Falls and Drugs in the Older Population: medical and societal consequences

Falls represent a major public health problem among older persons in western countries, since approximately a third of all persons aged 65 years and older experience at least one fall per year. This thesis provides insights in the epidemiology, injury patterns, healthcare costs, and mortality rates of falls in older adults. Furthermore, drug knowledge in older adults, hospitalizations due to an adverse drug reaction, and withdrawal of fall-risk increasing drugs as a preventative measure will be discussed. The main findings include that falls are leading to a high healthcare consumption. Per year, approximately 72.000 elderly visit the Emergency Department with injuries due to a fall (The Netherlands, 2007-2009). Fall-related injuries are age- and gender dependent. Women and the oldest old (>80 years) present more often with fractures, and have a higher injury severity. Over the last 28-years the number of admissions increased rapidly (1981, 14.000; 2008, 34.000). The increase was also seen in the United States. Main injury categories requiring admission were hip fractures, superficial injuries, and head injuries. The total number of required hospital bed days remained stable due a reduction of over 50% in the length of hospital stay per admission. Also fall-related mortality was reduced (1969-2008), and mortality rates for men and women became comparable. Pharmacotherapy is commonly used to treat medical conditions, but it is well known that side effects increase with an increasing number of drugs. Side effects include among others an increased fall-risk. Especially older adults are at risk for Adverse Drug Reactions, due to poor drug knowledge and polypharmacy, as shown in our data. The epidemiology of Adverse Drug Reactions related admissions is shown (The Netherlands, 1981-2007). A measure which might be useful to reduce the number of falls, is the reduction of fall-risk increasing drug, if possible. Therefore the protocol of a randomized controlled trial (IMPROveFALL study) is presented. The study results will be expected in 2013

Costs of falls in an ageing population: A nationwide study from the Netherlands (2007-2009)

Background: Falls are a common mechanism of injury in the older population, putting an increasing demand on scarce healthcare resources. The objective of this study was to determine healthcare costs due to falls in the older population. Methods: An incidence-based cost model was used to estimate the annual healthcare costs and costs per case spent on fall-related injuries in patients ≥65 years, The Netherlands (2007-2009). Costs were subdivided by age, gender, nature of injury, and type of resource use. Results: In the period 2007-2009, each year 3% of all persons aged ≥65 years visited the Emergency Department due to a fall incident. Related medical costs were estimated at €675.4 million annually. Fractures led to 80% (€540 million) of the fall-related healthcare costs. The mean costs per fall were €9370, and were higher for women (€9990) than men (€7510) and increased with age (from €3900 at ages 65-69 years to €14,600 at ages ≥85 year). Persons ≥80 years accounted for 47% of all fall-related Emergency Department visits, and 66% of total costs. The costs of long-term care at home and in nursing homes showed the largest age-related increases and accounted together for 54% of the fall-related costs in older people. Discussion: Fall-related injuries are leading to a high healthcare consumption and related healthcare costs, which increases with age. Programmes to prevent falls and fractures should be further implemented in order to reduce costs due to falls in the older population and to avoid that healthcare systems become overburdened

Intraossale infusie

ABSTRACT Intraosseous (IO) infusion is a long existing method to obtain vascular access and has gained renewed interest over the last decade. IO infusion is an easy, safe, rapid and effective alternative method for vascular access in emergency clinical care and prehospital situations. The IO access can be used for administration of fluids, medication, analysis of electrolytes, blood type and blood gasses. The proximal tibia is the most common insertion location. New IO needles (F.A.S.T.1., Bone Injection-Gun and EZ-IO) have been developed over the last decade, to make insertion easier. Guidelines such as the ATLS and ERC are changing and currently recommend the use of IO needles in the emergency setting, in trauma and non-trauma situations, in both children and adults as alternative for peripheral vascular access. This will increase the use of the IO needles in de future. Awareness of indications, contra-indications and complications should therefore be enhanced

A common ground for virtual humans: using an ontology in a natural language oriented virtual human architecture

When dealing with large, distributed systems that use state-of-the-art components, individual components are usually developed in parallel. As development continues, the decoupling invariably leads to a mismatch between how these components internally represent concepts and how they communicate these representations to other components: representations can get out of synch, contain localized errors, or become manageable only by a small group of experts for each module. In this paper, we describe the use of an ontology as part of a complex distributed virtual human architecture in order to enable better communication between modules while improving the overall flexibility needed to change or extend the system. We focus on the natural language understanding capabilities of this architecture and the relationship between language and concepts within the entire system in general and the ontology in particular. 1

Toward a Semi-Automated Scoping Review of Virtual Human Smiles

Smiles are a fundamental facial expression for successful human-agent communication. The growing number of publications in this domain presents an opportunity for future research and design to be informed by a scoping review of the extant literature. This semi-automated review expedites the first steps toward the mapping of Virtual Human (VH) smile research. This paper contributes an overview of the status quo of VH smile research, identifies research streams through cluster analysis, identifies prolific authors in the field, and provides evidence that a full scoping review is needed to synthesize the findings in the expanding domain of VH smile research. To enable collaboration, we provide full access to the refined VH smile dataset, key word and author word clouds, as well as interactive evidence maps.</p

Operating room rescheduling

Due to surgery duration variability and arrivals of emergency surgeries, the planned Operating Room (OR) schedule is disrupted throughout the day which may lead to a change in the start time of the elective surgeries. These changes may result in undesirable situations for patients, wards or other involved departments, and therefore, the OR schedule has to be adjusted. In this paper, we develop a decision support system which assists the OR manager in this decision by providing the three best adjusted OR schedules. The system considers the preferences of all involved stakeholders and only evaluates the OR schedules that satisfy the imposed resource constraints. The decision rules used for this system are based on a thorough analysis of the OR rescheduling problem. We model this problem as an Integer Linear Program (ILP) which objective is to minimize the deviation from the preferences of the considered stakeholders. By applying this ILP to instances from practice, we determined that the given preferences mainly lead to (i) shifting a surgery and (ii) scheduling a break between two surgeries. By using these changes in the decision support system, less surgeries are canceled and the perceived workload of all departments is reduced. The system can also be used to judge the acceptability of a proposed initial OR schedule