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Archives of Gerontology and Geriatrics Sep 2024Maintaining physical function is critical for older adults to achieve healthy aging. The Otago exercise program (OEP) has been widely used to prevent falls for older... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Maintaining physical function is critical for older adults to achieve healthy aging. The Otago exercise program (OEP) has been widely used to prevent falls for older adults. However, the effects of OEP on physical function remain controversial and the possible effects modifiers have not been assessed.
OBJECTIVE
To evaluate the effects of OEP on physical function in older adults and to explore potential moderators underlying the effects of OEP.
METHODS
We searched five electronic databases and relevant systematic reviews to identify studies. We included randomized controlled trials (RCTs) evaluating the effects of OEP as a single intervention on physical function among older adults aged 65 and over. Meta-analysis was performed using the random-effects model. Standardized mean differences (SMD) for physical function changes, pertinent to balance, strength, and mobility, were outcome measures. Subgroup analyses on exercise protocol and participants' characteristics were performed.
RESULTS
Thirteen RCTs consisting of 2402 participants were included in this systematic review and meta-analysis. Results indicated a significant effect of OEP on balance (SMD = 0.59, 95 % CI: 0.22∼0.96), lower body strength (SMD = 0.93, 95 % CI: 0.31∼1.55), and mobility (SMD = -0.59, 95 % CI: -0.95∼-0.22) against control groups. No significant OEP effects were found on upper body strength (MD = 1.48, 95 % CI: -0.58∼3.55). Subgroup analysis revealed that the video-supported delivery mode was more effective for improving balance (P = 0.04) and mobility (P = 0.02) than the face-to-face mode. Session durations over 30 min was more effective on lower body strength (P < 0.001) and mobility (P < 0.001) than those 1-30 min. Program period of 13-26 weeks was more effective on mobility (P = 0.02) than those of 4-12 weeks. However, the effects of OEP on physical function were not associated with age groups, and baseline falling risks.
CONCLUSION
The OEP could improve physical function including balance, lower body strength, and mobility in older adults. Implementing the OEP in video-supported, more than 30 min per session and 4-12 weeks may be the most appropriate and effective exercise protocol for improving physical function among older adults. More RCTs with rigorous design and larger scale are needed to further assess the effectiveness of diverse OEP protocols and quantify the dose-effect relationship.
Topics: Humans; Aged; Randomized Controlled Trials as Topic; Postural Balance; Accidental Falls; Exercise Therapy; Muscle Strength; Exercise; Male; Aged, 80 and over; Female
PubMed: 38718487
DOI: 10.1016/j.archger.2024.105470 -
Journal For Healthcare Quality :...As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of...
As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of evidence-based recommendations to guide nursing interventions that enhance the Q&S of patient care is lacking. Therefore, the purpose of our systematic review was to create evidence-based recommendations for the Q&S component of a nursing professional practice model for military hospitals. To accomplish this, a triservice military nursing team used Covidence software to conduct a systematic review of the literature across five databases. Two hundred forty-nine articles met inclusion criteria. From these articles, we created 94 recommendations for practice and identified eight focus areas from the literature: (1) communication; (2) adverse events; (3) leadership; (4) patient experience; (5) quality improvement; (6) safety culture/committees; (7) staffing/workload/work environment; and (8) technology/electronic health record. These findings provide suggestions for implementing Q&S practices that could be adapted to many healthcare delivery systems.
Topics: Humans; Patient Safety; Quality of Health Care; Quality Improvement; Leadership
PubMed: 38717788
DOI: 10.1097/JHQ.0000000000000430 -
Accident; Analysis and Prevention Jul 2024Despite the implementation of legal countermeasures, distracted driving remains a prevalent concern for road safety. This systematic review (following the Preferred...
Despite the implementation of legal countermeasures, distracted driving remains a prevalent concern for road safety. This systematic review (following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) summarised the literature on the impact of interventions targeting attitudes/intentions towards, and self-reported engagement in, distracted driving. Studies were eligible for this review if they examined self-reported behaviour/attitudes/intentions pertaining to distracted driving at baseline and post-intervention. Databases searched included PubMed, ProQuest, Scopus, and TRID. The review identified 19 articles/interventions, which were categorised into three intervention types. First, all program-based interventions (n = 6) reduced engagement in distracted driving. However, there were notable limitations to these studies, including a lack of control groups and difficulties implementing this intervention in a real-world setting. Second, active interventions (n = 9) were commonly utilised, yet a number of studies did not find any improvements in outcomes. Finally, four studies used a message-based intervention, with three studies reporting reduced intention and/or engagement in distracted driving. There is opportunity for message-based interventions to be communicated effortlessly online and target high-risk driving populations. However, further research is necessary to address limitations highlighted in the review, including follow-up testing and control groups. Implications are discussed with particular emphasis on areas where further research is needed.
Topics: Humans; Distracted Driving; Self Report; Intention; Accidents, Traffic; Attitude; Automobile Driving
PubMed: 38703591
DOI: 10.1016/j.aap.2024.107608 -
Accident; Analysis and Prevention Jul 2024Hazard perception (HP) has been argued to improve with experience, with numerous training programs having been developed in an attempt to fast track the development of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hazard perception (HP) has been argued to improve with experience, with numerous training programs having been developed in an attempt to fast track the development of this critical safety skill. To date, there has been little synthesis of these methods.
OBJECTIVE
The present study sought to synthesise the literature for all road users to capture the breadth of methodologies and intervention types, and quantify their efficacy.
DATA SOURCES
A systematic review of both peer reviewed and non-peer-reviewed literature was completed. A total of 57 papers were found to have met inclusion criteria.
RESULTS
Research into hazard perception has focused primarily on drivers (with 42 studies), with a limited number of studies focusing on vulnerable road users, including motorcyclists (3 studies), cyclists (7 studies) and pedestrians (5 studies). Training was found to have a large significant effect on improving hazard perception skills for drivers (g = 0.78) and cyclists (g = 0.97), a moderate effect for pedestrians (g = 0.64) and small effect for motorcyclists (g = 0.42). There was considerable heterogeneity in the findings, with the efficacy of training varying as a function of the hazard perception skill being measured, the type of training enacted (active, passive or combined) and the number of sessions of training (single or multiple). Active training and single sessions were found to yield more consistent significant improvements in hazard perception.
CONCLUSIONS
This study found that HP training improved HP skill across all road user groups with generally moderate to large effects identified. HP training should employ a training method that actively engages the participants in the training task. Preliminary results suggest that a single session of training may be sufficient to improve HP skill however more research is needed into the delivery of these single sessions and long-term retention. Further research is also required to determine whether improvements in early-stage skills translate to improvements in responses on the road, and the long-term retention of the skills developed through training.
Topics: Humans; Accidents, Traffic; Automobile Driving; Motorcycles; Bicycling; Perception; Safety; Pedestrians
PubMed: 38701558
DOI: 10.1016/j.aap.2024.107554 -
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 -
Oral Surgery, Oral Medicine, Oral... Jul 2024Naso-orbito-ethmoidal fractures (NOE) fractures are uncommon but critical injuries. This review aims to investigate the patient factors, procedural factors, and... (Review)
Review
OBJECTIVE
Naso-orbito-ethmoidal fractures (NOE) fractures are uncommon but critical injuries. This review aims to investigate the patient factors, procedural factors, and postoperative outcomes associated with the surgical management of NOE fractures.
STUDY DESIGN
PubMed and Scopus databases were systematically searched between 1993 and 2023 using the search strategy "(naso-orbito-ethmoidal OR nasoethmoid OR nasoorbitoethmoidal) AND fracture." Articles reporting clinical studies investigating the surgical management of NOE fractures were included. Articles that were duplicates, non-English, or non-full text; reported an unclear age range; reported insufficient data; and/or reported on a sample size less than 10 were excluded. Data on patient factors, procedural factors, and postoperative outcomes were extracted.
RESULTS
Of the 412 articles identified, 6 eligible articles (retrospective case series) representing 95 adult cases and 84 pediatric cases were included. The mean ages were 29.0 and 10.2 years, respectively. Most cases were male (65.3%; 73.9%). Motor vehicle accidents were the most common mechanism of injury (79.2% and 50.0%, respectively). Coronal incision was the most common approach. Epiphora (n = 33) and scar problems (n = 21) were the most common complications in adult and pediatric cases, respectively.
CONCLUSIONS
Further robust longitudinal studies with a clear description of fracture classification and surgical timing would be helpful. Gaps in knowledge include concomitant injuries, digitally-assisted applications, and risk factors for adverse outcomes.
Topics: Humans; Orbital Fractures; Ethmoid Bone; Skull Fractures; Nasal Bone
PubMed: 38697897
DOI: 10.1016/j.oooo.2024.02.021 -
Journal of Medical Internet Research Apr 2024Falls and their consequences are a serious public health problem worldwide. Each year, 37.3 million falls requiring medical attention occur. Therefore, the analysis of... (Review)
Review
BACKGROUND
Falls and their consequences are a serious public health problem worldwide. Each year, 37.3 million falls requiring medical attention occur. Therefore, the analysis of fall risk is of great importance for prevention. Artificial intelligence (AI) represents an innovative tool for creating predictive statistical models of fall risk through data analysis.
OBJECTIVE
The aim of this review was to analyze the available evidence on the applications of AI in the analysis of data related to postural control and fall risk.
METHODS
A literature search was conducted in 6 databases with the following inclusion criteria: the articles had to be published within the last 5 years (from 2018 to 2024), they had to apply some method of AI, AI analyses had to be applied to data from samples consisting of humans, and the analyzed sample had to consist of individuals with independent walking with or without the assistance of external orthopedic devices.
RESULTS
We obtained a total of 3858 articles, of which 22 were finally selected. Data extraction for subsequent analysis varied in the different studies: 82% (18/22) of them extracted data through tests or functional assessments, and the remaining 18% (4/22) of them extracted through existing medical records. Different AI techniques were used throughout the articles. All the research included in the review obtained accuracy values of >70% in the predictive models obtained through AI.
CONCLUSIONS
The use of AI proves to be a valuable tool for creating predictive models of fall risk. The use of this tool could have a significant socioeconomic impact as it enables the development of low-cost predictive models with a high level of accuracy.
TRIAL REGISTRATION
PROSPERO CRD42023443277; https://tinyurl.com/4sb72ssv.
Topics: Accidental Falls; Humans; Artificial Intelligence; Risk Assessment; Postural Balance
PubMed: 38684088
DOI: 10.2196/54934 -
Forensic Science International Jun 2024Bicycles are employed as means of transportation across various age groups, from young students to the elderly, for work, education, health, and leisure trips. Despite... (Review)
Review
Bicycles are employed as means of transportation across various age groups, from young students to the elderly, for work, education, health, and leisure trips. Despite not achieving high speeds, bicyclists remain vulnerable to severe and even fatal injuries when they are involved in traffic accidents. Although the rising awareness of ecological issues and traffic law enforcement mean that cyclists are increasingly susceptible to road traffic crashes and injuries. Injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence. The aim of this study is to provide a systematic review of the literature on injuries sustained in cyclists involved in road accidents describing and analysing elements useful for forensic assessment. The literature search was performed using PubMed, Scopus, and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving bicycles. A total of 128 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the bicycle accident was examined and discussed. This review highlights that injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence and the energy levels involved in the crash. The assessment of injuries offers valuable insights that integrated with circumstantial and engineering data perform the reconstruction of accident dynamics.
Topics: Humans; Bicycling; Accidents, Traffic; Wounds and Injuries
PubMed: 38677158
DOI: 10.1016/j.forsciint.2024.112027 -
BMC Health Services Research Apr 2024In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting...
BACKGROUND
In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient safety (PS) research using the GRIPP2 checklist.
METHODS
Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to December, 2023. Studies on PPI in PS research were included. We included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-SF) checklist.
RESULTS
A total of 8561 studies were retrieved from database searches, updates, and reference checks, of which 82 met the eligibility criteria and were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials. Only 6.1% (n = 5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which PPI influenced the study overall.
CONCLUSIONS
Our review shows a low frequency of PPI reporting in PS research using the GRIPP2 checklist. Furthermore, it reveals a sub-optimal quality in PPI reporting following GRIPP2-SF items. Researchers, funders, publishers, and journals need to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be encouraged and supported as it helps future researchers to plan and report PPI more effectively.
TRIAL REGISTRATION
The review protocol is registered with PROSPERO (CRD42023450715).
Topics: Humans; Patient Safety; Patient Participation; Checklist
PubMed: 38671476
DOI: 10.1186/s12913-024-11021-z -
JAMA Network Open Apr 2024Over the past 2 decades, several digital technology applications have been used to improve clinical outcomes after abdominal surgery. The extent to which these... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Over the past 2 decades, several digital technology applications have been used to improve clinical outcomes after abdominal surgery. The extent to which these telemedicine interventions are associated with improved patient safety outcomes has not been assessed in systematic and meta-analytic reviews.
OBJECTIVE
To estimate the implications of telemedicine interventions for complication and readmission rates in a population of patients with abdominal surgery.
DATA SOURCES
PubMed, Cochrane Library, and Web of Science databases were queried to identify relevant randomized clinical trials (RCTs) and nonrandomized studies published from inception through February 2023 that compared perioperative telemedicine interventions with conventional care and reported at least 1 patient safety outcome.
STUDY SELECTION
Two reviewers independently screened the titles and abstracts to exclude irrelevant studies as well as assessed the full-text articles for eligibility. After exclusions, 11 RCTs and 8 cohort studies were included in the systematic review and meta-analysis and 7 were included in the narrative review.
DATA EXTRACTION AND SYNTHESIS
Data were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline and assessed for risk of bias by 2 reviewers. Meta-analytic estimates were obtained in random-effects models.
MAIN OUTCOMES AND MEASURES
Number of complications, emergency department (ED) visits, and readmissions.
RESULTS
A total of 19 studies (11 RCTs and 8 cohort studies) with 10 536 patients were included. The pooled risk ratio (RR) estimates associated with ED visits (RR, 0.78; 95% CI, 0.65-0.94) and readmissions (RR, 0.67; 95% CI, 0.58-0.78) favored the telemedicine group. There was no significant difference in the risk of complications between patients in the telemedicine and conventional care groups (RR, 1.05; 95% CI, 0.77-1.43).
CONCLUSIONS AND RELEVANCE
Findings of this systematic review and meta-analysis suggest that perioperative telehealth interventions are associated with reduced risk of readmissions and ED visits after abdominal surgery. However, the mechanisms of action for specific types of abdominal surgery are still largely unknown and warrant further research.
Topics: Humans; Telemedicine; Patient Safety; Patient Readmission; Postoperative Complications; Abdomen; Digital Health
PubMed: 38669018
DOI: 10.1001/jamanetworkopen.2024.8555