Sze Pan Ching. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 162-178). / Abstracts in English and Chinese. / ABSTRACT --- p.i / ABSTRACT (IN CHINESE) --- p.iv / ACKNOWLEGEMENT --- p.vi / TABLE OF CONTENTS --- p.viii / LIST OF FIGURES --- p.xv / LIST OF TABLES --- p.xviii / LIST OF APPENDIX --- p.xx / LIST OF ABBREVIATIONS --- p.xxi / LIST OF DEFINITIONS OF TERMS --- p.xxii / Chapter I. --- INTRODUCTION --- p.1 / Chapter 1.1 --- Epidemiology of hip fracture among elderly worldwide --- p.1 / Chapter 1.2 --- Impact of hip fractures --- p.3 / Chapter 1.2.1 --- Mortality --- p.3 / Chapter 1.2.2 --- Hospitalization and institutionalization --- p.4 / Chapter 1.2.3 --- Morbidity --- p.4 / Chapter 1.2.4 --- Psychological impact and quality of life --- p.5 / Chapter 1.2.5 --- Financial burden --- p.6 / Chapter 1.3 --- Causes of hip fracture --- p.6 / Chapter 1.3.1 --- Mechanisms of hip fracture --- p.7 / Chapter 1.3.2 --- Degenerated protective mechanism --- p.8 / Chapter 1.3.3 --- Poor hip strength indices --- p.9 / Chapter 1.4 --- Prevention of hip fractures --- p.10 / Chapter 1.4.1 --- Reduction of the chance of lateral fall --- p.10 / Chapter 1.4.2 --- Increase hip strength indices --- p.11 / Chapter 1.4.3 --- Limitations of current strategies --- p.12 / Chapter 1.5 --- Hip protectors for prevention of hip fractures --- p.12 / Chapter 1.6 --- Effectiveness of hip protector --- p.14 / Chapter 1.6.1 --- Laboratory studies on effectiveness in force attenuation --- p.14 / Chapter 1.6.2 --- Clinical studies on prevention of hip fractures --- p.16 / Chapter 1.6.3 --- Cost-effectiveness study --- p.17 / Chapter 1.7 --- Problems on the use of hip protectors --- p.19 / Chapter 1.7.1 --- Discomfort --- p.19 / Chapter 1.7.2 --- Extra effort in wearing --- p.20 / Chapter 1.7.3 --- Appearance after wearing --- p.21 / Chapter 1.7.4 --- Urinary incontinence --- p.22 / Chapter 1.7.5 --- Oth er problems --- p.23 / Chapter 1.8 --- Acceptance and Compliance of hip protectors --- p.23 / Chapter 1.8.1 --- Acceptance --- p.23 / Chapter 1.8.2 --- Compliance --- p.24 / Chapter 1.9 --- Strategies to improve compliance of hip protector --- p.25 / Chapter 1.9.1 --- Better design of hip protector --- p.25 / Chapter 1.9.2 --- Encouragement/support to the user --- p.26 / Chapter 1.9.3 --- Support from nursing staff/carer --- p.27 / Chapter 1.10 --- Rationale and objectives of present study --- p.28 / Chapter II. --- METHODOLOGY --- p.36 / Chapter 2.1 --- Development of hip protector --- p.36 / Chapter 2.1.1 --- Design of the pads --- p.36 / Chapter 2.1.2 --- Design of the pants --- p.38 / Chapter 2.1.2.1 --- Fabric materials --- p.38 / Chapter 2.1.2.2 --- Anthropometric measurement --- p.42 / Chapter 2.1.2.3 --- Pattern design --- p.43 / Chapter 2.1.3 --- Trial use of hip protector --- p.43 / Chapter 2.1.4 --- Calculation and statistical method --- p.43 / Chapter 2.2 --- Mechanical test on force attenuation properties --- p.44 / Chapter 2.2.1 --- Testing system --- p.44 / Chapter 2.2.2 --- Simulation of impact force and identification of dropping height --- p.45 / Chapter 2.2.3 --- Testing method --- p.46 / Chapter 2.2.4 --- Calculation and statistical method --- p.47 / Chapter 2.3 --- Compliance study --- p.47 / Chapter 2.3.1 --- Setting --- p.47 / Chapter 2.3.2 --- Subjects --- p.48 / Chapter 2.3.3 --- Study design --- p.49 / Chapter 2.3.4 --- Implementation procedure and intervening Program --- p.49 / Chapter 2.3.4.1 --- Liaison with the heads and responsible staff in the elderly hostels --- p.49 / Chapter 2.3.4.2 --- Education program for hostel staff --- p.50 / Chapter 2.3.4.3 --- Education program for elderly subjects --- p.50 / Chapter 2.3.4.4 --- Fall and fracture risk counseling --- p.51 / Chapter 2.3.4.5 --- Consent and Ethical approval --- p.51 / Chapter 2.3.4.5 --- Provision of hip protector and training program on wearing hip protector --- p.51 / Chapter 2.3.4.6 --- Follow up and encouragement on the use of hip protector --- p.52 / Chapter 2.3.5 --- Outcome measures --- p.52 / Chapter 2.3.5.1 --- Primary outcome --- p.52 / Chapter 2.3.5.2 --- Secondary outcomes --- p.53 / Chapter 2.3.6 --- Measurement method --- p.55 / Chapter 2.3.6.1 --- Compliance --- p.55 / Chapter 2.3.6.2 --- Falls and fractures incidence --- p.56 / Chapter 2.3.6.3 --- Adverse effect and feedback after wearing hip protector --- p.56 / Chapter 2.3.6.4 --- Fear of fall --- p.57 / Chapter 2.3.6.5 --- Fall and fracture history --- p.57 / Chapter 2.3.6.6 --- Medical co-morbidities --- p.58 / Chapter 2.3.6.7 --- Presence of urinary incontinence --- p.58 / Chapter 2.3.6.8 --- Functional level --- p.58 / Chapter 2.3.6.9 --- Hand function --- p.58 / Chapter 2.3.6.10 --- Mobility --- p.59 / Chapter 2.3.6.11 --- Cognitive function --- p.59 / Chapter 2.3.7 --- Sample size calculation --- p.59 / Chapter 2.3.8 --- Calculation and Statistical method --- p.60 / Chapter III. --- RESULTS --- p.73 / Chapter 3.1 --- Design of hip protector --- p.73 / Chapter 3.1.1 --- The design of pants --- p.73 / Chapter 3.1.1.1 --- The fabric materials --- p.73 / Chapter 3.1.1.2 --- The size of the pants --- p.74 / Chapter 3.1.2 --- The design of pads --- p.75 / Chapter 3.1.2.1 --- Thickness of silicon padding --- p.75 / Chapter 3.1.1.2 --- Dimension of the hard shield --- p.75 / Chapter 3.2 --- Mechanical test on force attenuation properties of the pads --- p.76 / Chapter 3.2.1 --- Impact force --- p.76 / Chapter 3.2.2 --- Impact duration --- p.78 / Chapter 3.2.3 --- Selection of th e prototype --- p.78 / Chapter 3.3 --- Compliance study --- p.79 / Chapter 3.3.1 --- Demograph ics --- p.79 / Chapter 3.3.2 --- Primary outcome --- p.79 / Chapter 3.3.2.1 --- Initial acceptance rate --- p.79 / Chapter 3.3.2.2 --- Compliance rate --- p.79 / Chapter 3.3.2.3 --- Percentage of people wearing hip protector across the study period --- p.81 / Chapter 3.3.2.4 --- Percentage of protected fall --- p.81 / Chapter 3.3.3 --- Secondary outcomes --- p.81 / Chapter 3.3.3.1 --- Fall and related injury among the subjects in the study period --- p.81 / Chapter 3.3.3.2 --- Reasons for non-acceptance --- p.82 / Chapter 3.3.3.3 --- Feedback in using hip protector --- p.84 / Chapter 3.3.3.4 --- Factors associated with compliance and non-compliance (feedback in wearing hip protector) --- p.84 / Chapter 3.3.3.5 --- Factors associated with compliance and non-compliance (subject characteristics) --- p.85 / Chapter 3.3.3.6 --- Effect on mobility after wearing hip protector --- p.85 / Chapter 3.3.3.7 --- Fear of fall after wearing hip protector --- p.85 / Chapter IV. --- DISCUSSION --- p.123 / Chapter 4.1 --- Development of a hip protector for Chinese elderly --- p.124 / Chapter 4.1.1 --- Successful modifications made to the pads --- p.124 / Chapter 4.1.1.1 --- More comfort to wear with silicon cushioning materials added --- p.124 / Chapter 4.1.1.2 --- Better mechanical properties with semi-flexible plastic and silicon pad --- p.125 / Chapter 4.1.1.3 --- Smaller in dimension of the present model might improve appearance after wearing --- p.127 / Chapter 4.1.2 --- No significant improvement on compliance with modification of the pants --- p.128 / Chapter 4.2 --- Sufficient mechanical properties of hip protector demonstrated --- p.129 / Chapter 4.2.1 --- Mechanical test set up --- p.130 / Chapter 4.2.2 --- Mechanism of force attenuation --- p.132 / Chapter 4.3 --- No significant improvement on compliance shown --- p.134 / Chapter 4.4 --- Compliance at night time better than other studies --- p.136 / Chapter 4.5 --- Determinants of compliance mostly related to subjects' feedback of using hip protector rather than on their characteristics --- p.137 / Chapter 4.6 --- Better compliance observed in hostel with higher staff-to-subject ration and with occupational therapist as contact person --- p.138 / Chapter 4.7 --- Better acceptance rate of hip protector shown in the present study --- p.139 / Chapter 4.8 --- Identification of factors influencing acceptance --- p.139 / Chapter 4.9 --- Percentage of protected fall was higher than mean compliance --- p.141 / Chapter 4.10 --- No hip fracture occurred while subjects wearing hip protector --- p.141 / Chapter 4.11 --- Decreased fear of falling after wearing hip protector --- p.142 / Chapter 4.12 --- Limitation --- p.142 / Chapter 4.13 --- Recommendation --- p.143 / Chapter V. --- CONCLUSION --- p.146 / Chapter VI. --- APPENDIX --- p.148 / Chapter VII. --- BIBLIOGRAPHY --- p.162 / Chapter VIII. --- PUBLICATIONS --- p.179

Thesis (M.S.)--University of Michigan, 1999. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1999. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Introduction: Hip fracture surgery is the particular problem of very old patinets (>75 years), with high risk of VTE (up to 80%). It is essential to provide VTE prophylaxis. Patients advanced age and their polymorbidity contribute to the thrombophilic status. Objectives and methods: The aim of the study was to determine the changes of coagulation within the 28 post-operative days in 41 patients over 75 years who underwent hip fracture surgery. Another object was to determine acute phase response and an endothelial activation. The third task was to determine how affected is a key component of hemostasis, FXa activity by its specific inhibitor fondaparinux and enoxaparin, which inhibits FXa and thrombin in a 4:1 ratio and if there is bleeding complication in such a risk group patiens after antithrombotics long-term administration. Patients were randomly divided into two anticoagulant groups: fondaparinux (n = 23) and enoxaparin (n = 18). Results: Thrombophilia is demonstrated by a reactive increase of the most of these parameters preoperatively and reveals the effect of the initial trauma. A surgery further aggravates this reaction. This inflammatory and secondary prothrombogenic condition persisted until postoperative day 28. Both antithrombotics effectively inhibit thrombin generation without...

Introduction: Hip fracture surgery is the particular problem of very old patinets (>75 years), with high risk of VTE (up to 80%). It is essential to provide VTE prophylaxis. Patients advanced age and their polymorbidity contribute to the thrombophilic status. Objectives and methods: The aim of the study was to determine the changes of coagulation within the 28 post-operative days in 41 patients over 75 years who underwent hip fracture surgery. Another object was to determine acute phase response and an endothelial activation. The third task was to determine how affected is a key component of hemostasis, FXa activity by its specific inhibitor fondaparinux and enoxaparin, which inhibits FXa and thrombin in a 4:1 ratio and if there is bleeding complication in such a risk group patiens after antithrombotics long-term administration. Patients were randomly divided into two anticoagulant groups: fondaparinux (n = 23) and enoxaparin (n = 18). Results: Thrombophilia is demonstrated by a reactive increase of the most of these parameters preoperatively and reveals the effect of the initial trauma. A surgery further aggravates this reaction. This inflammatory and secondary prothrombogenic condition persisted until postoperative day 28. Both antithrombotics effectively inhibit thrombin generation without...

Foi analisada a parte trabecular do colo do fêmur de 13 pacientes do sexo feminino, com idade acima dos 60 anos, com o método da histomorfometria óssea. Sete destas pacientes tiveram fratura do colo do fêmur. Todas foram submetidas a artroplastia do quadril. O exame de densitometria óssea não mostrou diferença significativa. Na espessura média das trabéculas não houve diferença significativa, porém o número de trabéculas foi menor e a separação entre elas foi maior no grupo com fraturas. / A histomorphometry evaluation of the trabecular part of the femoral neck was performed in 13 women over 60 years old submitted to hip arthroplasty. Seven of these patients had a femoral neck fracture. The bone mineral density showed no difference between both groups. The average thickness did not have significant between both groups, but the trabecular separation was higher and the number of trabecular bone was lower in the fracture group.

Foi analisada a parte trabecular do colo do fêmur de 13 pacientes do sexo feminino, com idade acima dos 60 anos, com o método da histomorfometria óssea. Sete destas pacientes tiveram fratura do colo do fêmur. Todas foram submetidas a artroplastia do quadril. O exame de densitometria óssea não mostrou diferença significativa. Na espessura média das trabéculas não houve diferença significativa, porém o número de trabéculas foi menor e a separação entre elas foi maior no grupo com fraturas. / A histomorphometry evaluation of the trabecular part of the femoral neck was performed in 13 women over 60 years old submitted to hip arthroplasty. Seven of these patients had a femoral neck fracture. The bone mineral density showed no difference between both groups. The average thickness did not have significant between both groups, but the trabecular separation was higher and the number of trabecular bone was lower in the fracture group.

Chan Cheung Shing. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 88-90). / Abstracts in English and Chinese. / Abstract --- p.ii / Acknowledgements --- p.iv / Table of Contents --- p.v / List of Figures --- p.viii / List of Tables --- p.xii / Abbreviations and Notations --- p.xiii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background and Objective --- p.1 / Chapter 1.2 --- Contribution --- p.4 / Chapter 1.3 --- Thesis Outline --- p.5 / Chapter Chapter 2 --- System Architecture --- p.6 / Chapter 2.1 --- Conceptual Design --- p.6 / Chapter 2.2 --- Sensing Device and Fall-Detection Algorithm --- p.7 / Chapter 2.3 --- Mechanical Part --- p.10 / Chapter Chapter 3 --- Mechanical Design --- p.11 / Chapter 3.1 --- Similar Products --- p.11 / Chapter 3.1.1 --- Airbag Restraining Systems in Automobiles --- p.11 / Chapter 3.1.2 --- Airbag Jackets for Motorcycle and House Riders --- p.12 / Chapter 3.2 --- Mechanism adopted --- p.12 / Chapter 3.2.1 --- Time Requirement of Inflator --- p.12 / Chapter 3.2.2 --- Mechanism and Design --- p.13 / Chapter 3.2.3 --- Actuator --- p.14 / Chapter 3.2.4 --- Punch --- p.15 / Chapter 3.2.5 --- Airbags --- p.18 / Chapter 3.2.6 --- Other Mechanisms Tried --- p.19 / Chapter 3.3 --- Prototype --- p.21 / Chapter 3.3.1 --- Implementation --- p.21 / Chapter 3.3.2 --- Demonstration --- p.23 / Chapter Chapter 4 --- Inflation Estimation --- p.25 / Chapter 4.1 --- Theory and Model --- p.25 / Chapter 4.2 --- Validation of Model --- p.28 / Chapter 4.2.1 --- Testing Equipment --- p.28 / Chapter 4.2.2 --- Preprocessing of Pressure Sensor Outputs --- p.28 / Chapter 4.2.3 --- Validation for Basic Equations --- p.29 / Chapter 4.2.4 --- Adjustment of Discharge Coefficients --- p.36 / Chapter 4.2.5 --- Validation for Discharging to a Fixed Volume --- p.40 / Chapter 4.2.6 --- Estimation of the Size of Airbag's Leakage Hole --- p.45 / Chapter 4.2.7 --- Validation for Discharging to an Airbag --- p.47 / Chapter 4.2.8 --- Time Delay due to Addition of a Pipe --- p.52 / Chapter 4.3 --- Summary of Experiments --- p.53 / Chapter 4.4 --- Limitation of Model --- p.54 / Chapter 4.5 --- Prediction of Inflation Time and Airbag Pressure --- p.55 / Chapter 4.5.1 --- Effects of Orifice Size and Vent Size on Airbag Pressure and Volume --- p.55 / Chapter Chapter 5 --- Force Attenuation Estimation --- p.58 / Chapter 5.1 --- Theory and Model --- p.58 / Chapter 5.1.1 --- Kelvin-Voigt Model --- p.59 / Chapter 5.1.2 --- Standard Linear Solid Support Model --- p.59 / Chapter 5.2 --- Simple Testing for Validation --- p.61 / Chapter 5.3 --- Summary of Experiment --- p.64 / Chapter 5.4 --- Estimation --- p.64 / Chapter 5.4.1 --- Force Attenuation Ability of Prototype --- p.64 / Chapter 5.4.2 --- Minimum Airbag Volume and Pressure Required to Reduce the Force --- p.65 / Chapter Chapter 6 --- Future Work --- p.66 / Chapter 6.1 --- Impact Test for Airbag System --- p.66 / Chapter 6.2 --- The Effective Mass of the Target User --- p.67 / Chapter 6.3 --- The Motion Data Collection --- p.68 / Chapter 6.4 --- Modification in the Inflator --- p.69 / Chapter Chapter 7 --- Conclusion --- p.70 / Appendix A Review of Basic Thermodynamics and Fluid Dynamics --- p.72 / Chapter A.1 --- Thermodynamics --- p.72 / Chapter A.2 --- Fluid Mechanics: Incompressible and Compressible Flow --- p.75 / Appendix B Derivation of Equations --- p.77 / Chapter B.1 --- Mass Flow Rate Equations --- p.77 / Chapter B.2 --- Relationship between Rate of Changes of Airbag Pressure and Volume --- p.80 / Chapter B.3 --- Pressure Change of Compressed Gas Cylinder --- p.82 / Chapter B.4 --- Dominating Factors in the Mass Flow Rate Equation --- p.83 / Appendix C Dimensions of Inflator --- p.85 / Appendix D Experimental Data --- p.86

Orientador: William Dias Belangero / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T15:25:21Z (GMT). No. of bitstreams: 1 Guimaraes_FernandadeAquinoMoraes_M.pdf: 2147062 bytes, checksum: 5632ae3f5604084c60731a0035b47837 (MD5) Previous issue date: 2011 / Resumo: A população mundial está envelhecendo devido ao aumento na expectativa de vida. Tal fato contribui para aumentar a incidência de fraturas do quadril de forma significativa após os 60 anos, devido majoritariamente à osteoporose. Objetivou-se, neste estudo, comparar idosos, com fratura transtrocanteriana do fêmur (grupo estudo) com idosos sem fratura (grupo controle), pareados por gênero e idade, residentes em Lavras, Minas Gerais e região, para determinar os fatores de risco associados com a ocorrência dessa fratura e com a mortalidade pós-fratura. Esse estudo foi realizado na cidade de Lavras, Minas Gerais, entre o período de fevereiro de 2007 a dezembro de 2008. Foram incluídos 73 pacientes no grupo estudo com diagnóstico de fratura transtrocanteriana do fêmur que atenderam aos critérios de inclusão previamente definidos. No grupo controle foram entrevistados 156 idosos sem a presença de fratura. Todos os participantes, de ambos os grupos, foram acompanhados durante um ano. Foram incluídos em ambos os grupos somente participantes deambuladores na pré-fratura, com idade igual ou superior a 65 anos e de ambos os gêneros, sendo submetidos à aplicação de questionário padronizado em que se obtiveram informações sobre hábitos de vida, funcionalidade, estado civil, escolaridade, renda, moradia, comorbidades e capacidade cognitiva. Foram excluídos pacientes que não deambulavam, com doenças neurológicas e fraturas patológicas. As variáveis consideradas significativas, pela análise univariada, foram submetidas à análise multivariada (Regressão logística) considerando p?0,05. A média de idade do grupo estudo foi 81,51±7,1 anos e do grupo controle de 80,14±6,5 anos (p=0,16), sendo do gênero feminino 52/73 e 103/156 do grupo estudo e controle, respectivamente (p=0,43). As variáveis com diferenças significativas pela análise univariada, consideradas fatores de risco para esta fratura foram: comprometimento do estado cognitivo (p=0,000), dependência para realizar as atividades de vida diária e instrumentais da vida diária (p=0,000), número de comorbidades (p=0,004) e a presença de problemas otoneurológicos 7.47 (IC 3,12; 17,90). No grupo estudo o diabetes, idade ?80 anos, o desempenho das atividades diárias e o tempo de espera para a cirurgia foram significativamente diferentes. Pela análise multivariada, no grupo estudo, o diabetes e idade ?80 anos aumentou o risco de morte em 3,49 e 3,8 vezes respectivamente. O odds-ratio para mortalidade entre os diabéticos com e sem fratura foi 21,32 e para idade ?80 anos e <80 anos foi de 18,63. De acordo com os resultados, os fatores de risco significativamente associados com a ocorrência da fratura transtrocanteriana no idoso foram o comprometimento do estado cognitivo e a dependência funcional, além disso, há forte associação entre o excesso de mortalidade após um ano dessa fratura com a presença de diabetes e idade superior a 80 anos. (p=0,04). Entretanto, pela análise de regressão logística as variáveis que permaneceram significativas foram a baixa pontuação atingida no teste Mini Mental e a dependência para realizar as atividades de vida diária e instrumentais da vida diária. No primeiro ano pós-fratura, 21 pacientes morreram (p=0,000) no grupo estudo (n=73, 28,7%) e oito no grupo controle (n=156, 5,1%), com de odds-ratio de 7.47 (IC 3,12; 17,90). No grupo estudo o diabetes, idade ?80 anos, o desempenho das atividades diárias e o tempo de espera para a cirurgia foram significativamente diferentes. Pela análise multivariada, no grupo estudo, o diabetes e idade ?80 anos aumentou o risco de morte em 3,49 e 3,8 vezes respectivamente. O odds-ratio para mortalidade entre os diabéticos com e sem fratura foi 21,32 e para idade ?80 anos e <80 anos foi de 18,63. De acordo com os resultados, os fatores de risco significativamente associados com a ocorrência da fratura transtrocanteriana no idoso foram o comprometimento do estado cognitivo e a dependência funcional, além disso, há forte associação entre o excesso de mortalidade após um ano dessa fratura com a presença de diabetes e idade superior a 80 anos / Abstract: The world population is aging over the years, due to increased life expectancy. This contributes to increase the incidence of hip fractures significantly after 60 years, mostly due to osteoporosis. The aim of this study was to compare elderly patients with transtrochanteric femur fracture (study group) with the elderly (control group) without fracture, matched for age and gender, living in Lavras city, Minas Gerais and region to determine the risk factors associated the occurrence of the fracture and with mortality after fracture. This study was conducted in Lavras city, between period of the February 2007 to December 2008. Were included in the study group 73 patients with a diagnosis transtrocanteric femur fracture that met the inclusion criteria previously defined. In the control group were interviewed 156 elderly subjects without fracture. All participants from both groups were followed for one year. Were included in both groups only walked participants, with aged equal or over 65 years, both sexes and underwent a standardized questionnaire which obtained information of lifestyle, functionality, marital status, education, income, housing, comorbidities and cognitive ability. Exclusion criteria were not walk before fracture, with neurological diseases and pathological fractures. Significant variables by univariate analysis were then treated by multivariate analysis (logistic regression) and p?0.05 was considered. The average age of the study group was 81.51±7.1 years and the control group 80.14±6.5 years (p=0.16), female 52/73 in the study group and 103/156 in the control group (p=0.43). The variables that showed significant differences between groups by univariate analysis, considered risk factors for this fracture were: impaired cognitive state (p=0.000), dependence to perform activities of daily living and instrumental daily living (p=0.000), number of comorbidities (p=0.004) and presence of otoneurological problems (p=0.04). However, by logistic regression analysis the variables that remained significant were the low points reached in Mini-Mental test and dependence to perform activities of daily living and instrumental activities of daily living. In the first year after fracture 21 deaths in the study group (n=73, 28.7%) and 08 in control group (n=156, 5.1%; p=0.000) was observed. The odds ratio was 7.47 (CI 3.12, 17.90). Within the study group diabetes, age >=80 years, performance in diary activities and waiting time for surgery were significantly different. By multivariate analysis for the study group, only the presence of diabetes and age over 80 years increased death risk by 3.49 and 3.8 times respectively. Odds ratio for mortality between diabetics with and without transthrocanteric fracture was 21,32. The same comparison regarding age >=80 years and <80 was 18,63. According to results, of this study, the risk factors significantly associated with the occurrence of transtrochanteric fracture in the elderly were impaired cognitive status and functional dependence, moreover, there is a strong association between excess mortality after one year of the fracture with the diabetes and older than 80 years / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Bakgrund: Kvaliteten på sjuksköterskans omvårdnadsjournal kan återspegla den vårdkvalitet som tillhandahålls patienter. Patienter med en höftfraktur har ofta ett omfattande vårdbehov där omvårdnadsjournalen har en viktig funktion att strukturera dokumentation av vårdinsatser genom patientens vårdförlopp. Patienter med höftfraktur har ofta en komplex sjukdomsbild, där omvårdnadsdokumentationens kvalitet kan bidra till en säkrare vård för patienten. Kvaliteten på dokumentationen ökar vid en strukturerad journal och framförallt när ett standardiserat språk används. Journalgranskning är ett sätt att göra kvalitetskontroll av dokumentation. Motiv: Att drabbas av en höftfraktur innebär stora hälsorisker för en ofta redan skör person. Omvårdnadsdokumentationens kvalitet vid höftfraktur kan bidra till att patienten får bättre förutsättningar för att undvika komplikationer och till kortare vårdtid. Syfte: Att undersöka kvaliteten av omvårdnadsdokumentation för patienter med höftfraktur.Metod: En retrospektiv, deskriptiv och jämförande design där granskning av omvårdnadsjournaler användes för att besvara studiens syfte. Ett konsekutivt urval har gjorts av omvårdnadsdokumentation från 40 vårdtillfällen med patienter över 60 år som vårdats för en höftfraktur på en akutortopedisk avdelning. För granskningen användes journalgranskningsinstrumentet Cat-ch-ing. Resultat: De granskade omvårdnadsjournalernas kvalitet var varierande; ingen av journalerna hade en komplett dokumentation. Dokumentation av vårdplan och resultat av omvårdnadsåtgärder saknades i en majoritet av journalerna. Dokumentationen var av bättre kvalitet i gruppen yngre äldre patienter vid jämförelse med gruppen äldre äldre patienter. Ingen skillnad av kvalitet i dokumentationen kunde urskiljas utifrån vårdtidens längd då patienter som vårdats mindre än sju dygn eller sju dygn eller mer jämfördes. Konklusion: Kvaliteten av omvårdnadsdokumentationen var inte komplett. Det krävs ytterligare kunskap om förbättringsåtgärder i den kliniskas verksamheten för att säkerställa en omvårdnadsdokumentation av god kvalitet där patienter med höftfraktur vårdas. / Background: The quality of the nursing record can reflect the quality of nursing care provided to patients. Patients with a hip fracture often have an extensive need for care. The nursing record has an important function of describing the nursing process, nursing diagnoses and interventions. Patients with hip fractures often have complex health care needs and the nursing documentation can contribute to patient safety. The quality of the documentation increases with a structured journal. Furthermore, it should be written in a standardized language. Audit of nursing documentation can contribute to quality of care. Motive: Great health risks is a fact when suffering from a hip fracture, especially an already fragile person. The quality of the nursing documentation can contribute to better outcome in patient safety and the length of stay. Aim: To explore the quality of nursing documentation for patients with hip fractures. Methods: A retrospective descriptive and comparative design where audit of nursing records was used to attain the study's aim. A consecutive sample was used, where 40 patients’ health care records of nursing documentation for patients over the age of 60 with a hip fracture in an emergency orthopedic ward were included. The audit instrument Cat-ch-Ing was used. Result: The result showed that the quality was variable; none of the records had a complete documentation. Documentation of care plans were missing in a majority of the records. The documentation was of better quality in the group of younger elderly patients compared to that of older elderly patients. No quality differences were seen based on the length of stay. Conclusion: None of the records had a complete documentation. Further knowledge of how good quality nursing documentation on hip fractur patients can be implement for a sustainable result in clinical activities.