心血管系统病人发生跌倒与坠床原因分析与护理措施

目的:探讨如何预防和减少跌倒和坠床事件发生。方法:通过对跌倒与坠床事件发生的原因进行分析,提出相应的对策。结果:近1年来发生跌倒与坠床事故4例,跌倒后分别致股骨颈骨折1例,皮肤擦伤1例,血压下降2例。结论:预防和减少跌倒和坠床事件发生不仅需要护理人员严谨的工作态度,也需要医护之间良好的沟通,以及患者及家属的配合。     

Incidence rate of falls and its risk factors in patients with rheumatoid arthritis compared to controls: Four years of the TOMORROW study

Objective: Patients with rheumatoid arthritis (RA) have been recognized to experience falls frequently due to functional disabilities. The aim of this study was to prospectively investigate factors influencing falls in patients with RA compared to controls.

Methods: We compared the frequency of falls in 208 RA patients and 205 age- and sex-matched volunteers for four years and analyzed risk factors for falls in RA patients using multivariate regression analysis.

Results: No significant difference in the incidence rate of falls (/person-year) between patients with RA (median [interquartile range]: 0 [0, 0.5]) and controls (0 [0, 0.5]) was evident during four years. Logistic regression analysis identified age, sex, body mass index, history of falls, and lower limb implant at baseline as significant risk factors for falls. The highest quartile of anti-CCP antibody level (>300.6?U/ml) was the strongest predictor for multiple falls (odds ratio, 2.97; 95% confidence interval, 1.12–7.91, p?=?0.029) among RA patients.

Conclusion: During four years we could not observe the higher incidence rate of falls in RA patients compared to controls in our cohort. Subjects with a higher titer of anti-CCP antibody might be at higher risk of frequent falls among RA patients.     

Factors influencing short-term outcomes for older patients accessing emergency departments after a fall: The role of fall dynamics

BackgroundWhile the relevance of falls in raising the risk of fractures, hospitalization and disability in older age is well recognized, the factors influencing the onset of fractures and the need for ward admission after a fall have yet to be fully elucidated. We investigated which factors and fall dynamics were mainly associated with fall-related injuries and hospitalization among elderly persons accessing the Emergency Department (ED) following a fall.MethodsThe study involved 2144 older subjects who accessed the ED after a fall. Data on the fall´s nature and related injuries, ward admissions, history of falls, dementia, and medical therapies were examined for all patients. Considering dynamics, we distinguished accidental falls (due to interaction with environmental hazards while in motion) and falls from standing (secondary to syncope, lipothymia, drop attack, or vertigo).ResultsThe overall prevalence of fractures in our population did not differ significantly with advancing age, though hip fractures were more common in the oldest, and upper limb fractures in the youngest patients. Falls from standing were associated with polypharmacy and with higher ward admission rate despite a lower fractures´ prevalence than accidental falls. The chances of fall-related fractures were more than fourfold as high for accidental dynamics (OR = 4.05, 95%CI:3.10–5.29, p < 0.0001). Ward admission was associated with polypharmacy, dementia, anticoagulants´ use and fall-related fractures (OR = 6.84, 95%CI:5.45–8.58, p < 0.0001), while it correlated inversely with accidental fall dynamics.ConclusionsOutcomes of falls in older age depend not only on any fall-related injuries, but also on factors such as polypharmacy, cognitive status and fall dynamics.     

Research on Fall Prevention and Protection from Heights in Japan

The high frequency of fall accidents is a serious problem in Japan. Thus, more stringent countermeasures for preventing falls from scaffolds were developed and incorporated into institutional guidelines. These countermeasures aim to decrease deaths caused by falls from scaffolds. Despite the improvements in such measures, however, the rate of accidental fall deaths remains high in Japan’s construction industries. To improve the rigor of the countermeasures, a committee was established in our institute by the Japan Ministry of Health, Labour, and Welfare. This committee investigated the regulations applied in other countries and evaluated construction industry compliance with existing fall prevention guidelines. After considerable research and discussion, the Occupational Safety and Health Regulations and Guidelines were amended in 2009. The effects of the amended regulations have recently been investigated on the basis of accident reports. This paper describes the investigation and its results. The paper also discusses other research and workplace safety countermeasures for preventing falls and ensuring fall protection from heights.     

Postural balance in pregnancies complicated by hyperemesis gravidarum

Objective: To assess postural balance in females with pregnancies complicated by hyperemesis gravidarum (HG).

Methods: In this observational study, postural balance during the first trimester was measured using the Biodex Balance System (BBS) in 41 pregnant females (20 females with pregnancies complicated by HG and 21 healthy controls). The overall stability index (OA), anterior-posterior stability index (APSI), medial-lateral stability index (MLSI) and fall risk test (FRT) scores were obtained from the mean scores of three trials on the BSS. The four measurements obtained from the BBS (OA, APSI, MLSI and FRT) were compared between healthy pregnant females and those with pregnancies complicated by HG (HG group).

Results: The mean OA and APSI scores were significantly higher in the HG group compared to healthy pregnant controls (p?p?>?0.05). The FRT scores of HG patients were higher than healthy pregnant females (p?=?0.001).

Conclusions: Pregnant females with HG have poor postural stability/balance and high fall risk test scores. HG causes decreased postural equilibrium in the first trimester of pregnancy.     

基于案例的Teach-back在肿瘤患者预防跌倒 健康教育中的应用

目的 探讨基于案例的Teach-back法在肿瘤患者预防跌倒健康教育中的应用效果。方法 选取我科2016年6-12月120例肿瘤患者作为对照组,2017年1-6月140例肿瘤患者作为观察组。对照组实施传统预防跌倒健康教育,观察组采用基于案例的Teach-back法实施预防跌倒的健康教育。比较2组患者跌倒防范措施依从率、跌倒发生率的差异。结果 观察组患者跌倒防范措施依从率为97.63%,明显高于对照组的85.18%(χ²=2 774.640,P<0.001),患者跌倒发生率低于对照组(χ²=5.119,P=0.024)。结论 在肿瘤跌倒高风险患者中运用基于案例的Teach-back对患者进行健康教育,能有效提高患者跌倒防范措施的依从率,降低患者跌倒发生率,值得临床推广。     

Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis

Objective:

to determine the incidence of falls in elderly residents of long-stay institutions of the Federal District, to identify the aspects involved in the falls, in terms of risk factors, from the application of scales and the Taxonomy II of NANDA-I, and to define the level of accuracy with its sensitivity and specificity for application in the clinical nursing practice.

Method:

this was a cohort study with the evaluation of 271 elderly people. Cognition, functionality, mobility and other intrinsic factors were evaluated. After six months, the elderly people who fell were identified, with significance analysis then performed to define the risk factors.

Results:

the results showed an incidence of 41%. Of the 271 patients included, 69 suffered 111 episodes of falls during the monitoring period. Risk factors were the presence of stroke with its sequelae (OR: 1.82, 95% CI 1.01 - 3.28, p=.045), presenting more than five chronic diseases (OR: 2.82, 95% CI 1.43 - 5.56, p=.0028), foot problem (OR: 2.45, 95% CI 1.35 - 4.44, p=.0033) and motion (OR: 2.04, 95% CI 1.15 - 3.61, p=.0145).

Conclusion:

the taxonomy has high validity regarding the detection of elderly people at risk of falling and should be applied consistently in the clinical nursing practice.     

Effects of controlled whole-body vibration training in improving fall risk factors among individuals with multiple sclerosis: A pilot study

Purpose: The purpose of this study was to systematically examine the effect of an 8-week controlled whole-body vibration training on improving fall risk factors and the bone mineral density among people with multiple sclerosis (PwMS).

Methods: This study adopted a single group pre-test–post-test design. Twenty-five PwMS (50.3 years SD 14.1) received vibration training on a side-alternating vibration platform. Each training session was repeated three times every week for 8 weeks. Prior to and following the 8-week training course, a battery of fall risk factors were evaluated: the body balance, functional mobility, muscle strength, range of motion, and fear of falling. Bone density at both calcanei was also assessed.

Results: Twenty-two participants completed the study. Compared with pre-test, almost all fall risk factors and the bone density measurement were significantly improved at post-test, with moderate to large effect sizes varying between 0.571 and 1.007.

Conclusions: The 8-week vibration training was well accepted by PwMS and improved their fall risk factors. The important findings of this study were that vibration training may increase the range of motion of ankle joints on the sagittal plane, lower the fear of falling, and improve bone density.

• IMPLICATIONS FOR REHABILITATION

• An 8-week vibration training course could be well-accepted by people with multiple sclerosis (MS).

• Vibration training improves the risk factors of falls in people living with MS.

• Vibration training could be a promising rehabilitation intervention in individuals with MS.

     

体感交互技术训练对帕金森病患者平衡功能、足底压力及跌倒发生率的影响

目的 分析体感交互技术训练对帕金森病患者平衡功能、足底压力及跌倒发生率的影响。方法 选取2020年2月-2022年4月三二〇一医院收治的115例帕金森患者,按不同训练方案分为常规组（n=56）与体感交互组（n=59）。常规药物治疗期间,常规组实施传统平衡训练,体感交互组接受体感交互技术训练。比较两组训练4周后Berg平衡量表（Berg Balance Scale,BBS）评分,动、静态足底压力分布,跌倒发生率。结果 训练后体感交互组BBS评分高于常规组（P＜0.05）;训练前后比较,常规组BBS评分无统计学意义（P＞0.05）,体感交互组BBS评分有所提升,具有统计学意义（P＜0.05）。训练前两组静态、动态足底压力分布无统计学意义（P＞0.05）,两组静态站立时双脚压力由低到高排序为：2区＜1区＜3区＜6区＜5区＜4区＜7区＜8区;行走时左足：2区＜6区＜1区＜3区＜5区＜4区＜7区＜8区,右足：2区＜6区＜1区＜3区＜5区＜7区＜8区＜4区。训练后两组站立时双足的3区压力上升,双足压力：2区＜1区＜6区＜5区＜3区＜4区＜7区＜8区;行走时左足：2区＜6区＜1区＜5区＜3区＜4区＜7区＜8区,右足压力分区未变。训练后两组静态跌倒风险指数评分上升,动态跌倒风险指数评分下降,且体感交互组评分优于常规组（P＜0.05）。1个月随访期间,常规组发生11例跌倒,体感交互组发生2例,体感交互组跌倒发生率3.39%低于常规组19.64%（P＜0.05）。结论 体感交互技术训练能有效改善帕金森患者平衡功能康复情况,有助于更好调整动、静态足底压力分布,降低跌倒风险,减少跌倒发生情况。