Väntetiden för patienter som ådragit sig höftfraktur till operation är ofta lång och kan uppgå till över ett dygn. I första delen av vårdkedjan är det ambulanssjuksköterskan som möter patienter som ådragit sig höftfraktur och omhändertagandet där smärtbehandling ingår genomförs med stöd av upprättade vårdriktlinjer. Ambulanssjuksköterskan har ett ansvar enligt svensk lag att den prehospitala akutsjukvården som genomförs ska vara evidensbaserad. Syftet med denna studie var att undersöka specialistutbildade ambulanssjuksköterskors uppfattningar om möjligheten att bedriva evidensbaserad vård vid prehospital smärtbehandling av patienter med höftfraktur. Detta är en kvalitativ studie med beskrivande design. Resultatet visade att den specialistutbildade ambulanssjuksköterskan uppfattade generellt att vårdriktlinjerna var tydliga och lätta att förhålla sig till. De uppfattade att smärtbehandling var väl fungerande och evidensbaserad. Vårdriktlinjerna var tydliga och lätta att förhålla sig till och informanterna uppfattade att smärtbehandlingen var väl fungerande och evidensbaserad. / The waiting time for patients that sustain hip fractures is often long and can be more than twenty-four hours. The Ambulance nurse provides the first care for those whom sustain a hip fracture.  These patients receive pain management care from the ambulance nurse as recommended by given guidelines.  The ambulance nurse has a responsibility by Swedish law to administer care in an evidence based care, prehospital in the emergency care. The intention of this study was to investigate the specialist educated ambulance nurses current opinions of the possibility to give evidence based care, during prehospital pain management to patients who have a hip fracture. This is a qualitative study with descriptive design. The outcome of this study shows that the specialist educated ambulance nurses believe that the guidelines are clear and easy to follow in general.  Their opinion was that the pain management was functional and evidence based. The guidelines were clear and easy to relate to and the informants experienced the pain management as evidence based.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [102]-108).

Submitted by Jaqueline Silva (jtas29@gmail.com) on 2014-12-12T19:33:12Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação-Tiago Amaral Rebouças Moreira-2013.pdf: 5214451 bytes, checksum: f94d6423ad4fe0ef896bd01542da545b (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-12-16T09:22:36Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação-Tiago Amaral Rebouças Moreira-2013.pdf: 5214451 bytes, checksum: f94d6423ad4fe0ef896bd01542da545b (MD5) / Made available in DSpace on 2014-12-16T09:22:36Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação-Tiago Amaral Rebouças Moreira-2013.pdf: 5214451 bytes, checksum: f94d6423ad4fe0ef896bd01542da545b (MD5) Previous issue date: 2013-10-31 / Introduction: Approximately 1.5 million hip fractures ocurr annually worldwide in elderly people, this number is expected to increase to 6.3 million by 2050. Mortality rates within the first year varies from 11.2% to 35%. An estimated 23 – 50% of these patients recover their previous walking ability. Factors involved in the increased mortality of these patients are not completely understood. The objective of the presente study was to evaluate the morbimortality of elderly patients treated surgically for hip fracture. Patients and methods: Medical records of patients ≥60 years of age who underwent surgery for the treatment of hip fracture between 1 January 2010 and 31 December 2011 in a reference hospital of the Central-West region of Brazil were retrospectively analysed. Patients with history of high-energy trauma, pathologic fracture due to bone tumor or unable to walk before the fracture were excluded. The variables under study were: gender, age, comorbidities, previous hip fracture, fracture type, time between admission and surgery, assisted walking before injury, and hospitalization time. The follow-up period was 1 year. Univariate and multivariate (Cox proportional hazards) analyses were performed. The survival curve was estimated by using the Kaplan-Meier method. Results: Of the 835 patients with hip fractures, 427 were included in the study. Of these, 63.5% were women. One hundred and twenty-nine patients died; 38.0% of them were men. Age and length of hospital stay were associated with progression to death (p = 0.000). On Cox analysis, an age ≥ 90 years (hazard ratio [HR], 3.54; 95% confidence interval [CI], 1.46–8.59) and the presence of chronic obstructive pulmonary disease (HR, 2.44; 95%: CI, 1.25–4.74) proved to be predictors of death. Among the survivors, 58.7% exhibited the same walking ability they had before the injury and 14.7% became wheelchair-bound. Conclusions: The mortality rate in the first year was 30.2%. Age ≥90 years and chronic obstructive pulmonary disease were identified as predictors of death. Among those patients who were alive after 1 year, 52.5% maintained the ability to walk without assistance and 14.7% became wheelchair-bound. / Resumo viii RESUMO Introdução: Anualmente, ocorrem aproximadamente 1,5 milhão de fraturas do quadril, em idosos, no mundo e estima-se que, em 2050, serão 6,3 milhões. As taxas de mortalidade no primeiro ano após a fratura variam de 11,2% a 35 %. O percentual de pacientes que recuperam a capacidade de deambulação prévia varia entre 23 e 50%. Os fatores envolvidos no aumento da mortalidade dos pacientes acometidos não são plenamente conhecidos. O objetivo foi avaliar a morbimortalidade de pacientes idosos submetidos ao tratamento cirúrgico de fratura do quadril. Pacientes e Métodos: Estudo longitudinal retrospectivo de prontuários de pacientes idosos operados de fratura do quadril, no período de 01 de janeiro de 2010 a 31 de dezembro de 2011, em um hospital de referência, na região Centro- Oeste do Brasil. Foram excluídos os registros de pacientes com fratura patológica de causa tumoral, história de trauma de alta energia e incapazes de deambulação anteriormente à fratura. Foram variáveis de exposição: sexo; idade; procedência; cardiopatia, doença pulmonar obstrutiva crônica, hipertensão arterial sistêmica, diabetes mellitus e câncer; fratura prévia do quadril oposto; tipo de fratura; tempo para cirurgia; deambulação com auxílio anterior à fratura e tempo de internação. Foram realizadas análises univariada e multivariada (riscos proporcionais de Cox). Riscos relativos foram calculados como harzard ratios (HRs). A curva de sobrevivência foi estimada por meio do método de Kaplan-Meier. Resultados: Dos 835 pacientes com fratura do quadril, operados nesse período, foram incluídos no estudo 427 pacientes. Desses, 63,5% eram do sexo feminino. Cento e vinte e nove pacientes (30,2%) morreram no primeiro ano após a fratura, 49 (38,0%) eram do sexo masculino. As variáveis idade e tempo de internação mostraram-se estatisticamente associadas à evolução para o óbito no primeiro ano de seguimento (p=0,000). Na análise multivariada, a idade maior que 90 anos (HR: 3,54; IC95%: 1,46 – 8,59) e a presença de doença pulmonar obstrutiva crônica (HR: 2,44; IC95%: 1,25 – 4,74) mostraram-se preditores de óbito. Entre os pacientes sobreviventes, 58,7% apresentavam a mesma capacidade de marcha que possuíam previamente à fratura e 14,7% tornaram-se cadeirantes. Conclusões: A mortalidade em um ano foi de 30,2%. Idade superior a 90 anos e presença de doença pulmonar obstrutiva crônica foram identificados como preditores de óbito. Dentre os pacientes com sobrevida superior a um ano, 52,5% mantiveram a capacidade de deambulação sem auxílio e 14,7% tornaram-se cadeirantes.

Bakgrund   Höftfrakturer är ett globalt problem och mängden personer som drabbas har ökat sedan 90-talet och antalet drabbade kommer fortsätta öka med en ökande äldre population. Mellan 12–17 procent dör inom det första året efter en höftfraktur varav att alla lider av en högre risk att dö i förtid samt att mängden som återgår till samma funktionsförmåga sedan innan höftfrakturen är inte hög. Något som kan bedöma hur en person upplever sin hälsa är livskvalité. Författarna finner därför att det skulle vara intressant att belysa vad som händer med livskvalitén för den som drabbas av en höftfraktur.  Syfte Syftet med denna studie var att beskriva personers upplevda livskvalité vid höftfraktur. Metod En icke systematisk litteraturstudie har utförts på 17 artiklar, tre med kvalitativ design och 13 med kvantitativ design och en med mixed method. Artiklarna är inhämtade från CINAHL och Pubmed med hjälp av olika sökordskombinationer. Artiklarna kvalitetsgranskades utifrån Sophiahemmet högskolas bedömningsinstrument. En integrerad analys utfördes därefter och artiklarna delades in i tre steg för att identifiera huvudkategorier och underkategorier. Resultat Utifrån resultatartiklarna som bedömde livskvalité utifrån mätinstrument försämrades den upplevda livskvalitén som följd av höftfrakturen. Många upplevde en förbättring av livskvaliteten inom ett år men att den inte blev lika bra som före höftfrakturen. De kvalitativa artiklarna tar upp andra aspekter av att leva efter höftfraktur som “rädslor & oro efter höftfraktur”, “Självständighet och ensamhet efter höftfraktur” och “Förväntningar efter höftfraktur”. Slutsats Majoriteten av de som drabbas av en höftfraktur upplever fortsatt försämrad livskvalité och hälsa en tid efter höftfrakturen inträffat. Det finns ett klart utvecklingsområde för att förbättra omvårdnaden vid en höftfraktur. Fortsatta studier inom ämnet livskvalité, hälsa och höftfraktur bör fokuseras på kvalitativa studier för att utveckla förståelsen för vad patienterna upplevelser och erfarenheter vid höftfraktur. / Background Hip fractures are a global problem and the amount of people suffering from this has increased since the 1990s and the number of people suffering from this condition will continue to increase with an increasing older population. Between 12-17 percent dies within the first year after hip fracture of which everyone affected has a higher risk for premature death. Something that assesses how a person experiences their health was quality of life. The authors of this study therefore find it interesting to see what happens with quality of life during and after hip fracture.  Aim The aim of this study was to describe patients' experienced quality of life during and after study.  Method A non-systematic literature study has been performed on 17 articles, three with a qualitative design, 13 with a quantitative design and one with mixed method. The articles have been obtained from CINAHL and Pubmed with the help of different keyword combinations. The articles have been quality reviewed with the Sophiahemmet högskolas assessment instrument. An integrated analysis has been done in three steps to identify main- and sub-themes.  Results From the result in the articles that assessed quality of life through assessment instruments the perceived quality of life deteriorated due to the hip fracture. Many of the patients perceived an improvement in quality of life within a year but that it did not turn out as well as before the hip fracture. The qualitative studies brought up other aspects of living with hip fracture such as “fears and worries after hip fracture”, “independence and loneliness after hip fracture” and “Expectations after hip fracture”. Conclusions The majority of those who suffer from a hip fracture experience a continued deterioration in quality of life and health some time after the hip fracture has occurred. There was a clear area for ​​development to improve nursing care for patients with a hip fracture. Continued studies in the subject of quality of life, health and hip fracture should focus on qualitative studies to develop an understanding of what patients experience with a hip fracture.

The relationship between milk intake and risk of osteoporotic fractures is uncertain. Associations between milk intake and milk avoidance in relation to osteoporotic hip fracture were examined in the Utah Study of Nutrition and Bone Health (USNBH), a statewide case-control study. Cases were ascertained at Utah hospitals treating 98 percent of hip fractures during 1997-2001 and included 1188 men and women aged 50-89 years. Age- and gender-matched controls were randomly selected from Utah driver's license and Medicare databases (N= 1324). In-person interviews were conducted and participants reported frequency of milk intake per week at age 18 and during pregnancy among women who reported being pregnant. Milk avoidance for a period of more than one year and duration of milk avoidance were also reported. Diet and supplement intake in the one-year period before fracture (cases) or the interview (controls) was assessed using a picture-sort food frequency questionnaire. Milk consumption frequency was categorized into four levels of intake at each life stage. Total calcium intake was categorized into quintiles of distribution of intake. Logistic regression models were used to examine associations between milk intake and milk avoidance and risk of hip fracture while controlling for the potential confounding effects of gender, age, body mass index, alcohol use, smoking, physical activity, estrogen use, and total calorie, protein, calcium, and vitamin D intake. Recent milk intake, milk intake during pregnancy, and milk avoidance duration were not associated with risk of hip fracture. A borderline association was found at age 18 showing a decreased risk of hip fracture among those in the highest quartile (2: 15 cups of milk per week) of milk intake (odds ratio (OR): 0.86, 95 percent confidence interval (Cl): 0.75, 1.00; P = 0.046). Milk avoidance for a year or more was associated with an increased risk of hip fracture compared to those who did not avoid milk (OR: 1.38, 95 percent CI: 1.07, 1.78). A significant interaction was found between milk avoidance and quintile of total calcium intake (P = 0.02). Milk avoidance was associated with a significantly higher risk of hip fracture at the lowest two quintiles of calcium intake (OR: 1.72, 95 percent CI: 1.26, 2.17; P = 0.02 and OR: 1.58, 95 percent CI: 1.01, 2.15; P = 0.01, respectively) but was not associated with elevated risk among those with higher calcium intakes. In conclusion, milk intake during pregnancy for women, and in the year before hip fracture (for cases) or before interview (for controls), was not associated with hip fracture risk. The highest level of milk intake at age 18 was associated with decreased risk of hip fracture. Avoidance of milk for one year or more was associated with hip fracture risk, but only among those with low calcium intake (Q1 and Q2).

Bakgrund: Höftfrakturer är en vanlig och allvarlig händelse som främst drabbar äldremänniskor. Risken för komplikationer är stor, dödligheten efter frakturen är hög och vägentillbaka till sitt vanliga liv kan för patienterna vara lång. Då livskvalitet ofta är kopplat till denegna hälsan är det viktigt att identifiera vad som påverkar livskvaliteten hos just dessa patienter. Syfte: Syftet med detta examensarbete var att studera vilka faktorer som påverkat livskvalitetenhos patienter över 60 år efter en höftfraktur.Metod: Designen i detta examensarbete var en deskriptiv, induktiv design med kvantitativ ansatssom gjordes i form av en litteraturstudie. Resultatet baserades på tretton kvantitativa studier ochstudiernas kvalitet granskades med hjälp av en kvalitetsgranskningsmall. Resultatet analyserades,likheter och skillnader identifierades. Resultat: Sex kategorier återfanns gällande vad som påverkat livskvaliteten efter höftfraktur hospatienter över 60 år: patientkaraktäristika, mental hälsa, fysisk hälsa, vården, förmåga att utföraADL samt social situation. Slutsats: Hög ålder, depression, kognitiv nedsättning, smärta, nedsatt förmåga till rörelse ochADL samt att drabbas av vårdrelaterade komplikationer var alla faktorer som visade sig påverkapatienternas självskattade livskvalitet negativt. Faktorer som visade sig positivt influeralivskvaliteten var att ha ett gott socialt stöd, erhålla god rehabiliterande träning, samt informationoch utbildning om sitt sjukdomstillstånd. Sjuksköterskan har en viktig roll i arbetet med attförbättra patienters livskvalitet då många av de påverkande faktorer som identifierats i dettaexamensarbete faller under sjuksköterskans ansvarsområde. / Background: Hip fractures are both common and serious injuries that primarily affect theelderly. There is a high risk of complications, mortality is high and the road of rehabilitation is along one. Quality of life is often intertwined with health, wherefore it is important to identify thatwhich affects quality of life for these patients. Aim: The aim of this bachelor thesis was to study which factors affect the quality of life ofpatients aged 60 and older after having suffered a hip fracture.Method: The design of this bachelor thesis was a descriptive, inductive design with aquantitative approach in the form of a literature study. The results are based on thirteenquantitative studies, which quality was assessed with the aid of a quality review template. Theresults were analyzed, similarities and differences were noted. Results: The elements that have been found to influence quality of life after a hip fracture wereorganized in six categories: patient characteristics, mental health, physical health, the health caresystem, ability to perform ADL and social situation. Conclusion: Old age, depression, cognitive impairment, pain, reduced ability to move andperform ADL independently, as well as suffering from care-related complications were elementsthat were shown to affect patients' self-rated quality of life negatively. Elements that positivelyinfluenced the quality of life were having good social support, receiving good rehabilitativetraining, as well as getting information and education about their illness. The nurse has animportant role when it comes to improving patients' quality of life, since many of the influencingelements identified in this degree project fall within the nurse's area of responsibility.

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