The STRATIFY scale has been implemented as a preventive strategy for predicting the risk of accidental falls among hospitalized adults. However, there is still uncertainty about its accuracy. This ...study aimed to perform an external validation of the STRATIFY fall prediction scale in hospitalized adults in one tertiary care hospital in Bogotá, Colombia. The study was a retrospective cohort of adult hospitalized patients in a high-level complexity care hospital. The sample selected included admitted patients (age ≥ 18), consecutively by the institution between 2018 and 2020, with an evaluation of the fall risk measured by the STRATIFY score given to each at the time of hospital admission. For assessing the scale's feasibility, its discriminative capability was obtained by calculating sensitivity, specificity, likelihood ratios, predictive values, and area under the ROC curve. The evaluation included 93,347 patient hospital records (mean 56.9 years, 50.2% women). The overall sensitivity score was 0.672 IC 95% 0.612-0.723, the specificity score was 0.612 IC 95% 0.605-0.615, and the positive likelihood ratio was 1.73 IC 95% 1.589-1.891. The area under the ROC curve was 0.69 IC 95% 0.66-0.72. Subgroups of age obtained similar results. Applying the STRATIFY scale at hospital admission resulted in a lower performance of the tool-predict falls in hospitalized patients. It is necessary to implement an individual evaluation of the risk factors for falls in order to structure appropriate care plans to prevent and improve hospital safety.
Intra-hospital falls have become an important public health problem globally. The use of movement sensors with alarms has been studied as elements with predictive capacity for falls at hospital ...level. However, in spite of their use in some hospitals throughout the world, evidence is lacking about their effectiveness in reducing intra-hospital falls. Therefore, this study aims to develop a systematic review and meta-analysis of existing scientific literature exploring the impact of using sensors for fall prevention in hospitalized adults and the elderly population.
We explored literature based on clinical trials in Spanish, English, and Portuguese, assessing the impact of devices used for hospital fall prevention in adult and elderly populations. The search included databases such as IEEE Xplore, the Cochrane Library, Scopus, PubMed, MEDLINE, and Science Direct databases. The critical appraisal was performed independently by two researchers. Methodological quality was assessed based on the ratings of individual biases. We performed the sum of the results, generating an estimation of the grouped effect (Relative Risk, 95% CI) for the outcome first fall for each patient. We assessed heterogeneity and publication bias. The study followed PRISMA guidelines.
Results were assessed in three randomized controlled clinical trials, including 29,691 patients. A total of 351 (3%) patients fell among 11,769 patients assigned to the intervention group, compared with 426 (2.4%) patients who fell among 17,922 patients assigned to the control group (general estimation RR 1.20, 95% CI 1.04, 1.37, P = .02, I2 = 0%; Moderate GRADE).
Our results show an increase of 19% in falls among elderly patients who are users of sensors located in their bed, bed-chair, or chair among their hospitalizations. Other types of sensors such as wearable sensors can be explored as coadjutants for fall prevention care in hospitals.
Objective. This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and ...risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated. Methods. Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included pressure ulcers or pressure lesions or decubitus ulcers and prevention or preventive and repositioning or positioning or position changes or postural change and patient at risk or vulnerable and hospitalized or ICU or intensive care. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included. Results. Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy. Conclusion. The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.
El debate sobre la renta básica y sus distintas formas, como el ingreso mínimo vital, ha descuidado con frecuencia su dimensión de género. La justificación de la nueva prestación, recién aprobada por ...el Gobierno de España, apela a las ideas de justicia y eficiencia en la distribución de los recursos, pero ¿hay lugar para la preocupación por la igualdad de género? En este artículo discutimos las distintas aproximaciones desde las que esta cuestión se ha abordado, evaluando los argumentos e identificando las preguntas clave que deberían marcar el debate actual en nuestro país para evitar impactos no queridos sobre el bienestar de las mujeres y la igualdad de género. ¿Hasta qué punto un ingreso mínimo vital puede considerarse un instrumento para la profundización de la igualdad de género? ¿Hay efectos potencialmente perversos que puedan ser anticipados?
¿Cuál es la incidencia de la participación ciudadana en la formulación de políticas públicas locales? Este artículo de reflexión responde, exploratoriamente, esta pregunta desde el caso de la ...política pública del deporte, la recreación y la actividad física en Medellín. Teniendo en cuenta el mismo método, instrumentos e información recolectada durante el proceso original de reformulación, se contrasta esta información con la incorporada en los documentos oficiales que recogen la actualización de la política pública. Aunque se invoca la metodología de co-creación, se mantienen los mismos canales y limitaciones a la participación ciudadana; entonces, se participa, pero no se co-crea.
This study explores the code-switching practices of five core ESL teachers from the elementary grades in Quebec francophone schools. Through a fine-grained emic analysis of the teachers' reasons for ...code-switching, the study illuminates how they variously used French as a resource to fulfil their institutional roles as teachers. In addition, the study shed light on how strategies as a pedagogical resource were variously used by teachers to maximize the use of English. Considering the elementary level of language proficiency of the students, the present study underscores Carless's contention that the teacher's experiences, beliefs, and competencies may be a more significant factor than the students' language level for target language use. However, it also draws attention to how contextual factors constrain teachers' ability to maximize the L2 in line with their beliefs and the requirements of the provincial ESL curriculum.
Les auteures se penchent sur les pratiques d’alternance des codes de cinq professeurs d’anglais langue seconde enseignant au primaire dans des écoles francophones du Québec. Une analyse émique ...détaillée des motifs pour lesquels les enseignants alternent les codes met en lumière la façon dont ils utilisent le français comme ressource à différents moments pour s’acquitter des responsabilités institutionnelles qui relèvent de leur rôle d’enseignants. L’étude éclaire en outre la façon dont les enseignants recourent à des stratégies à différents moments comme ressource pédagogique pour maximiser l’usage de l’anglais. Compte tenu du niveau élémentaire de compétence linguistique des élèves, l’étude met en évidence l’affirmation de Carless selon laquelle l’expérience de l’enseignant, ses croyances et ses compétences peuvent jouer un rôle plus important que la compétence linguistique des élèves dans l’utilisation de la langue cible. Toutefois, elle attire également l’attention sur la façon dont les facteurs contextuels restreignent la possibilité pour les enseignants de maximiser l’usage de la langue seconde en concordance avec leurs croyances et les exigences du programme provincial d’anglais langue seconde.
This study was aimed to identify the mobilization patterns of acute myocardial infarction (AMI) patients during their first three days in the coronary care unit (CCU) by performing a prospective ...observational pilot study design. The study included 31 diagnosed AMI patients admitted to three CCUs. Mobilization patterns classified as bed rest, semi-fowler, transfer to chair, and standing/walking were documented by CCU nurses for 72 consecutive hours after patient admission to the CCU. Of 2,232 possible mobilization periods (72 hr × 31 patients), 1,385 recorded observations of mobilization (62%) were obtained. Bed rest and semi-fowler positions were the most common mobilization patterns; together they accounted for 70% of the documented positions over the first 72 hr in the CCU. Patients who experience an uncomplicated AMI spend the majority of their first 72 hr in CCU in bed.
PDF
