Effectiveness of the Wearable Sensor based Ambient Intelligent Geriatric Management System (AmbIGeM) in Preventing Falls in Older People in Hospitals

Background

The Ambient Intelligent Geriatric Management (AmbIGeM) system augments best practice and involves a novel wearable sensor (accelerometer and gyroscope) worn by patients where the data captured by the sensor are interpreted by algorithms to trigger alerts on clinician handheld mobile devices when risk movements are detected.

Methods

A 3-cluster stepped-wedge pragmatic trial investigating the effect on the primary outcome of falls rate and secondary outcome of injurious fall and proportion of fallers. Three wards across 2 states were included. Patients aged ≥65 years were eligible. Patients requiring palliative care were excluded. The trial was registered with the Australia and New Zealand Clinical Trials registry, number 12617000981325.

Results

A total of 4924 older patients were admitted to the study wards with 1076 excluded and 3240 (1995 control, 1245 intervention) enrolled. The median proportion of study duration with valid readings per patient was 49% ((interquartile range [IQR] 25%-67%)). There was no significant difference between intervention and control relating to the falls rate (adjusted rate ratio = 1.41, 95% confidence interval [0.85, 2.34]; p = .192), proportion of fallers (odds ratio = 1.54, 95% confidence interval [0.91, 2.61]; p = .105), and injurious falls rate (adjusted rate ratio = 0.90, 95% confidence interval [0.38, 2.14]; p = .807). In a post hoc analysis, falls and injurious falls rate were reduced in the Geriatric Evaluation and Management Unit wards when the intervention period was compared to the control period.

Conclusions

The AmbIGeM system did not reduce the rate of falls, rate of injurious falls, or proportion of fallers. There remains a case for further exploration and refinement of this technology given the post hoc analysis findings with the Geriatric Evaluation and Management Unit wards.

Clinical Trials Registration Number: 12617000981325

Effectiveness of an Ambient Intelligent Geriatric Management system (AmbIGeM) to prevent falls in older people in hospitals: protocol for the AmbIGeM stepped wedge pragmatic trial

Background

Although current best practice recommendations contribute to falls prevention in hospital, falls and injury rates remain high. There is a need to explore new interventions to reduce falls rates, especially in geriatric and general medical wards where older patients and those with cognitive impairment are managed.

Design and methods

A three-cluster stepped wedge pragmatic trial, with an embedded qualitative process, of the Ambient Intelligent Geriatric Management (AmbIGeM) system (wearable sensor device to alert staff of patients undertaking at-risk activities), for preventing falls in older patients compared with standard care. The trial will occur on three acute/subacute wards in two hospitals in Adelaide and Perth, Australia.

Participants

Patients aged >65 years admitted to study wards. A waiver (Perth) and opt-out of consent (Adelaide) was obtained for this study. Patients requiring palliative care will be excluded.

Outcomes

The primary outcome is falls rate; secondary outcome measures are: (1) proportion of participants falling; (2) rate of injurious inpatient falls/1000 participant bed-days; (3) acceptability and safety of the interventions from patients and clinical staff perspectives; and (4) hospital costs, mortality and use of residential care to 3 months postdischarge.

Discussion

This study investigates a novel technological approach to preventing falls in hospitalised older people. We hypothesise that the AmbIGeM intervention will reduce falls and injury rates, with an economic benefit attributable to the intervention. If successful, the AmbIGeM system will be a useful addition to falls prevention in hospital wards with high proportions of older people and people with cognitive impairment.

Trial registration number

Australian and New Zealand Clinical Trial Registry: ACTRN 12617000981325; Pre-results.

A novel, disposable, screen-printed amperometric biosensor for glucose in serum fabricated using a water-based carbon ink

Screen-printed amperometric glucose biosensors have been fabricated using a water-based carbon ink. The enzyme glucose oxidase (GOD) and the electro-catalyst cobalt phthalocyanine were mixed with the carbon ink prior to the screen-printing process; therefore, biosensors are prepared in a one-step fabrication procedure. Optimisation of the biosensor performance was achieved by studying the effects of pH, buffer strength, and applied potential on the analytical response. Calibration studies were performed under optimum conditions, using amperometry in stirred solution, with an operating potential of +500 mV versus SCE. The sensitivity was found to be 1170 nA mM(-1), with a linear range of 0.025-2 mM; the former represents the detection limit. The disposable amperometric biosensor was evaluated by carrying out replicate determinations on a sample of bovine serum. This was achieved by the method of multiple standard additions and included a correction for background currents arising from oxidizable serum components. The mean serum concentration was calculated to be 8.63 mM and compared well with the supplier's value of 8.3 mM; the coefficient of variation was calculated to be 3.3% (n=6).

Amperometric, screen-printed, glucose biosensor for analysis of human plasma samples using a biocomposite water-based carbon ink incorporating glucose oxidase

This paper describes the optimisation of a screen-printing water-based carbon ink containing cobalt phthalocyanine (CoPC) and glucose oxidase (GOD) for the fabrication of a glucose biosensor. To optimise the performance of the biosensor, the loadings of the electrocatalyst (CoPC) and enzyme (GOD) were varied. It was found that the maximum linear range was achieved with a CoPC loading of 20% (m/m, relative to the mass of carbon) and a GOD loading of 628 U per gram of carbon. In our studies we chose to employ chronoamperometry, as this technique is commonly used for commercial devices. The optimum operating applied potential was found to be +0.5 V, following an incubation period of 60 s. The optimum supporting electrolyte was found to be 0.05 M phosphate buffer at pH 8.0, which resulted in a linear range of 0.2-5 mM, the former represents the detection limit. The sensitivity was 1.12 microA mM(-1). The effect of temperature was also investigated, and it was found that 40 degrees C gave optimal performance. The resulting amperometric biosensors were evaluated by measuring the glucose concentrations for 10 different human plasma samples containing endogenous glucose and also added glucose. The same samples were analysed by a standard spectrophotometric method, and the results obtained by the two different methods were compared. A good correlation coefficient (R(2) = 0.95) and slope (0.98) were calculated from the experimental data, indicating that the new devices hold promise for biomedical studies.

BMPs as mediators of roof plate repulsion of commissural neurons

During spinal cord development, commissural (C) neurons, located near the dorsal midline, send axons ventrally and across the floor plate (FP). The trajectory of these axons toward the FP is guided in part by netrins. The mechanisms that guide the early phase of C axon extension, however, have not been resolved. We show that the roof plate (RP) expresses a diffusible activity that repels C axons and orients their growth within the dorsal spinal cord. Bone morphogenetic proteins (BMPs) appear to act as RP-derived chemorepellents that guide the early trajectory of the axons of C neurons in the developing spinal cord: BMP7 mimics the RP repellent activity for C axons in vitro, can act directly to collapse C growth cones, and appears to serve an essential function in RP repulsion of C axons.

Intramedullary pressure and pulmonary function during total knee arthroplasty

Twenty-eight patients who underwent unilateral total knee arthroplasty and 20 patients who underwent simultaneous bilateral total knee arthroplasties participated in this study and were randomized to have either a fluted or round 10-mm diameter femoral intramedullary alignment rod used during surgery. The intramedullary rods were cannulated and connected with pressure tubing to a monitor which provided measurements of pressure at the tip of each rod. Arterial blood gas measurements on room air were obtained before and on the morning after surgery. An arterial line was placed and an arterial blood gas measurement was obtained at the time of skin incision and again after tourniquet release. Pulmonary shunt was calculated from the arterial blood gas measurements. Intramedullary pressure during rod insertion was significantly higher for the groups of patients having the round compared with the fluted rod. The change in pulmonary shunt during surgery was lowest for the patients in the unilateral group having the fluted rod and highest for the patients in the bilateral group having the round rod. A fluted rather than a round intramedullary alignment rod should be used to minimize intramedullary pressure and pulmonary shunting during unilateral and bilateral total knee arthroplasties.

Increased buffer pH enhances sensitivity and specificity of human papillomavirus detection using consensus primer based PCR

Polymerase chain reaction (PCR) buffers were optimized for the specific detection of human papillomavirus (HPV) sequences. The effect of pH, potassium chloride concentration and magnesium chloride concentration of three different consensus primers were examined. Several phylogenetically distinct HPVs (HPV1, HPV2, HPV6, HPV8, HPV16, HPV18, and HPV20) were used to determine the optimal buffer components. Genital types were less sensitive to changes in pH than cutaneous types. Higher buffer pH, with a few exceptions, led to increased sensitivity and specificity of HPV detection.

Electrode and bacterial survival with iontophoresis in synthetic urine

Urinary catheters, especially in patients with long-term catheter requirements, frequently are a source of infection. Iontophoresis has been proposed as a method to decrease or eliminate such infections. Several types of material were examined for their potential use as electrodes in an iontophoretic catheter system. Silver, copper and nickel electrodes did kill microorganisms but did not show longevity. Carbon and gold electrodes showed longevity and killing of microorganisms. Gold proved to be somewhat better than carbon in killing Klebsiella pneumoniae in a broth. Few organisms survived iontophoresis. Those few that survived (mainly Klebsiella in broth), when rechallenged by iontophoresis, did not show any striking resistance to iontophoresis. Our data support the proposition that inclusion of electrodes, depending on the electrode type, in a catheter probably will decrease or eliminate a bacterial population in urine and, thus, may help prevent catheter-related infections and their sequelae.

Orienting behavior of juvenile frogs with both a pre-metamorphically rotated and a normal eye

We have studied the orienting behavior of juvenile Rana pipiens in which one eye was rotated at late larval stages and the other eye left intact. Such frogs orient accurately to stimuli falling solely in the visual field of the intact eye and systematically misorient to stimuli falling solely in the field of the rotated eye. Stimuli within the area of visual field overlap elicited two distinct sets of responses, one attributable to the normal and the other to the rotated eye.