| 1. |
- Al-Ani, Amer, et al.
(författare)
-
Low bone mineral density and fat free mass in young and middle-aged patients with a femoral neck fracture
- 2015
-
Ingår i: European Journal of Clinical Investigation. - : Wiley. - 0014-2972 .- 1365-2362. ; 45:8, s. 800-806
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundReduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture.Materials and methodsAltogether, 185 patients with femoral neck fracture aged 20–69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered.ResultsNinety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (< 50 years), 27% had a Z-score of BMD ≤ −2 SD. More than half of the middle-aged patients (50–69 years) had osteopenia, that is T-score −1 to −2·5, and 35% had osteoporosis, that is T-score < −2·5, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0·702, 0·740 vs. 0·803 g/cm2 (P = 0·03), and a median FFMI of 15·9, 17·7 vs. 17·5 kg/m2 (P < 0·001), respectively. FFMI < 10th percentile of an age- and gender-matched reference population was observed in one-third.ConclusionsA majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.
|
|
| 2. |
- Al-Ani, Amer N., et al.
(författare)
-
Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? : A Prospective Study of 246 Patients
- 2010
-
Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 91:1, s. 51-57
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture. Design: Population-based cohort study. Setting: A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals. Participants: Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture. Interventions: Not applicable. Main Outcome Measure: Walking ability and ADLs index at 4-month and 12-month follow-up. Results: Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83: confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; Cl, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; Cl, 1.44-19.65: P=.012) and ADLs index before fracture (OR=2.5; Cl. 1.8-3.5: P<.001), while type of surgery was not (P=.376). Conclusions: Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.
|
|
| 3. |
|
|
| 4. |
- Cederholm, Tommy, et al.
(författare)
-
Nutritional treatment of bone fracture.
- 2005
-
Ingår i: Curr Opin Clin Nutr Metab Care. - : Ovid Technologies (Wolters Kluwer Health). - 1363-1950. ; 8:4, s. 377-81
-
Tidskriftsartikel (refereegranskat)
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
- Gillespie, Ulrika, et al.
(författare)
-
Perceived value of ward-based pharmacists from the perspective of physicians and nurses
- 2012
-
Ingår i: International Journal of Clinical Pharmacy. - : Springer. - 2210-7703 .- 2210-7711. ; 34:1, s. 127-135
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundClinical pharmacy in a hospital setting is relatively new in Sweden. Its recent introduction at the University Hospital in Uppsala has provided an opportunity for evaluation by other relevant professionals of the integration of clinical pharmacists into the health-care team.ObjectivesThe objectives of this descriptive study were to evaluate the perceived value of wardbased clinical pharmacists from the perspective of hospital based physicians and nurses and to identify potential advantages and disadvantages related to the new inter professional collaboration. Another objective was to evaluate the experiences of general practitioners on receiving medication reports from wardbased clinical pharmacists.SettingTwo acute internal medicine wards at the University Hospital in Uppsala, where a previously reported randomized controlled trial investigating the effects of ward based clinical pharmacists on re-visits to hospital was undertaken.MethodsData were collected by questionnaires containing closed- and openended questions. The questionnaires were distributed during the nine-month study period of the randomized controlled trial by an independent researcher to 29 hospital-based physicians and 44 nurses on the study wards and to 21 general practitioners who had received two or more medication reports. Answers were analysed descriptively for the closedended questions and by content analysis for the open-ended questions.Main outcome measure The main outcome measure was the physicians’ and nurses’ level of satisfaction with the new collaboration with clinical pharmacists, from a hospital and primary care perspective.ResultsSeventy-six percent of the hospital-based physicians and 81% of the nurses completed the questionnaire. Ninety-five percent of the physicians and 93% of the nurses were very satisfied with the collaboration. Out of the 17 general practitioners (81%) that completed the questionnaire 71% wanted to continue to receive medication reports in a similar way in the future. Increased patient safety and improvements in patients’ drug therapy were the main advantages stated by all three groups of respondents. Eighteen percent of the hospital-based physicians and 21% of the nurses thought that the collaboration had been time-consuming to certain or to a high extent.Conclusions The majority of the respondents, both GPs and hospital based physicians and nurses, were satisfied with the new collaboration with the ward based pharmacists and perceived that the quality of the patients’ drug therapy and drug-related patient safety had increased.
|
|
| 10. |
- Hedström, Margareta
(författare)
-
Effects of anabolic hormone treatment in elderly patients with hip fracture
- 2001
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The principal aims of these studies were to investigate the status of hip fracture patients regarding BMD, body composition and some nutritional factors at the time of the fracture and changes in these variables during the postoperative period. A further aim was to determine whether anabolic hormone treatment could had any beneficial effects after a hip fracture. A retrospective study was conducted on 437 consecutive patients with femoral neck fractures. The rate of deep wound infection was low, 3%, indicating that general prophylactic antibiotic treatment should not be recommended but might be considered when the operation time is prolonged. The mortality rate was more than twice the expected for age, 24% during the first year. Besides senile dementia, high age, male gender, was a low serum albumin on admission good predictors of mortality during the first year after a hip fracture. Twenty-five consecutive patients, with a femoral neck fracture underwent quantitative CT (QCT) at the distal femur and proximal tibia, with mostly trabecular bone, and at the middle femur, with mostly cortical bone. There was no difference in bone mineral density (BMD) between the fractured and the uninjured leg at the time of fracture. Six months postoperatively there was a loss of BMD bilaterally in the trabecular bone, most markedly on the fractured side. Muscle volume decreased on the fractured side but increased on the uninjured side during the six months. Circulating IGF-I levels generally correlate well with GH secretion in healthy well-nourished patients with normal GH responsiveness. Twenty-three hip fracture patients (mean age 80) and 20 coxarthrotic patients (mean age 77) who underwent a total hip replacement were studied consecutively. The hip fracture patients had lower total body mass, BMD (DXA) and IGF-I levels than the coxarthrotic group on admission. A catabolic state seems to develop after a hip fracture, with a significant decrease in lean body mass and BMD after 6 months. Body weight and IGF-I have influence on BMD. Since GH and anabolic steroids have been used to promote anabolism in a variety of clinical catabolic situations, we evaluated the effects of hormonal intervention with GH or anabolic steroids after a hip fracture in two studies. A one-year randomised study with the anabolic steroid -nandrolone decanoate, active vitamin D (alphacalcidol) and calcium or calcium alone was performed on 63 women with hip fractures. The treatment Was well tolerated, with few adverse events. QCT measurements showed beneficial effects of anabolic steroids and alphacalcidol on both bone and muscle volume during the first 12 months. Gait speed and Harris' hip score were significantly better in the anabolic group than in the control group after 6 and 12 months. A double-blind placebo-controlled 12-week study with s.c. daily injections of GH or placebo for 3-4 weeks was performed, on 20 women and men with hip fractures. GH treatment increased the IGF-I levels. The GH treatment had positive effects on total bone mineral content (BMC) (DXA) and on BMC at the distal femur in both legs (QCT) at the end of treatment and 2 months after termination of treatment. GH also preserved lean body mass during treatment without serious side-effects. In conclusion, anabolic hormones seem to have a positive effect on the catabolic state after a hip fracture.
|
|
