bluuebunny/crossref_metadata_2025 huggingface dataset:
2851 Reducing the number of unplanned admissions to hospital through a multidisciplinary single point of access pre-hospital
Authors: Sage S , Baxter A , O’Riordan S , Seeley J , McGarvey J
Published: January 2025

Background

East Kent has 38,101 people over 80 years, 39, 021 living with moderate or severe frailty and 304 care homes. This population have high levels of unplanned admissions which can put them at risk of long hospital stays, reduced mobility and increased delirium. East Kent Ambulance services (SECAMB), Acute hospitals (EKHUFT) and Community Services (KCHFT) have piloted a single-point of access consisting of an ED consultant, community frailty clinician, Urgent care senior nurse, advanced paramedic practitioners. They sit together at the ambulance bases, 10 am-6 pm Monday to Fridays. This team reviews all patients awaiting ambulances to assess whether there are alternative services to ED which would meet the individuals’ needs.

Method

The MDT assesses all patients listed as awaiting an emergency ambulance. Clinical records can be accessed from all services including GP records. If patients would benefit from treatment by alternative services, rather than conveyance, the paramedics are asked to call the MDT. This allows clinical assessment, history and investigation results to be taken into account in planning care. Patients and Carers are involved in deciding how they would like to receive medical care via a video or phone link with clinicians.

Results

Conveyance to hospital pre pilot 62% post pilot less than 50%. Ashford catchment: admissions save weekly 27.3, bed days saved weekly 179.2. Thanet Catchment: admissions saved weekly 19.1, bed days save weekly 106.9.

Conclusion

Many people can be treated effectively without conveyance to hospital through pre-hospital triage, consultation and planning by senior clinicians in a multi-disciplinary team.
2890 Exercise practitioner-led physical activity in hospitalised older people: saints foundation—university hospital Southampton
Authors: Draper P , Batchelor J , Diamante N , Hedges P , Gealer M , McCafferty R , Leli H , Patel HP
Published: January 2025

Introduction

University Hospital Southampton (UHS) and Saints Foundation (SF) have partnered to test and deliver rehabilitation to hospitalised older adults via a non-registered Exercise Practitioner (EP) to promote physical activity (PA) and address hospital associated deconditioning. Now in its third phase, the project has evolved in response to patient and staff feedback. It delivers regular gym-based exercise classes and additional interventions, which have maintained or improved patients’ dependency levels on discharge.

Method

From September 2023, the EP has delivered daily gym-based group interventions as well as 1:1 rehabilitation to hospitalised older adults. In addition, exercise prescription education for staff and signposting to community-based interventions is provided. Interventions take place in the acute therapy gym or wards.

Results

Between October 2023 and February 2024, the EP reviewed 115 patients, with a mean age of 86 yrs. 90 (78%) underwent group-based intervention whereas 25 (22%) received 1:1 input. 100 (87%) patients maintained or improved their predicted to actual discharge destination, compared to 13 (11%) whose physical capability declined and 2 (2%) who died. 20 (17%) were readmitted within 30 days of discharge. Elderly Mobility Scores (EMS) improved from a mean of 13.42 to 13.97. Most patients were reviewed twice or more. Most patients (79% after 2 interventions) maintained a 4 m gait speed score of >0.8 m/s. Patient satisfaction and confidence in function rated high.

Conclusion

Intervention via a non-registered EP continues to have a positive impact on older adults’ ability to maintain or improve function during an acute hospital stay. Factors such as outbreaks of infectious illness, staff absence and vacancies and high patient acuity prevent more frequent EP led intervention. Although overall strength and functional gains are limited, patient confidence in function remains high. Our future aim is to expand the project across UHS and bridge the gap to community rehabilitation services.
2765 Reducing avoidable discharge delays on an elderly admissions Ward
Authors: Newton-Clarke A , Atkinson M , Shelton K , McDaniel S
Published: January 2025

Introduction

Our aim is to improve clinical efficiency by reducing avoidable discharge delays, increased number of discharges and availability of specialist Frailty beds. We intend to undertake 8 PDSA cycles with a new idea.

Background

23 bedded Acute Frailty Short Stay Unit (AFU). Patient group defined as those admitted to the unit from April ‘24 to current. Our initial spot-audit analysed 18 patients; the mean total avoidable delay was 31.52 hours (range 4.73–123.3 hours). Initial analysis demonstrated that delays became longer throughout the course of the day.

Methods

We evaluated staff opinions on the discharge process with a survey. Outcome measure identified as number of weekly discharges and appropriate patient flow to the AFU. Balancing measure identified as number of readmissions within 48 hours. PDSA cycle 1 allocated a doctor to write discharge letters during MDT. PDSA cycle 2 allocated a suitcase symbol to a potential discharge in the next 24 hours. We then adapted the suitcase with colours to differentiate between ready and awaiting investigations/aim home in 24 hours. The next involved allocating a discharge doctor to review patients with an amber suitcase from the previous day first.

Results

Initial staff feedback has been positive. Data demonstrated an increase from the baseline (from below 20 to an average of 25 discharges a week). This then dipped throughout May, during which time there was an unusual level of escalation, staff absences and annual leave. The data has begun to recover to a high of 27 discharges in the week of the start of June.

Conclusions

Utilising the MDT has been vital in the sustainability of the project. On-going staff surveys and regular meetings will help to ensure sustainability. Ongoing focus and further cycles are on encouraging junior members of the team to be involved with the intervention.
2780 Avoiding acute admissions by working in a multi-disciplinary team alongside paramedics in the West Kent clinical navigation hub
Authors: Heskett A , Mummaneni J , Hicks W
Published: January 2025

Introduction

Home Treatment Service (HTS, a Frailty Hospital at Home model that provides Comprehensive Geriatric Assessment, diagnostics and treatments to avoid hospital admission for people with frailty) within Kent Community Health NHS Foundation Trust has increased links with the Acute and Ambulance Trusts. The MDT interacts with visiting paramedics within a clinical navigation hub (CHUB).

Method

61 HTS referrals from the CHUB were compared with 61 direct clinician referrals from December 2023 to February 2024. The NEWs score, length of stay (LOS) and Advance Care Planning (ACP) documents were analysed.

Results

The average LOS under HTS via the CHUB was 2.61 days and 3.65 days for direct referrals. 27% of NEWS scores from the CHUB were high compared with 14% from direct referrals. 48 out of the 61 (78.6%) patients identified as requiring HTS by the CHUB had no ACP documents (the presence of a DNAR was not counted as this does not give community options). 37 out of 61 (60.6%) had no ACP on direct referral to HTS triage.

Conclusion(s)

Referrals directed to HTS proactively from the CHUB have a higher percentage of NEWS scores that would require hourly observations and/or escalation to medical assessment. The CHUB explores community options while weighing benefits and risks of transfer to hospital in real time. The LOS between the two referral sources is not hugely different and suggests that we are identifying patients requiring similar management regardless of source of referral. The CHUB gives options to patients who have fewer advance decisions recorded to support the direction of their care at the point of an emergency response. The CHUB allows HTS to access a different group of patients who may not have had routes to HTS enabled previously.
2812 Local radiological reporting of vertebral fragility fractures: a missed opportunity for early osteoporosis intervention?
Authors: Ali F , Obasi E , Burger R , Rodwell-Shah S
Published: January 2025

Introduction

Vertebral fragility fractures (VFFs) are the most prevalent form of osteoporotic fracture, with an incidence of >20% in women >70 years old1. While often clinically silent in isolation, VFFs are associated with future osteoporotic fractures, decreased quality of life and an 8-fold increase in age-adjusted mortality2. Radiologists may facilitate early diagnosis of VFFs, allowing for more cost-effective intervention with greater patient outcomes 3. However, a national audit in 2019 demonstrated widespread failings in the radiological recognition and reporting of VFFs1, according to criteria outlined by the Royal Osteoporosis Society4. Crucially, only 2% of reports in patients with moderate–severe VFFs recommended referral to Fracture Liaison Services (FLS), compared to the national target of 100%. Here, we evaluate local VFF recognition and reporting performance, relative to the Royal College of Radiologists (RCR) targets5.

Methods

Single-centre retrospective analysis of all CT thorax, abdomen and pelvis scans in >50-year-olds. Two cycles were completed, with implementation of educational posters and a quick-code reporting alert between cycles. The proportion of reports meeting best practice criteria were measured. The criteria included: assessment of bony integrity (target 100%), correct identification of moderate–severe VFFs (target 90%), use of correct terminology in reports (target 100%), referral of moderate–severe VFFs to the FLS (target 100%).

Results

Bony integrity was assessed in 100% in both cycles. Identification of moderate–severe VFFs improved from 37% to 64% between cycles. Correct terminology was used in 63% and 56% of reports in the first and second cycles respectively. 0% of patients were recommended for FLS referral in both cycles.

Conclusion

This audit demonstrates local shortcomings in VFF recognition and reporting. While there was an improvement in identification of VFFs between cycles, RCR targets were still not met post-intervention. This reflects a nation-wide issue in the under-diagnosis.

References available on request.
2608 Improving the uptake of telephone interpreter Services for non-English Speaking Patients in South Yorkshire
Authors: Srivastava N , Pinidiya J , Marsh J
Published: January 2025

Introduction

Language is a social determinant of health, as constituted by the World Health Organisation (WHO) back in 1948. UK migration rates have risen exponentially recently, and with it the inability for patients to speak functional English is a growing concern. Poorer health information and avoidance of service use creates fundamental health inequity within this demographic. The UK’s ever-changing sociodemographic landscape necessitates a growing focus on health outcomes within non-English speaking patients.

Aim

To explore the barriers towards interpreter service use within South Yorkshire and how to improve communication with non-English speaking patients.

Method

Data was collected in a mixed quantitative-qualitative approach. A yes/no approach was adopted to answer the study objectives (i.e. whether family members had translated on behalf of relatives or if interpreter service use was documented). Observational comments from the notes were used to contextualise the data for further discussion. This was compared to available UK guidelines.

Findings

There was a widespread reliance on family members to interpret on patients’ behalf, seen in 75% of non-English speaking patients on the sampled wards. Only 50% of these patients had documented use of interpreter phone lines across the wards, significantly below the audit’s standards.

Discussion

Barriers to interpreter services may be attributed to inefficiencies within its online nature, including queues and connectivity issues. This discourages its uptake, especially in the face of increasing hospital pressures. The high reliance on family members requires ethical considerations. These include issues with confidentiality, poor safety netting and disjointed communication of diagnoses when family members are used to translate. Ultimately, reliance on family members should be actively discouraged. This project recommends a language assessment tool and identification charts to guide NHS staff to appropriate interpreter services, preventing care delays.
2731 Evaluation of practice of advanced care planning in GIM wards in Queen Alexandra Hospital/Portsmouth hospitals university trust
Authors: Yahia G , Almoukadem M , Kanaan A , Hasanli E
Published: January 2025

Introduction

In today’s healthcare practice, many patients live longer with multiple health issues, often in a frail or terminally ill state. Their quality of life doesn’t necessarily improve. These patients require optimal supportive care that respects their dignity. Advanced Care Plans (ACPs) are crucial here, facilitating person-centred discussions about future care preferences while the patients have the mental capacity for meaningful participation. We aim in this study to assess how many patients in General Internal Medicine department would benefit from ACP and compare that to our current practice in implementing ACPs.

Method

This cross-sectional retrospective study was done in 2 instances, 1 month apart from 29/03/23 to 01/05/23. The Sample size was 300 patients. The eligibility criteria were life expectancy of 12 months or less, age of 80 years and above, Clinical Frailty Scale (CFS) 8 or more, advanced dementia, and end-stage disease.

Result

33 patients (11%) met the eligibility criteria for ACP. 8 patients (24.2%) were above the age of 85. 25 patients (75.8%) had a Clinical Frailty Scale score higher than 7. 12 patients (36%) had terminal cancer. ACP was done for only 6% of the cases that meet the eligibility criteria. Within three months, 90% of these cases passed away. It is important to mention that in 57.6% of the cases, ACP was discussed with the patient and the next of kin (NOK) but was not formally documented.

Conclusion

Our findings revealed that only 6% of the eligible cases had evidence of ACP. This aligns with the study ‘advanced care planning in patients referred to the hospital for acute medical care: Results of a National Day of Care survey’ which showed 4.8% had an ACP. The absence of ACP in the vast majority of re-admitted patients represents a significant missed opportunity to improve care.
2843 Evaluating dementia pathway services: a Sussex-wide patients and carers’ perspective
Authors: Coleman L , Mensah E , Ali K
Published: January 2025

Introduction

As the prevalence of dementia continues to increase across the UK, understanding the lived experience of patients and carers affected by dementia becomes paramount. There is an established dementia pathway in Sussex for people living with dementia (PLWD) and their carers. To improve care and inform future commissioning priorities, the Brighton and Hove Health Watch (BHHW- a community interest company) surveyed the opinions of a group of PLWD and their carers around initial diagnosis and subsequent support.

Methods

PLWD and their carers receiving social support and willing to provide feedback were included in this survey. Using a topic guide, BHHW volunteers conducted a telephone interview with this group exploring their experience with their general practitioner (GP), and the memory assessment service (MAS) in relation to diagnosis, and post-diagnosis support. Transcribed interviews were analysed using qualitative thematic analysis (inductively and deductively) using Braun and Clarke’s method.

Results

Forty-five participants were interviewed, 37 carers and 6 PLWD (average age 78.2 range 64–95 years) between December 2022 and May 2023. Thirty-nine participants (86%) were of white-British ethnicity. Participants reported a range of different experiences with no consistent pattern by age, gender or location. Participants were generally satisfied with the initial GP care they received. The waiting time to access MAS was six weeks on average, an acceptable timeframe for the group. Some participants reported waiting as long as two years since the initial GP consultation before a dementia diagnosis was eventually made. Participants were generally satisfied by the thorough MAS review. Most participants felt that the information material they immediately received after dementia diagnosis was complex and overwhelming. Social support offered post-diagnosis was commendable.

Conclusion

The lived experience of PLWD and their carers in Sussex was generally positive. However, a tailored approach to post-diagnosis information provision is required.
2826 The effect of age and frailty on outcomes for older adults admitted with acute coronary syndrome: an analysis of MINAP registry
Authors: Chakravorty MK , Sritharan S , Capper I , Nakum S , Chakraborty T , Kaza N , Jethwa N , Shah J
Published: January 2025

Introduction

Frailty, independent of age, is associated with adverse outcomes following admission with Acute Coronary Syndrome (ACS) but is often not accounted for in risk stratification scores. Those identified as frail may not be considered for invasive interventions despite evidenced benefits (1) and are at risk of worsening geriatric syndromes on discharge.

Purpose

We aimed to assess clinical outcomes in older adults admitted with ACS, with or without frailty to suggest if there is a role for geriatrician input in improving healthcare usage and preventing adverse events.

Method

Anonymised data was obtained from an NHS trust’s MINAP registry of patients admitted with ACS between April 2022 to March 2023. Baseline demographics, Clinical Frailty Score (CFS), GRACE and HEART scores, total length of stay (LOS), days as inpatient pre- and post-procedure, adverse events during admission, readmission rates and all-cause mortality rate at 30 days and 1 year were calculated.

Results

288 patients over age 65 admitted with ACS were included in analysis. Median age was 73 [IQR 67–80.75]. Patients over 75 years had higher rates of frailty (38.5% of 75–84 years and 50.0% over 85 years had CFS ≥ 5 versus 14.9% 65–74 years (p < 0.00001)). 253 (87%) patients underwent invasive angiogram during admission. Although age was not a limiting factor, frail patients were less likely to have an angiogram: 24.9% of CFS ≥ 5 versus 57.1% of CFS ≤ 3 (p = 0.00199). Mean LOS was 9.02 days with a median of 7[IQR 4–12]. There was a trend for longer LOS post-angiogram particularly for patients with CFS 4–5 versus CFS ≤ 3 (11.3 days v 8.92 days p = 0.053).

Conclusions

Input from geriatricians and wider multidisciplinary team may help to optimise decision-making and care of patients admitted with ACS with mild to moderate frailty.

Reference

1. Damluji et al. J Am Heart Assoc. 2019;8:e013686.
2603 Optimising the research capacity and capability within a multi-disciplinary (district general hospital) elderly care department
Authors: McColl AJ , Chatterjee A , Joseph M , Sammour M
Published: January 2025

Introduction

Older adults, particularly those with multi-morbidity, frailty or cognitive impairment, are under-represented in clinical research studies. To facilitate inclusive research for this population requires empowerment of all members of the multi-disciplinary team to promote and advocate for this underserved population. However, understanding of the personal and organisational barriers to staff engagement with research within Elderly Care remains limited.

Method

Using an amended version of the research capacity and culture tool an anonymous online survey open to all staff members of an Elderly Care Department (n = 351) in a District General Hospital was undertaken. The survey results were used to inform the departmental 5-year research strategy and launch a multifaceted educational and engagement programme.

Results

107 responses to the survey were received with a wide multi-disciplinary contribution. Despite 89% of respondents stating research was not part of their job, 96% were willing to be more involved in research. Motivators to staff engagement in research included: dedicated time for research (74%), research skills training (73%), mentors (67%), research relevant to elderly care (62%), hearing from researchers within the department (54%) and local promotion of research studies (49%). Barriers to research included: lack of time (78%), unsure of opportunities (65%) and lack of skills (47%). As a result of the survey numerous departmental interventions have been staged: a multi-disciplinary research half day, research opportunity display boards, monthly departmental presentations, promotion of the associate Principal Investigator scheme, Q&A webinars and a section in quarterly newsletter.

Conclusion(s)

Multi-disciplinary staff working within Elderly Care can be motivated to advocate and engage with research opportunities for older adults. Supporting their engagement through the provision of dedicated time, research skills training and promotion of opportunities is key.
2775 Advancing professional development in older People’s healthcare: a survey of BGS and UKCPA pharmacy professionals
Authors: Alićehajić-Bečić Đ , Mitchell A
Published: January 2025

Introduction

The British Geriatrics Society (BGS) highlighted the need for workforce improvement and development of a skilled multidisciplinary team (MDT) in older people’s healthcare in their 2024 roundtable, ‘Transforming care for older people’. This survey aimed to gather views from pharmacy professionals on career progression and how the BGS and UK Clinical Pharmacy Association (UKCPA) can support their advancement in this speciality.

Method

A Google Forms questionnaire was designed to collect data on demographics, education, working practices, and specialisation. Respondents were asked about the need for defined core competencies and an advanced curriculum for the speciality, as well as the support professional groups should provide. The survey was distributed through BGS and UKCPA communication channels.

Results

Thirty-eight pharmacy professionals responded, with pharmacists comprising the majority (n = 37, 97%), working primarily in secondary (n = 21, 55%) and primary care (n = 12, 32%). Most respondents were female (n = 31, 82%) and 61% (n = 23) identified as white British. Over 80% (n = 31) were at a senior level (band 8a or above), with 68% (n = 26) having over 10 years’ experience. Many identified as specialists in care of older people (n = 29, 76%). There was unanimous support for an advanced pharmacist curriculum specific to older people’s care for those seeking to credential at an advanced level, and 90% (n = 34) agreed on the need for core competencies for all pharmacy staff in this area. Key themes to enable progression included structured support, mentorship, clear career pathways, accredited courses, and opportunities to share expertise.

Conclusion

The BGS and UKCPA are well-positioned to develop an advanced curriculum in older people’s healthcare, aligned with existing professional pathways already implemented by the Royal Pharmaceutical Society. Joint initiatives to provide structured development opportunities could enhance the specialist workforce, ensuring high-quality pharmacy services are provided routinely as part of multidisciplinary teams caring for older people.
2820 A survey assessing medical Professional’s confidence and understanding of Iron studies in elderly people
Authors: Freeman N , Ninan S
Published: January 2025

Introduction

Iron deficiency anaemia (IDA) is common in older people, but traditional ferritin cutoffs may not be applicable in older people and iron studies are increasingly being used to diagnose iron deficiency anaemia. We wish to update guidance for diagnosing IDA, but first wished to survey current knowledge.

Method

Clinical staff working with older people were asked to complete a survey. They answered questions relating to confidence in interpreting ferritin and iron studies. Their knowledge of interpreting iron studies was assessed with two multiple choice questions illustrating common scenarios.

Results

When asked on a scale of 1–5 how confident the 126 participants were at interpreting ferritin, the mean was 3.7. For iron studies, it was 3.26. Among consultants, the mean confidence in interpreting ferritin was 4.19, in doctors of other grades this was 3.55, and for other medical professionals (PAs, ACPs and pharmacists) 2.78. Regarding iron studies, the mean confidence in consultants was 3.68, 2.96 in doctors of other grades, and 2.84 in other medical professions. 85.4% of consultants and 72.4% doctors of other grades correctly answered the case on a patient with anaemia of chronic disease. 91.6% consultants and 82.7% doctors of other grades correctly answered the case on a patient with IDA. For both cases, 76.9% of the other medical professionals answered correctly.

Conclusions

The data suggests that clinicians of all grades felt less confident in interpreting iron studies than ferritin. A significant proportion of medical professionals did not correctly interpret iron studies. We have consulted with our colleagues in haematology and gastroenterology and drafted a revised guideline to help interpretation and suggest that IDA guidance should have advice on iron study interpretation. We will also examine IV iron prescription use and provide clear guidance on indications, tracking costs related to this.
2776 Leveraging Technology for Delivery of dementia prevention interventions remotely: through the Participant’s Lens
Authors: Faig K , Steeves A , Gallibois M , McGibbon CA , Handrigan G , Tranchant CC , Bohnsack A , Jarrett P
Published: January 2025

Objectives

The objective of this study was to examine participant’s experience with remote delivery during SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681), a home-based, double-blind, randomised controlled trial targeting older adults at risk for dementia. Metrics included study adherence, adverse events (AEs), participant’s attitudes towards technology, and protocol deviations (PDs) due to technological difficulties.

Methods

Participants underwent 16 weeks of physical and cognitive interventions (three sessions/week) remotely administered in their homes via Zoom for HealthcareTM. Participants used a laptop, webcam, and required email and internet access. Throughout the trial, adherence, AEs, and PDs were recorded. Post- intervention, survey questions about satisfaction with technology were administered and semi-structured interviews were conducted which underwent thematic analysis.

Results

Sixty participants, mean age 68.9 and 76.7% female, were randomised to one of four intervention arms, with 52 completing the 16-week intervention. Adherence rate was 87.5% with no significant difference between treatment arms (p = 0.656). There were 88 AEs reported in 42 participants. The majority (71.6%) of AEs were unrelated to the intervention, and 69.3% were classified as mild. There was one serious AE, unrelated to the intervention. Most (74.9%) participants reported overall satisfaction with technology, with Zoom being both enjoyable (81.0%) and easy to use (96%). Most enjoyed using the computer (87%), and the majority (87.0%) encountered few difficulties with connectivity. Of the 2496 intervention sessions, 14 (0.56%) were missed due to technical difficulties. Technical difficulties requiring modification to the intervention, such as an unstable internet connection, were reported on 79 occasions (3.0%). Themes from the interviews were: participants built rapport with the research assistants; felt better participating; had fun; and technology helped overcome barriers to participation.

Conclusions

Using technology to deliver dementia prevention interventions remotely was well received by participants Participation occurred safely from the comfort of their own home with few technical difficulties.
2860 Can clinical assessments be administered in a remotely delivered clinical trial targeting older adults at risk for dementia?
Authors: Steeves A , Jarrett P , Faig K , Tranchant CC , Handrigan G , Witkowski L , Haché J , MacMillan K , Gullison A , Omar H , Pauley C , Sexton A , McGibbon CA
Published: January 2025

Introduction

Research suggests that physical and cognitive exercise can have a positive effective on those with dementia, but less is known about such interventions in those at risk for dementia. Understanding the feasibility of administering clinical assessments remotely using Zoom for HealthcareTM in the context of a dementia prevention trial for at risk older adults is not well understood.

Methods

SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681) is a home-based, remotely delivered clinical trial targeting older adults at risk for dementia. Participants underwent a screening/baseline assessment and were randomised to one of four physical and cognitive exercise intervention arms for 16 weeks (3 times per week). They were reassessed immediately post-intervention and 6-months later. The standardised assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life were done at all three points. A research coordinator completed the assessments on a one-on-one basis via Zoom for HealthcareTM. The quality-of-life questionnaire was mailed to the participant.

Results

Forty-eight of 60 participants (80%) (mean age 68.7 ± 5.7 years, 81.3% female) completed the study. Most participants (75.0%) were cognitively intact with at least 2 dementia risk factors. No participants withdrew from the trial because of difficulty with the remote delivery of the assessments. There were no statistically significant changes in any of the assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, or quality of life throughout the study.

Conclusion

This study demonstrates it is possible to administer standardised clinical assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life remotely in the context of a clinical trial. The study was not powered to detect meaningful differences in these assessments. Nevertheless, this confirms the feasibility of remotely administering clinical assessments to older adults at risk for dementia.
2663 Estimating the effect of frailty on long term survival following emergency laparotomy
Authors: Price A , Pearce L , Griffiths J , Smith J , Tomkow L , Martin P
Published: January 2025

Introduction

Around 30,000 emergency laparotomies are performed each year across the United Kingdom. Over half are in people aged 65 years or above, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but longer-term mortality risk has been less extensively studied, despite clear implications for person-centred care. This study aimed to estimate the influence of frailty on longer-term mortality (> 90 days) following emergency laparotomy.

Methods

A retrospective analysis of National Emergency Laparotomy Audit (NELA) data was undertaken, including records entered between 01/12/18 and 30/11/20. Baseline patient characteristics including Clinical Frailty Scale (CFS) are routinely collected within NELA. Data are linked via NHS Digital with Office for National Statistics mortality data. A multivariate analysis was undertaken using a Cox proportional hazards model with hospital-level random effects. Potential confounders were identified via a directed acyclic graph and included in the model as covariates.

Results

23,290 patients remained alive at 90 days post-surgery and were therefore included in the analysis. After adjusting for other covariates, increasing frailty was associated with an increased risk of longer-term mortality. Compared with CFS 1–3, adjusted HR were 1.86 (95% CI 1.68–2.05) for CFS 4, 2.23 (95% CI 2.03–2.45) for CFS 5, 3.26 (95% CI 2.99–3.57) for CFS 6, 4.53 (95% CI 3.97 (95% CI 5.17) for CFS 7, 5.80 (95% CI 4.44–7.57) for CFS 8 and 5.36 (95% CI 4.06–7.08) for CFS 9.

Conclusion

Older people living with frailty remain at increased risk of death beyond 90 days following emergency laparotomy. This information should be incorporated into shared decision-making, enabling patients to make informed choices about their care. Future work must explore how outcomes for this group might be improved through targeted post-operative support.
2786 Defining advanced multimorbidity: a scoping review of research, policy and practice
Authors: Bowers SP , Black P , McCheyne L , Wilson D , Penfold RS , Stapleton L , Channer P , Mills SEE , Williams L , Quirk F , Bowden J
Published: January 2025

Introduction

As people are living for longer with multiple long-term health conditions (MLTCs), there are also more people dying with and from MLTCs. Dying with/from MLTCs can be unpredictable, lead to uncertainty for patients, caregivers and healthcare professionals, and hinder timely conversations around future care planning. There is no universally accepted definition informing the identification of individuals with MLTCs who may be approaching the end of life (advanced multimorbidity). This scoping review synthesised how advanced multimorbidity is defined in research, policy and practice.

Methods

Using the Arksey and O’Malley framework and relevant updates, scoping review methodology was used to search multiple databases and Grey Literature, summarised via the PRISMA-ScR. Two reviewers selected final study texts, which underwent content analysis. Stakeholder consultations with clinicians, academics and public participants ensured context and relevance of findings.

Results

From 10,316 unique publications, 38 final texts were included. Most (33/38) were published in the last decade. Many were quantitative (18/38) though a variety of other study types were included. Participants were mainly elderly—mean age 78.5 years. Only 4/38 studies integrated patient and public involvement. Forty-four different definitions of advanced multimorbidity were identified across the 38 studies, with only 2 definitions used across multiple studies. Definitions varied in the type and number of conditions included. Twenty-six definitions incorporated multiple variables to define advanced multimorbidity, while the remaining 18 used a single variable. Variables were conceptualised as discrete (functional assessments, age, healthcare utilisation etc) or holistic (self-assessment, clinician assessment, assessment tools). Stakeholders preferred definitions that were user-friendly and clinically driven.

Conclusions

The lack of consensus around an advanced multimorbidity definition creates unwarranted heterogeneity and barriers to advancing research in this field. This review highlights the need for a standardised approach that is context-appropriate and meaningful to practice and care, to facilitate proactive realistic conversations and decision-making.
2806 Assessing medication self-Management in Older People at hospital-to-home transition: a systematic review of measures and tools
Authors: Mohamed H , Tomlinson J , Ali E , Badawoud A , Silcock J , Jameson A , Sutherland A , Smith H , Fylan B , Gardner PH
Published: January 2025

Introduction

Adverse drug events from medication-related harm (MRH) can lead to hospital readmissions, compromised quality of life, and even death. After hospital discharge, older people can experience heightened vulnerability and are often unprepared for self-care and medication self-management. Effective medication self-management involves more than adherence; it requires patients to monitor their condition(s), build routines, recognise errors, seek help, understand when to alter medications, and discuss these issues with healthcare professionals. Determining medication self-management capability in older people can guide supportive interventions and improve medication-related outcomes. This systematic review identifies measures which assess medication self-management capability for older people transitioning from hospital-to-home.

Method

A comprehensive search was conducted in electronic databases (Medline, EMBASE, PsychINFO, CINAHL, Cochrane Library of Systematic Reviews, and PROSPERO) for articles from database inception to 2023. Eligible studies included participants aged 65 or older experiencing a hospital-to-home transition, and measures containing at least one medication self-management component. Data extraction was performed using a standardised form. Characteristics of measures were tabulated and summarised descriptively. This review is registered with PROSPERO (CRD42023464325).

Results

14 studies were included, identifying 12 unique measures. These measures predominantly had an adherence-focus, with other medication self-management components included to a lesser degree. Timing of measure administration and the individual administering the measure varied greatly across studies. Medication self-management capability was assessed through physical and cognitive skills. The number and type of skills assessed differed between measures. None of the measures considered all medication self-management components, with self-monitoring and adaptability specifically lacking.

Conclusion

Current measures for medication self-management capability assessment primarily focus on cognitive and physical skills, with significant emphasis on medication adherence. This can lead to other important skills being overlooked. Findings further highlight the importance of comprehensive definitions when considering medication self-management across the hospital-to-home transition, and recommendations are provided for developing future measures.
2624 Exploring the experience of older people in care homes with the Administration of Oral Medication
Authors: Davies H , Watchman K , Hoyle L
Published: January 2025

Introduction

Residents of care homes for older people experience multi-factorial problems when being given oral medication. A systematic integrated mixed-methods review of the literature revealed that practices of modifying tablets, crushing and mixing with food, in attempts to administer medication, remain widespread internationally. There is a high prevalence of swallowing problems. Care home routines are time pressured, and there are incidences of disempowering practices and language associated with processes of medication administration. The literature presented very little from the residents’ experience, largely representing them as passive recipients in the activity.

Objective

The aim of this study was to explore the experience of residents of care homes for older people who need help from care staff to take their medication. Its purpose was to answer a single research question, ‘What is the experience of residents of care homes when oral medication is administered?’

Methods

Observation of an episode of medication administration and semi-structured interviewing were conducted with eight residents between the ages of 84 and 95 from care homes in Scotland. Data was analysed in accordance with a Gadamerian philosophy of hermeneutics, with a commitment to understanding and representing the participants’ experience.

Results

Four themes emerged from the data, ‘Being in control/relinquishing control’, ‘Being comfortable in routine’, ‘Trusting’, and ‘Swallowing’. Interpretive exploration of these themes revealed the importance of facilitating individual routines when taking medication, and that a trusting relationship with staff and with the medication can be an indicator of vulnerability. The risks to autonomy in relation to taking medication, and an imbalance of power for care home residents who are given medication to take emerged as an overarching concept.

Conclusion

Recommendations focus on the potential for empowering practices in relation to taking medication, both for those who provide care, and for those who prescribe medication.
Aesthetic Efficacy and Safety of Combined Microfocused Ultrasound With Visualization and Calcium Hydroxylapatite Treatment: A Systematic Review of Human Evidence
Authors: Amiri Mojgan , Meçani Renald , Niehot Christa D , Muharremi Guido , Spada Julieta , Vasconcelos Rossana , Pavicic Tatjana , Sattler Sonja , Levin Melissa K , Tuck Wah Siew , Carroll Julia , Cook Sonya , Muka Taulant
Published: January 2025

Although microfocused ultrasound with visualization (MFU-V) and calcium hydroxylapatite– carboxymethylcellulose (CaHA-CMC) have their individual strengths and have demonstrated effectiveness in aesthetic improvement and improving skin laxity, a combined treatment may sometimes be required to achieve comprehensive aesthetic enhancements that meet patients’ needs and preferences. This review systematically summarizes the available evidence on combined MFU-V and CaHA-CMC treatment. A comprehensive search was conducted in Embase, MEDLINE ALL (Ovid), Web of Science Core Collection, and Cochrane Central. We included studies conducted in adults that examined the effectiveness, safety, and/or mechanism of action of combined MFU-V and CaHA-CMC treatment. Out of 4019 references, 11 studies, mainly pre-post studies, were included in this analysis. Overall, regardless of the area treated, improvements in global aesthetic scales, skin quality parameters, and patients’ satisfaction following combined treatment, accompanied by mild to moderate adverse effects, were found. In addition, histological studies indicated increased neocollagenesis and elastin synthesis posttreatment. Our review highlights promising outcomes from combined MFU-V and CaHA-CMC treatment. Nevertheless, due to the limited number of studies, further research is essential to gain a deeper understanding of this combined treatment's efficacy, safety, and applicability.

Level of Evidence: 3 (Therapeutic)
Lichen nitidus
Authors: Palaniappan Vijayasankar , Karthikeyan Kaliaperumal
Published: January 2025

Lichen nitidus (LN) is a rare inflammatory skin condition characterized by small, shiny, flat-topped papules, commonly affecting children and young adults. Its etiology remains unclear, though immune-mediated pathways are suspected. LN is often asymptomatic, with papules primarily on the trunk, upper limbs, and genitalia. Diagnosis relies on characteristic histopathology, notably a “claw clutching a ball” pattern. Though it often resolves spontaneously, LN may present persistently, sometimes requiring topical treatment. This review highlights LN's clinical, histological, and dermoscopic features, discusses variants and associated systemic conditions, and offers guidance for dermatologists in managing this distinct dermatosis.
Denosumab withdrawal increases vertebral fracture and mortality risk compared with zoledronate
Authors: Lu Ko-Hsiu , Wang Shiow-Ing , Yang Shun-Fa
Published: January 2025

Objective

Rebound vertebral fractures (VFs) after Denosumab (Dmab) withdrawal have been documented, highlighting the need for further research into this phenomenon and the importance of a well-planned strategy for discontinuing Dmab.

Methods

From the TriNetX US network, we enrolled osteoporosis patients aged 50 years or older who had withdrawn from at least two doses of Dmab and compared them with a matched cohort who had received at least one dose of zoledronate (ZOL) before discontinuation. We analyzed hazard ratios (HR) with 95% confidence intervals (CI) and conducted Kaplan-Meier analyses, along with subgroup analyses, drug discontinuation modification, and sensitivity analyses.

Results

After matching propensity scores (n = 10,422) between the two cohorts (Dmab: 11,104 and ZOL: 15,976), we found that the risks of VFs (HR = 1.479, 95% CI = 1.222−1.789) and its subcategories—thoracic (1.309, 1.023−1.674), lumbar (1.865, 1.425−2.440), and collapsed fractures (1.928, 1.462−2.542)—as well as all-cause mortality (1.588, 1.475−1.710), were significantly higher in the Dmab group compared with the ZOL group. Stratified analyses showed increased VF risks in Dmab patients who were female, aged 50-64, 65 years or older, and white, regardless of fracture history compared with those using ZOL.

Conclusion

After adjusting for drug discontinuation, Dmab showed an increased risk of VFs within the first two years, contributing to an elevated overall mortality risk. Sensitivity analyses revealed consistent results across different regions.
Market based emission reduction plan in the process of "double carbon": mechanism, effect and implementation environment
Authors: Yang Ke , Yu Wei , Wang Anqi , Zhao Tongtong
Published: January 2025

Based on a sample of prefecture-level cities in China from 2004 to 2017, the policy effects of the “market-based mechanism”design of emission reduction tools are examined. The study concludes that China's carbon emissions trading system has a very significant emission reduction effect, and the market-based reform has a facilitating effect, while a reasonable corporate tax burden and environmental regulation intensity have a synergistic effect on the operational efficiency of the carbon market. It is also found that China's carbon emissions trading system has a significant impact on corporate R&D behavior, but its role needs to be further developed.
Efficient low rank matrix recovery with flexible group sparse regularization
Authors: Yu Quan , Bai Minru , Zhang Xinzhen
Published: January 2025

In this paper, we present a novel approach to the low rank matrix recovery (LRMR) problem by casting it as a group sparsity problem. Specifically, we propose a flexible group sparse regularizer (FLGSR) that can group any number of matrix columns as a unit, whereas existing methods group each column as a unit. We prove the equivalence between the matrix rank and the FLGSR under some mild conditions, and show that the LRMR problem with either of them has the same global minimizers. We also establish the equivalence between the relaxed and the penalty formulations of the LRMR problem with FLGSR. We then propose an inexact restarted augmented Lagrangian method, which solves each subproblem by an extrapolated linearized alternating minimization method. We analyse the convergence of our method. Remarkably, our method linearizes each group of the variable separately and uses the information of the previous groups to solve the current group within the same iteration step. This strategy enables our algorithm to achieve fast convergence and high performance, which are further improved by the restart technique. Finally, we conduct numerical experiments on both grayscale images and high altitude aerial images to confirm the superiority of the proposed FLGSR and algorithm.
Type IV PilD mutant stimulates the formation of persister cells in Pseudomonas aeruginosa
Authors: Qiu Huifang , Dai Weijun
Published: January 2025

Background

Pseudomonas aeruginosa clinical isolates that lack motility do not express type IV pilin, yet the biological roles of this absence in the infection process remain poorly understood.

Objectives

We asked whether the absence of motility in these bacteria is associated with increased antibiotic persistence.

Methods

In this study, we analysed type IV PilD protein sequences in the database and conducted antibiotic-tolerant persister cell assays.

Results

We found that PilD variants were common in P. aeruginosa clinical isolates. Our results revealed that inactivation of PilD resulted in a significantly higher level of surviving persister cells following ciprofloxacin treatment. This PilD-mediated persistence did not involve previously described mechanisms, such as phenazine pyocyanin, biofilm or stringent response.

Conclusions

Our findings connect the non-motility of clinical P. aeruginosa isolates with the survival of persister cells, highlighting the clinical significance for the development of strategies to eradicate P. aeruginosa infections.