The effects of a home-based exercise program on balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults: a pilot study.

PURPOSE: The purpose of this pilot study was to evaluate the effects of a home-based standing exercise and balance training program on balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults. METHODS: A quasi-experimental single group pre- to posttest design was utilized in 14 subjects, 9 male and 5 female, aged 71 to 85 years receiving home care. Measurements included the Falls Efficacy Scale (FES), Performance Oriented Mobility Assessment (POMA), and the One-Leg Stance Test (OLST) administered prior to and following 4 weeks of exercise and balance training. Participants trained twice per day, 5 days per week for 4 weeks, and maintained exercise logs. RESULTS: Pre- to posttest differences on the FES, POMA, and OLST were analyzed with the Wilcoxon signed rank test and the 2-tailed paired t test, respectively, with statistical significance set at .05. Analysis demonstrated significant improvements on the FES, POMA, and OLST following 4-weeks of standing exercise and balance training. Based on entrance and exit interviews, 6 of the 14 participants had a history of falls in the 6 months prior to the study, while only 2 participants reported having a single, minor fall by discharge. CONCLUSIONS: The results of the present pilot study demonstrated significant improvement in balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults following participation in a home-based exercise and balance training program. However, definitive conclusions need to await validation from more rigorously designed studies before the present training program can be confidently recommended to physical therapists engaged in home care practice.

Impact of a computerized alert during physician order entry on medication dosing in patients with renal impairment.

Computerized assistance to clinicians during physician order entry can provide protection against medical errors. However, computer systems that provide too much assistance may adversely affect training of medical students and residents. Trainees may rely on the computer to automatically perform complex calculations and create appropriate orders and are thereby deprived of an important educational exercise. An alternative strategy is to provide a critique at the completion of an order, requiring the trainee to enter the entire order but displaying an alert if an error is made. While this approach preserves the educational components of order-writing, the potential for errors exists if the computerized critique does not induce clinicians to correct the order. The goal of this study was to determine (a) the frequency with which errors are made by trainees in an environment in which renal dosing adjustment calculation for antimicrobials are done by the system after the user has entered an order, and (b) the frequency with which prompts to clinicians regarding these errors leads to correction of those orders.