80 research outputs found
Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation
Abstract
Background
Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable.
Aim
To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England.
Design
Realist review and multisite case study. (1) Systematic searches to identify stakeholders’ theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60).
Setting
Three Trusts, one orthopaedic and one older person ward in each.
Results
Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling.
Limitations
Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted.
Conclusions
(1) Leadership: There should be a clear distinction between senior nurses’ roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling.
Future work
(1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English.
Study registration
This study is registered as PROSPERO CRD42020184458.
Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information
Geospatial Semantics: Why, of What, and How?
Abstract. Why are notions like semantics and ontologies suddenly getting so much attention, within and outside geospatial information communities? The main reason lies in the componentization of Geographic Information Systems (GIS) into services, which are supposed to interoperate within and across these communities. Consequently, I look at geospatial semantics in the context of semantic interoperability. The paper clarifies the relevant notion of semantics and shows what parts of geospatial information need to receive semantic speci-fications in order to achieve interoperability. No attempt at a survey of ap-proaches to provide semantics is made, but a framework for solving interopera-bility problems is proposed in the form of semantic reference systems. Particular emphasis is put on the need and possible ways to ground geospatial semantics in physical processes and measurements. 1. Introduction: Wh
Rapidly labelled ribonucleoprotein particles in rat liver cytoplasm and their relevance to the transport of messenger RNA
The appearance of rapidly labelled particles in the cytoplasm of rat liver has been followed in animals treated with 0.5 mg/kg actinomycin D to inhibit the synthesis of ribosomal subunits. Particles labelled under these conditions show a polydisperse sedimentation pattern on sucrose gradients, extending from 10 to 80 S with a maximum at 30 S. On CsCl gradients their density is 1.54 g/cm3. A component with a density of 1.38 g/cm3 has been observed under certain conditions, but this is considered to be an artifact. The RNA found in these particles has a polydisperse distribution on sucrose gradients extending from 7 to 35 S with a maximum at 17 S. Rapidly labelled non-ribosomal RNA is transported to the cytoplasm and becomes associated with polysomes in the presence of both actinomycin D and cycloheximide during short labelling periods. These results are discussed in relation to theories of the transport of mRNA from the nucleus to the cytoplasm
Safety and Efficacy of Pralatrexate in the Management of Relapsed or Refractory Peripheral T-cell Lymphoma
Effects of GO 4 IT . . . NOW! Strategy Instruction on the Written IEP Goal Articulation and Paragraph-Writing Skills of Middle School Students With Disabilities
MreB of Streptomyces coelicolor is not essential for vegetative growth but is required for the integrity of aerial hyphae and spores
MreB forms a cytoskeleton in many rod-shaped bacteria which is involved in cell shape determination and chromosome segregation. PCR-based and Southern analysis of various actinomycetes, supported by analysis of genome sequences, revealed mreB homologues only in genera that form an aerial mycelium and sporulate. We analysed MreB in one such organism, Streptomyces coelicolor. Ectopic overexpression of mreB impaired growth, and caused swellings and lysis of hyphae. A null mutant with apparently normal vegetative growth was generated. However, aerial hyphae of this mutant were swelling and lysing; spores doubled their volume and lost their characteristic resistance to stress conditions. Loss of cell wall consistency was observed in MreB-depleted spores by transmission electron microscopy. An MreB–EGFP fusion was constructed to localize MreB in the mycelium. No clearly localized signal was seen in vegetative mycelium. However, strong fluorescence was observed at the septa of sporulating aerial hyphae, then as bipolar foci in young spores, and finally in a ring- or shell-like pattern inside the spores. Immunogold electron microscopy using MreB-specific antibodies revealed that MreB is located immediately underneath the internal spore wall. Thus, MreB is not essential for vegetative growth of S. coelicolor, but exerts its function in the formation of environmentally stable spores, and appears to primarily influence the assembly of the spore cell wall
Using Context as an Assist in Word Solving: The Contributions of 25 Years of Research on the Interactive Strategies Approach
- …