Peter A. Bath

Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham, UK

The objectives of this work were: to estimate the incidence of falls within an at-risk group of community-dwelling elderly people; to assess the risk factors associated with incident falls; to examine the effects of incident falls on survival. A random sample of 1042 community-dwelling older people in Nottingham (UK) were interviewed in 1985 and survivors re-interviewed at 4-year follow-up. The at-risk group was defined as survivors who had not fallen in the year prior to the baseline interview (n=444). One-year fall recall was assessed using a questionnaire and included physical health, mobility, prescribed drugs and time spent walking. Body-weight and handgrip strength were measured. Eight-year post-fall mortality was recorded. In 1989 117 new fallers were identified. These people fell a total of 233 times in the year prior to re-interview (incidence rate: 524.8 per 1000 person-years at risk; 95% confidence intervals (CI): 473.3–576.3). People aged less than 75 were more likely to fall outdoors than people aged 75␣and over (χ2=5.715, df=1, p=0.017). Risk factors associated with falling were: being less healthy (odds ratio (OR): 0.55; p=0.052); having a walking speed in the range stroll/very slow/non-ambulant compared with normal/brisk/fast (OR: 1.99; p<0.01); and number of prescribed drugs (OR: 1.30; p=0.01). When analysed separately, indoor and outdoor falls presented differential risk profiles, with evidence that indoor falls were associated with frailty, while outdoor falls were associated with compromised health status in more active people. In 8-year post-fall monitoring, multiple (3+) fallers and indoor fallers showed a significant excess mortality. The differences in risk factors for, and prognoses following, indoor and outdoor falls, emphasise the complex interactions between intrinsic and extrinsic factors associated with falling among older people.

Social engagement and health outcomes among older people: introduction to a special section

Active social engagement has been shown to be associated with better health and health outcomes across a number of studies (Berkman and Syme 1979; House et al. 1982; Kaplan et al. 1988; Bygren et al. 1996; Glass et al. 1999; Bassuk et al. 1999; Wang et al. 2002; Mendes de Leon et al. 2003). However, the research studies over the last few decades have used different definitions and measures of social engagement, and the terminology used to define and measure social engagement has not been wholly consistent (Andersson 1998; Bennett 2002). Some studies on social engagement have considered social participation (Bygren et al. 1996; Glass et al. 1999), i.e. the involvement in actual activities which have a social element, other studies have examined social networks, i.e. the number of contacts with friends and relatives and membership of groups and organisations (Bowling and Browne 1991; Seeman et al. 1996; Unger et al. 1999), and yet others have focused on social support, i.e. the level of instrumental and emotional help available to an individual (e.g. Everard et al. 2000). Although the distinction between these different types of social engagement is apparent in the literature, there are clear overlaps between these types of social engagement across studies (e.g. Everard et al. 2000). For example, while attending church services is an activity which often has a social element, it can also stimulate contact with close friends. The overlap is also reflected in studies which have examined two or more of these types of engagement in combination—for example, Mendes de Leon et al. (2003) examined the effects of both participation in social activity and social networks on disability. In this special section on social engagement in older people, the studies focus on social participation, and in this Introduction we review research which has examined the relationship between this aspect of social engagement and health. While this review includes studies which have examined social participation and the other types of social engagement, it excludes those studies focusing only on social networks and/or social support, without reference to actual participation in social activities. The research to date has considered social engagement in relation to an increasingly varied series of health outcome measures, including mortality (Berkman and Syme 1979; House et al. 1982; Kaplan et al. 1988; Bygren et al. 1996; Glass et al. 1999), disability (Mendes de Leon et al. 2003), cognitive functioning (Aartsen et al. 2002), cognitive decline (Bassuk et al. 1999) and the risk of dementia (Fratiglioni et al. 2000; Wang et al. 2002). This special section reports new research concerning the relationship between social participation and physical health. Likewise, in this review we concentrate on research which has examined the impact of social participation on physical health outcomes.

Acceptance of health information technology in health professionals: An application of the revised technology acceptance model

The response of health professionals to the use of health information technology (HIT) is an important research topic that can partly explain the success or failure of any HIT application. The present study applied a modified version of the revised technology acceptance model (TAM) to assess the relevant beliefs and acceptance of HIT systems in a sample of health professionals (n = 133). Structured anonymous questionnaires were used and a cross-sectional design was employed. The main outcome measure was the intention to use HIT systems. ANOVA was employed to examine differences in TAM-related variables between nurses and medical doctors, and no significant differences were found. Multiple linear regression analysis was used to assess the predictors of HIT usage intentions. The findings showed that perceived ease of use, but not usefulness, relevance and subjective norms directly predicted HIT usage intentions. The present findings suggest that a modification of the original TAM approach is needed to better understand health professionals’ support and endorsement of HIT. Perceived ease of use, relevance of HIT to the medical and nursing professions, as well as social influences, should be tapped by information campaigns aiming to enhance support for HIT in healthcare settings.

Health informatics: current issues and challenges

Health informatics concerns the use of information and information and communication technologies within healthcare. Health informatics and information science need to take account of the unique aspects of health and medicine. The development of information systems and electronic records within health needs to consider the information needs and behaviour of all users. The sensitivity of personal health data raises ethical concerns for developing electronic records. E-health initiatives must actively involve users in the design, development, implementation and evaluation, and information science can contribute to understanding the needs and behaviour of user groups. Health informatics could make an important contribution to the ageing society and to reducing the digital divide and health divides within society. There is a need for an appropriate evidence base within health informatics to support future developments, and to ensure health informatics reaches its potential to improve the health and well-being of patients and the public.

Clinical nurse specialists in palliative care. Part 1. A description of the Macmillan Nurse caseload

Macmillan Nurses play a significant role in specialist palliative care services in the UK, providing direct and indirect services to patients with complex palliative care needs and to their families. Existing literature shows a developing understanding of the role; however, little detailed data exist regarding the clinical work that they undertake. This paper provides evidence from a major evaluation study, commissioned by Macmillan Cancer Relief. It reports the methods of data collection for the study and then goes on to use data from the evaluation to describe the caseload of Macmillan Nurses. Between September 1998 and October 1999, a team of researchers worked alongside 12 Macmillan teams for a period of 8 weeks with each team. Prospective data were gathered on all new referrals to the services within the 8-week period. This included demographic details, timing of referral, the nature and purpose of contacts, and interventions, recorded from case notes and Macmillan Nurse records. Where possible, a date of death was obtained for all patients. A total of 814 new patients were referred during the study period (range 45– 114 per site). The most common reasons for referral were emotional care for the patient (57%), pain control (27%), and other physical symptoms (33%). Thirteen per cent of the patients referred to the services died within 1 week of referral while 40% died within 6 weeks; thus, a significant proportion of patient work is focused on care at the end of life. It is also noteworthy that one-third of patients were still alive, indicating that some patients are being cared for earlier in the illness trajectory. On average, each new patient referral received two or more ‘face-to-face’ visits and two follow-up phone calls within the 8-week period. It would appear that Macmillan Nurse teams have been successful in getting access to relevant patients. As with any service that provides a complex set of interventions, the Macmillan teams have to adapt and develop the services in each setting. Whilst it is clearly important for the development of a Macmillan service to be tailored to the local conditions, the evidence on diversity suggests that in some cases, stronger guidance, in partnership with both Macmillan Cancer Relief and core providers, may be justified.

Clinical nurse specialists in palliative care. Part 3. Issues for the Macmillan Nurse role.

The remit and boundaries of the Macmillan Nursing role in the UK have been called into question recently by a number of policy-driven changes. The rapid appointment of tumour site-specific nurses and the development of posts for palliative medicine, stemming originally from the Calman Hine recommendations for reorganizing cancer services, have created unparalleled challenges of adaptation to new working practices and procedures. The extent to which Macmillan Nurses are adapting to these new demands was addressed as part of a major evaluation study of UK Macmillan Nursing in 12 sites commissioned by the UK charity Macmillan Cancer Relief. This paper draws upon semi-structured interviews with Macmillan Nurses (n = 44) and their key colleagues (n = 47). We found that differences of expectation between Macmillan Nurses and their managers about the appropriate focus of their work lead to problems of role ambiguity and role conflict; that Macmillan Nurses lack resources with which to develop an educative and consultative role and yet substitute for inadequacies in skills and knowledge of other health care staff; and that problems are associated in co-working with newly appointed cancer site-specific nurses and palliative medicine colleagues. Macmillan Nursing has a crucial role to play in meeting the objectives in the NHS Cancer Plan. However, in order to ensure that their expertise is used efficiently and effectively, there is an urgent need to clarify the nature and scope of the Macmillan Nurse role, to attend to issues of team working and to improve the skills of nonspecialist staff in palliative care.

The total cost of publication in a hybrid open-access environment: Institutional approaches to funding journal article-processing charges in combination with subscriptions

As open‐access (OA) publishing funded by article‐processing charges (APCs) becomes more widely accepted, academic institutions need to be aware of the “total cost of publication” (TCP), comprising subscription costs plus APCs and additional administration costs. This study analyzes data from 23 UK institutions covering the period 2007–2014 modeling the TCP. It shows a clear rise in centrally managed APC payments from 2012 onward, with payments projected to increase further. As well as evidencing the growing availability and acceptance of OA publishing, these trends reflect particular UK policy developments and funding arrangements intended to accelerate the move toward OA publishing (“Gold” OA). Although the mean value of APCs has been relatively stable, there was considerable variation in APC prices paid by institutions since 2007. In particular, “hybrid” subscription/OA journals were consistently more expensive than fully OA journals. Most APCs were paid to large “traditional” commercial publishers who also received considerable subscription income. New administrative costs reported by institutions varied considerably. The total cost of publication modeling shows that APCs are now a significant part of the TCP for academic institutions, in 2013 already constituting an average of 10% of the TCP (excluding administrative costs).

Similarity searching in files of three-dimensional chemical structures: Comparison of fragment-based measures of shape similarity

This paper compares several fragment-based measures that can be used to quantify the degree of similarity between pairs of three-dimensional (3-D) chemical structures. The fragments that are considered contain two, three, or four atoms and encode distance information, angular information or both but do not involve chemical information such as atomic type. The effectiveness of the various measures is compared using eight literature datasets for which biological-activity data and calculated 3-D structures are available, and a set of carbohydrate structures from the Cambridge Structural Database that have been classified into eight distinct groups. Similarity searches on these datasets suggest that the four-atom fragments are the most effective.

Open-access repositories worldwide, 2005-2012: Past growth, current characteristics and future possibilities

This paper reviews the worldwide growth of open‐access (OA) repositories, 2005 to 2012, using data collected by the OpenDOAR project. Initial repository development was focused on North America, Western Europe, and Australasia, particularly the United States, United Kingdom, Germany, and Australia, followed by Japan. Since 2010, there has been repository growth in East Asia, South America, and Eastern Europe, especially in Taiwan, Brazil, and Poland. During the period, some countries, including France, Italy, and Spain, have maintained steady growth, whereas other countries, notably China and Russia, have experienced limited growth. Globally, repositories are predominantly institutional, multidisciplinary and English‐language based. They typically use open‐source OAI‐compliant software but have immature licensing arrangements. Although the size of repositories is difficult to assess accurately, available data indicate that a small number of large repositories and a large number of small repositories make up the repository landscape. These trends are analyzed using innovation diffusion theory, which is shown to provide a useful explanatory framework for repository adoption at global, national, organizational, and individual levels. Major factors affecting both the initial development of repositories and their take‐up include IT infrastructure, cultural factors, policy initiatives, awareness‐raising activity, and usage mandates. Mandates are likely to be crucial in determining future repository development.

What progress has been made towards implementing national guidance on end of life care? A national survey of UK general practices:

The objectives of this study were to establish the extent to which UK primary care has adopted recommended practices on supportive and palliative care of adults with cancer, and to relate this to participation in national initiatives. We conducted a cross-sectional postal questionnaire survey of a random sample of UK general practices. In total, 60.0% of practices (2096 of 3495) responded to the survey: 61.5% reported involvement with the Gold Standards Framework (GSF); 24.4% with the Liverpool or other End of Life Care Pathway; 12.3%, with the Preferred Place of Care (PPC) initiative; and 8.4% with Advance Care Planning (ACP). Participation in GSF contributed most to the variance in practice organization scores; and practice organization scores contributed most to the variance in clinical care scores. Participation in ACP or PPC, and higher clinical care scores were associated with an increased likelihood of reported high rates of death at home for cancer patients. Our findings appear to support the role of national initiatives in improving the quality of end-of-life care delivery in general practice. A population-based study would be required to assess the effect of end of life care on clinical outcomes and patient or carer experience.