RESUMEN
BACKGROUND: Mobility is critical for self-management. Understanding factors associated with improvement in mobility during home healthcare can help nurses tailor interventions to improve mobility outcomes and keep patients safely at home. OBJECTIVES: The aims were to (a) identify patient and support system factors associated with mobility improvement during home care, (b) evaluate consistency of factors across groups defined by mobility status at the start of home care, and (c) identify patterns of factors associated with improvement and no improvement in mobility within each group. METHODS: Outcome and Assessment Information Set data extracted from a national convenience sample of 270,634 patient records collected from October 1, 2008 to December 31, 2009 from 581 Medicare-certified, home healthcare agencies were used. Patients were placed into groups based on mobility scores at admission. Odds ratios were used to index associations of factors with improvement at discharge. Discriminative pattern mining was used to discover patterns associated with improvement of mobility. RESULTS: Overall, mobility improved for 49.4% of patients; improvement occurred most frequently (80%) among patients who were able, at admission, to walk only with the supervision or assistance of another person at all times. Numerous factors associated with improvement in mobility outcome were similar across the groups (except for those who were chairfast but were able to wheel themselves independently); however, the number, strength, and direction of associations varied. In most groups, data mining-discovered patterns of factors associated with the mobility outcome were composed of combinations of functional and cognitive status and the type and amount of help required at home. DISCUSSION: This study provides new data mining-based information about how factors associated with improvement in mobility group together and vary by mobility at admission. These approaches have potential to provide new insights for clinicians to tailor interventions for improvement of mobility.
Asunto(s)
Minería de Datos , Servicios de Atención de Salud a Domicilio , Limitación de la Movilidad , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Caminata/fisiología , Actividades Cotidianas , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Bases de Datos Factuales , Femenino , Humanos , Masculino , Medicare , Persona de Mediana Edad , Recuperación de la Función/fisiología , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos , Adulto JovenRESUMEN
This paper demonstrates the feasibility of ligation and tissue penetration for surgical suturing tasks using magnetically actuated suture needles. Manipulation of suture needles in minimally invasive surgery involves using articulated manual/robotic tools for needle steering and controlling needle-tissue or thread-tissue interactions. The large footprints of conventional articulated surgical tools significantly increase surgical invasiveness, potentially leading to longer recovery times, tissue damage, scarring, or associated infections. Aiming to address these issues, we investigate the feasibility of using magnetic fields to tetherlessly steer suture needles. The primary challenge of such a concept is to provide sufficient force for tissue penetration and ligation. In this work, we demonstrate proof-of-concept capabilities using the MagnetoSuture™ system, performing tissue penetration and ligation tasks using ex vivo tissues, customized NdFeB suture needles with attached threads, and remote-controlled magnetic fields. To evaluate the system performance, we conducted experiments demonstrating tetherless recreation of a purse string suture pattern, ligation of an excised segment of a rat intestine, and penetration of rat intestines.