Anabolic steroids for rehabilitation after hip fracture in older people (Protocol)

THIS IS NOT THE MOST RECENT VERSION OF THIS PROTOCOL please see: http://hdl.handle.net/2328/39182 Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is made available in accordance with Cochrane Database of Systematic Review's repositories policyThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To examine the effects of anabolic steroids on functional outcome (independence, mobility and activities of daily living) after surgical treatment of hip fracture in older people. The following main comparisons are intended, set in the context of usual or conventional care: Anabolic steroids versus no or placebo intervention Anabolic steroids with other intervention (either nutrition or exercises or both) versus no or placebo interventio

Using audit and feedback to increase clinician adherence to clinical practice guidelines in brain injury rehabilitation: v

ObjectiveThis study evaluated whether frequent (fortnightly) audit and feedback cycles over a sustained period of time (>12 months) increased clinician adherence to recommended guidelines in acquired brain injury rehabilitation.DesignA before and after study design.SettingA metropolitan inpatient brain injury rehabilitation unit.ParticipantsClinicians; medical, nursing and allied health staff.InterventionsFortnightly cycles of audit and feedback for 14 months. Each fortnight, medical file and observational audits were completed against 114 clinical indicators.Main outcome measureAdherence to guideline indicators before and after intervention, calculated by proportions, Mann-Whitney U and Chi square analysis.ResultsClinical and statistical significant improvements in median clinical indicator adherence were found immediately following the audit and feedback program from 38.8% (95% CI 34.3 to 44.4) to 83.6% (95% CI 81.8 to 88.5). Three months after cessation of the intervention, median adherence had decreased from 82.3% to 76.6% (95% CI 72.7 to 83.3, pConclusionA fortnightly audit and feedback program increased clinicians’ adherence to guideline recommendations in an inpatient acquired brain injury rehabilitation setting. We propose future studies build on the evidence-based method used in the present study to determine effectiveness and develop an implementation toolkit for scale-up.</div

Important features of home-based support services for older Australians and their informal carers

This author accepted manuscript (post print) is made available in accordance with the publisher copyright policy following 24 month embargo from the date of publication (8 February 2015) in accordance with publishers copyright policy.In Australia, newly initiated, publicly subsidised ‘Home-Care Packages’ designed to assist older people (≥65 years of age) living in their own home must now be offered on a ‘consumer-directed care’ (CDC) basis by service providers. However, CDC models have largely developed in the absence of evidence on users’ views and preferences. The aim of this study was to determine what features (attributes) of consumer-directed, home-based support services are important to older people and their informal carers to inform the design of a discrete choice experiment (DCE). Semi-structured, face-to-face interviews were conducted in December 2012–November 2013 with 17 older people receiving home-based support services and 10 informal carers from 5 providers located in South Australia and New South Wales. Salient service characteristics important to participants were determined using thematic and constant comparative analysis and formulated into attributes and attribute levels for presentation within a DCE. Initially, eight broad themes were identified: information and knowledge, choice and control, self-managed continuum, effective co-ordination, effective communication, responsiveness and flexibility, continuity and planning. Attributes were formulated for the DCE by combining overlapping themes such as effective communication and co-ordination, and the self-managed continuum and planning into single attributes. Six salient service features that characterise consumer preferences for the provision of home-based support service models were identified: choice of provider, choice of support worker, flexibility in care activities provided, contact with the service co-ordinator, managing the budget and saving unspent funds. Best practice indicates that qualitative research with individuals who represent the population of interest should guide attribute selection for a DCE and this is the first study to employ such methods in aged care service provision. Further development of services could incorporate methods of consumer engagement such as DCEs which facilitate the identification and quantification of users’ views and preferences on alternative models of delivery

What are frail older people prepared to endure to achieve improved mobility following hip fracture? A Discrete Choice Experiment

Publisher's version made available in accordance with the publisher's policy.Objective: To investigate the preferences of frail older people for individualised multidisciplinary rehabilitation to promote recovery from a hip fracture. Design: Discrete Choice Experiment. Setting: Acute and Rehabilitation Hospitals in Adelaide, South Australia. Subjects: Eighty-seven patients with recent hip fracture (16 living in residential care facilities prior to fracture). Methods: Patients providing informed consent (or consenting family carer proxies in cases where patients were unable to provide informed consent (n = 10)) participated in a face to face interview following surgery to repair a fractured hip to assess their preferences for different configurations of rehabilitation programs. Results: Overall, participants expressed a strong preference for improvements in mobility and a willingness to participate in rehabilitation programs involving moderate pain and effort. However, negative preferences were observed for extremely painful interventions involving high levels of effort (2 h per day for 2 months). Subgroup analysis revealed consistently similar preferences according to place of residence (residential care vs community). Conclusions: Improvements in mobility are highly valued by frail older people recovering from hip fracture, including those living in residential care. Further research should be directed towards achieving greater equity in access to rehabilitation services for the wide spectrum of patients attending hospital with hip fractures. Key words: discrete choice experiment; hip fracture; older people; residential care; rehabilitation

Study and optimization of RPCs for high rate applications

Due to the low cost, good time resolution and the properties of RPCs with respect to electronics damage protection, they are chosen for many large experiments. These detectors are reliable and stable in their operation with counting rates up to kHz/cm2. The aim of this work is to understand the fundamental rate limits of RPCs in order to find an efficient way for their optimization and hence, extend their applications. Several types of materials have been used and operational parameters have been optimized in this work comprising simulations and experiment. High efficiency, excellent position resolution, low noise and high rate capability is demonstrated. These type of RPCs open new avenues in several applications, for example in crystallography, biology and medicine

Promoting Activity in Geriatric Rehabilitation: A Randomized Controlled Trial of Accelerometry

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background Low activity levels in inpatient rehabilitation are associated with adverse outcomes. The study aimed to test whether activity levels can be increased by the provision of monitored activity data to patients and clinicians in the context of explicit goal setting. Methods A randomized controlled trial in three sites in Australia included 255 inpatients aged 60 and older who had a rehabilitation goal to become ambulant. The primary outcome was patients’ walking time measured by accelerometers during the rehabilitation admission. Walking times from accelerometry were made available daily to treating therapists and intervention participants to motivate patients to improve incidental activity levels and reach set goals. For the control group, ‘usual care’ was followed, including the setting of mobility goals; however, for this group, neither staff nor patients received data on walking times to aid the setting of daily walking time targets. Results The median daily walking time in the intervention group increased from 10.3 minutes at baseline to 32.1 minutes at day 28, compared with an increase from 9.5 to 26.5 minutes per day in the control group. Subjects in the intervention group had significantly higher non-therapy walking time by about 7 minutes [mean (95% CI): 24.6 (21.7, 27.4)] compared to those in the control group [mean(95% CI): 17.3 (14.4, 20.3)] (p = 0.001). Conclusions Daily feedback to patients and therapists using an accelerometer increased walking times during rehabilitation admissions. The results of this study suggest objective monitoring of activity levels could provide clinicians with information on clinically important, mobility-related activities to assist goal setting. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12611000034932 http://www.ANZCTR.org.au

A new type of resistive plate chamber: the multigap RPC

This paper describes the multigap resistive plate chamber (RPC). The goal is to obtain a much improved time resolution, keeping the advantages of the wide gap RPC in comparison with the conventional narrow gap RPC (smaller dynamic range and thus lower charge per avalanche which gives higher rate capability and lower power dissipation in the gas gap)

Rehabilitation in dementia care

The Accepted Manuscript (AM) is the final draft author manuscript, as accepted for publication by a journal, including modifications based on referees’ suggestions, before it has undergone copyediting, typesetting and proof correction. This is sometimes referred to as the post-print version. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: [email protected] rehabilitation is increasingly accepted as valuable in the management of chronic disease. Whereas traditional rehabilitation models focussed on recovery, maintaining independence and delaying functional decline are now considered worthwhile aims even where full recovery is not feasible. Despite this, rehabilitation is notably absent from dementia care literature and practice. People with dementia report frustration with the lack of availability of structured post-diagnosis pathways like those offered for other conditions. Alternative terms such as ‘re-ablement’ are used to refer to rehabilitation-like services, but lack an evidence-base to guide care. This commentary will discuss possible reasons for the resistance to accept multidisciplinary rehabilitation as part of dementia care, and identifies the value of doing so for people with dementia, their families, and for health professionals

Body composition in older community-dwelling adults with hip fracture: portable field methods validated by dual-energy X-ray absorptiometry

Ageing is associated with weight loss and subsequently poor health outcomes. The present study assessed agreement between two field methods, bioelectrical impedance spectroscopy (BIS) and corrected arm muscle area (CAMA) for assessment of body composition against dual-energy X-ray absorptiometry (DXA), the reference technique. Agreement between two predictive equations estimating skeletal muscle mass (SMM) from BIS against SMM from DXA was also determined. Assessments occurred at baseline < 14 d post-surgery (n 79), and at 6 months (6M; n 75) and 12 months (12M; n 63) in community-living older adults after surgical treatment for hip fracture. The 95 % limits of agreement (LOA) between BIS and DXA, CAMA and DXA and the equations and DXA were assessed using Bland–Altman analyses. Mean bias and LOA for fat-free mass (FFM) between BIS and DXA were: baseline, 0·7 ( − 10·9, 12·4) kg; 6M, − 0·5 ( − 20·7, 19·8) kg; 12M, 0·1 ( − 8·7, 8·9) kg and for SMM between CAMA and DXA were: baseline, 0·3 ( − 11·7, 12·3) kg; 6M, 1·3 ( − 4·5, 7·1) kg; 12M, 0·9 ( − 5·4, 7·2) kg. Equivalent data for predictive equations against DXA were: equation 1: baseline, 15·1 ( − 9·5, 20·6) kg; 6M, 17·1 ( − 12·0, 22·2) kg; 12M, 17·5 ( − 13·0, 22·0) kg; equation 2: baseline, 12·6 ( − 7·3, 19·9) kg; 6M, 14·4 ( − 9·7, 19·1) kg; 12M, 14·8 ( − 10·7, 18·9) kg. Proportional bias (BIS: β = − 0·337, P< 0·001; CAMA: β = − 0·294, P< 0·001) was present at baseline but not at 6M or 12M. Clinicians should be cautious in using these field methods to predict FFM and SMM, particularly in the acute care setting. New predictive equations would be beneficial.This research was supported by the National Health and Medical Research Council (NHMRC), Australia