bluuebunny/crossref_metadata_2025_split huggingface dataset:
58 The Benefits of A Virtual Ward Model in the Management of Care of Elderly Patients Admitted with Decompensated Heart Failure
Authors: Reid P , Kandasamy V , Chambers B , Tomos L , Procter H , Pushpangadan M , Bulugahapitiya S 
Published: March 2021

Abstract

Introduction
Heart failure in elderly patients is associated with increasing rates of hospitalisation and readmission. The Care of Elderly department at Bradford Royal Infirmary has developed a virtual ward service to support patients at home on discharge from hospital. We wished to assess if patients admitted with heart failure and discharged under the virtual ward model had a reduced length of stay in hospital and if their readmission rate was altered, compared to patients not discharged under the virtual ward.

Method
A retrospective study of patients admitted under the Care of Elderly team with decompensated heart failure was undertaken. Patients admitted over 12 months were identified and assessed length of stay and readmission rates at 7 and 30 days post admission. There were no set criteria for discharge to the virtual ward, but patients were selected for virtual ward care based on; symptom burden, renal function and ongoing PT/OT support.

Results
Of the 358 patients identified in this study, 83 (23%) were discharged to the virtual ward (VW). On average patients spent 7 days (+/− 5.3) under the virtual ward service. Average length of hospital stay for VW patients was 2.3 days compared to 6.5 days for patients not discharged under the virtual ward (p &lt; 0.0001). Of the patients discharged to the virtual ward, 8 (10%) were readmitted within 7 days and 23 (28%) were readmitted within 30 days, similar to readmission rates in patients not discharged under the virtual ward with 25 (11%) and 62 (27%) patients readmitted after 7 and 30 days respectively.

Conclusions
65 Comparison of Frax and Qfracture in Predicting Fragility Fractures in Patients Presenting with Falls
Authors: Brook S , Todorov G , Comninos A N 
Published: March 2021

Abstract

Introduction
Falls are a major risk factor for fragility fractures and patients should be appropriately assessed to reduce future fragility fracture risk. National guidelines provide recommendations on assessing fracture risk using calculators to guide therapy initiation. FRAX and QFracture are the two main calculators used, however they differ considerably in their inputs. The aim of this study was to compare the risk estimation and performance between these two frequently used calculators to help determine their appropriate utility.

Methods
Data from patients aged ≥70 years admitted with a fall to the Acute Medical Units at Charing Cross Hospital between 1st Dec 2018–31st March 2019 were retrospectively collected, covering all inputs required for the two risk calculators.
The 10-year major osteoporotic and hip fracture risks were calculated using FRAX and QFracture and compared. The one-year major osteoporotic and hip fracture risks from QFracture were assessed against actual one-year fracture rates.

Results

Conclusions
Risk calculators are effective tools to aid the decision of bone therapy initiation. Here we demonstrate that there is a strong correlation between the two commonly used calculators. However, in terms of absolute risk values there is a mean 8.9% difference with QFracture providing higher risks in this “fallers” group. As absolute treatment thresholds are frequently used to guide bone therapy initiation, opposing recommendations may result. Therefore, there is a need to further explore calculator performance and determine which would more accurately serve different patient groups.
71 Developing A Portfolio for Advanced Practitioners Working with Older People
Authors: MacDiarmid L 
Published: March 2021

Abstract

Introduction
Advanced Nurse Practitioners (ANP’s) have a professional responsibility to ensure that they maintain professional competence (Whiteing, N. in Hinchcliffe and Rogers Eds pp192–219, 2008).
The aim of the portfolio is to assist ANP’s in developing evidence demonstrating continued advanced level practice. At the time of the study, there was a dearth of evidence relating to competencies for qualified ANP’s, working with older people.
The aim was to move away from the traditional confines of “nurse does this, doctor does this”, and to embrace the concept of developing skills to meet the clinical demands of service provision for our older people.

Methods
Participatory action research methodology was adopted—using the Review, Plan and act cycle (Edwards and Talbot, p63 1999; Holloway & Wheeler p155–156, 1996).

Review
A literature search and review of competencies relating to advanced practice and older people was undertaken.

Plan
A portfolio of knowledge and skills was collated utilising the information from the review. A matrix was created incorporating four Pillars of Advanced Practice (SGHD 2008), the Nursing and Midwifery Code (NMC, 2015) and modified competencies for Joint Royal Colleges of Physicians Training Board Geriatric curriculum (JRCPTB), (2010, amended 2013 and 2015).
The portfolio was sent out to existing team members, and local Consultant Geriatricians based in the Acute Trust and local University for comment and amendments were made.

Act
The portfolio was used by staff as a trial and evaluated.
Written feedback was obtained through questionnaires.

Results
The portfolio was well evaluated by staff using it, including recommendations for improvement.
Portfolio has been shared at national groups and via social media and has been well received.

Conclusions
An Advanced Practice Portfolio of capabilities is being used, based on action research cycles, enhancing the level of care received by older people.
75 Community Dnacpr Forms: Opening A Can of Worms
Authors: Odone J , Schiff R 
Published: March 2021

Abstract

Background
There is no national guidance for the transfer of Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions between care settings. This issue has been highlighted within our Integrated Care Trust. We reviewed our local process, to improve the transfer of DNACPR decisions between care settings.

Method
A third PDSA cycle was completed to evaluate intervention.

Intervention
Frequently asked questions were added to the reverse side of the DNACPR form to improve patient understanding. All patients discharged home were given this updated form during a pilot study. The impact of the intervention was analysed with a follow-up phone call (n = 30) and discussed at a staff focus group.

Results
No improvement in patient understanding was shown post-intervention, however the intervention was overwhelmingly supported by staff. 60% of patients reported receiving a DNACPR form on discharge and 12% recalled being informed that they would be discharged home with a form.

Conclusion
Further work is required on the DNACPR pathway across primary and secondary care. The next cycle will involve ensuring that the community form is highlighted in hospital discussions regarding DNACPR decisions.
78 A Quality Improvement Project on Oxygen Administration Within the Geriatrics COVID-19 Cohort Ward
Authors: Hickson L , Liu A K L , Bailey G , Bruce S , Kawafi K , Reid D , Gowda V 
Published: March 2021

Abstract

Introduction
Due to the COVID-19 pandemic, many medical and surgical wards were reassigned as COVID-19 cohort wards to accommodate the number of patients admitted with the virus. Nurses and healthcare assistants (HCAs) from various departments and backgrounds were redeployed to these areas. Within the geriatrics population, patients with severe COVID-19 often have high oxygen requirements and can rapidly deteriorate. Therefore, we conducted a quality improvement project within the geriatrics COVID-19 ward focused on improving patient safety by improving oxygen administration to patients. We also aimed to enhance the knowledge and confidence levels of nurses and HCAs in regards to oxygen administration.

Method
From April–July 2020, we compared the oxygen that was administered to COVID-19 patients against the oxygen therapy that was documented on observation charts. This included whether the correct type of device, flow rate and target oxygenation saturations were used. We carried out multiple Plan-Do-Study-Act (PDSA) cycles including a staff education session on oxygen administration, placed an oxygen guidelines poster on each patient’s bedside, administered a short quiz and distributed reminder lanyard cards. We also conducted a staff survey comparing knowledge and confidence on oxygen administration before and after an education session.

Results
Overall there has been an improvement in oxygen charting and administration after 4 PDSA cycles. There is 100% correct use of oxygen device and correct setting of oxygen flow rate after the 2nd and 3rd PDSA cycles. After the teaching session, all staff reported feeling more confident in oxygen management. Based on the audit data and quiz results, there was an improvement in knowledge of oxygen administration.

Conclusions
We have demonstrated that by using simple time-efficient and cost-effective interventions, improvements can be made in oxygen administration and subsequently patient safety. This has the potential to influence prognostic outcomes among the geriatrics population with COVID-19.
80 Improving Documentation of DNAR Decisions on the Acute Medical Take
Authors: Sweeney A , Bellenberg H , Butt H , Badat S , Epstein D 
Published: March 2021

Abstract

Introduction
The BMA, Resuscitation Council and Royal College of Nursing have set out clear guidelines on documentation of Resuscitation discussions and decisions.1 On the acute medical take documentation of these discussions and decisions can be unclear despite use of an electronic patient record (EPR). The aim of this audit was to improve documentation of Do Not Attempt Resuscitation (DNAR) decisions in EPR.

Methods
We listed patients admitted on the medical take over 1-week, looking at resuscitation status and the documentation of the DNAR decision. We then implemented a change to the format of the EPR treatment escalation plan (TEP) form. Prior to the change the DNAR form was behind the TEP form which had to be clicked on separately and was not mandatory to complete. After the intervention the DNAR decision was placed in a box on the front page of the TEP form to ensure that it was clear and accessible.

Results
Pre-intervention we reviewed 114 patients notes of which 94 were DNAR. Of these 94 only 17 (18%) had correctly documented DNAR decisions in EPR. Following the intervention we again looked at all admissions to the medical take over a 1-week period, out of 151 patients 75 were DNAR and of these 75 patients 29 had correctly documented DNAR forms. This shows an increase in the percentage of the DNAR decisions filled in from 18% to 39%.

Conclusion
The results show that although there has been an improvement in the number of DNAR decisions being documented there are still a large percentage of patients who do not have this correctly documented. We are designing further interventions to ensure that the DNAR documentation is marked as a mandatory part of the TEP form as well as educating around the importance of this documentation.
84 COVID-19 and Associations with Frailty and Multimorbidity: A Prospective Analysis of UK Biobank Participants
Authors: Woolford S J , D’Angelo S , Curtis E M , Parsons C M , Ward K A , Dennison E M , Patel H P , Cooper C , Harvey N C 
Published: March 2021

Abstract

Introduction
Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. We therefore investigated whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19 in the UK Biobank. Method 502,640 participants aged 40–69 years at baseline (54–79 years at COVID-19 testing) were recruited across UK 2006–10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available 16/03/2020–01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups.

Results
4,510 participants were tested for COVID-19 (positive = 1,326, negative = 3,184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥4 comorbidity groupings vs 0–1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. Furthermore, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants.

Conclusions
Frailty and multimorbidity do not appear to aid risk stratification, in terms of a positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.
89 Improving Pain Assessment and Management for Patients with Cognitive Impairment on the Care of the Older Person (COOP) Wards
Authors: Ryan K , Whitehead J , Lindenberg N , Shah K 
Published: March 2021

Abstract

Introduction
Patients with cognitive impairment are at risk of underassessment and inadequate management of pain. Self-reporting is unlikely to be a reliable indicator of pain and numerical scales have reduced validity, hence an alternative assessment tool must be used. The Abbey Pain Scale is widely regarded to be user friendly. Regular analgesia should be used for these patients where possible instead of “as required” (PRN). Using QIP methodology, we aimed to improve the use of the Abbey Pain Scale for assessment of patients with cognitive impairment and better analgesia prescribing.

Methods
Audit of patient records on COOP wards (computer and physical notes, n = 48 first cycle, n = 32 second cycle) before and after staff training, assessing patients with cognitive impairment for: use of Abbey Pain Scale; use of regular paracetamol; pain assessments documented by different healthcare professionals.

Results
In the first cycle, 16 patients had cognitive impairment: only 1 of these patients (6%) was assessed using the Abbey Pain Scale. Group teaching for the multidisciplinary team on pain assessments was undertaken with practice development nurses. In the re-audit, 13 patients had cognitive impairment and 6 of these (46%) were assessed using the Abbey Pain Scale, showing a clear improvement following staff training. The second cycle showed a 50% increase in the prescription of regular paracetamol for patients with cognitive impairment. There was also a 2.5-fold improvement in therapy staff documenting pain assessments between the two audits.

Conclusions
Staff training in the use of the Abbey Pain Scale led to an almost 8-fold increase in its use for patients with cognitive impairment. Training on the use of the Abbey Pain Scale should be regularly provided to nurses, physiotherapists and doctors on the care of the older person wards.
94 The Comprehensive Frailty Assessment At Forth Valley Royal Hospital (FVRH) Digitalised: For COVID-19 and Beyond!
Authors: Rodgerson M J , McNeil L 
Published: March 2021

Abstract

Introduction
Comprehensive Geriatric Assessment (CGA) improves outcomes for frail patients; at FVRH this is delivered by the Frailty Intervention Team (FIT) comprising of senior nurses, allied health professionals (AHPs) and doctors. Faced with COVID-19, we took the opportunity to digitalise CGA documentation to preserve these benefits for patients whilst facing greater acuity, staffing and time pressures. An electronic solution was adopted to reduce paper-usage in COVID-receiving areas. Prior to COVID-19, CGA was recorded within case-notes, presenting challenges when patients were readmitted out-of-hours as these were stored off-site and not accessible out-of-hours.

Method
Trakcare is the patient-management system in many Scottish hospitals. The Electronic Patient Record (EPR) was used to record pro-forma against admissions which were accessible and updatable for any patient 24–7-365. Patients meeting the Healthcare Improvement Scotland (HIS) Frailty criteria were considered “frailty-positive”, with an e-alert added- reappearing on any re-admission. Providing no HIS-exclusion criteria, an electronic-CGA (e-CGA) was recorded or updated. The pro-forma designed contained information not immediately available to clerking practitioners. This evolved following discussion amongst the FIT to include information such as escalation-status, medication-arrangements and baseline cognition.

Results
Over 13 weeks, 116 EPRs were reviewed. During weeks 1–3 (n = 8, 12, 7 respectively), e-CGA completion averaged 31%. Following FIT collaboration, this rose to 82% (n = 9) by week 12. Qualitative feedback from the MDT indicated that FIT, downstream wards and night-staff felt that having access to previous escalation-plans made immediate-management easier to determine, and discussions with families more productive for patients.

Conclusions
Development of the FVRH e-CGA is ongoing, with an electronic frailty-screening tool being implemented to improve frailty-identification on admission to ensure correct streaming of patients to the FIT. We have demonstrated a cost-neutral method for improving access to CGA for patients using existing IT systems whilst protecting staff time, preserving patient care during the COVID-19 pandemic.
99 Heritability of Temperature and the Effects of Ageing on Temperature Regulation: An Observational Multi-Cohort Study
Authors: Penfold R S , Zazzara M B , Österdahl M F , Veenith T , Lord J M , Steves C J 
Published: March 2021

Abstract

Introduction
Ageing affects homeostasis and immunosenescence, resulting in aberrant fever and immune responses to infection in older adults. This study assesses heritability of basal temperature and explores effects of ageing on basal temperature and temperature in response to SARS-CoV-2 infection.

Methods
Observational study using multiple cohorts. Participants: (a) Twin volunteers: 1089 healthy adults enrolled in Twins-UK, mean age 59 (17); tympanic temperature measurements; (b) Community-based: 3972 adults using the COVID Symptom Study mobile application, age 43 (13); self-reported test-positive for SARS-CoV-2 infection; self-reported temperature measurements; (c) Hospitalised: cohorts of 520 and 757 adult patients with emergency admission to two teaching hospitals between 01/03/2020–04/05/2020, age 62 (17) and 68 (17) respectively; RT-PCR-confirmed SARS-CoV-2 infection.

Analysis
(a) heritability analysed using saturated and ACE univariate models; linear mixed-effect model for associations between basal temperature and age, sex and BMI. (b&c) multivariable linear regression for associations between temperature and age, sex and BMI; multivariable logistic regression for associations between fever(&gt;/= 37.8°C) and age, sex and BMI.

Results
Basal temperature in twins demonstrated 50% heritability (95%CI[42–57%]). In healthy twin, community-based and hospitalised cohorts, increasing age is associated with lower temperatures, and increasing BMI with higher temperatures: (a) Twins (age:p &lt; 0.001; BMI:p = 0.002); (b) Community-based (age: p &lt; 0.001; BMI: p &lt; 0.001); (c) Hospitalised (1st hospital: age: p = 0.106; BMI: p = 0.033; 2nd hospital: age: p &lt; 0.001; BMI: p = 0.010). Increasing age was negatively and BMI positively associated with fever (1st hospital: Age: OR = 0.99, p = 0.033; BMI: OR = 1.00, p = 0.045; 2nd hospital: Age: OR = 0.99, p = 0.010; BMI: OR 1.02, p = 0.038).

Conclusions
Heritability of basal temperature suggests a genetic component to thermoregulation. Associations observed between increasing age and lower temperatures and higher BMI and higher temperatures are important in understanding effects of ageing and obesity on basal temperature and the fever response. In older adults, findings have important implications for defining fever thresholds and diagnosing infections, including SARS-CoV-2.
118 “The Elderly LBGTQ* Population”
Authors: McCormack R S 
Published: March 2021

Abstract

Introduction
With an aging population, there will be an aging LBGTQ* population. Little education exists for medical professionals on their specific healthcare needs; the discrimination that still exists towards this group and the barriers they face when accessing healthcare. This project aimed to develop and deliver education sessions for medical professionals on “The Elderly LBGTQ* Population” in NHS Forth Valley, evaluating the quality of these sessions. With clinicians attending these sessions, it could lead to safer, more accessible and improved patient care for elderly LBGTQ* patients.

Methods
“The Elderly LBGTQ* Population” session was developed through research of relevant literature and liaising with local equality and diversity team. Two sessions were delivered in Autumn 2019. Data on quality of session was collected from feedback forms completed by those attending. Comments on feedback forms were used to shape future direction of sessions.

Results
77% of those attending felt it was of high relevance to them, with 95% rating presentation quality and content quality as “high”. Comments received included the sessions being “excellent and thought provoking”, with many stating this was their first time receiving such teaching and were grateful for highlighting the specific issues facing this population.

Discussion
Following the success of education sessions, the aim is to deliver more locally and expand across Scotland, hopefully with involvement from third sector organisations working with this population. Feedback will again be gathered to allow for continued development of sessions and ensure they remain of high quality and relevance. An e-Learning module is also in development with Association for Elderly Medicine Education, allowing for UK wide access.