Hornsby Ku ring gai Health Service

Hornsby, Australia

Hornsby Ku ring gai Health Service

Hornsby, Australia
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Jones G.R.D.,St Vincents Hospital | Jones G.R.D.,University of New South Wales | Barker G.,Hornsby Ku ring gai Health Service | Goodall I.,Austin Health | And 3 more authors.
Medical Journal of Australia | Year: 2011

• An international consensus statement recommends that dual reporting of haemoglobin A1c (HbA1c) levels - in the current units (percentage) and Système International (SI) units (mmol/ mol) - be used as an interim measure for a 2-year transition period before progressing towards the use of SI units only. • This recommendation is supported by the Australasian Association of Clinical Biochemists, the Australian Diabetes Educators Association, the Australian Diabetes Society and the Royal College of Pathologists of Australasia. • The SI units are a true measure of HbA1c and remove potential confusion between HbA1c values and blood glucose values.


PubMed | University of New South Wales, The George Institute for Global Health, Falls and Balance Research Group and Hornsby Ku ring gai Health Service
Type: Journal Article | Journal: Age and ageing | Year: 2014

frail older people have a high risk of falling.assess the effect of a frailty intervention on risk factors for falls and fall rates in frail older people.randomised controlled trial.241 community-dwelling people aged 70+ without severe cognitive impairment who met the Cardiovascular Health Study frailty definition.multifactorial, interdisciplinary intervention targeting frailty characteristics with an individualised home exercise programme prescribed in 10 home visits from a physiotherapist and interdisciplinary management of medical, psychological and social problems.risk factors for falls were measured using the Physiological Profile Assessment (PPA) and mobility measures at 12 months by a blinded assessor. Falls were monitored with calendars.participants had a mean (SD) age of 83.3 (5.9) years, 68% were women and 216 (90%) completed the study. After 12 months the intervention group had significantly better performance than the control group, after controlling for baseline values, in the PPA components of quadriceps strength (between-group difference 1.84 kg, 95% CI 0.17-3.51, P = 0.03) and body sway (-90.63 mm, 95% CI -168.6 to -12.6, P = 0.02), short physical performance battery (1.58, 95% CI 1.02-2.14, P 0.001) and 4 m walk (0.06 m/s 95% CI 0.01-0.10, P = 0.02) with a trend toward a better total PPA score (-0.40, 95% CI -0.83-0.04, P = 0.07) but no difference in fall rates (incidence rate ratio 1.12, 95% CI 0.78-1.63, P = 0.53).the intervention improved performance on risk factors for falls but did not reduce the rate of falls.ACTRN12608000250336.


Fairhall N.,University of Sydney | Sherrington C.,The George Institute for Global Health | Lord S.R.,Falls and Balance Research Group | Kurrle S.E.,Hornsby Ku ring gai Health Service | And 6 more authors.
Age and Ageing | Year: 2014

Background: frail older people have a high risk of falling.Objective: assess the effect of a frailty intervention on risk factors for falls and fall rates in frail older people.Design: randomised controlled trial.Participants: 241 community-dwelling people aged 70+ without severe cognitive impairment who met the Cardiovascular Health Study frailty definition.Intervention: multifactorial, interdisciplinary intervention targeting frailty characteristics with an individualised home exercise programme prescribed in 10 home visits from a physiotherapist and interdisciplinary management of medical, psychological and social problems.Measurements: risk factors for falls were measured using the Physiological Profile Assessment (PPA) and mobility measures at 12 months by a blinded assessor. Falls were monitored with calendars.Results: participants had a mean (SD) age of 83.3 (5.9) years, 68% were women and 216 (90%) completed the study. After 12 months the intervention group had significantly better performance than the control group, after controlling for baseline values, in the PPA components of quadriceps strength (between-group difference 1.84 kg, 95% CI 0.17-3.51, P = 0.03) and body sway (-90.63 mm, 95% CI -168.6 to -12.6, P = 0.02), short physical performance battery (1.58, 95% CI 1.02-2.14, P ≤ 0.001) and 4 m walk (0.06 m/s 95% CI 0.01-0.10, P = 0.02) with a trend toward a better total PPA score (-0.40, 95% CI -0.83-0.04, P = 0.07) but no difference in fall rates (incidence rate ratio 1.12, 95% CI 0.78-1.63, P = 0.53).Conclusion: the intervention improved performance on risk factors for falls but did not reduce the rate of falls. © The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.


Koczy P.,Robert Bosch GmbH | Becker C.,Robert Bosch GmbH | Rapp K.,Robert Bosch GmbH | Rapp K.,University of Ulm | And 9 more authors.
Journal of the American Geriatrics Society | Year: 2011

Objective: To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes. Design: Cluster-randomized controlled trial. Setting: Forty-five nursing homes in Germany. Participants: Three hundred thirty-three residents who were being restrained at the start of the intervention. Intervention: Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used, the adverse effects, and alternatives to their use. Technical aids, such as hip protectors and sensor mats, were provided. The training was designed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints. Measurements: The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention. Secondary outcomes were partial reductions in restraint use, percentage of fallers, number of psychoactive drugs, and occurrence of behavioral symptoms. Results: The probability of being unrestrained in the intervention group (IG) was more than twice that in the control group (CG) at the end of the study (odds ratio=2.16, 95% confidence interval=1.05-4.46). A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG. No negative effect was observed regarding medication or behavioral symptoms. The percentage of fallers was higher in the IG. Conclusion: The intervention reduced restraint use without a significant increase in falling, behavioral symptoms, or medication. © 2011 The American Geriatrics Society.


Cameron I.D.,University of Sydney | Kurrle S.,University of Sydney | Quine S.,University of Sydney | Sambrook P.,Royal North Shore Hospital | And 6 more authors.
Osteoporosis International | Year: 2011

Summary: For people at high risk of hip fracture living in community settings, providing hip protectors at no cost increased adherence, but the additional effect of an educational programme was limited. Overall, the level of adherence was modest. Introduction: The objective of the study was to increase adherence with hip protector use by older people at high risk of hip fracture. The study included two randomised controlled trials with 308 older people recruited from three hospital rehabilitation wards and 171 older people recruited from the community. Methods: Participants were randomised into three groups. The control group received a brochure about hip protectors. The no cost group were fitted with free hip protectors and asked to use them. The combined group received free hip protectors and education sessions about their use. Adherence with the use of hip protectors at 3 and 6 months after recruitment was measured. Secondary outcomes were falls, fractures and hospitalisations. Results: Very few participants in the two control groups bought a hip protector. Overall adherence in the four intervention groups was modest, but higher in the community recruitment setting (49%) than in the hospital recruitment setting (36%) at 6 months. In the community recruitment group, at 3 months of follow-up, a significantly higher number of participants in the combined group (62%) were wearing hip protectors compared to the no cost group (43%, p=0.04). Five hip fractures occurred during the study, with four sustained whilst not wearing the hip protectors. Conclusion: Providing hip protectors at no cost to community living older people at high risk of hip fractures modestly increases initial acceptance and adherence with hip protector use. Additional education may further increase hip protector use in people living in the community in the short term. © 2010 International Osteoporosis Foundation and National Osteoporosis Foundation.


Cameron I.D.,University of Sydney | Fairhall N.,University of Sydney | Langron C.,Hornsby Ku ring gai Health Service | Lockwood K.,University of Sydney | And 5 more authors.
BMC Medicine | Year: 2013

Background: Frailty is a well known and accepted term to clinicians working with older people. The study aim was to determine whether an intervention could reduce frailty and improve mobility.Methods: We conducted a single center, randomized, controlled trial among older people who were frail in Sydney, Australia. One group received an intervention targeting the identified characteristics of frailty, whereas the comparison group received the usual health care and support services. Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry. The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria, and mobility as assessed by the Short Physical Performance Battery. Secondary outcome measures included disability, depressive symptoms and health-related quality of life.Results: A total of 216 participants (90%) completed the study. Overall, 68% of participants were women and the mean age was 83.3 years (standard deviation, 5.9). In the intention-to-treat analysis, the between-group difference in frailty was 14.7% at 12 months (95% confidence interval: 2.4%, 27.0%; P = 0.02). The score on the Short Physical Performance Battery, in which higher scores indicate better physical status, was stable in the intervention group and had declined in the control group; with the mean difference between groups being 1.44 (95% confidence interval, 0.80, 2.07; P <0.001) at 12 months. There were no major differences between the groups with respect to secondary outcomes. The few adverse events that occurred were exercise-associated musculoskeletal symptoms.Conclusions: Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program.Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000250336. © 2013 Cameron et al; licensee BioMed Central Ltd.


Cameron I.D.,University of Sydney | Cameron I.D.,Hornsby Ku ring gai Health Service | Schaafsma F.G.,University of Sydney | Wilson S.,St Vincents Hospital | And 2 more authors.
Journal of Rehabilitation Medicine | Year: 2012

To explore the influence of level of functioning and cognitive status on outcome after rehabilitation for older people with different types of impairment. Design: An inception cohort study. Subjects: A total of 560 older people, mean age 80.0 years, participating in rehabilitation programmes in the Sydney area. Methods: Level of functioning using the Functional Independence Measure (FIM TM), the Barthel Index, cognitive status using the Mini Mental State Examination (MMSE), and type of impairment were assessed on admission. Level of functioning and length of hospital stay were assessed on discharge and after 6 months. Results: Disability on admission was the strongest independent predictor for functioning at discharge (B = 0.35,R 2= 0.49 p < 0.001) and follow-up (B = 0.22,R 2= 0.27, p < 0.001), and for length of hospital stay (B = -0.63,R 2= 0.12, p < 0.001). Cognitive status at admission (mean MMSE 25 (standard deviation 5.3)) was also a significant predictor of functioning at discharge and at follow-up (B = 0.30,R 2= 0.42, p < 0.01). Functional status prior to injury, joint replacement impairment category, and type of hospital had marginal, but statistically significant, impacts on functioning after discharge. Conclusion: Functional status on admission to a rehabilitation facility has stronger predictive value than type of impairment for rehabilitation outcome for older people. Cognitive impairment may have a small adverse effect on rehabilitation outcome.© 2012 The Authors.


Fairhall N.,University of Sydney | Kurrle S.E.,Hornsby Ku ring gai Health Service | Sherrington C.,University of Sydney | Lord S.R.,University of New South Wales | And 5 more authors.
BMJ Open | Year: 2015

Introduction: Frailty is a major concern due to its costly and widespread consequences, yet evidence of effective interventions to delay or reduce frailty is lacking. Our previous study found that a multifactorial intervention was feasible and effective in reducing frailty in older people who were already frail. Identifying and treating people in the pre-frail state may be an effective means to prevent or delay frailty. This study describes a randomised controlled trial that aims to evaluate the effectiveness of a multifactorial intervention on development of frailty in older people who are pre-frail. Methods and analysis: A single centre randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Two hundred and thirty people aged above 70 who meet the Cardiovascular Health Study frailty criteria for prefrailty, reside in the community and are without severe cognitive impairment will be recruited. Participants will be randomised to receive a multifactorial intervention or usual care. The intervention group will receive a 12-month interdisciplinary intervention targeting identified characteristics of frailty and problems identified during geriatric assessment. Participants will be followed for a 12-month period. Primary outcome measures will be degree of frailty measured by the number of Cardiovascular Health Study frailty criteria present, and mobility measured with the Short Physical Performance Battery. Secondary outcomes will include measures of mobility, mood and use of health and community services. Ethics and dissemination: The study was approved by the Northern Sydney Local Health District Health Research Ethics Committee (1207-213M). The findings will be disseminated through scientific and professional conferences, and in peer-reviewed journals. Trial registration number: Australian New Zealand Clinical Trials Registry: ACTRN12613000043730.


PubMed | University of New South Wales and Hornsby Ku ring gai Health Service
Type: Journal Article | Journal: BMJ open | Year: 2015

Frailty is a major concern due to its costly and widespread consequences, yet evidence of effective interventions to delay or reduce frailty is lacking. Our previous study found that a multifactorial intervention was feasible and effective in reducing frailty in older people who were already frail. Identifying and treating people in the pre-frail state may be an effective means to prevent or delay frailty. This study describes a randomised controlled trial that aims to evaluate the effectiveness of a multifactorial intervention on development of frailty in older people who are pre-frail.A single centre randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Two hundred and thirty people aged above 70 who meet the Cardiovascular Health Study frailty criteria for pre-frailty, reside in the community and are without severe cognitive impairment will be recruited. Participants will be randomised to receive a multifactorial intervention or usual care. The intervention group will receive a 12-month interdisciplinary intervention targeting identified characteristics of frailty and problems identified during geriatric assessment. Participants will be followed for a 12-month period. Primary outcome measures will be degree of frailty measured by the number of Cardiovascular Health Study frailty criteria present, and mobility measured with the Short Physical Performance Battery. Secondary outcomes will include measures of mobility, mood and use of health and community services.The study was approved by the Northern Sydney Local Health District Health Research Ethics Committee (1207-213M). The findings will be disseminated through scientific and professional conferences, and in peer-reviewed journals.Australian New Zealand Clinical Trials Registry: ACTRN12613000043730.


Gunewardene R.,Hornsby Ku ring gai Health Service | Lampe L.,Hornsby Ku ring gai Health Service | Lampe L.,University of Sydney | Ilchef R.,University of Sydney
Australasian Psychiatry | Year: 2010

Objective: Psychiatric populations may be particularly at risk of hepatitis C (HCV), less likely to receive appropriate interventions and at greater risk of liver damage due to comorbid substance abuse. This study sought to determine the prevalence of HCV in two inpatient psychiatric populations of seriously mentally ill patients and the relationship to risk factor screening. Method: Two inpatient units were chosen in similar socio-economic areas. Persons admitted to these wards over the course of the study were invited to participate and provided with pre-test counselling. Where informed consent was obtained, individuals were included in the study. It was planned to screen all consenting patients. However, funding was reduced for one site meaning that only patients with identified risk factors could be screened there. Results: Around 18% of psychiatric inpatients admitted to risk factors for HCV. The prevalence of HCV with screening of all consenting patients in unit A was 3.2%. With selective screening in unit B, 41.7% of those with identified risk factors tested positive. These results compare to the Australian community rate of approximately 1.1%. Conclusion: Results are consistent with elevated rates of HCV in mentally ill populations elsewhere in the world, and provide support for selective screening. © 2010 The Royal Australian and New Zealand College of Psychiatrists.

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