Use of a clustering method to describe the clinical profiles of older fallers: the value of a multidisciplinary consultation

OBJECTIVES

The population of older adults is particularly heterogeneous with regard to frailty and the risk of falling, the two of which are linked. We conducted an exploratory, analysis (with no preconceived ideas) of data collected during multidisciplinary falls consultations (MFCs), to identify people with similar profiles.

MATERIALS AND METHODS

We performed an observational, multicentre study of older patients (aged 75 and over) having been evaluated in an MFC. We excluded adults with a Mini Mental State Examination score < 14/30, an activities of daily living score < 4/6, or an unstable medical condition. Each participant underwent a clinical interview, impedancemetry, and a physical activity assessment (a questionnaire, and use of an activity tracker on 5 consecutive days). The K-means method and ascending hierarchical clustering were used to identify clusters of people with common characteristics.

RESULTS

Of the 106 participants, the median [IQR] mean number of falls in the previous 6 months was 1 [2]. Three functional clusters were identified: (i) fallers with poor mobility, difficulty getting up off the ground after a fall, and using a mobility aid for walking; (ii) an intermediate sedentary group with a gait speed of ~ 0.6 m s-1, and (iii) active people with a timed "up and go" test time below 15 s and a gait speed above 0.8 m s-1.

CONCLUSIONS

The population of older fallers referred for an MFC is heterogeneous. The presence of certain clinical characteristics enabled the definition of three patient clusters, which might help physicians to determine the most appropriate care objectives and pathways.

[Smoking habits among staff at the Rochefort-sur-Mer Hospital]

OBJECTIVE

The aim of the study was to establish an inventory of staff in the hospital who smoked to allow better identification of people at risk and thus develop targeted preventive strategies, which we hoped would be more effective.

PATIENTS AND METHODS

This survey was conducted at the Rochefort-sur-Mer Hospital in March 2008. The sociodemographic characteristics of the population responding and differences in characteristics between smokers and non-smokers were examined. The level of dependence of smokers and patterns of smoking in the workplace were also evaluated. The results were compared with those of the survey "Baromètre tabac personnel hospitalier 2003".

RESULTS

The response rate was 57%, with the study population characterized by a high proportion of women (82%). The proportion of smokers was 29%, similar to that found in the general population (30%) but higher than 24% of the survey of hospital staff Tobacco Barometer 2003. The hospital staff is still weakly dependent on tobacco. The attitude to smoking was strongly linked to socioeconomic group and the domestic staff and health care assistants were most likely to smoke and were also the most dependent. Finally, the hospital has itself become a smoke free environment without tobacco.

CONCLUSION

It is essential to promote measures to prevent smoking among hospital staff taking into account its specific features (high proportion of women). Targeted actions should in particular be conducted amongst the groups of workers who are the most affected.

Effect of declining owned-cat population on veterinary practices in Sydney

OBJECTIVES

To investigate relationships between declining owned-cat populations and cat-related clinical work and practice activities.

DESIGN

Sydney practitioners were interviewed, and practice records were examined, from small animal veterinary practices (n = 56) in Sydney. Using data that covered a 4 year period, the age distribution of cats was examined and associated trends in cat-related clinical work were analysed.

RESULTS

Important changes in the pet population attending veterinary practices were found, with 38.2% of respondents reporting a fall in cat desexings from 1996 to 2000.

CONCLUSIONS

While economic impact could not be determined, the qualitative data demonstrated that the majority of practices in the survey were active in the promotion of cat ownership. The study provides a useful model for future investigations. To facilitate this process and to enhance principals' knowledge of their practice's population dynamics, we advocate a minimum standard of data collection that records week-by-week activities and the deaths of pets.

Ambulatory infusional cancer chemotherapy: nursing role in patient management. The Cancer Center of Boston

The role of nursing in infusional cancer chemotherapy (ICC) may vary depending on the practice setting. Nurses in free-standing centers and office practices perform many duties that nurses in other facilities may not, because of the lack of many of the supports that benefit hospitals with their multidepartmental and hierarchical structures. Nurses function collaboratively with physicians in the planning and the implementation of patient treatment. Patient-related nursing responsibilities include patient/family education, drug preparation and administration, patient assessment for treatment toxicity, recognition and management of complications related to the catheter or infusion device, and telephone triage. Other duties more removed from patient care might include inventory management, research data collection and management, quality assurance and improvement, compliance with regulatory issues, and a myriad of other responsibilities. The transition of patient care to the outpatient setting has broadened the scope of nursing to include nonpatient care responsibilities due to financial constraints brought about by health care reform, changes in reimbursement patterns, and overhead required to maintain and deliver quality patient care. As a result of nursing responsibilities, it becomes paramount that the aforementioned constructs for program support are in place and that all nurses are consistently trained and have a template to follow for patient treatment and management. Nursing ability to perform patient-related tasks should be proven by formal written and practical competencies repeated annually and as procedural changes are implemented. The paragraphs to follow suggest nursing management of patients receiving ICC using a model developed at The Cancer Center of Boston (TCC).

Surveillance of the patient receiving infusional cancer chemotherapy: nursing role in recognition and management of catheter-related complications. The Cancer Center of Boston

Surveillance of the patient on infusional cancer chemotherapy (ICC) is paramount to patient safety. Key to this issue is diligence in monitoring for complications of infusion catheters. Nursing knowledge and awareness are essential for the early detection of such complications. The following is a composite of the manifestations of commonly experienced catheter-related complications. The incidence, detection and management issues are presented from the perspective of 15 years experience with ICC at The Cancer Center of Boston (TCC).