Examining evidence based resistance plus balance training in community-dwelling older adults with complex health care needs: Trial protocol for the Muscling Up Against Disability project

Available online 6 October 2016Abstract not availableJustin W.L. Keogh, Tim Henwood, Paul Gardiner, Anthony Tuckett, Brent Hodgkinson, Kevin Rous

Strategies to reduce medication errors with reference to older adults

Background  In Australia, around 59% of the general population uses prescription medication with this number increasing to about 86% in those aged 65 and over and 83% of the population over 85 using two or more medications simultaneously. A recent report suggests that between 2% and 3% of all hospital admissions in Australia may be medication related with older Australians at higher risk because of higher levels of medicine intake and increased likelihood of being admitted to hospital. The most common medication errors encountered in hospitals in Australia are prescription/medication ordering errors, dispensing, administration and medication recording errors. Contributing factors to these errors have largely not been reported in the hospital environment. In the community, inappropriate drugs, prescribing errors, administration errors, and inappropriate dose errors are most common. Objectives  To present the best available evidence for strategies to prevent or reduce the incidence of medication errors associated with the prescribing, dispensing and administration of medicines in the older persons in the acute, subacute and residential care settings, with specific attention to persons aged 65 years and over. Search strategy  Bibliographic databases PubMed, Embase, Current contents, The Cochrane Library and others were searched from 1986 to present along with existing health technology websites. The reference lists of included studies and reviews were searched for any additional literature. Selection criteria  Systematic reviews, randomised controlled trials and other research methods such as non-randomised controlled trials, longitudinal studies, cohort or case-control studies, or descriptive studies that evaluate strategies to identify and manage medication incidents. Those people who are involved in the prescribing, dispensing or administering of medication to the older persons (aged 65 years and older) in the acute, subacute or residential care settings were included. Where these studies were limited, evidence available on the general patient population was used. Data collection and analysis  Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data where possible. All other data were presented in a narrative summary. Results  Strategies that have some evidence for reducing medication incidents are: •  computerised physician ordering entry systems combined with clinical decision support systems; •  individual medication supply systems when compared with other dispensing systems such as ward stock approaches; •  use of clinical pharmacists in the inpatient setting; •  checking of medication orders by two nurses before dispensing medication; •  a Medication Administration Review and Safety committee; and •  providing bedside glucose monitors and educating nurses on importance of timely insulin administration. In general, the evidence for the effectiveness of intervention strategies to reduce the incidence of medication errors is weak and high-quality controlled trials are needed in all areas of medication prescription and delivery

Medication management in older adults: What a systematic review tells us

In this thesis, we present the construction of UWB transmitters and receivers over multi-antenna channels. Given the carrier-less nature of the UWB transmissions, most of the existing space-time (ST) coding schemes can not be associated with this nonconventional technique. In order to solve this problem, we propose new families of ST codes that can be associated with carrier-less UWB transmissions. At a first time, we adapt the mathematical tools based on cyclic division algebras to construct new totally-real coding schemes over the field of rational numbers. At a second time, we show that additional performance gains can be obtained when applying additional intra-symbol coding on the pulses used to convey a given information symbol. Finally, we propose a new approach for the construction of modulation-specific codes that can be associated with pulse position modulation and with hybrid pulse position and amplitude modulation. The new modulation-specific codes show the best known performance among the existing ST-UWB schemes. In some situations, these codes satisfy all the construction constraints of the perfect codes in addition to the constraint of being totally real. We also consider the problem of constructing distributed ST-UWB codes that permit to profit from the spatial diversity in a distributed manner. Novel amplify-and-forward and decode-and-forward strategies are proposed and investigated over the UWB channels. We present analytical, semi-analytical and numerical analysis of the proposed solutions over realistic indoor highly frequency-selective channels. Issues related to the transceiver design and decoding strategies of practical UWB systems are studied.<Ce rapport de thèse présente des nouvelles méthodes d'émission et de réception basées sur les transmissions ULB pour les canaux à antennes multiples. Pour les systèmes ULB il devient excessivement difficile de récupérer l'information de phase et les codes espace-temps existants ne peuvent pas être appliqués. Pour résoudre ce problème, nous proposons la construction de nouvelles familles de codes espace-temps pour les systèmes ULB impulsionnels. Dans un premier temps, les outils mathématiques basés sur les algèbres cycliques de division ont été adaptés pour la construction d'un schéma de codage totalement réel. Dans un deuxième temps, nous avons proposé une autre famille de codes basée sur l'introduction du codage conjoint symbole-impulsion. Finalement, nous proposons des nouvelles constructions spécifiques aux modulations de positions ou aux modulations conjointes de position et d'amplitude. Ces constructions permettent d'obtenir une famille de code présentant les meilleures performances parmi tous les schémas de codage espace-temps ULB existant dans la littérature. Dans certains cas, cette famille de codes totalement réels satisfait toutes les contraintes de construction des codes parfaits. Enfin, nous nous sommes intéressés à des constructions de codes distribués pour les systèmes ULB coopératifs. Nous présentons des nouvelles techniques de coopération pour les stratégies type "amplify-and-forward" et "decode-and-forward". Nous présentons une analyse analytique, semi-analytique et numérique des solutions proposées sur des canaux ULB sélectifs en fréquence. Nous présentons aussi des schémas pratiques de transmission, réception et décodage des systèmes multi-antennes ULB

A comparison of palliative care outcome measures used to assess the quality of palliative care provided in Residential Aged Care Facilities: A systematic review

It is now recognised that palliative care in residential aged care facilities (RACFs) is important, particularly for people with non-cancer disease. While Australia leads the world with the first evidence-based guidelines for a palliative approach in this setting, limited research has been undertaken in measuring the extent to which these guidelines and other practice initiatives will impact on resident and family outcomes. This is due in part to the difficulties of measuring outcomes in palliative care in these settings and particularly the lack of evidence for the validity of measurement tools in palliative care. Despite these problems measuring outcomes is important for the development of high quality care, particularly in settings where new models of care are being developed

Effectiveness of topical skin care provided in aged care facilities

Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.6% of the population, up from 12.1% in 1996. It is projected that this figure will rise to 21% or 5.1 million Australians by 2031. In 1998, 6% (134 000) of adults in Australia aged 65 years and over were residing in nursing homes or hostels and this number is also expected to rise. As skin ages, there is a decreased turnover and replacement of epidermal skin cells, a thinning subcutaneous fat layer and a reduced production of protective oils. These changes can affect the normal functions of the skin such as its role as a barrier to irritants and pathogens, temperature and water regulation. Generally, placement in a long-term care facility indicates an inability of the older person to perform all of the activities of daily living such as skin care. Therefore, skin care management protocols should be available to reduce the likelihood of skin irritation and breakdown and ultimately promote comfort of the older person. Objectives The objective of this review was to determine the best available evidence for the effectiveness and safety of topical skin care regimens for older adults residing in long-term aged care facilities. The primary outcome was the incidence of adverse skin conditions with patient satisfaction considered as a secondary outcome. Search strategy A literature search was performed using the following databases: PubMed (NLM) (1966–4/2003), Embase (1966–4/2003), CINAHL (1966–4/2003), Current Contents (1993–4/2003), Cochrane Library (1966–2/2003), Web of Science (1995–12/2002), Science Citation Index Expanded and ProceedingsFirst (1993–12/2002). Health Technology Assessment websites were also searched. No language restrictions were applied. Selection criteria Systematic reviews of randomised controlled trials, randomised and non-randomised controlled trials evaluating any non-medical intervention or program that aimed to maintain or improve the integrity of skin in older adults were considered for inclusion. Participants were 65 years of age or over and residing in an aged care facility, hospital or long-term care in the community. Studies were excluded if they evaluated pressure-relieving techniques for the prevention of skin breakdown. Data collection and analysis Two independent reviewers assessed study eligibility for inclusion. Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data. Results The resulting evidence of the effectiveness of topical skin care interventions was variable and dependent upon the skin condition outcome being assessed. The strongest evidence for maintenance of skin condition in incontinent patients found that disposable bodyworn incontinence protection reduced the odds of deterioration of skin condition compared with non-disposable bodyworns. The best evidence for non-pressure relieving topical skin care interventions on pressure sore formation found the no-rinse cleanser Clinisan to be more effective than soap and water at maintaining healthy skin (no ulcers) in elderly incontinent patients in long-term care. The quality of studies examining the effectiveness of topical skin care interventions on the incidence of skin tears was very poor and inconclusive. Topical skin care for prevention of dermatitis found that Sudocrem could reduce the redness of skin compared with zinc cream if applied regularly after each pad change, but not the number of lesions. Topical skin care on dry skin found the Bag Bath/Travel Bath no-rinse skin care cleanser to be more effective at preventing overall skin dryness and most specifically flaking and scaling when compared with the traditional soap and water washing method in residents of a long-term care facility. Information on the safety of topical skin care interventions is lacking. Therefore, because of the lack of evidence, no recommendation on the safety on any intervention included in this review can be made