Effects of emergency department Care Coordination Team referrals in older people presenting with a fall

Objectives: The study aims to describe the characteristics of patients presenting to an ED with a fall and evaluate multidisciplinary Care Coordination Team (CCT) referrals on patient outcomes. Methods: A single-centred retrospective analysis of electronic data at an adult tertiary hospital was performed using data from 2004 to 2009 of presentations for patients aged 65 years or over with a fall. The primary outcome measure was representation to hospital within 30 days, comparing patients referred to CCT and those not referred. Secondary outcomes were differences in demographic characteristics, mode of arrival, triage score and readmission. Results: The proportion of ED patients presenting with a fall and their mean age is stable over time. From 2006 to 2009, 5162 fallers were referred to CCT in a decreasing trend, but with increased urgency. Statistically significant predictors for being referred to CCT were increasing age, being female, arriving by ambulance, being transferred from a nursing home and higher socioeconomic category. Arrival by ambulance and a history of previous falls were associated with representation and readmission. A decreasing trend from 2006 to 2009 was seen in rate ratios and odds ratios via regression modelling for both representation and readmission in patients referred to CCT. Conclusion: Maturing of the CCT is associated with a decrease in representation and readmission rate. Over time, the CCT attended higher urgency patients associated with stable admission rates. These associations were not significant and the clinical effectiveness of ED CCTs requires further examination

Does the Integration of Telehealth into Occupational Therapy Practice Impact Clinical Outcomes for Hand and Upper Limb Rehabilitation? A Matched Case Control Study

Health services are capitalizing on the rise of telehealth and seeking to develop sustainable models incorporating telehealth into standard care. Further research is required to explore the service and clinical outcomes of telehealth in occupational therapy hand and upper limb practice. This research utilized a case-control study to explore the feasibility and clinical outcomes of case matched patients who received a telehealth hybrid model versus traditional in-person care. One hundred and two patients were recruited (n=51 in the controls and cases) with a mean age of 45 years. Telehealth was not inferior to standard care with no significant increase in therapy time (p=0.441) or length of referral (p=0.047). There was no difference in clinical adverse events (p=0.741). Patients who received telehealth had significantly less withdrawals from the service (p = 0.031). Patient and therapist satisfaction were high, supporting the ongoing use and continued implementation of telehealth in occupational therapy

Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position?

<p>Abstract</p> <p>Background</p> <p>Adult socioeconomic position (SEP) is one of the most frequently hypothesised indirect pathways between childhood SEP and adult health. However, few studies that explore the indirect associations between childhood SEP and adult health systematically investigate the mediating role of multiple individual measures of adult SEP for different health outcomes. We examine the potential mediating role of individual measures of adult SEP in the associations of childhood SEP with self-rated health, self-reported mental health, current smoking status and binge drinking in adulthood.</p> <p>Methods</p> <p>Data came from 10,010 adults aged 25-64 years at Wave 3 of the Survey of Family, Income and Employment in New Zealand. The associations between childhood SEP (assessed using retrospective information on parental occupation) and self-rated health, self-reported psychological distress, current smoking status and binge drinking were determined using logistic regression. Models were adjusted individually for the mediating effects of education, household income, labour market activity and area deprivation.</p> <p>Results</p> <p>Respondents from a lower childhood SEP had a greater odds of being a current smoker (OR 1.70 95% CI 1.42-2.03), reporting poorer health (OR 1.82 95% CI 1.39-2.38) or higher psychological distress (OR 1.60 95% CI 1.20-2.14) compared to those from a higher childhood SEP. Two-thirds to three quarters of the association of childhood SEP with current smoking (78%), and psychological distress (66%) and over half the association with poor self-rated health (55%) was explained by educational attainment. Other adult socioeconomic measures had much smaller mediating effects.</p> <p>Conclusions</p> <p>This study suggests that the association between childhood SEP and self-rated health, psychological distress and current smoking in adulthood is largely explained through an indirect socioeconomic pathway involving education. However, household income, area deprivation and labour market activity are still likely to be important as they are intermediaries in turn, in the socioeconomic pathway between education and health.</p

Perturbed myoepithelial cell differentiation in BRCA mutation carriers and in ductal carcinoma in situ.

Myoepithelial cells play key roles in normal mammary gland development and in limiting pre-invasive to invasive breast tumor progression, yet their differentiation and perturbation in ductal carcinoma in situ (DCIS) are poorly understood. Here, we investigated myoepithelial cells in normal breast tissues of BRCA1 and BRCA2 germline mutation carriers and in non-carrier controls, and in sporadic DCIS. We found that in the normal breast of non-carriers, myoepithelial cells frequently co-express the p63 and TCF7 transcription factors and that p63 and TCF7 show overlapping chromatin peaks associated with differentiated myoepithelium-specific genes. In contrast, in normal breast tissues of BRCA1 mutation carriers the frequency of p63+TCF7+ myoepithelial cells is significantly decreased and p63 and TCF7 chromatin peaks do not overlap. These myoepithelial perturbations in normal breast tissues of BRCA1 germline mutation carriers may play a role in their higher risk of breast cancer. The fraction of p63+TCF7+ myoepithelial cells is also significantly decreased in DCIS, which may be associated with invasive progression

An occupational therapy delirium pathway reduces hospital re-presentations in older adults with delirium: A before and after observational study

Introduction: The hospital environment can exacerbate symptoms of delirium; as such there is a move to promote early supported discharge for patients with delirium. However, the occupational therapy role and impact of intervention is not well known. Our study evaluated an occupational therapy delirium pathway facilitating early assessment, intervention and supported discharge to home compared with hospital-based care. Method: A before and after, observational study design. Data was collected regarding hospital use, patient function (Functional Independence Measure/Functional Assessment Measure) and the carer experience (Preparedness for Caregiving Scale). Results: Ninety patients (43 control and 47 intervention group patients) were recruited with a mean patient age of 82.8 years (SD 7.6). There was a significant difference in hospital re-presentations (n = 3 in the intervention group compared to n = 10 in the control group (p = 0.026)). Hospital length of stay did not significantly differ between the groups (p = 0.534). The mean score for the Preparedness for Caregiving Scale was 3.3 indicating that most carers felt ‘pretty well prepared’. However, patients continued to experience significant functional decline (p = 0.006). Conclusion: An occupational therapy delirium pathway reduced hospital re-presentations and could be implemented in clinical practice to better support patients recovering from delirium as they transition from hospital to home

Improving care for older patients visiting emergency departments. Are they receiving falls prevention guideline care?

Background: The primary objective was to examine whether the Emergency Department (ED) treatment of older adults who fall in Australia is concordant with falls prevention and management clinical guideline care recommendations. Methods: A retrospective medical records audit was completed for patients 65years and older, who at-tended the ED with a fall and were discharged home. An audit tool was developed from local, national, and international falls clinical guidelines. Results: One thousand and twenty-seven patients presented following a fall throughout 2020. One hundred and seven patient medical records were audited. Assessment of cognition (94%), medication review (76%) and use of a falls risk screen (76%) were commonly completed. Under half of the patients had a documented gait evaluation (40%) and review of vision (18%). Concordance with guideline care was more likely for older patients (p = 0.042), with higher levels of comorbidity (p = 0.013), who required care assistance (p = 0.008) and received treatment from a multidisciplinary team (p \u3c 0.001) in an observation ward (p \u3c 0.001). Conclusions: Older patients with increased comorbidities and higher care needs had more falls guideline care recommendations documented. This was likely to occur when patients were moved to the observation ward where more comprehensive care by a multidisciplinary team could occur

Does the integration of telehealth into occupational therapy practice impact clinical outcomes for hand and upper limb rehabilitation? A matched case control study.

Health services are capitalizing on the rise of telehealth and seeking to develop sustainable models incorporating telehealth into standard care. Further research is required to explore the service and clinical outcomes of telehealth in occupational therapy hand and upper limb practice. This research utilized a case-control study to explore the feasibility and clinical outcomes of case matched patients who received a telehealth hybrid model versus traditional in-person care. One hundred and two patients were recruited (n=51 in the controls and cases) with a mean age of 45 years. Telehealth was not inferior to standard care with no significant increase in therapy time (p=0.441) or length of referral (p=0.047). There was no difference in clinical adverse events (p=0.741). Patients who received telehealth had significantly less withdrawals from the service (p = 0.031). Patient and therapist satisfaction were high, supporting the ongoing use and continued implementation of telehealth in occupational therapy

Risk Assessment and the Impact of Point of Contact Intervention Following Emergency Department Presentation with a Fall

<p><i>Aim:</i> To determine whether a multifactorial intervention can decrease the frequency of secondary falls in older patients presenting to an emergency department with a fall. <i>Methods:</i> A randomized control design comparing multifactorial follow-up intervention to standard care. Risk assessments included Falls Risk for Older Persons—Community Setting Screening Tool (FROP Com Screen) and the Two Item Screening Tool, which were compared for sensitivity. <i>Results:</i> Eight patients (14%) in the control group and 11 patients (20.8%) in the intervention group experienced falls (<i>p</i> = 0.373). The proportion of those identified as high risk that fell was similar between the FROP Com Screen (17%) and the Two Item Screening Tool (17%). Patients on average waited 35 days in the control group and 40 days in the intervention group for an outpatient appointment. <i>Conclusions:</i> There was no significant benefit of the intervention. Our findings support interdisciplinary collaboration, multifactorial intervention, and risk management for falls prevention.</p