Use Of Assist Devices Research Articles

Association of anti-HSC70 autoantibodies with cutaneous ulceration and severe disease in juvenile dermatomyositis.

JDM is an inflammatory myopathy characterized by prominent vasculopathy. AECAs are frequently detected in inflammatory and autoimmune diseases. We sought to determine whether AECAs correlate with clinical features of JDM, and thus serve as biomarkers to guide therapy or predict outcome. Plasma samples from 63 patients with JDM, 49 patients with polyarticular JIA and 40 juvenile healthy controls were used to detect anti-heat shock cognate 71 kDa protein (HSC70) autoantibodies, a newly identified AECA, in ELISA assays. Clinical features were compared between JDM patients with and without anti-HSC70 autoantibodies. Anti-HSC70 autoantibodies were detected in 35% of patients with JDM, in 0% of patients with JIA (P < 0.0001) and in 0% of healthy donors (P < 0.0001). Both the presence of cutaneous ulcers (59% vs 17%, P < 0.002) and the use of wheelchairs and/or assistive devices (64% vs 27%, P < 0.007) were strongly associated with anti-HSC70 autoantibodies in JDM. High scores on the severity of myositis damage measures at the time of measurement of anti-HSC70 autoantibodies and an increased number of hospitalizations were also associated with anti-HSC70 autoantibodies. Intravenous immunoglobulin therapy was used more often in anti-HSC70 autoantibody-positive patients. Anti-HCS70 autoantibodies are detected frequently in children with JDM and are novel myositis-associated autoantibodies correlating with disease severity.

Sarcoidosis among US Hispanics in a Nationwide Registry

BackgroundSarcoidosis has been well studied in multiple races and ethnic groups. However, there is a paucity of data that describes sarcoidosis in Hispanics. We aimed to determine the prevalence of Hispanic ethnicity, clinical characteristics and impact of sarcoidosis among Hispanics from a US based national registry. MethodsWe conducted a national registry-based study investigating 3835 respondents to the Sarcoidosis Advanced Registry for Cures questionnaire. This registry is a web-based, self-reported questionnaire that provides data related to demographics, diagnostics, organ involvement, treatment modalities, and the physical and psychosocial impact of sarcoidosis. We compared Hispanic patients to non-Hispanics. We performed multivariate logistic regression analysis adjusting for age, gender, education, income and insurance status and looked at the association between Hispanic ethnicity with depression, chronic pain syndrome, chronic fatigue syndrome, impact on family finances, employment-based disability and job termination. ResultsNine percent of the patients reported a Hispanic ethnicity and the majority of these patients self-identified as white women. The most common organs involved were the lungs (74.9%), central lymph nodes (53.8%), and peripheral lymph nodes (37.1%). Hispanics reported more peripheral nerves and peripheral lymph nodes involvement than non-Hispanics. Hispanics experienced more depression, sleep apnea, and chronic pain syndrome than non-Hispanics. The use of mobility assistive devices was more common among Hispanics, as well as employment-based disability, and disease-related job termination compared to non-Hispanics. The majority of Hispanics reported significantly more pain that interfered with the enjoyment of life than non-Hispanics. On multivariate logistic regression analysis, Hispanic ethnicity was associated with depression (adjusted odds ratio (aOR) = 1.5; 95% CI: 1.01–2.2), chronic pain syndrome (aOR = 1.7; 1.1–2.6), job termination due to sarcoidosis (aOR = 1.7; 1.1–2.7) and higher impact on family finances (aOR = 1.7; 1.1–2.5). ConclusionThe clinical presentation of sarcoidosis in Hispanic patients differs from that in non-Hispanic patients living in the United States. These differences should be considered when managing Hispanic patients with sarcoidosis. We encourage more studies that investigate phenotyping among Hispanics with sarcoidosis.

Risk factors for functional deterioration in a cohort with late effects of poliomyelitis: A ten-year follow-up study.

More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome. To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years. A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires. Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions. Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.

ANALISIS KINERJA SIMPANG EMPAT TAK BERSINYAL (Studi Kasus : Persimpangan Jalan Ahmad Yani Ekor Lubuk Kota Padang Panjang).

ABSTRACTTransportation is the movement of people or goods from one place to another or from the place of origin to the destination with or without the use of assistive devices. To expedite these activities, it is necessary to increase the capacity of the road structure where adequate planning of transportation modes is needed by prioritizing aspects of speed and also considering aspects of safety, comfort and environmental impact. To optimize the function of the road network, an intersection transportation system is implemented. The Ahmad Yani Street intersection (Padang Panjang – Solok Highway) is one of the main roads in the city of Padang Panjang where the activity in this road area is quite large. The pattern of traffic regulation at this intersection is not yet regular, so vehicles are often found scrambling for space to pass through the intersection and have a higher risk of accidents, this will cause congestion. The purpose of this study is to determine the level of performance of unsignaled intersections in serving traffic based on data obtained from field surveys and to determine the traffic flow at the Ahmad Yani, Street, Padang Panjang City. The research method used in this research is quantitative (field survey). The survey was conducted for 3 days, namely Monday, Friday, and Saturday. Which from the presearch results peak hours occur on Mondays. This intersection has a high side resistance with a degree of saturation (DS) = 1.883, the average delay is -9.52 and the queue probability is also high 160.29% - 379.51%.Keywords : Degree of Saturation, Side Barrier, Unsignalized Intersection, Delay, Queue Opportunity, MKJI

INTERVENTION OF ASSISTIVE TECHNOLOGY ON PERFORMANCE OF VISUALLY IMPAIRED STUDENTS IN KISWAHILI LANGUAGE IN PUBLIC PRIMARY TEACHERS’ COLLEGES IN KENYA

Education is a universal right to all including those with disabilities. Students with visual impairments can struggle with a wide variety of challenges in a mainstreamed classroom setting. Assistive Technology intervention by use of assistive devices in teaching, use of assistive teaching methods, taking care of visually impaired severity and boosting positively the student-teacher related factors improve their performance. The purpose of this study was to examine the intervention of Assistive Technology on performance of Visually Impaired students in Kiswahili in Public Primary Teachers’ Colleges in Kenya. The paper adopts a quasi-experimental design by use of a pre-test and post-test. It has been appropriate to analyze the treatment effect of using AT in teaching VI students in one group while applying the natural teaching methods on the control group. The target population was three teachers’ colleges in Kenya (Asumbi, Machakos and Mosoriot). A standardized examination was given to the two groups. Another examination was given to the two groups after giving one group a treatment of use of discussion groups, peer consultation and use of teacher assistive teams. The AT devices were critical in teaching VI students in order to improve their performance in languages and therefore their adequacy in college determined the rate of students’ performance. The researcher found out that the attitude of the teachers in teaching VI students was positive but the challenges in ensuring quality teaching of Languages included the students having a negative attitude towards languages, teachers have a negative attitude towards their career and lack of adequate teaching and learning materials. The researcher found out that the most significant methods that the teachers used to teach Languages to students with VI were: lectures, assignments and group discussions. The findings inferred that the partially blind students were better suited for the natural teaching methods than the totally blind students as they performed higher when taught using natural teaching methods. The paper recommends that the management of tertiary institutions should invest on interventions like the assistive technology in enhancing their academic performance. The researchers further recommends that other strategies for teaching VI students like use of peer consultations between the VI students with sighted students, use of quieter rooms, teacher assistance teams; extended exam time for VI students and shorter assignments to the VI students should also be employed to enhance Language to students with visual impairment. The significance of the study is that AT device intervention such as use of digital recorder in teaching can improve students’ academic performance.

Impacts of Mobility Dogs on Kinematics during Ambulation: A Quantitative Study

While prior research has explored various physiological consequences associated with assistive device use for ambulation, limited research has specifically explored the impact of mobility dog partnership on human kinematics. This descriptive study examined the impact of mobility dog partnership on kinematics of individuals in the normal young adult population. Sixteen participants were video recorded while walking in a straight line for 3.7 m (12 feet) under three different conditions (ambulating with no device, ambulating with a standard cane on the left side, and ambulating with a mobility dog on the left side). Differences between joint angles under each of the conditions were analyzed. Statistically significant differences were found in left elbow flexion when comparing ambulating with a cane versus ambulating with no device; left shoulder abduction when comparing ambulating with a cane versus ambulating with a mobility dog, ambulating with a mobility dog versus no device, and ambulating with a cane versus no device; and left hip extension when comparing ambulating with a mobility dog versus no device, and when ambulating with a mobility dog versus a cane. These findings suggest that providers should evaluate and monitor potential negative impacts of assistive devices such as mobility dogs on human kinematics.

1011 The Implications of The Use of Left Ventricular Assist Devices (Lvads) Or Extra-Corporeal Membrane Oxygenation (ECMO) In Patients with Severe Heart Failure

Abstract Introduction Heart failure (HF) is a chronic, debilitating and progressive disease(1). Consequently, guidelines recommend heart transplants for patients suffering from end-stage HF, termed destination therapy(2). However, with increasing disparity between the number of donor hearts available and people on the waiting list, identifying the most suitable interim intervention (bridge-to-transplant) therapy is paramount(3,4). Method A scoping search identified controversy surrounding LVAD versus ECMO in end-stage HF. Discussions with an expert in the field at a tertiary centre in the UK (Queen Elizabeth Hospital Birmingham) enabled refinement of the topic. A literature review was conducted, followed by a title and abstract screen. Subsequently, remaining literature was critically appraised. Results First generation LVADs may decrease mortality by 48% in comparison to optimal medical management, although have been associated with disabling stroke. Second and third generation LVADs demonstrate impressive survival at 30 days (&amp;gt;95%), a strong favourable long-term prognostic indicator. Additionally, improvement in HF severity and QoL have been demonstrated. Unlike ECMO, LVAD appears to be feasible as a DT, lasting as long as 8 years. However, the cost of LVADs may be prohibitive, higher than transplantation2. However, ECMO may facilitate multi-organ and right ventricular recovery, enabling transplantation to occur with increased stability. Neither option has conclusive evidence for cost-effectiveness. Conclusions Both LVADs and ECMO can be considered as effective BTT options, suitable in different clinical scenarios. The decision for BTT intervention should be undertaken on a case-by-case basis, in accordance with NICE guidelines, aiming for optimal outcomes in terms of survival, functionality and QoL.

Prevalence and Risk Factors of Falls among Egyptian Elderly Attending Primary Health Centers in Suez Governorate

Abstract Objectives To estimate the prevalence and probable risk factors of falls among a sample of community-dwelling older adults in Suez Governorate, Egypt. Design A cross-sectional comparative study. Setting and Participants Study included 300 older adults (both men and women) recruited from 3 primary healthcare centers, all located in Suez Governorate, Egypt (Alsalam medical center, Mubarak medical center and Alsabbah medical center). Methods All participants were questioned about their fall history in the precedent year and were assessed using: Structured interview questionnaire and physical examination, Fall Risk Assessment Tool, Basic and instrumental activities of daily living, Timed Up and Go test, Single leg stance test, handgrip strength measurement, Mini-Mental Status Examination and Geriatric Depression Scale-15. Participants were categorized as faller and non-faller groups according to their fall history in the precedent year and were then compared as regard common fall risk factors (intrinsic and extrinsic). Results Prevalence of falls among the studied populations was 29%. Women fell more frequently than men (accounting for 64.4% and 35.6% of fallers, p = 0.01). Most falls occurred indoors (58.3%). A significant association was found between fall history and age, sex, muscle weakness, depression, urinary incontinence, IHD, visual impairment, fear of falling, use of assistive device, postural hypotension, and polypharmacy. Conclusion Prevalence of falls in community-dwelling elderly in Suez Governorate is 29%. Identification of factors significantly affecting elderly falls can help in planning public health policies and programs for prevention of falls.

Effects of assistive devices on postural control following a balance disturbance along the anterior-posterior direction.

Assistive devices provide balance and stability to those who require a greater base of support, especially during ambulation or in tasks essential to functional daily living. In ambulatory assistive device use, center of pressure (COP) movement as one of the measurements of postural control is a factor when assessing fall risk, with an overall goal of maintaining postural equilibrium. There is a lack of research on assistive devices, such as walkers, regarding measurable outcome variables related to fall risk. The purpose of this study was to determine how much the postural control in single limb stance during a balance perturbance is affected by utilizing three different walker types designed to promote stability: the standard walker, the front-wheeled walker with straight wheels and the front-wheeled walker with caster wheels. Is postural sway control in single limb stance during a balance perturbance affected by walker type? Twenty-three healthy adults participated and gave consent. The NeuroCom® SMART EquiTest® system was utilized to simulate forward falls. Subjects stood on the system's force plate, which was tipped backwards quickly, forcing subjects to attempt to maintain balance. Each participant experienced 18 simulated perturbations, during which they were asked to maintain balance while using one of three walkers in single-limb stance. Each trial was completed using random assignment of three different walker types. Leg dominance of the stance leg was also randomized for each trial. The type of walker and the leg dominance in the standing limb significantly affected postural control in a balance perturbance in the A-P direction. The walker type significantly affected the COP maximum displacement in anterior-posterior (AP) direction. However, the leg dominance significantly affected COP maximum displacement in AP and medio-lateral (ML) directions and COP velocity in AP direction. The findings suggest that when fully grounded, a standard walker is more stable than the front-wheeled walker. However, this does not indicate that the standard walker is more stable than other types of walkers when it is being picked up and moved forward during normal use.

Activity Participation in the Pediatric Skeletal Dysplasia Population

<h3>Research Objectives</h3> To investigate activities children with skeletal dysplasia participate.To identify activities with the greatest and lowest participation rates among children with skeletal dysplasia .To investigate participation patterns among children with skeletal dysplasia. <h3>Design</h3> Children with skeletal dysplasia were asked to complete the Children's Assessment of Participation and Enjoyment (CAPE) survey during visits July 2014-June 2019. Demographic information and use of assistive devices was collected retrospectively. <h3>Setting</h3> City-based ambulatory orthopedic hospital. <h3>Participants</h3> Sixty-six children (38 females, 28 males) average age 11.5+/-4.21 years participated. Twenty-three (35%) were at least 13 years old, 43 (65%) were younger than 13. Thirty-two had average stature for age, 34 had short stature. There were 21 different skeletal dysplasia diagnoses among the participants. Fifteen children (23%) used assistive devices. Thirty-six children identified as white, 10 as black, 9 as Hispanic, 9 as Asian, 2 as other. <h3>Interventions</h3> CAPE was validated in Ontario, Canada for children (ages 6-21) with or without disabilities. <h3>Main Outcome Measures</h3> CAPE measures children participation of 55 informal and formal activities of five activity types: recreational, active-physical, social, skill-based, and self-improvement. <h3>Results</h3> Children participated in an average of 27.6+/-9.21 activities (overall diversity scores) out of 55 individual activities. CAPE diversity responses for each domain were used to compare the degree of activity involvement. Intensity and enjoyment were calculated. Chi-square analyses were conducted to analyze responses by each individual item. Paired t-tests were used to compare variation across population demographics. All statistical analysis was conducted using SPSS 22 for Windows. <h3>Conclusions</h3> Children with skeletal dysplasia participate in a wide variety of activities. Greatest participation was in social activities, lowest in physical activities. Use of assistive devices did not affect participation; there were no participation differences between genders. No study has previously evaluated the participation activities in this population. <h3>Author(s) Disclosures</h3> Dr. Cathleen Raggio received consulting fees from Alexion Pharmaceuticals, Ascendis and Biomarin. She was on speaker's bureau for Alexion Pharmaceuticals and Medical Advisory Board for Osteogenesis Imperfecta Foundation. Erin Carter on Medical Advisory Board for Little People of America, Inc.

Postacute Rehabilitation for Survivors of COVID-19 in an Inpatient Rehabilitation Setting: A Case Series

Research ObjectivesTo investigate the rehabilitation outcomes of patients with COVID-19, admitted to an in-hospital inpatient rehabilitation unit.DesignCase series method. All patients were followed up by phone call six months after discharge.SettingIn-hospital Inpatient Rehabilitation Unit.ParticipantsSubjects included three male patients in the age range of 55-65 with underlying medical conditions after COVID-19 infection with a mean acute hospital stay of 39 days.InterventionsAll three patients received services from an interdisciplinary team led by a physical medicine and rehabilitation specialist. Interventions were focused on managing ongoing medical issues, weaning off of supplemental oxygen, restorative and compensatory training to improve independence with functional mobility, activities of daily living, assessment and treatment of dysphagia, speech/voice, and cognitive-communication deficits.Main Outcome MeasuresSix-minute Walk Test, 10-meter Walk Test, GG codes, Berg Balance Scale, MRC sum score, Montreal Cognitive Asessment, Dynamometry and 9-hole Peg Test.ResultsThe average length of stay at the rehabilitation unit was 21 days. The distance on six-minute walk has improved from being unable to walk for six minutes on admission to an average of 921 feet at a speed of 1.05m/s. Two out of three patients remained at medium risk of falls requiring use of assistive devices for mobility. Persisting dysphagia and dependence on supplemental oxygen was an issue for one patient. All three patients discharged home with support from family members and no episode of readmission to hospital within six months after discharge.ConclusionsOngoing fatigue, cognitive impairment and reduced endurance demonstrates the impact of COVID-19 on multiple organ systems in the body. Intensive inpatient rehabilitation is beneficial to accelerate recovery process, while managing ongoing medical issues.Author(s) DisclosuresRussell ME: Speakers Bureau for Allergan and Merz.LIjo, Hamilton, Wren: Nothing to disclose.

Developing a Counseling Tool for Determining the Choice of Contraceptives in Women of Fertile Age

In 2016, the CPR (Contraceptive Participant Rate) was 57.9%. Efforts to increase CPR are pursued by launching a family planning program, through an educational approach and introducing various contraceptives at childbearing age, the government is striving to reduce population growth very quickly (BKKBN, 2016).Research Objectives: To develop counseling aids. Research Methods Using the research action cycle, qualitative methods with 5 midwives and 5 patients.Research location in Sleman Regency, Yogyakarta.Analysis techniques using thematic analysis.Research Results: Communication patterns between providers and patients tend to be in two-way communication patterns. In the use of assistive devices, all providers do not use ABPK in the KB counseling process for various reasons. Although the impact is positive, namely the availability of a complete source of information from each contraceptive Conclusion: The development of counseling aids has changed from a manual design to a digital-based tool, which is an application installed on Android

Role of Occupational Therapy While Working with Cerebral Palsy Children Using Orthopedic Assistive Devices

The main aim of the following research paper is to identify and interpret the preconditions and instructions for the implementation of effective Occupational Therapy intervention during the use of orthopedic assistive devices. In trying to highlight the role, professional skills, and perspectives of the occupational therapist, it will be possible to identify the key provisions that, if applied, will encourage the maximum participation of a child with Cerebral Palsy in several activities that are meaningful to him/her, thereby improving his/her quality of life and well-being. The methodology of data collection, processing, and analysis of the research is based on a combined method approach, which allows combining quantitative data collection and use of quantitative methods to later conclude the data obtained through certain numerical patterns. Structural interviews and designed questionnaires were used with 50 children having Cerebral Palsy and their parents or caregivers. The results showed that today in Armenia, due to the problems of obtaining and using orthopedic assistive devices, as well as the lack of professional supervision and monitoring, it is limited or does not ensure the maximum independent participation of children with Cerebral Palsy in community life, self-care, and professional activities.

The influence of organizational factors, eldercare worker characteristics and care situation on the use of assistive devices during resident handling in eldercare work

We evaluated the influence of organization, eldercare worker and care situation on the use of assistive devices during resident handling in eldercare work. We conducted a multi-level study among 20 nursing homes, 126 wards within the nursing homes, 549 eldercare workers within the wards, who performed a total of 1306 care episodes including 3695 resident handlings. The influence of organization (i.e. nursing home and ward), eldercare worker and care situation (i.e. care episode and resident handling) on the use of assistive devices was evaluated using variance components analysis and multivariate generalized linear mixed model. Nursing homes, wards, eldercare workers, care episodes and ‘within care episode’ all contributed to the total variance in use of assistive devices. Organizational factors and care situation factors were significantly associated with use of assistive devices. All levels of the nursing homes, but in particular care situation, influence the use of assistive devices during resident handling.

Are resident handlings in eldercare wards associated with musculoskeletal pain and sickness absence among the workers? A prospective study based on onsite observations.

Objectives:We aimed to identify eldercare wards with different types of resident handling characteristics (‘phenotypes’) and determine the prospective association between these characteristics and musculoskeletal pain and sickness absence among workers during a one-year follow-up.Methods:Our study was based on the DOSES cohort, including 467 workers at 103 eldercare wards. At baseline, resident handlings were assessed using onsite observations. Workers’ self-reported musculoskeletal pain and sickness absence were assessed during the following year using text messages. Observations of the frequency of handlings per shift, use of assistive devices, assistance from others, and barriers (interruptions and impediments) were estimated for each worker, aggregated at ward level, and entered into a latent profile analysis, identifying ward phenotypes. We then used generalized estimating equations to determine associations between ward phenotypes, musculoskeletal pain and sickness absence.Results:We identified four ward phenotypes: ‘turbulent’ (many handlings with devices and assistance, many barriers), ‘strained’ (many handlings without devices or assistance, some barriers), ‘unpressured’ (few handlings, yet without devices or assistance, few barriers) and ‘balanced’ (some handlings with devices and assistance, some barriers). Compared to workers in balanced wards, workers in turbulent wards had more days with neck-shoulder and low-back pain (LBP); and those working in strained wards had more days with LBP and higher pain intensities.Conclusion:We found that ward phenotypes based on resident handling characteristics were predictive of musculoskeletal pain and sickness absence over one year. This shows that organizational factors related to resident handling are important determinants of musculoskeletal health among eldercare workers.

Validity of 2 Fall Prevention Strategy Scales for People With Stroke, Parkinson's Disease, and Multiple Sclerosis.

Falls are a common and persistent concern among people with neurological disorders (PwND), as they frequently result in mobility deficits and may lead to loss of functional independence. This study investigated the ceiling and floor effects, internal consistency, and convergent validity of 2 patient-reported fall prevention strategy scales in PwND. This is a prospective cohort study. Two-hundred and ninety-nine PwND (111 people with multiple sclerosis, 94 people with Parkinson's disease, and 94 people with stroke) were seen for rehabilitation and assessed. The number of retrospective and prospective falls, use of walking assistive devices, scores on the Fall Prevention Strategy Survey (FPSS), Falls Behavioural Scale (FaB), and balance and mobility scales (Berg Balance Scale, Dynamic Gait Index, Timed Up and Go, 10-m walking test, and Activities-specific Balance Confidence) were analyzed. Total score distributions showed negligible ceiling and floor effects for both the FPSS (ceiling: 0.3%, floor: 0.3%) and the FaB (ceiling: 0%, floor: 0%). The Cronbach α (CI) was of 0.87 (0.85-0.89) for the FPSS and 0.86 (0.84-0.88) for the FaB. In terms of convergent validity, the FPSS and FaB were moderately correlated (Spearman correlation coefficient = 0.65). Moreover, the correlations between the FPSS and FaB and balance and mobility scales ranged from 0.25 to 0.49 ( P < .01). Both scales are slightly better able to distinguish between retrospective fallers/nonfallers [area under the curve, AUC (95% CI): FPSS: 0.61 (0.5-0.7); FaB: 0.60 (0.5-0.6)] compared with prospective fallers/nonfallers [AUC (95% CI): FPSS: 0.56 (0.4-0.6); FaB: 0.57 (0.4-0.6)]. Both scales accurately identified individuals who typically required the use of a walking assistive device for daily ambulation [AUC (95% CI): FPSS: 0.74 (0.7-0.8); FaB: 0.69 (0.6-0.7)]. Multiple regression analysis showed that previous falls, use of an assistive device, and balance confidence significantly predicted participants' prevention strategies (FPSS: R2 = 0.31, F(8,159) = 10.5, P < .01; FaB: R2 = 0.31, F(8,164) = 10.89, P < .01). The FPSS and the FaB appear to be valid tools to assess fall prevention strategies in people with neurological disorders. Both scales provide unique and added value in providing information on individual behavior for fall prevention.

Use of multiplate electrode aggregometry for personalisonalisation of antiplatelet therapy in left ventricular assisst device patients

Abstract Funding Acknowledgements Type of funding sources: None. Background The use of Left Ventricular Assist Devices (LVAD) has noticeably improved the survival for patients with advanced heart failure. However, this treatment is associated with significant adverse effects. Personalisation of antiplatelet therapy is a key in control and reduction of bleeding/thromboembolic complications of this treatment. However, ISHLT and the manufacturer still recommend unified treatment of 150 mg of acetylsalicylic acid for all LVAD patients. In our centre, we base the treatment decision on clinical picture and patient’s responsiveness to antiplatelet therapy. The treatment of choice is acetylsalicylic acid in doses 37.5 mg (1 patient), 75 mg (25 patients) and 150 mg (33 patients). For patients unresponsive or intolerant to acetylsalicylic acid we use 75 mg of clopidogrel, currently 9 patients. 1 patient receives both, 75 mg clopidogrel and 75 mg acetylsalicylic acid. Purpose To gain a better understanding of the platelets function and patients" responses to antiplatelet therapy. In aim to reduce the prevalence of bleeding/thromboembolic related adverse events in LVAD patients, and therefore improve patients outcome. Methods In 2020, we decided to introduce a structured/test-based approach to antiplatelet therapy in this patients group. With the use of Multiplate Electrode Aggregometry (MEA) we have attempted to diagnose platelet disorders and monitor effectiveness of antiplatelet therapy. Based on MEA platlets inhibition test we were able to tailor the therapy. The retrospective audit was conducted with inclusion criteria; 1. Thromboembolic events include pump thrombosis and any other ischemic complications. Bleeding events contains gastrointestinal (GI) and central nervous system (CNS) events. 2. Any thromboembolic and bleeding events after starting antiplatelet therapy, in the first year after LVAD implantation Results The tables below presents reduction in both thromboembolic and bleeding complications. Conclusion Presented data can be interpreted that, the test-based approach to antiplatelet therapy may be beneficial in limiting the adverse effects of LVAD therapy. However, it needs to be acknowledged that the observation was carried out on a small group of the patients, over a short period of time. Therefore, an extended period of observation is recommended to obtain further data.

Analysis of the Effectiveness of Employee Performance in Improving Public Services at the Bagan Sinembah Sub-District Office, Rokan Hilir Regency, Riau Province

This study aims to find out the Effectiveness of Employee Performance in Improving Public Services at the Bagan Sinembah Sub-District Office, Rokan Hilir Regency. This study used qualitative approach. Based on the results of research and discussion on Employee Work Effectiveness in Improving Public Services at the Bagan Sinembah District Office, Rokan Hilir Regency, Riau Province. The motivation here is defined as a performance of leaders and employees towards work situations in their agency environment, those who perform positively on their work situations will show high work motivation, this is also very supportive in creating enthusiasm and increasing Performance Effectiveness.Employees in Improving Public Services at the Bagan Sinembah Sub-District Office, Rokan Hilir Regency, Riau Province in each of the implementation of his duties and direction from the leadership to his subordinates can also create productive cooperation to achieve the goals that have been set. The ability to carry out the work has been good and the quality of the work has also obtained maximum results, with the achievement of this effective performance Performance EffectivenessEmployees in Improving Public Services at the Bagan Sinembah Sub-District Office, Rokan Hilir Regency, Riau Province have been required to apply good management standards and have been assessed and verified by the institution entitled to provide certification. Technology here is related to the use of assistive devices in an organization, doing a job is certainly supported by adequate technology.Provision of information and technology facilities in Performance EffectivenessEmployees in Improving Public Services at the Bagan Sinembah Sub-District Office, Rokan Hilir Regency, Riau Province has improved with the existence of WIFI networks and other supporting facilities that really help in completing the work.

The role of assistive devices in frail elderly people with fragility fractures: a narrative review

Fragility fractures commonly lead to disability. To improve and/or maintain physical function and independence in patients with bone fragility, several aids and orthoses are often prescribed in clinical practice for different purposes. Walking aids such as crutches, canes, walkers and wheelchairs are designed to assist walking and prevent falls in people with gait and balance impairments, or who are unable to walk alone. To facilitate transfers in patients with balance and coordination disorders, muscle weakness and impaired respiratory function, mobility devices such as toilet, shower and bed aids may be useful. Hip protectors are designed to decrease the impact forces generated by a fall on the greater trochanter. Wearing these devices at the time of a fall can decrease the risk of hip fracture. Spinal orthoses support a specific vertebral region, and they are worn, in the case of fractures, with the aim of providing stability, relieving pain and improving mobility. However, to maximise the beneficial effects and reduce the risk of adverse events, physicians need to promote correct use of assistive devices, as their incorrect use may increase the risk of both falls and of fall-related injuries.

The Effect of Infectious Complications During Ventricular Assist Device Use on Outcomes of Pediatric Heart Transplantation.

To describe the impact of infectious adverse events (IAEs) during ventricular assist device (VAD) support on graft loss, infection, and rejection after pediatric heart transplant (HT). Pedimacs data were linked to Pediatric Heart Transplant Society (PHTS) data for patients receiving a VAD followed by HT between September 2012 and December 2016. Linked patients were categorized into IAE on VAD (group A) and no IAE on VAD (group B). Infectious adverse event locations included nondevice, device (external or internal), and sepsis. Post-HT outcomes for analysis were graft loss, infection, and rejection. Time-dependent analysis included Kaplan-Meier and multiphase parametric hazard function analysis. We linked 207 patients (age 9.4 ± 6.3 years). Post-HT follow-up was 19.4 patient-months (<8 days-4.1 years). Group A included 42 patients (20%) with 62 IAEs. Group B included 165 patients without an IAE. Group A patients were younger (7.4 ± 6.1 vs. 9.5 ± 6.3 years; p = 0.03), waited longer for HT (5.3 ± 4.1 vs. 2.9 ± 2.5 months; p = 0.0005), and were hospitalized longer post-HT (42 ± 59 vs. 23 ± 22 days; p = 0.05). VAD-related IAEs were rare (N = 11). Groups A and B had similar freedom from first post-HT infection, rejection, and graft loss (all p > 0.1). However, patients with VAD-related IAE were somewhat more likely to experience rejection (p = 0.03) and graft loss (p = 0.01). Children with an IAE on VAD who survive to HT are younger, wait longer for HT, and remain hospitalized longer than those without an IAE on VAD. Overall, IAE on VAD did not impact post-HT outcomes, but VAD-related IAE may be associated with graft loss and rejection.