Predicting the risk of falling – efficacy of a risk assessment tool compared to nurses' judgement: a cluster-randomised controlled trial [ISRCTN37794278]

BACKGROUND: Older people living in nursing homes are at high risk of falling because of their general frailty and multiple pathologies. Prediction of falls might lead to an efficient allocation of preventive measures. Although several tools to assess the risk of falling have been developed, their impact on clinically relevant endpoints has never been investigated. The present study will evaluate the clinical efficacy and consequences of different fall risk assessment strategies. STUDY DESIGN: Cluster-randomised controlled trial with nursing home clusters randomised either to the use of a standard fall risk assessment tool alongside nurses' clinical judgement or to nurses' clinical judgement alone. Standard care of all clusters will be optimised by structured education on best evidence strategies to prevent falls and fall related injuries. 54 nursing home clusters including 1,080 residents will be recruited. Residents must be ≥ 70 years, not bedridden, and living in the nursing home for more than three months. The primary endpoint is the number of participants with at least one fall at 12 months. Secondary outcome measures are the number of falls, clinical consequences including side effects of the two risk assessment strategies. Other measures are fall related injuries, hospital admissions and consultations with a physician, and costs

Pre-andean area of Santiago de Chile: Perceptions, attitudes and preferences of urban visitors

The aim of this work was to determine the attitudes, perceptions and preferences of the visitors in relation to the pre-andean landscapes of Santiago. Questionnaires and interviews to the visitors were carried out in different places of this area. The results show that the visitors perceive the pre-andean area as a deteriorated landscape, due to urban expansion. They agree that it is important to generate a harmonious relationship between the city and its natural environment, through a planning process that is coherent with the landscape, such as the creation of environmental education programmes for the people to know and protect the ecosystem. Furthermore, it was found out that the majority of the visitors prefer forested landscapes, slightly altered, and that natural vegetation impacts positively on people’s opinion.The results put forward the development of an active management process of the landscape, that involves the expectations and needs of the citizens, and a urban development based on environmental sustainable development, which should tend to recover the natural landscapes of the pre-andean area of Santiago as a project, common to all citizens.El propósito de este trabajo fue conocer las actitudes, percepciones y preferencias de visitantes por los paisajes precordilleranos de Santiago. Se construyó y aplicó un cuestionario a visitantes y se realizaron entrevistas en distintos sitios de la precordillera. Los resultados muestran que los visitantes perciben la precordillera de Santiago como un paisaje deteriorado, debido a la expansión urbana. Concuerdan en que es importante generar una relación armoniosa entre la ciudad y su entorno natural, a través de una ordenación coherente del paisaje; como crear programas de educación ambiental para que la gente conozca y proteja este ecosistema. Además, se constató que la mayoría de los visitantes prefiere paisajes boscosos, poco alterados, y la vegetación natural incide en la valoración positiva de los individuos.A partir de los resultados se sugiere desarrollar una gestión activa del paisaje, que involucre las expectativas y necesidades de la población y, un desarrollo urbanístico basado en el desarrollo ambiental sostenible, lo que debería tender a recuperar los paisajes naturales de la precordillera de Santiago como un proyecto común de todos los ciudadanos

Precordillera Andina de Santiago: Percepciones, actitudes y preferencias en visitantes urbanos

El propósito del trabajo fue conocer las actitudes, percepciones y preferencias de visitantes por los paisajes precordilleranos de Santiago. Se construyó y aplicó un cuestionario a visitantes y se realizaron entrevistas en profundidad en distintos sitios de la precordillera. Los resultados muestran que los visitantes perciben la precordillera de Santiago como un paisaje deteriorado, debido a la expansión urbana. Concuerdan en que es importante generar una relación armoniosa entre la ciudad y su entorno natural, a través de una ordenación coherente del paisaje; como crear programas de educación ambiental para que la gente conozca y proteja este ecosistema. Además, se constato que la mayoría de los visitantes prefiere paisajes boscosos, poco alterados, y la vegetación natural incide en la valoración positiva de los individuos. A partir de los resultados se sugiere desarrollar una gestión activa del paisaje, que involucre las expectativas y necesidades de la población y, un desarrollo urbanístico basado en el desarrollo ambiental sostenible, lo que debería tender a recuperar los paisajes naturales de la precordillera de Santiago como un proyecto común de todos los ciudadanos

Training of patient and consumer representatives in the basic competencies of evidence-based medicine: a feasibility study

<p>Abstract</p> <p>Background</p> <p>Evidence-based medicine (EBM) has become standard approach in medicine. Patients and health authorities increasingly claim active patient roles in decision making. Education to cope with these roles might be useful. We investigated the feasibility, acceptability and possible impact of EBM training courses for patient and consumer representatives.</p> <p>Methods</p> <p>We designed a generic one-week EBM course based on previous experience with EBM courses for non-medical health professionals. A course specific competence test has been developed and validated to measure EBM skills. Formative and summative evaluation of the course comprised: 1) EBM skills; 2) individual learning goals; 3) self-reported implementation after six months using semi-structured interviews; 4) group-based feedback by content analysis. EBM skills' achievement was compared to results gathered by a group of undergraduate University students of Health Sciences and Education who had attended a comparable EBM seminar.</p> <p>Results</p> <p>Fourteen EBM courses were conducted including 161 participants without previous EBM training (n = 54 self-help group representatives, n = 64 professional counsellors, n = 36 patient advocates, n = 7 others); 71% had a higher education degree; all but five finished the course. Most participants stated personal learning goals explicitly related to practicing EBM such as acquisition of critical appraisal skills (n = 130) or research competencies (n = 67). They rated the respective relevance of the course on average with 80% (SD 4) on a visual analogue scale ranging from 0 to 100%.</p> <p>Participants passed the competence test with a mean score of 14.7 (SD 3.0, n = 123) out of 19.5 points. The comparison group of students achieved a mean score of 14.4 (SD 3.3, n = 43). Group-based feedback revealed increases of self confidence, empowerment through EBM methodology and statistical literacy, and acquisition of new concepts of patient information and counselling. Implementation of EBM skills was reported by 84 of the 129 (65%) participants available for follow-up interviews. Barriers included lack of further support, limited possibilities to exchange experiences, and feeling discouraged by negative reactions of health professionals.</p> <p>Conclusions</p> <p>Training in basic EBM competencies for selected patient and consumer representatives is feasible and accepted and may affect counselling and advocacy activities. Implementation of EBM skills needs support beyond the training course.</p

Проект системы оборотного водоснабжения для охлаждения гальванических ванн

Объект разработки: Кожухотрубчатый теплообменник. Цель работы: Рассчитать теплообменник для охлаждения оборотной воды. В ходе выполнения работы: Выполнены все необходимые расчеты для конструирования аппарата. Определены размеры и основные механические характеристики. Основные конструктивные, технологические и технико-эксплуатационные характеристики: Диаметр аппарата 159 мм, длина теплообменных труб 3 м, диаметр труб 25х2 мм, рабочее давление трубного пространства 0,2Development object: Shell and tube heat exchanger. Purpose of work: Calculate a heat exchanger for cooling the circulating water. In the course of the work: All the necessary calculations for the design of the apparatus have been completed. The dimensions and main mechanical characteristics are determined. The main design, technological and technical and operational characteristics: The diameter of the apparatus is 159 mm, the length of the heat exchange tubes is 3 m, the diameter of the tube

Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review.

AIMS: To systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management. METHODS: We carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indicators and mortality, morbidity, or diabetes management for adults with type 1 diabetes. Data extraction and quality assessment was undertaken for all included studies. A narrative synthesis was conducted. RESULTS: A total of 33 studies were identified. Twelve cohort, 19 cross sectional and 2 case control studies met the inclusion criteria. Regardless of healthcare system, low socioeconomic status was associated with poorer outcomes. Following adjustments for other risk factors, socioeconomic status was a statistically significant independent predictor of mortality in 9/10 studies and morbidity in 8/10 studies for adults with type 1 diabetes. There appeared to be an association between low socioeconomic status and some aspects of diabetes management. Although only 3 of 16 studies made adjustments for confounders and other risk factors, poor diabetes management was associated with lower socioeconomic status in 3/3 of these studies. CONCLUSIONS: Low socioeconomic status is associated with higher levels of mortality and morbidity for adults with type 1 diabetes even amongst those with access to a universal healthcare system. The association between low socioeconomic status and diabetes management requires further research given the paucity of evidence and the potential for diabetes management to mitigate the adverse effects of low socioeconomic status

Supporting self-management after attending a structured education programme: a qualitative longitudinal investigation of type 1 diabetes patients’ experiences and views

Background: Structured education programmes for patients with diabetes and other chronic conditions are being widely adopted. However, follow-up studies suggest that course graduates may struggle to sustain the self-care practices taught on their courses over time. This study explored the support needs of patients with type 1 diabetes after attending a structured education programme promoting an empowerment approach and training in use of flexible intensive insulin therapy, a regimen now widely advocated and used to manage this condition. The objective was to inform future support offered to course graduates. Methods: Repeat, in-depth interviews with 30 type 1 diabetes patients after attending Dose Adjustment for Normal Eating (DAFNE) courses in the UK, and six and 12 months later. Data were analysed using an inductive, thematic approach. Results: While the flexible intensive insulin treatment approach taught on DAFNE courses was seen as a logical and effective way of managing one’s diabetes, it was also considered more technically complex than other insulin regimens. To sustain effective disease self-management using flexible intensive insulin treatment over time, patients often expected, and needed, on-going input and support from health care professionals trained in the approach. This included: help determining insulin dose adjustments; reassurance; and, opportunities to trouble-shoot issues of concern. While some benefits were identified to receiving follow-up support in a group setting, most patients stated a preference or need for tailored and individualised support from appropriately-trained clinicians, accessible on an ‘as and when needed’ basis. Conclusions: Our findings highlight potential limitations to group-based forms of follow-up support for sustaining diabetes self-management. To maintain the clinical benefits of structured education for patients with type 1 diabetes over time, course graduates may benefit from and prefer ongoing, one-to-one support from health care professionals trained in the programme’s practices and principles. This support should be tailored and personalised to reflect patients’ specific and unique experiences of applying their education and training in the context of their everyday lives, and could be the subject of future research

Blood glucose testing and primary prevention of diabetes mellitus type 2 - evaluation of the effect of evidence based patient information

<p>Abstract</p> <p>Background</p> <p>Evidence-based patient information (EBPI) has been recognised as important tool for informed choice in particular in the matter of preventive options. An objective, on the best scientific evidence-based consumer information about subthreshold elevated blood glucose levels (impaired fasting glucose and impaired glucose tolerance) and primary prevention of diabetes, is not available yet. Thus we developed a web-based EBPI and aim to evaluate its effects on informed decision making in people 50 years or older.</p> <p>Methods/Design</p> <p>We conduct a web-based randomised-controlled trial to evaluate the effect of information about elevated blood glucose levels and diabetes primary prevention on five specific outcomes: (i) knowledge of elevated blood glucose level-related issues (primary outcome); (ii) attitudes to a metabolic testing; (iii) intention to undergo a metabolic testing; (iv) decision conflict; (v) satisfaction with the information. The intervention group receives a specially developed EBPI about subthreshold elevated blood glucose levels and diabetes primary prevention, the control group information about this topic, available in the internet.</p> <p>The study population consists of people between 50 and 69 years of age without known diabetes. Participants will be recruited via the internet page of the cooperating health insurance company, Techniker Krankenkasse (TK), and the internet page of the German Diabetes Centre. Outcomes will be measured through online questionnaires. We expect better informed participants in the intervention group.</p> <p>Discussion</p> <p>The design of this study may be a prototype for other web-based prevention information and their evaluation.</p> <p>Trial registration</p> <p>Current Controlled Trial: ISRCTN22060616.</p