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Biomedical subjects

I D Cameron

Publications and source records attributed to I D Cameron.

At least 37 records · Page 2Linked to original sources
PubMed2001

Hip protectors in aged-care facilities: a randomized trial of use by individual higher-risk residents.

OBJECTIVES: To investigate the effect of use of external hip protectors on occurrence of hip fracture. DESIGN: Randomized controlled trial, with randomization at the individual level. SETTING: residential aged-care facilities in urban areas of New South Wales, Australia. PARTICIPANTS: 174 women, aged 75 years and older, who had had two or more falls or one fall requiring hospital admission in the previous 3 months, and who lived in hostels or nursing homes. Eighty-six subjects were in the intervention group and 88 in the control group. INTERVENTION: Use of external hip protectors and encouragement by nurses to use the protectors. MEASUREMENTS: Follow-up visits at approximately 2 weeks and 2, 10 and 18 months to determine falls and fall injury (including hip fracture); we also measured adherence to hip protector use. RESULTS: The mean age of participants was 85; they lived in 32 different aged-care facilities, two-thirds of which were nursing homes. Intervention and control groups had similar baseline characteristics, with a mean Barthel index of 58 at enrollment and a mean Short Portable Mental Status Questionnaire score of six errors, indicating severe disability and major cognitive impairment. During follow-up, a mean of 4.6 falls per person occurred. There was no difference in mortality, with 28 deaths in each group. Eight hip fractures occurred in the intervention group and seven in the control group (hazard ratio 1.46; 95% confidence interval 0.53-4.51). No hip fractures occurred when hip protectors were being worn as directed. Adherence was about 57% over the duration of the study and hip protectors were worn at the time of 54% of falls in the intervention group. Adherence varied markedly between institutions, but the greatest was about 80%. CONCLUSION: Hip protectors were not effective in reducing the incidence of hip fractures in this study, but because of low statistical power, a reduction in risk of hip fracture of up to 50% may not have been detected. There was limited adherence with their use, resulting in a large number of falls occurring without hip protectors in place. All hip fractures in the intervention group occurred when hip protectors were not being used.

Aged↗
PubMed2000

Quality of life related to fear of falling and hip fracture in older women: a time trade off study.

OBJECTIVE: To estimate the utility (preference for health) associated with hip fracture and fear of falling among older women. DESIGN: Quality of life survey with the time trade off technique. The technique derives an estimate of preference for health states by finding the point at which respondents show no preference between a longer but lower quality of life and a shorter time in full health. SETTING: A randomised trial of external hip protectors for older women at risk of hip fracture. PARTICIPANTS: 194 women aged >/= 75 years enrolled in the randomised controlled trial or who were eligible for the trial but refused completed a quality of life interview face to face. OUTCOME MEASURES: Respondents were asked to rate their own health by using the Euroqol instrument and then rate three health states (fear of falling, a "good" hip fracture, and a "bad" hip fracture) by using time trade off technique. RESULTS: On an interval scale between 0 (death) and 1 (full health), a "bad" hip fracture (which results in admission to a nursing home) was valued at 0.05; a "good" hip fracture (maintaining independent living in the community) 0.31, and fear of falling 0.67. Of women surveyed, 80% would rather be dead (utility=0) than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home. The differences in mean utility weights between the trial groups and the refusers were not significant. A test-retest study on 36 women found that the results were reliable with correlation coefficients within classes ranging from 0.61 to 0.88. CONCLUSIONS: Among older women who have exceeded average life expectancy, quality of life is profoundly threatened by falls and hip fractures. Older women place a very high marginal value on their health. Any loss of ability to live independently in the community has a considerable detrimental effect on their quality of life.

Accidental Falls↗
PubMed2000

Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures.

BACKGROUND: Hip fracture is a major cause of morbidity in older people and its impact, both on the individual and to society, is substantial. OBJECTIVES: To examine the effects of co-ordinated multidisciplinary inpatient rehabilitation, compared with usual orthopaedic care, for older patients with hip fracture. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline (up to April 1998), and reference lists of published papers and books. We also contacted colleagues and trialists. SELECTION CRITERIA: Randomised and quasi-randomised trials of postsurgical care using specialised rehabilitation of mainly older patients (aged 65 years or over) with hip fracture. DATA COLLECTION AND ANALYSIS: Trial assignment to included, excluded and awaiting assessment categories, was by consensus. Two reviewers independently assessed trial quality and extracted data. Limited additional information was sought from most trialists. As well as pooling of data from primary outcomes, supplementary analyses were performed to combine clinically relevant outcomes and investigate possible explanatory factors. MAIN RESULTS: In this minor update, one new trial is identified and has been placed in "studies awaiting assessment". Of another three trials previously pending assessment, one has now been excluded. The five included trials involved 1068 patients. The combined outcomes of death or requiring institutional care at final follow-up showed no significant difference between intervention and control groups (Peto odds ratio 0.92; 95% confidence interval 0.71 to 1.18). There was considerable heterogeneity in length of stay and cost data. Using death and deterioration in function as a further combined outcome variable yielded a Peto odds ratio of 0.83 (95% confidence interval 0.64 to 1. 07). This should be interpreted with caution due to heterogeneity. No quality of life measures were reported and the two trials investigating carer burden showed no detrimental effect from the intervention. The review update did not result in any new data for these outcomes. REVIEWER'S CONCLUSIONS: The trials reviewed had different aims, interventions and outcomes. As a consequence, results were heterogeneous and the question of effectiveness of different types of co-ordinated inpatient rehabilitation after hip fracture cannot be answered conclusively. There is a trend to effectiveness when combined outcome variables (death and institutional care, death and deterioration in function) are considered. Future trials of postsurgical care involving inpatient rehabilitation, or other models such as 'early supported discharge' and 'hospital at home' schemes, should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than attempt to evaluate its components.

Aged↗
PubMed2000

Lifestyle factors affecting bone ultrasonometry of the calcaneus in Japanese women.

Ultrasonometry is increasingly used to assess bone characteristics. A group of 1412 women with a mean age of 57 years attended a screening examination in a Japanese city. Seventy-four percent of participants were postmenopausal. Broadband ultrasound attenuation (BUA), speed of sound (SOS), and Stiffness index (SI) of the calcaneus were measured; subjects also completed a questionnaire examining lifestyle factors; anthropometric data were recorded. Analysis showed that the strongest predictors of decreased BUA, SOS, and SI were increased age and menopausal status. Higher body mass index and current participation in exercise or sports were significant predictors of increased BUA, SOS, and SI in a multivariate model. Higher calcium intake predicted increased BUA (P = 0.004) and missing meals predicted a lower SOS (P = 0.019). This study suggests that dietary factors as well as physical activity influence bone characteristics assessed by QUS. QUS may be a suitable technique to assess the effect of lifestyle changes on bone.

Adult↗
PubMed2000

Hip protectors improve falls self-efficacy.

OBJECTIVES: To investigate the effect of use of external hip protectors on subjects' fear of falling and falls self-efficacy (belief in their own ability to avoid falling). DESIGN: Randomized controlled trial. SETTING: Aged-care health services in Sydney, Australia. PARTICIPANTS: 131 women aged 75 years or older, who had two or more falls or one fall requiring hospital admission in the previous year and who live at home. Sixty-one subjects were in the intervention group and 70 in the control group. INTERVENTION: Use of external hip protectors and encouragement to use the protectors by an adherence nurse. MEASUREMENTS: At the time of enrolment into a wider study examining the effect of hip protectors on hip fractures, participants recruited at home completed an assessment of fear of falling and falls efficacy as measured by the Falls Efficacy Scale and the Modified Falls Efficacy Scale. At 4-month follow-up, these scales were readministered by an observer who was not aware of the allocation of the participant to intervention or control groups. RESULTS: Fear of falling and falls self-efficacy, as measured by the Falls Efficacy and Modified Falls Efficacy Scales, were similar at baseline in both groups. Fear of falling was present at follow-up in 43% of subjects using hip protectors and 57% of the control group (chi2 = 2.58, P = 0.11). Hip protector users had greater improvement in falls self-efficacy at follow-up as measured by the Falls Efficacy Scale (t = 2.44, P = 0.016) and the Modified Falls Efficacy Scale (t = 2.08, P = 0.039). CONCLUSION: Hip protectors improve falls self-efficacy. As users of hip protectors feel more confident that they can complete tasks safely, they may become more physically active and require less assistance with activities of daily living.

Accidental Falls↗
PubMed2000

Mortality and morbidity after hip fracture: can evidence based clinical pathways make a difference?

OBJECTIVE: To evaluate whether evidence based clinical pathways for acute management of hip fracture have an effect on patient care, short term mortality, or residential status. METHODS: Observational cohort study comparing management, as determined by medical record review, and outcomes, as determined by telephone followup 4 months post-fracture, before (n = 455) and after (n = 481) clinical pathway implementation within pathway hospitals as well as between patients admitted to hospitals with (n = 2) and without (n = 4) pathways. RESULTS: Mean age was 82 years, 80% were women and 30% were admitted from nursing homes. Significant improvement in best practice as recommended by evidence based clinical guidelines was evident in pathway hospitals for most components of care. However, compliance was variable and nonpathway hospitals performed better for some (use of spinal anesthesia, avoidance of urinary catheters). After adjusting for potential confounders, no difference was found in 4 month mortality between the pathway (17.6%) and non-pathway (16.8%) patients (OR 0.8, 95% CI 0.5-1.5). There was a nonsignificant reduction in median acute care hospital length of stay of 1 day (p = 0.200) for non-nursing home patients and a significant reduction of 1 day (p = 0.038) for nursing home patients in the pathway hospitals. There was a nonsignificant decrease in admission rates for new patients to nursing homes in pathway hospitals (18.5%) compared to non-pathway hospitals (24.3%) (OR 0.5, 95% CI 0.3-1.1). CONCLUSION: Clinical pathways were associated with increased use of evidence based best practice, some reduction in acute hospital length of stay, but no significant effect on 4 month mortality or residential status. Their development and maintenance were resource intensive and further work on the implementation of evidence based guidelines is needed to determine whether they can influence patient outcomes.

Aged↗
PubMed1999

How best to fix a broken hip. Fractured Neck of Femur Health Outcomes Project Team.

OBJECTIVES: To develop evidence-based guidelines for the treatment of proximal femoral fractures to optimise functional outcome while minimising length of stay in hospital. DATA SOURCES: Systematic literature search of MEDLINE and CINAHL computer databases, bibliographies, and current contents of key journals for 1966-1995. STUDY SELECTION: English-language randomised controlled trials of all aspects of acute-care hospital treatment of proximal femoral fracture among subjects aged 50 years and over with proximal femoral fractures not due to metastatic disease. DATA EXTRACTION: Two independent reviewers, blinded to authors, institution and study results, followed a standard Cochrane Collaboration protocol and assessed study quality and treatment conclusions. When necessary, a third review was performed to reach consensus. RESULTS: Of the 120 articles published between 1966 and December 1995, 97 met the inclusion criteria. Fifteen clinical interventions were reviewed. Five were supported by National Health and Medical Research Council (NHMRC) level I evidence (prophylactic anticoagulants, prophylactic antibiotics, regional anaesthesia, pressure-relieving mattresses, and internal surgical fixation), two had no supporting randomised controlled trial evidence (time to surgery, time to mobilisation after surgery) and the remainder were classified as having Level II evidence. A review of current practice (1993-94) identified wide variability in these interventions across five acute-care hospitals in the Northern Sydney Area Health Service. CONCLUSIONS: Randomised controlled trial evidence (NHMRC Levels I and II) exists for many, but not all, aspects of hip fracture treatment. There is a need for changes to be made to some aspects of practice in accordance with evidence-based guidelines.

Anesthesia, Conduction↗
PubMed1997

Elder abuse: prevalence, intervention and outcomes in patients referred to four Aged Care Assessment Teams.

OBJECTIVE: To establish the prevalence and patterns of elder abuse, and outcomes of intervention, among patients of four Australian Aged Care Assessment Teams. DESIGN: Descriptive study, with victims identified retrospectively from medical records for the first three months, and prospectively form the remaining nine months, of 1994. SETTING: Four area-based Aged Care Assessment Teams in three States. PATIENTS: Referred patients over 65 years of age who lived in private homes and who met a predetermined definition of elder abuse. MAIN OUTCOME MEASURES: Prevalence of abuse, types of abuse and the effect of interventions. RESULTS: The overall prevalence of elder abuse in the study population was 1.2% (95% CI, 0.4%-2.0%). The rate identified retrospectively was double that identified prospectively. Psychological abuse was the most common form of abuse detected. Patterns of abuse were identified and related to psychopathology of the abuser (30%), dependency of the older person and carer stress (25%), domestic violence (19%), carer abuse (18%) and financial dependency (8%). Interventions and outcomes varied according to the pattern of abuse. CONCLUSION: Our findings on the factors causing elder abuse are consistent with those identified in previous Australian studies. The prevalence of elder abuse detected in this study was lower than that in other Australian and overseas studies. A more uniform approach to detection is necessary, which may be aided by improved identification and management techniques, and appropriate training of health professionals in aged care services in case definition, interventions and management.

Aged↗
PubMed1994

Heat exhaustion in The Sun-Herald City to Surf fun run.

OBJECTIVE: To investigate the relationship between motivational factors and physical and biological causes of heat exhaustion in fun run entrants. DESIGN AND SETTING: Case-control study, The Sun-Herald City to Surf fun runs in Sydney in 1991 and 1992. PARTICIPANTS: There were 63,732 race entrants who completed the run and received a finishing time; 79 runners with heat exhaustion and 310 age, sex and performance matched controls were enrolled in the study. MAIN OUTCOME MEASURE: A diagnosis of heat exhaustion was made if a runner collapsed and, when first receiving medical care, had a rectal temperature of 38 degrees C or higher. RESULTS: Two readily identifiable groups of runners were at high risk of heat exhaustion--accomplished non-élite (preferred) runners and runners of good ability (Group A). The attack rate was highest among accomplished non-élite runners, but a combination of a relatively high rate and the large number of entrants in Group A runners accounted for most cases. Four major risk factors for heat exhaustion were identified: motivation to exceed previous performance targets; failure to drink fluids during the run; failure of trained runners to acclimatise for the race by training in the warmer parts of the day; and previous history of heat exhaustion. CONCLUSION: Information from this investigation will enable more effective targeting of educational prevention programs in The Sun-Herald City to Surf fun run and provide baseline data for monitoring the effectiveness of these programs to modify high risk behaviour by participants.

Adolescent↗
PubMed1994

Cost effectiveness of accelerated rehabilitation after proximal femoral fracture.

A randomised controlled trial comparing an accelerated rehabilitation program after proximal femoral fracture with conventional care and rehabilitation was conducted with 252 elderly patients treated at an Australian general hospital in 1989/1990. This paper presents a cost-effectiveness analysis of the accelerated rehabilitation program. The measure of cost was all direct costs of treatment and subsequent care (medical and non-medical) incurred during the 4 months after fracture. Effectiveness was defined as whether the patient returned to semi-independent living; or if moderately or severely disabled prior to the fracture to the premorbid level of physical independence. The cost for treatment up to 4 months after fracture was estimated at A$ 10,600 per accelerated rehabilitation patient and A$ 12,800 per conventional care patient (1990 Australian dollars, A$). Thus, accelerated rehabilitation releases resources equivalent to approximately 17% of costs for treatment per patient. When cost effectiveness is considered, the potential cost savings rise to 38% per recovered patient.

Activities of Daily Living↗
PubMed1992

Patterns of elder abuse.

OBJECTIVE: To establish the rate of occurrence and patterns of elder abuse, and outcomes of intervention, in an Australian population. DESIGN: Retrospective review of medical records over a 12-month period from July 1990 to June 1991. SETTING: An area-based geriatric and rehabilitation service attached to a district hospital. PATIENTS: Referred patients over 65 years of age, who lived in private homes and who met a predetermined definition of elder abuse. RESULTS: The rate of occurrence of elder abuse in the study population was 4.6%, with 29 cases of psychological abuse, 25 cases of physical abuse, 16 cases of neglect, and 13 cases of material/financial abuse. Patterns of abuse were identified and related to dependency of the older person (42%), psychopathology of the abuser (37%), family violence (14%), and carer stress (5%). Interventions and outcomes varied according to the pattern of abuse. CONCLUSION: The rate of occurrence and patterns of abuse of the elderly have been established for the first time in an Australian population. Intervention aimed at reducing the impact of elder abuse is effective, and should be tailored to the pattern of abuse that is occurring.

Aged↗