WIHI - A Podcast from the Institute for Healthcare Improvement

1. Falls are common health events that cause discomfort and disability for older adults and stress for caregivers. Previous falls; strength, gait and balance impairments; and medications are the strongest risk factors for falling.

2. The most effective strategy for reducing the rate of falling in community-living older adults may be intervening on multiple risk factors including strengthening and balance exercises through physical therapy, medication reduction, environmental modifications to reduce fall hazards, cataract surgery. Vitamin D has strong evidence of benefit for preventing fractures among older men at risk and probably of preventing falls in all at risk older adults.

3. While challenges and barriers exist, fall prevention strategies can be incorporated into clinical practice.

Momentum for Maternity of the Safest Kind

The Next Wave of Reform for Medical Education

The Health Care Tune Up-Show! Leading with Logic and Emotion

1. A clinical trial is a powerful tool for showing whether an intervention works, but the heterogeneity of trial participants means it is a mistake to assume that the overall (or group) benefit of an intervention found in such a trial is the same for every participant.

2. The absolute benefit of an intervention is greater for trial participants (and for patients generally) whose baseline risk for a bad outcome is high than it is for those whose baseline risk is low.

3. A quality improvement program in any one organization is like an individual patient, in the sense that it is highly complex, is unstable (i.e., changes over time), and its local circumstances are unique, all of which make it hard (although not impossible) to judge whether a quality improvement program in any particular setting actually works, and to know whether it would work elsewhere.

Message to Managers: Crises Happen. Plan Ahead!

Tipping the Scales: Fresh Ideas to Combat Obesity

1. A conventional evidence-based approach is modified by 3 important caveats: prognosis, insufficient evidence, and patient goals and preferences.

2. Conceptually, the care of older persons can be dividide into 3 time frames: short term, which focuses on remediating the current problems; mid-range, focussing on preventive and foreseeable problems; and long-range, which focus on eventual decline and living arrangements.

3. Individual providers need to structure their practices to efficiently and comprehensively accommodate the diverse needs of elderly patients.

Adverse Events and Their Aftermath: SOS from Clinicians

1) The most likely cause of acute onset monocular floaters or flashes is posterior vitreous detachment and if left untreated vitreous detachment complicated by retinal tear can progress to vision-threatening retinal detachment.

2) A minimum approach to evaluating a patient with suspected posterior vitreous detachment should include a history of change in vision or curtain of darkness, measurement of visual acuity and assessment of confrontational visual fields.

3) High-risk features for retinal tear in the setting of acute posterior vitreous detachment are subjective or objective visual acuity loss, monocular visual field loss (or curtain of darkness), and vitreous pigment or hemorrhage on slit-lamp examination and patients with any of these clinical findings should be referred for same day ophthalmology assessment.