Assessment of the elderly: it’s worth covering the risks

Background Comprehensive assessments provide an invaluable opportunity to identify those at risk of adverse health events, enabling timely access to appropriate health care. Aims This study aimed to evaluate the effectiveness of a comprehensive assessment tool, the Adult Patient Assessment Tool (APAT), particularly in relation to early identification of older people at risk of falls, pressure areas, cognitive impairment or delirium, or patients with mental illness or substance abuse. Methods Concurrent mixed methods including an initial retrospective medical record audit and focus groups were used. Results With the introduction of the APAT, assessment of falls risk and mental illness increased. The number of nursing actions relating to pressure areas and falls also increased, indicating a greater awareness of patients’ individual needs. Non-clinical information gathered through the APAT enabled a more holistic approach to patient care. Conclusion The use of electronic medical records would alleviate pressures on nurses’ time, providing an opportunity to store and retrieve comprehensive nursing assessment and benefit patient health care. Implications for nursing management Early assessment results in an increased number of nursing activities related to patient care. Further education relating to mental health and substance abuse screening and cognitive assessment may enhance the completion of these tools.     

Catecholamine Secretion in Fetal Adaptation to Stress

From the beginning of labor, the fetus must successfully adapt from intrauterine life to the stress of birth and, finally, to extrauterine life. The role of hormones known as catecholamines in this adaptive mechanism is described. An understanding of the physiology of catecholamine secretion will enhance the nursing care of mothers and their infants during this important transitional period.     

Patterns of alcohol consumption in white collar-workers–a cross-sectional and longitudinal study

A 6-year follow-up of a cohort of male and female while collar workers in whom there was baseline information on alcohol consumption and access co data on sickness absence, promotion and labour turnover, revealed that even moderate alcohol and consumption in this population was associated with social costs for the employer and the employee, particularly in terms of sickness absence. The longitudinal examination of consumption in this study suggests that early intervention in a drinking career may reduce alcohol consumption and consequently avoid years of morbidity and sickness absence, as well as having a favourable influence on promotion prospects and labour turnover.     

Athetosis Increases Resting Metabolic Rate in Adults with Cerebral Palsy

Objectives To determine whether resting metabolic rate (RMR) is higher or lower in adults with cerebral palsy compared with the RMR of control subjects and to further examine physical characteristics of cerebral palsy that might affect RMR.Design Twenty-one adults with cerebral palsy (9 women, 12 men) were compared with 50 control subjects (25 men, 25 women) within the same age range (18 through 50 years). The following measurements were made: RMR by indirect calorimetry, anthropometries, body composition, and habitual physical activity patterns. The study was conducted at the University of Vermont General Clinical Research Center and the Ball State University Human Performance Laboratory.Statistical analyses Mean values±standard deviations, t tests, Pearson product-moment correlation coefficients, analysis of covariance, and stepwise multiple correlation regression analysis were used to examine the relationships among variables of interest.Results No significant differences were found in body weight, body mass index, fat mass, percentage body fat, and measured RMR between the two groups. The subjects with cerebral palsy were significantly shorter, had less fat-free mass, and expended fewer kilocalories in leisure time activities than the control subjects. After statistical adjustment for differences in fat-free mass, the subjects with cerebral palsy had a 14% (P<.001) higher adjusted RMR (1,742 kcal/day) compared with that of the control subjects (1,534 kcal/day). According to stepwise regression analysis, RMR was best predicted in the entire sample by fat-free mass and the presence or absence of athetosis (multiple R=.83, P<.001). The presence of cerebral palsy alone was not significantly correlated with RMR.Conclusions The increased energy requirements of adults with cerebral palsy can be partially explained by athetotic movements. In this sample, the presence of athetosis increased RMR by an average of 524 kcal/day. JAm Diet Assoc. 1995; 95:145-148.     

Comparison of Multiple-Pass 24-Hour Recall Estimates of Energy Intake With Total Energy Expenditure Determined By the Doubly Labeled Water Method in Young Children

Objective This study determined the accuracy of the multiple-pass 24-hour recall method for estimating energy intake in young children by comparing it with measurements of total energy expenditure made using the doubly labeled water method.Design Three multiple-pass 24-hour recalls were obtained over a 14-day period to estimate mean energy intake. Total energy expenditure was measured over the same 14-day period under free-living conditions using the doubly labeled water technique.Subjects/setting Twenty-four children between the ages of 4 and 7 years were tested at the General Clinical Research Center/Sims Obesity Nutrition Research Center at the University of Vermont.Statistical analysist Tests, paired t tests, Pearson product-moment correlation coefficients, pairwise comparison to show relative bias and limits of agreement, and regression analysis were used to test the relationships among study variables.Results No difference was found between 3-day mean energy intake and total energy expenditure for the group (t=2.07, P=.65). The correlation between individual measures of energy intake and total energy expenditure was not statistically significant (r=.25, P=.24).Conclusions Data from 3 days of multiple-pass 24-hour recalls were sufficient to make valid group estimates of energy intake. The method was not precise for individual measurements of energy intake. J Am Diet Assoc. 1996; 96:1140-1144.     

The supervision of mentally disordered offenders: the work of probation officers and their relationship with psychiatrists in England and Wales

This article presents data from a study which has provided evidence of probation officers’ close involvement with some of the most hard to help psychiatric patients and of the nature of their working relations with psychiatrists. Given the burden of responsibility they carry, and the training deficiencies they report, it is clear that probation officers could work more confidently and effectively in this field if there were more opportunities for consultation and shared working with the psychiatric services. We conclude with some suggestions for improving collaboration between psychiatrists and probation officers.