Algorithm of medication review in frail older people: Focus on minimizing the use of high-risk medications

Aim Frail older people typically suffer several chronic diseases, receive multiple medications and are more likely to be institutionalized in residential aged care facilities. In such patients, optimizing prescribing and avoiding use of high-risk medications might prevent adverse events. The present study aimed to develop a pragmatic, easily applied algorithm for medication review to help clinicians identify and discontinue potentially inappropriate high-risk medications. Methods The literature was searched for robust evidence of the association of adverse effects related to potentially inappropriate medications in older patients to identify high-risk medications. Prior research into the cessation of potentially inappropriate medications in older patients in different settings was synthesized into a four-step algorithm for incorporation into clinical assessment protocols for patients, particularly those in residential aged care facilities. Results The algorithm comprises several steps leading to individualized prescribing recommendations: (i) identify a high-risk medication; (ii) ascertain the current indications for the medication and assess their validity; (iii) assess if the drug is providing ongoing symptomatic benefit; and (iv) consider withdrawing, altering or continuing medications. Decision support resources were developed to complement the algorithm in ensuring a systematic and patient-centered approach to medication discontinuation. These include a comprehensive list of high-risk medications and the reasons for inappropriateness, lists of alternative treatments, and suggested medication withdrawal protocols. Conclusions The algorithm captures a range of different clinical scenarios in relation to potentially inappropriate medications, and offers an evidence-based approach to identifying and, if appropriate, discontinuing such medications. Studies are required to evaluate algorithm effects on prescribing decisions and patient outcomes.

Towards an understanding of the information dynamics of the handover process in aged care settings: A prerequisite for the safe and effective use of ICT

Background Poor clinical handover has been associated with inaccurate clinical assessment and diagnosis, delays in diagnosis and test ordering, medication errors and decreased patient satisfaction in the acute care setting. Research on the handover process in the residential aged care sector is very limited. Purpose The aims of this study were to: (i) Develop an in-depth understanding of the handover process in aged care by mapping all the key activities and their information dynamics, (ii) Identify gaps in information exchange in the handover process and analyze implications for resident safety, (iii) Develop practical recommendations on how information communication technology (ICT) can improve the process and resident safety. Methods The study was undertaken at a large metropolitan facility in NSW with more than 300 residents and a staff including 55 registered nurses (RNs) and 146 assistants in nursing (AINs). A total of 3 focus groups, 12 interviews and 3 observation sessions were conducted over a period from July to October 2010. Process mapping was undertaken by translating the qualitative data via a five-category code book that was developed prior to the analysis. Results Three major sub-processes were identified and mapped. The three major stages are Handover process (HOP) I “Information gathering by RN”, HOP II “Preparation of preliminary handover sheet” and HOP III “Execution of handover meeting”. Inefficient processes were identified in relation to the handover including duplication of information, utilization of multiple communication modes and information sources, and lack of standardization. Conclusion By providing a robust process model of handover this study has made two critical contributions to research in aged care: (i) a means to identify important, possibly suboptimal practices; and (ii) valuable evidence to plan and improve ICT implementation in residential aged care. The mapping of this process enabled analysis of gaps in information flow and potential impacts on resident safety. In addition it offers the basis for further studies into a process that, despite its importance for securing resident safety and continuity of care, lacks research.

Use of lifts and refuge floors for fire evacuation in high rise apartment buildings

If current population and accommodation trends continue, Australian cities will, in the future, have noticeable numbers of apartment buildings over 60 storeys high. With an aging population it follows that a significant proportion of those occupying these buildings will be senior citizens, many of whom will have some form of disability. For these occupants a fire emergency in a high rise building presents a serious problem. Currently lifts cannot be used for evacuation and going down 60 storeys in a fire isolated staircase would be physically impossible for many. Therefore, for many, the temptation to remain in one’s unit will be very strong. With an awareness of this behaviour trend in older residents, many researchers have, in recent years, explored the possible wider use of lifts in a fire emergency. So far the use of lifts for evacuation has been approved for a small number of buildings but wide acceptance of this solution is still to be achieved. This paper concludes that even in high-rise apartment buildings where lifts are approved for evacuation, architects should design the building with alternative evacuation routes and provide suitable safe refuge areas for those who cannot use the stairs when the lifts are unavailable.

Use of ITS to improve level crossings safety : open issues

Level crossing crashes have been shown to result in enormous human and financial cost to society. According to the Australian Transport Safety Bureau (ATSB) [5] a total of 632 Railway Level crossing (RLX) collisions, between trains and road vehicles, occurred in Australia between 2001 and June 2009. The cost of RLX collisions runs into the tens of millions of dollars each year in Australia [6]. In addition, loss of life and injury are commonplace in instances where collisions occur. Based on estimates that 40% of rail related fatalities occur at level crossings [12], it is estimated that 142 deaths between 2001 and June 2009 occurred at RLX. The aim of this paper is to (i) summarise crash patterns in Australia, (ii) review existing international ITS interventions to improve level crossing and (iii) highlights open human factors research related issues. Human factors (e.g., driver error, lapses or violations) have been evidenced as a significant contributing factor in RLX collisions, with drivers of road vehicles particularly responsible for many collisions. Unintentional errors have been found to contribute to 46% of RLX collisions [6] and appear to be far more commonplace than deliberate violations. Humans have been found to be inherently inadequate at using the sensory information available to them to facilitate safe decision-making at RLX and tend to underestimate the speed of approaching large objects due to the non-linear increases in perceived size [6]. Collisions resulting from misjudgements of train approach speed and distance are common [20]. Thus, a fundamental goal for improved RLX safety is the provision of sufficient contextual information to road vehicle drivers to facilitate safe decision-making regarding crossing behaviours.

Assessing ease of use of the Staminalift bed mover

Battery powered bed movers are increasingly being used within the hospital setting. These energy augmenting devices facilitate the safe movement of beds and patients by healthcare workers. The use of powered bed movers is believed to result in reduced physical efforts on the behalf of staff members, which may be associated with a decreased risk of occupational related injuries. A provisional study was performed in a hospital environment to assess the muscular efforts associated with moving hospital beds both manually and with the aid of a bed mover. The results enable the effects of using bed movers to be quantified.

The use of thermal imaging in assessing skin temperature following cryotherapy : a review

Nineteen studies met the inclusion criteria. A skin temperature reduction of 5–15 °C, in accordance with the recent PRICE (Protection, Rest, Ice, Compression and Elevation) guidelines, were achieved using cold air, ice massage, crushed ice, cryotherapy cuffs, ice pack, and cold water immersion. There is evidence supporting the use and effectiveness of thermal imaging in order to access skin temperature following the application of cryotherapy. Thermal imaging is a safe and non-invasive method of collecting skin temperature. Although further research is required, in terms of structuring specific guidelines and protocols, thermal imaging appears to be an accurate and reliable method of collecting skin temperature data following cryotherapy. Currently there is ambiguity regarding the optimal skin temperature reductions in a medical or sporting setting. However, this review highlights the ability of several different modalities of cryotherapy to reduce skin temperature.

Use of brain computer interface to drive : preliminary results

This paper reports on the implementation of a non-invasive electroencephalography-based brain-computer interface to control functions of a car in a driving simulator. The system is comprised of a Cleveland Medical Devices BioRadio 150 physiological signal recorder, a MATLAB-based BCI and an OKTAL SCANeR advanced driving experience simulator. The system utilizes steady-state visual-evoked potentials for the BCI paradigm, elicited by frequency-modulated high-power LEDs and recorded with the electrode placement of Oz-Fz with Fz as ground. A three-class online brain-computer interface was developed and interfaced with an advanced driving simulator to control functions of the car, including acceleration and steering. The findings are mainly exploratory but provide an indication of the feasibility and challenges of brain-controlled on-road cars for the future, in addition to a safe, simulated BCI driving environment to use as a foundation for research into overcoming these challenges.

Raising awareness of Australian Aboriginal peoples reality : Embedding Aboriginal knowledge in social work education through the use of field experiences

Effective social work practice with Aboriginal peoples and communities requires knowledge of operational communication skills and practice methods. In addition, there is also a need for practitioners to be aware of the history surrounding white engagement with Aboriginal communities and their cultures. Indeed, the Australian Association of Social Workers (AASW) acknowledges the importance of social workers practising cultural safety. Engendering knowledge of cultural safety for social work students is the opportunity to listen and talk with Aboriginal people who have experienced the destructive impacts of colonisation and the subsequent disruption to family and community. This article discusses the use of field experiences within a Masters of Social Work (Qualifying) Program (MSW) as an educational method aimed at increasing student awareness of contemporary Aboriginal issues and how to practice effectively and within a culturally safe manner.

A systematic review of prescribing criteria to evaluate appropriateness of medications in frail older people

This study systematically reviews the published literature regarding inappropriate prescribing in frail individuals aged at least 65 years. Twenty-five of 466 identified studies met the inclusion criteria. All papers measured some surrogate indicators of frailty, such as performance-based tests, cognitive function and functional dependency. Beers criteria were used in 20 studies (74%) to evaluate inappropriate medication use and 36% (9/25) studies used more than one criterion. The prevalence of inappropriate medications ranged widely from 11 to 92%. Only a few studies reported the relationship between potentially inappropriate medication use and surrogate measures of frailty. These diverse findings indicate the need for a standardized measure for assessing appropriateness of medication in frail older individuals. Prescribing tools should address both medication and patient-related factors such as life expectancy and functional status to minimize inappropriate prescribing in frail individuals.

Analysis and evaluation of use of the V1 and South East Freeway Bicycleway post completion of Stage C of the V1

Executive Summary: Completion of the Veloway 1 (V1) will provide a dedicated and safe route for cyclists between the Brisbane CBD and the Gateway Motorway off-ramp at Eight Mile Plains alongside the South East Motorway. The V1 is being delivered in stages and when completed will provide a dedicated 3m wide cycleway 17km in length. Two stages (D and E) remain to be constructed to complete the V1. Major trip attractors along the V1 include the Mater, Princes Alexandra and Greenslopes Hospitals, two campuses of Griffith University, Garden City shopping centre and the Australian Tax Office. This report assesses the available evidence on the impacts on cycling behaviour of the recently completed V1 Stage C. The data sources informing this review include three intercept surveys, motion activated traffic cameras and travel time surveys on the V1 and adjoining South East Freeway Bikeway (SEFB), Strava app data, and cyclist crash data along Logan Road. The key findings from the evidence are that the completed V1 Stage C has: a Attracted cyclists from Holland Park, Holland Park West, Mt Gravatt and southern parts of Tarragindi onto the V1 Stage C. b Reduced the crash exposure of pedestrians to cyclists by attracting higher speed cyclists off the adjoining SEFB onto the cycling dedicated V1 Stage C. c Reduced the potential crash exposure of cyclists to motor vehicles by attracting cyclists off Logan Road on to the V1. d Provided travel time benefits to cyclists and reduced road crossings (eight down to two). e Predominantly attracted adults commuting alone to and from work and university. The evidence shows that the two traffic crossings across Birdwood Road (required as a temporary measure until the V1 is completed) negate much of the travel time gains of the V1 Stage C compared to the adjoining SEFB for southbound cyclists. Many cyclists accessing the V1 Stage C from the south are cycling in high-volume vehicular traffic lanes to reduce their travel time along Birdwood Road, but in the process are increasing their exposure to crashes with motor vehicles. Based on these findings this report recommends that TMR: a. Continue with plans to complete the V1 Veloway b. Undertake an engineering feasibility assessment to determine the viability of constructing a section of the V1 Stage E from the intersection Weller and Birdwood Roads over Marshall Road and along Bapaume Road on the western side of the Motorway to the intersection of Bapaume and Sterculia Roads. c. In the interim, improve signage and Birdwood Road crossing points for cyclists accessing and egressing the southern end of the V1 Stage C. d. Work with Brisbane City Council to identify the safest and most practical bicycle facilities to facilitate cycle travel between Logan Road and the V1 south of Birdwood Road. e. Improve the awareness of the V1 Stage C through signage for cyclists approaching from the north with the aim of providing a better understanding of the route of the V1 to the south. f. Refine the use of motion activated traffic cameras to improve the capture rate of useable images and obtain an ongoing collection over time of V1 usage data. g. Undertake discussions with Strava, Inc. to refine the presentation of Strava data to improve visual understanding of maps showing before and after cycle route volumes along and on roads leading to the V1.

Manufacturing and use of human placenta-derived mesenchymal stromal cells for phase I clinical trials: Establishment and evaluation of a protocol

Background/Aim. Mesenchymal stromal cells (MSCs) have been utilised in many clinical trials as an experimental treatment in numerous clinical settings. Bone marrow remains the traditional source tissue for MSCs but is relatively hard to access in large volumes. Alternatively, MSCs may be derived from other tissues including the placenta and adipose tissue. In an initial study no obvious differences in parameters such as cell surface phenotype, chemokine receptor display, mesodermal differentiation capacity or immunosuppressive ability, were detected when we compared human marrow derived- MSCs to human placenta-derived MSCs. The aim of this study was to establish and evaluate a protocol and related processes for preparation placenta-derived MSCs for early phase clinical trials. Methods. A full-term placenta was taken after delivery of the baby as a source of MSCs. Isolation, seeding, incubation, cryopreservation of human placentaderived MSCs and used production release criteria were in accordance with the complex regulatory requirements applicable to Code of Good Manufacturing Practice manufacturing of ex vivo expanded cells. Results. We established and evaluated instructions for MSCs preparation protocol and gave an overview of the three clinical areas application. In the first trial, MSCs were co-transplanted iv to patient receiving an allogeneic cord blood transplant as therapy for treatmentrefractory acute myeloid leukemia. In the second trial, MSCs were administered iv in the treatment of idiopathic pulmonary fibrosis and without serious adverse effects. In the third trial, MSCs were injected directly into the site of tendon damage using ultrasound guidance in the treatment of chronic refractory tendinopathy. Conclusion. Clinical trials using both allogeneic and autologous cells demonstrated MSCs to be safe. A described protocol for human placenta-derived MSCs is appropriate for use in a clinical setting, relatively inexpensive and can be relatively easily adjusted to a different set of regulatory requirements, as applicable to early phase clinical trials.

Use of semi-active dampers in seismic mitigation of building structures

This research provides information for providing the required seismic mitigation in building structures through the use of semi active and passive dampers. The Magneto-Rheological (MR) semi-active damper model was developed using control algorithms and integrated into seismically excited structures as a time domain function. Linear and nonlinear structure models are evaluated in real time scenarios. Research information can be used for the design and construction of earthquake safe buildings with optimally employed MR dampers and MR-passive damper combinations.