bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Hua Power Plant Beckles Stress Simulation Analysis
Authors: Sun Hebin , Zhao Chaoyou
Published: January 2024

The thermal pipeline is important to play an important role in the operation of thermal power plant equipment, and the safe and stable operation of the body and accessories is very important. The elbow, as an indispensable part of the thermal pipeline, directly affects the safety of the unit. On the basis of the GB/T 16507-2013 “Water Pipe Boiler” standard, this article uses the simulation simulation software to analyze the stress of 90 ° elbow under different bending radius. Distribution status. The calculation results show that: under the same wall thickness, the maximum stress is concentrated in the inner arc. As the curved radius R increases, the maximum stress of the inner arc gradually decreases. At the same time Instead, it gradually increased. Under different wall thickness, the maximum stress occurs at the outer arc.
Model-based investigation and optimization of electrolyte filling using laser structured electrodes
Authors: Biebl M , Nasser H , Hoster H
Published: January 2024

The wetting of battery electrodes with electrolyte is a time- and cost-intensive process step. One of the biggest problems is the time it takes for the liquid electrolyte to be absorbed into the porous electrode. To reduce this wetting time, laser structured electrodes can be used. The resulting grooves facilitate deeper penetration of the electrolyte during the wetting process, leading to faster wetting. Multiphysics simulations and measurement data will be used to optimize the wetting process and to investigate the influence of the structuring geometry on the wetting time. In addition to modelling the structured electrode, achieving a suitable meshing is crucial. Moreover, the physical behavior of the wetting process will be represented by selecting appropriate and realistic boundary conditions. Capillary effects and fluid flow in porous media will be considered to describe the wetting process. The computer model will be validated using measurement data. In this paper it is shown that the wetting time can be significantly reduced by using structured electrodes. It is also shown that the wetting time is further reduced for smaller distances between the grooves. The software COMSOL MULTIPHYSICS will be used to create the model.
Preparation and performance evaluation of hydrogen-producing catalysts for diesel reforming
Authors: Yuan B , Sun Z , Zhou Y X , Zhao M W , Wang A , Peng Y T
Published: January 2024

Ru/Al2O3 catalyst was prepared by standard impregnation method. The catalytic reforming performance of Ru/Al2O3 and commercial high nickel/low nickel catalysts on commercial No.0 diesel oil was studied. The regeneration method of carbon-deposited catalyst was also discussed. The results show that commercial low nickel catalyst has poor catalytic activity and stability for diesel, and increasing the water-carbon ratio can slightly improve the conversion rate of diesel. Increasing the reforming reaction temperature and adding methanol additives can effectively improve the catalytic activity of commercial high nickel catalysts. Ru/Al2O3 is a potential catalyst for diesel reforming, reducing the reforming reaction temperature can effectively prevent the catalyst from high temperature hydrolysis deactivation. Hydrogen peroxide has a good regeneration effect on Ru/Al2O3 catalyst.
Dynamic simulation analysis of working equipment of small backhoe hydraulic excavator
Authors: Tan Yaojia , Chen Xiusheng , Shi Feifan , Wang Jindi , Cao Mengxuan , Liu Qing , Wang Chonglei
Published: January 2024

To further improve the performance of a company’s excavator, reduce the production cost, and simplify the complex process of dynamic modeling, a 13-ton small backhoe hydraulic excavator working device was taken as the research object, and a virtual prototype was established by using Pro/E and ADAMS software. The excavation resistance was calculated and the STEP function was defined, the dynamic simulation analysis was carried out during the working process of the excavator, and the stress change curve of the hinge point was obtained, which reduced the calculation amount, and provided a reference for the finite element analysis and optimization design of the working device of the excavator.
Ice sensitivity analysis of different airfoils
Authors: Huo Zimo , Kong Manzhao , Deng Yiju
Published: January 2024

When an aircraft passes through clouds containing supercooled water droplets, it condenses into ice on the surface of the wing. Wing icing will reduce the flight envelope of the aircraft as a whole, limit the flight range and speed, and threaten flight safety. The range and intensity of icing are not only determined by meteorological conditions but also closely related to the types of airfoils. In order to study the influence of airfoils on icing, GAW-2 high lift airfoil, NLF (1)-0215F natural laminar airfoil and SC (2)-0714 supercritical airfoil are selected as the representatives of the three mainstream airfoils. The Numerical simulation method is used to analyze the influence of icing parameters on the three airfoils, summarize the icing rules and analyze the differences.
Modeling and simulation of arc dynamic behavior in Tri-Arc twin wire GMAW
Authors: Ren Guochun , Zhong Pu , Li Liangyu
Published: January 2024

The triple-arc (Tri-Arc) twin wire gas metal arc welding (GMAW) is an innovative approach to twin-wire welding. It establishes two arcs between the welding wires and the workpiece and introduces a third arc, called the “M arc” between the two wires. To theoretically analyze how various welding parameters affect this process, an equivalent circuit method is employed to establish a dynamic mathematical model for Tri-Arc twin wire gas metal arc welding. The welding process is characterized and simulated using MATLAB simulations to analyze variations in current signals and the wire stick-out. The results indicate that the main arc burns in a dynamic equilibrium state with periodic fluctuations, the current gradually decreases over time, and the arc is elongated. These simulation outcomes closely mirror real welding processes.
Effects of cutter modification on the meshing characteristics of intersected beveloid gear and involute cylindrical gear
Authors: Cao Yaofeng , Ni Gaoxiang , Fang Zifan , Liu Zhanqi
Published: January 2024

The parabolic cutter is introduced into the design of intersected beveloid gear and involute cylindrical gear pair, and the numerical model of the normal section tooth profile of the parabolic cutter is established. Based on the hobbing theory, the equation of the beveloid gear face of tooth machining with a modification cutter is derived. The mesh characteristics analysis model of gear pair is established, and the impacts of modification coefficients on meshing characteristics that contact pattern, transmission error, meshing stiffness, contact force, and tooth root stress are studied.
Quick trim modeling for tiltrotor aircraft in conversion mode
Authors: Zhang Xincui , Yang Youxu , Chen Shengjiu , Sun Lubin
Published: January 2024

The conversion mode in tiltrotor aircraft is of paramount importance and complexity, necessitating the trim results to ensure stable tilting using the trim model. Quick trim modeling is conducted for tiltrotor aircraft in conversion mode, focusing on the aerodynamics of the rotor using modified lift line theory. Furthermore, we develop the nonlinear flight dynamics of tilt-rotor aircraft. Based on this aircraft model, a double-layer cycle iterations method is employed to establish an efficient and rapid trim model for the tiltrotor in conversion mode at any tilt angle or during any aerial maneuver. Using Boeing Model 222 as an example, trim results for conversion mode are calculated and compared with reference data to validate the effectiveness and precision of our model.
Structure design and verification of spaceborne ka-band channel synthesis multiplexer components
Authors: Cao Jian , Peng Xin , Hu Shunping , Sun Hongyang , Lin Lin , Liu Jiangtao , Bai Yun
Published: January 2024

A method for the structural design of a Ka channel synthesis multiplexer is proposed in accordance with the footprint area, weight, natural frequency, and mechanical environment adaptability requirements of the space-borne equipment. This design utilizes key U-type folded design methods, in which two Ka channel synthesis multiplexers are cross-folded onto an integrated structural frame to reduce the equipment layout area to 33.6% of the original plane layout. Mechanical analysis and ground tests are utilized to verify the correctness and rationality of the Ka channel synthesis multiplexer structure design. This structural design concept for the Ka channel synthesis multiplexer provides a reference for the structural design of similar spaceborne equipment.
The influence of pre-strain levels on the microstructure and performance of aircraft 7b04 aluminum alloy skin
Authors: Du Jianning , Wang Lin , Li Jie , Cui Li , Jiang Xiuyu
Published: January 2024

The study focuses on the 7B04 alloy sheet. It investigates the effects of different pre-strain levels on the microstructure, mechanical properties, and fatigue behavior of the alloy through the use of optical microscopy, scanning electron microscopy, and DIC (Digital Image Correlation) system. The experimental results demonstrate that the yield strength and tensile strength of the alloy increase with the increase in pre-strain levels. At the same time, the elongation decreases with the increase in tensile deformation. In the non-uniform region, the plastic deformation capacity index of the material (denoted as ψ) follows the order ψ (non-uniform region (DIC value)) > ψ (original gauge length value) > ψ (uniform region (DIC value)). It is recommended to control the maximum local strain below ψ (uniform region (DIC value)) during production to avoid deformation instability or concentration. Furthermore, the thickness of the material decreases linearly with increasing tensile deformation, with each 4% increase in tensile deformation resulting in a 1.2% reduction in thickness. The fatigue life of the alloy increases gradually with the increase in pre-strain levels in the direction perpendicular to the fiber. At the same time, it decreases in the direction parallel to the fiber. Different deformation levels and loading directions exhibit similar fatigue fracture characteristics. Within the range of 12% pre-strain levels, the microstructure of the material remains continuous and intact without noticeable cracks at grain boundaries or phase boundaries. At the macroscopic level, when the pre-strain level exceeds 6%, distinct slip bands appear on the sheet, which is correlated with the micro-scale grain slip. This is accompanied by deformation bands and micro-cracks in the microstructure. The findings of this study are of significant importance for understanding the influence of pre-strain levels on the mechanical properties and fatigue behavior of the 7B04 alloy. The study provides valuable references for engineering practices in related fields, thereby ensuring the integrity and usability of manufactured components.
Temperature control method and verification for spaceborne atomic clock based on phase change technology
Authors: Yang Changpeng , Ren Hongyan , Song Yunfei , Xu Feng , Yang Huning
Published: January 2024

The spaceborne atomic clock, as the time reference for navigation signal generation and system ranging, is the core component of the satellite system payload, and temperature stability is one of the main factors affecting the output frequency stability of the atomic clock. To ensure its continuous and stable operation in orbit, the temperature control system needs to provide a good working temperature environment for it. This article takes the high stability temperature control of the rubidium atomic clock in low-Earth inclined orbit as the research background, and conducts research on temperature control methods and phase change devices based on phase change technology. Simulation analysis and in-orbit telemetry data show that, by utilizing the temperature stability characteristic during the phase change process, the phase change temperature control system effectively suppresses the temperature fluctuations of the rubidium atomic clock caused by drastic changes in the space thermal environment.
Chemical and thermal stability of electrospinned polyvinylidene fluoride/graphene composite membranes
Authors: Yang Heshan , Zhang Xingying , Ni Haitao
Published: January 2024

The effect of graphene content, spinning flow rate, and distance on the chemical and thermal stability of electrospinned polyvinylidene fluoride (PVDF)/graphene composite membranes was systematically investigated. Long-duration soaking experiments by three typical solution media, diluted hydrochloric acid, dimethyl sulfoxide, and mixed-solution of lithium hexafluorophosphate/methyl ethyl carbonate, were used to evaluate the chemical stability of the selected samples. The relevant results of relative mass change rate all indicate that the chemical stability of PVDF composite materials increases with increasing graphene content as well as flow rate or decreasing distance. Moreover, there is a clear consistency between thermal stability and chemical stability. The results of the thermal shrinkage rate evidence that the thermal stability of the samples could be enhanced by increasing graphene content, flow rate, and decreasing spinning distance.
Variability aware ultra-low power design of NOR/NAND gate using non-conventional techniques
Authors: Sharma Uma , Jhamb Mansi
Published: January 2024

Fundamental to digital signal processing applications such as the Arithmetic Logic Unit (ALU), logic gates serve as the foundational components. This paper presents NOR and NAND gates engineered for operation within the ultra-low voltage (LV) and low power domains (LP). Utilizing the floating gate MOSFET (FGMOS) approach, this study adopts a strategy to enhance performance, focusing on reducing design complexity and minimizing power consumption.The proposed FGMOS-NAND/NOR gate design is investigated for important device parameters such as power (pwr), delay (tp), power delay product (PDP), and energy delay product (EDP). At 0.7 V supply, the overall power consumption of the FGMOS NOR and NAND gates is 0.442 nW and 0.323 nW, respectively. Further, carbon nanotube field effect transistor (CNTFET) technology is used to implement NOR and NAND gates in this research work. A rigorous comparative analysis was conducted in this research study to assess the performance of non-conventional technologies, specifically field-effect transistors with floating gate (FGMOS) and carbon nanotube field-effect transistors (CNFET), in comparison to the conventional complementary metal-oxide-semiconductor (CMOS) technology. Notably, our investigation revealed that when carbon nanotube field-effect transistor (CNTFET) technology is synergistically employed in conjunction with FGMOS technology, the overall circuit performance is significantly enhanced. Furthermore, in order to estimate the robustness and reliability of the proposed designs, comprehensive analysis pertaining to delay and power-delay product (PDP) variability were meticulously carried out within the scope of this research article.
Non-Abelian Toda-type equations and matrix valued orthogonal polynomials
Authors: Deaño Alfredo , Morey Lucía , Román Pablo
Published: January 2024

In this paper, we study parameter deformations of matrix valued orthogonal polynomials. These deformations are built on the use of certain matrix valued operators which are symmetric with respect to the matrix valued inner product defined by the orthogonality weight. We show that the recurrence coefficients associated with these operators satisfy generalizations of the non-Abelian lattice equations. We provide a Lax pair formulation for these equations, and an example of deformed Hermite-type matrix valued polynomials is discussed in detail.
Rees algebras of sparse determinantal ideals
Authors: Celikbas Ela , Dufresne Emilie , Fouli Louiza , Gorla Elisa , Lin Kuei-Nuan , Polini Claudia , Swanson Irena
Published: January 2024

We determine the defining equations of the Rees algebra and of the special fiber ring of the ideal of maximal minors of a

2
×
n

2\times n

sparse matrix. We prove that their initial algebras are ladder determinantal rings. This allows us to show that the Rees algebra and the special fiber ring are Cohen-Macaulay domains, they are Koszul, they have rational singularities in characteristic zero and are F-rational in positive characteristic.
On generalized main conjectures and 𝑝-adic Stark conjectures for Artin motives
Authors: Maksoud Alexandre
Published: January 2024

Given an odd prime number

p
p

and a

p
p

-stabilized Artin representation

ρ
\rho

over

Q

\mathbb {Q}

, we introduce a family of

p
p

-adic Stark regulators and we formulate an Iwasawa-Greenberg main conjecture and a

p
p

-adic Stark conjecture which can be seen as an explicit strengthening of conjectures by Perrin-Riou and Benois in the context of Artin motives. We show that these conjectures imply the

p
p

-part of the Tamagawa number conjecture for Artin motives at

s
=
0

s=0

and we obtain unconditional results on the torsionness of Selmer groups. We also relate our new conjectures with various main conjectures and variants of

p
p

-adic Stark conjectures that appear in the literature. In the case of monomial representations, we prove that our conjectures are essentially equivalent to some newly introduced Iwasawa-theoretic conjectures for Rubin-Stark elements. We derive from this a

p
p

-adic Beilinson-Stark formula for finite-order characters of an imaginary quadratic field in which

p
p

is inert.

Along the way, we prove that the Gross-Kuz’min conjecture unconditionally holds for abelian extensions of imaginary quadratic fields.
1874 Developing a pathway direct to elderly medicine clinic for frail patients referred via colorectal fast-track: pilot and outcomes
Authors: Nixon A , Memery T , Morgan J , Brown A , Scampion C
Published: January 2024

Introduction

It is increasingly recognised within oncogeriatrics that standard fast-track pathways for suspected malignancy can be inappropriate for frail and elderly patients (Thomas et. al.; Age and Ageing; 2021; 50; ii8-ii13). Specifically for colorectal referrals, following standard pathways can mean undergoing invasive and expensive endoscopic investigations which may be unwanted and not alter overall management. Streaming frail patients to elderly medicine may increase opportunities for comprehensive geriatric assessment whilst reducing unwanted invasive tests and time spent on fast-track pathways.

Methods

A 3-month retrospective audit of frail patients seen in colorectal fast-track clinic was conducted to evaluate existing practice at Bradford Teaching Hospitals. This informed the design of a new pathway streaming frail patients directly to elderly clinic within 2 weeks. This was implemented in a 3-month pilot with data prospectively collected to compare outcomes.

Cohorts: - 26 patients (median age 79, WHO performance status 3) seen by colorectal team March-June 2022.

- 20 patients (median age 85, WHO performance status 2) streamed to elderly medicine clinic October 2022- March 2023.

Results

- Median time to fast-track pathway removal was 62 days for patients managed via colorectal clinic compared to 31 days via elderly medicine. - Invasive tests and imaging (CT/endoscopy) fell from 1.4 tests per patient in colorectal clinic to 0.4 patients in the pilot. - 2 diagnoses of cancer made via colorectal clinic, but no further treatment for either patient. 1 diagnosis of lung cancer in pilot group, patient undergoing radiotherapy. - Patients seen in elderly clinic had greater rates of positive diagnosis for symptoms (e.g: infective/iatrogenic).

Conclusions

Streaming frail elderly patients referred via colorectal fast-track to elderly medicine reduced the number of invasive investigations undertaken and time spent on fast-track pathways. Expanding this successful pilot could improve long-term clinical quality in the service and more widely if disseminated.
1891 Role of telemetry in detecting atrial fibrillation in acute ischaemic stroke
Authors: Gan L , Adhiyaman V
Published: January 2024

Introduction

Atrial Fibrillation (AF) causes 15% of ischaemic strokes. The National Clinical Guideline for Stroke recommends at least 24 hours of cardiac monitoring and a longer duration if cardio-embolic stroke is suspected. The British Heart Rhythm Society suggests up to 72 hours of cardiac monitoring. Currently, there is little data on the use of telemetry in detecting AF in acute strokes. Our study aims to evaluate the detection rate of new onset AF in acute stroke with telemetry and to determine if there was any correlation between the duration of telemetry and the detection rate of AF.

Method

All patients with ischaemic stroke who were admitted to stroke ward over a 3-month period were retrospectively analysed. Exclusion criteria were patients who were known to have AF, had new AF on admission electrocardiogram, patients receiving palliative care, patients who were discharged home early without having a telemetry and patients with missing records.

Results

61 patients met the inclusion criteria and 5 (8.2%) had AF on telemetry. Two patients had AF on day 1, one on day 2 and two on day 3. All of these patients were anticoagulated. The duration of telemetry ranged between 1- 19 days however no AF was detected beyond the third day of this study.

Conclusions

AF was detected in 8% of patients with ischaemic stroke within the first 72 hours of admission. Among the patients in whom AF was detected, 5% were detected between 24 hours and 72 hours of admission. Studies (EMBRACE and CRYSTAL trials) have shown that prolonged cardiac monitoring (30 days and 6 months to a year respectively) resulted in higher detection rates of AF. This study suggests that patients with ischaemic stroke should be monitored for at least 72 hours due to a higher detection rate of AF.
1853 Improving treatment for urinary tract infections for older adults in the Health and Ageing Unit
Authors: Petho H , Maruthan S , Poole-Wilson O
Published: January 2024

Introduction

A suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Therefore, correct recognition and documentation of UTIs, as well prescribing of antibiotics, is important for optimising patient care.

Methods

We reviewed UTI antibiotic prescribing practice across the Health and Ageing Unit (HAU) wards at Kings College Hospital over a two-month period. Weekly data we collected from all patients commenced on antibiotics for a suspected UTI highlighted key areas for improvement. We designed and delivered a multifaceted educational intervention to all healthcare professionals caring for older adults across the HAU. This consisted of teaching sessions, distribution of posters, and board round reminders.

Results

A further two months of data post-intervention showed improvements in several outcomes. Correct prescribing rose from 61% to 93%. The number of prescriptions with stop dates went up from 50% to 68%. The number of patients with urine samples processed in the laboratory rose from 64% to 93%. We also saw an improvement in the management of patients with catheter associated UTIs.

Conclusions

A multidisciplinary team intervention of teaching and visual cues improved the management of UTIs. This shows the power of multifaceted educational interventions for improving the care of older adults.
2020 Improving pain management in non-verbal patients
Authors: Babar L , Hodges G , Dudley I , Sessani M , Currie H , Nicolson P
Published: January 2024

Introduction

Identification of pain generally relies on patient self-reporting of symptoms. Patients with limited communication, advanced dementia or learning disabilities are unable to self-report pain. This results in pain being under-recognised and under-treated. Consequences of this are serious and include physical and psychological distress, longer length of stay and worse outcomes.1

Methods

Abbey Pain Score (APS) [Figure 1] was introduced on a single Healthcare of the Older Person ward.2,3 It was used as the primary means of assessing pain in non-verbal patients (NVP) in place of the usual verbal pain scale (scored 0-10). [Figures 2 and 3] Ward-based teaching for all doctors, nurses and healthcare assistants was conducted before introduction of the APS. Data was collected for 20 consecutive NVP.

Figure 1: Abbey Pain Score (Six items observed & Score)

Vocalisation: 0-3;

Facial expression: 0-3;

Change in body language: 0-3;

Behavioural change: 0-3;

Physiological change: 0-3;

Physical changes: 0-3.

Scoring scale: No Pain (0-2); Mild Pain (3-7); Moderate Pain (8-13); Severe (14+).

Results

At baseline we identified that pain as a symptom was missed in 54 % of NVP using the verbal pain score. With introduction of APS this dropped only slightly at 3 months but there was an increased uptake in scoring NVP on APS. With persistent engagement there was a significant decline in number of patients with un-managed pain needs. Figure 3: Abbey pain score (All patients with any pain)

Baseline

Pre-intervention: 21 / 39 (54 %); Post-intervention (3 months): 10 / 20 (50 % Post-intervention (12 months): 1 / 19 (5 %)

Conclusion

ABP is an effective means of addressing pain in NVP. It is simple to implement and can lead to significant improvements in patient care.
1868 Eight to Hydrate: Promoting oral hydration of elderly patients in hospital
Authors: Williams M , Anketell R , Georgiakakis E , Mizoguchi R
Published: January 2024

Introduction

Dehydration is associated with prolonged hospital admissions and complications. Elderly patients are more susceptible due to physiology, dexterity and cognition. The British Dietetic Association recommends minimum 7 beverages per day whilst The British Nutrition Foundation advises proactive dehydration risk management in hospital. This project aimed to reduce the proportion of elderly patients at risk of dehydration in hospital.

Methods

Staff documented oral hydration over 24 hours for patients on the Care of the Elderly ward. Additional factors obtained retrospectively included demographics, dementia diagnosis, fluid prescriptions and fluid restriction. Criteria adapted from a ‘Hydration Care Assessment Tool’ defined risk of dehydration by daily intake as low (>1500mls), medium (800-1500mls), high (400-800mls) or very high (<400mls). Approximating each drink as 200mls, we set a daily target of 8 beverages; equating to low risk. Visual hydration trackers were placed at patients' bedsides and junior doctors reminded the multi-disciplinary team each morning. Data collection was repeated after 2 weeks.

Results

First cycle recruited 13 males, 16 females with mean age 78.5. Over 50% were Very High Risk (5/29) or High Risk (12/29) of dehydration whilst the remainder were Medium Risk (10/29), or Low risk (2/29). 4/5 (80%) at Very High Risk received intravenous fluids. Of the High-Risk group, more than half had a diagnosis of dementia and 3/12 (25%) received fluids intravenously. Following intervention, 12 males and 7 females were recruited with mean age 76. Proportion at highest risk was reduced: Very High Risk (5/29 to 0/19; -100%), High Risk (12/29 to 3/19; -61%). Therefore, more were at Medium Risk (10/29 to 13/19; +101%) and Low Risk (2/29 to 3/19; +131%).

Conclusion

Though improved, few patients meet hydration recommendations. However simple visual reminders are an effective starting point. Further interventions could include oral fluid prescriptions and reflect staff and patient feedback.
1804 Feedback fatigue in the Foundation Year 1 Older Person's Unit cohort: A quality improvement project
Authors: Moore S
Published: January 2024

Introduction

On designing and leading the Foundation Year 1 (FY1) Older Person’s Unit (OPU) teaching programme at St Thomas’ Hospital, London (STH), it was identified that the method of feedback collation was inefficient and yielding poor quality feedback from FY1s. Feedback fatigue was high.

Plan

FY1 trainees were initially asked to complete feedback for their FY1 OPU teaching on paper forms. This yielded a high response rate (100% of forms completed), but feedback quality was poor. The time taken to collate responses from the paper feedback forms was disproportionate to the quality of feedback received.

Intervention 1

An online feedback form was designed and emailed to the FY1 trainees after each teaching session. This collated responses automatically into a password protected Excel spreadsheet.

Study

The online feedback form initially yielded a high response rate, along with constructive feedback. Time taken to collate responses was reduced to zero. However, was noted that the response rate fell gradually to approximately 20%. The two main factors inhibiting responses were a heavy email burden and forgetting to fill in the feedback form.

Intervention 2

A QR code linked to the online feedback form was designed, with the intention of being shown at the end of each teaching session. This was emailed out to all presenters in advance and incorporated into their teaching presentations.

Study

Feedback response rate attained 100% consistently over a 2-month period. The feedback quality received was higher, with constructive comments being fed back in a timely matter.

Conclusion

Timely recognition of feedback fatigue in the FY1 trainee cohort is extremely important. Designing and implementing methods by which to negate and overcome this is important in obtaining feedback such that future teaching sessions can be continually improved and tailored to FY1 learning needs.
1879 On a knife's edge: role of a Clinical Nurse Specialist on balancing complex treatment decisions in acute surgery
Authors: Norridge F , Anand K , Grundy P , Mullins A , Patel H P , Hewertson E
Published: January 2024

Introduction

1 in 4 older individuals having emergency general surgery live with frailty, are more likely to have a longer hospital stay, readmission rate, morbidity and mortality. This underscores the importance of individualised approaches to care through Shared Decision Making (SDM). We introduced SDM into our surgical liaison service aiming to measure effectiveness and patient outcomes.

Methods

Between October 2021 and September 2022, patients aged >70 years living with frailty admitted to the surgical unit were identified by an Older Persons Clinical Nurse Specialist (CNS). Involvement in treatment decisions was measured by using the patient and clinician SDM-Q9 questionnaire. Pre-admission as well as follow-up quality of life scores at 6 months using the EQ-5D-5L (0-100) as well as Decision Regret were obtained on subsets of patients.

Results

Of a total of 76 patients seen by the CNS, follow-up data were available for 61 patients, clinician and patient SM-Q9 were completed in 54 patients. Clinicians were 10% more likely to strongly or completely agree that they explained choice available, 16% more likely to feel they explained treatment options compared with patients. Patients were less likely to feel completely involved in decision making. However, they were more likely to agree they understood clinical information presented them. Low levels of decision regret were ascertained at follow up where 18 patients agreed and 32 patients strongly agreed that a right decision was made of their care. Of 15 patients who underwent emergency laparotomy, mean EQ-5D scores across all domains from improved from baseline (69 vs 78).

Conclusions

CNS led implementation of SDM is feasible, acceptable. Patients felt involved in their care and had lower levels of decisional regret. Encouraging and investing in an environment where health professionals take time to determine what is important to their patient can be associated with better outcomes.
1726 Vitamin D single dose loading regimen in neck of femur fracture patients
Authors: Blackburn S , McIntyre R , Williams M , Asumang J , Gandee A , Khinder S , Sharma A
Published: January 2024

Introduction

The best practice tariff for Neck of Femur Fractures (NOFF) was designed to improve patient outcomes and includes establishing and implementing a bone protection plan (BPP). Optimal management is often delayed due to insufficient vitamin D levels. Here we reviewed the administration of anti-resorptive therapies (AR) when giving vitamin D loading doses over 7 weeks compared to stat high dosing followed by maintenance therapy.

Method

Pre-intervention, we reviewed vitamin D levels, the treatment given and the bone protection therapy administered in all new NOFF admissions over 3 months. We introduced once only high dose vitamin D therapy in vitamin D deplete individuals over the subsequent 3 months; deplete (Vit D <50) patients received 140,000 units stat colecalciferol and adcal maintenance, patients with insufficient levels (Vit D 50-70) received 60,000 units stat colecalciferol and adcal maintenance and replete individuals received adcal maintenance. Patients were then given in-patient AR therapy or referred to fracture liaison service (FLS) for further BPP assessment.

Results

Pre-intervention included 64 patients, of which 61% (N=39) had low vitamin D levels (deplete and insufficient combined). These patients were loaded with once weekly 40,000 units of vitamin D for 7 weeks and referred to FLS, with 51% (N=24) receiving an appointment within 4 months. Only 14% (N=9) received in-patient AR treatment. Post intervention, 84 patients were reviewed. Vitamin D replacement was required in 69% (N=59) of patients, of which 83% (N=49) received loading regimen as per protocol. This allowed 53% (N=20) of eligible patients to receive in-patient AR therapy with 43% (N=11) of those not receiving therapy being impacted by junior doctor strikes.

Conclusion

Administrating high dose vitamin D to NOFF patients allowed us to increase in-patient AR therapy treatment 3.7 times. This simple intervention results in less out-patient appointments and treatment is given before an opportunity to re-fracture.
1996 The use of electronic 4AT delirium identification tool in inpatient care
Authors: Jabir Z , Alićehajić-Bečić D
Published: January 2024

Introduction

Delirium is an acute, fluctuating change in mental status, with inattention, disorganised thinking and altered levels of consciousness. This has serious consequences including the increased risk of dementia, death, length of hospital stay and increased chance of new admission to long term care. Therefore, prompt identification and management are essential. NICE recommends the use of the 4AT score in identification of delirium to improve subsequent management.

Method

A retrospective descriptive study was done identifying all patients admitted to Wigan infirmary who received a 4AT during the 1/4/22-30/9/22. Patients were excluded if aged <64, 4AT score of 1-3 (a score over 4 is positive for delirium) and had multiple admissions. This reduced the sample size to 275 from 8648 patients, of these data was collected from the individual electronic records from the first 110 patients.

Results

The average age of patients within the sample is 81, average 4 AT score of 6 and the average CSF was 5. There was a diagnosis of delirium in 32 (29%), and 'confusion' in 10 (15%), a past medical history of dementia in 49 (45%) and cognitive impairment/suspected dementia in a further 10 (9%), PD was found in 9 (8%) of patients. A basic blood test screen to identify a cause for delirium was done in 50 (45%) of patients. DNA CPR was present in 59 (54%) of patients, and a DOLS in 43 (39%) during the admission reviewed. Patients were on a significant number of medication (mean of 10 on discharge) and had an average of 3 ward moves. Length of stay was 20.3 days and 51 (46%) were deceased within a year of admission.

Conclusion

Embedding 4AT in electronic records improves recognition of delirium. Further work will be undertaken to improve management of this condition once it is recognised.
1808 QIP to improve the board round process on a general geriatric medicine ward
Authors: Crofts J , Baguneid C , Hillarious A
Published: January 2024

Introduction

Effective board rounds improve the patient’s experience and reduce the risks associated with a prolonged hospital stay. Ward C54 at Queen’s Medical Centre is a 30-bedded ward dedicated to the provision of care for older, frail (CFS ≥ 6) patients. Board round on C54 was unstructured and could take over an hour. The project team set out to reduce the duration of board round, improve the quality of information handed over and improve staff satisfaction with board round.

Method

Pre- and post-intervention data on the daily duration of board round were collected by the junior doctors on the ward. PDSA methodology was then used to test the following interventions: 1. Nerve centre updated daily by the junior doctor responsible for that bay 2. Junior doctors to present information using 4Q approach 3. Staff nurse in each bay highlighting any issues for that bay. Pre- and post-intervention surveys were also distributed to staff working on C54.

Results

The duration of board round was reduced from an average of 52 minutes to an average of 38 minutes post-intervention. Over 90% of survey respondents believed the board round to be more efficient and over 80% were either satisfied or very satisfied with board round duration.

Conclusions

The findings have shown it is possible to improve the duration of and staff satisfaction with board round by giving MDT members a framework to help structure handover of written and verbal information. Future considerations include providing teaching sessions to staff on the board round process.
2050 Scoping an Oncogeriatric Pathway in Acute Care
Authors: Cooper H , Ganjam S , Badawi A , McIntosh A , Marshall E
Published: January 2024

Introduction

Oncogeriatrics is relatively new concept aligning geriatric services with oncology, whereby older cancer patients have a comprehensive geriatrics assessment (CGA) to support oncology decision-making and improve outcomes and quality of care. Despite the rationale, evidence for effective oncogeriatric services is largely based upon specialist centres. We initiated a feasibility study February 2021, to establish criteria and pathway implications for an Acute Trust without oncology beds.

Method

Following an iterative process, a pathway was established between the Lung MDT and the established frailty unit. Patients with lung cancer who met criteria would be seen within a week and underwent a CGA by a frailty practitioner, consultant geriatrician, physiotherapist, occupational therapist. Referrals were made as appropriate to allied services e.g. dietician, pharmacy, continence teams etc.

Results

We refined the referral criteria and process, identifying the presence of a geriatrician at Lung MDT as key to ensuring incorporation of CFS (Rockwood) for effective MDT case discussion. Defining the cohort and pathway was challenging given the complex interplay of cancer symptom burden and comorbidity set against COVID, workforce pressures and cancer targets. Final referral criteria were: age over 70, Rockwood 4 or more, a formal lung cancer diagnosis, and a plan to undergo active treatment. Referral numbers were low during the feasibility phase. Only 38 patients were referred and we saw 23 patients over a 2-year period. Referral rates increased in the final 3 months of the pilot although only 9 of 22 who met criteria were referred.

Conclusion

Establishment of an effective oncogeriatrics service is challenging. The feasibility study has established a baseline for potential activity and job planning. Analysis of individual patient benefit is ongoing. Longer term we aim to extend the service to support patients after treatment has started, provide prehab, and include patients with all types of cancer.
1942 Developing a Frailty SDEC Team at Salford Care Organisation
Authors: Dewar R , Swinnerton E , Ingham C , Elliott C , McFarlane J , Pattison T , Fox J , Butler L
Published: January 2024

Introduction

Frail older adults have longer waiting times in emergency departments (ED’s), are more likely to be admitted, and have longer lengths of stay1,2. The NHS Long Term Plan requires hospitals to provide an Acute Frailty Service (AFS) for at least 70 hours/week and complete a Clinical Frailty Score (CFS) within 30 minutes of arrival3. The plan advocates Same Day Emergency Care (SDEC) to reduce admission related harms and discharge patients in a timely way4. The introduction of an acute frailty CQUIN that requires prompt identification of frailty and initiation of CGA is another driver for the development of AFS5.

Methods

We created an acute frailty SDEC team including a frailty nurse, clinical-fellow, advanced clinical practitioners and GPs. The team was present in ED on weekdays between 9am-5pm with 1-2 team members on each shift. A Consultant Geriatrician provided advice and support. We developed loose frailty SDEC criteria: - Age >=65years with CFS>=5 and - NEWS<3 - Triage note suggests patient may not need hospital admission.

Results

Over a 4-month period, 262 patients were seen by the SDEC team. Age and CFS score for this population are shown in Graphs 1 and 2.

Graph 1: Age of Patients Reviewed by SDEC Team

Graph 2: CFS Score of Patients Reviewed by SDEC Team -74% were seen within 2 hours as demonstrated in Graph 3

Graph 3: Minutes patients waited to be seen (WTBS) from arrival at ED triage - 131(50%) of patients were discharged directly from ED. A further 25 patients were later discharged from EAU.

Conclusions

A frailty SDEC service results in early identification of frailty, timely assessment in ED and a high likelihood of discharge (60%) directly from ED or EAU rather than being admitted to an inpatient ward. Implementation of a 7-day service would only serve to increase these figures.
2049 Evaluating the rate, timeliness and accuracy of centralised Clinical Frailty Score documentation at a major NHS A&E department
Authors: Ghaffari E , Collier A , Robb T J , Brenchley C , Carrick J , Osei-Banahene M , Martin J , Singh S , McKelvie S
Published: January 2024

Introduction

Between 5-10% of patients attending the emergency department (ED) are elderly patients living with frailty. NHS England now recommends that all patents aged >65 presenting to acute care should have a Clinical Frailty Score documented within 30 minutes of arrival. We audited the CFS documentation from the Electronic Patient Record (EPR) for patients aged >65 presenting to our local E.D.

Methods

Our baseline audit looked at patients aged >65 presenting to our ED from 01/09/23-07/09/2023 (n=430). We extracted data for rate and timeliness of documentation from EPR. To calculate accuracy, we compared the documented scores from ED triage staff, with that of our therapist led Frailty Intervention Team (FIT). We excluded patients not assessed by the FIT.

We then re-audited the data for 3 separate weeks after delivering a tailored teaching session for band 6 and 7 nurses, and introduction of an educational poster.

Results

We found exceptional baseline compliance and timeliness of CFS scoring with a 97% documentation rate with a median time of 31 mins from presentation. When assessing accuracy of triage nurse CFS documentation, we found that 42% of patients fell into a lower category of frailty when compared to scores allocated by the FIT. Following teaching sessions and poster education, we observed no improvement in this.

Conclusion

Our audit identified an overall excellent baseline compliance and timeliness in EPR documentation of CFS scores despite the department’s heavy workload. We noted a significant under-recognition of frailty at ED triage compared to specialist therapist scoring. Despite delivering education sessions and introduction of an educational poster there is still significant room for improvement in accurate identification of frailty with the CFS.
1946 Reducing admission to hospital of frail people, with acute illness, from care homes: A quality improvement project
Authors: Seeley J , Cole S , Sage S
Published: January 2024

Background

The East Kent Frailty Home Treatment Service (Frailty HTS) provides person-centred, hospital-level care for people living with frailty. The Frailty HTS can diagnose and treat acute medical illness at home or in care homes. The team philosophy is “we identify what you want and strive to make it happen”. This project was underpinned by advance care planning for people living in care homes, which the frailty team supports through proactive work with the primary care network care homes teams. Frailty is associated with increased healthcare costs and poor outcomes associated with hospitalisation. The acute hospitals were under extreme pressure. The Frailty HTS serves 360 care homes.

Methods

Carers and the ambulance service discuss all acutely unwell care home residents with the Frailty HTS prior to conveyance except in the case of a long bone fracture or acute cardiac/cardiovascular event (unless care plan is not for escalation). There were communications initiatives to care homes and Ambulance Trust explaining referral process and eligibility. A dedicated frailty HTS clinician was available to respond to calls.

Results

The pilot has seen an increase in referrals of people living in care homes from SECAMB to Frailty HTS (monthly average up from 49 up to 64) an increase in direct referral from care homes (monthly average up from 15 to 21.5). We also saw a reduction in attendance of care home residents at ED (monthly average down from 276 to 209) and reduced admissions to hospital from care homes (monthly average down from 203 to 191)

Conclusion

his project raised awareness of an alternative to acute hospital care for people living in care homes. Referrals to the Frailty HTS were increased and attendance at ED and admissions to hospital reduced. Due to system pressures it continued to run and became business as usual.
2046 Outcomes of exercise practitioner-led physical activity in hospitalised older people: Saints Foundation - UHS Partnership
Authors: Draper P , Batchelor J , Hedges P , Gealer M , McCafferty R , Leli H , Patel H P
Published: January 2024

Background

University Hospital Southampton (UHS) partnered with Saints Foundation (SF), to test the feasibility and acceptability of a non-registered Exercise Practitioner (EP) to work alongside the therapy team to promote physical activity (PA) of hospitalised older people. Our aim was to collect trust level data to review the impact the EP had on outcomes such as length of stay (LOS) and discharge destination (DD) and identify and address any additional challenges that arose.

Methods

The EP delivered twice weekly gym-based group interventions as well as regular 1:1 rehabilitation and education sessions to hospitalised older patients. Interventions were ward based or within the acute therapy gym.

Results

From June to August 2023, the EP reviewed 82 patients, mean age of 88 years. 15 (18%) patients underwent 1:1 rehabilitation whereas 67 (82%) patients underwent gym-based rehabilitation sessions. Median LOS for patients reviewed by the EP was 15 days compared with average departmental LOS of 8 days. 53 (65%) patients were able to either maintain or improve their predicted to actual discharge destination, compared with 10 (12%) patients whose physical capability declined. Of those remaining, 1 patient died and 18 others had not yet been discharged. High patient satisfaction levels continued to be reported.

Conclusion

Intervention by a non-registered EP appears to have an impact on patients’ ability to maintain or improve level of function and physical dependency during acute hospital stay. Factors such as outbreaks of infectious illness and staffing challenges prevented more frequent EP led intervention. Next steps include introducing daily class-based interventions. Participants will be encouraged to attend at least three classes. Anticipated benefits include improvement in patients’ functional levels and reductions in physical dependency on discharge. Additional data will be collected on fear of falling and confidence in function as well as uptake of post discharge activity and readmission.