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Objectives: It is widely known that sleep disorders are a common problem among older persons. Few reviews have described current knowledge about the holistic concept of sleep health of community-dwelling older people., Aim: This study aimed to describe the current state of knowledge and identify research gaps concerning sleep health among community-dwelling older persons., Method: We conducted a scoping review. Searches were conducted in three databases (Medline, CINAHL, and PsycINFO) to identify scientific articles including outcomes with all five sleep health dimensions (sleep duration, sleep continuity, timing, wakefulness/daytime sleepiness, and sleep quality) among community-dwelling older persons aged ≥65 years. Eight articles were included from a total of 1826 hits, with sample sizes between 1413 and 6485., Results: The sleep health outcomes of community-dwelling older adults differed between the sexes. Older persons with at least two or more poor sleep health dimensions might have increased risk for depression, higher healthcare costs and mortality, while self-reported better sleep health might be associated with lower odds of frailty., Conclusion: Future research is needed to confirm the findings by investigating the multidimensional concept of sleep health in a general older population. The identified knowledge gaps are how persons ≥80 years' experience their sleep health, and how sleep medicine is prescribed to treat sleep problems in persons ≥80 years in different care contexts.

Introduction: Elder abuse is prevalent and associated with different forms of ill health. Despite this, healthcare providers are often unaware of abusive experiences among older patients and many lack training about elder abuse. The overall aim of this study is to determine the effectiveness of an educational intervention on healthcare providers' propensity to ask older patients questions about abusive experiences., Methods and Analysis: Healthcare providers at hospital clinics and primary healthcare centres in Sweden will undergo full-day education about elder abuse between the fall of 2021 and spring of 2023. The education consists of (1) theory and group discussions; (2) forum theatre, a form of interactive theatre in which participants are given the opportunity to practise how to manage difficult patient encounters; and (3) post-training reflection on changing practices.The design is a non-randomised cluster, stepped wedge trial in which all participants (n=750) gradually transit from control group to intervention group with 6-month interval, starting fall 2021. Data are collected using the Responding to Elder Abuse in GERiAtric care-Provider questionnaire which was distributed to all clusters at baseline. All participants will also be asked to answer the questionnaire in conjunction with participating in the education as well as at 6-month and 12-month follow-up. Main outcome is changes in self-reported propensity to ask older patients questions about abuse post-intervention compared with pre-intervention. Linear mixed models including cluster as a random effect will be used to statistically evaluate the outcome., Ethics and Dissemination: The study has been approved by the Swedish Ethical Review Authority. The results will be published in peer-reviewed journals and conference proceedings. If the intervention is successful, a manual of the course content will be published so that the education can be disseminated to other clinics., Trial Registration Number: NCT05065281., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Falls and related injuries are common among older people, and several drug classes are considered to increase fall risk., Aims: This study aimed to investigate the association between the use of certain drug classes and falls in older nursing home residents in Sweden, and relate these to different age groups., Methods: Information on falls that occurred in the previous year and regular use of possible fall risk drugs including non-benzodiazepine hypnotics (zopiclone and zolpidem) was collected from 331 nursing home residents during 2008-2011. Over the following 6 months, the occurrence of serious falls, requiring a physician visit or hospital care, was registered. Association between serious falls and drug use was compared between an older (≥ 85 years) and a younger group., Results: An increased fall risk (Downton Fall Risk Index ≥ 3) was found in 93% of the study subjects (aged 65-101 years). Baseline data indicated an association between falls that occurred in the previous year and regular use of non-benzodiazepine hypnotics (p = 0.005), but not with the other studied drug classes. During the following 6 months, an association between use of non-benzodiazepine hypnotics and serious falls in the older group (p = 0.017, odds ratio 4.311) was found. No association was found between the other studied drug classes and serious falls., Discussion: These results indicate an association between falls and the use of non-benzodiazepine hypnotics, compounds that previously have been considered generally well-tolerated in older people., Conclusions: Caution is advocated when using non-benzodiazepine hypnotics regularly in older people living in nursing homes.

Background: Anemia is common in elderly people and especially in nursing home residents. Few studies have been performed on the consequences of anemia in a nursing home population. This study explored the prevalence of anemia in nursing homes in Sweden, including risk factors and mortality associated with anemia or hemoglobin (Hb) decline., Methods: Three hundred ninety patients from 12 nursing homes were included during 2008-2011. Information about medication, blood samples, questionnaire responses and information about physical and social activities was recorded. The baseline characteristics of the patients were compared for subjects with and without anemia. Vital status was ascertained during the following 7 years from baseline to compare the survival. Hb levels <120 g/L in women and <130 g/L in men were used to define anemia. For 220 of the subjects Hb change during one year was registered and the quartiles in Hb change were compared in terms of baseline characteristics and mortality., Results: The prevalence of anemia at baseline was 52% among men and 32% among women. The men with anemia had a two-year mortality significantly higher (61%) than the men without anemia (29%, p = 0.001) but there was no statistical difference in two-year survival in women. In anemic men there was a higher mortality (Hazard Ratio = 1.58) during a total follow-up period of up to 7 years after adjustment for age, increased B-type natriuretic peptide (BNP) and decreased estimated Glomerular Filtration Rate (eGFR). Among men, but not women, we found baseline correlations between anemia and elevated BNP (>100 ng/L) and severely reduced eGFR (<30 ml/min). When the lowest quartile of Hb change (decline > 9 g/L) was compared with the highest (improvement > 6 g/L) the mortality was higher in the lowest quartile (p = 0.03)., Conclusions: Anemia is common in nursing home residents in Sweden, especially among men for whom it is related to higher mortality. A rapid Hb drop is associated with higher mortality. Regardless of earlier Hb values, monitoring Hb regularly in a nursing home population seems important for catching rapid Hb decline correlated with higher mortality.

Introduction: A relapsed idiopathic clubfoot can be effectively treated with transfer of the entire tibialis anterior tendon to the mid-dorsum of the foot following repeated manipulations and serial casts., Step 1 Preoperative Planning: Ensure that the foot has been adequately corrected for tendon transfer by performing both clinical and radiographic evaluation., Step 2 Prepare the Patient: Position the patient supine, induce general anesthesia, and perform a caudal block for postoperative pain management., Step 3 Identify and Release the Tibialis Anterior Tendon From Its Insertion: Identify the tibialis anterior tendon and release its insertion on the medial cuneiform and first metatarsal bones., Step 4 Prepare the Tendon and Surrounding Tissues for Transfer: Release obstructing tissues and prepare the freed tendon for lateral transfer to the mid-dorsum of the foot., Step 5 Prepare the Lateral Cuneiform for Tendon Transfer and Fixation: Identify the lateral cuneiform with fluoroscopy and prepare it for transfer of the tibialis anterior tendon., Step 6 Transfer and Secure the Tendon: Make a subcutaneous path, transfer the tendon, and secure it in the osseous tunnel of the lateral cuneiform., Step 7 Postoperative Care: We apply a long leg cast and restrict patients to non-weight-bearing for six weeks., Results: The tibialis anterior tendon transfer has been used to treat relapsing idiopathic clubfoot with great success for more than fifty years.IndicationsContraindicationsPitfalls & Challenges.

Background: Asymmetric bilateral hip dislocations are a rare injury pattern in which one hip dislocates posteriorly, and the contralateral hip dislocates anteriorly. We report a case of bilateral asymmetric hip dislocations and provide a comprehensive review of all available reports, identifying 104 total cases, which is 70 more than previously reported., Purpose: To review and evaluate the total body of literature regarding bilateral asymmetric hip dislocations., Methods: Comprehensive literature review and analysis of all reports of bilateral asymmetric hip dislocations with concurrent case report., Results and Conclusions: Bilateral, asymmetric represent approximately 0.01%-0.02% of all joint dislocations. There has been a substantial increase in the number of case reports in the literature in the last 10 years. Males are more likely than females to incur this injury pattern and the most common mode of injury is motor vehicle accident Urgent closed reduction should be attempted in an efficient and safe manner to avoid potential complications, and open reduction should be considered in irreducible dislocations. Post reduction management should include stability assessment and CT to assess for associated injuries and intraarticular fragments; although no clear guidelines for post-reduction treatment emerged. Common complications include: nerve palsies, AVN and heterotopic ossification.

Orthopaedic surgery requires a high degree of technical skill. Current orthopaedic surgical education is based largely on an apprenticeship model. In addition to mounting evidence of the value of simulation, recent mandated requirements will undoubtedly lead to increased emphasis on surgical skills and simulation training. The University of Iowa's Department of Orthopaedic Surgery has created and implemented a month long surgical skills training program for PGY-1 residents. The goal of the program was to improve the basic surgical skills of six PGY-1 orthopaedic surgery residents and prepare them for future operative experiences. A modular curriculum was created by members of the orthopaedic faculty which encompassed basic skills felt to be important to the general orthopaedic surgeon. For each module multiple assessment techniques were utilized to provide constructive critique, identify errors and enhance the performance intensity of trainees. Based on feedback and debriefing surveys, the resident trainees were unanimously satisfied with the content of the surgical skills month, and felt it should remain a permanent part of our educational program. This manuscript will describe the development of the curriculum, the execution of the actual skills sessions and analysis of feedback from the residents and share valuable lessons learned and insights for future skills programs.

The aim of the study was to identify nurses' ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic.Descriptions of ethics in a caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice.A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis.THREE CATEGORIES WERE IDENTIFIED: showing consideration, connecting, and caring for. These categories formed the basis of the core category: "Corroborating." In corroborating, the focus is on the person in need of integrity and self-determination; that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration (i.e., to benefit someone); nurses must also connect and care for the older person (i.e., demonstrate non-maleficence) in order to corroborate that person.The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence, and non-maleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care, and reception in an equivalent manner.