bluuebunny/crossref_metadata_2025 huggingface dataset:
Hardware in the loop testing of converter control in solar PV and BESS based islanded microgrid
Authors: Singh Akash Kumar , K Seethalekshmi
Published: August 2024

Over the past decades, microgrids have garnered significant attention due to their ability to offer resilient power supply and efficiently integrate renewable energy sources (RESs). The test model includes an islanded microgrid having common voltage source converter for solar photovoltaic and battery energy storage system, characterized by low inertia. To minimize the effect of reduced inertia caused by lack of synchronous generators and also to cope up with the variation in power output from different renewable energy sources, an adaptive virtual inertia and damping based control, is incorporated through voltage source converter control, utilizing swing equation of the synchronous generator. However, it is imperative to verify the proposed control strategy before implementation in an actual plant. In that direction, this paper discusses the practicality of the proposed control in the real-time using Controller Hardware-in-the-Loop (CHIL) platform. So, the plant is built in real time simulator OP4512 and the proposed control is implemented using practical microcontroller TMS320F28379D. Subsequently, configuration and modelling of ADC and EPWM are explained. CHIL testing platform demonstrates flawless compatibility with the converter control, having a system model running in real time. Simulation results are compared with that of HIL results for various loading configurations, hence proving the efficacy of the proposed control strategy.
An improved prairie dog optimization algorithm integrating multiple strategies and its application
Authors: Wang Yan , Wang Nan , Gao Teng , Bu Fanyang , Zhu Xiqian
Published: August 2024

Aiming at the problems in prairie dog optimization (PDO), such as uneven population distribution at initialization, slow convergence, imbalance between global exploration and local exploitation, and the tendency to get trapped in the local optimum, this study proposes an Improved prairie dog optimisation algorithm integrating multiple strategies (IMSPDO). Firstly, the population is initialized using spatial pyramid matching (SPM) chaotic mapping combined with improved random opposition-based learning (IROL) to solve the problems of uneven distribution and poor diversity of the population. Secondly, the prey escapes energy formula mentioned in the harris hawks optimization (HHO) is introduced to achieve the smooth transition between the exploration phase and the exploitation phase, balancing the algorithm’s global exploration capability and local exploitation capability. Additionally, the idea of the particle swarm optimization (PSO) is applied to enhance the global optimization capability of the algorithm. Finally, the ideas of simulated annealing (SA), polynomial mutation and Cauchy mutation are also introduced to improve the ability that individuals to jump out of the local optimum. The performance of the improved algorithm is verified on a set of 21 classical benchmark functions and 8 CEC2020 test functions. The proposed IMSPDO is also evaluated against original PDO, and six other commonly used algorithms. The result of the Wilcoxon rank-sum test shows that there is a significant difference between the selected algorithms and IMSPDO. Furthermore, 3 engineering examples are used to further test the superiority of IMSPDO in dealing with real-world problems.
Understanding the functional roles of modelling components in spiking neural networks
Authors: Yin Huifeng , Zheng Hanle , Mao Jiayi , Ding Siyuan , Liu Xing , Xu Mingkun , Hu Yifan , Pei Jing , Deng Lei
Published: August 2024

Spiking neural networks (SNNs), inspired by the neural circuits of the brain, are promising in achieving high computational efficiency with biological fidelity. Nevertheless, it is quite difficult to optimize SNNs because the functional roles of their modelling components remain unclear. By designing and evaluating several variants of the classic model, we systematically investigate the functional roles of key modelling components, leakage, reset, and recurrence, in leaky integrate-and-fire (LIF) based SNNs. Through extensive experiments, we demonstrate how these components influence the accuracy, generalization, and robustness of SNNs. Specifically, we find that the leakage plays a crucial role in balancing memory retention and robustness, the reset mechanism is essential for uninterrupted temporal processing and computational efficiency, and the recurrence enriches the capability to model complex dynamics at a cost of robustness degradation. With these interesting observations, we provide optimization suggestions for enhancing the performance of SNNs in different scenarios. This work deepens the understanding of how SNNs work, which offers valuable guidance for the development of more effective and robust neuromorphic models.
Schools as Socialization Agents for Turkana Pastoralists’ Children
Authors: Ng’asike John Teria
Published: August 2024

Education worldwide has influenced the socialization of children. In Kenya, formal education is the right for every child. This underlines provision for free and compulsory education enshrined in the constitution of Kenya. However, investment in education in Kenya is not equal to the constitution declaration of access to quality education for every child across the country. In pastoralist traditional cultural communities, families have embraced education, but access to quality education has become problematic. Due to its poor quality, education as a socializing agent for pastoralist children has created cultural conflicts between school children and their families. The schools are alienating children from their own families. The consequences are that the pastoralist communities have developed a disdain for education including their own school children. This chapter explores insights into these conflicts by contrasting socialization of children in schools and child-rearing practices of the Turkana pastoralist communities of Kenya.
School Culture and Inequalities in Brazil
Authors: Altenfelder Anna Helena , Mansutti Maria Amabile , de Oliveira Romualdo Portela
Published: August 2024

The objective of this chapter is to discuss the culture of school failure that affects everything from the implementation of public policies to the relationships that take place in schools and classrooms. To do so, initially, the concept of school culture is briefly discussed, and the structure and functioning of the Brazilian educational system are presented alongside the existing inequalities. Four pieces of research carried out by Cenpec, a civil society organization whose mission is to contribute to quality public education for all, are analyzed in order to show that significant portions of the population, based on markers of class, race, ethnicity, and territory, have been historically excluded from school. Despite advances in legislation and in the formulation of policies and programs that sought to address the issue in the last 30 years, it is still a challenge to guarantee the constitutional right to a successful school trajectory.
2192 Implementation of 4AT and delirium bundle in patient management—a quality improvement project
Authors: Ahmed A , Honney K
Published: August 2024

Introduction

Delirium affects up to 50% of older individuals within hospital environments, with a notable occurrence in 30% of those aged 65 and above in emergency departments. This QIP aimed to enhance the early recognition of delirium by implementing the 4AT assessment and optimise assessments and investigations by implementing the Delirium Bundle.

Method

A survey involving 39 doctors was conducted to evaluate their comprehension of delirium and awareness of the Delirium Bundle. PDSA 1 involved retrospective data analysis of medical records for patients admitted with delirium and used as a preliminary baseline to evaluate how the delirium bundle is being utilised. PDSA 2 integrated multiple teaching sessions and the implementation of the Delirium Bundle, assessing the effectiveness of these interventions.

Results

In PDSA 1, twenty-nine patients were identified. None of the patients had a 4AT assessment done. Twenty patients (69%) had a haematological screen done, eight patients (27%) had an ECG done, twenty patients (69%) had a CXR done, eighteen patients (62%) had an MSU test done, eight patients (28%) had cultures done, and twenty-three (79%) had a CT head scan done. In PDSA 2, thirty patients were identified. Seven patients had a 4AT assessment done, sixteen patients (53%) had a haematological screen done, nineteen patients (63%) had an ECG done, twenty-two patients (73%) had a CXR done, fifteen patients (50%) had an MSU test done, fourteen patients (47%) had cultures done, and 20 patients (67%) had a CT head scan done.

Conclusion

The implemented changes showed effectiveness with increased 4AT assessments and enhanced confusion screening. Improvements in assessments and investigations for diagnosed delirium patients were evident. To further enhance efforts, future initiatives include incorporating the 4AT assessment in clerking booklets, conducting continuous teaching sessions, and displaying posters in relevant wards.
2297 Impact of creation and subsequent expansion of the acute frailty team at Queen Elizabeth Hospital, Gateshead on patient outcomes
Authors: Brock P , Filler H , Frost L , Maughan K
Published: August 2024

Introduction

An Acute Frailty Team pilot was launched in December 2022 at the QEH. The aim was to reduce unnecessary hospital admissions and length of stay (LOS) by providing interventions in the Emergency Admissions Unit (EAU), through comprehensive geriatric assessment. Following the pilot’s success additional recruitment was made to the multi-disciplinary team (MDT) and the service revaluated. The MDT consists of a Consultant Geriatrician, Specialist Frailty Practitioner, Frailty Fellow, Physiotherapist, Technical Instructor, Occupational Therapist, and Pharmacist.

Method

To allow comparisons a pre-pilot control group audit of 100 patients ≥65 with a clinical frailty score > 5 was undertaken. This data has subsequently then been compared to a phase-1 (Consultant Geriatrician, Specialist Frailty Practitioner team) audit of 121 patients and a phase-2 (full MDT) audit of 133 patients with the same parameters.

Results

The creation and expansion of the acute frailty team has reduced the average length of stay from 13.8 days, pre-pilot, to 9.4 days in phase-1 and subsequently been maintained at 9.56 days during phase-2. More frail patients are now being discharged from the emergency admission unit (EAU). Pre-pilot 7% of patients were discharged from EAU, increasing to 13% during phase-1 and 18.75% phase-2. 16% of patients were originally discharged within 72 hours of admission, this increased to 20% during phase-1 and 24.81% phase-2. This is also reflected in 7-day discharge data (37%, to 39% to 44.36%).

Conclusion(s)

MDT expansion of the acute frailty team at the QEH has resulted in improved recognition and holistic assessment of frail patients’ needs and reduced their length of stay.
2349 How to provide a cost-effective geriatric peri-operative service within general surgery in line with NELA BPT
Authors: Sabbagh H , Abu A , Peck G , Reese G , Koizia L
Published: August 2024

Introduction

More than 50% of patients undergoing emergency general surgery are >65 years. The Emergency Laparotomy and Frailty (ELF) study showed strong associations between frailty (CFS ≥ 5) and increased mortality, risks of complications, and length of hospital stay.

Methods

For nearly 10 years, we have had geriatric liaison input for general surgery and colorectal patients in a tertiary teaching centre. This has transformed into a fully embedded service involving consultant geriatrician, registrars and senior house offices, providing 3-day a week medical input. NELA best practice tariff (BPT) April 2023 emphasises perioperative Geriatric team involvement in frail patients aged 65 and above. The main metrics include CFS, an MDT-based risk assessment, treatment escalation decision making and perioperative geriatrician involvement.

Results

The service has previously demonstrated significant improvement in patient care and holistic management including reducing the length of stay in hospital (average decrease of 5.5 days). Simple job planning, use of current resources and efficiency can mean Trusts can incorporate geriatricians with essential skills to improve patient management and reach NELA BPT.

Conclusion

Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Introducing a multidisciplinary geriatric liaison service into the general surgical department can achieve high levels of compliance with national guidelines, resulting in better outcomes for patients as well as financial benefits for Trusts. This is particularly pertinent given the financial constraints on many services across the NHS, this is an opportunity to increase revenue and build a geriatric workforce.
2311 Doing nothing is NOT an option—successful collaboration as part of wider quality improvement exercise in frailty services
Authors: Acharya J , Manzoor A , Lisk R , Mahmood R
Published: August 2024

Introduction

Population is growing old worldwide and UK is no exception. Health service models designed to cater the needs of service users are under immense pressure due to the ageing phenomenon. With unprecedented demand, their often low acuity, hence low priority and delayed conveyance to hospital and unavailability of services to address their needs due to delayed arrival; frail older patients often have to wait longer in emergency department (ED) to receive care in ED. Innovation and news models of care are therefore need of the hour to address this challenging situation.

Methods

Quality improvement initiative to establish acute frailty service. Development of Older Person assessment unit (OPAU) in Oct 2022 with already established and functional acute frailty team. Plan for direct referral to OPAU from South East coast ambulance service (SECAmb) colleagues. Weekly meetings with SECAmb. Geriatrician of the Day supporting alternative pathways instead of ED. Development of frailty poster with criteria to referral and uploaded on SECAmb work iPads, displayed in ambulances delivery area and ambulance queuing area inside the hospital. Single point of access phone number launched April 2023 to access frailty team & other alternative services from outside the hospital. SECAmb webinar for education and awareness of alternative pathways (UCR, SDEC, frailty, virtual ward), attended by 40 front line SECAMB staff.

Results

October 2022–0 patients. November 2022–2 patients. December 2022–8 patients. January 2023–18 patients. February 2023–32 patients. March 2023–33 patients. April 2023–39 patients.

Conclusion

With sustained efforts and effective collaboration, number of patients being referred to alternate pathway (frailty team) are increasing with anticipated significant reduction to SECAmb conveyance to ED in the long run, addressing overcrowding issues.
2259 Assessing antibiotic usage on a geriatric ward
Authors: Truman M , Ajibola I , Tan W , Rawoo R
Published: August 2024

Introduction

The World Health Organisation lists antibiotic resistance as one of the biggest threats to global health [1]. We contribute to this as clinicians, through errors such as delayed review of prescriptions or prescribing against local trust guidelines.

Method

We have carried out a quality improvement project to improve antibiotic prescriptions on a geriatric ward at Croydon University Hospital. We carried out a fortnightly cross-sectional analysis of the antibiotic prescriptions on a geriatric ward. This included looking at the antibiotic prescribed, indication, duration, route of administration and presence of a review date. These were then compared to trust guidelines. After the first 8-weeks, we delivered a departmental teaching session on antibiotic prescriptions. We then re-audited the prescriptions. Following this, we sent out weekly email reminders on locating trust guidelines and information on prescriptions. We then re-audited following this. Finally, we created an e-learning resource to deliver to the ward on antibiotic prescriptions. We are planning to deliver this to the ward and re-audit afterwards.

Results

Initially, up to 90.0% of prescriptions differed from trust guidelines. Common reasons for differences when compared included incorrect drug prescribed, incorrect frequency of dosing, or non-specific indications leading to difficulty comparing. Following all interventions, approximately 32% of prescriptions differed from trust guidelines. This showed sustained improvement across 2 complete PDSA cycles (plan, do, study, act). A 3rd PDSA cycle is ongoing at present and preliminary data has shown approximately 28% of prescriptions differed from trust guidelines.

Conclusion

This quality improvement project has successfully contributed to a reduction in prescription errors and safe prescribing. We will continue to provide information to our colleagues on antibiotic stewardship, to further encourage safe prescribing. [1]. Antibiotic resistance (2020) World Health Organisation. Available at: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance (Accessed: May 2023).
2322 Passing the baton from emergency visit to community care: factors that impact delivery of targeted geriatric care?
Authors: Espelata WDV , Kee JXL , Koh XY , Loi FC , Ang ASH , Rosario BH
Published: August 2024

Introduction

Older patients attending the Emergency Department (ED) and discharged home are at higher risk of adverse outcomes. Geriatric Ambulatory ED services were developed with the aim to deliver goal-directed care of older patients from ED using onward referral to Community Providers.

Method

A retrospective review was undertaken from 13th January 2022 to 23rd December 2022 in older patients discharged from the ED following a targeted geriatric assessment and recommended community follow-up interventions. Demographic information, functional ability, hospital utilisation and mortality (up to one year), and any post-visit fragility fractures were reviewed. Data collection included identification of osteoporosis or osteopenia during or following the index ED visit.

Results

108 patients were assessed, of whom, 74% were female, average age 76 years, range 61–93 years. 65% of patients were CFS scored, 9% were CFS 6 or 7, 15% CFS 4 or 5 and 41% CFS 1–3. GP review was advised for 76% of patients and 61% attended and therapy interventions were recommended for 9.3%, of whom, 3% attended. The majority presented with falls (82%) and half of those who fell, sustained a fracture. Osteoporosis or osteopenia was newly identified in 30% but in 44% of patients bone health remained unevaluated and only 8% had newly initiated anti-resorptive and 9% existing treatment. 4% experienced fragility fracture following their ED visit. Uptake was low for therapy (30%) and nursing interventions (14%). Following the index ED visit, 7% patients attended ED within 7-days, and 5% admitted to hospital within 30-days. 35% of patients re-attended ED and 22% were hospitalised within one year. One year mortality was 5%.

Conclusion

ED targeted geriatric assessment can identify patients with falls and fragility fractures but better collaboration and communication between primary and secondary care is needed. Recommended bone health assessment occurred in a relatively small proportion of patients.
2289 The association of heart rate and cholinesterase inhibitor use among elders living with dementia: a retrospective cohort study
Authors: Siramongkholkarn S , Suwanlilkit Y , Chongprasertpon R , Ungprasert P , Thanapluetiwong S
Published: August 2024

Introduction

Cholinesterase inhibitors (ChEIs) are the primary medication for dementia treatment. Bradycardia is a potential adverse effect associated with ChEIs. However, the relationship between ChEIs and bradycardia has not been definitively established, particularly in the Asian population. We conducted a study investigating the association between ChEIs and heart rate.

Methods

We retrieved data from electronic medical records (EMR) of patients aged over 60 who were diagnosed with mild cognitive impairment or dementia at Ramathibodi Hospital between January 2009 and December 2022. These patients had outpatient records at 3, 6, and 12 months after the diagnosis. After filtering out by eligibility criterias, patients were categorised into ChEIs and non-ChEIs use, and then were 1:1 matched by baseline characteristics. We compared heart rate changes between the groups using Student’s t-tests or Mann Whitney U test depending on their distribution and Bayesian linear regression. Bradycardia was analysed using Kaplan–Meier Estimates and Cox proportional hazards model.

Results

790 eligible patients were included, with 395 patients in each group. The median of difference of changes from baseline heart rate between group were − 0.5 BPM (p = 0.06), −1.5 BPM (p = 0.12), and − 1.5 BPM (p = 0.002) at 3, 6, and 12 months, respectively. The bradycardia incidence was higher in the ChEIs group (38.5%) compared with the non-ChEIs group (30.6%) at 12 months, but this difference was not statistically significant (p = 0.2). Among all regarded variables, baseline heart rate, age and beta-blocker usage associated with bradycardia, with adjusted hazard ratios (aHR) = 0.888 (95% CI 0.873–0.904, p < 0.001), 1.019 (95% CI 1.001–1.037, p = 0.035) and 1.334 (95% CI 1.045–1.703, p = 0.021).

Conclusions

The use of ChEIs was found to be associated with a decrease in heart rate. However, the changes were minimal and may not have had clinical implications for the patient.
2142 Shared decision-making on treatment escalation planning in the acute medical setting for older patients: a qualitative study
Authors: Warner BE , Wells M , Vindrola-Padros C , Brett SJ
Published: August 2024

Introduction

Shared Decision-Making (SDM) is increasingly expected in most aspects of UK medical practice and can be particularly important for older patients to guide goals of care. Treatment Escalation Plans (TEP) summarise medical intervention to be attempted in the event of acute deterioration. Current guidance advocates SDM in TEP but it is unclear whether this is considered practicable by clinicians. This study aims to understand clinicians’ perspectives on SDM in TEP for older patients in the acute medical setting.

Methods

This was a qualitative study following a relativist constructivist approach. 26 consultant and registrar doctors were recruited from general internal medicine, intensive care, palliative care and emergency medicine. A clinical doctoral student conducted semi-structured interviews including vignettes of older multi-morbid patients with capacity to discuss treatment escalation. Reflexive thematic analysis was performed. Ethics approvals were obtained from the Health Research Authority 22/HRA/4387.

Results

Three themes were generated: ‘An unequal partnership’, ‘Options without equipoise’ and ‘Decisions with shared understanding’. SDM incorporating patient preferences with clinical opinion was seldom perceived to be appropriate. Clinical complexity and use of intuition, together with lack of perceived moral equipoise, motivated clinicians to develop medically acceptable TEPs. Shared understanding with the patient and family and avoiding conflict were important.

Conclusions

Contrary to current guidance, SDM was considered a potential barrier to formulating appropriate TEPs in the acute medical setting. This study suggests potential incompatibility between policies prioritising patient autonomy and the right to make unwise decisions, and those stating clinicians’ prerogative to determine realistic chance of treatment success and not provide intervention considered medically inappropriate.
2252 Competencies required by all hospital doctors caring for older adults: a group concept mapping study
Authors: Buckley E , Barrett A , Bennett D , O'Tuathaigh C , Cooke J
Published: August 2024

Introduction

It is increasingly recognised that for the foreseeable future most hospital inpatient contacts with older adults will be completed by doctors not specifically trained in geriatric medicine. To guarantee the delivery of sufficient healthcare, it is essential that every hospital doctor is equipped with geriatric medicine competencies. Which exact competencies are required and how they should be prioritised for hospital doctors serving the older adult population remains unclear. Allowing for the broad, complex and multidisciplinary nature of geriatric medicine, we carried out a group concept mapping (GCM) study to determine the geriatric medicine competencies required by all hospital doctors.

Methods

GCM is a mixed methods approach utilising six phases to generate expert group consensus, enabling participants to organise and represent their ideas in order to identify a common understanding about competencies required by all hospital doctors. Healthcare professionals, patient advocacy groups and clinical educators generated and sorted ideas and then rated identified competencies. Hierarchical cluster analysis and multi-dimensional scaling were utilised to analyse participant input.

Results

Thirty-four stakeholders generated 88 competencies. Twenty completed the subsequent sorting and rating of competencies. Nine competency domains were identified by participants as integral for all hospital doctors to care for older adults: communication skills, medicolegal affairs, prescribing, delirium, falls and bone health, engaging specialist services, universal principles of care, managing hospitalisation and components of specialist gerontology. Domains rated most important related to interpersonal communication skills, medicolegal concerns, recognition, and management of delirium.

Conclusion

The nine competency domains indicate the diverse skillset required by all doctors to provide comprehensive care to older adults within a hospital setting. This study identifies competencies that may serve as a foundational framework for ensuring quality healthcare for the ageing population. Future initiatives should consider incorporating these competencies to improve inpatient care provided by hospital doctors to older adults.
2144 Improving PA students confidence in managing geriatric patients with a bespoke teaching programme and a novel bleep simulation
Authors: Thompson L
Published: August 2024

Introduction

BGS reports in its ‘Case for more Geriatricians’ that the number of people age over 85 is set to double by 2045. As well as Geriatric specific policies in the Ageing Well programme of the NHS Longterm Workforce Plan there are plans to expand the number of allied health professionals including Physician Associates (PA). We set out to improve PA students’ knowledge of and confidence in managing geriatric patients with a bespoke teaching programme culminating in a novel bleep simulation.

Methods

We identified the students’ needs with a preliminary survey and then created a teaching programme on medical topics and issues common to geriatric wards with weekly lectures and small group work. The programme culminated in a bleep simulation where students were contacted via bleep to come to different parts of the medical education centre and respond to scenarios which would be common on geriatric wards. These included reviewing unwell patients and issues such as aspiration, constipation and urinary retention. The students were required to amend or create prescriptions and interpret test results with access to the BNF and relevant local guidelines.

Results

Students were asked how useful the simulation was and how much it had improved their confidence in working on geriatric wards. The average score for both statements was greater than 9/10. The students were asked before and after the simulation how confident they were responding to bleeps and managing clinical scenarios in geriatric patients. Both scores doubled following the simulation to 6.7/10 (from 2.5 and 3.3 respectively).

Conclusion

The Faculty of Physician Associates curriculum does not necessitate placements in geriatrics and its matrix of core clinical conditions does not include any specific to geriatrics. Through a bespoke teaching programme and a novel bleep simulation we increased PA students’ confidence in managing geriatric patients.
2234 Temporal trends in Parkinson’s disease-related mortality from 1999–2020: a Nationwide cohort study
Authors: Sokhal BS , Menon SPK , Shepherd T , Muller S , Arora A , Mallen C
Published: August 2024

Introduction

Parkinson’s disease (PD) is the most common neurodegenerative movement disorder and is associated with significant disability. The prevalence of PD is increasing and the literature demonstrates potential sex and race disparities in patient outcomes. There is a paucity of data about the demographic trends in PD-related mortality in the United States (US). This descriptive study aimed to report the national demographic trends in PD-related mortality over a 20-year period.

Methods

From January 1999 to December 2020, the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC-WONDER) Underlying Cause of Death database was queried. Data were extracted to determine the PD-related age adjusted mortality rate (AAMR) stratified by age, sex, ethnicity and geographic area, with the 1999 deaths as the reference group. Annual percentage change (APC) for AAMR was then calculated using Joinpoint regression.

Results

From 1999 to 2020, there were 515,884 PD-related deaths in the study period. AAMR increased from 5.3 per 100,000 population in 1999 to 9.8 per 100,000 in 2020. Males had consistently higher AAMR than females and white race had consistently higher overall AAMR (7.6 per 100,000), followed by American Indians/Alaska Natives (4.4 per 100,000), Asians/Pacific Islanders (4.1 per 100,000) and Black/African Americans (3.4 per 100,000). The Midwest had the highest AAMR followed by West, South and Northeast. Utah, Idaho and Minnesota had the highest state-level AAMR.

Conclusion

This study using a national dataset identified significant age, sex, race and geographic disparities in PD-related mortality in the US. Older age, male sex, white race and Midwest locality were associated with the highest AAMR.
2235 National Trends in motor neurone disease-associated mortality from 1999–2020
Authors: Imantalab D , Sokhal BS , Menon SPK , Kara S , Muller S , Mallen C
Published: August 2024

Introduction

Motor Neurone Disease (MND) is a neurodegenerative condition affecting the spinal cord and brainstem, commonly associated with a reduced life expectancy. This study describes demographic trends in MND-associated mortality in the United States over 20 years.

Methods

Data were extracted from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research Underlying Cause of Death database. Death certificates from 1999–2020 with MND (International Classification of Diseases-10th Revision code G12.2) recorded as the cause of mortality were extracted and annual MND-associated crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 persons with 95% confidence intervals (CI) were calculated. Joinpoint regression was used to calculate the annual trends in MND-associated mortality by calculating the annual percentage change.

Results

Between 1999 to 2020, there were a total of 140,945 MND-associated deaths. Overall AAMR was 1.9 per 100,000 persons (95% CI 1.9–1.9). Male sex had a consistently higher AAMR (2.3 per 100,000 95% CI 2.3–2.3) than female sex (1.6 per 100,000 95% CI 1.5–1.6). White patients had higher AAMR (2.1 per 100,000 95% CI 2.0–2.1) than Black/African Americans (1.1 per 100,000 95% CI 1.0–1.1), American Indians/Alaska Natives (0.8 per 100,000 95% CI 0.7–0.9), Asians/Pacific Islanders (0.8 per 100,000 95% CI 0.7–0.9). The 3 US States with the highest AAMR were Vermont, followed by Minnesota and Maine.

Conclusions

This national study demonstrates that there were a significant number of MND-associated deaths in the United States, with higher rates associated with certain patient demographics. The knowledge of these trends facilitates the design of appropriate services in areas of higher need, allowing for the introduction of pathways that support more suitable care and enhanced quality of life.
2258 The need for delirium education and psychosocial care after discharge: a realist analysis of interviews with key stakeholders
Authors: Raghuraman S , Richards E , Mahmoud A , Morgan-Trimmer S , Clare L , Anderson R , Goodwin V , Allan L
Published: August 2024

Introduction

There is limited understanding of long-term delirium care after discharge from hospital for older people. A realist approach was used to investigate the contextual factors and mechanisms of care that influence recovery from delirium. Realist evaluation is fundamentally theory-driven. A preliminary programme theory was used as the foundation for theory testing and refinement to develop the RecoverED intervention.

Method

Realist interviewing techniques were used to obtain real-world and lived experiences of delirium recovery and service use in the community for theory-building and testing. Semi-structured interviews were conducted with a purposive sample of people with delirium (N = 7), informal carers (N = 14), and healthcare professionals (N = 24). Data from the interviews were analysed using a deductive codebook of Context-Mechanism-Outcome (CMO) configurations. Open coding was also performed to identify inductive themes, which were then aggregated to elicit explanatory statements.

Results

There was support for a multicomponent delirium intervention including cognitive and physical rehabilitation, and psychosocial support. The analysis revealed the need for an additional component which focused on improving awareness and understanding about delirium among those with lived experience. In the context of insufficient knowledge about delirium, people experienced increased fear and anxiety among other negative outcomes. Offering a focused educational component as part of the intervention is expected to contribute to recovery outcomes. This was associated with CMOs identifying the need for positive relationships with staff, improving communication with staff and sense-making through staff emotional support.

Conclusion(s)

The preliminary programme theory was refined based on the realist analysis data. Additional components were included, one of which was targeted education for people with delirium and carers. Following a consultation with an expert panel, the intervention is being tested in a feasibility trial and process evaluation, which will analyse data from multiple sources using realist methods to further refine the intervention.
2304 Models of care and the role of clinical pharmacists in UK primary care for older people: findings from a scoping review
Authors: Burnand A , Woodward A , Kolodin V , Manthorpe J , Jani Y , Orlu M , Bhanu C , Samsi K , Vickerstaff V , Wilcock J , Rait G , Davies N
Published: August 2024

Introduction

Pharmacists have traditionally worked in primary care, in the community, and with GPs. However, the role of the clinical pharmacist in primary care is evolving and there are plans to employ more clinical pharmacists in the NHS. With an ageing UK population, there is an increase in the number of people living with multiple long-term conditions, accompanied by polypharmacy, posing numerous challenges to healthcare systems. This review investigates the evidence about the varied roles and services delivered by clinical pharmacists in primary care, capturing the perspectives of health and care professionals, older adults, and their carers.

Method

Our scoping review followed the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. A broad search was conducted in 2023 in CINAHL, Cochrane, Medline, SCOPUS, and Web of Science. We included articles that explored the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences.

Results

A total of 23 articles was included. These shed light on the multifaceted responsibilities of clinical pharmacists for older people. Stakeholder perspectives, including healthcare professionals and care home staff, emphasise the positive outcomes of clinical pharmacist involvement, from reducing other practitioners’ workloads to improving patient safety. However, communication gaps among the primary care team and those living with dementia, concerns about competence, and the need for clear role definitions of clinical pharmacists emerge as challenges.

Conclusions and implications

The review enhances our understanding of the clinical pharmacist service in the UK and identifies gaps in research evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. The findings can be used for policymaking, workforce planning, and healthcare provision to improve the services for older people in the UK.
2197 Effectiveness of horticultural therapy on the psychosocial and physical function of older adults with normal cognitive function.
Authors: Johandi F , Giang TA , Cheng LJ , Hay MSG , Yap P
Published: August 2024

Introduction

Horticultural therapy (HT) is not uncommonly used as non-pharmacological therapy for patients with dementia. However, less is known about its effects on older adults with normal cognition. This systematic review and meta-analysis syntheses available evidence to evaluate the effects of HT on psychosocial and physical function in cognitively intact older adults.

Method

A systematic search in 9 electronic databases for experimental and quasi-experimental studies was performed between January 1, 2001, and July 19, 2021. Studies involving participants above 60 years old with normal cognition, analysing psychosocial and physical effects of HT, were included. Cochrane Risk of Bias 2 (RoB2) tool and Risk of Bias in Non-randomised Studies- of Interventions (ROBINS-I) were used to assess risk of bias. Meta-analysis was conducted using Stata software. Cochran’s Q test and I2 were used to explore statistical heterogeneity. Narrative synthesis was conducted for trials unsuitable for quantitative pooling.

Results

Nineteen articles (2191 participants) were included. Meta-analyses found that HT showed moderate-large effects on psychosocial outcomes, with improved self- efficacy (Hedges’ g = 0.49, 95%Confidence Interval: 0.07,0.91, 3 trials, I2:0.00%) and self-esteem (g = 1.01, 95%CI:0.33,1.68, 2 trials, I2:0.00%), and decreased depressive symptoms (g = −3.33, 95%CI:-6.29,-0.37, 4 trials, I2:98.51%). Narrative synthesis suggested benefits in Health-related Quality of Life. Regarding physical effects, HT improved exercise duration and intensity (g = 1.37, 95%CI:0.92,1.82, 2 trials, I2:0.00%). Effects on anxiety, social engagement and fitness did not achieve statistically significance.

Conclusion

The findings support the potential role of HT in promoting psychosocial and physical function among older adults with intact cognition. Given high statistical heterogeneity, more work is needed to explore the effect of possible moderators on treatment effects.
2200 Association between gait speed deterioration and EEG abnormalities
Authors: García-Agustin D , Rodríguez-Rodríguez V
Published: August 2024

Introduction

Physical and cognitive decline at an older age is preceded by changes that accumulate over time until they become clinically evident difficulties. These changes, frequently overlooked by patients and health professionals, may respond better than fully established conditions to strategies designed to prevent disabilities and dependence in later life. The objective of this study was twofold: to provide further support for the need to screen for early functional changes in older adults and to look for an early association between decline in mobility and cognition.

Methods

A cross-sectional cohort study was conducted on 95 active functionally independent community-dwelling older adults in Havana, Cuba. We measured their gait speed at the usual pace and their cognitive status using the MMSE. A value of 0.8 m/s was used as the cut-off point to decide whether they presented a decline in gait speed. A quantitative analysis of their EEG at rest was also performed to look for an associated subclinical decline in brain function.

Results

Results show that 70% of the sample had a gait speed deterioration (i.e. lower than 0.8 m/s), of which 80% also had an abnormal EEG frequency composition for their age. While there was no statistically significant difference in the MMSE score between participants with a gait speed above and below the selected cut-off, individuals with MMSE scores below 25 also had a gait speed<0.8 m/s and an abnormal EEG frequency composition.

Conclusions

Our results provide further evidence of early decline in older adults – even if still independent and active - and point to the need for clinical pathways that incorporate screening and early intervention targeted at early deterioration to prolong the years of functional life in older age.
2319 Deficits comprising multi-dimensional frailty indices based on routine data: sub-analysis of a scoping review
Authors: Dlima S , Hall A , Aminu A , Todd C , Vardy E
Published: August 2024

Introduction

The frailty index (FI) is a frailty assessment tool calculated as the proportion of the number of deficits, or ‘things that individuals have wrong with them’, to the total number of variables in the index. Routine health and administrative databases are valuable sources of deficits to automatically calculate FIs. There is large heterogeneity in the deficits used in FIs. This sub-analysis of a scoping review on routine data-based FIs aimed to describe and map the deficits used in multi-dimensional FIs.

Methods

Seven databases were searched to find literature published between 2013 and 2023. The main inclusion criterion was multi-dimensional FIs constructed from routinely collected data. Multi-dimensional FIs should have deficits in at least two of the following categories: ‘symptoms/signs’, ‘laboratory values’, ‘disease classification’, ‘disabilities’, and ‘other’.

Results

Of the 7526 publications screened, 57 distinct FIs were identified from 56 included studies. Most FIs were developed in the USA (n = 15) and in hospital settings (n = 19). The most dominant data source of deficits to calculate the FIs was hospital records (n = 21). Twenty-five FIs were developed for specific conditions and populations, for example, cancer, HIV, dementia, organ transplant recipients, and veterans. The median number of deficits used in the FIs was 36 (range = 5–72). Almost all the FIs (n = 56) had at least one deficit in the ‘symptoms/signs’ category, followed by ‘disease classification’ (n = 55) and ‘disabilities’ (n = 50). Approximately two-thirds of all the deficits were ‘symptoms/signs’ and ‘disease classifications’.

Conclusion

These findings highlight the reactive approach to frailty assessment, as most of these FIs were calculated from hospital data and used symptoms/signs and diseases as deficits. Given the heterogenous manifestations and long-term impacts of frailty, using a more proactive approach that leverages non-clinical routine data is warranted to prevent frailty development and progression.
2358 Evaluation of a novel screening protocol for respiratory viral infections in long-term care homes
Authors: Devereaux E , King C , Meeker S , Rockwood K
Published: August 2024

Introduction

Respiratory viral illnesses (RVI) pose a serious threat to LTC residents. Those with frailty often experience non-specific presentations causing delayed diagnosis and treatment of infection. To facilitate early RVI detection, a screening protocol was developed to evaluate changes in cognitive and functional status of LTC residents using the Single Question in Delirium (SQiD) with new Single Question in Functioning (SQiF) and Single Question in Reduced Mobility (SQiRM). This study aims to address: (i) If novel (SQiD/SQiF/SQiRM) screening was superior to public health in detecting COVID-19 in LTC, and; (ii) Did combining the novel and public health screening improve detection of COVID-19.

Methods

The novel screening protocol was integrated into daily screening for RVI at three LTC homes in Nova Scotia, Canada. Daily assessments were recorded in consenting residents. If any of the novel protocol was positive, the 4As Test (4AT) and Hierarchal Assessment of Balance and Mobility (HABAM) were evaluated and a positive 4AT and/or HABAM triggered an RVI swab for COVID-19. Area under the curve (AUC,) sensitivity and specificity analysis using PCR tests as the reference criterion was utilised. Between October 2021 to February 2024, 378 LTC residents consented to participate, resulting in 142 positive COVID-19 PCR tests.

Preliminary results

show public health screening had a sensitivity of 68.3%, specificity of 52.1% and AUC of 0.60. Novel protocol exhibited sensitivity of 12.0%, specificity of 85.2% and AUC of 0.49. Combining public health and novel screening yielded a sensitivity of 80.3%, specificity of 32.3% with a AUC of 0.59.

Conclusions

Preliminary results suggest that incorporating public health and novel protocol screening for daily RVI assessments in LTC is advantageous. Predictive accuracy is slightly less with combined screening, but sensitivity of the combined screening protocols remains high.

Other information

Ethical approval obtained from Nova Scotia Health Research Ethics Board # 1026558.
2296 Co-developing a qualitative study exploring the determinants of safe anti-coagulation in frail older adults.
Authors: Ali K , Mensah E , Kirkham F , Rajkumar C
Published: August 2024

Introduction

Despite the knowledge that oral anti-coagulation (OAC) is effective in secondary prevention of stroke, prescribing rates are low in frail older patients with atrial fibrillation (AF), dementia, and high fall risks. A joint decision-making approach between clinicians, patients and carers is needed to negotiate the risk–benefit balance. The aim of this participatory study was to engage with a group of older adults, their carers and healthcare professionals to identify key themes that will inform a planned qualitative study exploring frail older patients’ acceptance of and adherence to OAC.

Methods

We identified a group of twenty-eight adults (aged >65 years) and carers from community partners: ‘Ageing Well’ platform, Health Watch team, and the University of the Third Age (U3A) in Brighton and Hove, East Sussex, UK. Using two case vignettes of hypothetical OAC decisions, we hosted two virtual focus group meetings with the above cohort, followed by a virtual meeting with four geriatricians, two pharmacists, a GP and a patient champion. Inductive thematic analysis was performed on the group discussions by two researchers independently.

Results

Five key themes were identified as crucial to include in the future qualitative study discussions: (i) age should not be a barrier to anti-coagulation (ii) individualised, holistic assessment by a specialist is mandatory (iii) annual review of anti-coagulation should be performed, revisiting patients and carers’ understanding of the risks and benefits (iv) patient and carer education should be tailored to their medical and social background, and (v) quality of life should be a key factor in OAC decisions.

Conclusion

Engaging with a group of older adults in a co-development exercise helped identify key themes for a future study of anti-coagulation in frail older adults with AF.