Michael Fitzharris

Randomised factorial trial of falls prevention among older people living in their own homes

Abstract Objective: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. Design: A randomised controlled trial with a full factorial design. Setting: Urban community in Melbourne, Australia. Participants: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. Interventions: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. Main outcome measure: Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home. Results: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined. Conclusions: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70–84 years living at home who rate their health as good.

A systematic review of the costs and benefits of helicopter emergency medical services

INTRODUCTION Helicopter emergency medical services (HEMS) are popular in first world health systems despite inconsistent evidence in the scientific literature to support their use. The aim of the current study was to perform a systematic review of economic evaluations of HEMS, in order to determine the economic cost of HEMS and the associated patient-centered benefits. METHOD A systematic review was performed of studies that provided a cost estimate of HEMS. The inclusion criteria consisted of English language articles that estimated both the costs and outcomes of a HEMS and fulfilled pre-specified criteria in relation to a cost analysis, cost-minimisation, cost-effectiveness or cost-benefit evaluation. Identified studies were synthesised according to the patient diagnosis (trauma, non-trauma or non-specific) and the type of HEMS transport under review (primary scene retrieval or secondary inter-facility transport). All costs were converted to US dollars and indexed for inflation. RESULTS Fifteen studies met the inclusion criteria. Among all studies the annual cost of HEMS ranged from

Crash characteristics and patterns of injury among hospitalized motorised two-wheeled vehicle users in urban India

115,777 to

Effectiveness of Mandatory License Testing for Older Drivers in Reducing Crash Risk Among Urban Older Australian Drivers

5,571,578. Five studies showed HEMS to be a more expensive transport alternative without an associated benefit while eight studies provided cost-effectiveness ratios of

Motorcycle protective clothing: protection from injury or just the weather?

3292 and

Thoracic aortic injury in motor vehicle crashes: the effect of impact direction, side of body struck and seat belt use

2227 per life year saved for trauma,

General health status and functional disability following injury in traffic crashes

3258 per life saved and

The Whitehorse NoFalls trial: effects on fall rates and injurious fall rates

7138 and

Analysis of General Aviation Crashes in Australia Using the Human Factors Analysis and Classification System

12,022 per quality adjusted life year for non-trauma and

Estimating the global incidence of traumatic spinal cord injury

30,365 and