Interventions for preventing falls in acute- and chronic-care hospitals: a systematic review and meta-analysis

OBJECTIVES: To determine the characteristics and the effectiveness of hospital fall prevention programs. DESIGN: Systematic literature search of multiple databases (Medline, Cinahl, Precinahl, Invert, the Cochrane Library) and of the reference list of each identified publication. SETTING: Inclusion of prospective controlled‐design studies reporting the effectiveness of fall prevention programs in hospitals. PARTICIPANTS: Two reviewers. MEASUREMENTS: The methodological qualities of the studies were assessed based on 10 criteria. For the meta‐analysis, the relative risk of a fall per occupied bed day (RR_fall) and the relative risk of being a faller (RR_faller) were calculated. RESULTS: Eight studies met the inclusion criteria, of which four studies tested multifactorial interventions. Although these studies took place in hospitals, most were conducted on long‐stay (mean length of stay (LOS) >1.5 years) and rehabilitation units (mean LOS 36.9 days). For analysis of the number of falls, one unifactorial and two multifactorial studies showed a significant reduction of 30% to 49% in the intervention group, with the greatest effect obtained in the unifactorial study that assessed a pharmacological intervention. The pooled RR_fall for the four multifactorial studies became nonsignificant after adjustment for clustering (RR_fall=0.82, 95% confidence interval (CI)=0.65–1.03). No studies reported a significant reduction, either single or pooled, in the number of fallers in the intervention group (pooled RR_faller‐0.87, 95% CI=0.70–1.08). CONCLUSION: This meta‐analysis found no conclusive evidence that hospital fall prevention programs can reduce the number of falls or fallers, although more studies are needed to confirm the tendency observed in the analysis of individual studies that targeting a patient's most important risk factors for falls actively helps in reducing the number of falls. These interventions seem to be useful only on long‐stay care units.     

2010-2013年某医院住院患者死因分析

目的:通过分析某医院2010-2013年住院患者死因构成及变化趋势,为医院管理提供参考依据.方法:收集该院2010-2013年全部住院死亡病例,按照国际疾病分类编码(ICD-10)进行分类,用SPSS13.0统计软件进行统计分析.结果:2010-2013年该院住院病人死亡229人,其中男性病死率为3.74‰,女性为1.81‰,男性病死率高于女性(P＜0.05).4年间,肿瘤逐渐超过了损伤和中毒成为了该院住院病人第二大死亡原因;住院病人病死率为2.80‰,平均发展速度88.93％,平均增长速度-11.07％,总体呈下降趋势.结论:调查病例中男性病死率高于女性,可能与男性的危险暴露率高有关;死亡住院病人主要为66岁以上人群,降低老年人的病死率是今后医院发展和医疗工作的一个重要内容;病死率总体呈下降趋势,但慢性非传染性疾病已经逐渐超过损伤和中毒,成为更加主要的致死原因,严重危害人们的健康和生命.     

2021年遂宁市中心医院住院患者应用利伐沙班的合理性分析

目的 调查2021年遂宁市中心医院住院患者临床应用利伐沙班的合理性,为临床合理用药提供参考。方法 回顾性调查分析遂宁市中心医院2021年1月—12月住院患者使用利伐沙班抗凝的病例共2 405份,对其应用的适应症、禁忌症、用法用量、用药时机、用药疗程、药物转换的合理性进行分析。结果 2 405例应用利伐沙班的病历中,适应症不合理306例,存在用药禁忌84例;2 099例具有应用利伐沙班适应症的病历中,用法用量不合理741例,给药时机不合理15例,疗程不合理31例,药物转换不合理104例。结论 遂宁市中心医院住院患者应用利伐沙班主要存在无适应症用药、用法用量不合理等用药现象,应加强宣教。     

老年专科护理小组对住院患者跌倒防范的影响

目的:探讨老年专科护理小组对住院患者跌倒防范的影响。方法:收集老年专科护理小组实施防跌倒护理干预前后的住院病例,比较其跌倒发生率、跌倒致损伤发生率。结果:老年专科护理小组实施防跌倒护理干预后住院患者跌倒发生率、跌倒致损伤发生率较干预前均下降(P<0.05)。结论:老年专科护理小组对全院住院患者实施防跌倒护理干预,在防范住院患者跌倒方面取得肯定、良好的临床效果。     

Efficacy and safety of a pharmacist-managed inpatient anticoagulation service for warfarin initiation and titration

What is known and Objective: Anticoagulation consultations provided by a pharmacist‐staffed inpatient service, similar to the experience reported in outpatient anticoagulation clinics, can potentially improve anticoagulation control and outcomes. At Tan Tock Seng Hospital, a 1200‐bed acute care teaching hospital in Singapore, pharmacist‐managed anticoagulation clinics have been in place since 1997. Pharmacist‐managed services were extended to inpatient consultations in anticoagulation management from April 2006. Our objective was to assess the effect of implementing a pharmacist‐managed inpatient anticoagulation service. Methods: This was a single‐centre cohort study. Baseline data from 1 January 2006 to 31 March 2006 were collected and compared with post‐implementation data from 1 April 2006 to 31 March 2007. Patients newly started on warfarin for deep vein thrombosis, pulmonary embolism or atrial fibrillation in general medicine and surgery departments were included. The three endpoints were as follows: (i) percentage of international normalized ratios (INRs) achieving therapeutic range within 5 days, (ii) INRs more than 4 during titration and (iii) subtherapeutic INRs on discharge. Results and Discussion: A total of 26 patients in the control period were compared with 144 patients who had received dosing consultations by a pharmacist during the initiation of warfarin. The provision of pharmacist consult resulted in 88% compared to 38% (P < 0·001) of INR values achieving therapeutic range within 5 days. There was a reduction in INR values of more than 4 during titration from 27% to 2% (P < 0·001), and subtherapeutic INR values on discharge without low molecular weight heparin from 15% to 0% (P < 0·001). The mean time to therapeutic INR was reduced from 6·5 to 3·9 days (P < 0·001) and mean length of stay after initiation of warfarin from 11 to 7·7 days (P = 0·004). What is new and Conclusion: Inpatient anticoagulation care and outcomes were significantly improved by a pharmacist‐managed anticoagulation service. The time to therapeutic INR was achieved appropriately and efficiently without compromising patient’s safety.     

Anxiety and depression levels of inpatients in the city centre of Kirşehir in Turkey

Ünsal A, Ünaldi C, Baytemir Ç. International Journal of Nursing Practice 2011; 17 : 411–418 Anxiety and depression levels of inpatients in the city centre of Kir?ehir in Turkey The aim of this study was to determine the anxiety and depression levels of inpatients. A cross‐sectional study was conducted in K?r?ehir in the middle part of Turkey with a sample of 433 inpatients. As the data‐gathering tools, a questionnaire form and Hospital Anxiety and Depression Scale (HADS) were used. Statistical analyses were performed using Kruskal–Wallis Variance analysis and Mann–Whitney U‐test. The mean HADS‐depression scores of patients were compared according to the clinics they were in, and the difference was found to be significant for HADS‐depression (P < 0.01) scores. The mean HADS‐anxiety score of participants was 9.07, and the mean HADS‐depression scores was 8.88. Among the participants in this study, 44.3% had an anxiety disorder (HADS‐anxiety score of ≥ 10) whereas the 73.7% showed depression (HADS‐depression score of ≥ 7). Results indicate that support, counselling, and routine screening for anxiety and depression should be provided to inpatients.     

脑卒中患者出院时生活质量及相关因素分析

目的 调查脑卒中患者出院时生活质量,并分析其相关因素.方法 利用横断面研究设计,采用自设问卷和脑卒中生活质量影响量表3.0版对94例来自4所三级甲等医院住院脑卒中患者一般情况和入院及出院时的生活质量进行测评.结果 出院脑卒中患者生活质量影响量表6个领域的总分为(502.79±90.05)分;相关分析显示,年龄、住院时间...