Findings from three methods to identify falls in hospitals: Results from the Ambient Intelligent Geriatric Management system fall prevention trial.

OBJECTIVE: To (a) compare characteristics of patients who fall with those of patients who did not fall; and (b) characterise falls (time, injury severity and location) through three fall reporting methods (incident system reports, medical notes and clinician reports). METHODS: A substudy design within a stepped-wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used. RESULTS: Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16-34] vs. 12 [8-19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%-25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%). CONCLUSIONS: This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes.

Outcome of uncomplicated ureteric calculi managed with medical expulsive therapy in the outpatient clinic of a urology unit in Sri Lanka.

OBJECTIVE: Although medical expulsive therapy (MET) is shown to be effective for ureteric calculi, the optimum duration and the stone size suitable for MET are not well established yet. The objectives of the study were to determine the optimum duration and maximum stone size suitable for MET. RESULTS: All patients with radiologically confirmed uncomplicated ureteric calculi treated with MET using tamsulosin over a period of 6 months in the outpatient setting were followed up. There were 213 patients. 165 were men. Mean age was 42 years. At presentation 42 stones were in upper ureter (19.7%), 51 in mid ureter (23.9%), 120 in lower ureter (56.3%). The majority (82.7%) of stones were less than 10 mm. Seven stones (3.3%) were over 15 mm. Ninety-two (43.2%) patients had spontaneous passage of stones within 6-weeks of MET. Another 38.9% passed the stone within the next 6-weeks. Thirty-eight patients (17.8%) required surgery. Uncomplicated ureteric stones up to 10 mm can be given a trial of MET using tamsulosin which can be extended up to 12-weeks with a success rate over 92%. This may have substantial clinical and fiscal benefits by reducing the number of interventional procedures especially in resource-poor settings.

Closing the theory to practice gap for newly qualified doctors: evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice.

PURPOSE: The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to practice gap' of doctors preparing for their internship. This paper evaluates the impact of a 2-day peer-delivered Acute Care Skills Training (ACST) course as part of the GIP. STUDY DESIGN: The ACST course was developed by an interprofessional faculty, including newly graduated doctors awaiting internship (pre-intern), focusing on the recognition and management of common medical and surgical emergencies. Course delivery was entirely by pre-intern doctors to their peers. Knowledge was evaluated by a pre- and post-course multiple choice test. Participants' confidence (post-course) and 12 acute care skills (pre- and post-course) were assessed using Likert scale-based questions. A subset of participants provided feedback on the peer learning experience. RESULTS: Seventeen courses were delivered by a faculty consisting of eight peer trainers over 4 months, training 320 participants. The mean (SD) multiple choice questionnaire score was 71.03 (13.19) pre-course compared with 77.98 (7.7) post-course (p<0.05). Increased overall confidence in managing ward emergencies was reported by 97.2% (n=283) of respondents. Participants rated their post-course skills to be significantly higher (p<0.05) than pre-course in all 12 assessed skills. Extended feedback on the peer learning experience was overwhelmingly positive and 96.5% would recommend the course to a colleague. CONCLUSIONS: A peer-delivered ACST course was extremely well received and can improve newly qualified medical graduates' knowledge, skills and confidence in managing medical and surgical emergencies. This peer-based model may have utility beyond pre-interns and beyond Sri Lanka.

Usefulness of 99mTc Dimercaptosuccinic acid scans after the first episode of urinary tract infection in children admitted to the Lady Ridgeway Hospital for Children, Sri Lanka.

99mTc-DMSA scan is the best investigation to assess renal scarring after urinary tract infection (UTI) in children. The aim of this study was to describe the findings of DMSA scans done six months after the first UTI. A descriptive cross-sectional study was done among 110 boys and 80 girls selected by systematic sampling. Urine culture was positive in 164 (86.3%) children. There was no statistically significant association between the DMSA scan result and gender, family history of UTI (p=1.00), family history of vesico-ureteric reflux (p=1.00), febrile UTI (p=0.134) and positive urine culture (p=1.00).In 93.7% of children DMSA scan was negative. Hence routinely recommending DMSA scans following UTI must be reconsidered.

A sonographic scoring system to assess the risk of thyroid malignancy.

Prediction of thyroid malignancy with fine needle aspiration cytology or individual ultrasound characteristics has several limitations. This study evaluates the usefulness of a combination of ultrasound characteristics in predicting malignancy in patients with thyroid nodules. We assessed 189 thyroid nodules using ultrasonography and histology. Each nodule was assigned a score based on ultrasonographic characteristics. This score was compared with histology to identify ability to predict malignancy. There were 28 malignant nodules. The scoring system was appropriate for clinical use, obtaining an area under ROC curve of 0.822 [p< 0.0001] 95% confidence. FNAC of nodules with a score of more than 4 can be recommended (100% sensitivity). Nodules with a score less than 8 can be offered total thyroidectomy when FNAC is inconclusive (97.5% sensitivity). A combination of ultrasonographic criteria increase the accuracy of predicting malignancy in thyroid nodules.

Evaluation of physical activity among adults with diabetes mellitus from Sri Lanka.

We evaluated the patterns of physical activity (PA) and the prevalence of physical inactivity among Sri Lankan adults with diabetes mellitus. Data were collected as part of a wider cross-sectional national study on diabetes in Sri Lanka. PA during the past week was assessed using the short version of the IPAQ. Overall prevalence of physical inactivity was 13.9%. Females (3091 ± 2119) had a significantly higher mean weekly total MET minutes than males (2506 ± 2084) (p < 0.01). Inactivity of those residing in urban (17.2%) areas was higher than rural (12.6%) in all adults. Participants from Moor ethnicity were more inactive compared to others. Adults who were physically active had significantly low waist and hip circumferences, BMI and systolic blood pressure.

Low cost and batteryless sensor-enabled radio frequency identification tag based approaches to identify patient bed entry and exit posture transitions.

INTRODUCTION: Falls in hospitals and residential care facilities commonly occur near the bed. The aim of this study was to investigate the accuracy of a continuously wearable, batteryless, low power and low cost monitoring device (Wearable Wireless Identification and Sensing Platform) with a single kinematic sensor capable of real-time monitoring to automatically detect bed entry and exit events. MATERIALS AND METHODS: Three dimensional acceleration readings and the strength of the transmitted signal from the WISP was interpreted to identify bed exit events and sensitivity, specificity and Receiving Operator Curves (ROC) were determined. RESULTS: The sensor located over sternum method performed best with sensitivity and specificity values of 92.8% and 97.5% respectively for detecting bed entry and values of 90.4% and 93.80% respectively for bed exit. On the other hand, the sensor-on-mattress algorithm achieved sensitivity and specificity values of 84.2% and 97.4% respectively for bed entry and 79% and 97.4% for bed exit detection. CONCLUSION: The WISP located over the sternum method is the preferred method to detect bed entry and exit. However, further work in frail older people is required to confirm the performance of this method.

Large cervical osteophyte--another cause of difficult flexible fibreoptic intubation.

A patient suffering from ankylosing spondylitis required surgical excision of a large anterior osteophyte of the cervical spine. Fibreoptic nasal intubation was difficult due to distortion of the airway by the osteophyte. This cause of difficult flexible fibreoptic intubation has not been described previously.

Hypomagnesaemia, cardiac arrhythmias and orthotopic liver transplantation.

Two patients who underwent orthotopic liver transplantation and developed peroperative cardiac arrhythmias are presented. In one, the arrhythmias were refractory to treatment with anti-arrhythmic drug therapy until serum magnesium levels were restored to normal. The other patient had a low pre-operative serum magnesium level and developed atrial fibrillation on induction of, and during, anaesthesia. Patients undergoing orthotopic liver transplantation may be a group especially predisposed to hypomagnesaemia. The importance of monitoring serum magnesium levels in such patients who develop peroperative cardiac arrhythmias is emphasised.

Ventilatory capacity after three methods of anaesthesia for inguinal hernia repair: a randomized controlled trial.

One hundred consecutive male patients undergoing elective inguinal herniorrhaphy were randomized to receive general, epidural or local anaesthesia, and the patterns of ventilation were studied before and after operation. General anaesthesia caused more depression of FEV1 and FVC than the other two methods, but no important arterial hypoxia or clinical chest complications ensued. One patients suffered minor staphylococcal wound infection, and one died of massive pulmonary embolism on the eleventh day.