The health care system has to deal with substantial health care costs, which are expected to continue to rise due to increasingly elderly populations. One way of saving has been a reduction of the number of beds in hospitals. The consequence is that acute patients are inappropriately admitted to non-specialized wards because of limited beds. These patients are also known as ‘‘outliers’’. In this study, consecutive patients with a hip fracture treated at the orthopaedic department (n = 273) are compared with patients treated at other departments (n = 147) according to the incidence of complications and the length of stay (LOS) before and after the introduction of an evidence-based clinical pathway. There was no medical difference between the populations. However, the strict demands of saving costs, with limited beds, have resulted not only in economic consequences with prolonged hospitalization, but also in patient suffering and the inconvenience of increased postoperative complications.Patients treated at non-specialized wards had an extra LOS of 3.7 days in the acute hospital settings and furthermore, 13.6 days of LOS including rehabilitation compared to patients treated at the orthopaedic department. In addition, we consider the implemented evidence-based clinical pathway to be successful since the number of complications was reduced. It is a major challenge to establish effective treatment and rehabilitation for patients after a hip fracture aiming to avoid complications and reduce LOS. These fragile patients with a hip fracture ought to be treated at the orthopaedic department, or at departments with geriatric and rehabilitation knowledge. Physiotherapists, occupational therapists and nurses specialising in orthopaedics and geriatricians should take an active part in the care of these patients.

Hip fractures are a major cause of hospital stay among the elderly, and result in increased disability and mortality. In this study from 1 April 2003 to 31 March 2004, the influence of optimised treatment of hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year were investigated. Comparisons were made between the first 210 patients in the period and the last 210 patients, who followed the new clinical pathway introduced at the University Hospital in Lund, Sweden. Early surgery, within 24h, was not associated with reduced mortality, but was significantly associated with reduced length of stay (p<0.001). Significantly more cases of osteosynthesis for femoral neck fracture were reoperated compared with all other types of surgery (p<0.001) when reoperations with extraction of the hook pins in healed fractures were excluded. Mortality was significantly higher among men than women at 4 (p=0.025) and 12 (p=0.001) months after fracture and among medically fit patients with administrative delay to surgery compared with patients with no delay (p<0.001).

Objective: This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system.

Design: A cross-sectional survey.

Participants: A total of 197 registrants from three international cleft/craniofacial meetings.

Interventions: Participants were sent a web-based questionnaire concerning cleft classification systems.

Main outcome measures: Frequency of commonly used classification systems, their perceived indications and limitations.

Results: A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity.

Conclusions: Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.

OBJECTIVE: To investigate the influence of gender, dispositional optimism, and coping strategies on appearance-related distress among individuals with unilateral cleft lip and palate (UCLP).

DESIGN: Cross-sectional design with self-report questionnaires analyzed primarily with Spearman correlations (r _s) and multivariate regression analyses.

SETTING: A tertiary cleft center in Sweden.

PARTICIPANTS: Eighty individuals with UCLP born 1966 to 1986. The mean age for men (n = 50) and women (n = 30) was 38.8 and 37.4 years, respectively.

MAIN OUTCOME MEASURES: The Derriford Appearance Scale 24 measured appearance-related distress, the Life Orientation Test-Revised, short version measured dispositional optimism and pessimism, and the Coping Orientation to Problems Experienced, short version included 14 coping strategies.

RESULTS: Women had higher appearance-related distress than men, which was significantly (P < .05) related to self-blame (r _s = 0.59), pessimism (r _s = 0.59), and low optimism (r _s = -0.56). Men's appearance-related distress was significantly associated with low active coping (r _s = 0.35), low use of emotional support (r _s = 0.29), denial (r _s = 0.39), behavioral disengagement (r _s = 0.41), and pessimism (r _s = 0.28). The only significant gender interaction reflected greater impact of optimism in reducing appearance-related distress for women (β = -0.06).

CONCLUSIONS: This study showed that high levels of dispositional optimism decrease appearance-related distress, particularly for women. The coping strategies used differed between men and women, and the results suggest that both gender and psychosocial facto r _s need to be considered in regard to appearance-related distress among individuals with UCLP in both clinical and research settings. A possible way to decrease distress is to strengthen positive coping strategies and dispositional optimism.

Syftet med denna studie var att undersöka hur gastric bypass-opererade individer upplever sin orala hälsa efter kirurgin. En empirisk studie med en kvalitativ ansats genomfördes. Datainsamlingen som användes var semistrukturerade intervjuer med en intervjuguide som underlag. Urvalet bestod av åtta informanter i åldrarna 24–64 och som valdes genom ett snöbollsurval. En kvalitativ innehållsanalys användes för att analysera intervjuerna. Resultatet redovisas utifrån temat Förändringar efter gastric bypass-operation relaterat till oral hälsa. Informanterna upplevde att de fått erosionsskador, karies, muntorrhet, oral halitosis och parodontala problem postoperativt. Samtliga informanter upplevde en försämrad allmänhälsa efter operationen och förändrade kostvanor som innebar att de började äta regelbundna måltider med korta tidsintervall. Slutsatsen av studien visar att informanterna upplevde en försämrad oral hälsa efter gastric bypass-operationen, där erosionsskador, karies, muntorrhet, oral halitosis och parodontala problem angavs till följd av de förändrade kostvanorna samt den påverkan på den allmänna hälsan som uppstod till följd av operationen. 

OBJECTIVE: The primary aim of this study was to compare corresponding scores between 2 existing cleft-specific patient-reported outcome measures (PROMs)-Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q. The second aim of the study was to investigate patient opinion on the 2 PROMs.

DESIGN: Cross-sectional questionnaire study.

SETTING: Participants were recruited from a University Hospital. They answered CHASQ and CLEFT-Q either in the hospital or at home.

PARTICIPANTS: Thirty-three participants with cleft lip and/or palate, aged 10 to 19 years.

MAIN OUTCOME MEASURE: CHASQ and CLEFT-Q.

RESULTS: The CHASQ scores and the corresponding CLEFT-Q scores on appearance correlated significantly. Corresponding scores regarding speech did not correlate significantly. A majority, 15 (58%) participants, answered that they liked CLEFT-Q more than CHASQ, 18 participants (69%) thought CHASQ was easier to complete, and 19 (76%) thought CLEFT-Q would better inform health care professionals.

CONCLUSION: Both instruments showed strengths and limitations. Clinicians will have to consider each instrument's respective qualities when choosing to implement either PROM.