A failed fall prevention study in an acute care setting: Lessons from the swamp

Designing and implementing fall intervention studies in acute care settings presents researchers with a number of challenges. To date, there are no fall prevention interventions that have unequivocal empirical support in these settings. Based on the best available evidence a multistrategy fall prevention program was implemented using a pretest-post-test design over a 12-month period. The results indicated no reduction in the fall rate. Contrary to the expected result, the fall rate increased post the implementation of the multistrategy fall prevention program. To assist other researchers understand the contextual and methodological barriers to conducting fall prevention research in acute care settings, this paper discusses the difficulties experienced in this study.     

Treatment of anticholinergic-induced ileus with neostigmine

A 33-year-old man with a history of recreational benztropine abuse presented to the emergency department with confusion, abdominal pain, and distention. An abdominal radiograph revealed gross fecal loading. He was initially treated with intravenous fluids and opiate analgesia. Subsequently, a diagnosis of anticholinergic poisoning was made, based on tachycardia, delirium, dry mucosa, and reduced bowel sounds. Treatment with tacrine reversed the delirium, and a history of repeated benztropine use was obtained. Persistent ileus was treated with repeated doses of neostigmine, and gastrointestinal motility returned with prompt defecation. Neostigmine appears to be useful in reversing ileus caused by anticholinergic drug overdose. Theoretically, it may be useful in reversing anticholinergic ileus resulting from acute drug overdose, allowing or enhancing decontamination, but the safety and potential efficacy of neostigmine in this scenario have not been established.     

Head and pelvic movements during a dynamic reaching task in sitting: Implications for physical therapists

OBJECTIVES: To describe the distance reached, speed, and movement of the head and pelvis of healthy volunteers; to describe any influence of age on these variables; and to compare healthy volunteers and subjects with hemiplegia while performing a seated reaching task. DESIGN: Age-matched, case-control study. SETTING: Gait laboratory in a general hospital. PARTICIPANTS: A convenience sample of 53 healthy volunteers (30 women; 23 men; mean age, 57yr; range, 30-79yr) and 5 subjects with hemiplegia (2 women, 3 men; mean age, 65yr; range, 60-78yr) were recruited within 6 weeks poststroke. INTERVENTIONS: Participants sat on a bench with feet supported and reached laterally as far as they could without falling. MAIN OUTCOME MEASURES: The speed, distance reached, and angular movements of the head and pelvis were recorded by using the 3-dimensional movement analysis system. RESULTS: A significant age-related reduction in the distance reached (p < .001), velocity of the movement (p =.000), and pelvic tilt used (p < .01) was found among healthy volunteers. Comparison of data from healthy volunteers and subjects with hemiplegia showed a significant reduction in the angular movements of the heads of subjects with hemiplegia. CONCLUSIONS: The findings suggest conservation of movement with increasing age and stroke. This movement reduction could have negative effects on a subject's ability to make postural changes in response to disturbance and activity. Such information may assist therapists to gain insight into the nature of balance deficits and the adaptive behavior that could result.     

Feeling the cold: implications for nurse managers arising from the financial pressures in health care in England

Hewison A . (2010) Journal of Nursing Management 18 , 520–525
Feeling the cold: implications for nurse managers arising from the financial pressures in health care in England Aim The purpose of this short paper is to identify some of the implications and opportunities nurse managers in England face as a result of the current global economic recession. Background Government borrowing and poor global economic conditions have combined to create a £175 billion budget deficit in the UK. The National Health Service in England will be required to make substantial savings in order to help offset this shortfall. Key issues This is a brief critical commentary which examines some of the challenges and opportunities for nurse managers in England. It draws on a number of sources to identify key issues concerning nursing management arising from the financial pressures facing health care. Conclusion The next few years are going to be very difficult for nurses and their managers, however, the current situation also presents opportunities to advance the contribution and influence of nursing and nursing management. Implications for nursing management What nurse managers do next will be crucial in shaping the NHS response to the financial storm and the future nature of health care in England.     

Microwave disinfection of dentures for the treatment of oral candidiasis

Thirty-four institutionalized subjects (mean age, 81 years) with a positive test for C. albicans pseudohyphae were randomly assigned to test (microwave) and control (soak) groups. All subjects received the same course of topical antifungal medication (Nystatin 300,000 IU lozenges 3x daily for 14 days). Subjects in the microwave treatment group had their maxillary denture scrubbed and then microwaved for one minute at 850 Watts. This procedure was repeated three times. For subjects receiving the standard denture soak treatment, the nursing staff was instructed to disinfect the maxillary dentures in 0.2% chlorhexidine digluconate solution overnight for 14 days, changing the solution every two days. Infestation of the tissue surface of the maxillary denture with C. albicans progressively took place over the three-month period following treatment such that 8 (53%) of the microwaved dentures and 16 (84%) of the soaked dentures demonstrated pseudohyphae as determined by Gram stain. Infection of the soft tissues with the hyphal form of C. albicans also increased with time. After three months, one (8%) patient in the microwave group and 12 (63%) patients in the denture soak group demonstrated pseudohyphae on the cytological smears. Re-infestation of the denture surface and infection of the adjacent soft tissue were delayed dramatically in patients whose dentures were microwaved compared with those whose dentures were disinfected by being soaked in a chlorhexidine solution. However, microwave treatment is not recommended for all dentures and should be used with caution.     

The development of occupational standards in the practice of diagnostic ultrasound: Part 1, background

This, the first of two papers considers the development of occupational standards in the practice of diagnostic ultrasound, giving an overview of the background to the project which was commissioned by the NHS Executive South and West and the College of Radiographers. The paper provides a review of the literature related to occupational standards with key themes, such as the role of professional bodies in monitoring practice and practitioners and the derivation and definition of occupational standards. Other models and projects which have developed methods of standards design in areas of radiography and diagnostic ultrasound (such as the development of competency based standards for medical radiation science professions) are also considered. The paper concludes with a reflection on the need for continual evaluation of occupational standards and their use in practice.