved from 0.4 to (SD 0.27) to 0.7 (SD 0.14). After 30 days, 32% still used opioids. All patients completed the web-registration. Pain, EQ-5D and HOOS-PS improved substantially from preoperatively to twelve months follow-up.

Conclusion

Fast-track THA patients can expect continued postoperative pain and impaired quality of life the first week at home, before gradually improvement. After thirty days, 32 % of the patients still used opioids.

导言：有关全髋关节置换术（THA）后最初几周患者在家疗效报告的文献很少。全髋关节置换术后住院时间大大缩短。因此，了解患者是否能在出院后早期自行管理术后康复非常重要，这样才能为患者提供真实的术前信息，改变患者的期望值，并使患者能够监控自己的康复过程。术后三十天内，使用网络登记工具每周收集两次患者报告结果。对疼痛、功能和生活质量的数字评分量表（0-10）、EQ-5D 和阿片类药物的使用情况进行了登记。术后四周进行电话访谈。术前、术后三个月和十二个月的随访中记录了疼痛、EQ5D和髋关节特定生理功能评分（HOOS-PS）。从第0天到第30天，疼痛从4.0（SD 2.23）减轻到2.3（SD 1.75），功能从4.4（SD 2.06）改善到7（SD 1.57），生活质量从6.3（SD 2.69）改善到7.8（SD 1.47），EQ-5D从0.4（SD 0.27）改善到0.7（SD 0.14）。30 天后，32% 的患者仍在使用阿片类药物。所有患者都完成了网络登记。从术前到 12 个月的随访期间，疼痛、EQ-5D 和 HOOS-PS 均有显著改善。30天后，32%的患者仍在使用阿片类药物。

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引用次数: 0

Association of tramadol use with risk of hip fractures in patients with osteoarthritis: A systematic review and meta-analysis of observational studies 骨关节炎患者使用曲马多与髋部骨折风险的关系：观察性研究的系统回顾和荟萃分析

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2023-12-12 DOI: 10.1016/j.ijotn.2023.101078

Mansour Bahardoust , Sepideh Mousavi , Javad Khaje Mozafari , Zahra Deylami Moezi , Meisam Haghmoradi , Pouya Ebrahimi , Homan Alipour , Heeva Rashidi

Objective

Many studies have reported conflicting results for the use of tramadol with the risk of fractures, especially hip fractures. This systematic review and meta-analysis study aimed to evaluate the association of tramadol use versus codeine use with the risk of hip fracture for the first time.

Methods

PubMed, Scopus, Google Scholar, and Web of Science databases were searched with specific keywords to find studies that examined the association of tramadol use with hip fracture risk in patients with osteoarthritis up to May 2023. The risk of hip fracture secondary to tramadol versus codeine use was estimated based on age and sex. This systematic review was conducted based on the PRISMA checklist. Heterogeneity between studies was evaluated using Cochran's Q and I2 tests. Egger's test was used to check publication bias. The Newcastle-Ottawa Checklist (NOS) was used to assess the quality of the studies.

Findings

Ten studies with 1,939,293 participants were reviewed. The majority of participants were female. Based on the study evaluation checklist, most studies were of good quality. Tramadol use significantly increases the overall risk of hip fracture. (HR: 1.32, 95% CI: 1.14, 1.51, P: 0.001, I²:19.3%) Tramadol use significantly increases the risk of hip fracture in men (HR: 1.48, 95% CI: 1.24, 1.73, P: 0.001 I²:35%) and age ≤65 years (HR: 1.63, 95% CI: 1.45, 1.80, P: 0.001, I²:0%).

Conclusion

The use of tramadol significantly increases the risk of hip fracture. This increased risk of hip fracture was greater in males younger than 65 years.

目的许多研究报告了曲马多与骨折风险，特别是髋部骨折的矛盾结果。这项系统回顾和荟萃分析研究旨在首次评估曲马多与可待因使用与髋部骨折风险的关系。方法以特定关键词检索spubmed、Scopus、Google Scholar和Web of Science数据库，查找截至2023年5月曲马多使用与骨关节炎患者髋部骨折风险相关的研究。曲马多与可待因继发髋部骨折的风险是根据年龄和性别来估计的。本系统评价是根据PRISMA检查表进行的。采用Cochran’s Q和I2检验评估研究间的异质性。Egger检验用于检验发表偏倚。使用纽卡斯尔-渥太华检查表(NOS)来评估研究的质量。研究结果回顾了1,939,293名参与者的10项研究。大多数参与者是女性。根据研究评估表，大多数研究质量良好。曲马多的使用显著增加髋部骨折的总体风险。(HR: 1.32, 95% CI: 1.14, 1.51, P: 0.001, I2:19.3%)曲马多使用显著增加男性髋部骨折的风险(HR: 1.48, 95% CI: 1.24, 1.73, P: 0.001 I2:35%)和年龄≤65岁(HR: 1.63, 95% CI: 1.45, 1.80, P: 0.001, I2:0%)。结论曲马多的使用明显增加髋部骨折的风险。在65岁以下的男性中，髋部骨折的风险增加更大。

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引用次数: 0

Risk prediction models for postoperative delirium in elderly patients with fragility hip fracture: A systematic review and critical appraisal 老年脆性髋部骨折患者术后谵妄的风险预测模型：系统回顾与批判性评估

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2023-12-10 DOI: 10.1016/j.ijotn.2023.101077

Bingqian Zhou , Ai Wang , Hong Cao

Background

Elderly patients with fragility hip fracture continue to experience a high rate of postoperative delirium (POD), which has a significant negative impact on prognosis and imposes a huge economic burden. A number of risk prediction models have been developed to detect POD early. However, the risk of bias and clinical applicability of the models remain unclear. The aim of this study was to systematically evaluate risk prediction models for POD.

Methods

CNKI, WanFang DATA, Vip Database, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched for studies published by July 2023. The literature was screened independently by two investigators. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS) and the Prediction Model Risk of Bias Assessment Tool (PROBAST) were respectively used for data extraction, risk of bias, and applicability assessment.

Results

A total of 16 studies on the construction of POD risk prediction models were included. The area under the ROC curve of the models ranges from 0.670 to 0.957. The most common predictors of POD included age, history of dementia, history of delirium, ASA classification, preoperative waiting time, and preoperative albumin level. All models had a high risk of bias, mainly due to inadequate sample size, inappropriate handling of missing data, a lack of model performance evaluation, and overfitting of the models.

Conclusions

Overall, risk prediction models for POD in fragility hip fracture patients are still in the development stage. The majority of POD prediction models have substantial bias risks, attributable primarily to poor reporting of analysis and evaluation of model performance. In future research, it is recommended to conduct validation of the models or develop localized prediction models with demonstrated high performance, with the aim of benefiting POD screening.

Systematic review registration

PROSPERO CRD42023449153.

背景老年脆性髋部骨折患者术后谵妄（POD）的发生率仍然很高，这对预后有很大的负面影响，并造成巨大的经济负担。目前已开发出许多风险预测模型来早期检测 POD。然而，这些模型的偏倚风险和临床适用性仍不明确。本研究旨在系统评估 POD 的风险预测模型。方法检索 CNKI、万方数据、维普数据库、SinoMed、PubMed、Web of Science、Embase 和 Cochrane 图书馆 2023 年 7 月前发表的研究。文献由两名研究人员独立筛选。数据提取、偏倚风险和适用性评估分别采用了预测模型研究系统性综述批判性评估和数据提取清单（CHARMS）和预测模型偏倚风险评估工具（PROBAST）。模型的 ROC 曲线下面积从 0.670 到 0.957 不等。最常见的 POD 预测因素包括年龄、痴呆史、谵妄史、ASA 分级、术前等待时间和术前白蛋白水平。所有模型的偏倚风险都很高，主要原因是样本量不足、缺失数据处理不当、缺乏模型性能评估以及模型过度拟合。大多数 POD 预测模型都存在很大的偏倚风险，主要原因是分析报告和模型性能评估不完善。在未来的研究中，建议对模型进行验证，或开发已证明性能较高的局部预测模型，以促进 POD 筛查。

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引用次数: 0

Nurse-led ultrasound-guided femoral nerve block: A randomised controlled trial of two different patient flow systems in an emergency department 护士引导下的超声引导股神经阻滞：急诊科两种不同患者流系统的随机对照试验

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2023-12-04 DOI: 10.1016/j.ijotn.2023.101074

Elin Saga , Ragnhild S. Falk , Pia C. Bing-Jonsson , Kirsti I. Skovdahl , Espen Lindholm

Introduction

Elderly with hip fractures present complex challenges. Effective pain management is crucial for recovery and quality of life. However, pain control can be difficult and requires customized care.

Methods

We conducted an unblinded, randomised controlled trial investigating the effects of ultrasound-guided femoral nerve block in patients with hip fracture performed by specially trained nurses (Group Nurse) compared to anaesthesiologists (Group Anaesthesiologist). The hypothesis was that a single shot ultrasound-guided femoral nerve block would result in a total summarized lower dynamic numeric rating scale score for pain intensity during the first 120 min after admission for patients in Group Nurse compared to Group Anaesthesiologist measured in five timepoints. The primary outcome was measured by a cumulative numeric rating scale score for dynamic pain (with flexion of the hip until maximum 30° from bed surface) during the first 120 min after admission to the emergency department.

Results

From February 2020 to June 2021, 263 patients were screened, of which 42 (16.0%) consented and were randomly allocated; 21 in each arm. The primary outcome was not different between groups (p = 0.24), and displayed no substantial superiority of specially trained nurses over anaesthesiologist. No complications or adverse effects were observed in either group. The use of systemic analgesics and the development of delirium was similar between the two groups. In the Nurse Group, patients were administered their ultrasound-guided femoral nerve block earlier.

Conclusion

Our study did not demonstrate a statistically significant beneficial effect of specially trained nurses over anaesthesiologist on cumulative pain in performing ultrasound-guided femoral nerve blocks, while no side-effects/complications or adverse effects were observed in either group.

Clinicaltrial

The trial was registered on October 31, 2019 at Clinicaltrials.gov (NCT04145752).

导言：髋部骨折老人面临着复杂的挑战。有效的疼痛控制对患者的康复和生活质量至关重要。方法我们进行了一项非盲法随机对照试验，调查由受过专门培训的护士（护士组）与麻醉师（麻醉师组）对髋部骨折患者进行超声引导下股神经阻滞的效果。我们的假设是，与麻醉师组相比，护士组患者在入院后 120 分钟内的疼痛强度动态数字评分量表的总和要低于麻醉师组患者在五个时间点的疼痛强度动态数字评分量表的总和。主要结果由急诊科入院后 120 分钟内动态疼痛（髋关节屈曲至与床面呈最大 30°）的累积数字评级量表评分来衡量。结果从 2020 年 2 月至 2021 年 6 月，共筛选了 263 名患者，其中 42 人（16.0%）同意并被随机分配；每组 21 人。各组间的主要结果无差异（P = 0.24），显示受过专门培训的护士与麻醉师相比并无明显优势。两组均未发现并发症或不良反应。两组患者使用全身镇痛药和出现谵妄的情况相似。在护士组中，患者更早地接受了超声引导下的股神经阻滞。结论我们的研究并未证明，在进行超声引导下的股神经阻滞时，受过专门培训的护士比麻醉师对累积疼痛有统计学意义上的显著优势，而两组中均未观察到副作用/并发症或不良反应。该试验于2019年10月31日在Clinicaltrials.gov（NCT04145752）上注册。

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引用次数: 0

SELF-CONCEPT development of school-aged children with congenital upper limb differences: A mixed-methods study 学龄儿童先天上肢差异的自我概念发展:一项混合方法研究

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2023-11-21 DOI: 10.1016/j.ijotn.2023.101066

Sally Ann Martens , Terry A. Badger

Background

School-aged children enter an essential phase of psychosocial development in which they begin to form their self-concept. Having a negative self-concept has a direct relationship on the gradual evolution of a child's personality which can influence academic and career success, peer interactions and relationships, generativity and life satisfaction and meaning. There is limited research examining self-concept in children with congenital upper limb differences.

Objectives

Describe self-concept in school-aged children with congenital upper limb differences (CULD).

Methods

In this convergent mixed methods study, we used the Piers Harris Children's Self-Concept Scale (PHCSCS) and modified photovoice methodology to explore self-concept in school aged children with CULD. The quantitative results from the PHCSCS were merged with the qualitative findings from the 63 photographs and 63 written descriptions provided by nine children.

Results

Mean self-concept was 51.22 (±10.43). Mean domain scores: behavioral adjustment 52 (±8.19), freedom from anxiety 48.56 (±10.42), happiness and satisfaction 49.44 (±10.73), intellectual and school status 54.78 (±10.31), and social acceptance 49.89 (±8.64). Nine participants described five themes of self-concept: emotions, sense of accomplishments, positive view of oneself and one's physical body, hobbies, and a sense of connection. Children defined their self-concept through expressions of self-efficacy, self-image, and social identity.

Implications

Results created a more comprehensive description of self-concept, and expanded understanding of the social identity of school-aged children with congenital upper limb difference. Future research is needed to examine the relationships between self-efficacy, self-image, and social identity to develop interventions promoting healthy self-concept development.

学龄儿童进入心理社会发展的重要阶段，开始形成自我概念。消极的自我概念与儿童个性的逐渐演变有直接关系，而个性的逐渐演变会影响学业和职业成功、同伴互动和关系、创造力和生活满意度和意义。关于先天性上肢差异儿童自我概念的研究有限。目的探讨学龄儿童先天性上肢差异(CULD)的自我概念。方法采用融合混合方法，采用Piers Harris儿童自我概念量表(PHCSCS)和改进的光声法对学龄儿童的自我概念进行研究。PHCSCS的定量结果与9名儿童提供的63张照片和63份书面描述的定性结果合并。结果平均自我概念为51.22(±10.43)。平均领域得分:行为调整52分(±8.19)分，焦虑自由48.56分(±10.42)分，幸福和满意度49.44分(±10.73)分，智力和学业状况54.78分(±10.31)分，社会接受程度49.89分(±8.64)分。九名参与者描述了自我概念的五个主题:情绪、成就感、对自己和身体的积极看法、爱好和联系感。儿童通过自我效能感、自我形象和社会认同的表达来定义自我概念。结果对学龄期先天性上肢差异儿童的自我概念进行了较为全面的描述，扩大了对其社会认同的认识。未来需要进一步研究自我效能感、自我形象和社会认同之间的关系，以制定促进健康自我概念发展的干预措施。

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引用次数: 0

Safety-promoting interventions for the older person with hip fracture on returning home: A systematic review 老年人髋部骨折回家后的安全促进干预措施:一项系统综述

IF 1.4 Q3 NURSING

International Journal of Orthopaedic and Trauma Nursing

Pub Date : 2023-11-08 DOI: 10.1016/j.ijotn.2023.101063

Paula Rocha , Cristina Lavareda Baixinho , Andrea Marques , Maria Adriana Henriques

Background

Older adults with a prior history of falls that results in hip fractures have difficulties in regaining pre-fracture functional capacity. Scientific evidence has shown benefits of the implementation of multidimensional rehabilitation programs, but this evidence is not systematized with regard to continuity of care after hospital discharge.

Objective

To identify interventions that promote safety and functional recovery of older adults with hip fractures after hospital discharge.

Method

A systematic review was carried out according to Cochrane methodology. The research strategy was predefined for the MEDLINE and CINAHL databases. The identified articles were screened according to the eligibility criteria by two independent reviewers. The articles included in the bibliographic sample were evaluated for risk of bias.

Results

Of the 10,036 articles found, 10 were included in this systematic review. The safety-promoting interventions identified were: exercise training, occupational therapy/activities of daily living training, transfer and gait training, strengthening exercises, education on assistive device use, fall prevention education, nutritional assessment, environmental modifications/adjustments at home, use of an app, medication, self-care education, and support and counseling.

Conclusions

In eight studies analyzed, exercise training emerged as the most effective intervention for promoting the safety of older adults after hip fractures on returning home. Three studies associated two or more interventions, which focused on exercise training, occupational therapy/training of activities of daily living, and conventional postoperative rehabilitation with transfer and gait training, strengthening exercises, education on assistive device use and discharge planning, aiming to achieve muscle strengthening and safe gait, associated with the performance of activities of daily living.

背景:有跌倒史导致髋部骨折的老年人在恢复骨折前的功能能力方面存在困难。科学证据已经表明实施多维康复计划的好处，但这一证据并没有系统地考虑到出院后护理的连续性。目的探讨促进老年髋部骨折患者出院后安全性和功能恢复的干预措施。方法采用Cochrane方法学进行系统评价。研究策略是预先为MEDLINE和CINAHL数据库制定的。确定的文章由两名独立审稿人根据资格标准进行筛选。对纳入文献样本的文章进行偏倚风险评估。结果在10036篇文献中，有10篇被纳入本系统综述。确定的安全促进干预措施包括:运动训练、职业治疗/日常生活活动训练、转移和步态训练、强化练习、辅助装置使用教育、预防跌倒教育、营养评估、家庭环境改变/调整、应用程序的使用、药物、自我保健教育以及支持和咨询。在分析的八项研究中，运动训练是促进老年人髋部骨折后回家安全的最有效干预措施。三项研究联合了两种或两种以上的干预措施，重点是运动训练、日常生活活动的职业治疗/训练，以及常规术后康复与转移和步态训练、强化练习、辅助器具使用教育和出院计划，旨在实现肌肉强化和安全步态，与日常生活活动的表现相关。

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引用次数: 0