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      The Use of the Self-Standing Turning Transfer Device to Perform Bed-To-Chair Transfers Reduces Physical Stress among Caregivers of Older Patients in a Middle-Income Developing Country

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          Abstract

          Manual transfer of elderly patients remains commonplace in many developing countries because the use of lifting equipment, such as hoists, is often considered unaffordable luxuries. The aim of this study was, therefore, to evaluate the usage and potential benefits of a low-cost, mechanical turning transfer device among elderly patients and their caregivers on a geriatric ward in a developing country in South East Asia. Fifty-six inpatients, aged 66–92 years, on a geriatric ward, and their caregivers were recruited. Participants were asked to transfer from bed-to-chair transfer with manual assistance, and the task was repeated using the Self-standing Turning Transfer Device (STurDi). The time taken to perform manual transfers and STurDi-assisted transfers was recorded. Physical strain was assessed using the perceived physical stress-rating tool for caregivers with and without the use of the device. User satisfaction was evaluated using the usefulness, satisfaction, and ease of use questionnaire. There was a significant reduction in transfer-time with manual transfers compared to STurDi-assisted transfers [mean (SD) = 48.39 (13.98) vs. 36.23 (10.96); p ≤ 0.001]. The physical stress rating was significantly lower in STurDi-aided transfers compared to manual transfers, shoulder [median (interquartile range) = 0 (1) vs. 4 (3); p = 0.001], upper back [0 (0) vs. 5 (4); p = 0.001], lower back [0 (1) vs. 5 (3), p = 0.001], whole body [1 (2) vs. 4 (3), p = 0.001], and knee [0 (1) vs. 1 (4), p = 0.001]. In addition, majority of patients and caregivers definitely or strongly agreed that the device was useful, saved time, and was easy to use. We have therefore demonstrated in a setting where manual handling was commonly performed that a low-cost mechanical transfer device reduced caregiver strain and was well received by older patients and caregivers.

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          Paresis acquired in the intensive care unit: a prospective multicenter study.

          Although electrophysiologic and histologic neuromuscular abnormalities are common in intensive care unit (ICU) patients, the clinical incidence of ICU-acquired neuromuscular disorders in patients recovering from severe illness remains unknown. To assess the clinical incidence, risk factors, and outcomes of ICU-acquired paresis (ICUAP) during recovery from critical illness in the ICU and to determine the electrophysiologic and histologic patterns in patients with ICUAP. Prospective cohort study conducted from March 1999 to June 2000. Three medical and 2 surgical ICUs in 4 hospitals in France. All consecutive ICU patients without preexisting neuromuscular disease who underwent mechanical ventilation for 7 or more days were screened daily for awakening. The first day a patient was considered awake was day 1. Patients with severe muscle weakness on day 7 were considered to have ICUAP. Incidence and duration of ICUAP, risk factors for ICUAP, and comparative duration of mechanical ventilation between ICUAP and control patients. Among the 95 patients who achieved satisfactory awakening, the incidence of ICUAP was 25.3% (95% confidence interval [CI], 16.9%-35.2%). All ICUAP patients had a sensorimotor axonopathy, and all patients who underwent a muscle biopsy had specific muscle involvement not related to nerve involvement. The median duration of ICUAP after day 1 was 21 days. Mean (SD) duration of mechanical ventilation after day 1 was significantly longer in patients with ICUAP compared with those without (18.2 [36.3] vs 7.6 [19.2] days; P =.03). Independent predictors of ICUAP were female sex (odds ratio [OR], 4.66; 95% CI, 1.19-18.30), the number of days with dysfunction of 2 or more organs (OR, 1.28; 95% CI, 1.11-1.49), duration of mechanical ventilation (OR, 1.10; 95% CI, 1.00-1.22), and administration of corticosteroids (OR, 14.90; 95% CI, 3.20-69.80) before day 1. Identified using simple bedside clinical criteria, ICUAP was frequent during recovery from critical illness and was associated with a prolonged duration of mechanical ventilation. Our findings suggest an important role of corticosteroids in the development of ICUAP.
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            Usability and User Experience

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              The effect of bed rest and potential of prehabilitation on patients in the intensive care unit.

              Declines in physical activity that accompany an admission to an intensive care unit (ICU) represent a significant stress to the body. Decreases in physical activity have been demonstrated to result in losses in functional capacity of the musculoskeletal and cardiovascular systems. These two systems are central to achieving and maintaining functional independence, which is a prerequisite for discharge from a healthcare facility, as is independent functioning of the individual in the community setting. Whereas a decrease in physical activity will result in an attenuation in the functioning of the cardiovascular and musculoskeletal systems, increases in physical activity can stimulate gains in their functional capacity. The concept of improving the functional capacity of the body to withstand anticipated musculoskeletal stressors has had limited application to the effects of inactivity associated with an ICU admission. By increasing an individual's functional capacity through increased physical activity prior to an ICU admission, it seems reasonable that the patient would retain a higher level of functional capacity over their entire ICU admission. The process of enhancing functional capacity of the individual to enable them to withstand the stressor of inactivity associated with an admission to ICU is termed prehabilitation. A generic program of prehabilitation includes warm-up, aerobic, strength, flexibility, and functional task components. The initial level of prehabilitation training and the progression of the training will be different for each individual based upon their initial functional capacity and the degree to which they individually respond to increases in physical activity. Declines in physical activity among ICU patients represents a significant health risk that may be reduced through introducing prehabilitation interventions.
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                Author and article information

                Contributors
                Journal
                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                2296-858X
                25 September 2014
                2014
                : 1
                : 32
                Affiliations
                [1] 1Department of Biomedical Engineering, Faculty of Engineering, University of Malaya , Kuala Lumpur, Malaysia
                [2] 2Institute for Public Health , Kuala Lumpur, Malaysia
                [3] 3Department of Nursing Studies, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
                [4] 4Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
                [5] 5Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
                Author notes

                Edited by: Liang-Kung Chen, Taipei Veterans General Hospital, Taiwan

                Reviewed by: Simone Scarlata, Campus Bio Medico University, Italy; Mario Ulises Pérez-Zepeda, Instituto Nacional de Geriatría, Mexico; Tai-Yin Wu, Taipei City Hospital, Renai Branch, Taiwan

                *Correspondence: Maw Pin Tan, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia e-mail: mptan@ 123456ummc.edu.my

                This article was submitted to Geriatric Medicine, a section of the journal Frontiers in Medicine.

                Article
                10.3389/fmed.2014.00032
                4292054
                52468f3b-8ecc-4b96-a12b-30eadd74562e
                Copyright © 2014 Goh, Muslimah, Ng, Subramanian and Tan.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 21 June 2014
                : 11 September 2014
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 16, Pages: 6, Words: 4995
                Categories
                Medicine
                Original Research

                aged,carer,transfer devices,early rehabilitation,back injury

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