Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults.

Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Of the 33 included studies, common PAC intervention domains included implementing facility-based strategies (e.g., staff education), evaluating patient-specific fall risk factors (e.g., function), and developing an individualized risk profile and treatment plan that targets the patient's constellation of fall risk factors. However, there was variability across studies in how and to what extent the domains were addressed. While further research is warranted, health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach that fosters a culture of safety, addresses individuals' fall risk, and champions a multidisciplinary team.

Driving under the influence with blood alcohol concentrations over 0.4 g%.

The aim of this study was to evaluate the characteristics of traffic offenders with unusually high blood-alcohol concentrations (BAC>0.4 g%) when arrested. The BAC that kills one person might be easily tolerated by another, depending on, among other things, the person's age, pattern of drinking, and the development of tolerance. The archives of two forensic laboratories, one in Sweden and the other in Wisconsin (USA), were searched to find traffic offenders with BACs>0.4 g%. The results were compared in relation to the person's age and gender, mean BAC and the weekday and time of day of the arrest. The mean age (±standard deviation) of N=158 Swedish offenders was 45±9.0 y, which was not significantly different from the 43±9.4 y in N=233 Wisconsin drivers (p>0.05). Overall there were more men (78%) than women (22%) arrested with BAC's>0.4 g%, although the proportion of women in Wisconsin (35%) was higher than in Sweden (9%) (p<0.001). The mean (median) and highest BAC did not differ between jurisdictions; 0.429 g% (0.422) and 0.546 g% in Sweden and 0.428 g% (0.421 g%) and 0.526 g% in Wisconsin. In Sweden 40% of the arrests occurred on Fridays and Saturdays, whereas in Wisconsin the arrests of people with such high BAC's were more evenly distributed throughout the week. Forty eight percent of the arrests in Sweden were made between 12 noon and 6 pm compared with 37% in Wisconsin. Neither the mean age of offenders nor their mean BAC seemed to depend on the weekday or time of day of the arrest. Attempting to drive with a BAC above 0.4 g% verifies the development of an appreciable tolerance to ethanol-induced cognitive and psychomotor impairment. Reaching such a high BAC probably requires continuous heavy drinking over several days as opposed to an evening's binge drinking.

Dextromethorphan in Wisconsin drivers.

Dextromethorphan is a synthetic analogue of codeine used in hundreds of over-the-counter medications for its antitussive effects. There have been numerous reports of dextromethorphan abuse by young adults. Dextromethorphan can produce psychoactive effects similar to that of marijuana, and higher doses will produce dissociative effects, including sensory enhancement and hallucinations. The Wisconsin State Laboratory of Hygiene examined data from blood samples submitted from January 1999 through December 2004 to determine the incidence of dextromethorphan in suspected impaired drivers. A total of 108 samples were found to be positive for dextromethorphan during this time. Dextromethorphan concentrations in these cases ranged from less than 5 to 1800 ng/mL (mean 207 ng/mL), compared to an expected therapeutic concentration range of 0.5-5.9 ng/mL. Overall, the highest dextromethorphan concentrations observed were in males aged 16-20 years. Ninety-six percent of the specimens included in this study were also found to be positive for drugs other than dextromethorphan. A review of police and drug recognition expert reports from several of these cases showed that dextromethorphan-impaired drivers exhibited poor psychomotor performance on standardized field sobriety tests, horizontal gaze nystagmus, vertical gaze nystagmus, and overall signs of central nervous system depression.

Forensic Toxicology Program: alcohol and drug testing in Wisconsin drivers.

The Forensic Toxicology Program of the Wisconsin State Laboratory of Hygiene (WSLH) provides analytical and support services to assist in the identification of alcohol- and/or drug-impaired drivers and to assist in determining cause of death. These services are provided to law enforcement agencies, the Wisconsin Department of Natural Resources, the Wisconsin Department of Transportation, and county medical examiners and coroners. Program staff is active in alcohol and drug training, policy-making, and research on a national and international level.