Balance and falls risk in women with lower limb osteoarthritis or rheumatoid arthritis

Lower limb arthritis is a risk factor for falls, although few studies have used comprehensive balance assessment to determine the degree to which this contributes to falls risk. This study evaluated the falls risk and balance impairment of women with lower limb osteoarthritis (OA) or rheumatoid arthritis (RA). Methods: A cross-sectional comparative study was conducted of women living in the general community. Seventeen women with lower limb OA [mean age: 66.9 years, standard deviation (SD) ¼ 9.8 years], 17 with lower limb RA (mean age: 66.3 years, SD ¼ 9.4 years), and 17 age-matched healthy (no lower limb arthritis) women (mean age: 66.3 years, SD ¼ 10.1 years) were recruited. All participants underwent a comprehensive balance and mobility assessment, including clinical balance measures (Step Test, Functional Reach), self-generated (Neurocom Balance Master long plate), and externally generated (Chattecx Balance System) force platform measures. Falls risk was assessed using the Falls Risk for Older People e Community version (FROP-Com). Results: Sixty-five percent of the OA and 65% of the RA women reported one or more falls in the preceding 12 months, and both groups had significantly higher falls risk (FROP-Com) than the matched sample (p < 0.001). Both OA and RA participants had significantly impaired balance and mobility, lower activity level, and lower falls efficacy after adjustment for multiple comparisons, compared to the matched sample. Although women with RA performed worse on the majority of measures than the OA women, the difference was only significant for the Maximum Excursion measure of the Limits of Stability test. Conclusions:Women with lower limb OA or RA have mild to moderate falls risk and balance impairments in comparison to age-matched older women. Further research is needed to evaluate whether exercise programs targeting balance performance, and other interventions to address their multiple falls risk factors, can improve balance and reduce falls in these clinical groups

Evaluation of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) a staff simulation training intervention to improve palliative care of people with advanced dementia living in nursing homes: a cluster randomised controlled trial

Background: People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care. Objective: The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia. Design: Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside. Subjects & setting: One thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. Methods: Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence. Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes. Results: At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified. Conclusion: This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618002012257. Registered 14 December 2018

Transforming knowledge systems for life on Earth: Visions of future systems and how to get there

© 2020 The Author(s) Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent