771 research outputs found
Ambulatory assisted living fallers at greatest risk for head injury
No full textOBJECTIVES: To determine the relationship between head injuries sustained during each fall with various known high risk health and demographic factors predictive of falls.
DESIGN: Prospective cohort study conducted over 1 year
SETTING: Assisted living and skilled nursing units of a Continuing Care Retirement Community located in the northeastern United States.
PARTICIPANTS: Sixty nine OAs who fell.
MEASUREMENTS: Age, gender, diagnosis, high risk medication, functional, cognitive, ambulation/elimination status, mode of locomotion, fall related symptoms and the position of the fall, were analyzed using General Estimating Equations among elderly fallers with and without head injury.
RESULTS: A total of 173 falls (average of 2.9 times) were observed for 62 patients who had complete injury data. Injuries were recorded in 40.5% of falls, with 41.4% being head injuries. Head injuries were more likely to be hematomas than lacerations (66.7% vs. 14.7%) and among assisted living residents (p=0.04). Head injured patients were more likely to be walking at the time of the fall (69% vs. 36.1%) and less likely to have bowel incontinence (3.5% vs. 28.5%; p=0.04). None of the high risk diagnosis or medications associated with falls risk increased risk for head injury.
CONCLUSION: Those at greatest risk for head injury were ambulatory assisted living residents. None of the known clinical conditions predictive of risk to fall were predictive of head injury. For head injury prevention to be successful we need a closer examination of resident’s mobility, shoe-wear, health behavior with respect to ability to use assistive devices, and floor surface landing area. Future health policy implications include measures to ensure standard of care practices for head injured patients are in place.This is the peer reviewed version of the following article: Gray-Miceli, D. L., Ratcliffe, S. J. and Thomasson, A. (2013), Ambulatory Assisted Living Fallers at Greatest Risk for Head Injury. Journal of the American Geriatrics Society, 61: 1817–1819, which has been published in final form at https://dx.doi.org/10.1111/jgs.12467. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Peer reviewe
Teaching Strategies for Atypical Presentation of Illness in Older Adults
No full textAtypical presentation of illness is one of those phenomena where “seeing is believing”. Expert geriatric nurses and clinicians know all to well the early signs and symptoms of this frequent masquerader of bacterial infections, pain, acute myocardial infarction, heart failure or other serious medical ailments in older adults. Students however, as novices to clinical practice, require interactive learning approaches to reflect on the client’s illness presentations, help with developing the necessary skills to analyze and synthesize clinically relevant data, and to witness resolution of an atypical presentation when found and treated. We discuss various learner-centered, interactive approaches to teach students how to recognize an atypical presentation of illness using a real-life clinical case. Outlined are teaching strategies for faculty, drawn on visual, auditory, reading and kinesthetic modes of student learning. Use of the senses to teach nurses about care of patient’s is not entirely new or innovative, as reflected on by Florence Nightingale’s (1846) earliest writings of the "rules of nursing".Peer reviewe
Use of a comprehensive postfall assessment tool to prevent falls
No full textNursing research in fall prevention should not only identify etiologic risk factors to fall, but seek to identify underlying causes, whenever possible. Few studies have investigated the use of a comprehensive post fall assessment tool (PFAT) by nurses as an intervention for the prevention of recurrent falls, especially one that prompts nurses to consider all potential causes through a categorization scheme. This study tested use of a comprehensive PFAT as an intervention, prospectively, facility-wide for 1 year by RNs using a pre-post-test design. A 29.4% reduction in the fall rate (z=3.89; p <0.001), 27.6% decline in total falls experienced by all fallers (p<0.001) and a 34.0% decline for recurrent fallers (p = 0.025) from pre-intervention to intervention year was observed when trained nurses categorized falls according to perceived causes. These declines are likely due to consistent and rigorous use by trained nursing staff, prompting their critical examination of each fall.Peer reviewe
Alberto Quadrio Curzio - Valeria Miceli, Sovereign Wealth Funds. A complete guide to state-owned investment funds
No full textThe present contribution is a review article of the book of Alberto Quadrio Curzio and Valeria Miceli "Sovereign Wealth Funds. A complete guide to state-owned investment funds" Harriman House, Petersfield (UK), 2010. This article aims at analyzing the content of the volume in which the authors describe the role of SWFs in global financial market, assessing the weight and the strategies and predicting their developments
Current Approaches to Post-fall Assessment in Nursing Homes
No full textFalls in nursing homes occur among a large percentage of residents. Their onset necessitates a postfall assessment (PFA) be performed by clinical staff to determine likely etiology. The absence of an empirically validated comprehensive postfall assessment tool has led to considerable variability in the types of PFAs performed. The purpose of this study was to examine the types of PFA tools available, their content, and to compare this with national recommendations for fall assessment in geriatric practice.Peer reviewe
Improving the quality of geriatric nursing care: Enduring outcomes from the Geriatric Nursing Education Consortium
No full textThe nation's aging demographics, few nursing faculty with gero-expertise, and insufficient geriatric content in nursing programs has created a national imperative to increase the supply of nurses qualified to provide care for older adults. GNEC, the Geriatric Nursing Education Consortium, a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the NYU Nursing Hartford Institute for Geriatric Nursing was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, processes, and development of GNEC evidence-based curricular materials, and the dissemination of these materials through six, two and a half day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended an FDI. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over two years. Administrative and faculty level recommendations to sustain and expand GNEC are highlighted.Peer reviewe
I fondi sovrani del Paese di Mezzo
No full textTra le molte dimensioni che fanno della Cina una potenza globale capace
di sviluppare strategie geoeconomiche e geopolitiche di lungo periodo,
emerge anche quella degli investimenti all’estero, nel cui ambito giocano
un ruolo cruciale i fondi sovrani. Storia e gestione del China Investment
Corporation, fondo sovrano di fatto proprietario di gran parte del sistema
bancario e finanziario cinese. I cui investimenti servono al resto del mondo;
ma lo preoccupano
Sovereign Wealth Funds. A complete guide to state-owned investment funds
No full textSovereign Wealth Funds (SWFs) - state investment vehicles based on balance of payment surpluses - have come increasingly under the scrutiny of public opinion over the past decade. Their remarkable investments in developed economies have also attracted the attention of politicians, academics and financial operators. At first ignored, then seen as a cause for concern, they finally came to be viewed as stabilising agents amid the troubles of the 2007-2009 financial tsunami. Having sponsored the bailouts of some significant Western banks, SWFs underwent a phase of retrenchment concomitant with the shrinking of economic growth, the bursting of financial and real-estate bubbles and the emphasis on refocusing liquidity on domestic markets that followed in the wake of the crisis. Since the second half of 2009, however, SWFs have adjusted targets and strategies to the new financial paradigm and re-engaged in the global economy, proving to be major players in the international financial markets
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