RESUMEN
Hyponatraemia is common in hospitalised patients. In recent years the relationship between hyponatraemia and bone metabolism, falls and fractures has become more established. This study evaluates the prevalence of hyponatraemia (plasma sodium<135mmol/l) in 3897 patients undergoing operative treatment for hip fracture and the relationship between hyponatraemia and mortality in these patients. Hyponatraemia was an independent risk factor for increased post-operative mortality on multivariate analysis. Median age at admission was 83 years. Hyponatraemia was present in 19.1% of patients with hip fracture on admission, 29.5% of patients in the first 24h post-operatively and 20% of patients at discharge. There was a significant association between hyponatraemia and time from admission to surgery indicating that patients admitted with hyponatraemia waited longer. The median follow-up time was 863 (range 0-4352) days. There were 2460 deaths (63.1% of the original 3897 patients) prior to the censor date. A total of 1144 patients (29.4% of the original 3897 patients) died within 12 months of discharge. Median time to death for patients with and without hyponatraemia on admission was 34 months (SE 1.7 months) and 41 months (SE 2.5 months) respectively (p=0.003). Median time to death for patients with and without hyponatraemia within 24h post-operatively was 35 months (SE 2.5 months) and 42 months (SE 1.7 months) respectively (p=0.004). Following elimination of other independent variables associated with increased mortality, hyponatraemia on admission was associated with an increased risk of death (adjusted HR 1.15, p=0.005). Post-operative hyponatraemia was also associated with an increased risk of death (adjusted HR 1.15, p=0.006). Trends suggested that hyponatraemia within 48h of discharge was associated with an increased risk of death (adjusted HR 1.15, p=0.636). Hyponatraemia is common in elderly patients with hip fractures both at initial presentation and during admission. In this vulnerable patient group, hyponatraemia may delay time to definitive surgery and is a potentially reversible cause of increased post-operative mortality. Every effort should be made to identify and correct hyponatraemia in hip fracture patients.
Asunto(s)
Fracturas de Cadera/mortalidad , Hiponatremia/mortalidad , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Fracturas de Cadera/sangre , Fracturas de Cadera/cirugía , Mortalidad Hospitalaria , Hospitalización , Humanos , Hiponatremia/sangre , Hiponatremia/diagnóstico , Masculino , Periodo Posoperatorio , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiologíaRESUMEN
OBJECTIVES: Critics of the Department of Health 'bare below the elbow' guidelines have raised concerns over the impact of these dress regulations on the portrayed image and professionalism of doctors. However, the importance of the doctor's appearance in relation to other professional attributes is largely unknown. The purpose of this study was to determine the opinion of patients on the importance of appearance and the style of clothing worn by doctors. DESIGN: Patient questionnaire survey, administered across four Scottish regions. SETTING: Orthopaedic outpatient departments. PARTICIPANTS: 427 patients and accompanying relatives. MAIN OUTCOME MEASURES: The absolute and relative importance of the doctors' appearance, as reported using a 5-point Likert scale. The absolute and relative importance of the style of clothing worn by doctors, as reported using a 5-point Likert scale. The rank preferences for four different styles of doctors' attire as illustrated by standardised clinical photographs. RESULTS: The study was appropriately powered to identify a 0.5 difference in mean rank values with 0.90 power at a = 0.05. The majority of participants felt the doctors' appearance was important but not as important as compassion, politeness and knowledge. Only 50% felt that the style of doctors clothing mattered; what proved more important was an impression of cleanliness and good personal hygiene. In terms of how patients would prefer doctors to dress in clinic, the most popular choice proved to be the smart casual style of dress, which conforms with the 'bare below the elbows' dress code policy. The smart casual clothing style was the highest ranked choice irrespective of patient age, gender, regional or socioeconomic background. CONCLUSIONS: The doctors' appearance is of importance to patients and their relatives, but they view many other attributes as more important than how we choose to dress. While not specifically addressing the role of doctors clothing in the transmission of infection, our results do support the preference of patients for 'bare below the elbows' workplace attire.
Asunto(s)
Vestuario/normas , Ortopedia , Prioridad del Paciente/estadística & datos numéricos , Médicos/normas , Adulto , Anciano , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Escocia , Encuestas y CuestionariosRESUMEN
The prevalence of Parkinson's disease is expected to rise. We evaluated the short-term clinical outcomes following primary Total Knee Arthroplasty (TKA) in a group of patients with Parkinson's disease in a case controlled study. Within the review period 32 TKAs were implanted in patients with Parkinson's disease and 33 TKAs were implanted in an age-matched control group (mean age: 73 years). Pre-operatively there were no between-group differences in Knee Society Score, Pain score, Knee Society Function Score or range of movement. Knee Society Score (KSS) improved in both groups post-operatively with no significant between-group differences (p = 0.707). Pain score also improved in both groups. There was no functional improvement following TKA in the Parkinson group. Total Knee Arthroplasty provided excellent pain relief in patients with Parkinson's disease with an acceptable complication profile, although functional ability did not improve.