Antony Johansen

Publication

• Date
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Research

I am first author for a number of national guidelines and a dozen national audit reports, and this sample of my 100 papers shows how my interests range across the epidemiology, prevention and acute management of fractures, nutrition, frailty, orthogeriatrics and audit.

Fracture epidemiology

Johansen A, Evans R, Stone MD, Richmond P, Lo SV, Woodhouse KW. The incidence of fracture in the United Kingdom: a study based on the population of Cardiff. Injury 1997; 28: 655-660

Johansen A, Evans RJ, Bartlett C, Stone MD. Fractures in the elderly: factors that influence the need for admission to hospital following presentation to the A&E department. Injury 1998; 29:779-784

Johansen A, Lyons RA, Jones S, Jones G, Stone MD, Palmer SR. Fracture incidence among elderly people in institutional care: linking injury surveillance data with a postal code-based register of residential and nursing homes. International J Consumer and Product Safety 1999; 6: 215-221 

Johansen A, Stone M; Torgerson DJ, Dolan P. The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporosis International 2000; 11:551-2

Fracture prevention

Lyons RA, Johansen A, Brophy S, Newcombe RG, Phillips CJ, Lervy B, Evans R, Wareham K and Stone MD. Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation. Osteoporosis International 2007; 18,6: 811-818

The DIPART (vitamin D Individual Patient Analysis of Randomised Trials) Group. Patient level pooler analysis of 65,800 patients from seven major vitamin D fracture  trials in US and Europe. BMJ 2010;340:b5463

Singh I, Hooton K, Edwards C, Lewis B, Anwar A, Johansen A. Inpatient hip fractures: understanding and addressing the risk of this common injury. Age and Ageing 2020; 49: 481–486 https://doi:10.1093/ageing/afz179

Johansen A,  Sahota O,  Dockery F, Black AJ, MacLullich AMJ,  Javaid MK, Ahern E, Gregson CL. Call to action: a five nations consensus on the use of intravenous zoledronate after hip fracture. Age and Ageing 2023; 52.9 https://doi.org/10.1093/ageing/afad172

Acute fracture management

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 doi.org/10.1136/ bmjopen-2014-006956 

Poacher AT, Hoskins HC, Protty MB, Pettit R, Johansen A. The impact of adopting low-molecular-weight heparin in place of aspirin as routine thromboprophylaxis for patients with hip fracture. Post-grad Med J 2022. http://dx.doi.org/10.1136/postgradmedj-2022-141628

Frailty and nutrition

Krishnan M, Beck S, Havelock W, Eeles E, Hubbard R, Johansen A. Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results Age Ageing 2013 doi: 10.1093/ageing/aft084

Duncan DG, Beck SJ, Hood K, Johansen A. Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward. Age Ageing 2006; 35: 148-153

Anaesthesia

Johansen A, Tsang C, Boulton C, Wakeman R and Moppett I. Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database Anaesthesia 2017 https://doi.org/10.1111/anae.13908

Physiotherapy

Johansen A, Boulton C, Burgon V, Rai S, Ten Hove R, Wakeman R. Using the National Hip Fracture Database (NHFD) to define the impact of physiotherapist assessment on early mobilisation after hip fracture. Physiotherapy Journal 2017. https://doi.org/10.1016/j.physio.2017.11.053

International audit

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. http://dx.doi.org/10.1016/j.injury.2017.08.001 

Johansen A,  Ojeda-Thies C, Poacher AT,  Hall AJ, Brent C, Ahern EC, Costa ML, on behalf of the Global Fragility Fracture Network Hip Fracture Audit Special Interest Group. Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons. Bone Joint J 2022;104-B(6):721–728 https://doi.org/10.1302/0301-620X.104B6.BJJ-2022-0080.R1

Johansen A, Hall, AJ, Ojeda-Thies C, Poacher AT, Costa ML. Standardisation of global hip fracture audit could facilitate learning, improve quality, and guide evidence-based practice: An international study of hip fracture registries in 20 countries using the Fragility Fracture Network 2022 Minimum Common Dataset. Bone Joint Journal 2023  https://boneandjoint.org.uk/article/10.1302/0301-620X.105B9.BJJ-2023-0281

Teaching

I have used lectures and interactive teaching to champion the new specialty of orthogeriatrics within my hospital, within Wales, across the UK and internationally. I have pioneered new approaches to the care of frail and older trauma patients, using hip fracture as a model with which to understand their needs, and improve how health services respond to them.

My teaching of students, surgical and medical juniors and our multidisciplinary team, and my national and international lecturing aims to support the adoption of hip fracture audit and orthopaedic-geriatric collaboration in other countries.

Protocols for the assessment and management of patients are key to improving care and outcome. Much of my work has focused on the development of protocols for the initial care of my own patients with hip and other femoral fractures.

These protocols are summarised in the clerking and 'care bundle' document around which care is organised in Cardiff: 

https://drive.google.com/file/d/1XkjJXIWX_Pe_D3fge43lV2BAa826W4lE/view?usp=sharing

My series of YouTube talks is an induction resource for students, nurses, therapists and juniors joining the department. These talks are also intended as a free resource for people developing hip fracture service in countries where the incidence of this injury is rising, but the specialties of orthogeriatrics and geriatric medicine are less well developed.

Hip fracture made simple

A very quick introduction to key aspects of acute hip fracture care https://youtu.be/qbN50gg5uUg (15 minutes)

Orthogeriatrics talks

Using hip fracture to help us understand Frailty https://youtu.be/cVpnS2MSIaU (28 minutes)

Using hip fracture to help us understand Peri-operative care https://youtu.be/U0xBgtK_Sfo (35 minutes)

Using hip fracture to help us understand Delirium https://youtu.be/Ri78onBt_gw (27 minutes)

Using hip fracture to help us understand Nutrition https://youtu.be/1BNtLIpQDbI (19 minutes)

Using hip fracture to help us understand Falls https://youtu.be/GzZDpZtE-7I (22 minutes)

Using hip fracture to help us understand Osteoporosis https://youtu.be/OTiIBXKehFc (19 minutes)

Biography

In the 1990s geriatricians in Cardiff pioneered the medical support of frail and older patients our acute trauma wards, and in 1997 I became the world’s first consultant geriatrician to work full-time in the acute orthopaedic setting. 

The extraordinarily generous support of geriatrician colleagues, specialist nurses, pharmacists and others has allowed me to help establish the new specialty of 'orthogeriatrics', and experience collaborating with surgeons in Cardiff led to my co-authoring the British Orthopaedic Association ‘Blue Book’ on fragility fractures, and 2011 NICE guidelines on hip fracture.

I've led the national clinical audit of hip fracture, the National Hip Fracture Database (NHFD) since 2013, and ran national sprint audits in collaboration with the Association of Anaesthesia (ASAP) and Chartered Society of Physiotherapy (PHFSA).

Since its establishment the NHFD has presided over a halving of mortality, using an open access website to help clinical staff, health service managers and the general public examine and improve the quality of care offered in different hospitals; something I discuss in my role as Geriatrician Lead for the NHFD in this video.

As chair of the Hip Fracture Audit special interest group of the global Fragility Fracture Network (FFN). I am now trying to support similar ventures around the world. Health services in different countries can learn from each other if all national audits try to collect comparable data; the 'minimum common dataset'; something I discuss in this video