Malmö University Publications
Change search
Refine search result
12 1 - 50 of 69
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Bartha, Erzsebet
    et al.
    Research Assistant, Karolinska Institute, CLINTEC, Division of Anesthesiology, Karolinska University Hospital, Stockholm, Sweden..
    Davidson, Thomas
    Assistant Professor, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden..
    Hommel, Ami
    Assistant Professor, Department of Health Sciences, Lund University, Lund, Sweden..
    Thorngren, Karl-Göran
    Professor, Department of Orthopedics, Lund University Hospital, Lund, Sweden..
    Carlsson, Per
    Professor, Center for Medical Technology Assessment, Linköping University..
    Kalman, Sigridur
    Professor, Karolinska Institute, CLINTEC, Division of Anesthesiology, Karolinska University Hospital..
    Cost-effectiveness Analysis of Goal-directed Hemodynamic Treatment of Elderly Hip Fracture Patients2012In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 117, no 3, p. 519-530Article in journal (Refereed)
    Abstract [en]

    Background

    Health economic evaluations are increasingly used to make the decision to adopt new medical interventions. Before such decisions, various stakeholders have invested in clinical research. But health economic factors are seldom considered in research funding decisions. Cost-effectiveness analyses could be informative before the launch of clinical research projects, particularly when a targeted intervention is resource-intensive, total cost for the trial is very high, and expected gain of health benefits is uncertain. This study analyzed cost-effectiveness using a decision analytic model before initiating a large clinical research project on goal-directed hemodynamic treatment of elderly patients with hip fracture.

    Methods

    A probabilistic decision analytic cost-effectiveness model was developed; the model contains a decision tree for the postoperative short-term outcome and a Markov structure for long-term outcome. Clinical effect estimates, costs, health-related quality-of-life measures, and long-term survival constituted model input that was extracted from clinical trials, national databases, and surveys. Model output consisted of estimated medical care costs related to quality-adjusted life-years.

    Results

    In the base case analysis, goal-directed hemodynamic treatment reduced average medical care costs by €1,882 and gained 0.344 quality-adjusted life-years. In 96.5% of the simulations, goal-directed hemodynamic treatment is less costly and provides more quality-adjusted life-years. The results are sensitive to clinical effect size variations, although goal-directed hemodynamic treatment seems to be cost-effective even with moderate clinical effect.

    Conclusion

    This study demonstrates that cost-effectiveness analysis is feasible, meaningful, and recommendable before launch of costly clinical research projects.

  • 2. Bergman, J
    et al.
    Nordström, A
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kivipelto, M
    Nordström, P
    Bisphosphonates and mortality: confounding in observational studies?2019In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, no 10, p. 1973-1982Article in journal (Refereed)
    Abstract [en]

    Numerous observational studies suggest that bisphosphonates reduce mortality. This study showed that bisphosphonate use is associated with lower mortality within days of treatment, although the association was not significant until the second week. Such an early association is consistent with confounding, although an early treatment effect cannot be ruled out. INTRODUCTION: The purpose of this study was to examine whether confounding explains why numerous observational studies show that bisphosphonate use is associated with lower mortality. To this end, we examined how soon after treatment initiation a lower mortality rate can be observed. We hypothesized that, due to confounding, the association would be observed immediately. METHODS: This was a retrospective cohort study of hip fracture patients discharged from Swedish hospitals between 1 July 2006 and 31 December 2015. The data covered 260,574 hip fracture patients and were obtained from the Swedish Hip Fracture Register and national registers. Of the 260,574 patients, 49,765 met all eligibility criteria and 10,178 were pair matched (bisphosphonate users to controls) using time-dependent propensity scores. The matching variables were age, sex, diagnoses, prescription medications, type of hip fracture, type of surgical procedure, known or suspected dementia, and physical functioning status. RESULTS: Over a median follow-up of 2.8 years, 2922 of the 10,178 matched patients died. The mortality rate was 7.9 deaths per 100 person-years in bisphosphonate users and 9.4 deaths in controls, which corresponded to a 15% lower mortality rate in bisphosphonate users (hazard ratio 0.85, 95% confidence interval 0.79-0.91). The risk of death was lower in bisphosphonate users from day 6 of treatment, although the association was not significant until the second week. CONCLUSION: Bisphosphonate use was associated with lower mortality within days of treatment initiation. This finding is consistent with confounding, although an early treatment effect cannot be ruled out.

    Download full text (pdf)
    FULLTEXT01
  • 3.
    Björkelund, K. B.
    et al.
    Departments of Anesthesiology and Intensive Care, Clinical Sciences & Department of Health Sciences, Lund University, Lund, Sweden.
    Hommel, A.
    Department of Health Sciences & Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Thorngren, K.-G.
    Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Gustafson, L.
    Department of Psychogeriatrics, Clinical Sciences, Lund University, Lund, Sweden.
    Larsson, S.
    Department of Cardiothoracic Surgery, Lund University Hospital, Lund, Sweden.
    Lundberg, D.
    Departments of Anesthesiology and Intensive Care, Clinical Sciences, Lund University, Lund, Sweden.
    Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 6, p. 678-688Article in journal (Refereed)
    Abstract [en]

    Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium.

    Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (≥65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale.

    Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test.

    Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.

  • 4.
    Björkman Björkelund, Karin
    et al.
    Lund University, Department of Health Sciences, Lund, Sweden.
    Hommel, Ami
    Lund University, the Department of Health Sciences, and the Department of Orthopedics, Clinical Sciences.
    Thorngren, Karl-Göran
    Lund University, Department of Orthopedics, Clinical Sciences.
    Lundberg, Dag
    Lund University, Department of Anesthesiology and Intensive Care, Clinical Sciences.
    Larsson, Sylvia
    Lund University, Department of Health Sciences.
    Factors at admission associated with 4 months outcome in elderly patients with hip fracture.2009In: AANA Journal, Vol. 77, no 1, p. 49-58Article in journal (Refereed)
    Abstract [en]

    The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Mortality within 4 months was significantly associated with ASA physical status 3 and 4, age 85 years or older, male sex, dementia diagnosis, fewer than 8 correct answers on the Short Portable Mental Status Questionnaire, 4 or more prescribed drugs, hemoglobin level less than 100 g/L, creatinine level more than 100 micromol/L, dependency in living, inability to walk alone, and fracture other than undisplaced intracapsular. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.

  • 5.
    Björkman Björkelund, Karin
    et al.
    Lund University, Department of Health Sciences, Lund, Sweden.
    Hommel, Ami
    Lund University, the Department of Health Sciences and the Department of Orthopedics, Clinical Sciences..
    Thorngren, Karl-Göran
    Lund University, Department of Orthopedics, Clinical Sciences.
    Lundberg, Dag
    Lund University, Department of Anesthesiology and Intensive Care, Clinical Sciences.
    Larsson, Sylvia
    Department of Cardiothoracic Surgery, Lund University Hospital.
    The influence of perioperative care and treatment on 4-months outcome in elderly with hip fracture2011In: AANA Journal, ISSN 0094-6354, Vol. 79, no 1, p. 51-61Article in journal (Refereed)
    Abstract [en]

    The purpose of this descriptive cohort study was to identify perioperative risk factors associated with postoperative outcome up to 4 months after surgery in elderly patients with hip fracture. Data were collected prospectively through the Swedish National Hip Fracture, the local Acute and Emergency, and Anesthesia registers, and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Perioperative risk factors predicting death within 4 months after surgery were fasting time of 12 or more hours and blood transfusion of 1 U or more. Risk factors predicting postoperative confusion were postoperative oxygen saturation less than 90% and fasting time 12 hours or longer. Risk factors predicting in-hospital complications were transfusion of 1 or more units of blood, preoperative oxygen saturation less than 90%, and fasting time 12 hours or more. Risk factor predicting length of stay longer than 10 days was blood transfusion of 1 U or more. To minimize morbidity and mortality, providers should increase efforts to optimize the patients' oxygen saturation and hemoglobin level and reduce fasting time and waiting time for surgery.

  • 6. Brent, Louise
    et al.
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Maher, Ann Butler
    Hertz, Karen
    Meehan, Anita J.
    Santy-Tomlinson, Julie
    Nursing care of fragility fracture patients2018In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 49, no 8, p. 1409-1412Article in journal (Refereed)
    Abstract [en]

    The challenge of caring for patients with fragility fractures is particularly acute for nursing teams who are in short supply and work with patients following fracture on a 24 h basis, coordinating as well as providing complex care. This paper considers the role of nurses within the orthogeriatric team and highlights the value of effective nursing care in patient outcomes. It explores the nature of nursing for patients with fragility fracture with a focus on the provision of safe and effective care and the coordination of care across the interdisciplinary team. It also highlights the need for specific skills in orthopaedic and geriatric nursing as well as specialist education. (C) 2018 Elsevier Ltd. All rights reserved.

  • 7.
    Bååth, Carina
    et al.
    Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University and Research, County Council of Värmland, Karlstad, Sweden.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skåne University Hospital, Malmö, Sweden.
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
    Hommel, Ami
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Pressure-reducing interventions among persons with pressure ulcers: resultas from the first three national pressure ulcer prevalence surveys in Sweden2014In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 20, no 1, p. 58-65Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives The overall aim of this study was to describe preventive interventions among persons with pressure ulcer (PU) in three nationwide PU prevalence surveys in Sweden. Methods A cross-sectional research design was used; more than 70 000 persons from different hospitals and nursing homes participated in the three prevalence surveys conducted in March 2011, October 2011 and March 2012. The methodology used was that recommended by the European Pressure Ulcers Advisory Panel. Results The overall prevalence of PU categories I–IV in hospitals was 16.6%, 14.4% and 16.1%, respectively. Corresponding figures for nursing homes were 14.5%, 14.2% and 11.8%, respectively. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PU category I. Conclusions Despite the three prevalence studies that have showed high prevalence of PU the use of preventing interventions is still not on an acceptable level. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PUs, and individual-planned repositioning also increased. However, when persons already have a PU they should all have pressure-reducing preventive interventions to prevent the development of more PUs. Preventing PUs presents a challenge even when facilities have prevention programmes. A PU prevention programme requires an enthusiastic leader who will maintain the team's focus and direction for all staff involved in patient care.

  • 8.
    Deprez, Julie
    et al.
    Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Kottner, Jan
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;Institute of Clinical Nursing Science, Charité Universitätsmedizin, Berlin, Germany.
    Eilegård Wallin, Alexandra
    Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ohde, Nils
    nstitute of Clinical Nursing Science, Charité Universitätsmedizin, Berlin, Germany.
    Bååth, Carina
    Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden; Faculty of Health, Welfare and Organisation, Østfold University College - Campus Frederikstad, Fredrikstad, Norway.
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hultin, Lisa
    Department of Public Health and Caring Sciences, Upsalla University, Upsalla, Sweden; Upsalla University Hospital, Upsalla, Sweden.
    Josefson, Anna
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Beeckman, Dimitri
    Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    What are the prognostic factors for the development of incontinence-associated dermatitis (IAD): a protocol for a systematic review and meta-analysis2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 7, article id e073115Article in journal (Refereed)
    Abstract [en]

    Introduction: Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research.

    Methods and analysis: This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I2 statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance.

    Ethics and dissemination: No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.

    Download full text (pdf)
    fulltext
  • 9.
    Desirée, Sjöstrand
    et al.
    Department of Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden.
    Hommel, Ami
    Department of Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden.
    Anders, Johansson
    Sections of Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden.
    Causes of Surgical Delay and Demographic Characteristics in Patients with Hip Fracture2013In: Open Journal of Orthopedics, ISSN 2164-3008, Vol. 03, no 04, p. 193-198Article in journal (Refereed)
  • 10.
    Dobožinskas, Paulius
    et al.
    Lithuanian Medicine academy University of Health Sciences.
    Valavičienė, Rasa
    Kaunas College University of Applied Sciences.
    Hommel, Ami
    Lund University, Lund University Hospital, Department of Orthopedics, Sweden.
    Changes In Care Management After “Fast Track” Protocol Introduction For Hip Fracture Patients2015In: Sveikatos mokslai, ISSN 1392-6373, Vol. 25, no 5, p. 126-130Article in journal (Refereed)
    Abstract [en]

    Background and objective. The introduction of fast track schemes for patients with hip fracture usually results in reductions in length of stay and mortality, and reduces the numbers of complications. The aim of this study was to evaluate the changes in procedure performance, time from admission to surgery and length of stay after introduction of the fast track protocol (FTP). Materials and methods. 235 patients with hip fracture treated before FTP introduction and after the introduction were prospectively investigated. We studied the use of fracture immobilization, analgesics, infusion therapy, blood test sampling and ECG registration during these two periods. Information about the mean/median time period from admission to surgery and length of stay in the hospital (LOS) in the orthopaedic department was recorded. Results. Significant improvements in the use of immobilization, infusion therapy, blood test sampling and ECG recording were observed after FTP introduction. Also significant reductions were observed in both waiting time for surgery and for LOS. Conclusion. Introduction of a FTP improved the use of procedures necessary for hip fracture patient care, while reducing wait to surgery time and LOS.

    Download full text (pdf)
    fulltext
  • 11.
    Estev, Bibi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Registered Nurses’ Perceptions of Factors Contributing to Trust-Based Public Management2020In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 10, no 11, p. 1126-1141Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to illuminate registered nurses’ (RNs) perceptions of Trust-Based Public Management (TBPM) in Swedish health care. Design: This study follows a phenomenografic approach guided by Ference Marton’s philosophy. Methods: Semi-structured interviews were used to identify variations in RNs’ perceptions of TBPM. Between February and April 2019, 24 RNs from five Swedish public healthcare departments participated in the study. Results: The results show that none of the participants had previously heard about the work of the Swedish Delegation for TBPM. The study revealed perceptions those politicians and managers were absent from the workplace, that power had been displaced to HR, and that perceptions of trust in the leadership and of working to guidelines varied. Perceptions varied between RNs employed by the municipalities and by the hospitals concerning administration, the time allotted for work, cooperation, and education.

    Download full text (pdf)
    fulltext
  • 12.
    Fridlund, Bengt
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden; School of Health Sciences, Jönköping University, Jönköping, Sweden .
    Jönsson, A. C.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Andersson, E. K.
    Department of Health Sciences, Lund University, Lund, Sweden; School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.
    Bala, S.-V.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Dahlman, G.-B.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Forsberg, A.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Glasdam, S.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Hommel, A.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Kristensson, A.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Lindberg, C.
    Department of Health Sciences, Lund University, Lund, Sweden; School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.
    Sivberg, B.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Sjöström-Strand, A.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Wihlborg, J.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Samuelson, K.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Essentials of Nursing Care in Randomized Controlled Trials of Nurse-Led Interventions in Somatic Care: A Systematic Review2014In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 04, no 03, p. 181-197Article, review/survey (Refereed)
    Abstract [en]

    Background: Nursing practice has to contribute to evidence pointing out why there is a need for more nurse-designed randomized control trials (RCTs) focusing on evidence-based practice (EBP). How far this EBP has progressed in different health aspects is usually established by systematic reviews of RCTs. Nurse-led RCTs exist but no study has addressed the essentials of nursing care. Aim: The aim was therefore to determine the essentials of nurses’ interventions by means of nurse-led RCTs in somatic care focusing on the stated context, goals, content, strategies as well as the nurse’s role related to effectiveness. Methods: A systematic review was realized according to Cochrane review assumptions to identify, appraise and synthesize all empirical evidence meeting pre-specified eligibility criteria. The PRISMA statement guided the data extraction process (n<span "="" style="box-sizing: border-box; padding: 0px; margin: 0px; color: rgb(35, 35, 35); font-family: Verdana, Arial, Helvetica, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: justify; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; font-size: 10pt;"> =<span "="" style="box-sizing: border-box; padding: 0px; margin: 0px; color: rgb(35, 35, 35); font-family: Verdana, Arial, Helvetica, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: justify; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; font-size: 10pt;"> 55) from PubMed and CINAHL. Results: Of the RCTs in somatic care, 71% showed a positive effectiveness of nurse-led interventions, of which the nurse had a significant role with regard to being the main responsible in 67% of the studies. Also, 47% of the RCTs presented a theoretical standpoint related to the nurse-led interventions and most prominent were international evidence-based guidelines. Goals were found to have either a patient-centered or a professional-centered ambition. Strategies were based on patient-directed initiatives, nurse-patient-directed initiatives or nurse-directed initiatives, while contents were built upon either a patient-nurse interaction or a nursing management plan. Conclusions: This review underlines the necessity of a holistic view of a person, as nurse-led RCTs comprising a patient-centered ambition, patient-directed initiative and patient-nurse interaction plan showed beneficial nursing care effectiveness, particularly if theory-based. In a nurse-led RCT, a basic theoretical perspective is advantageous as well as to elucidate the role of the nurse in relation to the estimated effects.

  • 13. Gesar, Berit
    et al.
    Baath, Carina
    Hedin, Hanne
    Hommel, Ami
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hip fracture; an interruption that has consequences four months later: A qualitative study2017In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 26, p. 43-48Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Effects following a hip fracture often lead to functional disabilities and increased dependence on others. Although persons sustaining a hip fracture constitute a heterogeneous group in Swedish health care, they tend to be treated as a homogenous one. AIM: The aim of this study was to reveal how previously healthy people, aged 65 years and older, described how they had adapted to daily life four months after a hip fracture. METHOD: The follow-up interviews were performed by the first author four months after the hip fracture. Data were analysed using conventional inductive content analysis. FINDINGS: The results from the interviews highlight that sustaining a hip fracture - even four months later - was seen by the participants as an interruption leading to lasting consequences for everyday life. The recovery process during this period was complex and consisted of both physical and psychological strain. Some were resigned, some strived in order to regain independence and some handled the situation by means of self-confidence and self-efficacy. CONCLUSION: Previous healthy and independently-living participants described, in different ways that the hip fracture was an interruption that still affected everyday life. The absence of psychological support may be one of the reasons for dependency after four months.

  • 14.
    Gesar, Berit
    et al.
    Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; Department of Orthopaedics, Falun Hospital, Falun, Sweden.
    Bååth, Carina
    Department of Health Sciences, Karlstad University, Karlstad; County Council of Värmland, Sweden.
    Hedin, Hanne
    Department of Orthopaedics, Falun Hospital, Falun, Sweden .
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Health Care Science, Lund University; Department of Orthopaedics, Skåne University Hospital Lund, Lund, Sweden.
    Patient reported outcomes at acute hospital stay and four months after hip fracture surgery. A register and questionnaire study2018In: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 6, no 1, p. 119-127Article in journal (Refereed)
    Abstract [en]

    Introduction: The large and increasing number of hip fracture patients, in combination with the large impact that this is having on daily living activities, is emphasizing the importance of identifying factors that have a detrimental impact on post-operative outcomes. There are benefits to planning the ward in a way that prevents a steep decline in recovery after hip fracture surgery. Adding the patient`s perspective into the healthcare assessment, via shared healthcare decision-making, allows the patient’s needs and preferences to be taken fully into account. The aim of this study was to identify factors that predict how patients recover after hip fracture surgery.

    Methods: A descriptive quality register/questionnaire study in acute orthopaedic wards, 2 to 5 days after surgery, with a follow-up 4 months later. The patients included were ≥65 years of age and had been previously healthy and living independently before the hip fracture.

    Results: The participants in this study had returned to their own homes after 4 months, but only 21% reported themselves as being fully or almost fully recovered. In several domains of recovery, all 3 age groups (65-74, 75-84 and 85-97) reported different challenges both during their acute hospital stay and at the 4 months follow-up. The recovery phase is heterogeneous and requires individual care. The way that this is planned has an influence on patient outcome.

    Conclusion: Patients sustaining a hip fracture are heterogeneous and different age groups experience different challenges. At 4 months follow-up, one fifth of the participants reported themselves fully or almost fully recovered and most of them had returned to their own homes. The Swedish National Hip Fracture Register and the patient-reported questionnaires employed in this study are appropriate tools to audit further development of healthcare to improve quality of life after hip fracture surgery. 

  • 15.
    Gesar, Berit
    et al.
    Department of Clinical Sciences, Faculty of Medicine, Lund University.
    Hommel, Ami
    Department of Health Sciences, Lund University, Lund, Sweden.
    Hedin, Hanne
    Department of Orthopaedics, Falun Hospital, Falun, Sweden.
    Bååth, Carina
    Department of Health Sciences, Karlstad University, Karlstad, Sweden. County Council of Varmland, Karlstad, Sweden..
    Older patients' perception of their own capacity to regain pre-fracture function after hip fracture surgery: an explorative qualitative study2017In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 24, p. 50-58Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo explore healthy older patients' perceptions of their own capacity to regain pre-fracture function in the acute phase following hip fracture surgery.BackgroundThe incidence of hip fractures is expected to increase. In Sweden, of the patients who sustain a hip fracture, 40 per cent are healthy and lived independently pre fracture. However, a hip fracture often results in declined functional outcomes for 40 per cent of these patients.DesignThe study had an explorative inductive qualitative design.MethodsSemi-structured interviews (n = 30) were conducted two to five days after hip fracture surgery. Data were analysed using manifest inductive content analysis.ResultsAs a description of patients' perception of their own capacity to regain pre-fracture function after a hip fracture, one main category emerged: To end up in a new situation with or without control. Patients expressed that they believed in recovery and thought nothing would be altered. However, since they had to adapt to the ward culture at the acute hospital, they became passive and became insecure about their future life situation.ConclusionThe attitudes of staff at the acute hospital can influence the outcome for hip fracture patients. Patients believe in recovery but do not receive psychological support to regain physical capacity.

    Download full text (pdf)
    fulltext
  • 16.
    Gunningberg, Lena
    et al.
    Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden; School of Nursing, University of California, San Francisco, CA, USA.
    Hommel, Ami
    Lund University and Skåne University Hospital, Lund, Sweden.
    Bååth, Carina
    Karlstad University and County Council of Värmland, Karlstad, Sweden.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skåne University Hospital, Malmö, Sweden.
    The first national pressure ulcer prevalence survey in county council and municipality settings in Sweden2012In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 5, p. 862-867Article in journal (Refereed)
    Abstract [en]

    Aim: To report data from the first national pressure ulcer prevalence survey in Sweden on prevalence, pressure ulcer categories, locations and preventive interventions for persons at risk for developing pressure ulcers. Methods: A cross-sectional research design was used in a total sample of 35 058 persons in hospitals and nursing homes. The methodology used was that recommended by the European Pressure Ulcer Advisory Panel. Results: The prevalence of pressure ulcers was 16.6% in hospitals and 14.5% in nursing homes. Many persons at risk for developing pressure ulcers did not receive a pressure-reducing mattress (23.3–27.9%) or planned repositioning in bed (50.2–57.5%). Conclusions: Despite great effort on the national level to encourage the prevention of pressure ulcers, the prevalence is high. Public reporting and benchmarking are now available, evidence-based guidelines have been disseminated and national goals have been set. Strategies for implementing practices outlined in the guidelines, meeting goals and changing attitudes must be further developed.

  • 17. Gunningberg, Lena
    et al.
    Sving, Eva
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Alenius, Carina
    Wiger, Per
    Baath, Carina
    Tracking pressure injuries as adverse events: National use of the Global Trigger Tool over a 4-year period.2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, no 1, p. 21-27Article in journal (Refereed)
    Abstract [en]

    AIM: To examine the frequency, preventability, and consequences of hospital acquired pressure injuries in acute care hospitals over a 4-year period. METHOD: A retrospective record review was performed using the Swedish version of the Global Trigger Tool (GTT). A total of 64 917 hospital admissions were reviewed. Data were collected between 2013 and 2016 from all 63 Swedish acute care hospitals. RESULTS: The prevalence of pressure injuries (category 2-4) was 1%. Older patients, "satellite patients", and patients with acute admissions had more pressure injuries. Most pressure injuries (91%) were determined to be preventable. The mean extended length of hospital stay was 15.8 days for patients who developed pressure injuries during hospitalization. CONCLUSION: The GTT provides a useful and complementary national perspective on hospital acquired pressure injuries across hospitals, informing health care providers on safety priorities to reduce patient harm. Clinical leaders can use information on the preventability and the consequences of pressure injuries, as well as evidence-based arguments for improving the health care organization.

  • 18.
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Magnetsjukhus och transformerande ledarskap2022In: Våga leda omvårdnad / [ed] Ziegert, Kristina, Stockholm: Liber , 2022, 1, p. 191-206Chapter in book (Other academic)
  • 19.
    Hommel, Ami
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Andersson, Åsa
    God och nära vård2022In: Implementering av sjuksköterskans kärnkompetenser / [ed] Leksell Janeth & Lepp Margret, Stockholm: Liber, 2022, 1, p. 78-101Chapter in book (Other academic)
  • 20.
    Hommel, Ami
    et al.
    Department of Orthopedics, Lund University Hospital, Sweden. Department of Health Sciences, Lund University, Sweden.
    Bjorkelund, Karin B
    Department of Health Sciences, Lund University, Sweden.
    Thorngren, Karl-Göran
    Department of Orthopedics, Lund University Hospital, Sweden.
    Ulander, Kerstin
    Department of Health Sciences, Kristianstad University, Sweden.
    A study of a pathway to reduce pressure ulcers for patients with a hip fracture2007In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 11, no 3-4, p. 151-159Article in journal (Refereed)
  • 21.
    Hommel, Ami
    et al.
    Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden; Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden.
    Bjorkelund, Karin B.
    Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden.
    Thorngren, Karl-Göran
    Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden.
    Ulander, Kerstin
    Department of Health Sciences, Kristianstad University, SE-29188 Kristianstad, Sweden.
    Differences in complications and length of stay between patients with a hip fracture treated in an orthopaedic department and patients treated in other hospital departments2008In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 12, no 1, p. 13-25Article in journal (Refereed)
    Abstract [en]

    The health care system has to deal with substantial health care costs, which are expected to continue to rise due to increasingly elderly populations. One way of saving has been a reduction of the number of beds in hospitals. The consequence is that acute patients are inappropriately admitted to non-specialized wards because of limited beds. These patients are also known as “outliers”. In this study, consecutive patients with a hip fracture treated at the orthopaedic department (n = 273) are compared with patients treated at other departments (n = 147) according to the incidence of complications and the length of stay (LOS) before and after the introduction of an evidence-based clinical pathway. There was no medical difference between the populations. However, the strict demands of saving costs, with limited beds, have resulted not only in economic consequences with prolonged hospitalization, but also in patient suffering and the inconvenience of increased postoperative complications.

    Patients treated at non-specialized wards had an extra LOS of 3.7 days in the acute hospital settings and furthermore, 13.6 days of LOS including rehabilitation compared to patients treated at the orthopaedic department. In addition, we consider the implemented evidence-based clinical pathway to be successful since the number of complications was reduced. It is a major challenge to establish effective treatment and rehabilitation for patients after a hip fracture aiming to avoid complications and reduce LOS. These fragile patients with a hip fracture ought to be treated at the orthopaedic department, or at departments with geriatric and rehabilitation knowledge. Physiotherapists, occupational therapists and nurses specialising in orthopaedics and geriatricians should take an active part in the care of these patients.

  • 22.
    Hommel, Ami
    et al.
    Department of Health Sciences, Lund University, Sweden; Department of Orthopedics, Lund University Hospital, Sweden..
    Bjorkelund, Karin B.
    Department of Health Sciences, Lund University, Sweden.
    Thorngren, Karl-Göran
    Department of Orthopedics, Lund University Hospital, Sweden.
    Ulander, Kerstin
    Department of Health Sciences, Kristianstad University, Sweden.
    Nutritional status among patients with hip fracture in relation to pressure ulcers2007In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 26, no 5, p. 589-596Article in journal (Refereed)
  • 23.
    Hommel, Ami
    et al.
    Department of Health Sciences; Lund University; Lund Sweden;Department of Orthopedics; Skåne University Hospital; Lund Sweden.
    Bååth, Carina
    Department of Health Sciences; Karlstad University; Karlstad Sweden and Country Council of Varmland, Sweden.
    A national quality registers as a tool to audit items of the fundamentals of care to older patients with hip fractures2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 11, no 2, p. 85-93Article in journal (Refereed)
    Abstract [en]

    Background

    The Swedish healthcare system has a unique resource in the national quality registers. A national quality registry contains individualised data concerning patient problems, medical interventions and outcomes after treatment, within all healthcare settings. Many healthcare settings face challenges related to the way they deliver the fundamentals of care, therefore, it is important to audit the outcome. It is estimated that the number of people aged 80 years or older will have almost quadrupled between 2000 and 2050. Hip fracture has been recognised as the most serious consequence of osteoporosis because of the risk of its complications, which include pain, acute confusional state, pressure ulcers, infections, disability, diminished quality of life and mortality.

    The aim of this study was therefore to explore if and how a national quality register can be used as an audit tool for the fundamentals of care when it concerns older patients suffering from a hip fracture.

    Method

    For this study we retrospectively selected and audited variables retrieved from the national quality hip fracture register. The audit included 1083 patients 80 years and older, consecutively admitted to a university hospital in the south of Sweden, in 2011–2013.

    Results

    Nearly half of the patients were admitted from their own homes and were living alone. Almost half of the patients could walk outdoors before the fracture occurred. After 4 months, 28.5% of the patients walked outdoors. Additionally, after 4 months about 30% of the patients were still suffering from pain after hip fracture surgery and still using analgesics. There was a reduction in length of stay between 2011 and 2013. As a part of the national quality register the questions from EQ5D were used before surgery and after 4 months. Before discharge from hospital there were less registered complications in 2012 and 2013 compared with 2011.

    Conclusions

    The national hip fracture quality register allows healthcare staff to analyse nursing outcomes and to highlight some fundamental aspects of care.

    Implications for practice

    Greater awareness, among hospital staff, of risk factors for complications in hip fracture patients may lead to improved patient care. Through registration in a quality register and working with the results we as Registered Nurses can ensure quality health care for older adults. 

  • 24.
    Hommel, Ami
    et al.
    Skåne University Hospital, Lund, Sweden.
    Gunningberg, Lena
    Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bååth, Carina
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; County Council of Värmland, Karlstad, Sweden.
    Successful factors to prevent pressure ulcers: an interview study2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 1-2, p. 182-189Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To explore successful factors to prevent pressure ulcers in hospital settings. Background. Pressure ulcer prevalence has been recognised as a quality indicator for both patient safety and quality of care in hospital and community settings. Most pressure ulcer can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions initiated nationwide pressure ulcer prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of pressure ulcer in the spring of 2014 was 14% in hospital settings with a range from 2.7-36.4%. Design. Qualitative semistructured interviews were conducted. Methods. A qualitative content analysis, in addition to Promoting Action on Research Implementation in Health Services frameworks, was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014. Results. Three main categories were identified as successful factors to prevent pressure ulcer in hospitals: creating a good organisation, maintaining persistent awareness and realising the benefits for patients. Conclusion. The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of pressure ulcer is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organisation in prevention work. Relevance to clinical practice. The nurse managers' attitude and engagement are crucial to enable the personnel to work actively with pressure ulcer prevention. Strategies are proposed to advance clinical leadership, knowledge, skills and abilities for the crucial implementation of pressure ulcer prevention.

  • 25.
    Hommel, Ami
    et al.
    Department of Orthopaedic, Lund University Hospital, 22185 Lund, Sweden; Department of Health Sciences, Lund University, 22100 Lund, Sweden.
    Kock, Marie-Louise
    Department of Health Sciences, Lund University, 22100 Lund, Sweden.
    Persson, Jeanette
    Department of Health Sciences, Lund University, 22100 Lund, Sweden.
    Werntoft, Elisabeth
    Department of Health Sciences, Lund University, 22100 Lund, Sweden.
    The Patient's View of Nursing Care after Hip Fracture2012In: ISRN Nursing, ISSN 2090-5483, E-ISSN 2090-5491, Vol. 2012, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Background. The pathway for patients with a hip fracture described in this study is a fast track. Many studies have focused on prevention of various complications but, so far, the patient’s view of nursing care has not been highlighted. Aim. The aim of the study is to illuminate the patient’s view on nursing care when treated for a hip fracture. Method. Ten patients were interviewed. A content analysis design was conducted. Findings. From the analysis, four main categories emerged: waiting times; pain/pain relief and mobilisation; attitude/information and sense of security; complications. Conclusion. Patients generally felt satisfied with the nursing provided. The staff created a feeling of security and showed interest and empathy for the patient. However, patients experienced a stressful waiting for surgery, and patients who developed confusion waited more than 24 hours for surgery. Therefore, waiting time must be decreased. Furthermore, patients’ descriptions of a variety of pain problem show, for example, that good collaboration between the nurse and physiotherapist is critical for achieving good pain relief before mobilisation. Nursing staff need to be attentive and should elicit the patient’s feelings through patient-focused communication in order to relieve anxiety about going home.

  • 26.
    Hommel, Ami
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Lilja-Andersson, Petera
    Department of Health Sciences, Lund University, Lund, Sweden.
    When nurses need nursing: expectations and experiences2012In: International Journal of Person Centered Medicine, ISSN 2043-7730, Vol. 2, no 3, p. 344-351Article in journal (Refereed)
    Abstract [en]

    Rational and aim of the study: This paper explores the expectations and experiences of the care given when 5 registered nurses working as nurse teachers are affected by life-threatening illness or injury. This is important as little is known about patient`s preferences for care and as far as we know none have described when the patients are nurses.Method: Data were collected through interviews and analyzed by means of content analysis.Results: Five nurses have after life-threatening illness or injury made their entrance to the patients’ world. When we analyzed the text information, confirmation, participation, empowerment and responsibility emerged as main categories. The informants are struggling for information and confirmation. They want to be involved and take responsibility in the care. Conclusion: When a professional practitioner becomes ill, it is reasonable that the demands of care are very high. The requirements that emerge in the interviews; however, were surprisingly reasonable and were more related to basic needs than to receive care of extraordinary quality. That itself says a lot of what is happening within us humans when we become patients and it also gives us a unique opportunity for knowledge and understanding. Today’s trend to provide person-centered care is even more important to express how important it is to confirm humans’ individual needs.

  • 27.
    Hommel, Ami
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Magnéli, Martin
    Samuelsson, Bodil
    Schildmeijer, Kristina
    Sjöstrand, Desirée
    Göransson, Katarina E
    Unbeck, Maria
    Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events: a multicenter cohort study using global trigger tool2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 102, article id 103473Article in journal (Refereed)
    Abstract [en]

    For decades, patient safety has been recognized as a critical global healthcare issue. However, there is a gap of knowledge of all types of adverse events sensitive to nursing care within hospitals in general and within orthopaedic care specifically. Objectives The aim of this study is to explore the incidence and nature of nursing-sensitive adverse events following elective or acute hip arthroplasty at a national level. Design A retrospective multicenter cohort study. Outcome variables Nursing-sensitive adverse events, preventability, severity and length of stay. Methods All patients, 18 years or older, who had undergone an elective (degenerative joint disease) or acute (fractures) hemi or total hip arthroplasty surgery at 24 hospitals were eligible for inclusion. Retrospective reviews of weighted samples of 1998 randomly selected patient records were carried out using the Swedish version of the Global Trigger Tool. The patients were followed for readmissions up to 90 days postoperatively throughout the whole country regardless of index hospital. Results A total of 1150 nursing-sensitive adverse events were identified in 728 (36.4%) of patient records, and 943 (82.0%) of the adverse events were judged preventable in the study cohort. The adjusted cumulative incidence regarding nursing-sensitive adverse events for the study population was 18.8%. The most common nursing-sensitive adverse event types were different kinds of healthcare-associated infections (40.9%) and pressure ulcers (16.5%). Significantly higher proportions of nursing-sensitive adverse events were found among female patients compared to male, p < 0.001, and patients with acute admissions compared to elective patients, p < 0.001. Almost half (48.5%) of the adverse events were temporary and of a less severe nature. On the other hand, 592 adverse events were estimated to have contributed to 3351 extra hospital days. Conclusions This study shows the magnitude of nursing-sensitive adverse events. We found that nursing-sensitive adverse events were common, in most cases deemed preventable and were associated with different kinds of adverse events and levels of severity in orthopaedic care. Registered nurses play a vital role within the interdisciplinary team as they are the largest group of healthcare professionals, work 24/7 and spend much time at the bedside with patients. Therefore, nursing leadership at all hospital levels must assume responsibility for patient safety and authorize bedside registered nurses to deliver high-quality and sustainable care to patients.

    Download full text (pdf)
    FULLTEXT01
  • 28.
    Hommel, Ami
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Orthopaedics, Skane University Hospital, Malmö, Sweden.
    Santy-Tomlinson, Julie
    Faculty of Biology, Medicine and Health, Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK.
    Pressure Injury Prevention and Wound Management2018In: Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient / [ed] Karen Hertz, Julie Santy-Tomlinson, Springer, 2018, p. 85-94Chapter in book (Refereed)
    Abstract [en]

    The management of wounds and the prevention of pressure injuries (also known as pressure ulcers) are fundamental aspects of the management of the patient following fragility fracture, especially following hip fracture and associated surgery. Ageing skin and multiple comorbidities are significant factors in skin injury and wound healing problems. The aim of this chapter is to provide the reader with an overview of evidence-based approaches to the prevention of pressure injuries and to wound management following hip fracture surgery. 

    Download full text (pdf)
    fulltext
  • 29.
    Hommel, Ami
    et al.
    Department of Health Sciences, Lund University, Sweden; Department of Orthopaedics, Lund University Hospital, Sweden.
    Ulander, Kerstin
    Department of Health Sciences, Kristianstad University, Sweden.
    Bjorkelund, Karin B.
    Department of Health Sciences, Lund University, Sweden.
    Norrman, Per-Ola
    Department of Orthopaedics, Lund University Hospital, Sweden.
    Wingstrand, Hans
    Department of Orthopaedics, Lund University Hospital, Sweden.
    Thorngren, Karl-Göran
    Department of Orthopaedics, Lund University Hospital, Sweden.
    Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year2008In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 39, no 10, p. 1164-1174Article in journal (Refereed)
    Abstract [en]

    Hip fractures are a major cause of hospital stay among the elderly, and result in increased disability and mortality. In this study from 1 April 2003 to 31 March 2004, the influence of optimised treatment of hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year were investigated. Comparisons were made between the first 210 patients in the period and the last 210 patients, who followed the new clinical pathway introduced at the University Hospital in Lund, Sweden. Early surgery, within 24 h, was not associated with reduced mortality, but was significantly associated with reduced length of stay (p < 0.001). Significantly more cases of osteosynthesis for femoral neck fracture were reoperated compared with all other types of surgery (p < 0.001) when reoperations with extraction of the hook pins in healed fractures were excluded. Mortality was significantly higher among men than women at 4 (p = 0.025) and 12 (p = 0.001) months after fracture and among medically fit patients with administrative delay to surgery compared with patients with no delay (p < 0.001).

  • 30.
    Hommel, Ami
    et al.
    Department of Orthopedics, Lund university Hospital, Lund Swede.
    Ulander, Kerstin
    Department of Nursing, Lund University, Sweden.
    Thorngren, Karl-Goran
    Department of Orthopedics, Lund university Hospital, Lund Sweden.
    Improvements in pain relief, handling time and pressure ulcers through internal audits of hip fracture patients2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 1, p. 78-83Article in journal (Refereed)
  • 31. Hälleberg Nyman, Maria
    et al.
    Forsman, Henrietta
    Wallin, Lars
    Ostaszkiewicz, Joan
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Eldh, Ann Catrine
    Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care-A process evaluation of an implementation intervention in the orthopaedic context2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, no 2, p. 282-289Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS, AND OBJECTIVES: The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery. METHODS: A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed. RESULTS: Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit. CONCLUSION: To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.

  • 32. Ivarsson, Bodil
    et al.
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sandberg, Magnus
    Sjostrand, Desiree
    Johansson, Anders
    The experiences of pre- and in-hospital care in patients with hip fractures: A study based on Critical incidents2018In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 30, p. 8-13Article in journal (Refereed)
    Abstract [en]

    Background: Hip fractures are described to have a significant impact on patients' well-being and different fasttrack concepts could result in a reduction of the patient's psychological and emotional reactions before pre- and intrahospital care. Aims and objectives: This study aimed to elucidate perceived situations of significance experienced by patients with hip fracture during the prehospital-and in-hospital care. Design: The study used a qualitative approach using a critical incident technique (CIT), 14 patients with hip fractures were included. Methods: All informants had undergone surgery for a hip fracture, were able to communicate in Swedish and had no cognitive impairment. Results: The main area Oscillating between being satisfied and to endure a new demanding situation emerged from five categories: Pain and pain management, Feeling fear and satisfaction in perioperative care, Experiencing continuity in care, Considering information and Felling confirmed. Conclusion: Experiences of prehospital care shows a positive impact though the patients experienced this part of the pathway professionally. However, the patients described critical incidents according to their experiences of pain seems to have significant damagingly impact on the patients' well-being. The patient also describe a sense of uncertainty in their individual involvement of care.

  • 33. Johansen, Antony
    et al.
    Golding, David
    Brent, Louise
    Close, Jacqueline
    Gjertsen, Jan-Erik
    Holt, Graeme
    Hommel, Ami
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Pedersen, Alma B.
    Rock, Niels Dieter
    Thorngren, Karl-Goran
    Using national hip fracture registries and audit databases to develop an international perspective2017In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 10, p. 2174-2179Article in journal (Refereed)
    Abstract [en]

    Hip fracture is the commonest reason for older people to need emergency anaesthesia and surgery, and leads to prolonged dependence for many of those who survive. People with this injury are usually identified very early in their hospital care, so hip fracture is an ideal marker condition with which to audit the care offered to older people by health services around the world. We have reviewed the reports of eight national audit programmes, to examine the approach used in each, and highlight differences in case mix, management and outcomes in different countries. The national audits provide a consistent picture of typical patients - an average age of 80 years, with less than a third being men, and a third of all patients having cognitive impairment - but there was surprising variation in the type of fracture, of operation and of anaesthesia and hospital length of stay in different countries. These national audits provide a unique opportunity to compare how health care systems of different countries are responding to the same clinical challenge. This review will encourage the development and reporting of a standardised dataset to support international collaboration in healthcare audit. (C) 2017 Elsevier Ltd. All rights reserved.

  • 34.
    Jonsson, M. H.
    et al.
    Department of Anaesthesia and Intensive Care Medicine; Ystad Hospital; Ystad Sweden;Department of Clinical Sciences; Lund University; Lund Sweden.
    Bentzer, P.
    Department of Clinical Sciences; Lund University; Lund Sweden;Department of Anaesthesia and Intensive Care; Helsingborg Hospital; Helsingborg Sweden.
    Turkiewicz, A.
    Department of Clinical Sciences; Lund University; Lund Sweden;Clinical Epidemiology Unit; Orthopaedics; Lund University; Lund Sweden.
    Hommel, Ami
    Department of Clinical Sciences; Lund University; Lund Sweden;Clinical Epidemiology Unit; Orthopaedics; Lund University; Lund Sweden.
    Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden: A prospective observational study2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 8, p. 1057-1063Article in journal (Refereed)
  • 35.
    Jonsson, Magnus H.
    et al.
    Department of Anaesthesia and Intensive Care Medicine Ystad Hospital Ystad Sweden;Department of Clinical Sciences Lund University Lund Sweden.
    Hommel, Ami
    Department of Clinical Sciences Lund University Lund Sweden;Clinical Epidemiology Unit Orthopaedics Lund University Lund Sweden.
    Todorova, Lizbet
    Department of Clinical Sciences Lund University Lund Sweden.
    Melander, Olle
    Department of Clinical Sciences Lund University Lund Sweden;Department of Emergency and Internal Medicine Skåne University Hospital Malmö Sweden.
    Bentzer, Peter
    Department of Clinical Sciences Lund University Lund Sweden;Department of Anaesthesia and Intensive Care Helsingborg Hospital Helsingborg Sweden.
    Novel biomarkers for prediction of outcome in hip fracture patients: An exploratory study2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 64, no 7, p. 920-927Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the value of biomarkers for prognostication in hip fracture patients. The main objective of the present study was to assess if biomarkers add useful information to an existing risk score for prediction of 30-day mortality in patients suffering from out of hospital hip fractures.Methods: In  a  prospective  observational  single  centre  study,  association  between  plasma  concentration  of  ninety-two  biomarkers  at  admission  and  30-day  mortality  was analysed using logistic regression adjusted for risk factors included in Nottingham Hip Fracture Score (NHFS). Biomarkers associated with the outcome in the adjusted analysis were further evaluated by calculating the net reclassification improvement (NRI) and the change in area under the receiver operating characteristics curve (AUC) relative to the NHFS.Results: 997 patients were included. Sixty-two patients died within 30 days (6.2%). Eleven  biomarkers  were  associated  with  30-day  mortality  in  adjusted  analysis.  Of  these biomarkers Growth Differentiation Factor-15 (GDF-15) had NRI for the pri-mary outcome (12.1%; 95% CI: 1.2-23.3) and Carbohydrate Antigen 125 (CA-125) im-proved the AUC relative to NHFS (improvement: 0.05; 95% CI: 0.01-0.10, P  =  .027). Both CA-125 and GDF-15 improved the AUC for a composite outcome of 30-day mortality and cardiovascular complications.Conclusions: Adding GDF-15 or CA-125 to the Nottingham Hip Fracture Score im-proves the discrimination with regard to predicting 30-day mortality and may help to identify a subgroup of hip fracture patients with a particularly poor prognosis. The value  of  these  biomarkers  should  be  explored  in  further  studies  to  confirm  clinical  utility.

    Download full text (pdf)
    fulltext
  • 36.
    Jonsson, Magnus H.
    et al.
    Department of Anaesthesia and Intensive Care Medicine, Ystad Hospital, Ystad, Sweden;;Department of Clinical Sciences, Lund University, Lund, Sweden;.
    Hommel, Ami
    Department of Clinical Sciences, Lund University, Lund, Sweden;;Department of Orthopaedics, Skåne University Hospital, Lund, Sweden;.
    Turkiewicz, Aleksandra
    Department of Clinical Sciences, Lund University, Lund, Sweden;;Clinical Epidemiology Unit Orthopaedics, Skåne University Hospital, Lund, Sweden;.
    Ekelund, Ulf
    Department of Clinical Sciences, Lund University, Lund, Sweden;;Department of Internal and Emergency Medicine, Skåne University Hospital, Lund, Sweden;.
    Melander, Olle
    Department of Clinical Sciences, Lund University, Lund, Sweden;;Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden;.
    Englund, Martin
    Department of Clinical Sciences, Lund University, Lund, Sweden;;Clinical Epidemiology Unit Orthopaedics, Skåne University Hospital, Lund, Sweden;.
    Bentzer, Peter
    Department of Clinical Sciences, Lund University, Lund, Sweden;;Department of Anaesthesia and Intensive Care Medicine, Helsingborg Hospital, Helsingborg, Sweden.
    Plasma lactate at admission does not predict mortality and complications in hip fracture patients: a prospective observational study2018In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 78, no 6, p. 508-514Article in journal (Refereed)
    Abstract [en]

    Hip fractures in elderly carry a high mortality. Our objective was to test the hypothesis that plasma lactate concentration at hospital admission can be used to identify patients with a high risk for poor outcome. Hip fracture patients admitted to a university hospital in Sweden from January 2011 to August 2014 in whom a venous lactate was obtained at admission were included in this prospective observational study. Primary outcome measure was 30-d mortality and secondary outcome measure was a composite outcome of 30-d mortality and postoperative complications. Lactate concentration was evaluated as a continuous predictor using logistic regression, crude and adjusted for age, gender and American Society of Anesthesiology Physical Status (ASA PS) score. Discrimination was evaluated using receiver operating characteristics (ROC) analysis. Totally, 690 patients were included. Median age was 84 years (interquartile range [IQR] 77–90). At 30-d follow-up, mortality was 7.2%, and 45% of the patients had suffered the composite outcome. Median lactate level was 1.3 mmol/L (IQR 1.0–1.8 mmol/L). The odds ratio (OR) by each 1.0 mmol/L increase in the lactate concentration for 30-d mortality was 1.13 (95% CI 0.77–1.68) while for the composite outcome it was 1.06 (95% CI 0.85–1.3). Similar results were obtained after adjustment for age, sex and ASA PS classification for both outcomes. Area under the ROC curve for lactate as a predictor of 30-d mortality was 0.51 (95% CI 0.45–0.57). In our cohort, plasma lactate at admission does not appear to be a useful biomarker to identify high-risk patients after hip fracture.

  • 37.
    Jonsson, Magnus H.
    et al.
    Ystad Hospital; Lund University.
    Åkesson, Anna
    Skåne University Hospital Lund.
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Grubb, Anders
    Lund University Hospital.
    Bentzer, Peter
    Lund University; Helsingborg Hospital.
    Markers of renal function at admission and mortality in hip fracture patients-a single center prospective observational study2021In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 81, no 3, p. 201-207Article in journal (Refereed)
    Abstract [en]

    Plasma cystatin C and shrunken pore syndrome (SPS) are associated with increased mortality in older adults. The objective was to assess the association between these markers of kidney function at admission and mortality in hip fracture patients. Hip fracture patients presenting at Lund University Hospital were eligible for inclusion. Cox regression was used to assess association between plasma cystatin C, creatinine, cystatin C- or creatinine-based estimations of glomerular filtration rate (eGFR(CYS) and eGFR(CREA)), or SPS (defined as eGFR(CYS)/eGFR(CREA) < 0.7) and mortality during one year follow up. Improvement in discrimination relative to the Nottingham Hip fracture score was assessed by Receiver Operational Characteristics (ROC) analysis and calculation of Net Reclassification Index (NRI). 996 patients were included in the study. Cystatin C, creatinine, eGFR(CYS) and eGFR(CREA) were associated with one-year mortality in both unadjusted and adjusted analyses. The association with mortality was stronger for cystatin C and for eGFR(CYS) than for creatinine and eGFR(CREA). Patients with SPS had doubled mortality compared with patients without SPS (43.7 and 20.2%, respectively, p < .001). Hazard ratio for SPS in the adjusted analysis was 1.66 (95%CI; 1.16-2.39, p = .006). None of the markers improved discrimination compared to the Nottingham Hip Fracture Score using ROC analysis whereas eGFR(CYS) and eGFR(CREA) improved NRI. Our conclusion is that plasma concentrations of creatinine or cystatin C, eGFR(CYS) or eGFR(CREA) or SPS at admission in hip fracture patients are associated with mortality when known risk factors are accounted for. Identification of high risk patients may be improved by eGFR(CYS) or eGFR(CREA).

    Download full text (pdf)
    fulltext
  • 38.
    Kjällquist-Petrisi, Anna
    et al.
    Malmö University Hospital.
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Preceptors’ experiences of peer learning in an intensive care unit2021In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 54, article id 103086Article in journal (Refereed)
    Abstract [en]

    In Sweden, there is a lack of nurses with competence in intensive and critical care as well as experienced critical care nurses with a formal education in preceptorship. Using the peer learning model could be one way to assure the quality of critical care practice placements for post-graduate nursing students as this model requires only one preceptor for every two students. This study's aim was to examine the experience of preceptors regarding peer learning at a university hospital intensive care unit. The study followed a qualitative descriptive design. The participants were nine preceptors with experience working as critical care nurses ranging from 3 to 24 years. Each preceptor was interviewed individually using a semi-structured interview guide. The data were subjected to conventional inductive content analysis. The analysis reveals three categories: collaboration and communication; responsibility; and psychosocial environment. Some preceptors felt responsible for the delivery of adequate clinical practice despite students having difficulties in communicating and collaborating with each other or being at different experience levels. While preceptors and students need more preparation and knowledge about peer learning it can, nevertheless, contribute to the development of collaboration and communication skills within the intensive care setting.

  • 39.
    Kulbay, Akin
    et al.
    Karolins­ka institutet.
    Vest, Dan
    Blekingesjukhuset.
    Thorngren, Karl-Göran
    Skånes universitetssjukhus.
    Hommel, Ami
    Skånes universitetssjukhus.
    Hedström, Margareta
    Karolinska sjukhuset.
    Sekundärprevention – fortfarande en utmaning efter fragilitetsfraktur: Få läkemedelsbehandlingar efter höftfrakturer – trots frakturkedjor2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, article id 21033Article in journal (Refereed)
    Abstract [en]

    Yearly 16 000 osteoporosis related hip fractures occur in Sweden. They cause suffering for patients and high costs for society. Subsequent fractures can be reduced with osteoporosis diagnostics and treatment. 4 322 patients from two hospitals using Fracture Liaisson Services in Sweden were included to identify the rate of osteoporosis diagnostics and treatment during the first year after a hip fracture. Data between 2010-01-01 and 2018-12-31 were included from the Swedish National Hip Fracture Registry (Rikshöft). 99.2 % of all patients underwent FRAX risk assessment and DEXA was conducted on 17.3 % of patients. Women were more frequently examined with DEXA than men (21% vs 10.2 %). 6% received medical osteoporosis treatment after the fracture, women were treated more often than men (7% vs 4%). Conclusions: less than 10% received drug therapy after the first year after the hip fracture. Men underwent diagnostics and received treatment at a lower rate than women.

    Download full text (pdf)
    fulltext
  • 40.
    Leonardsson, Olof
    et al.
    Skåne University Hospital.
    Rolfson, Ola
    University of Gothenburg.
    Hommel, Ami
    Skåne University Hospital.
    Garellick, Göran
    University of Gothenburg.
    Åkesson, Kristina
    Skåne University Hospital.
    Rogmark, Cecilia
    Skåne University Hospital.
    Patient-Reported Outcome After Displaced Femoral Neck Fracture: A National Survey of 4467 Patients2013In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 95, no 18, p. 1693-1699Article in journal (Refereed)
    Abstract [en]

    Background: Arthroplasty appears to be superior to internal fixation, with regard to complication rates, as a treatment for displaced femoral neck fractures. Less is known about the result as perceived by the patient. The aims of this prospective observational study were (1) to determine whether patient-reported outcomes after a displaced femoral neck fracture can be evaluated on a nationwide basis by means of a mailed survey, and (2) to evaluate differences among treatment methods with respect to patient-reported pain, health-related quality of life, and satisfaction with the surgical result.

    Methods: Through collaboration between the Swedish Hip Arthroplasty Register and the Swedish National Hip Fracture Register, 5902 patients (median age, eighty-four years; range, eighteen to 103 years) treated with internal fixation, total hip arthroplasty, or hemiarthroplasty for a displaced femoral neck fracture were identified. A composite questionnaire, including the EQ-5D and visual analog scales for pain and for satisfaction with the surgical result, was mailed to the 4467 patients who remained alive (median follow-up, fourteen months; range, seven to twenty-two months).

    Results: The total response rate was 79% (n = 3513); 72% to 75% of the patients completed each of the questionnaire sections. Both patients below and patients above seventy years of age treated with total hip arthroplasty reported less pain and were more satisfied compared with those treated with internal fixation or hemiarthroplasty (although the differences between total hip arthroplasty and hemiarthroplasty in patients below seventy years of age did not reach significance).

    Conclusions: A mailed patient-reported outcomes questionnaire is a feasible method for national follow-up of hip fractures, with an acceptable response rate. The study also suggests that total hip arthroplasty as a treatment for femoral neck fracture is associated with less pain and greater satisfaction at short-term follow-up compared with internal fixation and hemiarthroplasty, both in patients younger and older than seventy years.

    Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  • 41.
    Lindholm, Christina
    et al.
    Department of Health Sciences, Kristianstad University, Sweden and Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden.
    Sterner, Eila
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden.
    Romanelli, Marco
    Wound Healing Research Unit, Department of Dermatology, Pisa, Italy.
    Pina, Elaine
    National Institute of Public Health, Lisbon, Portugal.
    Torra y Bou, Joan
    RN, Barcelona, Spain.
    Hietanen, Helvi
    Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland.
    Iivanainen, Ansa
    Mikkeli University of Applied Sciences, Mikkeli, Finland.
    Gunningberg, Lena
    Department of Surgical Science, Uppsala University, Uppsala, Sweden.
    Hommel, Ami
    Department of Health Sciences, Lund University, Lund, Sweden.
    Klang, Birgitta
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Dealey, Carol
    School of Health Sciences, University of Birmingham, Birmingham, UK.
    Hip fracture and pressure ulcers – the Pan-European Pressure Ulcer Study – intrinsic and extrinsic risk factors2008In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 5, no 2, p. 315-328Article in journal (Refereed)
    Abstract [en]

    Pressure ulcers (PU) in patients with hip fracture remain a problem. Incidence of between 8·8% and 55% have been reported. There are few studies focusing on the specific patient-, surgery- and care-related risk indicators in this group. The aims of the study were

    • to investigate prevalence and incidence of PU upon arrival and at discharge from hospital and to identify potential intrinsic and extrinsic risk factors for development of PU in patients admitted for hip fracture surgery.
    • to illuminate potential differences in patient logistics, surgery, PU prevalence and incidence and care between Northern and Southern Europe. Consecutive patients with hip fracture in six countries, Sweden, Finland, UK (North) and Spain, Italy and Portugal (South), were included. The patients were followed from Accident and Emergency Department and until discharge or 7 days. Prevalence, PU at discharge and incidence were investigated, and intrinsic and extrinsic risk indicators, including waiting time for surgery and duration of surgery were recorded. Of the 635 patients, 10% had PU upon arrival and 22% at discharge (26% North and 16% South). The majority of ulcers were grade 1 and none was grade 4. Cervical fractures were more common in the North and trochanteric in the South. Waiting time for surgery and duration of surgery were significantly longer in the South. Traction was more common in the South and perioperative warming in the North. Risk factors of statistical significance correlated to PU at discharge were age ≥71 (P = 0·020), dehydration (P = 0·005), moist skin (P = 0·004) and total Braden score (P = 0·050) as well as subscores for friction (P = 0·020), nutrition (P = 0·020) and sensory perception (P = 0·040). Comorbid conditions of statistical significance for development of PU were diabetes (P = 0·005) and pulmonary disease (P = 0·006). Waiting time for surgery, duration of surgery, warming or non warming perioperatively, type of anaesthesia, traction and type of fracture were not significantly correlated with development of PU.
  • 42.
    Loodin, Åsa
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The effects of preoperative oral carbohydrate drinks on energy intake and postoperative complications after hip fracture surgery: A pilot study2021In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 41, article id 100834Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hip fractures represent a major clinical burden for patients. Studies on the effect of preoperative carbohydrate loading before different surgical interventions have shown promising results but have not been tested in patients with hip fracture.

    AIM: This study aimed to investigate the effects of preoperative oral carbohydrate drinks on the postoperative energy intake and incidence of complications after hip fracture surgery.

    METHOD: This was a pilot study using a quasi-experimental design with a control group and an intervention group.

    RESULT: The number of patients affected by more than one complication was higher in the control group than in the intervention group. According to the logistic regression analysis, the risk of any postoperative complication was reduced by approximately 50% OR (95% CI) 0.508 (0.23-1.10) in patients in the IG compared to those in the CG (p = 0.085).

    CONCLUSION: The result of this pilot study indicated that using preoperative carbohydrate drinks can decrease the number of postoperative complications in patients with a hip fracture. Furthermore, the number of patients who meet their energy needs during the first three days postoperatively might increase. More research is needed to confirm the effect of preoperative carbohydrate drinks.

    Download full text (pdf)
    fulltext
  • 43. MacDonald, Valerie
    et al.
    Maher, Ann Butler
    Mainz, Hanne
    Meehan, Anita J.
    Brent, Louise
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hertz, Karen
    Taylor, Anita
    Sheehan, Katie Jane
    Developing and Testing an International Audit of Nursing Quality Indicators for Older Adults With Fragility Hip Fracture2018In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 37, no 2, p. 115-121Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fragility hip fracture in older adults often has poor outcomes, but these outcomes can be improved with attention to specific quality care indicators. PURPOSE: The International Collaboration of Orthopaedic Nursing (ICON) developed an audit process to identify the extent to which internationally accepted nursing quality care indicators for older adults with fragility hip fracture are reflected in policies, protocols, and processes guiding acute care. METHODS: A data abstraction tool was created for each of 12 quality indicators. Data were collected using a mixed-methods approach with unstructured rounds. A rationale document providing evidence for the quality indicators and a user evaluation form were included with the audit tool. A purposeful sample of 35 acute care hospitals representing 7 countries was selected. RESULTS: Thirty-five hospitals (100%) completed the survey. Respondents viewed the content as relevant and applicable for the defined patient population. Although timing and frequency of implementation varied among and within countries, the identified quality indicators were reflected in the majority of policies, protocols, or processes guiding care in the hospitals surveyed. CONCLUSION: Developing and testing an audit of nurse-sensitive quality indicators for older adults with fragility hip fracture demonstrate international consensus on common core best practices to ensure optimal acute care.

  • 44.
    Madsen, Ulla Riis
    et al.
    Department of Orthopedic Surgery, Slagelse &amp; Holbæk Hospital, Region Sjaelland, Denmark.
    Hommel, Ami
    Faculty of Health, Department of Health Sciences, Lund University, Lund, Sweden.
    Bååth, Carina
    Faculty of Health, Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Berthelsen, Connie Bøttcher
    Institute of Health, Section of Nursing, Aarhus University, Aarhus, Denmark.
    Pendulating—A grounded theory explaining patients’ behavior shortly after having a leg amputated due to vascular disease2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, no 1, p. 32739-32739Article in journal (Refereed)
    Abstract [en]

    Introduction

    Although the group of vascular leg amputated patients constitutes some of the most vulnerable and frail on the orthopedic wards, previous research of amputated patients has focused on patients attending gait training in rehabilitation facilities leaving the patient experience shortly after surgery unexplored. Understanding patients’ behavior shortly after amputation could inform health professionals in regard to how these vulnerable patients’ needs at hospital can be met as well as how to plan for care post-discharge.

    Aim

    To construct a grounded theory (GT) explaining patients’ behavior shortly after having a leg amputated as a result of vascular disease.

    Method

    In line with constructivist GT methodology, data from ethnographic observations and interviews were simultaneously collected and analyzed using the constant comparative method covering the patients’ experiences during the first 4 weeks post-surgery. Data collection was guided by theoretical sampling and comprised 11 patients. A GT was constructed.

    Results

    Patients went through a three-phased process as they realized they were experiencing a life-changing event. The first phase was “Losing control” and comprised the sub-categories “Being overwhelmed” and “Facing dependency.” The second phase was “Digesting the shock” and comprised the sub-categories “Swallowing the life-changing decision,” “Detecting the amputated body” and “Struggling dualism.” The third phase was “Regaining control” and comprised the sub-categories “Managing consequences” and “Building-up hope and self-motivation.” “Pendulating” was identified as the core category describing the general pattern of behavior and illustrated how patients were swinging both cognitively and emotionally throughout the process.

    Conclusion

    The theory of “Pendulating” offers a tool to understand the amputated patients’ behavior and underlying concerns and to recognize where they are in the process. Concepts from the theory could be used by health professionals who support patients coping with the situation by offering terms to express and recognize patients’ reactions.

  • 45. Magneli, Martin
    et al.
    Unbeck, Maria
    Rogmark, Cecilia
    Rolfson, Ola
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Samuelsson, Bodil
    Schildmeijer, Kristina
    Sjostrand, Desiree
    Gordon, Max
    Skoldenberg, Olof
    Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 3, p. 1-9, article id e023773Article in journal (Refereed)
    Abstract [en]

    Objectives Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties. Design Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data. Setting 24 different hospitals in four major regions of Sweden. Participants 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients. Primary and secondary outcome measures The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate. Results The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47). Conclusions The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.

    Download full text (pdf)
    FULLTEXT01
  • 46.
    Maher, Ann Butler
    et al.
    Long Branch, NJ, USA.
    Meehan, Anita J
    NICHE Program, Akron General Medical Center, Akron, OH, USA.
    Hertz, Karen
    University Hospital of North Staffordshire, UK.
    Hommel, Ami
    Dept. of Orthopaedics, Skane University Hospital, Lund/Dept. of Health Sciences Lund University, Sweden.
    MacDonald, Valerie
    Fraser Health Authority, BC, Canada.
    O’Sullivan, Mary P
    Cork University Hospital, Wilton, Cork, Ireland.
    Specht, Kirsten
    Cork University Hospital, Wilton, Cork, Ireland.
    Taylor, Anita
    Cork University Hospital, Wilton, Cork, Ireland.
    Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 1)2012In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 16, no 4, p. 177-194Article in journal (Refereed)
    Abstract [en]

    This paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus here. This includes in this part:

    Pain

    Delirium

    and in the second, subsequent, part

    Pressure Ulcers

    Fluid Balance/Nutrition

    Constipation/Catheter Associated Urinary Tract Infection

    Vigilant nursing assessment and prompt intervention may prevent the development of the complications we discuss. If they do occur and are identified early on, they may resolve with appropriate and timely nursing management.

    This “tool kit” has been developed under the auspices of the International Collaboration of Orthopaedic Nursing (ICON) a coalition of national associations of orthopaedic nursing (www.orthopaedicnursing.org).Previous article in issue

  • 47.
    Maher, Ann Butler
    et al.
    Long Branch, NJ, USA.
    Meehan, Anita J
    NICHE Program, Akron General Medical Center, Akron, OH, USA.
    Hertz, Karen
    University Hospital of North Staffordshire, UK.
    Hommel, Ami
    Dept. of Orthopaedics, Skane University Hospital, Lund; Dept. of Health Sciences Lund University, Sweden.
    MacDonald, Valerie
    Fraser Health Authority, BC, Canada.
    O’Sullivan, Mary P
    Cork University Hospital, Wilton, Cork, Ireland.
    Specht, Kirsten
    Dept. of Orthopaedics, Vejle Hospital, Vejle, Denmark.
    Taylor, Anita
    Royal Adelaide Hospital, Adelaide, SA, Australia.
    Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 2)2013In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 17, no 1, p. 4-18Article in journal (Refereed)
    Abstract [en]

    The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus. This includes (in the first, earlier, part):

    Pain

    Delirium

    and in this part

    Pressure Ulcers

    Fluid Balance/Nutrition

    Constipation/Catheter Associated Urinary Tract Infection

    Vigilant nursing assessment and prompt intervention may prevent the development of the complications we discuss. If they do occur and are identified early on, they may resolve with appropriate and timely nursing management.

    This “tool kit” has been developed under the auspices of the International Collaboration of Orthopaedic Nursing (ICON) a coalition of national associations of orthopaedic nursing (www.orthopaedicnursing.org).

  • 48. McLiesh, Paul
    et al.
    Hommel, Ami
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    The value of specialist orthopaedic nurses2016In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 22, p. 1-2Article in journal (Refereed)
    Abstract [en]

    As orthopaedic nurses we believe that we possess specialist orthopaedic knowledge and skills that are used daily to deliver effective care to our patients. In the acute care setting this care has been traditionally delivered in specialist orthopaedic wards or units. Recently, in some settings, the number of these speciality wards has decreased and the care of patients with orthopaedic injuries or illnesses has been moved to more generic wards, either surgical or medical. The motivation for this change may be rationalisation of service delivery, decreased number of beds or a belief that the needs of orthopaedic patients no longer require care delivered by specialist nurses.

  • 49.
    Meehan, A.J.
    et al.
    International Collaboration of Orthopaedic Nursing; Akron OH USA;Nursing Administration; Akron General Medical Center; Akron OH USA.
    Maher, A.B.
    International Collaboration of Orthopaedic Nursing; Akron OH USA;Long Branch NJ USA.
    Hommel, A.
    International Collaboration of Orthopaedic Nursing; Akron OH USA;Department of Health Sciences; Lund University; Lund Sweden.
    The International Collaboration of Orthopaedic Nursing: advancing nursing through technology2015In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 62, no 2, p. 203-206Article in journal (Refereed)
    Abstract [en]

    Aim

    To report on the International Collaboration of Orthopaedic Nursing, a mostly virtual network of orthopaedic nursing organizations across four continents.

    Background

    Formed by leaders of three national associations, the collaboration is based on recognition of patient problems and challenges shared by orthopaedic nurses globally.

    Methods/Initiatives

    The Collaboration provides a range of services including education, mentoring, and organizational development. Low cost internet-based technologies, such as email and Skype, support global networking in real time.

    Discussion/Implications for Nursing and Health Policy

    The Collaboration is a cost effective example of how nurses can collaborate internationally to promote the highest standards of orthopaedic nursing.

  • 50. Meehan, Anita J.
    et al.
    Maher, Ann Butler
    Brent, Louise
    Copanitsanou, Panagiota
    Cross, Jason
    Kimber, Cheryl
    MacDonald, Valerie
    Marques, Andrea
    Peng, LingLi
    Queiros, Carmen
    Roigk, Patrick
    Sheehan, Katie Jane
    Skuladottir, Sigrun Sunna
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture2019In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 32, p. 3-26Article in journal (Refereed)
12 1 - 50 of 69
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf