Clinicians’ perspectives and clinical efficacy of a health information technology tool in hospital falls risk assessment and prevention among older persons

Background The expanding ageing population has resulted in a focus on older persons within many healthcare systems. Falls present a growing problem with a significant impact on the community and healthcare system. Identifying falls risk factors and preventing falls have become priorities for many hospital and government policies, yet the evidence for the acceptability and efficacy of such interventions remains limited. Health technology has the potential to influence the field of falls prevention. Within research and clinical use, single and multi-component health technology strategies have been trialled to identify falls risk and prevent falls incidents. These have included sensor systems, video surveillance, and electronic health records. This thesis sought to evaluate the role of health technology in falls risk assessment and prevention, its perceptions by clinicians as end-users, and its effectiveness in reducing falls in hospital. More specifically, the thesis examined clinicians’ perspectives and use of a health information technology tool. This tool incorporated an iPad™ device and automatically generated visual cues to highlight individual patients’ falls risk. Its accuracy and efficacy in identifying and addressing falls risk scenarios, was evaluated compared to a standard screening tool. The aim of this study was to ultimately develop an acceptable and usable tool, in collaboration with clinicians, to deliver effective falls prevention in hospital. Methods Two methodologies and separate analyses were undertaken to complete this thesis: 1) An integrative review collated evidence for the effectiveness and clinicians’ perspectives of health technology use in falls prevention; and 2) an action research study evaluated clinicians’ perspectives on the health information technology tool, and informs its clinical use and efficacy in reducing hospital fall rates. Data was derived from focus group and survey research, with implementation of the health information technology tool occurring over consecutive 12-week periods on two medical wards at a single hospital setting. Both qualitative and quantitative analyses were applied to the data. Results Integrative review evidence, presented for the first time in this thesis, highlighted the lack of robust, consistent evidence for the acceptability and efficacy of health technology measures in falls prevention. The research conducted in this thesis addressed this gap in knowledge by evaluating staff’s attitudes towards the health information technology tool. It evaluated its positive and negative aspects, barriers to use, and recommendations for improvement; alongside its accuracy and effectiveness in reducing fall rates. Overall, clinicians were supportive for incorporating the tool into clinical practice. They perceived it as a useful, timely means of alerting staff and patients to falls risk scenarios, and resulting in better quality of care and understanding of falls risk for patients. Clinicians identified issues with usability and lack of time for tool use, and highlighted potential improvements to tool design. As befitting action research methodology, the health information technology tool has undergone refinement based on clinicians’ feedback. This has resulted in improved technology, clearer functioning of selection keys, colour coding of patients’ falls risk, having an automated trigger for patient education on falls risk, and provision of more iPad™ devices for more efficient use. The falls risk scores for the health information technology tool and standard falls risk in older person screening tool were similar, and did not differentiate between falls-risk and non-risk situations. Both tools had high sensitivity and low specificity for identifying falls-risk scenarios. They had similar rates of completion by clinicians on the wards. Implementation of the intervention tool had mixed outcomes on hospital fall rates. Conclusion This thesis contributed new information to address the knowledge gap on health technology uptake and efficacy in addressing hospital falls risk. Clinicians were willing to use the health information technology tool, and identified benefits to using the tool for themselves and their patients. The intervention tool demonstrated similar acceptability and accuracy to the standard falls risk screening tool. Staff’s concerns about usability are addressed in tool refinement, with active participation of end-users were considered key to improving intervention acceptance and usage, along with maximising useful feedback to further inform tool development. The effect of implementing the intervention tool on fall rates was mixed, highlighting the challenges of identifying and managing falls risk scenarios in hospital settings. The work arising from this thesis informed the development of a hand held android device used in the Ambience Intelligence Geriatric Management (AmbiGEM) system, incorporating printed visual cues with movement sensor alarms that alert clinicians to high-risk patient manoeuvres. Future research directions will involve evaluation of the acceptability and efficacy of the AmbiGEM system, which is currently undergoing clinical trial in two hospitals in South and Western Australia.Thesis (MPhil) -- University of Adelaide, Adelaide Medical School, 201

Dietary protein intake and transition between frailty states in octogenarians living in New Zealand

Funding Information: Funding: This research was funded by Health Research Council of New Zealand (HRC 09/068B; UoA ref: 3624940) and Ministry of Health New Zealand (MOH ref: 345426/00; UoA ref: 3703221) which funded the project management and data collection work; Nga¯ Pae o te Ma¯ramatanga (UoA ref: 3624946) which funded the Ma¯ori engagement and project management. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Adequate nutritional status may influence progression to frailty. The purpose of this study is to determine the prevalence of frailty and examine the relationship between dietary protein intake and the transition between frailty states and mortality in advanced age. We used data from a longitudinal cohort study of Māori (80–90 years) and non-Māori (85 years). Dietary assessments (24-h multiple pass dietary recalls) were completed at the second year of follow-up (wave 2 and forms the baseline in this study). Frailty was defined using the Fried Frailty criteria. Multi-state modelling examined the association of protein intake and transitions between frailty states and death over four years. Over three quarters of participants were pre-frail or frail at baseline (62% and 16%, respectively). Those who were frail had a higher co-morbidity (p < 0.05), where frailty state changed, 44% showed a worsening of frailty status (robust → pre-frail or pre-frail → frail). Those with higher protein intake (g/kg body weight/day) were less likely to transition from robust to pre-frail [Hazard Ratio (95% Confidence Interval): 0.28 (0.08–0.91)] but also from pre-frail to robust [0.24 (0.06–0.93)]. Increased protein intake was associated with lower risk of transitioning from pre-frailty to death [0.19 (0.04–0.80)], and this association was moderated by energy intake [0.22 (0.03–1.71)]. Higher protein intake in this sample of octogenarians was associated with both better and worse outcomes.publishersversionpublishe

The epidemiology of childhood psoriasis: a scoping review

Psoriasis is an inflammatory noncommunicable skin disease that affects both adults and children. At present, the epidemiology and natural history of psoriasis are not widely understood. This scoping review aimed to map the existing literature on the epidemiology of childhood psoriasis, identify research gaps for future studies and provide a comprehensive, clinically useful review. Search strategies were developed for Ovid Medline, Ovid Embase, Google Scholar and hand searching. In total, 131 articles met the inclusion criteria and were mapped; 107 articles were included for data extraction. Over the last 25 years there has been a dramatic increase in the volume of published observational epidemiological studies on childhood psoriasis. The majority were case series or cross-sectional studies, concentrated in Europe, Asia and North America. The prevalence of childhood psoriasis was found to be higher in European countries, older children and girls. Up to 48·8% of children had a family history of psoriasis in a first-degree relative. The most frequent subtype was plaque psoriasis and the most common initial sites of presentation were the scalp, limbs and trunk. Specific genetic differences have been found between child-onset and adult-onset populations. Case–control and cohort studies investigating risk factors for psoriasis onset, comorbidities and long-term health outcomes were extremely limited. The choice of study design and heterogeneity in methodology limit the validity and generalizability of the information, consistency of the results, and comparability of the studies. Well-designed epidemiological studies are needed to provide precise and consistent information about the frequency and clinical presentation, risk factors, associated diseases and long-term outcomes in childhood psoriasis

Nutrition risk: cultural aspects of assessment

Aim: To assess a nutrition risk screening tool amongst Māori and non-Māori of advanced age. Method: A cross sectional feasibility study was conducted in three North Island locations. One hundred and eight communityliving residents aged 75-85 years were assessed for nutrition risk using &apos;the validated questionnaire &apos;Seniors in the Community: Risk Evaluation for Eating and Nutrition&apos;, Version II (SCREENII) and level of physical activity using the &apos;Physical Activity Scale for the Elderly&apos; (PASE). Physical assessments included height and weight. Results: Fifty-two percent of participants were assessed to be at high nutrition risk (SCREENII score &lt;50; range 29-58; out of maximum score 64). Nutrition risk factors amongst Māori and non-Māori respectively differed for weight change in the previous six months (45.2% and 18.7%, p=0.005), skipping meals (54.8% and 13.3%, p&lt;0.001), fruit and vegetable intake (77.4% and 18.7%, p&lt;0.001) and the use of meal replacements (28.1% and 9.3%, p=0.013). Process evaluation showed that Māori took different meaning from the individual question items in SCREENII. Level of physical activity (PASE score) was higher for Māori, median (IQR): 125 (74) than non-Māori, 72 (74) (p&lt;0.001) especially for leisure-time and household related activity. BMI was higher for Māori median (IQR): 31.5 kg/m 2 (6.8) compared to non-Māori 24.7 kg/m 2 (5.4) (p&lt;0.001). Conclusions: The nutrition risk tool suggested that Māori were at high risk for malnutrition despite higher BMI and higher levels of activity. Several items of the screening tool were interpreted differently among Māori compared to non-Māori. Further development is needed to ensure accurate assessment

Soil methane sink capacity response to a long-term wildfire chronosequence in Northern Sweden

Boreal forests occupy nearly one fifth of the terrestrial land surface and are recognised as globally important regulators of carbon (C) cycling and greenhouse gas emissions. Carbon sequestration processes in these forests include assimilation of CO2 into biomass and subsequently into soil organic matter, and soil microbial oxidation of methane (CH4). In this study we explored how ecosystem retrogression, which drives vegetation change, regulates the important process of soil CH4 oxidation in boreal forests. We measured soil CH4 oxidation processes on a group of 30 forested islands in northern Sweden differing greatly in fire history, and collectively representing a retrogressive chronosequence, spanning 5000 years. Across these islands the build-up of soil organic matter was observed to increase with time since fire disturbance, with a significant correlation between greater humus depth and increased net soil CH4 oxidation rates. We suggest that this increase in net CH4 oxidation rates, in the absence of disturbance, results as deeper humus stores accumulate and provide niches for methanotrophs to thrive. By using this gradient we have discovered important regulatory controls on the stability of soil CH4 oxidation processes that could not have not been explored through shorter-term experiments. Our findings indicate that in the absence of human interventions such as fire suppression, and with increased wildfire frequency, the globally important boreal CH4 sink could be diminished

Testosterone in advance age: a New Zealand longitudinal cohort study: life and living in advanced age (te puāwaitanga o ngā tapuwae kia ora tonu)

OBJECTIVES: Serum testosterone (T) levels in men decline with age. Low T levels are associated with sarcopenia and frailty in men aged &gt;80 years. T levels have not previously been directly associated with disability in older men. We explored associations between T levels, frailty and disability in a cohort of octogenarian men. SETTING: Data from all men from Life and Living in Advanced Age Cohort Study in New Zealand, a longitudinal cohort study in community-dwelling older adults. PARTICIPANTS: Community-dwelling (&gt;80 years) adult men excluding those receiving T treatment or with prostatic carcinoma. OUTCOMES MEASURES: Associations between baseline total testosterone (TT) and calculated free testosterone (fT), frailty (Fried scale) and disability (Nottingham Extended Activities of Daily Living scale (NEADL)) (baseline and 24&thinsp;months) were examined using multivariate regression and Wald\u27s &chi;2 techniques. Subjects with the lowest quartile of baseline TT and fT values were compared with those in the upper three quartiles. RESULTS: Participants: 243 men, mean (SD) age 83.7 (2.0) years. Mean (SD) TT=17.6 (6.8) nmol/L and fT=225.3 (85.4) pmol/L. On multivariate analyses, lower TT levels were associated with frailty: &beta;=0.41, p=0.017, coefficient of determination (R2)=0.10&thinsp;and disability (NEADL) (&beta;=-1.27, p=0.017, R2=0.11), low haemoglobin (&beta;=-7.38, p=0.0016, R2=0.05), high fasting glucose (&beta;=0.38, p=0.038, R2=0.04) and high C reactive protein (CRP) (&beta;=3.57, p=0.01, R2=0.06). Low fT levels were associated with frailty (&beta;=0.39, p=0.024, R2=0.09) but not baseline NEADL (&beta;=-1.29, p=0.09, R2=0.09). Low fT was associated with low haemoglobin (&beta;=-7.83, p=0.0008, R2=0.05) and high CRP (&beta;=2.86, p=0.04, R2=0.05). Relationships between baseline TT and fT, and 24-month outcomes of disability and frailty were not significant. CONCLUSIONS: In men over 80 years, we confirm an association between T levels and baseline frailty scores. The new finding of association between T levels and disability is potentially relevant to debates on T supplementation in older men, though, as associations were not present at 24 months, further work is needed

Risk of liver fibrosis associated with long-term methotrexate therapy may be overestimated

Background & Aims: The risk of significant liver fibrosis from prolonged methotrexate (MTX) exposure has been estimated at around 5%, prompting intensive monitoring strategies. However, the evidence is derived from retrospective studies that under-reported risk factors for liver disease. We evaluated the risk of long-term MTX therapy on liver fibrosis in a longitudinal cohort study using two non-invasive markers.Method: Between 2014-2021, adult patients diagnosed with rheumatoid arthritis (RA) or psoriasis for >−2 years were recruited prospectively from six UK sites. The MTX group included patients who received MTX for >−6 months, whereas the unexposed group included those who never received MTX. All patients underwent full liver profiling, with transient elastography (TE) and enhanced liver fibrosis (ELF) marker measurements.Results: A total of 999 patients (mean age 60.8 ± 12 years, 62.3% females) were included. Of 976 with valid TE values, 149 (15.3%) had liver stiffness >−7.9 kPa. Of 892 with a valid ELF, 262 (29.4%) had ELF >−9.8. Age and BMI were independently associated with elevated liver stiffness and ELF. Neither MTX cumulative dose nor duration was associated with elevated liver stiffness. Diabetes was the most significant risk factor associated with liver stiffness >−7.9 kPa (adjusted odds ratio = 3.19; 95% CI 1.95–5.20; p −9.8 (odds ratio = 1.76; 95% CI 1.20–2.56; p = 0.003), suggesting the degree of joint inflammation in RA may confound ELF as a non-invasive marker of liver fibrosis.Conclusion: The risk of liver fibrosis attributed to MTX itself might have been previously overestimated; there is a need to consider modifying current monitoring guidelines for MTX

H. pylori-infection and antibody immune response in a rural Tanzanian population

BACKGROUND: Helicobacter pylori (H. pylori) infection is ubiquitous in sub-Saharan Africa, but paradoxically gastric cancer is rare. METHODS: Sera collected during a household-based survey in rural Tanzania in 1985 were tested for anti-H. pylori IgG and IgG subclass antibodies by enzyme immunoassay. Odds ratios (OR) and confidence intervals (CI) of association of seropositivity with demographic variables were computed by logistic regression models. RESULTS: Of 788 participants, 513 were aged ≤17 years. H. pylori seropositivity increased from 76% at 0–4 years to 99% by ≥18 years of age. Seropositivity was associated with age (OR 11.5, 95% CI 4.2–31.4 for 10–17 vs. 0–4 years), higher birth-order (11.1; 3.6–34.1 for ≥3(rd )vs. 1(st )born), and having a seropositive next-older sibling (2.7; 0.9–8.3). Median values of IgG subclass were 7.2 for IgG1 and 2.0 for IgG2. The median IgG1/IgG2 ratio was 3.1 (IQR: 1.7–5.6), consistent with a Th2-dominant immune profile. Th2-dominant response was more frequent in children than adults (OR 2.4, 95% CI 1.3–4.4). CONCLUSION: H. pylori seropositivity was highly prevalent in Tanzania and the immunological response was Th2-dominant. Th2-dominant immune response, possibly caused by concurrent bacterial or parasitic infections, could explain, in part, the lower risk of H. pylori-associated gastric cancer in Africa