Estudo transversal retrospectivo realizado um hospital universitário de grande porte do sul do Brasil para analisar o Diagnóstico de Enfermagem (DE) Risco de quedas e os cuidados de enfermagem prescritos para pacientes adultos hospitalizados em unidades clínicas e cirúrgicas no ano de 2011. Especificamente, buscou-se identificar a prevalência do DE, o perfil clínico dos pacientes, os fatores de risco estabelecidos e os cuidados prescritos para esses pacientes, agrupando os últimos de acordo com as intervenções descritas na Nursing Interventions Classifications (NIC). A amostra constituiu-se de 174 pacientes, e os dados foram coletados em sistema de prescrição informatizado e prontuário online. A análise foi realizada pela estatística descritiva e o agrupamento dos cuidados de enfermagem nas intervenções NIC baseou-se no método de mapeamento cruzado. O estudo foi aprovado em Comitê de Ética e Pesquisa (nº 110631). Houve prevalência do DE Risco de quedas em 4% das internações estudadas, o perfil dos pacientes com este DE apontou para idosos, sexo masculino (57%), internados nas unidades clínicas (63,2%), com tempo mediano de internação de 20(10-24) dias, portadores de doenças neurológicas (26%), cardiovasculares (74,1%) e várias comorbidades (3±1,8). Os fatores de risco mais prevalentes foram alteração neurológica (43,1%), mobilidade prejudicada (35,6%) e extremos de idade (10,3%). Entre os 48 diferentes cuidados de enfermagem prescritos, os mais frequentes foram manter grades no leito (83,2%), orientar paciente/família quanto aos riscos e prevenção de quedas (49,4%) e manter campainha ao alcance do paciente (40,8%). O agrupamento dos cuidados nas intervenções NIC apontou Controle do Ambiente: segurança (29,2%), Prevenção de Quedas (20,6%) e Monitoração Neurológica (15%) como as mais prevalentes. A intervenção Prevenção de Quedas compreendeu o maior número de cuidados diferentes. Concluiu-se que a prevalência deste DE ainda é pequena no cenário de estudo, o que talvez possa ser modificado após o início da utilização de instrumento preditor de risco. O perfil dos pacientes com este DE mostra que são em maioria idosos, com doenças neurológicas e cardiovasculares e diversas comorbidades, o que requer cuidados preventivos à multiplicidade desses fatores. A intervenção Prevenção de Quedas mostrou-se realmente prioritária ao DE Risco de quedas, pois suas atividades se direcionam à multifatorialidade do evento. O uso de linguagens padronizadas na prática clínica pode contribuir para a qualificação do cuidado, norteando protocolos de prevenção e de segurança aos pacientes. / Retrospective cross-sectional study performed in a large university hospital in southern Brazil to analyze the ND Risk for fall and nursing cares prescribed for adult patients hospitalized in clinical and surgical units in 2011. The specific objectives were: identify the prevalence of the ND Risk for fall; the clinical profile of patients; the risk factors established and nursing cares prescribed for these patients, grouping them according to the interventions described in the Nursing Interventions Classification (NIC). The sample consisted of 174 patients and the data were collected in medical records and computerized system. The data analysis was done by the descriptive and analytic statistics and the grouping of nursing cares in the NIC interventions was based on the cross-mapping method. The study was approved by Ethics and Research Committee (number 110631). The results showed a prevalence of the ND Risk for fall in 4% of the hospitalizations studied. The profile of the patients with this ND pointed to elderly, male (57%), hospitalized in clinical units (63.2%), with median time of hospitalizations of 20 (10-24) days, with neurological disorders (26%), cardiovascular (74,1%) and many comorbidities (3±1,8). The risk factors most prevalent were: Neurological alteration (43.1%), Impaired mobility (35.6%) and Age extremes (10.3%). Were identified 48 different nursing cares prescribed, being the most frequent Keep the bars in the bed (83.2%), Guide patient/family about the risks and prevention of falls (49.4%) and Keep the bell within reach of the patient (40.8%). The care grouping in the NIC interventions pointed to Environment control: security (29.2%), Prevention of falls (20.6%) and Neurological monitoring (15%) as the most prevalent. The intervention Prevention of falls comprehended the largest number of different cares. It was concluded that the prevalence of this ND is still low in the studied scenario, which may be modified after the beginning of the use of the risk predictor instrument. The profile of patients with this ND shows that they are most elderly, with neurological and cardiovascular diseases and many comorbidities, which requires preventive cares to the multiplicity of these factors. The intervention Prevention of falls proved to be really priority to the ND Risk for fall, because its activities are directed to the multifactorial of the event. The use of standardized language in clinical practice can contribute to qualify the care, guiding prevention and patient’s safety protocols. / Estudio transversal retrospectivo realizado en un hospital universitario de grande porte del sur de Brasil para analizar el Diagnostico de Enfermería (DE) Riesgo de Caídas y los cuidados de la enfermería prescriptos para pacientes adultos hospitalizados en unidades clínicas y cirúrgicas durante el año de 2011. Los objetivos específicos fueron: identificar la permanencia del DE Riesgo de caídas; el perfil clínico de los pacientes; los factores de riesgo establecidos y los cuidados prescriptos para esos pacientes, además de agrupar de acuerdo con las intervenciones descriptas en la Nursing Interventions Classifications (NIC). La muestra se constituyó de 174 pacientes y los datos colectados en sistema informatizado y prontuarios. El análisis fue realizada por la estadística descriptiva y agrupamiento de los cuidados de enfermería en las intervenciones NIC se ha basado en el método de mapeamiento cruzado. El estudio fue aprobado por el Comité de Ética e Investigación (nº 110631). El permanencia del DE Riesgo de caída fue de 4% en las internaciones estudiadas. El perfil de los pacientes puntó para ancianos, sexo masculino (57%), internados en las unidades clínicas (63,2%), con tiempo medio de internación de 20 (10-24) días, portadores de enfermedades neurológicas (26%), cardiovasculares (74,1%) y diversas morbilidades (3±1,8). Los factores de riesgo más permanentes fueron: Alteración neurológica (43,1%), Movilidad perjudicada (35,6%) y de los Extremos de edad (10,3%). Se identificaron 48 cuidados de enfermería prescriptos siendo los más frecuentes: mantener baranda en las camas (83,2%), orientar paciente/familia en cuanto a los riesgos y prevención de caídas (49,4%) y mantener el timbre al alcance del paciente (40,8%). El agrupamiento de los cuidados en las intervenciones NIC apuntaron Control de Ambiente: seguridad (29,2%). Prevención de Caídas (20,6%) y Monitoreo Neurológico (15%) como las más permanentes. La intervención Prevención de Caídas comprendió el mayor número de diferentes cuidados. Se concluyó que la permanencia de este DE todavía es pequeña en el escenario del estudio, lo que tal vez pueda ser modificado después del inicio de la utilización de instrumento predictor de riesgo. Los pacientes con este DE muestra que son en mayoría ancianos, con enfermedades neurológicas y cardiovasculares y diversas morbilidades, y que requieren cuidados preventivos a la multiplicidad de estos factores. La intervención Prevención de Caídas se mostró realmente prioritaria al DE Riesgo de Caídas, pues sus actividades se direccionan a los diferentes factores del evento. El uso de lenguajes padronizados en la práctica clínica puede contribuir para la cualificación del cuidado norteando protocolos de prevención y de seguridad a los pacientes.

Detecting unusual movement (falls) for elderly people in enclosed environments is receiving increasing attention and is likely to have massive potential social and economic impact. In this thesis, new intelligent computer vision processing based techniques are proposed to detect falls in indoor environments for senior citizens living independently, such as in intelligent homes. Different types of features extracted from video-camera recordings are exploited together with both background subtraction analysis and machine learning techniques. Initially, an improved background subtraction method is used to extract the region of a person in the recording of a room environment. A selective updating technique is introduced for adapting the change of the background model to ensure that the human body region will not be absorbed into the background model when it is static for prolonged periods of time. Since two-dimensional features can generate false alarms and are not invariant to different directions, more robust three-dimensional features are next extracted from a three-dimensional person representation formed from video-camera measurements of multiple calibrated video-cameras. The extracted three-dimensional features are applied to construct a single Gaussian model using the maximum likelihood technique. This can be used to distinguish falls from non-fall activity by comparing the model output with a single. In the final works, new fall detection schemes which use only one uncalibrated video-camera are tested in a real elderly person s home environment. These approaches are based on two-dimensional features which describe different human body posture. The extracted features are applied to construct a supervised method for posture classification for abnormal posture detection. Certain rules which are set according to the characteristics of fall activities are lastly used to build a robust fall detection model.

Digitized by Kansas Correctional Industries

Introdução: Estudos recentes têm mostrado que as quedas são a causa externa de morte mais importante entre idosos, podendo levar a hospitalização, lesões, dependência e aumento nos custos dos serviços sociais e de saúde. O comprometimento da mobilidade funcional é um importante fator de risco para quedas, mas aspectos sociais, ambientais e comportamentais também podem influenciar nesse evento. Objetivo: Identificar os aspectos socioeconômicos e contextuais associados com a mobilidade funcional e quedas em idosos residentes no município de São Paulo. Métodos: Foram utilizados os dados do Estudo Saúde, Bem-Estar e Envelhecimento (SABE), uma amostra representativa para os indivíduos com idade igual ou superior a 60 anos do município de São Paulo, em 2010. As variáveis dependentes do estudo foram a ocorrência de alguma queda no último ano e o comprometimento da mobilidade funcional, mensurada pelo teste Timed Up and Go (TUG). Fatores individuais (estado marital, raça/cor, anos de estudo e percepção de suficiência de renda) e contextuais (Índice de Gini, área verde/ habitante, taxa de homicídio e percentual de domicílios em favelas) foram analisados por modelos logísticos multiníveis. Resultados: De 1.190 idosos inclusos, 29 por cento relataram ter caído no último ano e 46 por cento apresentaram comprometimento da mobilidade funcional. Os fatores individuais socioeconômicos não apresentaram associação com a ocorrência de queda, mas ter 8 anos ou mais de anos de estudo foi um fator protetor para comprometimento da mobilidade em todos os modelos testados (OR: 0,56). Morar em subprefeituras com taxa de homicídio moderada apresentou associação com chance aumentada de cair (OR: 1.51, 95 por cento IC: 1.09-2.07). Moderada área verde se associou com maior chance de cair entre os indivíduos com 80 anos e mais (OR:2,63, 95 por cento IC: 1.23-5.60). Conclusão: Os resultados estão de acordo com a literatura em relação à associação das características do bairro de residência com quedas e mobilidade funcional em idosos. Estratégias voltadas para prevenção de quedas e de dificuldade na mobilidade funcional devem considerar aspectos sociais e ambientais de locais públicos. Este estudo foi financiado pela Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (nº processo: 2014/06721-4) / Introduction: Recent studies show that falls are the most important external cause of death in elders, leading to hospitalization, injuries, dependency, and to increased costs of health and social care services. Functional mobility impairment is a risk factor for falling, but social, environmental and behavioral aspects may also affect this event. Objective: To identify the socioeconomics and contextual aspects associated with functional mobility and falls in elderly residents of the Municipality of São Paulo, Brazil. Methods: We used data from Health, Wellbeing and Aging (SABE) Study, a representative study of individuals aged 60 and older of the Municipality of São Paulo in 2010. The dependent variables of interest were the occurrence of any fall in the last year and functional mobility impairment, assessed by the Timed Up and Go (TUG) test. Individual (marital status, race, years of schooling and perception of income sufficiency) and contextual (Gini coefficient, green areas per capita, and homicide rate) factors were analyzed by multilevel logistic models. Results: From the sample of 1,190 elderly individuals, 29 per cent reported a fall in the last year and 46 per cent had mobility impairment. The socioeconomic individual factors were not significantly associated with falling, but having eight or more years of schooling was a protective factor for mobility impairment for every model (OR: 0.56). Living in a neighborhood with a moderate homicide rate was associated with higher odds of falling (OR: 1.51, 95 per cent CI: 1.09-2.07). Neighborhoods with moderate greens spaces were associated with higher odds of falling for individuals 80 years old and older (OR: 2.63, 95 per cent CI: 1.23-5.60). Conclusion: Our findings support the concern that neighborhood characteristics are associated with falls and mobility impairment for the elderly. Strategies to prevent falls and mobility impairment in developing countries should consider public environment and social aspects.

O Brasil cada vez mais torna-se um país de cabelos brancos, e, este processo traz reflexos para a sociedade brasileira e para a assistência à saúde desta população. Destaca-se as causas externas como um problema de saúde pública que oferecem grande impacto na saúde dos idosos. Estes têm capacidade reduzida de recuperação e permanecem hospitalizados por maior tempo. Portanto, nesta investigação buscou-se identificar a relação entre o idoso vítima de trauma e os fatores de risco envolvidos no acidente. Objetivo Geral: Desenvolver indicadores de predição de risco para o trauma em idosos. Objetivos Específicos: Caracterizar o perfil dos idosos vitimas de trauma atendidos no pronto-socorro; Verificar quais os mecanismos de trauma sofrido pelos idosos; Conhecer os fatores que contribuíram para a ocorrência do trauma; Analisar os fatores de risco para a ocorrência do trauma em idosos. Estudo quantitativo, transversal realizado no prontosocorro (PS) de dois hospitais da cidade de Curitiba, sendo aprovada por suas Comissões de Ética em Pesquisa. Os critérios de inclusão foram os seguintes: pacientes com 60 anos ou mais, de ambos os gêneros, vítimas de trauma, que estavam sendo atendidos no PS e que aceitaram participar da pesquisa de maneira voluntária ou por autorização de cuidadores ou familiares, em caso de déficit cognitivo e/ou auditivo. A coleta de dados foi realizada à beira do leito por meio de uma entrevista estruturada; os dados obtidos foram organizados em planilha Excel e analisados por meio do programa computacional Statistical Package for the Social Sciences - SPSS versão 15.0. Os resultados foram descritos por frequências e percentuais. Para avaliação da associação entre duas variáveis qualitativas, foi considerado o teste de Qui-quadrado ou o teste exato de Fisher. Para avaliação conjunta da associação de fatores com o mecanismo do trauma (queda ou outros eventos), foi ajustado um modelo de Regressão Logística (stepwise backward). A partir do ajuste, foram estimados os valores de odds ratio com respectivos intervalos de confiança de 95%. Os sujeitos foram 261 idosos que atenderam aos critérios de inclusão, sendo 148 mulheres (56,7%) e 43,3% homens. A faixa de idade variou de 60 a 103 anos, e a média foi de 72,6 ± 9,3 anos. Grande parte da amostra tinha idade abaixo de 70 anos (44,8%). Com relação ao estado civil, 43,3% dos pacientes eram casados; 35,2%, viúvos; 13%, separados, amasiados; e 8,4%, solteiros. Os mecanismos de trauma mais frequentes foram: queda (75,9%), atropelamento (9,6%), trauma direto (5,4%) e acidente automobilístico (3,8%). O medicamento mais utilizado foi o anti-hipertensivo (45,2%). A análise multivariada permitiu afirmar que, independentemente das outras variáveis incluídas no modelo, o gênero feminino, a presença de cuidador, medicação de uso contínuo e a presença de problemas auditivos aumentam significativamente a probabilidade de trauma por queda. Problemas de visão sem uso de óculos e idosos com renda de até 3 salários mínimos tendem a 7 ter maior probabilidade de trauma por queda. Esses resultados permitem estabelecer que os fatores que mais interferem no trauma em idosos podem, se avaliados durante a consulta de enfermagem, possibilitar ações de saúde para a sua prevenção. / Brazil is becoming more and more a country of white hair and this process brings consequences for Brazilian society and the health care of its population. The highlights are the external causes as a matter of public health that offers great impact on the health of the elderly. The aged have their ability of recovery reduced and remain hospitalized for longer periods of time. Therefore, this research aimed to identify the relation between the aged victim of trauma and the risk factors involved in the accident. General objective: develop indicators of risk prediction for trauma in the aged. Specific objectives: describe the profile of aged victims of trauma seen in the emergency room; Check which mechanisms of trauma are suffered by the aged; Learn the factors that contributed to the occurrence of the trauma; Analyze the risk factors for the occurrence of the trauma in the aged. Quantitative cross study, held in the emergency department of two hospitals in Curitiba, which was approved by their Research Ethics Committees. The inclusion criteria were as follows: patients of 60 years old or more, both gender, victims of trauma that were being seen at the emergency room and accepted to participate in the research voluntarily or under authorization of caregiver or family in case of cognitive or/and hearing deficit. The data collection was made through a semi-structured interview by the bed; the data obtained were organized in an excel spreadsheet and analyzed by computer program Statistical Package for the Social Sciences - SPSS version 15.0. The results were described by frequencies and percentages. To evaluate the association between two qualitative variables, it was considered the Chisquare test or the Fishers exact test. To jontly evaluate the factors associated with the mechanism of trauma (fall and other events), it was adjusted a logistic regression model (stepwise backward). As from the ajustment, it were estimated the odds ratio values with respective confidence intervals of 95%. The subjects were 261 elderly people that met the inclusion criteria, 148 women (56,7%) and 43,3% men. The age ranged from 60 to 103 years old, and the average was 72,6 ± 9,3 years old. The great majority of the sample was under 70 years old (44,8%). Regarding to marital status, 43,3% of patients were married; 35,2%, widowed; 13%, separated, in cohabitation and 8,4%, single. The mechanisms of trauma more frequent were: fall (75,9%), running over (9,6%), direct trauma (5,4%) and car accident (3,8%). The medicament most used was the anti-hypertensive (45,2%). The multivariate analysis allowed to say that, independently of other variables included in the model such as the female gender, the presence of the caregiver, the continued use of medication and the presence of hearing problems increased significantly the probability of trauma by fall. Sight problems without wearing glasses and aged with incomes up to 3 minimal wages tend to have higher probability of trauma by fall. These results allowed establishing that the factors that most interfere in trauma in the aged may, if evaluated during the nursing consultation, enable health actions for its prevention.

Falls and injuries related to falls are some of the most common and costly incidents that occur in the long-term care environment. Purposeful hourly rounding is a proactive way for nursing staff to identify patient needs and demonstrate positive fall prevention outcomes. This project examined a process improvement endeavor of a long-term care unit that experienced an increase in the number of falls over 3 months. The purpose was to evaluate whether staff education and implementation of an evidence-based hourly rounding program would affect the number of patient falls. The Johns Hopkins nursing evidence-based conceptual model, Kurt Lewin's change model, and the Shewhart cycle process improvement model were used to implement the change process as well as the Studer Group best practice hourly rounding tools. A sample of 40 residents was included in a quantitative descriptive design describing the implementation of hourly rounding. Staff were educated 30 days prior to implementation. Pre and post project fall rates were retrieved from the VA fall data management system and revealed a 55% decrease over 3 months post staff education. The use of evidence-based hourly rounding measures increased over the same time period. Nurse leaders must ensure rounding programs are evidence-based, clearly defined in policies, and include robust education plans. There are limited studies on the relationship between education and hourly rounding; therefore, future studies should focus on outcomes of initial and ongoing education for program success and sustainability. Falls are a healthcare concern nurses must address at any point-of-care to promote public safety through prevention and to facilitate positive social change by providing a safe hospital environment.

Residents who fall in SNF either sustain significant decline to quality of life or die from their injuries. The average fall costs about $34,000 per incident. On average, 19.8% of residents fall at least once per month. The purpose of this project was to assess, identify, and advance nursing practice to decrease falls by evaluating current facility standard of practice, fall policy, procedures, and protocol. The objective was to create actions that would close the communication gap between clinicians and residents. This project encourages clinicians to intertwine resident feedback and strategies into the plan of care to help reduce fall risk. A focus group was conducted with 11 residents with previous fall experience. Through structured discussion, several important gaps in communication related to residents' plan of care were identified. Examples identified include, 10 of 11 residents indicated they were never asked to participate in their plan of care, 10 of 11 residents indicated staff did not listen to them, and 11 of 11 stated they did not know they could change the plan of care that staff had put in place. Further feedback from the focus group demonstrated residents desire to be involved in their care however, they were largely excluded from this process in the past. This project contributes to positive social change by identifying ways to close the communication gaps and reduce risk for falls by intertwining clinician and resident fall practices. A highly recommended fall committee was established at the project facility to encourage staff buy in, advancement of nursing practice and resident involvement in reducing falls.

Falls constitute a health care safety concern, specifically among the geriatric population institutionalized in health care facilities. From the pattern of observed falls at the project site, a discrepancy between fall prevention measures and expected outcomes was noted. Knowledge deficiency, inadequate practice skills, and insufficient organizational support were found to be the major obstacles to improving fall prevention. The purpose of this systematic literature review project was to identify evidence-based actions to reduce falls. The project was guided by Taylor's personality theory and Watson's theory of care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used to evaluate and analyze 4 of the 47 screened publications. The evidence supported 5 interventions: furthering implementation facilitators, removing barriers, improving strategies, integrating personality, and using a fall risk assessment tool. The systematic review addressed practice gaps, organizational support, and barriers to curb recurrent falls. By contributing to the improvement of individual and population health, the project might lead to a positive socioeconomic change by reducing falls and their complications.

Introduction The consequences of falling can be fatal to elderly. The mortality, morbidity and the risk ofanxiety and depression increases following a fall. Drug prescription is a preventable fall risk,making the association between antihypertensive medications and risk of falling an importantarea of investigation. Aim Compile the results from studies which have examined the effect of initiating or changing theantihypertensive medication on fall risk in people aged 60 years or older. Methods Data sources: MEDLINE and Cochrane databases. Study selection: Original articles ofcohort-, case control-, case crossover-, cross-sectional- and randomized controlled trial type,published between January 2000 and May 2019 and written in English were included. Dataassessment: 6 studies met the criteria and were included. Study quality was assessed for eachstudy. Results Three studies found significant short-term increase in fall risk, regardless of drug type. Onestudy discovered an 18% increase in fall risk for every 5-day gap in treatment. Two studiesevaluated antihypertensive drug types separately and found contradictive results of thiazidediuretics on short-term fall risk. Calcium channel blockers showed a protective effect andbeta blockers an increased risk during the first 3 weeks after initiating treatment. Conclusions No consistent consensus was seen regarding the short-term fall risk in separateantihypertensive drug types, though most studies agree in a short-term risk increase aftergeneral antihypertensive treatment initiation or change.

[pt] O desenvolvimento de estudos de inventário para Pequenas Centrais Hidroelétricas – PCHs – é uma atividade custosa e demorada. A motivação desta dissertação é, de forma rápida e econômica, verificar a real viabilidade destes projetos. Um modelo computacional foi criado para automatizar estudos de inventário, identificando o potencial de geração hidroelétrica e os locais de instalação dos projetos. A partir da identificação do potencial, é estudada a definição de possíveis eixos de barramento, ou seja, resolve-se o problema da divisão de quedas para um determinado rio. Este trabalho, então, discute a implementação de um modelo para avaliação do potencial hidroelétrico que seleciona e dimensiona projetos hidroelétricos em uma bacia hidrográfica. Este potencial é desenvolvido baseando-se na maximização do benefício líquido, e inclui restrições sócio-ambientais que podem ser adaptadas a diferentes regulamentos locais. Através desta automatização, espera-se reduzir os riscos de empresários investirem uma quantidade de dinheiro significativa em bacias hidrográficas pouco promissoras. / [en] The development of inventory studies for Small Hydropower Plants is a costly and time consuming activity. The motivation of this dissertation is to, quickly and economically, verify the true viability of these projects. A computational model was created to automate inventory studies, identifying the hydroelectric generation potential and the projects’ installation sites. After the identification of the potential, the definition of project siting and project sizing is studied. In other words, the model determines the most adequate sites to build dams among several candidate locations and, for each selected case, the plant design (gross head, installed capacity, reservoir size and others). This potential is developed through the maximization of total net benefit, and includes environmental constraints that can be adapted to different regulations. Through this automation, the risks for entrepreneurs investing a significant amount of money in unpromising river basins are expected to reduce.