PubMed Health⌕ Search

Biomedical subjects

Margot A Gosney

Publications and source records attributed to Margot A Gosney.

6 recordsLinked to original sources
PubMed2006

Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses.

OBJECTIVES: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES: Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS: 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION: There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

Accident Prevention↗
PubMed2006

Enterobacter sakazakii in the mouths of stroke patients and its association with aspiration pneumonia.

BACKGROUND: Previous studies by our group have identified a high prevalence of Gram-negative bacilli in the mouths of stroke patients. Eradication of such organisms by selective decontamination of the digestive tract (SDD) has not previously been studied. Enterobacter sakazakii is a rarely found organism that has previously been identified as a cause of neonatal meningitis and sepsis but that has rarely been reported as a pathogen in older people. The purpose of this study was to look specifically for E. sakazakii in the mouths of stroke patients and to correlate its isolation with response to SDD gel and the presence of clinical complications such as pneumonia. METHODS: Following an acute stroke, 203 patients were recruited for the study and received placebo or SDD in a 50:50 ratio. Oral swabs were obtained on nine separate occasions and E. sakazakii was cultured from them. Clinical data were prospectively collected and analysed. RESULTS: E. sakazakii was identified in 7 of 203 patients. The organism was almost exclusively removed by SDD gel, but in those patients in whom an abnormal swallow was present, pneumonia was found in two of the four cases. CONCLUSION: E. sakazakii may colonise the mouths of acute stroke patients. Since SDD gel is not routinely administered to such patients, this organism may be implicated in patients who subsequently develop aspiration pneumonia.

Journal Article↗
PubMed2005

Clinical assessment of elderly people with cancer.

As the elderly population increases, the diagnosis of cancer will become more common than it is today, and difficult decisions about treatment will need to be made by various health-care providers. An important issue not only for patients but also for the whole health-care system is that only those who will benefit from therapy are treated. Individuals for whom treatment will add neither quantity nor quality to their lifespan should not be subjected to potentially harmful treatment. Many assessment scales are validated in elderly people but not used in elderly patients with cancer. Comprehensive geriatric assessment provides an overarching method of assessment before, during, and after treatment. The benefits and shortcomings of other assessment scales are discussed in this review, showing settings in which their use might be appropriate in the developing specialty of geriatric oncology.

Activities of Daily Living↗
PubMed2004

Can a short period of micronutrient supplementation in older institutionalized people improve response to influenza vaccine? A randomized, controlled trial.

OBJECTIVES: To test the hypothesis that a micronutrient supplement can improve seroconversion after influenza immunization in older institutionalized people. DESIGN: : Randomized, double-blind, placebo-controlled study. SETTING: Nursing and residential homes in Liverpool, United Kingdom. PARTICIPANTS: One hundred sixty-four residents aged 60 and older from 31 homes were initially randomized; of these, 119 (72.6%) completed the study. INTERVENTION: Participants were randomized to receive a micronutrient supplement providing the reference nutrient intake for all vitamins and trace elements or identical placebo. Tablets were taken over an 8-week period during September and October 2000; influenza vaccine was administered 4 weeks after their commencement. MEASUREMENTS: The hemagglutination-inhibiting antibody response as defined by a fourfold or greater titer rise over 4 weeks and assessed separately for each of the three antigens contained in the 2000/2001 influenza vaccine (A/New Caledonia/20/99 (H1N1), A/Moscow/10/99 (H3N2), B/Beijing/184/93 (B)). RESULTS: Despite a significant increase in serum concentrations of vitamins A, C, D3, E, folate, and selenium in the supplemented group, there was no significant difference between groups (supplemented vs placebo, respectively) in the proportion of participants seroconverting to H1N1 (41% vs 49%, P=.374), H3N2 (49% vs 58%, P=.343), or B (41% vs 40%, P=.944). CONCLUSION: A micronutrient supplement providing the reference nutrient intake administered over 8 weeks had no beneficial effect on antibody response to influenza vaccine in older people living in long-term care.

Aged↗
PubMedDate not supplied

Difficulties of recruitment for a randomized controlled trial involving influenza vaccination in healthy older people.

BACKGROUND: In a randomized controlled trial to determine the cost benefits of influenza vaccination in fit healthy individuals aged 65-74 years, recruiting individuals to the study was more difficult than anticipated. OBJECTIVES: To investigate reasons for poor recruitment. MATERIALS AND METHODS: 6,058 people were initially identified as eligible for the study but only 729 (12%) were subsequently randomized. Individuals (n = 2,583) who returned cards indicating that they did not wish to participate were sent a postal questionnaire asking for reasons why they felt unable to consent for the study. RESULTS: 1,173/2,583 (45.4%) questionnaires were returned. A total of 2,621 reasons were given for nonparticipation, i.e. a mean of 2.2 reasons per questionnaire returned. Reasons given for noninvolvement were: reluctance to participate in a research project (53%); concerned about side effects (34%); self-perceived view of not requiring influenza vaccination (31.7%); preference for own doctor to give the vaccine (29.1%); objection to name "Geriatric Medicine" on the letter of invitation (25.2%); already been vaccinated (17.3%); illness requiring vaccination out of the study (13.8%); previous bad reaction to the vaccine (6.4%); unable to attend on day of vaccination (4.3%); unable to get to general practice surgery (4%); already involved in a clinical trial (2.5%); fear of needles/dislike of injections (1.6%); doubts about vaccine efficacy (0.3%); egg allergy (0.2%). CONCLUSION: Inaccurate beliefs about influenza vaccination persist across a wide section of the community. Efforts should be made by all health professionals to correct these false beliefs and ensure that those at risk can be easily recognized and targeted for vaccination.

Aged↗