Effectiveness of non-pharmacological interventions to prevent falls in older people: a systematic overview. The SENATOR Project ONTOP Series

Background: Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. Objectives: To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. Methods: We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. Results: Fifty-nine systematic reviews were identified which consisted of single, multiple and multi-factorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. Conclusions: The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.

Novel efficient technologies in Europe for axle bearing condition monitoring – the MAXBE project

Axle bearing damage with possible catastrophic failures can cause severe disruptions or even dangerous derailments, potentially causing loss of human life and leading to significant costs for railway infrastructure managers and rolling stock operators. Consequently the axle bearing damage process has safety and economic implications on the exploitation of railways systems. Therefore it has been the object of intense attention by railway authorities as proved by the selection of this topic by the European Commission in calls for research proposals. The MAXBE Project (http://www.maxbeproject.eu/), an EU-funded project, appears in this context and its main goal is to develop and to demonstrate innovative and efficient technologies which can be used for the onboard and wayside condition monitoring of axle bearings. The MAXBE (interoperable monitoring, diagnosis and maintenance strategies for axle bearings) project focuses on detecting axle bearing failure modes at an early stage by combining new and existing monitoring techniques and on characterizing the axle bearing degradation process. The consortium for the MAXBE project comprises 18 partners from 8 member states, representing operators, railway administrations, axle bearing manufactures, key players in the railway community and experts in the field of monitoring, maintenance and rolling stock. The University of Porto is coordinating this research project that kicked-off in November 2012 and it is completed on October 2015. Both on-board and wayside systems are explored in the project since there is a need for defining the requirement for the onboard equipment and the range of working temperatures of the axle bearing for the wayside systems. The developed monitoring systems consider strain gauges, high frequency accelerometers, temperature sensors and acoustic emission. To get a robust technology to support the decision making of the responsible stakeholders synchronized measurements from onboard and wayside monitoring systems are integrated into a platform. Also extensive laboratory tests were performed to correlate the in situ measurements to the status of the axle bearing life. With the MAXBE project concept it will be possible: to contribute to detect at an early stage axle bearing failures; to create conditions for the operational and technical integration of axle bearing monitoring and maintenance in different European railway networks; to contribute to the standardization of the requirements for the axle bearing monitoring, diagnosis and maintenance. Demonstration of the developed condition monitoring systems was performed in Portugal in the Northern Railway Line with freight and passenger traffic with a maximum speed of 220 km/h, in Belgium in a tram line and in the UK. Still within the project, a tool for optimal maintenance scheduling and a smart diagnostic tool were developed. This paper presents a synthesis of the most relevant results attained in the project. The successful of the project and the developed solutions have positive impact on the reliability, availability, maintainability and safety of rolling stock and infrastructure with main focus on the axle bearing health.