Fall prevention in the community: what older people say they need

Original article can be found at: http://www.bjcn.co.uk/ Copyright MA HealthcareUptake of and adherence to fall prevention interventions is often poor and we know little about how older people’s perceptions of and beliefs about fall prevention interventions affect uptake. This study aimed to explore older people’s perceptions of the facilitators and barriers to participation in fall prevention interventions. We undertook a qualitative study with older people who had taken part in, declined to participate or adhere to fall prevention interventions using semi-structured interviews (n=65), and 17 focus groups (n=122) with older people (including 32 South Asian and 30 Chinese older people) in primary and community care settings in the South of England. A number of factors acted as either barriers or facilitators to uptake of interventions. Older people also made recommendations for improving access to interventions. Community nurses are ideally placed to screen older people, identify those at risk of falling and refer them to appropriate interventions as well as providing health promotion and education.Peer reviewe

Weight Loss and Illness Severity in Adolescents With Atypical Anorexia Nervosa.

BACKGROUND:Lower weight has historically been equated with more severe illness in anorexia nervosa (AN). Reliance on admission weight to guide clinical concern is challenged by the rise in patients with atypical anorexia nervosa (AAN) requiring hospitalization at normal weight. METHODS:We examined weight history and illness severity in 12- to 24-year-olds with AN (n = 66) and AAN (n = 50) in a randomized clinical trial, the Study of Refeeding to Optimize Inpatient Gains (www.clinicaltrials.gov; NCT02488109). Amount of weight loss was the difference between the highest historical percentage median BMI and admission; rate was the amount divided by duration (months). Unpaired t tests compared AAN and AN; multiple variable regressions examined associations between weight history variables and markers of illness severity at admission. Stepwise regression examined the explanatory value of weight and menstrual history on selected markers. RESULTS:Participants were 16.5 ± 2.6 years old, and 91% were of female sex. Groups did not differ by weight history or admission heart rate (HR). Eating Disorder Examination Questionnaire global scores were higher in AAN (mean 3.80 [SD 1.66] vs mean 3.00 [SD 1.66]; P = .02). Independent of admission weight, lower HR (β = -0.492 [confidence interval (CI) -0.883 to -0.100]; P = .01) was associated with faster loss; lower serum phosphorus was associated with a greater amount (β = -0.005 [CI -0.010 to 0.000]; P = .04) and longer duration (β = -0.011 [CI -0.017 to 0.005]; P = .001). Weight and menstrual history explained 28% of the variance in HR and 36% of the variance in serum phosphorus. CONCLUSIONS:Weight history was independently associated with markers of malnutrition in inpatients with restrictive eating disorders across a range of body weights and should be considered when assessing illness severity on hospital admission

Exploration of synergistic and redundant information sharing in static and dynamical Gaussian systems

To fully characterize the information that two source variables carry about a third target variable, one must decompose the total information into redundant, unique, and synergistic components, i.e., obtain a partial information decomposition (PID). However, Shannon's theory of information does not provide formulas to fully determine these quantities. Several recent studies have begun addressing this. Some possible definitions for PID quantities have been proposed and some analyses have been carried out on systems composed of discrete variables. Here we present an in-depth analysis of PIDs on Gaussian systems, both static and dynamical. We show that, for a broad class of Gaussian systems, previously proposed PID formulas imply that (i) redundancy reduces to the minimum information provided by either source variable and hence is independent of correlation between sources, and (ii) synergy is the extra information contributed by the weaker source when the stronger source is known and can either increase or decrease with correlation between sources. We find that Gaussian systems frequently exhibit net synergy, i.e., the information carried jointly by both sources is greater than the sum of information carried by each source individually. Drawing from several explicit examples, we discuss the implications of these findings for measures of information transfer and information-based measures of complexity, both generally and within a neuroscience setting. Importantly, by providing independent formulas for synergy and redundancy applicable to continuous time-series data, we provide an approach to characterizing and quantifying information sharing amongst complex system variables

Mechanisms of the noxious inflammatory cycle in cystic fibrosis

Multiple evidences indicate that inflammation is an event occurring prior to infection in patients with cystic fibrosis. The self-perpetuating inflammatory cycle may play a pathogenic part in this disease. The role of the NF-κB pathway in enhanced production of inflammatory mediators is well documented. The pathophysiologic mechanisms through which the intrinsic inflammatory response develops remain unclear. The unfolded mutated protein cystic fibrosis transmembrane conductance regulator (CFTRΔF508), accounting for this pathology, is retained in the endoplasmic reticulum (ER), induces a stress, and modifies calcium homeostasis. Furthermore, CFTR is implicated in the transport of glutathione, the major antioxidant element in cells. CFTR mutations can alter redox homeostasis and induce an oxidative stress. The disturbance of the redox balance may evoke NF-κB activation and, in addition, promote apoptosis. In this review, we examine the hypotheses of the integrated pathogenic processes leading to the intrinsic inflammatory response in cystic fibrosis

Purinergic signalling and immune cells

This review article provides a historical perspective on the role of purinergic signalling in the regulation of various subsets of immune cells from early discoveries to current understanding. It is now recognised that adenosine 5'-triphosphate (ATP) and other nucleotides are released from cells following stress or injury. They can act on virtually all subsets of immune cells through a spectrum of P2X ligand-gated ion channels and G protein-coupled P2Y receptors. Furthermore, ATP is rapidly degraded into adenosine by ectonucleotidases such as CD39 and CD73, and adenosine exerts additional regulatory effects through its own receptors. The resulting effect ranges from stimulation to tolerance depending on the amount and time courses of nucleotides released, and the balance between ATP and adenosine. This review identifies the various receptors involved in the different subsets of immune cells and their effects on the function of these cells

Pre-hospital Pain Management: the paramedics perspective

Peer reviewe

Practice Nurses as Mentors for Student Nurses. An untapped educational Resource

Peer reviewe

Developing a new response to non-urgent emergency calls : evaluation of a nurse and paramedic partnership intervention

Original article can be found at: http://journals.cambridge.org/action/login Copyright Cambridge University Press DOI: 10.1017/S1463423608000765Aim To evaluate a new service development whereby a nurse and a paramedic working in partnership attended non-urgent emergency calls. Background The demand for emergency ambulance services both nationally (in the UK) and internationally has been steadily increasing. A large proportion of calls made to the emergency ambulance service are classified as non-urgent. An alternative response to these calls may release the standard ambulance service to attend more urgent calls. A pilot project was initiated in order to provide an alternative response to non-urgent emergency calls in an Ambulance Trust in England with support from the local Primary Care Trust. This alternative response comprised a district nurse or an emergency nurse practitioner dispatched with a paramedic to visit low-priority emergency calls. The pilot service was trialled during a 15-week period in 2003–2004. Methods This paper evaluates the cost effectiveness of the pilot service by examining both the resource use and the outcomes of the service. Findings It was found that introducing this service to the current provision would increase the overall cost to the ambulance services. However, a reduction in conveyance rate to the hospital was observed as people could be treated on-scene. A reduction in conveyance rate to the hospital would lead to reduced admissions to accident and emergency departments and subsequent hospitalization. This paper provides an indication that further development of this type of service has the potential to be cost effective, if the wider health care economy is considered, as the cost savings made in secondary care could more than balance the costs to the Ambulance Services in providing such a servicePeer reviewe