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Trần Thị Vân Anh, Nguyễn Thanh Hương, Nguyễn Xuân Thùy
Content
Preamble
Total hip arthroplasty (TPA) is optimal therapy for diseases in
the head top and femoral neck.
population aging tendency:
→ There are many patients of femoral neck fracture
and hip disease.
TPA: Technique – Quality of lide (QOL) of patients of hip
dislocation → important
The world: Numerous researches on QOL of HD patients
in USA, Australia, Greece, Italy, France, Croatia…
In Vietmale, such research has not been conducted yet.
Viet Duc Hospital: 500 TPA cases (in 2013)
Purpose
- Help patients and doctors to select the suitable therapy
- Evaluate efficiency of operation and nursing
- Determine supporting methods for nursing and treatment
BSF36 Toolkit
36 questions for 8 problems of QOL
Some international researches on QOL of the patients after
total hip arthroplasty using SF36 toolkit
The further it is after operation, the higher QOL point is
Less factors related to QOL changing point
Study combined with qualitative has not been recorded
yet
Veljko santie’(Croatia-
2012) evaluate and
compare points of QOL
02 years before and
after operation
Veljko santie’(Croatia-
2012) evaluate and
compare points of QOL
02 years before and
after operation
Henning R
Johansson (Germany
- 2010): evaluate 6,
12, 24 months before
and after operation
Henning R
Johansson (Germany
- 2010): evaluate 6,
12, 24 months before
and after operation
Alessandro Aprato (Italy
-2011) evaluate 2 years
after, compare FNF
group and degenerative
coxathroxis group
Alessandro Aprato (Italy
-2011) evaluate 2 years
after, compare FNF
group and degenerative
coxathroxis group
Research objective
Describe changes in QOL of the patients before
and after THA at Viet Duc Hospital in 2014
Đặc điểm cá nhân - Tuổi- Giới- Nơi sinh sống- Nghề nghiệp- Trình độ học vấn- Tình trạng hôn nhân- Chi phí cho bệnh tật (Có BHYT hay tự chi trả toàn bộ )
Đặc điểm cá nhân - Tuổi- Giới- Nơi sinh sống- Nghề nghiệp- Trình độ học vấn- Tình trạng hôn nhân- Chi phí cho bệnh tật (Có BHYT hay tự chi trả toàn bộ )
Yếu tố lâm sàngChẩn đoán:- Viêm thoái hóa khớpháng- Hoại tử chỏm xương đùi- Khối u ở chỏm, cổ xương đùi- Gãy chỏm hoặc cổ xương đùi- Chấn thương gây biến dạng ổ cốiThời gian mắc bệnhChỉ số mật độ xương
Yếu tố lâm sàngChẩn đoán:- Viêm thoái hóa khớpháng- Hoại tử chỏm xương đùi- Khối u ở chỏm, cổ xương đùi- Gãy chỏm hoặc cổ xương đùi- Chấn thương gây biến dạng ổ cốiThời gian mắc bệnhChỉ số mật độ xương
Sự đau đớn- Mức độ đau- Cường độ- Thời gian- Ảnh hưởng đến mất ngủ,đến dinh dưỡng
Sự đau đớn- Mức độ đau- Cường độ- Thời gian- Ảnh hưởng đến mất ngủ,đến dinh dưỡng
Yếu tố tâm lýYếu tố tâm lýDịch vụ y tếĐiều trị liên quan đến bệnh
trước và sau phẫu thuật
Dịch vụ y tếĐiều trị liên quan đến bệnh
trước và sau phẫu thuật
Khả năng vận động- Hoạt động hàng ngày- Lao động - Vận động đi lại - Sinh hoạt cá nhân
Khả năng vận động- Hoạt động hàng ngày- Lao động - Vận động đi lại - Sinh hoạt cá nhân
Hỗ trợ hàng ngày Từ gia đình, người thân và những người xung quanh
Hỗ trợ hàng ngày Từ gia đình, người thân và những người xung quanh
Dịch vụ xã hộiDịch vụ xã hội
Chất lượng cuộc sống người bệnh
(Có chỉ định phẫu thuật thay khớp háng)
Khung lý thuyết
Research methods
• Object: Hip dislocation patients at Viet Duc
Hospital, surgeons and nurses
• Time: Feb - Jun 2014
• Place: 02 Departments of Orthopaedic Sugery,
Orthopaedics Institute under Viet Duc Hospital
• Longitudinal study design: combine
quantitative and qualitative study
Sample size, collection, processing, analysis of data
Quantitative- Main purpose
04 interview with patients
02 interview with surgeons
01 discussion with nurse group
- Instruction board PVS and TLN
- bandage removal, coding, by-
subject analysis.
Qualitative-Total: 115 patients
- Interview three times:
Hospitalization, discharge and 01
month after follow-up examination.
- Data entry: Epidatta 3.0;
SPSS16.0 analyzer.
- Analysis: statistic description,
pairing test.
Study variables
Quantitative variable• Personal characteristics• Clinical characteristics• QOL point (Gross point: Min=0; Max=100)
Qualitative subject: Influence factors and solutions to QOL improvements for the patients, medical workers.
Point <25 26-50 51-75 76-100
QOL Poor Average Fair Fairly good - Good
Results and discussion
General information on patients (n=115)Content Frequency Percent
Age
< 30 years 08 7,0
30 - 49 years 32 27,8
50 - 69 years 55 47,8
≥ 70 years 20 17,4
Mean age (Mean ± SD) 54,5 ± 11,98
The oldest and youngest age 19 - 87
Gender male 80 69,6
female 35 30,4
Residence Rural 71 61,7
Urban 44 38,3
Marriage status Unmarried 07 6,1
Married 99 86,1
Divorce/widowed 09 7,8
Medical insurance
With medical insurance 107 93,0
self-pay 08 7,0
Lưu Hồng Hải (2008) 54.2 years of age
Anakwe (UK- 2010) 68.0 years
of age
Veljko santie’(Croatia - 2012)
72.6
Tshonga (Greece - 2011) 74.8
Clinical characteristics (n=115)
ContentFrequenc
y Percent
Diagnosis
femoral neck fracture 35 30,4
necrosis of the femoral head 33 28,7
femoral neck disease 04 3,5
Hip osteoarthritis 43 37,4
Suffering period < 01 month 24 20,9 From 1-> less than 06 months 14 12,2 From 06-> 12 months 15 13,0 >12 months 62 53,9
Surgical methods
total hip arthroplasty 99 86,1
Bipolar hip arthroplasty 16 13,9
Mean days of treatment by clinincal features and surgical method (n=115)
Index Frequency Mean days of treatment ± SD
Diagnosis
femoral neck fracture 35 11,8 ± 4,15
necrosis of the femoral head 33 9,3 ± 3,54
femoral neck disease 4 9,0 ± 2,00
Hip osteoarthritis 43 8,9 ± 2,56
Surgical methods
total hip arthroplasty 99 9,3 ± 2,94
Bipolar hip arthroplasty 16 13,3 ± 5,02
Total 115 9,8 ± 3,26
Mean QOL point before and after operationTshonga (Greece – 2011) QOL point Before operation 29.3 and 55.1; 62.3 (after 3 , 6 months), Patient is female > 65 years of age
Mean QOL point by physical health field
Tshonga :
Before operation
29.3
After 03 months
64.4
Tshonga :
Before operation
29.3
After 03 months
64.4
Veljko santie’: Before operation
30 After 6 months 65
Veljko santie’: Before operation
30 After 6 months 65
Mean QOL point by mental health field
Veljko santie’ : Before
operation 22,2 sau 06
months 94,4
Veljko santie’ : Before
operation 22,2 sau 06
months 94,4
Tshonga Before
operation 18,3;
sau 03 months
63,1
Tshonga Before
operation 18,3;
sau 03 months
63,1
Some factors
affect the QOL
change
Treatment, care
Treatment, care
Quá tải
Quá tải
Information supply
Information supply
Surgerical technique, I have no comment but patients are overcrowded.
On some days, I have been already operated but lied with other patients in
the same bed. Being painful and overcrowde made me unable to move, but stepping out of bed may tread on
other patients; fear to be stuck, fall may dislocate the new hip that is more
miserable“
“First day after surgery, I felt too painful; using up the
analgestic, I cannot bears the pain but just wanted to
die.”
When need, it lacks; when no need, it is
redundant
“After operation, which food can I eat? What should I keep off?”
Propaganda method of medicine sector is not very good; just concentrating in some big cities
and only big hospitals can perform this surgery. A bit far from these places, in northern delta for
example, people thinks that hip dislocation is so formidable. They wonder whether they can move
if taking out their hip and replacing with a new artificial hip?” (PTV-02)
Propaganda method of medicine sector is not very good; just concentrating in some big cities
and only big hospitals can perform this surgery. A bit far from these places, in northern delta for
example, people thinks that hip dislocation is so formidable. They wonder whether they can move
if taking out their hip and replacing with a new artificial hip?” (PTV-02)
“When I did not have access or surgery, people round me said that my disease could not operated, that I had to live with such flood. That’s why I was in two minds about doing and not doing…”, “Even on that day I was ready for surgery that is scheduled, my aunt said: “Oh, my God. Please, I beg you not to have operation; if yes, you will be unable to walk, surely like me, don’t operate”.
“Will I move on my foot again? Can I do heavy works? Or “Will I get married, have sex or will there any influence, or will my hip be dislocated?”
SOLUTION-Satellite hospital, transfer of technical packaget.- Cooperate with junior hospitali.- Build more facilities
SOLUTION
Using mass media.
Develop consulting form, guidance on
monitoring and prevention from post-
operative complications
Today is the third days since my operation but nobody has guided me to practice; maybe on
weekend no rehabilitation officers is
working
SOLUTIONMonitor, control painWork assignmentTrain, develop instruction sheet …Nutrition provision
Conclusion
Change in QOL of the patients
There is change in QOL point after TPA ( Hospitalization
24.6; Discharge 39.5; Follow-up exam 61.6 ; p< 0.001)
Mean point of 8 areas rise at the time of follow-up exam
(p<0.0001).
Postoperative physical functioning reduced (35.8 to
25.5; p< 0.001)
Factors affecting the QOL change (from quantitative
results): Overload, treatment and care, information
supply to the patients.
Recommendations
Rehabilitation solution: Training the nurses in
rehabilitation knowledge; assigning the rehabilitation
technicians working on Saturdays and Sundays.
Provide meals to each patient.
Develop consulting form, guidance on monitoring and
prevention from after-TPA complications…
Continue this research for a longer period.
THANK YOU VERY MUCH12/02/14 24
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