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Impulsivity-related falls (IRFs) sustained by hospitalized, older adults can lead to critical adverse events. The purpose of this study was to determine whether 7 common fall risk factors contributed to the occurrence of IRF in hospitalized, older adults. This study found that 31% of falls were classified as IRF. Logistic regression indicated that inattention and mobility were contributors to IRF. Early identification of these 2 risk factors could improve identification of potential IRFs and reduce fall rates. [ABSTRACT FROM AUTHOR]

When Americans voted in November 2008, many had the presidential candidates' positions on health care reform in mind. Health savings accounts, which are high deductible health plans coupled with a tax-protected savings account, are 1 type of consumer-directed health plan (CDHP) that gained strong support from the Bush administration. Despite evidence of the effectiveness of CDHPs in constraining costs in other countries, the Obama health plan contains no mention of their role in future US health reform. This article seeks to provide the reader with a better understanding of how CDHPs can help to improve the use of health resources and reduce national health care expenditures by exploring the history and previous research on several types of consumer-directed plans and by providing a comparative analysis of the use of CDHPs in other countries. [ABSTRACT FROM AUTHOR]

Introduction: To engage effectively and efficiently in self-directed learning and knowledge-seeking practices, it is important that physicians construct well-formulated questions; yet, little is known about the quality of good questions and their relationship to self-directed learning or to change in practice behavior. Methods: Personal learning projects (PLPs) submitted to the Canadian Maintenance of Certification program were examined to include underlying characteristics, quality of therapeutic questions (population, intervention, comparator, outcome [PICO] mnemonic), and relationships between stage of change and level of evidence used to resolve questions. Results: We assessed 1989 submissions (from 559 Fellows of the Royal College of Physicians and Surgeons of Canada [RCPSC]). The majority of submissions were by males (69.2%) aged 40–59 (59.4%) with an average of 24.3 (range 6–58, SD 11.1) years since graduation. The most frequent submissions were treatment (36.6%) and diagnosis (22.3%) questions. Half of all questions described ≥2 components (PICO), and only 3.7% of questions included all 4 components. Cross tabulations indicated only 1 significant trend for the use of narrative reviews and the outcome “integrating new knowledge' (P < .000). Discussion: Self-directed learning skills comprise an important strategy for specialists maintaining or expanding their expertise in patient care, but an important obstacle to answering patient care questions is the ability to formulate good ones. Engagement in most major learning activities is stimulated by management of a single patient: formal accredited group learning events are of limited value in starting episodes of self-directed learning. Low levels of evidence used to address learning projects. Future research should determine how best to improve the quality of questions submitted and whether or not these changes result in increased efficiencies, more appropriate uses of evidence, and increased changes in practice behaviors. [ABSTRACT FROM AUTHOR]

It has been 20 years since the lost estimate of the public health workforce's size and composition. This study provides a best estimate through secondary analysis of existing workforce reports, summaries, and information gathered from chief health officials in 50 states and 6 territories, public health organizations, and federal agencies. Results indicate that the workforce consists of some 448,254 persons in salaried positions as follows: 44.6 percent professionals, 4 percent officials/administrators, 14 percent technicians, and 13 percent clerical/support. Workforce size may have decreased by as much as 10 percent over the lust 20 years, despite a 25 percent increase in population and rising health hazards. [ABSTRACT FROM AUTHOR]