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Background: While many falls are preventable, they remain a leading cause of injury and death in older adults. Primary care clinics largely rely on screening questionnaires to identify people at risk of falls. Limitations of standard fall risk screening questionnaires include suboptimal accuracy, missing data, and non‐standard formats, which hinder early identification of risk and prevention of fall injury. We used machine learning methods to develop and evaluate electronic health record (EHR)‐based tools to identify older adults at risk of fall‐related injuries in a primary care population and compared this approach to standard fall screening questionnaires. Methods: Using patient‐level clinical data from an integrated healthcare system consisting of 16‐member institutions, we conducted a case–control study to develop and evaluate prediction models for fall‐related injuries in older adults. Questionnaire‐derived prediction with three questions from a commonly used fall risk screening tool was evaluated. We then developed four temporal machine learning models using routinely available longitudinal EHR data to predict the future risk of fall injury. We also developed a fall injury‐prevention clinical decision support (CDS) implementation prototype to link preventative interventions to patient‐specific fall injury risk factors. Results: Questionnaire‐based risk screening achieved area under the receiver operating characteristic curve (AUC) up to 0.59 with 23% to 33% similarity for each pair of three fall injury screening questions. EHR‐based machine learning risk screening showed significantly improved performance (best AUROC = 0.76), with similar prediction performance between 6‐month and one‐year prediction models. Conclusions: The current method of questionnaire‐based fall risk screening of older adults is suboptimal with redundant items, inadequate precision, and no linkage to prevention. A machine learning fall injury prediction method can accurately predict risk with superior sensitivity while freeing up clinical time for initiating personalized fall prevention interventions. The developed algorithm and data science pipeline can impact routine primary care fall prevention practice. [ABSTRACT FROM AUTHOR]

This qualitative study examined the influence of school culture on services for students with significant support needs. Students with significant support needs are defined as those who typically have cognitive impairments, often paired with sensory and physical challenges, and who require substantial supports to receive benefit from education. Using Schein's (1988) definition of culture, ethnographic methods, including observations, interviews and artifacts, were used to collect data related to artifacts, values, and assumptions. Results of this study indicate a strong sense of family, community and belonging. However, belonging did not include critical components of instruction as described as best practice in special education literature.

Using a comprehensive set of quality indicators grounded in evidence-based practices, evaluation, planning, and improvement of services for students with the most significant support needs can be completed. This nine-step process is described with examples for implementation.

This article addresses ways that regular and special education teachers can provide training for paraeducators and delineates the roles and responsibilities appropriate for paraeducators. Training suggestions cover the interview, orientation, sharing information, meetings, and team skills. Paraeducator responsibilities require teaching students inclusion skills, interpersonal/social skills, daily living skills, community skills, and domestic skills. (Contains references.) (DB)

The study aims to evaluate the efficacy of a fall prevention tool kit (FPTK) using health information technology (HIT) in reducing the incidents of fall in acute care hospitals. The results indicate that the use of such a tool kit significantly reduced the number of falls.

Background/Aims: Coronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter. Methods: A descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography. Results: Female participants reported greater difficulty in recalling treatment information (P<0.03), found discussions about alternative treatments more confusing (P<0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P<0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P<0.002). Conclusions: Patients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent. [ABSTRACT FROM AUTHOR]

Background Living with an implanted cardioverter-defibrillator increases survival, but the effects of the device on health status, quality of life, and psychological state over time are not clear. Objectives To [...]

* BACKGROUND Within the challenging healthcare environment are nurses, patients, and patients' families. Families want proximity to their loved ones, but the benefits of such proximity depend on patients' conditions [...]