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document
Using dietetic assistants to improve the outcome of hip fracture : a randomised controlled trial of nutritional support in an acute trauma ward . OBJECTIVE To examine how improved attention to nutritional status and dietary intake , achieved through the employment of dietetic assistants ( DAs ) , will affect postoperative clinical outcome among elderly women with hip fracture . DESIGN Open prospective randomised controlled trial , comparing conventional nursing care with the additional nutritional support provided by DA . SETTING Thirty-eight bedded acute trauma ward in a teaching hospital . PARTICIPANTS All but 11 of 344 consecutive admissions with acute nonpathological hip fracture were approached . Three hundred and eighteen ( 93 % ) agreed to inclusion . Sixteen were ineligible as they were immediately transferred to another acute ward , were managed conservatively or died preoperatively . PRIMARY OUTCOME MEASURE Postoperative mortality in the acute trauma unit . SECONDARY OUTCOME MEASURES Postoperative mortality at 4 months after fracture , length of stay , energy intake and nutritional status . RESULTS DA-supported participants were less likely to die in the acute ward ( 4.1 versus 10.1 % , P = 0.048 ) . This effect was still apparent at 4 month follow-up ( 13.1 versus 22.9 % , P = 0.036 ) . DA-supported subjects had significantly better mean daily energy intake ( 1,105 kcal versus 756 kcal/24 h , 95 % CI 259-440 kcal/24 h , P < 0.001 ) , significantly smaller reduction in mid-arm circumference during their inpatient stay ( 0.39 cm , P = 0.002 ) and nonsignificantly favourable results for other anthropometric and laboratory measurements . CONCLUSION Dietetic or nutrition assistants are being introduced in units across the UK . This , the largest ever study of nutritional support after hip fracture , shows that their employment significantly reduced patients ' risk of dying in the acute trauma unit ; an effect that persisted at 4 month follow-up .
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Intervention_Other
dietetic assistants
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Intervention_Other
dietetic assistants ( DAs )
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Intervention_Educational
conventional nursing care
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Intervention_Other
additional nutritional support provided by DA
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Intervention_Other
Dietetic or nutrition assistants
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Outcome_Physical
nutritional status
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Outcome_Mental
dietary intake
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Outcome_Other
postoperative clinical outcome
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Outcome_Mortality
Postoperative mortality
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Outcome_Mortality
Postoperative mortality at 4 months after fracture
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Outcome_Other
length of stay
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Outcome_Mental
energy intake
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Outcome_Physical
nutritional status
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Outcome_Mortality
likely to die
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Outcome_Mental
mean daily energy intake
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Outcome_Other
anthropometric and laboratory measurements
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Outcome_Mortality
patients ' risk of dying
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Participant_Condition
hip fracture
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Participant_Condition
acute trauma ward
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Participant_Age
elderly
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Participant_Sex
women
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Participant_Condition
hip fracture
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Participant_Sample-size
Thirty-eight
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Participant_Sample-size
11 of 344
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Participant_Sample-size
Three hundred and eighteen ( 93 % )
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Participant_Sample-size
Sixteen
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Participant_Condition
were ineligible