Patient education to prevent falls among older hospital inpatients : a randomized controlled trial

Background Falls are a common adverse event during hospitalization of older adults, and few interventions have been shown to prevent then. Methods This study was a 3-group randomized trial to evaluate the efficacy of 2 forms of multimedia patient education compared with usual care for the prevention of in-hospital falls. Older hospital patients (n = 1206) admitted to a mixture of acute (orthopedic, respiratory, and medical) and subacute (geriatric and neurorehabilitation) hospital wards at 2 Australian hospitals were recruited between January 2008 and April 2009. The interventions were a multimedia patient education program based on the health-belief model combined with trained health professional follow-up (complete program), multi-media patient education materials alone (materials only), and usual care (control). Falls data were collected by blinded research assistants by reviewing hospital incident reports, hand searching medical records, and conducting weekly patient interviews. Results Rates of falls per 1000 patient-days did not differ significantly between groups (control, 9.27; materials only, 8.61; and complete program, 7.63). However, there was a significant interaction between the intervention and presence of cognitive impairment. Falls were less frequent among cognitively intact patients in the complete program group (4.01 per 1000 patient-days) than among cognitively intact patients in the materials-only group (8.18 per 1000 patient-days) (adjusted hazard ratio, 0.51; 95% confidence interval, 0.28-0.93]) and control group (8.72 per 1000 patient-days) (adjusted hazard ratio, 0.43; 95% confidence interval, 0.24-0.78). Conclusion Multimedia patient education with trained health professional follow-up reduced falls among patients with intact cognitive function admitted to a range of hospital wards.

Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project) : study protocol

Background: An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. ---------- Methods/Design: A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned.---------- Discussion: Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally.

Patient preference for falls prevention in hospitals revealed through willingness-to-pay, contingent valuation survey

Rationale, aims and objectives: Patient preference for interventions aimed at preventing in-hospital falls has not previously been investigated. This study aims to contrast the amount patients are willing to pay to prevent falls through six intervention approaches. ----- ----- Methods: This was a cross-sectional willingness-to-pay (WTP), contingent valuation survey conducted among hospital inpatients (n = 125) during their first week on a geriatric rehabilitation unit in Queensland, Australia. Contingent valuation scenarios were constructed for six falls prevention interventions: a falls consultation, an exercise programme, a face-to-face education programme, a booklet and video education programme, hip protectors and a targeted, multifactorial intervention programme. The benefit to participants in terms of reduction in risk of falls was held constant (30% risk reduction) within each scenario. ----- ----- Results: Participants valued the targeted, multifactorial intervention programme the highest [mean WTP (95% CI): $(AUD)268 ($240, $296)], followed by the falls consultation [$215 ($196, $234)], exercise [$174 ($156, $191)], face-to-face education [$164 ($146, $182)], hip protector [$74 ($62, $87)] and booklet and video education interventions [$68 ($57, $80)]. A ‘cost of provision’ bias was identified, which adversely affected the valuation of the booklet and video education intervention. ----- ----- Conclusion: There may be considerable indirect and intangible costs associated with interventions to prevent falls in hospitals that can substantially affect patient preferences. These costs could substantially influence the ability of these interventions to generate a net benefit in a cost–benefit analysis.

Making sense of brain tumour: A qualitative investigation of personal and social processes of adjustment

This study investigated personal and social processes of adjustment at different stages of illness for individuals with brain tumour. A purposive sample of 18 participants with mixed tumour types (9 benign and 9 malignant) and 15 family caregivers was recruited from a neurosurgical practice and a brain tumour support service. In-depth semi-structured interviews focused on participants’ perceptions of their adjustment, including personal appraisals, coping and social support since their brain tumour diagnosis. Interview transcripts were analysed thematically using open, axial and selective coding techniques. The primary theme that emerged from the analysis entailed “key sense making appraisals”, which was closely related to the following secondary themes: (1) Interactions with those in the healthcare system, (2) reactions and support from the personal support network, and (3) a diversity of coping efforts. Adjustment to brain tumour involved a series of appraisals about the illness that were influenced by interactions with those in the healthcare system, reactions and support from people in their support network, and personal coping efforts. Overall, the findings indicate that adjustment to brain tumour is highly individualistic; however, some common personal and social processes are evident in how people make sense of and adapt to the illness over time. A preliminary framework of adjustment based on the present findings and its clinical relevance are discussed. In particular, it is important for health professionals to seek to understand and support individuals’ sense-making processes following diagnosis of brain tumour.

Social control of the drinking driver

It is more that 20 years since the “Social Control of the Drink Driver” edited by Laurence, Snortum and Zimring (1988) were published. It was, and remains a major examination of the issue involving 17 scientists from all relevant disciplines and policy centres and represents the current practice and experience at the time. While much of, but by no means all, the content is centred on the North American experience the scholarship and range of research data explored through the investigative lens of lawyers, pharmacologists, psychologists, sociologists, criminologists and economists covers all the major issues being examined in Europe, and Australia at the time. More importantly, it presents the policy aspirations and goals of nine countries and includes a comparison of deterrence and the legal context in six countries; emerging technologies for control and the potential contributions of education and rehabilitation. The experience of promoting evidence based policies and practices are generally experienced in all countries as both laborious and painfully slow. However, this ICADTS meeting in Norway provides an opportunity to challenge these feelings by re-examining the current situation compared with that documented over 20yrs ago. This presentation will undertake a reality check on just what we have achieved within that time and try to attribute success and failure towards recommendations for our future endeavours.

Extending Alexander’s ecological dominance-social competition (EDSC) evolutional model

Alexander’s Ecological Dominance and Social Competition (EDSC) model currently provides the most comprehensive overview of human traits in the development of a theory of human evolution and sociality (Alexander, 1990; Finn, Geary & Ward, 2005; Irons, 2005). His model provides a basis for explaining the evolution of human socio-cognitive abilities. Our paper examines the extension of Alexander’s model to incorporate the human trait of information behavior in synergy with ecological dominance and social competition as a human socio-cognitive competence. This paper discusses the various interdisciplinary perspectives exploring how evolution has shaped information behavior and why information behavior is emerging as an important human socio-cognitive competence. This paper outlines these issues, including the extension of Spink and Currier’s (2006a,b) evolution of information behavior model towards a more integrated understanding of how information behaviors have evolved (Spink & Cole, 2006).

Extending Alexander’s ecological dominance-social competition model : information behavior adaptation

Alexander’s Ecological Dominance and Social Competition (EDSC) model currently provides the most comprehensive overview of human traits in the development of a theory of human evolution and sociality (Alexander, 1990; Finn, Geary & Ward, 2005; Irons, 2005). His model provides a basis for explaining the evolution of human socio-cognitive abilities. Our paper examines the extension of Alexander’s model to incorporate the human trait of information behavior in synergy with ecological dominance and social competition as a human socio-cognitive competence. This paper discusses the various interdisciplinary perspectives exploring how evolution has shaped information behavior and why information behavior is emerging as an important human socio-cognitive competence. This paper outlines these issues, including the extension of Spink and Currier’s (2006a,b) evolution of information behavior model towards a more integrated understanding of how information behaviors have evolved (Spink & Cole, 2006).

Improving matching process in social network

Online dating networks, a type of social network, are gaining popularity. With many people joining and being available in the network, users are overwhelmed with choices when choosing their ideal partners. This problem can be overcome by utilizing recommendation methods. However, traditional recommendation methods are ineffective and inefficient for online dating networks where the dataset is sparse and/or large and two-way matching is required. We propose a methodology by using clustering, SimRank to recommend matching candidates to users in an online dating network. Data from a live online dating network is used in evaluation. The success rate of recommendation obtained using the proposed method is compared with baseline success rate of the network and the performance is improved by double.

A social matching system for an online dating network : a preliminary study

Due to the change in attitudes and lifestyles, people expect to find new partners and friends via various ways now-a-days. Online dating networks create a network for people to meet each other and allow making contact with different objectives of developing a personal, romantic or sexual relationship. Due to the higher expectation of users, online matching companies are trying to adopt recommender systems. However, the existing recommendation techniques such as content-based, collaborative filtering or hybrid techniques focus on users explicit contact behaviors but ignore the implicit relationship among users in the network. This paper proposes a social matching system that uses past relations and user similarities in finding potential matches. The proposed system is evaluated on the dataset collected from an online dating network. Empirical analysis shows that the recommendation success rate has increased to 31% as compared to the baseline success rate of 19%.

Nurse-led telephone interventions for people with cardiac disease : A review of the research literature

Background: Nurse-led telephone follow-up offers a relatively inexpensive method of delivering education and support for assisting recovery in the early discharge period; however, its efficacy is yet to be determined. Aim: To perform a critical integrative review of the research literature addressing the effectiveness of nurse-led telephone interventions for people with coronary heart disease (CHD). Methods: A literature search of five health care databases; Sciencedirect, Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest and Medline to identify journal articles between 1980 and 2009. People with cardiac disease were considered for inclusion in this review. The search yielded 128 papers, of which 24 met the inclusion criteria. Results: A total of 8330 participants from 24 studies were included in the final review. Seven studies demonstrated statistically significant differences in all outcomes measured, used two group experimental research design and valid and reliable instruments. Some positive effects were detected in eight studies in regards to nurse-led telephone interventions for people with cardiac disease and no differences were detected in nine studies. Discussion: Studies with some positive effects generally had stronger research designs, large samples, used valid and reliable instruments and extensive nurse-led educative interventions. Conclusion: The results suggest that people with cardiac disease showed some benefits from nurse-led/delivered telephone interventions. More rigorous research into this area is needed.

Social infrastructure planning and sustainable community : example from south east Queensland, Australia

Social infrastructure and sustainable development represent two distinct but interlinked concepts bounded by a geographic location. For those involved in the planning of a residential development, the notion of social infrastructure is crucial to the building of a healthy community and sustainable environment. This is because social infrastructure is provided in response to the basic needs of communities and to enhance the quality of life, equity, stability and social well being. It also acts as the building block to the enhancement of human and social capital. While acknowledging the different levels of social infrastructure provision from neighbourhood, local, district and sub-regional levels, past evidence has shown that the provision at neighbourhood and local level and are affecting well-being of residents and the community sustainability. With intense physical development taking place in Australia's South East Queensland (SEQ) region, local councils are under immense pressure to provide adequate social and community facilities for their residents. This paper shows how participation-oriented, need-sensitive Integrated Social Infrastructure Planning Guideline is used to offer a solution for the efficient planning and provision of multi-level social infrastructure for the SEQ region. The paper points out to the successful implementation of the guideline for social infrastructure planning in multiple levels of spatial jurisdictions of Australia's fastest growing region.

A test of the job demands : resources model with HIV/AIDS volunteers

Burnout has been identified as a significant factor in HIV/AIDS volunteering. It has been associated with depression, anxiety and the loss of volunteers from the health care delivery system. The aim of this study was to test the independence of the health and motivational processes hypothesized within the Job Demands – Resources model of burnout in HIV/AIDS volunteers. Participants were 307 HIV/AIDS volunteers from state AIDS Councils throughout Australia who completed self-report measures pertaining to role ambiguity and role conflict, social support, burnout, intrinsic and organizational satisfaction, and depression. Findings suggested that the independence of the dual processes hypothesized by the model was only partially supported. These findings provide a model for burnout which gives a framework for interventions at both the individual and organizational level which would contribute to the prevention of burnout, depression, and job dissatisfaction in HIV/AIDS volunteers.

Engaging energy saving through motivation-specific social comparison

Comparison is widely used in research projects and commercial products whose goal is to motivate energy saving at home. This research builds on fundamental theories from social psychology in an attempt to shed light on how to motivate consumers to conserve energy by providing relevant people for social comparison depending on consumer’s motivation to compare. To support the research process, the mobile application EnergyWiz was developed through a theory-driven design approach. Along with other features EnergyWiz provides users with three types of social comparison – normative, one-on-one and ranking. The results of interviews with prospective users are used to derive design suggestions for relevant people for comparison (comparison subjects).

Diversity management for innovation in social enterprises in the UK

This paper examines the linkages between diversity management (DM), innovation and high performance in social enterprises. These linkages are explicated beyond traditional framing of DM limited to workforce composition, to include discussions of innovation through networked diversity practices; reconciliation; and funding options. The paper draws upon a UK-based national survey and the case study data. Multiple data collection methods were used, including semi-structured interviews, questionnaires and workshops with participant observation. NVivo and SPSS software packages were utilized in order to analyse the qualitative and quantitative data, respectively. We used thematic coding and cropping techniques in analysing the case studies in the paper. A broad range of conflicting and supporting literature was enfolded into the conversations and discussion. The paper demonstrates that social enterprises exhibit unique characteristics in terms of size and location, as well as their double remit to add value both economically and socially. As a conclusion, we argue for social enterprises to consider options for DM in the interests of maximization of innovation and business performance. We contend that further research is needed to describe how social entrepreneurs draw upon their various ‘diversity resources’ in the process of innovation