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Perspectives of wheelchair users with spinal cord injury on fall circumstances and fall prevention: A mixed methods approach using photovoice. PLoS One 2020; 15:e0238116. [PMID: 32857793 PMCID: PMC7454945 DOI: 10.1371/journal.pone.0238116] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Wheelchair users with spinal cord injury are at a high risk of falls. However, the perspectives of wheelchair users with spinal cord injury on their fall circumstances and their preferences for fall prevention strategies/interventions remain understudied. Therefore, we aimed to: a) describe the circumstances of falls experienced by wheelchair users with spinal cord injury over a six-month period, b) explore their perspectives of why falls occurred in certain situations, and c) explore their perspectives on recommended content/structure of fall prevention strategies/interventions. Methods This sequential explanatory mixed methods study had two phases. Phase I involved tracking of falls experienced by wheelchair users with spinal cord injury over six months, in which participants completed a survey after experiencing a fall to track the number/circumstance of each fall. Data from the surveys were descriptively reported. Phase II involved a photovoice focus group discussion of the survey findings and their preferences for fall prevention strategies/interventions. Data from the focus group discussion were analyzed using a thematic analysis. Results Thirty-two participants completed phase I. More than half of the participants fell at least once in six months. Falls commonly occurred in the afternoon during a transfer, or when participants were wheeling over uneven ground. One-third of the falls caused an injury. Eleven participants that fell during phase I participated in the focus group. Two main themes were identified from the discussion: 1) “circumstances surrounding the falls” (e.g. when falls occurred, the home is a ‘safe space’) and 2) “suggestions and preferences for fall prevention strategies/interventions” (e.g. fall prevention involves all, fall prevention training available as needed). Conclusion Fall prevention strategies/interventions should be an integral component of rehabilitation practices across the lifespan. Participants recommend customizing fall prevention strategies/interventions to their specific needs to guide the structure, content, and delivery of targeted fall prevention programs.
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Jiang W, Song Y, Zhang H, Huang R, Yin Y, Tan B. Inappropriate initial urinary catheter placement among older Chinese hospital inpatients: An observational study. Int J Nurs Pract 2020; 26:e12791. [PMID: 31793146 DOI: 10.1111/ijn.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/15/2019] [Accepted: 09/07/2019] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study is to evaluate incidences of inappropriate initial urinary catheter placements within an older inpatient cohort. METHODS A total of 200 inpatients that received urinary catheterizations within 24 hours of admission were recruited for this observational study. The key demographic and clinical factors were recorded. Adverse outcomes were assessed by examining incidences of catheter-associated urinary tract infection (CAUTI) during hospitalization, after transfer to skilled nursing facilities, second, duration of hospital stay and by scoring changes on the Katz Index of Independence in Activities of Daily Living. Correlative relationships between demographic data and clinical factors with adverse outcomes were analyzed. RESULTS Inappropriate initial urinary catheterization in our cohort was approximately 39%. This was associated with elevated Charlson comorbidity index scores and increased dependency, with correlations to medical diagnosis. We also observed that the primary rationale for the procedure (inappropriate catheterization) was for neurogenic bladder (where intermittent catheterization was indicated) and in 'convenience-of-care' catheterizations. Inappropriate catheter placement was ultimately associated with an elevated CAUTI at point of discharge, with transfers to skilled nursing facilities and also with an increased duration of hospital stay. CONCLUSIONS Inappropriate catheter placement was prevalence in southwestern China and associated with adverse outcomes.
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Affiliation(s)
- Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunling Song
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongzhong Huang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ouyang M, Billot L, Song L, Wang X, Roffe C, Arima H, Lavados PM, Hackett ML, Olavarría VV, Muñoz-Venturelli P, Middleton S, Pontes-Neto OM, Lee TH, Watkins CL, Robinson TG, Anderson CS. Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial. Int J Stroke 2020; 16:200-206. [PMID: 32075569 DOI: 10.1177/1747493020908140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST). METHODS Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as "poor outcome," scores 3-6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates. RESULTS Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13-1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59-2.18). The number exposed to IUC for poor outcome was 13. CONCLUSIONS IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.
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Affiliation(s)
- Menglu Ouyang
- The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia.,The George Institute China at Peking University Health Science Center, Beijing, China
| | - Laurent Billot
- The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia
| | - Lili Song
- The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia.,The George Institute China at Peking University Health Science Center, Beijing, China
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia
| | - Christine Roffe
- Department of Neurosciences, 105646Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Hisatomi Arima
- The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia.,Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Pablo M Lavados
- Departmento de Neurologia and Psiquiatria, Clínica Alemana de Santiago, Servicio de Neurología, Unidad de Neurología Vascular, Vitacura, Chile
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, UK
| | - Verónica V Olavarría
- Departmento de Neurologia and Psiquiatria, Clínica Alemana de Santiago, Servicio de Neurología, Unidad de Neurología Vascular, Vitacura, Chile
| | - Paula Muñoz-Venturelli
- The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia.,Center for Clinical Studies, School of Medicine-Clínica Alemana, ICIM, 28071Universidad del Desarrollo, Santiago, Chile
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia, Australian Catholic University, Sydney, Australia
| | - Octavio M Pontes-Neto
- Stroke Service-Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan
| | - Caroline L Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia.,The George Institute China at Peking University Health Science Center, Beijing, China.,Center for Clinical Studies, School of Medicine-Clínica Alemana, ICIM, 28071Universidad del Desarrollo, Santiago, Chile.,Neurology Department, 2205Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia.,Heart Health Research Center, Beijing, China
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