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Medical Science Monitor : International... Jan 2024BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was...
BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC. MATERIAL AND METHODS A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (M.L. and A.P.) independently screened the titles and abstracts, and full-text articles were assessed for eligibility. Data were extracted, and a quality assessment was performed using appropriate techniques. RESULTS A total of 15 studies met the inclusion criteria. The studies included in the review demonstrated a correlation between rationing of nursing care and patient safety. The results of these studies revealed that there is an inverse relationship between rationing of nursing care and patient safety. The review found that when nursing care is rationed, there is a higher incidence of falls, medication errors, pressure ulcers, infections, and readmissions. In addition, the review identified that the work characteristics of nurses, such as workload, staffing levels, and experience, were associated with RONC. CONCLUSIONS RONC has a negative impact on patient safety outcomes. It is essential for healthcare organizations to implement effective strategies to prevent the RONC. Improving staffing levels, workload management, and communication amo0ng healthcare providers are some of the strategies that can support this.
Topics: Humans; Health Care Rationing; Patient Safety; Accidental Falls; Communication; Databases, Factual
PubMed: 38196186
DOI: 10.12659/MSM.942031 -
Enfermeria Clinica (English Edition) 2024To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. (Meta-Analysis)
Meta-Analysis
Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT.
OBJECTIVE
To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals.
METHODS
We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016-2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category.
RESULTS
A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR+=0.87). Multifactorial (RR+=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively.
CONCLUSIONS
Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.
Topics: Humans; Aged; Exercise; Accidents, Home; Accidental Falls; Randomized Controlled Trials as Topic
PubMed: 38185371
DOI: 10.1016/j.enfcle.2024.01.001 -
Annals of Medicine and Surgery (2012) Dec 2023The risk of falls in people living with HIV (PLHIVs) on antiretroviral therapy (ART) has received little attention in the literature. The aim of the meta-analysis is to... (Review)
Review
OBJECTIVE
The risk of falls in people living with HIV (PLHIVs) on antiretroviral therapy (ART) has received little attention in the literature. The aim of the meta-analysis is to quantify the association between fall risk and various categories of drugs used in ART.
MATERIAL AND METHODS
PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Any observational study or controlled trial that reported on the relationship of at least one antiretroviral drug with falls in PLHIVs was included. Data on the frequency of single fallers, multiple fallers (≥2 falls), and non-fallers were extracted and studied for each drug and drug category. The pooled results were reported as an odds ratio (OR) with a 95% confidence interval (CI).
RESULTS
A total of five observational studies (51 675 participants) were included out of 414 articles obtained through a literature review. Stavudine use was found to be associated with an increased risk of single falls in PLHIVs (OR: 1.69, 95% CI: 1.08-2.66, =0.02). However, efavirenz (OR: 0.82, 95% CI=0.76-0.89, <0.001) and zidovudine (OR: 0.82, 95% CI=0.77-0.92, <0.001) were found protective against the single falls. Didanosine had no significant association with fall risk (OR: 1.23, 95% CI: 0.78-1.93, =0.37). Likewise, protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were discovered to have no significant association with fall risk.
CONCLUSION
Most drug categories of ART have no significant association with the risk of falls in PLHIVs. However, certain drugs, such as didanosine and stavudine, which have the inherent effect of causing balance deficits and neuropathy, should be used cautiously.
PubMed: 38098550
DOI: 10.1097/MS9.0000000000001411 -
Gait & Posture May 2024To examine whether immersive virtual reality (VR) can improve balance, gait, mobility and fear of falling in older people. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To examine whether immersive virtual reality (VR) can improve balance, gait, mobility and fear of falling in older people.
DATA SOURCES
MEDLINE, EMBASE, CINAHL, PsycINFO, ProQuest Central (Engineering and Computer Science) and reference lists of included articles.
STUDY SELECTION
Randomised controlled trials that administered immersive VR training and assessed balance, gait and mobility outcomes in older adults without neurological disorders (mean age ≥ 65). Primary outcomes were standing balance (e.g. postural sway), multi-item balance scales (e.g. Berg Balance Scale), gait (e.g. gait speed) and mobility (e.g. Timed Up and Go test). Secondary outcomes comprised measures of enjoyment, fear of falling, adherence (e.g. dropout rate), feasibility/usability and adverse effects (e.g. motion sickness).
RESULTS
Meta-analyses showed that immersive VR training significantly improved standing balance (SMD: 0.51, 95% CI: .15, 0.86, p = 0.005, I = 28% - 3 studies, n = 79) and performance on the Berg Balance Scale (MD: 2.36, 95% CI: 1.17, 3.56, p=0.0001, I=0% - 4 studies, n = 190). No significant improvement in gait, mobility or fear of falling was found. Subgroup analyses revealed higher training doses (≥4.5 total hours) and VR interventions using non-head mounted displays were more likely to improve standing balance. No meta-analyses were conducted for enjoyment, adherence, feasibility/usability and adverse events.
CONCLUSIONS
The findings indicate immersive VR has beneficial effects on balance, but not gait, mobility or fear of falling. Further research is required to examine these outcomes in trials that also include quantitative measurements of enjoyment, adherence, clinical feasibility, usability and adverse effects.
Topics: Humans; Postural Balance; Aged; Gait; Accidental Falls; Virtual Reality Exposure Therapy; Virtual Reality
PubMed: 38581933
DOI: 10.1016/j.gaitpost.2024.03.009 -
BMC Geriatrics May 2024The association between vitamin D supplementation and the risk of falls in older adults has been controversial. This systematic review and network meta-analysis aims to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The association between vitamin D supplementation and the risk of falls in older adults has been controversial. This systematic review and network meta-analysis aims to assess the efficacy of vitamin D, calcium, and combined supplementation in the prevention of falls.
METHODS
Randomized controlled trials (RCTs) on the efficacy of vitamin D in fall prevention were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science from inception to May 9, 2023. The network meta-analysis was performed using a random effects model in R4.1.3 and Stata15.0. Heterogeneity was evaluated by the I statistic, and publication bias was assessed using funnel plots, Begg's test, and Egger's tests. Data were pooled and expressed as relative risk (RR) and 95% confidence interval (CI).
RESULTS
A total of 35 RCTs involving 58,937 participants were included in this study, among which 11 RCTs (31.4%) applied calcium combined with vitamin D. There was low heterogeneity (I = 11%) among the included studies. Vitamin D supplementation at 800-1000 International Unit (IU)/d resulted in a lower risk of falls than placebo or no treatment (RR = 0.85, 95%CI: 0.74-0.95). In addition, 800-1000 IU/d of vitamin D with or without calcium were more effective in preventing falls than calcium alone. High-dose vitamin D (> 1000 IU/day) increased the risk of falls compared with 800-1000 IU/d of vitamin D. According to the subgroup analysis, daily administration of 800-1000 IU/d vitamin D was associated with a 22% reduction in the risk of falls (RR = 0.78, 95%CI:0.64-0.92), whereas intermittent vitamin D administration had no preventive effect. Furthermore, 800-1000 IU/d of vitamin D also significantly decreased the risk of falls in old adults with ≤ 50 nmol/L 25-hydroxyvitamin D [25(OH)D] (RR = 0.69, 95%CI:0.52-0.86) but not in individuals with > 50 nmol/L 25(OH)D.
CONCLUSION
Vitamin D supplementation at 800-1000 IU/d is associated with a lower risk of falls among older adults. 800-1000IU/d of vitamin D has a benefit on prevention of falls in population received daily dose regimens and in population with vitamin D deficiency.
Topics: Accidental Falls; Humans; Vitamin D; Dietary Supplements; Network Meta-Analysis; Aged; Randomized Controlled Trials as Topic; Calcium; Vitamins
PubMed: 38698349
DOI: 10.1186/s12877-024-05009-x -
Expert Review of Medical Devices 2024Wearable devices and telemedicine are increasingly used to track health-related parameters across patient populations. Since gait and postural control deficits... (Review)
Review
INTRODUCTION
Wearable devices and telemedicine are increasingly used to track health-related parameters across patient populations. Since gait and postural control deficits contribute to mobility deficits in persons with movement disorders and multiple sclerosis, we thought it interesting to evaluate devices in telemedicine for gait and posture monitoring in such patients.
METHODS
For this systematic review, we searched the electronic databases MEDLINE (PubMed), SCOPUS, Cochrane Library, and SPORTDiscus. Of the 452 records retrieved, 12 met the inclusion/exclusion criteria. Data about (1) study characteristics and clinical aspects, (2) technical, and (3) telemonitoring and teleconsulting were retrieved, The studies were quality assessed.
RESULTS
All studies involved patients with Parkinson's disease; most used triaxial accelerometers for general assessment ( = 4), assessment of motor fluctuation ( = 3), falls ( = 2), and turning ( = 3). Sensor placement and count varied widely across studies. Nine used lab-validated algorithms for data analysis. Only one discussed synchronous patient feedback and asynchronous teleconsultation.
CONCLUSIONS
Wearable devices enable real-world patient monitoring and suggest biomarkers for symptoms and behaviors related to underlying gait disorders. thus enriching clinical assessment and personalized treatment plans. As digital healthcare evolves, further research is needed to enhance device accuracy, assess user acceptability, and integrate these tools into telemedicine infrastructure.
PROSPERO REGISTRATION
CRD42022355460.
Topics: Humans; Gait; Posture; Wearable Electronic Devices; Parkinson Disease; Telemedicine; Multiple Sclerosis
PubMed: 38124300
DOI: 10.1080/17434440.2023.2298342 -
Osteoporosis International : a Journal... Aug 2023Previous randomized controlled trials have reported inconsistent findings regarding the effects of high-dose vitamin D supplementation on a risk of falls and fractures.... (Meta-Analysis)
Meta-Analysis
UNLABELLED
Previous randomized controlled trials have reported inconsistent findings regarding the effects of high-dose vitamin D supplementation on a risk of falls and fractures. This meta-analysis of 15 trials shows that intermittent or single high-dose vitamin D supplementation had no preventive effect on the risk of falls and fractures and might even increase the risk of falls.
PURPOSE
Randomized controlled trials (RCTs) have reported controversial findings regarding the associations between intermittent or single high-dose vitamin D supplementation and a risk of falls and fractures in adults. This study aimed to investigate those associations using a systematic review and meta-analysis.
METHODS
We searched PubMed, EMBASE, and Cochrane Library from inception to May 25, 2022. Data were extracted for a random-effects meta-analysis to calculate a pooled relative risk (RR) with a 95% confidence interval (CI).
RESULTS
Out of 527 articles, a total of 15 RCTs were included in the final analysis. In a meta-analysis of RCTs, intermittent or single high-dose vitamin D supplementation showed no significant beneficial effect in the prevention of either falls (RR, 1.03 [95% CI, 0.98-1.09]; I = 56.6%; n = 11) or fractures (RR, 0.99 [95% CI, 0.87-1.14]; I = 48.3%; n = 11). Among the subgroup meta-analyses by various factors, intermittent or single high-dose vitamin D supplementation reduced the risk of fractures in the subgroup meta-analysis of RCTs that included fewer than 1000 participants (RR, 0.74 [95% CI 0.57-0.96]; I = 0.0%; n = 5). However, its beneficial effect was not observed in those including 1000 or more participants (RR, 1.06 [95% CI 0.92-1.21]; I = 57.5%; n = 6). In contrast, intermittent or single high-dose vitamin D3 supplementation increased the risk of falls on the borderline of statistical significance (RR, 1.06 [95% CI 0.99-1.15]; P = 0.051; I = 50.0%; n = 7).
CONCLUSIONS
Intermittent or single high-dose vitamin D supplementation had no preventive effect on the risk of falls and fractures and might even increase the risk of falls.
Topics: Adult; Humans; Vitamin D; Accidental Falls; Dietary Supplements; Vitamins; Fractures, Bone
PubMed: 37120684
DOI: 10.1007/s00198-023-06761-3 -
International Journal of Nursing... Aug 2023The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults... (Review)
Review
AIMS
The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults.
METHODS
A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors.
RESULTS
Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings.
CONCLUSION
The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.
Topics: Humans; Aged; Independent Living; Accidental Falls; Cross-Sectional Studies; Reproducibility of Results; Risk Factors; Risk Assessment
PubMed: 35871775
DOI: 10.1111/ijn.13083 -
Experimental Gerontology Oct 2023Falls are the second leading cause of accidental injury deaths globally. Older age is a key risk factors for falls. Besides older age, physical inactivity and... (Review)
Review
BACKGROUND
Falls are the second leading cause of accidental injury deaths globally. Older age is a key risk factors for falls. Besides older age, physical inactivity and malnutrition are identified risk factors for falls. Smart health technologies might offer a sustainable solution to prevent falls by supporting physical activity and nutritional status.
OBJECTIVE
The aim is to identify, describe, and synthesize knowledge, and identify knowledge gaps on the use of existing smart health technologies to support health behaviour in relation to physical activity and nutrition, among older (65+) in risk of falling.
METHODS
A scoping review was conducted following the PRISMA-ScR. Searches were carried out in PubMed, Scopus, and Embase using search strings on the themes; smart health technology, physical activity, nutrition, behaviour, falls and older. Identified literature was screened. Data from the included studies was extracted and synthesized.
RESULTS
2948 studies were obtained through searches. 18 studies were included. Various smart health technologies are used for fall prevention to support physical activity among older, including software and applications for smart phones, TV, and tablet. Three gaps were identified: use of smart health technologies to support nutrition in fall prevention. Inclusion of relevant stakeholders and fall prevention in low-and middle-income countries.
CONCLUSIONS
Smart health technology can offer sustainable and cost-effective fall prevention in the future. More knowledge is needed on the use of smart health technologies to support nutritional status for fall prevention, and studies involving older with physical and cognitive conditions, and studies on measures for fall prevention in low- and middle-income countries is needed.
Topics: Accidental Falls; Biomedical Technology; Eating; Exercise; Health Behavior; Humans; Aged
PubMed: 37660762
DOI: 10.1016/j.exger.2023.112282 -
Clinical Rehabilitation Sep 2023To evaluate the prevalence and factors associated with vestibular dysfunction in people who fall. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the prevalence and factors associated with vestibular dysfunction in people who fall.
DATA SOURCES
All electronic records from MEDLINE, CINAHL, Embase and psycINFO databases were searched to 9 December 2022.
REVIEW METHODS
Participants were adults with at least one fall within the previous year who were exposed to at least one vestibular function test. Any published peer reviewed trial designs were accepted. Included studies were assessed for risk of bias using a modified Epidemiological Appraisal Instrument. The quality of each meta-analysis was assessed using modified Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULTS
Ten trials (468 participants) were identified, six of which had high methodological quality. Vestibular dysfunction was found in 61% (48.01-72.32) = 78% of participants. The most prevalent type of dysfunction was from tests of vestibulo-ocular reflex at 61% (49.79 to 70.49) = 68%, followed by benign paroxysmal positional vertigo at 22% (10.30-40.32) = 87% and central dysfunction at 11% (2.24-37.76) = 50%. People who fall with vestibular dysfunction had reduced walking function compared to those without dysfunction -0.51 (-0.85 to -0.16) = 11%. Dizziness was not related to vestibular dysfunction in people who fall 0.25 (-0.10 to 0.60), = 0%. The quality of the body of evidence ranged from very low to high.
CONCLUSION
More than one in two people who fall have vestibular dysfunction. Clinicians cannot rely on dizziness report to indicate need for vestibular screening in those who fall. A vestibular screen should be incorporated into a comprehensive falls assessment.
Topics: Adult; Humans; Prevalence; Vertigo; Dizziness; Risk Assessment
PubMed: 37036433
DOI: 10.1177/02692155231162423