Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper.

INTRODUCTION: Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore. METHODS AND ANALYSIS: This is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum of 5 participants/cluster), over 6 time periods with 8-week intervals in Central and North regions of Singapore. The primary analysis will be conducted under the intention-to-treat principle. A general linear mixed model or generalised estimating equation analysis appropriate for a multilevel longitudinal study incorporating an appropriate error distribution and link function will be used. Markov model will be developed to estimate the incremental cost per quality-adjusted life years and incremental cost per fall prevented from the implementation of falls prevention strategies from a societal perspective. Conditional on there being clinically relevant differences in short-term outcomes, we will implement simulation modelling to project the long-term divergence in trajectories for outcomes and costs using the Markov model. ETHICS AND DISSEMINATION: Ethics approval has been obtained. Results will be disseminated in publications and other relevant platforms. TRIAL REGISTRATION NUMBER: NCT04788251.

Interprofessional bedside rounds: Nurse-physician collaboration and perceived barriers in an Asian hospital.

Interprofessional bedside rounds by nurses and physicians provide valuable space and time for the discussion of patient care, which is essential for providing quality care. However, nurse-physician collaboration and barriers to attending these rounds are not well-examined. This study aimed to examine the collaboration of nurses and physicians and their perceived barriers to interprofessional bedside rounds. A cross-sectional survey was conducted on 371 medical ward-based nurses and physicians from an acute care tertiary hospital in Singapore, using a 27-item Nurse-Physician Collaboration Scale and a 21-item Perceived Barriers to Interprofessional Bedside Rounds questionnaire. The overall Nurse-Physician Collaboration scores indicated positive attitudes toward nurse-physician collaboration in bedside rounds, with no significant difference found between nurses and physicians. While the sharing of information was reported to be the most frequent collaborative activity, the cooperative relationship was rated to be the least frequent behavior. The highest ranked barriers were related to time-related issues. The nurses reported a significantly greater perceived barrier in attending bedside round than the physicians. To optimize nurse-physician collaboration, the study advocates healthcare leaders to foster cooperative relationships between nurses and physicians and to reorganize ward routines to provide designated time periods for nurses to attend rounds.

APPLICATION OF THE SPRINKLES - A HOME FOOD IRON FORTIFICANT / 营养学报

Iron deficiency (ID) and iron deficiency anemia (IDA) remain prevalent nutritional problems in many parts of the world. Among infants and young children, IDA has adverse effects on growth and development. Mental deficits exhibited in infancy can be long lasting. Efforts are being made to combat these problems. However, in the past decade little success was made. Currently there is interest in developing home fortificants that are versatile, inexpensive, efficacious and effective. One of these is the Sprinkles, which contain iron fumarate coated with a soy lipid and other micronutrients. The Sprinkles is packaged in small sachets and intended to be added to ready-to-eat home-prepared complementary foods once a day. An acceptance test was conducted in 5 cities in China. The Sprinkles was provided for the acceptance by infants aged 6-24 months and children of 2-5 years in 4 successive weeks. Their mothers were interviewed 4 times during the period of the study. The results showed that both the mothers, the infants and young children accepted the foods with added Sprinkles well.