bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of plasma step gradient modification on surface electrical properties of epoxy resin
Authors: YAN Jiyuan , LIANG Guishu , LIAN Hongliang , SONG Yanze , PENG Chengkai , KANG Yuchan , XIE Qing 
Published: March 2021

Abstract
In this paper, plasma fluorination is combined with plasma silicon deposition to achieve step gradient modification on an epoxy resin surface. The physicochemical characteristics of samples are investigated and the electrical performances measured. The obtained results show that compared with untreated and single treated samples, the samples treated by step gradient modification significantly improve the flashover performance. According to experiment and simulation, the mechanism explanations are summarized as follows. First, it is found that the step gradient conductivity can effectively optimize the electric field distribution of a needle-needle electrode. Then, step gradient modification suppresses the accumulation of surface charge at the triple junction and makes the charge distribution more uniform. Furthermore, it can accelerate the surface dissipation on a high electrical field region and control the dissipation rate on a low electrical field region. All these results can restrain surface discharge and increase the flashover voltage. The step gradient modification method proposed in this paper provides a new idea for improving the surface insulation performance.
8 Improving Delirium Screening and Recognition Through Quality Improvement Crowdsourcing: Results of A Panspecialty Multi-Centre Project
Authors:   Geriatric Medicine Research Collaborative
Published: March 2021

Abstract

Background
Delirium is common in hospitalised older adults. It is distressing and devastating. Unfortunately, delirium remains under-recognised in clinical practice.

Methods
We conducted a multi-centre crowdsourced quality improvement project, with three rounds of data collection. We shared guidelines, toolkits, and educational tools in web-based folders, alongside social media and conference dissemination. We recorded delirium screening completion within 48 hours of admission and delirium recognition by the usual care team in unscheduled admissions (≥65 years). Delirium was diagnosed prospectively in Round-1 (R1) and Round-3 (R3), and retrospectively in Round-2 (R2) (validated approach).

Results
Across all rounds (82 sites), delirium prevalence was 16.3% (491/3013). Delirium screening (R1: 27.3%, R2: 29.6%, R3: 37.1%; p &lt; 0.001) and recognition (R1: 34.2%, R2: 57.1%, R3: 63.2%; p &lt; 0.001) improved across each round. Odds of screening (OR 1.52, CI 1.19–1.93) and recognition (OR 3.65, CI 1.94–6.87) were greater in R3 compared to R1 in multivariable analysis. Likelihoods of delirium screening (OR 0.49, CI 0.28–0.85) and recognition (OR 0.15, CI 0.03–0.82) were reduced in patients admitted under other surgery specialties. Local delirium teams were associated with increased screening odds (OR 1.75, CI 1.40–2.18), and geriatrics teams embedded into admissions units were associated with increased recognition odds (OR 1.66, CI 1.03–2.69). Documentation of delirium on discharge summaries also improved (R1: 28.6%, R2: 48.4%, R3: 46.6%). Odds of discharge documentation (OR 3.19, CI 1.18–8.82) were greater in R2 compared to R1 in multivariable analysis. Across all rounds, delirium was associated with increased hospital mortality (HR 1.83, CI 1.30–2.60) and length of stay (+3.18 days; p &lt; 0.001) in multivariable analysis.

Conclusion
Delirium is common across all specialties. It is associated with increased mortality and length of stay. Trainee-led quality improvement crowdsourcing can be used to improve delirium screening, recognition, and documentation on discharge summaries.
9 Patient Outcomes From A General Inpatient Rehabilitation Ward, Does Frailty or Reason for Admission Make A Difference to Patient Outcome?
Authors: Alcorn E , Wentworth L 
Published: March 2021

Abstract

Introduction
With our ageing population there is increasing number of patients who experience a decline in their mobility either because of their underlying diagnosis or as a consequence of their hospital stay. There are only a limited number of inpatient rehabilitation beds and it is therefore important to identify those that would benefit the most from inpatient rehabilitation.

Method
We undertook a retrospective study looking at three months of discharges from an inpatient rehabilitation ward in Manchester. Patients were categorised based on diagnosis (Pubic rami fracture, other fractures, fall with no bony injury and finally medical reasons) and Clinical Frailty Score to see if either had any effect on whether patients mobility improved and to what degree.

Results
Patients with a reduced mobility on admission were identified and then categorised based on diagnosis. Of those patients admitted with a pubic rami fracture 66.7% improved on the ward with 33.3% of patients reaching their baseline mobility. The mobility of 85.7% of patients with other fractures improved with 42.9% reaching their baseline. Patients admitted following a fall without bony injury showed, 75% improvement with 50% reaching their baseline. Of those admitted for medical reasons 88.9% of those improved but only 22.2% reaching their baseline mobility. The lowest proportion of any category. Those admitted for medical reasons also had the longest median average stay on the rehab ward (33.5 days) followed by other fractures (33 days) then fall with no bony injury (21.5 days) and finally the shortest average stay, pubic rami fractures (20 days).
Patients were also grouped occurring to their preadmission Clinical Frailty Score. With the exception of those who scored four (only a small number of patients), there was a negative correlation between an increasing frailty score and the proportion of patients whose mobility improved. However as frailty score increased the proportion of patients who improved to their baseline increased.

Conclusion
Our study has shown that the majority of patients benefitted from their admission regardless of diagnosis, however those admitted for medical reasons had the lowest chance of reaching their baseline mobility despite the longest admissions on the ward. Further research may be beneficial to investigate if they do better in a different rehabilitation setting.
13 Caregiving Burden and Unmet Support Needs in Chinese Caregivers and Cancer Patients
Authors: Leung D Y P 
Published: March 2021

Abstract

Introduction
Cancer burden continues to rise globally and locally. Due to the shift of the cancer care from the hospital to the community, many cancer patients requiring needs in palliative care from their informal caregivers. Many caregivers often taking up the important roles and responsibilities but their own needs are largely neglected, and hence may induce caregiving burden. This study aims to explore the relationships of caregiving burden with unmet support needs in both cancer patients and their caregivers.

Method
A convenience sample of 280 patient-caregiver dyads was recruited from the oncology outpatient clinic of two hospitals in Hong Kong between April and June 2018. Among them, 258 (92.1%) patient-caregiver dyads provided complete information on unmet supportive care needs (Patient: the 34-item SCNS-SF34-C, Caregivers: the 26-item SPUNS-SF), and caregiving burden (Caregiver Strain Index).

Results
Among the patients, their mean age was 60.8 (SD = 13.6) and 66% were female. Among the caregivers, their mean age was 49.3 (SD = 14.6), 67.2% were female, and 38.2% were children of the patient. Mean level caregiving burden in caregivers was 4.87 (SD = 3.75) out of a range 0–13. Regression analysis showed that higher caregiving burden was associated significantly with higher caregiver’s unmet support in personal and emotional needs (βstd = 0.348) and future concerns (βstd = 0.204), and patient’s unmet support in physical and daily living needs (βstd = 0.201), but lower caregiver’s unmet support in information needs (βstd = −0.233) after controlling for age, gender, and education level of both patients and caregivers.

Conclusions
The findings shed lights in designing interventions aim at reducing caregiving burden by targeting caregiver’s unmet support in personal and emotional need and those caregivers are taking care of cancer patients with unmet support in physical and daily living needs. However, the finding on caregiver’s unmet support in information needs was a protective factor of caregiving burden warrants further exploration.
14 A Systematic Review of the Prevalence and Implications of Frailty in Diabetes Mellitus
Authors: Hanlon P , Faure I , Corcoran N , Butterly E , Lewsey J , McAllister D A , Mair F S 
Published: March 2021

Abstract

Background
Frailty, an age-related state of vulnerability to adverse health outcomes, is an important factor in the management of diabetes. This systematic review aims to summarise the observational data on prevalence of frailty in diabetes and the association between frailty and generic (e.g. mortality) and diabetes specific (e.g. hypoglycaemia) outcomes.

Methods
We searched three electronic databases for observational studies assessing frailty in adults (≥18 years) with diabetes (type 1, type 2, or unspecified). Eligible studies quantified the prevalence or incidence of frailty or the association between frailty and clinical outcomes in the context of diabetes.

Results
118 studies included, using 18 different frailty measures. Frailty phenotype was the most used (n = 69) followed by frailty index (n = 16) and the FRAIL scale (n = 10). Studies were highly heterogenous in terms of setting (88 community, 18 outpatient, 10 inpatient, 2 residential care), population demographics, and inclusion criteria. The median frailty prevalence in community-based studies using the frailty phenotype was 13% (interquartile range 7-18%). Frailty was identified in “middle-aged” (&lt;65 years) as well as older people with diabetes. Diabetes was consistently associated with incident frailty. Frailty was associated with higher mortality, hospital admission, incident disability. Frailty was associated with hypoglycemic events in 1/1 study. Frailty was also associated cross-sectionally with micro- and macro-vascular complications, lower quality of life, and cognitive impairment. Frailty was not associated with difference in mean HbA1c, however people with frailty were more likely to have high (&gt;9%) or low (&lt;6.5%) HbA1c.

Conclusions
Frailty in diabetes is common but inconsistently measured. Frailty is associated with a range of adverse outcomes. Research gaps include the relationship between frailty and glycaemia (particularly hypoglycaemia and the relationship between HbA1c and outcomes in the context of frailty), and the impact of frailty in specific groups such as middle-aged people and in low and low-middle income countries.
19 Integrated Falls Prevention Pathways; the Benefits of Organisational Collaboration
Authors: Tanks E , Michael A 
Published: March 2021

Abstract

Introduction
There is continuous increased demand on the NHS, while resources are finite. Developing pathways with Integration and streamlining of services is crucial to achieve good outcome and better use of resources. Falls service is a good example. In Dudley, three separate services existed for managing falls: a local authority team, a NHS therapy team and a Consultant-led Falls & Syncope clinic. We collaborated and reorganised the services to improve patient care and achieve better outcome.

Methods
We integrated services into one pathway, where patients are triaged to the relevant service based on clinical need via a Single Point of Access. One multifactorial assessment- based on NICE guideline CG161 and Quality Standard QS86- was developed, which is completed by all services (streams). This allows their assessment to be transferred to another stream if clinically indicated, saving repetition/duplication. An extensive training programme was delivered to up-skill staff across the pathway in completing areas of best practice (e.g. postural BP measurement, balance/mobility assessments, cognitive assessment, FRAX score, medication issues). Additionally we established a Falls MDT meeting with representation from all streams, to discuss complex cases, and developed a shared, electronic database to track patient journeys and monitor service outcomes.

Results
Falls admission rate decreased by 29.4% for patients 65 y and over and 25.2% for 80+. This equates to 433 fewer falls compared to peak rate; saving an estimated £3.4million. Also, hip fracture admission rate decreased by 19.2% for patients 65 y and over and 23.5% for 80+. This equates to 91 fewer hip fractures compared to peak rate; saving an estimated £1.3million. Much improved service collaboration and resource sharing.

Conclusion
A collaborative approach between organisations, utilising existing resources in a system that places patients at the heart of the service, improves patient experience and outcomes, alongside significant financial savings.
27 Can Sarcopenia be Used to Estimate Outcomes in Elderly Patients Treated with Chemoradiotherapy for Bladder Cancer?
Authors: Corden M 
Published: March 2021

Abstract

Introduction
Ageing is a risk factor for bladder cancer, with a median age at diagnosis of 71 years. In addition, sarcopenia shows promise as a prognostic biomarker for bladder cancer. This study evaluates sarcopenia as a predictor of overall survival (OS) for older patients treated with chemoradiotherapy for bladder cancer.

Methods
185 bladder cancer patients treated (from 2010–2017) with chemoradiotherapy were available for analysis. Pre-therapeutic computed tomography scans were identified and single slices at the L3 level were identified. Machine learning software was used to segment skeletal muscle and obtain its cross-sectional area. This was normalised against height squared to calculate a skeletal muscle index for each patient. Sarcopenia was defined using international consensus definitions (&lt;39 cm2/m2 in females and &lt; 55 cm2/m2 in males). Differences in survival function between patients ≤75 and &gt; 75 years were visualised using Kaplan–Meier curves. Age distribution between sarcopenic and non-sarcopenic patients was also explored. Finally, a multivariable Cox proportional hazards model was conducted to investigate interactions between sarcopenia and increased age with respect to OS.

Results
Of 185 patients, 114 (61.6%) were sarcopenic and 71 (38.4%) were non-sarcopenic; 101 (54.6%) and 84 (45.4%) patients were ≤ 75 and &gt; 75 years old respectively. No differences in OS were observed between the two age groups (p = 0.50). There was no interaction between sarcopenia and age as a continuous variable was observed with respect to OS (p = 0.682); however, when age was categorised an interaction was seen (p = 0.058). Nevertheless, after adjusting for performance status, T-stage, hydronephrosis, albumin, haemoglobin, neutrophil and lymphocyte counts, the interactions between age and sarcopenia were no longer observed (age continuous, p = 0.474; age categorized, p = 0.765).

Conclusions
Patients with bladder cancer over 75 years of age have a modest increase in probability of developing sarcopenia but this does not impact on OS.
36 Feasibility of Resistance Exercise to Failure at Different Loads in Frail and Healthy Older Adults?
Authors: Marshall-McKenna R , Campbell E , Ho F , Banger M , Rowe P , McAlpine C , McArthur K , Quinn T J , Gray S R 
Published: March 2021

Abstract

Introduction
Resistance training (RT) is the most effective way to increase muscle mass and function in older adults both with/without sarcopenia/frailty. In younger adults, when RT is performed to muscle failure the load lifted does not mediate the magnitude of response, but there are no studies in older adults. We aimed to determine the feasibility of recruitment to a RT intervention working to muscle failure at different loads in frail and healthy older adults.

Methods
We performed an 8-week randomised feasibility trial of lower limb RT to volitional muscular failure, at high and low load. Participants were recruited via hospital outpatient clinics and newspaper advertisements. Outcomes included: frailty assessment (Fried criteria); muscle strength (maximum voluntary contraction/one-repetition maximum); functional abilities (Short Physical Performance Battery); safety/adverse events were recorded via a log, and patient experiences from focus groups.

Results
110 people were assessed for eligibility, and 58 randomised (frail n = 6, prefrail n = 20, robust n = 32) to either high (n = 30) or low load (n = 28) groups. Mean age of participants was 72 years (range 65–93), 36 were female, 22 male. Session attendance was 95% (high load) and 90.4% (low load). Most participants were recruited via advertisements. All participants reported feeling safe and reassured in the RT sessions. Two participants had a serious adverse event, one related to RT (hypotension) and several had adverse events (three intervention-related). Pain was reported at both loads (high n = 9, low n = 8) yet all completed. There were no differences (P &gt; 0.05) in effects of RT outcome variables between low and high load groups.

Conclusion
In this feasibility trial the recruitment of frail patients via clinics was limited. Performing supervised RT to muscle failure in older adults was safe/acceptable and the load at which RT was performed did not influence its efficacy. Future research into the effectiveness of such RT is warranted.
38 Dementia, Apoe and COVID-19 Severity
Authors: Masoli J , Kuo C L , Atkins J , Pilling L , Delgado J , Kuchel G , Melzer D 
Published: March 2021

Abstract

Introduction
During the COVID-19 pandemic, pre-existing dementia was associated with a 3x increase in risk of hospitalisation and (25.6%) of COVID-19 related deaths had dementia. However, it is unclear whether people living with dementia are at higher risk of COVID-19 due to dementia or whether there may be a biologically plausible link between dementia and COVID-19. The ApoE e4 allele is highly associated with dementia. We aimed to test the COVID-19 risk associated with dementia and the association between ApoE e4e4 allele and COVID-19 with the aim of clarifying biological vulnerability.

Methods
UK Biobank (England) participants baseline (2006 to 2010), plus secondary care data to 2017. Separate analysis tested dementia and ApoE genotype association with COVID-19 status (16th March-31st May 2020) or mortality (to March 31, 2020, plus incomplete deaths from April, 2020) in logistic models, adjusted for demographics and technical covariates.

Results
In 269,070 participants aged 65+, including 507(0.2%) hospitalized COVID-19 patients, those with pre-existing dementia were at increased risk of being hospitalized for COVID-19 (OR = 3.50 95% CI 1.93 to 6.34) and also for COVID-19 and death (OR = 7.30 95% CI 3.28–16.21). In 375,689 European-ancestry UKB participants, ApoE e4e4 homozygotes were more likely to be COVID-19 test positives (reaching genome-wide significance: OR = 2.24, 95% CI:1.72–2.93, p = 3.24 × 10–9) and of mortality with test-confirmed COVID-19 (OR = 4.29, 95% CI: 2.38–7.72, p = 1.22 × 10–6), compared to e3e3s homozygotes. The associations were little changed in subsets of participants who were free of diseases associated with ApoE e4 and COVID-19 severity.

Conclusion
Dementia was found to be disproportionally common in older adults who develop severe COVID-19. We have shown a plausible genetic pathway of increased COVID-19 risk with dementia, therefore suggesting that the positive association between dementia and COVID-19 is not just the result of high cases of COVID-19 in care homes.
44 Improving Discussions Around Treatment Escalation Decisions in Patients with Subdural Haematomas on A Neurosurgical Ward
Authors: Haire E , Kimpton G 
Published: March 2021

Abstract

Background
It is becoming increasingly accepted that discussion and documentation of patient wishes and clinical decisions regarding treatment escalation planning are an essential part of patient care. Following the Tracey judgement, it became a legal requirement, rather than a recommendation, for doctors to involve patients and their families in DNAR decisions.
A previous audit in the neurosurgical department found a high prevalence of patients at risk of deterioration with little evidence of attempt to discuss or document treatment escalation decisions (TEDs).

Aims

Methods
We conducted surveys of the multi-disciplinary team within the neurosurgical department to gain a better understanding of their opinions about the current discussion and documentation of TEDs in the department. These contained a mixture of rating scales and free text answers. Following this we engaged senior staff in plans to improve this by introducing these discussions to governance meetings and educated all members of the ward using e learning and tea trolley teaching.

Results
Amongst 18 healthcare professionals, 12 felt patients did not have clear TEDs. Ten felt discussions were not appropriately timed. Response themes included feeling unsupported, poor timing of conversations and low quality documentation. Following this a consensus decision from the consultant body mandated documentation of TEDs in patients presenting with chronic subdural haematomas. We have worked closely with the national ReSPECT programme and established the neurosurgical ward as a lead for the introduction of the new form.

Conclusion
The neurosurgery department is now at the forefront of the move to improving discussions and documentation about patient wishes in the Trust. Additionally, we have opened the conversation within the multi-disciplinary team and provided training and education about the importance of TEDs.
141 Face Time’ for the First Time: Patients, Families and Junior Doctors
Authors: White H , Tuck A , Pyrke B , Murphy E , Figg K , Cartwright G , Abdalla B 
Published: March 2021

Abstract

Introduction
Over the course of the COVID-19 pandemic, supporting effective communication between patients and their families has been a recognised challenge in the healthcare environment. Virtual communication via telecommunication and video-calling is more important than ever, but with minimal clinician education, preparation and relevant technological infrastructure available in the context of a global pandemic, we have recognised communication as an area for improvement as junior doctors working on a COVID-19 ward.

Methods
We interviewed via telephone 22 nominated next of kin relatives of patients admitted to a COVID-19 ward in the University Hospital of Llandough during May 2020 using a pre-prepared survey. We then provided relatives with the opportunity to engage with video-call updates from a doctor (with the patient’s permission). In appropriate scenarios, we used video calling to break bad news and to facilitate difficult communications with family members. These video calls were provided via Accurx, an NHS approved video communication system.

Results
Initial survey results showed an average understanding score of their relative’s current clinical plan of 5.5/10, with 63% of respondents saying they did not feel well informed. Nearly a quarter of respondents (22%) had received difficult news over the phone during the COVID-19 pandemic, and 86% said they would find video communication useful. Post-intervention survey results suggested a unanimous improvement in relative satisfaction, with relatives reporting an increased understanding around the admission, reassurance around the quality of care being given and less isolation from the patient.

Conclusions
The COVID-19 pandemic has provided novel communication challenges to physicians, promoting flexibility and adaptation to some of the core inter-personal skills we develop throughout training. Technology plays a huge role in this, and the use of video calling in particular can preserve non-verbal communication within the doctor-relative relationship and improve emotional connection between patients and their loved ones.