Patient falls within the hospital setting continue to be a significant challenge globally with almost one million hospital falls occurring in the U.S. annually. Recent calculations showed that the ...average total cost of a hospitalized patient fall was $62,521. One evidenced-based tool that has been shown to be effective is a colorful laminated poster, Fall TIPS poster, that was designed to engage and involve the patient in their fall prevention. One academic medical center utilized this implementation showing a successful return on investment (ROI). This project used a pre-post implementation design. After a successful pilot using the poster on one unit, the implementation was spread to all Adult Acute Care units (n = 10) within the institution. The outcome measures were fall and fall with injury counts and rates. The process measure was the completion of the fall prevention poster measured via audits. The calculation of ROI was completed using a four-step framework. The outcome data of fall and fall with injury showed a decrease from the pre-intervention months with both the fall count and rate decreasing by 23% and the fall with injury count and rate decreasing by 40%. The overall ROI calculation estimated an ROI of $982,700. The successful results from this project support the evidence that shows this program and the use of the Fall TIPS poster helps reduce patient falls within the hospital and yields a favorable ROI.
The Niagara companion Revie, Linda L
The Niagara companion,
c2003, 2006, 2003, 2006-01-01, 2010-11-22
eBook, Book
What is it about Niagara Falls that fascinates people? What draws them to it? Is it love, obsession, or fear? In The Niagara Companion, Linda Revie searches for an answer to these questions by ...examining the paintings and writings about the Falls from the late seventeenth century, when the first Europeans discovered Niagara, to the early twentieth century. Linda Revie's study considers how three centuries of representations are shaped by the earliest encounters with the waterfall and notes shifts in the construction of landscape features and in human figures, both Native and European, in the long history of fine art depictions. Travel narratives, both literary and scientific, also come under her scrutiny, and reveal how these chronicles were influenced by previous pictures coming out of Niagara, particularly some of the first from the seventeenth century. In all of these portraits and texts, she notes a common pattern of response from the observers — moving from anticipation, to disappointment, to a kind of recovery. But in the end, there is fear. Even long after Niagara had become a tourist mecca, it was often drawn as a primordial wilderness — a place where civilization vies with wildness, artifice with nature, fear with control, the natural with the mastered. Throughout this history of images and narratives, as humans struggle to control nature, the notion of wildness prevails. Those who want a deeper understanding of why Niagara Falls continues to fascinate us, even today, will find Linda Revie's book an excellent companion.
Background
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated ...in 2012.
Objectives
To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017.
Selection criteria
Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals.
Data collection and analysis
One review author screened s; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence.
Main results
Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.
Care facilities
Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence).
There is low‐quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).
There is moderate‐quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.
Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low‐quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low‐quality evidence).
Hospitals
Three trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low‐quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).
We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low‐quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low‐quality evidence).
Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low‐quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low‐quality evidence).
Authors' conclusions
In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.
In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
This study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or ...older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars.
Incidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index.
In 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women.
Medically treated falls among older adults, especially among older women, are associated with substantial economic costs.
Widely implementing evidence-based interventions for fall prevention is essential to decrease the incidence and healthcare costs associated with these injuries.
One job town High, Steven C
One job town,
2018, 2018, 2018-05-04
eBook
"There's a pervasive sense of betrayal in areas scarred by mine, mill and factory closures. Steven High's One Job Town delves into the long history of deindustrialization in the paper-making town of ...Sturgeon Falls, Ontario, located on Canada's resource periphery. Much like hundreds of other towns and cities across North America and Europe, Sturgeon Falls has lost their primary source of industry, resulting in the displacement of workers and their families. One Job Town takes us into the making of a culture of industrialism and the significance of industrial work for mill-working families. One Job Town approaches deindustrialization as a long term, economic, political, and cultural process, which did not begin and simply end with the closure of the local mill in 2002. High examines the work-life histories of fifty paper mill workers and managers, as well as city officials, to gain an in-depth understanding of the impact of the formation and dissolution of a culture of industrialism. Oral history and memory are at the heart of One Job Town, challenging us to rethink the relationship between the past and the present in what was formerly known as the industrialized world"--
Injuries from falls are major contributors to death and complications in older adults. In this pragmatic, cluster-randomized trial, a multifactorial intervention that was administered by nurses did ...not result in a significantly lower rate of first adjudicated serious fall injury than enhanced usual care.
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