Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus

BACKGROUND: The identification of patients with gait disturbance associated with idiopathic normal pressure hydrocephalus (iNPH) is challenging. This is due to the multifactorial causes of gait disturbance in elderly people and the single moment examination of laboratory tests. OBJECTIVE: We aimed to assess whether the use of gait sensors in a patient's home environment could help establish a reliable diagnostic tool to identify patients with iNPH by differentiating them from elderly healthy controls (EHC). METHODS: Five wearable inertial measurement units were used in 11 patients with iNPH and 20 matched EHCs. Data were collected in the home environment for 72 h. Fifteen spatio-temporal gait parameters were analyzed. Patients were examined preoperatively and postoperatively. We performed an iNPH sub-group analysis to assess differences between responders vs. non-responders. We aimed to identify parameters that are able to predict a reliable response to VP-shunt placement. RESULTS: Nine gait parameters significantly differ between EHC and patients with iNPH preoperatively. Postoperatively, patients with iNPH showed an improvement in the swing phase (p = 0.042), and compared to the EHC group, there was no significant difference regarding the cadence and traveled arm distance. Patients with a good VP-shunt response (NPH recovery rate of ≥5) significantly differ from the non-responders regarding cycle time, cycle time deviation, number of steps, gait velocity, straight length, stance phase, and stance to swing ratio. A receiver operating characteristic analysis showed good sensitivity for a preoperative stride length of ≥0.44 m and gait velocity of ≥0.39 m/s. CONCLUSION: There was a significant difference in 60% of the analyzed gait parameters between EHC and patients with iNPH, with a clear improvement toward the normalization of the cadence and traveled arm distance postoperatively, and a clear improvement of the swing phase. Patients with iNPH with a good response to VP-shunt significantly differ from the non-responders with an ameliorated gait pattern

Evaluation rechnergestützter Pflegedokumentation auf vier Pilotstationen (PIK-Studie 2000/2001)

Seit Jahren besteht der Wunsch, die Pflegedokumentation durch EDV-Einsatz zu unterstützen, um die Qualität der Dokumentation zu erhöhen, Aufwände für die Pflegekräfte zu reduzieren, pflegerische Abläufe zu unterstützen, und Auswertungsmöglichkeiten für Pflegemanagement und Pflegeforschung zu verbessern. Die Einführung des rechnergestützten Pflegedokumentationssystems PIK auf vier Pilotstationen am Universitätsklinikum Heidelberg wird seit 1998 durch eine umfassende Evaluationsstudie begleitet. Ziel der Studie ist es, Erfolgsfaktoren und Auswirkungen rechnergestützter Pflegedokumentationssysteme zu ermitteln, und Empfehlungen für eine optimale Einführungsstrategie aufzustellen. Daher werden unter anderen die Auswirkungen der PIK-Einführung auf Qualität und Vollständigkeit der Pflegedokumentation, auf die Akzeptanz des Pflegeprozesses, und auf die Akzeptanz von Computern allgemein und in der Pflege untersucht. Ausserdem werden die Akzeptanz von PIK bei pflegerischen und nicht-pflegerischen Mitarbeitern sowie die Auswirkungen auf die multiprofessionelle Kooperation berücksichtigt. Der vorliegende Forschungsbericht berichtet umfassend über die Planung, Durchführung und Auswertung der Evaluation von PIK. Als Ergebnis der Studie wird unter Abwägung aller bisherigen Erkenntnisse empfohlen, ein rechnergestütztes Pflegedokumentationssystem mittelfristig am Klinikum Heidelberg einzuführen

Gait pattern analysis in the home environment as a key factor for the reliable assessment of shunt responsiveness in patients with idiopathic normal pressure hydrocephalus

BackgroundThe identification of patients with gait disturbance associated with idiopathic normal pressure hydrocephalus (iNPH) is challenging. This is due to the multifactorial causes of gait disturbance in elderly people and the single moment examination of laboratory tests.ObjectiveWe aimed to assess whether the use of gait sensors in a patient's home environment could help establish a reliable diagnostic tool to identify patients with iNPH by differentiating them from elderly healthy controls (EHC).MethodsFive wearable inertial measurement units were used in 11 patients with iNPH and 20 matched EHCs. Data were collected in the home environment for 72 h. Fifteen spatio-temporal gait parameters were analyzed. Patients were examined preoperatively and postoperatively. We performed an iNPH sub-group analysis to assess differences between responders vs. non-responders. We aimed to identify parameters that are able to predict a reliable response to VP-shunt placement.ResultsNine gait parameters significantly differ between EHC and patients with iNPH preoperatively. Postoperatively, patients with iNPH showed an improvement in the swing phase (p = 0.042), and compared to the EHC group, there was no significant difference regarding the cadence and traveled arm distance. Patients with a good VP-shunt response (NPH recovery rate of ≥5) significantly differ from the non-responders regarding cycle time, cycle time deviation, number of steps, gait velocity, straight length, stance phase, and stance to swing ratio. A receiver operating characteristic analysis showed good sensitivity for a preoperative stride length of ≥0.44 m and gait velocity of ≥0.39 m/s.ConclusionThere was a significant difference in 60% of the analyzed gait parameters between EHC and patients with iNPH, with a clear improvement toward the normalization of the cadence and traveled arm distance postoperatively, and a clear improvement of the swing phase. Patients with iNPH with a good response to VP-shunt significantly differ from the non-responders with an ameliorated gait pattern

Appetite and falls: Old age and lived experiences

Falling among older adults is a well-known public health problem but the association between falling and appetite is seldom studied although poor nutritional status is accepted as a risk factor for falls. On this background the aim of this study was to understand how older adults, who have fallen several times within a year, related their experiences of appetite as a phenomenon in everyday life. In narrative in-depth interviews, eight women and four men contributed with their stories. Using interpretative phenomenology the thematic analysis resulted in three main themes: appetite for food; appetite for social relations and appetite for influence. Eating was not trivial everyday routine and required self-regimentation. Meals were not an object of desire, but of discipline out of the wish to survive. Feelings, reflections and ambivalence were bound to the lack of appetite on food. The participants were oriented towards the forbidden, the delicious and to everyday food as a strengthener and as medicine. In their dependency on help, home was the framework for establishing social relations as means of social support. As well as family and neighbours, the significant others were persons on whom the participants were dependent. Personal relationships and mutual dependencies may ensure social security in lives characterised by contingency and maintain influence in daily life. Falling is both a dramatic and a trivial incident where life and death could be at stake. From this perspective, connectedness was prominent in all fall stories. The quest for influence and a sense of social connectedness was the incentive to re-enter local community arenas and to express solidarity. In health-care practice multi-factorial fall-prevention should be complemented with a multi-dimensional approach in order to balance the medical approach with humanistic and societal approaches towards fall-prevention

Diversity dynamics in New Caledonia: towards the end of the museum model?

<p>Abstract</p> <p>Background</p> <p>The high diversity of New Caledonia has traditionally been seen as a result of its Gondwanan origin, old age and long isolation under stable climatic conditions (the museum model). Under this scenario, we would expect species diversification to follow a constant rate model. Alternatively, if New Caledonia was completely submerged after its breakup from Gondwana, as geological evidence indicates, we would expect species diversification to show a characteristic slowdown over time according to a diversity-dependent model where species accumulation decreases as space is filled.</p> <p>Results</p> <p>We reanalyze available datasets for New Caledonia and reconstruct the phylogenies using standardized methodologies; we use two ultrametrization alternatives; and we take into account phylogenetic uncertainty as well as incomplete taxon sampling when conducting diversification rate constancy tests. Our results indicate that for 8 of the 9 available phylogenies, there is significant evidence for a diversification slowdown. For the youngest group under investigation, the apparent lack of evidence of a significant slowdown could be because we are still observing the early phase of a logistic growth (i.e. the clade may be too young to exhibit a change in diversification rates).</p> <p>Conclusions</p> <p>Our results are consistent with a diversity-dependent model of diversification in New Caledonia. In opposition to the museum model, our results provide additional evidence that original New Caledonian biodiversity was wiped out during the episode of submersion, providing an open and empty space facilitating evolutionary radiations.</p

At holde balance Betingelser for og perspektiver i forhold tilforebyggelse af fald blandt gamle mennesker

Baggrund. Faldulykker blandt gamle mennesker er et folkesundhedsproblem i Danmark, Norden såvel som i den vestlige verden. Forebyggelse af fald har været grebet an i en befolkningsorienteret adfærdsmotiverendeog –regulerende modus. Denne faldforebyggelsestankegang er i opbrud. Formål. At beskrive hvorledes fald,faldhændelser og at miste balanceopleves og håndteres af gamle mennesker, der bor i selvstændig bolig. Studiet har ligeledes fokus på at undersøge sammenhænge i den faldforebyggende indsats med udgangspunkt i hvad de, der er faldet, har oplevet. Studiet bidragertil udvikling af sundhedsfremmende og faldforebyggende indsats i forhold til den enkelte og til den samlede indsats. Metode. Afhandlingenbygger på fire delstudier (I-IV). I de fire studier anvendes fortolkende fænomenologiskfilosofisk tilgang og analytisk metode. I et studie (III) sker det i en case study ramme og er suppleret med kritisk diskursanalytisk analyse og fortolkning af dokumenter. I alt blev ni kvinder og fire mænd (75-94 år) narrativt interviewetom at falde. To social-og sundhedshjælperen blev individuelt interviewet, de deltog også i fokusgruppeinterview sammen med to social-og sundhedsassistent kolleger og en sygeplejerske, der alle kom ihovedpersonernes hjem irelation til den faldforebyggende indsats. Resultater. For at kunne håndtere det sårbare, skrøbeligeog dødens nærhed ved fald udviklede fortællerne forskellige metoder til at klare situationer for at kunne tilpasse egne ressourcer til konteksten og opnå følelser af velvære (I). Frygt eller bekymring for at falde var altid usynligt tilstede og blev håndteret forskelligt. På den ene side blev frygten konkretiseret i en bekymring for at befinde sig i en nedværdigende situation på den anden side var frygten en eksistentiel udfordring og tegn på dødens nærhed (II). Hovedpersonerne forventede personlige relationer, indflydelse og valgmuligheder i samarbejdet med sundhedspersonale om forebyggelseaf fald. Løsninger skulle forhandles og balancerede mellem professionel og personlig omsorg (III). De, der var faldet viste ikke stor appetit på mad men spiste for at være i live. Appetitten viste sig i at have indflydelse i sociale relationer både til social-og sundhedspersonalet, til familie og naboer og med udgangspunkt i oplevelse af sociale tilhørsforhold have samfundsmæssig indflydelse. Konklusion. Forebyggelse af fald må fremover indebære også sundhedsfremmetankegang og tager udgangspunkt i betydninger og kontekst for på denne måde ikke blotat være multifaktoriel, men også multidimensionel med eksistentielt perspektivBackground. Falls among older persons are a public health problem in Denmark, the Nordic countries and the rest of the Western world. In a population perspective fall-prevention has been characterised by an individual behavioural modificationand a regulating mode. This kind of fall-prevention discourseis nowbreaking up. Aim. To describe how community-dwelling older adults experience and handle falls, falling and loss ofbalance. The focus is also on examination offalls as contextual phenomena with the older adults’ experiences. This study will contribute to develop health promotion and fall-prevention to individuals and to the fall-prevention as so. Methodology. This thesis consists offour studies/articles (I-IV). Interpretative phenomenology as philosophical and analytical method was used. In one study (III) case study methodwas used as a framework,complemented bycritical discourse-analytic interpretation of documents. Within thefour studies nine women and four men (75-94 years old) were interviewed in narrative in-depth interviews about falling. In article III,five health and social workers and a nurse were interviewed. Results. In coping withfalling accidents, vulnerability, frailty and death imminence the participants developed various methods ofmanagingeveryday lifeat home. They describedadaptive resourcesused to achieve an adequate quality oflife andexperiencea feeling of well-being (I). Fear of fallingwas always present and was met in differentways. On one handwas worry aboutungraceful situationsnot able to manage on your own; on the other hand was the willto live with the fear.(II). The two protagonists, dependent onhome-care developed their own strategies for preventingfalls. The health professionals created a supportive network; a platform of continuity where the efforts of the older persons and the staff complemented each other. The staff had no clear approachto addressing issues raised by accidental falls or the prevention of falls (III).Eating and appetite on foodwerenot trivial everyday routines. The participants showed no particular interest in eating but ateto stay alive. Even if they had little appetite forfood, the participants showed great appetite forestablishing social relationships withfamily, neighbours and health care staff,as well as appetite forestablishing an influence in these relations and in local communities and society. Conclusion. In the future,fall-prevention must takea health promotion approach and contextualise falling accidents withexperiences and meanings as point of reference. Fall-prevention will be not only multifactorial,but also multidimenssional and existentia