bluuebunny/crossref_metadata_2025 huggingface dataset:
Robust analogue of electromagnetically induced transparency for stable meta-devices
Authors: Liu Shanshan , Li Quan , Zhu Jun , Lu Guangda , Chen Tai , Wang Shuang
Published: March 2021

Recently, studying metasurface structures for mimicking the quantum phenomena of electromagnetically induced transparency (EIT) has drawn continuous attention, which promotes a new generation of functional electromagnetic devices, including slow-light devices, optical sensors, and so on. In some cases, metasurfaces which can realize stable EIT effect is of critical importance in the real applications. Here, we propose a novel planar terahertz metasurface which exhibits strong EIT behavior owing to the strong coupling between the dark mode and bright mode. The EIT effect is very robust, which is stable to various variations of the geometric parameters, opening up a new avenue to improve the device stability based on metasurfaces.
A mesoscopic digital twin that bridges length and time scales for control of additively manufactured metal microstructures
Authors: Heo Tae Wook , Khairallah Saad A , Shi Rongpei , Berry Joel , Perron Aurelien , Calta Nicholas P , Martin Aiden A , Barton Nathan R , Roehling John , Roehling Tien , Fattebert Jean-Luc , Anderson Andy , Nichols Albert L , Wopschall Steven , King Wayne E , McKeown Joseph T , Matthews Manyalibo J
Published: March 2021

We present our recent development of an integrated mesoscale digital twin (DT) framework for relating processing conditions, microstructures, and mechanical responses of additively manufactured (AM) metals. In particular, focusing on the laser powder bed fusion technique, we describe how individual modeling and simulation capabilities are coupled to investigate and control AM microstructural features at multiple length and time scales. We review our prior case studies that demonstrate the integrated modeling schemes, in which high-fidelity melt pool dynamics simulations provide accurate local thermal profiles and histories to subsequent AM microstructure simulations. We also report our new mechanical response modeling results for predicted AM microstructures. In addition, we illustrate how our DT framework has been validated through modeling–experiment integration, as well as how it has been practically utilized to guide and analyze AM experiments. Finally, we share our perspectives on future directions of further development of the DT framework for more efficient, accurate predictions and wider ranges of applications.
On the electronic structure of a recently synthesized graphene-like BCN monolayer from bis-BN cyclohexane with single-atom vacancies: a DFT study
Authors: dos Santos Ramiro M , Giozza William F , de Sousa Júnior Rafael T , da Silva Filho Demétrio A , Ribeiro Júnior Luiz A
Published: March 2021

Since the rising of graphene, boron nitride monolayers have been deeply studied due to their structural similarity with the former. A hexagonal graphene-like boron–carbon–nitrogen (h-BCN) monolayer was synthesized recently using bis-BN cyclohexane (B2N2C2H12) as a precursor molecule. Herein, we investigated the electronic and structural properties of this novel BCN material, in the presence of single-atom (boron, carbon, or nitrogen) vacancies, by employing density functional theory calculations. The stability of these vacancy-endowed structures is verified from cohesion energy calculations. Results showed that a carbon atom vacancy strongly distorts the lattice leading to breaking on its planarity and bond reconstructions. The single-atom vacancies induce the appearance of flat midgap states. A significant degree of charge localization takes place in the vicinity of these defects. It was observed a spontaneous magnetization only for the boron-vacancy case, with a magnetic dipole moment about 0.87 μ

B
.Our calculations predicted a direct electronic bandgap value of about 1.14 eV. Importantly, this bandgap value is intermediate between gapless graphene and insulating hexagonal boron nitride.
Mechanisms contributing to ado-trastuzumab emtansine-induced toxicities: a gateway to better understanding of ADC-associated toxicities
Authors: Endo Yukinori , Mohan Nishant , Dokmanovic Milos , Wu Wen Jin
Published: March 2021

In order to improve the safety of novel therapeutic drugs, better understanding of the mechanisms of action is important. Ado-trastuzumab emtansine (also known as T-DM1) is an antibody-drug conjugate (ADC) approved for the treatment of HER2-positive breast cancer. While the treatment with T-DM1 results in significant efficacy in the selected patient population, nonetheless, there are concerns with side effects such as thrombocytopenia and hepatotoxicity. While current understanding of the mechanism of T-DM1-mediated side effects is still incomplete, there have been several reports of HER2-dependent and/or -independent mechanisms that could be associated with the T-DM1-induced adverse events. This review highlights the importance of HER2-independent mechanism of T-DM1 to induce hepatotoxicity, which offers a new insight into a role for CKAP5 in the overall maytansinoid-based ADC (DM1 and DM4)-mediated cytotoxicity. This discovery provides a molecular basis for T-DM1-induced off-target toxicity and opens a new avenue for developing the next generation of ADCs.
2 Adiposity and Development of Dementia: A Systematic Review of Recently Published Longitudinal Studies
Authors: Xiang Y
Published: March 2021

Background and Objectives

The socioeconomic burden of dementia is very high and on the rise. Currently there is no cure for dementia; therefore, it is key to identify the modifiable risk factors for this condition. The association between adiposity and dementia is not yet convincingly established. This systematic review aimed to critically appraise the quality and to synthesise the findings of recently published longitudinal studies examining the association between adiposity and the development of dementia.

Methods

A comprehensive literature search on longitudinal studies published between 2013 and 2018 was conducted across MEDLINE, EMBASE, PsycINFO and SCOPUS. The quality of selected papers was assessed using the Newcastle-Ottawa Quality Assessment Scale for cohort studies (NOS) and PRISMA-IPD checklist. The results of the included studies were qualitatively synthesised.

Results

Of the 1,370 citations identified and reviewed, 10 completely met the inclusion criteria. Of the 10 included studies, 9 were high quality cohort studies, scoring an average of 8.4 out of 9 for NOS. One study was an individual patient data meta-analysis study (IPD). The IPD had high scientific rigour and largely adhered to the PRISMA-IPD checklist. In total, the 9 cohort studies included more than 2 million subjects, with 3 cohorts recruiting exclusively men. The IPD contained data from 39 cohorts and 1.3 million participants. 4 studies were conducted in highly selective cohorts. Apart from European male populations, the other populations were markedly under-represented. All studies used body mass index (BMI) as a proxy for adiposity. None of the included studies did a sample size calculation. Only half of the included studies were able to produce significant results, suggesting insufficient sample size and lack of power. The included studies reached contradictory results, with half of the studies favouring a protective effect of adiposity.

Conclusions

In view of the results and quality of the studies, this review found that there was insufficient evidence to establish the association between adiposity and dementia. Current evidence suggests an association between mid-life obesity and dementia development in late-life. Longer studies were more likely to conclude that adiposity was detrimental to health. The inconsistent conclusions could be the result of reverse causality. To conclusively establish the link between adiposity and dementia, more research with robust methodology is warranted.
3 Estimating the Burden of Dementia in Latin America and the Caribbean: A Systematic Review and Meta-Analysis
Authors: Xiang Y , Chan K , Rudan I
Published: March 2021

Background and Objectives

Rapid increase in life expectancy has resulted in an increase in the global burden of dementia that is expected to become a leading cause of morbidity in the future. Low- and middle-income countries are expected to bear an increasing majority of the burden, but lack data for accurate burden estimates that are key for informing policy and planning. Bayesian methods have recently gained recognition over traditional frequentist approaches for modelling disease burden for their superiority in dealing with severely limited data. This study provides updated estimates of dementia prevalence in Latin America and the Caribbean (LAC) for the years 2015, 2020 and 2030. Given the paucity of data, estimates were developed using a Bayesian methodology and confirmed by the traditional frequentist approach, with the aim of providing methodological insights for future disease burden estimates.

Methods

A comprehensive systematic literature search was conducted to identify all relevant primary studies published between the years 2010–2018. The quality of the included studies was critically assessed. A random-effects model (REM) and a Bayesian normal-normal hierarchical model (NNHM) were used to obtain the pooled prevalence estimate of dementia for people aged 60 and above. The latter model was also developed to estimate age-specific dementia prevalence. Using UN population estimates, total and age-specific projections of the burden of dementia were calculated.

Results

The prevalence of dementia in LAC was found to be 14% (10–21%) in those above age 60 based on REM, and 8% (5–11.5%) based on NNHM. The prevalence increased from 2% (1–4%) in people aged 60–69 to 29% (20–37%) in people above the age of 80. The number of people living with dementia in LAC in 2015 was estimated at 5.68 million, with future projections of 6.86 million in 2020 and 9.94 million in 2030.

Conclusions

The findings of this review found that burden of dementia in LAC is substantial and continues to rapidly grow. The projected rise in dementia cases in the future should prompt urgent governmental response to address this growing public health issue. We were also able to demonstrate that given the overall paucity of data, a Bayesian approach was superior for estimating disease prevalence and burden.
4 A Cross-Sectional Study of the Oral Health and Oral-Health-Related Quality of Life of Older Adults Admitted to An Acute Hospital in the North East of England
Authors: Steel B J
Published: March 2021

Introduction

Oral health has a strong relationship with general health, wellbeing and quality of life. The importance of establishing and protecting oral health in older adults is increasingly recognised. Admission to an acute hospital can be a good opportunity to assess and intervene with oral health, however data on the oral health of this population are very sparse.

Methods

A cross-sectional study of adults aged over 65 admitted to the acute medical ward within the Northumbria Specialist Emergency Care Hospital, Northumberland. Ethical approval was granted and all participants gave written consent. Data were obtained via verbal questions and a bedside visual examination by a dentist. Recorded were—gender, age, time since last dental visit, current oral symptoms, number of teeth present, number of decayed teeth, requirement for dental treatment, global oral health including health of hard and soft tissues and oral hygiene using the Oral Health Assessment Tool (OHAT) and oral-health-related quality of life using the Gohai scale.

Results

32 participants took part, 16 male and 16 female, of average age 81.9 (range 69–94). Time since last dental visit ranged from a few months to 30+ years. 14 complained of oral dryness and 7 of loose dentures. 15 had no current oral symptoms. 18 participants had no teeth. The remainder had an average of 13.3 teeth of which 5.8 were restored. 22 had dentures. 9 had active dental disease requiring treatment. OHAT score (with 0 indicating perfect health and 14 the worst score) mean 3.6. Gohai score (scored from 12 indicating best to 60 indicating worst quality of life) mean 19.4 and range 14–33.

Conclusions

The dental status of this group is variable but this study indicates the presence of troublesome oral symptoms and active dental disease requiring treatment, with a significant number not having seen a dentist for some time.
11 Frailty and the Rate of Fractures in Patients Initiated on Antihypertensive Medication
Authors: Österdahl M F , Wong A , Douglas I , Sinnott S J , Smeeth L , Williamson E , Tomlinson L
Published: March 2021

Introduction

There is concern regarding adverse effects of antihypertensive treatment, including falls and subsequent fractures, especially hip fractures. As frailty is increasingly recognised as an important risk factor for adverse outcomes, we examined its relationship to fracture rates in older patients after starting antihypertensives.

Methods

Using the Clinical Practice Research Datalink (CPRD), we identified participants over 65-years old starting a first-line antihypertensive medication. Using deficits identified in CPRD we classified patient-level frailty as “Fit”, “Mild”, “Moderate” or “Severe” using the Electronic Frailty Index. We calculated the rate of fractures by frailty level and fracture site, and determined the rate ratio (RR) of first fracture by frailty level, adjusting for confounding, using multivariable poisson regression. We conducted sensitivity analyses to additionally adjust for ethnicity, deprivation, and bisphosphonate use.

Results

44% of participants were classified as mildly frail or greater, but frail participants experienced 58% of all fractures, and 63% of hip fractures. The whole cohort showed a crude rate of 14.1 fractures/1000 person-years, with 4.5 hip fractures/1000 person-years. In severe frailty, this rises to 51.0 fractures/1000 person-years, and 17.7 hip fractures/1000 person-years. After adjustment for confounding, increasing frailty was associated with greater rate of any fracture, reaching RR 2.85 (95% confidence interval 2.43–3.33) for severe frailty versus fit. Results were unchanged in sensitivity analyses.

Conclusions

Frailty and fracture are both common in older participants who start antihypertensive medications. Increasing frailty was positively associated with increased rates of fracture. Clinicians need awareness of this relationship to consider fracture risk assessment and prevention in these patients.
15 What Influences Loss of Appetite in Older People? A Qualitative Study
Authors: Cox N J , Ibrahim K , Morrison L , Robinson S M , Roberts H C
Published: March 2021

Introduction

Appetite loss in older people is common and associated with malnutrition, sarcopenia and frailty. Management of appetite loss may prevent these health burdens but currently no effective clinical interventions exist. This is partly due to lack of knowledge about influences on appetite perceived by older individuals. These views may provide novel avenues for intervention on appetite loss. Aim: To understand older individual’s perceptions of influences on appetite loss.

Method

Semi-structured qualitative interviews with men and women aged ≥65 years, living in their own home, were audio-recorded and transcribed. Reflexive thematic analysis, with inductive coding, generated themes with data examples.

Results

13 individuals (8/13 female, 4/13 living alone) were recruited. Accounts of influences on appetite were grouped into three themes: physical, psychological and external factors. The physical theme related to a physical state of ageing, using energy and being active, and physical symptoms, illness and treatment. The psychological theme explained the influence of mood or wellbeing, the appeal of food, and reward in the activity of cooking. External factors related to influences of other people, coping with life experiences and transitions, and perceptions of health. Influences were perceived to impact on appetite loss in distinct ways, via a physical feeling of fullness (physical theme), or creating a negative experience with food and eating (psychological and external themes). Individuals tended to have either a physical or psychological focus. Importantly, illness and its treatment impacted on both appetite loss narratives.

Conclusions

A number of influences on appetite are described by older individuals, relating to their physical and psychological self, and social and environmental factors. These seem to impact on appetite loss in distinct ways, by precipitating either a physical feeling of fullness, or a negative experience with food and eating. Identifying factors affecting an individual’s appetite could facilitate person-centred approaches to management.
16 Pharmacological Interventions for Sialorrhoea in Parkinson’s Disease: A Systematic Review
Authors: Reid A , Smyth C , Reid J , Bailey M
Published: March 2021

Introduction

We looked at patients with Idiopathic Parkinson’s disease and reviewed articles that used any pharmacological therapy to attempt to reduce the volume or burden of sialorrhoea. The control was patients on placebo or receiving usual best care. The primary outcome was symptom burden of sialorrhoea.

Method

The review was registered on Prospero (CRD42016042470.) 7 electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS) were searched until April 2019 using search terms for sialorrhoea and Parkinson’s disease. We additional searched through the last 6 years of abstracts from the International Movement Disorder Conference, Movement Disorder Society International Congress and World Parkinson’s Congress. Hand searching was performed of published journals from the Movement Disorder Journal of the Movement Disorder Society and Neurology. Inclusion criteria included patients aged over 18; patients with a diagnosis of Idiopathic Parkinson’s disease; patients with the complication of sialorrhoea and any pharmacological therapy aimed at reducing sialorrhoea. All articles were assessed for risk of bias independently by two assessors using the Cochrane risk of bias tool.

Results

7 articles were included from the 1,015 screened citations. 3 studies used Botox B as an intervention with clear objective measures and low risk of bias. These studies did show a significant reduction in sialorrhoea however the largest study showed some reporting bias and the others had small numbers and a short follow up period. 1 study looked at Botox A which showed significant improvement in sialorrhoea but had short follow-up.

Conclusion

Most studies have very small numbers and were followed up for only 1 month. There was significant heterogeneity in outcome measures but little evidence of significant harm from from the treatments studied. Overall, more robust evidence is required in order to achieve a gold standard in the treatment of sialorrhoea.
18 Socio-Demographic Associations of COVID Antibody in Multi-Ethnic Healthcare Workers
Authors: Patel M , Nair M , Pirozzoli E , Cienfuegos M C , Aitken E
Published: March 2021

Introduction

Healthcare workers are particularly susceptible to developing COVID-19 owing to close and frequent contact with COVID-19 patients. This study aimed to describe prevalence of SARS-COV-2 antibodies amongst healthcare workers within a hospital trust and examine factors associated with increased prevalence of this antibody.

Methods

Data was obtained over a 4-week period in 2020 from a cross-sectional prospective survey of healthcare workers serving a multi-ethnic inner-city population who had IgG SARS-COV-2 antibody. Multiple, overlapping sources of notification were implemented to promote the availability of the test. Anonymised socio-demographic data about staff members were cross referenced with data of the antibody tests.

Results

Of 7,013,6,212 (89%) staff undertook the antibody test during the study period. The overall detection rate of IgG SARS COV-2 antibody was 26%(1584/6212). Univariate analyses reveal that there were no differences in the prevalence rates in terms of gender or age. Compared to white staff members (18%), prevalence of the antibody was significantly greater in Black(38%) and Asian(27%) staff members. The combined prevalence for all BAME staff members was 32%. The prevalence rates of staff in general wards (43%) were significantly higher other areas of the trust. For staff in emergency medicine, intensive care and anaesthetics, prevalence was 23%, whereas for other clinical teams it was 21%. In terms of professional groups, prevalence rates were highest amongst nursing and allied clinical services (28%), followed by doctors (23%), whereas, it was lower for non-clinical staff(19%).

Discussion

This large multi-ethnic hospital-based study has described the prevalence of recent exposure to SARS-COV-2 infection amongst healthcare workers and determined socio-demographic associations of this prevalence including ethnicity, professional healthcare groups, and geographical areas of work in healthcare settings. The study provides information that may be useful in future COVID studies examining the role of antibody testing both in general populations as well as in healthcare settings.
20 Comparison of Six Frailty Screening Tools in Patients Aged 65+ with An Arm Fragility Fracture
Authors: Ibrahim K , Lim T , Mullee M A , Yao G L , Zhu S , Baxter M , Tilley S , Russel C , Roberts H C
Published: March 2021

Introduction

Frailty is associated with an increased risk of falling and fracture, but not routinely assessed in fracture clinic. Early identification and management of frailty among older people with arm fragility fracture could help avoid further falls and fractures, especially of the hip. We evaluated the feasibility of assessing frailty in a busy fracture clinic.

Methods

People aged 65+ years with an arm fracture in one acute trust were recruited. Frailty was assessed in fracture clinics using six tools: Fried Frailty Phenotype (FFP), FRAIL scale, PRISMA-7, electronic Frailty Index (e-FI), Clinical Frailty Score (CFS), and Study of Osteoporotic Fracture (SOF). The sensitivity and specificity of each tool was compared against FFP as a reference. Participants identified as frail by 2+ tools were referred for Comprehensive Geriatric Assessment (CGA).

Results

100 patients (mean age 75 years±7.2; 20 men) were recruited. Frailty prevalence was 9% (FRAIL scale), 13% (SOF), 14% (CFS > 6), 15% (FFP; e-FI > 0.25), and 25% (PRISMA-7). Men were more likely to be frail than women. Data were complete for all assessments and completion time ranged from one minute (PRISMA-7; CFS) to six minutes for the FFP which required most equipment. Comparing with FFP, the most accurate instrument for stratifying frail from non-frail was the PRISMA-7 (sensitivity = 93%, specificity = 87%) while the remaining tools had good specificity (range 93%–100%) but average sensitivity (range 40%–60%). Twenty patients were eligible for CGA. Five had recently had CGA and 11/15 referred were assessed. CGA led to 3–6 interventions per participant including medication changes, life-style advice, investigations, and onward referrals.

Conclusion

It was feasible to assess frailty in fracture clinic and to identify patients who benefitted from CGA. Frailty prevalence was 9%—25% depending on the tool used and was higher among men. PRISMA-7 could be a practical tool for routine use in fracture clinics.
21 Realist Review of General Practitioners’ Role in Advancing Practice in Care Homes (Grape Study)
Authors: Chadborn N H , Gordon A L , Devi R , Williams C , Goodman C , Sartain K
Published: March 2021

Introduction

Many care home residents have high levels of complex needs and their medical care is the responsibility of the general practitioner (GP) in UK. GPs have multiple roles, including gatekeeper for access to other healthcare services and often play a leadership role in the healthcare team. Our aim is to develop realist programme theories for how GPs interact with care homes to facilitate improvements in care of residents.

Method

Using realist review we aimed to describe “what works” for GPs to be involved in improvements in care of residents. Firstly we carried out a scoping review of UK literature and interviewed GP leaders in order to build programme theory. Secondly iterative literature searches were performed in Medline, Embase, CINAHL, PsycInfo, ASSIA, Scopus and many grey literature databases. This international literature is being used to test and refine programme theories and to explore the range of contexts.

Results

A scoping search identified a small number (n = 5) of recent UK articles (2010–19) that described GP input into quality improvement. To gain insight into context, observational studies (n = 4 in UK and Ireland) were identified which described concerns about workload and resource constraints. To develop initial programme theories, we conducted interviews with 6 GP leaders, where themes of risk and specialism were identified. We are developing the following mechanisms within programme theory: where GP profession have an ownership of the agenda, this encourages GP involvement. In other initiatives, the mechanism may be a trusting relationship between GP and another practitioner, eg pharmacist.

Conclusion

Many reported projects which aim to improve care quality in care homes do not describe how the initiative relates to GP practice. We have identified mechanisms which, when present, may cause GPs to contribute leadership and medical expertise, and thus lead to successful outcomes for residents.
32 Quantifying the Prevalence of Frailty in Drug Trials and the Relationship with Serious Adverse Events
Authors: Hanlon P , Butterly E , Lewsey J , Siebert S , Mair F S , McAllister D A
Published: March 2021

Introduction

Frailty is common in clinical practice, but trials rarely report on participant frailty. Consequently, clinicians and guideline-developers assume frailty is largely absent from trials and have questioned the relevance of trial findings to frail people. Therefore, we examined frailty in phase 3/4 industry-sponsored clinical trials of pharmacological interventions for three exemplar conditions: type 2 diabetes mellitus (T2DM), rheumatoid arthritis (RA), and chronic obstructive pulmonary disease (COPD).

Methods

We constructed a 40-item frailty index (FI) in 19 clinical trials (7 T2DM, 8 RA, 4 COPD, mean age 42–65 years) using individual-level participant data. Participants with a FI >0.24 were considered “frail”. Baseline disease severity was assessed using HbA1c for T2DM, Disease Activity Score-28 (DAS28) for RA, and % predicted FEV1 for COPD. Using generalised gamma regression, we modelled FI on age, sex and disease severity. In negative binomial regression we modelled serious adverse event rates on FI, and combined results for each index condition in a random-effects meta-analysis.

Results

All trials included frail participants: prevalence 7–21% in T2DM trials, 33–73% in RA trials, and 15–22% in COPD trials. Increased disease severity and female sex were associated with higher FI in all trials. Frailty was associated with age in T2DM and RA trials, but not in COPD. Across all trials, and after adjusting for age, sex, and disease severity, higher FI predicted increased risk of serious adverse events; the pooled incidence rate ratios (per 0.1-point increase in FI scale) were 1.46 (95% CI 1.21–1.75), 1.45 (1.13–1.87) and 1.99 (1.43–2.76) for T2DM, RA and COPD, respectively.

Conclusion

Frailty is identifiable and prevalent among middle aged and older participants in phase 3/4 drug trials and has clinically important safety implications. Trial data may be harnessed to better understand chronic disease management in people living with frailty.
34 Discharge After Hip Fracture Surgery by Mobilisation Timing: Secondary Analysis of the UK National Hip Fracture Database
Authors: Goubar A , Almilaji O , Martin F C , Potter C , Jones G D , Sackley C , Ayis S , Sheehan K J
Published: March 2021

Background

To maximise the benefits of hip fracture surgery the National Institute for Health and Care Excellence Clinical Guideline recommends mobilisation on the day after hip fracture surgery based a low to moderate quality trial with a small sample size. There is a need to generate additional evidence to support early mobilisation as a new UK Best Practice Tariff (BPT).

Objective

To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30-days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death.

Method

We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between January 2014 and December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 hours of surgery) and those mobilised late accounting for potential confounders and the competing risk of in-hospital death.

Results

106,722 (79%) of patients first mobilised early. The average rate of discharge was 60.1 (95% CI 59.8–60.5) per 1,000 patient days, varying from 65.2 (95% CI 64.8–65.6) among those who mobilised early to 44.5 (95% CI 43.9–45.1) among those who mobilised late, accounting for the competing risk of death. By 30-days postoperatively, the crude and adjusted odds ratios of discharge were 2.26 (95% CI 2.2–2.32) and 1.93 (95% CI 1.86–1.99) respectively among those who first mobilised early compared to those who mobilised late, accounting for the competing risk of death.

Conclusion

Early mobilisation led to a near two fold increase in the adjusted odds of discharge by 30-days postoperatively. We recommend inclusion of mobilisation within 36 hours of surgery as a new UK BPT to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.
39 The Experiences of Treatment Burden Among People with Parkinson’s Disease and Their Caregivers: A Systematic Review
Authors: Tan Q Y , Ibrahim K , Cox N J , Lim S E , Coutts L , Fraser S , Roberts H C
Published: March 2021

Introduction

Treatment burden is the “workload of healthcare and its impact on patient functioning and well-being”. High treatment burden may lead to non-adherence to treatment regimens, poor health outcomes, poor quality of life and wasted healthcare resources. Treatment burden among people with Parkinson’s (PwP) and their caregivers has not been previously explored.

Methods

Using five electronic databases (MEDLINE, Embase, CINAHL, Scopus and PsychInfo), we conducted a systematic review of studies published since 2006 when the first National Institute for Clinical Excellence (NICE) Clinical Guideline for Parkinson’s Disease was published. This allows an understanding of the impact of current healthcare systems on treatment burden. We included qualitative and mixed-method studies with a qualitative component that reported data from PwP and/or caregivers. Quantitative studies, qualitative data from clinical trials not related to usual care and grey literature were excluded. Two reviewers independently screened articles and extracted data. Data analysis was conducted using framework analysis.

Results

1757 articles were screened, and 39 included in this review. Understanding treatment burden among PwP and their caregivers was not the primary aim in any of the included studies. They described the experiences of those living at home and during hospital or care home admissions. Issues with medications (adherence to advice, effectiveness, side-effects and timing), obtaining appropriate levels of information and healthcare provision (lack of integrated care, care coordination and person-centred approach) were among factors that exacerbate treatment burden experienced by PwP and caregivers. Both reported the impact of Parkinson’s on their daily lives, physical and mental exhaustion of self-care and limitations on their role and social activities.

Conclusion

This review describes considerable treatment burden experienced by PwP and their caregivers and its major influences including aspects of current healthcare provision. Future research should focus on patient-centred care with service redesign to improve this treatment burden.
42 Is Mitochondrial Function Measured by 31P Magnetic Resonance Spectroscopy Associated with Physical Performance in Older People with Functional Impairment?
Authors: Chungath R R , Witham M D , Clarke C L , Hutcheon A , Gandy S , Gingles C , Priba L , Nicholas S , Cavin I , Sumukadas D , Struthers A D , George J
Published: March 2021

Background

Mitochondrial dysfunction has been proposed as a therapeutic target to improve muscle strength and endurance, but the contribution that mitochondrial dysfunction makes to impaired skeletal muscle performance in older people remains unclear. We studied the relationship between phosphocreatine recovery rate (a measure of skeletal muscle mitochondrial function) and physical performance in older people.

Methods

We analysed data from the Allopurinol in Functional Impairment (ALFIE) trial. Participants aged 65 and over, who were unable to walk 400 m in six minutes, underwent 31P magnetic resonance spectroscopy of the calf after exercise at baseline and at 20 weeks follow up. The phosphocreatine recovery half-life time (t-half) was derived as a measure of mitochondrial function. Participants also undertook the 6-minute walk distance, the Short Physical Performance Battery test (SPPB), and had muscle mass measured using bio-impedance analysis. Bivariate correlations and multivariable regression analyses were conducted to determine associations between t-half and baseline factors.

Results

One hundred and seventeen people underwent baseline 31P magnetic resonance spectroscopy, mean age 80.4 years (SD 6.0); 56 (48%) were female. Mean 6-minute walk was 291 m (SD 80) and mean SPPB score was 8.4 (SD 1.9). T-half was significantly correlated with SPPB score (r = 0.22, p = 0.02) but not with 6-minute walk distance (r = 0.10, p = 0.29). In multivariable linear regression, muscle mass and weight, but not t-half, were independently associated with SPPB score and with 6-minute walk distance. The change in t-half between baseline and 20 weeks was not significantly associated with the change in SPPB (r = 0.03, p = 0.79) or with the change in 6-minute walk distance (r = −0.11, p = 0.28).

Conclusion

Muscle mass, but not phosphocreatine recovery time, was associated with Short Physical Performance Battery score and 6-minute walk distance in this cohort of older people with functional impairment.
43 Renewing the Frailty Experience: Bringing CGA Into the Emergency Department
Authors: Saxton N , Mayne D
Published: March 2021

Topic

Early recognition and multidisciplinary management of frail patients in acute care is a national priority. This is reflected in the NHS 10 year plan, NHS Improvement (NHSI) and Getting It Right First Time (GIRFT) ambitions for acute care. The Sunderland Royal Hospital acute frailty service currently reviews frail patients on the Medical Admissions Unit (MAU) each morning. Analysis of our emergency department (ED) data demonstrates that most frail patients arrive to the ED between 12 pm and 18 pm leading to a cohort of frail patients who are not receiving comprehensive geriatric assessment early in their patient journey. Here, we present our piloted expansion of the frailty service into the ED.

Intervention

Currently the frailty service is provided on MAU between 9 am and 1 pm. The pilot service expansion ran for five weeks between September and October 2018 and involved the acute frailty team being available to ED and MAU from Monday to Friday 0830 am to 1700 pm. Frail patients were proactively identified using the ED patient tracker as well being referred to the team by ED staff.

Improvement

During the pilot, the team reviewed 131 additional patients. 85% were seen in ED. 61 patients were discharged directly from ED and 33 patients were admitted directly to a back of house medical ward resulting in reduced MAU occupancy rates in the evenings. Concerns that bringing full MDT assessment into ED might result in increased time spent in ED were proven to be unfounded. Median length of stay for admitted patients was low with 49% discharged within 7 days and 9.9% 30 day readmission rate. Feedback from ED and community teams was positive.

Discussion

It is recognised that early CGA is beneficial for patients with frailty syndromes who are admitted to hospital. Most commonly, this takes place on medical admissions wards. Through this pilot, we have demonstrated significant added benefits of bringing the acute frailty team and crucially CGA into the emergency department setting. As well as increased discharges directly from ED, we demonstrated a reduction in length of stay and readmissions as well as improved patient flow. Our aim is to permanently implement a seven day frailty service with input on MAU as well as ED.
46 Promoting Advance Care Planning of Patients with Parkinsonism in the Community
Authors: Lim C Khuang , Miller C , Jones T
Published: March 2021

Introduction

NICE guideline recommends that all patients with Parkinson’s disease should be reviewed every 6–12 months and offered opportunities to discuss Advanced Care Planning (ACP) (1, 2). There is evidence demonstrating that Advanced Care Plans results in shorter length of stay in the last year of life and lower hospital costs (2, 3). A local baseline audit showed that Advanced Care Planning was not performed adequately.

Methods

A local baseline audit on community care home patients with Parkinsonism was completed in February 2018. A community-based Parkinson’s clinic was commenced in June 2018. Patients with parkinsonism who were unable to attend hospital clinics due to underlying frailty, neuropsychiatry and physical issues, were reviewed. At each visit, advice was provided on medicines management and there were discussions around Advance Care Planning.

A re-audit was completed in August 2019. Patient’s Electronic Patient Records were scrutinised to evaluate progress and identify those who had died. Data was analysed using Microsoft Excel.

Results

The initiative contributed directly to end of life care in 7/17 patients. Parkinson’s disease medications were rationalised in 11/17 (64.70%). 14/17 (82.35%) had a community-based Do Not Resuscitate order completed.

Conclusions

The community Parkinson’s clinic service promoted Advance Care Planning in patients with Parkinsonism. This service provides specialist input in frail older people with Parkinsonism who were unable to attend hospital clinic, promoting end of life choices around where they wished to die and avoiding unnecessary hospitalisation in the final stages of their life.
47 What are the Associations Between Renal Biochemistry and Physical Performance in Older Patients with Advanced Chronic Kidney Disease? Findings From the Bicarb Trial Cohort
Authors: Witham M D , Lamb E J , Sumukadas D , Band M M , Soiza R L , Hampson G , McNamee P , Avenell A
Published: March 2021

Background

Impaired physical performance is common in older people with advanced chronic kidney disease. It is unclear which metabolic derangements contribute to this impairment. This analysis examined cross-sectional associations between renal biochemical indices and physical performance in older people with advanced chronic kidney disease.

Methods

We analysed data from the BiCARB multicentre trial, which enrolled patients aged 60 and over, with chronic kidney disease stage 4 or 5, not on dialysis, and with serum bicarbonate <22 mmol/L. Participants undertook baseline Short Physical Performance Battery (SPPB), grip strength and six minute walk test. Renal biochemistry (serum creatinine, cystatin C, phosphate, bicarbonate), haemoglobin, and NT-pro-B-type natriuretic peptide (NTproBNP) were measured at baseline. Associations were tested using Spearman’s rho and generalised linear modelling using forced entry was used for multivariable regression analysis.

Results

The analysis included 300 participants (mean age 74 years; 86 [29%] women). Mean baseline SPPB was 8.1 points (SD 2.3); mean six-minute walk distance was 311 m (SD 132). Age (r = −0.27, p < 0.001) and BNP (r = −0.27, p < 0.001) were most strongly associated with the SPPB. Age (r = −0.33, p < 0.001), haemoglobin (r = 0.24, p < 0.001), cystatin C (r = −0.21, p < 0.001) and NTproBNP (r = −0.32, p < 0.001) were most strongly associated with six-minute walk distance. For grip strength, age (r = −0.35, p < 0.001), cystatin C (r = −0.24, p < 0.001), and NTproBNP (r = −0.31, p < 0.001) were most strongly associated in men, with similar but weaker associations for women. Creatinine and bicarbonate concentrations were not significantly associated with any physical performance measures. Factors in multivariable regression independently associated with six-minute walk distance were age, sex, BMI, cystatin C, phosphate and NTproBNP; with SPPB were age and BMI; and with grip strength were age, sex and cystatin C.

Conclusions

Some biochemical markers related to kidney function are modestly associated with physical performance in older people with advanced chronic kidney disease; patterns differ between different performance measures.
147 Improving Urine Specimen Collection in Elderly Medical Inpatients—A Quality Improvement Project
Authors: Singh S , Abbas Z , Yousuf Q
Published: March 2021

Introduction

The National Institute for Health Research reported in 2012 that urinary tract infections are a significant cause of mortality especially among the elderly population with 4,835 deaths in England and Wales. During an elderly care rotation, it was noted that a number of elderly inpatients were being treated for UTIs without urine samples for culture and sensitivity being collected. They were treated with antibiotics largely on the basis of positive urine dipsticks and/or clinical signs and symptoms. Despite local policy reflecting current national guidance on the diagnosis of UTIs in the elderly population, compliance remained poor.

Method

A quality improvement project using both quantitative and qualitative methodology was designed to determine the number of elderly medical inpatients (≥ 65 years) who have had urine sampling done within 48 hours of presentation as well as to seek to improve this aspect of patient care by determining limiting factors which could prove a hindrance to urine sampling in this age cohort. Quality improvement methods were used to improve and optimise urine sampling rates.

Results

The percentage of elderly medical inpatients having a urine sample taken on admission during the project period increased from 35% to just under 100%. Quality improvement methods have successfully identified and improved this aspect of the elderly care service leading to better patient care.

Conclusion

It was identified that lack of awareness and communication from both sides of the medical and care teams contributed to untimely urine sampling at our hospital. Education and personal discussion represents a sustainable intervention which could easily be replicated in other Trusts. Further work is underway with the development of a teaching session to support nurses and clinical support workers obtaining urine samples from incontinent patients undertaken by one of our community continence clinical nurse specialists.
50 Using A Targeted Teaching Intervention to Drive up the Quality of Discharge Summaries. Shop 75+
Authors: Robey R C , Danson A , Evans J , Froggatt J , Pederson A , Cross T , Vilches-Moraga A , Gaillemin O
Published: March 2021

Background

Quality improvement project examining discharge communication, and a targeted teaching intervention.

Introduction

Poor quality, incomplete or missing discharge summaries (DSs) are associated with avoidable/ameliorable adverse events after discharge [1]; preventable readmission [2,3]; failure to implement discharge plans [4]; and medication continuity errors [4,5].

Methods

To review the quality of DSs produced, each month forty representative DSs are randomly selected from four clinical areas and qualitatively assessed (total > 1,000, August 2017—to date). Alongside this, in August 2018, incoming foundation doctors were surveyed on perceptions of the purpose/importance of DSs, and training provided on writing them. They were resurveyed after teaching delivery in November 2018 and April 2019.

Interventions

Data from QI review and survey were used to generate a teaching intervention, in the form of an interactive slide set for delivery in small group settings. This was delivered in weekly mandatory teaching sessions. PDSA cycles were completed for teaching sessions, and the slide set was developed accordingly.

Results

After the teaching sessions, we noted improvement in satisfaction with training provided on writing DSs (from 24% to 40%), as well as confidence in writing high-quality DSs (from 28% to 100%). We demonstrated increases in responses including the patient as an intended audience for the DS (from 51% to 84%), and rating “patient information in lay terms” of “high importance” (from 41% to 72%). These changes in perceptions were accompanied by improvement in the quality of DSs produced, particularly with respect to the quality of follow-up actions detailed and the quality of patient information provided in lay terminology. The average monthly proportion of DSs achieving a “great score” in these areas increased from 20% and 28% respectively (August 2017—June 2018), to 44% and 71% (August 2018—March 2019).

Conclusions

These data provide proof-of-principle that targeted teaching, constructed around prior questionnaire surveys, improves awareness of the purpose of DCs and leads to improvement in the quality of DSs produced and enhanced patient safety.
149 Non-Pharmacological Treatment of Bone Health in Fallers
Authors: Moran E
Published: March 2021

Introduction

1 in 2 women and 1 in 5 men will suffer a fragility fracture. Research into calcium and vitamin D supplements has found no consistent evidence to suggest that they reduce the risk of osteoporotic fractures. There has been little research to suggest that dietary calcium is effective at reducing the risk osteoporotic fractures, but supplements have been linked to increased risk of cardiovascular disease and urinary stones. Bisphosphonates have been shown to reduce the risk of osteoporotic fractures and are usually taken in combination with calcium and vitamin D supplements given that deficiencies must be corrected prior to starting. This study set out to assess the dietary calcium intake of patients who attend the falls clinic and explore their attitudes towards dietary change, as an alternative or adjunct to a calcium and vitamin D tablet.

Methods

Data was collected during private interviews conducted with patients who attended the falls clinic. The Edinburgh University Centre for Genomic and Experimental research (CGEM) food frequency calculator was used to calculate dietary calcium intake. Microsoft Excel was used to collate and analyse the data.

Results

No association was found between dietary calcium intake, age and sex. We did find that mean dietary calcium intake was significantly less than the recommended daily amount for adults with osteoporosis, with 80% not getting their recommended daily intake (p < 0.05). We identified patients who don’t receive a calcium and vitamin D supplement as an at-risk group who would benefit from advice on sources of dietary calcium and 83% of patients said that they would be interested in a leaflet on sources of dietary calcium.

Conclusion

This study has identified a group of patients who will hopefully benefit from a leaflet on sources of dietary calcium and as result improve their bone health.