bluuebunny/crossref_metadata_2025 huggingface dataset:
68 Urinary Catheterisation in Trauma and Orthopaedic Patients
Authors: Shammout S , Pavana T , Johnson A
Published: February 2020

Background

The use of urinary catheterisation in neck of femur fracture patients is often debated as common best practice to manage and appropriate fluid assessment. Routine catheterisation increases the risk bacteraemia, genitourinary injury, worsening mobility, risk of pressure sores and predisposition to delirium and falls. There is a need for increased awareness of urinary catheterisation management in conjunction with healthcare-associated infections. NHS improvement has issued a letter aiming to half healthcare-associated Gram-negative bacteraemia, the majority of which is catheter-related. This project aims to identify barriers to safe catheter care in the orthopaedic population; by determining if management of urinary catheters is complaint with NICE quality standards (QS61).

Introduction

Appropriate perioperative care can help manage the associated risk of neck of femur fractures. The British Hip Society and British Orthopaedic Association have provided little guidance on postoperative care and risk management. Appropriate catheter care will improve overall patient care but reducing mortality and associated morbidity, by shortening stay by early mobilisation and management of complications.

Methods

All catheterised trauma and orthopaedic patients in a district general hospital over one month (February) were included 67% of which had sustained neck of femur fractures. Data from nursing and doctors’ records on the following parameters were collected: demographics, the reason of admission, indication/location for catheterisation and responsible clinician; the number of days catheterised, the reason for the retention of catheterisation and management of suspected/confirmed catheter-related infection. Data were collected in April following the implementation.

Intervention

A urinary care pathway was launched based on the HOUDINI algorithm and educational seminars for medical and nursing staff were conducted.

Results

Mean age of patients was 78. Initial data was suggestive of poor documentation and prolonged, inappropriate retention of urinary catheterisation and not in accordance with current guidance. Data was recollected in April after the launch of the pathway; data was indicative of marginal improvement of catheter care management, reduced time of catheter retention, improved documentation likelihood of review.

Conclusions

Incorporating a catheter care pathway in managing orthopaedic patients has shown improvement in the overall documentation and management of urinary catheterisation. Despite this improvement demonstrated, implementation of the pathway is still substandard. This pathway will be incorporated into an innovative integrated neck of femur pathway in June.
70 Prevalence of Sarcopenia in A Longitudinal UK Cohort Study Using Ewgsop2 Criteria Varies Widely Depending on Which Measures of Muscle Strength and Performance are Used
Authors: Kilgour A H M , Redmond P , Taylor A , Deary I J , Starr J M , Shenkin S D
Published: February 2020

Background

The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines have recently been published to aid diagnosis of sarcopenia in the clinical setting and to allow for better comparison between research studies. The guidelines recommend several different tests for diagnosing sarcopenia. We hypothesised that the prevalence of sarcopenia might vary depending on which tests are used.

Methods

We used data from Wave 3 of the Lothian Birth Cohort 1936 study, a longitudinal ageing study of healthy, community dwelling older adults (n= 697, 52% men, mean age 76y), to assess the prevalence of sarcopenia using the suggested cut-offs in the EWGSOP2 guidelines. Probable sarcopenia was defined as low muscle strength (measured by handgrip strength and 5x chair stand test), confirmed sarcopenia was defined as low muscle strength + low lean mass (measured by bioimpedance analysis), and severe sarcopenia was defined as confirmed sarcopenia + low muscle performance (measured by gait speed and short physical performance battery score). SPSS version 24.0 was used for statistical analysis.

Results

The maximum prevalence of probable sarcopenia was 24.2% in men and 24.8% in women, of confirmed sarcopenia was 7.4% in men and 11.0% in women, and of severe sarcopenia was 4.6% in men and 5.9% in women, when either of the cut-offs for muscle strength +/- muscle performance were met. When using only one measure of muscle strength +/- performance, rates of probable sarcopenia ranged from 7.7% to 21.1% in men and 5.9% to 21.3% in women; rates of confirmed sarcopenia ranged from 3.9% to 5.3% in men and 5.1% to 9% in women; and rates of severe sarcopenia ranged from 1.4% to 3.9% in men and from 2.0% to 5.1% in women.

Conclusions

In a UK-based longitudinal ageing study we found that the prevalence of probable, confirmed and severe sarcopenia varied widely using the EWGSOP2 guidelines depending on which identifying tests were used. We found that the cut-off points suggested for some of the measures in the guidelines are not comparable and may lead to differing groups being identified as sarcopenic between different trials. We suggest modification of the cut-offs to adjust for this.
75 Is Cerebral Autoregulation Altered in Ageing? A Review
Authors: Perez-Denia L , Claffey P , Kenny R A , Finucane C
Published: February 2020

Introduction

Cerebral autoregulation (CA) ensures constant cerebral blood flow (CBF) in the face of blood pressure (BP) disturbances. While CA impairment is often implicated in the aetiology of age-related disorders e.g. falls, syncope, and brain ageing, there is conflicting evidence on the effect of normal or healthy ageing on cerebral autoregulation. Here we present results of a review investigating the effect of ageing on CA.

Methods

A search was performed in Pubmed using the search terms “cerebral autoregulation” AND (“ageing” OR “age” OR “older” OR “elderly”). Studies were included if they were human studies in English assessing CA in healthy volunteers (free from disease) in which the effect of ageing on CAR was studied. Exclusion criteria included non-human studies, diseased cohorts and studies not measuring CA.

Results

26 studies (n=1326 total participants, age range 12-88) meeting the inclusion/exclusion criteria were identified. Significant heterogeneity was noted in applied methodologies with 88% of studies using static and 53% using dynamic protocols to measure CA. Transcranial Doppler (88%) and Near Infrared Spectroscopy (NIRS) (11%) were the most commonly used. Transfer function analysis (TFA) (38%), the Autoregulatory Index (ARI) (15%), and wavelet analysis (11%) were used to derive CA metric. The majority of studies suggested that CA is preserved (n=15) with ageing. However, a smaller number of studies (n=7) noted that CA is impaired or altered with ageing.

Conclusions

There is a paucity of literature examining the relationship between CA and chronological ageing, with 60 per cent of studies reviewed suggesting that CA is preserved. Current hypotheses suggest that preservation of CA with ageing serves as a ‘reserve’ to compensate for impairment of other systems. Future work should investigate the role of impaired CA as potential biomarker of biological ageing.
76 The Cinema and Geriatric Medicine: An Approach to ‘Hard-To-Reach’ Places in the Curriculum
Authors: Patel R , Wolfendale H , Ragunathan J , Parikh R J
Published: February 2020

Introduction

Cinema is powerful - it can depict complex stories, spark discussion and foster reflection.1 Potentially, in geriatric medicine, the impact of serious diagnoses could be explored and learners’ preconceptions concerning ageing challenged. Thus, could film be used to explore and assess ‘hard-to-reach’ curriculum areas? The Mental Health in Older Adults module (MSc in Geriatric Medicine - Salford University) uses film in the oral assessed presentation. We wished to explore the utility of this

Methods

Learners (North-West Speciality Registrars) were allocated different feature films exploring mental health themes. 8 learners each delivered a ten-minute presentation focusing on a topic selected after viewing the film. The audience comprised Speciality Registrars who could ask questions.

The content of the presentations was reviewed. The key topics/themes tackled were analysed.

Results

Learners watched one of the following: Iris, Tokyo Story, Still Alice, My Feral Heart, Firefly Dreams, The Carer, Away from Her and Amour.

Each film generated 3 or more topics/themes. These were diverse and included: depression in chronic illness; loneliness; neuropsychological complications of stroke and the management and impact of dementia. Presenters set these into the film’s context and reflected on the interaction between physical health and social and psychological factors. ‘Hard-to-reach’ areas included: culture and social care, filial piety, and preconceptions of intellectual disability. Neglected areas tackled included suicide in older adults and the impact of dementia in younger adults.

Audience feedback was positive. The reflective nature of the session provided new insights and was engaging

Conclusions

Film is a medium that allows ‘hard-to-reach’ (and teach) areas to be tackled and assessed. The use of film was well received and importantly had utility. The topics learners reflected upon were complex and challenged their own and their audiences’ conceptions of clinical problems.

Reference

1. Law M, et al, Perspect Med Educ. 2015 4(5): 218–224.
77 Developing and Testing An Education-Career Pathway in Healthcare for Older People (ECHO) to Promote Retention in Early-Career Gerontological Nurses
Authors: Naughton C , Ezhova I , Hayes N , Fitzpatrick J
Published: February 2020

Background

The NHS Long Term Plan (2019) sets specific targets for multidisciplinary services for frail older people over the next ten years. Delivery and sustainability is crucially dependant on the capability and capacity of gerontological nursing. High cost cities such as London experience high staff vacancy rates in acute care older adult services.

Aim

The study took a regional approach, working with NHS Trusts to develop a multicomponent intervention to increase retention and competencies of early career nurses working in gerontological services. The study examined the acceptability and feasibility of the intervention and tested a quasi-experiential evaluation design. Ethical approval was obtained from the University Ethics committee.

Methods

A co-design approach with stakeholders, early career nurses, educationalists and nurse managers, produced a multicomponent intervention: education module (masters level), gerontological competency booklet, external clinical learning opportunities, career coaching and mentorship delivered over a six-month period. The evaluation involved a mix-methods pre-post survey and focus group interviews.

Results

Twenty-nine early career nurses were recruited from five Trusts. The multicomponent intervention was well received, but there were difficulties facilitating external learning opportunities and providing career mentors. The primary outcome was intention to remain in gerontological nursing (measured using a point Likert scale). Pre-post the intervention this remained high (mean score 6 IQR 5-7), p=0.78. There was a significant increase in gerontological knowledge: at baseline the median score was 87 (IQR 81-102) compared to 107 (IQR 98-112) post-intervention, p=0.006. In focus groups participants identified three main mechanism of action for ECHO: building gerontological knowledge and skills; professional identity as older adult nurse; and networking to broaden horizons.

Conclusions

The study has demonstrated the potential of Trusts to work collaboratively with education providers to deliver a model of career-education pathway that may help attract and retain early career nurses to work in gerontology.
80 An Exploration of What Stakeholders Reveal About the Behaviours and Personality of Registered Nurses Working in Older People’s Acute Care Settings and the Potential Influence on Nursing Care
Authors: Day H
Published: February 2020

Background

Concern around poor standards of nursing care for older people in hospital has been explored in relation to workload and operational pressures. What is less evident from existing literature is an explanation as to why nurses behave differently under the same pressures within the same concrete situations. Notions of personality and associated behaviours as possible influencers on nursing care delivery are variables that required consideration. Aim To critically explore the behaviours of registered nursing staff working in older people's acute care settings from the perspectives gathered from key stakeholders, and to identify whether there are any distinguishing personality traits that influence effective care delivery for older people.

Methods

A constructivist grounded theory methodology was used. Semi structured interviews were conducted to gather data from 12 stakeholder participants.

Results

Through the analysis of data gathered from stakeholders a rubric describing specific behaviours with associated traits emerged leading to the identification of two major types of nursing staff. One group of nurses who work with older people are perceived to have no real desire to do so and in turn their care behaviours are perceived as ‘cold’ and task based. The second group of nurses are perceived as having a true commitment to older people’s wellbeing and their behaviours lead to the delivery of care that is perceived as being highly skilled and compassionate. The proposed theoretical framework that was constructed from this data analysis identifies four key personality traits related to nursing behaviours: conscientiousness, sociability, integrity and coping under a core category heading of ‘the authentic self’. Whilst the authentic self is identified as being the direct influencer on how care is delivered which is defined as the consequence, the influence of context is also taken into account.

Conclusions

This research offers insights into the meaning of four key traits and the behavioral facets comprising them, the associated behaviors that are displayed and what effect these have on nursing care delivery. Implications for healthcare practice include the potential for further research that can inform the development of educational and recruitment strategies for older people’s nurses which will have a positive impact on the care of the older patient in hospital.
81 Can Simulation-Based Training be Used to Teach Geriatric Medicine?
Authors: Oates R , Lettal K , Allen N , Deivasikamani G
Published: February 2020

Introduction

Health Education England (HEE) and the Joint Royal Colleges of Physicians Training Boards recognise the importance of simulation-based training especially for Core Medical Trainees in improving patient outcomes and enhancing learning (Enhancing UK Core Medical Training through Simulation based training, Health Education England 2016). Research also suggests simulation training can be used to address a wide variety of medical curricula agenda from emergency presentations to breaking bad news (Beaubien 2004, Quality & Safety in healthcare). HEE suggests simulation training can be used to develop understanding but also communication skills and awareness of human factors and are focusing on developing a national strategy.

Geriatric Medicine is complex and trainees are expected to be competent in managing elderly patients in a variety of presentations. Our aim was to ascertain the confidence levels of CMT doctors managing elderly patients and whether simulation-based teaching is effective for geriatric teaching.

Methods

Three scenarios addressing common geriatric conditions were developed by a Geriatric Medicine Registrar and overseen by Geriatric Consultant. Scenarios including delirium secondary to sepsis, Opiate toxicity secondary to acute kidney injury (complicated by addressing dementia and risk of self-harm) and identifying and demonstrating appropriate palliative approaches to a catastrophic subdural haemorrhage. Trainees were given a brief summary of a case and asked to review and manage the ‘patient’.

A geriatric registrar alongside two CMT doctors designed a pre and post confidence questionnaire using Likert scales and free text boxes to explore respondents’ views.

Results

100% of trainees found the simulation training useful and would recommend the sessions. 100% of trainees stated preference for simulation-based teaching opposed to lecture and work based assessments. Confidence increased across all three scenarios post simulation. 70% of trainees stated they felt confident to manage delirium with sepsis pre-simulation, this increased to 91% post simulation. Trainees commented ‘feel confident to manage sepsis but not complicated by delirium or AKI’ and ‘prefer simulation to lectures’

Conclusions

CMT doctors enjoy and find simulation training in geriatric medicine useful and show preponderance to this. Simulation training can be used to expose trainees to real life complex geriatric medicine scenarios in a safe environment. This programme will be developed to encompass additional medical scenarios and also to be delivered to foundation year doctors.
87 Effects of Community Falls Prevention Service Closure on ICD-10 Coded Fracture Rates in Older People: An Interrupted Time Series Approach
Authors: McCarthy A , McMeekin P , Anderson G , McCarthy S , Parry S W
Published: February 2020

Introduction

Guidelines on falls prevention recommend case ascertainment based on opportunistic case ascertainment and referral in those who have fallen. In October 2009 we implemented a novel multidisciplinary, multifactorial falls, syncope and dizziness service with enhanced case-ascertainment through proactive, primary care-based screening for associated risk factors. In addition to comprehensive geriatric assessment, 25% of 4032 service participants underwent strength and balance training. The baseline outcomes have been previously reported.1 Funding was withdrawn, and the service closed on 31/01/2014. We examined the effect of service-closure on fractures presenting to secondary care with and without the service running.

Methods

An interrupted time series method was used. ICD-10 coded fracture numbers attending secondary care were determined (Hospital Episode Statistics from 01/02/2012-31/05/2017) for all North Tyneside residents ≥60 years at the time of service closure, including 25-months with, and 40-months without, service provision.

Results

There was a 0.9% (p=0.018) monthly reduction in falls over 25-months of service provision which increased during the winter months of a 9.8% (p=0.015) increase. In the month following the service closure there was an initial increase in fractures of 8.5% (p=0.231), followed by an increase in the monthly time trend of 1% (p=0.018). This resulted in a post-service monthly increase in fractures of 0.1%, an estimated extra 625 fractures over the 40-month post-service cessation period. At an average £8600 per fracture, the estimated cost may have been £5,375,000.

Conclusions

In this naturalistic experiment, following an initial drop in fractures, disinvestment in this service resulted in a rise in elders’ fractures presenting to secondary care. The closure of the service may have had a large unintended cost, averaging £1.5 million annually, versus annual running costs of £220,000. Further research is needed to control for patient-level characteristics and to establish the cost-effectiveness of the service.
91 To What Extent are Patients’ Future Care Preferences Shared Between Secondary and Primary Care? A Retrospective Chart Review
Authors: Hopkins S A , Athauda P , Halliday A , Honney K , Jakupaj A , Kaneshamoorthy M , Mark H , Pampali C , Van der Poel L , Ondhia D , Balogun A , Vincent M , Fritz Z , Barclay S
Published: February 2020

Introduction

When a doctor is informed of a patient’s future care preferences if they were to lose capacity, there is an ethical and legal obligation to share this information with the treating medical team. In frail older patients, conversations about treatment preferences often occur during hospital admission. We sought to assess the communication of these preferences to the patient’s GP.

Methods

Retrospective chart review of consecutive discharges from acute geriatric wards across seven hospitals. Records were excluded if the patient was admitted for less than 48 hours, was under orthogeriatric care, or died in hospital.

Results

339 notes were included, 41-50 from each hospital. GPs were informed of the resuscitation status of 28% of all patients. 52% of patients had an inpatient DNACPR, the GP was informed of 54% of these. 36% of patients had an inpatient ceiling of treatment documented, of which GPs were informed of 19%. 53% of hospital DNACPRs were converted into community DNACPRs on discharge: GPs were informed of only 24% of new community DNACRPs. 47% of patients discharged with a new community DNACPR lacked capacity to be involved in that decision; for just 6% of these was the GP asked to review the DNACPR order in the community. Inpatient Advance Care Planning (ACP) discussions were held for 9% of patients, of which the GP was informed in 59% of cases. 49% of ACP conversations involved the next-of-kin but not the patient. Among patients who had a new DNACPR decision made during their admission (n=124), there was documentary evidence in only 25% that the patient or next-of-kin was informed whether this was time-limited or indefinite.

Conclusions

Communication from hospitals to GPs about resuscitation, ceiling of care and ACP discussions is very limited. For patients who have expressed ongoing future care preferences, there is a legal obligation to share this information with the treating medical team, which on discharge is the GP.

There is poor documentary evidence of discussions with patients about whether DNACPR decisions are time-limited or indefinite. Furthermore, many hospitalised frail patients lack capacity to make DNACPR decisions but they may subsequently regain capacity, particularly those with delirium. Despite this, GPs are rarely asked to review new community DNACPRs, including those made for patients without capacity.
95 Goals-Of-Care and Advance Care Planning Discussions with Hospitalised Frail Older People: What is the Evidence?
Authors: Hopkins S A , Bentley A , Phillips V , Barclay S
Published: February 2020

Introduction

National guidelines suggest that patients in the last year of life should be identified, their prognosis and future care options discussed, with advance care planning (ACP) recorded. Goals-of-care should be discussed with hospitalised patients at risk of deteriorating or with life-limiting conditions. The stated purpose of ACP and goals-of-care discussions is to increase goal-concordant care (i.e. patients receiving treatments they would wish to receive, and not receiving those they would not want). This literature review investigates the evidence-base for these policies and outcomes.

Review question

What is the evidence for goals-of-care and ACP discussions with hospitalised frail older people?

Methods

Systematic literature review and narrative synthesis. Electronic search of MEDLINE, CINAHL, ASSIA, PsycINFO, and Embase databases from January 1990 to September 2017. An updated search until May 2019 is currently underway.

Results

Of 8077 unique articles identified, 17 met inclusion criteria. There is no evidence that goals-of-care discussions lead to increased goal-concordant care; there is observational evidence that they increase the accuracy of documented preferences. Currently, rates of goals-of-care discussions are variable (38-72%), and there is poor concordance between patients’ actual and documented preferences, with agreement in only 31-33% of cases.

Present rates of ACP are very low (0-3%), with mixed evidence for benefits of ACP. One single-centre randomised controlled trial suggests ACP improves outcomes for patients who die within 6 months of discharge, including increased goal-concordant care and reduced family distress.

There is very limited evidence concerning patients’ and family members’ experiences of these discussions, their reasons for wishing (or not) to participate in discussions, or their perceptions of the important outcomes. Most (80%) patients would like to be involved in decisions about their care; 48% consider these conversations very important. The views and experiences of healthcare professionals have been little studied.

Conclusions

The asserted aim of goals-of-care and ACP discussions is to increase goal-concordant care; the extent to which this reflects patients’ priorities is unknown. In younger patient populations, while 40% of patients consider goal-concordant care the most important outcome, one third of patients consider family-related outcomes to be more important. Further research is needed to understand the perspectives of frail older patients, their families and clinicians, in order to make these discussions and subsequent care truly patient-centred.
97 Complexity In Croydon
Authors: Smith J , Gass N , Huntley M , Nanuck R , Vandendris S , Bell C , Heitz E , Wilson T
Published: February 2020

Introduction

The Complex Care Support Team (CCST) are a newly-formed, integrated service, caring for Croydon residents when existing services decide additional multidisciplinary team input is required.

There is no single definition of healthcare complexity. Most cases encountered by the team have involved many different services and professionals. The team have found that by forging relationships and co-ordinating care across organisational boundaries, some of the “complexities” can be mitigated. We aim to develop our understanding of the needs of this population and the underlying drivers for complexity in Croydon.

Methods

The records on EMIS, CERNER and ePJS were reviewed from the inaugural two months of the service, for:Rockwood Frailty ScoreNumber of medicationsNumber of long-term conditionsED attendances or admissions to hospital over the preceding year.

After team discussion on every case, underlying causes of complexity were assigned to four groups: medical, psychological, social and systems failure.

Results

Of the 57 people accepted by CCST over 2 months, 39 required reviewing in person. 5 records were not completed, so 34 cases were included for evaluation. The age range of this cohort was 49-92, with 17 male and 17 female. Results revealed significant frailty, multimorbidity and polypharmacy. 91% had two or more underlying drivers for complexity, with the largest underlying driver being systems failure, in 85% of cases.

Conclusions

This work improves our understanding of the needs of the population deemed the most “complex” in Croydon. The likelihood of multiple underlying drivers for complexity was high, highlighting how complex health issues are likely to span both professional and organisational boundaries. This can in itself be a significant underlying driver for complexity, illustrated here as “systems failure”. In developing current and future services, this work reinforces the vital benefits of multidisciplinary and cross-organisational working currently occurring in CCST.
109 Hyponatraemia in Older Patients is Often Untreated, Despite Greater Mortality Burden; Results of A Prospective Cohort Study
Authors: Thorpe O , Cuesta M , Tormey W T , Sherlock M , Williams D J , Thompson C J , Garrahy A
Published: February 2020

Introduction

Hyponatraemia is associated with increased morbidity and mortality, and is commoner in elderly patients. The aetiology and outcomes of hyponatraemia in the elderly has not been defined in prospective studies.

Methods

A single-centre 9 month prospective observational study of hyponatraemic (HN) patients (</= 130 mmol/L) was performed. Clinical outcomes in patients ≥65 years (Elderly patients, EP) and those <65 years (Young Patients, YP) were analysed, and compared with age-matched eunatremic controls, Analysis was performed using Graphpad-Prism 7.

Results

1321 consecutive admissions with hyponatraemia (67% EP, median age of EP 77 (65–98) years) and 1122 eunatremic controls (63% EP, median age of EP 77 (65–99) years) were analysed.

Median nadir plasma sodium was similar in both groups with HN, 128 (107–130) mmol/L EP vs 128(110–130) mmol/L YP (p = 0.62). EP hyponatraemic patients were more likely to have hypovolaemic hyponatraemia (34%) compared with YP with hyponatraemia (28%, p = 0.03). Diuretic-induced hyponatraemia was twice as common in EP (8%) compared with YP (4%, p = 0.01). Malignancy-induced SIAD occurred with similar frequency in both groups (7% in EP SIAD vs 8% in YP SIAD, p = 0.65). Respiratory disease was causative in 10% cases of EP SIAD, compared with 4% in YP SIAD, p = 0.0004.

Hyponatraemia was corrected in 53% of EP, compared with 64% of YP, p = 0.0001. Length of stay and re-admissions rates were similar across hyponatraemia age groups. EP with HN were 2.4 times more likely to die in hospital, compared with eunatremic age-matched controls, (OR 2.4, 95% CI 1.6–3.7, p < 0.0001).

Conclusions

The causation of hyponatraemia is different in elderly patients. Hyponatraemia in EP is often uncorrected, despite increased mortality compared with eunatremic age-matched controls.
111 Rates and Risk Factors for Hospital Admission in People With Dementia: Systematic Review
Authors: Shepherd H , Livingston G , Chan J , Sommerlad A
Published: February 2020

Background

Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority. However, no intervention has yet reduced admissions of community-dwelling people with dementia. We therefore aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia, and to identify socio-demographic and clinical predictors of hospitalisation.

Methods

We searched MEDLINE, Embase and PsycINFO from inception to May 9, 2019. We included observational studies which (1) examined community-dwelling people with dementia of any age or dementia subtype, (2) diagnosed dementia using validated diagnostic criteria, and (3) examined all-cause general (i.e. non-psychiatric) hospital admissions. Two authors screened abstracts for inclusion and independently extracted data and assessed included studies for risk of bias. Three authors graded evidence strength using Cochrane’s GRADE approach, including assessing for evidence of publication bias using Begg’s test. We used random effects meta-analysis to pool estimates for hospitalisation risk in people with and without dementia.

Results

We included 34 studies of 277,432 people with dementia; 17 from US, 15 from Europe and 2 from Asia. Pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 (95% confidence interval 1.21, 1.66) in studies adjusted for age, sex, and physical comorbidity. Hospitalisation rates in people with dementia was between 0.37 and 1.26/person-year in high-quality studies. There was strong evidence that admission is associated with older age, and moderately strong evidence that multimorbidity, polypharmacy, and lower functional ability are associated with admission. There was strong evidence that dementia severity alone is not associated.

Conclusions

People with dementia are more frequently admitted to hospital than those without dementia, independent of physical comorbidities. Future interventions to reduce unnecessary hospitalisations should target potentially-modifiable factors, such as polypharmacy and functional ability, in high-risk populations.
The Role of Clinical Examination in Midface Volume Correction Using Hyaluronic Acid Fillers: Should Patients Be Stratified by Skin Thickness?
Authors: Nikolis Andreas , Enright Kaitlyn M , Lazarova Desislava , Sampalis John
Published: February 2020

Background

Aesthetic physicians have several hundred injectable products to select from. Due to differences in their manufacturing technology, these products display varying biophysical qualities, such as their cohesivity and lift capacity. Currently, there is no guidance to objectively selecting the best product for a particular patient. Therefore, an algorithmic approach is required to take specific skin characteristics into consideration.

Objectives

To evaluate (1) whether subjects seeking injectable treatments for midfacial volume loss and/or contour deficiency can be stratified based on specific skin characteristics (eg, thickness, fat quantity, bony structure) and (2) whether particular hyaluronic acid fillers perform best when used in such particular strata.

Methods

This was a prospective, Phase IV, open-label, single-center clinical trial. Thirty female patients with midface/cheek volume loss and/or contour deficiency were recruited (mean age, 53.5 years; SD, 12.57; range, 35–75 years). Subjects were treated with either Restylane Lyft (HAL) or Restylane Volyme (HAV) and followed for 4 months post-injection. Treatment allocation was based on the treating physician’s clinical evaluation and compared with ultrasound evaluation. Ultrasound images were used to confirm stratification. Safety and efficacy assessments were performed at each study visit: baseline, week 2, week 4, week 8, and week 16. Subgroup analyses evaluated whether particular strata performed best when treated with specific products.

Results

The 2 investigative products varied in their efficacy, depending on the characteristics of the subject.

Conclusions

The use of a treatment algorithm may improve outcomes for patients seeking injectable treatments for midfacial volume loss and contour deficiencies.

Level of Evidence: 2
Redrawing Wallace’s Line based on the fauna of Christmas Island, eastern Indian Ocean
Authors: Ali Jason R , Aitchison Jonathan C , Meiri Shai
Published: February 2020

Based on a comprehensive literature survey, we determined the sources of the terrestrial vertebrate species on Christmas Island, asking where they originated relative to Wallace’s Line (the southern end of the divide lies 1100 km to the east, where the Lombok Strait adjoins the eastern Indian Ocean). The two bats, Pipistrellus murrayi and Pteropus natalis, are from the west. Concerning the endemic and ‘resident’ bird species, one is from the west (Collocalia natalis), four are from the east (Accipiter fasciatus, Egretta novaehollandiae, Falco cenchroides and Ninox natalis) and the other 15 are ambiguous or indeterminate. Most of the land-locked species are also from the east: rodents Rattus macleari and Rattus nativitatis, and squamates Cryptoblepharus egeriae, Emoia nativitatis and Lepidodactylus listeria. Additionally, two have westerly origins (Crocidura trichura and Cyrtodactylus sadleiri), one is ambiguous (Emoia atrocostata) and another is unknown (Ramphotyphlops exocoeti). West-directed surface currents that flow across the eastern Indian Ocean towards Christmas Island would have facilitated most of the land-animal colonizations. We therefore suggest that Wallace’s Line be redrawn such that the landmass is placed on the Australasian side of this fundamental biogeographical boundary.
Improving diagnosis and prognosis in disorders of consciousness
Authors: Owen Adrian M
Published: February 2020

This scientific commentary refers to ‘Prognosis for patients with cognitive motor dissociation identified by brain-computer interface’, by Pan etal. (doi: 10.1093/brain/awaa026).
Sex and Pubertal Status Influence Dendritic Spine Density on Frontal Corticostriatal Projection Neurons in Mice
Authors: Delevich Kristen , Okada Nana J , Rahane Ameet , Zhang Zicheng , Hall Christopher D , Wilbrecht Linda
Published: February 2020

In humans, nonhuman primates, and rodents, the frontal cortices exhibit grey matter thinning and dendritic spine pruning that extends into adolescence. This maturation is believed to support higher cognition but may also confer psychiatric vulnerability during adolescence. Currently, little is known about how specific cell types in the frontal cortex mature or whether puberty plays a role in the maturation of some cell types but not others. Here, we used mice to characterize the spatial topography and adolescent development of cross-corticostriatal (cSTR) neurons that project through the corpus collosum to the dorsomedial striatum. We found that apical spine density on cSTR neurons in the medial prefrontal cortex decreased significantly between late juvenile (P29) and young adult time points (P60), with females exhibiting higher spine density than males at both ages. Adult males castrated prior to puberty onset had higher spine density compared to sham controls. Adult females ovariectomized before puberty onset showed greater variance in spine density measures on cSTR cells compared to controls, but their mean spine density did not significantly differ from sham controls. Our findings reveal that these cSTR neurons, a subtype of the broader class of intratelencephalic-type neurons, exhibit significant sex differences and suggest that spine pruning on cSTR neurons is regulated by puberty in male mice.
T-cell senescence accelerates angiotensin II-induced target organ damage
Authors: Pan Xiao-Xi , Wu Fang , Chen Xiao-Hui , Chen Dong-Rui , Chen Hong-Jin , Kong Ling-Ran , Ruan Cheng-Chao , Gao Ping-Jin
Published: February 2020

Aims

Aging is a risk factor for cardiovascular diseases and adaptive immunity has been implicated in angiotensin (Ang) II-induced target organ dysfunction. Herein, we sought to determine the role of T-cell senescence in Ang II-induced target organ impairment and to explore the underlying mechanisms.

Methods and results

Flow cytometric analysis revealed that T cell derived from aged mice exhibited immunosenescence. Adoptive transfer of aged T cells to immunodeficient RAG1 KO mice accelerates Ang II-induced cardiovascular and renal fibrosis compared with young T-cell transfer. Aged T cells also promote inflammatory factor expression and superoxide production in these target organs. In vivo and in vitro studies revealed that Ang II promotes interferon-gamma (IFN-γ) production in the aged T cells comparing to young T cells. Importantly, transfer of senescent T cell that IFN-γ KO mitigates the impairment. Aged T-cell-conditioned medium stimulates inflammatory factor expression and oxidative stress in Ang II-treated renal epithelial cells compared with young T cells, and these effects of aged T-cell-conditioned medium are blunted after IFN-γ-neutralizing antibody pre-treatment.

Conclusion

These results provide a significant insight into the contribution of senescent T cells to Ang II-induced cardiovascular dysfunction and provide an attractive possibility that targeting T cell specifically might be a potential strategy to treat elderly hypertensive patients with end-organ dysfunction.
Junctophilin-2 tethers T-tubules and recruits functional L-type calcium channels to lipid rafts in adult cardiomyocytes
Authors: Poulet Claire , Sanchez-Alonso Jose , Swiatlowska Pamela , Mouy Florence , Lucarelli Carla , Alvarez-Laviada Anita , Gross Polina , Terracciano Cesare , Houser Steven , Gorelik Julia
Published: February 2020

Aim

In cardiomyocytes, transverse tubules (T-tubules) associate with the sarcoplasmic reticulum (SR), forming junctional membrane complexes (JMCs) where L-type calcium channels (LTCCs) are juxtaposed to Ryanodine receptors (RyR). Junctophilin-2 (JPH2) supports the assembly of JMCs by tethering T-tubules to the SR membrane. T-tubule remodelling in cardiac diseases is associated with downregulation of JPH2 expression suggesting that JPH2 plays a crucial role in T-tubule stability. Furthermore, increasing evidence indicate that JPH2 might additionally act as a modulator of calcium signalling by directly regulating RyR and LTCCs. This study aimed at determining whether JPH2 overexpression restores normal T-tubule structure and LTCC function in cultured cardiomyocytes.

Methods and results

Rat ventricular myocytes kept in culture for 4 days showed extensive T-tubule remodelling with impaired JPH2 localization and relocation of the scaffolding protein Caveolin3 (Cav3) from the T-tubules to the outer membrane. Overexpression of JPH2 restored T-tubule structure and Cav3 relocation. Depletion of membrane cholesterol by chronic treatment with methyl-β-cyclodextrin (MβCD) countered the stabilizing effect of JPH2 overexpression on T-tubules and Cav3. Super-resolution scanning patch-clamp showed that JPH2 overexpression greatly increased the number of functional LTCCs at the plasma membrane. Treatment with MβCD reduced LTCC open probability and activity. Proximity ligation assays showed that MβCD did not affect JPH2 interaction with RyR and the pore-forming LTCC subunit Cav1.2, but strongly impaired JPH2 association with Cav3 and the accessory LTCC subunit Cavβ2.

Conclusions

JPH2 promotes T-tubule structural stability and recruits functional LTCCs to the membrane, most likely by directly binding to the channel. Cholesterol is involved in the binding of JPH2 to T-tubules as well as in the modulation of LTCC activity. We propose a model where cholesterol and Cav3 support the assembly of lipid rafts which provide an anchor for JPH2 to form JMCs and a platform for signalling complexes to regulate LTCC activity.
Inhibition of Histone Deacetylation by MS-275 Alleviates Colitis by Activating the Vitamin D Receptor
Authors: Li Chunxiao , Chen Yi , Zhu Huatuo , Zhang Xiuming , Han Lu , Zhao Zuodong , Wang Jinghua , Ning Longgui , Zhou Weihua , Lu Chao , Xu Lei , Sang Jianzhong , Feng Zemin , Zhang Yuwei , Lou Xinhe , Bo Xiaochen , Zhu Bing , Yu Chaohui , Zheng Min , Li Youming , Sun Jing , Shen Zhe
Published: February 2020

Background

Ulcerative colitis [UC] is a common chronic inflammatory bowel disease without curative treatment.

Methods

We conducted gene set enrichment analysis to explore potential therapeutic agents for UC. Human colon tissue samples were collected to test H3 acetylation in UC. Both in vivo and in vitro colitis models were constructed to verify the role and mechanism of H3 acetylation modification in UC. Intestine-specific vitamin D receptor [VDR]-/- mice and VD [vitamin D]-deficient diet-fed mice were used to explore downstream molecular mechanisms accordingly.

Results

According to the Connectivity Map database, MS-275 [class I histone deacetylase inhibitor] was the top-ranked agent, indicating the potential importance of histone acetylation in the pathogenesis of UC. We then found that histone H3 acetylation was significantly lower in the colon epithelium of UC patients and negatively associated with disease severity. MS-275 treatment inhibited histone H3 deacetylation, subsequently attenuating nuclear factor kappa B [NF-κB]-induced inflammation, reducing cellular apoptosis, maintaining epithelial barrier function, and thereby reducing colitis activity in a mouse model of colitis. We also identified VDR as be a downstream effector of MS-275. The curative effect of MS-275 on colitis was abolished in VDR-/- mice and in VD-deficient diet-fed mice and VDR directly targeted p65. In UC patients, histone H3 acetylation, VDR and zonulin-1 expression showed similar downregulation patterns and were negatively associated with disease severity.

Conclusions

We demonstrate that MS-275 inhibits histone deacetylation and alleviates colitis by ameliorating inflammation, reducing apoptosis, and maintaining intestinal epithelial barrier via VDR, providing new strategies for UC treatment.
State Formation, Criminal Prosecution and the Privy Council in Restoration Scotland
Authors: Kennedy Allan
Published: February 2020

Historians have begun to think about the emergence of the early modern ‘state’ in complex and creative ways, far from the conventional focus on overweening central bureaucracies. One component of this discourse is the role of criminal law and criminal prosecution, which, it has been argued (particularly by English scholars), assisted state-forming processes by providing a universal interface between ruler and ruled, and by demarcating common patterns of behaviour. This paper attempts to apply these ideas to the case of early modern Scotland—whose decentralised legal system and reputation for judicial barbarity has tended to discourage research—through detailed analysis of the judicial activities of the Privy Council. Focusing on the reigns of Charles II and James VII & II, the paper assesses the Council’s theoretical competence as a criminal court, and also reconstructs its day-to-day activities in terms of the kinds of cases tried, the varieties of punishment imposed, and the use of alternative mechanisms such as judicial commissions. The paper argues that the Restoration Privy Council was clearly able to utilise its judicial powers as a state-building tool, despite the general diffuseness of judicial authority in Scotland. It is suggested, therefore, that the Scottish data confirms the utility of criminal prosecution in early modern projects of state formation, underlining historians’ need to conceptualise the process in broad, multi-faceted terms.
Impact of uncertainties of GOCE gravity model on crustal thickness estimates
Authors: van der Meijde M , Pail R
Published: February 2020

In the last few years many studies have applied data of satellite gravity sensors for solid Earth applications. The use of different methodologies has been shown to result in large variations in crustal thickness even when using the same data as source. It is, however, difficult to estimate what is a significant difference between such models. Up to now the impact of the inherent uncertainty of Gravity Field and steady-state Ocean Circulation Explorer (GOCE) data on solid Earth applications has never been quantified. With this study we will provide uncertainty boundaries for crustal modelling based on the GOCE TIM5 covariance matrix. Different noise realizations have been calculated using a Monte Carlo-like simulation and added to the TIM5 model coefficients. The resulting differences in crustal thickness amount to maximum ±0.2 km, which is less than 1 per cent of the total thickness, and much smaller than many other uncertainties involved in the inversion process.
Assessing the Burden of Laboratory-Confirmed Respiratory Syncytial Virus Infection in a Population Cohort of Australian Children Through Record Linkage
Authors: Moore Hannah C , Lim Faye J , Fathima Parveen , Barnes Rosanne , Smith David W , de Klerk Nicholas , Blyth Christopher C
Published: February 2020

Background

Significant progress has been made towards an effective respiratory syncytial virus (RSV) vaccine. Age-stratified estimates of RSV burden are urgently needed for vaccine implementation. Current estimates are limited to small cohorts or clinical coding data only. We present estimates of laboratory-confirmed RSV across multiple severity levels.

Methods

We linked laboratory, perinatal, and hospital data of 469 589 children born in Western Australia in 1996–2012. Respiratory syncytial virus tests and detections were classified into community, emergency department (ED), and hospital levels to estimate infection rates. Clinical diagnoses given to children with RSV infection presenting to ED or hospitalized were identified.

Results

In 2000–2012, 10% (n = 45 699) of children were tested for RSV and 16% (n = 11 461) of these tested positive. Respiratory syncytial virus was detected in community, ED (both 0.3 per 1000 child-years), and hospital (2.4 per 1000 child-years) settings. Respiratory syncytial virus-confirmed rates were highest among children aged <3 months (31 per 1000 child-years). At least one third of children with RSV infection presenting to ED were diagnosed as other infection, other respiratory, or other (eg, agranulocytosis).

Conclusions

Respiratory syncytial virus is pervasive across multiple severity levels and diagnoses. Vaccines targeting children <3 months must be prioritized. Given that most children are never tested, estimating the under-ascertainment of RSV infection is imperative.