Sway has been measured by Wright's Ataxiameter in 151 frail elderly and five young subjects, and compared with various sensory modalities. There is a close relationship between increased sway and impaired vibration sense in the legs. No correlations emerged with proprioception but this may reflect the imprecision of the test. That neither vision nor vestibular deprivation correlated with sway confirms the place of these senses as secondary in the maintenance of posture. Vestibular impairment was found in only 6% of the elderly subjects, by tilt test--and these were the very old. There was a limited relationship between falls in the past year and both sway and proprioception.

Background The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known. Methods This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent “intermediate” patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages. Results Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood. Conclusions This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.

Objectives-To study empirically whether ethical theory (from the mainstream principles-based, virtue-based, andfeminist schools) usefully describes the approaches doctors and nurses take in everyday patient care. Design-Ethnographic methods: participant observation and interviews, the transcripts of which were analysed to identify themes in ethical approaches. Setting-A British old-age psychiatry ward. Participants-The more than 20 doctors and nurses on the ward. Results-Doctors and nurses on the ward differed in their conceptions of the principles of beneficence and respect for patient autonomy. Nurses shared with doctors a commitment to liberal and utilitarian conceptions of these principles, but also placed much greater weight on relationships and character virtues when expressing the same principles. Nurses also emphasised patient autonomy, while doctors were more likely to adovate beneficence, when the two principles conflicted. Conclusion-The study indicates that ethical theory can, contrary to the charges of certain critics, be relevant to everyday health care -if it (a) attends to social context and (b) is flexible enough to draw on various schools of theory.

Psychological stress evokes rapid changes to the cardiovascular and neuroendocrine systems, responses that can become habituated following repeated exposure. This study, comprising of 2 phases, suggests that the immune system follows a similar trend. Phase 1: 15 healthy subjects (aged between 26 and 56 years) provided capillary blood samples before and after completing 3 basic tasks using, in turn, two automotive touch screen interfaces (Interface 1 -antecedent version, Interface 2 -improved version). Using a chemiluminescent technique termed Leukocyte Coping Capacity (LCC), the ability of leukocytes to produce reactive oxygen species in vitro was assessed. Significant differences in leukocyte activity were shown between treatment groups, where the greatest post-test decrease occurred after using Interface 1. Phase 2: a randomly selected sub-group (n=4) underwent weekly repeat testing using both interfaces. Significant differences in post-test leukocyte reactivity were exhibited between test weeks for each interface -the magnitude of response decreasing with successive exposure.