基于物联网的中西医结合护理对半自理老人跌倒效能的干预研究

目的 探讨中西医结合护理对半自理老人跌倒效能的影响.方法 将符合纳入标准的120例半自理老人,按照随机数字表法分为对照组和试验组,每组60例.基于物联网搭建半自理老年健康监测服务平台,对照组给予跌倒的知识普及讲座,试验组给予中西医结合护理干预.干预6个月后采用修订版跌倒功效量表(modified fall efficacy scale,MFES)评估老人跌倒效能.结果 干预后两组在MFES总分及14个条目方面比较,差异有统计学意义(P<0.05);试验组室内活动评分提高最为明显.结论 老年健康监测服务平台能准确传送、分析、反馈数据,实现老人健康监测全过程;中西医结合护理干预能提高半自理老人跌倒效能,缓解害怕跌倒症状、预防跌倒发生,促进老人身心健康,值得临床进一步推广应用.     

Effect of Cold-Rolling Directions on Recrystallization Texture Evolution of Pure Iron

The influence of cold-rolling directions on the recrystallization texture evolution of pure iron was examined. As-received pure iron sheets were cold-rolled under two different conditions (specimens A and B). Specimen A was cold-rolled in the vertical direction against the cold-rolling direction of the as-received sheet. Specimen B was cold-rolled in the vertical direction against the cold-rolling direction of the as-received sheet, and then in the cold-rolling direction of the as-received sheet. Cold-rolled specimens were heated to each desired temperature before being quenched in water to room temperature (298 ± 2 K). Both cold-rolled specimens showed the development of γ-fiber and {100}<011> orientation. Additionally, γ-fiber formed comparatively more in cold-rolled specimen A, while α-fiber developed comparatively more in cold-rolled specimen B. Strain distribution in cold-rolled specimen A was presumably inhomogeneous, whereas that in cold-rolled specimen B was rather uniform at the macro-scale. The formation of γ-fiber was confirmed in annealed specimen A. In annealed specimen B, however, the recrystallization texture tended to be random, and the formation of α-fiber was observed. Furthermore, the formation of Goss orientation in both annealed specimens was established. Recrystallized ferrite grains with Goss orientation nucleated in high strain regions of cold-rolled specimen. These findings show that by devising the cold-rolling direction, it is possible to discover new types of recrystallization textures.     

Retrospective analysis of 616 air-rescue trauma cases related to the practice of extreme sports

IntroductionExtreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations.AimOur aims were to perform an epidemiological analysis, to identify specific injuries and to describe the characteristic of prehospital procedures in ES accidents requiring HEMSs.MethodsThis is a retrospective study, reviewing all rescue missions dedicated to ESs provided by HEMS REGA Lausanne, from 1 January 1998 to 31 December 2008. ES were classified into three categories of practice, according to the type of risk at the time of the fall.ResultsAmong the 616 cases meeting inclusion criteria, 219 (36%) were clearly high-risk ES accidents; 69 (11%) and 328 (53%) were related to potential ES, but with respectively low or indeterminate risk at the time of the fall. In the high-risk ES group, the median age was 32 years and 80% were male. Mortality at 48 h was 11%, almost ten times higher than in the other two groups. The proportion of potentially life-threatening injuries (the National Advisory Committee for Aeronautics (NACA) score ≥ 4) was 39% in the high-risk ES group and 13% in the other two groups. Thirty per cent of the cases in the high-risk ES group presented an Injury Severity Score (ISS) >15, compared with 7% in the other groups. Thoracolumbar vertebral fractures were the most common injuries with 32% of all cases having at least one, involving the T12–L2 junction in 56% of cases. The other most frequent injuries were traumatic brain injuries (16%), rib fractures (9%), pneumothorax (8%) and femoral (7%), cervical (7%), ankle (5%) and pelvic (5%) fractures. Median time on site for rescue teams was higher in the confirmed high-risk ES group, with 50% of prehospital missions including at least one environmental difficulty.ConclusionsHigh-risk ESs led to high-energy accidents, characterized by a large proportion of severe injuries and axial traumas (spine, thorax, pelvis and proximal femur). We identified a considerable percentage of thoracolumbar vertebral fractures, mainly in the T12–L2 junction. HEMSs dedicated to high-risk ESs implied longer and more complex interventions.     

Fall injuries in Baghdad from 2003 to 2014: Results of a randomised household cluster survey

IntroductionFalls incur nearly 35 million disability-adjusted life-years annually; 75% of which occur in low- and middle-income countries. The epidemiology of civilian injuries during conflict is relatively unknown, yet important for planning prevention initiatives, health policy and humanitarian assistance. This study aimed to determine the death and disability and household consequences of fall injuries in post-invasion Baghdad.MethodsA two-stage, cluster randomised, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding injury specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship.ResultsNine hundred households totaling 5148 individuals were interviewed. There were 138 fall injuries (25% of all injuries reported); fall was the most common mechanism of civilian injury in Baghdad. The rate of serious fall injuries increased from 78 to 466 per 100,000 persons in 2003 and 2013, respectively. Fall was the most common mechanism among the injured elderly (i.e. ≥65 years; 15/24 elderly unintentional injuries; 63%). However, 46 fall injuries were children aged <15 years (49% of unintentional injuries) and 77 were respondents aged 15–64 years (36%). Respondents who spent significant time within the home (i.e. unemployed, retired, homemaker) had three times greater odds of having suffered a fall injury than student referents (aOR 3.34; 95%CI 1.30–8.60). Almost 80% of fall injured were left with life-limiting disability. Affected households often borrowed substantial sums of money (34 households; 30% of affected households) and/or suffered food insecurity after a family member's fall (52; 46%).ConclusionFalls were the most common cause of civilian injury in Baghdad. In part due to the effect of prolonged insecurity on a fragile health system, many injuries resulted in life-limiting disabilities. In turn, households shouldered much of the burden after fall injury due to loss of income and/or medical expenditure, often resulting in food insecurity. Given ongoing conflict, civilian injury control initiatives, trauma care strengthening efforts and support for households of the injured is urgently needed.     

The role of postural instability/gait difficulty and fear of falling in predicting falls in non-demented older adults

IntroductionPostural instability/gait difficulty (PIGD) and fear of falling (FoF) frequently co-exist, but their individual predictive values for falls have not been compared in aging. This study aims to determine both independent and combined effect of PIGD and FoF to falls in older adults without dementia.MethodsPIGD and other extrapyramidal signs were systematically assessed in 449 community-dwelling participants without Parkinson’s disease (76.48 ± 6.61 ys; 56.8% female) enrolled in this longitudinal cohort study. Presence of FoF was measured by a single-item question (Do you have a FoF?) and self-confidence by the Activities-specific Balance Confidence scale (ABC scale).ResultsOne hundred sixty-nine participants (38%) had an incident fall over a mean follow-up of 20.1 ± 12.2 months. PIGD was present in 32% and FoF in 23% of the participants. Both PIGD (adjusted hazard ratio (aHR): 2.28; p = 0.016) and self-confidence (aHR: 0.99; p = 0.040) predicted falls when entered simultaneously in the Cox model. However, presence of FoF (aHR: 1.99; p = 0.021) and self-confidence (aHR: 0.98; p = 0.006) predicted falls only in individuals with PIGD.ConclusionsPIGD and FoF were associated with future falls in older adults without dementia but FoF was a fall’s predictor only in individuals with PIGD.     

Self-management tasks to improve mobility and reduce fall risk are not leading to lower research participation in older adults

Purpose of studyThe first aim is to evaluate, in a sub-study, the recruitment process of the Senior Step Study, which was an intervention study on the self-management of mobility and fall risk; the second aim is to explore the reasons mentioned by older people, from three different settings, for (not) participating.MethodsSubjects were community-dwelling older persons, residents of homes for the elderly, and older persons regularly visiting community centres. The effectiveness of different recruitment procedures was analysed for each setting separately. We also analysed reasons for accepting and declining participation between the settings.ResultsThe total inclusion rate was 27.9%. A personal initial approach (i.e., first contact was face-to-face or in a group meeting) did not improve the inclusion rate. More subjects consented to participate after an introductory meeting (which was planned after the first face-to-face contact) compared to persons not having one (p < 0.01). At different settings, subjects gave different reasons for participation. No differences were found in the reasons for refusing participation. Especially in homes for the elderly, people refused to participate because the research was too burdensome.ConclusionsThe inclusion rates in this study are comparable to other self-management studies with older people. An introductory meeting during which the study design and benefits of participating are explained and formal interim evaluations of the recruitment process may benefit recruitment. Recruiting older persons for self-management tasks is possible with the appropriate recruitment process, enabling more research on this increasingly important research topic.     

Status and prospect of current inotropic agents

Critical reassessment of established inotropic drugs such as the phosphodiesterase inhibitors and the digitalis glycosides has reaffirmed the need for novel cardiotonic agents that will not only beneficially affect the haemodynamic and functional impairment of patients with overt congestive heart failure, but also prevent its clinical manifestation and reduce the high mortality. None of the drugs examined in these directions - calcium sensitisers, β-receptor blockers, sodium channel modulators, digitalis derivatives - have been shown to achieve these goals. The research on endogenous digitalis did not, as was hoped, reveal a general strategy for improving the therapeutic index of cardiac glycosides. The proof that Na+/K+-transporting ATPase of cardiac muscle is the molecular point of attack (receptor) for the inotropic and toxic effects of digitalis-like acting C/D-cis and C/D-trans steroids revealed the cyclopentano-perhydrophenanthrene nucleus as their common pharmacophoric lead structure. This has opened a wide field for lead development in the direction of derivatives that favourably discriminate between the inotropy-linked α1-isoform and the toxicity-linked α3-isoform of Na+/K+-ATPase as the basis for the design of inotropic agents with high therapeutic margin.     

Estimating fall risk with inertial sensors using gait stability measures that do not require step detection

Falls have major consequences both at societal (health-care and economy) and individual (physical and psychological) levels. Questionnaires to assess fall risk are commonly used in the clinic, but their predictive value is limited. Objective methods, suitable for clinical application, are hence needed to obtain a quantitative assessment of individual fall risk. Falls in older adults often occur during walking and trunk position is known to play a critical role in balance control. Therefore, analysis of trunk kinematics during gait could present a viable approach to the development of such methods. In this study, nonlinear measures such as harmonic ratio (HR), index of harmonicity (IH), multiscale entropy (MSE) and recurrence quantification analysis (RQA) of trunk accelerations were calculated. These measures are not dependent on step detection, a potentially critical source of error. The aim of the present study was to investigate the association between the aforementioned measures and fall history in a large sample of subjects (42 fallers and 89 non-fallers) aged 50 or older. Univariate associations with fall history were found for MSE and RQA parameters in the AP direction; the best classification results were obtained for MSE with scale factor τ = 2 and for maximum length of diagonals in RQA (72.5% and 71% correct classifications, respectively). MSE and RQA were found to be positively associated with fall history and could hence represent useful tools in the identification of subjects for fall prevention programs.     

Concurrent validation of an index to estimate fall risk in community dwelling seniors through a wireless sensor insole system: A pilot study

Falls are a major health problem for older adults with immediate effects, such as fractures and head injuries, and longer term effects including fear of falling, loss of independence, and disability. The goals of the WIISEL project were to develop an unobtrusive, self-learning and wearable system aimed at assessing gait impairments and fall risk of older adults in the home setting; assessing activity and mobility in daily living conditions; identifying decline in mobility performance and detecting falls in the home setting. The WIISEL system was based on a pair of electronic insoles, able to transfer data to a commercially available smartphone, which was used to wirelessly collect data in real time from the insoles and transfer it to a backend computer server via mobile internet connection and then onwards to a gait analysis tool. Risk of falls was calculated by the system using a novel Fall Risk Index (FRI) based on multiple gait parameters and gait pattern recognition. The system was tested by twenty-nine older users and data collected by the insoles were compared with standardized functional tests with a concurrent validity approach. The results showed that the FRI captures the risk of falls with accuracy that is similar to that of conventional performance-based tests of fall risk. These preliminary findings support the idea that theWIISEL system can be a useful research tool and may have clinical utility for long-term monitoring of fall risk at home and in the community setting.