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Use of a Fall Prevention Practice Guideline for Community-Dwelling Older Persons at Risk for Falling: A Feasibility Study.
Gerontology. 2008 Oct 16;
Authors: Milisen K, Geeraerts A, Dejaeger E
Background: Falls among older persons occur frequently and are a common cause of physical and psychological morbidity and healthcare utilization. The problem can be attributed to a complex interaction between health-related, behavioral and environmental factors. To ensure a uniform and evidence-based approach, a practice guideline was developed for fall prevention in community-dwelling older persons at risk for falls. Objective: To test the feasibility of integrating a fall prevention practice guideline into the daily practice of 4 primary healthcare disciplines, i.e. general practitioners, nurses, occupational therapists and physiotherapists. Methods: This was a descriptive study which was carried out by 10 local health networks located throughout Flanders. The subjects involved in the study were 99 primary care workers and 1,142 community-dwelling older patients (65 years or older) who could rise from a chair and transfer independently. For 6 months, primary care workers implemented our fall prevention guideline, which consisted of 3 parts (case finding, multifactorial in-depth assessment and interventions). After the 6-month trial phase, participating primary care workers were asked to complete a semistructured questionnaire to evaluate the feasibility of using the guideline in daily practice. Results: The average time spent on carrying out the guideline was 32.0 +/- 14.0 min. Healthcare workers from all 4 disciplines considered case finding to be their responsibility. The picture was different for the evaluation of risk factors and interventions. Although 87.5% considered fall prevention to be an important issue, healthcare workers from different disciplines failed to agree about how to integrate the prevention guideline into daily practice. Perceived barriers to implementing the guideline were lack of time (57.3%), poor motivation of the target population (53.3%) and insufficient cooperation between healthcare workers (37.3%). Conclusion: A guideline can be used to initiate the integration of prevention strategies into daily practice. Case finding is feasible for all disciplines. Multifactorial assessment and interventions require specific task allocation, multidisciplinary cooperation and clear communication.
PMID: 18931476 [PubMed - as supplied by publisher]
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Donnerstag, 06. November 2008
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Pan-Canadian Evaluation of Irreversible Compression Ratios ("Lossy" Compression) for Development of National Guidelines.
J Digit Imaging. 2008 Oct 18;
Authors: Koff D, Bak P, Brownrigg P, Hosseinzadeh D, Khademi A, Kiss A, Lepanto L, Michalak T, Shulman H, Volkening A
New technological advancements including multislice CT scanners and functional MRI, have dramatically increased the size and number of digital images generated by medical imaging departments. Despite the fact that the cost of storage is dropping, the savings are largely surpassed by the increasing volume of data being generated. While local area network bandwidth within a hospital is adequate for timely access to imaging data, efficiently moving the data between institutions requires wide area network bandwidth, which has a limited availability at a national level. A solution to address those issues is the use of lossy compression as long as there is no loss of relevant information. The goal of this study was to determine levels at which lossy compression can be confidently used in diagnostic imaging applications. In order to provide a fair assessment of existing compression tools, we tested and compared the two most commonly adopted DISCOM compression algorithms: JPEG and JPEG-2000. We conducted an extensive pan-Canadian evaluation of lossy compression applied to seven anatomical areas and five modalities using two recognized techniques: objective methods or diagnostic accuracy and subjective assessment based on Just Noticeable Difference. By incorporating both diagnostic accuracy and subjective evaluation techniques, enabled us to define a range of compression for each modality and body part tested. The results of our study suggest that at low levels of compression, there was no significant difference between the performance of lossy JPEG and lossy JPEG 2000, and that they are both appropriate to use for reporting on medical images. At higher levels, lossy JPEG proved to be more effective than JPEG 2000 in some cases, mainly neuro CT. More evaluation is required to assess the effect of compression on thin slice CT. We provide a table of recommended compression ratios for each modality and anatomical area investigated, to be integrated in the Canadian Association of Radiologists standard for the use of lossy compression in medical imaging.
PMID: 18931879 [PubMed - as supplied by publisher]
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