Depressive symptoms and adverse outcomes from hospitalization in older adults : secondary outcomes of a trial of falls prevention education

Depression is common in older people and symptoms of depression are known to substantially increase during hospitalization. There is little known about predictors of depressive symptoms in older adults or impact of common interventions during hospitalization. This study aimed to describe the magnitude of depressive symptoms, shift of depressive symptoms and the impact of the symptoms of depression among older hospital patients during hospital admission and identify whether exposure to falls prevention education affected symptoms of depression. Participants (n = 1206) were older adults admitted within two Australian hospitals, the majority of participants completed the Geriatric Depression Scale – Short Form (GDS) at admission (n = 1168). Participants’ mean age was 74.7 (±SD 11) years and 47% (n = 551) were male. At admission 53% (619 out of 1168) of participants had symptoms of clinical depression and symptoms remained at the same level at discharge for 55% (543 out of 987). Those exposed to the low intensity education program had higher GDS scores at discharge than those in the control group (low intensity vs control n = 652, adjusted regression coefficient (95% CI) = 0.24 (0.02, 0.45), p = 0.03). The only factor other than admission level of depression that affected depressive symptoms change was if the participant was worried about falling. Older patients frequently present with symptoms of clinical depression on admission to hospital. Future research should consider these factors, whether these are modifiable and whether treatment may influence outcomes.

Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: A pragmatic, stepped-wedge, cluster-randomised controlled trial

- Background Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme. - Methods Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886). - Findings Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42–0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42–0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7–19], control 10 days [6–18]). - Interpretation Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.

Caught between a rock and a hard place: Disruptive boys’ views on mainstream and special schools in New South Wales, Australia

Students with disruptive behaviour in the Australian state of New South Wales are increasingly being educated in separate “behaviour” schools. There is however surprisingly little research on how students view these settings, or indeed the mainstream schools from which they were excluded. To better understand excluded students’ current and past educational experiences, we interviewed 33 boys, aged between 9 and 16 years of age, who were enrolled in separate special schools for students with disruptive behaviour. Analyses reveal that the majority of participants began disliking school in the early years due to difficulties with school work and teacher conflict. Interestingly, while most indicated that they preferred the behaviour school, more than half still wanted to return to their old school. It is therefore clear that separate special educational settings are not a solution to disruptive behaviour in mainstream schools. Whilst these settings do fulfil a function for some students, the preferences of the majority of boys suggest that “mainstream” school reform is of first order importance.

Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: A qualitative process evaluation

- Objectives Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. - Design A qualitative exploratory study. - Methods Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. - Results Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. - Conclusions Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment.

Reducing falls in hospital through education to change patient and staff behaviour: A stepped wedge cluster randomised controlled effectiveness trial

Background: Falls remain the most frequent adverse event reported in hospitals, particularly geriatric rehabilitation wards. Randomised trials reducing fall injuries in hospitals have been elusive. Our previous randomised trial (n = 1206) demonstrated that multimedia education with physiotherapist falls educator support reduced falls among patients with higher cognition levels, but this benefit was offset by a potential increase in falls rates among patients with poor cognition. In the previous trial, hospital staff were blinded to the allocation of individual patients, and only delivered usual care.

Developing enterprise curriculum: Building on rock, not sand

Entrepreneurial education is the process of providing individuals with the ability to recognise commercial opportunities and the insight, self-esteem, knowledge and skills to act on them. It includes instruction in opportunity recognition, commercialising a concept, marshalling resources in the face of risk, and initiating a business venture. It also includes instruction in traditional business disciplines such as management, marketing, information systems and finance. The purpose of this paper is to describe the design and introduction of a new program in Entrepreneurship at the University of Tasmania. Rather than adopt a traditional business school (passive learning) approach, within this program the method and responsibility of learning has largely been reversed through the process of student centred learning. This method of learning represents a challenging departure from the traditional mainstream teaching practices. In considering the benefits achievable from this teaching method, this paper also considers the difficulties in transferring increased responsibility to students to manage their futures.

Geophysical evaluation methods for buried hill reservoirs in the Jiyang superdepression of the Bohai Bay basin, eastern China

The Jiyang superdepression is one of the richest hydrocarbon accumulations in the Bohai Bay basin, eastern China. Comprehensive seismic methods have been used in buried hill exploration in Jiyang to describe these fractured reservoirs better. Accurate seismic stratigraphic demarcation and variable-velocity mapping were applied to reveal the inner structure of the buried hills and determine the nature of the structural traps more precisely. Based on the analysis of rock properties and the characteristics of well-developed buried hill reservoirs, we have successfully linked the geology and seismic response by applying seismic forward technology. Log-constrained inversion, absorption coefficient analysis and tectonic forward-inversion with FMI loggings were applied to analyse and evaluate the buried hill reservoirs and gave satisfying results. The reservoir prediction was successful, which confirmed that the comprehensive utilization of these methods can be helpful in the exploration of buried hill reservoirs.

Competence in research planning in the fourth level of Spanish Secondary Education: a case study

In the last years, “Inquiry-Based Science Education” methodologies (IBSE) are being recommended by European institutions in order to improve the competence levels and the attitudes towards science of primary and secondary school students. Therefore, the aim of this study is to test the effectiveness of an IBSE methodology, the Methodology of Problem Solving as an Investigation (MPSI), for the teaching-learning process of planning of experiments in the fourth level of Spanish Secondary Education. By means of the students’ solutions for a series of open problems, the progress in the learning of the competences related to the planning of experiments has been analyzed, along with the influence of the methodology on the development of these competencies. The results show a students’ command from higher to lower levels on: emission of hypothesis, design of the experiment, qualitative analysis, identification of variables and reformulation of the open problem. Furthermore, the Methodology has contributed to an improvement of the scientific competence in the area of planning experiments.