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Liddicoat M, Johansen A, Boulton C, Hannaford J. Adding a subsidiary sprint audit dataset to a continuous national clinical audit - lessons from the National Hip Fracture Database. Future Healthc J 2019; 6:110. [PMID: 31363629 PMCID: PMC6616721 DOI: 10.7861/futurehosp.6-1-s110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Johansen A, Boulton C, O’Riordan S, Vasilakis N, Martin F. Falls and Fragility Fracture Audit Programme – using national audit data to monitor risk of hip fracture as a result of an inpatient fall. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-2-s49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Johansen A, Liddicoat M, Boulton C, White P, Ten Hove R. 38“HIP SPRINT” USING THE 2017 NATIONAL AUDIT OF PHYSIOTHERAPY TO DEVELOP QUALITY STANDARDS FOR PHYSIOTHERAPY AFTER HIP FRACTURE. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Johansen A, Liddicoat M, Hannaford J, Wakeman R, Boulton C, Dickinson R. 66INTRODUCING A NATIONAL PROGRAMME OF SCREENING WITH THE 4A TEST TO IDENTIFY DELIRIUM - THE COMMONEST COMPLICATION OF HIP FRACTURE SURGERY. Age Ageing 2019. [DOI: 10.1093/ageing/afy214.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Birkebaek NH, Kahlert J, Bjarnason R, Drivvoll AK, Johansen A, Konradsdottir E, Pundziute-Lyckå A, Samuelsson U, Skrivarhaug T, Svensson J. Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA 1c and other predictors of increasing BMISDS. Pediatr Diabetes 2018; 19:1198-1205. [PMID: 29781227 DOI: 10.1111/pedi.12693] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/30/2018] [Accepted: 04/30/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intensified insulin therapy may increase body weight and cause obesity. This study compared body mass index standard deviation score (BMISDS) and obesity rate in children with type 1 diabetes (T1D) in Denmark, Iceland, Norway and Sweden, and uncovered predictors for increasing BMISDS. METHODS Data registered in the Nordic national childhood diabetes databases during the period 2008-2012 on children below 15 years with T1D for more than 3 months were compiled, including information on gender, age, diabetes duration, hemoglobin A1c (HbA1c ), insulin dose, severe hypoglycemia (SH), treatment modality, height and weight. The Swedish reference chart for BMI was used for calculating BMISDS. RESULTS Totally, 11 025 children (48% females) (30 994 registrations) were included. Medians by the last recorded examination were: age, 13.5 years; diabetes duration, 4.3 years; HbA1c , 7.9% (63 mmol/mol); insulin dose, 0.8 IU/kg/d and BMISDS, 0.70. Obesity rate was 18.5%. Adjusted mean BMISDS (BMISDS adj) was inversely related to HbA1c and directly to diabetes duration. Higher BMISDS adj was found in those with an insulin dose above 0.6 IU/kg/d, and in girls above 10 years. Pump users had higher BMISDS adj than pen users, and patients with registered SH had higher BMISDS adj than patients without SH (both P < .001). CONCLUSION Obesity rate in children with T1D in the Nordic countries is high, however, with country differences. Low HbA1c , long diabetes duration, higher insulin dose, pump treatment and experiencing a SH predicted higher BMISDS. Diabetes caregivers should balance the risk of obesity and the benefit of a very low HbA1c.
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Chen I, Wind K, Dehlendorff C, Sørensen B, Vittrup B, Johansen A, Pfeiffer P, Bjerregaard J, Bojesen S, Nielsen S, Holländer N, Yilmaz M, Rasmussen L, Pallisgaard N, Johansen J, Spindler KL. Clinical utility of plasma cell-free DNA in patients with pancreatic cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chen I, Willumsen N, Dehlendorff C, Johansen A, Vittrup B, Krüger M, Pfeiffer P, Bjerregaard J, Bojesen S, Nielsen S, Holländer N, Yilmaz M, Rasmussen L, Karsdal M, Johansen J. Clinical utility of serum type III collagen in patients with pancreatic carcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Neuburger J, Currie C, Wakeman R, Georghiou T, Boulton C, Johansen A, Tsang C, Wilson H, Cromwell DA, van der Meulen J. Safe working in a 7-day service. Experience of hip fracture care as documented by the UK National Hip Fracture Database. Age Ageing 2018; 47:741-745. [PMID: 29796590 DOI: 10.1093/ageing/afy074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 11/12/2022] Open
Abstract
Objective to describe differences in care and 30-day mortality of patients admitted with hip fracture on weekends (Saturday-Sunday) compared to weekdays (Monday-Friday), and their relationship to the organisation of care. Methods data came from the National Hip Fracture Database (NHFD) linked to ONS mortality data on 52,599 patients presenting to 162 units in England between 1 January and 31 December 2014. This was combined with information on geriatrician staffing and major trauma centre (MTC) status. 30-day mortality and care were compared for patients admitted at weekends and weekdays; separately for patients treated in units grouped by the mean level of input by geriatricians, weekend geriatrician clinical cover and MTC status. Differences were adjusted for variation in patients' characteristics. Results there was no evidence of differences in 30-day mortality between patients admitted at weekends compared to weekdays (7.2 vs 7.5%, P = 0.3) before or after adjusting for patient characteristics in either MTCs or general hospitals. The proportion receiving a preoperative geriatrician assessment was lower at weekends (42.8 vs 60.7%, P < 0.001). 30-day mortality was lower in units with higher levels of geriatrician input, but there was no weekend mortality effect associated with lower levels of input or absence of weekend cover. Conclusion there was no evidence of a weekend mortality effect among patients treated for hip fracture in the English NHS. It appears that clinical teams provide comparably safe and effective care throughout the week. However, greater geriatrician involvement in teams was associated with overall lower mortality.
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Johansen A, Chiletti R, Best D. The impact of extracorporeal life support (ECLS) on hypoplastic left heart syndrome (HLHS) patients long term survival: A 10-year experience. Aust Crit Care 2018. [DOI: 10.1016/j.aucc.2017.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Holstein BE, Andersen A, Denbaek AM, Johansen A, Michelsen SI, Due P. Short communication: Persistent socio-economic inequality in frequent headache among Danish adolescents from 1991 to 2014. Eur J Pain 2018; 22:935-940. [PMID: 29349882 DOI: 10.1002/ejp.1179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between socio-economic status (SES) and headache among adolescents is an understudied issue, and no study has examined whether such an association changes over time. The aim was to examine trends in socio-economic inequality in frequent headache among 11- to 15-year-olds in Denmark from 1991 to 2014, using occupational social class (OSC) as indicator of SES. METHODS The study applies data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study. HBSC includes nationally representative samples of 11-, 13- and 15-year-olds. This study combines data from seven data survey years from 1991 to 2014, participation rate 88.6%, n = 31,102. We report absolute inequality as per cent difference in frequent headache between high and low OSC and relative inequality as odds ratio for frequent headache by OSC. RESULTS In the entire study population, 10.4% reported frequent headache. There was a significant increase in frequent headache from 8.0% in 1991 to 12.9% in 2014, test for trend, p < 0.0001. This increasing trend was significant in all OSCs. The prevalence of frequent headache was significantly higher in low than high OSC, OR = 1.50 (95% CI: 1.34-1.67). This socio-economic inequality in frequent headache was persistent from 1991 to 2014. CONCLUSION There was a significant and persistent socio-economic inequality, i.e. increasing prevalence of frequent headache with decreasing OSC. The association between socio-economic position and headache did not significantly change over time, i.e. the statistical interaction between OSC and survey year was insignificant. SIGNIFICANCE The prevalence of frequent headache among adolescents increases with decreasing SES. This socio-economic inequality has been persistent among adolescents in Denmark from 1991 to 2014. Clinicians should be aware of this social inequality.
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ten Hove R, Johansen A, Liddicoat M, Boulton C. The national physiotherapy hip fracture sprint audit (PHFSA). Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Johansen A, Golding D, Brent L, Close J, Gjertsen JE, Holt G, Hommel A, Pedersen AB, Röck ND, Thorngren KG. Using national hip fracture registries and audit databases to develop an international perspective. Injury 2017; 48:2174-2179. [PMID: 28803651 DOI: 10.1016/j.injury.2017.08.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
Hip fracture is the commonest reason for older people to need emergency anaesthesia and surgery, and leads to prolonged dependence for many of those who survive. People with this injury are usually identified very early in their hospital care, so hip fracture is an ideal marker condition with which to audit the care offered to older people by health services around the world. We have reviewed the reports of eight national audit programmes, to examine the approach used in each, and highlight differences in case mix, management and outcomes in different countries. The national audits provide a consistent picture of typical patients - an average age of 80 years, with less than a third being men, and a third of all patients having cognitive impairment - but there was surprising variation in the type of fracture, of operation and of anaesthesia and hospital length of stay in different countries. These national audits provide a unique opportunity to compare how health care systems of different countries are responding to the same clinical challenge. This review will encourage the development and reporting of a standardised dataset to support international collaboration in healthcare audit.
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Tsang C, Boulton C, Burgon V, Johansen A, Wakeman R, Cromwell DA. Predicting 30-day mortality after hip fracture surgery: Evaluation of the National Hip Fracture Database case-mix adjustment model. Bone Joint Res 2017; 6:550-556. [PMID: 28947603 PMCID: PMC5630992 DOI: 10.1302/2046-3758.69.bjr-2017-0020.r1] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/28/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. METHODS Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models' coefficients. This was followed by testing the performance of these refined models in a second validation dataset. RESULTS The 30-day mortality rate was 5.36% in the validation dataset (n = 3861), slightly lower than the 6.40% in the development dataset (n = 4044). The NHFD and Nottingham models showed a slightly lower discrimination in the validation dataset compared with the development dataset, but both still displayed moderate discriminative power (c-statistic for NHFD = 0.71, 95% confidence interval (CI) 0.67 to 0.74; Nottingham model = 0.70, 95% CI 0.68 to 0.75). Both models defined similar ranges of predicted mortality risk (1% to 18%) in assessment of calibration. CONCLUSIONS Both models have limitations in predicting mortality for individual patients after hip fracture surgery, but the NHFD risk adjustment model performed as well as the widely-used Nottingham prognostic tool and is therefore a reasonable alternative for risk adjustment in the United Kingdom hip fracture population.Cite this article: Bone Joint Res 2017;6:550-556.
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Johansen A, Boulton C, Burgon V, Rai S, Wakeman R. 21COGNITIVE IMPAIRMENT - PROFILING ITS IMPLICATIONS FOR PATIENTS WITH HIP FRACTURE. Age Ageing 2017. [DOI: 10.1093/ageing/afx115.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Johansen A, Tsang C, Boulton C, Wakeman R, Moppett I. Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database. Anaesthesia 2017; 72:961-966. [DOI: 10.1111/anae.13908] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/05/2023]
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Boulton C, Burgon V, Johansen A, Martin F, Rai S, Stanley R, Wakeman R. 121DELIVERING “BEST PRACTICE” FOR PATIENTS WITH HIP FRACTURE - DOES ORTHOGERIATRICIAN ENGAGEMENT WITH NATIONAL CLINICAL AUDIT DATA IMPROVE PERFORMANCE? Age Ageing 2017. [DOI: 10.1093/ageing/afx072.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wilson H, Boulton C, Burgon V, Johansen A, Neuburger J, Rai S, Wakeman R. 42USING THE NATIONAL HIP FRACTURE DATABASE TO DEVELOP A CLASSIFICATION OF MODELS OF ORTHOGERIATRIC CARE. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Johansen A, Boulton C, Burgon V, Rai S, Wakeman R. 117HIP FRACTURE: DOES WEEK-DAY OF PRESENTATION AFFECT LENGTH OF STAY? Age Ageing 2017. [DOI: 10.1093/ageing/afx072.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. 127THE IMPACT OF SOCIAL DEPRIVATION ON MORTALITY FOLLOWING HIP FRACTURE IN ENGLAND AND WALES: A RECORD LINKAGE STUDY. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Johansen A, Boulton C, Burgon V, Neuburger J, Rai S, Wakeman R. 126HIP FRACTURES IN HOSPITAL AND CARE HOMES - USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO IDENTIFY A POSSIBLE CARE GAP. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Boulton C, Burgon V, Johansen A, Martin F, Rai S, Stanley R, Wakeman R. 122AVOIDING DELAY IN SURGERY FOR HIP FRACTURE: USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO MONITOR AND IMPROVE COMPLIANCE WITH NATIONAL GUIDELINES. Age Ageing 2017. [DOI: 10.1093/ageing/afx072.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lewis S, Edwards L, Glasbey J, Johansen A. 9MEASURING HEALTH-RELATED QUALITY OF LIFE IN HIP FRACTURE - A PILOT STUDY. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Neuburger J, Currie C, Wakeman R, Johansen A, Tsang C, Plant F, Wilson H, Cromwell DA, van der Meulen J, De Stavola B. Increased orthogeriatrician involvement in hip fracture care and its impact on mortality in England. Age Ageing 2017; 46:187-192. [PMID: 27915229 DOI: 10.1093/ageing/afw201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Indexed: 01/08/2023] Open
Abstract
Objectives to describe the increase in orthogeriatrician involvement in hip fracture care in England and its association with improvements in time to surgery and mortality. Study design analysis of Hospital Episode Statistics for 196,401 patients presenting with hip fracture to 150 hospitals in England between 1 April 2010 and 28 February 2014, combined with data on orthogeriatrician hours from a national organisational survey. Methods we examined changes in the average number of hours worked by orthogeriatricians in orthopaedic departments per patient with hip fracture, and their potential effect on mortality within 30 days of presentation. The role of prompt surgery (on day of or day after presentation) was explored as a potential confounding factor. Associations were assessed using conditional Poisson regression models with adjustment for patients' sex, age and comorbidity and year, with hospitals treated as fixed effects. Results between 2010 and 2013, there was an increase of 2.5 hours per patient in the median number of hours worked by orthogeriatricians-from 1.5 to 4.0 hours. An increase of 2.5 hours per patient was associated with a relative reduction in mortality of 3.4% (95% confidence interval 0.9% to 5.9%, P = 0.01). This corresponds to an absolute reduction of approximately 0.3%. Higher numbers of orthogeriatrician hours were associated with higher rates of prompt surgery, but were independently associated with lower mortality. Conclusion in the context of initiatives to improve hip fracture care, we identified statistically significant and robust associations between increased orthogeriatrician hours per patient and reduced 30-day mortality.
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Johansen A, Boulton C, Hertz K, Ellis M, Burgon V, Rai S, Wakeman R. The National Hip Fracture Database (NHFD) - Using a national clinical audit to raise standards of nursing care. Int J Orthop Trauma Nurs 2017; 26:3-6. [PMID: 28237620 DOI: 10.1016/j.ijotn.2017.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
The National Hip Fracture Database (NHFD) is a key clinical governance programme for staff working in trauma wards across England, Wales and Northern Ireland. It uses prospectively collected information about the 65,000 people who present with hip fracture each year, and links these with information about the quality of care and outcome for each individual. The NHFD can, therefore, provide a picture of the care offered to frail older people with this injury - people who, between them, occupy nearly half of inpatient trauma beds. The NHFD uses its website (www.nhfd.co.uk) to feed back live information to each of the countries' 180 trauma units - allowing them to bench mark their performance against national standards, and against that in other hospitals. This helps to develop a consensus over the best care for frail older people in areas where national guidance is not yet available. This article shows how the NHFD is contributing to four key aspects of patient safety and nursing care: the prevention of pressure ulcers and post-operative delirium, the monitoring of falls incidence across hospitals and nutritional assessment of patients with hip fracture.
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Johansen A, Mahoney H. Should life-expectancy affect decisions over arthroplasty for hip fracture? Age Ageing 2017; 46:159-160. [PMID: 28181658 DOI: 10.1093/ageing/afw237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Birkebaek NH, Drivvoll AK, Aakeson K, Bjarnason R, Johansen A, Samuelsson U, Skrivarhaug T, Thorsson AV, Svensson J. Incidence of severe hypoglycemia in children with type 1 diabetes in the Nordic countries in the period 2008-2012: association with hemoglobin A 1c and treatment modality. BMJ Open Diabetes Res Care 2017; 5:e000377. [PMID: 28761652 PMCID: PMC5530237 DOI: 10.1136/bmjdrc-2016-000377] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Treatment of type 1 diabetes has been intensified aiming at normalizing blood glucose, which may increase the risk of severe hypoglycemia (SH). We aimed to compare the incidence of SH events in the four Nordic countries Denmark, Iceland, Norway and Sweden, and to assess the influence of hemoglobin A1c (HbA1c) and treatment modalities on the frequency of SH; particularly, to explore if a HbA1c target ≤6.7% (50 mmol/mol) is feasible. RESEARCH DESIGN AND METHODS Data on children below 15 years with a diabetes duration more than 1 year, registered in the national childhood diabetes databases in the four Nordic countries from 2008 to 2012, were compiled. Data completeness was more than 95%. RESULTS Totally 8806 (48% females) patients with 29 715 person years were included, mean age and diabetes duration were 11 years and 5.1 years, respectively. The overall rate of SH was 6.0 per 100 patient-years, and did not change during the study period. The Swedish population constantly had the lowest SH incidence while it decreased significantly in the Danish population. HbA1c decreased significantly over time (p<0.01), while the number of pump users increased (p<0.01). Stratifying for HbA1c levels showed the lowest risk of SH in patients with HbA1c ≤6.7% (≤50 mmol/mol), but in the statistical models adjusting for possible confounders the difference between the HbA1c groups disappeared. Pump users had the lowest SH risk, also after adjusting for possible confounders. CONCLUSIONS Risk of SH differs between the Nordic countries with the lowest risk in Sweden. Pump therapy was associated with decreased risk of SH. The low HbA1c group had the same or a lower risk of SH compared with the highest HbA1c groups. A target HbA1c ≤6.7% (≤50 mmol/mol) seems achievable without increasing the risk of SH.
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Johansen A, Boulton C, Neuburger J. Diurnal and seasonal patterns in presentations with hip fracture-data from the national hip fracture database. Age Ageing 2016; 45:883-886. [PMID: 27496916 DOI: 10.1093/ageing/afw133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 06/15/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE we set out to examine diurnal and seasonal variation in hip fracture presentations to question their origin and to consider their implications for the organisation of health services for older people. METHODS we used the National Hip Fracture Database to identify the time of presentation and surgery for 64,102 patients; all those older than 60 years who sustained this injury in England, Wales and Northern Ireland during 2014. RESULTS we found marked diurnal variation in rates of presentation, increasing sharply after 0800 hours and decreasing only after 1800 hours. Among people who sustained their hip fracture in hospital (n = 2,761) or in a care home (n = 12,141), there were peaks in presentations around 0900 and 1800 hours. Time of presentation had a very marked effect on whether surgery was delayed by more than 24 hours but less against the national guidelines of surgery within 36 hours or by the next day. There were 15.6% more presentations during December compared to all other months (9.5% versus 8.2%, P < 0.001), a pattern also found among people living in care homes (9.1% versus 8.3%, P < 0.001). CONCLUSIONS we have identified morning and evening peaks of presentation for inpatients and care home residents and a December increase in overall hip fracture numbers. These patterns warrant further investigation if those organising health services are to prevent this injury, and to provide appropriate beds and prompt operations for the people who sustain it.
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Johansen A. Should life expectancy affect decisions over arthroplasty for hip fracture? Age Ageing 2016. [DOI: 10.1093/ageing/el_928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study. Osteoporos Int 2016; 27:2727-2737. [PMID: 27098537 PMCID: PMC4981619 DOI: 10.1007/s00198-016-3608-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/01/2016] [Indexed: 12/02/2022]
Abstract
UNLABELLED We used routine hospital data to investigate whether socially deprived patients had an increased risk of dying following hip fracture compared with affluent patients. We found that the most deprived patients had a significantly increased risk of dying at 30, 90 and 365 days compared with the most affluent patients. INTRODUCTION To identify whether social deprivation has any effect on mortality risk after emergency admission with hip fracture and to determine whether any increased mortality observed among deprived groups was associated with patient and hospital-related factors. METHODS We used routine, linked hospital inpatient and mortality data for emergency admissions with a hip fracture in both England and Wales between 2004 and 2011. Mortality rates at 30, 90 and 365 days were reported. Logistic regression was used to identify any significant increases in mortality with higher levels of social deprivation and the influence of other risk factors on any increased mortality among the most deprived group. RESULTS Mortality rates at 30, 90 and 365 days were 9.3, 17.4 and 29.0 % in England and 8.3, 16.1 and 27.9 % in Wales. Social deprivation was significantly associated with increased mortality in the most deprived quintile compared with the least deprived quintile at 30, 90 and 365 days in England (OR = 1.187, 1.185 and 1.154, respectively) and at 90 and 365 days in Wales (1.135 and 1.203). There was a little interaction between deprivation and other risk factors influencing 30- and 365-day mortality except for patient age, pre-fracture residence and hospital size. CONCLUSIONS We demonstrated a positive association between social deprivation and increased mortality at 30 days post-admission for hip fracture in both England and Wales that was still evident at 90 and 365 days. We found little influence of other factors on social inequalities in mortality risk at 30 and 365 days post-admission.
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Johansen A, Wakeman R, Boulton C. 48EARLY RETURN TO OWN HOME AFTER HIP FRACTURE IS NOT UNSAFE – EVIDENCE FROM THE NATIONAL HIP FRACTURE DATABASE. Age Ageing 2016. [DOI: 10.1093/ageing/afw030.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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White SM, Moppett IK, Griffiths R, Johansen A, Wakeman R, Boulton C, Plant F, Williams A, Pappenheim K, Majeed A, Currie CT, Grocott MPW. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia 2016; 71:506-14. [DOI: 10.1111/anae.13415] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
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Johansen A, Schirmer H, Nielsen CS, Stubhaug A. Persistent post-surgical pain and signs of nerve injury: the Tromsø Study. Acta Anaesthesiol Scand 2016; 60:380-92. [PMID: 26537886 DOI: 10.1111/aas.12653] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 06/20/2015] [Accepted: 08/19/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The contribution of nerve lesions and neuropathic pain to persistent post-surgical pain (PPSP) is poorly established. The aim of this study was to assess the association between PPSP and symptoms and signs of possible nerve injury in an unselected surgical sample. METHODS Eighty-one individuals with and without persistent pain after surgical procedures, were recruited from a cross-sectional study. Follow-up examination with questionnaires and quantitative sensory testing was performed 15-32 months later (21-64 months after surgery). RESULTS The median rating of maximum pain intensity among individuals with PPSP decreased from numerical rating scale 4/10 at baseline to 2/10 at follow-up, but considerable changes occurred in both directions. Individuals with PPSP at follow-up were significantly more likely to self-report sensory abnormalities than those without PPSP; however, results from sensory testing did not differ significantly between the groups. Self-report of sensory disturbances at the site of surgery was associated with increased warm detection thresholds and tactile pain thresholds. Among individuals with PPSP, 61% had positive findings on sensory testing, suggesting probable neuropathic pain. CONCLUSION In this study, associations between self-reported symptoms and PPSP were stronger than associations between self-reported symptoms and results of psychophysical tests. Fluctuations in pain intensity together with wide ranges for normal variability in sensory functions, hampers detection of significant group differences. Methodological aspects of quantitative sensory testing applied in a mixed clinical sample are discussed.
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Rivers K, Johansen A, Smith F, Hewitt J. Development of an Evidence-Based Checklist to Evaluate Dehydration in Older Patients Admitted to a Bahamian Hospital. ACTA ACUST UNITED AC 2016. [DOI: 10.15761/gimci.1000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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84
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Boulton C, Burgon V, Johansen A, Martin F, Stanley R, Wakeman R, Williams A. 31FALLS AMONG HOSPITAL INPATIENTS USING HIP FRACTURE INCIDENCE TO MONITOR PATIENT SAFETY. Age Ageing 2015. [DOI: 10.1093/ageing/afv106.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Saltvedt I, Sletvold O, Marsh D, Johansen A, Pioli G. S-04: Quality improvement in hip fracture care. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30561-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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86
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Gillespie D, Hood K, Bayer A, Carter B, Duncan D, Espinasse A, Evans M, Nuttall J, Stanton H, Acharjya A, Allen S, Cohen D, Groves S, Francis N, Howe R, Johansen A, Mantzourani E, Thomas-Jones E, Toghill A, Wood F, Wigglesworth N, Wootton M, Butler CC. Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents. Age Ageing 2015; 44:853-60. [PMID: 26104506 DOI: 10.1093/ageing/afv072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/05/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND the risk factors for and frequency of antibiotic prescription and antibiotic-associated diarrhoea (AAD) among care home residents are unknown. AIM to prospectively study frequency and risks for antibiotic prescribing and AAD for care home residents. DESIGN AND SETTING a 12-month prospective cohort study in care homes across South Wales. METHOD antibiotic prescriptions and the development of AAD were recorded on case report forms. We defined AAD as three or more loose stools in a 24-h period occurring within 8 weeks of exposure to an antibiotic. RESULTS we recruited 279 residents from 10 care homes. The incidence of antibiotic prescriptions was 2.16 prescriptions per resident year (95% CI: 1.90-2.46). Antibiotics were less likely to be prescribed to residents from dual-registered homes (OR compared with nursing homes: 0.38, 95% CI: 0.18-0.79). For those who were prescribed antibiotics, the incidence of AAD was 0.57 episodes per resident year (95% CI: 0.41-0.81 episodes). AAD was more likely in residents who were prescribed co-amoxiclav (hazards ratio, HR = 2.08, 95% confidence interval, CI: 1.18-3.66) or routinely used incontinence pads (HR = 2.54, 95% CI: 1.26-5.13) and less likely in residents from residential homes (HR compared with nursing homes: 0.14, 95% CI: 0.06-0.32). CONCLUSION residents of care homes, particularly of nursing homes, are frequently prescribed antibiotics and often experience diarrhoea following such prescriptions. Co-amoxiclav is associated with greater risk of AAD.
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Johansen A, Boulton C, Burgon V, Martin F, Stanley R, Wakeman R, Williams A. P-435: Hip fracture following an inpatient fall: using the National Hip Fracture Database (NHFD) to identify the true scale of this challenge. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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88
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Johansen A, Tsang C, Cromwell D, Boulton C, Wakeman R, Burgon V. P-434: Predicting 30 day mortality after hip fracture: validating the use of National Hip Fracture Database (NHFD) data. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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89
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Johansen A, Kanijo B, Fredheim S, Olsen B, Hertz B, Lauridsen MH, Andersen MLM, Mortensen HB, Svensson J. Prevalence and predictors of severe hypoglycemia in Danish children and adolescents with diabetes. Pediatr Diabetes 2015; 16:354-60. [PMID: 25039921 DOI: 10.1111/pedi.12171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/31/2014] [Accepted: 06/06/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of severe hypoglycemia in Danish children and adolescents with type 1 diabetes and to pinpoint predictors of this acute complication in children on modern treatment modalities. RESEARCH DESIGN AND METHODS The study is based on data from DanDiabKids, a national diabetes register for children and adolescents. The register contains data on patients with type 1 diabetes with an ascertainment rate of 99%. Data from 3320 patients aged 0-18 yr was included in the study period from 1998 to 2009 and analyzed using a negative binomial model. RESULTS One thousand nine hundred and ninety-nine episodes of severe hypoglycemia in 867 patients were registered conferring an overall incidence of severe hypoglycemia of 15.1 [95% confident interval (CI): 13.8; 16.4] per 100 patient years. This remained unchanged during the study period. Duration of diabetes, age and treatment in centers managing less than 100 patients significantly increased the risk of severe hypoglycemia (p < 0.001). Patients on insulin pump therapy had a 42% reduced risk of severe hypoglycemia compared with pen treated patients (p = 0.01). Patients treated with five or more daily insulin injections had a 31% (95% CI: 17; 49) reduced risk of severe hypoglycemia compared to patients on fewer daily injections (p = 0.015). CONCLUSIONS Despite improvements in metabolic control over a decade the prevalence of severe hypoglycemic events remained unchanged. More intensive treatments such as insulin pump therapy and multiple daily injections on a national level seems to be a protective factor for developing severe hypoglycemia up to 2009.
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Griffiths R, White SM, Moppett IK, Parker MJ, Chesser TJS, Costa ML, Johansen A, Wilson H, Timperley AJ. Safety guideline: reducing the risk from cemented hemiarthroplasty for hip fracture 2015: Association of Anaesthetists of Great Britain and Ireland British Orthopaedic Association British Geriatric Society. Anaesthesia 2015; 70:623-6. [PMID: 25866041 PMCID: PMC6681143 DOI: 10.1111/anae.13036] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Abstract
Concise guidelines are presented for the preparation and conduct of anaesthesia and surgery in patients undergoing cemented hemiarthroplasty for hip fracture. The Working Party specifically considered recent publications highlighting complications occurring during the peri‐operative period 1, 2. The advice presented is based on previously published advice and clinical studies.
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Boulton C, Williams A, Johansen A, Wakeman R, Burgon V, Stanley R, Bunning T. Using data to improve care: National Hip Fracture Database next-generation online reporting. Future Hosp J 2015; 2:s8. [PMID: 31098136 PMCID: PMC6460161 DOI: 10.7861/futurehosp.2-2s-s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Boulton C, Williams A, Johansen A, Wakeman R, Burgon V, Stanley R, Bunning T. Using data to improve care: National Hip Fracture Database next-generation online reporting. Future Hosp J 2015. [DOI: 10.7861/futurehosp.2-2-s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fredheim S, Johansen A, Thorsen SU, Kremke B, Nielsen LB, Olsen BS, Lyngsøe L, Sildorf SM, Pipper C, Mortensen HB, Johannesen J, Svensson J. Nationwide reduction in the frequency of severe hypoglycemia by half. Acta Diabetol 2015; 52:591-9. [PMID: 25528006 DOI: 10.1007/s00592-014-0697-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 12/05/2014] [Indexed: 12/23/2022]
Abstract
AIMS To examine contemporary rates of severe hypoglycemia (SH) and identify the effect of predictors of SH in a pediatric type 1 diabetes population. METHODS The national diabetes register provided data on children residing in Denmark from 2008 to 2013 in this register-based population study. Robust Poisson regression models were applied. RESULTS The study population [n = 2,715 (50.9 % boys), mean (SD) age at onset; 8.1 (4.0) years, diabetes duration; 5.6 (4.9) years] comprised 7,390 person-years of data and 561 events of SH. The overall incidence of SH was 7.6 per 100 person-years. The incidence rate peaked with 16.0 per 100 person-years in 2008 reaching a nadir of 4.9 in 2011. Overall, insulin pump reduced the rate of SH with 27 % compared to any pen treatment (P = 0.003). When stratifying pen treatment, premixed insulin increased the rate of SH by 1.9-fold (P = 0.0015) and NPH increased the rate by 1.6-fold (P = 0.003) versus pump treatment, whereas long-acting insulin analogues were comparable with pump treatment (P = 0.1485). We found no association of SH with glycemic control (P > 0.05). CONCLUSIONS A nationwide halving in rates of severe hypoglycemia was observed during the study period independent of the prevailing average HbA1c level. Changes in diabetes care and successful educational programs may have influenced the lower incidence rate of severe hypoglycemia.
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Bonnesen CT, Plauborg R, Denbæk AM, Due P, Johansen A. Process evaluation of a multi-component intervention to reduce infectious diseases and improve hygiene and well-being among school children: the Hi Five study. HEALTH EDUCATION RESEARCH 2015; 30:497-512. [PMID: 25964369 DOI: 10.1093/her/cyv019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 04/17/2015] [Indexed: 06/04/2023]
Abstract
The Hi Five study was a three-armed cluster randomized controlled trial designed to reduce infections and improve hygiene and well-being among pupils. Participating schools (n = 43) were randomized into either control (n = 15) or one of two intervention groups (n = 28). The intervention consisted of three components: (i) a curriculum (ii) mandatory daily hand washing before lunch (iii) extra cleaning of school toilets. The aim of this study was to evaluate the implementation and to identify challenges to program implementation. Several data sources were used, including observations of school toilets, semi-structured interviews with school coordinators (n = 4), focus groups with pupils (n = 6) and teachers (n = 5), and questionnaires among pupils (n = 5440), teachers (n = 387) and school coordinators (n = 28). This study indicates that the curriculum was successfully implemented at most schools, and that teachers and pupils reacted positively to this part of the intervention. However, daily hand washing before lunch seems to be difficult to implement. Overall, the implementation process was affected by several factors such as poor sanitary facilities, lack of time and prioritization and objections against the increasing tendency to place the responsibility for child-rearing tasks on schools. This study reveals the strong and weak parts of the Hi Five study and can guide program improvement.
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Protty MB, Aithal S, Hickey B, Pettit R, Johansen A. 47 * THE DEBATE OVER MECHANICAL THROMBOPROPHYLAXIS AFTER HIP FRACTURE: TIME TO CHOOSE SIDES. Age Ageing 2015. [DOI: 10.1093/ageing/afv032.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Protty MB, Aithal S, Hickey B, Pettit R, Johansen A. Mechanical prophylaxis after hip fracture: what is the risk of deep vein thrombosis? A retrospective observational study. BMJ Open 2015; 5:e006956. [PMID: 25678543 PMCID: PMC4330328 DOI: 10.1136/bmjopen-2014-006956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Graduated compression stockings carry a potential risk of pressure, vascular and other complications. Current understanding of deep vein thrombosis (DVT) risk leaves it uncertain whether patients with hip fracture should wear stockings on both legs. OBJECTIVES To determine the association between the side of the hip fracture and the subsequent occurrence of symptomatic lower limb DVT. SETTING Single tertiary trauma centre, Wales. PARTICIPANTS All 3657 patients presenting with hip fracture between 2007 and 2013 were identified from our unit's National Hip Fracture Database. We excluded 404 patients (11.0%) resident outside our catchment area, leaving a total of 3253. Median age was 83 years (±12.4). PRIMARY/SECONDARY OUTCOME MEASURES We cross-linked patient details with Medical Physics records, to identify 634 (19.5%) who had undergone one or more lower-limb Doppler-ultrasound scans at some point during the study period. The distribution rates of DVT were calculated from this resulting data set. RESULTS Many of the total 634 scans were unrelated to the hip fracture, including 225 (35.5%) performed prior to the fracture. We calculated a baseline rate of DVT of 3.7/1000 patients per year, for the 3-month period immediately before the hip fracture. Scans performed following hip fracture showed DVT risk to be highest in the 3-month period after fracture (35.7/1000 patients per year). This resulted from a six-fold increase in DVTs on the side of the fracture (29.5/1000 patients per year, p<0.01). We found only a very small non-significant increase in DVT on the contralateral leg (6.1/1000 patients per year) CONCLUSIONS The additional risk of DVT after hip fracture is essentially confined to the fractured limb-the leg to which it is most painful to apply stockings. There appears little justification for the cost and potential risk of using stockings on the contralateral leg.
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Johansen A, Neuberger J, Boulton C, Williams A, Plant F, Wakeman R, Cromwell D, Wilson H, Moran C. 48 * USING THE NATIONAL HIP FRACTURE DATABASE (NHFD) TO PROFILE THE IMPACT OF HIP FRACTURE ON THE NHS. Age Ageing 2014. [DOI: 10.1093/ageing/afu126.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Johansen A, Newall F, Jones S. Evaluation of a ECLS nurse-led anticoagulation protocol: A before & after study. Aust Crit Care 2014. [DOI: 10.1016/j.aucc.2013.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Krishnan M, Beck S, Havelock W, Eeles E, Hubbard RE, Johansen A. Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results. Age Ageing 2014; 43:122-6. [PMID: 23832264 DOI: 10.1093/ageing/aft084] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION hip fracture is expensive in terms of mortality, hospital length of stay (LOS) and consequences for independence. Poor outcome reflects the vulnerability of patients who typically sustain this injury, but the impact of different comorbidities and impairments is complex to understand. We consider this in a prospective cohort study designed to examine how a patients' frailty index (FI) predicts outcome. METHODOLOGY consecutive patients with low trauma hip fracture were assessed, excluding only those unfit for surgery. Comprehensive Geriatric Assessment (CGA) findings were used to derive a FI for each patient, which was examined alongside other assessment and outcome data from our National Hip Fracture Database (NHFD) submission for these individuals. RESULTS we describe 178 patients; mean age 81 years, 73.5% female. The mean FI was 0.34 (SD = 0.16), and logistic regression identified abbreviated mental test score and FI as the strongest predictors of poor outcome. When patients were stratified by FI, 56 (31.5%) were in the low-frailty group (FI ≤0.25), 58 (32.5%) in intermediate (FI >0.25-0.4), and 64 (36%) in the high-FI group (FI >0.4). All the patients in the low-FI group returned to their original residence within a mean of 21.6 days. The mean LOS for the intermediate group was 36.3 days compared with 67.8 days in the high-FI group (P < 0.01) while 30-day mortality was 3.4% for the intermediate group compared with 17.2% for the high-FI group (P < 0.001). CONCLUSIONS individual CGA findings proved disappointing as outcome predictors, while FI turned out to be a better predictor of mortality, 30-day residence and length of inpatient stay.
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Krishnan M, Beck S, Cowen O, Hughes M, Havelock W, Eeles E, Hubbard R, Johansen A, Michael A, Teo PJ, Fisher G, Duggan E, Donoghue O, Savva G, Cronin H, Kenny R, Finucane C, Bhutta T, Musarrat K, Lakhani D, Musarrat K, Bhutta T, Kumar M, Bridge D, Patel A, Lakhani D, Marchetti R, Bullman N, Srikusalankul W, Varendran R, Anderson-Ranberg K, Ryg J, Vestergaard S, Eriksen ML, Masud T. Falls, fracture and trauma. Age Ageing 2013. [DOI: 10.1093/ageing/aft101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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