bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of Rolling Ball Control System Based on PID Algorithm
Authors: Huiyuan Cao , Bin Ren , Renhao Yang
Published: February 2020

The ball and plate system is a medium for researching automation control. As a multivariable, non-linear control object, the sphere studies how its fixed-point control and trajectory motion have great significance for automatic control. The software part of a ball and plate system designed in this paper adopts PID control. The hardware part uses STM32F103RCT6 as the main control chip. The position of the ball is obtained through the four-wire resistive screen and the HC05 Bluetooth module is used to communicate with the mobile phone. The corresponding state of the system is displayed by the TFT liquid crystal module. The fixed point control of the small ball and the specified trajectory movement are realized. The fixed point control can change the fixed point of the small ball at any time by clicking the mobile phone screen, and the specified trajectory movement can be controlled by the cricket system button or the mobile APP control.
Adaptive Dynamic Sliding Mode Control Laws for Attitude Stabilization of Flexible Spacecraft
Authors: Dong Xi , Dong RuiQi , Wu Ai-Guo
Published: February 2020

In this paper, an adaptive dynamic sliding mode control technique is adopted to stabilize the attitude of flexible spacecraft with disturbance. The mathematical model of flexible spacecraft is constructed by the modified Rodrigues parameters. The adaptive control technique is applied to guarantee stabilization of flexible spacecraft with disturbance. By introducing a dynamic switching function, the chattering caused by sign function of the traditional sliding mode control law can be eliminated. Finally, by comparing with the adaptive control law proposed in [12], a numerical example is employed to illustrate the effectiveness of the designed control law.
Simulation and experiment of a new DC fault current limiter topology
Authors: Wang Wenjie , Liu Jianzheng
Published: February 2020

With the development of high voltage direct current (HVDC) power transmission system, it is imperative to develop a practical current limiting device which can effectively protect the converter from the influence of fault current. Based on the topology of current limiter proposed in previous papers, considering the requirements of practical application conditions, an optimized topology is proposed, which consists of snubber circuit and arrester, both in simulation and experiment. In addition, the RC buffering circuit is added and the parameters are optimized to reduce the voltage impulse that the IGBT of fault current limiter would else bear. Simulation and experiment are carried out in DC system. Both simulation and experiment results can prove the effectiveness of the optimized current limiter circuit.
Research on the Feasibility of the Self-circulating Evaporative Cooling System with Composites Structure for High Power Rectifier Equipment
Authors: Yan Jing , Ruan Lin
Published: February 2020

Self-circulating evaporative cooling system is safe, effective and energy-saving. It has advantages compared with the traditional cooling technology. So it provides a new cooling method for high power rectifier equipment. Then take an example of the three-phase bridge full-controlled rectifier, a new cooling system with composite structure and non-single heat loads was proposed. Through analysis on the circulation mechanism and operation characteristics, the feasibility of the self-circulating evaporative cooling system which is composed of horizontal and vertical hollow conductor was studied in this paper.
The cluster-delay consensus of nonlinear multi-agent systems via impulsive control
Authors: Zhang Zhenhua , Peng Shiguo , Chen Tao
Published: February 2020

Based on the impulsive control strategy, the cluster-delay consensus of nonlinear multi-agent systems is studied in this paper for the first time. Different from the traditional continuous control method, impulsive control only acts on the systems at discrete impulsive moments, so it has the advantages of low control costs, fast response speed and strong adaptability. In addition, by the impulsive protocol, the state information of all neighboring agents is used to update their own state at impulse instants. Based on the graph theory and Lyapunov stability theory, some sufficient consensus criteria are given. Finally, the correctness of theoretical results is illustrated by numerical simulation.
Research on precision marketing of banking based on improved collaborative filtering algorithms
Authors: Bian Yuning , Li Yeli , Zeng Qingtao , Sun Yanxiong , Yu Linxuan , He Wei
Published: February 2020

With the rapid development of the Internet, the banking industry is facing great challenges. How to attract more customers under the huge impact of the Internet is the most important issue for banks to consider. In the context of big data, banks are using a variety of means to collect data and build their own customer portraits to adjust their marketing strategies. This article provides an improved collaborative filtering algorithm --- time-related similarity calculation method. This improved collaborative filtering algorithm can provide a new reference for the bank’s precision marketing.
A compact Robot-based defect detection device design for silicon wafer
Authors: Chen Xiaoyan , Zhao Chundong , Chen Jianyong , Zhang Dongyang , Zhu Kuifeng , Su Yanjie
Published: February 2020

With the development of semiconductor chips manufacturing, the quality of chips are required to a higher level. At present, as a key element of chip produce process, wafer surface defect detection is a hard challenge for operators, as manual detection accuracy and efficiency are depend on such factors as visual fatigue and inspection error. This paper proposes a defect detection approach for silicon wafer and designs a control system. The system takes PLC as the control core in charge the communication of the PC and the robots, which carries out the logical control instruction. The silicon wafer images are taken by a high precision camera, and processed by the algorithms and the defect elements central coordinates are output to robots. The four-axis robots are driven by the servo motors to mark the defective elements. In order to improve work efficiency, two robots were designed to cooperate to realize wafer transplanting and marking. The device runs smoothly and efficiently, and has prospecting application future.
Design and implementation of real-time robot operating system based on freertos
Authors: Shao Li , Wang Chuanxi , Chu Chong , Song Yinan , Hu Haoyu , Yang Yanan , Fei Wenyu , He Xiaoyang
Published: February 2020

With the advancement of artificial intelligence technology, the product of its integration with robots:intelligent robots, is appearing more and more in people’s lives and work. Compared to the single function of industrial robots, intelligent robots have the ability to perceive, recognize and decide on the outside world. In order to achieve these functions, data needs to be collected by various types of sensors, and then processed by various algorithms. The introduction of these modules has increased the complexity of the system. Therefore, in order to reduce the complexity between the functional modules, reducing the coupling between modules, and improving the code reuse rate of the functional modules has become an urgent task. This paper proposes an improved FreeRTOS operating system have a driver layer, a middleware layer, and a functional module layer. The experimental results show that the scheme can support the maximum 2000hz module response frequency and the Topic data throughput rate of 2K Bytes per second.
Research on Power Interface Algorithm of Power Hardware-in-the-loop Simulation for Isolated Operation of Modular Multilevel Converters
Authors: Zhan Rong-rong , Liu Long-hao , Zhao Yu-wei , Wei Ming-yang , Li Yanjun
Published: February 2020

A current source type power interface algorithm is proposed for the power hardware-in-the-loop (PHIL) simulation of modular multi-level converters (MMC) operating with an isolated gird such as a wind farm. To improve the stability and accuracy of hybrid simulation system, a virtual impedance and the running method is proposed for MMCs. A simulation model based on the proposed interface algorithm is established in MATLAB. The test results show that the hybrid simulation system maintains high stability and accuracy. At the power interface, the relative error of voltage is less than 2%, and the relative error of active power is less than 2%. The proposed power interface algorithm is applicable to MMCs operating with an isolated grid.
Energy-Saving Control of Induction Motor for Electric Vehicle Based on Online Parameter Estimation
Authors: Shengwen Fan , Shuya Dai , Ruizhi Li , Xinsen Zhang
Published: February 2020

In order to improve the problem of insufficient endurance mileages of pure electric vehicles, an energy-saving control strategy of induction motor based on the online parameter estimation is proposed. Considering the model of considering the iron loss of the stator of the induction motor, the loss minimization model is used to control the energy of the motor to reduce the steady-state loss of the motor. At the same time, an observer with the model reference adaptive system (MRAS) is designed to online estimated the rotor time constant and stator resistance of the motor, and reduce the influence of parameter variation on the loss minimization control, which makes the loss model more accurate and the energy-saving effect is more ideal. Finally, the control strategy is verified by simulation. The simulation results show that the energy-saving effect of this algorithm is obvious when the motor runs at a high speed under a light load.
Study of Development Scenarios for Bottoming Unit Binary Cycle to Utilize Exhaust Steam from Back Pressure Turbine Geothermal Power Plant
Authors: Nandaliarasyad Naufal , Maulana Dimas Taha , Darmanto Prihadi Setyo
Published: February 2020

Binary cycle using organic working fluid or ORC system has been applied in geothermal and some other industrial processes to recover low grade and waste energy to generate electricity. The conventional system to utilize geothermal energy is a condensing system or back pressure system which depend on a turbine used in the system. Two units of the power plant in Flores, Indonesia are using back pressure turbine, which means that there is still a chance to increase the electrical power of the steam which is released through the turbine. The amount of exhaust steam available from these two units power plant is more than 62,000 kg per hour with 99°C of temperature and around 2,430 kJ/kg enthalpy. This research is trying to get the optimum power that can be generated by the ORC regarding other consideration parameters such as ambient temperature, thermodynamics condition of resource steam, and energy conversion of each apparatus. It is the aim of this paper to present a thermodynamic study on the utilization of ORC as the bottoming cycle with various types of working fluids to produce additional electricity. Several working fluids are chosen to find the optimum ORC system to utilize this exhaust steam such as isobutane, butane, isobutene, isopentane, propane, propyne, neopentane, R245fa, R236fa, and R134a. ORC system used in this research is simple ORC with basic components such as Pre-Heater, Evaporator, Expander, Condenser, and Pump. The properties of working fluids are calculated by REFPROP. The results show that this binary cycle can generate up to 2.25 MW with the thermal efficiency around 10% depend on the working fluid used. Two working fluids in this scenario that provide the best power generated are Propyne and Isopentane. The type of working fluid must also be considered, propyne is a wet type while isopentane is a dry type working fluid.
The Application of Numerical Simulation Result for Geothermal Financial Model with Probabilistic Approach: A Comprehensive Study
Authors: Winofa Nevi Cahya , Lesmana Ade , Pratama Heru Berian , Saptadji Nenny Miryani , Ashat Ali
Published: February 2020

Feasibility of developing a geothermal project depends on the financial return generated from the investment. One of the strategies to achieve optimum return is formulating a financial model with a high level of confidence. Technical input parameters in the financial model are determined by the amount of available geothermal reserve in the form of a field development scenario. The best method for predicting geothermal reserve is a numerical simulation. The objective of this study is to determine the electricity tariff to generate 30 MW, 60 MW, and 110 MW which meet the 50% of the Rate of Return value will be equal or not exceed 16% (P50) for a specific geothermal field with a probabilistic approach. This study started with determining the technical input parameters: the number of production wells; make­up wells; and injection wells from each development scenarios based on numerical simulation result that has been studied by another researcher. The electricity tariff that meets the P50 of Rate of Return at 16% was calculated for those scenarios. Then, the tariffs were evaluated based on the Average Cost of Electricity Generation (BPP) on the relevant local grid. The result shows that the tariff or/and generation cost need to be negotiated. Moreover, total investment and economic indicators forecasting indicated that the investment was attractive. Lastly, sensitivity analysis shows that Rate of Return strongly affected by well drilling cost and power plant cost (EPCC).
Pre-feasibility Study of Condensing Wellhead Generating Unit Utilization in Partially Vapor Dominated System
Authors: Dahlan M A , Pratama H B , Saptadji N M
Published: February 2020

The development of geothermal fields needs 5-6 years from the first well drilled until the operation of the central power plant. Between the gap years, the wells will be shut in and will be re-opened when the power plant is ready. However, there is an alternative to utilize the wells with Wellhead Generating Unit (WGU), the small power plant which can generate the electricity as soon as the drilled productive wells completed. Then, the objective of this study is to decide the preferable scheme for the installed capacity of WGU with economic consideration. Correspondingly, this study uses two full factorial experimental design with Monte Carlo simulation to calculate and design the condensing turbine. Steam fraction, mass flow rate, turbine inlet pressure, and turbine exhaust pressure are the parameters to be analyzed in the Monte Carlo Simulation. The economic feasibility of the project is based on capital expenditure, decline curve analysis, and electricity price. The result of probability, P10, P50, and P90 of gross power output and Specific Steam Consumption (SSC) are 6.1, 7.9, 9.9 MWe and 1.85, 1.89, 1.93 kg/s/MWe respectively. Based on the economic evaluation, the P10, P50, and P90 of Internal Rate of Return (IRR) and Net Present Value (NPV) are 12%, 16%, 21% and 1.1 MUSD, 3.6 MUSD, 6.0 MUSD respectively over 30 years of WGU lifetime. This paper is the first study for designing the WGU combined with an economic study based on the technical evaluation to propose the best option to develop the field.
Updating the Conceptual Model of Cisolok-Cisukarame Geothermal field, West Java, Indonesia
Authors: Sumartha Ayu Gracia Ade , Kurniawan Iqbal , Wiradinata Rizky , Nandaliarasyad Naufal , Sutopo  , Pratama Heru Berian , Prabata Todheus Welly
Published: February 2020

The cisolok-cisukarame geothermal field is a liquid dominated geothermal system situated in Sukabumi District, West Java, Indonesia. Geothermometry survey shows that Cisolok-Cisukarame has temperature approximately 185-212°C in the reservoir. The temperature of the reservoir shows that this is a medium enthalpy geothermal system. The thermal manifestation distributed around the Cisolok-Cisukarame area when the Cisukarame indicated as the upflow zone and Cisolok as the outflow zone. It is located at the eroded volcanic area with cooling pluton acting as the heat source of the system. Based on EBTKE, Cisolok-Cisukarame geothermal field has 45 MWe possible reserve. NE-SW and N-S faults are acting as the main conduit of the geothermal system. The primary purpose of this study is to build a computer model describing the natural state condition based on the geological, geochemical, geophysical, and well temperature data from several published literature. The model was validated by using mass-heat flow profile obtained from the observation data to achieve the best representation of the actual condition. The condition was achieved by modifying the permeability structures and productivity index. This model is the first natural state model of Cisolok-Cisukarame geothermal field. The natural state model then is used to build an updating conceptual model of Cisolok-Cisukarame by using data from a result of numerical modeling. Based on the parameters obtained from the numerical modeling, a new model of Cisolok-Cisukarame geothermal field is successfully representing the heat and mass flow within the system.
1 Review of the Identification and Management of Contractures in Inpatients with Dementia In A District General Hospital
Authors: Burns R , Wightman R , Mon H , Robertson A
Published: February 2020

Background

Patients with dementia are at risk of contractures which are associated with pain, pressure sores, increased carer burden and reduced function (1). It has been estimated up to 55% of residents in nursing homes have a contracture (2). Locally, patients are identified and treated in care homes. We questioned why comparatively few hospital inpatients were seen.

Methods

We audited acute elderly inpatients at a large district general hospital on two days. Patients with a diagnosis of dementia were identified and then checked for contractures. Information was collected on a proforma. Patients audited on day one were excluded from day two.

Results

410 patients were audited. 100 patients were identified with dementia. 21 individual contractures were identified with the hands been the most common site (47.6%). Only three contractures had been highlighted in the medical notes. Patients with contractures were more likely to be at home with carers or in a care facility (93.7% verse 64.3%). None of the patients with contractures were independently mobile. Higher proportions (31.2% vs 8.3%) with contractures were bedbound compared to those without. Complications were identified, with two patients reporting pain and three patients having pressure sores. Only one patient was receiving treatment for their contractures. Patients with contractures were more likely to have a higher frailty score, had a previous stroke (37.5% verse 13.1%) and have a vascular type dementia (31.3% verse 14.2%).

Conclusions

Contractures were a significant problem in our inpatient population in patients with a diagnosis of dementia. A large proportion were not identified by the clerking team, not receiving treatment and beginning to have complications. Subsequently a presentation highlighting this issue was carried out to junior doctors on the elderly wards, a coding proforma for contractures was produced and a guide to management of this issue is being put together for use in the inpatient setting.

References

1. Souren L, Franssen, Reisberg E. Contractures and loss of function in patients with Alzheimer's disease, J. Am. Geriatr. Soc. 1995; 43(6): 650–655.

2. Offenbacher M, Sauer S, Riess J, Muller M, et al. Disabil Rehabil 2013; 36(7): 529–538.
2 PDSA Audit Improves Identification and Management of Urinary Incontinence In Post Stroke Patients
Authors: Bryant J , McErlean D , Datta-Chaudhuri M , Prakash K G , Morell J
Published: February 2020

Introduction

Urinary incontinence is a prognostic indicator of mortality and functional recovery in stroke. There is a small evidence base that early intervention within the first three months may improve continence status and subsequent physical and psychological consequences.

Methods

Utilising a proforma and PDSA, data was collected on the identification and assessment of urinary continence status for patients admitted to a stroke unit. Five agreed standards from NICE (2012) and RCP (2016) guidelines formed the basis of audit. Three cycles of prospective data for a total of 66 patients was collected over four months, implementing quality improvement measures after each cycle.

Results

22 participants per cycle. Cycle one demonstrated continence status was identified by the nursing team (100%), and the medical team (41%). However, standards regarding further care planning and assessment (22%), MDT input (11%) and subsequent behavioural and practical interventions (11%) was low.

Change strategy, i) awareness training, ii) development of MDT prompt sheet.

Cycle two, medical identification (82%), MDT discussion (100%), and continence specific interventions (66%), care planning decreased from 22% to 0%.

Change strategy, incontinent patients receive an individualised assessment within 7 days by the advanced nurse practitioner, this assessment should consider all available evidence-based interventions, with the aim of reducing urinary incontinence within the early phases of stroke.

Cycle three showed an overwhelming improvement to all five standards, nursing and medical identification (100%, 91.

Conclusions

PDSA style audit led to quality improvement. The identification of urinary continence status post stroke was high, but due to multifactorial elements often did not progress to assessment or intervention from the MDT. Utilising the existing role of the trainee advanced practitioner patients received evidence-based continence reviews in a timely manner, with no additional cost impact to the service.
5 Improving Diagnosis and Management of Urinary Tract Infections for Elderly Patients
Authors: Al-makdase L , Ioannou P , Tew Z Y , Khan M , Debnath M , Ogunrinde I , Shields L
Published: February 2020

Introduction

Diagnosis of urinary tract infection (UTI) in the elderly population is challenging as they commonly present with atypical signs and symptoms. Prevalence of asymptomatic bacteriuria in the elderly population is high. Hence, urine dipstick and urine culture are no longer diagnostic tests. UTI is over-diagnosed and overtreated in the elderly, resulting in poor antimicrobial stewardship. This project was carried out to assess and improve the current practices in the diagnosis and treatment of UTI in the Department of Medicine of the Elderly.

Methods

We reviewed current Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for health and Care Excellence (NICE) guidelines on management of UTI and defined indications for performing urine dipstick and sending urine culture. We then collected and assessed data on all urine dipsticks performed, urine cultures sent, and use of antibiotics in treating UTI and asymptomatic bacteriuria in three Medicine of the Elderly wards in Aberdeen Royal Infirmary.

We carried out intervention by means of presenting and discussing findings of Plan-Do-Study-Act (PDSA) cycles in departmental multi-disciplinary Quality Improvement (QI) meetings followed by educational sessions.

Results

Our baseline data showed 77% of urine dipsticks were performed without clinical indication and 18% of patients had urine cultures sent without clinical indication. After presenting our initial findings and carrying out an educational intervention session, 25% of patients had urine dipstick done without clinical indication, and 0% of patients had urine cultures sent without clinical indication. However, over the course of four subsequent PDSA cycles, practices in investigation of UTI fluctuated but were overall consistently better than the initial practice with further interventions. In all PDSA cycles, no patients were treated for asymptomatic bacteriuria.

Conclusions

Multidisciplinary team involvement in discussion of this QI project findings and educational sessions proved to be an effective form of intervention for improving current practice.
11 Mortality Rates for Patients Admitted to Complex Care/Care of the Elderly Wards At Southmead Hospital, Bristol
Authors: Burrell A , Woodcraft H , Devine M
Published: February 2020

Background

Existing data examining mortality rates following inpatient hospital admissions in the United Kingdom is either condition specific or examining all inpatient mortality based on single time point audits. This clinical effectiveness project aimed to assess 1, 3, 6 and 12 month mortality rates in patients admitted to complex care/care of the elderly (CC/CotE) wards at Southmead hospital, Bristol

Methods

Data were collected by the trust's Business Insider department and analysed by the authors. All patients admitted to the four CC/CotE wards from July-December 2017 were included. Data collected included age, gender, date of admission, length of stay, date of discharge, and date of death if applicable.

Results

2673 patients were admitted to CC/CotE wards from July-December 2017. 42.72% of patients were male, mean age of patients was 82.46 years. Mean length of stay was 16.68 days, with mean length of stay on CC/CotE ward specifically 9.08 days. 292 (10.92%) of patients died during the index admission. Overall mortality rates were:1 month: 11.34% (303 patients)3 month: 21.59% (577 patients)6 month: 30.15% (806 patients)12 month: 38.53% (1030 patients)

12 month mortality increased with age from 75 upwards (34.04% in 75-79 years, 42.94% 85-89 years, 50.27% 95-99 years, 66.67% 100-104 years) but was similar in those aged 65-69 and 70-74 (29.41% and 28.18% respectively).

Discussion

An improved understanding of mortality rates in patients admitted under CC/CotE may aid clinicians' ability to prognosticate. Appreciating that over a third of CC/CotE patients are potentially in the last year of life provides further impetus to begin advanced care planning discussions during inpatient admissions.
14 Rational Prescribing in the Frail Elderly Population: A Quality Improvement Project to Reduce Inappropriate Prescribing Using STOPP-Frail Criteria
Authors: Brooke J , Darnell R , Boltova M , Hashemi N
Published: February 2020

Introduction

2.5 million people in the UK are aged over 80 and up to 50% can be considered frail. Complex co-morbidities and polypharmacy are linked with adverse drug effects and negative outcomes. NICE recommends a medication review yearly, and a hospital admission provides an opportunity for this. STOPP-Frail is a screening tool designed to highlight medications that could be reduced/stopped with a view to improving quality of life. We conducted a quality improvement project to quantify levels of inappropriate prescribing at Croydon University Hospital (CUH), with a view to de-prescribing and reducing adverse drug effects.

Methods

A retrospective analysis was carried out on the Elderly Care wards at CUH. Data was collected from 60 consecutive patients discharged from 1st November 2018, utilising electronic Cerner records. Recorded medication on admission and discharge, noting any amendments in accordance with the STOPP-Frail criteria.

Results

Data collected from 60 patients; one exclusion for not meeting STOPP-Frail criteria (n=59). Median age 86 years (69 to 103 years). Mean number of medications on admission 7.42 (1 to 15). 93.2% patients had polypharmacy (defined as ≥ 4 medications). Mean number of medications on discharge 8.22; an increase of 0.8/patient.

19.4% admission medications met STOPP-Frail criteria for inappropriate prescriptions. Only 18.8% of these were reduced or stopped during admission. Gastrointestinal and cardiovascular medications were most commonly inappropriately prescribed (n=27 and 24 respectively). Most common medications not amended were lipid-lowering therapies (n=21) and proton-pump inhibitors (n= 20).

Conclusions

The opportunity to rationalise medication in the frailest patients admitted to CUH is missed in over 80% of cases. STOPP-Frail provides clear guidance to aid clinicians in reducing inappropriate prescribing. An educational programme is in place to highlight medication rationalisation and guide clinicians in the use of the STOPP-Frail tool. This includes doctors’ induction, departmental teaching, posters and computer flash cards.
16 Comparison of Characteristics and Outcomes for Older Adults Admitted to Specialty Wards Versus Outlying Wards at Royal Bournemouth and Christchurch Hospitals
Authors: Stafford A , Martin A , Tiwari D
Published: February 2020

Background

At Royal Bournemouth and Christchurch Hospitals (RBCH) elderly patients are admitted to either the acute medical unit or the older person’s assessment unit. If the inpatient stay is likely to be longer than 72 hours, then patients are transferred to one of three elderly care wards. If these wards are at capacity, then patients must be outlied to other wards.

Introduction

GMC guidance June 2014, states hospital inpatients should have a named consultant. Studies have shown that length of stay and outcomes can be affected when the patient is on an outlying ward. This issue affects many hospitals and specialties, and also impacts older frail patients at RBCH. During winter elderly care admission rates increase, and more patients are outlied. Our aim was to improve the care and outcomes for elderly care patients treated on outlying wards.

Methods

The notes of 50 specialty ward patients and 50 outlying patients were compared from the first two weeks of January and February 2019 using scanned electronic records where elderly care was responsible for their treatment. We studied demographic characteristics, length of stay, mortality, readmission within 30 days of discharge, frequency of consultant review, escalation plans, discharge destination and ward moves.

Interventions

A dedicated outlying team was created for the 2018/2019 winter to attempt to improve outcomes for outlying elderly care patients. This team consisted of a geriatrician, registrar, SHO and allied health care professionals including a physiotherapist and discharge coordinator.

Results

Our results showed that outlying patients had a significantly longer average length of stay compared to patients on specialty ward (13.8 days vs 8.2 days, p=0.01). A significantly higher proportion of patients in outlying wards did not have a consultant review every 72 hours (66% vs 8.3% specialty ward patients, p=0.001). However the specialty ward patients had a significantly higher number of readmissions within 30 days (30.6% vs 16%, p=0.04).

Conclusions

We found that despite a dedicated team, outlying patients had a significantly longer length of stay and were seen by a consultant less often than patients on a specialty ward. Further work is needed to ensure equality of care for these patients. Patients with complex medical needs are generally triaged to specialty wards, which may account for their higher readmission rate.
20 Cervical Spine Fragility Fractures in Older People: 5-Year Experience At A Regional Spine Centre
Authors: Tarawneh A M , Taqvi S , Salem K M I , Sahota O
Published: February 2020

Introduction

Cervical spine fractures are particularly prevalent in older people and commonly occur following a fall from standing height or less, in the presence of degenerative spinal disease. Atlanto-axial complex and odontoid process injuries are the most frequent type of fractures and are potentially life threatening. Published in-hospital and 1-year mortality rates in older people are eightfold higher than in younger patients. The aim of this study was to identify the incidence and characteristics of cervical spine fractures in older people presenting to a regional spine centre.

Methods

Clinical records and radiographs were retrospectively reviewed using our institutional registry covering a 5-year period. Data included patient age, gender, mechanism of trauma, level of fracture, stability of the fracture, treatment modality, imaging modality, and mortality rates.

Results

A total of 209 patients above the age of 70 with cervical spine fractures were treated in our centre from 2015-2019. The mean age of the patients at the time of injury was (82.4 ±7.5) years with the majority (n=117; 56%) being females.

One-hundred fifty-one patients (72.2%) experienced fractures in the atlanto-axial complex. Particularly, Dens fractures were the most commonly reported fracture (n=119; 56.9%). Most of the patients encountered stable cervical spine fractures (n=181; 86.6%) and these were managed by external immobilization with hard collar or halo vest.

Mechanism of trauma was divided into two main categories, low energy and high energy. Low energy trauma was the most common cause that lead to cervical spine fractures (n=169; 80.9%), compared to high energy trauma (n=40; 19.1%). CT scan and X-ray were the main imaging modalities utilized to detect cervical spine fractures. Whereas, MRI was only utilized in (n=51; 24.4%).

Overall mortality rate was (n=17; 8.1%) at 30 days. Out of which (n=1; 5.9%) was in a patient who was surgically treated while the remaining (n=16; 94.1%) were in those treated conservatively.

Conclusions

Cervical spine injuries in older people are clinically important. Low energy trauma particularly falls, were the main mechanism of cervical spine injury. Upper cervical spine injuries, mainly C2, is the most common cervical spine fracture and were most commonly detected using CT scan. External immobilization was our treatment of choice for most of the cervical spine injuries in the older people. These patients are very similar with respect to mean age, mechanism of injury and 30 days mortality rate as hip fracture patients.
21 The Jean Bishop Team, Hull: A New Model of Care for Comprehensive Geriatric Assessment of the Frail Population
Authors: Athorn K , Folwell A , Harman D , Kar S , Windass L
Published: February 2020

Introduction

Hull CCG recognised system’s over-reliance on reactive, hospital care and workforce deficits, requiring a modernised service model for frail older people that moved from individual provider focus to system-wide perspective, with emphasis on proactive care.

Methods

Electronic Frailty Index (eFI) in primary care system identified 3,200 out of 300,000 Hull residents Hull with severe frailty. Recruited 9 GPs with extended role in older people’s care and Advanced Nurse Practitioners to support 4 Community Geriatricians. Redesigned roles for pharmacy, social services and non-clinical care coordinator teams. New therapy roles created, multiple third sector organisations involved, including carer support, and purpose-built location with older people in mind.

Interventions

Structured and anticipatory comprehensive geriatric assessment of all 3200 residents (either at home or in care homes) by the multidisciplinary multiagency team. Pre-assessment home visit by support worker to complete patient concern’s questionnaire. Dedicated patient transport and one-stop multi-disciplinary team assessment in one building. Proactive discussion of RESPECT and advance care planning, electronic personalised care plan delivered with system-wide record sharing across providers, Same day basic diagnostics available. Complex care coordinators ongoing support in community. Multi-disciplinary outreach to care homes and truly housebound.

Results

99.7% patients and carers extremely likely/likely to recommend the service 21,000 interventions for 2,500 patients seen since June 2018 Majority of patients moderately frail by Clinical Frailty Score Average saving on drug costs - £110.17 /patient/year 15% reduction in ED attendances, 29% reduction in emergency admissions Patients’ survey: adequate time and opportunity to discuss health problems/concerns, felt informed and empowered during consultation and in future planning Very high levels of staff satisfaction

Conclusions and future

Innovative high quality, cost-effective new model of care delivering improved patient care and experience with emphasis on proactive care and future planning High levels of patient and staff satisfaction Future expansion with disease specific teams including COPD, parkinsonism and diabetes and targeting moderately frail by eFI. Redesign of community services with improved integration across teams and providers can be a blue-print for other services.
22 Design and Implementation of A Nutrition Clinical Pathway for Patients with Fractured Neck of Femur
Authors: Kingdon J , Aadan H , Husain S , Atkinson C , Thomson C , Braude P
Published: February 2020

Background

Patients with a fractured neck of femur (FNOF) are commonly malnourished pre-admission, have reduced oral intake in hospital and a hypermetabolic state up to three months postoperatively (E Paillaud 2000). Malnutrition is associated with functional deterioration, higher morbidity and mortality.

Evidence suggests nutritional supplementation post-surgery can reduce postoperative complications. As a result, nutritional assessment is included in the National Hip Fracture Database best practice tariff (Avenell, Cochrane Database of Systematic Reviews 2016).

Introduction

Our aim was to design and implement a clinical pathway for patients with FNOF to identify malnutrition and provide appropriate nutritional support.

Intervention

A retrospective audit of 25 patients was completed to understand baseline rates of assessment, prescription of supplements and referral to dietetics. Using these data meetings were arranged to develop a clinical pathway. Key stakeholders included dietetics, orthopaedic surgeons, geriatricians, physiotherapists and nurses. The pathway was evaluated and optimised with two Plan-Do-Study-Act (PDSA) cycles looking at 25 patients each time.

Results

Baseline: 79% received a nutritional assessment, 32% had nutritional supplements prescribed and 36% (n=9) met criteria for referral to a dietician, of which 55%were referred. However, an additional 5 referrals were made to dietetics for patients who did not meet criteria, a 50% inappropriate referral rate.

PDSA cycle 1: increased nutritional assessment (85%), increased nutritional supplements prescribed (92%), decreased inappropriate referrals to dietetics (43%).

PDSA cycle 2: increased nutritional assessment & nutritional supplements prescribed (100%), increased inappropriate referrals to dietetics (80%).

Conclusions

The implementation of a nutrition pathway has led to increased identification and treatment of malnutrition, which has in addition improved accrual of the best practice tariff. However, greater number of inappropriate referrals have been made to dietetics. This is partly attributed to difficulty weighing patients on admission, and where no weight is inputted on the Malnutrition Universal Screening Tool a “High Risk” score is generated triggering a referral. We are now looking at alternative methods to obtaining a weight such a mid-upper arm circumference.
26 Empowering Nursing Staff to Identify Delirium and Provide Intervention for Older Patients Post Transcatheter Aortic Valve Implantation Procedure in A Cardiology Ward: A Quality Improvement Project
Authors: Bulled E
Published: February 2020

Background

Delirium is a common condition, particularly in the hospital setting, and has associated poor outcomes. Transcathether Aortic Valve Implantation provides a less invasive intervention for the treatment of Aortic Stenosis and this patient group often presents with increased risk factors for delirium. Nurses are in a key position to identify and manage delirium with literature suggesting educational interventions can support this.

Aim

The aim of the quality improvement project is to empower nursing staff to identify delirium and provide intervention for older patients post Transcatheter Aortic Valve Implantation procedure in a cardiology ward.

Methods

A driver diagram supported local problem analysis and stakeholder analysis identified those required to support change. The Behaviour Change Wheel and COM-B system identified behaviours required for change and guided intervention design. Plan, Do, Study, Act cycles directed project planning and the implementation of interventions.

Results

Nurse knowledge of delirium scores increased for ten out of twenty-three nurses or 43.7% post delirium training session. Nurse self-perceived confidence increased in three aspect of delirium care: recognising signs and symptoms, undertaking screening and delivering interventions for the management of it. All nurses were either likely or extremely likely to recommend both delirium training sessions provided to their colleagues. When comparing the data prior to and during the QIP intervention, an increased in identification and management of delirium was demonstrated. However demonstrating if there is a direct correlation between nursing staff attending delirium training sessions and patients having increased identification of delirium and management interventions has been more difficult to ascertain.

Conclusions

The Quality Improvement Project was well received and useful in raising awareness of delirium and enhancing nurse knowledge and confidence in delirium care. Next steps involve additional delirium training and data collection to explore the impact of the interventions further. Feedback has been positive and discussions about potential spread to other contexts and care pathways have taken place.
27 Re-Audit of Orthostatic Blood Pressure Measurement to Prevent Falls and Fall-Related Complications for Geriatrics Inpatients from A Secondary Care Hospital
Authors: Sultana Z , Sarda P , Ang S Kim
Published: February 2020

Introduction

Orthostatic Hypotension is a common cause of falls leading to injury and morbidity in older adults. In the National Audit of Inpatient Falls 2015 audit, only 16% of 4846 patients had an orthostatic Blood Pressure (L/S BP) recorded by their third day in the hospital. There is also variation in the understanding of how doctors and nurses perform orthostatic BP. This could have adverse effects on detection rates and accuracy of the procedure resulting in misdiagnosis. As a result, the Royal College of Physicians (RCP) has released guidance on Orthostatic BP measurements to perform the standardising practice and improving accuracy. The purpose of this quality improvement project (QIP) is to work on the action plan from the orthostatic BP measurement QIP has done in 2017, by introducing laminated guidelines in patient’s notes and re-audited in 2018 to record any improvement. The re-audit of 2018 showed remarkable improvement but still not as equal as the gold standard as RCP. Therefore, the second loop of re-audit performed in 2019 in major Geriatrics wards and other wards while involved larger sample (patient) numbers. We used four questioners as the audit proforma.

Methods

Wards were audited to find out whether orthostatic BP is measured as per RCP guidelines. Afterward, a laminated copy of the RCP recommended method of measuring orthostatic BP was put into all Early Warning Score ‘Observation’ folders with a sheet designed specifically for recording Orthostatic (L/S BP). The procedure of L/S BP measurement was re-audited after the intervention to find out changes in performing orthostatic (L/S BP) (as per RCP guidelines).

Results

There is a remarkable improvement of outcome reveals in the second loop of re-audit. Regarding RCP guideline compliance, it is 93.33% which is closer to the gold standard. And in case of symptoms identification and documentation, it is 100%, which is equal to the RCP gold standard.

Conclusions

Inclusion of guidelines in notes improves investigation; inclusion of supplementary recording sheet improves documentation. Re-audit reflects the remarkable improvement to compliance with RCP guidelines in measuring Orthostatic BP measurement and patient’s symptoms documentation.
29 Geriatric Emergency Medicine (GEM) Bootcamp and Bootcamp Bitesize Training
Authors: Sendall C , Williamson M , Solomon C , Belcher R
Published: February 2020

Introduction

In 2016 we ran a successful pilot of Geriatric Emergency Medicine (GEM) Bootcamp at Imperial College Healthcare Trust. This has developed into an annual regional conference which to date has been attended by over 440 delegates. This year we have been able to expand GEM Bootcamp to offer smaller ‘Bitesize Bootcamps’ with tailored learning for individual organisations, with more than 100 delegates already having accessed this resource.

Methods

In developing the curriculum for GEM Bootcamp and Bootcamp Bitesize we engaged a significant range of local healthcare providers. We undertook a learning needs analysis, which surveyed the target audience- specifically looking for self-reported gaps in knowledge- as well as analysing data from incidents, complaints and compliments. This allowed us to identify areas which there was opportunity for learning as well as ensuring a personalised curriculum

Results and conclusions

GEM Bootcamp feedback was overwhelmingly positive, with 100% of delegates stating they would recommend the day to colleagues. The relevance to practice was rated 4.4/5 with many positive comments about the opportunity to meet many interested people, generate conversations and raise awareness of frailty. The self-reported improvement of knowledge was from 2.95/5 pre-course to 3.89/5 post course.

To date we have delivered Bitesize Bootcamp to a local nursing care centre (which accounts for 50% of the admissions from care homes to the ICHT), London Ambulance Service (LAS), acute medicine and medicine for the elderly from a local trust, ICHT A&E nurses and Capital Nurse trainees. All bitesize training delegates self-reported an increase in their frailty knowledge. On average over the 5 bitesize sessions delegates reported an improvement from 3/5 pre-training to 4.1/5 post training. The development of links with local partners and the delivery of a consistent message about best practice in frailty have also been valuable outcomes
32 Medicine for Older People Liaison Service to Acute Surgery Reduces Length of Stay of Older People Living with Frailty
Authors: Everett R , Patel H
Published: February 2020

Background

Of people admitted to the acute surgical unit (ASU) only 23% of them are aged over 70. However the number of bed days they occupy are disproportionate to this; comprising 48% of the total bed days. The average number of bed days rises exponentially with age, with those aged under 70 averaging less than two days; those aged 80 averaging approximately 4.5 bed days and those aged over 90 approximately 7 bed days.

This disparity was recognised and a Medicine for Older People (MOP) liaison team comprising consultant geriatrician and Advanced Clinical Practitioner in Frailty starting working with the acute surgical team in November 2018, initially providing support two days a week, increasing to 5 days in March 2019.

Methods

The MOP liaison team meets with the acute surgical team each morning identifying and discussing relevant patients; those identified as living with frailty with associated complexity and uncertainty. This group of patients is then reviewed by the MOP liaison team utilising the principles of the comprehensive geriatric assessment to formulate a person-centred plan. Plans are discussed and coordinated with the surgical, nursing and therapy teams utilising a multi-disciplinary/ multi-professional approach.

Results

Length of stay is the main outcome measure and readmissions are monitored. Data on admission length and readmissions was analysed from April 2018 and has continued following commencement of the liaison service.

Primary results- Length of stay has reduced from 4.4 to 3.3 days on average for all over 70-year-olds admitted to the ASU team. Whilst admission rates have dropped across all age ranges the biggest reduction in readmissions is among the over 80-year-olds with an almost 50% reduction as opposed to a 33% reduction in the under 70 age group

Conclusions

Proactively managing the admissions and discharges of patients with frailty allows them to receive the right care at the right time in their period of crisis and shortens their admissions by approximately 25%.