Using FRAX to assess the risk that an older person will suffer a fragility fracture.

A challenge of planning for local health services is how to prevent the effects of diseases of older age in order to reduce individual suffering and also wider economic costs to society. This article discusses FRAX® (Fracture Risk Assessment), a computer-based algorithm that allows 10-year probability of a hip and osteoporotic fracture calculation in people aged 40-90 years. The inclusion of FRAX within the portfolio of risk assessment measures available to community nurses is recommended to aid identification and referral of clients at risk of fragility fractures.

Participation in community exercise classes: barriers to access.

Falls prevention is an important part of national health policy and while there are many causes of falls, there is increasing evidence that advocates the use of targeted balance and stability exercise training to address the risk factor of postural instability. The introduction of these exercise programmes in primary care raise questions about the most effective implementation methods that are accessible and acceptable to older people and support maximum adherence. An understanding of factors that support adherence of older people to exercise programmes is of value to community nurses to enable them to deliver health promotion advice appropriately. The purpose of this paper is to discuss the findings from interviews with older people to explore their experiences in relation to access and acceptability of local community based postural stability exercise classes.

A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial.

OBJECTIVES: To determine whether a nurse led education and direct access service improves the care of children with urinary tract infections. DESIGN: Prospective cluster randomised trial. SETTING: General practitioners in the catchment area of a UK paediatric nephrology department. PARTICIPANTS: 88 general practices (346 general practitioners, 107 000 children). MAIN OUTCOME MEASURES: Rate and quality of diagnosis of urinary tract infection, use of prophylactic antibiotics, convenience for families, and the number of infants with vesicoureteric reflux in whom renal scarring may have been prevented. RESULTS: The study practices diagnosed twice as many urinary tract infections as the control practices (6.42 v 3.45/1000 children/year; ratio 1.86, 95% confidence interval 1.42 to 2.44); nearly four times more in infants (age < 1 year) and six times more in children without specific symptoms. Diagnoses were made more robustly by study practices than by control practices; 99% v 89% of referred patients had their urine cultured and 79% v 60% had bacteriologically proved urinary tract infections (P < 0.001 for both). Overall, 294 of 312 (94%) children aged under 4 years were prescribed antibiotic prophylaxis by study doctors compared with 61 of 147 (41%) by control doctors (P < 0.001). Study families visited hospital half as much as the control families. Twice as many renal scars were identified in patients attending the study practices. Twelve study infants but no control infants had reflux without scarring. CONCLUSION: A nurse led intervention improved the management of urinary tract infections in children, was valued by doctors and parents, and may have prevented some renal scarring.

A portrait of district nursing: its contribution to primary health care.

This paper explores the role and contribution of district nursing within primary health care. Examples of how this service is organised within different health care systems are used to discuss the context-dependent nature and challenges of the work. By drawing on UK policy change, health priorities and recent research into district nursing, the paper concludes that, in attempting to deal with the challenges of health care in the 21st century, the significance and potential of district nursing services are frequently overlooked. It is recommended that a research strategy for district nursing should build on the profession's comprehensive understanding of the needs of families and communities and should aim to provide evidence for practice that will further improve patient and client outcomes.