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.

Entre moralité et politique: l’éducation de Louis XV et la question de l’instruction financière du prince sous l’Ancien Régime

Studies on princely education rarely focus on the training received by future kings to perform one of their key functions – supervising the finances of the monarchy. Failure to address this issue is all the more surprising than one of the major consequences of Louis XIV’s coronation was to grant the king the direction of finances until the French Revolution, thus raising the issue of the financial education of the prince. Based on a largely unpublished body of primary sources, especially several manuscripts specifically written for the financial education of Louis XV and princes in the XVIIIth century, this article explores the teaching approaches and programme of a highly technical nature that the king’s tutors considered essential to the monarch’s duties.

DMP XV palaeohydrology and palaeoenvironment: initial results and report of 2010 and 2011 fieldwork

This paper reports the results of fieldwork conducted in the 2010 and 2011 DMP field seasons and of analysis of samples collected during these and previous years. Research has involved 1) studying palaeolake sediment outcrops, 2) using ground penetrating radar (GPR) to determine their extent under the Dahān Ubārī, and 3) coring palaeolakes in order to determine their palaeoenvironmental records. Research on these samples is continuing but some initial findings are discussed in this paper. The most extensive palaeolake sediments are found within the al-Mahruqah Formation and were deposited by a giant lake system that developed in the Fazzān Basin during past humid periods. Stratigraphic analysis of Lake Megafazzān sediments suggests two different sedimentary successions, a lake margin succession distinctive for its lacustrine and palaeosol carbonates, and a clastic-dominated, intensely rootleted, basin-centre succession which has terrestrial intervals (aeolian and palaeosols) as well as in the upper parts lacustrine limestones. Both basin margin and basin centre successions are underlain by fluvial deposits. Magnetostratigraphy suggests that the formation may be as old as the mid-Pliocene. After the Lake Megafazzān phase, smaller palaeolakes developed within the basin during subsequent humid periods. One of the largest is found in the Wādī al-Hayāt in the area between Jarma and Ubārī. Similar deposits further west along the Wādī at progressively higher altitudes are interpreted as small lakes and marshes fed by springs issuing from aquifers at the base of the escarpment, last replenished during the Holocene humid phase. Dating of sediments suggests that this was between c. 11 and c. 8 ka. The Wādī ash-Shāţī palaeolake core also provides a Holocene palaeoclimate record that paints a slightly different picture, indicating lake conditions until around 7 ka, whereupon it started oscillating until around 5.5 ka when sedimentation terminates. The reasons for the differences in these records are discussed.