Study protocol of a randomized clinical trial evaluating the effectiveness of a primary care intervention using the Nintendo™ Wii console to improve balance and decrease falls in the elderly.

BACKGROUND: Balance alteration is a risk factor for falls in elderly individuals that has physical, psychological and economic consequences. The objectives of this study are to evaluate the usefulness of an intervention utilizing the Nintendo™ Wii console in order to improve balance, thereby decreasing both the fear of falling as well as the number of falls, and to evaluate the correlation between balance as determined by the console and the value obtained in the Tinetti tests and the one foot stationary test. METHODS/DESIGN: This is a controlled, randomized clinical trial of individual assignment, carried out on patients over 70 years in age, from five primary care centers in the city of Mataró (Barcelona). 380 patients were necessary for the intervention group that carried out the balance board exercises in 2 sessions per week for a 3 month period, and 380 patients in the control group who carried out their usual habits. Balance was evaluated using the Tinetti test, the one foot stationary test and with the console, at the start of the study, at the end of the intervention (3 months) and one year later. Quarterly telephone follow-up was also conducted to keep track of falls and their consequences. DISCUSSION: The study aimed to connect the community with a technology that may be an easy and fun way to assist the elderly in improving their balance without the need to leave home or join rehabilitation groups, offering greater comfort for this population and decreasing healthcare costs since there is no need for specialized personnel. TRIAL REGISTRATION: Current Control Trial NCT02570178.

Prevalencia de lesiones en el ámbito de la atención primaria, a propósito de las variantes de registro / Prevalence of injuries in the field of primary care in view of the recordkeeping variation

Objetivo: determinar la prevalencia de lesiones en un área de Atención Primaria del Instituto Catalán de la Salud, e identificar los diagnósticos NANDA y/o la Codificación Internacional de Enfermedades (CIE-10) utilizados. Material y método: estudio descriptivo transversal o de prevalencia, multicéntrico, en el ámbito urbano de la red de Atención Primaria de Salud en Barcelona(Área Metropolitana Nord (MN) que da servicio a 1.404.807 habitantes).Las variables de estudio fueron los diagnósticos NANDA yCIE-10 relacionados con lesiones, registrados en el aplicativo e-CAP: edad, sexo y distribución geográfica. Las lesiones se dividieron en: deterioro de la integridad tisular, deterioro de la integridad cutánea, herida, úlcera y quemadura. Resultados: fueron localizados 39.374 registros de lesiones, lo que suponía una prevalencia del 2,8%. Bajo el diagnóstico enfermero “Deterioro de la integridad tisular” se registraron un 53% de lesiones. La mayor prevalencia también se dio para este diagnóstico (1,49%). La distribución de los registros según la CIE-10 representaban un 41% del global y el 59% utilizaron la clasificación internacional NANDA. En todos los intervalos de edad el mayor porcentaje era el que correspondía al “Deterioro de la integridad tisular”. Según sexos, un 49% de lesiones se registran en mujeres. Conclusiones: coexiste una gran variabilidad de registros en la historia clínica de Atención Primaria y de utilización de diagnósticos. El volumen de diagnósticos de “Deterioro de la integridad tisular” indica que el criterio de utilización de dicho diagnóstico no es homogéneo para todos los profesionales. Registrar adecuadamente no debe comportar una sobrecarga para el profesional, ni representar un gasto en la aplicación. Es fundamental disponer de sistemas de registros eficaces, eficientes y efectivos (AU)

Purpose: Determine the prevalence of injuries within one Primary Care District, Catalonian Health Institute, and identify the NANDA diagnoses and/or the International Classification of Diseases (ICD-10) coding used. Material and method: Multi-center, descriptive cross-sectional or prevalence study in urban environment of the Primary Health Care network in Barcelona(North Metropolitan Area, serving 1,404,807 inhabitants). The study variables were the NANDA and ICD-10 diagnosis related to injuries recorded in thee-CAP application, age, gender and geographic distribution. The injuries were divided into: deterioration of tissue integrity, deterioration of skin integrity, wound, ulcer and burn. Results: A total of 39,374 injury records were located, having meant a 2.8%prevalence. A total of 53% of the injuries were recorded under the “deterioration of tissue integrity” nursing diagnosis. The greatest prevalence was also found for this diagnosis (1.49%). The breakdown of the records according to ICD-10 totaled 41% of all, 59% having employed the international NANDA classification. For all age ranges, the highest percentage was that of “deterioration of tissue integrity”. By genders, 49% of the injuries we rerecorded in females. Conclusions: A high degree of variability exists in what is recorded on the Primary Care clinical records and in the use of diagnostics. The number of patients diagnosed with “deterioration of tissue integrity” indicates that the criterion for employing this diagnosis is not homogeneous among all of these professionals. Recording data properly must not entail any overload for professionals, nor involve an expense in the application. It is crucial to avail of efficacious, efficient, effective record-keeping systems (AU)