bluuebunny/crossref_metadata_2025 huggingface dataset:
1599 DOCUMENTED NEUROLOGICAL EXAMINATION IN PATIENTS PRESENTING WITH FALLS
Authors: Smith N , Mulligan L , Jones K
Published: July 2023

Introduction

In Scotland, more than 18,000 older people are admitted to hospital after a fall each year. One in three people over the age of 65 experience a fall at least once each year (1). Neurological examination is an essential part of the initial assessment of these patients in hospital and can determine the cause of falls such as stroke, peripheral neuropathies and Parkinson’s disease. Local anecdotal evidence suggested that this was often not carried out, with the potential for delayed diagnosis and treatment.

Method

Baseline data was collected from clinical notes of admissions to the care of the elderly (COTE) wards at University Hospital Hairmyres (UHH) over a 1-month period. Multiple departmental education sessions were arranged to highlight to medical staff the importance of neurological examination in patients presenting to hospital following a fall. Following these sessions the data collection cycle was repeated. A poster has now been designed highlighting common causes of falls and in particular emphasising the importance of performing a neurological examination, with a further cycle of data collection planned.

Results

36.8% of patients admitted to COTE wards in August 2022 were admitted with falls, with only 23% of patients having a neurological exam documented on admission. Following the initial intervention, 30 patients’ notes were reviewed in January 2023. 56.7% of patients were admitted with falls and frequency of documented neurological examination had increased to 58.8%.

Conclusion

Educational sessions resulted in a 156% increase in documented neurological examinations for patients admitted with falls. We hope this improvement will lead to earlier identification of causes of patients’ falls, allowing prompt management. Our project is ongoing, with planned implementation of posters as a secondary intervention, with further data collection in due course.

Reference

1. NHS Inform. Why Falls Matter. Available from: https://www.nhsinform.scot/healthy-living/preventing-falls/why-falls-matter (accessed 27 November 2022).
1629 IMPROVING THE DOCUMENTATION OF BEST INTEREST DECISION MAKING AND SKIN CHECKS IN THE USE OF MITTENS
Authors: Tyler A , McWilliams E
Published: July 2023

Introduction

Mittens are used to facilitate necessary interventions safely in patients who lack the mental capacity adhere to them. A serious incident (SI) occurred at our Trust when a patient, with delirium, developed pressure ulcers to their wrists as a result of prolonged use of mittens. A subsequent investigation revealed that there had been inadequate skin checks and insufficient documentation, from the medical team, directing the use of mittens.

Method

A multidisciplinary QIP was initiated:

After the QIP, a notes review was completed for all patients over the age of 65 years who had a mittens checklist completed before and after the interventions. Notes were assessed for documentation of a mental capacity assessment, communication of a best interest decision, prescription of mittens and completion of a daily skin assessment.

Results

Documentation of a capacity assessment improved from 9% to 47%. Communication with relatives improved from 0% to 35%. Prescription of mittens, on the drug chart, improved from 0% to 24%. Documentation of a daily skin assessment Increased from 0% to 94%

Conclusions

This QIP brought about improved documentation of best interest decisions related to mittens and ensured regular skin checks. The next stages will involve expanding the QIP to other departments within the hospital and reinforcing messaging about communication with relatives and prescription of mittens.
1545 THE EFFECTS OF DIETARY NITRATE SUPPLEMENTATION ON PHYSICAL PERFORMANCE IN OLDER PEOPLE – A SYSTEMATIC REVIEW
Authors: Renji R , Robinson S M , Witham M D
Published: July 2023

Background

Dietary nitrate (inorganic nitrate) supplementation has been proposed as an intervention to improve muscle function via increased nitric oxide (NO) availability. Although some studies show benefit in younger adults, the effects in older people are unclear. This systematic review evaluated the effects of dietary nitrate supplementation on physical performance and muscle strength measures in older people.

Method

The review was conducted according to a prespecified protocol by two reviewers. We included interventional studies using dietary nitrate supplementation, mean participant age 60 and over, with or without sarcopenia or impaired physical performance. Outcomes of interest were physical performance and measures of muscle strength and mass. Risk of bias was assessed using a structured tool. Results were grouped by intervention and outcome measures and were described by narrative synthesis.

Results

Our search strategy found 1174 titles; 25 studies were included in the review. Study size ranged from 8 to 72 participants. Data on baseline functional status were not available, but 7 studies were in healthy older adults. The intervention duration ranged from a single dose to twelve weeks. Most studies had high or unclear risk of bias; three had low risk of bias. One hundred and nineteen outcomes were reported; 62 were physical performance measures and 57 were muscle strength measures. Twenty-nine outcomes showed significant improvement, two showed significant worsening and 88 showed no statistically significant difference. Results that showed significant improvement did not group together under any particular outcome measure, supplementation product or duration. Meta-analysis was not possible due to heterogeneity of populations, intervention duration and outcome measures.

Conclusion

Current evidence suggests that increasing intake of dietary nitrates may be beneficial for physical performance and muscle strength in older people, however data are limited. Future studies should be longer, larger and target older people with sarcopenia or impaired physical performance.
1483 REDUCING DOOR TO NEEDLE TIME THROUGH SIMULATION-BASED EDUCATION
Authors: Irvine J , Bowman M , Dynan K , McCallion C , Thompson J , McDowell V , Williamson K
Published: July 2023

Background and Aims

Many medical specialty trainees report a lack of confidence in hyperacute stroke management, contributing to inefficient patient care. We identified a lack of knowledge of our pathways, as well as difficulty managing human factors, particularly communication and teamwork. We hypothesised that the implementation of a simulation-based education programme could address these issues amongst medical specialty trainees and lead to improvements in our door-to-needle (DNT) times.

Methods

We organised a scenario-based simulation education session for our trainees led by a multi-disciplinary faculty. We addressed the management of acute ischaemic stroke, intracerebral haemorrhage, and basilar artery occlusion, as well as thrombolysis complications. Learners were surveyed before and after each session to gauge improvements in knowledge and confidence using a Likert scale. Free text feedback was sought from both learners and faculty to identify areas for improvement. We measured the mean DNT 3 months before and after our session.

Results

We improved both the knowledge and confidence of trainees in managing hyperacute stroke presentations and the human factors involved in a stroke pathway. We received feedback regarding the staffing of our on-call team and improving communication, including the use of lanyard cards and single point of contact devices. We also noted an improvement in our mean DNT amongst trainees who attended our training from 51mins to 34mins. Our resources were trialled in two other healthcare trusts to refine them further, before expanding the programme locally and regionally to improve training across all healthcare trusts.

Conclusions

Simulation education is beneficial in improving knowledge and confidence in the management of hyperacute stroke and can contribute to reduced DNT.
1527 DELIRIUM ON HOSPITAL ADMISSION IS ASSOCIATED WITH ADVERSE OUTCOMES IN PATIENTS WITH A HIP FRACTURE: THE IMPACT DELIRIUM STUDY
Authors: Penfold R S , Hall A J , Anand A , Duckworth A D , Clement N D , MacLullich A M J
Published: July 2023

Aim

Delirium is associated with adverse outcomes following hip fracture, but large-scale routine data studies investigating pre-operative delirium are lacking. Our aims were to assess delirium prevalence on hospital admission and, in patients admitted from home, determine associations with: (i) mortality; (ii) length of stay; (iii) post-discharge level of care, and (iv) hospital readmission within 180 days.

Methods

This retrospective cohort study was conducted in a major trauma centre using routine clinical records and validated audit data. Consecutive patients aged ≥50 years admitted with a hip fracture between 01/03/20-30/11/21 were included. Admission delirium status was determined by 4’A’s Test score≥4. Patients with missing scores were excluded. Associations of delirium with mortality, discharge to higher care and readmission with 180-day follow-up were assessed using multivariable logistic regression adjusted for age, sex, deprivation, and ASA grade.

Results

A total of 1821 patients (mean age 80.7 years; 71.7% female) were admitted, 1383 (mean age 79.5; 72.1% female) from home. 87 patients (4.8%) were excluded due to missing 4AT scores. Delirium prevalence in the whole cohort was 26.5% (460/1734): 14.1% (189/1340) in patients from home, 68.8% (271/ 394) in the remaining patients. In home-dwelling patients, delirium was associated with a 3 day longer median acute stay (p<0.001). In multivariable analyses, delirium was independently associated with higher mortality at 180 days (Odds Ratio (OR) 1.69, 95% Confidence Interval (CI) 1.13-2.54; p=0.013), discharge to higher care (OR 2.82, CI 1.99-4.00; p<0.001), and readmission within 180 days (OR 1.77, CI 1.01-3.11; p=0.046).

Conclusions

More than one in four patients had delirium on admission. More than one in seven admitted from home had delirium; this was associated with adverse outcomes. Routine admission delirium assessment could guide prognostication, targeted peri-operative management, and proactive care planning. Research should focus on identifying potentially modifiable risk factors and mediators of adverse outcomes following delirium.
1456 FACTORS INFLUENCING ADHERENCE TO CHRONIC DISEASE MEDICATION AMONG OLDER ADULTS IN INDIA: ANALYSIS OF WHO - SAGE2
Authors: Tolley A , Grewal K , Weiler A , Papameletiou A , Hassan R , Basu S
Published: July 2023

Background

There is a growing number of older adults in India and accordingly a rising burden of non-communicable diseases (NCDs). Poor medication adherence among patients with NCDs is prevalent in India and is associated with adverse outcomes, increased mortality and consequently increased patient and healthcare system costs. Understanding the factors which influence adherence across India is vital to guide interventions towards improved adherence. This study examined the factors influencing medication adherence in older adults (50 years or older) with NCDs in India.

Method

Data analysis was conducted from the second wave of the World Health Organisation’s ‘Study on global AGEing and adult health (SAGE)’ to identify socioeconomic, health-related, geographical and social support variables that influence medication adherence in adults with NCDs. Bivariate analysis and multivariate logistic regression modelling were conducted.

Results

The average medication adherence rate was 51% across 2840 patients with one or more NCDs. The strongest factors predicting non-adherence were multimorbidity (odds ratio 0.49, 95% CI 0.41-0.58) and feelings of depression (0.48, 95% CI 0.32-0.70). Rural living (0.71, 95% CI 0.48-1.05), tobacco use (0.75, CI 0.58-0.97), never having attended school (0.75, 95% CI 0.62-0.92) and feelings of anxiety (0.83, 95% CI 0.67-1.02) were also independent associated with poor adherence. Older age (1.89, 95% CI 1.40-2.55) was associated with improved adherence while there was a weak association between increased wealth and medication use.

Conclusion

Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and low educational status.
1564 INCIDENCE AND HEALTHCARE COST OF FALL-RELATED READMISSIONS AFTER DISCHARGE AMONG OLDER PATIENTS
Authors: Xing Qian X , Hing Chau P , Fong D Y T , Ho M , Woo J
Published: July 2023

Introduction

Older patients are vulnerable to falls after discharge as hospitalization could induce declines in physical function, mobility, and muscle strength. Falls may cause readmissions and subsequent healthcare burden. However, such incidence rates and costs have not been understudied. This study aimed to investigate the incidence and costs of fall-related readmissions in older patients.

Method

A population-based retrospective cohort study was conducted among patients aged 65 or over and discharged from public hospitals in Hong Kong from 2007 to 2017. The administrative data for inpatient admission were obtained from the Hospital Authority Data Collaboration Lab. The fall-related readmissions within 12 months following discharge were identified by the International Classification of Diseases code of diagnosis. The incidence rates were calculated in terms of person-years. The costs were computed based on the public ward maintenance fees adopted since 2007.

Results

In total, 611,349 older patients with a mean (SD) age of 75.3(7.6) were analyzed. Within 12 months after discharge, 18,608 patients (3.0%) had 20,666 fall-related readmissions, giving an incidence rate of 35.2 per 1000 person-years. Meanwhile, such rates (per 1000 person-years) were 44.7 for women, 25.5 for men, 20.5 for patients aged 65-74, 41.0 for patients aged 75-84, and 76.2 for patients aged ≥85. The annual cost exceeded HKD 145.6 million (23.9 million USD PPP in 2018) for older patients, and the mean cost per fall-related readmission was HKD 7,827 (1,286 USD PPP).

Conclusion

The fall-related hospital readmissions were important adverse events during the transitional period and caused a considerable healthcare burden to the patients, family caregivers, and the health system. Health professionals are suggested to implement interventions during hospitalizations or at the early stage after discharge to reduce falls, particularly for women and patients aged ≥85. For instance, increase physical activity during the hospital stay can be considered for fall prevention.
1485 THE TASTE AND ACCEPTABILITY OF A HIGH PROTEIN, FORTIFIED ICE CREAM COMPARED WITH HOSPITAL MILKSHAKE NUTRITIONAL SUPPLEMENT
Authors: Marsh K , Avery A , Sahota O
Published: July 2023

Introduction

Oral nutritional supplement (ONS) prescription is commonly recommended for malnourished patients in hospital. However, compliance with ONS is often low. Ice cream may be a promising nutritional intervention. We undertook a study designed to compare the acceptability of high protein, fortified, ice cream called Nottingham-Ice Cream (N-ICE CREAM) with routinely prescribed milkshake ONS.

Methods

Fifty older (≥ 65 years) inpatients with hip or spine fractures were recruited from Queens Medical Centre, Nottingham. Patients were randomised into two groups, receiving two days of N-ICE CREAM and milkshake ONS. Group A received N-ICE CREAM first and Group B, milkshake ONS first. We measured compliance, acceptability (hedonic characteristics; rating 0 dislike a lot to 7 like a lot), attitudes towards length of prescription (rating 0 very unconfident to 4 very confident) and preference.

Results

Mean (standard deviation, SD) age of patients was 80.6 (7.7) years. The majority (n = 21, 67.7%) preferred N-ICE CREAM. Mean compliance to N-ICE CREAM was greater in both Groups (Group A (n = 22) 69.9 (30.0) % and Group B (n = 26) 56.3 (39.3) %) compared to the milkshake ONS (Group A (n = 22) 43.4 (4.7) % and Group B (n = 26) 53.6 ± (40.2) %). This was statistically significant in Group A (p < 0.05). Mean hedonic ratings were higher for N-ICE CREAM with an overall impression score of 5.8 compared with 4.6 for milkshake ONS. Confidence score for both products decreased with increasing time length. Both had an overall confidence score of 2.9.

Conclusions

High protein N-ICE CREAM is more accepted and preferred by older patients with a hip or spine fracture compared to standard milkshake ONS. Further, research should explore optimal timing for N-ICE CREAM administration and long-term compliance, as well as clinical outcomes.
1531 MULTIPLE MODIFIABLE COMPONENTS OF HOSPITAL SERVICE DELIVERY PREDICT HIP FRACTURE: A NATIONAL RECORD-LINKAGE STUDY
Authors: Patel R , Baji P , Griffin J , Drew S , Johansen A , Chesser T , Javaid M K , Griffin X L , Ben-Shlomo Y , Marques E , Judge A , Gregson C L
Published: July 2023

Introduction

Substantial variations remain in hip fracture care delivery across the UK despite established standards and guidelines. We aimed to predict adverse patient outcomes following hip fracture from modifiable hospital-level organisational factors and develop implementation tools to improve national service delivery.

Method

We used a national record-linkage cohort of 178,757 patients (≥60 years) with a hip fracture in England and Wales (2016–19). We linked patient-level hospital admissions, National Hip Fracture Database and mortality data with 231 metrics from 18 hospital-level organisational-level audits and reports. Multilevel models identified organisational factors, independent of patient case-mix, associated with patient outcomes: length of hospital stay, emergency 30-day readmission, 120-day mobility recovery, days in hospital and health costs over 365-days, and mortality (30- and 365-day) in 172 hospitals across England and Wales.

Results

Over one-year patients with mean (SD) age 83 (8.6) years, spent 31.7 (32.1) days in hospital, costing £14,642 (£9,017), and 50,354 (28.2%) died. We identified 46 key organisational factors independently associated with one or more patient outcome, of which 14 were (a) associated with cost and/or bed-day savings over one year, (b) consistently associated with other positive patient outcomes, and (c) potentially modifiable. Factors included weekend physiotherapy provision (mean saving per patient/year: £676 [95%CI:£67-1285]), orthogeriatrician assessment (£529 [£148-910]), direct admission to a hip fracture ward (3.4 [-0.36-7.07]days), regular dissemination of audit data to staff (0.85 [0.30-1.39]days). These data have informed the development of a hospital-specific cost-benefit calculator, with a model business case for service improvement, specialty checklists, audit and ‘how to’ guides for complex care delivery.

Conclusion

All hospitals should try to provide the best available hip fracture care equally across England and Wales. We identified multiple, potentially modifiable, organisational factors associated with important patient outcomes following hip fracture. Our practical and freely-available toolkit should help reduce variation in service delivery.
1631 ASSOCIATION BETWEEN ADMISSION INFLAMMATORY MARKERS AND 30-DAY MORTALITY IN PATIENTS WITH HIP FRACTURE
Authors: Kolhe S N , Holleyman R , Langford S , Chaplin A , Reed M R , Witham M D , Sorial A K
Published: July 2023

Introduction

Risk prediction tools help guide prognostic conversations and benchmarking in hip fracture care. The Nottingham Hip Fracture Score (NHFS) shows only moderate predictive ability for 30-day mortality. We assessed whether routine markers of inflammation could improve the discriminant ability of the NHFS to predict 30-day mortality following hip fracture surgery.

Methods

We studied consecutive patients admitted with hip fractures at a large-volume trauma unit between 2015 and 2020. Baseline NHFS and postoperative outcome data were extracted from a local registry and linked to routine laboratory data from patients’ electronic clinical records. We selected measurements taken closest to admission pre-operatively. The biomarkers studied were albumin (negative acute-phase reactant), C-reactive protein (CRP), neutrophil count, and neutrophil-lymphocyte ratio (NLR). Univariate and multivariate logistic regression analyses were performed separately for each combination of NHFS and inflammatory marker. C-statistics were calculated to assess the discriminant ability of the NHFS with and without each inflammatory marker for 30-day mortality.

Results

We included 1710 patients, mean age 82.5 years (SD 8.2). 1199 (70.1%) were women. 104 (6.1%) patients died within 30 days of admission. In univariate analysis, admission NHFS, albumin, CRP and NLR were significantly different between those alive and dead at 30 days. Higher admission albumin was an independent predictor of 30-day mortality in multivariate analysis (OR=0.86 [95%CI 0.81-0.91], p≤0.001) as was higher CRP (OR=1.93 [95%CI 1.04-1.44], p=0.013). The addition of albumin significantly improved the discriminant ability of the NHFS for 30-day mortality (p≤0.001) (c-statistic 0.742 [95%CI 0.683-0.800] vs 0.681 [95%CI 0.617-0.745] for the NHFS alone). Other inflammatory biomarkers did not significantly improve discrimination of 30-day mortality when added to the NHFS.

Conclusions

Admission albumin improves the discrimination of 30-day mortality in patients undergoing hip fracture surgery when combined with the NHFS, whereas other markers of inflammation including CRP, neutrophil count and NLR did not.
1505 USING PATIENT AND PUBLIC INVOLVEMENT (PPI), DATA AND DESIGN TO COMMUNICATE ABOUT FRAILTY TO THE GENERAL PUBLIC
Authors: Johnson L , Anand A , Marshall A , Seth S , Bach B
Published: July 2023

Introduction

Despite the high prevalence of frailty among older people, the clinical definitions and implications of frailty are not well understood by the public. Existing communication material is predominantly technical in nature and aimed at healthcare professionals. This project integrated expertise in geriatric medicine, data science, user design and patient and public involvement (PPI) to develop an accessible visual communication resource on frailty that linked data stories, clinical perspectives and public views of frailty in later life.

Methods

We recruited three public contributors from the University of Edinburgh Advanced Care Research Centre’s PPI network to contribute to formulating the aims and objectives of the communication resource. We developed user personas and case scenarios to consider the intended audience for the communication resource and how they might interact with it. To ensure that all key messages were data-driven, we analysed quantitative survey data from the English Longitudinal Study of Ageing (ELSA) (n=7289), which included information on sex, age and health deficits used to calculate standardised Frailty Index scores. We developed a storyboard to present each piece of information.

Results

Using an iterative co-design process with our PPI contributors, we tested different ways of communicating frailty information and ELSA data insights. Visual elements were incorporated to enhance engagement and informativeness. Core themes of the final 6-page resource included placing frailty in the context of resilience, healthy ageing and interactions with common health issues such as living with multiple long-term conditions. The prevalence of frailty and differences between mild, moderate and severe levels were communicated using person-examples inspired by ELSA data.

Conclusions

We produced a communication resource, informed by a co-design process, that addresses a key gap in existing frailty resources. Our work shows the value of integrating user experience research methods, public patient involvement and data insights to enhance health communications.
1600 COMMUNITY-BASED COMPLEX INTERVENTIONS TO SUSTAIN INDEPENDENCE IN OLDER PEOPLE: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Authors: Crocker T F , Lam N , Ensor J , Jordão M , Bajpai R , Bond M , Forster A , Riley R , Gladman J , Clegg A ,   complex interventions review team
Published: July 2023

Introduction

Sustaining independence is important for older people, but there is insufficient guidance about which community services to implement.

Methods

Systematic review and network meta-analysis (NMA; PROSPERO CRD42019162195) to synthesise effectiveness evidence from randomised or cluster-randomised controlled trials of community-based complex interventions to sustain independence for older people (mean age 65+) living at home, grouped according to their intervention components. Main outcomes: Living at home, activities of daily living (ADL), care-home placement, and service/economic outcomes at one year. We searched five databases and two registries, and scanned reference lists. A random-effects NMA was used. We assessed risk of bias, inconsistency, and certainty of evidence.

Results

We included 129 studies (74,946 participants). Nineteen intervention components, including ‘multifactorial-action’ (individualised care planning), were identified in 63 combinations. Few studies contributed to each comparison. High risk of bias and imprecision meant results were very low certainty (not reported) or low certainty (unless otherwise stated). Findings may not apply to all contexts. For living at home, evidence favoured ‘multifactorial-action and review with medication-review’ (odds ratio (OR) 1.22, 95% CI 0.93 to 1.59; moderate certainty), and three other interventions: ‘multifactorial-action with medication-review’; ‘cognitive training, medication-review, nutrition and exercise’; and ‘ADL, nutrition and exercise’. Four interventions may reduce odds of remaining at home. For instrumental ADL (IADL), evidence favoured ‘multifactorial-action and review with medication-review’ (standardised mean difference (SMD) 0.11, 95% CI 0.00 to 0.21; moderate certainty). Two interventions may reduce IADL. For personal ADL, evidence favoured ‘exercise, multifactorial-action and review with medication-review and self-management’ (SMD 0.16, 95% CI -0.51 to 0.82). Among homecare recipients, evidence favoured addition of multifactorial-action and review with medication-review (SMD 0.60, 95% CI 0.32 to 0.88). Other findings were inconclusive.

Conclusions

The intervention combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Unexpectedly, some combinations may reduce independence.
1643 LIVING LABS APPROACH TO INTEGRATE DIGITAL CARE PLANS INTO RELATIONSHIP-BASED CARE IN CARE HOMES
Authors: Chadborn N , Astle A , Heath R , Watt J , Gordon A
Published: July 2023

Introduction

Teaching and Research in Care Homes (ToRCH) is a living labs partnership between University of Nottingham and three care homes in Derbyshire and Nottinghamshire. We aim to engage care home teams in research, including knowledge exchange and co-designing research proposals.

Methods

We conducted 7 workshops / focus groups with 10 staff members. These were supplemented by site visits, where the researcher observed staff meetings and met with residents and relatives (for patient and public involvement). We elicited discussion by appreciative inquiry method and recorded findings through field notes. Ideas built over time, iteratively, through ongoing discussion.

Results

Digital care records, in place in all member care homes, were a focus of discussion and we identified three topics for improvement projects and accompanying research: A) Emerging from lockdown, care homes identified newly appointed staff may have missed aspects of training about digital documentation, e.g. using language consistent with the model of care. Additional support may optimise use of digital records consistent with relationship-based practice. B) Using digital care record for benchmarking to support improvement projects. C) Realtime analysis of digital care records to identify deterioration and deliver proactive care. Our partnership is working with the software providers to develop these projects to improve continuity of proactive care and to develop indicators to assess outcomes of improvement projects.

Conclusion

Our living labs partnership has enabled care home teams to reflect on their use of digital care records and how these mediate communication within the care team as well as with family carers and primary care colleagues. Fresh perspectives have emerged which may accelerate the impact of digitalisation of care homes.
1653 THINKING OUTSIDE THE BOX: EXPLORING USER AND CARER PERCEPTIONS OF PHARMACY-FILLED MULTI-COMPARTMENT MEDICATION COMPLIANCE AIDS
Authors: Chin K , Hegarty A , Thielemans L , Schiff R
Published: July 2023

Introduction

Medication non-adherence is estimated to cost the NHS >£500 million a year in preventable morbidity, mortality and health service use. Multi-compartment medication compliance aids (MCAs) are provided in an effort to promote adherence, despite opposing recommendations from NICE and the Royal Pharmaceutical Society. This study aimed to understand the views of patients and carers of MCAs, including those who have declined or discontinued the use of a pharmacy-filled medication compliance aid (pMCA).

Method

A researcher-administered questionnaire survey of older adults (“users”) and carers, who used, declined or discontinued a pMCA. Participants were recruited from inpatient, outpatient and community services at a central London NHS trust. Thematic analysis was conducted by two independent researchers to identify overarching themes.

Results

88 users and 88 carers were interviewed. The majority of pMCAs were started by healthcare professionals or requested by the carer due to polypharmacy. 12 of 61 users (20%) did not know why a pMCA had been provided, with only 6 requesting the aid themselves. 5 (8%) current pMCA users considered returning to taking medicines from their original packaging. Themes common to both groups included polypharmacy and poor product design. A theme identified solely in the patient group was autonomy and independence, while carers commented on time, waste and sustainability, and responsibility and associated mistakes. For the most part, carers and users perceived MCAs as useful tools to assist medication adherence.

Conclusion

pMCAs are often issued to manage complex medication regimens which are cognitively overwhelming, sometimes at the expense of patient autonomy. Healthcare professionals should aim to reduce the need for pMCAs through individualised medication reviews and rationalisation and improvement of pathways to obtain medicines. If their use is unavoidable, the design of the product and healthcare systems surrounding their use should be optimised to improve the user experience.
1492 EFFECTIVENESS OF EXERCISE INTERVENTIONS ON BODY COMPOSITION AND FUNCTIONAL OUTCOMES IN SARCOPENIA: A SYSTEMATIC REVIEW
Authors: Hussain H
Published: July 2023

Background

Sarcopenia is defined as the age-related progressive loss of skeletal muscle mass, strength, and function. Although many different interventions have been suggested for the management of sarcopenia, the effectiveness of such treatments is still uncertain.

Objective

To systematically assess the different interventions strategies currently reported and to evaluate their effects on muscle mass, muscle strength, and physical function outcomes in sarcopenic participants.

Methods

Web of Science, ClinicalTrials.gov, and Scopus were systematically searched for exercise, nutritional, pharmacological, and other randomised controlled trial interventions in participants diagnosed with sarcopenia and ≥50 years of age. Eligibility was assessed through reviewing titles and abstracts, and if a study was found to be eligible the full texts were read for confirmation. Risk of bias was performed on included studies and subsequently data including study, participant, and intervention characteristics, were extracted. Using this data, the studies were subgrouped according to intervention type and outcomes reported, and meta-analysis was performed on exercise interventions.

Results

Database searching retrieved 2558 records. 21 full-texts were assessed for eligibility, of which 7 were included in the meta-analysis. Meta-analysis revealed that exercise interventions significantly improved appendicular skeletal muscle mass (0.5kg, 0.09-0.91CI, P=0.02), timed up and go (-1.67s, -2.43--0.91CI, P<0.0001), grip strength (2.04kg, 0.39-3.70CI, P=0.02), and knee extension strength (12.35Nm, 8.47-16.23CI, P<00001).

Conclusion

Exercise interventions significantly improved many body composition and functional outcomes in sarcopenic participants, and these results are in line with other reviews, however further research is required to consolidate these findings due to the small number of studies with heterogeneous methods.
1601 PUBLIC AND PATIENT INVOLVEMENT AND ENGAGEMENT (PPIE) OF OLDER PATIENTS IN CODESIGN OF RESEARCH INTO PERIOPERATIVE SERVICES
Authors: Hall H , Paveley A , Mudford L , Dhesi J , Partridge J
Published: July 2023

Introduction

Patient and public involvement and engagement (PPIE) is essential to delivering patient centred, quality research. Older adults constitute an increasing proportion of the surgical population but are unintentionally excluded from traditional models of engagement. We describe the process and outputs of conducting PPIE to support future research examining the scale up of CGA-based perioperative services such as POPS (Perioperative medicine for Older People undergoing Surgery).

Method

Patients undergoing elective surgery at four NHS hospitals in England and Wales were asked to consider participation in PPIE. Twenty-two expressed interest; nine offered to participate, six declined due to their own or relative’s ill health, two withdrew, five did not respond. Six were able to participate on proposed dates. Three had access to email and video calling to join a group Microsoft Teams call. Three took part in 30-minute individual telephone calls. A patient representative from Centre for Perioperative Care (CPOC) acted as peer facilitator for the interview structured around five pre-agreed questions.

Results

Six older patients contributed through PPIE to codesign research examining perioperative services for older people, with three volunteers for long-term involvement as part of a research steering group. The group offered insight into their experience of traditional and POPS-led perioperative pathways. This group emphasised the need for coordinated care, delivered by clinicians with a holistic understanding of the whole perioperative pathway, the need to reduce duplication of information provision and diagnostic testing and a proactive approach to hospital discharge planning. Participants agreed that POPS services should be established nation-wide and that research should focus on implementation and scale-up. The need for PPIE in the dissemination of future research findings was highlighted.

Conclusion

Involving older adults in PPIE is possible and necessary to deliver healthcare services, including novel perioperative care pathways, tailored to service users.
1662 PILOT TESTING OF A BRIEF PRE-CONSULTATION MEDICINES ADHERENCE SCREENER IN A GERIATRIC OUTPATIENT SETTING
Authors: Stevenson J M , Chapman S , Ibrahim A , Ibrahim T , Syed N , Weinman J
Published: July 2023

Introduction

In older adults, medicines non-adherence is prevalent and harmful. Current methods of identification have limitations with direct questioning often being met with a reluctance to “admit” non-adherence to healthcare professionals. The Making Medicines Work for You screener has been developed to support patients and clinicians identify and discuss adherence issues in a clinical setting. This study aimed to pilot the screener and identify barriers to medication adherence in an unspecified geriatric outpatient population.

Method

Patients attending the Older Person’s Assessment Unit at a large London teaching hospital between June – October 2022 completed the 7-item paper-based screener, with the support of a carer or researcher where necessary. Descriptive analysis was used to determine the incidence and type of barriers to adherence. Associations and correlations between the screener and existing measure of adherence and medicines beliefs were assessed using Chi square and Spearman’s Rank, respectively.

Results

Of 245 patients approached, 226 consented to participate: 120 (53.1%) male; mean age 78.3 years (SD 6.7 years). 64 (28.3%) reported having someone help with their medicines and 67 (29.6%) used a multicompartment compliance aid. 193 barriers were reported: 115 (50.9%) identified at least one barrier to adherence (median 1, range 0-5). “I’ve found my own way to use my medicines” (n=53, 27.5%) and “I sometimes forget to take my medicines” (n=45, 23.3%) were the most frequently reported barriers. The screener demonstrated strong association with MARS5 (p<0.001), and moderate correlations with the MARS5 (r -0.34, p<0.001) and BMQ Concerns (r 0.29, p<0.001).

Conclusion

Despite support with medication being common, half of the participants reported barriers to medication adherence. The high rate of completion, strong association and moderate correlation with existing adherence measures suggest that the screener may have value in this setting. Further work is required to explore the barriers identified and develop appropriate interventions.
1618 A SURVEY OF ATTITUDES TOWARDS PHYSICAL ACTIVITY AND ACCEPTABILITY OF REMOTE PHYSIOTHERAPY FOR PEOPLE WITH PARKINSON’S DISEASE
Authors: Chadborn N , Beckhelling J , Skelly R , Lindop F , Brown L , Gordon A
Published: July 2023

Introduction

People who have recently been diagnosed with Parkinson’s disease (PD) may do less physical activity than the general population because of PD symptoms or loss of confidence. We have developed a remote physiotherapy intervention for which we are running an ongoing feasibility trial. To gain a broader understanding of attitudes to physical activity and physiotherapy, we surveyed people with early PD in UK. We also sought views on use of digital technology and receiving teleconsultations with health practitioners.

Method

We developed a questionnaire which was distributed on paper to local Parkinson’s UK groups, and online which was distributed via Parkinson’s UK media and more broadly via social media. The online questionnaire was hosted by JISC Online Surveys. The initial filter question asked whether the respondent was diagnosed within the previous 4 years and was resident in UK. We received n valid responses online and n valid paper responses. In terms of demographics, the most frequent age category was 60-69 years, with just over half being male (53%). Respondents of diverse ethnicities were 1.7% of the total sample.

Results

For physical activity, the majority of participants reported a high or average level of physical activity, with only 11% reporting a low level. The majority of participants reported that regular exercise was extremely or very important for keeping well with PD. When asked about barriers to being active, the most common response was apathy (36%), followed by difficulties due to PD symptoms and feeling exhausted. These barriers may be amenable to physiotherapy intervention, and we asked participants about their experience of physiotherapy. 44% reported that they had never had physiotherapy for PD; the remainder ranged from single assessment to more than one course of physiotherapy.
A qualitative study exploring the experiences and needs of people living with young onset dementia related to driving cessation: ‘It’s like you get your legs cut off’
Authors: Scott Theresa L , Rooney Donna , Liddle Jacki , Mitchell Geoffrey , Gustafsson Louise , Pachana Nancy A
Published: July 2023

Background

driving disruptions have significant impact on individuals living with dementia, their care partners and family members. Previous studies show that for older people with dementia, stopping driving is one of the hardest things that they cope with. To date, no studies exist that address the expressed needs and experiences of people living with young onset dementia (YOD) who are adjusting to life without driving, whose needs are not well understood and whose needs might be expected to differ from those of older people with dementia.

Methods

a multi-perspective, qualitative descriptive phenomenological approach was undertaken. A topic guide was developed in consultation with lived experience experts. In-depth interviews (n = 18) with 10 people with YOD and eight family caregivers were conducted, to elicit lived experiences in relation to changing and cessation of driving. Interviews were recorded and transcribed verbatim. Data were analysed using a hybrid approach, employing deductive and inductive coding.

Results

core findings reflected the impact and coping strategies employed by people with YOD and their care partners across four themes: (i) losses and burdens, (ii) the unique challenges of YOD, (iii) coping and adjustment and (iv) how to meet needs.

Conclusions

driving disruptions often come at a time when people living with YOD are likely to have significant financial and family commitments, or they/their partners may be employed or raising a family, negatively impacting individual’s roles and self-identities. Intervention to support emotional and practical adjustment and reduce social isolation is essential for coping.
Breast Augmentation: A Cross-Sectional Survey of UK and Irish Aesthetic Surgeons
Authors: Jabir Shehab , Vadodaria Shailesh , Nugent Nora , Sankar Thangasamy Kathiresan
Published: July 2023

Background

Breast augmentation surgery is the most frequently performed aesthetic surgical procedure within the United Kingdom year on year. However, many variations exist among surgeons regarding various aspects of implant usage and technique.

Objectives

The aim of this study was to evaluate current trends and practices in breast augmentation, within the United Kingdom and correlate them to evidence-based literature.

Methods

An electronic survey of 41 questions was sent to 201 surgeons performing breast augmentation within the United Kingdom and Republic of Ireland. The survey inquired about the surgeons themselves, their practice, implant choice, surgical technique, post-op care, revision surgery, and impact of breast implant–associated anaplastic large cell lymphoma among several other questions.

Results

There were a total of 166 respondents, with 146 completing the survey fully, equaling a response rate of approximately 73%. Overall, there were specific trends in certain aspects such as type of practice, number of augmentations performed per surgeon per year, preferred implant manufacturer, and implant characteristics. That said, there has been a change in other aspects such as implant texture with an increase in the use of smooth implants. The United Kingdom and Ireland concur with certain internationally dominant practice preferences, including the use of inframammary incisions and post-op bra use.

Conclusions

This survey suggests that many aspects of breast augmentation surgery in the United Kingdom are approaching standardization. There are, however, some variations in practice and controversies remaining as expected. It is our belief that further standardizing this very common aesthetic surgical procedure according to evidence-based guidelines will help to improve outcomes for patients.
The association between Staphylococcus aureus colonization on cheek skin at 2 months and subsequent atopic dermatitis in a prospective birth cohort
Authors: Rinnov Maria Rasmussen , Gerner Trine , Halling Anne-Sofie , Liljendahl Mie Sylow , Ravn Nina Haarup , Knudgaard Mette Hjorslev , Trautner Simon , Skov Lone , Thomsen Simon Francis , Egeberg Alexander , Jakasa Ivone , Kezic Sanja , Petersen Andreas , Larsen Anders Rhod , Dam-Nielsen Casper , Jarløv Jens Otto , Thyssen Jacob P
Published: July 2023

Background

Staphylococcus aureus may worsen already established atopic dermatitis (AD), but its primary role in the aetiopathogenesis and severity of AD is unclear.

Objectives

To compare the prevalence of S. aureus colonization in early infancy in children who developed AD during the first 2 years of life with children who did not.

Methods

In this prospective birth cohort study, which included 450 infants, we analysed bacterial swabs collected from cheek skin at 0 and 2 months of age. The development of AD, and its severity, was diagnosed by a physician and monitored prospectively for 2 years. Information on parental atopy, filaggrin gene mutation status and use of antibiotics and emollients was included in the analyses.

Results

At birth, the occurrence of S. aureus colonization was similar in infants who developed subsequent AD and those who did not. At 2 months of age, S. aureus colonization was more common in children who later developed AD (adjusted hazard ratio 1.97, 95% confidence interval 1.21–3.19; P = 0.006). No association was found between S. aureus colonization and AD severity or age at onset.

Conclusions

It remains unknown whether colonization with S. aureus may directly increase the risk of AD, or whether it should be considered as secondary to skin barrier impairment or a skewed immune activity, but according to our findings, S. aureus colonization is more commonly increased at 2 months of age in children who later developed AD.
Association Between Duration of SARS-CoV-2 Positivity and Long COVID
Authors: Pozzi Chiara , Sarti Riccardo , Levi Riccardo , Mollura Maximiliano , Azzolini Elena , Barbieri Riccardo , Mantovani Alberto , Rescigno Maria
Published: July 2023

In an observational study, we analyzed 1293 healthcare workers previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of which 34.1% developed postacute sequelae of SARS-CoV-2 infection (also known as long COVID). Using a multivariate logistic regression model, we demonstrate that the likelihood of developing long COVID in infected individuals rises with the increasing of duration of infection and that 3 doses of the BNT162b2 vaccine are protective, even during the Omicron wave.
Sedation and shivering management after cardiac arrest
Authors: Geller Bram J , Maciel Carolina B , May Teresa L , Jentzer Jacob C
Published: July 2023

Management of sedation and shivering during targeted temperature management (TTM) after cardiac arrest is limited by a dearth of high-quality evidence to guide clinicians. Data from general intensive care unit (ICU) populations can likely be extrapolated to post-cardiac arrest patients, but clinicians should be mindful of key differences that exist between these populations. Most importantly, the goals of sedation after cardiac arrest are distinct from other ICU patients and may also involve suppression of shivering during TTM. Drug metabolism and clearance are altered considerably during TTM when a low goal temperature is used, which can delay accurate neuroprognostication. When neuromuscular blockade is used to prevent shivering, sedation should be deep enough to prevent awareness and providers should be aware that this can mask clinical manifestations of seizures. However, excessively deep or prolonged sedation is associated with complications including delirium, infections, increased duration of ventilatory support, prolonged ICU length of stay, and delays in neuroprognostication. In this manuscript, we review sedation and shivering management best practices in the post-cardiac arrest patient population.