bluuebunny/crossref_metadata_2025_split huggingface dataset:
121 A Newly-Developed Smart Insole System with Instant Reminder: Paves the Way towards Integrating Artificial Intelligence (AI) Technology to Improve Balance and Prevent Falls
Authors: Ma Christina Zong-Hao , Chung Alan Kai-Lun , Ling Yan To , Huang Zi-Hao , Cheng Connie Lok-Kan , Zheng Yong-Ping 
Published: December 2019

Abstract

Background
Falls in senior people have high incidence& lead to severe injuries [1]. Application of smart wearable systems (with sensors to monitor user’s balance and corresponding instant reminder to let tusers adjust posture/motion) can effectively improve static standing balance [2], reduce reaction time and body sway in response to balance perturbation [3], improve walking pattern [4], and reduce the risk of falls [5, 6]. However, previous systems have not considered the daily monitor of user’s balance and falling risks, and the personalized reminder. Artificial intelligence (AI) and big data analytics have been widely used to monitor the daily physical activity [7], while few studies have utilized them to improve balance/gait and prevent falls.

Methods
This study has optimized previous devices by integrating AI technology and developed a new smart insole system. The system consisted of insoles with embedded sensors that can capture the foot motion and plantar pressure, smart watch that connected with insoles wirelessly and then transmitted the foot motion and force data to Cloud server via Wi-Fi, central Cloud server for big data transmission and storage, workstation for big data analytics and machine learning, and user interface for data visualization (e.g. smartphone, tablet, and/or laptop).

Results & Discussion
The system transmission rate was up to 30 Hz. The collected big data contained all sensor signals captured before and after delivering reminder, and from day-to-day monitoring of users. The customized reminder varied in the type, frequency, magnitude, and amount/dosage. This AI smart insole system enabled the monitor of daily balance and falling risks and the provision of timely-updated and customized reminder to users, which could potentially reduce the risk of falls and slips. It can also act as a balance-training device.

References
1. Rubenstein.Age ageing, 2006. 35(suppl2):p.ii37-ii41.
2. Ma.Sensors, 2015. 15(12):p.31709-31722.
3. Ma&Lee.Human Movement Science, 2017. 55:p.54-60.
4. Ma.Topics in stroke rehabilitation, 2018. 25(1):p.20-27.
5. Wan.Archives of physical medicine& rehabilitation, 2016. 97(7):p.1210-1213.
6. Ma.Sensors, 2016. 16(4):p.434.
7. Badawi.Future Generation Computer Systems, 2017. 66:p.59-70.
123 Acceptability of the Ambient Intelligent Geriatric Management (AMBIGEM) System: A Technological Solution to Prevent in-Patient Falls
Authors: Dollard Joanne , Visvanathan Renuka , Hill Keith , Ranasinghe Damith , Lange Kylie , Jones Katherine , Boyle Eileen , Zhou Adele , Ng Nicholas , Wilson Anne 
Published: December 2019

Abstract
AmbIGeM is a technological solution to prevent in-patient falls in patients aged &gt;65. It has been evaluated in a 100-week stepped wedge pragmatic design in two geriatric evaluation and management (GEM) wards and a general medical ward in two Australian hospitals (Visvanathan, Ranasinghe, Wilson et al., Injury Prevention, 2017,0:1). Evaluation of acceptability of the AmbIGeM system from the perspectives of patients and staff who experienced it is reported here.
30 patients completed a 24-item survey, 27 patients were interviewed, 22 staff participated in 3 focus groups and 51 staff completed a 39-item survey. Survey data were descriptively analysed, and focus group and interview data were thematically analysed.
In patient surveys, patients were overall strongly positive, with means 8+ (on 11-point scale) on most items. In patient interviews, the AmbIGeM system was considered a good idea to prevent falls. Most patients thought the singlets comfortable and had no concerns for their privacy nor impact on normal activity. Patients and families felt reassured, although sometimes they misunderstood the purpose of AmbIGeM. In staff focus groups, staff perceived AmbIGeM beneficial in that it can detect and alert movement in patients who require supervision. In both GEM wards, AmbIGeM was considered particularly beneficial,practical and valuable to use on night shift. Factors such as perceived technical limitations (false and delayed alerts) and felt staff burden impacted on acceptability. In staff surveys, 56% agreed/strongly agreed that AmbIGeM has the capability to prevent falls while 16% disagreed/strongly disagreed, 62% thought AmbIGeM would be more user friendly if it was consistently accurate and 76% believed that AmbIGeM takes a moderate/lot of extra work.

Conclusion
AmbIGeM is largely acceptable to patients and requires further refinement for staff. Feedback is valuable to further refine the system.
124 Core Stability is Involved in the Fall Risk of Older Adults
Authors: Satoshi Tagashira , Atsushi Takashima , Takeshi Shintani 
Published: December 2019

Abstract

Background
Fall prevention in older adults is an important task. Lower extremity function is a main focus in fall prevention. There are few previous studies focusing on core stability. The purpose of this study was to investigate the relationship between fall risk and core stability.

Methods
The study participants were 33 community-dwelling older adults (mean age: 65±17 years old; 5 men, 28 women). The fall risk was assessed using the Fall Risk Index-21 (FRI-21). Core stability measured the retention time of Side Bridge (SB) and Front Bridge (FB). Secondary outcome measures included lower extremity muscle strength (knee extension, hip abduction) and physical function (two-step test). Statistical analysis investigated the correlation between the measurement items.

Results
We found a significant negative correlation between FRI-21 and SB (r = -0.51, p&lt;0.01) and FRI-21 and FB (r = -0.47, p&lt;0.01). We also found a correlation between FRI-21 and the two-step test (r = -0.40, p&lt;0.05). There was no significant correlation between FRI-21 and lower extremity muscle strength.

Discussion
FRI and Core stability showed moderate correlation. It suggests that the core and hip muscle functions involved in posture retention are involved with fall.

Conclusion
The risk of falls in older adults was related to core stability. If the core stability of older adults improves, it may help to reduce the risk of falling. Therefore, it is useful to consider core stability in the assessment of fall risk.
125 A Novel Immersive Virtual Reality Dual Tasking Platform for Older Adults
Authors: Yap Kwee Yong Joyce , Kua Ee Chia Joanne , Tan Cai Ning , Ding Xiao Ming , Ismail Noor Hafizah Bte , Chew Oi Khuan Pamela 
Published: December 2019

Abstract
Dual task training benefits older adults by improving their balance and gait parameters. There is strong evidence suggesting its usefulness in reduction of falls with reduced falls risk. Current interventions for dual task training include exercises with cognitive exercises. There exists limited evidence for the use of Virtual Reality (VR) in training for dual tasking. Our study sets out to evaluate the usability and feasibility of an immersive VR dual tasking platform for older adults.
An immersive VR dual tasking training platform for older adults was developed in conjunction with the engineers for this pilot study. The cognitive task involves training of executive function through an immersive 3-dimensional game where the participants have to follow instructions to catch and avoid certain specified objects. The motor task involves walking on a motorized treadmill at a preset speed. The two tasks were incorporated into a single platform with a training protocol over twelve sessions. We evaluated for side effects from using this immersive VR device and tolerability of the training protocol.
The mean age of the participants is 62.9(±3.0)years old. Their mean comfortable gait speed is 1.27m/s. There were no falls throughout the entire training program. Participants tolerated the training protocol well with only 0.83% (1/120 training sessions) experiencing lower muscle ache/pain. The most common adverse effect from the immersive VR environment was tiredness – which made up 88% of all the adverse effects. However, this did not prevent participants from completing the training. The mean rating on the Borg Scale of perceived exertion is fairly light.
The VR platform and training protocol is safe and feasible for use in healthy older adults. We aim to conduct a clinical trial using this VR dual tasking platform in older adults to assess for clinical benefits in falls preventions, improvements in gait parameters and cognitive scores.
127 Older Adults' Knowledge and Perceptions of Falls: A Mixed Methods Study
Authors: Ng Cheah Ping , Singh Devinder Kaur Ajit , Tan Maw Pin , Kumar Saravana 
Published: December 2019

Abstract

Introduction
Falls is a global issue due to its devastating consequences and costs associated with fall injuries in older adults. There is limited information regarding knowledge and perceptions about falls among older individuals in Malaysia. The aim of this study was to assess knowledge and perceptions of falls among older adults.

Methods
A total of twenty-five (n=25) community dwelling older adults were invited to participate in this study (age range 61-83, median=73). Focus group discussions were conducted to explore older adults’ perceptions on falls, while the Fall Risk Assessment Questionnaire (FRAQ) was used to assess their knowledge on falls.

Results
Three themes emerged from the qualitative data, which were ‘Ageing and its association with falls’, ‘Reactions to a fall’ and ‘Knowledge of fall interventions’. The quantitative results showed that more than half of the participants considered themselves at the risk of falls (n=15, 60%). Older adults had better knowledge on behavioral and environmental (percentage of errors: 19.4%; 35.2%) compared to medical and medication related fall risk factors (percentage of errors: 55.2%; 57.33%).

Discussion
Older adults had both positive and negative views on ageing and falls. Some of the fall prevention strategies highlighted were in line with evidence-based recommendations. However, majority exhibit fall prevention behaviors that were largely based on their personal experiences. Older adults lacked the knowledge on medical related fall risk factors as these require understanding of various medical conditions and the related medications.

Conclusion
Education intervention emphasizing on ageing, medical and medication related fall risk factors should now be evaluated.
132 Impact of Falls Intervention Team (FIT) in Sungai Buloh Hospital
Authors: Liew Chiat Fong , Rajalingam Vijayendran , Suhaimin Farrah Wahida Md , Pirathayini Vicknesha , Sim Pearly Kim Aik , Nordin Nordiana , Mu'iz Arifin Muhamad Afiq , Selamat Hasnah , Sa'at Nadiah 
Published: December 2019

Abstract

Introduction
There is an exponential rise in the number of falls in medical wards, Sungai Buloh Hospital over the years. 57.7% (71/123) of the total falls in 2018 occurred in the Medical Department which raised concerns. As part of the falls reduction strategy, a Falls Prevention And Awareness program have been instituted in the department since September 2017 as well as formation of Falls Intervention Team (FIT) in March 2018. This includes: 1. Education: regular Continuous Medical Education (CME) , and Continuous Nursing Education (CNE): Checklist, Morse Falls Scale, and Falls Prevention Flipchart.
2. Identification: wristband , bed-tagging, and board-tagging of high risk patients.
3. Prevention: Targeted intervention implemented based on risk factors.

Objectives
The primary objective of this study was to assess the knowledge on falls education, identification and prevention upon introduction of FIT.

Methods
Audits were done upon initiation of FIT and the following 12 months later in all 11 Medical wards. They were based on the above 3 components using a standard audit form HSB-MED –022. Paired T test was used in analysis in SPSS version 23.

Results
There is an increment of awareness in education by 32% (p &lt; 0.00). Identification of those at high risk of falls has also increased by 11% (p &lt; 0.023, Wilcoxon Signed ranks test). Audit on prevention also revealed an increment of awareness by 14% over 12 months period (p &lt; 0.038).
The highest numbers of falls were seen in the wards with the lowest implementation of risk education and identification.

Conclusion
Despite the rising trend of the number of falls, FIT has proven to raise awareness, improved falls education, identification and prevention among healthcare personnel in medical wards in our setting.
133 Factor’s Contrubuting for Non-Compliance Physiotherapy Sesions among Geriatric Patient at Physiotherapy Fall Intervention Program
Authors: Embong Julaida , Lim L K , Lee F S , Adha M Nawawi , Rajadurai S , Fadzil N A A , Manap N S , Chong E G M , Yau W K 
Published: December 2019

Abstract

Introduction
Current world is going through an increase in ageing population with one in eight people in the world are aged 60 or over. By 2025, 15 % of Malaysia population will be aged above 60 years old. Physiotherapy playing a major role in facilitates healthy ageing process. However, compliance to physiotherapy session is still low among geriatric population.
A defaulter was defined as a patient who presented for less than 6 visits during the whole period.

Method
A Retrospective study will calling patient after patient did not turn up the physiotherapy appointment and interview was done on appointment with the doctor together. This study was conducted at Geriatric Clinic, Hospital Kuala Lumpur. Physiotherapy session records were tracked to get there number of defaulters in Physiotherapy Geriatric clinic during 2017 & 2018.

Result
Reasons for defaulting the therapy session was gained via phone call interview and during Geriatrician appointment. Total of 223 samples were tracked and interviewed in this study. The result reveals 73% of the patients defaulted in 2017 and 51% in 2018 respectively. Lack of facilities comprises 22% of factors for non-compliance. Meanwhile other factors such as human resource and functional capabilities contribute 14% and 19% respectively for patient’s non-compliance.

Conclusion
As conclusion, clinic need to take steps such as call to remind their appointment and provide proper home education to increase patient’s compliance. Together with in poor compliance which was successfully brought down by taking into consideration patient factors. This may be the best compromise until which time where special parking lots, improved transportation services or adequate skilled facilities in the periphery are made available to the patients.
135 Gendered Differences in Effect of Falls-Related Threat Appraisal on Attitudes Towards Exercise amongst Community-Dwelling Older Singaporeans
Authors: Sim Silvia YH , Tan Pey June , Ismail Noor Hafizah , Mallya Jagadish , Chan Angelique , Wong Chek Hooi 
Published: December 2019

Abstract

Introduction
Previous studies have established that perceived threat can function as motivation to adopt protective health behaviours (Rogers, 1975; Tannenbaum, 2015 etc). However, while perceived falls-related threat improves intention and participation in falls prevention programmes (Yardley et al, 2007; Dorresteijn et al, 2012), some studies have also found that for women, perceived falls-related threat doubles as a barrier to exercise (Sandlund, 2008; Bruce et al, 2002; Cousins, 2000). The evidence is less clear for men. This paper seeks to analyse gendered differences in how falls-related threat appraisal affects perceived importance of exercise.

Methods
Secondary data analysis was conducted on data from the National KAP Study in Singapore, where a cross-sectional survey was conducted on community-dwelling Singaporeans aged ≥60 (N=549). Sub-group analyses were conducted for men (n=212) and women (n=337). Multiple logistic regressions were conducted to assess the effect of threat appraisal on perceived importance of strength and balance exercise, controlling for potential confounders. Perceived falls-related threat was assessed two ways: (a) Concern about falling, measured by the Falls Efficacy Scale – International (FES-I) and (b) Perceived chance of sustaining severe injuries if one fell.

Results
For women, concern about falling is not significantly related to perceived importance of exercise (p=0.08). However, perceived chance of sustaining injuries has a small positive relationship with perceived importance of exercise (OR:1.4; 95%CI:1.1-1.8; p&lt;0.01). The reverse is true for men – concern about falling has a positive relationship with perceived importance of exercise (OR: 2.6; 95%CI: 1.3-5.4, p&lt;0.01), while perceived severity of injury is not significantly related to perceived importance of exercise (p=0.94).

Conclusion
The results suggest that men and women appraise falls-related threat differently and this affects their attitudes towards exercise. However, more research is needed to elucidate the mechanisms behind this difference. This will have implications on targeting health messages for men and women.
138 The use of Fall Risk-Increasing Drugs among Older People in Nursing Home
Authors: Omar Marhanis Salihah , Shiow-Ling Lee 
Published: December 2019

Abstract
Medication use has been one of the modifiable risk factors in causing falls. Falls are the leading cause of injury among older people. The incidence of falls will greatly impact the independence of the older people to carry out normal activity. This study aimed to determine the prevalence of drugs causing falls and the fall risk status among older people residing in nursing homes. A cross-sectional study was conducted among residents in 27 long term care facilities in Malaysia from March 2018 until November 2018 using a researcher-assisted questionnaire. In this study, 212 elderly residents were recruited and further categorized into frail (6.6%, n=14), pre-frail (57.5%, n= 122) and robust (35.8%, n=76). The frailty status was found to be significantly associated with the risk of falling (p &lt; 0.001). Of all residents recruited, 68.4% (n=145) were taking at least one FRIDs or orthostatic drugs. Antipsychotics and calcium channel blockers were the most frequently used FRIDs. Length of stay in facilities (&lt;1 year), frailty status, number of medication, use of CCB or RAS inhibitors are associated with an increased risk of falling (p&lt;0.05). Therefore majority of the older people residing in nursing homes were prone to the use of fall-risk medications, particularly ODs. Frail older people had a greater risk in falling compared to those who were non-frail.
139 Assessment of Nurses’ Attitude and Perception on Patient Safety in a Teaching Hospital
Authors: Krishnasamy Karthikayini , Hashim Afzawahiza , Sivanandy Palanisamy 
Published: December 2019

Abstract

Introduction
Patient safety issues have become a major concern in healthcare organizations that lead to undesired events and reduce patients’ quality of life (QoL). Around 10% of patients affected by serious medical errors during treatment, among these 14% result in death and 70% in disability. Nurse-led services are paramount in the treatment and have vital role in minimizing patient safety issues. Hence, a study was aimed to analyse the nurses’ attitude and perception on patient safety and, to determine the potential predictors for patient safety outcome dimensions.

Method
A quantitative descriptive cross-sectional study was conducted at a 900 bed teaching hospital. Random sampling technique was adopted to select nurses with more than 6 months of working experience in the hospital. Hospital Survey On Patient Safety (HSOPS) tool was used in this study, it had 42 items with 12 dimensions.

Results
Out of 390 questionnaires distributed, 360 were returned with complete details and the response rate was 92%. Among the safety culture dimensions, only two items scored more than 75% of positive response rate (PRR) which were ‘Organizational learning-continuous improvement’ (PRR 84%) and ‘Teamwork within unit’ (PRR 80%). The ‘Communication openness’ and ‘Hospital handoffs and transition’ scored a very low PRR which were 43% and 37% respectively, as most of the nurses felt that sharing information or issues with colleagues may be held against them. Reporting of errors were very low in the current set-up as most of the nurses reported 1-2 adverse events in a year which was noted as highest among all specialties.

Conclusion
The current level of patient safety in this teaching hospital need an immediate attention as most of the patient safety domains scored a very low PRR. Safety measures need to be taken before the issues reaches worst situation and adverse impact on patients’ health related QoL.
140 Midodrine Hydrochloride in the Management of Elderly Patients with Neurocardiogenic Syncope: A Prospective Observational Study
Authors: Teo Angelene , Vilches-Moraga Arturo , Staniland John 
Published: December 2019

Abstract

Background
Midodrine hydrochloride is an alpha-1 agonist that has been used in the management of syncope in patients with orthostatic hypotension, vasovagal syncope and vasodepressor carotid sinus syndrome when non-pharmacological means have failed. However, there are very limited information about its use, tolerability and side effects among the elderly population.

Objectives
We aim to document effectiveness of Midodrine in patients who have been diagnosed with neurocardiogenic syncope assessed and managed at a specialist falls and syncope outpatient unit. We monitored for changes in patients' symptoms, adverse reactions reported and optimum drug dosages that have shown benefit in this cohort of patients.

Methods
A prospective observational study of 33 subjects aged between 68 and 94 (mean age 79) who have been started on Midodrine therapy following positive tilt table test or confirmed diagnosis of symptomatic orthostatic hypotension despite conservative managements. They have been followed up for a mean of 2.9 years.

Results
81% of patients( n=27) reported significant improvement in their symptoms. Although 7 patients reported adverse reactions to Midodrine, the majority of the patients tolerated the therapy well and continued on the treatment except for one patient who experienced gastrointestinal discomfort and withdrew completely.
Commonest side effects are pruritus and piloerection, but they are not amenable to treatment due to underlying mechanism of action of Midodrine on hair follicles. The dosage varies from 2.5mg to 10mg, taken at 8am, 12pm and 5pm due to risk of nocturnal supine hypertension. Higher dose did not correlate with higher possibility of experiencing side effects.

Conclusion
Midodrine appears to be effective, safe and well tolerated among the elderly population. It should be considered in the management of patients with neurocardiogenic syncope when non-pharmacological means have failed, irrespective of age. This observational study requires further confirmation by randomised control studies with larger sample size.