Biomedical subjects
Antony Johansen
Publications and source records attributed to Antony Johansen.
Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward.
OBJECTIVE: To examine how improved attention to nutritional status and dietary intake, achieved through the employment of dietetic assistants (DAs), will affect postoperative clinical outcome among elderly women with hip fracture. DESIGN: Open prospective randomised controlled trial, comparing conventional nursing care with the additional nutritional support provided by DA. SETTING: Thirty-eight bedded acute trauma ward in a teaching hospital. PARTICIPANTS: All but 11 of 344 consecutive admissions with acute nonpathological hip fracture were approached. Three hundred and eighteen (93%) agreed to inclusion. Sixteen were ineligible as they were immediately transferred to another acute ward, were managed conservatively or died preoperatively. PRIMARY OUTCOME MEASURE: Postoperative mortality in the acute trauma unit. SECONDARY OUTCOME MEASURES: Postoperative mortality at 4 months after fracture, length of stay, energy intake and nutritional status. RESULTS: DA-supported participants were less likely to die in the acute ward (4.1 versus 10.1%, P = 0.048). This effect was still apparent at 4 month follow-up (13.1 versus 22.9%, P = 0.036). DA-supported subjects had significantly better mean daily energy intake (1,105 kcal versus 756 kcal/24 h, 95% CI 259-440 kcal/24 h, P<0.001), significantly smaller reduction in mid-arm circumference during their inpatient stay (0.39 cm, P = 0.002) and nonsignificantly favourable results for other anthropometric and laboratory measurements. CONCLUSION: Dietetic or nutrition assistants are being introduced in units across the UK. This, the largest ever study of nutritional support after hip fracture, shows that their employment significantly reduced patients' risk of dying in the acute trauma unit; an effect that persisted at 4 month follow-up.
The effect of socioeconomic deprivation on fracture incidence in the United Kingdom.
Lifestyle factors such as diet and physical activity vary in different social and income groups, and are known to be important influences on the incidence of osteoporotic fractures. Financial and social pressures are a common concern for older people. We set out to study the effect of socioeconomic deprivation on the incidence of fracture in older people and to compare the findings with those for younger groups. The All Wales Injury Surveillance System (AWISS) is a computerized system that collects injury data from most A&E departments throughout Wales. In this population-based study of 1.8 million people living in the 445 electoral tracts covered by AWISS in south, west, and northeastern Wales, we identified all 60,106 residents who presented with a fracture in 1999 and 2000. We linked details of their fracture with published Townsend deprivation scores for the electoral tract in which they were living and calculated fracture rates by fifths of deprivation. We observed the expected pattern of increasing fracture incidence in older age groups. Fracture incidence was significantly higher in electoral wards with poorer Townsend scores, resulting from a marked effect of socioeconomic deprivation on fracture incidence among younger adults with a rate ratio of 1.64 (95% CI, 1.57 to 1.72). This effect diminished with age, and was not observed in older age groups. At ages 85 and over the rate ratio was 0.94 (95% CI, 0.87 to 1.01). Socioeconomic factors clearly play a part in the causation of fracture in younger adults. Lifestyle influences are important in older age groups, but socioeconomic deprivation does not appear to be a risk factor for the development of osteoporotic fractures in elderly people.
Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff.
Fracture prevention strategies will be most cost-effective if targeted on groups of frail elderly people who are at particularly high risk of falls and fractures. Elderly people living in care homes are one potential target population, but fracture incidence in this setting remains poorly defined in many countries. We used the All Wales Injury Surveillance System (AWISS) in a population-based study of people aged over 65 years living in the city of Cardiff. We linked a postcode-based register of all sheltered accommodation and all residential and nursing homes in the city with injury data from Cardiff's single Accident and Emergency Department. Cardiff has 47,700 residents aged over 65 years with 1918 (4.0%) living in residential or nursing homes and 1868 (3.9%) in sheltered accommodation. In 1999 we identified a total of 1305 fractures including 366 hip fractures, giving a crude fracture incidence of 27.4/1000 per year and 7.7/1000 per year, respectively. Care home residents suffered 213 fractures, 95 of which were of the hip, giving a crude fracture incidence of 111.1/1000 per year and 49.5/1000 per year, respectively. People living in sheltered accommodation suffered 94 fractures, including 28 at the hip, giving a crude fracture incidence of 51.4/1000 per year and 15.3/1000 per year, respectively. People in care homes and sheltered accommodation tend to be older than those living in the community, and we adjusted for this by calculating age- and gender-standardized relative ratios for each setting. Compared with the community dwelling population, care home residents had an overall fracture risk of 2.9 (95% CI 2.5-3.3) and a hip fracture risk of 3.3 (95% CI 2.6-4.2). People in sheltered accommodation had a total fracture risk of 1.7 (95% CI 1.4-2.1), and a hip fracture risk of 1.6 (95% CI 1.1-2.4). Such figures support the potential cost-effectiveness of strategies that seek to prevent fractures in care homes and sheltered accommodation, and are of special interest to those planning intervention studies in these settings.
Seasonal variation in the incidence of wrist and forearm fractures, and its consequences.
We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of wrist and forearm fractures. We examined seasonal variation in the incidence of these injuries, and looked at resulting pressures on outpatient and inpatient trauma services. AWISS collected data from eight Accident and Emergency (A&E) departments which between them serve a total of 1.2 million people in South Wales. During a single year, we identified all 5013 people who presented with a wrist or forearm fracture. Seasonal variation in wrist/forearm fracture incidence was apparent, but showed a different pattern in different age groups. Overall incidence figures were dominated by an increase in children's fractures in spring and summer. Children under the age of 15 suffered a total of 360 wrist and forearm fractures during the three winter months; an incidence of 5.9/1000 per year that was only about half that observed during the remainder of the year (10.7/1000 per year). In contrast, older people showed a higher incidence in the winter. During the winter months people aged over 75 sustained a total of 160 wrist/forearm fractures; an incidence of 8.2/1000 per year, significantly higher than the incidence observed in other months (5.8/1000 per year). Seasonality of incidence was not apparent in other age groups. Children presenting during the spring and summer months were significantly more likely to need admission to hospital; 22.8% were admitted compared with just 10.3% of those presenting during the winter months (P<0.001, chi(2)-test). Other age groups showed no significant seasonal variation in the likelihood of hospital admission.
Clostridium difficile associated diarrhoea: how good are nurses at identifying the disease?
Explore the source record for details and available documents.
Screening for visual impairment in older people: validation of the Cardiff Acuity Test.
Poor visual acuity (VA) is a risk factor for falls, and a common impediment to rehabilitation, but conventional VA testing is difficult in dysphasic, deaf or confused patients. In the Cardiff acuity test (CAT) observation of the subject's eye movements (preferential looking) indicates if they can see a vanishing optotype on a card. The test is quick, and requires no speech or understanding on the part of the subject. We consider its usefulness in frail, elderly patients. Seventy-three patients aged 47-99 (mean 78) years, were tested in good lighting, wearing their usual spectacles. Cards ordered 'A' to 'K' with increasingly faint targets were sequentially presented at 1 m, until the subject's eye movements indicated the target to be invisible. We then performed conventional Snellen acuity chart testing. Twenty-three were retested by a second observer, and 24 subjects were retested by the same observer on another day. We used correlation coefficients to confirm inter-observer (r=0.95, P<0.01), and test-retest (r=0.97, P<0.01) reliability. Snellen chart measurements of VA were possible in all but six subjects. The results of CAT and Snellen acuity tests showed statistically significant correlation (r=0.35, P<0.01). The World Health Organisation (WHO) define significant impairment as a Snellen test acuity below 6/18, and using the 'G' card as a threshold were able to detect this degree of impairment with a sensitivity of 91.7%, and a specificity of 90.9%. The CAT is reliable, and highly acceptable to elderly patients, and may be useful as a screening tool in clinical practice, and for epidemiological purposes.