Validating the Falls Behavioural (FaB) scale for older people: A Rasch analysis

Purpose. Rasch modelling was used to establish the validity and robustness of the Falls Behavioural (FaB) Scale for Older people.

Methods. The sample comprised 678 community-residing elderly people aged 65 – 98 years. Data were analysed by calculating goodness of fit statistics, principal components analysis of residuals and by exploring the effectiveness of the category rating response-scale.

Results. A partial-credit rating scale was the best fitting solution and the major change to the original version of the FaB. Analysis supported a 29-item intervention version and a briefer 24-item outcome evaluation (research) version. The latter produced item mean infit statistics of 1.00 (Z = 0.0, SD = 0.33) and mean outfit statistics of 1.03 (Z = 0.0, SD = 0.53), a person separation of 2.36 and internal reliability of 0.85.

Conclusion. The 29 item partial rating scale is valid, reliable and would be useful in clinical situations when used as a prompt for discussion and in raising clients' awareness of potential hazards; it also can be used as an outcome measure. The short form is a useful alternate for evaluating the effectiveness of fall reduction interventions that aim to encourage protective strategies when negotiating the environment, mobilizing and doing activities of daily living. Both scales would be improved by adding very difficult and very easy items to increase the range of ability levels of the people to whom it can be applied with precision.     

择期手术患者术前心理状况及需求调查分析及对策

目的了解择期手术病人术前的心理状况及需求,探讨减轻病人焦虑的对策。方法2005年4～5月对108例择期手术病人术前焦虑程度及需求状况进行调查。结果手术病人待手术期间焦虑度(SAS)明显高于术前1d(P<0.05);男性病人随着手术的临近,焦虑程度有明显的波动;<20岁组与20～39岁组病人待术期间SAS明显高于术前1d(P<0.05);初中组和高中组病人待手术期间SAS明显高于术前1d(P<0.05)。结论术前访视要求病房护士与手术室护士合作,访视内容要因性别、年龄、文化程度等而异。     

Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study

Introduction Hip fracture patients represent a frail group of elderly with increased morbidity and mortality. The aim of this study was to evaluate the occurrence and distribution of a second hip fracture in the time interval between the first and the second hip fracture.Methods All incident hip fractures in residents of Funen County, Denmark, from 1994 through 2004 were recorded. Verified fractures were sequenced within each patient using the unique Danish identification numbers.Results In total, 9990 incident hip fractures occurred: 9122 first hip fractures and 868 (8.7%) second fractures. Within the first year after the first hip fracture, the incidence rate of the second fracture in men decreased from 73 per 1000 person-years (py) during the first 3 months to 8 per 1000 py at 12 months; in women, it decreased from 116 per 1000 py during the first 3 months to 15 per 1000 py at 12 months. Of all the second fractures, 50% occurred within 12 months in men and within 19 months in women.Conclusions Few hip fracture patients experience a second hip fracture and when they do, it is within a short time-frame from the first. The risk of sustaining a second hip fracture is high during the first 12 months following the first hip fracture, decreasing to a level equal to or below the incidence of the first hip fracture after this 12-month period. Preventive strategies at the time of the first hip fracture should therefore aim at immediate effects, as interventions with effects after 12 months (men) and 19 months (women) bypass at least 50% of the fractures.The study is part of a PhD study for the first author. All authors have participated in the conceptual design of the study and finalisation of the current publication based on a first draft written by the first author. Analysis of data and data management were by first and second author.     

人工全髋关节置换术患者出院后家庭访视效果评价

目的评估人工全髋关节置换术患者出院后家庭访视效果。方法对愿意接受家庭访视护理40例全髋关节置换术患者出院后进行家庭访视,给予心理康复、肢体功能锻炼指导、健康教育等。结果第1次家庭访视与术后6个月访视患者肢体功能评定等级优良率,掌握疾病相关康复知识、技能,并发症发生率分别经秩和、字2检验,P均<0.01,有显著性差异,术后6个月时各项指标优于第1次访视时。结论家庭访视能消除患者负性情绪,肢体功能康复良好,疾病相关知识及康复技能掌握率增加,并发症减少。     

循证医学在美国的应用与实践

中国循证医学中心代表团对美国循证医学的现状与发展进行了考察,寻找我国与国际上存在的差距,为进一步促进和规划我国循证医学的发展提供借鉴.     

Role of the home visit medical service for patients with behavioral and psychological symptoms of dementia (BPSD) living in the community

Background: It is important for patients with behavioral and psychological symptoms of dementia (BPSD) in the community, who refuse to go to clinics, to be medically served by means of home visits. However, there are a few clinics in Japan that are specialized in home visits for BPSD. Methods: The home visit medical service provided to several patients with BPSD was reviewed and the strategy for the treatment of BPSD was analyzed. Results: It was found that the medical approach of home visits for patients with BPSD needed to be based on daily life information as well as medical information. Conclusions: The medical service alone is not enough to provide appropriate care for patients with BPSD who are living in the community. Using the case studies presented herein, we have demonstrated the importance of ‘daily life information’ for medical intervention. Issues relating to the exacerbation of BPSD and the cooperation of caregivers in the drug monitoring system at home are also considered.     

Concurrent and subsequent tumors in the same host: A model to evaluate the host tumor interaction

There is evidence which demonstrates an immune rejection response (IRR) directed against tumor cells in some experimental and human tumors. In the case of FSa-1, a methylcholanthrene-induced fibrosarcoma of the C₃Hf/Sed mouse, the IRR is manifested by a decrease in the dose of radiation expected to control half of the treated tumors (TCD₅₀) and an increase in the number of tumor cells expected to transplant the tumor in half of the transplanted recipients (TD₅₀) in immunized hosts. FSaI was transplanted simultaneously in the right and left legs of male and female C₃Hf/Sed mice and each tumor was given 3750 rad when it measured 8 mm. in diameter (viz the TCD₅₀ value for 8 mm FSaI growing as one isotransplant per animal). The two tumors in any one animal usually responded similarly with either permanent regression or local recurrence after irradiation. In a second experiment, a group of animals received also concurrent tumors. This time an immunogenic FSaI was transplanted in one side and a non immunogenic mammary carcinoma (MDAH-MCaIV) on the opposite side. The tumors were irradiated with TCD₅₀ doses (3750 rad for FSaI and 6500 for the less radioresponsive MCa). The distribution of local control and recurrence was probabilistic; 50% of the animals exhibited one tumor destroyed and one recurring. In a third experimental group mice were subsequently transplanted with FSaI Mice who showed no recurrence after irradiation of their first FSaI showed a stronger tendency to reject the second implantation than those who previously had local recurrence and subsequent amputation. Retransplants were controlled more easily by irradiation in the group that had been successfully treated for the first transplant. These data indicate that within the inbred population of C₃Hf/Sed mice there is a relatively broad distribution of capacities to react effectively against the FSaI challenge. This was not predicted by the delayed hypersensitivity skin reaction (DHSR) to the FSaI antigen.     

Predictors of Compliance with the Postpartum Visit among Women Living in Healthy Start Project Areas

Objectives: Few studies have examined factors associated with compliance with a postpartum visit (PPV). The identification of such factors is of particular importance in populations with high rates of unintended pregnancies and medical complications of pregnancy. This study seeks to determine factors associated with compliance with a PPV among low-income women in the population served by fourteen Healthy Start sites. Methods: Data from the Healthy Start Survey of Postpartum Women were reviewed to identify variables associated with compliance with a PPV at or beyond 6 weeks. Multiple logistic regression models were created, based on a sociobehavioral model of health services use, to examine which types of factors (demographic, social, enabling or need) are most strongly associated with the use of a PPV. Results: The study population consisted of survey respondents interviewed six weeks or more following delivery. Eighty-five percent of respondents had had a PPV at time of interview. In a multiple regression analysis, enabling factors such as multiple moves (OR (95% CI)=0.34 (0.18, 0.67)), trouble understanding the provider (OR (95% CI)=0.65 (0.43, 0.99)) and appointment reminders (OR (95% CI)=2.37 (1.40, 4.02)) were most strongly associated with a PPV. Conclusions: This work finds that women with unstable housing, transportation barriers, and difficulties communicating with providers are at risk for not receiving a PPV. This suggests that access to postpartum health services in the Healthy Start communities studied may not be entirely equitable. Policies aimed at improving interconception care will need to address these barriers to accessing health services.     

剖宫产术后再次妊娠分娩方式的临床分析

目的探讨剖宫产术后再次妊娠的分娩方式。方法对2006年1月～2010年12月洛阳市涧西区人医院和汝阳县人民医院288例剖宫产术后再次妊娠孕妇的分娩方式、分娩结局及母婴并发症进行回顾性分析。结果 288例中120例阴道试产（阴道试产组）,96例试产成功,成功率80.0%;选择再次直接剖宫产168例（剖宫产组）,手术产率58.3%。两组新生儿5min Apgar评分、产后输血率、子宫内膜炎比较,差异无统计学意义,但阴道试产组先兆子宫破裂显著高于剖宫产组（P〈0.05）,而剖宫产组的产后发热率明显高于阴道试产组（P〈0.05）;阴道试产失败组的先兆子宫破裂、产后发热及新生儿5min Apgar评分≤7分发生率、住院日明显高于阴道试产成功组,差异有统计学意义（P〈0.05）,子宫内膜炎和输血发生率差异无统计学意义（P〉0.05）。结论剖宫产术后再次妊娠分娩并非是剖宫产绝对指征,阴道试产的成功率是比较高的,成功的阴道试产可减少术后感染率、住院天数,但阴道试产失败可能会增加子宫破裂、胎儿窘迫及产后感染等并发症的发生率,住院天数也明显增加,应根据产妇的具体情况综合分析,选择合理的分娩方式,严格掌握阴道试产的适应证和禁忌证。