This intervention used an inexpensive, human resources-based approach to significantly reduce the incidence of falls in the population at highest risk of falling. The additional benefits to patients in terms of cognitive improvement bear further investigation.

BackgroundThe purpose of this study was to explore women's views of the design of a large pragmatic cost-effectiveness randomised controlled trial of the policy of offering a health professional-delivered intervention to promote early presentation with breast symptoms in older women and thereby improve survival, with a view to informing protocol development. The trial will recruit over 100,000 healthy women aged 67+, and outcome data will be collected on those who develop breast cancer. The scale of the trial and the need for long-term follow-up presented a number of design challenges in relation to obtaining consent, ascertaining and contacting participants who developed breast cancer, and collecting outcome data.MethodsQualitative study involving 69 women participating in 7 focus groups and 17 in-depth interviews. 15 women had a previous diagnosis of breast cancer and 54 did not.ResultsThe women held strong views and had a good understanding of the rationale of the design of clinical trials. The women recognised that in a very large trial with long-term follow-up it was necessary to incorporate design features to make the trial feasible and efficient. Most strikingly, they supported the idea of opt-out consent and identifying women with breast cancer using routine datasets.ConclusionsThis model of user involvement engaged women well with the design challenges of the trial and led to improvements to the protocol. The study strengthens the case for user involvement, in particular through focus groups and in-depth interviews, in the design of trials.

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Falls are a significant burden on the Australian health care budget and can result in loss of personal independence, injury or death. A sustained high rate of inpatient falls in a 550‐bed acute care hospital has made it imperative for nurses to identify patients at highest risk, in order to implement preventive interventions. This study examined the prevalence of “intrinsic high risk” characteristics identified by the literature in people who fell during hospitalisation, to confirm the validity of these predictors in detecting risk. Over ten weeks 91 inpatients fell (total 118 falls) and were assessed for intrinsic risk factors. Most prevalent was impaired ambulatory status resulting in balance instability. Other high prevalence factors included cognitive impairment and age > 75. Commonly cited factors, such as urinary or faecal incontinence, medications and history of prior falls, were found less frequently. No significant differences in risk factors by gender were identified.