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e19152 Background: Cancer treatment is becoming more complex, necessitating subspecialty expertise and multidisciplinary approaches to treatment planning. Simultaneously, there is increasing demand to provide care as close to home as possible. While tumor boards have long been an institutional backbone to providing high-quality multidisciplinary care in tertiary facilities, connecting several hospitals and dozens of cancer specialists in a large integrated healthcare system is unique and potentially transformational for smaller facilities and communities. Methods: Using highly-secure, network firewall-protected Cisco Telepresence and WebEx capabilities, 11 disease specific tumor boards (Breast, GI, Sarcoma, GU, Thoracic, Head/Neck, Melanoma, Neuro, Heme, Hepatobiliary, Gyn) were organized across Intermountain Healthcare’s 24 geographically and medically diverse hospitals spanning over 500 miles. Meetings for each of these disease-specific tumor boards have been held at least every 1-2 weeks, at set times and days since July 2019. Cases are submitted to the appropriate tumor board by individual providers from anywhere in the system. Submitted cases are reviewed by a designated subspeciality leader. Cases are either added to the system-wide agenda, or at times, the clinical decision can be resolved immediately. Included cases’ records including pathology, radiology and pertinent medical history are obtained for display and discussion. After each tumor board, recommendations and conclusions are recorded by nurse navigators for future review and consultation. Results: From July 2019 to February 2020, 1,598 patient cases were discussed. Just as relevant, 293 unique oncology providers (surgeons, medical oncologists, radiation oncologists, genetic counselors, nurse navigators, and therapists) participated in tumor board discussions. These deliberations provided insight, experience and recommendations directly related to patient care. Conclusions: Our system-wide, disease-specific, multi-disciplinary tumor boards are useful in connecting oncology providers and subspecialists. This effort has led to better collaboration, coordination and delivery of high-quality cancer care to patients throughout a large healthcare system that includes thousands of patients and dozens of cancer providers in smaller/rural communities. In addition, provider engagement has improved. Work is ongoing to prospectively evaluate the effects on treatment decisions and clinical outcomes.

OBJECTIVES: To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition. DESIGN: A preplanned subgroup comparison of the effectiveness of a cluster-randomized, nonblinded, usual-care, controlled trial. SETTING: Nine residential facilities in Umea, Sweden. PARTICIPANTS: All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini-Mental State Examination (MMSE; n = 378). An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean ± standard deviation = 83.9 ± 5.8 vs 82.2 ± 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6–15) vs 17 (13–18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group. INTERVENTION: A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem-solving conferences. MEASUREMENTS: The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group. RESULTS: A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls P = .016 and P = .121 and adjusted hazard ratio P < .001 and P = .420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group (P = .006). CONCLUSION: The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group.

The aim of this study was to describe incidences of falls and fall-related injuries, and to identify predisposing factors for falls in very old people in a prospective population-based follow-up study for falls. The study is part of the Umea 85+ Study which includes half of the population aged 85, and the total population aged 90 and > or =95 (-103), in Umea, Sweden. Of the 253 people interviewed, 220 (87%) were followed up for falls for 6 months, of whom 109 lived in ordinary and 111 in institutional housing. A comprehensive geriatric baseline assessment was made through interviews and testing during home visits. Forty percent of the participants did fall a total 304 times, corresponding to 2.17 falls per Person Year (PY). It occurred 0.83 injuries per PY, including 0.14 fractures per PY. In a Cox regression analysis, the independent explanatory risk factors for time to first fall were dependency in activities of daily living (ADL), thyroid disorders, treatment with selective serotonin reuptake inhibitors (SSRIs) and occurrence of falls in the preceding year. It could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture within 1 year. ADL, thyroid disorders and treatment with SSRIs should be considered in fall prevention programmes.

to evaluate and compare the prognostic validity relative to falls of the Timed Up-and-Go test (TUG), a modified Get-Up-and-Go test (GUG-m), staff's judgement of global rating of fall risk (GLORF) and fall history among frail older people.cohort study, 6-month prospective follow-up for falls.183 frail persons living in residential care facilities in Sweden, mean age 84 years, 73% women.the occurrence of falls during the follow-up period were compared to the following assessments at baseline: the TUG at normal speed; the GUG-m, a rating of fall risk scored from 1 (no risk) to 5 (very high risk); the GLORF, staff's rating of fall risk as 'high' or 'low'; a history of falls in the previous 6 months. These assessment tools were evaluated using sensitivity, specificity and positive and negative likelihood ratios (LR(+) to rule in and LR(-) to rule out a high fall risk).53% of the participants fell at least once. Various cut-off values of the TUG (12, 15, 20, 25, 30, 35, 40 s) and the GUG-m showed LR(+) between 0.9 and 2.6 and LR(-) between 0.1 and 1.0. The GLORF showed an LR(+) of 2.8 and an LR(-) of 0.6 and fall history showed an LR(+) of 2.4 and an LR(-) of 0.6.in this population of frail older people, staff judgement of their residents' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk. A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk. The grading of fall risk by GUG-m appears of very limited value.

Background and aims: Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling. Methods: 187 out of all residents living in 9 facilities, ≥65 years of age were at high risk of falling. The facilities were clusterrandomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering. Results: At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (≥10 cm, p

To study precipitating factors for falls among older people living in residential care facilities.Prospective cohort study.Five residential care facilities.140 women and 59 men, mean age +/- SD 82.4 +/- 6.8 (range, 65-97).After baseline assessments, falls in the population were tracked for 1 year. A physician, a nurse, and a physiotherapist investigated each event, and reached a consensus concerning the most probable precipitating factors for the fall.Previous falls and treatment with antidepressants were found to be the most important predisposing factors for falls. Probable precipitating factors could be determined in 331 (68.7%) of the 482 registered falls. Acute disease or symptoms of disease were judged to be precipitating, alone or in combination in 186 (38.6%) of all falls; delirium was a factor in 48 falls (10.0%), and infection, most often urinary tract infection, was a factor in 38 falls (7.9%). Benzodiazepines or neuroleptics were involved in the majority of the 37 falls (7.7%) precipitated by drugs. External factors, such as material defects and obstacles, precipitated 38 (7.9%) of the falls. Other conditions both related to the individual and the environment, such as misinterpretation (eg, overestimation of capacity or forgetfulness), misuse of a roller walker, or mistakes made by the staff were precipitating factors in 83 (17.2%) of falls.Among older people in residential care facilities, acute diseases and side effects of drugs are important precipitating factors for falls. Falls should therefore be regarded as a possible symptom of disease or a drug side effect until proven otherwise. Timely correction of precipitating and predisposing factors will help prevent further falls.

BACKGROUND AND AIMS: It is of great importance to consider whether a tool's predictive value is generalizable to similar samples in other locations. Numerous fall prediction systems have been developed, but very few are evaluated over a different time period in a different location. The purpose of this study was to validate the predictive accuracy of the Mobility Interaction Fall (MIF) chart, and to compare it to staff judgement of fall risk and history of falls. METHODS: The MIF chart, staff judgement, and fall history were used to classify the risk of falling in 208 residents (mean age 83.2 +/- 6.8 years) living in four residential care facilities in northern Sweden. The MIF chart includes an observation of the ability to walk and simultaneously interact with a person or an object, a vision test, and a concentration rating. Staff rated each resident's risk as high or low and reported the resident's history of falls during the past 6 months. Falls were followed up for 6 months. RESULTS: During the follow-up period, 104 residents (50%) fell at least once indoors. Many of the factors commonly associated with falls did not differ significantly between residents who fell at least once and residents who did not fall. In this validating sample the predictive accuracy of the MIF chart was notably lower than in the developmental sample. A combination of any two of the MIF chart, staff judgement, and history of falls was more accurate than any approach alone; more than half of the residents classified as 'high risk' by two approaches sustained a fall within 3 months. CONCLUSIONS: Residents classified as 'high risk' by any two of the MIF chart, staff judgement, and history of falls should be regarded as particularly prone to falling and in urgent need of preventive measures. Upprättat; 2003; 20070222 (andbra)

BACKGROUND AND AIMS: Falls are frequent among older people living in residential care facilities. The aim of this study was to investigate the prediction accuracy of the Downton fall risk index among older people living in residential care facilities at 3, 6 and 12 months, and with two different definitions of falls. METHODS: Seventy-eight residents in one residential care facility, 56 women and 22 men, mean +/- SD age 81 +/- 6 years, participated in this study. Forty-seven percent of participants had dementia, 45% depression, and 32% previous stroke. Forty-one percent of participants used a walking device indoors, and the median score of the Barthel ADL Index was 16. At baseline, the Downton fall risk index was scored for each individual. A score of 3 or more was taken to indicate high risk of falls. Participants were followed up prospectively for 12 months, with regard to falls indoors. RESULTS: At 3, 6 and 12 months, and using a fall definition including all indoor falls, sensitivity ranged from 81 to 95% with the highest value at 3 months, and specificity ranged from 35 to 40%. The prognostic separation values ranged from 0.26 to 0.37. Within 3 months, the risk of falling was 36% in the high-risk group (index score > or = 3) and 5% in the low-risk group. The accuracy of predictions did not improve when applying a fall definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded. CONCLUSIONS: Already after 3 months, the Downton fall risk index appears to be a useful tool for predicting falls, irrespective of their cause, among older people in residential care facilities Validerad; 2003; 20070206 (andbra)

Aims: A prospective study was carried out to investigate the incidence, circumstances, and injuries from falls among frail older people living in three different types of Swedish residential care settings. Methods: The settings were senior citizens' apartments, an old people's home, and a group dwelling for people with dementia. The falls were registered during the three-year study period on a semi-structured fall report, and injurious falls were categorized according to severity. Results: In total 428 falls occurred among 121 residents. The incidence rate of falls at the group dwelling was twice the rates of the old people's home and senior citizens' apartments (4282 compared with 1709 and 2114 falls per 1000 person-years respectively). Some 27% of the falls occurred during the night (2100 h to 0600 h) and 28% were related to a visit to the lavatory. The presence of acute disease at the time of a fall was diagnosed in 23% of the falls. Some type of injury occurred in 118 falls (28%) and 36 of these (8%) led to moderate or serious injuries. In total 48 fractures were diagnosed. Conclusions: In a preventive programme for falls and injuries in residential care settings, areas of particular interest should include falls after mealtimes and falls at night, conditions of acute diseases, rising up from sitting, walking, and activities in progress, especially visits to the lavatory.

Preoperative rinsing with cetylpyridinium chloride was found to have no effect on the incidence of bacteremia associated with the surgical removal of impacted third molars. A bacteremia was detected in 76 per cent of the patients, with the predominant organisms isolated being anaerobic.

A recent incident involving a shocked first-year pediatric resident who observed a black teenage mother chewing part of a tuna sandwich and feeding the resultant "mush" to her 8-month-old infant stimulated us to look for documentation of various child-rearing practices that were familiar to us from our work with mothers of various ethnic groups. There is ample literature describing cultural beliefs about disease causation and cure; however, we could find little that described day-to-day parenting behaviors. We surveyed 68 black child care providers in Omaha, concerning their knowledge and use of child-rearing practices for infants (Table). METHODS A questionnaire approved by the University of Nebraska Medical Center Institutional Review Board was administered nonrandomly to black care givers by personnel in our pediatric clinics or by public health nurses during home visits.