bluuebunny/crossref_metadata_2025_split huggingface dataset:
30 Informant-Reported Decline Associates with Silent Acute Stroke Lesions and Worse Small Vessel Disease in Mild Stroke Patients
Authors: Clancy U , Garcia D J , Hewins W , Stringer M , Thrippleton M , Chappell F M , Brown R , Blair G , Arteaga C , Valdes-Hernadez M , Wiseman S , Hamilton I , Job D , Doubal F N , Wardlaw J M 
Published: March 2021

Abstract

Introduction
Small vessel disease (SVD) commonly causes stroke and dementia. Early clinical predictors of disease progression are lacking. We aimed to determine whether informant reports of chronic cognitive/functional decline, prerequisites for dementia diagnosis, are associated with (a)baseline SVD burden, measured by Fazekas scores and (b)SVD change, measured by incident subcortical Diffusion-weighted Imaging (DWI) lesions.

Method
We prospectively recruited patients with mild ischaemic stroke, performed diagnostic MRI, and invited participants to repeat MRI 3- to 6-monthly. Informants completed the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) prior to baseline visit, a 16-item questionnaire which assesses patients’ cognitive and functional decline in the preceding ten years. Scores range from 1–5: a score above 3.3 has high sensitivity/specificity for dementia post-stroke. We conducted linear regression with IQCODE as the dependent variable, adjusting for age, sex, baseline MoCA, disability (modified Rankin Scale).

Results
We recruited 106 participants (mean age 67 years;range 40–86;33% female). Ninety-three informant questionnaires were returned. IQCODE associated with baseline Fazekas score; Fazekas 6 (β = 0.28, p = 0.04) vs. Fazekas 3 (β = 0.03, p = 0.67), R2 = 0.11, adjusted for age, sex, baseline MoCA, disability.
Incident DWI lesions were common (15/106; 14/15 subcortical; no active embolic sources; median 67 days post-stroke). Four were asymptomatic, two reported stroke-like symptoms and nine had neuropsychiatric/non-focal symptoms. IQCODE was higher in those with a new lesion vs. without (β = 0.21, p = 0.02), R2 = 0.09, while age (β = −0.004, p = 0.19), MoCA (β = −0.006, p = 0.56) and disability (β = 0.06, p = 0.2) were not.

Conclusions
Higher SVD burden and incident, mostly “silent” stroke lesions associate more strongly with informant concerns of cognitive/functional decline than age or objective cognitive tests. These findings are novel in an ischaemic stroke population and the first to assess IQCODE/SVD progression. Future work should determine whether combining informant reports with imaging features of small vessel disease improves early detection of dementia.
31 Physical Activity, Muscle Strength and Quantity: Preliminary Findings From the Mass_Lifecourse Cohort
Authors: Bowden-Brown K J , Murray J C , Hurst C , Granic A , Sayer A A , Dodds R M 
Published: March 2021

Abstract

Introduction
We established the MASS_Lifecourse study to investigate changes in skeletal muscle between ages 45–85. Reduced physical activity (PA) is a key factor linked to the development of sarcopenia. Our aim was the describe the amount and patterns of PA and sedentary behaviour (SB), and relationships with muscle strength and quantity, among MASS_Lifecourse participants.

Method
Participants wore a triaxial accelerometer on their dominant wrist for seven days. Recordings were analysed to calculate time in moderate-vigorous PA (MVPA) with time not in MVPA classified as SB based on wrist position. Muscle strength was measured with a Jamar grip dynamometer and the 5 chair-stand test. Muscle quantity was assessed using appendicular lean muscle mass from dual-energy X-ray absorptiometry. Physical performance was assessed by gait speed.

Results
68 participants (31 male) aged 47–84 (mean 65) participated in the present study. Median daily MVPA was 19.1 (IQR 7.1, 36.6) minutes and was lower with age. The mean sedentary time per day was 767.1 minutes per day and increased with age. The pattern of MVPA across the day changed with age: the oldest group (75–84 years) achieved a lower morning activity peak followed by an earlier decline whilst the younger groups were more consistently active throughout the day. Participants were more active than population reference data from the Active Lives Survey. Time spent in MVPA was positively associated with muscle strength and physical performance, whereas SB was negatively associated. Muscle quantity was not associated with PA or SB.

Conclusions
Participants in the MASS_Lifecourse study are more active than the general population but still show age-related declines in physical activity and strength. Future work in the cohort aims to elucidate mechanisms underlying the age-related loss of muscle strength and quantity.
37 Factors Influencing Mealtime Care for People with Dementia Living in Care Homes: An Ethnographic Study
Authors: Faraday J , Abley C , Exley C , Patterson J 
Published: March 2021

Abstract

Introduction
More and more people with dementia are living in care homes. Often they depend on care home staff for help with eating and drinking. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to identify factors influencing mealtime care for this population.

Methods
Over twenty-five hours of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care home staff and residents living with dementia. Twenty-two semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. The study used a constant comparison approach, so that data from early observations and interviews were explored in more depth subsequently.

Results
Five factors were identified which influenced mealtime care for people with dementia living in care homes. These were: environment (such as background music and building layout); kitchen and food (including connectivity between kitchen staff and others); staffing (for example: staff ratios and allocation); knowledge and support (including training, resources and supportive culture); and relationship with wider care team (such as family involvement, and the role of visiting health and social care professionals).

Conclusions
This study is part of a bigger project which will develop a staff training intervention to improve mealtime care for people with dementia living in care homes. The intervention will be informed by these findings, and by complementary evidence on good practice in mealtime care (from primary and secondary studies). It is anticipated that good mealtime care may improve quality of life for care home residents, and reduce hospital admissions.
40 Improving Urinary Catheter Documentation and Care in Geriatric Wards
Authors: Costa A V , Zhunus A , Storey B , Sait M S , Shah S , Sanei F , Mathew J , Heitor M 
Published: March 2021

Abstract

Introduction
NICE guidelines state that urinary catheter insertion, changes and care should be documented. Duration of catheterization is directly linked to the risk of developing a catheter-associated UTI. Furthermore, Public Health England has announced a national aim to reduce the incidence of Gram-negative bacteraemia by 50% by March 2021, and targeting catheters is one of the first steps.

Local problem
These issues are relevant to the elderly population at Princess Royal University Hospital, where documentation surrounding catheters was found to be inadequate. Despite there being an Electronic Patient Record (EPR) order for catheter insertion and monitoring available, this was not being used. Our primary aim was for all patients to have this order. We also hoped to reduce the weekly rate of catheter days (catheter days per 100 bed days), and improve documentation in clinical notes.

Methods
We focused on two medical wards and sampled all patients admitted over a period of 4 months who had a catheter at the time of data collection. We identified catheterized patients and whether they had an EPR catheter order on a daily basis. Additional parameters such as indication, insertion date, inserter, and documentation standards were extracted from EPR on a weekly basis. Patients were kept “live” and contributing to catheter day calculations until they were no longer on the ward or if the catheter was removed.

Interventions
We implemented changes over 2 PDSA cycles. Interventions included the addition of catheter columns to boards and education sessions for doctors and nurses (cycle 1), as well as catheter posters, alert cards, and circulation of emails with guidance to doctors and nursing staff (cycle 2).

Results
A total of 87 patients were analysed during the project. There was an increase in EPR orders being used, with the 100% target being reached on the final data collection point, and with data showing a significant shift above baseline. Furthermore, there was a decrease in the weekly rate of catheter days, but changes were difficult to sustain. We also saw a general improvement in documentation standards.

Conclusion
By improving documentation and reducing unnecessary catheterization, we hope to have reduced the overall risk of infection whilst improving patient comfort and experience. Lessons may be transferrable to other trusts.
49 Longitudinal Change of Sleep in the Elderly and Its Associations with Health
Authors: Didikoglu A , Maharani A , Payton A , Canal M M , Pendleton N 
Published: March 2021

Abstract

Introduction
In elderly populations, sleep quality deteriorates and sleep time shifts towards earlier times. These sleep characteristics have been associated with cardiovascular, metabolic and psychiatric disorders, cognitive decline and mortality. Our aims are to examine longitudinal changes of sleep in older adults and to investigate the relationship between sleep variations, general health and mortality.

Methods
The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age cohort (6,375 participants, recruited in the North of England, between 1983 and 1993) was used. Mixed models were used to investigate individual sleep trajectories (5 waves in 30-year period). Sleep timing and efficiency trajectories were clustered using latent class analysis and analysed against daily habits, health and mortality.

Results
Older adults have decreased sleep efficiency (~20%) and early sleep time (~30 min) between 40 and 100 years of age. Those in the high sleep efficiency latent class had minimal decrease in their sleep efficiency as they aged. Belonging to the high sleep efficiency latent class was associated with having lower prevalence of hypertension, circulatory problems, arthritis, breathing problems and recurrent depression compared to the low efficiency latent class. Results showed a higher risk of hypertension and metabolic syndrome in the evening-type latent class compared to morning-type individuals. Evening class was associated with traits related to lower health such as reduced sport participation, increased risk of depression and psychoticism personality, late eating, increased smoking and alcohol usage. Survival analysis revealed that individuals in the evening class had 1.15-fold increased risk of all-cause mortality compared to those with morning preferences.

Conclusion
Ageing is associated with decreased sleep efficiency and early sleep timing. However, there are detectable subgroups of sleep traits that are related to prevalence of different diseases and longevity. Understating these subgroups may pave the way for new treatments for healthy sleeping habits in older population.
140 Lessons From the Front Line: Communication is Key
Authors: Pyrke B , Abdalla B , Cartwright G , Figg K , Murphy E , Tuck A , White H 
Published: March 2021

Abstract

Introduction
As junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this.

Methods
Pre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points.

Results
Pre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life.

Conclusions
Education around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.
142 Improving Functional Outcomes During Covid-19 for Both COVID-19 and Non COVID-19 Positive Older Adults Through the Introduction
Authors: Roberts F , Birmingham K , Darlison L , Hertzberg K , Chapman K , Krampikowski J , Bunden D , King L , Tebbutt E , Potter E 
Published: March 2021

Abstract

Purpose
To improve the functional outcomes of older adults presenting to the Health and Ageing wards during the COVID-19 pandemic through a focussed rehabilitation list. The intended benefits to the older adult and service were for: 1. Daily rehabilitation input for older adults. 2. Older adults to spend less time immobile. 3. Ongoing rehabilitation intervention while awaiting medical clearance for discharge. 4. Increased staff satisfaction 5. Better outcomes on discharge. 6. Rehabilitation ethos on the Health and Ageing wards.

Methods
The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver proactive interventions as a result of analysis of baseline data and stakeholder involvement. These interventions were aimed at developing communication around the rehabilitation list within the team and sustainability of this list.

Results
The project resulted in better functional outcomes for older adults and increased staff morale. Between May 2020–June 2020, a total of 56 patients were seen on the rehabilitation list, with 84% of these patients seeing improvements in their Elderly Mobility Scores (EMS). 27% of patients on the rehabilitation list saw a change to their initial discharge plan, either needing reduced packages of care or reduced need for ongoing rehabilitation in an external setting.

Conclusions
The quality improvement project found that with focussed rehabilitation older adult inpatients with or without COVID-19 can make significant functional gains. These gains have wider effects on their outcomes on discharge and also for the service through increased morale and job satisfaction. Due to demand and capacity issues in the acute setting, older adults who would often benefit from ongoing input are not always reviewed regularly. This project demonstrates that with focussed rehabilitation older adults can improve and achieve better functional outcomes.
145 Improvement of Bowel Monitoring in the Acute Stroke Unit
Authors: Yip S Y 
Published: March 2021

Abstract

Introduction
Constipation can lead to complications such as pain, acute kidney injury and delirium. This problem is more apparent in patients who are aphasic or frail, such as those suffering from stroke or have cognitive impairments. However, early recognition and timely prescription of laxatives can help prevent these complications and prevent unnecessary Per-rectal examination and exposure from radiation with abdominal X-rays.

Methods
This is a Quality Improvement Project that was carried out in the Acute Stroke Unit in Aberdeen Royal infirmary looking at the effectiveness of bowel monitoring and suggesting methods for improvement with the addition of an end-of-bed stool chart. The aims of the stool charts were to aid junior doctors in timely laxative prescription and to guide fluid management. The project was carried out from April to July 2020 using the PDSA cycle and presented to MDT in the ASU. Results show a 100% improvement in bowel monitoring with 67% compliance rate of the new stool charts.
A survey was carried out and results show that 90% of the nursing team preferred the new stool chart. In conclusion, I think that the new stool chart serves its purpose in improving patient management amongst junior doctors. It should be implemented as standard care protocol in the acute stroke unit and definitely can be applicable in other wards.
146 Improving Outcomes in Aspiration Pneumonia: A Collaborative Approach
Authors: Richards-Taylor S , Kitchener R , Whiffen M , Tiwari D 
Published: March 2021

Abstract

Introduction
Aspiration pneumonia is a major cause of morbidity and mortality especially in older adults. Our Trust recorded higher than expected mortality ratios in this group of patients. Aim To investigate reasons behind higher than expected mortality and improve outcomes. Intervention We developed a collaborative approach of investigating mortality in aspiration pneumonia with joint input from Speech and Language (SALT) specialists.

Method
We conducted structured retrospective review of annual mortality in aspiration pneumonia in 3 PDSA (plan, do, study, and act) cycles in 2015/18/20. We collected data on clinical care, diagnostic accuracy, SALT referral/input, feeding at risk discussion, communication with primary care. We monitored mortality ratios on national systems.

Results
We improved clinical and nursing care by auditing mouth care, bed elevation and safe feeding. We also developed electronic-SALT referral form to improve timings for the reviews (first PDSA cycle). SALT team developed “feeding at risk proforma” to formalise risk feeding where safe swallow plan was not possible (second PDSA cycle). We modified discharge summaries and made this a multidisciplinary document in the Trust so that SALT can communicate feeding plans to primary care (third PDSA cycle). Mortality ratios improved significantly in this period from Relative risk of 152 (higher than expected range) in 14/15 to 86 (within expected range) in 19/20.

Conclusion
We have demonstrated significant improvement in hospital mortality ratios from aspiration pneumonia and therefore improved care by collaboratively working with SALT team and bringing changes in stepwise manner. Multidisciplinary mortality reviews are key to improving outcomes for our patients.
151 Optimising Bone Health on Sheffield Frailty Unit Through Quality Improvement
Authors: Orton C M , Sinson N E , Blythe R , Hogan J , Vethanayagam N A , Peel N 
Published: March 2021

Abstract

Introduction
NICE and the National Osteoporosis Guidance Group (NOGG) advise on evaluation of fracture risk and osteoporosis treatment1,2, with evidence suggesting that screening and treatment reduces the risk of fragility fractures 3,4,5. However, it is often overlooked in the management of older patients within secondary care. Audit data from Sheffield Frailty Unit (SFU) in 2018 showed that national guidance was not routinely followed. Fracture Risk Assessment Tool (FRAX®) scores were not calculated and bone health was poorly managed. Therefore, we undertook a quality improvement project aiming to optimise bone health in patients presenting to SFU.

Method & Intervention
In January 2019 we collaborated with Sheffield Metabolic Bone Centre (MBC) to develop a pathway aiming to improve bone health assessment and management in patients presenting to SFU with a fall or fragility fracture. This included a user-friendly flow chart with accompanying guidelines, alongside education for staff. Performance was re-evaluated in May 2019, following which a tick box prompt was added to post take ward round documentation. A re-audit was performed in March 2020.

Results
In March 2018 0% of patients presenting with a fall had a FRAX® score calculated and only 40% of those with a new fragility fracture were managed according to guidelines. In May 2019, this had improved to 18% and 100% respectively. In March 2020 86% of patients had a FRAX® score calculated appropriately and 100% of fragility fractures were managed according to guidelines. In both re-audits 100% of FRAX® scores were acted on appropriately.

Conclusions
There has been a significant increase in the number of patients who have their bone health appropriately assessed and managed after presenting to SFU. However, achieving optimum care is under constant review with the aim to deliver more treatment on SFU, thereby reducing the need for repeat visits to the MBC.
158 Management of Atrial Fibrillation in Patients with Cerebral Amyloid Angiopathy: Multidisciplinary Neuro-Cardiology Approach
Authors: Hashmi M A , Sheikh A A 
Published: March 2021

Abstract

We present two cases that highlight the clinical challenge of anti coagulation in patients with intracerebral haemorrhage (ICH) due to Cerebral Amyloid Angiopathy (CAA) and co-existent non-valvular Atrial Fibrillation (AF).

Case 1
78 -Years right-handed functionally independent gentleman presented with right parietal intracerebral haemorrhage (ICH) on Dabigatran that required reversal. He had a background history of hypertension, persistent AF and a previous ICH on warfarin. Post atrial septal defect repair, he had multiple unsuccessful cardioversions for AF, and a failed catheter ablation after the first stroke. Magnetic Resonance Imaging (MRI) brain showed Cerebral Amyloid Angiopathy (CAA), the cause of his recurrent bleeds. Anticoagulation was not started due to severe CAA on imaging and recurrent bleeds. He was referred for left atrial closure device.

Case 2
79-Years female presented with left parietal haemorrhage and new onset atrial fibrillation. Work up for ICH showed normal BP readings and clotting profile. Her MRI brain showed a large lobar bleed with mild small vessel disease and evidence of no other imaging features suggestive of CAA. As optimal timing to start anticoagulation after ICH is unknown, she was suggested to take part in a clinical trial. Her family declined the offer of clinical trial and also anti coagulation due to few falls. Her CHAD-VaSc and HAS-BLED score were 4 and 2 respectively. She was then referred to tertiary centre for left atrial appendage closure device.

Conclusion
Safety and timing to initiate DOAC for AF in this group is not established yet, understanding hemorrhagic risk using Boston Criteria for CAA diagnosis should be considered in addition to HAS-BLED score. Shared decision making and comprehensive discussions with cardiologist are of paramount importance. Non pharmacological intervention studies WATCHMAN and PREVAIL have proven procedural efficacy, however, in elderly population, decision making is complex due to frailty, dementia and co-morbidities.