A Cluster Randomised Controlled Trial to Evaluate a Policy of Making Hip Protectors Available to Residents of Nursing Homes

Objectives: to evaluate the effectiveness of a policy of making hip protectors available to residents of nursing homes. Design: a cluster randomised controlled trial of the policy in nursing and residential homes, with the home as the unit of randomisation. Setting: 127 nursing and residential homes in the greater Belfast area of Northern Ireland. Participants: 40 homes in the intervention group (representing 1,366 occupied beds) and 87 homes in the control group (representing 2,751 occupied beds). Interventions: a policy of making hip protectors available free of charge to residents of nursing homes and supporting the implementation process by employing a nurse facilitator to encourage staff in the homes to promote their use, over a 72-week period. Main outcome measures: the rate of hip fractures in intervention and control homes, and the level of adherence to use of hip protectors. Results: there were 85 hip fractures in the intervention homes and 163 in the control homes. The mean fracture rate per 100 residents was 6.22 in the intervention homes and 5.92 in the control homes, giving an adjusted rate ratio for the intervention group compared to the control group of 1.05 (95% CI 0.77, 1.43, P = 0.76). Initial acceptance of the hip protectors was 37.2% (508/1,366) with adherence falling to 19.9% (272/1,366) at 72 weeks.Conclusions: making hip protectors available to residents of nursing and residential homes did not reduce the rate of hip fracture. This research does not support the introduction of a policy of providing hip protectors to residents of nursing homes.

Learning collaboration in General Internal Medicine: a pilot project for undergraduate students in nursing, physiotherapy and medicine

Background: A form of education called Interprofessional Education (IPE) occurs when two or more professions learn with, from and about each other. The purpose of IPE is to improve collaboration and the quality of care. Today, IPE is considered as a key educational approach for students in the health professions. IPE is highly effective when delivered in active patient care, such as in clinical placements. General internal medicine (GIM) is a core discipline where hospital-based clinical placements are mandatory for students in many health professions. However, few interprofessional (IP) clinical placements in GIM have been implemented. We designed such a placement. Placement design: The placement took place in the Department of Internal Medicine at the CHUV. It involved students from nursing, physiotherapy and medicine. The students were in their last year before graduation. Students formed teams consisting of one student from each profession. Each team worked in the same unit and had to take care of the same patient. The placement lasted three weeks. It included formal IP sessions, the most important being facilitated discussions or "briefings" (3x/w) during which the students discussed patient care and management. Four teams of students eventually took part in this project. Method: We performed a type of evaluation research called formative evaluation. This aimed at (1) understanding the educational experience and (2) assessing the impact of the placement on student learning. We collected quantitative data with pre-post clerkship questionnaires. We also collected qualitative data with two Focus Groups (FG) discussions at the end of the placement. The FG were audiotaped and transcribed. A thematic analysis was then performed. Results: We focused on the qualitative data, since the quantitative data lacked of statistical power due to the small numbers of students (N = 11). Five themes emerged from the FG analysis: (1) Learning of others' roles, (2) Learning collaborative competences, (3) Striking a balance between acquiring one's own professional competences and interprofessional competences, (4) Barriers to apply learnt IP competences in the future and (5) Advantages and disadvantages of IP briefings. Conclusions: Our IP clinical placement in GIM appeared to help students learn other professionals' roles and collaborative skills. Some challenges (e.g. finding the same patient for each team) were identified and will require adjustments.

Radiosensibilité individuelle : les tests vont changer nos pratiques [Intrinsic radiosensitivity: predictive assays that will change the daily practice].

The impact of curative radiotherapy depends mainly on the total dose delivered homogenously in the targeted volume. Nevertheless, the dose delivered to the surrounding healthy tissues may reduce the therapeutic ratio of many radiation treatments. In a same population treated in one center with the same technique, it appears that individual radiosensitivity clearly exists, namely in terms of late side effects that are in principle non-reversible. This review details the different radiobiological approaches that have been developed to better understand the mechanisms of radiation-induced late effects. We also present the possibilities of clinical use of predictive assays in the close future.

Health equity audit - learning from practice briefing

This briefing provides a summary of learning from three workshops on HEA, and examples of completed or near-completed HEAs to illustrate these learning points. It is recognised that this experience is evolving.

U.S. National Parks and "The Tragedy of the Commons" : A contribution to the characterization of U.S. mountain guides' professional practice

This paper aims at presenting the stakes related to the access to protected land in the United States and to its conservation, through the analysis of the professional practice of U.S. mountain guides. From a methodological standpoint, this research is based both on a theoretical analysis grounded in the field of environmental economics and on an empirical study. The authors' starting point is Garrett Hardin's paper, "The Tragedy of the Commons" (Science, 1968), even if it introduces some confusion on the notion of common goods. So as to avoid this confusion, the authors use two theoretical tools pertaining to a typology of common goods and the different property rights that can be applied in National Parks. Finally, they apply this framework to the observations made on the field in Colorado in July 2009.

Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Full report

This report arises from a project commissioned by the Department of Health's Equality and Human Rights Group to produce an evidence-based review with a national perspective that addresses (i) ethnic differentials in health and healthcare and (ii) evidence of effective NHS and other action, including seective examples of good practice to illustrate each area. Rather than aiming for comprehensive coverage, the Department suggested a document that focuses on selective topics and population health priorities drawn from the NHS plan, existing and developing National Service Frameworks, and other policy documents and which, collectively, are encompassed in the NHS's 10-point Race Equality Action Plan. The authors were not asked to review the evidence on other key areas (such ashypertension, stroke, disability, etc.), ethnic disparities in the wider determinants of health, and on some specific groups such as Gypsy Travellers and refugees and asylum seekers. Some of these topics are covered in other reviews.

Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Executive summary

This report arises from a project commissioned by the Department of Health's Equality and Human Rights Group to produce an evidence-based review with a national perspective that addresses (i) ethnic differentials in health and healthcare and (ii) evidence of effective NHS and other action, including seective examples of good practice to illustrate each area. Rather than aiming for comprehensive coverage, the Department suggested a document that focuses on selective topics and population health priorities drawn from the NHS plan, existing and developing National Service Frameworks, and other policy documents and which, collectively, are encompassed in the NHS's 10-point Race Equality Action Plan. The authors were not asked to review the evidence on other key areas (such ashypertension, stroke, disability, etc.), ethnic disparities in the wider determinants of health, and on some specific groups such as Gypsy Travellers and refugees and asylum seekers. Some of these topics are covered in other reviews.

Implementation plan for reducing health inequalities in infant mortality: A good practice guide

The publication shows how to narrow the health inequalities gap in infant mortality by looking at current examples of best practice.

Quantifying the gap between policy and practice in cardiovascular risk reduction: a review of evidence from recent cardiovascular and diabetes audits in the UK

As part of CHD NSF implementation, a pilot project is being undertaken under the auspices of the National Screening Committee to test the practical implications and outcomes of implementing a systematic programme of cardiovascular risk reduction in primary care, initially identifying those at high risk due to pre-existing cardiovascular disease or diabetes. To assist in assessing the magnitude of the challenge faced by the pilot programmes, the UK National Screening Committee (NSC) commissioned a review of current practice based on recent cardiovascular and diabetes audits in the UK. This report details the findings of the review, providing 6 key recommendations for future cardiovascular audits.

Electronic monitoring of compliance to lipid-lowering therapy in clinical practice

Nonadherence to treatment is a common problem in the clinical management of hypercholesterolemic patients. This study was carried out with the aim of monitoring the daily compliance to a 6-month course of lipid-lowering therapy, using a microelectronic device, the Medication Event Monitoring System (MEMS), versus pill count. Forty men with primary hypercholesterolemia were prescribed fluvastatin 1 x 40 mg daily, provided in a MEMS package to record the date and time of each opening of the pillbox. Thirty-nine of 40 patients (98%) completed the study. Total cholesterol and LDL cholesterol levels decreased significantly (18% and 25%, p < 0.001) during the 6-month therapy period. A high mean rate of compliance was achieved by MEMS using the following three indexes--compliance to total prescribed dose (88.8% +/- 13.5%), compliance to prescribed days (82.4% +/- 19.5%), and compliance to prescribed time of day (81.86% +/- 19.5%)--and by pill count (93.4% +/- 9.5%). In addition, the MEMS provided some patterns of nonadherence to medication, undetectable by pill count alone, such as a drug holiday in 38% of cases, a drug omission for more than 7 consecutive days in 9% of cases, and, conversely, use of more than the one prescribed daily dose in 47% of cases. A significant correlation between the rate of compliance and the decrease in LDL cholesterol was observed only when the compliance was assessed by MEMS. The results indicate that MEMS is a useful tool for monitoring compliance in clinical practice and may possibly increase adherence to long-term lipid-lowering therapy.

Regional guidelines for nurses when sharing information with NIGALA

Effective safeguarding children practice depends upon information sharing, collaboration and understanding between families, agencies and professionals. Nurses are required to work in partnership with other disciplines and agencies to safeguard and promote the health and wellbeing of children and young people. This includes working in partnership with the guardian ad litem (guardian) appointed by the court when making decisions regarding the best interests of a child or young person.This guidance replaces previous regional guidance. Regional implementation will ensure that information held by nurses is shared with the guardian in a consistent, timely and appropriate manner, so that informed decisions can be made in the best interests of children and young people.

Infection prevention and control. Best practice advice for nurseries and childcare settings

This booklet provides nurseries and childcare settings with comprehensive infection prevention and control advice.It includes simple, practical and easily understood guidance on the day-to-day implementation of good infection prevention and control practices, as well as specific actions to take in the event of outbreaks of infection.Areas covered include suitable childcare premises, hand hygiene, immunisation, decontamination, toys, personal items, toilets, nappy changing, laundry, food hygiene and pets.The booklet includes illustrations, diagrams, a glossary and key points to remember in each section to ensure the advice is easy for all staff to understand and pass on to others.It also provides contact details for each of the Health and Social Care early years teams in Northern Ireland.

Norovirus incident outbreak pack for nursing and residential homes

Norovirus Incidents and�Outbreaks Pack for Nursing and Residential Homes from PHA Duty Room October 2013.

Nutritional guidelines and menu checklist for residential and nursing homes

Care home residents should receive a varied diet that meets their nutritional needs in appropriate surroundings.This booklet ensures residential and nursing home managers and care providers have access to guidelines that help them achieve the aims set out by the Regulation and Quality Improvement Authority (RQIA), ie.�empowerment of, and positive engagement with, residents in all aspects of their care, including nutrition.It also provides practical nutrition advice and menu guidance.