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Doherty AJ, O'Donoghue A, Harrison J. Developing an understanding of the risk factors for falls among adults with intellectual disabilities: a commentary. Br J Community Nurs 2023; 28:238-242. [PMID: 37130713 DOI: 10.12968/bjcn.2023.28.5.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Commentary on: Pope J, Truesdale M, Brown M. Risk factors for falls among adults with intellectual disabilities: A narrative review. J Appl Res Intellect Disabil. 2021; 34: 274-285. 10.1111/jar.12805 Falls are a serious and common problem for people with intellectual disabilities (ID). Whilst there is available evidence on falls risk factors for the general population, there is a lack of awareness and understanding of the contributing risk factors for this population. This commentary critically appraises a recent narrative review which sought to identify the risk factors for falls among people with ID. Clinical practice implications: Community nurses may identify people with ID at risk of falls, and work alongside other healthcare professionals and carers to provide tailored multidisciplinary falls-prevention interventions for individuals with ID living in the community.
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Affiliation(s)
- Alison J Doherty
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire
| | | | - Joanna Harrison
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire
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Doherty AJ, Benedetto V, Harris C, Ridley J, O'Donoghue A, James-Jenkinson L, Fidler D, Clegg A. Preventing falls at home among people with intellectual disabilities: A scoping review. J Appl Res Intellect Disabil 2023. [PMID: 37076958 DOI: 10.1111/jar.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/10/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Falls are common among people with intellectual disabilities. Many falls happen within the home. Our scoping review aimed to identify evidence for falls-risk factors and falls-prevention interventions for this population. METHOD We conducted a multi-database search to identify any type of published study that explored falls-risk factors or falls-prevention interventions for people with intellectual disabilities. Following a process of (i) title & abstract and (ii) full-text screening, data was extracted from the included studies and described narratively. RESULTS Forty-one studies were included. Risks are multifactorial. There was limited evidence of medical, behavioural/psychological, or environmental interventions to address modifiable risk factors, and no evidence of the interventions' cost-effectiveness. CONCLUSIONS Clinically and cost effective, acceptable and accessible falls-prevention pathways should be available for people with intellectual disabilities who are at risk of falls from an earlier age than the general population.
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Affiliation(s)
- Alison J Doherty
- Institute for Global Health and Wellbeing, University of Central Lancashire, Preston, UK
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment (HTA) Unit, Applied Health Research hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), based at the University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Institute for Global Health and Wellbeing, University of Central Lancashire, Preston, UK
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment (HTA) Unit, Applied Health Research hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), based at the University of Central Lancashire, Preston, UK
| | - Catherine Harris
- Institute for Global Health and Wellbeing, University of Central Lancashire, Preston, UK
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment (HTA) Unit, Applied Health Research hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), based at the University of Central Lancashire, Preston, UK
| | - Julie Ridley
- Institute for Global Health and Wellbeing, University of Central Lancashire, Preston, UK
- Centre for Citizenship and Community, University of Central Lancashire, Preston, UK
| | | | | | - Dave Fidler
- Pathways Associates (Community Interest Company), Accrington, UK
| | - Andrew Clegg
- Institute for Global Health and Wellbeing, University of Central Lancashire, Preston, UK
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment (HTA) Unit, Applied Health Research hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), based at the University of Central Lancashire, Preston, UK
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O'Donnell D, O'Mahony A, Doyle M, O'Gorman M, O'Donoghue A, O'Halloran A, Mulcahy R, Pope G, Cooke J. Point Prevalence of Frailty and Cognitive Impairment Exceeds the Capacity of a Single Ward - Specialist Geriatric Wards to lead Best Practice. Ir Med J 2022; 115:690. [PMID: 36920487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Chang E, Daly J, Hawkins A, McGirr J, Fielding K, Hemmings L, O'Donoghue A, Dennis M. An evaluation of the nurse practitioner role in a major rural emergency department. J Adv Nurs 1999; 30:260-8. [PMID: 10404003 DOI: 10.1046/j.1365-2648.1999.01071.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this pilot study was to investigate whether nurse practitioners are able to provide a level of primary health service applicable to remote/isolated settings in wound management and treatment of blunt limb trauma. It was hypothesized that there would be no significant difference in the quality of care, or the level of client satisfaction, provided by the medical officers and the nurse practitioners in the study. Two groups participated in the study, nurse practitioners and medical officers. The study used a randomized trial design. Data were collected using quantitative and qualitative methods. Two hundred and thirty-two clients participated in the study. Of this number 63 were supervised cases in the pilot trial. In the randomized trial participants were distributed between nurse practitioners and medical officers (n = 169), of which 91 were randomized to medical officers and 78 to nurse practitioners. Telephone interviews were conducted to evaluate client satisfaction. The majority of study participants were surveyed for client satisfaction (n = 132). This represents approximately 78% of the randomized sample and multivariate analysis was carried out on the data. Study results indicate that there were no significant differences between the two groups in relation to client satisfaction. Very positive outcomes of treatment were consistent across groups in the study. The study also found that there was strong support for the role of the nurse practitioner in the rural emergency setting. Recommendations include further research to measure the efficacy of nurse practitioners utilizing the selected competencies in remote/isolated settings.
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Affiliation(s)
- E Chang
- Faculty of Health, Centre for Research in Healthy Futures, University of Western Sydney Hawkesbury, Richmond, NSW, Australia
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Thompson CH, Kemp GJ, Taylor DJ, Conway M, Rajagopalan B, O'Donoghue A, Styles P, McKenna WJ, Radda GK. Abnormal skeletal muscle bioenergetics in familial hypertrophic cardiomyopathy. Heart 1997; 78:177-81. [PMID: 9326994 PMCID: PMC484900 DOI: 10.1136/hrt.78.2.177] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To determine the skeletal muscle metabolic manifestations of familial hypertrophic cardiomyopathy. DESIGN A case-control study. SETTING 31P magnetic resonance spectroscopy of the calf muscle was performed on volunteers from a centre specialising in familial hypertrophic cardiomyopathy. PATIENTS Five patients with abnormal beta myosin heavy chain protein in cardiac and skeletal muscle and five patients with a troponin T abnormality in cardiac muscle were compared with healthy controls. RESULTS High energy phosphate metabolism in vivo was examined in a non-invasive manner. In resting muscle, the beta myosin heavy chain group had a higher ratio of phosphocreatine to ATP concentration (4.51 (SD 0.17)) than either the troponin T group (3.88 (0.42)) or controls (n = 16; 4.04 (0.40)). Exercise duration was reduced compared to controls, and during the fourth minute of exercise phosphocreatine depletion and muscle acidification were greater in both patient groups. After exercise, the recovery of phosphocreatine-an index of oxidative metabolic capacity of the muscle-was slower in the beta myosin heavy chain group (mean half time 0.65 (0.08) minutes) than in the troponin T group (0.60 (0.17) minutes) or controls (0.48 (0.14) minutes). CONCLUSIONS Exercise metabolism was abnormal in both groups of subjects, and the affected contractile protein determined the metabolic changes in muscle at rest and during recovery. In patients with abnormal beta myosin heavy chain protein, there was a decrease in oxidative capacity consistent with the reduction in mitochondria reported in muscle biopsy studies of similar patients.
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Affiliation(s)
- C H Thompson
- MRC Biochemical and Clinical Magnetic Resonance Unit, John Radcliffe Hospital, Oxford, UK
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Watkins H, McKenna WJ, Thierfelder L, Suk HJ, Anan R, O'Donoghue A, Spirito P, Matsumori A, Moravec CS, Seidman JG. Mutations in the genes for cardiac troponin T and alpha-tropomyosin in hypertrophic cardiomyopathy. N Engl J Med 1995; 332:1058-64. [PMID: 7898523 DOI: 10.1056/nejm199504203321603] [Citation(s) in RCA: 608] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Familial hypertrophic cardiomyopathy can be caused by mutations in the genes for beta cardiac myosin heavy chain, alpha-tropomyosin, or cardiac troponin T. It is not known how often the disease is caused by mutations in the tropomyosin and troponin genes, and the associated clinical phenotypes have not been carefully studied. METHODS Linkage between polymorphisms of the alpha-tropomyosin gene or the cardiac troponin T gene and hypertrophic cardiomyopathy was assessed in 27 families. In addition, 100 probands were screened for mutations in the alpha-tropomyosin gene, and 26 were screened for mutations in the cardiac troponin T gene. Life expectancy, the incidence of sudden death, and the extent of left ventricular hypertrophy were compared in patients with different mutations. RESULTS Genetic analyses identified only one alpha-tropomyosin mutation, identical to one previously described. Five novel mutations in cardiac troponin were identified, as well as a further example of a previously described mutation. The clinical phenotype of four troponin T mutations in seven unrelated families was similar and was characterized by a poor prognosis (life expectancy, approximately 35 years) and a high incidence of sudden death. The mean (+/- SD) maximal thickness of the left ventricular wall in subjects with cardiac troponin T mutations (16.7 +/- 5.5 mm) was significantly less than that in subjects with beta cardiac myosin heavy-chain mutations (23.7 +/- 7.7 mm, P < 0.001). CONCLUSIONS Mutations in alpha-tropomyosin are a rare cause of familial hypertrophic cardiomyopathy, accounting for approximately 3 percent of cases. Mutations in cardiac troponin T account for approximately 15 percent of cases of familial hypertrophic cardiomyopathy in this referral-center population. These mutations are characterized by relatively mild and sometimes subclinical hypertrophy but a high incidence of sudden death. Genetic testing may therefore be especially important in this group.
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Affiliation(s)
- H Watkins
- Howard Hughes Medical Institute, Boston, MA
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