Health technologies for the prevention and detection of falls in adult hospital inpatients: a scoping review.

OBJECTIVE: The objective of this scoping review was to examine and map the evidence relating to the reporting and evaluation of technologies for the prevention and detection of falls in adult hospital inpatients. INTRODUCTION: Falls are a common cause of accidental injury, leading to significant safety issues in hospitals globally, and resulting in substantial human and economic costs. Previous research has focused on community settings with less emphasis on hospital settings. INCLUSION CRITERIA: Participants included adult inpatients, aged 18 years and over; the concept included the use of fall-prevention or fall-detection technologies; the context included any hospital ward setting. METHODS: This scoping review was conducted according to JBI methodology for scoping reviews, guided by an a priori protocol. A wide selection of databases including MEDLINE, CINAHL, AMED, Embase, PEDro, Epistimonikos, and Science Direct were searched for records from inception to October 2019. Other sources included gray literature, trial registers, government health department websites, and websites of professional bodies. Only studies in the English language were included. A three-step search strategy was employed, with all records exported for subsequent title and abstract screening prior to full-text screening. Screening was performed by two independent reviewers and data extraction by one reviewer following agreement checks. Data are presented in narrative and tabular form. RESULTS: Over 13,000 records were identified with 404 included in the scoping review: 336 reported on fall-prevention technologies, 51 targeted detection, and 17 concerned both. The largest contributions of studies came from the USA (n=185), Australia (n=65), the UK (n=36), and Canada (n=18). There was a variety of study designs including 77 prospective cohort studies, 33 before-after studies, and 35 systematic reviews; however, relatively few randomized controlled trials were conducted (n = 25). The majority of records reported on multifactorial and multicomponent technologies (n = 178), followed by fall detection devices (n = 86). Few studies reported on the following interventions in isolation: fall risk assessment (n = 6), environment design (n = 8), sitters (n = 5), rounding (n = 3), exercise (n = 3), medical/pharmaceutical (n = 2), physiotherapy (n = 1), and nutritional (n = 1). The majority (57%) of studies reported clinical effectiveness outcomes, with smaller numbers (14%) reporting feasibility and/or acceptability outcomes, or cost-effectiveness outcomes (5%). CONCLUSIONS: This review has mapped the literature on fall-prevention and fall-detection technology and outcomes for adults in the hospital setting. Despite the volume of available literature, there remains a need for further high-quality research on fall-prevention and fall-detection technologies.

Association of psychosocial-spiritual experiences around childbirth and subsequent perinatal mental health outcomes: an integrated review.

Background: Perinatal mental health is a concern for women, families, communities and maternity care providers internationally. However, there is little understanding of poor perinatal maternal mental health and association with women's experiences of childbirth. Further understanding of psychosocial-spiritual experiences in childbirth and subsequent perinatal mental health is required.Aim: Systematically identify and synthesise the range of evidence available on psychosocial-spiritual experiences around childbirth and foreground possible associations with subsequent perinatal mental health outcomes.Method: Integrated analysis of a range of literature types was undertaken. A comprehensive search strategy was created, and nine databases were searched from 2000 to 2018. Defined inclusion and exclusion criteria were applied independently by two reviewers. Critical appraisal was carried out independently by two reviewers and a third reviewer to resolve differences. The Ecology of Childbirth conceptual framework guided the review.Findings: Six articles were included and four synthesised themes were developed: relationships and kinship matter; significance of childbirth and spiritual experiences; honouring spiritual growth and well-being; and physical manifestations and embodiment. Discussion of the themes using the Ecology of Childbirth framework highlight new perspectives and reveal phenomena lying within and beyond childbirth experiences that may influence perinatal mental health. A new conceptual model is proposed.Conclusions: New insights highlight a paucity of research in the area of perinatal mental health and psychosocial-spiritual childbirth experiences. Further research needs to include postnatal mood disorders and the possible associations with psychosocial-spiritual experiences.

Health technologies for falls prevention and detection in adult hospital in-patients: a scoping review protocol.

REVIEW OBJECTIVE/QUESTIONS: The objective of this scoping review is to map the evidence relating to the reporting and evaluation of health technologies for the prevention and detection of falls in adult hospital in-patients. The following questions will guide this scoping review.

The impact of spousal bereavement on hospitalisations: Evidence from the Scottish Longitudinal Study.

This paper estimates the impact of spousal bereavement on hospital inpatient use for the surviving bereaved by following the experience of 94,272 married Scottish individuals from 1991 until 2009 using a difference-in-difference model. We also consider the sample selection issues related to differences in survival between the bereaved and non-bereaved using a simple Cox Proportional-Hazard model. Before conducting these estimations, propensity score approaches are used to re-weight the non-bereaved to generate a more random-like comparison sample for the bereaved. We find that those bereaved who survive are both more likely to be admitted and to stay longer in hospital than a comparable non-bereaved cohort. Bereavement is estimated to induce on average an extra 0.24 (95% CI [0.15, 0.33]) hospital inpatient days per year. Similar to previous studies, we estimate the bereaved have a 19.2% (95% CI [12.5%, 26.3%]) higher mortality rate than the comparable non-bereaved cohort.

Decision precision or holistic heuristic?: Insights on on-site selection of student nurses and midwives.

Concerns about quality of care delivery in the UK have led to more scrutiny of criteria and methods for the selection of student nurses. However few substantive research studies of on-site selection processes exist. This study elicited and interpreted perspectives on interviewing processes and related decision making involved in on-site selection of student nurses and midwives. Individual and focus group interviews were undertaken with 36 lecturers, 5 clinical staff and 72 students from seven Scottish universities. Enquiry focused primarily on interviewing of candidates on-site. Qualitative content analysis was used as a primary strategy, followed by in-depth thematic analysis. Students had very mixed experiences of interview processes. Staff typically took into account a range of candidate attributes that they valued in order to achieve holistic assessments. These included: interpersonal skills, team working, confidence, problem-solving, aptitude for caring, motivations, and commitment. Staff had mixed views of the validity and reliability of interview processes. A holistic heuristic for overall decision making predominated over belief in the precision of, and evidence base for, particular attribute measurement processes. While the development of measurement tools for particular attributes continues apace, tension between holism and precision is likely to persist within on-site selection procedures.

The economic cost of bereavement in Scotland.

Aspects of the socioeconomic costs of bereavement in Scotland were estimated using 3 sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around £20 million. Cost of bereavement coded consultations in primary care was estimated at around £2.0 million annually. In addition, bereaved people were significantly less likely to be employed in the year of and 2 years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement.

A national study of selection processes for student nurses and midwives.

BACKGROUND: This paper presents the main findings from a project that aimed to evaluate selection processes for the recruitment of student nurses and midwives. OBJECTIVES: The main objectives were to: Design The evaluation was designed principally to achieve explanation, with multiple case study methodology adopted as the main approach. Within this ambit mixed methods of data collection involving questionnaires and interviews were used. Participants Seven of the Scotland-based Higher Education Institutions participated in the research, with participation from Admissions Tutors, clinical interviewers, academic interviewers, and students. METHODS: The methods included: a scoping questionnaire with follow-on questionnaire to elicit views on the strengths and limitations of chosen selection processes; interviews and focus groups to build on these findings. Analytical approaches were congruent with the chosen data collection approaches. Findings HEIs typically have rationales for their various chosen approaches to selection. However, our findings indicate that there is a lack of evidence for most selection approaches particularly in relation to interviewing. There is a growing evidence-base for the use of multiple mini interviews, and emotional intelligence testing. CONCLUSIONS: There is a need to work collectively cross-UK to bring together the evidence-base around selection so that processes and decision-making are as valid, reliable, effective and transparent as possible.

Bereavement care for older people in healthcare settings: qualitative study of experiences.

AIM: This study aimed to explore the experiences of healthcare staff of caring for bereaved older people, and older people's experiences of bereavement care. BACKGROUND: Loss through death of close family members, partners and friends inhibits the physical, emotional and social well being of older people. The rising population of older people and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. DESIGN: A qualitative design drawing on phenomenological methodology was used to understand interactions between healthcare staff and bereaved older people. The study was set in hospital wards, general practice and community nursing teams, and care homes. Healthcare staff and a sample of recently bereaved older people participated. METHODS: Purposive sampling took place to recruit staff with a range of roles, and older people who were 65 years of age or more, and bereaved of a family member or friend for between 6 months and 5 years. Participants took part in in-depth interviews, and data were analysed systematically. RESULTS: Thirty-nine participants were recruited, and three key themes arose from the data: (i) Bereavement care depends on an established relationship between healthcare staff and the patient's relatives; (ii) Preparation for the relative's death may not equate to being prepared for bereavement; (iii) The 'Open Door' to bereavement care is only slightly ajar. CONCLUSIONS: The study identified the interactions of healthcare staff with bereaved older people in terms of the bereavement journey. Staff demonstrated awareness of difficulties the bereaved person may encounter and showed commitment to providing support. However, lack of flexibility in services restricts meaningful interactions. IMPLICATIONS FOR PRACTICE: (i) Healthcare staff may identify gaps in services in terms of preparing relatives and follow-up post-bereavement; (ii) Therapeutic relationships between staff and relatives enable ongoing support; (iii) Development of practice guidelines is a key consideration.

Bereavement and bereavement care in health and social care: provision and practice in Scotland.

The interview study described here aimed to explore current views of and practice in bereavement care and identify priorities for service development in Scotland. Fifty-nine participants who worked with the bereaved in some way, or whose interest was in bereavement or bereavement care, were interviewed. They represented National Health Service organizations, chaplaincy departments, educational institutions, academic departments, voluntary groups, and other related bodies, such as funeral directors. Transcripts were read repeatedly and initial emerging themes were identified, coded and shared between research team members to reach a consensus for key themes. Priority areas for development were related to raising public awareness, coordination of services, guidance, and professional education.

Effect of multivitamin and multimineral supplementation on cognitive function in men and women aged 65 years and over: a randomised controlled trial.

BACKGROUND: Observational studies have frequently reported an association between cognitive function and nutrition in later life but randomised trials of B vitamins and antioxidant supplements have mostly found no beneficial effect. We examined the effect of daily supplementation with 11 vitamins and 5 minerals on cognitive function in older adults to assess the possibility that this could help to prevent cognitive decline. METHODS: The study was carried out as part of a randomised double blind placebo controlled trial of micronutrient supplementation based in six primary care health centres in North East Scotland. 910 men and women aged 65 years and over living in the community were recruited and randomised: 456 to active treatment and 454 to placebo. The active treatment consisted of a single tablet containing eleven vitamins and five minerals in amounts ranging from 50-210 % of the UK Reference Nutrient Intake or matching placebo tablet taken daily for 12 months. Digit span forward and verbal fluency tests, which assess immediate memory and executive functioning respectively, were conducted at the start and end of the intervention period. Risk of micronutrient deficiency at baseline was assessed by a simple risk questionnaire. RESULTS: For digit span forward there was no evidence of an effect of supplements in all participants or in sub-groups defined by age or risk of deficiency. For verbal fluency there was no evidence of a beneficial effect in the whole study population but there was weak evidence for a beneficial effect of supplementation in the two pre-specified subgroups: in those aged 75 years and over (n 290; mean difference between supplemented and placebo groups 2.8 (95% CI -0.6, 6.2) units) and in those at increased risk of micronutrient deficiency assessed by the risk questionnaire (n 260; mean difference between supplemented and placebo groups 2.5 (95% CI -1.0, 6.1) units). CONCLUSION: The results provide no evidence for a beneficial effect of daily multivitamin and multimineral supplements on these domains of cognitive function in community-living people over 65 years. However, the possibility of beneficial effects in older people and those at greater risk of nutritional deficiency deserves further attention.

A cost-utility analysis of multivitamin and multimineral supplements in men and women aged 65 years and over.

BACKGROUND & AIMS: As people age there is a progressive dysregulation of the immune system that may lead to an increased risk of infections, which may precipitate hospital admission in people with chronic heart or respiratory diseases. Mineral and vitamin supplementation in older people could therefore influence infections in older people. However, the evidence from the available randomised controlled trials (RCTs) is mixed. The aim of the study was to assess the relative efficiency of multivitamin and multimineral supplementation compared with no supplementation. METHODS: Cost-utility analysis alongside an RCT. Participants aged 65 years or over from six general practices in Grampian, Scotland, were studied. They were randomised to one tablet daily of either a multivitamin and multimineral supplement or matching placebo. Exclusion criteria were use of mineral, vitamin or fish oil supplements in the previous 3 months (1 month for water soluble vitamins), vitamin B12 injection in the last 3 months. RESULTS: Nine hundred and ten participants were recruited (454 placebo and 456 supplementation). Use of health service resources and costs were similar between the two groups. The supplementation arm was more costly although this was not statistically significant ( pound15 per person, 95% CI-3.75 to 34.95). After adjusting for minimisation and baseline EQ-5D scores supplementation was associated with fewer QALYs per person (-0.018, 95% CI-0.04 to 0.002). It was highly unlikely that supplementation would be considered cost effective. CONCLUSIONS: The evidence from this study suggests that it is highly unlikely that supplementation could be considered cost effective.

A systematic review of multivitamin and multimineral supplementation for infection.

BACKGROUND: Infections are major causes of morbidity and mortality worldwide. Micronutrients have important functions in the body's immune system. This systematic review examined the evidence from randomized controlled trials (RCTs) on whether multivitamin and multimineral supplementation is effective in reducing infection. METHODS: Electronic databases searched: Cochrane Controlled Trials Register, EMBASE, MEDLINE, BIOSIS, CAB abstracts. Hand searching of nutrition journals and reference lists was carried out. RCTs and quasi-randomized trials of supplementation of adults with at least two vitamins or minerals or a combination were selected. Study results were combined in meta-analysis plots where appropriate. RESULTS: Twenty studies were included in the review. Small numbers were available for each meta-analysis. Results are presented here without the Chandra group studies. No significant difference was found in the number of episodes of infection in older people (>or = 65 years) between those supplemented and those not supplemented; (WMD) 0.06 [95% confidence interval (CI) -0.04, 0.16], P = 0.25. In other adults groups, there were significantly less episodes of infection in those supplemented; (WMD) -1.20 (95% CI -2.08, -0.32), P = 0.008. There was no significant difference between those older people supplemented and those not supplemented in the number with at least one infection; relative risk (RR) 0.98 (95% CI 0.86, 1.11), P = 0.77. Similarly, there was no significant difference in the numbers in other adult groups who had at least one episode of infection between those supplemented and those taking placebo; (RR) 0.81 (95% CI 0.65, 1.00), P = 0.06. Subgroup analyses suggested that supplemented people aged 65 years or over may benefit more if they are undernourished and supplemented for over 6 months, WMD -0.67 infections (95% CI -1.24, -0.10), P = 0.02. CONCLUSION: Further large trials are needed, particularly in undernourished older people. Trials of supplementation periods of over 6 months are recommended.

Effect of multivitamin and multimineral supplements on morbidity from infections in older people (MAVIS trial): pragmatic, randomised, double blind, placebo controlled trial.

OBJECTIVE: To examine whether supplementation with multivitamins and multiminerals influences self reported days of infection, use of health services, and quality of life in people aged 65 or over. DESIGN: Randomised, placebo controlled trial, with blinding of participants, outcome assessors, and investigators. SETTING: Communities associated with six general practices in Grampian, Scotland. PARTICIPANTS: 910 men and women aged 65 or over who did not take vitamins or minerals. INTERVENTIONS: Daily multivitamin and multimineral supplementation or placebo for one year. MAIN OUTCOME MEASURES: Primary outcomes were contacts with primary care for infections, self reported days of infection, and quality of life. Secondary outcomes included antibiotic prescriptions, hospital admissions, adverse events, and compliance. RESULTS: Supplementation did not significantly affect contacts with primary care and days of infection per person (incidence rate ratio 0.96, 95% confidence interval 0.78 to 1.19 and 1.07, 0.90 to 1.27). Quality of life was not affected by supplementation. No statistically significant findings were found for secondary outcomes or subgroups. CONCLUSION: Routine multivitamin and multimineral supplementation of older people living at home does not affect self reported infection related morbidity. TRIAL REGISTRATION: ISRCTN: 66376460.