Acute Care

The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in ...

Brown-Sequard syndrome (BSS) and Brown-Sequard-plus syndrome (BSPS) are characterised by asymmetrical paresis with hypalgesia more marked on the less paretic side. This study examined the clinical features of 38 patients (30 males and 8 females; mean age=32 years) with traumatic cervical BSS or BSPS who underwent comprehensive in-patient rehabilitation. Twenty two injuries were caused by road traffic accidents, 8 by penetrating injuries, 5 by diving injuries, and 3 by other causes. After an average of 35 days in acute care and 79 days in rehabilitation, 37 patients had increased muscle strength, all 38 patients improved functional abilities, 29 patients walked independently, 34 had spontaneous bladder emptying, 36 were discharged home, and 14 were employed. Statistically significant increases (p<0.001) were made in modified Barthel index functional scores between admission and discharge. Patients with BSPS had a better prognosis than did those with 'pure' BSS. Patients ...

Title. Evaluation of three fall-risk assessment tools in an acute care settingAim.  This paper is a report of a study to evaluate the validity of three fall-risk assessment tools to identify patients at high risk for falls.Background.  Patient falls make up 38% of all adverse events occurring in hospital settings, and may result in physical injury and undesirable emotional and financial outcomes. No single fall-risk assessment tool has been conclusively validated.Method.  The Morse Fall Scale, St Thomas Risk Assessment Tool in Falling Elderly Inpatients, and Hendrich II Fall Risk Model were validated in inter-rater reliability and validity studies in 2003. This included assessment of the probability of disagreement, κ-values, sensitivity, specificity, positive predictive values and negative predictive values of the assessment tools with the associated 95% CI.Findings.  One hundred and forty-four patients were recruited for the inter-rater reliability study. The probabilities of disagreement were between 2·8% and 9·7%, and 95% CI for all tools ranged from 1·1% to 15·7%. The κ-values were all higher than 0·80. In the validity study, 5489 patients were recruited to observe 60 falls. The Morse Fall Scale at a cutoff score of 25 and Heindrich II Fall Risk Model at a cutoff score of 5 had strong sensitivity values of 88% and 70%, respectively. However, in comparison with the Morse Fall Scale (specificity = 48·3%), only the Heindrich II Fall Risk Model had a more acceptable level of specificity (61·5%).Conclusion.  The Heindrich II Fall Risk Model is potentially useful in identifying patients at high risk for falls in acute care facilities.

symptoms of dizziness, and known categories of medications increasing risk.10 This tool screens for primary prevention of falls and is integral in a post-fall assessment for the secondary prevention of falls. TARGET POPULATION: The Hendrich II Fall Risk Model is intended to be used in the acute care setting to identify adults at risk for falls. The Model is being validated for further application of the specific risk factors in pediatrics and obstetrical populations. VALIDITY AND RELIABILITY: The Hendrich II Fall Risk Model was validated in a large case control study in an acute care tertiary facility with skilled nursing and rehabilitation populations. The risk factors in the model had a statistically significant relationship with patient falls (Odds Ratio 10.12-1.00, .01 > p

Objective: Despite high rates of co-occurring substance use disorder in people with severe mental illness, substance use disorder is often undetected in acute-care psychiatric settings. Because underdetection is related to the failure of traditional screening instruments with this population, the authors developed a new screen for detection of substance use disorder in people with severe mental illness. Method: On the

Health and nursing are shifting from acute care to community settings, causing confusion for clients and professionals. Although the holistic nursing perspective has improved care to human beings in interaction with their environment and has moved nursing away from pathology-focused care, the community as the focus of care has not been addressed. This article presents an integrated model of community health that expands holistic nursing to the community as client. The model clarifies nursing care for the individual, family, aggregate, and community. One can focus on any one level, with the awareness that each is part of a unified whole. Holistic community nursing completes the circle of care by moving beyond the particular part to focus on the greatest health for the community. The intent is to help nurses describe their unique areas of expertise within the complex community system and to establish a basis for collaboration and partnership.