Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events

Aims and objectives To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. Background While there are evidence‐based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Design Critical incident technique. Methods Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south‐east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Results Three themes emerged from 23 reflective accounts of fall events: “direct observation is confounded by multiple observers” and “knowing the person has cognitive impairment is not enough,” and “want to rely on the guideline but unsure how to enact it.” While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Conclusions Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice To reduce falls, nurses can involve the family to support “knowing the patient” to enable prediction of impulsive actions; shift the focus of in‐service from lectures to specific case presentations, with collaborative analysis on person‐focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.Full Tex

Implementation of the Australasian Teletrial Model : lessons from practice

The Australasian Tele-trialModel (ATM) involves the use of telehealth technology to conduct clinical trials at satellite sites. Under the direction of state governments, led byQueenslandHealth (QH) and the Clinical Oncology Society of Australia (COSA), a streamlined process for review, authorisation and conduct of the teletrials model has been developed. Some state governments and cancer centres around the country have developed new standard operating procedures (SOPs) to incorporate teletrials into routine practice. Queensland Health has undertaken reforms in governance and contract approval processes to facilitate its implementation in Queensland. Several pharmaceutical companies and trial groups have begun incorporating teletrials into trial protocols to enhance rural and regional access to trials, access to rare cancer trials even within a metropolitan setting and overall rate of recruitment. Several cancer centres around the country have begun embedding this model as part of their strategic and operational plans and several state departments of health have established steering committees to drive state-wide adoption. The National Mutual Acceptance (NMA) is currently coordinating the review and development of a standardised teletrials subcontract with the outcome that the teletrials subcontract will be adopted by Medicines Australia as a standard template to use with their suite of other standard clinical trial agreements. This supplement covers various aspects of the concept of the Australasian Tele-trial Model and its implementation, to share our experiences with those who would like to adopt this model as part of their routine practice and to encourage more uptake across the nation thus placing the patient at the centre of healthcare

Outcomes of Stages I and II Follicular Lymphoma in the Era of 18F-FDG PET-CT Staging: An International Collaborative Study from the Australian Lymphoma Alliance

Kitty Crowther, Mon Ami Jim, Pastel, 1996. Quelques phrases pour résonner une sublime fable du racontage : Elle déroule son fil sur des galets - six par double page - qui voient s'effectuer la rencontre de Jack, le corbeau, et de Jim, la mouette. Des moments contemplatifs ou plutôt de spauses dans la profondeur des galets nous arrêtent sur une pleine page. Puis l'amour sur un galet s'avoue tête bêche dans un lit. Le village n'accueille pas l'étranger mais quand les histoires que racontent les..