Please select the eligibility criteria that correspond to the clinical trial below.
Title: ED Ultrasonographic Regional Anesthesia to Prevent Incident Delirium in Hip Fracture Patients (EDU-RAPID) Multi-center Stepped Wedge Cluster Randomized Trial
Brief Summary: Hip fractures are common, costly and affect older people - Canadians spend 1 billion dollars to treat hip fractures each year. Unfortunately, as many as two-thirds of hip fracture cases suffer a complication known as delirium, or acute confusion. Patients with delirium may become frightened and agitated. This in turn leads to other serious problems. Having delirium doubles the chances of dying or can increase the need for admission into a nursing home. People with delirium spend an extra week in hospital on average.

Using ultrasound to locate and 'freeze' or block specific nerves can stop hip fracture pain almost immediately, and use of this technique is known to reduce delirium when administered by Anaesthetists to patients at the time of their hip operation. Unfortunately, patients with hip fractures commonly wait hours or even days in the Emergency Department (ED) prior to their operation. Currently, these patients are given narcotic pain killers like morphine to dull their pain, as most ED physicians have not been trained in using this 'freezing' technique and Anaesthetists are rarely able to leave the operating room to administer freezing to patient in the ED.

The EDU-RAPID study will test whether training ED physicians on how to use the nerve freezing technique will reduce the number of patients who develop delirium after a hip fracture. To study this, ED physicians will be trained at 6 hospitals in small groups every 6 weeks over 18 months. The study will look at how patients who are treated by ED physician who has been trained compare to patients treated by a ED physician who has not yet been trained. Also, the study will see if the training motivates ED physicians to use the block regularly.

If correct, this study could significantly improve the comfort, quality of life, and independence of patients who suffer a hip fracture. In addition, if the study shows a reduction in delirium rates, this could represent a significant cost reduction to the health care system.


Options:
A: Inclusion Criteria:

* Femoral neck fracture
* Fracture due to low energy trauma
* Ability to understand danish and give informed consent
* Ability to walk before trauma
* Indication for osteosynthesis
* ≥ 8 in OMC (Orientation-Memory-Concentration) test with a possible maximum of 28 points
* Informed consent

Exclusion Criteria:

* Drug or medical abuse
* Drug intolerance
* Pathological fractures
* Inflammatory arthritis
* Patient included in the study with the contralateral hip
B: Inclusion Criteria:

* At the cluster level, ED physicians practicing at a participating site will be eligible.
* At the patient level, all hip fractures seen by a participating ED physician will be eligible

Exclusion Criteria:

* ED physicians who work casually (less than 0.25 Full Time Equivalent)
* ED Physicians who are routinely using U/S guided RA for hip fracture patients, or decline participation in the trial.
* Patients' age less than 65 years;
* Patients who are delirious on initial assessment by ED physician or severe dementia
* Patients with communication problems (critically ill, unconscious, language barrier despite use of secure telephone-based translation service)
* Patients with allergies to narcotics or local anesthetic; or anticoagulant use (e.g. warfarin, dabigatran, rivaroxaban).
* Patients with hip fractures not requiring surgery (e.g. greater trochanter avulsion) will also be excluded.
C: Inclusion Criteria:

* fracture of the hip

Exclusion Criteria:

* multiple fractures,
* delay (more than 12 hours) from the time of injury until admission to the hospital,
* local infections, hypersensitivity to local analgetics,
* cognitive impairment
D: Inclusion Criteria:

* American Society of Anaesthesiologists (ASA) score I and II
* Elective surgery of repair of unilateral, single femoral fracture under spinal anaesthesia performed in General Operation Theatre, Hospital Kuala Lumpur. The fracture may involve femoral neck or femoral shaft.

Exclusion Criteria:

* Patient with contraindication for spinal anaesthesia
* Known hypersensitivity or contraindication to medication used in this study
* Morbid obesity (body mass index (BMI) \> 35 kg/m2)
* Infection at the intended site of administration of fascia iliaca compartment block
* Patient with impaired cognitive function

Answer: B