Feasibility of a nurse‐led in‐home cognitive behavioral program to manage concerns about falls in frail older people: A process evaluation

Concerns about falls and related avoidance of activities are common problems among older people living in the community. In this study we examined the feasibility and acceptability of AMB‐Home (the Dutch in‐home version of A Matter of Balance), a nurse‐led in‐home cognitive behavioral program developed for frail community‐living older people with concerns about falls and related activity avoidance. The multicomponent program consisted of seven individual sessions, including three home visits and four telephone contacts. Data were collected from eight nurses and 194 participants. Generally, the program was considered acceptable and feasible by both the nurses and the participants. When AMB‐Home turns out to be effective, the implementation of a fine‐tuned version of this in‐home program in regular health care, would be a natural next step. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36:257–270, 2013     

Level of physical activity in men and women with chronic stroke

ABSTRACT

Introduction: Community-dwelling stroke survivors generally show low levels of physical activity (PA). An improved understanding of the factors influencing participation in PA after stroke is imperative to improve levels of PA. Furthermore, gender differences in PA have received little attention in stroke research. The objective of this study was to examine gender differences in PA, physical functioning and psychological factors and the association between these factors and PA in men and women 1–3-year post-stroke. Materials and methods: A total of 187 community-dwelling individuals with stroke (65–85 years old, 29% women) were included in a secondary analysis based on data from a cross-sectional study. The exclusion criteria were severe cognitive or language dysfunction or dementia. The level of PA was measured by the Physical Activity Scale for the Elderly. Physical function included balance, walking speed and mobility. Psychological factors included depression, health-related quality of life and fall-related self-efficacy. Falls and fear of falling were each measured with a single question. Results: There were no significant differences in PA levels between men and women. In multiple regression analyses, walking speed (p < 0.001) was associated with PA in men, and balance (p = 0.038) was associated with PA in women. Conclusions: The results indicate that strategies to increase PA levels 1–3-year post-stroke could be improved by considering gender-specific factors.     

Non‐pharmacological means to prevent fractures among older adults

Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long‐standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a ‘simple’ fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high‐impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called ‘fall‐induced high‐impact injuries’ instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal‐trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury‐site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone‐specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor‐assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury‐site protection, padded strong‐shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.     

直接粘结颊面管与带环颊面管在直丝弓矫治技术中的对比研究

目的：比较直接粘结颊面管与带环颊面管在直丝弓矫治技术中的临床应用。方法：选择临床病例60例共274颗磨牙,随机分成2组,分别使用直接粘接法和带环法粘结颊面管,观察一年半内颊面管脱落率,并评价治疗前后磨牙区的牙周探诊深度变化。结果：两组病例1.5年内颊面管脱落率无显著性差异,而直接粘接颊面管磨牙区牙周情况明显优于带环颊面管。结论：直接粘接颊面管的粘接强度能达到预期的矫治目标,更易于磨牙区口腔卫生的维护。     

Frequent Tanning Bed Use, Weight Concerns, and Other Health Risk Behaviors in Adolescent Females (United States)

Objective To examine the association between tanning bed use and weight concerns, health risk behaviors, and peer influence. Methods The Growing Up Today Study (GUTS) is an ongoing prospective cohort study of adolescents established in 1996. In 1999, a total of 6,373 adolescent females ages 12–18 (offspring of participants in the Nurses Health Study 2) completed the survey. Results Almost nine percent (8.6%) of the adolescent girls had used a tanning bed 1–9 times and an additional 5.4% had used tanning beds at least 10 times in the past year (frequent users). Logistic regression models revealed that frequent tanning bed use was associated with being highly concerned about weight (OR = 1.5, 95%CI = 1.1, 2.0), frequently dieting to lose weight (OR = 1.5, 95%CI = 1.1, 2.0), using laxatives or vomiting to control weight (OR = 3.6; 95%CI = 2.2–5.8), having friends who placed a lot of importance on being thin (OR = 2.6; 95%CI = 1.3–5.1), smoking cigarettes (OR=1.7, 95%CI = 1.1, 2.6), binge drinking (OR = 2.1, 95%CI = 1.3, 3.1), using recreational drugs (OR = 3.0; 95%CI = 2.4, 3.8), and trying to look like females in the media (sometimes/pretty much: OR = 1.3, 95%CI = 1.0, 1.8). Conclusion Frequent tanning bed use among adolescent females is associated with a range of health risk behaviors. This effect may be mediated by peer influence and a desire to look like other females in the media. Multi-pronged approaches, particularly those that target attitudes of young females, are needed to combat increased use of tanning beds.     

多发伤在急诊ICU中的处理──附146例临床分析

我院急诊监护室七年共收入多发伤病人146例，占同期创伤病人的37．8％。男性108例，女性38例，年龄5-76岁，以交通意外伤和高处坠落伤为多。本文采用1974年Owaga修正制订的创伤指数对146例多发伤病人进行了分析总结，发现创伤指数与并发症发生率、病死率均成直线正相关关系，其相关系数分别为0．997和0．966（P＜0．05）。存活组118例，平均创伤指数为21．3±5．1，死亡组28例，平均创伤指数为27±4．4，两组比较，创伤指数有显著位差异（P＜0．01）。并发症以休克、急性呼吸功能衰竭最为常见。作者认为，创伤指数能较准确地评估伤情、指导治疗、反映预后，值得在抢救现场和救护车上推广。迅速全面地查明伤情是诊治严重多发伤的关键，CT、B超、胸腔穿刺是快速、简便、准确的诊断方法。作者强调，严重多发伤的快速抢救，有效止血和大剂量广谱抗生素的早期应用是救治成功的关键。     

Measuring the psychological outcomes of falling: a systematic review

The objectives were to identify fall-related psychological outcome measures and to undertake a systematic quality assessment of their key measurement properties. A Cochrane review of fall-prevention interventions in older adults was used to identify fall-related psychological measurements. PubMed, CINAHL, and PsycINFO were systematically searched to identify instruments not used in trials and papers reporting the methodological quality of relevant measures. Reference lists of articles were searched for additional literature, and researchers were contacted. Two reviewers undertook quality extraction relating to content, population, reliability, validity, responsiveness, practicality, and feasibility. Twenty-five relevant papers were identified. Twenty-three measures met the inclusion criteria: six single-item questions, Falls Efficacy Scale (FES), revised FES, modified FES, FES-UK, Activities-specific Balance and Confidence Scale (ABC), ABC-UK, Confidence in maintaining Balance Scale, Mobility Efficacy Scale, adapted FES, amended FES, Survey of Activities and Fear of Falling in the Elderly (SAFFE), University of Illinois at Chicago Fear of Falling Measure, Concern about Falling Scale, Falls Handicap Inventory, modified SAFFE, Consequences of Falling Scale, and Concern about the Consequences of Falling Scale. There is limited evidence about the measurement properties of single-item measures. Several multiitem measures obtained acceptable reliability and validity, but there is less evidence regarding responsiveness, practicality, and feasibility. Researchers should select measures based on the constructs they intend to study. Further research is needed to establish and compare the instruments' measurement properties.     

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

Aims and objectives. To examine the impact of written and verbal education on bed‐making practices, in an attempt to reduce the prevalence of pressure ulcers. Background. The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco‐elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress. Design. A prospective randomized pre/post‐test experimental design. Methods. Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re‐examined one month later. One researcher was blinded to the educational delivery received by the wards. Results. Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (χ² = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (χ² = 0, P = 0.987). Conclusions. Clear, concise written instruction improved practice but verbal education was not additionally beneficial. Relevance to clinical practice. Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.     

自制球拍式约束手套防止管道拔脱的护理

目的探讨自制球拍式约束手套在防止管道拔脱护理中的效果。方法选取2012年1～11月我科收治90例留置管道、有拔管风险、需肢体约束的患者,合理将他们分为观察组和对照组,观察组患者使用自制球拍式约束手套,对照组使用普通约束带。观察约束的效果,有无滑脱、管道拔出、血行不畅、勒伤或擦伤、舒适度、家属接受等情况,观察并记录血压、心率、脉搏等情况。结果经统计,观察组患者滑脱、管道拔出、血行不畅、勒伤或擦伤、不舒适等情况的发生率均明显低于对照组,家属接受情况优于对照组;观察组患者血压、心率、脉搏的平均值都在正常范围内,生理状况优于对照组患者,具有统计学意义（P〈0．05）。结论自制球拍式约束手套在防止管道拔脱护理中的临床效果好,受到家属认可,耐用时间长,是很好的护理选择方式。     

应用灰色关联分析法综合评价医院病床使用效率

目的构建评估医院病床工作效率差异的方法,为医院病床管理提供参考。方法建立包括平均病床周转次数、病床使用率、出院者平均住院日等指标在内的综合指标体系,对某三甲医院各个分院的病床工作效率进行灰色关联分析。结果被评估的医院的病床工作效率由高到低依次为:B医院、A医院、C医院、D医院、E医院、F医院。结论用灰色关联分析可以有效比较不同医院的病床工作效率,值得应用推广。