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Get PDFBackground: As our society ages, falls have emerged as a leading cause of accidental injury and death globally, significantly impacting older adults’ quality of life (Matchar et al., 2017; WHO, 2021). The consequences of falls are profound, encompassing physical injuries, psychological distress, and substantial healthcare costs. In the U.S., Medicare spends approximately $31.3 billion annually on fall-related care (Gettel et al., 2020). These statistics underscore the need for standardized fall prevention strategies in primary care.
Purpose: This Doctor of Nursing Practice (DNP) project aimed to implement a standardized systems-level process change for fall risk screening and education during Medicare Annual Wellness Exams (MAWEs) at a rural clinic in southeast Nebraska. An organizational practice audit revealed inconsistent screening and no prior educational intervention, prompting project organization case managers to request a formal process improvement.
Design: Using the Plan-Do-Study-Act (PDSA) model, the team developed and tested a fall prevention protocol. This included administering fall risk screening questions and providing corresponding educational handouts to at-risk patients. A staff education session was held to introduce the workflow, and a project team member was on-site to support implementation.
Methods: The intervention involved organizational staff using three CDC STEADI-based fall risk screening questions during MAWEs. Responses were documented in the electronic health record, and patients screening positive received risk-specific educational handouts. Data collection focused on adherence to the protocol, specifically the completion of screening and delivery of handouts. An assessment of the feasibility of intervention and fidelity of implementation was completed monthly.
Results: Of the 378 MAWEs completed during the intervention period, only 57.1% of patients were fully screened. Educational handouts were provided to just 7.1% of the total patients, with approximately 20-26% of people who reported ‘yes’ to each category receiving education. Among those who received handouts, 63% were given all handouts appropriate to their identified risk factors, indicating inconsistent delivery of education.
Conclusion: The project revealed important gaps in screening fidelity and patient education. Despite initial training, fall prevention practices were inconsistently applied. Gender differences were also noted, with women more likely to report fall-related fears and unsteadiness when walking. Men and women experienced falls at similar rates. This intervention highlights the importance of workflow integration, accountability, and staff engagement to enhance fall prevention efforts. Standardizing fall risk screenings and education in primary care can improve patient safety, reduce injuries, and support aging-in-place
The Use of Platelet-Rich Fibrin in Maintaining Vascularity for Intentionally Replanted Teeth: A Randomized Clinical Trial
Get PDFBackground: A primary goal for a mature tooth autotransplant is preserving tooth vitality. Platelet-rich fibrin (PRF) has characteristics that may improve the success of autotransplanted mature teeth by decreasing harmful inflammation and boosting vascular growth. This prospective human trial aimed to evaluate the effectiveness of PRF on vitality in a mature tooth replantation model. Methods: This double-blind, randomized controlled trial included 18 participants with 70 single-rooted vital teeth planned for prosthetic extraction. Experimental teeth were extracted and apicoectomized to increase vascular growth. PRF was condensed into the canals before teeth were replanted in their respective sockets. In the same patient, control teeth received identical treatment without PRF. Teeth were splinted and monitored for 3 through 11 months before final vitality testing, extraction, and histologic analysis of pulpal tissue. Results: Comparison of vitality testing did not yield statistically significant differences between experimental and control teeth. In addition, histologic evaluation of infiltrate type and health of pulp did not reveal any benefit from the addition of PRF. Out-of-mouth time marginally differed between experimental and control groups (mean difference, 0.26 [95% CI, −0.50 to −0.020]; P =.04) but did not affect vitality testing (P =.86). Inflammation state of the recipient site is believed to have confounded final results. Conclusions: PRF applied to the periapical region did not improve the chances of vitality retention after extraction and replantation; however, it is possible site inflammation may have affected vitality results and confounded the effects of PRF
A Rare Delayed Neuropsychiatric Encephalopathy After Hyperbaric Oxygen Treatment for Carbon Monoxide Poisoning: A Couple’s Case Report
Get PDFIntroduction: Carbon monoxide (CO) poisoning is caused when carbon monoxide builds up in the blood, most specifically due to its high binging affinity for the heme structure in hemoglobin.1 This can lead to serious tissue damage and even be fatal. CO poisoning is primarily the result of incomplete combustion of fuels, with common sources domestically and internationally including furnaces, gas heaters, generators, and motor vehicles.2 Symptoms tend to present as neuropsychiatric symptoms, such as dementia, psychosis, parkinsonism, and incontinence. There are few well-researched CO poisoning specific treatments, which suggest supplemental oxygen and hyperbaric oxygen being most effective. We present a case of CO poisoning in two individuals who were both treated with hyperbaric oxygen therapy,
Background: Two patients (83-year-old male, 74-year-old female) presented to the emergency department secondary to accidental carbon monoxide poisoning. On scene, emergency services confirmed high Carboxyhemoglobin (COHb) of 35%, and with a Glasgow Coma Scale (GCS) of 4/15 and 3/15 for the male and female respectively; they were subsequently intubated and transferred for emergent hyperbaric oxygen treatment. Due to the post CO non-traumatic brain injury sustained, they were eventually admitted to an inpatient rehabilitation (IPR). On admission, both were fully orientated with progressive improvement of cognition through the initial 2 weeks of their stay. Both patients experienced a drastic cognitive decline deemed to be a delayed post-CO exposure sequalae, which started week two of the female’s IPR stay and two months post-IPR for the male,
Results: Both patients suffered late onset neuropsychiatric encephalopathic effects secondary to carbon monoxide poisoning despite acute aggressive hyperbaric oxygen treatment right after initial injury.
Conclusion: Aggressive hyperbaric treatment has been shown to improve cognitive functioning. For these patients, the effects of hyperbaric treatment did not prevent the progression of delayed onset carbon monoxide induced encephalopathy
Survey of Current Clinical and Imaging Practices Amongst Regional Obstetric Providers in Nebraska: A Discussion of Future Application of Artificial Intelligence in Fetal Echocardiography
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Analysis of Female Medical Student Matriculation Into Orthopaedic Surgery Nationally by Medical School
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The Advanced Practice Provider’s Role in Fellow Medical Education and Training: A Mixed Methods Survey Study to Evaluate Current Educational Interactions, Perspectives, and Models
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