Falls in older people - an overview for the acute physician.

Falls are common amongst older adults inflicting a substantial socioeconomic burden. Aetiology is often multifactorial. Comprehensive individualised assessment is pivotal to direct effective interventions. We provide an overview of falls and highlight an approach for acute physicians who will increasingly encounter this mode of presentation in an ageing population.

Homologous blood use and conservation techniques for cardiac surgery in the United Kingdom.

The transfusion laboratories of 32 cardiothoracic surgical centres for adults were surveyed to determine the donor blood requirement for open heart surgery in the United Kingdom. Details of the transfusion practice and the use of blood conservation techniques were sought from a representative senior cardiac anaesthetist at each centre. Suitable data were received from 24 transfusion laboratories (75%) and 29 anaesthetists (90%). The mean (SD) blood use was 5.07 (1.53) units per operation. Seven centres routinely transfused fresh frozen plasma to all patients postoperatively. Experience with autologous deposit (three centres), "cell separators" (four centres), and the reinfusion of shed mediastinal blood (four centres) was limited. Prebypass phlebotomy for postbypass reinfusion (14 centres) and the infusion of residual oxygenator blood (27 centres) were the conservation techniques most commonly applied. In only nine centres was a postoperative normovolaemic anaemia to a haemoglobin concentration of less than 100 g/l accepted. Applying blood conservation techniques more widely would help to maintain blood supplies and reduce morbidity and mortality related to transfusion.

Linking public health and the health of the Chesapeake Bay.

The Chesapeake Bay has a profound impact on the lives of all who reside in the 64,000 square miles of its watershed. From crab cakes to sail-boats, drinking water to naval ships, the Bay touches virtually every aspect of life in the region. The Bay has inspired literature, driven the regional economy, and shaped political decision making and development patterns for homes, industry, agriculture, and transportation. As population demands increase and urban boundaries expand into pristine landscapes, the sustainability of the Chesapeake Bay and its resources face unprecedented pressures. Consequently, the public's health also is vulnerable to Bay pollution and other stresses stemming from development activities and widespread growth occurring throughout the Chesapeake Bay watershed. This paper will examine the linkages between the environmental quality of the Bay and the population health status, recommend ways to bridge ecological and human health concerns in the context of the Bay, and finally present a framework for developing a public health report card for the Bay.

Measuring critical care redesign: impact on satisfaction and quality.

This report describes restructuring on four critical care units at an acute, tertiary care hospital in South-east Pennsylvania. Utilizing a Patient Centered Care conceptual framework that had been successfully applied in the medical-surgical areas, restructuring involved three main areas: revamping of work processes, inclusive of redesigned staff roles; environmental and facility changes; and enhancement of telecommunication and information systems. Preliminary analyses six months post redesign revealed improvements and maintenance in four outcomes areas--satisfaction, quality and efficiency, and costs of care.