四方联动防跌护理在社区跌倒高危老年人中的应用

目的探讨专科护士-社区护士-个体-家庭四方联动防跌护理模式在社区跌倒高危老年人中的应用与效果。方法选取深圳市龙岗区的2个社区,随机分为观察组和对照组,从两个社区登记建档的跌倒高风险老年居民中分别随机抽选45名进行干预。观察组采用"专科护士-社区护士-个体-家庭"四方联动推进的综合干预方案。对照组接受社区防跌倒常规护理。于干预前及干预后12个月使用修订版社区老年人跌倒危险评估量表、步态和平衡测试量表对两组老年人进行评测,记录两组1年内跌倒发生例次。结果干预期间跌倒发生情况:观察组1人次,对照组6人次。观察组步态和平衡测试得分提高,跌倒危险评估表得分降低,与对照组比较,差异有统计学意义(均P0.01)。结论四方联动的综合干预方案应用于社区居家老年人,能有效降低老年人跌倒风险,提升其防跌能力,对预防社区老年人跌倒的发生有积极作用。     

Simple screening test for risk of falls in the elderly

Background:   The aim of this study is to construct a simple screening test for the risk of falls in community-dwelling elder persons.
Methods:   A total of 1378 community-dwelling people aged 65 years and older in five different communities in Japan were asked to answer a self rated questionnaire including 22 items covering physical, cognitive, emotional and social aspects of functioning and environmental factors. At a six-month follow-up, the outcome of fall occurrence and the number of falls was ascertained by social workers, health visitors or nurses.
Results:   Five out of 22 items were selected using a logistic regression model. Using this five-item version, a screening test was constructed, and at the best cut-off point, the sensitivity and specificity were 68% and 70%, respectively. The validity of this scale was tested on persons with cognitive dysfunction.
Conclusion:   The simplicity and the predictive validity of the screening test support the use of this test in health check ups or general outpatient facilities.     

Time course of the increase in airway responsiveness associated with late asthmatic reactions to toluene diisocyanate in sensitized subjects

To understand better the mechanism of the increase in airway responsiveness associated with late asthmatic reactions, we determined the time course of toluene diisocyanate (TDI) effect on airway responsiveness in six sensitized subjects who exhibited a late asthmatic response after TDI exposure (0.018 +/- 0.005 ppm, 30 min) in the laboratory. Airway responsiveness was assessed before TDI exposure and then at 8 hr, 1 day, 1 wk, and 1 mo after TDI exposure. To assess responsiveness we determined the provocative dose of methacholine causing a decrease in FEV1 of 20% (PD20FEV1). The methacholine PD20 decreased from 0.50 mg geometric standard error of the mean (GSEM = 1.54) to 0.06 mg (GSEM = 1.55) (p less than 0.001) at 8 hr after exposure to TDI, was still decreased to 0.15 mg (GSEM = 1.93) (p less than 0.05) at 1 day, returned to 0.26 mg (GSEM = 1.91) (p greater than 0.05) at 1 wk, and returned to 0.43 mg (GSEM = 1.71) at 1 mo, indicating that full recovery occurred within 1 to 4 wk. These results demonstrate that TDI-induced late asthmatic response is associated with a reversible increase in airway responsiveness to methacholine and suggest that the TDI effect is linked to an acute inflammatory response in the airways.     

Machine Learning Predicts the Fall Risk of Total Hip Arthroplasty Patients Based on Wearable Sensor Instrumented Performance Tests

BackgroundThe prevalence of falls affects the wellbeing of aging adults and places an economic burden on the healthcare system. Integration of wearable sensors into existing fall risk assessment tools enables objective data collection that describes the functional ability of patients. In this study, supervised machine learning was applied to sensor-derived metrics to predict the fall risk of patients following total hip arthroplasty.MethodsAt preoperative, 2-week, and 6-week postoperative appointments, patients (n = 72) were instrumented with sensors while they performed the timed-up-and-go walking test. Preoperative and 2-week postoperative data were used to form the feature sets and 6-week total times were used as labels. Support vector machine and linear discriminant analysis classifier models were developed and tested on various combinations of feature sets and feature reduction schemes. Using a 10-fold leave-some-subjects-out testing scheme, the accuracy, sensitivity, specificity, and area under the receiver-operator curve (AUC) were evaluated for all models.ResultsA high performance model (accuracy = 0.87, sensitivity = 0.97, specificity = 0.46, AUC = 0.82) was obtained with a support vector machine classifier using sensor-derived metrics from only the preoperative appointment. An overall improved performance (accuracy = 0.90, sensitivity = 0.93, specificity = 0.59, AUC = 0.88) was achieved with a linear discriminant analysis classifier when 2-week postoperative data were added to the preoperative data.ConclusionThe high accuracy of the fall risk prediction models is valuable for patients, clinicians, and the healthcare system. High-risk patients can implement preventative measures and low-risk patients can be directed to enhanced recovery care programs.     

双黄连粉针剂加蒙脱石治疗婴幼儿秋季腹泻的疗效观察

目的: 观察双黄连粉针剂加蒙脱石口服治疗婴幼儿秋季腹泻的疗效.方法: 双黄连粉针剂加蒙脱石口服治疗102例秋季腹泻患儿,并与单用蒙脱石或双黄连组相比较.结果: 治疗组总有效率达92.1%,病程明显缩短(4.52±0.56)d;而单用蒙脱石或双黄连组有效率分别为67.4%,60.2%;病程分别为(5.90±0.72)d,(6.15±0.92)d,联合用药组与单用蒙脱石或双黄连组相比较,总有效率及病程均有显著性差异(P＜0.01).结论: 双黄连加蒙脱石治疗婴幼儿秋季腹泻疗效好,可提高治愈率,缩短病程,是较为安全而有效的药物.     

The environment and falls prevention: Do environmental modifications make a difference?

Background and Aims:  Environmental modification is a strategy widely recommended in many falls prevention programs. However the effectiveness of such a strategy has not been well established. This study aimed to evaluate published research related to falls prevention and environmental modification for older people.
Method:  A review of research conducted between 1993 and 2004 was undertaken. Ageline, Cinahl and OvidMedline databases were searched using falls prevention, home modifications, environmental modifications and occupational therapy as key words.
Results:  Eighteen articles were found relating to community and institutional dwellings and the relevance of environmental modifications.
Conclusion:  There is some evidence to support the use of environmental modification as a strategy in falls prevention for older people particularly in association with multidisciplinary/multifactorial programs targeted to those people with a history of falls.     

五禽戏锻炼对中老年女性膝关节肌力及平衡能力影响的临床研究

目的观察五禽戏锻炼对中老年女性膝关节肌力及平衡能力的影响。方法将56例中老年女性志愿者采用类实验的方法分为干预组与对照组,每组28例。干预组进行五禽戏锻炼,对照组进行拉伸锻炼。两组均干预12个月,观察比较膝关节等速肌力测试指标及Berg平衡量表评分(以下简称Berg评分)的变化情况。结果 (1)干预组组内各时点比较:右膝伸肌、左膝屈肌T1与T2的PW比较,差异有统计学意义(P0.05);左右膝关节屈、伸肌T2与T3的PW比较,差异均无统计学意义(P0.05);左右膝关节屈、伸肌T1与T3的PW比较,差异均有统计学意义(P0.05)。对照组组内各时点比较:左右膝关节屈、伸肌T1、T2、T3时点分别两两相比,PW差异均无统计学意义(P0.05)。(2)组间T3时比较,两组左右膝伸肌的PW差异均有统计学意义(P0.05),而两组左右膝屈肌的PW差异均无统计学意义(P0.05)。(3)干预组组内各时点比较:T1、T2、T3两两比较时,Berg评分差异均有统计学意义(P0.05)。对照组组内各时点比较:T1与T2、T1与T3比较时,Berg评分差异均有统计学意义(P0.05);T2与T3比较,Berg评分差异无统计学意义(P0.05)。组间T3时比较,两组Berg评分差异有统计学意义(P0.05)。结论五禽戏锻炼可以提高中老年女性膝关节相关肌力,起到延缓肌力下降、提高平衡能力的作用。     

住院病人跌倒管理中护士自我评价与真实世界跌倒事件的反思与启示

目的:通过传染病专科医院护理人员对于跌倒管理现状的自评及以往跌倒事件的回顾性梳理与分析,挖掘现有跌倒管理体系中的问题,剖析并思考,为今后建立针对不同医疗机构特点的跌倒管理路径的深入研究提供思路。方法:本研究采用横断面研究设计与回顾性分析,于2019年7月1日—2019年8月31日选择在北京地区某传染病专科医院研究期间工作的所有在岗注册护士展开调研,采用《住院病人跌倒预防之临床护士工作自评量表》进行数据收集。同时针对过去5年间该医院发生的41例跌倒事件展开回顾性分析,发现现存问题,探讨管理新思路。结果:参与自评调查的342名护理人员自我评价得分为(242.06±16.21)分,显示出较好的认知水平及预防跌倒的执行力。不同人事编制的护士对陪侍人的宣教工作、不同岗位护士对跌倒标识的管理能力、不同学历护士对病人提供生活用具的意识与能力、不同年龄段护士对后勤部门的协作能力比较差异均存在统计学意义(P<0.05)。结合过去几年间院内发生的41例跌倒事件进行分析,跌倒病人年龄为29～86岁,其中男性27例,女性14例,ADL评分≥60分者30例,事件发生前的最近跌倒风险评分显示无风险者或轻度风...