The role of psychiatrists in family medicine training

The authors surveyed 356 family medicine residency training directors to determine the role of psychiatrists in family medicine training. Two hundred five responses were received, covering the training experiences of 3696 residents. Psychiatrists were actively involved in the training programs, but their role was circumscribed to areas of traditional, demonstrated expertise. Most of the program directors rated psychiatrists as highly useful. Programs rating psychiatrists highly useful differed from low usefulness raters only in having both general psychiatry and consultation-liaison rotations available. This lends support to the hypothesis that consultation-liaison activities provide the most useful method of integrating psychiatrists into family medicine training programs.     

The influence of smoker status, smoking history, sex, and situational variables on smokers'' self-efficacy

Recent work in smoking cessation has focused on cognitive factors related to relapse and maintenance. The present investigation utilized an established self-efficacy-based questionnaire to determine whether sex, length of smoking history, successful quitting attempts, and environmental events affected subjects' perceived confidence of resisting smoking urges. It was hypothesized that: (a) subjects with fewer years smoking would have higher self-efficacy than those smoking for longer periods; (b) reported self-efficacy would be lowest for those situations involving negative moods; and (c) successful quitters would report higher self-efficacy than unsuccessful quitters. The second and third hypotheses were strongly confirmed, and a nonsignificant tendency in the expected direction was found for the first hypothesis. The results were generally consistent with the self-efficacy and the Abstinence Violation Effect (AVE) models.     

老年人跌倒的危险因素

老年人跌倒是严重的公共卫生事件。跌倒严重影响老年人的生存质量,给整个社会及家庭带来沉重经济负担。影响跌倒的危险因素是多方面的,随着年龄的增长,老年人会出现中枢和周围神经系统退变、感觉功能衰退、肌肉力量下降、平衡能力下降、步态稳定性下降。这些变化是导致老年人跌倒的危险因素,而心脑血管类疾病、神经系统疾病、药物不良反应、环境因素和跌倒恐惧症也使老年人跌倒风险增加。     

跌倒危险评估表应用于老年患者的信度和效度研究

目的:探讨昆士兰大学跌倒危险因素评估表(Falls Risk Assessment Tool,FRAT)应用于我国老年住院患者的信度和效度,以确定其应用价值.方法:采取方便抽样的方法,用跌倒评估量表对某医院890 例老年患者进行调查,评价量表的信度、效度及预测性能.结果:总量表Cronbach's α系数为0.91,各...     

Refracture following Fracture Liaison Service Assessment Illustrates the Requirement for Integrated Falls and Fracture Services

The Fracture Liaison Service (FLS) allows appropriate antiosteoporosis therapy to be targeted to potentially reduce future fracture risk. A proportion of these treated patients will still experience a further fracture. This work reviews the characteristics of these patients. Data were collated for patients >65 years old presenting to the South Glasgow FLS between January 2001 and August 2004. There were 2,489 patients who presented (incident fracture group), and 129 (5.2%) sustained an additional fracture (refracture group). Median age of the incident fracture group was 77.8 years vs. 80.6 years for the refracture group (P = nonsignificant). The refracture group was determined according to whether their incident fracture was hip (n = 47) or nonhip (n = 82). When the incident fracture was hip, a refracture was more likely to be a further hip fracture (χ² = 14.4, P = 0.002) and patients refractured sooner (median time to refracture 194 [range 10–1,134] days vs. 258 [range 6–1,081] days [nonhip]) (P = nonsignificant). In the refracture group, 76% of patients were already on osteoporosis treatment after their incident fracture. Patients over 65 years of age presenting to FLS who sustain an additional fracture are older; are likely to sustain another hip fracture after an incident hip fracture; often refracture early, particularly when the incident fracture is of the hip; and are often already on antiosteoporosis treatment. Therefore, it is important to identify these high-risk patients and offer a combined approach of prompt drug treatment through a systematic and specialist osteoporosis management team along with reducing any reversible falls risk factors.     

Falls in patients with chronic obstructive pulmonary disease: A call for further research

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress. The effects of COPD, however, are not exclusively limited to respiratory function and people with COPD face many non-respiratory manifestations that affect both function and mobility. Deficits in function and mobility have been associated with an increased risk for falling in older adults. The purpose of this study was to provide a theoretical framework to identify risks factors for falls in people with COPD. We have analyzed the literature to identify possible relationships between pathophysiological changes observed in COPD and common risk factors for falls. Well-established fall risk factors in people with COPD include lower limb muscle weakness and impaired activities of daily living. Other intrinsic risk factors such as gait and balance deficits, nutritional depletion, malnutrition, depression, cognitive impairments and medications are possible risk factors that need to be confirmed with more studies. There is no evidence that visual deficits are common in COPD. The role that precipitating factors such as syncope and postural hypotension may have on fall risk is unclear. Exacerbations and dyspnea do not have a precipitating effect on fall risk but they contribute to the progressive physical deterioration that may theoretically increase the risk for falls. While these results suggest that people with COPD might have an increased susceptibility to fall compared to their healthy peers, further research is needed to determine the prevalence of falls and specific risk factors for falls in people living with COPD.     

Tranquilliser use as a risk factor for falls in hospital patients

This study looked at associations of tranquilliser use and falls risk in a hospital population of confused and nonconfused patients. In a prospective observational study in a rehabilitation hospital for elderly patients, we followed 1025 consecutive patients. The number of fallers, recurrent fallers and total falls was recorded. Confused patients (p < 0.0001) and patients on tranquillisers (p = 0.001) were significantly more likely to fall than nonconfused patients and patients off tranquillisers. Confused patients on tranquillisers were significantly more likely to have recurrent falls (p = 0.026) when compared with confused patients off tranquillisers. The risk was apparent from admission, persisting throughout the first 30 days of stay. This was not noted for nonconfused patients. We identified a stratification of risk for falls with nonsignificant trends for confused and nonconfused patients on tranquillisers to be fallers and to have more falls compared with patients off tranquillisers. These data are associational and do not necessarily imply causality. There is however no evidence to recommend the routine withdrawal of tranquillisers from all patients. Any future research needs to include confused patients.     

Improving nursing students’ assessment of fall risk in community-dwelling older adults

Nationally, approximately one third of older adults fall each year. Falls and resulting injury result in decreased mobility, functional impairment, loss of independence, and increased mortality. Utilization of evidence-based protocols by health care providers to identify older adults at risk of falling is limited, and rates of participation by older adults in prevention activities is low. Because of nursing’s increasing role in caring for older adults, development of fall prevention education for nursing students would result in increased awareness of the need for fall prevention in community-dwelling older adults and increased access of older adults to falls risk assessment. There is a need to extend research to inform teaching and learning strategies for fall prevention. After pretesting, a convenience sample of 52 undergraduate nursing students and 22 graduate nursing students completed an online education program and performed a falls risk assessment on an older adult. After completing the clinical assignment, students completed a posttest and self-efficacy survey. Data were analyzed using multivariate statistical tests. Results revealed an increase in knowledge and student self-reporting of efficacy of fall risk assessment skills for the older adult population. This study suggests that nursing students acquired the necessary knowledge and self-efficacy for assessing fall risk of older adults through the combination of an online learning module and participating in actual fall risk assessment of an older adult.