bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of various electrospinning parameter and sol-gel concentration on morphology of silica and titania nanofibers
Authors: Abdillah Umar , Yazid Hafizal , Ahmad Sahrim , Makhtar Nurulizzati , Zaubidah Siti , Shan Chen Ruey , Hadifah Syifa Nur
Published: March 2022

Nano scale fibers of SiO2and TiO2with various compositions of viscosity and parameter have been prepared by electrospinning the precursor of tetraethyl orthosilicate (TEOS) and titanium (IV) isopropoxide (TiP). Different concentrations of polymer precursor polyvinylpyrrolidone (PVP) and applied voltages were studied. Distance tip to collector of 15 cm and flow rate of 0.003 mL/h were fixed for entire electrospinning process. The morphology of nanofibers was evaluated versus different solution concentrations as well as different applied voltages. Concentration focused in this study included 5 %wt, 10 %wt and 15 %wt of PVP along with 15 kV – 17.5 kV of voltages applied. The as-spun nanofibers were characterized by SEM. Results showed that the average fiber diameter decreases with decreasing of polyvinylpyrrolidone (PVP) solution concentration.
Fabrication of magnetic sugarcane bagasse paper
Authors: Azlin Azmi Annur , Amira Othman Siti
Published: March 2022

Generally, development in the pulp and paper industry requires extensive cutting of trees, which in effect contributes to deforestation. The dramatic growth in demand for wood supply, combined with the increasingly increasing cost of timber, has created a surge of interest in the use of non-wood plant fibres for paper production in widely developed countries. The use of waste material in pulping and paper-based industries could be beneficial as it helps prevent the need for disposal, which currently increases agricultural costs and causes environmental deterioration due to pollution and fires. In this research, the sugarcane bagasse was dry and chopped into 5 cm in lengths. The fibre and pulp were separated and put in a pulp disintegrator then it was weighed and mixed with water. The paper that fabricates will be irradiated with gamma-ray and then followed by characterizing with Scanning Electron Microscope- Energy Dispersive X-Ray Analysis (SEM-EDX) and Fourier-transform infrared spectroscopy (FTIR). The SEM-EDX result shows that the weight and atomic percentage of the ferrite (Fe) increase after the irradiation. While for the FTIR, the entire sample exhibit the absorption range of 3400 to 2400 cm−1region. The paper will be compared with the properties of multipurpose paper.
Applying empirical method for performance metrics measurement of a nuclear security system
Authors: Ibrahim Maizura , Nurbahyah Hamdan Siti , Ismail Saa’idi , Safuan Sulaiman Mohamad , Norazam Mohamed Aris Sufian , Hasnor Bin Hasan Mohd , Dzul Aiman Aslan Mohd , Fatini Abdul Ghani Nur , Hamijah Ab Hamid Amy
Published: March 2022

A nuclear security system is often developed based on a particular framework. In our case, a nuclear security system is developed based on the big data analytics framework with the purpose of integrating all nuclear security systems within a nuclear facility. Nuclear security can be defined as the prevention and detection of, and response to, theft, sabotage, unauthorized access, illegal transfer, or other malicious acts involving nuclear material, other radioactive substances, or their associated facilities. Whereas, big data analytics is denoted as a new way of collecting, analyzing large amounts of data, finding the appropriate patterns to support decision making, hence improving the action taken in solving the problems. The system-based evaluations methodology is widely used to measure the performance metrics of nuclear security systems. However, the system-based evaluation methodology consumes time and demands a lot of effort because in applying the methodology, a complete nuclear security system that is based on the particular framework needs to be designed, developed, and implemented in the nuclear facilities environment before the performance metrics could be measured. In this paper, we present an empirical method of measuring the performance metrics by utilizing the Rasch Measurement Model. The methodology is formulated to reduce the time and efforts in measuring the performance metrics of a nuclear system that is developed based on a framework…
Amorphous black phosphorus: wet-chemical synthesis and atomic disordering-dependent electrocatalytic performance
Authors: Sun Zhaojian , Zhang Bowen , Khurram Muhammad , Yan Qingfeng
Published: March 2022

Although crystalline black phosphorus (c-BP) is attracting enormous interest in the past few years for a wide range of applications, studies on amorphous BP (a-BP) have been quite rare due to the difficulty in its controllable synthesis. The reason lies in that the elemental phosphorous precursor favors to form c-BP, which is the thermodynamically stable phase. Herein, we report a facile ethylenediamine intercalation-and- deintercalation strategy to realize gram-scale preparation of a-BP. The atomic disordering in a-BP can be handily tuned by controlling the reaction time. Interestingly, the a-BP demonstrates atomic disordering-dependent oxygen evolution reaction (OER) activity. The a-BP with higher atomic disordering delivers higher OER performance. Such enhanced OER activity is ascribed to more low-coordination sites and unpaired electrons which usually served as active sites, as verified by electrochemically active surface area measurement results and electron spin resonance. Density functional theory calculation further reveals the enhancement for OER activity is mainly attributed to boosting conversion from O* to OOH*. Our results not only create a controllable wet-chemical approach to scalable production of a-BP but provide insights into structure-property relationship and its underlying mechanisms.
Refining and reinforcing effects of TiC-Al2O3/Al ribbons inoculant on Al–Si–Mg–Ti alloy
Authors: Liu Lu , Cui Chunxiang , Geng Hongtao , Liang Yingguang , Cui Sen , Lei Shichang , Zhang Shuo
Published: March 2022

In this study, TiC-Al2O3/Al ribbons inoculant were prepared by mechanical alloying, spark plasma sintering (SPS) and melt spinning. Adding 5vol.% TiC-Al2O3/Al ribbons to an Al–Si–Mg–Ti (ASMT) alloy melt significantly refined the α-Al grains from 28.5 μm to 14.9 μm. In addition, the morphology of the eutectic silicon were modified and optimized, changing from needle-like silicon to spherical silicon. Adding the TiC-Al2O3/Al ribbons significantly improved the mechanical properties of TiC-Al2O3/Al–Si–Mg–Ti (TAASMT) alloy, including its elastic modulus (EM), yield strength (YS), ultimate tensile strength (UTS) hardness, and elongation which were increased by 5.4%, 18.4%, 32.7%, 8.3%, and 62.3%, respectively. These increases in the mechanical properties could be attributed to the intracrystalline reinforcement of the Al2O3 and TiC nanoparticles, well-bonded particle/matrix interface, modification of the eutectic silicon phases, and synergistic effects of the Orowan strengthening, Coefficient of thermal expansion (CTE) mismatch strengthening, load transfer, grain refining strengthening, and geometrically necessary dislocations (GND) strengthening.
Remote sensing for monitoring tropical dryland forests: a review of current research, knowledge gaps and future directions for Southern Africa
Authors: David Ruusa M , Rosser Nick J , Donoghue Daniel N M
Published: March 2022

Climate change, manifest via rising temperatures, extreme drought, and associated anthropogenic activities, has a negative impact on the health and development of tropical dryland forests. Southern Africa encompasses significant areas of dryland forests that are important to local communities but are facing rapid deforestation and are highly vulnerable to biome degradation from land uses and extreme climate events. Appropriate integration of remote sensing technologies helps to assess and monitor forest ecosystems and provide spatially explicit, operational, and long-term data to assist the sustainable use of tropical environment landscapes. The period from 2010 onwards has seen the rapid development of remote sensing research on tropical forests, which has led to a significant increase in the number of scientific publications. This review aims to analyse and synthesise the evidence published in peer review studies with a focus on optical and radar remote sensing of dryland forests in Southern Africa from 1997–2020. For this study, 137 citation indexed research publications have been analysed with respect to publication timing, study location, spatial and temporal scale of applied remote sensing data, satellite sensors or platforms employed, research topics considered, and overall outcomes of the studies. This enabled us to provide a comprehensive overview of past achievements, current efforts, major research topics studies, EO product gaps/challenges, and to propose ways in which challenges may be overcome. It is hoped that this review will motivate discussion and encourage uptake of new remote sensing tools (e.g., Google Earth Engine (GEE)), data (e.g., the Sentinel satellites), improved vegetation parameters (e.g., red-edge related indices, vegetation optical depth (VOD)) and methodologies (e.g., data fusion or deep learning, etc.), where these have potential applications in monitoring dryland forests.
Analysis of the Li-ion battery industry in light of the global transition to electric passenger light duty vehicles until 2050
Authors: Usai Lorenzo , Lamb Jacob J , Hertwich Edgar , Burheim Odne Stokke , Strømman Anders Hammer
Published: March 2022

The decarbonization of the transport sector requires a rapid expansion of global battery production and an adequate supply with raw materials currently produced in small volumes. We investigate whether battery production can be a bottleneck in the expansion of electric vehicles and specify the investment in capital and skills required to manage the transition. This may require a battery production rate in the range of 4–12 TWh/year, which entails the use of 19–50 Mt/year of materials. Strengthening the battery value chain requires a global effort in many sectors of the economy that will need to grow according to the battery demand, to avoid bottlenecks along the supply chains. Significant investment for the establishment of production facilities (150–300 billion USD in the next 30 years) and the employment of a large global workforce (400k–1 million) with specific knowledge and skillset are essential. However, the employment and investment required are uncertain given the relatively early development stage of the sector, the continuous advancements in the technology and the wide range of possible future demand. Finally, the deployment of novel battery technologies that are still in the development stage could reduce the demand for critical raw materials and require the partial or total redesign of production and recycling facilities affecting the investment needed for each factory.
Projective flatness over klt spaces and uniformisation of varieties with nef anti-canonical divisor
Authors: Greb Daniel , Kebekus Stefan , Peternell Thomas
Published: March 2022

We give a criterion for the projectivisation of a reflexive sheaf on a klt space to be induced by a projective representation of the fundamental group of the smooth locus. This criterion is then applied to give a characterisation of finite quotients of projective spaces and Abelian varieties byQ\mathbb {Q}-Chern class (in)equalities and a suitable stability condition. This stability condition is formulated in terms of a naturally defined extension of the tangent sheaf by the structure sheaf. We further examine cases in which this stability condition is satisfied, comparing it to K-semistability and related notions.
702 COMMUNICATION CHALLENGES BETWEEN DOCTORS & RELATIVES DURING THE COVID-19 PANDEMIC: SIMPLE INTERVENTIONS WITH MEANINGFUL IMPACT
Authors: Patani B , Hudson M , Khan M , Head N , Long S
Published: March 2022

Background

& Aims Visiting restrictions during the COVID-19 pandemic resulted in reduced and inconsistent communication with the next-of-kin of elderly inpatients. This project aimed to improve communication between doctors and patients’ relatives in accordance with the GMC Good Medical Practice guidelines which outline that doctors ‘must be considerate to those close to the patient and be sensitive and responsive in giving them information and support’.

Methods

We created a virtual whiteboard on an elderly care ward in an inner London hospital documenting patient demographics, details of named next-of-kin and when they had been contacted. We aimed to update next-of-kin within 48-hours of ward admission and subsequently twice weekly. The outcome was measured via identical ‘pre- and post-intervention’ questionnaires recording the next-of-kin’s satisfaction with communication from the doctors. Questionnaires included 11 questions utilising a 5-point Likert scale for satisfaction. Results were anonymised and analysed using Microsoft Excel.

Results

Satisfaction with communication improved in 10 of the 11 domains of the questionnaire following intervention. Cumulative satisfaction scores post-intervention (N = 13) in comparison to pre-intervention (N = 25) were closer to the total possible satisfaction score per question for these 10 domains. The mean cumulative satisfaction score across all domains was 60% post-intervention compared with 44% pre-intervention. Satisfaction following intervention was particularly improved in the domains of frequency of communication (60% post-intervention.

32.8% pre-intervention) and how adequately questions and concerns were addressed (69.2% post-intervention; 45.6% pre-intervention).

Conclusion

During the COVID-19 pandemic healthcare professionals have had to adapt in communicating with patients’ next-of-kin. Our Introduction of robust standards and a virtual whiteboard to track communication resulted in improved satisfaction and proved useful in adapting to remote communication. We propose that similar practice and standards are extended across additional wards to encourage widespread optimal and consistent communication between doctors and patients’ relatives, an integral part of patient care.
727 BOOSTING BONE HEALTH: IMPROVING JUNIOR DOCTORS’ CONFIDENCE IN ASSESSING AND MANAGING FRAGILITY FRACTURES
Authors: Ge Y , Dennis L M
Published: March 2022

Introduction

Fragility fractures are a major disease burden in the UK. With an ageing population and number of fragility fractures predicted to double in 50 years, prevention in this high-risk population needs to be addressed. This audit aimed to examine the assessment of fracture risk in patients presenting with fragility fractures and improve awareness amongst trainee doctors through education.

Methods

A retrospective study was conducted on patients over 65 years admitted with fragility fractures, excluding neck of femur, from January to March 2021 (n = 51). Data was collected on Fracture Risk Assessment Tool (FRAX) scores, dual energy X-ray absorptiometry (DEXA) scans, and risk factors including body mass index (BMI), previous fragility fracture, smoking, alcohol intake, and serum calcium and vitamin D. A teaching seminar for junior doctors was delivered to increase confidence in assessing and managing fragility fractures.

Results

The mean age of patients was 79, with most common presentations being proximal humerus, distal femur and ankle fractures. 46% of patients had a previous fragility fracture. Smoking and alcohol history were documented in 72% and 60% of patients respectively, and 29% had BMIs calculated. 68% had calcium and 45% had vitamin D checked. DEXA scans occurred in 12%, all of whom had osteopenia or osteoporosis. Over half of patients were already on bone protection and 28% were subsequently started on bisphosphonates. A teaching session was delivered to junior doctors (n = 10), leading to improved confidence in assessing fracture risk by 30%, and improved confidence in managing fragility fractures by 35%. Knowledge of FRAX score increased from 62% to 100%.

Conclusion

A significant proportion of the over-65 population are likely to present with fragility fractures. Improving awareness and confidence amongst junior doctors can lead to identification of risk factors and help better prevent and manage fragility fractures in this high-risk population.
747 THE DIAGNOSIS AND MANAGEMENT OF HYPERKALAEMIA IN MEDICAL AND ELDERLY CARE INPATIENTS AT A DISTRICT GENERAL HOSPITAL
Authors: Broadhurst C , Thompson K , Tan W
Published: March 2022

Introduction

Severe hyperkalaemia is a dangerous and potentially life-threatening condition. Despite this knowledge, the incidence of hyperkalaemia in hospital inpatients remains high. On review of the acute management of hyperkalaemia at Croydon University Hospital, only 50% of medical and elderly care inpatients were managed correctly in line with hospital guidelines, and 50% of surveyed doctors did not feel confident managing acute hyperkalaemia—highlighting an urgent requirement for improvement. The project objectives were to improve management in line with hospital guidelines, overall prescription accuracy and the confidence of junior doctors in managing acute hyperkalaemia.

Methods

Two PDSA cycles; cycle one involved teaching sessions to doctors and the creation and circulation of information posters. Cycle two involved the development and implementation of a new electronic order prescription set for the management of acute hyperkalaemia.

Results

Post-intervention results showed an improvement in the correct management of hyperkalaemia from 50% to 80%. Prescription accuracy improved from 90% to 100%. Doctors reported an improvement in their overall confidence from 50% to 64%. Sub-group analysis identified no post-intervention improvement in the correct management of hyperkalaemia in care of the elderly (COTE, >80 years) patients. COTE patients were also less likely to be managed correctly (45% vs 57%) and to have accurate prescriptions (71% vs 100%). However, prescription accuracy did improve in the COTE group (50% to 100%).

Conclusion

This project achieved its initial objectives. However, COTE patients were less likely to be managed correctly. This may be secondary to being more complex patients, having multiple co-morbidities or significant polypharmacy, which may further contribute to hyperkalaemia. Doctors may feel less confident suspending or modifying medications in these cases and seek input from specialist teams prior to doing so. Future interventions will focus on delivering teaching sessions on hyperkalaemia in complex cases to improve confidence and understanding.
760 IMPROVING THE MANAGEMENT AND DURATION OF RESOLUTION OF ACUTE KIDNEY INJURY IN THE ELDERLY
Authors: Ghaddar Y , Stevens A , Pearl M , Sivagnanam T , Sheriff S P
Published: March 2022

Introduction

Acute Kidney Injury (AKI) is prevalent in elderly populations due to several factors: polypharmacy, anatomic/physiologic changes of the kidneys associated with aging. AKI can contribute to increased length of stay, morbidity and mortality. This audit sets out to establish if the guidance established by NICE is being followed and how it may be better implemented.

Method

This study audited patients ≥65 years, who were admitted with AKI/developed an AKI during admission. Patients were excluded if they were on renal replacement therapy or under palliative care. Data was collected from case notes and Clinical Work Station. Data collection points used included: senior review within 24 hours; assessment of fluid status; medication review; strict fluid balance; examine for retention +/− catheter; daily U&E and appropriate imaging. Our independent variable was an AKI sticker, this included a revised checklist for above data collection points that was applied to patients’ medical notes. In addition to this, we used posters on appropriate wards which explained the guidance and management of AKI. Awareness was continued by presenting at Care of The Elderly teaching and medical grand round. Then re-audited the following month.

Results

Both cycles involved 45 patients. After implementation, improvements in urine analysis (5%vs35%), assessments of retention (0%vs38%) and assessments of fluid balance (55%vs78%) were seen. In cycle 2, medication was reviewed more frequently, specifically a 30% increase in the review of nephrotoxics. While senior review within 24 hours remains high in both cycles. We measured the outcome by checking the resolution time of AKI. Mean Resolution time was reduced by 1.4 days.

Conclusion

This audit has demonstrated an increase in the optimisation of the management of AKI through ensuring all appropriate interventions and examinations are completed and reducing resolution time by using stickers and the posters.
774 KEEP SMILING! IMPROVING ORAL HEALTH ON AN ACUTE MEDICINE FOR THE ELDERLY WARD
Authors: Livie V , Livie J , McCulloch A
Published: March 2022

Good oral health in older patients is important for numerous reasons including facilitating fluid and nutritional intake, communication and quality of life. It is an essential component of providing holistic care and should be a daily care requirement during a hospital admission. Poor oral health leads to adverse outcomes including periodontitis, tooth loss, pneumonia and cardiovascular disease. Frail, elderly and those with dementia are at increased risk of poor oral health. Our group decided to undertake quality improvement work to improve our patient’s oral health care during their hospital stay.

Baseline data was collected in our acute medicine for the elderly ward which looked at a variety of factors which influence good oral health. This included access to drink, nursing assessment of dentition on admission and daily review of mouth care documented by nursing and medical staff. Following this, we implemented an educational session for medical staff to promote good oral care.

Results

showed an improvement in ensuring patients had their drink within arm’s reach (94% to 100%). Daily medical review of a patient’s oral health also increased from 0% to 24%.

Conclusion

We have made small steps in improving medical review and documentation of our patient’s oral health whilst in hospital. There is still a need for further improvement in assessment and documentation in order to minimise complications associated with poor mouth care. We have undertaken further educational sessions to our nursing colleagues and we plan to introduce a ward ‘oral health champion’ as part of our ongoing improvement work.
678 THE MENTAL HEALTH NURSE EXPERIENCE OF PROVIDING CARE FOR PEOPLE WITH DELIRIUM SUPERIMPOSED ON DEMENTIA
Authors: Pryor C
Published: March 2022

Introduction

People with severe dementia are frequently cared for by registered mental health nurses due to their often complex cognitive or psychological care needs. This study aimed to explore and describe the experiences of mental health nurses who provide care for people with delirium superimposed on dementia.

Methods

Activity Theory was used to inform, a mixed methods design. Commencing with semi structured interviews, before further quantitative exploration using a questionnaire. Framework analysis was used for qualitative analysis, followed by descriptive statistical analysis of questionnaire data. Robust integration of data was undertaken, and findings presented in an activity system graphic. Participants were registered mental health nurses working in 24-hour care settings for people with dementia.

Results

Five key themes emerged: 1. For RNMHs to use tools (such as scores or guidelines), they need to see them as useful and contextually relevant. Whilst they are aware of tools, they may choose not to use them if they do not see the value in them. 2. Knowing the person for whom they provide care is central and personal. The RNMHs favour aesthetic ways of knowing and use this to guide their care provision. 3. Hierarchy within the multidisciplinary team remains, however this is not seen as a negative. The RNMHs feel supported and secure within their wider MDT. 4. Burdens of care felt by the RNMHs is driven by the care environment and care context. 6. There remains a disconnection of mental and physical health in both care environments and how the RNMHs see their role.

Conclusion

This study is the first to explore the complexities of specifically the mental health nurse context in relation to DSD. The novel application of Activity Theory as a lens offered a unique frame to support exploration of the mental health nurses working environments and experiences.
709 IMPACT ON HEALTHCARE UTILISATION OF A GENERAL PRACTITIONER-LED MODEL OF CARE FOR PATIENTS WITH FRAILTY
Authors: Jones H E , Morrison I , Hurding S , Wild S , Anand A , Shenkin S D
Published: March 2022

Introduction

Primary care has a significant role to play in the identification and management of frailty. MidMed is a new dedicated GP-led service developed by a large practice in Midlothian for patients living at home with moderate or severe frailty. MidMed comprises a full-time GP performing a comprehensive geriatric assessment (CGA) adapted for primary care. Patients receive direct access to all appointments with the named GP. The aim of this study was to assess the impact of MidMed on healthcare utilisation in this patient group.

Methods

Patients with moderate or severe frailty at the MidMed practice were identified by the electronic Frailty Index (>0.24). After 16 months, patients who had been accepted into MidMed (MidMed group) were compared with those yet to be enrolled and who continued to receive usual care (non-MidMed group). Routinely collected data were used to identify outcomes including unscheduled hospital admissions, primary care consultations, continuity of care, outpatient attendances and mortality. Adjusted rate ratios were estimated using regression models.

Results

510 patients with moderate or severe frailty were identified (290 in MidMed, 220 in non-MidMed). Patients in each group were just as likely to have at least one hospital admission per year but those in MidMed had a reduced risk of further hospital admission compared to the non-MidMed group (adjusted RR 0.46 [95%CI 0.30–0.71]). MidMed was also associated with statistically significant higher usage of primary care (adjusted RR 1.52, [95%CI, 1.30–1.75]) and better continuity of care. There was no difference in mortality or the number of outpatient appointments when adjusted for co-variates.

Conclusion

A GP-led service for frailty is associated with lower risk of hospital readmission and improved continuity of care. Further studies are now required to better understand why use of such primary care services increase and whether this changes over time.
743 THE THIRD NATIONAL SURVEY OF UNDERGRADUATE TEACHING IN AGEING AND GERIATRIC MEDICINE AND ITS IMPACT ON STUDENTS’ ATTITUDES
Authors: Pearson G M E , Blundell A G , Gordon A L , Masud T , Ben-Shlomo Y , Henderson E J
Published: March 2022

Introduction

The British Geriatrics Society’s (BGS) recommended undergraduate curriculum was conceived in 2008 and mapped to the General Medical Council’s (GMC) standards [1]. Subsequently, two national surveys have described how geriatric medicine is taught in the UK and both identified areas for improvement [2,3]. In 2018, the GMC updated their statutory learning outcomes, therefore it is timely that the BGS remap their curriculum to this new guidance, with repeat surveys of UK institutions and students.

Methods

We will undertake a three-stage study of undergraduate education in geriatrics. Firstly, we will map the BGS recommended curriculum to the GMC’s ‘Outcomes for Graduates’. Secondly, we will survey UK medical schools on the content, methodology, timing and duration of teaching in geriatrics. Thirdly, we will assess medical students’ attitudes towards older people and a potential career in geriatric medicine.

Results

Descriptive analysis will be used for quantitative data. ‘White space’ questions will be analysed qualitatively using a framework approach. Medical school data will be compared to the BGS recommended curriculum to identify gaps in the current provision of education in geriatrics. We will test whether teaching exposure to geriatrics is associated with students’ attitudes and career intentions, conditional on student characteristics.

Conclusion

In order to meet the demands of the ageing population, it is essential that medical schools nurture doctors furnished with the knowledge, skills and values required to look after older adults with complex care needs. This study is an opportune evaluation of current UK teaching provision and student attitudes that will inform future iterations of the BGS recommended undergraduate curriculum and innovations in geriatric medicine education.

References

1. Forrester-Paton C, Forrester-Paton J, Gordon AL et al. Undergraduate teaching in geriatric medicine: mapping the British geriatrics society undergraduate curriculum to Tomorrow's doctors 2009. Age Ageing 2014; 43: 436–9.

2. Gordon AL, Blundell AG, Gladman JRF, Masud T. Research letter. Age Ageing 2010; 39: 385–8.

3. Gordon AL, Blundell AG, Dhesi JK et al. UK medical teaching about ageing is improving but there is still work to be done: the second National Survey of undergraduate teaching in ageing and geriatric medicine. Age Ageing 2014; 43: 293–7.
666 EFFECT OF PERINDOPRIL ON PHYSICAL PERFORMANCE, MUSCLE MASS AND QUALITY OF LIFE IN OLDER PEOPLE WITH SARCOPENIA: RESULTS: FROM THE
Authors: Witham M D , Adamson S , Avenell A , Band M M , Donnan P T , George J , Hapca A , Hume C , Kemp P , McKenzie E , Pilvinyte K , Smith K , Struthers A D , Sumukadas D ,   for the LACE study group
Published: March 2022

Introduction

Angiotensin-converting enzyme inhibitors such as perindopril have been proposed as treatments to improve muscle mass and physical performance but have not been tested in randomised controlled trials enrolling patients with sarcopenia.

Methods

We conducted a placebo-controlled, parallel group, double-blind, randomised two-by-two factorial trial. Participants aged 70 and over with low muscle mass by bioimpedance and either low grip strength or low walk speed, were recruited from 14 UK sites. Participants were randomised to receive one year of perindopril 4 mg once daily or matching placebo, and to receive leucine powder 2.5 g three times a day or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery, measured at baseline, 6 and 12 months, analysed using repeated-measures mixed models. Secondary outcomes included grip strength, quadriceps strength, six-minute walk distance, appendicular muscle mass measured by dual x-ray absorptiometry, quality of life measured using the EQ5D tool, falls rates and adverse events.

Results

We screened 320 people and randomised 145 participants, mean age 79 (SD 6) years; 78 (54%) were women and the mean SPPB was 7.0 (SD 2.4). 73 were randomised to perindopril and 72 to placebo. Median adherence was lower for perindopril (76% vs 96%; p < 0.001). Perindopril had no significant effect on the primary outcome (adjusted treatment effect −0.1 points [95%CI -1.2 to 1.0]). No significant treatment effect was seen for any secondary outcome except for worse EQ5D thermometer scores in the perindopril group (treatment effect −12 points [95%CI -21 to −3]). More adverse events were seen in the perindopril group (218 vs 165) but falls rates were similar (perindopril 2.0 [95%CI 1.1 to 3.0] per year; placebo 2.8 [95%CI 0.6 to 5.1] per year).

Conclusion

Perindopril did not improve measures of physical performance, muscle mass or quality of life in older people with sarcopenia.
667 EFFECT OF LEUCINE SUPPLEMENTATION ON PHYSICAL PERFORMANCE, MUSCLE MASS AND QUALITY OF LIFE IN OLDER PEOPLE WITH SARCOPENIA
Authors: Witham M D , Adamson S , Avenell A , Band M M , Donnan P T , George J , Hapca A , Hume C , Kemp P , McKenzie E , Pilvinyte K , Smith K , Struthers A D , Sumukadas D ,   for the LACE study group
Published: March 2022

Introduction

Leucine supplementation improves muscle protein synthesis in physiological studies and has been proposed as a treatment to improve muscle mass and physical performance. We tested the effects of leucine supplementation in a randomised controlled trial enrolling patients with sarcopenia.

Methods

We conducted a placebo-controlled, parallel group, double-blind, randomised two-by-two factorial trial. Participants aged 70 and over with low muscle mass by bioimpedance and either low grip strength or low walk speed, were recruited from 14 UK sites. Participants were randomised to receive one year of leucine powder 2.5 g three times a day or matching placebo, plus perindopril 4 mg once daily or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery, measured at baseline, 6 and 12 months, analysed using repeated-measures mixed models. Secondary outcomes included grip strength, quadriceps strength, six-minute walk distance, appendicular muscle mass measured by dual x-ray absorptiometry, quality of life measured using the EQ5D tool, falls rates and adverse events.

Results

We screened 320 people and randomised 145 participants, mean age 79 (SD 6) years; 78 (54%) were women and the mean SPPB was 7.0 (SD 2.4). 72 were randomised to leucine and 73 to placebo. Median adherence was the same in both groups (76% vs 76%; p < 0.001). Leucine had no significant effect on the primary outcome (adjusted treatment effect 0.1 points [95%CI -1.0 to 1.1]). No significant treatment effect was seen for any secondary outcome. There were similar numbers of adverse events in both groups (leucine 187, placebo 196) and falls rates were similar (leucine 1.9 [95%CI 0.9 to 2.9] per year; placebo 2.9 [95%CI 0.8 to 5.0] per year).

Conclusion

Leucine did not improve measures of physical performance, muscle mass or quality of life in older people with sarcopenia.
768 PREDICTORS OF INDEPENDENCE IN COMMUNITY-DWELLING OLDER PEOPLE
Authors: Taylor E , Goodwin V , Clegg A , Frost J , Ball S
Published: March 2022

Introduction

Many people wish to retain their independence as they age. Therefore, identifying factors that can predict sustainability of independence for older people over time are essential for preventing functional decline and maintaining quality of life.

Method

Longitudinal, health, social and economic data, from community-dwelling older people aged ≥75 years (collected at baseline (BL), 6, 12, 24 and 48 months), were obtained from the ongoing Community Ageing Research (CARE 75+) cohort study. Linear regression models were used to identify predictors of independence. The Nottingham Extended Activities of Daily Living (NEADL) score (range 0–66) at 12 months from BL was the dependent variable (DV) to indicate independence. Independent variables (IV)s were selected based on interviews with CARE75+ participants and known predictors such as, ethnicity and frailty. Each IV was regressed against the DV in univariable analyses. All IVs with p value <0.1 from univariable analyses, including baseline NEADL score, were included in the multivariable model.

Results

Data from 1,277 participants (mean (SD) age 84.61 (4.95); 49% male) were analysed. The multivariable model (adjusted R2: 0.71) showed that, in addition to higher BL NEADL (estimated effect 0.49, 95% confidence interval (CI) 0.41 to 0.58), white ethnicity, good sight, lower level of frailty, ability to perform basic activities of daily living, lower depression score, lower cognitive impairment, younger age, living circumstances, fewer hours of informal support, greater physical functioning and lower pain scores were predictors of a higher NEADL at 12 months (p < 0.05 for all).

Conclusion

As well as physical health, social and psychological variables are important in predicting independence, based on NEADL score, over time. Further research into the mechanisms behind these relationships will be conducted.
677 UTILITY OF 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING (ABPM) IN PATIENTS WITH ORTHOSTATIC HYPOTENSION (OH) AT SYNCOPE CLINIC
Authors: Arnott A , Reid G , Godwin J , Anderton L , Mitchell L
Published: March 2022

Introduction

OH is a disabling condition resulting from a sustained reduction in blood pressure (>20 systolic or 10 diastolic) within 3 minutes of standing. It is a common cause of syncope. Patients with concurrent hypertension experiencing syncope present a complex management dilemma where a balance must be established between symptom burden and risk of cardiovascular disease. Current guidance on ABPM use in syncope is limited. European society of cardiology syncope guidelines suggest ABPM in patients with ‘autonomic failure’ to assess nocturnal hypertension or drug-induced hypotension. Could this be improved with further explicit criteria on which patients to assess and how to act on results? The objective of this study is to review the use of 24 hour ABPM in OH within a tertiary referral syncope clinic.

Method

A retrospective analysis was performed electronically for patients with a final diagnosis of OH seen in a syncope clinic between March 2017 and May 2019. Data was collected on comorbidities, medication history, physical mobility, clinic blood pressure, ABPM Results: (if performed) and medication changes. Comparisons were made between patients who had ABPM and those who did not. Statistics were calculated using Fisher’s Exact Test (2 tailed).

Results

119 patients had a final diagnosis of OH in the study period. 45 had ABPM, 74 did not. The ABPM group had a significantly higher proportion of diagnosed hypertension (51.1% vs 23% (p = 0.0025)). A similar proportion of patients in both groups had medication changed however the ABPM group were significantly more likely to have antihypertensive therapy added (19.4% vs 1.8% (p = 0.0053)).

Conclusion

Using 24 hour ABPM in OH patients can aid clinical decision making in the sub-group with hypertension. This can guide the need for alteration/addition of antihypertensive therapy to balance optimum BP control with symptom burden.
697 PATIENTS WITH PARKINSONISM AND THEIR CAREGIVERS: A PROTOCOL FOR THE PRIME-UK CROSS-SECTIONAL STUDY
Authors: Tenison E , Lithander F E , Brazier D , Smith M , Ben-Shlomo Y , Henderson E J
Published: March 2022

Introduction

People with parkinsonism (PwP) are a highly heterogeneous group and the condition encompasses a spectrum of motor and nonmotor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. Whilst parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe a broad range of PwP in relation to their symptomatology, disability, health needs, disease stage, comorbidities and sociodemographics.

Methods

In this cross-sectional study, performed at one site, PwP (excluding those with drug-induced parkinsonism) will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support if required to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes.

Results

Our primary outcome is the frequency of various health outcomes (e.g. depression) and how they cluster together. Linear and logistic regression models will be used to test simple associations and interactions with gender, age group and socio-economic status.

Conclusion

It is necessary to consider the multifaceted problems that PwP experience, together with frailty and comorbidities, in order to fully appreciate the clinical complexity as well as the impact on caregiver well-being. This information is necessary to inform the development of a person-centered, individualised multicomponent intervention to target patients and caregivers most at risk of adverse outcomes. We hope that these findings will inform future intervention trials and improve accessibility to research participation.
738 DETERMINANTS OF MUSCLE DENSITY IN OLDER PEOPLE: FINDINGS FROM THE HERTFORDSHIRE COHORT STUDY (HCS)
Authors: Laskou F , Westbury L D , Fuggle N , Harvey N C , Patel H P , Cooper C , Ward K , Dennison E M
Published: March 2022

Introduction

Lower calf muscle density (CMD) as assessed by peripheral quantitative computed tomography (pQCT) is associated with greater hip fracture risk, independent of FRAX, falls and bone mineral density. To date, muscle density has been little studied, and its determinants are unknown. In this study, we examine the lifestyle and anthropometric determinants of future muscle density (MD) in the HCS.

Methods

197 men and 178 women, aged 59–70 years, were recruited. A lifestyle questionnaire collected information on physical activity, smoking, alcohol consumption and dietary patterns. Height and weight were measured. pQCT of the radius and tibia was performed a median of 11.5 (IQR 10.9, 12.3) years later. MD was measured at calf and forearm using standard methodology. Baseline characteristics in relation to MD at follow-up were examined separately using linear regression with sex, baseline age and follow-up time included as covariates in all models.

Results

Mean (SD) age at baseline was 64.7 (2.7) years; mean (SD) MD values (mg/cm3) were as follows: forearm [men 79.9 (3.1), women 77.2 (3.2)], calf [men 80.7 (2.6), women 78.5 (2.6)]. Baseline correlates (p < 0.05) of both lower forearm and CMD included female sex, lower weight, and lower BMI. SD difference in CMD for women compared to men, and per SD lower weight and BMI were − 0.84 [95%CI: −1.13, −0.54]), −0.37 [−0.46, −0.27] and − 0.31 [−0.40, −0.23] respectively. Additional correlates of lower CMD included older age and shorter stature. Relationships between MD and age were stronger at the calf (p < 0.001) than the forearm (p = 0.08). Lifestyle measures were not associated with MD.

Conclusion

Female sex, older age, and lower BMI were associated with lower MD in older community-dwelling adults, highlighting the need for sustained muscle conditioning in older individuals. Further studies in larger cohorts are required.
746 VALIDITY OF THE CARER DIRECTED NEEDS ASSESSMENT IN DEMENTIA (CANDID) FOR USE IN ADVANCED STAGE DEMENTIA CARE
Authors: O’Connor M , Glenn A , Elissa C
Published: March 2022

Introduction

End of life care for people dying of dementia and their carer/s is a growing area of importance. Unmet needs are coming amongst this group. A tool to identify the needs of this person-carer dyad is a necessary component for providing this care. The aim of this project was to determine the validity of a new tool, the CArer directed NeeDs assessment In Dementia (CANDID), which was developed for use in a randomised trial of end of life dementia care.

Method

Face validity of CANDID was assessed by an expert panel. A narrative review of the literature to evaluate existing tools available for assessing the needs of carers of people with advanced stage dementia was conducted. A sample of ten trial participants independently completed CANDID and the Carer Specific Needs Assessment Tool (CSNAT), which was selected as the reference tool based on the narrative review. The results from CANDID and CSNAT were compared to assess criterion validity. Participants also completed an evaluation survey to determine which tool they preferred, and why. Responses were compared qualitatively and quantitatively.

Results

CANDID has good face validity. There were insufficient participant numbers to establish criterion validity. The majority (n = 8) of participants preferred CANDID. Participants described a preference for a face to face tool with more specific questions.

Conclusion

Participant carers of people dying of dementia in this trial setting preferred a face to face evaluation of needs. Preliminary results from this study suggest that CANDID has face and content validity, and shows promise for criterion validity.
764 ROCKWOOD CLINICAL FRAILTY SCALE TO PREDICT LENGTH OF STAY,INPATIENT MORTALITY & READMISSION RATE IN A COMMUNITY HOSPITAL SETTING
Authors: Daly D , McSorley A
Published: March 2022

Introduction

Frailty is prevalent in elderly patients in acute medical wards. It is recognised that length of stay (LOS), inpatient mortality and readmission rates rise with increasing frailty. (Reference: Specialised Clinical Frailty Network: Clinical frailty Scale. 2018. https://www.scfn.org.uk/clinical-frailty-scale) The Rockwood clinical frailty scale (CFS) is a well-recognised and validated tool, which can be easily incorporated into the comprehensive geriatric assessment to identify the frailest patients and aid in clinical decision making. We collected data on elderly patients in a non-acute community setting to assess the relationship between degree of frailty and outcomes, in this subset of inpatients.

Methods

Data was collected on 200 patients admitted to a geriatrician led community hospital over an 8 month period. Patients were all transferred from the affiliated acute hospital site (both medical and surgical wards).Commonest acute diagnoses were: falls, fractures, infections, delirium and heart failure. Premorbid CFS was recorded and patients were divided into 2 groups: CFS ≤ 4: versus CFS ≥5, and outcomes compared to degree of frailty.

Results

Of 200 patients, aged ≥65 years, admitted from the acute hospital setting to the community hospital,28.5% had premorbid CFS ≤4,and 71.5% had premorbid CFS ≥5. Median LOS in the community hospital was 10 days in the less frail group compared to 13 days in the frailer group. One year emergency readmission rate was 58.5% in those with CFS ≤4,and 67% in those with CFS ≥5.

Conclusion(s)

Accurate recording of premorbid CFS in the non-acute hospital setting can be used to help predict patient outcomes. Used in conjunction with the CGA it is a tool that can aid decision making and prompt discussions with patients and/or families re advance care planning, specifically re suitability of transfer back to the acute hospital setting in the event of a decline in health.
814 GENERAL INTERNAL MEDICINE AND THE GERIATRIC MEDICINE WORKFORCE: RESULTS: OF THE RCP CENSUS AND WELLBEING SURVEY
Authors: Welch C , Copeland C
Published: March 2022

Background

In the UK, most geriatric medicine consultants also contribute to general internal medicine (‘acute take’) services. However, impact on workforce was unclear.

Methods

We used anonymised data available from the Royal College of Physicians (RCP) 2019 census, and the RCP wellbeing snapshot survey conducted in early 2020. We used multivariable analysis of covariance (adjusting for age, gender, nation, NHS academic or other contract type, contribution to general or acute medicine services, and less than full-time working) to assess for differences in mean excess Programmed Activities (PAs) worked above contracted PAs between geriatric medicine and other physician specialties. We used binary logistic regression analysis to assess for satisfaction in own specialty and general medicine (adjusting for variables above), and in perceived excess workload and excess hours (adjusting for age, gender, and nation).

Results

The RCP census included 16,746 consultant physicians, including 1,677 (10%) geriatricians. The wellbeing survey included 2,670 respondents, including 343 (12.8%) geriatricians. Geriatricians reported working excess programmed activities, but fewer than other specialties (adjusted means: 0.74, CI 0.59–0.89 vs. 0.95, CI 0.82–1.07; p < 0.001). Geriatricians were also less likely to report always or often working excess hours (OR 0.61, CI 0.47–0.78; p < 0.001) or having an excess workload (OR 0.60, CI 0.47–0.78; p < 0.001). There were no differences in satisfaction with their own specialty, but geriatricians were more likely to report increased satisfaction with general medicine (OR 1.65, CI 1.30–2.09; p < 0.001).

Conclusion

Physicians, in the UK, frequently report working excess hours beyond their contracted job plans. However, geriatricians report fewer excess hours than other specialties. Geriatricians also report greater perceived satisfaction working in general medicine than other physician specialties.