bluuebunny/crossref_metadata_2025_split huggingface dataset:
43 Renewing the Frailty Experience: Bringing CGA Into the Emergency Department
Authors: Saxton N , Mayne D 
Published: March 2021

Abstract

Topic
Early recognition and multidisciplinary management of frail patients in acute care is a national priority. This is reflected in the NHS 10 year plan, NHS Improvement (NHSI) and Getting It Right First Time (GIRFT) ambitions for acute care. The Sunderland Royal Hospital acute frailty service currently reviews frail patients on the Medical Admissions Unit (MAU) each morning. Analysis of our emergency department (ED) data demonstrates that most frail patients arrive to the ED between 12 pm and 18 pm leading to a cohort of frail patients who are not receiving comprehensive geriatric assessment early in their patient journey. Here, we present our piloted expansion of the frailty service into the ED.

Intervention
Currently the frailty service is provided on MAU between 9 am and 1 pm. The pilot service expansion ran for five weeks between September and October 2018 and involved the acute frailty team being available to ED and MAU from Monday to Friday 0830 am to 1700 pm. Frail patients were proactively identified using the ED patient tracker as well being referred to the team by ED staff.

Improvement
During the pilot, the team reviewed 131 additional patients. 85% were seen in ED. 61 patients were discharged directly from ED and 33 patients were admitted directly to a back of house medical ward resulting in reduced MAU occupancy rates in the evenings. Concerns that bringing full MDT assessment into ED might result in increased time spent in ED were proven to be unfounded. Median length of stay for admitted patients was low with 49% discharged within 7 days and 9.9% 30 day readmission rate. Feedback from ED and community teams was positive.

Discussion
It is recognised that early CGA is beneficial for patients with frailty syndromes who are admitted to hospital. Most commonly, this takes place on medical admissions wards. Through this pilot, we have demonstrated significant added benefits of bringing the acute frailty team and crucially CGA into the emergency department setting. As well as increased discharges directly from ED, we demonstrated a reduction in length of stay and readmissions as well as improved patient flow. Our aim is to permanently implement a seven day frailty service with input on MAU as well as ED.
46 Promoting Advance Care Planning of Patients with Parkinsonism in the Community
Authors: Lim C Khuang , Miller C , Jones T 
Published: March 2021

Abstract

Introduction
NICE guideline recommends that all patients with Parkinson’s disease should be reviewed every 6–12 months and offered opportunities to discuss Advanced Care Planning (ACP) (1, 2). There is evidence demonstrating that Advanced Care Plans results in shorter length of stay in the last year of life and lower hospital costs (2, 3). A local baseline audit showed that Advanced Care Planning was not performed adequately.

Methods
A local baseline audit on community care home patients with Parkinsonism was completed in February 2018. A community-based Parkinson’s clinic was commenced in June 2018. Patients with parkinsonism who were unable to attend hospital clinics due to underlying frailty, neuropsychiatry and physical issues, were reviewed. At each visit, advice was provided on medicines management and there were discussions around Advance Care Planning.
A re-audit was completed in August 2019. Patient’s Electronic Patient Records were scrutinised to evaluate progress and identify those who had died. Data was analysed using Microsoft Excel.

Results
The initiative contributed directly to end of life care in 7/17 patients. Parkinson’s disease medications were rationalised in 11/17 (64.70%). 14/17 (82.35%) had a community-based Do Not Resuscitate order completed.

Conclusions
The community Parkinson’s clinic service promoted Advance Care Planning in patients with Parkinsonism. This service provides specialist input in frail older people with Parkinsonism who were unable to attend hospital clinic, promoting end of life choices around where they wished to die and avoiding unnecessary hospitalisation in the final stages of their life.
47 What are the Associations Between Renal Biochemistry and Physical Performance in Older Patients with Advanced Chronic Kidney Disease? Findings From the Bicarb Trial Cohort
Authors: Witham M D , Lamb E J , Sumukadas D , Band M M , Soiza R L , Hampson G , McNamee P , Avenell A 
Published: March 2021

Abstract

Background
Impaired physical performance is common in older people with advanced chronic kidney disease. It is unclear which metabolic derangements contribute to this impairment. This analysis examined cross-sectional associations between renal biochemical indices and physical performance in older people with advanced chronic kidney disease.

Methods
We analysed data from the BiCARB multicentre trial, which enrolled patients aged 60 and over, with chronic kidney disease stage 4 or 5, not on dialysis, and with serum bicarbonate &lt;22 mmol/L. Participants undertook baseline Short Physical Performance Battery (SPPB), grip strength and six minute walk test. Renal biochemistry (serum creatinine, cystatin C, phosphate, bicarbonate), haemoglobin, and NT-pro-B-type natriuretic peptide (NTproBNP) were measured at baseline. Associations were tested using Spearman’s rho and generalised linear modelling using forced entry was used for multivariable regression analysis.

Results
The analysis included 300 participants (mean age 74 years; 86 [29%] women). Mean baseline SPPB was 8.1 points (SD 2.3); mean six-minute walk distance was 311 m (SD 132). Age (r = −0.27, p &lt; 0.001) and BNP (r = −0.27, p &lt; 0.001) were most strongly associated with the SPPB. Age (r = −0.33, p &lt; 0.001), haemoglobin (r = 0.24, p &lt; 0.001), cystatin C (r = −0.21, p &lt; 0.001) and NTproBNP (r = −0.32, p &lt; 0.001) were most strongly associated with six-minute walk distance. For grip strength, age (r = −0.35, p &lt; 0.001), cystatin C (r = −0.24, p &lt; 0.001), and NTproBNP (r = −0.31, p &lt; 0.001) were most strongly associated in men, with similar but weaker associations for women. Creatinine and bicarbonate concentrations were not significantly associated with any physical performance measures. Factors in multivariable regression independently associated with six-minute walk distance were age, sex, BMI, cystatin C, phosphate and NTproBNP; with SPPB were age and BMI; and with grip strength were age, sex and cystatin C.

Conclusions
Some biochemical markers related to kidney function are modestly associated with physical performance in older people with advanced chronic kidney disease; patterns differ between different performance measures.
147 Improving Urine Specimen Collection in Elderly Medical Inpatients—A Quality Improvement Project
Authors: Singh S , Abbas Z , Yousuf Q 
Published: March 2021

Abstract

Introduction
The National Institute for Health Research reported in 2012 that urinary tract infections are a significant cause of mortality especially among the elderly population with 4,835 deaths in England and Wales. During an elderly care rotation, it was noted that a number of elderly inpatients were being treated for UTIs without urine samples for culture and sensitivity being collected. They were treated with antibiotics largely on the basis of positive urine dipsticks and/or clinical signs and symptoms. Despite local policy reflecting current national guidance on the diagnosis of UTIs in the elderly population, compliance remained poor.

Method
A quality improvement project using both quantitative and qualitative methodology was designed to determine the number of elderly medical inpatients (≥ 65 years) who have had urine sampling done within 48 hours of presentation as well as to seek to improve this aspect of patient care by determining limiting factors which could prove a hindrance to urine sampling in this age cohort. Quality improvement methods were used to improve and optimise urine sampling rates.

Results
The percentage of elderly medical inpatients having a urine sample taken on admission during the project period increased from 35% to just under 100%. Quality improvement methods have successfully identified and improved this aspect of the elderly care service leading to better patient care.

Conclusion
It was identified that lack of awareness and communication from both sides of the medical and care teams contributed to untimely urine sampling at our hospital. Education and personal discussion represents a sustainable intervention which could easily be replicated in other Trusts. Further work is underway with the development of a teaching session to support nurses and clinical support workers obtaining urine samples from incontinent patients undertaken by one of our community continence clinical nurse specialists.
50 Using A Targeted Teaching Intervention to Drive up the Quality of Discharge Summaries. Shop 75+
Authors: Robey R C , Danson A , Evans J , Froggatt J , Pederson A , Cross T , Vilches-Moraga A , Gaillemin O 
Published: March 2021

Abstract

Background
Quality improvement project examining discharge communication, and a targeted teaching intervention.

Introduction
Poor quality, incomplete or missing discharge summaries (DSs) are associated with avoidable/ameliorable adverse events after discharge [1]; preventable readmission [2,3]; failure to implement discharge plans [4]; and medication continuity errors [4,5].

Methods
To review the quality of DSs produced, each month forty representative DSs are randomly selected from four clinical areas and qualitatively assessed (total &gt; 1,000, August 2017—to date). Alongside this, in August 2018, incoming foundation doctors were surveyed on perceptions of the purpose/importance of DSs, and training provided on writing them. They were resurveyed after teaching delivery in November 2018 and April 2019.

Interventions
Data from QI review and survey were used to generate a teaching intervention, in the form of an interactive slide set for delivery in small group settings. This was delivered in weekly mandatory teaching sessions. PDSA cycles were completed for teaching sessions, and the slide set was developed accordingly.

Results
After the teaching sessions, we noted improvement in satisfaction with training provided on writing DSs (from 24% to 40%), as well as confidence in writing high-quality DSs (from 28% to 100%). We demonstrated increases in responses including the patient as an intended audience for the DS (from 51% to 84%), and rating “patient information in lay terms” of “high importance” (from 41% to 72%). These changes in perceptions were accompanied by improvement in the quality of DSs produced, particularly with respect to the quality of follow-up actions detailed and the quality of patient information provided in lay terminology. The average monthly proportion of DSs achieving a “great score” in these areas increased from 20% and 28% respectively (August 2017—June 2018), to 44% and 71% (August 2018—March 2019).

Conclusions
These data provide proof-of-principle that targeted teaching, constructed around prior questionnaire surveys, improves awareness of the purpose of DCs and leads to improvement in the quality of DSs produced and enhanced patient safety.
149 Non-Pharmacological Treatment of Bone Health in Fallers
Authors: Moran E 
Published: March 2021

Abstract

Introduction
1 in 2 women and 1 in 5 men will suffer a fragility fracture. Research into calcium and vitamin D supplements has found no consistent evidence to suggest that they reduce the risk of osteoporotic fractures. There has been little research to suggest that dietary calcium is effective at reducing the risk osteoporotic fractures, but supplements have been linked to increased risk of cardiovascular disease and urinary stones. Bisphosphonates have been shown to reduce the risk of osteoporotic fractures and are usually taken in combination with calcium and vitamin D supplements given that deficiencies must be corrected prior to starting. This study set out to assess the dietary calcium intake of patients who attend the falls clinic and explore their attitudes towards dietary change, as an alternative or adjunct to a calcium and vitamin D tablet.

Methods
Data was collected during private interviews conducted with patients who attended the falls clinic. The Edinburgh University Centre for Genomic and Experimental research (CGEM) food frequency calculator was used to calculate dietary calcium intake. Microsoft Excel was used to collate and analyse the data.

Results
No association was found between dietary calcium intake, age and sex. We did find that mean dietary calcium intake was significantly less than the recommended daily amount for adults with osteoporosis, with 80% not getting their recommended daily intake (p &lt; 0.05). We identified patients who don’t receive a calcium and vitamin D supplement as an at-risk group who would benefit from advice on sources of dietary calcium and 83% of patients said that they would be interested in a leaflet on sources of dietary calcium.

Conclusion
This study has identified a group of patients who will hopefully benefit from a leaflet on sources of dietary calcium and as result improve their bone health.
150 The Association Between Increasing Frailty and Greater Co-Morbidity and Surviving Cardio Pulmonary Resuscitation
Authors: Thomas E , Lloyd A , Leopold N 
Published: March 2021

Abstract

Introduction
Population ageing is a triumph of public health and medical advancement but it can equally lead to burdensome and futile interventions at the end of natural life. This is especially relevant when offering treatments such as cardiopulmonary resuscitation (CPR) that can carry a significant burden of harm. The aim of this study was to investigate the association between increasing frailty and greater co-morbidity and surviving CPR.

Method
A retrospective analysis of prospectively collected data from contemporaneous patient notes and electronic patient records of all patients that suffered an in-hospital cardiac arrest between 1st April 2017 and March 31st 2018 in a tertiary hospital (that includes tertiary cardiology) in South Wales was undertaken.

Results
A total of 113 patient records were assessed. Average patient age was 74. Patient frailty was assessed based on calculation of Rockwood score (RS) and co-morbidity assessment based on Charlson index (CI). We identified a strong linear correlation between increasing CI and poor survival and rates of ROSC. No patient with a Charlson index of above 6 survived one year. Similarly, patients with a RS between 1–3 had a survival to discharge, 30 day and 1 year survival rate of 45.7%. Only 10.3% of those with a RS between 5–9 survived 1 year post cardiac arrest. No patient with a RS above 6 survived one year. No association between duration of CPR and patient frailty was identified. Increasing age was also found to be linearly associated with reduced likelihood of survival. This association was much less significant than the association with increasing RS or CI.

Conclusion
It is clear from our findings that both increasing patient frailty and level of co-morbidity significantly adversely affect survival from CPR. Accurate individualised assessment of both of these factors is therefore imperative when assessing the appropriateness of undertaking CPR.
152 The Relationship Between 25(OH) Vitamin D and Bone Mineral Density (BMD) in Patients 65 Years and Older with Prior Fragility Fractures
Authors: Obiechina N , Michael A , Nandi A , Jameel I , Javed F 
Published: March 2021

Abstract

Introduction
25(OH) vitamin D [25(OH) D] levels are known to influence skeletal health as well as muscle function. Some studies suggest a positive association between 25(OH) D levels and BMD at various skeletal sites in men but not in women. These findings were mostly observed in younger (less than 50 year old) cohorts. Evidence for this association in older patients with prior fragility fractures is lacking. Aim: To assess the correlation of 25(OH) D levels with T-scores at the neck of femur, hip and spine in patients 65 years and older with prior fragility fractures and the effect of gender on the correlation.

Methods
A retrospective, cross-sectional analysis of patients 65 and older with previous fragility fractures in patients attending a fracture prevention service. Data was extracted from the electronic records. SPSS 26 statistical software was used for statistical analysis. Pearson correlation coefficient was used to calculate correlation and regression coefficient for gender.

Results
151 patients were included; 26 males and 126 females. Mean age was 76.2 and 74.1 years respectively. In the males there was good positive, statistically significant correlation between the 25(OH) D and T-scores at the neck of femur (r = 0.415; p &lt; 0.05) and hip (r = 0.413; p &lt; 0.05), but correlation with T-score of the spine was not statistically significant (r = 0.349; p = 0.103). In the females there was no statistically significant correlation between 25(OH) D and T-scores at the neck of femur, hip or spine (r = 0.163; p = 0.077), (r = 0.096; p = 0.299) and (r = 0.114; p = 0.217) respectively.

Conclusion
In males, 65 years and older, with prior fragility fracture, there is a positive significant correlation between 25(OH) D and BMD at the neck of femur and hip whereas there is no significant correlation in females.
153 Age and the Extent of Chest Radiographic Findings in Hospitalized Patients with COVID 19
Authors: Fernandez A , Michael A , Obiechina N , Nandi A , Koh J 
Published: March 2021

Abstract

Introduction
Since the emergence of COVID 19 in December 2019, its clinical and radiological features are still being discovered and their prognostic implications evaluated. Chest X-ray (CXR) typically shows patchy or diffuse asymmetric airspace opacities. Regardless of the different classifications of radiological findings that have been used, it is becoming clear that multi-lobar changes in the lungs are associated with poorer outcomes than single lobar involvement or minimal/no radiological abnormalities.
Aim: To assess the correlation of age with the extent of CXR findings in hospitalized COVID 19 patients.

Methods
A retrospective, cross-sectional analysis was carried out on inpatients with RT-PCR confirmed COVID 19. Chest X-ray findings were classified as minimal/no radiological changes, single lobar opacification and multi-lobar changes (involving 2 or more lobes and/or ARDS changes). SPSS 26 software was used for statistical analysis. Spearman’s correlation and linear regression were used to assess correlation.

Results
211 patients were included in the analysis; 124 males and 87 females. Mean age of the patients was 72.4 years; SD +/−16.15. There was significant positive correlation between age and degree and extent of radiological changes in all patients (r = 0.367; p &lt; 0.01). This correlation persisted even when broken down by gender (r = 0.448; p &lt; 0.01) for males and (r = 0.322; p &lt; 0.01) for females. Discussion: Older age has been repeatedly reported as a risk factor for poor prognosis in COVID 19. The main findings of COVID-19 on CXR are those of atypical or organizing pneumonia. Older people tend to have more extensive involvement of the lungs. There could be many explanations for the CXR correlation with age including the diminished cardiovascular reserve with ageing, the accumulation of comorbidities and decreased or abnormal immune response.

Conclusion
Age significantly correlate with the extent of chest radiographic findings in inpatients with COVID 19.
155 Establishing A Community Frailty Unit During the COVID19 Pandemic
Authors: Wilson H 
Published: March 2021

Abstract

Introduction
In response to the Covid19 pandemic a community Hospital was transformed in to a Community Frailty Unit (CFU). The aims were to meet the needs of patients living with frailty including medical instability and end of life care outside the acute setting, to improve patient flow and to improve integration of acute and community frailty services.

Method
Existing community teams were integrated with an acute based multidisciplinary team including a frailty practitioner and pharmacist. Supported by programme managers they rapidly transformed (within 3 weeks) processes to align these with the acute site including paperwork, assessments, use of a flow board, board rounds and discharge to assess. Technology was used to organise transfers via the NHS Digital approved App Pando. Point of care testing and oxygen concentrators were put in place.

Results
Median and mean length of stay (LOS) in the acute site reduced by 59% (14.5 to 6 days) and 56% (18 to 8 days) respectively. Median and mean LOS in the community site reduced by 38% (16 to 10 days) and 39% (18 to 11 days) respectively. Readmissions fell from 10% to 2%. 85% of staff rated the following better or much better: the capability of the service to manage every aspect of the patient’s care; integration; co-ordination of transfers. 83% of staff rated patient experience better or much better and 79% rated discharge co-ordination better or much better. At 85% bed occupancy at a cost of £67 k/bed/year this released 5,525 bed days and 16.9 beds with a return on investment of £1,132,300.

Conclusion
It is possible to rapidly integrate community and acute services and to establish acute frailty unit care in a community setting. A CFU can lead to improved integration, patient flow, patient and staff experience at reduced system wide cost.
156 Potentially Inappropriate Cardiovascular Medications in Czech Older Adults in Acute Care: Inomed and Euroageism H2020 Project
Authors: Kummer I , Lukačišinová A , Gajdošová P , Bhagavathula A S , Brkic J , Fialová D 
Published: March 2021

Abstract

Introduction
Cardiovascular disorders (CVS) belong to the most frequent causes of deaths and cardiovascular medications among the most common drugs. Older patients are vulnerable to drug risks due to presence of pharmacological changes, polymorbidity, polypharmacy and geriatric syndromes. Thus, the effort to reduce prescribing of potentially inappropriate medications (PIMs) represents a substantial prevention strategy in this population.

Methods
This was a prospective, cross-sectional study conducted in 288 patients (65+) admitted to acute care geriatric wards in the Czech Republic from Aug 2018 to Jan 2019. We aimed to investigate prevalence of CVS PIMs using relevant parts of STOPP/START 2015 criteria, the EU(7) PIM 2015 list and the Beers criteria 2019. Only patients with stable health conditions were included in our study. Results: Overall prevalence of CVS PIMs was 77.6%. Undertreatment of CVS problems, identified by START criteria, was found in 63.2% patients. Prevalence of CVS PIMs according to different criteria was 16.1%, 23.6% and 30.9%, using the Beers criteria 2012, STOPP criteria and the EU (7)-PIM list; respectively. The most prevalent problem of undertreatment was the absence of statins with documented history of coronary, cerebral and peripheral vascular disease (excluding patients at the end-of-life or at the age of &gt;85 years) (27.3%). According to the EU (7)-PIM list, the most common CVS PIMs were the use of amiodarone in maintenance doses of &gt;200 mg/48 hours and use of spironolactone in doses of &gt;25 mg/day (9.0% and 5.6%; respectively).

Conclusions
This study confirmed high prevalence of CVS PIMs in older adults admitted to acute care hospitals in the Czech Republic. Detecting and identifying CVS PIMs is of high importance in order to prevent serious adverse drug events, higher mortality and increased frailty in vulnerable older population. Grant support: InoMed project (reg. No: CZ.02.1.01/0.0/0.0/18_069/0010046, 2019–2022), H2020-MCSF-ITN-764632, PROGRESS Q42 FoP, Charles University, SVV 260417.