bluuebunny/crossref_metadata_2025_split huggingface dataset:
101 Avoiding Burnout of the Care Home Workforce During the COVID-19 Pandemic and Beyond: Sharing National Learning and Local Initiatives
Authors: Johnston L , Malcolm C , Rambabu L , Hockley J , Shenkin S D 
Published: March 2021

Abstract

Introduction
COVID-19 in care homes has heightened the risk of staff burnout, undermining already problematic staff retention and low morale. There has been an associated proliferation of resources and online initiatives to support frontline workers, however, few of these are directly targeted at the care home workforce. Care home workers are highly skilled in caring for people with complex needs, but have very variable levels of formal training, and just over half of care homes in Scotland include registered nurses. This project will rapidly collate existing resources and identify, direct from care home workers, their best practice, initiatives, and resources used to support resilience and retention during this pandemic and moving forward.

Methods
1) Rapid review of care home specific evidence and resources (including published research and social media); 2) Online survey of Enabling Research in Care Homes (ENRICH) members across Scotland (n = 55); 3) Case studies within six care homes to identify what is working well and what is not in terms of promoting resilience and emotional support.

Results
The rapid review has identified a wide range of resources directed at supporting staff working in care homes; the survey and case studies will provide data on the key learning and resources that have supported staff, and outline the challenges identified. There are many resources available but staff do not access these. The role of the care home manager is key.

Key conclusions
This comprehensive review of resources and initiatives will make a valuable contribution to policy and practice designed to reduce burnout and foster retention not just in care homes but more widely across health and social care.
103 Periodontal Health and Sarcopenia: Cross-Sectional Evidence From A Cohort of 2040 Twin Volunteers
Authors: Zazzara M B , Wells P M , Bowyer R C E , Lochlainn M N , Thompson E J , Penfold R S , Steves C J 
Published: March 2021

Abstract

Introduction
Periodontitis is a chronic inflammatory disease affecting the periodontium, ultimately leading to looseness and/or loss of teeth. Sarcopenia refers to age-related reduction in muscle mass and strength. Similar to periodontitis, chronic low-grade inflammation is thought to play a key role in its development. In addition, both increase in prevalence with advancing age. Despite known associations with other diseases involving a dysregulated inflammatory response, for example rheumatoid arthritis,, the relationship between periodontitis and sarcopenia, and whether they could be driven by similar processes, remains uncertain. The aim of this study was to explore the association between periodontitis and sarcopenia.

Methods
Observational study of 2040 adult volunteers [age 67.18 (12.17)] enrolled in the TwinsUK cohort study. Presence of tooth mobility and number of teeth lost were used to assess periodontal health. A binary variable was created to define periodontitis. Measurements of muscle strength, muscle quality/quantity and physical performance were used to assess sarcopenia. A categorical variable was created according to the European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, to define sarcopenia (1: probable; 2: positive; 3: severe). Generalised linear mixed model analysis used on complete cases and age-matched (n = 1,288) samples to ascertain associations between periodontitis and sarcopenia.

Results
No significant association was found between periodontitis and sarcopenia in both the complete cases analysis and age-matched analysis. Results were consistent when analysis was adjusted for potential confounders including body mass index, frailty index, Mini Mental State Examination smoking, nutritional status and educational level.

Conclusions
This study found no significant association between periodontitis and sarcopenia in a cohort of 2040 adults. Although both periodontitis and sarcopenia have been linked to a dysregulated immune response and demonstrate an increase in prevalence with increasing age, our work is inconclusive due to the plethora of possible aetiopathogenetic pathways.
108 A Multidisciplinary Team Initiative to End PJ Paralysis Was Successful in Achieving Cultural Change on An Acute Geriatric Ward
Authors: Butler J , Welford T 
Published: March 2021

Abstract

Introduction
Prolonged bedrest amongst the elderly causes deconditioning leading to; increased hospital length of stay, additional social costs and decreased quality of life. An audit on an acute geriatric ward in November 2018, found that over a third of patients medically fit (PMF) to sit out remained in bed all day. Therefore, a service development initiative was undertaken, addressing the misconception that keeping elderly patients in bed is safe, when in fact, unintentional harm results.

Method
In a root cause analysis, four main reasons for bedrest were identified: risk aversion, unknown function, widespread “bed is safe” culture and lack of equipment. The project tasked getting PMF out of bed each day and was audited daily from November 2018 to present, involving all members of the multi-disciplinary team (MDT) and using a “plan, do, study, act” approach.

Results
Initially, the project showed an increase in percentage of PMF sitting out each day, but this subsequently decreased with winter pressures. However, for a whole year (February 2019–February 2020) a sustained and significant improvement was achieved (64.3%–89.7%). The pre-COVID19 period (February–March 2020) saw fluctuations in PMF sitting out. Data collection halted during the COVID19 peak, although observationally most patients remained in bed. Auditing resumed from June 2020 (COVID19 recovery phase) which showed a steady increase in PMF out of bed, with recent figures surpassing pre-COVID19 levels (97.8%).

Conclusion
Cultural change takes time to embed and needs persistent reviewing by a dedicated and engaged MDT. Improvements were made through more accessible doctor’s advice, better MDT education and communication, daily feedback of data and sourcing additional equipment. Disruption to working patterns over the COVID19 period made this unachievable and the project lost impetus. In the COVID19 recovery phase, the specialized MDT reformed and worked successfully to restore the cultural change as evidenced by audited data.
121 Mediating Factors Between Caregiver Burden and Quality of Life in Caregivers of Older Patients with Newly Diagnosed Lung Cancer
Authors: Zhu S , Yang C , Li J , Mei W 
Published: March 2021

Abstract

Introduction
Family caregivers of older patients with newly diagnosed lung cancer become responsible for patients’ care, usually without preparation or training in provision of care. Their efforts of care generate caregiving burden, which could deteriorate their quality of life and affect the prognosis of patients. The aims of this study were to examine associations between caregiver burden and quality of life, coping, social support for family caregivers, and to investigate whether coping and social support mediate associations between family caregiver burden and their quality of life.

Methods
A cross-sectional study was performed at two thoracic surgery wards in one tertiary hospital in Changsha, China from November 2019 to May 2020. This study involved 224 family caregivers of patients aged over 50 years and newly diagnosed with lung cancer. Caregivers-reported outcomes were measured by Zarit caregiver burden interview, simplified coping style questionnaire, social support rating scale, and quality of life family version. Structural equation modeling (SEM) was used to test the hypothesized mediation model.

Results
SEM indicated a good fit for the mediation model, which explained 49.7% of the variance of quality of life. Higher level of caregivers’ burden was negatively associated with quality of life (r = 0.183, P = 0.042). Coping partially mediated the effect of caregiver burden on quality of life (indirect effect −0.389, P = 0.000). Social support did not mediate the relationship between caregiver burden and quality of life (indirect effect −0.023, P = 0.087).

Conclusions
Caregivers’ burden of patients with newly diagnosed lung cancer is correlated to quality of life which is partially mediated by coping. Early intervention providing caregivers with positive coping strategies may improve their quality of life.
124 Perceived Quality of End-Of-Life Communication Provided by Healthcare Professionals Among Frail Older Chinese Patients
Authors: Leung D Y P , Wan Z , Chan H Y L , Chiu P K C , Lo R S K , Tang F W K 
Published: March 2021

Abstract

Introduction
Better communications among the patient, their family, and healthcare providers can enable a shared understanding on patient’s end-of-life (EOL) care preferences. Discussion about death-related issue however has been thought to be taboo among Chinese people. This study aims to explore perceived quality of EOL communication provided by healthcare professionals (HCPs) among frail older Chinese patients.

Method
Frail older patients were recruited from a medical ward of a public hospital for a randomized controlled trial of the effectiveness of a nurse-led advance care planning. Participants completed a baseline questionnaire including the 7-item Quality of Communication (QOC) Questionnaire which measures perceived quality of EOL communication provided by HCPs (0 “The worst or none happened” to 10 “The best”). Bivariate analyses examined associated factors of QOC.

Results
Between December 2018 and January 2020, 105 participants were recruited and have completed the QOC. Their mean age was 80 years old (SD = 7.1), and 74% (n = 78) reported had received some formal education. A total of 95 participants (91%) responded “0” to all the 7 items in QOC (poor QOC group). For individual QOC item, all participants scored “0” in 4 items, 99 scored “0” in Item 1 “Talking about details if you got sicker”, 104 scored “0” in Item 2 “Talking about how long you might have to live”, and 101 scored “0” in Item 7 “Respecting your spiritual or religious beliefs”. Participants with “0” score in QOC reported a significant lower mean level in certainty regarding decision-making in EOL preferences (1.2 ± 1.6 vs. 2.3 ± 1.8, p = 0.039).

Conclusion
Occurrence of talking about EOL care with frail older Chinese patients by HCPs was rare, and the quality of EOL communication associated with decision-making certainty regarding EOL preferences. Training of initiation of EOL discussions and improve communication skills for HCPs is essential. Funding: RGC, HKSAR, China (PolyU14162617H).
125 A Case of Mistaken Identity: An Obsolete Anti-Reflux Device in An Older Patient with Variable Gastrointestinal Symptoms
Authors: Squires C , Porter R , Ward B 
Published: March 2021

Abstract

Background
A frail 93-year-old lady presented with delirium and hypoxia, on a background of heart failure, constipation, cerebrovascular disease, and osteoporosis. A CTPA on admission revealed an unusual appearance of the left hypochondrium, leading to subsequent CT abdomen. This unexpectedly reported the presence of a gastric band. We therefore considered a possible misidentification as this procedure seemed unlikely in someone of her age. Her GP records revealed that she underwent surgical insertion of an Angelchik prosthesis in 1984. It transpired that our patient had experienced several longstanding symptoms, including reflux, bloating and constipation, which have all been observed in patients with Angelchik prostheses in situ.

Discussion
The Angelchik prosthesis is an anti-reflux device for patients with chronic reflux disease with or without hiatus hernia, introduced in 1979. It comprised of an elastomer shell ring filled with silicone gel, that was sited at the lower oesophagus and secured with DACRON tapes. It was initially lauded for its replicable insertion technique and promising early results with around 30,000 being inserted in mainly British and American Hospitals. However, over time it became apparent that a significant proportion of patients reported ongoing gastrointestinal symptoms due to device failure.
Serious complications such as gastric perforations were also recognised. Surgical removal was noted to be technically complex, providing further challenges. The Angelchik prosthesis therefore fell from favour after a period of use of only fifteen years, and is now rarely encountered. We discovered that our patient had experienced multiple long-standing gastrointestinal complaints potentially linked to her prosthesis, though this association had not previously been considered. Whilst her frailty meant that removal would not be pragmatic, it is uncertain if this could have been a possible consideration in the past. This device is relevant to geriatricians as many recipients are now elderly, and may report ongoing symptoms.
130 Improving Documentation of Bowel Movement on Geriatric Wards
Authors: Noar A , Parkin J , Hallam R , Wijekoon T , Walker C , Khan H , Tsui J , Chin K , Chakravorty M , Zalynda R 
Published: March 2021

Abstract

Introduction
Constipation is a widely prevalent issue in older adults that may result in complications such as urinary retention, delirium and bowel obstruction. Previous studies have indicated that while stool charts are well completed by nursing staff, they are infrequently monitored by doctors. This project aimed to improve the documentation of bowel movement by doctors on ward rounds to 85%, by the end of a 3-month period.

Methods
Formulation of the project was achieved using group work and a fishbone diagram which focussed on how doctors can improve on documenting bowel movements. Baseline data were collected from inpatient notes on weekdays over a three-week period on a geriatric ward in Northern General Hospital, Sheffield. Interventions of posters and stickers of the poo emoji were placed on walls and in inpatient notes respectively as a reminder. Post-intervention data were collected on weekdays over two weeks, and then repeated a month later to assess for a sustained change.

Results
The data on bowel activity documentation were collected from 28 patients. The baseline data showed that bowel activity was monitored daily on the ward 56.25% of the time. There was a significant increase in documentation of 85.75% following the interventions. The sustainability study showed that bowel activity was documented on the ward 59.09% of the time.

Conclusions
This study shows how a strong effect on behavioural change can be accomplished through simple interventions such as stickers and posters. As most wards currently still use paper notes, this is a generalisable model that other wards can trial. However, this study also shows the difficulty in maintaining behavioural change over extended periods of time. Further PDSA cycles should examine the reasons behind the difficulty sustaining the change and implement new changes that aim to overcome them.
131 Developing An Integrated Comprehensive Geriatric Unit
Authors: Emery R , Chan C Sin , Farnsworth M 
Published: March 2021

Abstract

Introduction
Surrey Downs Health and Care (SDHC) is an innovative partnership consisting of the acute trust, community provider, three local GP federations and local authority. Together they deliver integrated health and care services for the Surrey Downs population. In April 2019, SDHC formally took over the management of an acute escalation ward at Epsom General Hospital. The aim was to redesign the model of care to offer a more integrated approach towards the management of patients with frailty.

Method
A change in leadership with interface frailty consultants developing an integrated multidisciplinary team (MDT) with reassignment of community staff. All members of the MDT had an equal voice and this helped develop the one team ethos. There were many developments along the way, but key changes included the agreement that a patients’ time is the most valuable currency and that we should be changing conversations from “what is the matter with you?” to “what matters most to you?”

Results
1. A 100% increase in average daily discharges 2. An increase to 70% being discharged to their own home, versus 20% previously 3. A reduction from an average length of stay of 40 days to 13 days compared to the same time last year 4. Reduced 30-day readmissions at 15% versus previous average of 25%.

Conclusion
By blurring boundaries between the acute and community, allowed a frictionless pathway for patients. This has led to improvement in patient care and outcomes for the patient and system as a whole.
138 We Tried This At Home – Safety Analysis and Outcome of Community Resource Services
Authors: Norris S , Kumar A , Carney K , Jones A , Sweeting O , Kitson J 
Published: March 2021

Abstract

Introduction
There are several data sets published for acute frailty services in hospital but there is a lack of supporting data in the emerging field of Intermediate Care. Gwent has well-established Community Resource Teams (CRT) that were set up as “Hospital at Home” services. The objective being to treat frail, acute or sub-acute medically ill patients in their own environment by a consultant-led hospital-like team using a Comprehensive Geriatric Assessment. Although “Hospital at Home” services are often preferred by the patient and are in-line with Health board strategies “Care Closer to home” and “Clinical Futures”; it is important to ask ourselves whether we are able to deliver clinical care in the community safely?

Method
One year of data from 2018 was extracted from the CRT Portal, analysed and then validated by the health board’s performance teams. From the established data set, origin of referrals and discharge outcomes were identified. Finally, at 28 days of discharge from Gwent CRTs mortality and hospital admission rates were examined.

Results
4,308 out of 5,395 referrals (85%) were accepted to Gwent CRTs of which 59.60% (2,863) referrals were from primary care and 33.54% (1,445) were from secondary care. Our admission rates to secondary care services were 15.27% (658) whilst mortality rate was 3.92% (169). After successful medical management from Gwent CRTs of 3,481 patients in their own place of residence, 28 day hospital admission rate was 13.84% (482) whilst 28 day mortality rate (expected and unexpected) was 6.89% (240).

Conclusion
Although no equivalent data is currently available for comparison, a significant number of patients can be medically managed in their own place of residence. More than 80% of patients did not require hospital admission whilst mortality rates were encouraging. Further future re-evaluation of our service performance and its value is required.
Are Recent Cohorts Getting Worse? Trends in US Adult Physiological Status, Mental Health, and Health Behaviors Across a Century of Birth Cohorts
Authors: Zheng Hui , Echave Paola 
Published: March 2021

Abstract
Morbidity and mortality have been increasing among middle-aged and young-old Americans since the turn of the century. We investigated whether these unfavorable trends extend to younger cohorts and their underlying physiological, psychological, and behavioral mechanisms. Applying generalized linear mixed-effects models to data from 62,833 adults from the National Health and Nutrition Examination Surveys (1988–2016) and 625,221 adults from the National Health Interview Surveys (1997–2018), we found that for all sex and racial groups, physiological dysregulation has increased continuously from Baby Boomers through late-Generation X and Generation Y. The magnitude of the increase was higher for White men than for other groups, while Black men had a steepest increase in low urinary albumin (a marker of chronic inflammation). In addition, Whites underwent distinctive increases in anxiety, depression, and heavy drinking, and they had a higher level than Blacks and Hispanics of smoking and drug use in recent cohorts. Smoking is not responsible for the increasing physiological dysregulation across cohorts. The obesity epidemic contributes to the increase in metabolic syndrome but not in low urinary albumin. The worsening physiological and mental health profiles among younger generations imply a challenging morbidity and mortality prospect for the United States, one that might be particularly inauspicious for Whites.
Severe Maternal Morbidity: A Comparison of Definitions and Data Sources
Authors: Snowden Jonathan M , Lyndon Audrey , Kan Peiyi , El Ayadi Alison , Main Elliott , Carmichael Suzan L 
Published: March 2021

Abstract
Severe maternal morbidity (SMM) is a composite outcome measure that indicates serious, potentially life-threatening maternal health problems. There is great interest in defining SMM using administrative data for surveillance and research. In the United States, one common way of defining SMM at the population level is an index developed by the Centers for Disease Control and Prevention. Modifications to this index (e.g., exclusion of maternal blood transfusion) have been proposed; some research defines SMM using an index introduced by Bateman et al. (Obstet Gynecol. 2013;122(5):957–965). Birth certificate data are also increasingly being used to define SMM. We compared commonly used US definitions of SMM among all California births (2007–2012) using the kappa (κ) statistic and other measures. We also evaluated agreement between maternal morbidity fields on the birth certificate as compared with health insurance claims data. Concordance between the 7 definitions of SMM analyzed was generally low (i.e., κ &lt; 0.41 for 13 of 21 two-way comparisons). Low concordance was particularly driven by the presence/absence of transfusion and claims data versus birth certificate definitions. Low agreement between administrative data–based definitions of SMM highlights that results can be expected to differ between them. Further research on validity of SMM definitions, using more fine-grained data sources, is needed.
Drug purchase price volatility in an academic medical center
Authors: Cortes Armando , Park Megan , McCarthy Bryan C 
Published: March 2021

Abstract

Purpose
Inpatient drug purchase price trends at an 811-bed academic medical center are described.

Summary
Recent highly publicized drug price increases by pharmaceutical manufacturers have generated public interest in regulatory solutions to reduce drug costs. Monitoring drug price changes through internal dashboards has been demonstrated to aid in purchasing decisions to reduce the impact of drug price changes on inpatient pharmacy drug budgets. In this research, University of Chicago Medicine created an internal dashboard to detail specific inpatient drug purchase price trends. Dashboard data input included all medications purchased through the organization’s group purchasing organization over a 25-month time frame. A total of 69,245 drug purchases of 2,432 unique medications and/or dosage strengths were analyzed in the study. Within the 25-month time period, 706 medications (29%) had a net drug purchase price increase, while 898 (37%) had a net drug purchase price decrease. The range of net price percentage changes for medications with price increases was 0.01% to 733.6%; the range for medications with price decreases was 0.01% to 97.5%.

Conclusion
Relative to previous purchase prices, drug purchase prices decreased or remained the same more often than they increased over a 25-month time frame. However, drug purchase price percentage changes were far greater for medications whose prices increased rather than decreased.