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Which Strategy to Europe?
Hip Fractures Which Strategy to Europe? Paulo Felicíssimo
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Topics 1- Introduction 2- Why is important? 3- Incidence 3- Challenges
4- Clinical Pathway 5- Discharge Program 6- Conclusions
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Nota para conversão: _____ng/ml • 2.5 = ______nmol/L _____µg/dia • 40 = UI/dia
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Hip Fractures
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Why is Important? … de forma a padronizar a nossa actuação!
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4ª feira –
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This is a picture of my department…I spend most of time is with these girls!!!
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Hip Fractures World Prevision
1,6 Millions in 2000 2,6 Millions in 2025 it is supposed1,6 millions of fractures in 2000…..And it is expected 2,6 millions in 2025 , and probably 4,5 millions ! 4,5 Millions In 2050 Johnell O, Kanis JA, Osteoporos Int. 2006;17:
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…and gonna be worse!!!! … de forma a padronizar a nossa actuação!
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Growth of population
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Growth of life expectancy
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Population aging
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Hip Fracture Challenges
Medical Challenge Orthopedic Challenge Social / Familiar Challenge Economic Challenge Organizational Challenge Como em muitas outras áreas da Medicina as fracturas da extremidade proximal do fémur são um verdadeiro desafio….pluridisciplinar!
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The fracture is the drop of water in a full glass
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The Patient with a Fracture that has Diseases
The Patient with a Fracture that has Diseases???? or The Patient with Diseases that have a fracture???? …nós somos habitualmente o fim da linha! Quando recebemos um doente
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Are Orthopedic Departments prepared to Treat these Patients?
… de forma a padronizar a nossa actuação!
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No!!! Internal Medecine We try to know the opinion of the partners in this war
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No!!! We try to know the opinion of the partners in this war Anesthesiology
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No!!! Orthopedic Nurses
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…Yes!!!! and No!!!…and it's their fault!!!
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…No!!!!…
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No!!!
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Organizational Model Insufficient Not adjust ... Clinically Bad!
... Economically Bad! Diagnostic delay Therapeutic delay Higher mortality …existe pois uma opinião quase consensual… More Diagnosis Tests Discharge Delay
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Solution? …nós somos habitualmente o fim da linha! Quando recebemos um doente
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Multidisciplinar Team
Orthopedic Surgeon Internal Medicine Anesthesiology Physical Medicine and Rehabilitation Physiotherapy Nurse Social support Nutritionist Pharmaceutics
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Organizational Model Multidisciplinary
Teams!!!!! Clinical Pathway with Therapeutics Protocols!!!
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«Clinical pathway» Hip Fractures
Dia Emergence Room Analgesic Protocol VTE prophylaxis Geriatrics/Internal Medicine Medical evaluation 0- 2 Surgery Analgesic Protocol Timing of Surgery! Surgical Decision? Fracture Personality Parker and Parker scale Charlson comorbidity Scale VTE prophylaxis AB prophylaxis Anemia Protocol Avaliação Physiotherapy Protocolo Exames Complementares Nutrition Protocol 5- 7 Delirium Protocol Discharge
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Is this enough? … de forma a padronizar a nossa actuação!
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Previous Physical Function
Hip Fractures 15% of patients recover Previous Physical Function Mortality 20% to 30% In the first year 40% of patients severe disability
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After a Hip Fracture 10,4 / 100 Patients/ year 1
Incidence of new Osteoporotic Fracture is: 10,4 / 100 Patients/ year 1 2,5 X Superior to population with similar characteristics, without previous fracture 1 1 – Colón-Emeric C et al. The contribution of hip fractureto risk of subsequent fracture:data from two longitudinal studies. Osteoporos Int. 2003;14:
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What to do?
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We can try not to see
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We can hope that the obvious do not happen.
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Nothing to do because is a superior punish
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…or just give a little help
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Discharge Program!!! … de forma a padronizar a nossa actuação!
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Discharge Program - Hip Fractures
Dia Emergence Room Movement Medicine Fall Prevention 0- 2 Surgery Fracture Prevention Program Osteoporosis treatment Nutritional Protocol Physiotherapy GP Anemia Protocol Avaliação VTE prophylaxis Schedule Next appointment and X-ray 5- 7 Discharge Schedule Surgical Dressing
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Conclusions A Clinical Hospital Team organized in turn of a «Clinical Pathway» is the right answer for a success and management of resources It have to be a Multidisciplinary Team «speaking the same language» Discharge Program with GP in close participation Podem estar muito bem operados … mas se morrerem pouca vantagem existe!!!
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...all of this for a good physical and mental health of our old ladies.
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