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Suboptimal follow-up, prevention in geriatric fall-related head trauma – Science Daily

Falls are the leading cause of both fatal and nonfatal injuries in the United States for adults ages 65 and older. With 1 in 4 older adults falling annually, 27,000 deaths, 8 million emergency department (ED) visits, and 800,000 hospitalizations have occurred.

Follow-up after an ED-related fall visit is essential to initiate preventive strategies in these patients who are at very high risk for recurrent falls. Currently, it is unclear how frequently follow up occurs and whether preventive strategies are implemented.

Researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators explored this issue by investigating the rate of follow-up by older adults who sustain a fall-related head injury resulting in an ED visit, the rate and type of risk assessment and adoption of preventive strategies.

The one-year prospective observational study was conducted at two Southeast Florida hospitals with level-one trauma centers and ED volumes of 50,000 and 68,000 patients. For the study, researchers identified 1,527 patients ages 65 and older who suffered a head trauma associated with a ground-level fall.

Researchers followed up with an initial phone call 14 days after discharge from the hospital and asked the following questions: “Have you followed up with your primary care physician (PCP) since being discharged from the hospital?,” “Did your PCP assess the reason that you fell?,” and “Have you or your PCP started any interventions since your original ED/hospital discharge?”

If participants answered “yes” to starting any interventions, recommendations for specific interventions were categorized into types based on exercise activity, home modification, physical therapy/occupational therapy/rehabilitation, mobility aid, medication change, health aid, medical intervention, and footwear modification. Clinical and demographic characteristics were compared between patients with and without follow up.

Results of the study, published in the American Journal of Emergency Medicine, showed that only about 60 percent of ED patients with fall-related head injury followed up with their PCP, while 72 percent received a fall assessment and only 56 percent adopted a fall prevention strategy. Participants with PCP follow-up were significantly more likely to have a history of cancer or hypertension. Findings indicate an urgent need to promote PCP physician fall assessment and adoption of prevention strategies in these patients.

“We found that older patients treated in the emergency department for a fall-related head injury have suboptimal primary care physician follow-up and inadequate adoption of fall prevention strategies,” said Richard Shih, M.D., senior author and a professor of emergency medicine in FAU’s Schmidt College of Medicine. “Only 59 percent of our study subjects had follow-up with their provider. Of the patients in our study that had primary care physician follow-up, 28 percent reported that there was no fall-risk assessment and 44 percent did not receive fall prevention interventions.”

Findings also show that when a PCP institutes a fall-prevention intervention, physical therapy is the most common (68 percent).

“When referred to physical therapy, patients may be more likely to adopt fall prevention interventions and home safety modifications that have been shown to reduce recurrent fall, hospitalization and mortality,” said Shih. “Given the importance of fall prevention in this high-risk group, we strongly endorse that fall-risk assessment and patient education is performed in the emergency department or by the primary care physician. The physician follow-up should include fall-risk assessment and initiation of any appropriate interventions to prevent subsequent falls and fall-related injury.”

Study co-authors are Joshua J. Solano, M.D., associate professor of emergency medicine; Gabriella Engstrom, Ph.D., senior project coordinator; Maya Khazem, an FAU medical student; Lisa M. Clayton, D.O., chair and associate professor, Department of Emergency Medicine; Michael Wells, Ph.D., research assistant professor, Department of Emergency Medicine; Patrick G. Hughes, D.O., associate professor of emergency medicine; Charles H. Hennekens, M.D., Dr.PH, Sir Richard Doll Professor and senior academic advisor; Joseph Ouslander, M.D., professor of geriatric medicine; Scott M. Alter, M.D., assistant dean for clinical research and an associate professor of emergency medicine, all within FAU’s Schmidt College of Medicine; Leila Posaw, M.D., an emergency medicine physician; and Lara Goldstein, M.D., an emergency medicine physician.

This work was supported by the Dr. Alvin E. Smith Safety of Health Care Services (Grant RFA No. 208-01); the Florida Medical Malpractice Joint Underwriting Association awarded to Shih.

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Chamisa and Tshabangu emissaries in inter-faction talks – The Zimbabwe Mail

CCC leader Mr Nelson Chamisa co-opted Mr Sengezo Tshabangu into the party’s national executive committee

There have been at least two formal meetings between Nelson Chamisa and Sengezo Tshabangu “parties”, on 15 November 2023 and 16 November 2023, both in Bulawayo.

By Prof. Moyo

The meeting on 15 November was attended by Hon. Kucaca Phulu and Alderman Collect Ndlovu from SengezoTshabangu’s team, identified in the minutes as “The First Party”; while Nelson Chamisa’s team had Hon Prince Dubeko Sibanda and Tinashe Runganga, a legal practitioner, who are described in the minutes as “The Second Party”.

Regarding the crucial question of their respective mandates, “The First Party” said that its mandate was from its Interim Secretary General, Sengezo Tshabangu and the team that he leads; whereas “The Second Party” indicated that its mandate was from “the Leadership of the CCC and the Caucus of Parliament”, and that in any case its mandate was “drawn broadly from the Party”.

The minutes of 15 November indicate that the source of conflict was the candidate selection processes which were said to have involved various “offenses”, among them factionalism, tribalism, nepotism, corruption and bribery; with claims that party members across the country generally feel they were used after CCC indicated that those who had actively recruited voters under the Mugwazo (targeted) campaign would be given safe passage to be the party’s general election candidates, only for the opposite to happen. It is said that, when they returned from Mugwazo and after they used their personal resources, they found new, and often unknown “candidates” in their wards or constituencies who had been imposed on the communities as the CCC candidates for the 2023 harmonised general election.

To make a bad situation worse, it was said that there were widespread instances of the imposition of mayors and council office bearers across the country, and that these actually triggered the current turmoil in CCC, whose major symptom are the recalls of MPs and Councillors.


But, and crucially, while the above is given in the minutes as the mediate cause of the rupture in CCC, the minutes are also clear that the main genesis of the differences and mayhem that have led to the apparent split of CCC into two parties, to a point where now there is “Party One” and “Party Two” as captured in the minutes – was engendered by Nelson Chamisa’s unilateral dissolution of party structures that founded CCC on 22 January 2022 and the wanton disregard of CCC’s founding interim constitution; after the 23/24 August 2023 harmonised general election.

The second formal meeting was on 16 November. This was attended by Hon. Kucaca Phulu and Advocate Nqobizitha Mlilo from Sengezo Tshabangu’s team, “The First Party”; while Nelson Chamisa’s team had Hon Prince Dubeko Sibanda and Tinashe Runganga, “The Second Party”.

Notably, at this meeting, Hon Sibanda tendered apologies for Hon Amos Chibaya and Hon Gift Ostallos Siziva who he said could no longer be in attendance in the meeting as previously confirmed, because Hon Chibaya had been assigned some urgent tasks in Harare; while Hon Siziva had contracted a flu infection.

In the meeting, “The First Party” made it clear that the major issue for it was that CCC should return to the structures of the party as they were immediately after the 2019 Gweru Congress, and that other issues could then be negotiated from that starting premise. As far as “The First Party” – the Tshabangu team – was concerned, it was important and paramount for CCC to return to constitutionalism as at 2019, which was the situation that obtained when CCC was founded on 22 January 2022.

On the other hand, “The Second Party” – the Chamisa team – was adamant that the position of “The First Party” would not be acceptable because everyone “was now in 2023”, and that therefore the situation [of a new recently unveiled post-general election 2023 constitution] should prevail in 2023. While insisting on this posture, “The Second Party” intimated that “maybe there could be a mixture of 2023 and 2019” structures; but still maintained that “a return to 2019 was inconceivable for the Second Party”.

In the result, there was a stalemate which the two parties resolved to refer back to their principals.

Interestingly, two days later on 18 November 2023 – and this is also documented – Hon Agency Gumbo met with Tshabangu’s team at Zonkizizwe Complex, in Bulawayo, and reported that he had been sent with a mandate from Chamisa to make contact to ascertain what the key sticky issues really were, and to request the postponement of the interdict case that is before Justice Tawanda Chitapi, in the Harare High Court, to allow the politicians in both parties to resolve the contentious issues that have engulfed CCC. Gumbo also indicated that Chamisa was particularly troubled by the recall of his key aides, Amos Chibaya and Gift Ostallos Siziva, and that he was very keen to have their recall reversed!

Link to Minutes of Chamisa-Tshabangu Talks [Bulawayo, 15 November 2023] 

Link to Minutes of Chamisa-Tshabangu Talks [Bulawayo, 16 November 2023]

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