Inpatient Falls In The Elderly Health And Social Care Essay

Inpatient Falls In The Elderly Health And Social Care Essay As in common with other European countries, the population of 65 years and above in the UK is predicted to increase from 16% in 2008 to 23% by 2033 .(Statistics, 2009)With the increasing population of elderly people, falls has become a major public health problem .(Masud and Morris, 2001). Falls and its related injuries can result in considerable negative effects for example mortality, morbidity and suffering physical and mental stress for older people and social and financial burden their family.(Skelton and Todd, 2004). Falls can also increase health care costs for hospitals and social services. In 2004-05, 60% of all cases from hospitals related to falls in the UK(Oliver.D et al., 2007). Approximately 30% of people aged over 65 years (Skelton and Todd, 2004)and 50% of people over 80 years(INSTITUTE, 1998) suffer at least one fall per year. Among them, 30% of elderly falls result in physical injury with 4% to 5 % having serious injuries(Nakai et al., 2006). Moreover, falls are the commonest cause of injury-related death in people over 75 years.(Masud and Morris, 2001). Inpatient falls Interestingly, falling rates vary across different settings(Sherrington.C et al., 2001). The incidence of elderly patients falling is almost 3 times higher in hospital and health care institutions than in those living in the community(American Geriatrics Society and American Academy of Orthopaedic Surgeons Panel on Falls, 2001).According to hospital statistics, inpatient falls are the commonest adverse events in hospital reports(Terrell et al., 2009). In the UK, 98% of NHS organisations providing inpatient care reported over 200,000 falls during a year period from September 2005 to August 2006. There are approximately 4.8 falls for every 1000 bed days.(Vass.C et al., 2009) 50% of elderly patient falls occur at the bedside(INSTITUTE, 1998) .There are many intrinsic factors attributed to inpatient falls such as patients age, level of orientation, underlying disease, drug history, gait and stability, bowel and bladder problems. Extrinsic factors can also affect inpatient falls for example- hospital equipment, patients room lighting and level of staff provided etc.(Tzeng et al., 2008) Elderly in-patient falls in hospital affect both patients and health service organisations. Patients can suffer serious injuries including fractures, subdural haematoma , excessive bleeding and even death(Hitcho et al., 2004). Falls can also have psychological consequences such as fear of falling, and loss of confidence that can result in poor quality of life(Gillespie. LD et al., 2009). Falls can be costly to health sector organisations and in 1999, cost  £ 981 million in NHS and Personal Social Services (Skelton and Todd, 2004). Thus, prevention of falls in the hospital setting is a major public health issue concerning patient safety, quality and cost-effectiveness of health sectors(Nakai et al., 2006, Hitcho et al., 2004). Falls and their related injuries are complex and falling is a multifactorial phenomenon (Sherrington.C et al., 2001). .It is needed to understand more about the important risk factors of inpatient falls and see if they can be managed better on the ward. Previous researches also suggested to identify those who are at risk of falling in hospitals. Aim of the study to describe the pattern of falls among the inpatients in the Elderly wards of Nottingham University Hospital, NHS trust Objectives of the study to describe the demographic characteristics of inpatients who fall to identify the time and location of the inpatient fall to describe the nature of injury due to fall to specifically examine the movement of patients who fell (two hours before and after the incident) to identify the level of staffing at the time of when the inpatient fall occurred Methods The Data set The REFINE study is a randomised control trial which aims to reduce inpatient fall successfully and cost-effectively by using pressure sensor-pager technology. This detects pressure changes when the patient moves from the bed or bedside chair and then activates an alarm to a handled pager carried by nursing staff. Patients from five acute elderly wards in Nottingham University Hospital, NHS Trust are eligible for this study. Patients are randomised to pressure sensors or to usual care (i.e no alarm). Patients who are randomised to the intervention arm receive bedside chair and bed pressure sensors for the duration of their hospital stay. Patients who are permanently bed bound before admission, unconscious or receiving terminal care or previously participated in the study in an earlier admission are excluded from the study. This trial commenced in November 2008. From this time onwards, approximately 44 cases of inpatient falls has occurred among both arms of the study. Baseline data is collected by face to face interview or from patients medical and nursing notes and /or carer . These data involve demographic and residential details, reasons for admission, time of admission ,previous history of fall and fracture, mobility and transfer before the illness(measured by the Barthel ADL index), 30 point Mini Mental Stare examination and Health related quality of life measured using the EuroQol EQ -5D. Study population The cases of inpatient falls from the intervention arm which have already been documented in the REFINE trial from the time of commencement to January 2010 will be the study population of this study. Method 1 : For the objective 1 Demographic data of the particular fall patient including- age, sex, previous medical history, previous history of fall, reason for admission an residential detail will be used from baseline data recorded in the REFINE trial. Method 2 : For the objective 2 Time of the inpatient fall is recorded by the pressure sensor output. Both time and location of the inpatient fall are noted down in the patient safety incident form by the nurse. The author will use these incident forms of REFINE dataset to identify this. Method 3 : For the objective 3 The nature of injury due to fall in this study will be classified into abrasion, bruise, swelling, cut, laceration, dislocation, fracture or muscle sprain or strain. This information is also recorded in the patient incident form where the author will collect. Method 4 : For the objective 4 The frequency of position changes of the patients who fell including off and on the bed and bedside chair will be examined from 2 hours before and 2 hours after the fall. The sensor output will be used to obtain these data. Method 5 : For the objective 5 Number and skill mix of ward staff at the time of occurrence of the inpatient fall will be described by using the duty roster of staff. Analysis All analyses will be performed using SPSS version 16.0.Descriptive analysis will be conducted first to explore the characteristics of the study participants. Mean, standard deviation or median and IQ ranges will be used to summarise the continuous data such as age and time when fall happened. Binary variables such as sex will be summarised by proportion or percentage. Residential detail will be categorised into three groups as follows- home, nursing institutions and transfer from other wards such as surgical wards and then will be summarised by percent. Approximations of the risk of fall with P-value, Chi-square and Chi-square test for trends will be calculated among categorical variables such as sex, residential details. Fisher exact test will be used when Chi-square test is not appropriate Ethics Written, informed consent has already been obtained from the patients, or from ward staff if the patients were unable to understand the nature of consenting to research. The REFINE study was approved by Nottingham Research Ethics Committee 1 on 23rd May 2008. Time Table 21st January Peer review of the project 9th February Final protocol completed.(Landmark 2) From Landmark 2 to mid April Activity Initial Descriptive and simple analysis of data and writing literature review Output- Draft Literature review to supervisors From mid April to June 3rd Activity further analysis of dataset Output- Initial result of data analysis and poster/presentation of the project conference on 3rd June From 4th June to the end of June Activity write methods and result section , consider study findings, implications, weakness and strengths Output- First draft of method and result section to supervisors From 1st July to mid July Activity write the discussion Output- first draft of complete dissertation to supervisors From mid July to 16th August Activity Improving draft with support from supervisor Output final dissertation completed.

Coram, Robert Boyd: The Fighter Pilot Who Changed the Art of War

A biography of Col. John Boyd, Coram’s book reads much like the collection of interviews that it is. He gives the impression that if the reader happened upon any of these characters at happy hour, the stories would be identical. Dispersed throughout the book is a supply of background information and context, glimpses and bits about family life, and a very understandable layman’s introduction to the scholarly work of John Boyd. Coram is an ex-newspaper man that has recently produced two military biographies. He lays out for his reader not only the successes of John Boyd, but the rough edges of the man as well. The brilliance that brought the engineering world the Energy-Maneuverability equations was balanced by Boyd’s egoism and anti-authoritarianism. Coram’s objective seems to be to reveal a principle regarding brilliant personnel: that they are invaluable to any organization, providing the leadership can stomach their idiosyncrasies. Coram sets his Boyd biography up in three sections: Fighter Pilot, Engineer and Scholar. The three sections are based on the three major accomplishments of Col. Boyd. As a fighter pilot, Boyd used his creative intellect to develop advanced techniques and tactics, based on his subconscious knowledge of the workings of maneuverability based on available energy. As an engineer, Boyd codified the principles of energy-maneuverability, and evaluated all of the fighter aircraft of the time using the equations he developed. This evaluation, although looked upon skeptically at the time, has been proven to be accurate, and the E-M theory continues to be used to both evaluate and design aircraft. As a scholar, Boyd evaluated decision-making and came up with the ODDA loop. (Observe, Orient, Decide, Act) This concept is a simple diagram of the decision making process, and has been disseminated widely, with variations, all the way from the military to driver training curriculum. A variation of the model is called IPDE; Identify, Predict, Decide, Execute. An old adage says that a man’s best work is done after 50, and I believe that John Boyd validated it. His Destruction and Creation essay, which Coram includes at the end of the biography, is a masterful assembly of the concepts of the Heisenberg Principle and Thermodynamics, applied to a type of his decision-making theory. Concepts of the present system of thought, combined with concepts from multiple other disciplines, can be creatively made into a composite that is more than the sum of the pieces used, and useful for further evaluation. This is essentially the synthesis used in the development of the E-M theory equations. Coram deals as respectfully as possible with the dysfunctional family life of Boyd. Several passages leave the reader deeply saddened that such a brilliant man could be at the same time so base. He also presents the distinct probability that Boyd’s personality and fighter-pilot approach to obstacles caused as many personal difficulties as it remedied. Coram also reveals the truth that presentation is paramount; as Boyd’s abrasive presentation of his ideas initially caused much individual resistance, and his masterful presentation of his ideas later on was the main reason that they became widely adopted. Altogether, a well written biography, that leaves my wishing I had sat thru at least a few happy hours with Col. Boyd and his associates, if only to hear the tall tales of a meritorious veteran warrior-scholar. Coram brings John Boyd to the reader as he was; brilliant, dauntless, abrasive, even offensive, but loyal to his cause and his message. He leaves the reader with the nagging question: Am I going to Do something, or be content to Be somebody?

New Zealand dollar

Prime TV launched 1999:Alcohol purchase age for off-licenses reduced from 20 to 18 years of age 2001 :lintiest accrual is removed from student loans while studying. Students who accrued Interest prior to 2001 are still required to pay. 2002:30 June: The population of Canterbury reaches half a million. 7 July: 2002 general election, Labor-led government returned for a second term. 003:Population of New Zealand exceeds 4 million. 2004:Foreshore and Seabed Act passed. Call union Act passed MÂ ¤ROR Party formed. Maori TV begins broadcasting 2006:Labor enacts its election promise to remove interest on loans to students living In New Zealand. Five cent coins are dropped from circulation and existing 10 cent, 20 cent and 50 cent coins are replaced with smaller coins. The government announces a NAZIS 1. 5 billion surplus, the largest In the country's history and second only to Denmark in the Western World.South Island population reaches 1 million 2007:2 May: Fairview is launched, providing free-to-air digital television. July. Savvier retirement savings scheme introduced. 18 December:Cacciatore Finance Act enacted. 2008:11 January: mountaineer Sir Edmund Hillary dies. 2009:28 April: First confirmed New Zealand case in the 2009 swine flu outbreak. 2010:4 September: A magnitude 7. 1 earthquake strikes the Canterbury Region causing widespread damage to Christopher and surrounding areas. 2011 :22 February: A magnitude 6. 3 earthquake strikes Christopher causing widespread damage and 184 deaths. 3 October: All Blacks win Rugby World Cup against France, 8-7 in Eden Park, New Zealand. Holiday park guest night figures show pronounced events in March and April 2013. March figures were boosted by great weather and an early Easter, while April figures were adversely affected by the timing of holiday parks shows little movements in recent months. This may change when data for future months is added to the series. The weather was generally warm, dry, and sunny in March, but quite wet in April. Also, while the school holidays fell entirely in April in 2012, this year they fell partly in May.Although there was a drop in domestic guest nights, there was an increase in visitor arrivals and international guest nights. There were 2. 28 million visitor arrivals to New Zealand in the May 2013 year. This is up less than 1 percent from the May 2012 year, but that year was boosted by visitor arrivals for the Rugby World Cup. The increase in net migration over the last five months was mainly due to fewer New Zealand citizen departures to Australia. Immigration from and to NZ has changed dramatically over the years and this may be one of the major factors leading to the amount of people staying at hotels or holiday parks.More people will be coming into the country from the rugby world cup and also people not going anywhere from NZ from the earthquakes in NZ. /11 – The September 11 attacks were a series of four coordinated terrorist attacks launched by the Islamic terrorist group al-Qaeda upon the United States in New York City and the Washington, D. C. Area on Tuesday, September 11, 2001 In the year ended May 2013, there were 2. 628 million visitors, up less than 1 percent from the previous year. This year's increase was despite visitor numbers in the May 2012 year being boosted by the Rugby World Cup.New Zealand residents departed on 182,400 overseas trips in May 2013. This was up 2 percent from May 2012, and was also a record for a May month. In the May 2013 year, New Zealand residents departed on 2. 163 million overseas trips, up 2 percent from the previous year. The biggest increase was in trips to the United States (up 15,200), helped by a more favorable currency exchange rate. New Zealand had a seasonally adjusted net gain (more arrivals than departures) of 1,700 migrants in May 2013. This is the highest net gain since January 2010 (1 ,800).The increased net gain of migrants over the past five months was mainly due to fewer New Zealand citizens departing to Australia. There was also an increase in arrivals during this period. The seasonally adjusted net loss f 1,900 migrants to Australia in May 2013 was the smallest net loss since July 2010 (1 ,600). The latest net loss to Australia was well down on the recent high of 3,600 recorded in September 2011. In the May 2013 year, New Zealand had a net gain of 6,200 migrants. This compares with a net loss of 3,700 in the May 2012 year. Auckland, Canterbury, and Togo were the only regions that had net gains of international migrants.The Canterbury region's net gain of 2,600 migrants in the May 2013 year compared with a net loss of 2,500 in the May 2012 year, following the Christopher earthquake in February 2011. Temperature Since instrumental measurements began in the late 19th century, New Sealant's average air temperatures have fluctuated substantially year to year, and a number of studies indicate that New Sealant's average temperature has increased. A significant upwa rd trend in national average air temperature was detected of 0. 11 co per decade (for the period from 1896 to 1994) with a 95% confidence interval Ð’Â ± 0. ICC. This is roughly twice the trend reported for global data, which may be due to the relative absence of sulfate aerosols in the South Pacific. The Royal Society of New Sealant's Lear upward linear trend in the country-wide average air temperature of 0. Celsius. Financial crisis -Economic growth, which had slowed in 1997 and 1998 due to the negative effects of the Asian financial crisis and two successive years of drought, rebounded in 1999. A low New Zealand dollar, favorable weather, and high commodity prices boosted exports, and the economy is estimated to have grown by 2. 5% in 2000.Growth resumed at a higher level from 2001 onwards due primarily to the lower value of the New Zealand dollar, which made exports more competitive. The return of substantial economic growth led the unemployment rate to drop from . 8% in 1999 to 3. 4% in late 2005, the lowest rate in nearly 20 years. Although New Zealand enjoyed low unemployment rates in the years immediately prior to the financial crisis beginning in 2007, subsequent unemployment rose. New Sealant's large current account deficit, which stood at more than 6. 5% of GAP in 2000, has been a constant source of concern for New Zealand policymakers and hit 9% as of March 2006.The rebound in the export sector is expected to help narrow the deficit to lower levels, especially due to decreases in the exchange rate of the New Zealand dollar during 2008. Between 1985 and 2012, New Sealant's unemployment rate averaged 6. 29%. After the stock market crash of 1989, unemployment began to rise reaching an all-time high of 1 1. 20% in September 1991. By 2007, it had dropped again and the rate stood at 3. 5% (December 2007), its lowest level since the current method of surveying began in 1986. This gave the country the 5th-best ranking in the COED (with an COED average a t the time of 5. %). The low numbers correlated with a robust economy and a large backlog of Job positions at all levels. Unemployment numbers are not always directly comparable between COED nations, as they do not al keep labor market statistics in the same way. The percentage of the population employed also increased in recent years, to 68. 8% of all inhabitants, with full-time jobs increasing slightly, and part-time occupations decreasing in turn. The increase in the working population percentage is attributed to increasing wages and higher costs of living moving more people into employment.Smaller complex? Could be a build up of hotel or holiday park complexes that could determine an increase in the amount of people going to the holiday parks or hotels. The weather around these times? Income, employment, new age – parent's and kids not willing to do this anymore because new things such as technology is available and makes children grow up faster Families may have been clo ser back then than they are today economic conditions Minimum and maximum of trend line and talk about the difference = nature of the trend line Why it is increasing/decreasing at certain times on the graph? Changes in the world or new Zealand that may have made this extreme happen eye = scuffs how many Co's to put on the end to convert it to a real number 9/1 1 could eave has an impact on the traveling of the world population as they may be scared to travel as they don't want to be in risk of being killed. Also people over the world may have come over to NZ because of the events from 9/1 1 as they wanted to get away from all of the troubles in America.The introduction to television may also be a big factor as this would have made the population less likely to want to go outside as they are able to stay in and watch the world from the comforts of their home. New technology would have had a huge impact on tourism as people are getting lazier from these factors.

Cyber Bullying A Deep Seated Psychological Problem

Cyber Bullying Introduction Cyber bullying among teen occur when the teenagers harms or harass their peers over the information technology network. Cyber refers to any form of information technology and is not limited to social networks such as Facebook, blogs, twitter, SMS. It is important to note that an action can only be considered as bullying if it is repeated and conducted deliberately to harm or harass the victim. This paper seeks to argue that cyber bullying is a deep-seated psychological problem whose cause should be analyzed and the effects corrected. Cyber bullying includes acts of harassment, humiliation, or attacks on other people using information technology. The cyber bullies are interested in intimidating, controlling or manipulating their victims into conceding defeats, or carryout out specific illegal activities failure to which they will be humiliated. In most cases, cyber bullies seek to humiliate their targets publicly over the internet, or through cell phones and or web cams. Cyber bullies aim to humiliate their victims in the most awkward way and might use personal information such as messages, or pictures. These are sent online or as text messages to many people with the aim of exposing their victims and embarrassing them (Aisha 207-207). Causes of cyber bullying Cyber bullying has many causes. The