Translating a Multifactorial Fall Prevention Intervention into Practice: A Controlled Evaluation of a Fall Prevention Clinic

Although multifactorial fall prevention interventions have been shown to reduce falls and injurious falls, their translation into clinical settings has been limited. This article describes a hospital‐based fall prevention clinic established to increase availability of preventive care for falls. Outcomes for 43 adults aged 65 and older seen during the clinic's first 6 months of operation were compared with outcomes for 86 age‐, sex‐, and race‐matched controls; all persons included in analyses received primary care at the hospital's geriatrics clinic. Nonsignificant differences in falls, injurious falls, and fall‐related healthcare use according to study group in multivariate adjusted models were observed, probably because of the small, fixed sample size. The percentage experiencing any injurious falls during the follow‐up period was comparable for fall clinic visitors and controls (14% vs 13%), despite a dramatic difference at baseline (42% of clinic visitors vs 15% of controls). Fall‐related healthcare use was higher for clinic visitors during the baseline period (21%, vs 12% for controls) and decreased slightly (to 19%) during follow‐up; differences in fall‐related healthcare use according to study group from baseline to follow‐up were nonsignificant. These findings, although preliminary because of the small sample size and the baseline difference between the groups in fall rates, suggest that being seen in a fall prevention clinic may reduce injurious falls. Additional studies will be necessary to conclusively determine the effects of multifactorial fall risk assessment and management delivered by midlevel providers working in real‐world clinical practice settings on key outcomes, including injurious falls, downstream fall‐related healthcare use, and costs.     

A novel emergency medical services-based program to identify and assist older adults in a rural community

Rural-dwelling older adults experience unique challenges related to accessing medical and social services. This article describes the development, implementation, and experience of a novel, community-based program to identify rural-dwelling older adults with unmet medical and social needs that leveraged the existing emergency medical services (EMS) system. The program specifically included geriatrics training for EMS providers; screening of older adult EMS patients for falls, depression, and medication management strategies by EMS providers; communication of EMS findings to community-based case managers; in-home evaluation by case managers; and referral to community resources for medical and social interventions. Measures used to evaluate the program included patient needs identified by EMS or the in-home assessment, referrals provided to patients, and patient satisfaction. EMS screened 1,231 of 1,444 visits to older patients (85%). Of those receiving specific screens, 45% had fall-related, 69% medication management-related, and 20% depression-related needs identified. One hundred and seventy-one eligible EMS patients who could be contacted accepted the in-home assessment. Of the 153 individuals completing the assessment, 91% had identified needs and received referrals or interventions. This project demonstrated that screening by EMS during emergency care for common geriatric syndromes and linkage to case managers is feasible in this rural community, although many will refuse the services. Further patient evaluations by case managers, with subsequent interventions by existing service providers as required, can facilitate the needed linkages between vulnerable rural-dwelling older adults and needed community-based social and medical services.     

急诊床旁超声心动图对心血管疾病的临床应用价值

目的探讨急诊床旁超声心动图对心血管危重症的诊断价值。方法回顾性分析我院2008年1月～2009年3月进行急诊床旁超声心动图110例。结果床旁超声心动图检查的阳性率为88％（97／11o）。其中冠心病43例（39％,45／110）;高血压并心衰20例（18．2％．20／110）;外科术后患者10例（91％．10／110）;合并心包积液11例（10％,11／110）;慢性肺源性心脏病1O例（9．1％,10／110）;主动脉夹层6例（55％,6／110）;其他10例。结论急诊床旁超声心动图对心血管危重症的诊断及协助临床治疗具有重要应用价值。     

军队医院应急保障能力建设实践

本文分析了制约医院应急保障能力形成的主要因素,归纳了提高医院应急保障能力的基本途径,提出了加强应急机动、战伤救治和野战适应三种能力建设的建议,总结了加强医院应急保障能力建设的几点体会。     

Factors Associated with Extended Length of Stay for Patients Presenting to an Urban Psychiatric Emergency Service: A Case-Control Study

This study assessed factors associated with extended length of stay (ELOS) for patients presenting to a psychiatric emergency service (PES). Two hundred six subjects with a length of stay of 24 h or longer were compared with time-matched controls (patients that presented directly after the ELOS patient). Binary logistic regression was used to identify risk factors for ELOS. ELOS was associated with suicidal ideation, disposition to an inpatient unit, homicidal ideation, lack of insurance, homelessness, male gender, past history of psychiatric hospitalization, diagnosis of substance abuse, significant psychiatric co-morbidity (represented by three or more Axis I diagnoses), and diagnosis of a psychotic disorder. Lack of insurance, suicidal ideation, disposition to inpatient unit, and homicidal ideation all made nonredundant contributions to predicting stays of 24 h or longer.     

健全我国农村公共卫生应急体系的对策探析

我国农村公共卫生应急体系建设取得了很大进展,防控突发公共卫生事件的能力有了较大提高,但仍然不能很好地适应应对突发公共卫生事件的需要。当前,必须坚持以人为本,强化地方政府的公共卫生职能,进一步完善农村公共卫生应急体系。     

封条式管理及物品有效期一览表在抢救车管理中的应用

目的探寻更加科学合理的方法以保证抢救车内物品的数量及完整率,减少护士交班时间,提高工作效率,并方便紧急情况下的使用,确保抢救质量。方法绘制抢救车示意图,标明具体物品的摆放位置、基数,设计物品有效期一览表,同时采用封条式管理,专人负责,定期进行质量控制检查。结果大大地节省了护士的交接班时间,同时也让护士熟悉抢救车内物品的摆放位置,减少了抢救时的忙乱,物品完好率达100％。结论抢救车的规范化管理能提高医疗护理质量,也体现了将护士的时间还给患者的服务宗旨。     

五常法在院前急救管理工作中的作用

目的通过“五常法”提高院前急救质量工作质量,有效地保障患者的生命安全。方法运用“五常法”对院前急救工作进行管理。结果“五常法”规范管理,提高管理质量,消除了安全隐患、加强了急救意识、提高人员素质。结论“五常法”是有效的管理方法。     

四川地震重灾区疾病监测报告手机应急系统应用

目的探讨四川省地震灾害后,手机应急疾病监测报告信息系统用于报告网络恢复的方法及工作经验。方法分析传染病报告网络损失情况,了解当地通讯并选择恰当链路,组织及时下发并培训设备使用,及时掌握报告情况并进行督促。结果基本恢复报告体系,报告水平。结论方法可行,但实施须注意培训、督导、运行保障。     

汶川地震医学信息服务的实践总结与思考

总结了解放军医学图书馆在5．12汶川地震发生后进行的一系列医学信息服务实践,并对医学信息服务机构如何增强突发事件医学信息服务保障能力进行了思考。