Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Multidimensional preventive home visit programs aim at maintaining health and autonomy of older adults and preventing disability and subsequent nursing home admission, but results of randomized controlled trials (RCTs) have been inconsistent. Our objective was to systematically review RCTs examining the effect of home visit programs on mortality, nursing home admissions, and functional status decline. METHODS: Data sources were MEDLINE, EMBASE, Cochrane CENTRAL database, and references. Studies were reviewed to identify RCTs that compared outcome data of older participants in preventive home visit programs with control group outcome data. Publications reporting 21 trials were included. Data on study population, intervention characteristics, outcomes, and trial quality were double-extracted. We conducted random effects meta-analyses. RESULTS: Pooled effects estimates revealed statistically nonsignificant favorable, and heterogeneous effects on mortality (odds ratio [OR] 0.92, 95% confidence interval [CI], 0.80-1.05), functional status decline (OR 0.89, 95% CI, 0.77-1.03), and nursing home admission (OR 0.86, 95% CI, 0.68-1.10). A beneficial effect on mortality was seen in younger study populations (OR 0.74, 95% CI, 0.58-0.94) but not in older populations (OR 1.14, 95% CI, 0.90-1.43). Functional decline was reduced in programs including a clinical examination in the initial assessment (OR 0.64, 95% CI, 0.48-0.87) but not in other trials (OR 1.00, 95% CI, 0.88-1.14). There was no single factor explaining the heterogenous effects of trials on nursing home admissions. CONCLUSION: Multidimensional preventive home visits have the potential to reduce disability burden among older adults when based on multidimensional assessment with clinical examination. Effects on nursing home admissions are heterogeneous and likely depend on multiple factors including population factors, program characteristics, and health care setting.

DESIGN AND IMPLEMENT DYNAMIC PROGRAMMING BASED DISCRETE POWER LEVEL SMART HOME SCHEDULING USING FPGA

With the development and capabilities of the Smart Home system, people today are entering an era in which household appliances are no longer just controlled by people, but also operated by a Smart System. This results in a more efficient, convenient, comfortable, and environmentally friendly living environment. A critical part of the Smart Home system is Home Automation, which means that there is a Micro-Controller Unit (MCU) to control all the household appliances and schedule their operating times. This reduces electricity bills by shifting amounts of power consumption from the on-peak hour consumption to the off-peak hour consumption, in terms of different “hour price”. In this paper, we propose an algorithm for scheduling multi-user power consumption and implement it on an FPGA board, using it as the MCU. This algorithm for discrete power level tasks scheduling is based on dynamic programming, which could find a scheduling solution close to the optimal one. We chose FPGA as our system’s controller because FPGA has low complexity, parallel processing capability, a large amount of I/O interface for further development and is programmable on both software and hardware. In conclusion, it costs little time running on FPGA board and the solution obtained is good enough for the consumers.

DESIGN AND IMPLEMENTATION OF HOME USE PORTABLE SMART ELECTRONICS

The widespread of low cost embedded electronics makes it easier to implement the smart devices that can understand either the environment or the user behaviors. The main object of this project is to design and implement home use portable smart electronics, including the portable monitoring device for home and office security and the portable 3D mouse for convenient use. Both devices in this project use the MPU6050 which contains a 3 axis accelerometer and a 3 axis gyroscope to sense the inertial motion of the door or the human hands movement. For the portable monitoring device for home and office security, MPU6050 is used to sense the door (either home front door or cabinet door) movement through the gyroscope, and Raspberry Pi is then used to process the data it receives from MPU6050, if the data value exceeds the preset threshold, Raspberry Pi would control the USB Webcam to take a picture and then send out an alert email with the picture to the user. The advantage of this device is that it is a small size portable stand-alone device with its own power source, it is easy to implement, really cheap for residential use, and energy efficient with instantaneous alert. For the 3D mouse, the MPU6050 would use both the accelerometer and gyroscope to sense user hands movement, the data are processed by MSP430G2553 through a digital smooth filter and a complementary filter, and then the filtered data will pass to the personal computer through the serial COM port. By applying the cursor movement equation in the PC driver, this device can work great as a mouse with acceptable accuracy. Compared to the normal optical mouse we are using, this mouse does not need any working surface, with the use of the smooth and complementary filter, it has certain accuracy for normal use, and it is easy to be extended to a portable mouse as small as a finger ring.

Case Study of an Ergonomics Training Program for Nursing Home Workers

This paper describes a case study of a labor-based ergonomics-training program that makes use of some effective worker training methods. The program focus was on ergonomics awareness and back injury prevention for nursing home workers. It was developed and conducted by a not-for-profit organization affiliated with the Service Employees International Union. Training methods included the train-the-trainer model and the small group activity method. The investigation also compared the program components with those identified by the Occupational Safety and Health Administration (OSHA) as being key elements in effective safety training.

Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area

Rapid diagnostic tests (RDT) are sometimes recommended to improve the home-based management of malaria. The accuracy of an RDT for the detection of clinical malaria and the presence of malarial parasites has recently been evaluated in a high-transmission area of southern Mali. During the same study, the cost-effectiveness of a 'test-and-treat' strategy for the home-based management of malaria (based on an artemisinin-combination therapy) was compared with that of a 'treat-all' strategy. Overall, 301 patients, of all ages, each of whom had been considered a presumptive case of uncomplicated malaria by a village healthworker, were checked with a commercial RDT (Paracheck-Pf). The sensitivity, specificity, and positive and negative predictive values of this test, compared with the results of microscopy and two different definitions of clinical malaria, were then determined. The RDT was found to be 82.9% sensitive (with a 95% confidence interval of 78.0%-87.1%) and 78.9% (63.9%-89.7%) specific compared with the detection of parasites by microscopy. In the detection of clinical malaria, it was 95.2% (91.3%-97.6%) sensitive and 57.4% (48.2%-66.2%) specific compared with a general practitioner's diagnosis of the disease, and 100.0% (94.5%-100.0%) sensitive but only 30.2% (24.8%-36.2%) specific when compared against the fulfillment of the World Health Organization's (2003) research criteria for uncomplicated malaria. Among children aged 0-5 years, the cost of the 'test-and-treat' strategy, per episode, was about twice that of the 'treat-all' (U.S.$1.0. v. U.S.$0.5). In older subjects, however, the two strategies were equally costly (approximately U.S.$2/episode). In conclusion, for children aged 0-5 years in a high-transmission area of sub-Saharan Africa, use of the RDT was not cost-effective compared with the presumptive treatment of malaria with an ACT. In older patients, use of the RDT did not reduce costs. The question remains whether either of the strategies investigated can be made affordable for the affected population.

Feasibility and safety of same-day home discharge after radiofrequency catheter ablation

Interventional cardiology in a day-case setting might reduce logistic constraints on hospital resources. However, in contrast with coronary angioplasty, few data support the feasibility and safety of radiofrequency catheter ablation (RCA). The aim of this prospective, multicenter cohort study was to evaluate the feasibility and safety of RCA in 1,342 patients (814 men; mean age 57 +/- 17 years) considered eligible for ambulatory RCA, according to specific set of criteria, for common atrial flutter (n = 632), atrioventricular nodal reentrant tachycardia (n = 436), accessory pathways (n = 202), and atrial tachycardia (n = 72). Patients suitable for early discharge (4 to 6 hours after uncomplicated RCA) were scheduled for 1-month follow-up. Predictive factors for delayed complications were studied by multivariate analysis. Of the 1,342 enrolled patients, 1,270 (94.6%) were discharged the same day and followed for 1 month; no deaths occurred, and the readmission rate was 0.79% (95% confidence interval 0.30% to 1.27%). Six patients had significant puncture complications, 2 presented with symptomatic delayed pulmonary embolism, and 2 had new onset of poorly tolerated atrial flutter. None of these complications was life threatening. Multivariate analysis did not identify any significant independent predictors for delayed complications. In conclusion, these data suggest that same-day discharge after uncomplicated RCA for routine supraventricular arrhythmias is safe and may be applicable in clinical practice. This approach is known to be associated with significant patient satisfaction and cost savings and can be considered a first-line option in most patients who undergo routine ablation procedures.

Quality Management and Formalization in Social Service Organizations - A Survey on Home-Based Family Intervention Services

Although the effects of quality management on social work are still widely unexplored, critics suspect that it will lead to a negative standardization of working conditions, whereas supporters of quality management hope for a greater transparency and effectiveness of service delivery. This article reports on a survey of 30 managers, 261 professionals, and 435 families in 30 family intervention service organizations. It uses cluster analysis to explore the relationship between quality management and different forms of work formalization. Results showed that working conditions generally are enabling for professional practice, but differences exist between what is called here a managerialist machine bureaucracy, an atomistic professional organization, and a collegiate professional organization.

Language use at home and performance in English composition in multilingual Ghana

Ghana has witnessed a recurrent debate on the usefulness of indigenous Ghanaian languages in childhood education. It is assumed that using the mother tongue as a Medium of Instruction (MOI) during the early years improves children’s ability to acquire knowledge and other languages. Not everybody subscribes to this view though. There are those who feel that a solid start in English offers children a better chance of succeeding in school and in their careers. Presently, some parents who subscribe to the latter view have taken the extra step of stopping the use of indigenous Ghanaian languages at home. This paper presents the results of our investigation into whether the home language practices of Ghanaian students have any impact on their performance in English written argumentative discourse. The results are based on an analysis of an assigned essay of 92 students from one of Ghana’s best senior high schools. We then correlated their per¬formance with responses they gave to a questionnaire interrogating their background and language use at home. While some speak the native language at home, others grew up speaking exclusively English. We show that students who combine English and native Ghanaian languages at home performed better than those who used only English or only Ghanaian languages.