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Clinical characteristics and outcome determinants of stroke rehabilitation
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
before, knee 1.21/hip 1, discharge: knee 2.25/hip 2.12;IB before knee 96.2/hip 92, discharge knee 84.3/hip 92. Analgesic scale: 1◦ step: knee 65.6%/hip 34%; 2◦ : knee 86.8%/hip 11.3% and 3◦ : knee 88.9%/hip 11.1%. Hospital stay: knee 9.8 ± 4.3 days/hip 11.16 ± 4.4. Functional gain IB: knee 22.4 points/hip 19. No significant differences were found in age, functional situation on admission, and institutionalisation on discharge among others. Conclusions.– Geriatric patients cared for in a MSU for secondary functional deterioration to arthroplasty of the knee show better functional recovery on discharge, with a lower hospital stay, specifying greater analgesia, than those of hip arthroplasty. http://dx.doi.org/10.1016/j.eurger.2013.07.362 P299
Clinical characteristics and outcome determinants of stroke rehabilitation R.P. Ruberu , S. Manchanda , P. Connolly , L. Gilgan , D. Lecamwasam Royal Adelaide Hospital, Adelaide, Australia Aim.– A retrospective analysis of stroke outcome variables in stroke rehabilitation. Method.– Case notes of patients admitted to a rehabilitation centre between July 07 to July12 were reviewed. Selection criteria included ischemic or hemorrhagic strokes. Sixty-eight variables were analysed. Partition modeling was used to identify relationship between variables and their importance in stroke rehabilitation. Results.– Of 482 stroke patients 426 patients met inclusion criteria (mean age 70.67 SD = 13.31, SEM 0.645; male 58%, n = 245). Mean length of rehabilitation was 48.36 d. Majority (98%, n = 419) were from home prior to stroke and 80% (n = 333) returned home. For them the mean length of rehabilitation was 45.22 d where 66% (n = 221) were discharged within 50 days. t-test for total admission FIMS by discharge destination was performed. A significant difference in the total FIMS for patients who were discharged home compared to those discharged to either high level residential care (HLOC) (P < 0.001) or low level residential care (LLOC) (P = 0.0497) and a significant difference between those who were discharged to LLOC compared to HLOC (P = 0.0044). Total FIMS ≥ 77, carer support, and age less or equal to 77 years were associated with returning home. When considering patients with total FIMS 36–77, age less than 82 years and carer support were associated with returning home. HLOC was predictable in those who were greater or equal to 82 years, length of stay in acute hospital greater or equal to 14 days, FIMS for upper body dressing of less than 5. Conclusion.– Total FIMS together with other predictors prior to enrolling in an inpatient stroke rehabilitation would improve efficiency and patient outcomes. http://dx.doi.org/10.1016/j.eurger.2013.07.363 P300
Audit of postoperative haemoglobin testing in proximal femur fragility fracture S. Cook , G. Bidwell , C. Pulford , K. Shah Oxford University Hospitals Trust (OUH), Oxford, UK Introduction.– Many patients with hip fractures are anaemic and there is evidence to show that anaemia and transfusion can affect postoperative rehabilitation. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) Proximal Hip Fracture Guidelines state that point of care haemoglobin analysers (e.g. Hemocue) should be used routinely at the end of surgery to assess the degree of anaemia and guide blood transfusion. We audited postoperative haemoglobin (Hb) testing in our unit. Methods.– Assessment of all patients over 65 admitted to our hospital with a fragility fracture of the proximal femur over a 3-week
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period. We used retrospective assessment of the anaesthetic chart, recovery documentation and medical notes The results were presented at the monthly Fragility Fracture Meeting. Haemacue after surgery was introduced into the departmental protocol and postoperative instructions. We re-audited over a further 3-week period. Results.– Twenty-eight patients were audited in the first cycle and 26 in the second cycle. In the first cycle 56% of patients had an immediate postoperative Hb check–this improved to 85% in the second cycle. In the first cycle 75% of patients had an Hb check by 24 hours – this improved to 100% in the second cycle. Of those who had an Hb check in recovery 53.8% (7/13) in the first cycle and 41% (9/22) in the second cycle required immediate transfusion. Key conclusions.– Our completed audit cycle demonstrates considerable improvement in point of care Hb testing post-surgery for hip fracture, improving our compliance with AAGBI guidelines. http://dx.doi.org/10.1016/j.eurger.2013.07.364 P301
Geriatric inclusive art and length of stay in acute care unit S. Remondière , M. Mahé , F. Repussard , F. Decavel , C. Annweiler , O. Beauchet Angers University Hospital, Department of Neuroscience, Division of Geriatrics Medicine, Angers, France Text.– Although emotional well-being is known to improve health status amongst older community-dwellers, its effect amongst patients hospitalized in geriatric acute care units has not been examined yet. We have recently adapted a new form of art therapy for older patients hospitalized in acute care units, the “Geriatric Inclusive Art” (GIA). GIA uses painting to make inpatients aware of their abilities through an improvement of emotional well-being. We performed a pilot case-control study to determine whether a GIA session performed amongst inpatients hospitalized in a geriatric acute care unit could reduce the LHS. Between December 27th 2010 and December 14th 2011, 93 inpatients (mean age 83.9 ± 6.2years, 53.8% women) who benefited from one session of GIA and 95 paired control inpatients (mean age 85.4 ± 5.6years, 51.6% women) hospitalized in the geriatric acute care of Angers University Hospital (France) were prospectively included. The LHS was assessed using the administrative registry of Angers University Hospital. Participation at one GIA session was defined as painting a picture under the supervision of a moderator and a nurse. There were no significant differences for the baseline characteristics between cases and matched controls. Multiple linear regression model showed that attending one GIA session (P = 0.023) and a higher BMI (P = 0.031) were associated with a shorter LHS, whereas hospitalisation during fall was associated with a longer LHS (P = 0.020). Participation in one GIA session was associated with shorter LHS in our study. We suggest that painting improved emotional well-being amongst inpatients. This positive affect might act as a starter of awareness of inpatients’ abilities leading to better functioning and thus accelerating the discharge. http://dx.doi.org/10.1016/j.eurger.2013.07.365 P302
Polypharmacy and healthcare education: What does YouTube have to offer? C. Lisk Department of Medicine Barnet Hospital, Barnet, UK Introduction.– Polypharmacy is prevalent in Older Age Medicine with its attendant risks of adverse drug reactions. Simultaneously, YouTube has become the most common social Site for Video sharing with 60 hours of Video uploads per minute and a reputed 4 billion viewers daily. Given the increasing embrace of technology by us all,
before, knee 1.21/hip 1, discharge: knee 2.25/hip 2.12;IB before knee 96.2/hip 92, discharge knee 84.3/hip 92. Analgesic scale: 1◦ step: knee 65.6%/hip 34%; 2◦ : knee 86.8%/hip 11.3% and 3◦ : knee 88.9%/hip 11.1%. Hospital stay: knee 9.8 ± 4.3 days/hip 11.16 ± 4.4. Functional gain IB: knee 22.4 points/hip 19. No significant differences were found in age, functional situation on admission, and institutionalisation on discharge among others. Conclusions.– Geriatric patients cared for in a MSU for secondary functional deterioration to arthroplasty of the knee show better functional recovery on discharge, with a lower hospital stay, specifying greater analgesia, than those of hip arthroplasty. http://dx.doi.org/10.1016/j.eurger.2013.07.362 P299
Clinical characteristics and outcome determinants of stroke rehabilitation R.P. Ruberu , S. Manchanda , P. Connolly , L. Gilgan , D. Lecamwasam Royal Adelaide Hospital, Adelaide, Australia Aim.– A retrospective analysis of stroke outcome variables in stroke rehabilitation. Method.– Case notes of patients admitted to a rehabilitation centre between July 07 to July12 were reviewed. Selection criteria included ischemic or hemorrhagic strokes. Sixty-eight variables were analysed. Partition modeling was used to identify relationship between variables and their importance in stroke rehabilitation. Results.– Of 482 stroke patients 426 patients met inclusion criteria (mean age 70.67 SD = 13.31, SEM 0.645; male 58%, n = 245). Mean length of rehabilitation was 48.36 d. Majority (98%, n = 419) were from home prior to stroke and 80% (n = 333) returned home. For them the mean length of rehabilitation was 45.22 d where 66% (n = 221) were discharged within 50 days. t-test for total admission FIMS by discharge destination was performed. A significant difference in the total FIMS for patients who were discharged home compared to those discharged to either high level residential care (HLOC) (P < 0.001) or low level residential care (LLOC) (P = 0.0497) and a significant difference between those who were discharged to LLOC compared to HLOC (P = 0.0044). Total FIMS ≥ 77, carer support, and age less or equal to 77 years were associated with returning home. When considering patients with total FIMS 36–77, age less than 82 years and carer support were associated with returning home. HLOC was predictable in those who were greater or equal to 82 years, length of stay in acute hospital greater or equal to 14 days, FIMS for upper body dressing of less than 5. Conclusion.– Total FIMS together with other predictors prior to enrolling in an inpatient stroke rehabilitation would improve efficiency and patient outcomes. http://dx.doi.org/10.1016/j.eurger.2013.07.363 P300
Audit of postoperative haemoglobin testing in proximal femur fragility fracture S. Cook , G. Bidwell , C. Pulford , K. Shah Oxford University Hospitals Trust (OUH), Oxford, UK Introduction.– Many patients with hip fractures are anaemic and there is evidence to show that anaemia and transfusion can affect postoperative rehabilitation. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) Proximal Hip Fracture Guidelines state that point of care haemoglobin analysers (e.g. Hemocue) should be used routinely at the end of surgery to assess the degree of anaemia and guide blood transfusion. We audited postoperative haemoglobin (Hb) testing in our unit. Methods.– Assessment of all patients over 65 admitted to our hospital with a fragility fracture of the proximal femur over a 3-week
S111
period. We used retrospective assessment of the anaesthetic chart, recovery documentation and medical notes The results were presented at the monthly Fragility Fracture Meeting. Haemacue after surgery was introduced into the departmental protocol and postoperative instructions. We re-audited over a further 3-week period. Results.– Twenty-eight patients were audited in the first cycle and 26 in the second cycle. In the first cycle 56% of patients had an immediate postoperative Hb check–this improved to 85% in the second cycle. In the first cycle 75% of patients had an Hb check by 24 hours – this improved to 100% in the second cycle. Of those who had an Hb check in recovery 53.8% (7/13) in the first cycle and 41% (9/22) in the second cycle required immediate transfusion. Key conclusions.– Our completed audit cycle demonstrates considerable improvement in point of care Hb testing post-surgery for hip fracture, improving our compliance with AAGBI guidelines. http://dx.doi.org/10.1016/j.eurger.2013.07.364 P301
Geriatric inclusive art and length of stay in acute care unit S. Remondière , M. Mahé , F. Repussard , F. Decavel , C. Annweiler , O. Beauchet Angers University Hospital, Department of Neuroscience, Division of Geriatrics Medicine, Angers, France Text.– Although emotional well-being is known to improve health status amongst older community-dwellers, its effect amongst patients hospitalized in geriatric acute care units has not been examined yet. We have recently adapted a new form of art therapy for older patients hospitalized in acute care units, the “Geriatric Inclusive Art” (GIA). GIA uses painting to make inpatients aware of their abilities through an improvement of emotional well-being. We performed a pilot case-control study to determine whether a GIA session performed amongst inpatients hospitalized in a geriatric acute care unit could reduce the LHS. Between December 27th 2010 and December 14th 2011, 93 inpatients (mean age 83.9 ± 6.2years, 53.8% women) who benefited from one session of GIA and 95 paired control inpatients (mean age 85.4 ± 5.6years, 51.6% women) hospitalized in the geriatric acute care of Angers University Hospital (France) were prospectively included. The LHS was assessed using the administrative registry of Angers University Hospital. Participation at one GIA session was defined as painting a picture under the supervision of a moderator and a nurse. There were no significant differences for the baseline characteristics between cases and matched controls. Multiple linear regression model showed that attending one GIA session (P = 0.023) and a higher BMI (P = 0.031) were associated with a shorter LHS, whereas hospitalisation during fall was associated with a longer LHS (P = 0.020). Participation in one GIA session was associated with shorter LHS in our study. We suggest that painting improved emotional well-being amongst inpatients. This positive affect might act as a starter of awareness of inpatients’ abilities leading to better functioning and thus accelerating the discharge. http://dx.doi.org/10.1016/j.eurger.2013.07.365 P302
Polypharmacy and healthcare education: What does YouTube have to offer? C. Lisk Department of Medicine Barnet Hospital, Barnet, UK Introduction.– Polypharmacy is prevalent in Older Age Medicine with its attendant risks of adverse drug reactions. Simultaneously, YouTube has become the most common social Site for Video sharing with 60 hours of Video uploads per minute and a reputed 4 billion viewers daily. Given the increasing embrace of technology by us all,