bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermal design and flight validation of the chang’e-4 relay satellite
Authors: Ren Hongyan , Yang Changpeng , Sun Tengfei , Huang Xing
Published: January 2024

The Chang’e-4 relay satellite operates in the HALO orbit at the Earth-Moon Lagrange L2 point, which can provide relay communication to the lander and the rover operating on the lunar far side to maintain their contacts with the earth and is a key link of the Chang’e-4 exploration mission. Unlike most LEO (Low Earth Orbit) satellites, the outer space environment of the Chang’e-4 relay satellite is much harsher. The Chang’e-4 relay satellite must suffer from a torrid environment that faces direct sunlight or direct exposure to 4K deep cold space in a shadow zone which may last longer than 6 hours. The Chang’e-4 relay satellite must ensure the operation and temperature control of instruments and equipment during the shadow zone with a limited battery level. This proposes high demands on the TCD (Thermal Control Design). The entire satellite resources were reasonably used for integrated TCD with limited battery level and limited weight. According to the working mode of the Chang’e-4 relay satellite and its torrid environment, its TCD was completed successfully, and on-orbit test data conformed to the expected results and theoretical calculation. TCD of the Chang’e-4 relay satellite has worked normally since the day that the Chang’e-4 relay satellite was launched into space.
Study on the effects of incremental curing on the thermal conductivity, insulation, and mechanical properties of thermal conductive silicone rubber
Authors: Zhang Kang , Qiu Jianhui , Sakai Eiichi , Zhang Guohong , Yamaguchi Hiroyuki , Chonan Yasunori
Published: January 2024

With the development of fields such as electronics and telecommunications, electronic devices are becoming more integrated and powerful. Therefore, there is an increasing demand for high thermal conductive and insulating flexible materials. Silicone rubber (SR), as an excellent flexible substrate, is often combined with various thermal conductive fillers to enhance its thermal conductivity (TC). Carbon materials are commonly used as thermally conductive fillers. To improve the insulation performance while maintaining the TC of the material, uncured SR filled with boron nitride (BN) is used as an insulating layer on the same substrate. The TC of the once-cured BN/SR composite and the incremental cured BN/SR composite as a coating are 0.492 W/(mK) and 0.484 W/(mK), respectively, with a BN content of 10 vol%. The TC of carbon fiber (CF)/SR composites before and after surface treatment with BN/SR are 1.760 W/(mK) and 1.682 W/(mK), respectively, with a CF content of 20 vol%. The volume resistivity of the former is less than 104 Ω cm, while the latter is greater than 1014 Ω cm.
High injection molding welding strength and cross-sectional analysis of carbon fiber composite materials
Authors: Wu Haonan , Qiu Jianhui , Sakai Eiichi , Zhang Guohong , Zhao Wei , Tang Jianhua
Published: January 2024

In this study, carbon fibers, commonly used as reinforcement materials, were added to polyamide (nylon) PA6 to fabricate carbon fiber-reinforced thermoplastic composites (CFRTP), which were then subjected to injection molding welding. The aim of this research was to investigate the positive influence of carbon fibers on injection molding welding strength and explore the optimal injection conditions. Three different joining combinations and various injection parameters were examined. The tensile fracture surfaces after welding were observed using polarized microscopy and scanning electron microscopy. The reinforcing mechanism of carbon fibers was analyzed. Ultimately, the optimal conditions were determined as a mold temperature of 120°C, an injection temperature of 380°C, and an injection velocity of 150 mm/s. The addition of carbon fibers exhibited significant strengthening effects on the injection molded joints, and it also provided the potential for injection molding welding between resins with poor compatibility.
Effect of alloy composition on the 45 steel microstructure and properties of scanning electron beam surface alloying
Authors: Li Yusheng , Wang Mian , Wang Yupeng , Wei Xing , Ren Wenli , Ren Xulong , Li Zhibo
Published: January 2024

In order to improve the surface properties of 45 steel, the effects of different scanning electron beam treatments on the surface properties of 45 steel were studied. The research results indicate that after scanning electron beam surface alloying (SEBSA) treatment, in addition to forming needle like martensite, carbides (tungsten carbide and molybdenum carbide) also exist in the alloying zone of the strengthening layer, moreover, the grains become finer. After scanning electron beam alloying treatment, the surface hardness reached 1250HV, which is 5-6 times the substrate. Compared with the wear loss of the matrix, the wear resistance of the sample after SEBSA treatment increased by nearly six times.
Study on the effect of container tilt on the falling speed of suspended particles in gravity field
Authors: Pan Shuaicheng , Li Wenbo , Guo Anqi , Wang Shuohang
Published: January 2024

The boycott effect is widely used in wastewater purification, drinking water purification, and mixture treatment in industry and manufacturing. In this paper, we analyze the settling velocity of particles in the clear water and suspended zones, and investigate the reasons for the tilting angle of the vessel to accelerate the settling velocity of particles. This paper uses video tracking software to analyze the settling velocity of particles in the experiment and draws conclusions.
Spatial counterfactuals to explore disastrous flooding
Authors: Merz Bruno , Nguyen Viet Dung , Guse Björn , Han Li , Guan Xiaoxiang , Rakovec Oldrich , Samaniego Luis , Ahrens Bodo , Vorogushyn Sergiy
Published: January 2024

Flood-prone people and decision-makers are often unwilling to discuss and prepare for exceptional events, as such events are hard to perceive and out of experience for most people. Once an exceptional flood occurs, affected people and decision-makers are able to learn from this event. However, this learning is often focussed narrowly on the specific disaster experienced, thus missing an opportunity to explore and prepare for even more severe, or different, events. We propose spatial counterfactual floods as a means to motivate society to discuss exceptional events and suitable risk management strategies. We generate a set of extreme floods across Germany by shifting observed rainfall events in space and then propagating these shifted fields through a flood model. We argue that the storm tracks that caused past floods could have developed several tens of km away from the actual tracks. The set of spatial counterfactual floods generated contains events which are more than twice as severe as the most disastrous flood since 1950 in Germany. Moreover, regions that have been spared from havoc in the past should not feel safe, as they could have been badly hit as well. We propose spatial counterfactuals as a suitable approach to overcome society’s unwillingness to think about and prepare for exceptional floods expected to occur more frequently in a warmer world.
Extending third quantization with commuting observables: a dissipative spin-boson model
Authors: Medic Luka , Ramšak Anton , Prosen Tomaž
Published: January 2024

We consider the spectral and initial value problem for the Lindblad–Gorini–Kossakowski–Sudarshan master equation describing an open quantum system of bosons and spins, where the bosonic parts of the Hamiltonian and Lindblad jump operators are quadratic and linear respectively, while the spins couple to bosons via mutually commuting spin operators. Needless to say, the spin degrees of freedom can be replaced by any set of finite-level quantum systems. A simple, yet non-trivial example of a single open spin-boson model is worked out in some detail.
Accurate superposition modeling method of grinding-shot peening surfaces
Authors: Chen Jiling , Tang Jinyuan , Shao Wen , Li Xin , Zhao Jiuyue , Li Lin
Published: January 2024

The coexistence of initial surface texture features and shot peening texture features in the final surface topography is a significant feature of shot peening. After the initial surface topography is strengthened by shot peening, the wave peak will produce more substantial deformation relative to the wave valley, which has not been considered in the existing superposition modeling methods. And this will affect the correlation study between surface topography and performance. Taking the surface generated by the grinding-shot peening process as the research object, based on the feature extraction of measured topography, the concept of ‘Shot peening texture depth distribution surface’ is put forward. And the proposed precise superposition method uses the texture depth distribution surface to optimize the characteristic baseline of shot peening based on the existing theory. The measured grinding-shot peening surfaces verify the given method. It is found that the topographical and spatial features of the surfaces superimposed by this method are consistent with those of the measured surfaces, and the error of roughness parameters defined by ISO25178 are all less than 8%. Among them, the percentage errors of the critical parameters Spd, Sdq, and Sdr related to friction and lubrication are significantly reduced to 5%.
A photodetector based on p-GaN/N-MoS2 QDs heterojunction with high responsivity
Authors: Alwehaibi Maymunah A , Khoja Yasmeen A , Alghamdi Reem S , Alsuhaibani Fahdah A , Alshatwi Manar S , Aldamegh Ahmed A , Aldakheel Sarah A , Alromaeh Abdulaziz , Alwadi Norah M
Published: January 2024

Molybdenum disulfide (MoS2) is the most thoroughly investigated for photodetection applications with direct bandgap transition in low-dimensional structures, high light–matter interaction, and good carrier mobility. In this work, MoS2 quantum dots was synthesis by liquid exfoliation and characterized using scanning electron microscopy (SEM), Transmission electron microscopy (TEM), Fluorescence emission spectra (FES), UV–vis spectroscopy, and Photoluminescence (PL). The average size is ∼ 3.6 nm with strong absorption in the UV region and a band gap of 4.49 eV. Moreover, a novel structure of N- MoS2 QDs \ p-GaN heterojunction photodetector was deposited by spray coating. The PL of N- MoS2 QDs \ p-GaN emission spectra expanded from UV to visible light with high responsivity to the visible light of 7.06 mA W−1 and detectivity of 1.24 × 1010 jones.
Dosimetry audit in advanced radiotherapy using in-house developed anthropomorphic head & neck phantom
Authors: Kakade Nitin R , Kumar Rajesh , Sharma S D , Sapra B K
Published: January 2024

The treatment of head and neck (H&N) cancer presents formidable challenges due to the involvement of normal tissue and organs at risk (OARs) in the close vicinity. Ensuring the precise administration of the prescribed dose demands prior dose verification. Considering contour irregularity and heterogeneity in the H&N region, an anthropomorphic and heterogeneous H&N phantom was developed and fabricated locally for conducting the dosimetry audit in advanced radiotherapy treatments. This specialized phantom emulates human anatomy and incorporates a removable cylindrical insert housing a C-shaped planning target volume (PTV) alongside key OARs including the spinal cord, oral cavity, and bilateral parotid glands. Acrylonitrile Butadiene Styrene (ABS) was chosen for PTV and parotid fabrication, while Delrin was adopted for spinal cord fabrication. A pivotal feature of this phantom is the incorporation of thermoluminescent dosimeters (TLDs) within the PTV and OARs, enabling the measurement of delivered dose. To execute the dosimetry audit, the phantom, accompanied by dosimeters and comprehensive guidelines, was disseminated to multiple radiotherapy centers. Subsequently, hospital physicists acquired computed tomography (CT) scans to generate treatment plans for phantom irradiation. The treatment planning system (TPS) computed the anticipated dose distribution within the phantom, and post-irradiation TLD readings yielded actual dose measurements. The TPS calculated and TLD measured dose values at most of the locations inside the PTV were found comparable within ± 4%. The outcomes affirm the suitability of the developed anthropomorphic H&N phantom for precise dosimetry audits of advanced radiotherapy treatments.
A higher Gross–Zagier formula and the structure of Selmer groups
Authors: Kim Chan-Ho
Published: January 2024

We describe a Kolyvagin system-theoretic refinement of Gross–Zagier formula by comparing Heegner point Kolyvagin systems with Kurihara numbers when the root number of a rational elliptic curve

E
E

over an imaginary quadratic field

K
K

is

−
1

-1

. When the root number of

E
E

over

K
K

is 1, we first establish the structure theorem of the

p
∞

p^\infty

-Selmer group of

E
E

over

K
K

. The description is given by the values of certain families of quaternionic automorphic forms, which is a part of bipartite Euler systems. By comparing bipartite Euler systems with Kurihara numbers, we also obtain an analogous refinement of Waldspurger formula. No low analytic rank assumption is imposed in both refinements.

We also prove the equivalence between the non-triviality of various “Kolyvagin systems” and the corresponding main conjecture localized at the augmentation ideal. As consequences, we obtain new applications of (weaker versions of) the Heegner point main conjecture and the anticyclotomic main conjecture to the structure of

p
∞

p^\infty

-Selmer groups of elliptic curves of arbitrary rank. In particular, the Heegner point main conjecture localized at the augmentation ideal implies the strong rank one

p
p

-converse to the theorem of Gross–Zagier and Kolyvagin.
2031 Lying and standing blood pressure and ECG for the falling patient
Authors: White C , Boyd L , Teo A
Published: January 2024

Introduction

Many elderly patients admitted to hospital have presented following a fall. Causes for falls are often complex and multifactorial, but causes such as postural hypotension and cardiac arrhythmias are easily diagnosed with lying and standing blood pressure (LSBP) and ECG respectively. Therefore, these investigations should be offered as a minimum to any elderly patient after a fall. We aim to review and improve the number of patients receiving LSBP and ECG after presenting to the Acute Frailty Unit (AFU) with a fall.

Methods

Falls admissions were reviewed over two four-week periods, before and after intervention. We gathered information on whether patients had LSBP and ECG, and whether these were reviewed and documented by a doctor or specialist nurse. Patients who could not stand for LSBP were not included. Interventions included teaching for all staff on AFU about LSBP and ECGs, posters about investigations after falls, flash cards on how and when to perform LSBPs and a daily tick-box to complete at handover confirming investigations had been reviewed.

Results

During the first four weeks, 31 patients were identified who presented with falls. 31 (100%) had LSBP recorded and 25 (81%) of these had documentation that it had been reviewed by doctor or specialist nurse. 26 (84%) received an ECG and 24 (92%) of these had a documented review. After intervention, 42 patients were identified. 40 (95%) had LSBP recorded, 42 (100%) of these were reviewed. 42 (100%) of patients had an ECG and 36 (100%) of these were reviewed.

Conclusion

Multiple simple interventions including education, visual prompts and procedural changes can improve practice and help to ensure that minimum investigations are achieved for all frail patients presenting with falls. These interventions could be applied to other common presentations on the AFU and may be an appropriate next step.
2023 Oral nutritional supplement prescribing in care homes: The benefit of dietetic review
Authors: Taylor K , Hope S , Goodwin V
Published: January 2024

Introduction

Prevalence of malnutrition in care homes is high and oral nutritional supplements (ONS) often prescribed. Prescription and monitoring of ONS use varies considerably within residential settings. Locally dietetics are not funded to visit care homes and input is limited. This project explored dietetic ONS prescribing within care homes in one primary care network within Devon, recording the potential impact on costs.

Methods

All patients prescribed ONS (n=50) across 16 care homes were reviewed, alongside referrals to dietetics (n=39) from November 2022-March 2023. Supplements were switched to first-line formulary supplements where possible, stopped where unnecessary according to dietetic assessment, and a “food first” approach encouraged within homes. Cost of supplements prescribed pre-dietetic assessment, cost of new prescriptions, dietetic staff time and mileage costs were recorded. Supplement cost was calculated from the local formulary and staff cost from NHS oncosts.

Results

Patients seen represented 20% of all residents 20% (89/436) within the 16 care homes, suggesting high suspected clinical need. Mean age was 90 years, ranging from 73-103 years. Female patients accounted for the majority (n=68). Addressing inappropriate prescribing saved £57.62 per day in prescriptions through stopping or changing ONS. Cost of dietetic staff time and milage totalled £3105.80 over the five-month period meaning that after 54 days the dietetic review service was saving money. Patients often preferred first line powder-based supplements, and these were either similar or more appropriate in nutrient content than initially prescribed ONS. For example, one patient affected by pressure ulcers was prescribed a fat emulsion supplement. It contained no protein or micronutrients to promote skin healing (cost £3.15) whilst first--line supplements provided macronutrient and micronutrient needs (cost 52p each and £1.04 total prescription).

Discussion

Dedicated dietetic input for care home residents appears to save costs on ONS prescribing whilst providing specialist nutritional expertise.
1953 Improving access to community palliative care by raising awareness of services, indications for referral and referral pathways
Authors: Knowles B , Springbett P , Hunt C , Ingram O
Published: January 2024

Introduction

40% of 1056 patients discharged from our acute geriatrics ward met Gold Standards Framework (GSF) Prognostic Indicator Guidance for Recognition of Patients approaching End of Life (EOL). 92% were not referred to Community Palliative Care (CPC) services, meaning patients’ needs were not fully met and other services over-stretched. This project aimed to achieve a 10% reduction in missed referrals.

Methods

Highlighting the missed referral rate enabled engagement of key stakeholders including ward and palliative care multidisciplinary teams. This 12-month project comprised four PDSA Cycles: 1. Raising awareness of GSF and CPC through ward-based teaching; 2. Development of posters outlining referral criteria and pathways; 3. Hospital-wide survey of doctors’ understanding of treating patients approaching EOL, with real-time feedback on GSF and CPC; 4. Formal departmental and year-group teaching sessions. The outcome measure was the percentage of patients meeting GSF criteria who were not referred to CPC, as determined by retrospective analysis of discharge letters. Readmission rate was calculated as a marker of quality of life (QoL) and to assess the impact of missed referrals on the Trust.

Results

Interventions led to a sustained reduction in missed referrals (72% from 92%). Certain diagnoses are more readily referred, metastatic malignancy for example, 9x more frequently than advanced Parkinson’s. Patients meeting criteria averaged 3 admissions in the preceding year (compared to 1.7). Of those meeting criteria and still alive, patients not referred averaged 1 re-admission within 6 months compared to 0.3 when referred.

Conclusions

Missed CPC referrals impact patient QoL and increase the burden on acute inpatient services. Significant benefits could be seen if these findings are extended to other inpatient wards. There is also a need for education about the palliative stage of non-malignant diseases such as Dementia and Parkinson’s. Future steps include technology-based active screening of inpatients to facilitate referrals.
1906 Identifying Older Frail Patients Suitable for Same Day Emergency Care (SDEC); The Applicability of Patient Selection Scoring System
Authors: Burgess A J , Collins K , Burberry D J , James K H , Davies E A
Published: January 2024

Aim

Several patient selection scores have been developed to identify patients suitable for SDEC from triage in Emergency Departments (ED) and the acute medical intake. Scores are designed to improve system efficiency, overcrowding and patient experience. Studies have been conducted that compare these; none in frail older adults. This study compared the Glasgow Admission Prediction Score (GAPS), Sydney Triage to Admission Risk Tool (START) and the Ambulatory Score (Amb).

Methods

The Older Person’s Assessment service is ED based, accepting patients with frailty syndromes aged >70 years with same-day discharge for >75% of patients. The OPAS databank was retrospectively analysed from June 2020 to December 2021. Interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside each ambulatory score. ED documentation was used to gain triage data.

Results

748 attendances, 274(36.6%) Male with mean age 82.8(±8.5) years, CFS 5.2(±1.4) and CCI 6.7(±2.6) with 584(78.1%) discharged same day. Mean Amb score 4.2(±1.7), GAPS 21.4(±5.8), START 23.5(±4.7) all within admission range with 29.1% Mortality within 12 months. There was a significant difference between those admitted and discharged with CFS (p<0.001), mortality (p<0.001), Amb score and START score but not GAPS (p<0.001 vs p=0.03 vs p=0.17).

Conclusion

Frailty is an important determinant in identifying whether ambulatory care is appropriate. No score could be reliably used as a screen for suitable patients for SDEC services although the Amb score was the most accurate when assessing each individual variable. We are developing our own SDEC score for older, frailer adults which is currently being validated in the OPAS and SDEC settings.
2015 Identifying and Managing Visual Impairment in Older Patients with Falls on a Care of the Elderly (COTE) ward
Authors: Abbott C , Bristow E , Twiddy L , Warner A , Setchell R , Cavanagh A
Published: January 2024

Introduction

In 2019, the Royal College of Physicians (RCP) advised that all patients should have their vision screened if identified as a falls risk. Our aim was to implement a bedside visual screening test and establish an onward inpatient referral to Hospital Eye Services (HES).

Method

This is a collaborative Quality Improvement project involving Geriatric Medicine, HES and the Royal National Institute of Blind People (RNIB). A pilot study cross referenced falls admissions with previous known ophthalmic data to estimate the proportion of known vision loss in this group. In the second phase of the project, a bedside visual screening test has been introduced for all patients admitted to COTE with a fall. Patients failing the screening are reviewed by an RNIB Eye Clinic Liaison Officer (ECLO) and if necessary, a prompt inpatient HES review is arranged.

Results

Of 182 patients admitted following a fall, in the pilot study, 112 (61%) were known to ophthalmology previously. Of patients known to ophthalmology, 28 (25%) had vision of 6/18 or worse and would be considered to struggle with daily living tasks. 12 (10%) had a certificate of visual impairment (CVI) and 3 (3%) were eligible for CVI but had not been previously registered. One year following implementation of bedside vision testing, 287 patients had been reviewed after failing bedside screening. 97 of these had an onward referral sent or an intervention performed. The first ‘COTE ECLO’ post has been funded as a result of this work.

Conclusion

Assessing vision is a critical element of the assessment of patients with falls. Through collaboration with the RNIB and Ophthalmology a successful pathway has been developed to address visual impairment in this vulnerable group of patients.
1909 Evaluation of awareness and implementation of DNACPR decisions in trauma and orthopaedic Surgery
Authors: Taylor B , Naqvi H
Published: January 2024

Introduction

In-hospital CPR has survival rates of 15-20% [BMA Decisions on CPR, 3rd edition, 2016], further reduced with frailty and multimorbidity. Successful CPR is associated with significant morbidity and prolonged suffering. Do not attempt resuscitation (DNACPR) is an advanced medical decision, aimed at preventing harm where CPR is considered futile. [GMC Guidance.p128-145]

Aims

To reduce the burden of inappropriate CPR within surgical specialties using the following standards: 1. DNACPR status reviewed on admission, and all decisions implemented within 24hours of clerking. 2. DNACPR decisions implemented prior to surgery. 3. To assess clinician perceptions regarding DNACPR decisions.

Methods

This second cycle follows the intervention of a poster and departmental education in January 2020. A survey was sent to clinicians of all grades in Trauma and Orthopaedics (T&O) and General Surgery in January 2023. Data on implementation of DNACPR decisions was retrospectively collected over January and February 2023 for all T&O emergency and elective admissions >60-years-old.

Results

26 survey responses were obtained with all participants having had DNACPR discussions. 80.7% self-reported as confident/very confident in having these discussions. Out of 264 patients included, 80 discussions took place, of which 64 (80%) were implemented. 69% were implemented within 24hours of clerking, a 23% increase from cycle 1. 90% of community DNACPRs (9/10) were applied within 24hours, however the one remaining patient received inappropriate CPR. Of the 47 patients with DNACPR who had surgery, 87% were implemented prior to surgery, a 12% increase from cycle 1.

Conclusion

Improvement was demonstrated on both standards between cycles. This QI focused on implementation of DNACPR following discussions, however, did not consider patients in whom DNACPR may have been appropriate but not discussed. Further areas to explore include appropriateness of CPR/DNACPR decisions in advance of surgical interventions and the understanding behind limitations of treatment offered separate to CPR.
2048 Antipsychotic medication prescription in elderly patients in Royal Gwent Hospital, Wales
Authors: Dineshkumar K , Duric D , Peter E B
Published: January 2024

Introduction

he use of anti-psychotics is higher in older people than their younger adult counterparts due to high prevalence of dementia/delirium. Anti-psychotic drugs cause side effects which include cardiovascular, metabolic, extra pyramidal and risk of falls. So, we set out to do a QIP on antipsychotic medication prescription on our Geriatric wards comparing it with NICE guidelines.

Method

We had 2 approaches to use. Firstly, we prepared a check list for anti-psychotic medication monitoring according to NICE guidelines 2021 and we applied this retrospectively to our patients who had been initiated on anti-psychotics within the last year, the aim being to compare our practice with best practice. Secondly, we prepared a questionnaire for doctors to assess their knowledge about anti-psychotic NICE guidelines and distributed this to our junior doctors in RGH.

Results

• Main Indication for prescription was Behavioural and psychological symptoms of dementia (BPSD) - 94% of the time

• Risperidone was the most commonly prescribed (64%) antipsychotic.

• 83% of them had non-pharmacological methods tried before considering antipsychotic medications.

• 82% had their baseline ECGs checked and falls risk assessments done

• 35% had their lipids checked and 47% had their HbA1c checked

• 52% of the doctors were aware about NICE guidelines on prescribing anti-psychotic medications

• 70% of the doctors had knowledge about the side effects.

Conclusions

Our study showed the most commonly used antipsychotic drug was risperidone. We were good at documenting the indication, trying non-pharmacological methods and discussing side effects with patients/family. Hba1c, lipids and prolactin were not often checked, showing room to develop best practice. We are in the process of finalising stickers as a checklist when starting antipsychotics. To improve knowledge, we have presented the findings and aim to put up posters on wards and to do regular teachings.
1722 A Quality Improvement Project to improve MUST score and food chart completion on Frailty Wards
Authors: Zaki A , Alexander H
Published: January 2024

Introduction

Nutrition is one of the cornerstones of healthy aging. As we age, there are many changes in our bodies including decreased appetite and poor dentition, that contribute to increasing malnutrition. The MUST (Malnutrition Universal Screening Tool) score is a quick and effective tool to assess this. In this project, we reviewed MUST score and food chart completion on the frailty wards at EDGH to attempt to improve the nutrition of elderly patients.

Methods

The charts of seventy-five patients were reviewed over a period of one month. Following this, a training program for all the nursing staff was put in place. Initial results were discussed and the importance of nutrition in the elderly was highlighted. The staff were shown how to fill in the MUST score and follow management guidelines. Also, a reminder was set up on Nervecentre (local electronic patient record) for all staff.

Results

Of the initial seventy-five patients: 1 – a MUST score was completed for only 64% on admission to the ward 2 – 41.3% of patients were eating 50% or less of their meals 3 – In only 27% the reasons why they were not eating were documented. In the second cycle, eighty patients were included, and the results were markedly improved.

1 – The percentage of MUST score completion on admission increased to 91.3%

2 – Management guidelines were followed in 92.5% of the cases 3 – 18.8% with a MUST score of two or more, were referred to dietitians at an early stage

Conclusions

Our quality improvement project significantly increased MUST score completion and prompted action at an early stage. The third cycle in our improvement project is to improve the documentation of patients' food charts and encourage staff to look for and document the reasons why patients are not eating.
1720 Frailty and the impact of Electronic Advance Care Planning records on readmission rates and location of end of life care
Authors: Stapleton L , Marsh L , Rajeevan T
Published: January 2024

Introduction

Older people with severe frailty are 5 times more likely to die in the next 12 months than older non-frail people however prognosis and disease trajectory in frailty remains difficult to predict. Advance care planning (ACP) is often not fully discussed or documented due to these prognostic uncertainties, plus time/workload constraints. This can result in multiple admissions for people with frailty in the last 12 months of life and can lead to care and death in a non-preferred place. Electronic Advance Care Plans (eACP) can be useful in reducing unwanted admissions and promoting care and death in preferred location. This project aimed to improve proportion of patients receiving care in their preferred location and reduce readmission rates.

Method

Identified patients who wished to avoid hospital readmission with clinical frailty score of 6 or more and at least 2 unplanned admissions in the preceding 12 months over a 4-month period at a district general hospital in south London. ACP was discussed with patients and families and an eACP was generated. Patients were then followed up at 3 and 6 months to assess readmission rate and rate of end-of-life care in preferred location. 24 patients consented - 17 women, 7 men. Mean age of 88.3 Mean pre-admission frailty score of 6.1. High level of pre-admission co-morbidity with 80% having 3 or more major comorbidities.

Results

Readmission rate was 8%. One third of patients alive at 3 months all without readmission. 23 patients had died at 6 months. 13% died in hospital versus a national average of around 50%. 70% died in preferred place of death versus national average of around 49%.

Solution

Use of electronic Advance Care plans resulted in a low readmission rate and a higher proportion of people receiving end of life care in their preferred place of death.
1998 Advance care planning on the Same Day Emergency Care Older People's Unit - a quality improvement initiative
Authors: Kondo M , Stothard C , Nair S , Handalage C , Gould D , Harris J , Mukokwayarira C , Ferris T , Bowden A , Harrison L
Published: January 2024

Introduction

Same Day Emergency Care (SDEC) at St James’ Hospital, Leeds provides urgent care at the interface between primary and secondary care, offering comprehensive geriatric assessment (CGA) to those living with frailty, aiming to prevent hospitalisation and delay frailty progression. Advance care planning (ACP) is a vital component of prioritising care preferences including at end-of-life, but timing often falls short in practice. This quality improvement (QI) initiative aims to proactively open ACP discussions, allowing patients to consider their care goals, ensuring our care is aligned with their priorities.

Method

Between July 2022 and April 2023, the project involved 1039 patients. Led by Advanced Clinical Practitioners with support from consultant geriatricians and a palliative care specialist nurse, ACP discussions were encouraged through prompts in daily staff huddles and drop-in teaching sessions.

Results

ACP uptake increased from 7.8 % to 19.3%. Insights from a perception survey involving 83 healthcare professionals revealed key barriers including clinical workload, limited space, lack of experience and confidence as well as prognostic uncertainty and patient factors. Education and training, clinical supervision, patient information leaflets and a conducive environment were positively associated with ACP.

Conclusion

There has been a cultural shift in the department as the practitioners now routinely prompt staff to undertake ACP in safety huddles. Key catalysts for ACP initiation were found to be progression of frailty, terminal diagnoses, dementia, and recurrent hospital admissions. As a new SDEC unit is scheduled to open in the coming months, with provision of space and privacy, our aim is to improve the quality and quantity of ACP discussions with the patient at the centre of all decision-making. In line with these endeavours, parallel support within the community through our home (virtual) ward will further enhance proactive care planning in older people living with frailty.
1989 Improving accuracy of Clinical Frailty Scale (CFS) scoring on geriatric and oncology wards in Hull University Teaching Hospitals
Authors: Martin S , Asiwe R , Young J , Amusan M , Lim A , Stapley S
Published: January 2024

Introduction

The Rockwood Clinical Frailty Scale (CFS) is a tool that assesses global frailty, validated for use in people aged over 65. It assesses an individual’s functional status to assign a number from 1 (very fit) to 9 (terminally ill). Hull University Teaching Hospitals has integrated mandatory CFS assessment on admission for inpatients aged over 65. This project aimed to improve the accuracy of CFS scoring in an oncology and a geriatric ward by empowering ward nurses to better recognise frailty.

Methods

Phase 1. Baseline data was collected from admission CFS scores from inpatients on one geriatrics ward and one oncology ward. We then individually reviewed admission CFS scores for the same patients. We recorded concordance if the same score was assigned.

Phase 2. We surveyed nursing teams on both wards, as they assign the initial CFS score during a patient admission. This revealed unanimous recognition of the pivotal role accurate frailty recognition plays in targeting individualised frailty intervention and called for more staff training in frailty/CFS. Following this, we introduced a pictographic version of the Rockwood CFS scale to nursing stations where admission documentation takes place and re-assessed CFS score concordance.

Results

A substantial improvement in CFS score concordance was demonstrated within the geriatric ward, from 41% at baseline to 56%. However, only minimal change was observed within the oncology ward remaining static at 11.1% from baseline 8.3%.

Conclusions

We have worked with the two wards to disseminate knowledge and use of the NHS CFS app. Through collaboration with the trust’s frailty leads, the CFS app is now being incorporated into the electronic recording system, encouraging routine use of the app when calculating CFS scores. Once this change is implemented, we will recollect data again.
1908 Documentation in Clinical Frailty scores in patients aged >65 admitted to surgical assessment unit
Authors: Basharat B , Fayyaz A , Alkaissy R
Published: January 2024

Introduction

According to the latest NELA report, frailty doubles the risk of mortality in patients >65 and above, but review by a geriatrician can significantly reduce this risk. To identify patients at risk, the report recommended that a formal frailty assessment for all patients>65 should be performed. The aim of this audit was to check compliance with this recommendation.

Methods

Data were collected retrospectively from a prospectively maintained electronic hospital records. Patients > 65 years admitted acutely under general surgery were identified from handover lists spanning a period of two weeks. The admission documents were reviewed to check for a formal assessment of clinical frailty score (CFS) had been completed. Following initial results, posters were put up in the SAU doctors’ office and all clerking doctors made aware via e-mails, WhatsApp groups and teaching to complete a CFS for patients >65 years.

Results

In the first cycle, 50 patients were identified and compliance rate was 18%. Following intervention, 51 patients were identified in the subsequent cycle with a compliance rate of 47%. After a second intervention, 99 patients were identified with a compliance rate of 61%.

Discussion

The NELA report highlighted only 23% of patients had a CFS documented and this was similar to the results of the initial audit. The main reason was lack of awareness, which was addressed by creating an awareness among the colleagues via poster, group chats and emails. This brought compliance up to 47%. Another reason was doctors being unable to locate the CFS on the electronic clerking document. A second round of intervention by poster, group chat, email communication and teaching achieved a 61% completion rate. The recommendation is to continue to improve the documentation of CFS further and utilize this to get input from geriatricians.
1912 Reviewing the effect of COVID pandemic on changing clinical practice of administrating Zoledronic Acid to hip fracture patients
Authors: Tun Z L , Melrose R , Saharia R , Tazeen U
Published: January 2024

Introduction

Reduction in outpatient appointments during the COVID-19 pandemic and patient concern surrounding risk of contracting COVID-19 by attending day-case settings, resulted in delayed or cancelled medical treatments including Zoledronic Acid infusions as management for Osteoporosis. This, alongside recent research concluding that these treatments can be given safely as early as 1-2 weeks post-fracture, lead to the adaptation of protocol at Hull University Teaching Hospitals Trust in 2021, to provide rapid loading of Cholecalciferol over 6 days, prior to administration of Zoledronic Acid on day 7. However, some concerns remain surrounding the potential interference with bone remodelling and healing. This completed audit cycle evaluates the logistics and safety of this new protocol.

Methods

All patients over 60, admitted with neck of femur fracture who received Zoledronic Acid infusion as inpatient or outpatient in 2019 and 2021 were included in the initial and repeat audit respectively. Electronic records for the following 12 months were analysed evaluating for further fragility fracture and mortality rate.

Results

There was an increase in patients receiving Zoledronic Acid as an inpatient treatment from 21% in the initial audit to 97% in the repeat audit. There was a slight increase in mortality rate at one year from 14% to 19%. The percentage of a further fragility fracture within one year, remained stable at 7%.

Conclusion

The increase in inpatient infusions suggests more patients with significant frailty who would otherwise not have been able to attend outpatient settings, have been able to receive treatment. The mortality results reflect this frailer audit population. The absence of a substantial increase in the rate of further fragility fracture at one year; supports the earlier administration of Zoledronic Acid as a management protocol.
1938 Prevention of herpes zoster infection with a recombinant zoster vaccine to support healthy ageing in older adults
Authors: Ankobia A ,   on behalf of, Curran D , Doherty T M , Lecrenier N , Breuer T
Published: January 2024

Introduction

In the European Union, life expectancy has increased from 74 to 81 years between 1990 and 2018. Time spans living in ill health are also increasing. Vaccine recommendations focus primarily on vaccines that prevent death thereby extending length of life. The focus should also include vaccines that promote healthy ageing (HA), improving the quality of longer lifespans. The aims of this review are to describe the impact of herpes zoster (HZ) in adults ≥50 Years of Age (YOA), and to summarise the available evidence on how the recombinant zoster vaccine (RZV) contributes to HA.

Methods

We conducted a narrative review of published literature on the impact of developing HZ on HA and the ability of vaccination to prevent the subsequent burden of disease. Specifically, we describe HZ impact on functioning ability and quality of life, and impact of RZV on reducing the burden of HZ in adults ≥50 YOA.

Results

One in three people develop HZ in their lifetime. Approximately, 15 million cases of HZ occur annually worldwide in adults ≥50 YOA. Post-herpetic neuralgia (PHN, pain persisting for ≥ 90 days) occurs in up to 30% of patients, with HZ ophthalmicus affecting up to 25% of patients. HZ presents as a unilateral, vesicular rash with pain scored as “worst pain imaginable” in ≥15% of patients. Treatment options for HZ and its complications are limited and suboptimal with only 14% of patients with PHN satisfied with their treatment. Pain significantly impacts sleep, mood, physical, social and mental functioning. RZV elicits a strong and long-lasting immune response, targeting the decline in cellular immunity. RZV reduced the burden of HZ pain and interference on activities on daily living by >90% in adults aged ≥50 YOA.

Conclusion

RZV, by preventing HZ episodes, supports maintenance of functional ability contributing to wellbeing in older age.
1709 Comparative performance of six multimorbidity indices to discriminate intrinsic capacity impairments among older adults
Authors: Yang C , Cao X , Mo Y , Zhang J , Wang X
Published: January 2024

Introduction

Optimal intrinsic capacity (IC) is crucial for preserving the functional abilities of older adults. The presence of multimorbidity is closely associated with IC impairments. Various multimorbidity indices have been developed for diverse health outcomes. This study aimed to compare the performance of six commonly used multimorbidity indices to discriminate IC impairments among community-dwelling older adults.

Method

We used data from a multidimensional geriatric assessment program including 627 community-dwelling older adults in five cities of Hunan, China. Six multimorbidity indices were extracted from the data, including disease counts, Functional Comorbidity Index (FCI), the Deyo Charlson comorbidity index, two indices (total score and comorbidity index) derived from the Cumulative Illness Rating Scale-Geriatric (CIRS-G), and medication counts. The IC was measured with five individual domains, i.e., locomotion, vitality, sensory, cognition, and psychological capacity. Individuals were regarded as having IC impairments if they had impairments in one or more domains. Associations between multimorbidity indices and IC impairments were examined using logistic regression analyses. The discriminative ability of multimorbidity indices for IC impairments was compared using the c-statistics.

Results

A total of 374 (59.6%) participants had IC impairments. All multimorbidity indices were significantly associated with IC impairments after adjusting for confounding factors. All indices showed acceptable discriminative power (c-statistic ranged from 0.711 to 0.759) for IC impairments. The comorbidity index derived from CIRS-G resulted in the highest c-statistic, followed by the total score of CIRS-G and FCI.

Conclusions

Our study results suggest that multimorbidity indices differed in their ability to discriminate IC impairments. The comorbidity index derived from CIRS-G performed better than other multimorbidity indices included in this study. The comorbidity index has the potential as a simple proxy measure of indicating the need for interventions to optimise IC for older adults in community settings.
1851 Increasing number of deaths related to Parkinson’s disease (PD) and Parkinsonism
Authors: Adhiyaman V , Hobson P
Published: January 2024

Introduction

The burden of PD has exponentially risen from 2.5 million in 1990, to 6.1 million in 2016 (PD Collaborators. Lancet Neurol. 2018; 17(11):939-53). This is due to ageing population, increased longevity, increased duration of the disease and improved diagnosis. The aim of our study was to identify the trend on deaths related to PD and Parkinsonism over the last decade.

Methods

We collected our data from the Office of the National Statistics, using codes G20 (PD), G21 (Secondary Parkinsonism) and G22 (Parkinsonism classified elsewhere), to extract the number of deaths coded under these conditions from 2013 to 2021. The data was only available for England and Wales.

Results

Total number of deaths including all codes from 2013 to 2021 were 4518, 4950, 5542, 5734, 5936, 6508, 6207, 7414 and 7117. Deaths coded under G.20 are far higher compared to deaths coded under the others.

Conclusion

The number of deaths related to PD has been gradually increasing and has nearly doubled over the last 9 years. Although Covid 19 may have contributed to this increase over the last two years, there is an overall rising trend. We think this is primarily due to people with PD living longer leading to an increased prevalence and duration of the condition. This is linked to sarcopenia, frailty, immobility, cognitive impairment and dysphagia contributing to increased mortality in later years. Another reason could be due to more accurate documentation in death certificates. Even though there has been concerns that deaths certificates have not been accurately coded to include PD, (Hobson, Meara. 2018; 8(2):e018969), there is probably an improvement after the introduction of Medical Examiner services. It is important to recognise the increasing burden of PD to enable us to plan and invest in resources to improve the care of these patients.