bluuebunny/crossref_metadata_2025_split huggingface dataset:
157 Prevalence and Patterns of Drug-Disease Interactions in Long-Term Residents in Nursing Home Facilities in the Czech Republic
Authors: Lukačišinová A , Kummer I , Příhodová V , Bandari D K , Brkic J , Fialová D 
Published: March 2021

Abstract

Introduction
Prescription of potentially inappropriate medications, non-geriatric doses and drug-disease interactions contribute to high prevalence of adverse drug events, geriatric syndromes and symptoms, and increased frailty in older adults. Despite serious health and socio-economic consequences, a very few studies have been published on phenomenon of prescribing of drug-disease interactions (DDI) in older patients in Central and Eastern Europe.

Methods
This study aimed to investigate the prevalence of DDI and differences across nursing home (NH) facilities applying relevant parts of Beers 2012 criteria, Czech national consensus 2012 (CNC), and STOPP/START criteria vers.1. This is a retrospective cross-sectional study that analysed semi-implicitly InterRAI-LTC assessment protocols of 490 NH residents from 10 Czech NH facilities (N = 490, 65+) participating in the EU SHELTER project. Retrospective analyses were conducted in 2019 year.

Results
Prevalence of potentially inappropriate DDI ranged from 44.5% to 62.3% identified by STOPP criteria and CNC, respectively. The most common DDIs were long-term use of benzodiazepines in depressive residents (7.8%) and use of opioids in residents with chronic constipation without osmotic laxative treatment (7.4%). The prevalence of undertreatment identified by START criteria was 52.9%, mainly due to absence of statins in NH residents with diabetes mellitus and cardiovascular risk factors (9.8%) and the absence of anticoagulation therapy in patients with atrial fibrillation (7.1%).

Conclusions
Potentially inappropriate DDI were highly prevalent in Czech long-term NH residents with significant differences across NH facilities. Using method of semi-implicit medication reviews, we cannot judge the real quality of drug treatment, but there is a necessity to reduce the high prevalence of DDI in NHs in order to prevent potential adverse drug events. 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, FP7-HEALTH-F4–2008-201,917, SVV 260417.
160 The Effect of Frailty and COVID-19 Infection on Clinical Outcomes in Older Adults—A Single Centre Retrospective Study
Authors: Okuwoga O , Mufti S 
Published: March 2021

Abstract

Introduction
It was anticipated that the COVID-19 pandemic would put a strain on our healthcare system, disproportionately affecting older people. NICE guidance recommended using frailty scoring to support decision making around escalation of care. This study aimed to assess frailty, demographics and COVID-19 infection and to investigate how these related to outcomes of patients aged over 65 years admitted to hospital.

Methods
A single centre retrospective cohort study was carried out by reviewing the electronic health records of all admissions over 65 years. Data points collected included length of stay (LOS), frailty score using the Rockwood Clinical Frailty Scale (CFS) and mortality. Patients were stratified into COVID and non-COVID based on health records and into non-frail (CFS 1–4) and frail (CFS 5–9).

Results
A total of 257 patients admitted between 30th March and 30th April 2020 were included in the study (mean age 79 years, 43% female). 141 (54.9%) of patients were diagnosed with COVID-19 infection. 120 patients had CFS 1–4 and 136 has CFS 5–9. 1 patient did not have a frailty score due to insufficient information. 68 (26.8%) of all patients died during the admission. The relative risk (RR) of mortality of patients with coronavirus was 6.3 (95% CI 3.1–12.6, p &lt; 0.0001). The RR of mortality for frail patients compared to the non-frail was 2.1 (95% CI 1.3–3.2, p = 0.002). The median LOS for patients with COVID-19 was 5 days, compared to 4 days for patients who did not have coronavirus. Frailty did not predict longer admission, with median LOS of 5 days for both non-frail and frail patients.

Conclusion
The results demonstrated in this study show that COVID-19 infection and frailty were significantly associated with increased mortality in older patients. This validates the continued use of frailty scoring of older patients on admission to support care planning.
162 Relationship Between NT Pro BNP Levels and Heart Failure in Patients &gt;85 Years of Age
Authors: Sabharwal A , Okoli U , Smithard D 
Published: March 2021

Abstract

Introduction
Around 920,000 people in the UK have been Diagnosed with Heart Failure with a median age of diagnosis been 77 years. The most commonly used test used to diagnose and measure prognosis in HF is BNP levels.
B—Type Natriuretic Peptide is a hormone which is released in response to pressure changes in the ventricles. It causes Natriuresis which means removing sodium (salt) and water from the body thereby reducing the strain on the heart. It has a high negative predictive value to exclude heart failure with the following cut-off values.
High levels—NTproBNP &gt;2000 pg/ml.
Raised levels—NTproBNP 400–2000 pg/ml.
Normal levels—NTproBNP &lt;400 pg/ml.
The Aim of the study was to see if the cut off values of NT pro BNP Levels, which is the non-active pro hormone released from the same molecule that produces BNP are accurate in the elderly to diagnose Heart Failure.

Method
A retrospective study was carried out using 50 patients, age &gt; 85 years with a diagnosis of heart failure. A comparison was made to look at NT pro BNP values and Ejection fraction (EF) [1] of these patients. A cut off of 50% EF was taken as diagnosing Heart Failure.

Results
Out of 50 patients, only 39 were suitable for the study as the rest did not have either a BNP value or an TransThoracic ECHO to assess Ejection Fraction. Age group taken was 85–97 years.
22.5% patients with a NT pro BNP level &gt; 400 had an ejection fraction &gt;50%.

Conclusion
Although we could only involve 39 patients, the data above shows that in patients aged &gt;85 years with NT pro BNP values &gt;400 around 25% have a normal ejection fraction. This suggest that increasing the cut off values for NT pro BNP to 750 in the elderly should be considered to diagnose Heart Failure, hence reducing cost and getting a high positive predictive value. Although more work is needed on the same.

Reference
1. EF - in simple terms is amount of blood the heart is pumping into the body.
164 Standardised Anticipatory Care Planning in Care Homes Reduces Unscheduled Hospital Admissions
Authors: Munang L A , Rimer J H W , Ralston K , Kirby L , Robertson K , Box S 
Published: March 2021

Abstract

Background
Anticipatory care planning (ACP) is a proactive person-centred approach for “thinking ahead”, exploring and recording a person’s goals and preferred actions when their health deteriorates. As a key part of Comprehensive Geriatric Assessment of frail patients, care home (CH) residents would benefit from ACP.

Introduction
West Lothian has 16 care homes with 853 residents. Between Oct—Dec 2017, 5.21% of CH residents were admitted to hospital each month. Some of these admissions could have been avoided had there been robust ACP in place.

Methods
In 2017 West Lothian Health and Social Care Partnership appointed a GP lead for Care Homes. Through standardising ACP for CH residents, the goal was to improve the pathway for managing medical emergencies and reduce unnecessary unscheduled care calls and admissions. In 2019 this role was taken over by a team of 2WTE Advanced Nurse Practitioners and 1WTE Staff Nurse. Outcome measures include hospital admission rates, number of ACPs in place and uptake of ACP training amongst CH staff.

Interventions
In collaboration with the Medicine of the Elderly Department at St John’s Hospital, a standardised ACP Summary document was developed for use in all CHs. A medical advice and emergency flowchart was created to reduce unnecessary hospital admissions. An continuous education programme was delivered across all CH staff to facilitate and implement this.

Results
Medical admission rates from CHs have decreased by 60% from 6 to 2.2 admissions per week. The largest reduction is in CHs with full ACP use.

Conclusions
Standardised ACP significantly reduces the number of medical admissions. Continuous education and training is crucial in maintaining its implementation, and ensuring its routine use throughout CHs in West Lothian.
54 No One Told Me I Couldn’t Drive with Delirium
Authors: Watson H , Ralston L 
Published: March 2021

Abstract

Introduction
Delirium is a common cause and complication of hospital admissions. DVLA1, and Consensus guidelines2 exist for driving with dementia or mild cognitive impairment, but there are no specific guidelines pertaining to delirium. This audit set out to find the prevalence of delirium in a district general hospital prior to implementation of a standard screening tool. It was noteworthy that a significant number of patients with delirium were drivers.

Methods
The notes of 114 patients under the care of nine specialties, both medical and surgical were prospectively reviewed. Of those with risk factors for delirium, data was collected on the number of patients who had a diagnosis of delirium made during their admission. For patients at risk with no documented screening already completed a Confusion Assessment Method (CAM) screening test was performed by the lead author. In patients identified with delirium it was also established if they were current drivers via clerking documentation or by discussion with the patient/family. Drivers with delirium were highlighted in the medical notes and where possible discussions were had with the patient and their families regarding driving advice until the delirium had resolved.

Results
The prevalence of delirium in this group was 23% (n = 26/114). 20 patients had documented evidence of delirium and a further 6 patients were diagnosed as a result of this project. 15.4% (n = 4/26) of patients with delirium were current drivers. For this group there was no documented evidence that driving advice had been given to the patient or family.

Conclusion
This baseline audit has identified that delirium is not consistently screened for and identified. In patients with delirium, driving history is not being sought and consequently the opportunity for driving advice is being missed. Clear guidance from the DVLA on driving for patients with a resolving delirium is needed.

References
1. DVLA, 2018.
2. RCPsych, 2019.
56 Ageism in Myelodysplastic Syndrome
Authors: Hogan P , Enright H , Ryan D , O'Neill D 
Published: March 2021

Abstract

Background
Myelodysplastic Syndromes (MDS) are a group of haematological disorders which are common in older people and can be amenable to treatment. Ageism has previously been identified in studies of treatment for conditions affecting older people.

Objectives
To assess for the presence of ageism in studies of treatment for MDS.

Design
A review of the Cochrane Library of Systematic Reviews.

Setting
Desk-based.

Methods
Systematic reviews were analysed to determine: use of age as an exclusion criteria in randomized-control trials (RCTs); the comparison of ages of patients in RCTs to that of the median age of patients with MDS; exclusion of patients from RCTs on the basis of dementia or other conditions associated with ageing.

Results
17 reviews were identified, 2 of which were suitable for analysis. The two remaining systematic reviews reported data on 13 RCTs—of which 2 did not report age. The median age of all patients was 68. Three RCTs used a maximum age limit for therapy—one of which was lower than the median age of diagnosis of MDS. More recent studies tended to include older patients. No studies excluded patients on the basis of cognitive status.

Conclusion
There was some evidence of ageism identified in studies of treatment for MDS. There was limited data available in the Cochrane database of Systematic Reviews, which may itself be suggestive of ageism in such reviews.
57 Physical Activity Improvement in Elderly Hospitalised Patients at the Royal London: Exercise as Part of A Multimodal Intervention
Authors: Sayer K , Whiteaway K , Dawson J O , Simpson J , Chu W 
Published: March 2021

Abstract

Introduction
Approximately 65% of elderly patients admitted to hospital experience some level of deconditioning during their stay. This can lead to longer length of stays, premature admissions to care homes and loss of function whilst in hospital (British Geriatrics Society). There is evidence that exercise can be safe and effective in reversing functional decline in this population. However, there is limited evidence into the effectiveness and feasibility of running a multi modal exercise intervention (eg. Dance and Exercise) on a busy elderly care ward in the UK.

Method
An 8-week inpatient programme consisting of a 60-minute exercise classes once a week and/or 60-minute dance class once a week started on the Older Person’s Wards at the Royal London. Primary outcome measures included: 5 x Sit To Stands (5xSTS) and Falls Efficacy Scale International (FES-I). Secondary measures; Rockwood score, Barthel Index, Elderly Mobility Score (EMS), Mood, 4AT and handgrip strength. Patient satisfaction scores were also recorded.

Results
23 patients were included in the analysis, 3 patients attended the dance class, 14 attended the exercise class and 5 attended both. In total 37 sessions were completed. The average score for all outcome measures improved except one after 8 weeks. The 5xSTS times improved by an average of 7.7 seconds and the FES-I score dropped by 3.9. The Barthel score increased by 5 points. Handgrip strength increased by 2.3 kg and 57% improved on their EMS. Mood improved from 5.4/10 to 6.0/10 and 4AT from 2.7 to 1.7. Overall, 70% of participants reported enjoying the classes and 90% said they would re-attend.

Conclusion
A multifactorial intervention including seated dance and exercise sessions showed significant improvements in mobility, fear of falling, cognition and functional tasks. Further work will look into the impact on length of stay and readmissions inpatient to hospital.
67 The Evolution of A Frailty Service
Authors: Abbott C , Bishop K , Hill F , Finlow C , Maraj R 
Published: March 2021

Abstract

Introduction
In September 2017 our frailty service was started within our medium sized DGH in North Wales. Working with our management team we secured a significant clinical resource including:
We describe how resources, setting and staffing develop over a 2 year period in order to create a service which meets the needs of the local population.

Method
The service has been in a constant state of development since it has been in operation, utilising a PDSA model with regular meetings of clinical and managerial staff to analyse performance.

Results
With each new PDSA cycle the amount of patients reviewed has increased. With the move to AMU we increased the monthly number of patients reviewed from 29 to 172 patients reviewed, 97 of which were discharged directly from the unit.

Conclusion
Using QI methodology our Frailty Service has improved dramatically since its inception. We will continue to analyse how we work to improve patient outcomes and cost effectiveness.
68 A Full Audit Cycle: Documentation of Discharge Summaries and Functional Status in Electronic Discharge Letters
Authors: Mir A , Damany S , Tay H S 
Published: March 2021

Abstract

Introduction
Electronic discharge letter is the most effective way to handover to General Practitioners for the continuity of care by providing the information about what happened during hospitalisation and what needs to happen after discharge. Well written discharge letters prevent miscommunication, missing information and medications errors as well as reduction of hospital workload. It also provides timely follow up to decrease the risk of re-hospitalisation.
The aim of this project is to analyse the documentation of discharge summaries and functional status after hospital admission in discharge letters. Discharge summary template was introduced and made compulsory in all Geriatric wards following first cycle of audit. We then compared data after introduction of discharge summary template.

Methods
Electronic discharge letters were reviewed for all patients discharged from Geriatric Department in July 2019 and results were compared with data from January 2019.

Results
162 patients were discharged in the second cycle of audit. Among these, 18 patients were deceased, and 4 patients had no discharge letters available. Therefore, total number of discharge letters analysed was 140. Please see Table 1 for comparative results on documentation of discharge summaries in discharge letters.

Conclusions
Introduction of the discharge summary template improved the documentation of summaries in discharge letters. Well-written discharge letter ensures the smooth transition for when patients leave the hospital. Therefore, it should be accurate, precise and relevant.
73 Using the Gold Standards Framework to Identify Opportunities for Advance Care Planning
Authors: Harwood R , Enguell H , Sakuda K , Lunt E , Ali A 
Published: March 2021

Abstract

Introduction
Departmental discharge data (January 2017–January 2018) suggested a high number of “Day 1 Deaths” i.e. an individual who was readmitted 24 hours after discharge, and subsequently died during their readmission. We wondered if this was due to a lack of Advance Care Planning (ACP).

Methods
We undertook a retrospective case note audit of 50 cases from the “readmissions who died” (total 176/7421) subgroup, to understand whether or not they were predictably within the last days, weeks or months of life and whether there was ACP in place. We reviewed all Day 1 Deaths (16/50), and a random selection of cases across the Day 2–30 (34/50) data set.
We used the Gold Standards Framework (GSF) as a prognostic tool, by use of the intuitive “surprise question” (“would you be surprised if this person died within the next days, weeks, months?”) and the disease-specific Prognostic Indictors (PI).

Results
Using the GSF we (retrospectively) predicted death in 94% of the Day 1 deaths and 63% of the Day 2–30 deaths.
There was evidence of ACP in 32/50 patients (64%), predominantly in the form of a DNAR CPR (61%). There was very little evidence of other forms of ACP.
Readmissions were justified on the basis of a medical condition in 100% of cases; this was infective in 60% (30/50).
There were few interactions with secondary care in the 12 months prior to death (mode was 2 admissions in the month prior to death, 4 in the 12 months prior to death).

Conclusions
We must consider our discharge processes and medical decision making at the front door.
A Prognostic indicator Tool would be useful to focus medical decision making.
We must recognise infections as end stage disease in advanced ill health, including advanced frailty.
We need to consider how we facilitate meaningful involvement of older people in their medical care towards the end of life.
74 Improving Handover Between Doctors and Nurses on An Elderly Care Ward
Authors: Suseeharan K , Vedutla T 
Published: March 2021

Abstract

Background
The Royal College of Physician guidelines (2011) identified handover as a “high risk step” in patient care, especially in recent times within the NHS where shift patterns lead to more disjointed care with a high reliance on effective handover by all staff members.

Introduction
At Cannock Chase hospital, Fairoak ward is an elderly care rehabilitation ward where there is a large multi-disciplinary team. While working on the ward as doctors we noticed that handover between the MDT was poor. Anecdotal evidence from both doctors and nurses felt that this was a high risk area in need of improvement.

Aim
to improve handover between doctors and nurses on this elderly care ward.

Method
To measure the quality of current handover practice we did a questionnaire. A total of 12 questionnaires were completed which showed that 92% of staff felt that handover on the ward was very poor and 50% preferred both written and verbal handover.
We measured the number of tasks verbally handed over between doctors and nurses over 3 days. On average 65% of the tasks were completed.
We then made the below interventions and re-audited to see if there was any improvement.
Interventions over 3 week period:

Results
Questionnaire:
Measuring task completion after interventions;

Conclusion
This project has made a positive change qualitatively and quantitatively to the ward handover practice. Staff satisfaction regarding handover has improved and the number of “handed over” tasks completed daily has significantly improved. The written handover sheet had poor utilisation by staff but in 4 months we are going to re-audit and trial the handover sheet again to further improve service delivery. We hope this improvement will have a positive impact on patient care on this elderly care ward.
76 This is (Probably) Not the Frailty Solution You are Looking For: Utilisation of A Novel Stand-Alone Community-Based Ambulatory Care Unit
Authors: Dykes L , Jones C 
Published: March 2021

Abstract

Introduction/Aim
Our organisation wished to expand its “Care Closer To Home” capability, especially for older and/or frail patients. Our novel Ambulatory Care Unit (ACU) in a community hospital, staffed by GPs & nurses, opened a year ago. The ACU has some Point of Care (POCT) diagnostics, access to plain-film radiography and OT/physio. During the planning of the unit,” acute frailty” was anticipated to be core business. We wished to determine whether this turned out to be the case.

Method
Interrogation of the ACU patient log (spreadsheet collated from Data Collection Forms) Dec 2018-Nov 2019.

Results

Conclusion/Discussion
Recording of CFS by ACU staff was poor, limiting the validity of our results. Nevertheless, it is obvious that most patients seen in our ACU are not frail, and do not require therapies input. Those that are frail, however, have an acceptable conversion-to-admission rate of 8.6%, comfortably below the national target (20%).
Barriers to greater utilisation of our service for frail patients may include lack of urgent but non-emergency transport options for the less mobile, lack of access to certain commonly-used tests (e.g. CT, troponin) and referrer anticipation of difficulty discharging the frail patient in crisis without a new or boosted care package and/or access to respite beds. These aspects of service planning need to be addressed if the potential utility of community-based units like ours for frail patients is to be maximised.