68 * TIMED UP AND GO TEST RESULTS IN PATIENTS FOUND THROUGH GENERAL PRACTICE FALLS RISK SCREENING. PRELIMINARY EVALUATION OF THE NORTH TYNESIDE FALLS PREVENTION SERVICE (NTFPS)

Abstract Falls are the leading cause of older adult injury and cost $50bn annually. New digital technologies can quantitatively measure falls risk. Objective is to report on a validated wearable sensor-based Timed Up and Go (QTUG) assessment detailing 11 measures of falls risk, frailty and mobility impairment in older adults in six countries in 38 clinical and community settings. Second objective is to generate individual targeted falls prevention programs. 14,611 QTUG records from 8,521 participants (63% female) (72.7±10.7 years) available for analysis. QTUG time was 13.9±7.4 s; gait velocity was 101.9±32.5 cm/s. 25.8% of patients reported falling in previous 12 months; 26.2% of patients were at high fall risk. 21.5% not reporting a fall, were high fall risk. Participants had slow walking speed (29.8%); high gait variability (19.8%); problems with transfers (17.5%). Easily captured and interpreted sensor data is useful in a population-based approach to quantify falls risk stratification.

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Digital assessment of falls risk, frailty, and mobility impairment using wearable sensors

npj Digital Medicine ◽

10.1038/s41746-019-0204-z ◽

2019 ◽

Vol 2 (1) ◽

Cited By ~ 8

Author(s):

Barry R. Greene ◽

Killian McManus ◽

Stephen J. Redmond ◽

Brian Caulfield ◽

Charlene C. Quinn

Keyword(s):

Risk Assessment ◽

Fall Risk ◽

Falls Prevention ◽

Sensor Data ◽

Emergency Department Utilization ◽

Mobility Impairment ◽

Timed Up And Go ◽

Falls Risk ◽

Assessment Protocol ◽

Risk Of Falls

AbstractFalls are among the most frequent and costly population health issues, costing $50bn each year in the US. In current clinical practice, falls (and associated fall risk) are often self-reported after the “first fall”, delaying primary prevention of falls and development of targeted fall prevention interventions. Current methods for assessing falls risk can be subjective, inaccurate, have low inter-rater reliability, and do not address factors contributing to falls (poor balance, gait speed, transfers, turning). 8521 participants (72.7 ± 12.0 years, 5392 female) from six countries were assessed using a digital falls risk assessment protocol. Data consisted of wearable sensor data captured during the Timed Up and Go (TUG) test along with self-reported questionnaire data on falls risk factors, applied to previously trained and validated classifier models. We found that 25.8% of patients reported a fall in the previous 12 months, of the 74.6% of participants that had not reported a fall, 21.5% were found to have a high predicted risk of falls. Overall 26.2% of patients were predicted to be at high risk of falls. 29.8% of participants were found to have slow walking speed, while 19.8% had high gait variability and 17.5% had problems with transfers. We report an observational study of results obtained from a novel digital fall risk assessment protocol. This protocol is intended to support the early identification of older adults at risk of falls and inform the creation of appropriate personalized interventions to prevent falls. A population-based approach to management of falls using objective measures of falls risk and mobility impairment, may help reduce unnecessary outpatient and emergency department utilization by improving risk prediction and stratification, driving more patients towards clinical and community-based falls prevention activities.

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Implementation and initial evaluation of falls risk reduction resources in a rural Native American Community

Injury Epidemiology ◽

10.1186/s40621-021-00359-1 ◽

2021 ◽

Vol 8 (S2) ◽

Author(s):

Kyle M. Knight

Keyword(s):

Native American ◽

Risk Reduction ◽

Integrated Approach ◽

Health Care Facilities ◽

Falls Prevention ◽

Timed Up And Go ◽

Falls Risk ◽

Functional Reach ◽

Increased Risk ◽

Serious Injury

Abstract Background Although falls are common and can cause serious injury to older adults, many health care facilities do not have falls prevention resources available. Falls prevention resources can reduce injury and mortality rates. Using the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) model, a falls risk clinic was implemented in a rural Indian Health Service (IHS) facility. Methods A Fall Risk Questionnaire was created and implemented into the Provider’s Electronic Health Records system interface to streamline provider screening and referral of patients who may be at risk for falls to a group falls risk reduction class. Results Participants exhibited average improvements in the Timed Up and Go (6.8 s) (P = 0.0001), Five-Time Sit-to-Stand (5.1 s) (P = 0.0002), and Functional Reach (3.6 inches) (P = 1.0) tests as compared to their own baseline. Results were analyzed via paired t test. 71% of participants advanced out of an “increased risk for falls” category in at least one outcome measure. Of the participants to complete the clinic, all were successfully contacted and three (18%) reported one or more falls at the 90-day mark, of which one (6%) required a visit to the Emergency Department but did not require hospital admission. Conclusions In regards to reducing falls in the community, per the CDC STEADI model, an integrated approach is best. All clinicians can play a part in reducing elder falls.

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Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service

Australian Health Review ◽

10.1071/ah030088 ◽

2003 ◽

Vol 26 (3) ◽

pp. 88 ◽

Cited By ~ 34

Author(s):

Craig Whitehead ◽

Rachel Wundke ◽

Maria Crotty ◽

Paul Finucane

Keyword(s):

Controlled Trial ◽

Intervention Group ◽

Falls Prevention ◽

Evidence Based ◽

Patient Centered ◽

Falls Risk ◽

High Care ◽

Prevention Service ◽

Fall Rates ◽

Randomised Controlled

Aims:Evidence-based guidelines recommend a range of treatments for falls and injury prevention. We undertook arandomised trial of a falls prevention service to screen for falls risk factors and recommend to GPs an evidenced baseprescription for falls prevention.Methods:All patients who presented with a fall to the Emergency Department at Flinders Medical Centre over a 22-week periodwere considered for the study. We excluded patients with dementia, resident in high care or those transferred to otherhospitals and outside our catchment area. Of those who consented, we randomised patients between usual care or toan intervention consisting of a falls risk assessment and writing of an evidence-based prescription faxed to their GPfor action. Patients were followed for six months and uptake of advice and fall rates were monitored.Results:Four hundred and fifty patients presented with a fall-related attendance and of these 261 patients were eligible forinclusion in the trial. Of these 261 patients, 140 consented and were enrolled in the trial. Over the six monthspatients in the intervention group were more likely to uptake preventative advice (OR=12.3; 95%CI=4.2-35.9).We were unable to show a reduction in falls (OR=1.7; 95%CI=0.7-4.4).Conclusions:A patient centered evidence-based approach is feasible and effective in increasing uptake of falls prevention advice.Long term compliance with advice needs further exploration.

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A general practice provider federation in a mixed health economy in England: a case study investigation

British Journal of General Practice ◽

10.3399/bjgp18x696929 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X696929

Author(s):

Jill Mitchell

Keyword(s):

General Practice ◽

Shared Vision ◽

Health Economy ◽

Structured Interviews ◽

The North ◽

Common Strategy ◽

Common Purpose ◽

Collaborative Working ◽

The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

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Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy

Medicina ◽

10.3390/medicina57050457 ◽

2021 ◽

Vol 57 (5) ◽

pp. 457

Author(s):

Neil D. Reeves ◽

Giorgio Orlando ◽

Steven J. Brown

Keyword(s):

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Motor Nerve ◽

Step Length ◽

Falls Prevention ◽

Motor Deficits ◽

Falls Risk ◽

Walking Gait ◽

Risk Of Falls ◽

Diabetes Patients

Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.

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Hospital training for general practice: views of trainees in the North Western region.

BMJ ◽

10.1136/bmj.298.6685.1432 ◽

1989 ◽

Vol 298 (6685) ◽

pp. 1432-1434 ◽

Cited By ~ 16

Author(s):

H. Reeve ◽

A. Bowman

Keyword(s):

General Practice ◽

Western Region ◽

The North ◽

North Western

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Development of the Sydney Falls Risk Screening Tool in brain injury rehabilitation: A multisite prospective cohort study

Journal of Clinical Nursing ◽

10.1111/jocn.14048 ◽

2018 ◽

Vol 27 (5-6) ◽

pp. 958-968 ◽

Cited By ~ 1

Author(s):

Duncan McKechnie ◽

Murray J Fisher ◽

Julie Pryor ◽

Melissa Bonser ◽

Jhoven De Jesus

Keyword(s):

Cohort Study ◽

Brain Injury ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Screening Tool ◽

Risk Screening ◽

Injury Rehabilitation ◽

Falls Risk

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THE TEST RESULTS OF LOW-PERMEABILITY SHALE DEPOSITS WHEN DRILLING THE PRE-CRETACEOUS COMPLEX AT THE KARMALINOVSKOYE GAS CONDENSATE FIELD

Oil and Gas Studies ◽

10.31660/0445-0108-2018-6-45-58 ◽

2019 ◽

pp. 45-58

Author(s):

A. A. Zakharov ◽

S. V. Korotkov ◽

A. I. Gritsenko ◽

R. A. Ivakin ◽

V. G. Griguletsky

Keyword(s):

Hydraulic Fracturing ◽

Flow Rate ◽

Gas Condensate ◽

Low Permeability ◽

Test Results ◽

North West ◽

The North ◽

Exploratory Wells

The article reports the results of the analysis of the field prospecting activities of five exploratory wells at the Karmalinovskoye gas condensate field. We have found that the eastern part of the licensed area is characterized by the lack of fructuring in Paleozoic deposits, and the development of the productive deposit extends in the north-west direction. Hydraulic fracturing made it possible to get a stable gas and gas condensate flow rate in well № 4. This volume exceeds 3,8 times as large than flow rate in wells № 1 and № 2, which were tested after drilling without conducting hydraulic fracturing.

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