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Benign xanthomatous pseudotumors are rare, mass forming lesions composed of lipid laden histiocytes and tumor necrosis following chemotherapy.We present a rare case of young 36 year old male with primary mediastinal Hodgkin's lymphoma who developed xanthomatous pseudotumor mimicking relapse at the site of original disease on positron emission tomography. This scenario places emphasis on histologic confirmation of suspected treatment failure or relapse. Keywords: Nodular sclerosing Hodgkin's lymphoma, Tumor necrosis, Histiocyte-rich pseudotumor, PET

Changes within the Coronary veins secondary to pacing leads have not been described, this study assessed these changes in explanted hearts. Macroscopically fibrous sheaths formed around longstanding leads, leading to slit like channels for venous return in smaller veins. Histologically changes included bland fibrosis, a foreign body response to the lead, a chronic inflammatory response and inflammatory destruction of the media. Individuals responded in different ways with no clear relationship of changes to duration of the lead.

AIM AND OBJECTIVES To describe and compare identification of delirium, length of stay and discharge locations in two patient samples of falls, before and after an organisation-wide interprofessional delirium education and practice change along with implementation of a policy. BACKGROUND Delirium is a common and severe problem for hospitalised patients, with occurrence ranging from 14%-56%, morbidity and mortality from 25%-33%. Recent studies report that 73%-96% of patients who fell during a hospital stay had symptoms of delirium; however, the delirium went undiagnosed and untreated in 75% of the cases. DESIGN A descriptive, retrospective observational study using a pre/postdesign. METHODS Two chart reviews were performed on patient falls as identified in the hospital safety reporting system in 2009-2010 (98 fallers) and 2012 (108 fallers). An organisation-wide education was planned and implemented with monitoring of policy compliance. RESULTS After the education, documentation of the "diagnosis of delirium" and "no evidence of delirium" increased from 14.3%-29.5% and from 27.6%-44.4%. The documentation of "evidence of delirium" decreased significantly from 58.2%-25.9% (p

Aim This paper reports on a study undertaken to test the sensitivity, specificity and feasibility of four fall risk assessment tools. Background Falls risk assessment tools have been developed based on literature and findings from empirical studies, but the instruments often lack further testing in the clinical setting. Method Four falls risk assessment tools were tested simultaneously in this study. The data was collected in May-June 2006. All assessment tools were completed on a total of 1546 patients. Descriptive statistics were used for data analysis. Results The use of the instruments was moderately consistent among registered nurses, but the education provided did not entirely eliminate problems with accuracy. The sensitivity of the instruments was 57.1-100% and specificity was 24.9-69.3%. Conclusion The sensitivity and specificity of the instruments are important factors to consider when choosing an instrument. However, the strategies to educate staff and to intervene appropriately are equally important for an organization undertaking a proactive stance in mitigating the risk of falls. Implications for Nursing Management It is important for managers to test instruments in their own organizations and specific populations. It is also critical to carefully assess that the chosen instrument is easy and accurate in use. Language: en

Aim To evaluate currently available pediatric falls assessments instruments and to build a predictive fall model while also evaluating injury risk as a predictor of fall likelihood within the paediatric inpatient population. Background There is lack of paediatric-specific fall assessment instruments and little information on the exploration of injury risk as related to falls in hospitalized children. Method An ambispective, matched case-control design conducted in a sample of 100 inpatient paediatric patients. Results Two out of five instruments performed well to classify children at risk of falls. Longer length of stay, bleeding cautions/blood disorders and temperament/behaviour issues were significant predictors of fall likelihood. Cognitive impairment or neurological disease was not related to an increased likelihood of fall or injury risk for this sample. Conclusions More research is required to institute and standardize pediatric fall and injury risk assessments for everyday use. The explicit approach of using predictive modelling is critical in creating a universal, baseline reference for the most reliable and valid measure of assessment in children. Implications for nursing management Findings of the present study increase awareness of nursing managers and leaders as to the necessity for fall and injury risk assessment as a safety and quality measure for inpatient pediatric populations. Language: en

Background Delirium has been previously implicated as a risk factor for patient falls. This is a replication study of a 2009 investigation examining the prevalence of diagnosed and undiagnosed delirium in patients who fell during their hospital stay. Objective To determine the prevalence of delirium at our institution and to examine the relationship of falls with delirium, advanced age, and hospital procedures. Method Using the data collection tool developed for the 2009 study, the authors performed a retrospective review of records of 99 patients who fell during their inpatient stay. Similar information was gathered on patient demographics, fall date, fall location, hospital service type, discharge disposition, diagnosis of delirium (DD), synonyms used to describe delirium, metabolic derangements, and surgeries or procedures performed. Data were collected on the day of admission, day of the fall, and 2 days before the fall. Results Falls in the general hospital were associated with delirium (73% of subjects had evidence or a DD at the time of their fall), advanced age (64.5% were older than 70 years), and specific procedures and surgeries. Conclusion As identified in the previous study, improving delirium recognition and treatment may reduce the number of patient falls and promote more favorable outcomes such as reduced length of stay, fewer discharges to intermediate care facilities, and prevention of fall injuries. A comprehensive fall risk assessment that includes a delirium detection tool would improve the sensitivity and specificity of these instruments to detect those at greatest risk.

To evaluate currently available paediatric falls assessments instruments and to build a predictive fall model while also evaluating injury risk as a predictor of fall likelihood within the paediatric inpatient population.There is lack of paediatric-specific fall assessment instruments and little information on the exploration of injury risk as related to falls in hospitalized children.An ambispective, matched case-control design conducted in a sample of 100 inpatient paediatric patients. Results Two out of five instruments performed well to classify children at risk of falls. Longer length of stay, bleeding cautions/blood disorders and temperament/behaviour issues were significant predictors of fall likelihood. Cognitive impairment or neurological disease was not related to an increased likelihood of fall or injury risk for this sample.More research is required to institute and standardize paediatric fall and injury risk assessments for everyday use. The explicit approach of using predictive modelling is critical in creating a universal, baseline reference for the most reliable and valid measure of assessment in children.Findings of the present study increase awareness of nursing managers and leaders as to the necessity for fall and injury risk assessment as a safety and quality measure for inpatient paediatric populations.

In order to ensure the highest possible safety for our patients, we identified a need to introduce a falls risk assessment tool with high sensitivity, specificity and reliability within our institution. A comparative research study was conducted which evaluated several instruments against actual patient falls. Based on the findings a new instrument was selected and converted to an electronic format compatible with existing nursing informatics systems. We are now testing the use of this version of the instrument for its ability to guide appropriate interventions that prevent falls.

Objective Our objective was to describe how active transportation can help meet health and greenhouse gas emissions goals, and the ability of urban form strategies to impact both issues. In addition, we wanted to assess if there is an inverse relationship between active and motorized forms of travel. Methods A cross-sectional analysis of travel diary data was used to measure relationships among energy (kcal) burned from walking, energy (kcal) burned from motorized transportation, and the ratio of the two (the transport energy index) with regional accessibility and local walkability when adjusting for demographic factors. Multiple linear regression and descriptive statistics were employed to estimate these relationships. Results Transit accessibility, residential density, and intersection density were positive predictors of walk energy and the energy index and inverse predictors of motorized energy. The land use mix variable was negatively and significantly associated with energy burned from walking and from motorized transportation, with no significant impact on the transport energy index. Because a mixed land use pattern places destinations closer together, it reduces distances and thus energy demands for both walking and driving. Conclusions The results support the concept, previously untested empirically, that similar urban form strategies can have cobenefits for both physical activity and climate change.

Firearm fatalities occurring in Yorkshire and Humberside between 1975-1991 were examined; 130 cases were found, 64 were homicides, 55 suicides and 11 were accidental or unclassifiable. All but two of the suicides were men. Shotguns were the most frequent weapon used in both suicides and homicides. Of the 55 suicides, 17 were by men who had murdered before committing suicide. In 15 of these cases the assailants knew their victims. The other two cases involved murder of police officers. These cases were mostly with shotguns. In both homicide and suicide, rifled weapons and handguns were infrequently used. Most suicides and homicides occurred at home. Alcohol was again shown to be a significant factor in suicides. Overall firearms account for less than 10% of homicides in England and Wales and less than 5% of suicides in men and is most unusual in women.

In many landscapes, an important fire management objective is to reduce the negative impacts from unplanned fires on people, property and ecological values. In Australia, there exists an inherent assumption that high spatial variability in fire ages and hence fuel loads will have negative effects on both the incidence and spread of subsequent fires, and will enhance ecological values. A recent study using the process-based computer simulation model FIRESCAPE-SWTAS predicted several relationships between prescribed burn treatment levels and spatial patterning and management objectives in south-west Tasmania, Australia. The present study extended this investigation to additionally explore the effects of prescribed burning treatment unit size on unplanned fire incidence and area burned both in the general landscape and specifically in fire-intolerant vegetation. Simulation results suggest that treatment level had the greatest influence on modifying fire effects, whereas treatment unit size had the least effect. The model predicted that all three parameters interacted to determine the mean annual area burnt by unplanned fires. In fire-intolerant vegetation, treatment unit size did not influence the incidence of unplanned fires and the area burnt by unplanned fires in these communities. Where significant differences were evident, fire risk was reduced by higher treatment levels, deterministic spatial patterns of burning units, and smaller burning unit sizes.

Computer simulation modelling provides a useful approach for determining the trade-offs between the extent of prescribed burning and the long-term impacts of unplanned fires on management values. In the present study, FIRESCAPE-SWTAS, a process-based fire regime and vegetation dynamics model, was used in the World Heritage Area of south-west Tasmania, Australia, to investigate the implications of different prescribed burning treatments on identified management objectives. Treatments included annual prescribed burning of different proportions of the most flammable vegetation community, buttongrass moorlands. Additionally, a proposed strategic burning treatment for this landscape was simulated for comparison with these treatments. Simulations identified the nature of the relationships between the prescribed burn treatment level and the fire size distributions, the mean incidence, and the mean annual areas burnt by unplanned fires, with all three parameters declining with increases in treatment level. The study also indicated that strategically located treatment units were able to enhance the reduction in the fire risk to vegetation species susceptible to fire (fire-intolerant species).