A training ground Lay out improves rehabilitation after trauma surgery: A Fast Track Policy

Abstract   Fracture patients are frail and have high mortality. We investigated whether introducing a fast-track strategy during post-surgery care and including early rehabilitation protocols may shorten the length of hospital stay (LOS) while improving the overall clinical effectiveness. A training ground was built inside the inpatient area dedicated to trauma settings. Usual postoperative care consists of immobilization during the first day, but patients may start rehabilitation earlier, 24 hours after the surgical procedure, with a fast-track strategy. In general, gait speed, step length, and self-assessment in terms of mobility improve significantly in the first six postoperative weeks in fracture patients. As delayed postoperative mobility during hospitalization was observed, the established training ground may help with this concern. The expert physiotherapist may contribute to ameliorating the indicators showing great potential in postoperative rehabilitation regardless of fracture pattern. The primary outcome was postoperative physical functioning. Secondary outcomes included the patient’s assessment of therapeutic effect (overall improvement), perceived pain intensity, health services utilization, treatment side effects, and adverse events. Data were analyzed by univariate analysis and binary logistic regression showing a reduction of LOS of almost three days. Further, the optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Adding to the schedule, some PROMPTS (Patient-reported outcome measures) could further integrate the patient empowerment perspective into the quality set of values. For this reason, ‘fast track’ may define a crucial policy able to guarantee rapid rehabilitation, becoming a key factor to achieving a good clinical effect. Fast-track rehabilitation facilitates a shortened hospital stay and cost-saving and can be used to optimize the patient’s condition before admission to a rehabilitation facility Key messages • Early rehabilitation protocols may shorten the length of hospital stay (LOS) while improving the overall clinical effectiveness. • Human factors and patients empowerments may help.


Background:
Untreated tooth decay (caries) is the most common global health condition and one of the largest preventable disease burdens for society. It concerns both children and adults, particularly in low resource settings whereout of pocket expenditures for oral care often cause catastrophic health expenditures. The 2021 WHO Oral Health Resolution emphasized the relevance of developing so-called ''Best Buys'' for oral health. The purpose of this study was to identify the cost-effectiveness of Atraumatic Restorative Treatment (ART) and Silver Diamine Fluoride (SDF) as potential treatments to reduce the caries burden worldwide.

Methods:
Leaning on WHO CHOICE methodology, evidence scoping and an expert consensus were facilitated to extract model input parameters which were then fed into cost-effectivenessanalyses (CEA) for ART and SDF. The cost-effectiveness of the interventions was expressed as Cost per DALY averted.

Results:
The evidence scoping revealed relevant, information on the effectiveness and costs of ART and SDF. The CEA identified both ART and SDF to be potentially cost-efficient treatment strategies in settings with limited resources. SDF was found to provide a cost-efficient treatment alternative in settings where the comparably larger (human) resource requirements for ART cannot be met.

Conclusions:
The findings suggest that ART and SDF represent potentially cost-efficient strategies to reduce the caries burden in settings with limited resources. While ART has previously been proposed as part of WHO's essential package of oral care, SDF could provide a comparably inexpensive treatment alternative.

Key messages:
Untreated tooth decay (caries) is the most common global health condition and one of the largest preventable disease burdens for society. The CEA identified both ART and SDF to be potentially cost-efficient treatment strategies in settings with limited resources.
Fracture patients are frail and have high mortality. We investigated whether introducing a fast-track strategy during post-surgery care and including early rehabilitation protocols may shorten the length of hospital stay (LOS) while improving the overall clinical effectiveness. A training ground was built inside the inpatient area dedicated to trauma settings. Usual postoperative care consists of immobilization during the first day, but patients may start rehabilitation earlier, 24 hours after the surgical procedure, with a fast-track strategy. In general, gait speed, step length, and self-assessment in terms of mobility improve significantly in the first six postoperative weeks in fracture patients. As delayed postoperative mobility during hospitalization was observed, the established training ground may help with this concern. The expert physiotherapist may contribute to ameliorating the indicators showing great potential in postoperative rehabilitation regardless of fracture pattern. The primary outcome was postoperative physical functioning. Secondary outcomes included the patient's assessment of therapeutic effect (overall improvement), perceived pain intensity, health services utilization, treatment side effects, and adverse events. Data were analyzed by univariate analysis and binary logistic regression showing a

Conclusions:
In order to advocate for breast cancer control it is recommended to develop regional and municipal screening programs based epidemiological maps of cancer and ensure effective screening services for each woman through the State program prevention guideline. Key messages: Epidemiological maps of breast cancer are recommended for use in planning regional and municipal programs of cancer control, including screening which will help breast cancer control advocacy. Ensure effectiveness of screening services for each woman through the State program prevention guideline.

Conclusions:
Vaccination with RZV can protect older adults from HZ, thus maintaining QoL and promoting active and healthy ageing.

Key messages:
There is significant burden of disease due to HZ among adults 50 YOA due to ageing and immunosenescence. Vaccination can reduce burden of disease among the elderly and frail individuals and maintain QoL.