The effectiveness of multifactorial and multicomponent interventions for the prevention of falls for adults in hospital settings: a systematic review and meta-analysis.

The objective of this systematic review and meta-analysis was to evaluate the effectiveness of multicomponent and multifactorial interventions for reducing falls in adult in-patients. Falls are the most common cause of accidental injury in hospitals worldwide, resulting in high human and economic costs. In attempts to reduce the number of falls, a wide range of interventions have been employed, often in combination, either as a package (multicomponent) or tailored to the individual (multifactorial). There is a need to synthesise the findings from primary studies and assess which approach may be more effective. The systematic review included studies comprising adult inpatients aged 18 years and over from any hospital setting including elective, non-elective, day-case and secondary care. Randomized controlled trials (RCT), cluster-randomised trials, quasi-experimental controlled trials and historical controlled trials were included that presented sufficient information regarding the rate or number of falls. This effectiveness review was conducted in accordance with JBI methodology and was guided by an a priori protocol. A comprehensive 3-step search strategy was employed across 14 databases. Screening was conducted by two independent reviewers, and data was extracted using a bespoke data extraction tool designed for this review. Methodological quality was assessed using adapted versions of JBI critical appraisal checklists. Meta-analyses were conducted within a Bayesian framework to interpret results probabilistically and account for covariance in multiple sets of falls data reported in the same study. Effect sizes were calculated by comparing the rate or number of falls in the intervention group compared with usual care. Narrative syntheses were conducted on studies that met the inclusion criteria but did not provide sufficient data for inclusion in meta-analyses. A total of 9,637 records were obtained and following screening 24 studies were included in this review, 21 of which presented sufficient information to be included in meta-analyses. Most studies (n=16) comprised a weaker historical control design with 6 quasi-experimental and only 5 RCT studies. Multifactorial interventions were more common (n=18) than multicomponent (n=6), with the most frequent components including environmental adaptations and assistive aids (75% of studies). Meta-analyses provided evidence that both intervention types were effective at reducing the rate and risk of falls compared to usual care. Evidence was also obtained of greater reductions in rate and risk of falls with multicomponent interventions, however, analyses were potentially confounded by an association between intervention type and study design. Falls interventions routinely employed in hospitals can substantially reduce falls, however, no evidence was obtained in support of tailoring interventions to individual risk factors. Future high-quality RCTs are required that directly compare multicomponent and multifactorial interventions

Patient ratings in exercise therapy for the management of tendinopathy: a systematic review with meta-analysis.

The objective of this study was to synthesise exercise therapy intervention data investigating patient rating outcomes for the management of tendinopathy. A systematic review and meta-analysis of randomised controlled trials investigating exercise therapy interventions and reporting patient rating outcomes were undertaken. Eligible settings were considered to be any setting in any country listed as very high on the human development index. Eligible participants were considered to be people with a diagnosis of any tendinopathy of any severity or duration. Exercise therapy for the management of tendinopathy was considered for inclusion based on alignment with five different therapy classes: 1) resistance; 2) plyometric; 3) vibration; 4) flexibility; and 5) movement pattern retraining modalities. The main outcomes sought were those that measured patient rating of condition, including patient satisfaction and Global Rating of Change (GROC). From a total of 124 exercise therapy studies, 34 (Achilles: 41%; rotator cuff: 32%; patellar: 15%; elbow: 9%; and gluteal: 3%) provided sufficient information to be meta-analysed. The data were obtained across 48 treatment arms and 1246 participants. The pooled estimate for proportion of satisfaction was 0.63 [95% CrI: 0.53 to 0.73], and the pooled estimate for percentage of maximum GROC was 53 [95% CrI: 38 to 69%]. The proportion of patients reporting positive satisfaction and perception of change increased with longer follow-up periods from treatment onset. Patient satisfaction and GROC appear similar and are ranked moderately high demonstrating that patients generally perceive exercise therapies positively. Further research including greater consistency in measurement tools is required to explore and where possible, identify patient- and exercise-related moderating factors that can be used to improve person-centred care

Preferences of Hungarian consumers for quality, access and price attributes of health care services — result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments

Paleo-Ecology of the Yedoma Ice Complex on Sobo-Sise Island (Eastern Lena Delta, Siberian Arctic)

Late Pleistocene permafrost of the Yedoma type constitutes a valuable paleo-environmental archive due to the presence of numerous and well-preserved floral and faunal fossils. The study of the fossil Yedoma inventory allows for qualitative and quantitative reconstructions of past ecosystem and climate conditions and variations over time. Here, we present the results of combined paleo-proxy studies including pollen, chironomid, diatom and mammal fossil analyses from a prominent Yedoma cliff on Sobo-Sise Island in the eastern Lena Delta, NE Siberia to complement previous and ongoing paleo-ecological research in western Beringia. The Yedoma Ice Complex (IC) cliff on Sobo-Sise Island (up to 28 m high, 1.7 km long) was continuously sampled at 0.5 m resolution. The entire sequence covers the last about 52 cal kyr BP, but is not continuous as it shows substantial hiatuses at 36–29 cal kyr BP, at 20–17 cal kyr BP and at 15–7 cal kyr BP. The Marine Isotope Stage (MIS) 3 Yedoma IC (52–28 cal kyr BP) pollen spectra show typical features of tundra–steppe vegetation. Green algae remains indicate freshwater conditions. The chironomid assemblages vary considerably in abundance and diversity. Chironomid-based TJuly reconstructions during MIS 3 reveal warmer-than-today TJuly at about 51 cal kyr BP, 46-44 and 41 cal kyr BP. The MIS 2 Yedoma IC (28–15 cal kyr BP) pollen spectra represent tundra-steppe vegetation as during MIS 3, but higher abundance of Artemisia and lower abundances of algae remains indicate drier summer conditions. The chironomid records are poor. The MIS 1 (7–0 cal kyr BP) pollen spectra indicate shrub-tundra vegetation. The chironomid fauna is sparse and not diverse. The chironomid-based TJuly reconstruction supports similar-as-today temperatures at 6.4–4.4 cal kyr BP. Diatoms were recorded only after about 6.4 cal kyr BP. The Sobo-Sise Yedoma record preserves traces of the West Beringian tundra-steppe that maintained the Mammoth fauna including rare evidence for woolly rhinoceros’ presence. Chironomid-based TJuly reconstructions complement previous plant-macrofossil based TJuly of regional MIS 3 records. Our study from the eastern Lena Delta fits into and extends previous paleo-ecological Yedoma studies to characterize Beringian paleo-environments in the Laptev Sea coastal region

Jastrow-type calculations of one-nucleon removal reactions on open ss-dd shell nuclei

Single-particle overlap functions and spectroscopic factors are calculated on the basis of Jastrow-type one-body density matrices of open-shell nuclei constructed by using a factor cluster expansion. The calculations use the relationship between the overlap functions corresponding to bound states of the $(A-1)$-particle system and the one-body density matrix for the ground state of the $A$-particle system. In this work we extend our previous analyses of reactions on closed-shell nuclei by using the resulting overlap functions for the description of the cross sections of $(p,d)$ reactions on the open $s$-$d$ shell nuclei $^{24}$Mg, $^{28}$Si and $^{32}$S and of $^{32}$S$(e,e^{\prime}p)$ reaction. The relative role of both shell structure and short-range correlations incorporated in the correlation approach on the spectroscopic factors and the reaction cross sections is pointed out.Comment: 11 pages, 5 figures, to be published in Phys. Rev.

Correlation effects in single-particle overlap functions and one-nucleon removal reactions

Single-particle overlap functions and spectroscopic factors are calculated on the basis of the one-body density matrices (ODM) obtained for the nucleus $^{16}O$ employing different approaches to account for the effects of correlations. The calculations use the relationship between the overlap functions related to bound states of the (A-1)-particle system and the ODM for the ground state of the A-particle system. The resulting bound-state overlap functions are compared and tested in the description of the experimental data from (p,d) reactions for which the shape of the overlap function is important.Comment: 11 pages, 4 figures include