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Xu LJ, Zhao YJ, Han YL, Li WF, Liu XY, Wang JH, Ling Y, Li XY, Yan ZY, Li LH, Liu XG. Development and validation of a nomogram for individualizing fall risk in patients with hematologic malignancies. Geriatr Nurs 2024; 60:121-127. [PMID: 39241690 DOI: 10.1016/j.gerinurse.2024.08.030] [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: 03/21/2024] [Revised: 07/30/2024] [Accepted: 08/19/2024] [Indexed: 09/09/2024]
Abstract
Inpatient falls are common adverse events especially for patients with hematologic malignancies. A fall-risk prediction model for patients with hematologic malignancies are still needed. Here we conducted a multicenter study that prospectively included 516 hospitalized patients with hematologic malignancies, and developed a nomogram for fall risk prediction. Patients were divided into the modeling group (n = 389) and the validation group (n = 127). A questionnaire containing sociodemographic factors, general health factors, disease-related factors, medication factors, and physical activity factors was administered to all patients. Logistic regression analysis revealed that peripheral neuropathy, pain intensity, Morse fall scale score, chemotherapy courses, and myelosuppression days were risk factors for falls in patients with hematologic malignancies. The nomogram model had a sensitivity of 0.790 and specificity of 0.800. The calibration curves demonstrated acceptable agreement between the predicted and observed outcomes. Therefore, the nomogram model has promising accuracy in predicting fall risk in patients with hematologic malignancies.
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Affiliation(s)
- Lu-Jing Xu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, China
| | - Ya-Jing Zhao
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, China
| | - Yun-Ling Han
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, China
| | - Wei-Fang Li
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, China
| | - Xiao-Ya Liu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, China
| | - Jian-Hong Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China
| | - Yue Ling
- Department of Hematology, The First Affiliated Hospital of Shandong First Medical University, China
| | - Xiao-Yan Li
- Department of Hematology, The Second Hospital of Shandong University, China
| | - Zhen-Yu Yan
- Department of Hematology, North China University of Science and Technology Affiliated Hospital, Tangshan City, Hebei Province, China
| | - Lan-Hua Li
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, China.
| | - Xin-Guang Liu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, China.
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Cioce M, Grassi S, Borrelli I, Grassi VM, Ghisellini R, Nuzzo C, Zega M, Laurenti P, Raponi M, Rossi R, Boccia S, Moscato U, Oliva A, Vetrugno G. Predictive Power of Dependence and Clinical-Social Fragility Index and Risk of Fall in Hospitalized Adult Patients: A Case-Control Study. J Patient Saf 2024; 20:240-246. [PMID: 38470963 DOI: 10.1097/pts.0000000000001214] [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: 03/14/2024]
Abstract
OBJECTIVES Accidental falls are among the leading hospitals' adverse events, with incidence ranging from 2 to 20 events per 1.000 days/patients. The objective of this study is to assess the relationship between in-hospital falls and the score of 3 DEPendence and Clinical-Social Fragility indexes. METHODS A monocentric case-control study was conducted by retrieving data of in-hospital patients from the electronic health records. RESULTS Significant differences between the mean scores at the hospital admission and discharge were found. The BRASS scale mean (SD) values at the admission and at the discharge were also significantly higher in cases of in-hospital falls: at the admission 10.2 (±7.7) in cases versus 7.0 (±8.0) in controls ( P = 0.003); at the discharge 10.0 (±6.4) versus 6.7 (±7.5) ( P = 0.001). Barthel index mean (SD) scores also presented statistically significant differences: at the admission 60.3 (±40.6) in cases versus 76.0 (±34.8) in controls ( P = 0.003); at discharge 51.3 (±34.9) versus 73.3 (±35.2) ( P = 0.000).Odds ratios were as follows: for Barthel index 2.37 (95% CI, 1.28-4.39; P = 0.003); for Index of Caring Complexity 1.45 (95% CI, 0.72-2.91, P = 0. 255); for BRASS index 1.95 (95% CI, 1.03-3.70, P = 0.026). With BRASS index, the area under the curve was 0.667 (95% CI, 0.595-0.740), thus indicating a moderate predictive power of the scale. CONCLUSIONS The use of only Conley scale-despite its sensitivity and specificity-is not enough to fully address this need because of the multiple and heterogeneous factors that predispose to in-hospital falls. Therefore, the combination of multiple tools should be recommended.
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Affiliation(s)
- Marco Cioce
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence
| | - Ivan Borrelli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome
| | | | | | - Carmen Nuzzo
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Maurizio Zega
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | | | | | - Riccardo Rossi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene - Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'Agostino Gemelli'
| | - Umberto Moscato
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vetrugno
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Takekiyo T, Morishita S. Effect of rehabilitation in patients undergoing hematopoietic stem cell transplantation. Fukushima J Med Sci 2023; 69:73-83. [PMID: 37164764 PMCID: PMC10480509 DOI: 10.5387/fms.2022-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/22/2023] [Indexed: 05/12/2023] Open
Abstract
Patients undergoing hematopoietic stem cell transplantation (HSCT) tend to experience decline in physical function, mental function, and quality of life (QOL) after HSCT due to low activity caused by adverse reactions to chemotherapy used in pre-transplantation treatment and post-transplant complications. Rehabilitation for HSCT patients is effective in preventing decline in physical function, reducing fatigue, and improving QOL. A combination of aerobic exercise and strength training is recommended for exercise therapy. Risk management is also important in the implementation of exercise therapy, and the exercise intensity should be determined according to the presence of anemia, low platelet counts, or post-transplant complications. On the other hand, post-transplant complications can decrease the patient's motivation and daily activity level. A multidisciplinary approach, which includes physicians and nurses, is important to achieve early discharge from the hospital and as quick a return to society as possible.
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Affiliation(s)
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Science, Fukushima Medical University
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Sota, K, Uchiyama, Y, Kaida, K, Wakasugi, T, Takemura, D, Sasanuma, N, Ikegame K, Domen K. Balance Function after Balance Exercise Assist Robot Therapy in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: A Pilot Study. Prog Rehabil Med 2023; 8:20230003. [PMID: 36793372 PMCID: PMC9904881 DOI: 10.2490/prm.20230003] [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: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Objectives This study compared the balance function in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) with their balance function after subsequent training sessions with a Balance Exercise Assist Robot (BEAR). Methods In this prospective observational study, inpatients who underwent allo-HSCT from human leukocyte antigen-mismatched relatives were enrolled from December 2015 to October 2017. Patients were allowed to leave their clean room after allo-HSCT and underwent balance exercise training using the BEAR. Sessions (20-40 min) were performed 5 days per week and consisted of three games that were performed four times each. A total of 15 sessions were performed by each patient. Patient balance function was assessed before BEAR therapy according to the mini-balance evaluation systems test (mini-BESTest), and patients were divided into two groups (Low and High) based on a 70% cut-off value for the total mini-BESTest score. Patient balance was also assessed after BEAR therapy. Results Fourteen patients providing written informed consent fulfilled the protocol: six patients in the Low group, and eight patients in the High group. In the Low group, there was a statistically significant difference between pre- and post-evaluations in postural response, which a sub-item of the mini-BESTest. In the High group, there was no significant difference between pre- and post-evaluations in the mini-BESTest. Conclusions BEAR sessions improve balance function in patients undergoing allo-HSCT.
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Affiliation(s)
- Koichiro Sota,
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Hyogo, Japan
| | - Yuki Uchiyama,
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Katsuji Kaida,
- Division of Hematology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tatsushi Wakasugi,
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Daiki Takemura,
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Naoki Sasanuma,
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Kazuhiro Ikegame
- Division of Hematology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Japan
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Kondo S, Inoue T, Saito T, Kawamura Y, Katayama A, Nakamura M, Sumitani R, Takahashi M, Oura M, Sogabe K, Harada T, Fujii S, Nakamura S, Miki H, Kagawa K, Sato N, Ono R, Abe M, Katoh S. Allogeneic haematopoietic stem cell transplantation and patient falls: impact of lower extremity muscle strength. BMJ Support Palliat Care 2022:bmjspcare-2022-003582. [PMID: 35534187 DOI: 10.1136/bmjspcare-2022-003582] [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: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVES Patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) have a higher risk of falls than those receiving other therapies for haematological disorders. This study aimed to investigate the impact of pretransplant lower extremity muscle strength (LEMS) on post-transplant falls. METHODS In this retrospective cohort study, patients aged ≥18 years who underwent allo-HSCT were included. All data were extracted from medical records. LEMS was defined as the knee extension force measured by a handheld dynamometer divided by the patient's weight. The receiver operating characteristic (ROC) curve was used to calculate the optimal LEMS cut-off value for prediction of falls. Patients were categorised into low and normal LEMS groups based on the cut-off value. The impact of pretransplant LEMS on post-transplant falls was analysed using a Cox proportional hazards model. RESULTS In total, 101 patients were analysed. During the observation period, falls occurred in 32 patients (31.7%). The ROC curve analysis results showed that the optimal LEMS cut-off value for prediction of falls was 45.4% per body weight. In multivariate analysis, pretransplant low LEMS was a significant predictor of falls in model 1 with patient characteristics as a confounding factor and model 2 with medications-inducing falls as a confounding factor, respectively (model 1: HR 3.23, 95% CI 1.37 to 7.64; model 2: HR 2.82, 95% CI 1.20 to 6.59). CONCLUSIONS Pretransplant LEMS was a significant predictor of post-transplant falls. The results of this study may help to prevent falls in patients undergoing allo-HSCT.
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Affiliation(s)
- Shin Kondo
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Takashi Saito
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Yuka Kawamura
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - Ayane Katayama
- Division of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - Masafumi Nakamura
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Ryohei Sumitani
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Mamiko Takahashi
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Masahiro Oura
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Kimiko Sogabe
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Takeshi Harada
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shiro Fujii
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shingen Nakamura
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirokazu Miki
- Division of Transfusion Medicine and Cell Therapy, Tokushima University Hospital, Tokushima, Japan
| | - Kumiko Kagawa
- Department of Hematology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Nori Sato
- Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Masahiro Abe
- Department of Hematology, Tokushima University Hospital, Tokushima, Japan
| | - Shinsuke Katoh
- Department of Rehabilitation Medicine, Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities, Tokushima, Japan
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Cioce M, Lohmeyer FM, Botti S, Rostagno E, Orlando L, Vetrugno G, Oppedisano P, Zega M, Sica S, Valerio DS, Bacigalupo A, Fiore A. How to manage falls in hospitalized patients: A single center experience in allogeneic stem cell transplantation setting. Medicine (Baltimore) 2022; 101:e29132. [PMID: 35356952 PMCID: PMC10684116 DOI: 10.1097/md.0000000000029132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/23/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT In allogeneic hematopoietic stem cell transplantation (AHSCT), falls can lead to immediate and late consequences and in some cases to death. We analyzed risks and causes of falls with root cause analysis (RCA) based on which improvement interventions were implemented.A retrospective observational study was conducted to analyze with RCA data of incidence reports and medical records of patients admitted; an expert panel identified actions to prevent falls, which were collected in a checklist.Between December 2017 and November 2019, 214 patients were admitted to ordinary hospital stays for AHSCT or AHSCTrelated complications. In this period, 15 falls, involving 11 patients, occurred resulting in a 2.32 d/patient incidence. In 66.67% of cases minor head trauma occurred. Diuretic drugs (93.33%), induced hyper-diuresis in nonbladder catheter patients (93.33%) and antihypertensive drugs (93.33%) were reported as most common cause in our incident reports. The most frequent fall time slot was between 10 PM and 7 AM (60%). We determined with RCA diuretics and consequent induced hyper-diuresis (80%), self-insufficiency (40%), antihypertensive (33.3%) and noncompliance (33.3%) as the most common cause of falls. Finally, 16 actions, collected in a "safe comfort" checklist, were identified to prevent falls.Diuretic drugs inducing hyper-diuresis, self-insufficiency, poor patient compliance, orthostatic hypotension, fever, night-time and obstacles within inpatient units are the most common contributing factors. Therefore, administration of diuretic and antihypertensive drugs should be rescheduled and a multidimensional risk assessment scale integrated with a preventive action plan, such as the safe comfort checklist, should be implemented to reduce falls.
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Affiliation(s)
- Marco Cioce
- * Correspondence: Marco Cioce, Via Bernardo Barbiellini Amidei, n. 43 - 00168Rome, Italy (e-mail: ).
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Wheatley T, Desrosiers M, Specchierla D, Lynn EK, Jackson S. Increased Mobility and Fall Reduction: An Interdisciplinary Approach on a Hematology-Oncology and Stem Cell Transplantation Unit. Clin J Oncol Nurs 2021; 25:329-332. [PMID: 34019032 DOI: 10.1188/21.cjon.329-332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients in the hematology-oncology and stem cell transplantation (SCT) setting are at high risk for functional decline and falls related to prolonged hospitalizations and inactivity during inpatient treatment. After underperforming on the Press Ganey National Database of Nursing Quality Indicators benchmark for falls in 2018, staff on a hematology-oncology and SCT unit implemented a practical and evidence-based fall prevention program. Fall rates from 2018 to 2019 ranged from 3.4 to 4.8 falls per 1,000 patient days. After the introduction of the unit-based gym program, early mobility increased and falls decreased to 2.57 per 1,000 patient days.
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Grady L, Klein J, Patterson AE, Pompos C, Reich RR, Mason TM. Orthostatic Vital Signs Algorithm: Decreasing Falls in Patients Undergoing Blood and Marrow Transplantation or Treatment With Cellular Immunotherapy. Clin J Oncol Nurs 2020; 24:489-494. [PMID: 32945795 DOI: 10.1188/20.cjon.489-494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Falls experienced by patients undergoing blood and marrow transplantation or treatment with cellular immunotherapy (BMT-CI) may result in injury or death. An algorithm was developed using the patient fall circumstances identified in a chart analysis from 2016. OBJECTIVES This study aimed to determine if the Moffitt BMT-CI Orthostatic Vital Signs Algorithm could decrease inpatient falls. METHODS A pre-/post-test program evaluation was conducted for one year pre- and postimplementation of the algorithm on newly admitted inpatients. Adherence rate of nurses using the algorithm was monitored. FINDINGS Overall falls decreased from 5.38% to 3.44%, with zero falls or injuries related to orthostasis for newly admitted patients. Adherence of nurses using the algorithm increased from 60% to 93%. The fall rate has been sustained less than baseline with 100% adherence, and the algorithm has been adopted as standard of practice.
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Affiliation(s)
| | - John Klein
- H. Lee Moffitt Cancer Center and Research Institute
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Reducing Financial Impact: Community Services to Prevent Falls and Support Older Cancer Survivors. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Burden and impact of multifactorial geriatric syndromes in allogeneic hematopoietic cell transplantation for older adults. Blood Adv 2020; 3:12-20. [PMID: 30606722 DOI: 10.1182/bloodadvances.2018028241] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/02/2018] [Indexed: 11/20/2022] Open
Abstract
Multifactorial geriatric syndromes are highly prevalent in older patients with cancer. Because an increasing number of older patients undergo allogeneic hematopoietic stem cell transplantation (allo-HCT), we examined the incidence and impact of transplant-related geriatric syndromes using our institutional database and electronic medical records. We identified 527 patients age 60 years or older who had undergone first allo-HCT from 2001 to 2016 for hematologic malignancies. From the initiation of conditioning to 100 days posttransplant, new geriatric syndromes were predominantly delirium with a cumulative incidence of 21% (95% confidence interval [CI], 18%-25%) at day 100 followed by fall at 7% (95% CI, 5%-9%). In multivariable analyses of available pretransplant variables, fall within the last year, potentially inappropriate use of medication, thrombocytopenia, and reduced creatinine clearance were significantly associated with delirium; age older than 70 years and impaired activities of daily living were significantly associated with fall. In the 100-day landmark analysis, both delirium (hazard ratio [HR], 1.66; 95% CI, 1.09-2.52; P = .023) and fall (HR, 2.14; 95% CI, 1.16-3.95; P = .026) were significantly associated with increased nonrelapse mortality; moreover, fall (HR, 1.93; 95% CI, 1.18-3.14; P = .016), but not delirium, was significantly associated with reduced overall survival. Here, we establish baseline incidences and risk factors of common transplant-related geriatric syndromes. Importantly, we demonstrate significant associations of delirium and fall with inferior transplant outcomes. The burden and impact of transplant-related geriatric syndromes warrant the institution of patient-centered, preemptive, longitudinal, and multidisciplinary interventions to improve outcomes for older allo-HCT patients.
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Sato N, Hase N, Osaka A, Sairyo K, Katoh S. Falls among Hospitalized Patients in an Acute Care Hospital: Analyses of Incident Reports. THE JOURNAL OF MEDICAL INVESTIGATION 2018; 65:81-84. [PMID: 29593199 DOI: 10.2152/jmi.65.81] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Falls cause injuries such as fractures, skin lacerations, bleeding, and head injury, and could result in more severe medical conditions in hospitalized patients. We retrospectively investigated the incidence and characteristics of falls among hospitalized patients in an acute care hospital from incident reports by hospital staff between January and June 2013. There were 154 falls in 135 patients, 2 of which resulted in fracture. The average age of patients who fell was 63.9 (range 0 to 91) years. Many falls occurred at the bedside (68.2%). Approximately half of all falls were related to elimination (46.6%). The most common time of discovery of falls was 2:00-2:59 AM (14/154;9.1%), followed by early in the morning when patients would actively move. Fall rates in our hospital were 1.39 falls per 1,000 patient days. The department of respiratory medicine and rheumatology had the highest fall rate (3.08 falls per 1,000 patient days), followed by the departments of neurosurgery and neurology (2.98 falls per 1,000 patient days). This study revealed the characteristics of falls in an acute care hospital, and suggests that their notification in the hospital might help reduce the incidence of falls in hospitalized patients. J. Med. Invest. 65:81-84, February, 2018.
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Affiliation(s)
- Nori Sato
- Department of Rehabilitation Medicine, Tokushima University Hospital
| | - Naomi Hase
- Department of Nursing, Tokushima University Hospital
| | - Akemi Osaka
- Department of Nursing, Tokushima University Hospital
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Shinsuke Katoh
- Department of Rehabilitation Medicine, Tokushima University Hospital
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13
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Sayre CA, Belza B, Shannon Dorcy K, Phelan E, Whitney JD. Patterns of Hand Grip Strength and Detection of Strength Loss in Patients Undergoing Bone Marrow Transplantation: A Feasibility Study. Oncol Nurs Forum 2017; 44:606-614. [PMID: 28820524 DOI: 10.1188/17.onf.606-614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine the feasibility of measuring hand grip strength (HGS) daily in a population of recipients of bone marrow transplantation (BMT), to describe changes in strength measured by HGS, and to describe relationships between laboratory values (hematocrit, hemoglobin, and absolute neutrophil count) and HGS.
. DESIGN Prospective, longitudinal, repeated measures, within subject.
. SETTING Inpatient units at the University of Washington Medical Center in Seattle.
. SAMPLE 33 patients admitted in preparation for BMT or for complications from BMT.
. METHODS HGS measured on admission and daily.
. MAIN RESEARCH VARIABLES HGS, absolute neutrophil count, hemoglobin, and hematocrit.
. FINDINGS Participants found HGS testing to be relatively easy. Average time to complete testing was 7.2 minutes (SD = 1.95). Nineteen experienced 20% or greater decline in HGS during hospitalization, with nine experiencing decline during the conditioning phase. Age, gender, and hemoglobin correlated with HGS. Strength loss was more likely in those undergoing allogeneic compared to autologous BMT.
. CONCLUSIONS A majority of patients experienced strength decline during BMT, with a subgroup declining during conditioning. A positive relationship existed between HGS and hemoglobin and hematocrit in participants admitted for conditioning for BMT.
. IMPLICATIONS FOR NURSING Weakness increases risk for falls. Patients may experience as much as 50% strength loss during the course of hospitalization for BMT. Strength loss occurs in the conditioning phase for some patients.
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Miwa Y, Yamagishi Y, Konuma T, Sato T, Narita H, Kobayashi K, Takahashi S, Tojo A. Risk factors and characteristics of falls among hospitalized adult patients with hematologic diseases. J Geriatr Oncol 2017; 8:363-367. [PMID: 28743506 DOI: 10.1016/j.jgo.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/10/2017] [Accepted: 07/06/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Falls and fall-related injuries are major problems in hospitals. In hematologic patients, both disease and its treatment, including chemotherapy and allogeneic hematopoietic cell transplantation (allo-HCT), can cause anemia, febrile neutropenia, and bleeding tendency, which may result in falls and fall-related injuries. MATERIALS AND METHODS We retrospectively analyzed 397 consecutive admissions to the hematology unit at our institute which included 201 adult patients with hematologic disease. RESULTS AND CONCLUSIONS A total of 56 fall events were observed in 43 patients, and the incidence of falls was 2.49 per 1000 person-days. The median hemoglobin, platelet, and serum albumin levels prior to fall events were 8.65g/dl (range, 6.3-12.7), 38×109/l (range, 7-454), and 2.85g/dl (range, 1.6-4.3), respectively. Despite the presence of thrombocytopenia among the majority of patients who fell, no serious injury was observed. Multiple variable logistic regression analysis demonstrated that age older than 65years (hazard ratio [HR], 2.86; 95% confidence interval [CI], 1.17-6.99, P=0.02), admission for allo-HCT (HR, 9.48; 95% CI, 3.35-26.80, P<0.001), hypnotic medication (HR, 3.57; 95% CI, 1.56-8.20, P=0.002), urinary or intravenous catheter placement (HR, 2.34; 95% CI, 1.08-5.09, P=0.03), and hypoalbuminemia (HR, 2.30; 95% CI, 1.07-4.96, P=0.03) were significantly associated with increased fall risk. These findings indicated that special attention should be paid to patients with such risk factors during their treatment.
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Affiliation(s)
- Yoriko Miwa
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuko Yamagishi
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Tomoko Sato
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hatsuko Narita
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Koji Kobayashi
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoshi Takahashi
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Balance function in patients who had undergone allogeneic hematopoietic stem cell transplantation. Gait Posture 2015; 42:406-8. [PMID: 26233580 DOI: 10.1016/j.gaitpost.2015.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/21/2015] [Accepted: 07/13/2015] [Indexed: 02/02/2023]
Abstract
A previous study reported a 45% incidence of falling among allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients during hospitalisation. We investigated balance and physical function in allo-HSCT patients. Thirty patients (18 men and 12 women) who underwent allo-HSCT between February 2013 and September 2014 were included in this study. Patients were evaluated for up to 3 weeks before and 7 weeks after transplantation. Balance was evaluated using the Timed Up and Go test (TUG) and length of centre of pressure (CoP). Physical function was assessed using hand-grip strength, knee-extensor strength tests, and the 6 min walk test (6MWT). TUG and length of CoP were significantly increased following HSCT (P<0.01). Hand-grip strength, knee-extensor strength, and the 6MWT score decreased significantly after allo-HSCT (P<0.01). TUG and length of CoP were negatively correlated with hand grip and knee-extensor strength (P≤0.05). The allo-HSCT patients in this study had worsened dynamic and static movements of the CoP after transplantation as well as decline of physical function. Rehabilitation staff, nurses, and physicians should recognize the decreased balance function of patients who have undergone allo-HSCT.
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