Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses

OBJECTIVES: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES: Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS: 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION: There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

Comparative performance of UK PFI and non-PFI hospitals

Since the first PFI hospital was established in 1994, many debates centred on the value for money and risk transfer in PFIs. Little concern is shown with PFI hospitals’ performance in delivering healthcare. Exploratory research was carried out to compare PFI with non‐PFI hospital performance. Five performance indicators were analysed to compare differences between PFI and non‐PFI hospitals, namely the length of waiting, the length of stay, MRSA infection rate, C difficile infection rate and patient experience. Data was collected from various government bodies. The results show that only some indexes measuring patient experience emerge statistically significant. This leads to a conclusion that PFI hospitals may not perform better than non‐PFI hospitals but they are not worse than non‐PFI hospitals in the delivery of services. However, future research needs to pay attention to reliability and validity of data sets currently available to undertake comparison.

“Ce n’est pas elle qu’on voit”: the photograph in the work of Annie Saumont

The incorporation of ekphrastic evocations of photographs into fictional works is a growing trend charted by (mostly) literary and (occasionally) art critics interested in the effect of their inclusion in a narrative. What has emerged as a veritable affinity of photography with literature has produced a fertile interdisciplinary critical discourse around areas of intersection between visual and verbal. With regard to short fiction, the photograph is often subject to investigation as analogy, the photograph and the short story being considered metonymically related with regard to form and effect. This notion of a structural equivalence between short story and photograph is one stressed by author/photographer Julio Cortàzar, concerned to highlight the quality of intensity he ascribes to both forms, which he saw as ‘cutting out a piece of reality’ in order to ‘breaking out’ into a wider one. Given Annie Saumont’s oft-cited admiration of Cortàzar’s work it is unsurprising that in her own writing – of stories themselves often classed, in their elliptical density, as verbal snapshots – she should take an interest in photographs and/or photographers. This article seeks to explore and analyse different values Saumont ascribes to what was paradoxically described by Barthes as ‘invisible’, in that what we see when viewing a photograph is, (often treacherously), ‘ pas elle qu’on voit’: never, or never solely, the actual object itself …

Making the most of PAS data: Macro- and micro-level studies of Romano-British settlement

The Portable Antiquities Scheme (PAS) database includes records of over 225,000 artefacts of Roman date, with a wide geographical coverage and the potential to contribute to our understanding of Romano-British landscapes and settlement at several scales of analysis. This paper draws upon the author’s doctoral research to describe regional case studies from six counties (Wiltshire, Worcestershire, Warwickshire, Northamptonshire, North Lincolnshire and Cumbria) on the use of PAS data. The data have value nationally and regionally as general guides to ancient settlement patterns, but it is arguably at the micro-scale that they have the most potential. With reference to detailed landscape studies from parts of Warwickshire and Wiltshire, the paper argues that sites represented by PAS data are often rural settlements that show evidence for continued activity throughout the Roman period. The paper demonstrates that with an appropriate methodology PAS data can be an immensely valuable archaeological resource, particularly when interpreted at multiple scales, and can be considerably more than a guide to broad distributions of Roman finds.