bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification Methods for Transformer Turn-to-Turn Faults and Inrush Current Based on Electrical Information
Authors: Gong Xinyi , Zheng Yuping , Pan Shuyan , Wu Chonghao , Deng Jinzhao
Published: March 2022

Power transformer is the most imperative and crucial equipment in electrical power system. Accurately monitoring the occurrence of transformer faults and rapidly isolating the faults are of great significance to ensure the reliability of power supply and avoid serious damage to the transformer. There are many methods used in the transformer to monitor transformer running state. This paper provides a comprehensive overview of transformer turn-to-turn fault and inrush current identification methods based on electrical information, and expounds the systematic research content that needs to be carried out for transformer turn-to-turn fault identification methods based on magnetic flux leakage information.
Influence of the boundary effect, viscosity factor and heat conductivity mechanism on the shock front evolution
Authors: Adrianov A L
Published: March 2022

In this paper a new economical discrete-analytical approach is applied to the problem penetrating of a shock wave in the shear layer of a viscous heat-conducting gas at high Reynolds numbers.
Magnetoresistive effect in YbxMn1-xSat small concentrations
Authors: Kharkov A M , Abdelbaki H , Gelgorn A V , Cheremnykh N A
Published: March 2022

The results of measurements of electrical resistivity without a field and in magnetic field of 0.8 T in the temperature range 100 K < T < 450 K for compositionYbxMn1-xS with x = 0.05, 0.1 are presented. For the x = 0.05 the gigantic magnetoresistive effect at room temperature is found.
Particularities of the interstitial atoms and vacancies clusters formation in a thin cadmium telluride foil during in situ electron irradiation in a TEM
Authors: Loginov Y Y , Mozzherin A V , Paklin N N
Published: March 2022

The formation of interstitial atoms and vacancies, as well as their clusters in the form of dislocation loops and voids in CdTe is simulated. The sizes and features of the growth of dislocation loops and voids were determined depending on the irradiation time, taking into account the decrease in the number of nodes of the semiconductor crystal lattice with the irradiation time, since in experiments we studied a thin CdTe foil in a transmission electron microscope (TEM). The calculated and experimental data are compared.
Magnetoresistance of rare-earth-substituted garnet ferrite films
Authors: Masyugin A N , Aplesnin S S , Loginov Y Y , Stognij A I
Published: March 2022

Thin epitaxial films of garnet ferrite were studied using impedance spectroscopy. The influence of the magnetic field on the transport characteristics was investigated on the basis of the current-voltage characteristic characteristics (I-V) measured without a field and in a magnetic field H = 12 kOe. An increase in resistance in bismuth ferrite garnet was detected in a magnetic field at a temperature above room temperature.
Longitudinal shear waves in an elastic parallelepiped
Authors: Senashov S , Savostyanova I , Cherepanova O
Published: March 2022

This article new solutions will be built which can in particular be used to describe shear waves appearing in the elastic parallelepiped of a finite size. This problem is reduced to three wave equations with two spatial variables. At that, arbitrary initial data will be set, and on the boundary any conditions can be set which belong to either the first, or the second, or the third, or the mixed boundary value problems.
The thermodynamic analysis of physico-chemical processes of microarc oxidation of aluminium and titanium alloys
Authors: Snezhko A A , Strekaleva T V , Trifanov I V , Pchelkina T A , Karelina E A
Published: March 2022

The paper presents the results of assessing the probability of the occurrenceof physicochemical reactions in the electrolyte and on the electrodes while forming oxide coatings on aluminium and titanium alloys usinga microarc method. Calculations have been performed with the help of the thermodynamic analysis using the Hess’s law and Ostwald step rule. The calculations are coherent with the research results.
Observations on the construction methods used in Soviet-era shore navigational aids in the northern reaches of the Yenisei River
Authors: Goncharov A E , Gorodov A A
Published: March 2022

Intense navigation in the northernmost reaches of the Yenisei River during the Soviet era produced a rich industrial heritage. Among the more conspicuous objects are the remains of shore navigational aids, particularly leading lights and beacon towers. The surviving structures offer insights into the navigation methods used in this part of the Arctic. Navigational aides were also among the last industrial structures in the Soviet Arctic to be built of wood. Besides, they are important examples of structural engineering in the Arctic, meaning that they were designed to cope with the harsh environment.
New exposure room shielding incorporated with ferro boron concrete for neutron radiography imaging (NURI) facility at TRIGA PUSPATI Research Reactor
Authors: Syahir Sarkawi Muhammad , Zainal Jasman , Arif Sazali Muhammad , Syazwani Ali Nur , Afifah Basri Nor , Rawi Mohamed Zain Muhammad , Idris Faridah , Yazid Khair’iah , Mohd Isa Norriza , Jamro Rafhayudi
Published: March 2022

Simulation of the new exposure room shielding for Neutron Radiography Imaging (NURI) at 1 MW PUSPATI TRIGA MARK II (RTP) nuclear research reactor in Malaysian Nuclear Agency, Malaysia has been presented in this article. Previous exposure room shielding has to be disassembled due to various reasons such as radiation streaming problem and outdated since the exposure room was constructed in 1985. The NURI facility had been undergoing major upgrading for all their instrument including beam collimator, imaging system, sample positioning, instrumentation shielding, and exposure room shielding. This paper aims to simulate the radiation dose rate mapping for the new exposure room shielding for the NURI facility using the Monte Carlo simulation code of MCNPX. The exposure room shielding design consists of several modular blocks built from ordinary concrete and Ferro boron concrete. Ferro boron concrete is used to enhance the shielding performance of the facility. Results showed that exposure room shielding containing Ferro boron concrete manage to reduce the radiation by 1150 % at the critical area compared to ordinary concrete. The average radiation dose rate around the facility during operation at 1 MW reactor power ranging from 1 μSv/hr - 10 μSv/hr.
Mechanical properties and thermogravimetric analysis of peroxide prevulcanized natural rubber latex induced by Co-60 γ radiation
Authors: Ibrahim Sofian , Badri Khairiah , Thevy Ratnam Chantara , Chee Keong Chai , Sham Hasan , Noor Wadi Mat Lazim Mohd , Ali Noor Hasni M. , Hisyam Mohd Yusof Khairul
Published: March 2022

The radiation and peroxide vulcanizations of natural rubber latex are sharing the same problem which is low mechanical properties on their latex. This makes it unsuitable to be use in the production of premium latex products such as surgical glove. Moreover, there are some cases where the use of sensitizers in radiation vulcanization and activators in peroxide vulcanization tends to produced latex film with unpleasant smell and darken color respectively during the drying process. For this study, radiation of latex formulations based on 0.1 pphr of tert-butyl hydroperoxide and 0.06 pphr of potassium laurate at various radiation doses showed increment of tensile strength with increasing of radiation doses; radiation at 25 kGy produced rubber film with tensile strength of 20.7 MPa which is almost 7 times higher than control.
Time dependent reliability analysis for a critical reactor safety system based on fault tree approach
Authors: Hassan Ahmad , Mokhtar Zahira , Maskin Mazleha
Published: March 2022

Loss of coolant in the operation of any nuclear power plant will eventually become the primary source of hazard in the sequence of events leading to reactor core uncovery. Subsequent failure in removing the nuclear decay heat and preventing the core uncovery will further lead to loss of coolant accident (LOCA). In conjunction to this safety concern, it is crucial that the reliability of the plant emergency core cooling system is systematically and critically analysed. This article presents a case study on the time dependent reliability analysis for a safety injection system (SIS) of an advanced pressurized water reactor, based on the failure mode and effect analysis (FMEA) and fault tree (FT) analysis approach. The identified generic data for component reliability are carefully reviewed and used in this study. Based on the base case model, sensitivity and importance measure analysis for basic events are performed and the outcomes gained are presented and discussed. From the analysis, it is shown that the safety injection pumps of the SIS contribute significantly to the reliability of the system. In the short (at 0.5 hour) and long (7.0 hours and 72.0 hours) run, safety injection pumps are critical and influence the reliability of the SIS the most. The SIS’s FT logic model that has been developed and calculated shows the usability of the FMEA and FT approach that are implemented in analysing SIS time dependent reliability.
Assessment of rare earth and actinides (U and Th) elements in soil samples from Kapar industrial area, Selangor
Authors: Elias M S , Azman M A , Daung J A D , Hashim A , Laili Z , Omar S A , Shukor S
Published: March 2022

The study of rare earth and actinide elements have received attention nowadays due to rapid development in the extraction of the rare earth industry in Malaysia. Soil samples (18 areas) collected from the Kapar industrial area were analysed by using the neutron activation analysis (NAA) technique for the determination of rare earth elements and actinides (U, Th) concentration. The concentration of rare earth element such as La, Ce, Nd, Sm, Eu, Tb, Dy, Yb and Lu were ranged from 14.7-61.4, 30.6-132.8, 11.7-44.0, 2.12-9.60, 0.37-1.43, 0.03-1.57, 2.20-7.45, 0.28-0.81, and 1.99-4.15 mg/kg, respectively. The concentrations of uranium and thorium were a range of < 0.1-6.74 and 12.6-30.1 mg/kg, respectively. The results of geo-accumulation indicate the all-rare earth elements can be categorised as uncontaminated in all areas with an Igeo value below 0. The concentration of U can be categorised as uncontaminated to moderately contaminated (Igeo class 1) with Igeo values of 0 to 1 in the area of D, F, H, I, L, and N, whilst other areas can be categorised as uncontaminated with Igeo value < 0 (Igeo class 0). The thorium concentration in B, L, and N areas can be categorised as moderately contaminated with Igeo value 1 to 2 (Igeo class 2), whilst most of the area can be categorised as uncontaminated to moderately contaminated (Igeo values 0 to 1). The sources of Th contamination most likely originated from the anthropogenic and geogenic processes.
Integral representations for certain series
Authors: Duan Xue-Feng , Zhang Ruiming
Published: March 2022

In this work we apply the classical Plana summation formula to derive integral representations for certain infinite series that their general terms containing Gamma,

q
q

-Gamma, theta, Bessel, and Hurwitz zeta functions.
662 ENHANCING CARE BY IMPROVING DISCHARGE SUMMARIES
Authors: Davidson C , Zaw M K , Loh R , Grout C
Published: March 2022

Introduction

Within the Geriatric Medicine department at the Lister Hospital, Stevenage, the timeliness and quality of discharge summaries had become a source of complaints. Both primary care practitioners and families reported documentation was inadequate or incorrect. This project aimed to improve the quality of these discharge summaries in accordance with standards generated from previous audit data. Through improving communication it was clear that patient care could be enhanced.

Methods

Each month 15 discharge summaries were selected at random for review. Alongside patient notes these summaries were appraised in regards to standard discharge summary requirements: timeliness of delivery; adequate description of admission; and documentation of the follow up plan. They were also appraised on documentation of specific requirements for older aged adults including cognitive status, mobility status, discharge destination, need for home help, Rockwood Frailty score and resuscitation and escalation plans. Interventions including informal communication with junior doctors, circulation of a ‘Top Tips’ sheet, generation of an information poster and dissemination of information at local teaching sessions, took place, and were assessed, over regular PDSA cycles.

Results

showed a clear, sustained improvement in the quality of the discharge summaries. At the end of data collection, 100% of discharge summaries contained an adequate description of admission and an appropriate follow up plan. There was also significant improvement in documentation of specific requirements. Where documentation was initially very limited, following interventions, most discharge summaries contained details pertaining to discharge destination, need for home support, mobility status and resuscitation and escalation plans.

Conclusion

The relatively simple interventions have been found to have a sustained improvement in the quality of discharge summaries from the Geriatric Medicine Department at Lister Hospital, Stevenage. Whilst more work needs to be done it is hoped that this will already have enhanced patient care.
691 ‘ARE YOU CONCERNED ABOUT ME TODAY’ - AN MDT APPROACH TO IMPROVING DELIRIUM RECOGNITION
Authors: Bennett L , Boswell A , Huet H , Whitsey M
Published: March 2022

Introduction

Delirium is a common neuropsychiatric syndrome that increases the likelihood of adverse outcomes for patients admitted to hospital. Delirium is preventable and treatable. Recognition of the syndrome is challenging. Our aim was to increase this recognition through robust inpatient screening, utilising a multi-disciplinary team (MDT) approach.

Method

Stakeholder analysis for a quality improvement project revealed that junior doctors were members of the team most likely to perform a 4AT. Plan, do, study, act (PDSA) cycles were carried out: 1. Junior doctor engagement 2. Verbal prompts in huddle 3. Healthcare assistant (HCA) questionnaires.

Results

Baseline data showed that on average 0.6% patients had new 4AT over one week on elderly care wards. Intervention 1 involved 4AT handouts given to junior doctors. Number of 4ATs was 3% of patients per week. Intervention 2 used prompts in the morning MDT huddle, asking about concerns for patients. This increased the number of patients having 4AT per week to 6.5%. HCAs did not attend huddles and were targeted in the third intervention. A questionnaire with delirium information and the subsequent question ‘are you concerned about this patient’ was placed in patient bedside folders. This gave opportunity for HCAs to escalate patients to huddle so 4ATs could be carried out. The questionnaire was completed for 62% of patients, but only 1.4% patients were flagged up and subsequently had 4AT. This time was complicated however by the wards becoming Covid-19 wards.

Conclusion

Delirium is common however there is missed opportunity for earlier identification. Utilising HCAs with bedside questionnaires was time efficient and ensured robust escalation to prompt further investigation. When incorporated into huddle this could lead to more delirium diagnoses if carried out over a longer period, outside of the Covid-19 pandemic and on a ward solely populated with elderly care patients.
717 FLUSHI- AN INTERVENTION TO IMPROVE CATHETER CARE AND REDUCE UNNECESSARY CATHETERISATION DAYS
Authors: Anwyll N , Hyde K , Powell J
Published: March 2022

Introduction

Catheter-Associated Urinary Tract Infections (CAUTIs) are a common and preventable healthcare-associated infection that cost NHS hospitals an estimated £54.4 M per year. The risk of developing a CAUTI is intrinsically linked to the duration of an indwelling catheter. Our project was created in response to a clinical incident where a patient was mislabelled as having a long-term catheter (LTC) and discharged, subsequently enduring several unnecessary catheter days. We have created interventions with the primary aim of reducing the number of Short-term Catheters (STC) mislabelled as LTCs by 100%, and secondary aims of reducing the number of unnecessary catheter days, increasing the number of discharge summaries with correct catheter information and reducing the number of inappropriate catheterisations.

Method

All patients admitted to one Care of the Elderly from August 2020 with a new STC were included in this project. We designed the FLUSHI sticker as a tool for recording catheter care which specifically delineated between LTCs and STCs. In addition, it allowed space for recording essential catheter care and simplified the approach to indications for ongoing catheters. This was implemented alongside a Catheter Training Programme. Finally, specific catheter prompts were integrated into the discharge summary software to encourage the correct recording of catheter care on discharge. These data were compared with pre-intervention data to assess progression towards our aims.

Results

Provisional results have demonstrated a significant reduction in the proportion of patients with an STC mislabelled as having an LTC. In addition, we have seen a significant reduction in the number of unnecessary catheter days within inpatients.

Conclusions

The FLUSHI sticker is a valid intervention that allows for the delineation between STCs and LTCs, which in turn has reduced unnecessary catheter days, decreased the number of patients being mislabelled as having an LTC, and improved catheter communication on discharge.
722 IMPLEMENTATION OF TREATMENT ESCALATION PLANS IN A COMMUNITY PSYCHIATRIC HOSPITAL
Authors: Chua A Y T , Makh S K , Ghanchi A , Grayston J , Yasmeen N , Insigne S M , Woolford S , Wijayaweera S , Patel H P , Amin J
Published: March 2022

Introduction

Treatment Escalation Plans (TEP) detail appropriate ceilings of care and guide treatment of patients based on shared decision making. Whilst established in many acute trusts, TEP are not frequently used in community mental health hospitals. This is particularly concerning in organic mental health wards, where patients with severe dementia may be transferred to acute hospitals for treatment without consideration about whether this is appropriate. This quality improvement project aimed to develop and implement TEP within a community mental health hospital to support the management of our older patients with severe mental illness.

Methods

We designed a TEP form based on a prototype used in a partner acute trust and evaluated its use on our wards, comprising 20 patients between August–September 2020. We obtained quantitative data on use of TEP, including the length of time from admission to completion, as well as qualitative data from healthcare staff regarding their experience of using TEP.

Results

TEP implementation well received among members of staff. 100% of patients had a TEP in place within 2 weeks of admission. The mean time taken to complete a TEP was reduced from 7.1 days to 3.2 days following inclusion of the TEP proforma in admission packs. There was an improvement in understanding the purpose, comprehensiveness and location of TEP forms during their implementation. The key theme that arose from qualitative analysis of healthcare staff comments was that TEP forms provided clear guidance on appropriateness of escalation of care.

Conclusion

TEP forms offer clear guidance to treating clinicians about the ceilings of care for patients. TEP were successfully implemented in our community mental health hospital and we plan further post-implementation evaluation. We intend to roll out the TEP form across our mental health trust and share findings nationally to promote best practice.
745 PROACTIVE INPUT FROM GERIATRICIAN LED SURGICAL LIAISON SERVICE FOR OLDER SURGICAL PATIENTS AT ROYAL BERKSHIRE HOSPITAL, READING
Authors: Castaneda-Caicedo E , Khwaja M , Alam S , Warrior S
Published: March 2022

Introduction

Need for a geriatrician in the peri operative care of older surgical patients is evident by the NCEPOD reports in 2010 and 2011. Funding for Consultant Geriatrician led surgical liaison service for RBH was approved in 2014.We present a comparative review of the service during 2019/2020.

Methods

A retrospective audit of elective and emergency surgical patients over 65 years of age from January to March 2019 and June to September 2020 was done. Geriatrician input was provided on weekdays by Less than full time (80%) equivalent Consultant, 1 full time equivalent physician associate and a Gerontology Registrar on pro rota basis.

Results

We reviewed 76 patients in 2019 (Emergency 74/76 = 95% Vs Elective 2/76 = 3%) and 161patients in 2020 (Emergency134/161 = 83% Vs Elecetive27/161 = 17%). Majority of emergency presentations were small bowel obstruction, acute cholecystitis, and pancreatitis while laparoscopic right hemi colectomy was the commonest elective surgical admission. The average age of patients was 72 years (2019) and 79 years (2020). Length of stay up to 5 days reduced from 75% (51/76) in 2019 to 43% (70/161) in 2020. The overall length of stay reduced from 12 days to 8.5 days in 2019 and 2020, respectively 30 days readmission rate increased from 21% (16/76) in 2019 to 25.5% (41/161) in 2020. 75% (2019) and 96% (2020) of patients were discharged back to their usual residence and death rates reduced from 14% to 1% between the 2 audits.

Conclusion

There is an increase in patient number, age, and complexity. Number of elective surgical admissions after the 1st Covid wave has risen. Even with less than full time Consultant Geriatrician cover the service has helped to reduce the overall length of hospital, mortality rate and added to cost saving. There is need for senior cover for service to work efficiently and to meet its ever-increasing demand.
748 HEARING AIDS AND GLASSES: BEDSIDE SIGNS PROMPT ASSESSMENT OF SENSORY NEEDS, AN AUDIT
Authors: Laws E , Currie H , Batra R
Published: March 2022

Introduction

It is widely acknowledged that older adults with hearing or visual impairment are at higher risk of developing delirium. The National Institute for Clinical Excellence (NICE) guideline for delirium prevention in the hospital setting emphasises the importance of considering sensory impairment in the clinical assessment of patients at risk of delirium, yet it is often overlooked. This audit aimed to determine doctors’ documentation of sensory needs in a geriatrics department and the effect of bedside signs on this documentation.

Method

This study analysed documentation for all patients on three elderly care wards. Pre-defined search terms relating to hearing, visual and cognitive impairment were used to analyse whether sensory needs were mentioned during the patients’ hospital stay to study date. After the first round of data collection, bedside signs to indicate whether patients have hearing aids or glasses were installed, complemented by ward teaching on sensory impairment and delirium. Documentation was re-audited using the same pre-defined search terms as in the first round.

Results

The first round of data collection included 71 patients with an average age of 79 years. Only 30% of patients had documentation regarding sensory needs (hearing and/or vision) and 49% were documented as having delirium and/or dementia. The second round of data collection was completed one month after intervention and included 71 patients with an average age of 82 years. After intervention of bedside signs and ward teaching, doctors’ documentation of sensory impairment increased by 81%.

Conclusion

Installing bedside signs to indicate whether patients have hearing aids or glasses has improved documentation of sensory impairment, in turn prompting its consideration in assessment and care of patients at risk of delirium.
779 IMPROVING USE OF COORDINATE MY CARE USING A QUALITY IMPROVEMENT APPROACH FOR MEDICAL PATIENTS ADMITTED TO BARNET HOSPITAL
Authors: Goffe K , Wilson J , Gluck T , Brady J , Burns A , Bergbaum C , Petra H , Stewart M , Wilson E
Published: March 2022

Introduction

Coordinate My Care (CMC) is a digital care plan for communicating person-centred urgent and advance care planning. We recognised that it was not being consistently accessed on admission, nor updated on discharge, leading to a risk of ignoring patient wishes and previously clinician-agreed care plans. We used a quality improvement approach to increase use of CMC.

Method

We gathered baseline data on the number of users utilising their account, and explored current practice and barriers. A driver diagram was developed, a Steering Group met regularly, and interventions were tested using Plan, Do, Study, Act. Interventions began in January 2021, including electronic circulation of a guide to gain access to CMC, posters about CMC, departmental teaching, and drop-in training. A Core Group of clinicians repeatedly surveyed 12 medical ward areas and offered on-the-spot troubleshooting. To mitigate effects of staff turnover, we developed e-classroom training for new starters.

Results

53 people attended departmental teaching and drop-ins. The number of users utilising their account each month showed a steady increase, rising from 25 to 42 users. Monthly views of CMC records are increasing, with 167 in May 2021 compared to an average of 105 in the 5 months prior to the project. We have still to examine patient feedback.

Conclusion

Use of CMC is becoming more established. Future actions will concentrate on training (including in the emergency department and during junior doctor changeover), helping clinicians hold conversations, and establishing mentoring. Recording Advance Care Planning on CMC is a final step in a complex process of identifying that a patient may be in the last year of their life, starting conversations and taking actions. It follows that varied and sustained actions are needed to improve this, in order to realise the benefits of person-centred planning for our patients and those caring for them.
780 IMPROVING NUTRITIONAL SUPPORT FOR POST-SURGICAL FEMUR FRACTURE PATIENTS AT ST MARY’S HOSPITAL, LONDON
Authors: Donnelly L , Sharpe S , Heber I , Morgan C
Published: March 2022

Introduction

Malnutrition represents a common complication in femur fracture patients and is primarily caused by poor dietary intake. Malnutrition is associated with poor clinical outcomes, and is the strongest independent risk factor for recurrent femur fracture. High protein oral nutrition supplements (ONS) have been associated with improved clinical outcomes after femur fracture, including reduced complications, length of hospital stay, mortality and bone mineral density loss, and increases in functional status and quality of life (Volkert, Beck, Cederholm et al., Clinical Nutrition, 38, 10–47)). Accordingly, the European Society for Clinical Nutrition and Metabolism (ESPEN) advocates the use of ONS with all femur fracture patients in hospital.

Aim To improve nutritional support for post-surgical femur fracture patients at St Mary’s Hospital, London.

Methods

We plan to carry out three PDSA cycles to evaluate whether two separate interventions are effective in increasing the prescription rate of ONS in post-surgical femur patients. Each PDSA cycle included all patients who underwent surgical treatment for femur fracture during a one month period.

Results

‘Cycle 1’ included 18 patients (mean age: 84.6 years; range: 68–98 years) treated in March 2021. ONS were prescribed in 11% (2/18) post-surgical femur fracture patients. ‘Intervention 1’ comprised a dietician-led presentation during the Geriatric department weekly teaching session on 17/05/21. ‘Cycle 2’ data will be collected one month after ‘Intervention 1’.

Conclusion

‘Cycle 1’ results revealed low rates of ONS prescriptions for post-surgical femur patients. We anticipate higher ONS prescription rates following ‘Intervention 1’. We believe that doctors’ and dieticians’ awareness of the importance of nutritional support for post-surgical femur fracture patients is key to the success of this quality improvement project.
797 IMPROVING GERIATRIC CARE IN THE EMERGENCY DEPARTMENT; TREATT PROJECT: THE RAPID EARLY ASSESSMENT THERAPY TEAM
Authors: Foxley H , Colby C , Swin J , Leyland R
Published: March 2022

Introduction

At University Hospital Southampton (UHS) on average 400 elderly patients attend the emergency department (ED) each month following a fall with an estimated cost to the NHS of £2.3 billion a year. 50% of over 80’s fall at least once a year, after a first fall, 2/3 will fall again within the year. Since the creation of the Same Day Emergency Care (SDEC), treatment of those attending ED with frailty conditions has improved. However, the current therapy service cannot adequately assess these patients, leading to longer length of stay (LOS) and suboptimal functional outcomes. An initial 3-month pilot in ED identified those seen by a therapist had a reduced LOS compared with those who did not receive therapy (6.9 days vs 8.5 days). The data identified that 253 patients presenting later in the day received a substandard service.

Methods

An extended hours trial across a 2-month period was conducted. During this period therapists provided a proactive, responsive service to support comprehensive geriatric assessments (CGAs) in ED. Data was collected including demographics, diagnosis, response time, interventions, community referrals and LOS. The key outcome measures identified within the pilot were LOS, reduction in 1 night hospital stays, appropriate onward referrals, readmission rates and CGAs including falls reviews.

Results

This improvement project is in progress and the trial will be completed August 2021. The key areas for analysis will be LOS, readmission rates and the impact of early frailty assessments on discharge destination and admission avoidance.

Conclusion

With the aging population and local demographics in West Hampshire and Southampton city, frailty conditions are increasing. The demand on ED outweighs the current therapy service. The trial aims to avoid multiple admissions following falls, improve patients’ outcomes through reduced LOS and ensure appropriate referrals are made to ensure continuity of care into the community.
775 IMPROVING ADVANCE CARE PLANNING DISCUSSIONS AND COMMUNICATION WITH PRIMARY CARE IN GERIATRIC MEDICINE IN A DISTRICT GENERAL
Authors: Twigg M , Robins-Piotrowski D , Jenkin R
Published: March 2022

Introduction

Advance care planning and Respect forms are useful tools in the care of patients in geriatric medicine. Prior projects locally in acute medicine identified gaps in engaging appropriate patients in advance care planning. This quality improvement project aims to improve the identification and completion of Respect forms and how this information is passed on to primary care. NICEQS13 states there must be evidence to support conversations and care planning with relevant care agencies to ensure coordinated care.

Methods

The Supportive and Palliative Care Indicator Tool (SPICT) was utilised to identify patients who would benefit from RESPECT forms. Patient notes were reviewed prospectively to see if RESPECT forms were completed during admission and discharge summaries assessed to determine whether RESPECT information was included and communicated to primary care. Following PDSA cycle 1 the medical team were provided with structured education in advance care planning and importance of communicating RESPECT forms to primary care. Reminder notes were attached to all computer work stations as an aid memoire when completing discharge summaries. Following cycle 2 there was a change of staffing and RESPECT form communication was included in the induction pack alongside further informal ward based teaching.

Results

Identification of patients needing advance care planning improved from 80% to 100% of these patients being discharged with Respect forms. In the initial data collection 8% of Respect forms were communicated to primary care. This improved to 96% by the third cycle with sustained improvement across junior doctor rotations.

Conclusion

A sustained education program for geriatric medicine staff led to an increase in communication of advance care planning to GP’s. The NICE QS13 standards have been met and the methodology will be transferrable to other departments in the hospital. A more integrated platform with primary care would help improve communication with primary care further.
682 IMPACT OF DISCHARGE INTERVENTIONS FOR OLDER PATIENTS LEAVING HOSPITAL: A SYSTEMATIC REVIEW OF REVIEWS
Authors: O’Connell Francischetto E , Jones J , Davies S , Allen K , Combes G , Damery S
Published: March 2022

Introduction

The UK has an aging population and there is an increasing need for additional care and support services for elderly patients discharged from hospital. Despite a large evidence base on different discharge services there is inconsistent findings on their effectiveness. This systematic review of reviews aimed to evaluate the impact of a variety of discharge interventions on older people leaving hospital.

Method

Ten databases were searched (including Medline and The Cochrane Library) using multiple key search terms related to ‘systematic reviews’, ‘older people’ and ‘discharge’. Only systematic reviews of interventions for people aged over 60 years that provided additional support or adapted their discharge processes were included. Outcomes of interest included mortality, readmissions, length of hospital stay, patient health status and costs. Abstract, title and full-text screening was conducted independently by two reviewers. Interventions were categorised by intervention type and a narrative synthesis was conducted on data extracted.

Results

Of the 8,748 title and abstracts reviewed, 859 full texts were assessed for eligibility, of these 91 were taken forward to quality assessment and 66 moderate or high-quality reviews were included in the final synthesis. Interventions were categorised into 10 types and had varying impact on outcomes. A statistically significant positive impact on the outcomes of interest was found for: Interventions providing ‘rehabilitation, therapy or care at home (or in the community) around the time of discharge’ reducing length of stay; ‘primary care interventions’, ‘Discharge planning/coordination or case management’ and ‘patient education’.

Conclusion

This systematic review of reviews shows that different types and configurations of discharge interventions can benefit older patients in multiple ways when compared to usual care and highlights which intervention types make no difference or have negative impacts. These findings will help to inform the development of new discharge interventions and the direction of future research.
696 UNDERSTANDING INDEPENDENCE—OLDER PEOPLE’S PERSPECTIVES
Authors: Taylor E , Goodwin V , Clegg A , Ball S , Frost J
Published: March 2022

Introduction

Independence is an important personal goal for many older people. Achieving this goal in practice requires a shared-understanding of independence between older people and those supporting them, but a consensus of understanding remains elusive. This study aims to provide a basis for a person-centred understanding of independence by identifying which factors are important to the meaning, and experience, of independence for older people.

Method

In-depth interviews were conducted to explore the understandings of community-dwelling older people. Participants were purposively sampled from the Community Ageing Research 75+ cohort study. Analysis was guided by the Framework approach. Themes were identified through deductive and inductive exploration of the transcripts.

Results

Fourteen older people were interviewed ranging from 76–98 years old, six were male. Five themes were identified. The first three themes: participation, autonomy and control, underpinned participants’ understandings of independence. Engaging in meaningful activities, making decisions, and having control over help received were fundamental to participants’ understandings of independence. These three themes provided the common building blocks for unique configurations of independence. The importance of psychological qualities to the facilitation of independence, as they enabled participants to navigate environmental and social set-backs, presented a fourth theme, ‘Mind over Matter’. The final theme, ‘Participation reinforces psychological qualities’ represented the virtuous circle through which participation in meaningful activities reinforced the psychological attributes necessary to maintain independence.

Conclusion

Meanings of independence are as diverse as the people who develop them, whatever the age group. For the older participants of this study, despite differences, the meaning and facilitation of independence comprised several common themes. Achieving independence was a case of ‘Mind over Matter’ requiring personal effort, irrespective of environmental supports. Participation in meaningful activities was both a goal of independence and a means to reinforce the psychological qualities and energy needed to maintain it.
719 THE EFFECT OF LOCKDOWN ON THE INCIDENCE OF VTE IN HIP FRACTURE PATIENTS DURING THE COVID-19 PANDEMIC
Authors: Huque S , Robinson A , Singh N
Published: March 2022

Introduction

COVID-19 is associated with an increased risk of venous thromboembolism (VTE). We compared the incidence of VTE on a busy hip fracture unit during 2020 with previous years to identify factors that may have played a role in its development.

Methods

Data were retrospectively obtained by notes review for patients admitted with neck or shaft of femur fracture. This included baseline characteristics, comorbidities and operative risk factors for VTE.

Results

11 of 420 patients (2.6%) were diagnosed with VTE in 2020, compared with 25 of 2,115 patients (1.2%) between January 2015 and December 2019 (RR 2.2 [95% CI 1.1 to 4.5, p < 0.05]). Only one patient in 2020 had confirmed COVID-19. Retrospective data between 2015–2019 were incomplete, and so statistical analysis of demographic and operative risk factors was not conducted. Descriptive statistics show there were comparable proportions of smokers and malignancy in both groups, and the majority of patients in both groups received either mechanical or pharmacological VTE prophylaxis. A higher proportion of patients were independently mobile prior to admission in 2020 (72.7% vs 28%). There was a shorter interval to development of VTE in 2020 (mean 12 days in 2020 vs 25 days in 2015–2019).

Conclusion

Following hip fracture surgery patients were twice as likely to develop venous thromboembolism in 2020 than in the previous five years. There was also a shorter time to development of VTE. This was despite a higher reported level of premorbid mobility in 2020 in otherwise similar patient groups. We hypothesise that isolation due to the COVID-19 lockdown contributed to this result. This suggests a need for enhanced vigilance and prompt VTE prophylaxis in this vulnerable population in the event of further pandemic waves and lockdowns.
815 FRAILTY AND MULTIMORBIDITY ARE ASSOCIATED WITH LONGER LENGTH OF STAY IN OLDER UROLOGY PATIENTS
Authors: Ibitoye S , Parry F , Rideway A , Nitharsan R , Grange R , Braude P , Warren K , Shipway D
Published: March 2022

Introduction

Frailty and geriatric syndromes are becoming common place in surgical services. In general surgery, frailty has been shown to be associated with longer length of hospital stay. The effect of frailty on outcomes in Urology patients is not well described. We aimed to evaluate the effect of frailty and multimorbidity on length of stay in older patients admitted for emergency Urology care.

Methods

Adults aged 65 years and older admitted as an emergency to the Urology service during 4 months of 2020/21 were included. The primary outcome was time to discharge; analyses were adjusted for Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), age, gender, and surgical procedure (yes/no).

Results

142 patients were included, of these 60 (42.3%) were living with frailty (CFS ≥5), 32 (22.5%) were multimorbid and 59 (41.5%) underwent a surgical procedure. Longer length of stay was associated with frailty (adjusted-HR 0.560; 95% CI 0.376–0.835; p 0.004) and multimorbidity (adjusted-HR 0.556; 95% CI 0.367–0.842; p 0.006).

Conclusion

In this single-centre study we found frailty and multimorbidity to be associated with longer length of stay in patients admitted for emergency Urology care. Geriatric perioperative care interventions in other surgical specialties have been shown to reduce length of stay, the effect of such services within urology has yet to be established. Identification of frail and multimorbid patients could help to develop targeted strategies to improve outcomes, and ultimately reduce hospital stay.
Prevalence of Occasional Hypertension and Its Association With Overweight and Obesity in Children Aged 5–6 Years in Tianjin
Authors: Zhang Tao , Qiao Yi-juan , Li Wei-qin , Pan Lei , Liu En-qing , Liu Hong-yan , Wang Yue , Liu Jin , Wang Shu-ting , Guo Lu , Leng Jun-hong
Published: March 2022

Background

To investigate occasional hypertension in preschool children aged 5–6 years, and to analyze its association with overweight or obesity to provide the basis for early prevention.

Methods

Cluster random sampling was used to select 63 out of 1,802 kindergartens in 16 districts of Tianjin from 2016 to 2018. Blood pressure, height, and weight were measured among 21,393 children aged 5–6 years. A retrospective questionnaire survey was conducted to collect environmental factors. A multivariate logistic regression model was used to analyze the association between overweight or obesity and occasional hypertension, after adjustment for environmental factors.

Results

The prevalence of high blood pressure in preschool children of Tianjin was 11.9%, and the rate of occasional hypertension was 17.5%. The detection rate of abnormal blood pressure in overweight and obese children was significantly higher than that in normal weight children (P < 0.01). After adjusted for environmental factors, overweight and obesity were positively associated with high blood pressure and occasional hypertension. The odds ratio (95% confidence interval) of overweight for high blood pressure and occasional hypertension was 1.61 (1.41–1.83) and 1.79 (1.61–1.99), respectively; and odds ratio (95% confidence interval) of obesity for high blood pressure and occasional hypertension was 2.15 (1.85–2.50) and 3.16 (2.82–3.53), respectively.

Conclusions

Overweight and obesity increase the risk of occasional hypertension in preschoolers.
Automation Anxiety
Authors: Dinnen Zara
Published: March 2022

On “Amazon Prime Day” in 2019, Amazon workers across the globe went on strike to protest working conditions; protesters held up banners demanding “Human Workloads,” with the message “We Are Not Robots.” The fantasy of automation—its promises and pitfalls—is a mainstay of contemporary public discourse, organizing the ways we work and live. In this review essay, Zara Dinnen reads three recent scholarly, political, and artistic contributions to knowledge of automation: Smart Machines and Service Work: Automation in an Age of Stagnation by Jason E. Smith; Furious: Technological Feminism and Digital Futures by Caroline Basset, Sarah Kember and Kate O’Riordan; and Atlas of Anomalous AI edited by Ben Vickers and K Allado-McDowell. Each book offers a critical standpoint from which to apprehend and witness the situation of automation as it determines material and imaginary conditions of labor today. In conversation, the three works contest the ethical and political terrain of automation as a signifier of growth and progress under late capitalism.
‘Cambridge twist’: overlooked detail when teaching continuous sutures
Authors: Fumagalli Luca , Popeskou Sotirios Georgios , Pini Ramon , La Regina Davide , Galetti Ken , Majno-Hurst Pietro , Cristaudi Alessandra
Published: March 2022

When a continuous suture is performed, torsional tension builds up in the thread that can lead to curling and false knots, requiring deliberate corrective movements from the assistant or surgeon. The systematic 360° rotation of the needle holder each time a stitch is passed avoids this problem. The authors’ assumption was that this technical point is rarely demonstrated to trainees, and that even some experienced surgeons are unaware of it. This technical note describes the movement of the needle holder (called ‘Cambridge twist’ as a tribute to the surgical rotation where it was probably learnt) and reports a survey showing that it is less used and known than could be presumed from its simplicity. In addition, a review of the most accessible suturing tutorials on the internet showed that none mentioned this detail. Video 1 demonstrates the technique and its rationale.
Triglycerides–glucose index and the risk of cardiovascular events in persons with non-diabetic chronic kidney disease
Authors: Quiroga Borja , Muñoz Ramos Patricia , Sánchez Horrillo Ana , Ortiz Alberto , Valdivielso José Manuel , Carrero Juan Jesús
Published: March 2022

Background

Chronic kidney disease (CKD) is associated with high rates of cardiovascular events. We here explored whether the recently described triglycerides–glucose index (TyG) predicted the incidence of major adverse cardiovascular events (MACE) in these patients.

Methods

This observationa study was undertaken of 1142 persons with CKD and free from diabetes and 460 controls from the prospective NEFRONA study. The study exposure was the TyG index at cohort inclusion. The study outcome was MACE (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and hospitalization for unstable angina). Covariates included demographics, comorbidities, lipid profile, renal function and glycaemic control. Cox regression models evaluated the association between TyG index and 4-point MACE in patients with CKD.

Results

TyG was higher [median 8.63 (interquartile range 8.32–8.95)] in patients with CKD compared with controls (P < 0.001). TyG increased across albuminuria categories but was similar for glomerular filtration rate categories among patients with CKD stages 3–5. During 46 ± 13 months of follow-up, 49 (4.3%) MACE were registered. TyG predicted the occurrence of MACE {hazard ratio (HR) 1.95 [95% confidence interval (CI) 1.11–3.40] per TyG unit increase; and HR 2.29 (95% CI 1.24–4.20] for TyG values above the median of 8.63 units}. Sensitivity analysis for subgroups of participants according to age, kidney function, body mass index and imaging evidence of atherosclerosis yielded similar results, as did adjusted analysis. Neither triglycerides nor glucose alone was associated with MACE.

Conclusions

The TyG index is associated with the occurrence of major cardiovascular events in persons free from diabetes with non-dialysis dependent CKD.