bluuebunny/crossref_metadata_2025_split huggingface dataset:
88 The Truth Behind the Pubic Rami Fracture: Identification of Pelvic Fragility Fractures at A University Teaching Hospital
Authors: van Berkel D , Herschkovich O , Taylor R , Ong T , Sahota O 
Published: February 2020

Abstract

Introduction
Older patients presenting with pelvic fragility fractures (PFF) is an increasing epidemic. The most common pelvic fracture identified by plain radiograph is pubic rami fracture. These fractures are painful and often require admission to hospital. However, despite optimal analgesia, many of these patients struggle to mobilise and may have fractures of the posterior pelvic ring, which are overlooked and not visible on plain radiograph imaging. We aimed to quantify the number of patients progressing to further pelvic imaging in the form of computed tomography (CT) or magnetic resonance imaging (MRI) and the presence of concurrent fractures.

Methods
Prospective screening of pelvic imaging in patients aged over 70 years was undertaken at Nottingham University Hospitals NHS Trust over an 8-month period from October 2018.

Results
103 predominantly female (83%) patients were confirmed to have an acute fragility fracture of the pubic rami on plain radiograph. 19% of patients were discharged direct from the Emergency Department, 45% were admitted to Health Care of Older People (HCOP) teams, 30% to Trauma and Orthopaedic (T&O) teams and 6% to other specialities. 25% of the patients admitted underwent further pelvic imaging, which confirmed fragility fractures of the pubic rami in 88%, with 40% showing acetabular fractures and 68% showing sacral fractures of all types. A further 10 patients were diagnosed with pubic rami insufficiency fractures on further imaging, having had a normal initial radiograph, but had been admitted with poor mobility due to groin pain. In these 10 patients, 20% also had an acetabular fracture and 60% sacral fractures. Overall, 59% of patients with pubic rami fractures had an ipsilateral sacral fracture; a Type 1 Lateral Compression pelvic fracture by AO classification.

Conclusions
Pubic rami fractures are a significant problem in older people and often require admission to hospital. Further imaging confirms these fractures are complex, with co-existing fractures of the acetabulum and sacrum common. However despite this, only a quarter of patients admitted had further imaging. Where pelvic fractures are missed or severity not appreciated, appropriate pain control can be more difficult to achieve. With the potential for minimally invasive surgical options to aid pain management in sacral fractures, it may be prudent for all patients hospitalised with suspected or confirmed pelvic fracture to undergo further imaging.
89 Poor Attendance for DXA in Older People with A Low Trauma Fragility Fracture: A 6 Year Data Analysis of the Nottingham Fracture Liaison Service
Authors: Desai H , Hershkovich O , Ong T , Marshall L , Sahota O 
Published: February 2020

Abstract

Introduction
Hip Fractures are common and result in significant patient morbidity and increased mortality. Up to 40% of these patients have sustained a previous low-trauma fracture. The Department of Health advises that patients presenting with fragility fracture should have access to ‘Fracture Liaison Services (FLS)’. These are models of care which systematically identify patients at risk, assess bone health, treat patients (if needed) and follow patients up to support medication adherence.

Methods
Demographics of FLS patients between January 2012 and December 2017 was obtained retrospectively from the Nottingham University Hospitals FLS database. We examined DNA rates and further characteristics of these types of patients. Deprivation scores were deprived using the English indices of deprivation 2015 (1–Most deprived; 5-Least deprived). The 2016 cohort of patients were followed-up till January 2019 to assess for re-fractures.

Results
6528 high-risk patients were identified and referred to DXA. Mean (SD) age was 68±10.5 years [Females=5302 (81%)]. 1386 patients (21%) did not attend. High prevalence of non-attendance was in females [1032 patients (74%)] and the most deprived individuals [398 patients (29%)]. Females from the most deprived areas had the highest DNA rate [287 patients (29%)]. All eligible patients &gt;75 years old were referred (n=1542 (100%), [Females=1284 (83%), non-attendance=473 (31%), non-attendance in females=390 (82%), highly deprived females=96 (25%)]. 826 patients were referred in 2016. Median follow-up time was 2.46 years (IQR 0.16–3.00 years). 52 patients (7%) re-fractured. 17 patients (33%) DNA their previous DXA scan [Females=12 patients (71%)].

Conclusions
Nottingham FLS have identified patients with fragility fractures that are high-risk for further fractures. Despite a dedicated FLS there is a DNA of 21%. Many patients that DNA are generally considered as having a high-risk of further fractures; females, older age and more deprived. Further studies are needed to explore why patients do not attend for bone density scanning.
93 Telemedicine Implementation in Croydon Care Homes
Authors: Smith J , Tunbridge R , Houser K , Serdoz D 
Published: February 2020

Abstract

Background
Croydon has one of the largest numbers of care homes of any London borough. Following the success of telemedicine in the Airedale and Partners NHS vanguard, care home telemedicine has been commissioned in Croydon.
Despite encouraging results for some individual services, the formal evidence base for telemedicine remains ambiguous. We aim to further our understanding of the use, perceptions and implementation of the telemedicine service in the care homes of Croydon.

Methods
Results are being collected from care homes including:Usage (e.g. time of day, patient/caller intention)Outcomes (e.g. GP calls, conveyances to hospital)
In addition, a survey of GPs and care homes was completed, with redistribution of the survey planned six months after introduction of telemedicine.

Results
In the first four months data of the service, 42 care homes have implemented telemedicine since Jan 2019. For these care homes, the results show a reduction in ambulance call outs of 7% and a reduction in conveyances to hospital of 4%. In the care homes that have been using the service on a regular basis, the reduction in call outs and conveyances is considerably bigger. There is also increasing use of the telemedicine service in preference to calling a GP. This data will become more robust and analysed further with the ongoing use of the service.
Initial survey results highlight the varied opinions of telemedicine, including perceived change in workload and quality of care, and will be repeated in August 2019 to assess any change in perceptions.

Discussion
The emerging data shows encouraging results for those care homes that are high users of telemedicine service. However, there is significant time and resource involved to ensure uptake and correct use of telemedicine in care homes. With the survey, we have uncovered a varied understanding and perception of telemedicine across the Croydon system prior to its implementation in care homes and will discover if these perceptions change following its increasing use.
We will present the successes and challenges to the implementation of the telemedicine service in care homes so far, then discuss the opportunities for care home telemedicine in Croydon for the future.
99 Approaches to Eating and Drinking with Acknowledged Risk: A Systematic Review
Authors: Soar N , Birns J , Sommerville P , Lang A , Archer S 
Published: February 2020

Abstract

Introduction
Patients with dysphagia may consider eating and drinking with acknowledged risk (EDAR) instead of artificial hydration/nutrition. Timely consideration of complex issues is required including dysphagia reversibility, prognosis, risk/benefit discussions, patient wishes, their capacity, best interests and advanced care planning. This study aimed to ascertain if EDAR protocols improve care through a systematic literature review.

Methods
PUBMED, MEDLINE, CINAHL and EMBASE were searched for English language articles to May ‘19 with terms related to EDAR, dysphagia and end of life. Articles and conference abstracts with original data were agreed for inclusion by two independent reviewers. Levels of evidence were assessed using the Sackett scale (Cook et al, Chest. 1995; 4: 227–230). Study themes were identified and discussed.

Results
12 articles met the inclusion criteria with varied methodology. The highest level of evidence was III (cohort study) and most were limited to patients with dementia, stroke, in older person’s wards or residential homes. 4 articles described a systematic approach to EDAR for in-patients and reported reductions in days nil-by-mouth until feeding plans are made and improvements in documentation of decision making, nutrition plans and capacity assessment. Other major themes included the need for an EDAR protocol, staff, patient and carer/family knowledge of EDAR, development of a protocol and the language of “risk feeding”. Formal meta-analysis was not possible due to the level and mix of methodology.

Conclusions
There is a paucity of evidence to determine if EDAR protocols improve care. However support is emerging for a coordinated approach to managing EDAR. Findings suggest having a protocol is not enough; education, training and communication within teams and with patients and carers is essential and this justifies further work. The lack of research into the impact of EDAR protocols on patient and carer experience means they must be central to any future work.
101 A Posture and Mobility Training Package for Care Home Staff: Results of A Cluster Randomised Controlled Feasibility Trial
Authors: Graham L , Cundill B , Ellwood A , Fisher J , Goodwin M , Hawkins R , Holland M , Hull K , Hulme C , Kelly C , Williams R , Farrin A , Forster A 
Published: February 2020

Abstract

Introduction
Provision of care for care home residents with complex needs is challenging. Physiotherapy and activity interventions can improve physical well-being but are often time-limited and resource intensive. A sustainable approach is to enhance the confidence, skills and abilities of care home staff. This trial assessed the feasibility of undertaking a definitive evaluation of the Skilful Care Training Package (SCTP) - a posture and mobility training programme developed by physiotherapists for care home staff.

Methods
A parallel-group, cluster randomised controlled feasibility trial was undertaken in ten care homes in Yorkshire. Five were randomised to receive SCTP, five to usual care. SCTP was delivered by specialist physiotherapists, with the intention of training all direct care staff. Following consent, data were collected from and about residents with restricted mobility (those fulfilling the eligibility criteria) at baseline, three and six months post-randomisation by blinded researchers. Outcome measurement included resident mobility, posture, pain and quality of life. The feasibility of recruitment, retention, data collection and intervention delivery was assessed.

Results
All residents (348) at participating homes were screened for eligibility. 250 were eligible and 146 took part. Follow-up was balanced between arms, with an overall loss-to-follow-up rate of 28.8% at six months. Where residents were available for six-month follow-up, proxy data provision was excellent (97.1% - 100% of expected data). Difficulty collecting data directly from residents was experienced (43.3% of expected data) due to high levels of cognitive impairment. Staff attendance at training met or was close to pre-specified criteria for acceptability in three homes, with 63.0%, 63.6% and 65.8% direct care staff attending all sessions, and &gt;85% attending at least one session across all three homes. However attendance fell short of acceptability in two homes, with only 21.4% and 12.5% staff attending all sessions.

Conclusions
It is feasible to recruit and follow-up residents in a randomised trial comparing SCTP and usual care. Proxy data collection is a successful method, but collection of data from residents is difficult. Intervention delivery success was variable, illustrating heterogeneity between care homes. Future research will be informed by learning from those homes with greater intervention compliance. Work should be undertaken to investigate how best to collect meaningful data from residents.
103 A Review of Reviews of Emergency Department Interventions for Older People: Outcomes, Costs and Implementation Factors
Authors: van Oppen J , Preston L , Ablard S , Buckley Woods H , Mason S , Conroy S 
Published: February 2020

Abstract

Introduction
Older people’s emergency care is an international public health priority and remains sub-optimal in the UK. Strategies are needed to manage older patients sensitively and effectively. We reviewed emergency care interventions, evaluating evidence for outcomes, costs, and implementation.

Methods
We developed and registered (with PROSPERO, CRD42018111461) a review of reviews protocol. Screening was according to inclusion criteria for subject and reporting standards. Data were extracted and summarised in tabular and narrative form. Quality was assessed using AMSTAR2 and Joanna Briggs Institute tools. Due to intervention and outcome heterogeneity, findings were synthesised narratively. McCusker’s Elder-Friendly Emergency Department assessment tool was used as a classification framework.

Results
Eighteen review articles and three conference abstracts fulfilled inclusion criteria. The majority were systematic reviews, with four using meta-analysis. Fourteen reviews reported interventions initiated or wholly delivered within the ED, and four focussed on quality indicators or patient preferences.
Confidence was limited to each review’s interpretation of primary studies. Descriptions of interventions were inconsistent, and there was high variability in reporting standards. Interventions mostly focussed on screening and assessment, discharge planning, referrals and follow-up, and multi-disciplinary team composition and professional activities. 26 patient and health service outcomes were reported, including admissions and readmissions, length of stay, mortality, functional decline, and quality of life.

Conclusions
Our review of reviews demonstrated that the current, extensive evidence base of review studies lacks complexity, with limited or no evidence for the effectiveness of interventions; reviews commonly called for more primary research using rigorous methods. There is little review evidence for factors influencing implementation.
There was evidence that among interventions initiated in ED, those continued into the community yielded better outcomes. Service metrics (as valued by care commissioners) were evaluated as intervention outcomes more frequently than person-centred attributes (as valued by older people). Interventions were broadly holistic in nature.
105 Functional Recovery in Older Women Undergoing Surgery for Gynaecological Malignancies: A Systematic Review and Narrative Synthesis
Authors: Martin F E , Kalsi T , Dhesi J K , Partridge J S L 
Published: February 2020

Abstract

Introduction
Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. However older people are both more vulnerable to changes in function and often prioritise function over survival. There is limited published research examining function outside of context of sexual or urodynamic function following gynaeoncology surgery but a large body or research exists examining health-related quality of life (HrQOL) both as a pre-operative risk factor for survival and as a post-treatment outcome measure in its own right. HRQOL tools may report on physical function as a subcomponent within composite tools.
This systematic review and narrative synthesis describes functional recovery after gynae-oncology surgery with respect to baseline characteristics which - if identified – could enable pre- or post-operative risk reduction.

Methods
Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974-2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria:Mean/median age &gt;60Gynaeoncological treatment includes surgery (RCTs, observational or mixed methods studies).Any measure of functional ability as defined by WHO ICF classification section D1–D7 inclusive, D855, D860-79 and D9 using validated tool.Minimum pre-operative and one post-operative measure.
Results analysed and presented using narrative synthesis.

Results
Sixteen studies identified (7 Endometrial, 2 Ovarian, 2 Vulval, 6 mixed cancer types).
1/16 used a standalone functional assessment tool, 15/16 used Health-Related Quality of Life tools (EORTC QLQ C30 (10), FACT-G (3), SF-36 (3)) comprising items describing function.
More studies showed full recovery to baseline (n=11) than incomplete recovery (n=5 including 2 reporting age as a negative association). Recovery was more likely and occurred faster in minimally-invasive surgery. 1 study demonstrated failure to recover baseline functional independence by 12 months.
106 How do Geriatricians View Their Future Old Age?
Authors: Braithwaite E , Thomas D , Ninan S 
Published: February 2020

Abstract

Introduction
Despite, being a specialty intimately acquainted with growing old, there has been little research on how geriatricians view ageing in the terms it might affect themselves in the future. We wished to survey geriatricians as to how they viewed their own futures as they grew older.

Methods
We constructed a short survey using survey monkey and sent it to all BGS members, electronically. We also tweeted links to the survey from our personal accounts publicly. Only geriatricians were asked to reply. The survey was open between 25th March and 26th June 2019.

Results
143 people responded to the survey49% agreed or strongly agreed that they were looking forward to old age65% agreed or strongly agreed that they were worried about the thought of being frail70% agreed or strongly agreed that they were worried about developing dementia
Despite these responses89% agreed or strongly agreed that old age will be an enjoyable time of life76% agreed or strongly agreed that they promoted a positive image of older age to friends and colleagues85% agreed or strongly agreed that they would be enthusiastic about life in older age74% agreed or strongly agreed that they looked forward to the social life they would have in older age
Themes that arose in the free text responses regarding greatest fears for old age included dependence, physical disability and frailty, dementia, loneliness, bereavement, financial difficulties and the future of society. Respondents hopes for old age included independence and health, enjoying relationships, having more time, and contributing to society.

Conclusions
Despite, or perhaps because of, looking after frail older people as part of their profession, geriatricians have mixed feelings towards growing old themselves. Despite most agreeing that old age will be enjoyable, only half of respondents were looking forward to older age.
Dementia, dependency and loneliness were common fears for geriatricians. Geriatricians’ experience of older age is often in the form of looking after the people who are the frailest of their age group, with the most marked disease burden. Strategies for geriatricians to consider the breadth and variety of old age might come through engagement with the field of medical humanities, reflective practice and spending more time with older people who have less disease burden.
107 Increased Hospitalisation Associated with Nasogastric Feeding in Advanced Dementia: Experience of A Geriatric Unit in Singapore
Authors: Yang D , Fong E L , Chan M 
Published: February 2020

Abstract

Introduction
Tube feeding is not recommended in persons with advanced dementia and dysphagia; it does not improve nutrition, reduce infections or mortality. In Singapore, limited data exists on the prevalence of oral versus tube feeding in persons with advanced dementia, and the alignment between the mode of administering food and fluids and a prior advanced care plan (ACP) discussion.

Methods
Retrospective review of 120 patients from January to October 2017 was conducted to examine the prevalence of oral and tube feeding in advanced dementia patients with ACP, and the alignment of the chosen mode of intake with their ACP. Outcomes include rates of readmission, pneumonia, ACP revisions and mortality at six months.

Results
42 subjects fulfilling criteria were analysed. 81.0% continued oral feeding. There was a statistically significant difference in the decision for tube insertion between oral and tube feeding groups (p=0.02), which was influenced by the ACP discussion. Concordance with ACP discussion in the tube feeding group was mixed, with 50% agreeing for tube insertion and 33.3% who were clinically guided. Surrogates made the decisions in 90.5% of the discussions.
Six-month readmission rate was 32.4% for orally-fed patients versus 75% for tube-fed patients (p=0.045). 52.9% of admissions were attributed to pneumonia. 8.8% of orally fed patients revised their ACP to opt for a trial of treatment in their own home instead of readmission to the hospital. There was no difference in 6-month mortality (p=0.123).

Conclusions
Oral feeding was continued for most advanced dementia patients. Tube feeding does not offer survival benefit or prevent aspiration at 6 months, yet is associated with increased hospitalisations. ACP discussion should be initiated earlier to provide persons with dementia the opportunity to express their preferences for the mode of food and fluid intake.
108 Poor Appetite is Common in Hospitalised Older People and Associated with Subclinical Low Mood
Authors: Cox N J , Lim S E R , Baylis D , Howson F , Sayer A A , Robinson S M , Roberts H C 
Published: February 2020

Abstract

Introduction
Appetite loss in older people -anorexia of ageing (AA) - is common. Recognised consequences include undernutrition, sarcopenia, frailty, and increased mortality after discharge from hospital. Identification and management of AA may prevent onset of these health burdens. Whilst appetite can be assessed, this is often not routine.

Methods
Cross-sectional data from three studies (carried out 2010-2017), with comparable data collection methods and drawn from the same population, were combined. Participants were over 70 years, admitted to acute wards within a large UK hospital. Appetite was assessed using the simple 4 item Simplified Nutritional Appetite Questionnaire (SNAQ); a score of ≤14/20 defines poor appetite. Correlates of SNAQ scores were evaluated.

Results
The dataset included 474 participants (64% female) with mean age 84 (6.5), median Barthel 78 (IQR 53-91), mini-mental state exam (MMSE) 27 (IQR 23-29) and comorbidity index 5 (IQR 4-7). The median GDS for the population was 4 (IQR 4-6). The mean SNAQ score was 13.9 (SD 2.6), and 265 (56%) participants scored ≤14 indicating poor appetite. There was no significant difference between mean SNAQ scores of men and women (P=.26), or those living alone and with others (P=.62).
Age, MMSE, comorbidity index, and total number of medications were not related to SNAQ score in continuous analyses but geriatric depression score (GDS-15) was (adjusted coefficient -.248; P&lt;.001); such that lower mood was associated with poorer appetite.

Conclusions
These findings highlight the importance of assessing appetite in hospitalised older people, as poor appetite is very common. Appetite can be assessed in hospital using the simple 4 item SNAQ tool. Subclinical low mood, measured by GDS-15, had the strongest association with SNAQ score whilst in hospital. Therefore, for those with poor appetite in hospital, clinicians should have a low threshold to evaluate and treat low mood.