bluuebunny/crossref_metadata_2025 huggingface dataset:
1147 MORPHO-FUNCTIONAL EVALUATION OF 3MG/KG ICV-STZ RAT SHOWED SPORADIC ALZHEIMER'S LIKE PATHOLOGY WITH PROGRESSIVE DEMENTIA
Authors: Roy A , Sharma S , Sharma B , Nag T C , Katyal J , Gupta Y K , Jain S
Published: January 2023

Background

Intracerebroventricular streptozotocin (ICV-STZ) injection is among the best animal models to simulate sporadic Alzheimer’s disease (sAD). Abnormality in brain insulin signalling, neurodegeneration, neuroinflammation, cholinergic damage, mitochondrial dysfunction, genetic abnormality, respiratory problem, oxidative stress, gliosis, sleep disturbances are associated with cognitive abnormalities seen in ICV-STZ injected rats. Available experimental evidence has used varying doses of STZ (<1 to 3mg/kg) and studied its effect for different study durations, ranging from 14-21 (short), 30-42 (mild), 90-105 (moderate) and 250-270 (long) days. These studies indicated that 3mg/kg of body-weight is the optimum dose for inducing sAD in the rodents. However, studies on the pathological process with related the morphological and functional abnormalities reported were illusive.

Objective/Method

Hence in the present study, we have investigated the morpho-functional changes after 3mg/kg ICV-STZ treatment with a follow-up of two months in 54 male Wistar rats (ethical no. 937/IAEC/PhD-2016).

Results

Exhibited a spatial, episodic and avoidance memory decline and increase in anxiety (p<0.05) in ICV-STZ group progressively with time from 15th day to 60th day post-injection. Morphometry showed hippocampal atrophy with CA1, CA3 layer thinning (p ≤0.01) and loss of neurons (p<0.0001) associated with third ventricular enlargement (p= 0.007) in ICV-STZ rats versus sham, along-with extracellular amyloid plaque in AD rats with Congored staining. In addition, spine morphometry with Golgi-Cox impregnation of mossy fibre showed a reduction of spine density in AD group versus control and sham group (p<0.0001). Finally, immunohistochemistry of GSK3ß, PI3K and mtCOX-1 antigen in coronal sections revealed an increase in mean intensity of GSK3ß and decrease in PI3K and mtCox-1 in brain areas associated with limbic system in ICV-STZ group on 60th day.

Conclusion

These findings suggest progressive dementia and anxiety in 3mg/kg STZ treated rats, which may be due to hippocampal atrophy, amyloidopathy, ventricular enlargement, synaptic dysfunction and deficits in energy homeostasis of brain.
1295 CAN THE HOSPITAL FRAILTY RISK SCORE BE USED TO PREDICT POST-OPERATIVE OUTCOMES IN SPINAL SURGERY?
Authors: Johnston A , Rose B , Bilmen J , Fale A
Published: January 2023

Introduction

Frailty is a syndrome associated with increasing numbers of elderly hospital admissions and prolonged inpatient stays (Archibald et al, Geriatrics, 2020, 20, 17). In 2015, an estimated 14% of inpatients in the UK were considered to have a degree of frailty, representing an approximate annual cost to the NHS of £5.8 billion (Soong et al, BMJ Open, 2015, 5, e008456; Han et al, Age and Aging, 2019, 48, 665-671). Frailty is poorly defined; there are discrepancies in existing literature on how to best quantify frailty. It is recognised there is a higher risk of adverse outcomes in this vulnerable population due to lack of physiological reserve (Clegg et al, The Lancet, 2013, 381, 752-762). The Hospital Frailty Risk Score (HFRS) is a recent development to measure frailty and identify patients at risk (Gilbert et al, The Lancet, 2018, 391, 1775-1782). This study sought to establish whether the HFRS could be used in patients with degenerative spinal disease, undergoing decompression surgery, to predict post-operative outcomes.

Methods

A retrospective service evaluation of eligible patients in Leeds Teaching Hospitals Trust between March 2018 - March 2020. The exposure was the patients’ HFRS; the outcome was the length of stay (LOS) until physiotherapy discharge. Data was sourced from electronic records.

Results

214 patients were identified with an available HFRS value. Patients were categorised as low, intermediate or high frailty. Kruskal-Wallis test for LOS and categorical HFRS: X2 =8.673, p<0.05. The median HFRS value was 1.25 (interquartile range 0.00 to 3.35). Mann-Whitney U test for LOS and numerical HFRS: W=29297, p<0.05.

Conclusions

The results of this study complement pre-existing studies of similar natures, evaluating frailty scoring and post-operative outcomes, thus, supporting the potential for standardised use of HFRS alongside holistic patient examination to streamline pre-assessment, improve outcomes and reduce the NHS frailty burden.
1298 THE IMPACT OF ACUTE HEALTHCARE UTILISATION ON FUNCTIONAL DECLINE IN OLDER ADULTS OVER TIME: A POPULATION-BASED COHORT STUDY
Authors: Conneely M , Leahy S , Trépel D , Robinson K , Boland F , Moriarty F , Galvin R
Published: January 2023

Introduction

Acute healthcare use varies by age, with older adults the highest users of most acute healthcare services. International reports have highlighted increased use of Emergency Department (ED) services by older adults. Older adults who visit the ED may be admitted to hospital or discharged home and are vulnerable to adverse outcomes including cognitive decline, falls, readmission, mortality and hospital acquired limitations in activities of daily living. Using data from The Irish Longitudinal Study on Ageing (TILDA), the aim of this study was to investigate the impact of acute healthcare utilisation at baseline on subjective and objective measures of function at four-year follow-up in older adults.

Methods

This study represents a secondary analysis of a prospective cohort study where data from Wave 1 (baseline) and Wave 3 (four-year follow up) of TILDA were analysed in conjunction with a public and patient involvement group of older adults. Acute healthcare utilisation was defined as an ED visit with or without hospitalisation in the previous 12 months. Function was assessed objectively using Timed-Up-and Go (TUG) and grip strength and subjectively using self-report limitations in activities of daily living and instrumental activities of daily living.

Results

A total of 1516 participants met the study inclusion criteria. Mean age was 70.9 years (SD=4.6) and 48% were male. At baseline, 1280 participants reported no acute healthcare use. 118 indicated an ED visit but no hospitalisation in the previous twelve months and 118 reported both an ED visit and hospitalisation. Adjusting for all covariates, compared to those with no acute healthcare utilisation, those with an ED visit with no hospital admission had poorer TUG performance at follow up (β= 0.67, 95% CI: 0.34, 1.29, p=0.039).

Conclusion

The results of this study support a relationship between acute healthcare utilisation and functional decline assessed by TUG at follow-up.
1363 ‘FRAILTY AS AN ADJECTIVE RATHER THAN A DIAGNOSIS’ - THE IDENTIFICATION OF FRAILTY IN PRIMARY CARE: A QUALITATIVE INTERVIEW STUDY
Authors: Seeley A , Glogowska M , Hayward G
Published: January 2023

Introduction

In 2017 NHS England introduced proactive identification of frailty into the General Practitioners (GPs) Contract. There is currently little information as to how this policy has been operationalised by front-line clinicians, their working understanding of frailty, or perceptions of impact on patient care. Evidence from international settings suggests primary care clinicians may have mixed interpretations of frailty, with important implications for their willingness to support different frailty interventions. We aimed to explore the conceptualisation of frailty, and how community-dwelling frail older adults are identified in primary care.

Methods

Semi-structured interviews were conducted with primary care staff across England, including GPs, physician associates, nurse practitioners, paramedics and pharmacists. Thematic analysis was facilitated through NVivo (Version 13).

Results

31 practitioners participated (12 GPs, 19 non-GPs). Frailty was seen as difficult to define, with uncertainty in its value as a medical diagnosis. The most common working model was the frailty phenotype, associated with deterioration at end of life. There was a mixture of formal and informal processes for identifying frailty. A few practices had embedded population screening and structured reviews. Informal processes included use of ‘housebound’ as a proxy for frailty, identification through chronic disease and medication reviews, and holistic assessment through good continuity of care. Many clinicians described poor accuracy of the electronic Frailty Index, yet it was commonly used to grade frailty during protocolised chronic disease reviews. The Clinical Frailty Score, in contrast, was felt to be easy to use and interpret, but inconsistently recorded within electronic health records. Most clinicians favoured better tools for identifying frailty, alongside resources to support these individuals.

Conclusions

Concepts of frailty in primary care differ. Identification is predominantly ad-hoc, opportunistic and associated with terminal illness. A more cohesive approach to frailty, relevant to primary care, together with better diagnostic tools, may encourage wider recognition.
1177 SOCIO-DEMOGRAPHIC AND RISK FACTOR DIFFERENCES BETWEEN TIA AND TIA MIMICS
Authors: Patel M , Awatramani S , Kulendran A , Umasankar U
Published: January 2023

Introduction

Diagnosis of Transient Ischaemic Attack [TIA] is important to minimise risk of future strokes. This retrospective descriptive study aimed to evaluate socio-demographic and risk factor differences between TIA and TIA ‘mimics’ in patients presenting to an inner-city neurovascular clinic.

Methods

Data was obtained over a 2-year period [2019-2020] for all new patients assessed in a consultant-provided daily week-day neurovascular service that serves a million multi-ethnic, population. Data collected included socio-demographic details, clinical risk factors, source of referral and final clinical diagnoses.

Results

Of 1764 patients, 39% [694] were diagnosed as TIA; 61% [1070] were TIA mimics with 40 distinct differential diagnoses. Compared to TIA mimics, TIA patients were older [mean(SD): 69.3(13.8) vs 59.7(16.1),p<0.001]; higher prevalence of TIA mimics in females vs males [66% vs 54%; p<0.001]. There were proportionately more patients with TIA mimics from Black and minority ethnic groups (401/610:66%) compared whites (669/1154:58%)[p=0.034]. Compared to TIA mimics, TIA patients had higher prevalence of hypertension [56% vs 40%,p<0.001], Diabetes [22% vs 14%,p<0.001], Atrial Fibrillation [10% vs 4%,p<0.001], Chronic Heart Disease [18% vs 9%,p<0.001] and moderate to severe carotid stenosis [5% vs 0.4%,p<0.001]. Prevalence of other risk factors in TIA patients included Patent Foramen Ovale [1.4%], Cardiolipin Antibodies [3.2%], and Thrombophilia [2.3%]. 14% of TIA patients had no identifiable risk factors.

Discussion

This large survey has described socio-demographic [age, gender and ethnicity] differences and prevalence of risk factors between TIA patients and TIA mimics. These differences may be useful in terms accurate diagnosis of TIA by experienced clinicians. This study provides valuable information for clinicians and researchers of stroke services in future.
1285 IMPLEMENTATION OF A MEDICINE MANAGEMENT PLAN TO REDUCE MEDICATION-RELATED HARM IN OLDER PEOPLE POST-HOSPITAL DISCHARGE - AN RCT
Authors: Ali K , Mensah E , McDermott A , Stevenson J , Hamer V , Parekh N , Schiff R , Nyangoma S , Fowler-Davis S , Cammen T , Davies J G , Rajkumar C
Published: January 2023

Introduction

Medication-related harm (MRH) events are increasing among older adults especially in the 8-weeks after hospital discharge. The Discharge Medical Service (DMS), a UK initiative, aims to reduce post-discharge MRH. In this study, we will compare the clinical, economic, and service outcomes of the DMS.

Method

Using a randomised control trial design, 682 older adults ≥ 65years due for hospital-discharge will be recruited. Participants will be randomized to either intervention arm (medicine management plan (MMP) and DMS), or control arm (DMS only) using a 1:1 stratification. The MMP includes patient and carer education about MRH, copy of discharge medications, and MRH risk score calculated using a validated prediction tool (1). Data collection includes patient clinical and social demographics, and admission and discharge medications. At 8-weeks post discharge, study pharmacist will verify MRH through patient telephone interview, and review of patients’ GP records.

Data Analysis

Univariate analysis will be done for baseline variables comparing the intervention and control arms. Variables known to be associated with MRH will be described by the randomisation groups. Further multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the two arms and modelled to provide national estimates. Qualitative data from focus group interviews at participating hospital sites will explore practitioners’ understanding and acceptance of the DMS and MMP.

Conclusion

This study will inform the use of a validated MRH risk prediction tool, and provide a clinical, and economic evaluation of the DMS and MMP in the NHS. The study has ethics approval and is adopted in the national ageing research portfolio. We are seeking additional sites.

Reference

1. Parekh N, Ali K, Davies JG et al. Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool. BMJ Quality and Safety 2020; 29: 142–53.
1156 IMPROVING RECOGNITION OF POLYPHARMACY AND ADDRESSING INAPPROPRIATE PRESCRIBING ON A CARE OF THE ELDERLY WARD
Authors: Kirk W , Mizoguchi R , Safiulova I , Dede D , Yeo Z , Bailey J , Robertson S , Karran L
Published: January 2023

Introduction

Polypharmacy is an increasing concern in medicine which will lead to prescribing errors, serious drug interactions and potentially inappropriate prescribing.

Aim

To improve recognition of ‘Polypharmacy’, routine medication reviews during patient admissions and better communication and awareness of ‘Polypharmacy’ to General Practitioners (GP).

Methods

This audit consisted of two cycles both performed over 6 weeks.

Inclusion criteria

Patients aged 65 < and on 6 < medications, admitted to Elderly Care ward at Chelsea and Westminster hospital. Interventions after the first cycle included education such as encouragement of clear documentation in medical record and GP summary, introduction of medication reviews as part of ward round, collaborative work with pharmacists. Potentially Inappropriate Medications (PIMS) were assessed using the STOPP/START criteria approved by NICE guidelines for review of medication regimes and highlighting PIMS.

Results

First cycle - 30 patients were recruited with an average age of 79.2 (13 males and 17 females). An average number of PIMS at the time of admission was 1.3 and 0.5 on discharge. Only 1/30 (3.3%) has ‘Polypharmacy’ documented and medication reviewed; Medications Reconciliation was 29/30 (96.7%). None of the patient has documentation for Polypharmacy.

Second cycle - 29 patients were recruited with and average age of 80.1. (7 males and 22 females). PIMs on admission was 1.4 and 0.3 on discharge. 25/29 (86.2%) patients had ‘Polypharmacy being documented and Medication review for 29/29(100%). Medication Reconciliation was 29/29(100%). Most Common PIMS across both cycles were statins, antihypertensive and Proton Pump Inhibitor.

Conclusion

The interventions complete improved significantly the awareness of Polypharmacy. There is a significant increment in number of medication review of 96.7% and 82.9% on documentation for ‘Polypharmacy’, and 20% reductions in PIMS on discharge.
1189 ASSESSMENT OF DISCHARGE DESTINATION FOLLOWING SHORT-TERM DELIRIUM PLACEMENT
Authors: Morrison E , Muthukrishnan V
Published: January 2023

Introduction

“Pathway three delirium” is a short-term placement in a care home specific to North Yorkshire, for patients diagnosed with delirium during hospital admission, who are medically fit but have not recovered cognitively enough for discharge home. The goal is to allow extra time to recover from delirium, to allow return to patients’ own homes. At this placement, patients are followed up by the acute hospital liaison team.

Aims

To assess final discharge destinations after pathway three delirium placement. To analyse characteristics between discharge groups.

Methods

We analysed electronic records of patients on this pathway between August 2020 and November 2021. Data was gathered on age, gender, prior cognitive impairment, visual impairment, hearing impairment, living alone, requiring package of care, and alcohol misuse.

Results

64 patients were included, 39 females (61%), 25 males (39%), average age of 83.7 years. 20 (31%) were discharged home, 26 (41%) remained in residential or nursing homes, 10 (16%) were readmitted to hospital, 8 (12%) discharge location was unknown or “other”. Average age of those discharged home was 82.65yo, those discharged to residential/nursing homes: 83.88yo, and those readmitted: 85.8yo. 80% of those discharged home were women, compared to 61% of the total group and 50% of those who remained in nursing/residential care. The discharged home group contained 80% patients who lived alone, versus 58% in the residential/nursing home group, and 30% in readmitted. 25% of the home group had a care package pre-admission: versus 46% in the residential/nursing home group, and 38% across all groups. Cognitive impairment, sensory impairment and alcohol intake showed no apparent difference across destination.

Conclusions

These findings show that this short-term delirium placement enables some patients to return to their own home. Analysis suggests that younger patients, women and those with apparently less social support were more likely to go home.
1287 THE VALUE OF A MULTIDISCIPLINARY TEAM (MDT) IN MANAGING PATIENTS WITH COMPLEX OR UNEXPLAINED SYNCOPE
Authors: McCall R , Anderton L , Mitchell L
Published: January 2023

Introduction

Syncope is a common clinical problem with a lifetime prevalence of 20%.1 Syncope shares clinical features with other disorders including seizures, metabolic disturbances and sleep disorders.2 The assessment and management of syncope can be challenging. The syncope service at the QEUH is run by geriatricians and cardiologists with an interest in syncope. Although MDTs are recognised key components in contemporary patient care in areas such as heart failure and cancer management, there is no guidance on MDT working in syncope management.3/4 In November 2017, a syncope MDT was introduced at the QEUH involving cardiologists, geriatricians, a neurologist and cardiac physiologists. This in-person MDT occurs monthly with outcomes recorded on electronic medical records in addition to a database. The aim of this review was to understand the potential impact of the MDT on diagnostic yield and time to further investigation or management.

Method

A retrospective case note analysis was performed for patients reviewed at the Syncope MDT between November 2017 and December 2021.

Results

103 patients were discussed with an average age of 64 years. The main reason for referral was cardiology specialist advice (65%), neurology specialist advice (19.4%) and complex case review (13.6%). After MDT discussion, the percentage of patients with unexplained TLoC reduced from 26.2% to 14.6% without requirement for additional investigations. 8.7% of patients were started on anti-epileptic medication prior to outpatient neurology review after a diagnosis of seizure disorder was established and 23.1% of patients were streamlined for pacemaker or ILR insertion.

Conclusion

Introduction of a syncope MDT reduces unexplained syncope rates in complex patients, streamlines investigations, reduces the need for multi-speciality outpatient reviews and allows earlier introduction of anti-epileptic medication for those with a new seizure disorder. These benefits improve the patient experience by reducing time to diagnosis and treatment.
1290 CAN P1NP LEVELS INFLUENCE MANAGEMENT PLANNING FOR PATIENTS WITH A FRAGILITY HIP FRACTURE RECEIVING ANTI-RESORPTIVE MEDICATIONS?
Authors: Kraidi M , Wilkinson I , Bandyopadhay S , Griffiths S
Published: January 2023

Introduction

Procollagen-N-terminal-peptide (P1NP) is a bone formation marker. Bisphosphonates lead to a reduction in P1NP levels and levels are significantly elevated shortly after fracture. In older patients taking bisphosphonates who have had a further osteoporotic fracture there is a lack of evidence to guide ongoing osteoporotic management.

Objectives

To assess if measuring P1NP in patients receiving Bisphosphonates treatment who develop neck of femur fractures helps guide further management in regards to long term bone protection treatment.

Method

Retrospective descriptive cohort study of P1NP levels for the patients who presented with NOF# (>60yrs) and who were taking anti-resorptive medications. Cases were discussed in our complex bone health MDM and patient specific plans made accordingly.

Results

60 patients were identified between March 2017 and Sept 2021 had P1NP tested (2.6 % of the 2,303 total fractures in this time). Mean age 83 years (F:M – 54:6 / # type - IC:EC – 34:26). Overall: 17 (28%) patients had significantly elevated PINP with identifiable reasons. 39 (65%) patients had supressed P1NP levels (< 35mcg/L) and 5(7 %) between 36-39 mcg/L. Of those with supressed P1NP: Patients taking treatment >5 years (n=9) – Treatment stopped for 6 patients, 2 changed treatment following DXA and 1 continued. On treatment 3-5 years (n=8) – 5 continued with treatment, 1 had further ix and 2 treatments changed On treatment 1-3 years (n=17) – 14 continued treatment, 2 treatments stopped, 1 treatment changed On treatment <1 year (n=16) – all continued the same treatment

Conclusion

The measurement of P1NP has been helpful in making patient centred decisions in this cohort. It has added to the detailed discussions in the hip fracture bone health MDM and for 23% of patients with supressed bone turnover contributed to a change in management. Most changes occurred in those patients taking treatment for more than 5 years where the evidence of bone turnover suppression gives confidence to stop or change treatment.
1327 PROACTIVE COMPREHENSIVE GERIATRIC ASSESSMENT FOR CARE HOME RESIDENTS LIVING WITH FRAILTY
Authors: Robinson A , Chaplin A , Farnsworth M , Sin Chan C
Published: January 2023

Introduction

Frailty is a long-term condition with potentially significant associated healthcare costs and resource usage. The gold standard evidence-based intervention is a comprehensive geriatric assessment. The NHS Long Term Plan highlights the importance of ageing well and developing proactive services in the community. Care home residents often have unmet health and social care needs, and are frequently frail.

Methods

59 patients with severe or very severe frailty (Rockwood clinical frailty score 7 or 8) across three care homes with both residential and nursing provision were reviewed in person. They were then discussed in an MDT comprised of geriatricians, GPs, community matrons, district nurses, community therapists and care home staff in order to complete a virtual CGA resulting in a personalised care plan.

Results

In the 8 weeks after MDT, compared to the 8 weeks before, there was a 49% reduction in GP contacts (28 vs 55) and a 17% reduction in ED attendances (5 vs 6). There was a 133% increase in proactive referrals (7 vs 3) and 20 advanced care plans were completed. 74 medications were reduced or stopped whilst 4 medications were started, with a cost saving of £812.58 over the 8 week follow up.

Conclusions

Despite a small sample size and a short follow up period, these results suggest that intervention with a proactive CGA provides benefits to frail care home residents, particularly with regards to reductions in polypharmacy and improved access to advanced care planning. These results also suggest potential benefits to the wider system, with reductions in GP contacts and unplanned hospital attendance. We suggest that in future a CGA should be completed for each new resident to a care home as the basis of a personalised care plan.
1335 POSTURAL HYPOTENSION QUALITY IMPROVEMENT PROJECT - HOW GOOD WE ARE IN MEASURING IT?
Authors: Eng C , Cernovschi N , Aung Htin , Jozefczak J
Published: January 2023

Introduction

A large proportion of Morriston Hospital’s acute medical take consists of elderly patients admitted with falls. Postural hypotension is a cause of syncope and fall which contributes to morbidity, disability and death in cases of injury in the frail and elderly population1. Hence, diagnosing and treating postural hypotension is crucial. It is important that the measurement of lying-standing blood pressure (LSBP) is consistent to ensure reliability of results as this would affect patients’ management. The aim of this project is to assess how postural hypotension is diagnosed in various clinical areas and assess the quality of detection.

Methods

We designed a survey to identify baseline variation in method and accuracy in measuring postural hypotension and compared it against National Audit in-patient Falls RCP “Falls and fragility Fracture Audit Programme”1. The survey was distributed across acute and general clinical areas involving staff nurses, healthcare assistants and junior doctors. We collected and analysed the data, implemented outcomes and re-conducted the second PDSA. Grand Round presentation and worked-based tutorial sessions based on the above was our intervention.

Results

57 staff members (acute medical, surgical wards and emergency department) participated. PDSA2 showed improvement of >25% of participants allowing patients to rest before initial BP measurement compared to PDSA1. There is an improvement of approximately 7% in repositioning the patient. 47% measured standing BP between 1-3mins at PDSA1 and this has doubled in PDSA2. Conclusions

This study showed the importance in ensuring consistency in measuring LSBP. There was significant variation in timing and measurements which have impacted the results and interpretation of postural hypotension. The education sessions had positive impact and is also a sustainable practice.

Reference

1. Falls Prevention in Hospital, 2022.
1360 REVIEW OF OUTCOMES OF PATIENTS ADMITTED TO AN ENHANCED ASSESSMENT BED AT AN INTERMEDIATE CARE UNIT
Authors: Mason C , Edwards S , Packer S , Mahmood K , Gupta A
Published: January 2023

Introduction

The Norman Power Centre (NPC) is an Intermediate Care Unit, in Birmingham, UK, providing enhanced assessment beds (EAB) where patients undergo functional assessment after an acute admission. There is little published data regarding the outcomes for patients admitted to EAB, so we set out to analyse outcomes in our unit.

Method

Data was collected from 50 patients who were discharged from EAB between September 2021 and March 2022.

Results

The mean length of stay was 36 days, median was 29 days. Of the 50 patients: 4 went home with no services, 9 went home with Early Intervention Community Team (EICT) support, 5 went home with package of care (not EICT), 13 went to new residential home placements, 6 went to new nursing home placements, 11 were re-admitted to hospital, 1 died and 1 received palliative care. 28 patients went to the destination that was originally intended on admission, 9 went to a less restrictive option and 12 required a higher dependency destination (predominantly re-admission to hospital.) The change in Elderly Mobility Scale from admission to discharge ranged from -1 to +15. Mode and median were both 0 and mean change was +2. 49 patients had Barthel scores on admission and discharge. Change in score ranged between -1 and +9. Mode and median change was 0, and mean was +1.7.

Conclusions

This data shows positive outcomes in terms of discharging most patients to their intended, or better, destinations. It also gives us an objective measure of the change in functional status that patients are achieving during their stay. There is a high rate of hospital re-admissions, indicating the unstable nature of the health of frail people. We are now ready to move onto a PDSA cycle to see if we can improve outcomes for our patients.
1172 APPLYING THE NATIONAL STANDARDS OF PERIOPERATIVE CARE OF OLDER PEOPLE UNDERGOING EMERGENCY LAPAROTOMY (NELA)
Authors: Robinson P
Published: January 2023

Introduction

There are well documented in-equalities for outcomes for surgical intervention associated with Age and Frailty including emergency laparotomy. NELA data has shown over half of such patients are over 65 years old about one fifth are over 80. These patients having significantly higher mortality, longer hospital stays and it has also shown frailty to be an independent marker of poor outcomes. Through application of key standards these outcomes have improved however input from “consultant geriatrician-led MDT” remains stubbornly low nationally.

Aims

To improve local Trust performance in meeting the NELA standard: “Peri-operative assessment by a member of the Geriatrician-Led MDT for frail (CFS 5+) patients 65 or older” to >80% (Green: ≥80%, Amber: 50 – 79% Red: <50%) of estimated 100 patients per year.

Methods

1. Proactive case finding with general surgical teams; 2. Engagement with Emergency Surgical Committee and NELA leads; 3. Improved our own electronic referral system; 4. Assist in development of electronic booking system with emergency laparotomy cases

Results

We showed a significant improved in meeting the NELA standard from the red zone (Mean: 33% range 5% to 35%) into the amber with a of mean 60% (quartile range 52% to 78%) but still remains below our target with significant quarterly variation seen. All referrals and assessment remain post-intervention.

Limitations in measures:

Conclusions

Following a number of change ideas and despite challenging COVID related staffing issues we showed that a combination of key stakeholder engagement, proactive case-finding and improved referral processes we have improved Geriatrician input in frail patients undergoing emergency laparotomy. We suspect due to the non-systematic assessment of frailty that we may be missing some patients and or seeing late in care pathway.
1210 PROVISION OF EYE CARE SERVICES AND INTERVENTIONS IN CARE HOMES - A NARRATIVE SYNTHESIS REVIEW
Authors: Ma N , Low S , Hasan S , Banna S , Patel S , Kalsi T
Published: January 2023

Introduction

The prevalence of eye disease and visual impairment in care home residents is disproportionately higher compared to the general population. Access to eye care services and treatment can be variable for this vulnerable population.

Objective

This narrative synthesis reviews the available evidence of services and interventions for delivering eye care to care home residents. The key review questions:

Methods

Literature search of EMBASE/MEDLINE for original papers published since 1995. Two reviewers independently reviewed abstracts/papers. Data was extracted and evaluated using narrative synthesis.

Results

13 original papers met the inclusion criteria. On-site optometrist-led services improved diagnosis and management of eye conditions, with one study showing 53% of residents benefited from direct ophthalmology intervention. Provision of interventions such as cataract surgery, refractive error correction and low vision rehabilitation improved visual acuity and vision-related quality of life but did not improve cognitive or physical function, depression or health-related quality of life. There was little UK-based literature to inform eye service design or interventions to improve outcomes.

Conclusion

Care home-based eye assessments improve the management of eye conditions. Interventions improve visual acuity and vision-related quality of life. Further research and/or clinical service scoping is needed to better understand current UK services, access difficulties or examples of good practice as well as to identify and test cost-effective service models for this vulnerable group.
1211 FRAIL TRAUMA PATHWAY: ENCOUNTERING STUMBLING BLOCKS
Authors: Halevy C , Stephen F , Lochrie N , Jennings C
Published: January 2023

Introduction

The Trauma Audit and Research Network report “Major Trauma in Older People” highlighted the need to recognise falls in older patients as a mechanism leading to potentially life-threatening injuries. Reasons behind falls can be equally serious and must be addressed concurrently. A Frail Trauma Pathway was introduced in the Emergency Department (ED) of a Major Trauma Centre (MTC) and subsequent audit revealed it was underutilised. We relaunched the Frail Trauma Pathway incorporating a checklist with the aim of improving patient care.

Method

Retrospective data was collected over one week, including patients over 65 years with a Clinical Frailty Score ≥5, a low velocity trauma and multiple injuries or isolated head injury. We then updated the Frail Trauma Pathway incorporating a checklist, re-distributed it throughout the ED, sent staff email reminders and held teaching sessions. An educational “Advent Calendar” was circulated daily in December. Following this we repeated data collection.

Results

20 patients pre and 18 post-intervention fitted inclusion criteria. There was a reduction in admission rates, improvement in ED senior doctor review for primary survey, increase in timely administration of Parkinson’s disease medication and venous thromboembolism assessment. However, there was a decline in other parameters measured. Due to the small patient cohort, it is difficult to assess if changes in results post-intervention are statistically significant.

Conclusion

Several aspects of the frailty pathway showed improvement, notably admission reduction. This QIP demonstrates the difficulties of instigating change in an MTC, where numerous pathways result in ‘information overload’ and staff numbers are large and constantly changing. By focusing on the frail trauma checklist and incorporating it into our electronic records system we hope to improve compliance with the pathway. Further research on a national level is required to determine how to best care for this expanding cohort of patients.
1343 ADVANCE CARE PLANS (ACP) IN SECONDARY CARE: WHAT ARE THE PATIENT OUTCOMES FOLLOWING DISCHARGE FROM HOSPITAL WITH AN ACP?
Authors: Hay W , Yard J , O'Donnell J
Published: January 2023

Introduction

Treatment escalation plans are discussed in hospital but not always communicated to community care on discharge, leading to avoidable admissions to hospital and hospital deaths which may be not what the patient wants. The project aimed to review what happened to patients discharged from hospital with an ACP over a 12-month period.

Method

Older person service (OPS) inpatients were identified for ACP discussions, using Clinical frailty score, presence of life limiting conditions, co-morbidities, significant decline. Over a 12-month period 155 ACP's were completed using the ACP document on the Trust electronic record (EPR), including the level of appropriate care and preference for location of on-going care. On discharge copies of the ACP were sent with the patient, to their GP and the ambulance service. EPR was used to review patients up to 12 months post discharge.

Results

Of patients with an ACP; the wish of all patients was to remain out of hospital and be cared for in the community; 63% were discharged to care home setting; 19% were readmitted as inpatients (43.7% Trust OPS/no ACP readmissions); 8% of patients died before discharge; 92% of patients who died after discharged, died out of hospital (47.5% Trust OPS/no ACP deaths); 25% were still alive at 12 months. The process of completing the ACP and communicating the ACP was found to be long and not user friendly with multiple steps and needed refining.

Conclusion

ACP's offer support to facilitate patient's wishes. The use of ACP's in secondary care benefits patients on discharge, it reduces readmissions and in-hospital deaths. The current ACP document is lengthy and requires simplifying. This has led to a work group to redevelop the ACP into a more user friendly/shareable document, which will encourage on-going use of ACP's and can be adopted throughout the Trust.
1151 IMPROVING THE MEASUREMENT OF POSTURAL BLOOD PRESSURE WITH AD-HOC MOBILE TEACHING SESSIONS FOR NURSES AND HEALTHCARE ASSISTANTS
Authors: Jones T N , Wilson P , Hoy E , Pherwani S , Meng J , Jethwa N
Published: January 2023

Introduction

Falls are a major cause of morbidity and mortality in patients over 65. Unrecognised postural hypotension is a significant and treatable contributor. Training nurses and health-care assistants (HCAs) in correct measurement technique can be challenging, as these groups are rarely able to fully attend single sessions due to urgent clinical commitments, night duties and staff-shortages. We aimed to improve the frequency and quality of lying-standing blood pressure (LSBP) measurement in a Geriatric inpatient cohort.

Methods

Three PDSA cycles were performed over a 10-month period on a single Care of the Elderly ward, including an initial audit in March 2021. The outcome measures were:

1. the percentage of non-bedbound patients having LSBP correctly measured (5-min recumbent, 1 and 3-min standing readings), assessed by chart review and

2. the understanding and confidence of measurers in correct technique, as assessed by a questionnaire.

The intervention was developed into three separate days of ad-hoc mobile teaching sessions to allow reinforcement of knowledge. Trainers moved from bay-to-bay delivering a 5-minute pre-prepared presentation/demonstration on the indications and correct technique of LSBP measurement. This was repeated throughout each day until all measurers had participated.

Results

On initial assessment, only 21% (6/28) of non-bedbound patients had LSBP correctly measured. This improved to 44% (8/18) by July and 62% (8/13) by December 2021. When sampled, measurers had sustained improvements from July (n=8) to December (n=7), in terms of self-rated confidence (mean 4.4/5 vs 4.9/5), correct technique (25% vs 100%), interpretation of results (25% vs 43%) and knowledge of contraindications to measurement (88% vs 100%).

Conclusions

We describe a strategy using ad-hoc mobile teaching sessions to train nurses and HCAs to measure LSBP in a Geriatric inpatient cohort, which resulted in sustained improvements. We believe this technique is readily applicable to other units and areas of practice.
1324 DEVELOPMENT OF A M&M MEETING INTEGRATING THE SITUATIONAL JUDGEMENT REVIEW (SJR) FRAMEWORK IN A GERIATRIC DEPARTMENT
Authors: Palmer-Jones C , Zamfir I , Stoian I
Published: January 2023

Introduction

The National Mortality Case Record Review Programme commissioned in 2016 aimed to improve the learning from deaths process. As part of this aim, several reports were published, which identified barriers in implementing the mortality review process. Mortality and Morbidity (M&M) meetings can be an important mechanism for removing these barriers, and while have been in place for a long time in surgical specialties, are only recently becoming more common in medical specialties. We have developed an innovative M&M meeting in our geriatric department to integrate Mortality case reviews with teaching and QI development.

Methods

We created a standardised mortality data collection proforma, using the (SJR) framework as a template. During the development, feedback was obtained from consultants and juniors. Data was then collected using the proforma by trainees, and all mortality cases were then reviewed with consultant supervision, and specific cases were chosen for their educational benefit or requiring areas of improvement. Cases were then presented at the meeting. At the end of the meetings, an action plan was then created in collaboration with the consultant and juniors in the meeting to create a teaching plan or develop a QI project to help improve service.

Results

From feedback gained, the M&M was well received, and has already helped improve training and delivery of end of life care and recognising the dying patient. There were several difficulties identified during the process such as incomplete medical records, time and lack of engagement from other team members due to work pressures.

Conclusion

Mortality meetings are an essential part of junior doctor training and hospital clinical governance, often times underutilised. They can support quality improvement and professional learning, especially when facilitated by a standardised mortality review process.
1330 A SURVEY TO ASSESS REHAB THERAPY COMMUNICATION BETWEEN DIFFERENT MEMBERS OF THE MDT
Authors: Parish B E , Kaneshamoorthy M , Ukah N
Published: January 2023

Introduction

Physical rehabilitation is related to better surgical and medical outcomes for patients (WHO, 2021). In hospitals, the role of the rehab team is essential to promote faster and better recovery and to prevent falls (Brett et al., 2019). We wanted to review the communication between the rehab team and medical team to aid discharge planning. Better communication can reduce repetition.

Methods

A baseline survey was given to doctors, nurses, and rehab staff on a geriatric ward to review communication. The intervention was an A4 template highlighting the patients’ baseline and current function, which was placed by the bedside. A repeat survey was done to evaluate the effectiveness.

Results

Survey 1 had 13 participants. Survey 2 had 25 participants. 90% of doctors and nurses strongly agree that they need to know patients’ ability to transfer, mobilise, wash, dress and falls risks. 71.4% of rehab team agrees that patients’ rehab status is not clearly communicated between different members of the multidisciplinary team. 100% of rehab staff were asked about patient’s rehab status which improved to 71.4% after the intervention. After the intervention, 60% of doctors agree that they still find themselves asking other members of the MDT about patients’ rehab status, compared to only 37.5% of nurses.

Conclusion

To know patients’ rehab status is extremely important for their medical management, nursing management, and for their safety. A simple intervention had improved the awareness of patient rehab status, reducing time wasted on repetition. Another cycle to further improve communication by a teaching session with be conducted at each rotation ensure sustainability.

References

World Health Organization. (2021, November 10). “Rehabilitation.” Retrieved from https://www.who.int/news-room/fact-sheets/detail/rehabilitation.

Brett, L., Noblet, T., Jorgensen, M. and Georgiou, A., 2019. The use of physiotherapy in nursing homes internationally: a systematic review. PLoS One, 14(7), p. e0219488.
1337 IMPROVING THE PERI-OPERATIVE MANAGEMENT OF ANTICOAGULATION IN PATIENTS WITH NECK OF FEMUR FRACTURES (NOFFS)
Authors: Knight M , Sommar D , Mufti S
Published: January 2023

Introduction

Neck of femur fractures (NOFFs) are a clinically significant diagnosis, with 10% of patients dying within one month of diagnosis [1]. There is a strong association between earlier surgery and improvement in postoperative outcomes [2]. Taking anticoagulation can cause delays in patients being operated on. At Homerton University Hospital (HUH), no previous guideline existed to aid specifically in the management of patients with NOFFs on anticoagulation. We created a guideline in order to reduce delays to theatre, in keeping with national guidance (<36 hours to operation).

Methods

We audited all patients in 2020 admitted to HUH with NOFFs taking anticoagulation. A guideline was then created, reflecting new national guidance [3] on the management of anticoagulation pre-operatively for NOFF patients. Three PDSA cycles were completed, with repeat audit cycles following dissemination and teaching of guideline to relevant clinical groups.

Results

Following implementation of our guideline, 56% of patients had surgery within 36 hours of admission, compared to 25% previously. Advice being given to the admitting team regarding timing of the operation was more consistent, and the admitting team needed to ask for advice less often. There was an overall increase in consistency of management.

Conclusions

Ensuring NOFFs are operated on promptly reduces the risk of co-morbidity and mortality [2]. There are often incorrect delays to theatre following anticoagulation administration due to perceived risk of bleeding. We created and implemented a new guideline, which successfully reduced time taken for patients on anticoagulation to be taken to theatre for operation.

References

[1] NICE. ‘Hip Fracture: Management’. Clinical guideline. Published: 22 June 2011. Accessed at: nice.org.uk/guidance/cg124.

[2] Seong YJ, Shin WC, Moon NH, Suh KT. Timing of Hip-fracture Surgery in Elderly Patients. Hip Pelvis. 2020;32(1):11-16. doi: 10.5371/hp.2020.32.1.11.

[3] Griffiths R, Babu S, Dixon P et al. Ray), Guideline for the management of hip fractures. Anaesthesia 2020; 76: 225–37.
1257 IMPROVING HYDRATION IN ELDERLY PATIENTS ON OUTLIER WARDS AT NEWHAM UNIVERSITY HOSPITAL (NUH)
Authors: Smith C R E D , Aziz S , Duper S V
Published: January 2023

Introduction

Dehydration is a major contributing factor to morbidity and mortality in elderly patients, as they are at greater risk and more vulnerable to the consequences of inadequate fluid intake. Care of the Elderly (COE) wards are set up to meet the specific care needs of elderly patients, however, these care needs are not consistently met on medical outlier wards at NUH. This project aimed to improve hydration-related patient care on outlier wards using a sustainable intervention by increasing average daily fluid intake (ADFI) by 50% and patients with drinks within an arm’s reach by 50%.

Methods

Cycle 1: Hydration parameters (ADFI, glasses within reach, drinks offered, glasses filled) were audited for patients on two COE wards (n=25) and four outlier wards (n=19).

Cycle 2: Reminder to offer patients a drink added to outlier patients’ ward round entries and nurses verbally informed over 1 week (n=14).

Cycle 3: ‘Think Drink’ poster placed at outlier patients’ bedsides as a visual reminder and nurses verbally informed over 1 week (n=15).

Results

Cycle 1: ADFI was 774mls greater on COE than outlier wards, 299% more glasses within reach, 62% more drinks offered, 78% more glasses filled.

Cycle 2: 52% increase in ADFI (258mls), 104% more drinks within reach, 11% more drinks offered; 15% less glasses filled.

Cycle 3: further 8% increase in ADFI (62mls), 87% more glasses within reach, 4% more drinks offered, and 124% more glasses filled. Overall: 65% increase in ADFI, 280% more glasses within reach, 15% more drinks offered, and 90% more filled glasses.

Conclusions

An important gap in care was identified between COE and outlier wards, leaving elderly outlier patients vulnerable to dehydration. ‘Think Drink’ poster acted as a successful visual reminder for staff and visitors demonstrated by an increase in all hydration parameters, improving hydration-related patient care.