Добірка наукової літератури з теми "6-PACK falls prevention"

Abstract Background Falls are the most common cause of injury among older people in Thailand. However, there are no established falls prevention programs in our community. Telehealth is one of the strategies to overcome this unmet need. We have developed the Step Sensing System (SSS) for measuring gait speed and stepping accuracy of multi target stepping task (MTST). This system comprises of the footstep sensing modules, controller box and analyzing computer. SSS records each footfall and compares with an assignment for each walking trail. The results will be sent to a cloud storage which are accessible by web-based and mobile applications. By using this technology, we are able to remotely access falls risk and monitor MTST performance in older people. Methods We placed footstep sensing modules under a 6-metre mat, then asked a 32-year-old healthy woman to walk across the mat for 4 trails: usual-pace, faster-pace, usual-pace with 1 assigned target and usual-pace with 2 assigned targets on an alternating sequence. We evaluated the system reliability by comparing gait speed and stepping accuracy on 3rd and 4th trails with video recorded by Intel RealsenseTM Depth Camera (model D415). Results SSS and video recording has excellent correlation for gait speed and stepping accuracy measurement (intraclass correlation coefficient [ICC] > 0.99, p value < 0.001). The user satisfaction measured by the System Usability Scale was 70/100. Conclusions SSS demonstrated promising results on gait speed and stepping accuracy measurement in controlled environment. For the next step, we plan to increase ability of gait measurement on various parameters and perform the validity assessment in community setting.

In January 2016, the first case of mosquito-borne Zika infection in the mainland United States was confirmed in Miami, Florida. The first locally acquired case was reported 6 months later. Local public health and school officials began warning students of the outbreak on their return to the classroom in August 2016. In November–December 2016, we conducted a survey of students attending a large public university in Miami to determine how well informed they were about Zika. A multistage sampling design was used to contact teaching assistants and ask them for help in recruiting their students. Eligible students had to be 18 years of age or older and enrolled in at least one three-credit course during fall semester. A 25-item questionnaire based on the World Health Organization Zika Knowledge, Attitudes, and Practice Resource Pack was developed, pretested, and approved by the university’s institutional review board before it was made available to eligible students through Blackboard Learn or a survey link. About half (50.4%) of the 139 respondents had heard about Zika prior to 2016. Only one student was unaware of Zika before our survey. Most (47.1%) first learned about Zika through television, 18.8% from family or friends, and 15.2% from the Internet, social media, or university e-mail. Two thirds (66.2%) believed Zika could be prevented, 15.1% thought it might be prevented, and 85.7% had taken some precautions. A high level of awareness of the risk of Zika infection was apparent. Most students reported taking steps to avoid exposure to the Zika virus.

Abstract Gait has been linked with cognition in cognitively healthy and impaired older people. However, the studies in cognitively impaired people have been small, have not contrasted the strength of cognitive domain associations and have reported inconsistent findings. We examined baseline data of 309 older people with mild-moderate cognitive impairment (age 82±6 years; 47% female) who were participating in a large fall prevention randomised controlled trial. Gait speed was measured at usual pace over 2.4m and cognitive performance was assessed with the Addenbrooke’s Cognitive Examination-III (ACE-III). The ACE-III assesses cognitive domain performance (attention; memory; verbal fluency; language; visuospatial ability). Executive function (EF) was additionally examined using the Frontal Assessment Battery (FAB). Each cognitive domain was associated with gait speed in separate models adjusted for confounders. EF (verbal fluency and the FAB) demonstrated the strongest association which withstood adjustment for attention, memory, language and visuospatial ability. In contrast, visuospatial ability was the only cognitive domain to withstand adjustment for EF (verbal fluency, not the FAB). These findings support higher-order gait regulation. Characterising individuals at risk of negative health outcomes can assist in identifying effective prevention strategies. Forty-five older people with mild-moderate dementia were age-sex matched to two (n=90) healthy controls and all participants (age 81±6 years, 42% female) wore triaxial accelerometers (MoveMonitor, McRoberts) on their lower back for 7-days. Daily-life gait quantity and quality were estimated from the MoveMonitor. Steady-state clinical walking speed was assessed at usual pace over 2.4 to 10.0m. Participants with dementia had reduced gait quantity, slower clinical, habitual daily-life and maximum daily-life walking speeds and multi-domain gait impairment compared to controls. In participants with dementia, clinical walking speed more closely represented habitual daily-life walking speed, whereas in controls, it more closely represented maximum daily-life walking speed. These findings have assessment, functional (e.g. crossing roads) and training/treatment implications.

137 Background: ERAS efforts across surgical specialties have been evolving since 2012. At MD Anderson Cancer Center (MDACC), surgical and anesthesia services have been participating in this movement. In 2017, anesthesia, surgical, internal medicine, physical medicine and rehabilitation (PM&R), and nutrition teams collaborated to pilot a prehabilitation clinical pathway. Our goal was to develop a preoperative pathway using validated screening tools to incorporate prehabilitation for patients preparing for cancer surgery. Methods: This pilot included patients with thoracic and gynecological cancers who were at least 3 weeks prior to surgery. They were screened using the validated FRAIL index (Morley) and the Centers for Disease Control and Prevention fall risk screening tool. (Questions below) All patients who scored > / = 2 were referred to the PM&R clinic. Each patient received an individualized prehabilitation program including exercise, nutrition, and underwent screening for mood impairments: Fatigue: Are you fatigued at rest or with activities of daily living?; Resistance: Do you have any difficulty walking up one flight of steps without stopping for rest?; Aerobic: Are you unable to walk at least one block at a brisk pace and without stopping for rest?; Illness: Do you have more than five illnesses?; Loss of weight: Have you had unintended weight loss of more than 5% of your weight in the past 6 months?; Have you fallen in the past year?; Do you feel unsteady when standing or walking?; Do you worry about falling? Results: 27 referrals were received. 21 patients seen by PM&R (six were not seen due to scheduling conflicts). Average age was 70 years, 38% male. Baseline functional status was below aged-related normal values. Mean values for functional tests include: 6 minute walk test distance was 301 meters, five-times sit-to-stand was 12.4 seconds, and dynamic gait index score was 20.1. Conclusions: Prehabilitation as part of the team-based approach in cancer care is becoming an important part of ERAS pathways. Screening surgical patients for functional issues and fall risk is vital as these patients require prehabilitation to optimize them prior to surgery.

Background:As imaging technology improves small Pulmonary Emboli (PE) of debatable clinical relevance are increasingly detected leading to higher numbers of patients receiving anticoagulation. Although PE are an important cause of morbidity and mortality in patients undergoing repair of proximal femur fractures, this cohort of patients are at increased falls risk and are therefore largely unsuitable for long term anticoagulant therapy.Objective:1. To review sequential Computed Tomography Pulmonary Angiograms (CTPA) performed in patients who underwent repair of proximal femur fractures at our institution. 2. To establish the perioperative CT imaging performed.Design:A retrospective cross sectional study of all patients undergoing proximal femur fracture repair at a single tertiary referral.Methods:The theatre database was interrogated to reveal all patients undergoing proximal femur fracture repair over a 28 month period from 01/01/12 to 07/04/14 inclusive. This was cross-referenced with the Picture Archiving Communication System (PACS) to establish all imaging undertaken in the perioperative period. CTPA studies performed within the time period of 1 week prior to and 6 months post proximal femur fixation were included. CTPA studies and reports were assessed for quality and findings. D-Dimer results, if performed within 72 hours of the CTPA study, were recorded.Results:1388 patients underwent neck of femur fracture repair in the 28-month study period. Of this cohort 71 CTPA studies were performed in 71 patients (5.2%) with a mean age of 77.8 years (range 38 - 100). 53 (74.6%) of studies were negative for embolus and 17 (23.9%) studies revealed clot in a pulmonary artery (1 saddle embolus, 2 main pulmonary artery emboli, 7 lobar vessel emboli, 2 segmental artery emboli, 5 subsegmental emboli). Overall PE detection rate was 1.2% of our total study population. In all 71 studies, Houndsfield Unit (HU) in the main pulmonary artery (PA) was >200; which is considered to be of satisfactory quality to assess for segmental pulmonary emboli. 32% of patients had D Dimer levels performed, however no relationship with presence of PE on CTPA was demonstrated.Conclusion:The rate of positive CTPA studies in patients undergoing proximal femur fracture repair is 23.9% in our patient population, comparing favorably to published data. This is likely to reflect good compliance with prevention measures at ward level. D-Dimer results are unreliable for PE prediction.

The incidence of falls and serious injuries related to patient falls in hospitals is on the rise. This situation could potentially result in serious injuries and even death for the patient, as well as financial burden for acute care hospitals and increased workloads and stress for nursing staff. The incidence of falls in the metropolitan acute care hospital medical ward where this study was conducted continues to be problematic. This research study investigates the factors that cause patient falls in order to maintain and enhance sustainable falls prevention management. The falls risk assessment tool used in the hospital was part of the 6-PACK Falls prevention program for patients that was developed in 2002. A mixed method case study was employed for the research. Data was collected from a medical ward in two phases: Phase 1 analysed the quantitative falls data from the hospital RiskMan software tool and Patient Centred Care Plan (PCCP). This analysis informed the development of the qualitative research in Phase 2 which included the nurse questionnaire and nurse focus group discussions, as well as patient interviews to examine the complexities involved in falls management prevention. The triangulation of nurse and patient viewpoints of the falls prevention program, together with the administrative (RiskMan, PCCP) data, provides a fuller exploration of the contributing factors and adds to the body of knowledge in this important area. The Donabedian model of structure, process and outcome (SPO) was adapted to form an Inpatient Falls Prevention model that could be effective in the analysis of all aspects of patient care. The data collected in the quantitative and qualitative phases was analysed using this Inpatient Falls Prevention model. The case study identified that there were a significant number of patients whose falls risk assessment was not documented as part of their daily care plan. This resulted in high-risk patients not having falls prevention strategies implemented in their nursing care. For cognitively impaired patients falls were much higher for several reasons, including patient-nurse ratios, time challenges and issues surrounding the management of patients with dementia, delirium, and behavioural issues. The ward and bed layout, equipment malfunction, lack of patient education, and engagement in their falls prevention plan were also identified as contributing factors to inpatient falls. This study found that nurses failed to properly implement falls prevention strategies and management in the medical ward, and makes a number of recommendations for the benefit to all stakeholders - the healthcare system, hospitals, nurses, and most importantly, the patients. There is an increased need for professional development of nursing staff to identify and document patients at risk of falls and to modify the falls risk assessment tool. Patients need to be more actively engaged in their falls prevention plan and there needs to be better stakeholder communication: nurse to nurse, nurse to patient and nurse to allied health professionals. In addition, there is a need for more frequent PCCP auditing and immediate feedback to nursing staff. In this way, nurse knowledge of patient assessment, falls documentation and implementation strategies would assist in increasing patient safety and enhancing their hospital experience.