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Stoller S, Capozza S, Alberti P, Lustberg M, Kleckner IR. Framework to leverage physical therapists for the assessment and treatment of chemotherapy-induced peripheral neurotoxicity (CIPN). Support Care Cancer 2023; 31:293. [PMID: 37086308 DOI: 10.1007/s00520-023-07734-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neurotoxicity (CIPN) is a highly prevalent, dose-limiting, costly, and tough-to-treat adverse effect of several chemotherapy agents, presenting as sensory and motor dysfunction in the distal extremities. Due to limited effective treatments, CIPN can permanently reduce patient function, independence, and quality of life. One of the most promising interventions for CIPN is physical therapy which includes exercise, stretching, balance, and manual therapy interventions. Currently, there are no physical therapy guidelines for CIPN, thus limiting its uptake and potential effectiveness. METHODS Utilizing the authors' collective expertise spanning physical therapy, symptom management research, oncology, neurology, and treating patients with CIPN, we propose a comprehensive clinical workflow for physical therapists to assess and treat CIPN. This workflow is based on (1) physical therapy guidelines for treating neurologic symptoms like those of CIPN, (2) results of clinical research on physical therapy and exercise, and (3) physical therapy clinical judgement. RESULTS We present detailed tables of pertinent physical therapy assessment and treatment methods that can be used in clinical settings. CIPN assessment should include detailed sensory assessment, objective strength assessments of involved extremities, and validated physical performance measures incorporating static and dynamic balance, gait, and functional mobility components. CIPN treatment should involve sensorimotor, strength, balance, and endurance-focused interventions, alongside a home-based exercise prescription that includes aerobic training. We conclude with action items for oncology teams, physical therapists, patients, and researchers to best apply this framework to address CIPN. CONCLUSIONS Physical therapists are in a unique position to help assess, prevent, and treat CIPN given their training and prevalence, yet there are no physical therapy clinical practice guidelines for CIPN. Our preliminary suggestions for CIPN assessments and treatments can catalyze the development of guidelines to assess and treat CIPN. We urge oncology teams, physical therapists, patients, and researchers to develop, adapt, and disseminate this framework to help alleviate the burden of chemotherapy on patients with cancer.
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Affiliation(s)
- Stefanie Stoller
- Department of Physical and Occupational Therapy, Duke University Hospital, Durham, NC, USA
| | - Scott Capozza
- Rehabilitation Department, Yale New Haven Hospital, New Haven, CT, USA
| | - Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy and NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Maryam Lustberg
- Breast Medical Oncology, Yale Cancer Center, New Haven, CT, USA
| | - Ian R Kleckner
- Department of Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
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2
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Wichlas F, Hahn FM, Tsitsilonis S, Lindner T, Marnitz T, Deininger C, Hofmann V. The FRISK (Fracture Risk)-A New Tool to Indicate the Probability of Fractures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1265. [PMID: 36674018 PMCID: PMC9859434 DOI: 10.3390/ijerph20021265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Increasing patient inflow into the emergency department makes it necessary to optimize triage management. The scope of this work was to determine simple factors that could detect fractures in patients without the need for specialized personnel. Between 2014 and 2015, 798 patients were admitted to an orthopedic emergency department and prospectively included in the study. The patients received a questionnaire before contacting the doctor. Objective and subjective data were evaluated to determine fracture risk for the upper and lower extremities. The highest risk for fractures in one region was the hip (73.21%; n = 56), followed by the wrist (60.32%; n = 63) and the femoral shaft (4 of 7, 57.14%; n = 7). The regions with the lowest risk were the knee (8.41%; n = 107), the ankle (18.29%; n = 164), and the forearm shaft (30.00%; n = 10). Age was a predictor for fracture: patients older than 59 years had a risk greater than 59.26%, and patients older than 90 years had a risk greater than 83.33%. The functional questions could exclude fractures. Three factors seem to be able to predict fracture risk: the injured region, the patient's age, and a functional question. They can be used for a probatory heuristic that needs to be proven in a prospective way.
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Affiliation(s)
- Florian Wichlas
- Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Franziska Melanie Hahn
- Campus Virchow, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Serafeim Tsitsilonis
- Campus Virchow, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tobias Lindner
- Campus Virchow, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tim Marnitz
- Campus Virchow, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christian Deininger
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Valeska Hofmann
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
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Lyu H, Dong Y, Zhou W, Wang C, Jiang H, Wang P, Sun Y. Incidence and clinical characteristics of fall-related injuries among older inpatients at a tertiary grade a hospital in Shandong province from 2018 to 2020. BMC Geriatr 2022; 22:632. [PMID: 35915396 PMCID: PMC9341405 DOI: 10.1186/s12877-022-03321-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Falls are an important cause of injury and death of older people. Hence, analyzing the multifactorial risk of falls from past cases to develop multifactorial intervention programs is clinically significant. However, due to the small sample size, there are few studies on fall risk analysis of clinical characteristics of fallers, especially among older hospitalized patients. Methods We collected data on 153 inpatients who fell (age ≥ 60 years) from the hospital nursing adverse event reporting system during hospitalization at Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, from January 2018 to December 2020. Patient characteristics at the time of the fall, surrounding environment, primary nurse, and adverse fall events were assessed. The enumeration data were expressed as frequency and percentage, and the chi-squared was performed between recurrent fallers and single fallers, and non-injurious and injurious fall groups. Results Cross-sectional data showed 18.3% of the 153 participants experienced an injurious fall. Compared with single fallers, a large proportion of older recurrent fallers more often experienced preexisting conditions such as cerebrovascular disease or taking hypoglycemic drugs. They were exposed to higher risks and could experience at least 3 fall times in 3 months. Besides, the credentials of their responsible nurses were often higher. Factors that increased the risk of a fall-related injury were hypoglycemic drugs (OR 2.751; 95% CI 1.114–6.795), and nursing adverse events (OR 47.571; 95% CI 14.392–157.247). Older inpatients with bed rails (OR 0.437; 95% CI 0.190–1.005) or falling at the edge of the bed (OR 0.365; 95% CI 0.138–0.964) were less likely to be injured than those without bed rails or not falling at the edge of the bed. Fall risks were significantly correlated with more severe fall-related injuries. Older patients with moderate (OR 5.517; CI 0.687–44.306) or high risk (OR 2.196; CI 0.251–19.219) were more likely to experience fall-related injuries than those with low risk. Conclusions Older inpatient falls are an ongoing challenge in hospitals in China. Our study found that the incidence of fall-related injuries among inpatients aged ≥ 60 years remained at a minor level. However, complex patient characteristics and circumstances can contribute to fall-related injuries. This study provides new evidence on fall-related injuries of older inpatients in China. Based on the factors found in this study, regular fall-related injury epidemiological surveys that investigate the reasons associated with the injuries were crucial when considering intervention measures that could refine fall-related injuries. More prospective studies should be conducted with improved and updated multidisciplinary fall risk assessment and comprehensive geriatric assessment as part of a fall-related injury prevention protocol.
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Affiliation(s)
- Hong Lyu
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
| | - Yan Dong
- Outpatient Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Wenhong Zhou
- Nursing Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
| | - Chuanxia Wang
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Hong Jiang
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Ping Wang
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Yanhong Sun
- Department of Respiratory and Critical Care, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
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Powell-Cope G, Thomason S, Bulat T, Pippins KM, Young HM. Preventing Falls and Fall-Related Injuries at Home: Teaching family caregivers about home modification and what to do if a fall occurs. Home Healthc Now 2022; 40:128-132. [PMID: 35510966 DOI: 10.1097/nhh.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series explain principles for promoting safe mobility that nurses should reinforce with family caregivers. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage the caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Gail Powell-Cope
- Gail Powell-Cope is codirector of the Health Services Research and Development Center of Innovation on Disability and Rehabilitation Research at the James A. Haley Veterans' Hospital in Tampa, FL, where Susan Thomason is a research associate, Tatjana Bulat is director of the Tampa Patient Safety Center of Inquiry, and Karla M. Pippins is a neurologic clinical specialist, faculty of PT Neurologic Residency. Heather M. Young is dean of the Betty Irene Moore School of Nursing at the University of California, Davis, and associate vice chancellor for nursing at UC Davis Health . Contact author: Gail Powell-Cope, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Moshirfar M, Waite AJ, Ellis JH, Huynh R, Placide J, Barke MR, McCabe SE, Ronquillo YC, Hoopes PC, Bradley MJ, Hoopes PC. A One Year Longitudinal Comparative Analysis of Visual Outcomes Between Femtosecond Laser-Assisted Cataract Surgery and Standard Phacoemulsification Cataract Surgery. Clin Ophthalmol 2021; 15:4667-4680. [PMID: 34934306 PMCID: PMC8684426 DOI: 10.2147/opth.s336356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess visual outcomes over time of femtosecond laser-assisted cataract surgery compared to standard phacoemulsification cataract surgery. Design A retrospective, single-center comparative study. Methods Patient data including demographics, ocular biometry, pre- and postoperative visual acuity, postoperative complications, primary (uncorrected distance visual acuity over time) and secondary visual outcomes (uncorrected near visual acuity, best distance visual acuity, patient complaints, satisfaction, and postoperative surgery) were gathered and statistically analyzed. Demographic differences between patients receiving femtosecond-laser assisted cataract surgery (FLACS) versus standard phacoemulsification cataract surgery (PCS) were corrected for outcome comparison. Safety, efficacy, predictability, and stability were analyzed for each procedure and compared. Results A total of 155 eyes in PCS and 143 eyes in FLACS were analyzed at 1 week, 3 months, and 1 year using odds ratio. The odds ratio of being 20/20 or better and 20/40 or better at the specified time periods were similar and statistically insignificant at all time periods analyzed except 20/20 or better for uncorrected distance visual acuity (UDVA) at 1 year (p=0.0001) and uncorrected near visual acuity (UNVA) at 1 week (p=0.02). In both cases, the odds of being 20/20 or better favored FLACS. Mean UDVA, UNVA, and best distance visual acuity (BDVA) were all similar and statistically insignificant between the two groups. Postoperative patient complaints, safety, efficacy, predictability, and stability between the two groups showed no statistical significance. Conclusion Despite the odds ratio of being 20/20 or better favoring FLACS for UDVA at 1 year and UNVA at 1 week, the mean logMAR UDVA, BDVA, and UNVA were similar and statistically insignificant between the FLACS and PCS groups at 1 week, 3 months, and 1 year. Differences in visual acuity were likely due to differences other than surgical approaches. While both FLACS and PCS are appropriate approaches to cataract surgery, one does not appear to be superior when assessing longitudinal markers for visual acuity, safety, efficacy, predictability and stability.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA.,Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.,Utah Lions Eye Bank, Murray, UT, USA
| | - Austin J Waite
- A.T. Still University College of Osteopathic Medicine in Arizona, Mesa, AZ, USA
| | - James H Ellis
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rachel Huynh
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John Placide
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA
| | - Matthew R Barke
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA
| | - Shannon E McCabe
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA.,Mission Hills Eye Center, Pleasant Hill, CA, USA
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6
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Goldwag JL, Porter ED, Wilcox AR, Li Z, ScD TDT, Crockett AO, Wolffing AB, Mancini DJ, Martin ED, Scott JW, Briggs A. Geriatric All-Terrain Vehicle Trauma: An Unhelmeted and Severely Injured Population. J Surg Res 2021; 270:555-563. [PMID: 34826691 DOI: 10.1016/j.jss.2021.09.009] [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: 02/07/2021] [Revised: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND All-terrain vehicle (ATV) use is widespread, however, little is known about injury patterns and outcomes in geriatric patients. We hypothesized that geriatric patients would have distinct and more severe injuries than non-geriatric adults after ATV trauma. METHODS A retrospective cohort study was performed using the National Trauma Databank comparing non-geriatric (18-64) and geriatric adults (≥65) presenting after ATV trauma at Level 1 and 2 trauma centers from 2011 to 2015. Demographic, admission, and outcomes data were collected, including injury severity score (ISS), abbreviated injury scale (AIS) score, discharge disposition, and mortality. We performed univariate statistical tests between cohorts and multiple logistic regression models to assess for risk factors associated with severe injury (ISS>15) and mortality. RESULTS 23,568 ATV trauma patients were identified, of whom 1,954 (8.3%) were geriatric. Geriatric patients had higher rates of severe injury(29.2 v 22.5%,p<0.0001), and thoracic (55.2 v 37.8%,p<0.0001) and spine (31.5 v 26.0%,p<0.0001) injuries, but lower rates of abdominal injuries (14.6 v 17.9%,p<0.001) as compared to non-geriatric adults. Geriatric patients had overall lower head injury rates (39.2 v 42.1%,p=0.01), but more severe head injuries (AIS>3) (36.2 vs 30.2%,p<0.001). Helmet use was significantly lower in geriatric patients (12.0 v 22.8%,p<0.0001). On multivariate analysis age increased the odds for both severe injury (OR 1.50, 95% CI 1.31-1.72, p<0.0001) and mortality (OR 5.07, 95% CI 3.42-7.50, p<0.0001). CONCLUSIONS While severe injury and mortality after ATV trauma occurred in all adults, geriatric adults suffered distinct injury patterns and were at greater risk for severe injury and mortality.
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Affiliation(s)
- Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756
| | - Eleah D Porter
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756
| | - Allison R Wilcox
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756
| | - Zhongze Li
- Biomedical Data Science Department, Geisel School of Medicine at Dartmouth College
| | - Tor D Tosteson ScD
- Biomedical Data Science Department, Geisel School of Medicine at Dartmouth College
| | - Andrew O Crockett
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755
| | - Andrea B Wolffing
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755
| | - D Joshua Mancini
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755
| | - Eric D Martin
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755
| | - John W Scott
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109
| | - Alexandra Briggs
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755.
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7
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Fraile Navarro D, López García-Franco A, Niño de Guzmán E, Rabassa M, Zamanillo Campos R, Pardo-Hernández H, Ricci-Cabello I, Canelo-Aybar C, Meneses-Echavez JF, Yepes-Nuñez JJ, Kuindersma J, Gich Saladich I, Alonso-Coello P. Vitamin D recommendations in clinical guidelines: A systematic review, quality evaluation and analysis of potential predictors. Int J Clin Pract 2021; 75:e14805. [PMID: 34486779 DOI: 10.1111/ijcp.14805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/16/2021] [Accepted: 09/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vitamin D has been widely promoted for bone health through supplementation and fortification of the general adult population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and to explore predictive factors for their direction and strength. METHODS We searched three databases and two guideline repositories from 2010 onwards. We performed a descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association between direction and strength of recommendations, AGREE II domains' scores and pre-specified characteristics. RESULTS We included 34 guidelines, 44.1% recommended, 26.5% suggested and 29.4% did not recommend vitamin D supplementation. Guidelines that scored higher for "editorial independence" and "overall quality score" were less likely to recommend or suggest vitamin D supplementation (median 68.8 vs 35.4; P = .001 and 58.3 vs 37.5; P = .02). Guidance produced by government organisations and those that reported source of funding were associated with higher AGREE II scores. Unclear role of source of funding was associated with recommending or suggesting vitamin D supplementation (P = .034). Editorial independence was an independent predictor for recommending or suggesting vitamin D supplementation (OR 1.09; CI95% 1.02 to 1.16; P = .006). CONCLUSIONS Policymakers, clinicians and patients should be aware that lower quality guidelines and those reporting conflicts of interest are more likely to promote vitamin D supplementation. Guideline organisations should improve the quality of their recommendations' development and the management of conflicts of interest. Users and editors should be aware of these findings when using and appraising guidelines.
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Affiliation(s)
- David Fraile Navarro
- Health Centre Dr Mendiguchia Carriche, Servicio Madrileño de Salud, Leganes, Madrid, Spain
- Primary Care, Servicio Madrileño de Salud, Madrid, Spain
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Alberto López García-Franco
- Health Centre Dr Mendiguchia Carriche, Servicio Madrileño de Salud, Leganes, Madrid, Spain
- Primary Care, Servicio Madrileño de Salud, Madrid, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Rocío Zamanillo Campos
- Health Research Institute of the Balearic Islands (IdISBa), Balearic Islands, Spain
- Department of Health, Valencian International University (VIU), Valencia, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Balearic Islands, Spain
| | - Héctor Pardo-Hernández
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Balearic Islands, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Balearic Islands, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Jose F Meneses-Echavez
- Norwegian Institute of Public Health, Oslo, Norway
- Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia
| | - Juan José Yepes-Nuñez
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | - Jesse Kuindersma
- Biomedical Sciences, University of Groningen, Groningen, Netherlands
| | - Ignasi Gich Saladich
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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8
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Zheng L, Li G, Qiu Y, Wang C, Wang C, Chen L. Clinical practice guidelines for the prevention and management of frailty: A systematic review. J Adv Nurs 2021; 78:709-721. [PMID: 34617618 DOI: 10.1111/jan.15067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/23/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
AIMS To systematically search for clinical practice guidelines focusing on the prevention and management of frailty, to evaluate their methodological quality and to synthesize the consensus recommendations. DESIGN A systematic review. DATA SOURCES Guideline websites, related professional association websites and electronic databases were systematically searched through 4 November 2020. REVIEW METHODS We evaluated the methodological quality of the eligible guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II). Two reviewers synthesized the consensus recommendations proposed by at least two guidelines. RESULTS Eight guidelines met the eligibility criteria and were included in the review. The mean scores of the six domains were as follows: the 'scope and purpose' domain scored 88.0%, the 'clarity of presentation' domain scored 81.9%, the 'stakeholder involvement' domain scored 63.4%, the 'editorial independence' domain scored 62.2%, the 'rigour of development' domain scored 61.1% and the 'applicability' domain scored 57.8%. In total, we synthesized 23 recommendations for the prevention and management of frailty that are consistent among the included guidelines. CONCLUSIONS The number of clinical practice guidelines for the prevention and management of frailty is limited. The methodological quality of existing guidelines needs to be improved. Our synthesized findings provide an intuitive, convenient and summative reference resource for frailty prevention and management. It' is worth noting that recommendations described in the included guidelines require additional detail. IMPACT Although the prevention and management of frailty is urgent, there is currently a lack of evidences guiding these processes, especially in the prevention. The methodological quality of existing guidelines is insufficient, and the recommendations described in the guidelines require additional detail. Therefore, users of these guidelines, especially nurses, should make a careful decision according to the specific situation when using. Nurses also have a key role in providing more clinical evidences for the improvement of the quality of the guidelines.
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Affiliation(s)
- Lufang Zheng
- School of Nursing, Jilin University, Changchun, China
| | - Guichen Li
- School of Nursing, Jilin University, Changchun, China
| | - Yiming Qiu
- School of Nursing, Jilin University, Changchun, China
| | - Cong Wang
- School of Nursing, Jilin University, Changchun, China
| | - Chunyan Wang
- Senior Officials Inpatient Ward, First Hospital of Jilin University, Changchun, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China.,Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China
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9
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A Survey-Based Assessment of "Matter of Balance" Participant Fall-Related Experience. J Trauma Nurs 2021; 28:304-309. [PMID: 34491947 DOI: 10.1097/jtn.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Falls are a substantial cause of injury in older adults, which can be attributed to progressive lack of physical activity, associated comorbidities, social isolation, and chronic health conditions. Fall prevention courses are designed to educate participants on fall safety and increase activity levels and social engagement. OBJECTIVE The purpose of this study was to evaluate the perceived effectiveness of a nationally recognized fall prevention course on self-reported fall frequency and lifestyle habits. METHODS This was a single-group pretest-posttest study of a convenience sample of older adults enrolled in a group fall prevention program, A Matter of Balance, in a community setting between March 2019 and March 2020. Questionnaires were distributed at the first and final sessions of the course to evaluate participant perceptions of the program and its impact on their fall history, exercise habits, and social engagement. Comparisons were made using Wilcoxon rank sum tests. RESULTS A total of 40 class members agreed to participate, with 29 (73%) completing both the presurvey and the postsurvey. Responses indicated no change in the number of falls or participants following an established exercise routine. However, of those who fell prior to the course, 75% reported a reduction in falls. In addition, the participants reported an overall increase in weekly exercise frequency. In those who reported fear of falling, 71% reported a reduction in fear following the course. CONCLUSIONS The participants in this study self-reported a decrease in fall rate, a decrease in fear of falling, and an increase in exercise frequency. The course is not fall protective but can be considered an adjunct to fall prevention measures that include medical, medication, visual, and environmental management.
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Elderly trauma mortality in a resource-limited setting: A benchmark for process improvement. Injury 2021; 52:2651-2656. [PMID: 34272049 PMCID: PMC8429241 DOI: 10.1016/j.injury.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As life expectancy improves globally, the burden of elderly trauma continues to increase. Sub-Saharan Africa is projected to have the most rapid growth in its elderly demographic. Consequently, we sought to examine the trends in characteristics and outcomes of elderly trauma in a tertiary care hospital in Malawi. METHODS We performed a retrospective analysis of adult patients in the trauma registry at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from 2011-2017. Patients were categorized into elderly (≥ 65 years) and non-elderly (18-64 years). Bivariate analysis compared the characteristics and outcomes of elderly vs. non-elderly patients. The elderly population was then examined over the study period. Poisson regression modeling was used to determine the risk of mortality among elderly patients over time. RESULTS Of 63,699 adult trauma patients, 1,925 (3.0%) were aged ≥ 65 years. Among the elderly, the most common mechanism of injury was falls (n = 725 [37.7%]) whereas vehicle or bike collisions were more common in the non-elderly (n = 15,967 [25.9%]). Fractures and dislocations were more prevalent in the elderly (n = 808 [42.0%] vs. 9,133 [14.8%], p < 0.001). In-hospital crude mortality for the elderly was double the non-elderly group (4.8% vs. 2.4%, p < 0.001). Elderly transfers, surgeries, and length of stay significantly increased over the study period but mortality remained relatively unchanged. When adjusted for injury severity and transfer status, there was no significant difference in risk of in-hospital mortality over time. CONCLUSION At KCH, the proportion of elderly trauma patients is slowly increasing. Although healthcare resource utilization has increased over time, the overall trend in mortality has not improved. As the quality of care for the most vulnerable populations is a benchmark for the success of a trauma program, further work is needed to improve the trend in outcomes of the elderly trauma population in Malawi.
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Sharfman ZT, Parsikia A, Rocker TN, Kahn MD, Sokol SC, Stone ME, McNelis J, Sen MK, Dimitroulias A. Increased morbidity and mortality in elderly patients with lower extremity trauma and associated injuries: A review of 420,066 patients from the national trauma database. Injury 2021; 52:757-766. [PMID: 33069394 DOI: 10.1016/j.injury.2020.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/20/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is a paucity of research addressing the morbidity and mortality associated with polytrauma in elderly patients. This study aimed to compare the outcomes of elderly trauma patients with an isolated lower extremity fracture, to patients lower extremity fractures and associated musculoskeletal injuries. METHODS This study is a retrospective review from the National Trauma Database (NTDB) between 2008 and 2014. ICD 9 codes were used to identify patients 65 years and older with lower extremity fractures. Patients were categorize patients into three sub groups: patients with isolated lower extremity fractures (ILE), patients with two or more (multiple) lower extremity fractures (MLE) and, patients with at least one upper and at least one lower extremity fracture (ULE). Groups were stratified into patients age 65-80 and patients >80 years of age. RESULTS A total 420,066 patients were included in analysis with 356,120 ILE fracture patients, 27,958 MLE fracture patients, and 35,988 ULE fracture patients. The MLE group reported the highest dispatch to ACS level 1 trauma centers at 31.8% followed by the ULE group at 28.5% and the ILE group at 24.7% of patients (p<0.001). The overall rate of complications was highest in the MLE group followed by the ULE and then the ILE group (41.4%, 40.3%, 36.1%, respectively p<0.001). Motility rates in patients >80 years old in the MLE group and ULE group were similar (1.483 vs 1.4432). However, in the 65-80 year group the odds of mortality was 1.260 in the MLE group and 1.450 in the ULE group (p<0.001), such that the odds of mortality after sustaining a MLE fracture increases with age, whereas this effect was not seen in the ULE group. CONCLUSION Patients who sustained MLE and ULE fractures, had increased mortality, complications and in hospital care requirements as compared to patients with isolated lower extremity injuries. These outcomes are comparable between ULE and MLE fracture patients over the age of 80 however patients 65-80 with ULE fractures had increased mortality as compared patients 65-80 with MLE fractures. Understanding the unique considerations and requirements of elderly trauma patients is vital to providing successful outcomes.
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Affiliation(s)
- Zachary T Sharfman
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA; Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Afshin Parsikia
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA; Division of Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | - Ta'ir N Rocker
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA; Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mani D Kahn
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA; Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shima C Sokol
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | - Melvin E Stone
- Division of Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | - John McNelis
- Division of Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | - Milan K Sen
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
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Snyder JA, Rabideau AC, Schuerer DJE. Geriatric Trauma Service: to Consult or Not to Consult? CURRENT TRAUMA REPORTS 2021. [DOI: 10.1007/s40719-020-00211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Tarbert RJ, Singhatat W. Skilled nursing resident adherence with wearable technology to offer safer mobility and decreased fall injuries. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2020. [DOI: 10.1177/2516043520979193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hip fractures are a debilitating event for thousands of older adults each year in our communities and in our care facilities. The outcomes of sustaining a hip fracture include disability, significant cost and increased mortality in a growing population of those at risk of falls and fracture. Traditional methods of injury prevention from falls for those at risk of hip fracture include the wearing of hip protector clothing with limited adherence. A smart wearable designed to overcome barriers to adherence and offer hip protection with fall-sensing technology is emerging in older adult resident facilities to capture the fall as it occurs and avoid injury. This hip protection device has been evaluated in older adult residential settings to decrease fall injuries and support a culture of mobility. Adherence to the wear of the motion sensing technology can be accomplished by embedding the program into the daily care for residents identified as at risk of hip fracture. Successful adherence and shared results are illustrated with specific insight articulated in a single user case study.
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Ichikawa M, Kuriyama A, Shirakura Y, Ikegami T. Health and Economic Burden of Injurious Falls Into Irrigation Canals in Japan: A Retrospective Cohort Study. J Emerg Med 2020; 59:424-431. [PMID: 32771319 DOI: 10.1016/j.jemermed.2020.06.065] [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: 05/05/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Falls into small water bodies can cause drowning and trauma. Such falls, especially into irrigation canals, and the subsequent trauma are common in Japan. However, few studies have investigated their characteristics, costs, and prognosis. OBJECTIVE Our aim was to clarify the characteristics, prognosis, and economic burden of trauma due to falls into irrigation canals in Kurashiki City, Japan. METHODS This 4-year, single-center, retrospective cohort study was conducted at a Japanese tertiary care hospital between January 1, 2013 and December 31, 2016. We enrolled patients who had fallen into irrigation canals constructed more than 300 years ago, and transported to our hospital by ambulance. The study outcomes included the characteristics, prognosis, and health care costs of such trauma. RESULTS We enrolled 266 patients with a median age of 66 years (range 19-64 years). Most patients fell into irrigation canals while walking (49.3%), riding a bicycle (35.0%), or driving or riding in a car (7.1%). Extremities were the most frequently affected body parts, and the head and chest were less frequently affected. Four patients (1.5%) died in the emergency department (ED), and 121 (45.5%) were hospitalized (109 in our hospital and 12 transferred to other hospitals). The total costs of ED and hospital stays were 777,625 US dollars (266 patients) and 712,059 US dollars (109 patients hospitalized in our hospital), respectively. CONCLUSIONS Trauma due to falls into irrigation canals can be severe and even fatal, and the related costs are high. Our study highlights the importance of implementing appropriate measures to prevent falls into irrigation canals and of promoting awareness among citizens.
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Affiliation(s)
- Motohiro Ichikawa
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
| | - Yuki Shirakura
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
| | - Tetsunori Ikegami
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
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Haut ER. Eastern Association for the Surgery of Trauma (EAST) practice management guidelines and the perpetual quest for excellence. J Trauma Acute Care Surg 2020; 89:1-10. [PMID: 32251261 DOI: 10.1097/ta.0000000000002709] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Elliott R Haut
- From the Division of Acute Care Surgery, Department of Surgery, Department of Anesthesiology and Critical Care Medicine, and Department of Emergency Medicine, Johns Hopkins University School of Medicine; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine; and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Shih RD, Ouslander JG. Intracranial Hemorrhage in Older Adults: Implications for Fall Risk Assessment and Prevention. J Am Geriatr Soc 2020; 68:953-955. [PMID: 32142160 DOI: 10.1111/jgs.16399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Richard D Shih
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Joseph G Ouslander
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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Sairafian K, Towe CW, Crandall M, Brown LR, Haut ER, Ho VP. Sociodemographic Patterns of Outpatient Falls: Do Minority Patients Fall Less Frequently? J Surg Res 2019; 243:332-339. [PMID: 31255933 DOI: 10.1016/j.jss.2019.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/30/2019] [Accepted: 05/08/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Falls are the most common cause of injury in the elderly, resulting in $50 billion of annual spending. Social and demographic factors associated with falling are not well understood. We hypothesized minority groups (minority race, lower income, and lower education levels) would experience similar rates of falling to majority groups after adjustment for medical factors. MATERIAL AND METHODS We used the 2013 Medicare Current Beneficiary Survey Public Use File, a representatively sampled cross-sectional survey of Medicare outpatients. Fall was defined as at least one self-reported fall in the previous year. Logistic regression was performed to determine sociodemographic factors (age, sex, race, ethnicity, income, education level, and marital status) associated with fall. Health factors, physical limitations, and cognitive limitations were included as possible confounders. Data are presented as extrapolated weighted population proportions (±SE). RESULTS 13,924 Medicare beneficiaries, representing 47 million people, were included. 26.6% (±0.4) reported falling. In adjusted logistic regression, black and Hispanic patients had significantly fewer self-reported falls than white patients, after adjustment for medical conditions, physical limitations, and cognitive limitations. DISCUSSION Black and Hispanic Medicare patients are significantly less likely to have reported a fall than non-Hispanic whites. This finding differs from other health-related disparities in which minorities most commonly experience higher risk or more severe diseases. These data may also represent differences in self-reporting, indicating disparities in self-reported data in these cohorts. Further studies on social factors related to falling are needed in this population.
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Affiliation(s)
- Kevin Sairafian
- Division of Trauma, Department of Surgery, Critical Care, Burns, Emergency General Surgery. MetroHealth Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine- Jacksonville, Jacksonville, Florida
| | - Laura R Brown
- Division of Trauma, Department of Surgery, Critical Care, Burns, Emergency General Surgery. MetroHealth Medical Center, Cleveland, Ohio
| | - Elliott R Haut
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Vanessa P Ho
- Division of Trauma, Department of Surgery, Critical Care, Burns, Emergency General Surgery. MetroHealth Medical Center, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.
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Catching Quality Before It Falls: Preventing Falls and Injuries in the Adult Emergency Department. J Emerg Nurs 2019; 45:257-264. [DOI: 10.1016/j.jen.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/28/2018] [Accepted: 08/03/2018] [Indexed: 11/23/2022]
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Evaluating the Effectiveness of the Translated "A Matter of Balance" Fall Prevention Program Materials for Non-English-Speaking Participants. J Trauma Nurs 2019; 25:311-317. [PMID: 30216262 DOI: 10.1097/jtn.0000000000000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A Matter of Balance (MOB) is an evidence-based fall prevention program shown to reduce fear of falling (FOF) in English-speaking participants. The effectiveness of translated (Chinese and Spanish) MOB materials in reducing FOF is unknown. The objective of this study was to evaluate whether MOB was associated with reduced FOF in Chinese- and Spanish-speaking participants and included an English-speaking comparison group. Participants were recruited from MOB classes in Massachusetts and Illinois. Investigators used the Falls Efficacy Scale-International (FES-I) and a demographic questionnaire to survey the participants at the first class (baseline), the last class, and 6 months after the MOB course. Of the 90 participants who enrolled, 77 (85.6%) completed the course (Chinese: n = 37; Spanish: n = 19; and English: n = 21) and 54 (60%) completed the 6-month survey (Chinese: n = 33; English: n = 21). Chinese FES-I scores significantly increased (FOF worsened) at the end of the course (+7.1, p = .009), and 6-month survey scores were also significantly above the baseline score (+6.7, p = .0088). FES-I scores decreased (FOF declined) in both the Spanish (-6.6, p = .016) and English groups (-2.7, p = .14) at the last class, and English 6-month FES-I scores were slightly lower than baseline scores (-0.4, p = .8). Participation in the MOB program did not reduce FOF in the Chinese population, but MOB did show promise in reducing FOF in both the Spanish and English groups. Future studies are warranted to explore the cultural, social, and education-related factors that may influence effectiveness of the MOB program.
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Abstract
: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series explain principles for promoting safe mobility that nurses should reinforce with family caregivers. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage the caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Barraco RD. Trauma Prevention Activities for the Elderly. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Slager SL, Weir CR, Kim H, Mostafa J, Del Fiol G. Physicians' perception of alternative displays of clinical research evidence for clinical decision support - A study with case vignettes. J Biomed Inform 2017; 71S:S53-S59. [PMID: 28089913 DOI: 10.1016/j.jbi.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 09/12/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To design alternate information displays that present summaries of clinical trial results to clinicians to support decision-making; and to compare the displays according to efficacy and acceptability. METHODS A 6-between (information display presentation order) by 3-within (display type) factorial design. Two alternate displays were designed based on Information Foraging theory: a narrative summary that reduces the content to a few sentences; and a table format that structures the display according to the PICO (Population, Intervention, Comparison, Outcome) framework. The designs were compared with the summary display format available in PubMed. Physicians were asked to review five clinical studies retrieved for a case vignette; and were presented with the three display formats. Participants were asked to rate their experience with each of the information displays according to a Likert scale questionnaire. RESULTS Twenty physicians completed the study. Overall, participants rated the table display more highly than either the text summary or PubMed's summary format (5.9vs. 5.4vs. 3.9 on a scale between 1 [strongly disagree] and 7 [strongly agree]). Usefulness ratings of seven pieces of information, i.e. patient population, patient age range, sample size, study arm, primary outcome, results of primary outcome, and conclusion, were high (average across all items=4.71 on a 1 to 5 scale, with 1=not at all useful and 5=very useful). Study arm, primary outcome, and conclusion scored the highest (4.9, 4.85, and 4.85 respectively). Participants suggested additional details such as rate of adverse effects. CONCLUSION The table format reduced physicians' perceived cognitive effort when quickly reviewing clinical trial information and was more favorably received by physicians than the narrative summary or PubMed's summary format display.
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Affiliation(s)
- Stacey L Slager
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; George E Whalen VA Medical Center, Salt Lake City, UT, USA
| | - Heejun Kim
- School of Information and Library Science, University of North Carolina, Chapel Hill, NC, USA
| | - Javed Mostafa
- School of Information and Library Science, University of North Carolina, Chapel Hill, NC, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
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