Where are falls prevention resources allocated by hospitals and what do they cost? A cross sectional survey using semi-structured interviews of key informants at six Australian health services.

BACKGROUND: Falls are a major problem for patients and hospitals, resulting in death, disability and increased costs of healthcare. OBJECTIVES: This study aimed to estimate the resource allocation across a partnership of large health services, in an attempt to understand the amount and variability of resource allocation to various falls prevention activities. DESIGN: A cross sectional survey using semi-structured interviews. SETTING: Six tertiary health services in Australia. PARTICIPANTS: A collaboration of six health services, spanning twenty-eight hospitals, was formed to investigate falls prevention resource allocation. We interviewed 186 health service staff who were involved in falls prevention activities, such as projects, audits and risk management, clinical and operational managers responsible for falls prevention resource allocation and clinical staff on targeted acute, subacute and mental health wards. METHODS: This study used a mixed methods, cross sectional, observational design. To collect data, we used key informant interviews with a purposive and snowball sampled group of people working in the included health services. During interviews, study participants were asked where and how falls prevention resources and equipment were utilised and to estimate the time allocated to performing falls prevention activities. The opportunity cost of each activity was estimated. All costs were reported in Australian dollars. RESULTS: We estimate the annual opportunity cost of health service attempts to prevent in-hospital falls across the six health services to be AU$46,478,014. If we extrapolate this to a national level, health services would be consuming AU$590 million per year in resources trying to prevent falls in hospital. The areas of greatest resource consumption were physiotherapy (18%), continuous patient observers (14%), falls assessments (12%) and screens (8%), and falls prevention alarms (11%). Falls prevention alarms and falls risk assessment screening tools were also used only for falls prevention, and are potentially ineffective falls prevention strategies. CONCLUSIONS: Health services are investing considerable amounts of resource in attempting to prevent falls. However much of this resource is consumed in activities with weak or little evidence of effectiveness. Health services may be better served by considering tighter targeting, reduction or disinvestment in this area. This may release time and resources which could be used to provide interventions with a stronger evidence base, such as patient education using a structured patient education program or in other areas of practice where evidence of benefit exist.

HOspitals and patients WoRking in Unity (HOW R U?): telephone peer support to improve older patients' quality of life after emergency department discharge in Melbourne, Australia-a multicentre prospective feasibility study.

OBJECTIVES: To ascertain the feasibility and acceptability of the HOW R U? programme, a novel volunteer-peer postdischarge support programme for older patients after discharge from the emergency department (ED). DESIGN: A multicentre prospective mixed-methods feasibility study. SETTING: Two tertiary hospital EDs in metropolitan Melbourne, Australia. PARTICIPANTS: A convenience sample of 39 discharged ED patients aged 70 years or over, with symptoms of social isolation, loneliness and/or depression. INTERVENTION: The HOW R U? intervention comprised weekly social support telephone calls delivered by volunteer peers for 3 months following ED discharge. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were feasibility of study processes, intervention acceptability to participants and retention in the programme. Secondary outcomes were changes in loneliness level (UCLA-3-3-item Loneliness Scale), mood (5-item Geriatric Depression Scale) and health-related quality of life (EQ-5D-5L and EQ-VAS) postintervention. RESULTS: Recruitment was feasible, with 30% of eligible patients successfully recruited. Seventeen volunteer peers provided telephone support to patient participants, in addition to their usual hospital volunteer role. HOW R U? was well received, with 87% retention in the patient group, and no attrition in the volunteer group.The median age of patients was 84 years, 64% were female, and 82% lived alone. Sixty-eight per cent of patients experienced reductions in depressive symptoms, and 53% experiencing reduced feelings of loneliness, and these differences were statistically significant Patient feedback was positive and volunteers reported great satisfaction with their new role. CONCLUSION: HOW R U? was feasible in terms of recruitment and retention and was acceptable to both patients and volunteers. The overall results support the potential for further research in this area and provide data to support the design of a definitive trial to confirm the observed effects. TRIAL REGISTRATION NUMBER: ANZCTRN12615000715572; Results.

Disaster Metrics: A Comprehensive Framework for Disaster Evaluation Typologies.

Introduction The frequency of disasters is increasing around the world with more people being at risk. There is a moral imperative to improve the way in which disaster evaluations are undertaken and reported with the aim of reducing preventable mortality and morbidity in future events. Disasters are complex events and undertaking disaster evaluations is a specialized area of study at an international level. Hypothesis/Problem While some frameworks have been developed to support consistent disaster research and evaluation, they lack validation, consistent terminology, and standards for reporting across the different phases of a disaster. There is yet to be an agreed, comprehensive framework to structure disaster evaluation typologies. The aim of this paper is to outline an evolving comprehensive framework for disaster evaluation typologies. It is anticipated that this new framework will facilitate an agreement on identifying, structuring, and relating the various evaluations found in the disaster setting with a view to better understand the process, outcomes, and impacts of the effectiveness and efficiency of interventions. METHODS: Research was undertaken in two phases: (1) a scoping literature review (peer-reviewed and "grey literature") was undertaken to identify current evaluation frameworks and typologies used in the disaster setting; and (2) a structure was developed that included the range of typologies identified in Phase One and suggests possible relationships in the disaster setting. RESULTS: No core, unifying framework to structure disaster evaluation and research was identified in the literature. The authors propose a "Comprehensive Framework for Disaster Evaluation Typologies" that identifies, structures, and suggests relationships for the various typologies detected. CONCLUSION: The proposed Comprehensive Framework for Disaster Evaluation Typologies outlines the different typologies of disaster evaluations that were identified in this study and brings them together into a single framework. This unique, unifying framework has relevance at an international level and is expected to benefit the disaster, humanitarian, and development sectors. The next step is to undertake a validation process that will include international leaders with experience in evaluation, in general, and disasters specifically. This work promotes an environment for constructive dialogue on evaluations in the disaster setting to strengthen the evidence base for interventions across the disaster spectrum. It remains a work in progress. Wong DF , Spencer C , Boyd L , Burkle FM Jr. , Archer F . Disaster metrics: a comprehensive framework for disaster evaluation typologies. Prehosp Disaster Med. 2017;32(5):501-514.

HOspitals and patients WoRking in Unity (HOW R U?): protocol for a prospective feasibility study of telephone peer support to improve older patients' quality of life after emergency department discharge.

INTRODUCTION: Older people presenting to an emergency department (ED) have a higher likelihood of social isolation, loneliness and depression; which are all associated with negative health outcomes and increased health service use, including higher rates of ED attendance. The HOW R U? study aims to ascertain the feasibility and acceptability of a postdischarge telephone support programme for older ED patients following discharge. The intervention, which aims to improve quality of life, will be delivered by hospital-based volunteers. METHODS AND ANALYSIS: A multicentre prospective uncontrolled feasibility study will enrol 50 community-dwelling patients aged ≥70 years with symptoms of loneliness or depression who are discharged home within 72 hours from the ED or acute medical ward. Participants will receive weekly supportive telephone calls over a 3-month period from a volunteer-peer. Feasibility will be assessed in terms of recruitment, acceptability of the intervention to participants and level of retention in the programme. Changes in level of loneliness (UCLA-3 item Loneliness Scale), mood (Geriatric Depression Scale-5 item) and health-related quality of life (EQ-5D-5L and EQ-VAS) will also be measured postintervention (3 months). ETHICS AND DISSEMINATION: Research ethics and governance committee approval has been granted for this study by each participating centre (reference: 432/15 and 12-09-11-15). Study findings will inform the design and conduct of a future multicentre randomised controlled trial of a postdischarge volunteer-peer telephone support programme to improve social isolation, loneliness or depressive symptoms in older patients. Results will be disseminated through peer-reviewed journal publication, and conference and seminar presentation. TRIAL REGISTRATION NUMBER: ACTRN12615000715572, Pre-results.

Intravesical Bacillus Calmette-Guerin for treating bladder cancer.

Bladder cancer continues to be a leading cause of malignant neoplasm in men. Since 1976, Bacillus Calmette-Guerin (BCG) has been a recommended treatment for superficial bladder malignancy. BCG treatment indications, administration, side effects, patient education, and nursing implications are discussed.