Patients and nurses' perspective on oxygen therapy : a qualitative study

Aim. This paper is a report of a study to describe patients' and nurses' perspectives on oxygen therapy.
Background. Failure to correct significant hypoxaemia may result in cardiac arrest, need for mechanical ventilation or death. Nurses frequently make clinical decisions about the selection and management of low-flow oxygen therapy devices. Better understanding of patients' and nurses' experiences of oxygen therapy could inform clinical decisions about oxygen administration using low-flow devices.
Methods. Face-to-face interviews with a convenience sample of 37 adult patients (17 cardio-thoracic: 20 medical surgical) and 25 intensive care unit nurses were conducted from February 2007 to September 2007. Interviews were audio-taped, transcribed verbatim and then analysed using a thematic analysis approach.
Findings. The patients identified three key factors that underpinned their compliance with oxygen therapy: (i) device comfort; (ii) ability to maintain activities of daily living; and (iii) therapeutic effect. The nurses identified factors, such as: (i) therapeutic effect, (ii) issues associated with compliance, (iii) strategies to optimize compliance, (iv) familiarity with device, (v) triggers for changing oxygen therapy devices, as being key to the effective management of oxygen therapy.
Conclusion. Differences between the patients' and nurses' perspective of oxygen therapy illustrate the variety of factors that impact on effective oxygen administration. Further research should seek to provide a further in-depth understanding of the current oxygen administration practices of nurses and the patient factors that enhance or hinder effectiveness of oxygen therapy. Detailed information about nurse and patient factors that influence oxygen therapy will inform a sound evidence base for nurses' oxygen administration decisions.

Human behavior recognition with generic exponential family duration modeling in the hidden semi-Markov model

The ability to learn and recognize human activities of daily living (ADLs) is important in building pervasive and smart environments. In this paper, we tackle this problem using the hidden semi-Markov model. We discuss the state-of-the-art duration modeling choices and then address a large class of exponential family distributions to model state durations. Inference and learning are efficiently addressed by providing a graphical representation for the model in terms of a dynamic Bayesian network (DBN). We investigate both discrete and continuous distributions from the exponential family (Poisson and Inverse Gaussian respectively) for the problem of learning and recognizing ADLs. A full comparison between the exponential family duration models and other existing models including the traditional multinomial and the new Coxian are also presented. Our work thus completes a thorough investigation into the aspect of duration modeling and its application to human activities recognition in a real-world smart home surveillance scenario.

Activity recognition and abnormality detection with the switching hidden semi-Markov model

This paper addresses the problem of learning and recognizing human activities of daily living (ADL), which is an important research issue in building a pervasive and smart environment. In dealing with ADL, we argue that it is beneficial to exploit both the inherent hierarchical organization of the activities and their typical duration. To this end, we introduce the Switching Hidden Semi-Markov Model (S-HSMM), a two-layered extension of the hidden semi-Markov model (HSMM) for the modeling task. Activities are modeled in the S-HSMM in two ways: the bottom layer represents atomic activities and their duration using HSMMs; the top layer represents a sequence of high-level activities where each high-level activity is made of a sequence of atomic activities. We consider two methods for modeling duration: the classic explicit duration model using multinomial distribution, and the novel use of the discrete Coxian distribution. In addition, we propose an effective scheme to detect abnormality without the need for training on abnormal data. Experimental results show that the S-HSMM performs better than existing models including the flat HSMM and the hierarchical hidden Markov model in both classification and abnormality detection tasks, alleviating the need for presegmented training data. Furthermore, our discrete Coxian duration model yields better computation time and generalization error than the classic explicit duration model.

Hierarchical semi-markov conditional random fields for recursive sequential data

Inspired by the hierarchical hidden Markov models (HHMM), we present the hierarchical semi-Markov conditional random field (HSCRF), a generalisation of embedded undirected Markov chains to model complex hierarchical, nested Markov processes. It is parameterised in a discriminative framework and has polynomial time algorithms for learning and inference. Importantly, we develop efficient algorithms for learning and constrained inference in a partially-supervised setting, which is important issue in practice where labels can only be obtained sparsely. We demonstrate the HSCRF in two applications: (i) recognising human activities of daily living (ADLs) from indoor surveillance cameras, and (ii) noun-phrase chunking. We show that the HSCRF is capable of learning rich hierarchical models with reasonable accuracy in both fully and partially observed data cases.

Efficient Coxian duration modelling for activity recognition in smart environment with the hidden semi-Markov model

In this paper, we exploit the discrete Coxian distribution and propose a novel form of stochastic model, termed as the Coxian hidden semi-Makov model (Cox-HSMM), and apply it to the task of recognising activities of daily living (ADLs) in a smart house environment. The use of the Coxian has several advantages over traditional parameterization (e.g. multinomial or continuous distributions) including the low number of free parameters needed, its computational efficiency, and the existing of closed-form solution. To further enrich the model in real-world applications, we also address the problem of handling missing observation for the proposed Cox-HSMM. In the domain of ADLs, we emphasize the importance of the duration information and model it via the Cox-HSMM. Our experimental results have shown the superiority of the Cox-HSMM in all cases when compared with the standard HMM. Our results have further shown that outstanding recognition accuracy can be achieved with relatively low number of phases required in the Coxian, thus making the Cox-HSMM particularly suitable in recognizing ADLs whose movement trajectories are typically very long in nature.

Evidence based guidelines to improve engagement and participation for people experiencing depression

Background:
Depression can have a strongly negative impact on a person’s ability to engage with and participate in activities of daily living. Clinicians currently seeking guidance on best practice in this area currently need to access and critique a wide range of evidence from a number of disciplines. While some clinical practice guidelines are available, this form of evidence presentation presents several barriers to implementation.

Procedures:
This article proposes a new procedure for developing guidance for clinicians, known as evidence based guidelines. The purpose of the guidelines presented here is to provide guidance on appropriate assessment and intervention strategies with people experiencing depression, who wish to improve their engagement and participation in daily activities. They were constructed using a multiple methods procedure, with five phases.

Results:
Evidence based guidelines for the general population, older adults and people with co-morbid physical conditions are presented at the conclusion of this article.

Conclusion:
The procedure described here produces evidence based guidelines with built in measures to promote implementation into practice. The resulting guidelines for depression will enable clinicians from all disciplines to engage in best practice, and assist people with depression participate more fully in their lives.

Video Game Training and Reaction Time Skills Among Older Adults

The aim of the current study was to examine whether reaction time (RT) among older adults could be improved through video game training. Twenty-nine participants between the ages of 50 and 84 either played (N = 14) or did not play (N = 15) a video game, Pac-Man: Adventures in Time. All participants completed a pre- and postassessment of RT. Results from this study showed that there were no significant differences between the control and experimental groups on RT performance across time. These findings indicate that the amount of training provided may have been inadequate to improve RT skills. It is therefore important to investigate the amount of training required to allow older adults to respond faster to environmental stimuli and transfer skills to activities of daily living.

Influência de fatores biopsicossociais sobre a mortalidade de idosos no município de Santa Cruz/RN: um estudo prospectivo

The aging process if characterizes for a complex events network, from multidimensional nature, that encloses biological, social, psychic and functional aspects. The alteration of one or more aspects can speed up the aging process, anticipating limitations and until the death in the aged. For an adjusted confrontation of this question is necessary an interdisciplinary vision, in which the some areas of the knowledge can interact and with this to intervenes of the best possible form. Then, information derived from studies of aspects related to incidence, morbidity-mortality and transition patterns, involved in the health-illness process can more accurately identify risk groups thereby establishing links between social factors, illness, incapacity and death. Thus, this study aimed to identify, by a multidimensional vision, the risk factors of mortality in a coorth of elderly in a city in the interior of the state of Rio Grande do Norte (RN), Brazil. A prospective study carried out in Santa Cruz RN, where 310 elderly were randomly selected to form a baseline. The follow-up was 53 months. The predictive variables were divided into sociodemographic, physical health, neuropsychiatric and functional capacity. The statistical analysis carried out by bivariate analysis, survival analysis, followed by binary logistic regression and Cox regression, in the multivariate analysis, considering significant levels p < 0.05 and confidence interval (CI) of 95%. A total of 60 (19.3%) elderly died during the follow-up, where cardiovascular disease was the main cause. The survival was approximately 24.8 months. The study of general survival showed, at 12, 24, 36, and 48 months of observation, a survival rate of 97%, 54%, 31%, and 5% respectively, with a statistical difference in survival only observed for the variables of cognitive function and Basic Activities of Daily Living. In the logistic regression analysis, the risk factors identified were cognitive deficits (OR = 8.74), poor perception of health (OR = 3.89) and dependence for Basic Activities of Daily Living (OR = 3.96). In the Cox analysis, as well as dependence for Basic Activities of Daily Living (HR = 3.17), cognitive deficit (HR = 4.30) and stroke (CVA) (HR = 3.49) continued as independent risk factors for death. The risk factors found in the study can be interpreted as the primary predictors for death among elderly members of the community. Therefore, improvements in health conditions, with actions towards sustaining an autonomous life with special attention for elderly with cognitive impairment, could mean additional healthy quality of life, resulting in the reduction of premature mortality in this population

Sintomatologia depressiva e avaliação de níveis de TNFα IL-2 em indivíduos idosos e com doença pulmonar obstrutiva crônica

The aim of the present study was to assess the presence of depressive symptomatology among elderly residents in long-stay institutions (LSI) and in the community of Recife, Brazil. In total, 81 long-stay elderly patients (mean age of 75.55 ± 9.18 years) and 132 elderly (mean age of 73.14 ± 8.27 years) individuals from the community were evaluated. Depressive symptomatology was assessed by the Geriatric Depression Scale (GDS-15), cognitive status by the Mini Mental State Examination (MMSE) and capacity to perform the activities of daily living (ADL) by the Katz Index. Comorbities and the use of medication were recorded. The LSI elderly exhibited more depressive symptoms (p < 0.001) and more dependency (p< 0.001). We observed no differences in MMSE (p = 0.058). The elderly in the community displayed more comorbidities and the LSI elderly consumed more medication (p < 0.001 and p < 0.001, respectively). According to multivariate analysis (logistic regression), being male, having no spouse and having a low schooling level are risk factors for depressive symptoms. In conclusion, most elderly with depressive symptoms received no medication fordepression.

Resistência da artéria carótida e autônima funcional em mulheres idosas

High carotid artery resistance indices in the elderly arise mainly as a result of harmful daily lifestyle behavior and poor eating habits. The aim of this multidisciplinary study was to assess and correlate carotid artery resistance and functional autonomy in elderly women. A descriptive, exploratory cross-sectional study was conducted with a sample comprising 27 women, enrolled in pastoral programs in the city of Teresina, Brazil. Carotid artery resistance was assessed by a high-resolution Doppler ultrasound device and functional autonomy was evaluated through five protocol tests of the Latin American Development Group for the Elderly (GDLAM), simulating activities of daily life. The data were analyzed by the Shapiro-Wilk test and the correlation by Spearman s test, considering a p-value of <0.05. The sample consisted of women with mean age and standard deviation of (68.67 ± 4.52) years, respectively and carotid resistance index of (0.71 ± 0.07). The general index value of functional autonomy classified the elderly of the study group as weak in the performance of activities of daily living (30.46 ± 6.31). The general index of functional autonomy showed a high level of sedentary behavior in the group studied (p < 0.01). The sample was classified as weak in the performance of activities of daily life. The correlation coefficient between the carotid resistance index and the general GDLAM index was r = 0.998 and p = 0.000, showing a significant correlation. The elderly women assessed had a high carotid artery resistance index and low functional autonomy; a positive correlation was found between the dependent variables studied. To perform this study we formed a team composed of a nurse, who helped in organizing the sample and performing the examinations; a radiologist, who conducted the Doppler examinations; an angiologist, who collaborated in interpreting examination data; in addition to two physical education professors and two physical therapists, who applied the functional autonomy tests and conducted the 34 research along elderly health lines, contributing thus to the multidisciplinary character, fundamental for carrying out the study

Relação entre ambiente familiar e capacidade funcional de idosos residentes no município de Jequié-BA

(Objective) Assess the functional capacity and determine the difference between the means of functional capacity (basic and instrumental activities of daily living) and the age groups of elderly residents in an outlying area in the hinterland of Bahia/Northeast of Brazil. (Methods) Analytical study with cross-sectional design and a sample of 150 elderly individuals enrolled in four Health Units in the municipality of Jequié, Bahia, Brazil. The instrument consisted of sociodemographic and health data, the Barthel Index and the Lawton scale. (Results) In all, 78.00% of the elderly were classified as dependent in the basic activities and 65.33% in the instrumental activities of daily living. Using the Kruskal- Wallis test, we found a statistically significant difference between the means of instrumental activities and the age groups (p= 0.011). (Conclusion) An elevated number of elderly were classified as dependent in terms of functional capacity and increased age is related to greater impairment in the execution of instrumental activities of daily living

Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor

Contextualization: Several studies have examined the mobility of this group of children, however little is known about the impact of motor function in activities of daily living, considering the seriousness of their neuromotor damage. Objective: Identify the functional differences of children with Cerebral Palsy with different levels of motor dysfunction and correlate these differences with the areas of mobility, self-care and social function in functional ability and caregiver´s assistance of these children. Methods: An l analytical cross-section search was developed, which were part 70 children / families aged from 4 to 7.5 years, in the Rehabilitation Center for Children. As tools were used the Pediatric Evaluation Disability Inventory (PEDI) and the Gross Motor Function Classification System (GMFCS). Data analysis was performed by ANOVA and Pearson's correlation tests. Results: The results show the functional variability of children CP in different severity levels of motor disfunction This variation was observed in the areas of mobility, self-care and social function. The results also showed a strong correlation between the domains mobility and self-care, mobility and social function. Conclusions: The variability shown by the children with CP, suggests the use of PEDI and GMFCS as this association appears to increase the understanding of how the gross motor functions are related to activities of daily living, describing the best commitments and their degree of impact on functional activities. This correlation demonstrates how mobility is crucial to evaluate the performance and guide the therapeutic practice, to develop the children´s potencial, and guide the caregiver in stimulation

Uma análise sociodemográfica dos cuidadores formais de idosos institucionalizados no município de Natal/RN, 2012

The aging population and individual have been the subject of a multitude of studies nowadays. This is probably due to the impact of this phenomenon in various sectors of society, like social security, social assistance and public health. The process of aging of the individual imply the demand for specific services, considering the limitations and vulnerabilities of the individual at that stage of life cycle. The growth of the elderly contingent in the last decades raises challenges for policymakers, the family and also for the society at large. In this scenario, long-stay institutions for the elderly (LSIEs) appear as an option to aid and support the elderly and their family, assisting in all or part in the activities of daily living and self-care. Inside these LSIEs we find the professional responsible for the direct care of the elderly, the formal caregiver. In this context, this dissertation presents two main objectives: an analysis of the phenomenon of population aging in a given brazilian municipality Natal / RN, based on the Demographic Censuses of 2000 e 2010; and a social, demographic and economic characterization of the Formal caregiver for the institutionalized elderly in the municipality, evaluating aspects of his quality of life and also analyzing the institutions where they are inserted. Furthermore, we intend to identify demographic, socioeconomic and quality of life factors that are correlated with caregivers quitting the job. The data used in the second part of this work comes from the research project named Long-Stay Institutions for Elderly: abandonment or a family need? . This survey interviewed 92 caregivers in eleven LSIEs in Natal/RN. In the data treatment logistic regressions, cluster analysis and statistical tests were used. The survey revealed that aging in Natal is more pronounced in the older, more traditional districts: Petrópolis, Lagoa Seca and Tirol. It also allowed a broad characterization of the formal caregivers in LSIEs. Most of these professionals are female. The educational level is predominantly complete high school and more. Most caregivers reported being married or in union, or have ever been in a union. Family monthly income is under three times the minimum wage. The mean age is of 37.4 years. The mean time of work as a caregiver was 5.93 years. The associations showed that being woman, not being single, having caregiving training and physical limitations (regarding quality of life) are related to wanting to quit the caregiving job. As for the characterization of the LSIEs, it was found that the philanthropic ones are older and have most (62.5%) of the institutionalized elderly. The institutions managers gave social interaction and affinity with the elderly as the main criteria with which to evaluate and hire caregivers. It is intended with this study to contribute to improving the quality of life of the elderly and their caregiver, providing information on aspects of institutionalization of elderly both in the philanthropic and particular institutions, in Natal/RN; this dissertation may also be used as a starting point for later works

Avaliação multidimensional de pessoas idosas atendidas por equipes de saúde da família em Natal-RN: uma análise demográfica e epidemiológica

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