The Falls In Care Home study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes.

OBJECTIVE: To explore the feasibility of implementing and evaluating the Guide to Action Care Home fall prevention intervention. DESIGN: Two-centre, cluster feasibility randomized controlled trial and process evaluation. SETTING: Purposive sample of six diverse old age/learning disability, long stay care homes in Nottinghamshire, UK. SUBJECTS: Residents aged over 50 years, who had fallen at least once in the past year, not bed-bound, hoist-dependent or terminally ill. INTERVENTIONS: Intervention homes (n = 3) received Guide to Action Care Home fall prevention intervention training and support. Control homes (n = 3) received usual care. OUTCOMES: Recruitment, attrition, baseline and six-month outcome completion, contamination and intervention fidelity, compliance, tolerability, acceptance and impact. RESULTS: A total of 81 of 145 (56%) care homes expressed participatory interest. Six of 22 letter respondent homes (27%) participated. The expected resident recruitment target was achieved by 76% (52/68). Ten (19%) residents did not complete follow-up (seven died, three moved). In intervention homes 36/114 (32%) staff attended training. Two of three (75%) care homes received protocol compliant training. Staff valued the training, but advised greater management involvement to improve intervention implementation. Fall risks were assessed, actioned and recorded in care records. Of 115 recorded falls, 533/570 (93%) of details were complete. Six-month resident fall rates were 1.9 and 4.0 per year for intervention and control homes, respectively. CONCLUSIONS: The Guide to Action Care Home is implementable under trial conditions. Recruitment and follow-up rates indicate that a definitive trial can be completed. Falls (primary outcome) can be ascertained reliably from care records.

Renal cell carcinoma metastasis to the paranasal sinuses and orbit.

The authors report a rare case of renal cell carcinoma (RCC) metastasis to the paranasal sinuses. The authors review RCC and its potential for sinonasal metastasis and discuss the variable presentation and need for clinical suspicion for early diagnosis and treatment. A 74-year-old man presented with numbness of the left side of the face, reduced visual acuity and ptosis 12 years after nephrectomy for RCC. Imaging studies showed a lesion in the left pterygopalatine fossa and the histological features supported the diagnosis of metastatic RCC. RCC metastasis to the paranasal sinuses is very rare and can present with various symptoms depending on the affected organ. These symptoms occasionally are the initial manifestation of renal RCC and it is very important to recognise them so that the patient receives the appropriate therapy to improve survival.

Thinking falls-taking action: a falls prevention tool for care homes.

Falls in older people resident within care home settings are common and serious, often resulting in injury and mortality. Yet there is no standardised approach within UK care homes to assessing the risk of falls for individuals or identifying risk factors relevant for that person. The Guide to Action for Falls Prevention Tool - Care Homes (GtACH) was developed with local care homes in Nottinghamshire. Ten care homes were selected to participate in the study, four withdrawing before data collection commenced. Fourteen care home staff across six care homes tested the tool for usability and found it quick (20 minutes) and easy to use, yet only 53% of the recommended interventions highlighted were completed. The GtACH needs further evaluation to test whether its use prompts actions which reduce the number of falls, and the barriers to these actions being taken.

Osteosarcoma after external beam radiation therapy for recurrent choroidal melanoma.

A 59-year-old woman underwent enucleation for choroidal melanoma. She had a late recurrence of the melanoma, which was treated with surgery and radiotherapy. Nine years after radiation treatment, she presented with pain and an orbital mass. Biopsy of the mass revealed an osteoblastic osteosarcoma. This report describes the late recurrence of choroidal melanoma and subsequent radiation-induced osteosarcoma. The risk of radiation-induced malignancy should be considered in all patients receiving radiotherapy. Despite yearly review, osteosarcoma was diagnosed only when the patient had symptoms, thus raising questions about the merits of long-term follow-up in detecting recurrence or emergence of secondary tumors.