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Biomedical subjects

D G Seymour

Publications and source records attributed to D G Seymour.

At least 19 recordsLinked to original sources
PubMed2005

Screening elderly women for risk of future fractures--participation rates and impact on incidence of falls and fractures.

We have assessed the acceptability of a method for screening for risk of future hip fracture in elderly women. After receipt of an initial response to a mailed risk-factor questionnaire sent out to 5,306 women, women were randomly assigned to active or control groups. The active group was invited to participate in a screening visit that comprised a life-style questionnaire and a quantitative ultrasound heel scan. General practitioners (GPs) of women who were found to be in the lowest quartile of broadband ultrasound attenuation and/or who had two or more risk factors for hip fracture were advised to prescribe a calcium and vitamin D supplement. A second mailed questionnaire was sent to both groups 1 to 3 years later. Compared with the control group, the active group had a 56% lower risk of fracture (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81 adjusted age, weight, and treatment status). At follow-up, the proportion of fallers in the active group (25.3%) was lower than that in the control group (29.6%) (P = 0.064). The control group was found to have a higher rate of falls at follow-up than the active group (95% CI, 0.02-0.22); no difference was found at baseline (95% CI, -0.08 to +0.14). The screening method used was found to be acceptable to the majority of elderly women in this study. Screening the elderly in this way together with simple advice on treatment appears to reduce the age-associated increase in fall rates and the number of subsequent fractures. This form of screening may provide a cost-effective method to reduce falls and fractures in free-living elderly women. However, no such cost-effectiveness analysis has been performed to date.

Accidental Falls↗
PubMed2004

Assessment of individual quality of life using the SEIQoL-DW in older medical patients.

BACKGROUND: Many hospital admissions aim to optimize quality of life (QoL). However, the standard medical clerking does not systematically record QoL items. AIM: To examine whether the current disease-based clerking could be supplemented in older people with QoL information. DESIGN: Survey of non-elective admissions aged > or = 65 years. METHODS: Participants (n = 60) were interviewed on day 3-5 of their admission. QoL was measured using the SEIQoL-DW and the SF36 (version 2). Cognitive and physical function were also assessed. Aspects of feasibility and acceptability were explored, and the potential clinical benefits of the information investigated. RESULTS: Mean patient age was 81 years; 36 (60%) were female. Forty-five completed the SEIQoL-DW, (mean time 37.7 min), of whom 17 experienced practical difficulties drawing the cue levels, and 25 had difficulty manipulating the direct weighting device of the SEIQoL-DW. However, the assessment process was judged as acceptable, and elicited more subjective information than was recorded in medical and nursing notes. Doctors considered the individual QoL information potentially useful for planning discharge and follow-up. DISCUSSION: The SEIQoL-DW is probably too time-consuming for standard medical clerking. However, as it was judged acceptable by patients, and according to medical staff, gives potentially valuable information, there may be circumstances in which its use is worthwhile.

Aged↗
PubMed2001

Association between COLIA1 Sp1 alleles and femoral neck geometry.

Genetic factors play an important role in the pathogenesis of osteoporosis by affecting bone mineral density and other predictors of osteoporotic fracture risk such as ultrasound properties of bone and skeletal geometry. We previously identified a polymorphism of a Sp1 binding site in the Collagen Type 1 Alpha 1 gene (COLIA1) that has been associated with reduced BMD and an increased risk of osteoporotic fractures in several populations. Here we looked for evidence of an association between COLIA1 Sp1 alleles and femoral neck geometry. The study group comprised 153 patients with hip fracture, and 183 normal subjects drawn at random from the local population. Femoral neck geometry was assessed by analysis of pelvic radiographs in the fracture patients and DXA scan printouts in the population-based subjects. The COLIA1 genotypes were detected by polymerase chain reaction and were in Hardy Weinberg equilibrium: "SS" = 222 (66%); "Ss" = 105 (31.3%); and "ss" = 9 (2.7%). There was no significant difference in hip axis length or femoral neck width between the genotype groups, but femoral neck-shaft angle was increased by about 2 degrees in the Ss/ss genotype groups (n = 114) when compared with SS homozygotes (n = 222) (P = 0.001). Previous studies have suggested that an increased femoral neck-shaft angle may increase the risk of hip fracture in the event of a sideways fall by influencing the forces that act on the femoral neck. The association COLIAI genotype and increased femoral neck angle noted here may therefore contribute to the BMD-independent increase in hip fracture risk noted in previous studies of individuals who carry the 's' allele.

Aged↗
PubMed2001

Health care modelling and clinical practice. Theoretical exercise or practical tool?

The paper looks at potential uses of health care modelling techniques in day-to-day clinical practice, adopting the viewpoint of a specialist in geriatric medicine. After a brief review of the recent literature on the practical applications of bed modelling techniques, the potential of such techniques in the future is discussed. Possible barriers to the adoption of these techniques by clinicians are presented together with suggestions about ways of overcoming these barriers.

Aged↗
PubMed2001

Problems in using health survey questionnaires in older patients with physical disabilities. The reliability and validity of the SF-36 and the effect of cognitive impairment.

Reliability and validity of the SF-36 Health Survey Questionnaire was assessed in older rehabilitation patients, comparing cognitively impaired with cognitively normal subjects. The SF-36 was administered by face-to-face interview to 314 patients (58-93 years) in the day hospital and rehabilitation wards of a department of medicine for the elderly. Reliability was measured using Cronbach's alpha (for internal consistency) on the main sample and intraclass correlation coefficients on a test-retest sample; correlations with functional independence measure (FIM) were examined to assess validity. In 203 cognitively normal patients (Mini-Mental State Examination > or =24), Cronbach's alpha scores on the eight dimensions of the SF-36 ranged from 0.545 (social function) to 0.933 (bodily pain). The range for the 111 cognitively impaired patients was 0.413-0.861. Cronbach's alpha values were significantly higher (i.e. reliability was better) in the cognitively normal group for bodily pain (P = 0.003), mental health (P = 0.03) and role emotional (P = 0.04). In test-retest studies on a further 67 patients, an intraclass correlation coefficient of 0.7 was attained for five out of eight dimensions in cognitively normal patients, and four out of eight dimensions in the cognitively impaired. Only the physical function dimension in the cognitively normal group attained the criterion level (r > 0.4) for construct validity when correlated with the FIM. In this group of older physically disabled patients, levels of reliability and validity previously reported for the SF-36 in younger subjects were not attained, even on face-to-face testing. Patients with coexistent cognitive impairment performed worse than those who were cognitively normal.

Aged↗
PubMed2001

Pictorial outcome measures for the hospital care of older patients--a suggested toolkit.

OBJECTIVE: to propose three pictorial methods of presenting hospital outcome data, suitable for use in older patients entering medical specialties (including rehabilitation). PATIENTS: 224 patients (mean age 80.6 years, 56% female, 75% emergencies) admitted to a department of medicine for the elderly. PRESENTATIONAL TECHNIQUES: the methods we propose for the presentation of outcome data are (i) place of discharge, using a two-dimensional diagram; (ii) 'survival' analyses, but using discharge from hospital rather than death as the endpoint; and (iii) 'phase diagrams', a novel method of charting the progress of a cohort of patients. To illustrate these methods, the relationship between admission case-mix (with patients put into tertiles on the basis of their Barthel index score) and outcome is shown graphically. RESULT: each of the three techniques has different relative strengths, but their pictorial nature allows for rapid interpretation of data, showing, for example, the marked influence of case-mix. Separate analyses of subgroups of patients (such as those who die in hospital and those who survive) are also readily attainable by the three methods. CONCLUSIONS: the three methods of presenting outcome should be of benefit in comparing the performance of different units, particularly when case-mix is taken into account. The pictorial methods are complementary both to more conventional patient-based methods (mean duration of stay, median duration of stay, percentile duration of stay, regression analyses etc) and to modelling techniques using 'census' data from large numbers of patients.

Aged↗
PubMed2001

Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care.

BACKGROUND: regular medication review has been recommended for those over 75 and those on multiple drug therapy. Pharmacists are a potential source of assistance in reviewing medication. Evidence of the benefits of this process is needed. OBJECTIVE: to study the effect of medication review led by a pharmacist on resolution of pharmaceutical care issues, medicine costs, use of health and social services and health-related quality of life. DESIGN: randomized, controlled trial. SETTING: general medical practices in the Grampian region of Scotland. SUBJECTS: patients aged at least 65 years, with at least two chronic disease states who were taking at least four prescribed medicines regularly. METHODS: pharmacists reviewed the drug therapy of 332 patients, using information obtained from the practice computer, medical records and patient interviews. In 168 patients, a pharmaceutical care plan was then drawn up and implemented. The 164 control patients continued to receive normal care. All outcome measures were assessed at baseline and after 3 months. RESULTS: all patients had at least two pharmaceutical care issues at baseline. Half of these were identified from the prescription record, the rest from notes and patient interview. Of all the issues, 21% were resolved by information found in notes and 8.5% by patient interview. General practitioners agreed with 96% of all care issues documented on the care plans in the intervention group. At the time of follow-up, 70% of the remaining care issues had been resolved in the intervention group, while only 14% had been resolved in the control group. There were no changes in medicine costs or health-related quality of life in either group. There were small increases in contacts with health-care professionals and slightly fewer hospital admissions among the intervention group than the control group. CONCLUSIONS: pharmacist-led medication review has the capacity to identify and resolve pharmaceutical care issues and may have some impact on the use of other health services.

Aged↗
PubMed2000

Prevalence of hip fracture risk factors in women aged 70 years and over.

We estimated the prevalence of common risk factors for hip fracture and the numbers needed to treat (NNT) to prevent a hip fracture in various high-risk population groups, using a postal risk factor survey of women aged 70 years and above from General Practices in Grampian and Yorkshire. Recorded risk factors included prior fracture of any type; low body weight; smoking; and family history of fracture. The prevalence rates of hip fracture risk factors were 34%, 7% and 11% for previous fracture, maternal hip fracture and smoking, respectively for the Grampian practices (low body weight being defined as falling in the lowest quartile) and 34%, 7% and 7% for a single practice in the York area. Applying previously published estimates of risk, NNT analysis produced a value of about 300 for women with no risk factors, whilst for women with three risk factors it was between 32 and 71, depending on which risk factors were present and assuming intervention reduced fracture rates by 30% or 50%. Groups of women at high risk of hip fracture can easily be identified in primary care and offered treatment, with realistic prospects of hip fracture prevention.

Aged↗
PubMed2000

Determinants of survival in continuing care settings.

OBJECTIVE: To assess the relationship between the Barthel Index, a widely used assessment measure of physical dependency, and long-term survival in continuing care settings. DESIGN AND SUBJECTS: One hundred and eighty five older people moving into continuing care (hospital or nursing home) were prospectively assessed with regard to physical and mental impairment in 1991/2 and this population was followed up in 1996. RESULTS: In addition to the 185 patients who were assessed, there were 41 patients who died before they could be seen. Out of the total of 226 patients, 177 had died by the time of the census point in 1996. Multivariate (Cox regression) analysis of survival in the 185 patients indicated that only the Barthel Index (BI) and female sex were statistically significantly related to survival rates. Those with a BI of 12-20 had better survival than those with a BI of 7-11 (P = 0.015) or a BI of 0-6 (P = 0.007). CONCLUSIONS: The importance of careful assessment of those moving into continuing care settings is emphasised. Those patients who are physically less dependent are likely to have significantly longer survival periods and related use of continuing care resources.

Activities of Daily Living↗
PubMed1999

Age, deprivation and rates of inguinal hernia surgery in men. Is there inequity of access to healthcare?

OBJECTIVES: To study trends in hospital admissions for inguinal hernia surgery in men, examining relationships between age, deprivation and rate of surgery. DESIGN: graphical analyses of hospital discharge data and demographic information, guided by three hypotheses on urgency of surgery, age and evidence of discordance between population prevalence of disease and rates of surgery. SETTING AND SUBJECTS: Men undergoing inguinal hernia surgery in Scotland in 1982-4, 1987-9 and 1992-4. MAIN OUTCOME MEASURES: Rate of operation per 100 000 population. RESULTS: Over the study period, there has been (i) a marked increase in the rate of elective hernia operations in the over-65s, (ii) a stable rate of non-elective operations in all age groups, (iii) a lower rate of elective surgery in patients from deprived areas than in patients from affluent areas. CONCLUSIONS: During the period studied there has been decreasing inequity on the grounds of age but persisting inequity on the grounds of deprivation. These techniques of analysis are potentially applicable to many conditions and may be useful in equity audit in patients of all ages.

Adolescent↗
PubMed1996

First steps in building ACME--an admission case-mix system for the elderly.

In the United Kingdom, specialists in Geriatric Medicine usually have a major role in treating acute medical problems of elderly people, in addition to running rehabilitation services and continuing care. The proportion of the different types of patients varies widely from service to service, however, making it difficult for clinicians to compare their performance with that of colleagues. Existing casemix measurement systems are usually designed to deal with a more homogeneous patient group (e.g. rehabilitation, long-stay care) and/or are too detailed for day-to-day use. We describe our attempts to devise a simple casemix system which would be of practical day-to-day use for individual specialists in Geriatric Medicine. We have classified patients according to (1) the acuteness and potential for recovery of their presenting illness and (2) their functional status (based on simple measures of mobility and cognitive impairment). These factors have been incorporated into a three-point score, CMIX, which was capable of explaining 19.5% of the variability in duration of stay in a prospective study of 400 new admissions in two centres. In contrast, age and sex explained only 1% of variability in these patients. The pattern of patient outcome also differed significantly between the three CMIX categories. We also propose a simple graphical method of classifying outcome which should prove useful for audit purposes even when our casemix system is not employed.

Activities of Daily Living↗
PubMed1996

A 5-year survival study of general surgical patients aged 65 years and over.

A prospective 5-year survival study of 900 patients, aged 65 years and over, undergoing a general surgical procedure, demonstrated that following an initial high mortality rate the survival of the group as a whole approached that of an age-matched population. Non-elective admissions, age 75 years and over, ASA grade 4-5 and major surgery were associated with a high early mortality. Mortality associated with malignancy extended over 1 year. The study reinforces the conclusion that age alone should be no bar to surgery and anaesthesia, endorses the findings of the National Confidential Enquiry into Peri-operative deaths and emphasises the need to re-examine the provision of anaesthetic and surgical services in District General Hospitals. The benefits of elective admission in the very old are highlighted, along with the potential for extension of day case surgery.

Age Factors↗
PubMed1996

Self-funding and community care admissions to nursing homes in Aberdeen.

OBJECTIVE: Admissions to nursing homes are an essential component of community care following the Community Care Act reforms. The present study sought to evaluate recent admissions from the community or hospital to private nursing homes in Aberdeen, in order to assess care management in operation and to determine whether admission criteria or access are influenced by funding. DESIGN AND SUBJECTS: A census of admissions to 11 private nursing homes within Aberdeen City boundary was performed over a nine-month period (April 1994 to January 1995), one year after the NHS and Community Care Act reforms had been implemented. One hundred and nineteen residents (102 females), means (SEM) age, 83(1) years range 64-98 years, admitted from the community or hospital since 1 April 1994, were included. For each resident an evaluation of Barthel Index, Abbreviated Mental Test Score (AMTS), source of funding (Local Authority Funding (LAF) or private) and appropriateness of placement was made. RESULTS: Twenty-seven residents were admitted from home, 77 from hospital and 15 from residential or nursing homes. 58% (69 residents) were funded by LAF and 42% (50 residents) were funded privately. Barthel scores as mean (SEM): 10.7 (0.72) vs 14.1 (0.55), p < 0.001, were significantly higher in the privately funded group. 68.1% (81 residents) were considered to be appropriately placed. However, a significantly higher proportion of those with LAF funding were appropriately placed: (number of residents); 53 vs 28, p = 0.016. CONCLUSIONS: It would appear that there is a selection in favour of privately funded residents with a lower level of dependency. If resources are limited this could disadvantage more dependent patients in hospital who merit institutional care but require Local Authority funding support.

Aged↗