1,721,084 research outputs found
Verso la creazione in un mercato del gas: a proposito della distribuzione e della vendita del gas in ambito locale
No full textSTUDIO PROSPETTICO PER LA VALUTAZIONE DEI FATTORI DI RISCHIO DELLE CADUTE NELLE RESIDENZE SANITARIE ASSISTENZIALI (RSA) PER ANZIANI. FALL RISK ASSESSMENT IN INSTITUTIONALIZED ELDERLY LONGITUDINAL STUDY - FRAILS
Full text linkKeywords: falls; risk factors; older; nursing homes
Introduction
Falls are common in older persons and sometimes lead to unfavorable outcomes, as traumas and hip fracture. The elderly living in nursing homes are at greater risk of injury resulting from a fall, due to a higher degree of frailty. Some factors are more associated to falls and especially to traumatic falls: functional deficiency, use of aids for walking, osteoporosis, postural instability, deficit of balance and gait; chronic disease, cognitive impairment, and polytherapy use of psychotropic drugs, new environments, previous falls (1,2). The guidelines on the prevention of falls in older people recommend the evaluation of risk factors, as a key element to prevent further falls and, especially, trauma secondary to falls (3,4).
Aim of the study and Methods
In order to know the risk factors associated with falls, the incidence of falls and traumatic falls in people cared for in nursing home, it was performed a prospective observational study with 12 months of follow up (October 2013 - September 2014).
For every resident we detect the functional, cognitive and nutritional status, comorbidity, number and type of drugs, risk of falling, number and outcomes of falls. It was used univariate and multivariate logistic regression to estimate the predictive role of clinical variables on people who had fallen. Results were considered significant at a level of p value <0.05 and a confidence interval of 95%, with two-tailed test.
Results
The study, carried out in two nursing homes in Milan, involved 409 residents of which 331 in ordinary units, and in 78 specialized units for dementia, predominantly women (82%) with a mean age of 83 years (± 9.4).
Most of the residents had a total dependence (43.8%) or severe (32.8%) in the activities of daily living (Barthel index median: 26) and mild (11%), moderate (20%) or severe (42%) cognitive impairment, detected by the Mini Mental State Examination. Residents showed an average 6.30 (± 2.2) disease with moderate severity (2.24 ± 0.47), derived by the average of 13 categories of the Cumulative Illness Rating Scale. In 117 residents it was detected a risk of malnutrition: moderate (11.5%) or high (17.1%), using the Malnutrition Universal Screening Tool. However only 67 residents were underweight (body mass index: 0 to 18.49).
In one of the nursing home 83% (185/223) had a risk of falling, with a median value of 5, detected by the Conley Scale (≥2 values are indicative of risk). In the second RSA, based on the scores of Tinetti Balance Assessment Tool, 106/186 residents were at risk of falling, including 31.2% lower and 25.8% higher, while 80 residents were not considered at risk, because they did not walk. About 40% of the residents were restrained with one or more restraint and at 286/409 residents (70%) were applied to bilateral bed rails.
The residents took an average of 8.5 (± 3.4) active ingredients per day (median 8, range 0-19), of which an average of 4.8 (± 2.2) drugs at risk (median 5, range 0-14 ) which include cardiovascular drugs, agents on metabolism/alimentary tract and acting on the nervous system.
In the observation period 111/409 (27%) residents fell, of which 54 had a lesion from mild to severe. It was detected an average of 1.26 (± 0.48) falls/resident, with a range from 1 to 10 and a higher percentage (and statistically significant) of falls among males (28/75) compared with women (83/334 ) and the residents cared for in special unit for dementia (29/78) than residents in ordinary units (83/331).
Multivariate logistic regression confirmed statistically significant risk factors: type of nursing home unit, level of dependence in activities of daily living, previous falls, psycholeptics. Residents with a lower dependence in activities of daily living (Barthel> 27), compared to those with a total dependence, had a risk more than four times significantly higher (OR: 4.75; 95% CI 2.50 to 9.02 p: 0.000). Previous falls bring a three-fold risk of falling (OR: 3.34; 95% CI 1.5 to 7.44; P 0.003), instead the residents cared for in specialized units presented a two-fold risk (OR: 2.22; 95% CI 1.16 to 4.27; P 0.016). Although it was less significant, there was a greater risk of falling in people taking antipsychotic drugs (OR: 1.66; 95% CI 0.99 to 2.76; p: 0.052).
Conclusion
The prevalence of falls is quite in line with results described in literature. A lesser dependency in ADL seems to have a high predictive role, although in some studies was observed an opposite direction. The results confirmed that a previous fall should be taken as alert of further falls, although it is considered a predictor of more than one risk factor, and as such it cannot be eliminated or preventable, but can direct a first level of screening.
The risk assessment should be the first step to predict recurrent falls, although it should accept some degree of risk, because it is not possible to eliminate all of the falls. The results of this study will allow to direct the development of new research hypotheses, including the evaluation of multidimensional programs for the prevention of traumatic falls in nursing home, specifically targeted to major risk factors found in the elderly, which include the improvement / maintenance of functional ability and medication review
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Distalizzazione del secondo molare superiore mediante molle al nichel-titanio Sentalloy 100g e barra transpalatale di ancoraggio senza la cooperazione del paziente
No full textVariations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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