Process evaluation of a nurse-led multifactorial intervention protocol for risk screening and assessment of fall problems among community-dwelling older persons: a pilot-study.

This pilot study investigated the feasibility of a nurse-led fall prevention strategy in community-dwelling older persons. The sample included 126 subjects (mean age = 76 years) who could rise from a chair and transfer independently. During a home visit, a research nurse identified individuals at risk: a history of >or= 2 falls in the previous year or difficulties in gait and/or balance. Patients not at risk received an educational leaflet. Older persons at risk received an evaluation of risk factors for falling. Whenever problems were identified, the nurses gave specific advice and subjects were referred to their general practitioner (GP). After one month, adherence to these recommendations was evaluated. Twenty-seven individuals showed an increased risk of falling (21.4%). The mean number of risk factors per person was 3.4 (SD=1.2). Noncompliance with one or more of the fall prevention recommendations was 58.3%. Differentiated by type of recommendations, a high degree of compliance was observed for recommendations related to gait and balance, use of medication, orthostatic hypotension, urge-incontinence, environment and behavior (81.8%-100%). While most individuals followed the recommendation to consult their GP (66.7%-80%), most of the GP's failed to propose any further measures to prevent falls. Screening, evaluation of risk factors, giving advice and follow-up required on average 3.1 (SD=0.8), 29.4 (SD=15.1), 15.8 (SD=11.0) and 13.1 (SD=3.9) minutes, respectively. Of those subjects who were not at risk, 76.1% had read the leaflet and 74.6% of those considered it useful. This study provides preliminary evidence for the feasibility in terms of time investment to integrate a nurse-led multifactorial fall intervention in current care for older persons living at home. However, further investigation to increase compliance with recommendations and more insight in the GP's role relating to the management of patients at risk for falls is needed.

Static quadrupole moment of the five-quasiparticle k = 35/2 isomer in (179)w studied with the level-mixing spectroscopy method.

The spectroscopic quadrupole moment of the high-spin, high- K five-quasiparticle isomer (K(pi) = 35/2(-), T(1/2) = 750(80) ns, E(i) = 3349 keV) in (179)W has been determined using the level mixing spectroscopy method. A value Q(s) = 4.00(+0.83-1.06)e b was derived, which corresponds to an intrinsic quadrupole moment Q0 = 4.73(+0.98-1.25)e b and to a quadrupole deformation beta(2) = 0.185(+0.038-0.049). These values differ significantly from the deduced ground-state quadrupole moments and are in disagreement with the current theoretical predictions in this mass region.

Quadrupole moment of the 11(-) intruder isomer in 196Pb and its implications for the 16(-) shears band head.

The quadrupole moment of the 11(-) isomer in 196Pb has been measured by the level mixing spectroscopy method. This state has a pi(3s(-2)(1/2)1h(9/2)1i(13/2))11(-) configuration which is involved in most of the shears band heads in the Pb region. The first directly measured value of Q(s)(11(-)) = (-)3.41(66) b, coupled to the previously known quadrupole moment of the nu(1i(-2)(13/2))12(+) isomer allows us to estimate the quadrupole moment of the 16(-) shears band head as Q(s)(16(-)) = -0.32(10) b. The experimental values are compared to tilted axis cranking calculations, giving insight into the validity of the additivity approach to couple quadrupole moments and on the amount of deformation in the shears bands.