Dr. Lauren BeaupreProfessor in Physical Therapy
Professor in Physical Therapy with an adjunct appointment in the Division of Orthopaedic Surgery at the University of Alberta
Languages : English
Dr Beaupre is a Professor in Physical Therapy with an adjunct appointment in the Division of Orthopaedic Surgery at the University of Alberta in Edmonton, Canada. Her primary area of research evaluates methods of improving the care and recovery of frail seniors who have experienced a hip fracture, including those who reside in nursing homes or have cognitive impairment. She is the Hip Fracture Director for Bone and Joint Canada, a Knowledge to Action organization that promotes dissemination of best practices across the country to clinicians, decision- and policy-makers.
2011BACKGROUNDThe hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture.METHODSWe enrolled 2016 patients who were 50 years of age or older, who had either a history of or risk factors for cardiovascular disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. We randomly assigned patients to a liberal transfusion strategy (a hemoglobin threshold of 10 g per deciliter) or a restrictive transfusion strategy (symptoms of anemia or at physician discretion for a hemoglobin level of
Use of a Case Manager to Improve Osteoporosis Treatment After Hip Fracture: Results of a Randomized Controlled TrialArchives of Internal Medicine
22 October 2007BACKGROUNDPatients who survive hip fracture are at high risk of recurrent fractures, but rates of osteoporosis treatment 1 year after sustaining a fracture are less than 10% to 20%. We have developed an osteoporosis case manager intervention. The case manager educated patients, arranged bone mineral density tests, provided prescriptions, and communicated with primary care physicians. The intervention was compared with usual care in a randomized controlled trial.METHODSWe recruited from all hospitals that participate in the Capital Health system (Alberta, Canada), including patients 50 years or older who had sustained a hip fracture and excluding those who were receiving osteoporosis treatment or who lived in a long-term care facility. Primary outcome was bisphosphonate therapy 6 months after fracture; secondary outcomes included bone mineral density testing, appropriate care (bone mineral density testing and treatment if bone mass was low), and intervention costs.RESULTSWe screened 2219 patients and allocated 220, as follows: 110 to the intervention group and 110 to the control group. Median age was 74 years, 60% were women, and 37% reported having had previous fractures. Six months after hip fracture, 56 patients in the intervention group (51%) were receiving bisphosphonate therapy compared with 24 patients in the control group (22%) (adjusted odds ratio, 4.7; 95% confidence interval, 2.4-8.9; P < .001). Bone mineral density tests were performed in 88 patients in the intervention group (80%) vs 32 patients in the control group (29%) (P < .001). Of the 120 patients who underwent bone mineral density testing, 25 (21%) had normal bone mass. Patients in the intervention group were more likely to receive appropriate care than were patients in the control group (67% vs 26%; P < .001). The average intervention cost was $50.00 per patient.CONCLUSIONFor a modest cost, a case manager was able to substantially increase rates of osteoporosis treatment in a vulnerable elderly population at high risk of future fractures.
4 November 2005OBJECTIVESTo determine evidence-based best practices for elderly hip fracture patients from the time of hospital admission to 6 months postfracture.DATA SOURCESMEDLINE, Cochrane Library, CINAHL, Embase, PEDro, Ageline, NARIC, and CIRRIE databases were searched for potentially eligible articles published between 1985 and 2004.REVIEW METHODSTwo independent reviewers determined studies appropriate for inclusion using standardized selection criteria, extracted data, evaluated internal validity, and then rated studies according to levels of evidence. Only Level 1 or 2 evidence was included in our summary of clinical recommendations.RESULTSSpinal anesthesia, pressure-relieving mattresses, perioperative antibiotics, and deep vein thromboses prophylaxes had consistent evidence of benefit. Routine preoperative traction was not associated with any benefits and should be abandoned. Types of surgical management, postoperative wound drainage, and even “multidisciplinary” care, lacked sufficient evidence to determine either benefit or harm. There was little evidence to either determine best subacute rehabilitation practices or to direct ongoing medical issues (e.g., nutrition). Studies conducted during the subacute recovery period were heterogeneous in terms of treatment settings, interventions, and outcomes studied and had no clear evidence for best treatment practices.CONCLUSIONSThe evidence for perioperative practices is relatively robust and evidence-based perioperative treatment guidelines can be easily established. Conversely, more evidence is required to better guide the care of elderly patients with hip fracture during the subacute recovery period and convalescence.
August 2002OBJECTIVESTo determine the association between time to definitive surgical management and the rates of nonunion and infection in open fractures resulting from blunt trauma. To determine the association of other clinical determinants with these same adverse events.DESIGNRetrospective review of a consecutive series of open long bone fractures.SETTINGReferral trauma center with transport times often extending beyond eight hours from the time of injury.PATIENTSA total of 227 skeletally mature patients with 241 open long bone fractures were treated between January 1996 and December 1998; 215 fractures were available for review at a minimum of twelve months postinjury.INTERVENTIONMedical charts of all patients were reviewed using a standardized data collection form. All available records and radiograph reports were inspected. All cases were followed to clinical and radiographic union of the fracture or until a definitive procedure for nonunion or deep infection was carried out.MAIN OUTCOME MEASURESOccurrence of deep infections or nonunions after fracture treatment.RESULTSThe mean time to definitive treatment was eight hours and twenty-five minutes (range 1 hour 35 minutes to 30 hours 40 minutes). Forty patients went on to nonunion, and twenty developed a deep infection. In the final multivariate regression model, time was not a significant factor in predicting either nonunion or infection (p > 0.05). The strongest determinants for nonunion were found to be presence of infection and grade of injury (p < 0.05). The strongest predictors for the development of a deep infection were fracture grade and a lower extremity fracture (p < 0.05).CONCLUSIONSThe risk of developing an adverse outcome was not increased by aggressive debridement/lavage and definitive fixation up to thirteen hours from the time of injury when early prophylactic antibiotic administration and open fracture first aid were instituted.
Area of Expertise
Bone and Joint Canada : Hip Fracture Director
Health and Wellness
Writing and Editing
Health Care - Providers
University of Alberta : Public Health Sciences
University of Alberta : Physical Therapy