bluuebunny/crossref_metadata_2025_split huggingface dataset:
65 Improving Medicines Safety for Care Homes Residents
Authors: Okoli U , Kent J , Gadhia S 
Published: February 2020

Abstract

Introduction
Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes, yet 30–50% of prescribed medicines are not taken as recommended [1]. Polypharmacy and medication errors are common. Evidence suggests that there is a linear increase in medication errors with the number of medications a patient is prescribed.
This paper describes an approach to identity and address inappropriate polypharmacy and safety concerns in Buckinghamshire care homes. The workforce used was: primary care and care home pharmacists, technicians and geriatricians.

Methods
A successful business proposal enabled a new interdisciplinary model of care to be established. This was delivered in 2768 Buckinghamshire care home beds (63% of Bucks ICS bed capacity). The CCG pharmacists, GPs and pharmacy technicians reviewed medication for all residents followed by a medication and clinical review by a geriatrician for the most complex individuals. Other community specialist teams were included as part of a Multidisciplinary team as needed. Data on reviews, medicines stopped and safety were collected from 2013–2018.

Results
Overall 2134 medications were stopped for 1268 residents of 2102 reviewed, with 505 interventions to reduce falls risk. 942 safety issues were identified and resolved. Total savings on medicines optimisation, waste and non-elective admission prevented was £619,000. System wide safety included: community psychiatric nurse to support dementia diagnosis, specialist enteral feeding nurse reinstated and a new website to share and disseminate good practice standards.

Conclusions
Future direction of this work focuses on system wide improvements to promote multi-organisational interdisciplinary healthcare and social services professionals work in care homes. NHSE Pharmacy integrated funding has provided extra pharmacists and technicians to support the 37% of the care home beds not yet covered by March 2020.

Reference
1. Horne R, Weinman J, Elliot R, et al. 2005, NHS National Coordinating Centre for service delivery and organisation report.
68 Urinary Catheterisation in Trauma and Orthopaedic Patients
Authors: Shammout S , Pavana T , Johnson A 
Published: February 2020

Abstract

Background
The use of urinary catheterisation in neck of femur fracture patients is often debated as common best practice to manage and appropriate fluid assessment. Routine catheterisation increases the risk bacteraemia, genitourinary injury, worsening mobility, risk of pressure sores and predisposition to delirium and falls. There is a need for increased awareness of urinary catheterisation management in conjunction with healthcare-associated infections. NHS improvement has issued a letter aiming to half healthcare-associated Gram-negative bacteraemia, the majority of which is catheter-related. This project aims to identify barriers to safe catheter care in the orthopaedic population; by determining if management of urinary catheters is complaint with NICE quality standards (QS61).

Introduction
Appropriate perioperative care can help manage the associated risk of neck of femur fractures. The British Hip Society and British Orthopaedic Association have provided little guidance on postoperative care and risk management. Appropriate catheter care will improve overall patient care but reducing mortality and associated morbidity, by shortening stay by early mobilisation and management of complications.

Methods
All catheterised trauma and orthopaedic patients in a district general hospital over one month (February) were included 67% of which had sustained neck of femur fractures. Data from nursing and doctors’ records on the following parameters were collected: demographics, the reason of admission, indication/location for catheterisation and responsible clinician; the number of days catheterised, the reason for the retention of catheterisation and management of suspected/confirmed catheter-related infection. Data were collected in April following the implementation.

Intervention
A urinary care pathway was launched based on the HOUDINI algorithm and educational seminars for medical and nursing staff were conducted.

Results
Mean age of patients was 78. Initial data was suggestive of poor documentation and prolonged, inappropriate retention of urinary catheterisation and not in accordance with current guidance. Data was recollected in April after the launch of the pathway; data was indicative of marginal improvement of catheter care management, reduced time of catheter retention, improved documentation likelihood of review.

Conclusions
Incorporating a catheter care pathway in managing orthopaedic patients has shown improvement in the overall documentation and management of urinary catheterisation. Despite this improvement demonstrated, implementation of the pathway is still substandard. This pathway will be incorporated into an innovative integrated neck of femur pathway in June.
70 Prevalence of Sarcopenia in A Longitudinal UK Cohort Study Using Ewgsop2 Criteria Varies Widely Depending on Which Measures of Muscle Strength and Performance are Used
Authors: Kilgour A H M , Redmond P , Taylor A , Deary I J , Starr J M , Shenkin S D 
Published: February 2020

Abstract

Background
The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines have recently been published to aid diagnosis of sarcopenia in the clinical setting and to allow for better comparison between research studies. The guidelines recommend several different tests for diagnosing sarcopenia. We hypothesised that the prevalence of sarcopenia might vary depending on which tests are used.

Methods
We used data from Wave 3 of the Lothian Birth Cohort 1936 study, a longitudinal ageing study of healthy, community dwelling older adults (n= 697, 52% men, mean age 76y), to assess the prevalence of sarcopenia using the suggested cut-offs in the EWGSOP2 guidelines. Probable sarcopenia was defined as low muscle strength (measured by handgrip strength and 5x chair stand test), confirmed sarcopenia was defined as low muscle strength + low lean mass (measured by bioimpedance analysis), and severe sarcopenia was defined as confirmed sarcopenia + low muscle performance (measured by gait speed and short physical performance battery score). SPSS version 24.0 was used for statistical analysis.

Results
The maximum prevalence of probable sarcopenia was 24.2% in men and 24.8% in women, of confirmed sarcopenia was 7.4% in men and 11.0% in women, and of severe sarcopenia was 4.6% in men and 5.9% in women, when either of the cut-offs for muscle strength +/- muscle performance were met. When using only one measure of muscle strength +/- performance, rates of probable sarcopenia ranged from 7.7% to 21.1% in men and 5.9% to 21.3% in women; rates of confirmed sarcopenia ranged from 3.9% to 5.3% in men and 5.1% to 9% in women; and rates of severe sarcopenia ranged from 1.4% to 3.9% in men and from 2.0% to 5.1% in women.

Conclusions
In a UK-based longitudinal ageing study we found that the prevalence of probable, confirmed and severe sarcopenia varied widely using the EWGSOP2 guidelines depending on which identifying tests were used. We found that the cut-off points suggested for some of the measures in the guidelines are not comparable and may lead to differing groups being identified as sarcopenic between different trials. We suggest modification of the cut-offs to adjust for this.
75 Is Cerebral Autoregulation Altered in Ageing? A Review
Authors: Perez-Denia L , Claffey P , Kenny R A , Finucane C 
Published: February 2020

Abstract

Introduction
Cerebral autoregulation (CA) ensures constant cerebral blood flow (CBF) in the face of blood pressure (BP) disturbances. While CA impairment is often implicated in the aetiology of age-related disorders e.g. falls, syncope, and brain ageing, there is conflicting evidence on the effect of normal or healthy ageing on cerebral autoregulation. Here we present results of a review investigating the effect of ageing on CA.

Methods
A search was performed in Pubmed using the search terms “cerebral autoregulation” AND (“ageing” OR “age” OR “older” OR “elderly”). Studies were included if they were human studies in English assessing CA in healthy volunteers (free from disease) in which the effect of ageing on CAR was studied. Exclusion criteria included non-human studies, diseased cohorts and studies not measuring CA.

Results
26 studies (n=1326 total participants, age range 12-88) meeting the inclusion/exclusion criteria were identified. Significant heterogeneity was noted in applied methodologies with 88% of studies using static and 53% using dynamic protocols to measure CA. Transcranial Doppler (88%) and Near Infrared Spectroscopy (NIRS) (11%) were the most commonly used. Transfer function analysis (TFA) (38%), the Autoregulatory Index (ARI) (15%), and wavelet analysis (11%) were used to derive CA metric. The majority of studies suggested that CA is preserved (n=15) with ageing. However, a smaller number of studies (n=7) noted that CA is impaired or altered with ageing.

Conclusions
There is a paucity of literature examining the relationship between CA and chronological ageing, with 60 per cent of studies reviewed suggesting that CA is preserved. Current hypotheses suggest that preservation of CA with ageing serves as a ‘reserve’ to compensate for impairment of other systems. Future work should investigate the role of impaired CA as potential biomarker of biological ageing.
76 The Cinema and Geriatric Medicine: An Approach to ‘Hard-To-Reach’ Places in the Curriculum
Authors: Patel R , Wolfendale H , Ragunathan J , Parikh R J 
Published: February 2020

Abstract

Introduction
Cinema is powerful - it can depict complex stories, spark discussion and foster reflection.1 Potentially, in geriatric medicine, the impact of serious diagnoses could be explored and learners’ preconceptions concerning ageing challenged. Thus, could film be used to explore and assess ‘hard-to-reach’ curriculum areas? The Mental Health in Older Adults module (MSc in Geriatric Medicine - Salford University) uses film in the oral assessed presentation. We wished to explore the utility of this

Methods
Learners (North-West Speciality Registrars) were allocated different feature films exploring mental health themes. 8 learners each delivered a ten-minute presentation focusing on a topic selected after viewing the film. The audience comprised Speciality Registrars who could ask questions.
The content of the presentations was reviewed. The key topics/themes tackled were analysed.

Results
Learners watched one of the following: Iris, Tokyo Story, Still Alice, My Feral Heart, Firefly Dreams, The Carer, Away from Her and Amour.
Each film generated 3 or more topics/themes. These were diverse and included: depression in chronic illness; loneliness; neuropsychological complications of stroke and the management and impact of dementia. Presenters set these into the film’s context and reflected on the interaction between physical health and social and psychological factors. ‘Hard-to-reach’ areas included: culture and social care, filial piety, and preconceptions of intellectual disability. Neglected areas tackled included suicide in older adults and the impact of dementia in younger adults.
Audience feedback was positive. The reflective nature of the session provided new insights and was engaging

Conclusions
Film is a medium that allows ‘hard-to-reach’ (and teach) areas to be tackled and assessed. The use of film was well received and importantly had utility. The topics learners reflected upon were complex and challenged their own and their audiences’ conceptions of clinical problems.

Reference
1. Law M, et al, Perspect Med Educ. 2015 4(5): 218–224.
77 Developing and Testing An Education-Career Pathway in Healthcare for Older People (ECHO) to Promote Retention in Early-Career Gerontological Nurses
Authors: Naughton C , Ezhova I , Hayes N , Fitzpatrick J 
Published: February 2020

Abstract

Background
The NHS Long Term Plan (2019) sets specific targets for multidisciplinary services for frail older people over the next ten years. Delivery and sustainability is crucially dependant on the capability and capacity of gerontological nursing. High cost cities such as London experience high staff vacancy rates in acute care older adult services.

Aim
The study took a regional approach, working with NHS Trusts to develop a multicomponent intervention to increase retention and competencies of early career nurses working in gerontological services. The study examined the acceptability and feasibility of the intervention and tested a quasi-experiential evaluation design. Ethical approval was obtained from the University Ethics committee.

Methods
A co-design approach with stakeholders, early career nurses, educationalists and nurse managers, produced a multicomponent intervention: education module (masters level), gerontological competency booklet, external clinical learning opportunities, career coaching and mentorship delivered over a six-month period. The evaluation involved a mix-methods pre-post survey and focus group interviews.

Results
Twenty-nine early career nurses were recruited from five Trusts. The multicomponent intervention was well received, but there were difficulties facilitating external learning opportunities and providing career mentors. The primary outcome was intention to remain in gerontological nursing (measured using a point Likert scale). Pre-post the intervention this remained high (mean score 6 IQR 5-7), p=0.78. There was a significant increase in gerontological knowledge: at baseline the median score was 87 (IQR 81-102) compared to 107 (IQR 98-112) post-intervention, p=0.006. In focus groups participants identified three main mechanism of action for ECHO: building gerontological knowledge and skills; professional identity as older adult nurse; and networking to broaden horizons.

Conclusions
The study has demonstrated the potential of Trusts to work collaboratively with education providers to deliver a model of career-education pathway that may help attract and retain early career nurses to work in gerontology.
80 An Exploration of What Stakeholders Reveal About the Behaviours and Personality of Registered Nurses Working in Older People’s Acute Care Settings and the Potential Influence on Nursing Care
Authors: Day H 
Published: February 2020

Abstract

Background
Concern around poor standards of nursing care for older people in hospital has been explored in relation to workload and operational pressures. What is less evident from existing literature is an explanation as to why nurses behave differently under the same pressures within the same concrete situations. Notions of personality and associated behaviours as possible influencers on nursing care delivery are variables that required consideration. Aim To critically explore the behaviours of registered nursing staff working in older people's acute care settings from the perspectives gathered from key stakeholders, and to identify whether there are any distinguishing personality traits that influence effective care delivery for older people.

Methods
A constructivist grounded theory methodology was used. Semi structured interviews were conducted to gather data from 12 stakeholder participants.

Results
Through the analysis of data gathered from stakeholders a rubric describing specific behaviours with associated traits emerged leading to the identification of two major types of nursing staff. One group of nurses who work with older people are perceived to have no real desire to do so and in turn their care behaviours are perceived as ‘cold’ and task based. The second group of nurses are perceived as having a true commitment to older people’s wellbeing and their behaviours lead to the delivery of care that is perceived as being highly skilled and compassionate. The proposed theoretical framework that was constructed from this data analysis identifies four key personality traits related to nursing behaviours: conscientiousness, sociability, integrity and coping under a core category heading of ‘the authentic self’. Whilst the authentic self is identified as being the direct influencer on how care is delivered which is defined as the consequence, the influence of context is also taken into account.

Conclusions
This research offers insights into the meaning of four key traits and the behavioral facets comprising them, the associated behaviors that are displayed and what effect these have on nursing care delivery. Implications for healthcare practice include the potential for further research that can inform the development of educational and recruitment strategies for older people’s nurses which will have a positive impact on the care of the older patient in hospital.
81 Can Simulation-Based Training be Used to Teach Geriatric Medicine?
Authors: Oates R , Lettal K , Allen N , Deivasikamani G 
Published: February 2020

Abstract

Introduction
Health Education England (HEE) and the Joint Royal Colleges of Physicians Training Boards recognise the importance of simulation-based training especially for Core Medical Trainees in improving patient outcomes and enhancing learning (Enhancing UK Core Medical Training through Simulation based training, Health Education England 2016). Research also suggests simulation training can be used to address a wide variety of medical curricula agenda from emergency presentations to breaking bad news (Beaubien 2004, Quality & Safety in healthcare). HEE suggests simulation training can be used to develop understanding but also communication skills and awareness of human factors and are focusing on developing a national strategy.
Geriatric Medicine is complex and trainees are expected to be competent in managing elderly patients in a variety of presentations. Our aim was to ascertain the confidence levels of CMT doctors managing elderly patients and whether simulation-based teaching is effective for geriatric teaching.

Methods
Three scenarios addressing common geriatric conditions were developed by a Geriatric Medicine Registrar and overseen by Geriatric Consultant. Scenarios including delirium secondary to sepsis, Opiate toxicity secondary to acute kidney injury (complicated by addressing dementia and risk of self-harm) and identifying and demonstrating appropriate palliative approaches to a catastrophic subdural haemorrhage. Trainees were given a brief summary of a case and asked to review and manage the ‘patient’.
A geriatric registrar alongside two CMT doctors designed a pre and post confidence questionnaire using Likert scales and free text boxes to explore respondents’ views.

Results
100% of trainees found the simulation training useful and would recommend the sessions. 100% of trainees stated preference for simulation-based teaching opposed to lecture and work based assessments. Confidence increased across all three scenarios post simulation. 70% of trainees stated they felt confident to manage delirium with sepsis pre-simulation, this increased to 91% post simulation. Trainees commented ‘feel confident to manage sepsis but not complicated by delirium or AKI’ and ‘prefer simulation to lectures’

Conclusions
CMT doctors enjoy and find simulation training in geriatric medicine useful and show preponderance to this. Simulation training can be used to expose trainees to real life complex geriatric medicine scenarios in a safe environment. This programme will be developed to encompass additional medical scenarios and also to be delivered to foundation year doctors.
87 Effects of Community Falls Prevention Service Closure on ICD-10 Coded Fracture Rates in Older People: An Interrupted Time Series Approach
Authors: McCarthy A , McMeekin P , Anderson G , McCarthy S , Parry S W 
Published: February 2020

Abstract

Introduction
Guidelines on falls prevention recommend case ascertainment based on opportunistic case ascertainment and referral in those who have fallen. In October 2009 we implemented a novel multidisciplinary, multifactorial falls, syncope and dizziness service with enhanced case-ascertainment through proactive, primary care-based screening for associated risk factors. In addition to comprehensive geriatric assessment, 25% of 4032 service participants underwent strength and balance training. The baseline outcomes have been previously reported.1 Funding was withdrawn, and the service closed on 31/01/2014. We examined the effect of service-closure on fractures presenting to secondary care with and without the service running.

Methods
An interrupted time series method was used. ICD-10 coded fracture numbers attending secondary care were determined (Hospital Episode Statistics from 01/02/2012-31/05/2017) for all North Tyneside residents ≥60 years at the time of service closure, including 25-months with, and 40-months without, service provision.

Results
There was a 0.9% (p=0.018) monthly reduction in falls over 25-months of service provision which increased during the winter months of a 9.8% (p=0.015) increase. In the month following the service closure there was an initial increase in fractures of 8.5% (p=0.231), followed by an increase in the monthly time trend of 1% (p=0.018). This resulted in a post-service monthly increase in fractures of 0.1%, an estimated extra 625 fractures over the 40-month post-service cessation period. At an average £8600 per fracture, the estimated cost may have been £5,375,000.

Conclusions
In this naturalistic experiment, following an initial drop in fractures, disinvestment in this service resulted in a rise in elders’ fractures presenting to secondary care. The closure of the service may have had a large unintended cost, averaging £1.5 million annually, versus annual running costs of £220,000. Further research is needed to control for patient-level characteristics and to establish the cost-effectiveness of the service.