The greater number of older people in communities is reflected in their increasing demands on the services of accident and emergency (A&E) departments. Recognition of the complex needs of older adults attending A&E departments has resulted in many National Health Service trusts employing occupational therapists in these departments. The occupational therapists are required to assess and evaluate a patient's functional status and, using a team approach, to make decisions about his or her wider needs, including therapeutic requirements and social provision.
In order to audit the provision of the occupational therapy service in an A&E department, data were collected monthly over a 3-year period in a single district general hospital on the referrals made by medical and nursing staff. The mean age of the patients referred was 80 years. The majority of the patients were female and living alone. The most common presenting problem was that of a fall, with a resulting fracture in half of the patients. The occupational therapy input in the A&E department was demonstrated in this study to save admissions to acute hospital care, amounting to an equivalent of two beds saved in each of the years covered by the audit.
A risk-based framework for targeting investment in prescribed burning in Western Australia is presented. Bushfire risk is determined through a risk assessment and prioritisation process. The framework provides principles and a rationale for programming fuel management with indicators to demonstrate that bushfire risk has been reduced to an acceptable level. Indicators provide targets for fuel management that are applicable throughout the state and can be customised to meet local circumstances. The framework identifies eight bushfire risk management zones having broad consistency of land use, fire environment and management approach, which combine to create a characteristic risk profile. Thirteen fuel types based primarily on structural attributes of the vegetation that influence fire behaviour are recognised and used to assign models for fuel accumulation and fire behaviour prediction. Each bushfire risk management zone is divided into fire management areas, based on the management intent. These are areas where fuels will be managed primarily to minimise the likelihood of fire causing adverse impacts on human settlements or critical infrastructure, to reduce the risk of bushfire at the landscape scale or to achieve other land management outcomes. Indicators of acceptable bushfire risk are defined for each fire management area and are modified according to the distribution of assets and potential fire behaviour in the landscape. Risk criteria established in the framework can be converted to spatially represented targets for fuel management in each zone and can be reported against to measure the effectiveness of the fuel management program. In areas where the primary intent is to reduce the risk of bushfire at the landscape scale, managers have flexibility to apply prescribed fire in ways that maintain and enhance ecosystem services, nature conservation and landscape values through variation in the seasonality, intensity and scale of planned burning.
A Simplified Risk Model (SRM) is being developed to support environmental restoration and waste management (EM) planning activities. The SRM is designed to be able to quantitatively estimate risk for various EM alternatives within hours or days, given limited information about the processes covered within the alternative. The risk model covers radiological, chemical, and industrial risk from both accidents and normal, incident-&ee operations. A simple risk equation is used to model accident risk. Normal, incident-free operation risk is modeled using a multiplier on accident risk. Ongoing applications of the SRM are expected to lead to significant improvements to the model in the near hture.
F~~~~~m e d i c a I history doctors have had ethical and financial incentives to keep their patients alive. Preserving life as long as possible was, until recently, the
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