Examining Fall Risk Assessment in Geriatric Rehabilitation Settings Using Translational Research.

PURPOSE: The objective of this study was to identify gaps in and to improve the falls prevention strategy (FPS) of an inpatient rehabilitation facility (IRF) in Toronto, Canada. DESIGN: A modified version of the Stanford Biodesign Methodology was used. METHODS: Chart reviews, a focus group (n = 8), and semistructured interviews (n = 8) were conducted to evaluate the FPS. FINDINGS: Admission Functional Independence Measure score, age, and gender significantly correlated with risk for a fall. The tool used at this IRF was not effectively capturing patients who were at high risk for falls. All healthcare providers interviewed were knowledgeable of fall risks; however, a patient's fall risk status was rarely discussed as a team. CONCLUSIONS: The findings informed recommendations to improve the overall FPS at this IRF. CLINICAL RELEVANCE: Staff may require more coaching for implementing preventative measures/ensuring accountability and evaluating whether current strategies work. These insights can guide improvement initiatives at similar facilities elsewhere.

Laser Therapy for an Acquired Glomuvenous Malformation (Glomus Tumour): A Nonsurgical Approach.

BACKGROUND: Glomuvenous malformations (GVMs) (previously known as glomus tumours) are uncommon, benign, vascular neoplasms. Current treatments include surgical excision and sclerotherapy, often with high recurrence rates and poor cosmetic results. OBJECTIVE: We sought to use a nonsurgical approach for treatment of a GVM. METHODS: We present a patient with an acquired, biopsy-proven GVM of the heel unamenable to surgical excision, treated with a long pulsed 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. RESULTS: Excellent cosmesis and long-term remission were achieved after several treatment sessions. CONCLUSION: Our experience provides further evidence to support the safety and effectiveness of the 1064-nm Nd:YAG laser in the management of large and surgically challenging GVMs.

Australian women's perception of their preparation for and actual experience of a recent scheduled caesarean birth.

OBJECTIVE: to add to knowledge around women's perceptions of their preparation for and actual experience of a recent scheduled caesarean birth. DESIGN, PARTICIPANTS AND SETTING: a mixed method study incorporating a postal survey and one-on-one interviews was used. The survey provided feedback on resources to prepare women for their caesarean birth such as a positive birth class, DVD and birth plan. Women were also invited to participate in an interview to share perceptions of their preparation and actual birth experience. Participants attended the only public obstetric tertiary hospital in Western Australia and experienced their caesarean birth between August and December 2012 (n=256). Frequency distributions and univariate comparisons were employed for categorical data, whereas thematic analysis was undertaken with transcripts to extract common themes. FINDINGS: data reflect 46% (117 out of 256) of women returned a postal survey. The interview option was removed after three months of data collection, when 38 women were interviewed and data saturation was reached. Of the 61% (71 of 117) who completed a birth plan, 59% (42 of 71) felt it was used to guide their care. Only 38% (44 of 117) were able to stay together with their (baby and partner) in recovery. Thematic analysis revealed a positive theme suggesting their experience 'couldn't have been 'better' with sub-themes: 'involved in care'; 'informed the whole way through'; 'magical for him to be near me' and 'everything was done brilliantly'. Negative reflections centred around 'we were just a number' and included four sub-themes: 'no option'; 'still had questions'; 'separated from him and her' and 'none of it happened'. CONCLUSION: acknowledgement that a scheduled caesarean section is more than a surgical procedure, but a birth is paramount. For women to have a positive birth experience we must respect their wishes within their birth plan and embrace a family friendly model, where mothers, partners and babies can stay together.

Women's experiences of using a Snoezelen room during labour in Western Australia.

OBJECTIVE: to explore women's experience of using a Snoezelen room during their labour. DESIGN: a qualitative exploratory design was conducted to provide insight into the phenomenon of using a Snoezelen room for labouring women and to identify factors that could facilitate or inhibit use of this environment. The constant comparison method modified from the grounded theory methodology was used to analyse data from in-depth interviews. SETTING: Osborne Park Hospital, the second largest public provider of obstetric services in Western Australia, was the study setting. PARTICIPANTS: sixteen women, recruited from July 2005 to June 2006, agreed to participate in an in-depth interview and share their experience of using the Snoezelen room during a recent labour. FINDINGS: six themes were extracted from the data providing insight into what a Snoezelen environment can offer a labouring woman: distraction; relaxation; comfort; environmental control; choice of complementary therapies; and safety in a home-like atmosphere. Additional categories revealed factors that facilitated and/or detracted use of the room such as familiarity with features, being offered information and choice, timing in labour, the support person's response and working order of the room's features. IMPLICATIONS FOR PRACTICE: when sharing their experience, women focused upon the process of their labour and how they managed this process rather than specific outcomes such as analgesic used or type of birth. Although outcomes such as type of birth may not have been their preferred choice, these women were able to achieve satisfaction with how they managed their labour while in the Snoezelen room. This midwifery-led initiative contributed to these women's labour experiences, by offering a combination of complementary therapies within the safety of a hospital environment.