Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.

INTRODUÇÃO: A displasia do desenvolvimento do quadril (DDQ) é uma das patologias mais relevantes e polêmicas que acometem as crianças desde o nascimento. A anatomia tridimensional, a complexidade da articulação do quadril, o pouco conhecimento sobre o potencial de remodelação acetabular após luxação ou sub-luxação e as sequelas na marcha e na movimentação suscitam várias discussões sobre esse tema. A revisão bibliográfica a respeito dos diferentes tipos de capsulorrafia é muito pouco discutida entre os pesquisadores. Técnicas menos agressivas e que possibilitem maior resistência à recidiva da luxação após a redução cruenta devem ser pesquisadas. OBJETIVO: a presente pesquisa busca, por meio de ensaios biomecânicos, comparar as capsulorrafias com sutura simples e com âncoras, em quadris de coelhos. MATERIAL E MÉTODO: Foram utilizados 13 coelhos, 26 quadris, todos machos da raça Nova Zelândia albinos (Oryctolagus cuniculus). Inicialmente, realizamos um projeto piloto em três coelhos (06 quadris). Este experimento constou de 10 coelhos, divididos em 02 grupos: o grupo 1 submetido à capsulorrafia (quadris direito e esquerdo) com sutura simples utilizando fio absorvível de ácido poliglicólico e o grupo 2 submetido a capsulorrafia (quadris direito e esquerdo) com âncora de titânio. Após o período de quatro semanas de operados, todos animais foram submetidos à eutanásia e seus quadris congelados. Após um descongelamento prévio das peças no mesmo dia das análises biomecânicas, foram avaliados os parâmetros da rigidez (Rig), força máxima (Fmax), deformidade máxima (Dmax) e energia (E). RESULTADO: não houve diferença estatisticamente significante em relação à força no limite de proporcionalidade, rigidez e força máxima entre os grupos com sutura simples e com âncora. CONCLUSÃO: Por meio dos ensaios biomecânicos, tendo como parâmetro a rigidez (Rig), força máxima (Fmax), deformidade máxima (Dmax) e energia (E), ficou demonstrado que as capsulorrafias em quadris de coelhos com sutura simples e com âncora são semelhantes entre si. / INTRODUCTION:HDD (Hip Development Dysplasia) is one of the most important and controversial pathologies which affect children. The threedimensional anatomy and complexity of the hip joint, as well as the little understanding of the potential of acetabular reconstruction after luxation or sub-luxation and the later effects on the child\'s gait and movement, raise various points of discussion. Little literature exists about the different types of capsulorrhaphy. Techniques which are less aggressive or decrease risk of luxation after surgical reduction must be researched. OBJECTIVE: Using biomechanical studies, this research aims to compare hip capsulorrhaphy in rabbits, carried out with two different techniques: capsulorrhaphy with simple sutures and with anchors. MATERIAL AND METHOD: Thirteen New Zealand Albino (Oryctolagus cuniculus) male rabbits, twenty-six hip joints, were used. First, a pilot project was performed with three rabbits (six hip joints). The experimental group consisted of ten rabbits and was divided in two sub-groups: group 1 underwent capsulorrhaphy on both right and left hips with simple suture using polyglocolic acid absorbable thread, and group 2 underwent capsulorrhaphy with titanium anchors. After a four-week postoperation period, the animals were euthanized and the hip joints were frozen. On the same day the hip joints were unfrozen, a biomechanical study was carried out, evaluating the following parameters: rigidity, maximum force, maximum deformity and energy. RESULTS: There was no relevant statistical difference in rigidity, maximum force, maximum deformity and energy between the simple suture and anchor groups. CONCLUSION: Through biomechanical analyses, using parameters of rigidity, maximum force, maximum deformity and energy, it has been shown that a capsulorrhaphy with simple suture and with an anchor has similar results in rabbit hip joints.

<p>Cilj: Utvrditi funkcionalni i mentalni status pacijenata pre i posle medicinske rehabilitacije, a nakon operacije kuka kod osoba starije životne dobi primenom standardizovanih upitnika (SF36, Harris hip score, MMS, TUG, FES-I) . Materijal i metod:Istraživanje je bilo prospektivno i uzorak je činilo 96 pacijenata sa prethodnom operacijom kuka koji su u toku 18 meseci, od januara 2014., bili u rehabilitacionom programu na Klinici za medicinsku rehabilitaciju KCV. Kod svih pacijenata je registrovan: pol i starosna dob, kao i uzrok odnosno vrsta operativnog zahvata. Pacijenti su pregledani i anketirani sa svih 5 upitnika u tri vremenska trenutka: pre samog početka rehabilitacionog tretmana i na 3 i 6 meseci posle. SF-36 je generički merni obrazac koji se koristi za procenu kvaliteta života. Harris Hip Score (HHS) predstavlja merni instrument za procenu funkcionalnih parametara. Mini Mental State (MMS) se koristi kod procene mentalnog statusa. Timed Up and Go Test (TUG) je efikasan metod procene pokretljivosti i funkcije lokomotornog sistema kod starijih pacijenata. Falls Efficacy Scale- International (FES-I) je test kojim se meri stepen zabrinutosti od pada. Metodom ponovljenih merenja analizirana su stanja pacijenata pre i posle medicinske rehabilitacije. Izvr&scaron;ena je i korelaciona analiza kori&scaron;ćenih upitnika, kao i univarijantna analiza u odnosu na vrstu operacije. Rezultati:Nakon medicinske rehabilitacije posle operacije kuka kod osoba starije životne dobi je značajno bolji ukupni fizički skor SF36: 29,0 / 38,7 / 46,3; kao i vrednost HHS skora 50,2 / 63,4 / 76,3; i TUG testa 31,3s / 19,6s / 13,6s; (pre rehabilitacije, 3m i 6m respektivno). Postoje statistički značajne korelacije ukupnog fizičkog domena SF36 i vrednosti Harris Hip, TUG i FES-I, kao i ukupnog mentalnog domena SF36 i MMS skora. Zadovoljstvo pacijenata rehablitacionim tretmanom je u korelaciji sa vrednostima funkcionalnih testova (Harris Hip Score), testom ustani kreni (TUG) i ukupnim fizičkim domenom upitnika SF36, kao i sa skorom FES-I. Zaključci: Kvalitet života i funkcionalna sposobnost operisanih pacijenata nakon medicinske rehabilitacije je značajno bolja kako u komparaciji stanja na tri meseca i na početku rehabilitacije tako i u komparaciji stanja na 6 meseci u odnosu na stanje na 3 meseca.</p> / <p>Objective: To determine the functional and mental status of patients before and after medical rehabilitation after hip surgery in elderly by using standardized questionnaires (SF36, Harris hip score, MMS, TUG, FES-I). Materials and methods:The study was prospective and the sample consisted of 96 patients with previous hip surgery that during the 18 months from January 2014, was in a rehabilitation program at the Department of medical rehabilitation KCV. For all patients registered sex and age, as well as the cause and type of surgery.Patients are screened and interviewed with all 5 of the questionnaire in three time points: before the start of the rehabilitation treatment and at 3 and 6 months after. SF-36 is a generic form that measurement is used to assess the quality of life. Harris Hip Score (HHS) is a measuring instrument for the assessment of functional parameters. Mini Mental State (MMS) used in the assessment of mental status. Timed Up and Go Test (TUG) is an effective method of evaluating the mobility and function of the musculoskeletal system in older patients.Falls Efficacy Scale- International (FES-I) is a test that measures the level of concern of falling. Method of repeated measurements were used to analyse condition of patients before and after medical rehabilitation. There was also a correlation analysis of used questionnaires, as well as the univariate analysis in relation to the type of surgery. Results: After medical rehabilitation after surgery of the hip in the elderly is significantly better overall physical SF36 score: 29.0 / 38.7 / 46.3; as well as the value of the HHS score of 50.2 / 63.4 / 76.3; and the TUG test 31,3s / 19,6s / 13,6s; (before rehabilitation, 3m and 6m respectively). There are statistically significant correlations of total physical domain SF36 and values Harris Hip, TUG and the FES-I, and the overall mental domain of SF36 and MMS score. Patient satisfaction with rehabilitation treatment is correlated with the values of functional tests (Harris Hip Score) test Up and go (TUG) and total physical domain SF36 questionnaires, as well as the FES-I. Conclusion: Quality of life and functional capacity of treated patients after medical rehabilitation significantly improved both in comparison to the situation in three months and at the beginning of rehabilitation as well as in comparison at 6 months compared to 3 months.</p>