Enhanced Recovery After Surgery: Concepts and Application to Total Shoulder Replacement
BACKGROUND: Enhanced Recovery After Surgery (ERAS) focuses on optimizing each element on a treatment pathway and encouraging the patient to actively engage in his or her recovery and rehabilitation. It requires collaboration across a multidisciplinary team and has been successful in improving patient outcomes, length of stay (LOS), and costs for a wide range of surgical procedures, including musculoskeletal surgeries such as total hip and total knee replacement. PURPOSE: To examine the application of ERAS concepts to total shoulder replacement (TSR) surgery. METHODS: Hospital Episode Statistics (HES) in England on LOS for TSR surgery were examined, and a review of literature on the use of ERAS concepts in TSR was undertaken. RESULTS: Analysis of HES data suggested scope for improvement in reducing LOS. A review of the literature found some evidence of the use of ERAS concepts, particularly in multimodal pain management. CONCLUSIONS: Future research is now required for ERAS procedure-specific components for TSR surgery.

The Impact of Low Socioeconomic Status in Adults With Chronic Pain: An Integrative Review
OBJECTIVE: The objective of this study was to describe evidence about chronic pain (CP) in lower socioeconomic status (SES) adult populations. DESIGN: The study design was an integrative review. DATA SOURCES used were MEDLINE, CINAHL, and PsycINFO, published from January 2008 to February 2018. REVIEW/ANALYSIS METHOD: Whittemore and Kanfl's 5 staged methodology (problem identification, literature search, data evaluation, data analysis, and presentation) was used to guide the review. RESULTS: Disparities based on SES affect CP development and management. Childhood risk factors impact CP experience over the life course. Neighborhood SES affects pain-related outcomes, and those with lower SES in rural settings have a higher prevalence of prescription opioid use. NURSING IMPLICATIONS: Findings from this review will support nurses to interpret CP through the lens of SES.

Pharmacologic Management of Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune inflammatory disease of the joints, which can result in permanent cartilage and bone damage. Although the exact cause of RA is unknown, there are many risk factors that have been associated with RA. When RA occurs, the immune system mistakenly attacks healthy synovial and connective tissue. Available treatment options work to reduce inflammation or slow the disease progression. The American College of Rheumatology published guidelines for the treatment of rheumatoid arthritis in 2015, with an update expected in late 2019/early 2020. Nonpharmacologic therapy for patients with RA includes rest, occupational and physical therapy, and weight reduction and use of assistive devices, as necessary. Pharmacologic options include nonsteroidal anti-inflammatory drugs, corticosteroids, disease-modifying antirheumatic drugs, antitumor necrosis factor agents, and interleukin receptor antagonists.

Pharmacologic Management of Rheumatoid Arthritis
No abstract available

Engage Your Core: Empower Your Team No abstract available

Make a Difference No abstract available

Orthopaedic Nurse Navigator No abstract available

The Journey Toward Taking the Day for Granted Again: The Experiences of Rural Older People's Recovery From Hip Fracture Surgery BACKGROUND: A hip fracture is an unexpected, subjective, traumatic experience that affects the person in both physical and emotional ways. PURPOSE: The purpose of this study was to describe rural older people's experiences of recovering after hip fracture surgery. METHODS: Thirteen individual interviews were conducted with older people. The interview texts were analyzed with qualitative content analysis. RESULTS: Patients described finding themselves in a new and vulnerable situation, dependent on others for simple everyday chores. They struggled to regain independence while staying positive, convinced that they would recover. Fear of another fall, as well as lack of information, made recovery at home difficult. CONCLUSION: Older people who experience hip fractures need support during the recovery process. Because recovery begins at the hospital, this study highlight patients' need to participate in recovery planning, as well as the need to have information about what it means to be affected by a hip fracture and how to prevent it from happening again. This study emphasizes that nurses' awareness of patients' need to participate in planning the recovery process is crucial for enabling patients' return to a daily life that is similar to their prefracture life.

Randomized Controlled Trial of a Natural Food-Based Fiber Solution to Prevent Constipation in Postoperative Spine Fusion Patients BACKGROUND: Constipation after orthopaedic surgery occurs frequently, likely due to a combination of high levels of opioid medications for severe pain management and mobility limitations after surgery. It can result in serious complications, increased cost, and patient discomfort. PURPOSE: This study evaluated a natural food-based fiber solution to prevent constipation in postoperative orthopaedic patients. METHODS: A posttest control group-randomized study design was used. Dependent variables were presence of postoperative constipation, time to first bowel movement (BM), and total number of postoperative BMs. Descriptive statistics, Student's t tests, and Mann–Whitney nonparametric 2-group tests with chi-square analysis were used. Level of significance for all tests was p < .05. Forty-six participants were evaluated. RESULTS: Ages were similar for both the intervention and control groups. Bowel Function Index (BFI) scores were not significantly different (p = .448). No significant group differences were present for the individual BFI item scores (p > .05). The number of patients with a BM during the first 3 days was not significantly different (p = .489). There were no significant differences found between the 2 groups regarding laxative administration (p > .05 for all laxatives). CONCLUSION: Further studies are indicated that address natural fibers and pharmaceutical methods for the prevention of constipation after spinal surgery.

Randomized Controlled Trial of a Natural Food-Based Fiber Solution to Prevent Constipation in Postoperative Spine Fusion Patients No abstract available