Community care staff attitudes towards delivering a falls prevention exercise intervention to community care clients

Millions of older people world-wide receive community care services in their home to assist them to live independently. These services often include personal care, domestic assistance and social support which are delivered by non-university trained staff, and are frequently long term. Older people receiving community care services fall 50% more often than individuals of similar age not receiving services. Yet, few ongoing community care services include exercise programs to reduce falls in this population. We conducted an earlier study to examine the feasibility of community care staff delivering a falls prevention program. A critical finding was that while some of the assessment and support staff responsible for service delivery delivered the falls prevention exercise program to one or two clients, others delivered to none. Therefore, the aim of this qualitative sub-study was to understand reasons for this variation. Semi-structured interviews were conducted with 25 participating support staff and assessors from 10 community care organisations. Staff who had successfully delivered the intervention to their clients perceived themselves as capable and that it would benefit their clients. Older clients who were positive, motivated and wanted to improve were perceived to be more likely to participate. Staff who had worked at their organisation for at least 5 years were also more likely to deliver the program compared to those that had only worked up to 2 years. Staff that did not deliver the intervention to anyone were more risk averse, did not feel confident enough to deliver the program and perceived their clients as not suitable due to age and frailty. Experienced staff who are confident and have positive ageing attitudes are most likely to deliver falls prevention programs in a home care organisation.     

Parameters and standardization in obstetric Doppler

Obstetric Doppler is still largely empirically based, although possible clinical applications are already under examination. This article examines some of the basic instrumentation and hemodynamic issues — which physiological parameters would we ideally like to assess, and what can we do in practice with current Doppler instrumentation? It is shown that the rate of blood flow and the flow resistance are two of the most basic hemodynamic parameters. It is possible to estimate the flow rate with (specialized) Doppler equipment, but there is no method available at present to measure the flow resistance. Analysis of the blood velocity waveform provides some information concerning flow resistance, as long as it can be assumed that other factors that might affect the waveform have not deviated significantly from the norm. Practical considerations in choosing the instrumentation and designing the examination protocol are discussed, and issues of quality control are emphasized.     

Repair of cartilaginous fractures during chick limb development.

The embryonic chick wing has been used extensively in experimental analyses of the mechanisms involved in limb development. This study employs the embryonic wing in an examination of the possible origin of congenital pseudoarthrosis, a poorly understood limb disorder. To this end, chick radii were fractured in the middiaphysis prior to the onset of osteogenesis (6.5-7 days of incubation). The subsequent development of the fractured elements was examined using both whole mount preparations and histology. Callus cartilage did not form around any of the fractures. Nonetheless, the majority (29 of 33 specimens) of fractures united during primary osteogenesis (within 24-36 h of the operation), with bone formation occurring both across the fracture site and also over the cut ends of the cartilage. In addition, bones that exhibited a configuration similar to that described as giving rise to a type II congenital pseudoarthrotic condition were obtained. Typically, these bones showed an "hourglass" constriction midshaft and anterior bowing. These results suggest that the embryonic chick limb may serve as a useful experimental model system for the investigation of this congenital limb disorder.     

Treatment of intra-abdominal infections: cost comparison of ampicillin/sulbactam and clindamycin/gentamicin

The cost of 2 g ampicillin/1 g sulbactam given IV piggyback qid was compared with 900 mg clindamycin admixed with 1.5 mg/kg gentamicin given IV piggyback tid for the treatment of perforated or gangrenous appendicitis in 116 patients. Fifty-eight ampicillin/sulbactam-receiving patients incurred greater costs for IV supplies (+104.6/patient vs +67.9/patient) and nursing administration costs (+16.5/patient vs +10.7/patient). On the other hand, pharmacist and technician preparation costs were greater for the 58 clindamycin/gentamicin-receiving patients (+15.4/patient vs +13.3/patient). The clindamycin/gentamicin-receiving patients also incurred additional changes for laboratory fees and pharmacokinetic monitoring--+18.7/patient and +36.1/patient, respectively. When incorporating all cost parameters, there were no statistically significant differences in mean total drug therapy costs between the two treatment regimens--+433.3 +/- +58.5/patient for ampicillin/sulbactam and +373.8 +/- +86.2/patient for clindamycin/gentamicin.     

Methadone: old problems for new programmes

The present paper is concerned with factors which compromise the effective delivery of programmes incorporating methadone. Current clinical practices and programme characteristics are reviewed and policy issues regarding the role of methadone are considered, especially within the context of containing the spread of HIV infection. These issues are discussed in relation to empirical outcome studies, local prescribing trends and clinical case material. The authors conclude that there is an urgent need for: (1) an evaluation of the outcome of private practitioner methadone dispensation versus comprehensive agency-based therapy; (2) the accreditation of staff in all programmes incorporating methadone; and (3) the development of monitoring mechanisms, including on-site clinical audits of programmes.     

4S

A dramatic increase in the number of niche drugs with smaller markets may result from the sequencing of the human genome. As the information flow from this project speeds up, a number of pharmaceutical industry watchers are predicting this and other profound changes. Another likely effect is a reduction in basic research costs, but also a concomitant drop in profits from individual drugs.     

Frequent consulters in general practice: a systematic review of studies of prevalence, associations and outcome

We conducted a systematic review of the observational literature on frequent consulters in general practice. Electronic searching identified 34 studies which met our inclusion criteria. Frequent consulters were identified in a wide range of primary health care settings, confirming that a small proportion of patients is responsible for a disproportionate number of consultations. A cutoff of 9-14 consultations per annum was used to define a frequent consulter in most studies. Studies have examined a variety of associated characteristics, and indicate that frequent consulters are highly heterogeneous, and have high rates of physical disease, psychiatric illness and social difficulties. Few are likely to conform to the "heartsink" stereotype. These patients are likely to have multiple, complex problems, often including chronic physical disease, with or without psychological and social problems. The natural history of frequent consulting behavior seems to be to persist in many cases. Implications for management are discussed.