bluuebunny/crossref_metadata_2025_split huggingface dataset:
51 CT Head and Cervical Spine Audit in Patients Over the Age of 65: A District General Hospital Perspective
Authors: Hadley G , Billingsley S , Nakagawa S , Durkin C 
Published: March 2021

Abstract

Introduction
Cervical spine (c-spine) injury has a high morbidity and mortality in patients over the age of 65; more than 60% result from falls from standing height (Beedham et al., 2019).
The Canadian Cervical Spine Rule (Stiell et al., 2001) deems that there is a high risk of c-spine fracture if any of the following apply:
The c-spine cannot be cleared clinically if the patient fits any of the above criteria. Imaging should be considered. As a result of recent clinical experiences Trust Guidelines at Stoke Mandeville Hospital now reflect this evidence (Hadley et al., 2019).

Methods
Fifty patients over the age of 65 who had a computerised tomography (CT) head scan in the Emergency Department (ED) following a traumatic head injury were randomly selected over a 1 month period. Cases were checked for examination of c-spine and/or CT c-spine. Results of the first cycle of the audit were presented at an ED Education Meeting. Indications for CT c-spine were displayed in poster format around the ED. Following these interventions, a re-audit was carried out using the same methodology.

Results
In fifty patients aged over 65 attending ED during one month, 16% had a CT c-spine in addition to a CT head. There was documented c-spine examination of 16% of those without CT c-spine on admission. In the re-audit 38% of the fifty patients who had a CT head underwent CT c-spine. In the group that did not have imaging of the c-spine, the proportion with documented cervical spine examination on admission remained the same (16%).

Conclusion
There was a 137.5% increase in the number of patients aged over 65 who appropriately underwent a CT c-spine as per Trust and National guidelines. Simple interventions (staff education and posters within the ED) were sufficient to significantly alter practice. Current trauma triage is not optimal for older patients who are reviewed by more junior doctors, less likely to be transferred to Major Trauma Centres and more likely to die than younger patients with similar injuries (Major Trauma In Older People 2017 Report). An older person’s trauma team in ED with age-appropriate triage would lead to appropriate imaging in a timely fashion, potentially improving the morbidity and mortality of these vulnerable patients.
163 Frailty, Doesn’t That Mean Birdlike? Research Into Attitudes and Understanding of Frailty in Undergraduate and Postgraduate Trainees
Authors: Hartley S , Cropp A , Fisher J 
Published: March 2021

Abstract

Introduction
Frailty is an increasingly recognised concept, with 25–50% of over 85’s estimated to be frail1,. Previous research considered medical students’ attitudes towards older people2, yet despite the correlation between frailty and increased age3, little is known about attitudes of healthcare professionals towards frailty.
We researched attitudes towards, and understanding of, frailty in undergraduate and postgraduate trainees, with a view to guiding future educational interventions.

Method
Approval was granted by Northumbria Healthcare NHS Foundation Trust (NHCT) Research and Development department, Newcastle University’s Research Management Group and the HRA.
3 cohorts were recruited; 3rd year Newcastle University MBBS Students, 5th year Newcastle University MBBS Students and Foundation Year 2 and Core Medical Trainees working for NHCT (junior doctors). Data was collected during scheduled teaching at NHCT and individuals were invited to participate via email prior to this. Those not participating were still required to attend the teaching. Participants provided written consent.
Within each cohort, small group discussions around frailty and Comprehensive Geriatric Assessment (CGA) were prompted using open questions (e.g. “what does frailty mean to you?”), during which participants anonymously submitted phrases to an online word-cloud generator. Discussions were audio recorded and transcribed.
Transcriptions and word-clouds were analysed using Simple Content Analysis. The over-arching themes within each cohort were identified and compared with other cohorts. Interpretations were reviewed by an independent researcher to enhance rigour.

Results
Each cohort associated frailty with older age and weakness, and often used it as a byword for complexity. Frailty was described as an abstract construct composed of personal experiences rather than an objectively defined descriptor. All associated it with negative emotions.
Cohorts differed in their approach, with 3rd year students primarily focussed on defining frailty, whereas junior doctors prioritised the clinical challenges it presented.
Junior doctors demonstrated limited understanding of CGA whilst undergraduate students were almost universally ignorant of it.

Conclusions
The lack of understanding around frailty and CGA is concerning given its high prevalence. The identification of negative emotions increases this concern. To challenge this, focussed educational interventions addressing understanding and attitudes ought to be developed for tomorrow’s doctors.

References
1. Clegg et al. Lancet 2013; 381: 752–62.
2. Samra et al. Age Ageing 2017; 46: 911–9.
3. Romero-Ortuno et al. Age Ageing 2012; 41: 684–9.
53 Development of Early Supported Frailty Discharge Team
Authors: La Thein M , Le Aung S U , Bafdhel L 
Published: March 2021

Abstract

Introduction
The aim of the audit is to find out whether Rockall clinical frailty score (CFS) has an effect on hospital admissions, such as length of hospital stay, readmission within 30 days after discharge. By knowing the association, we can provide early supported frailty discharge team’s service to patients with specific frailty scores to reduce 30-day readmission rate.

Method
58 patients from Geriatric wards of Southend Hospital including age, reason of admission, and Proactive Elderly Advanced Care Plan (PEACE) status were collected as a baseline. Admission status, length of hospital stay, readmission and mortality were recollected on a weekly basis in the month of October and November 2019, together with clinical frailty score documented on discharge.

Results
The analysed data was left with 37 patients, after excluding 22 patients whose clinical frailty scores not documented on discharge.
Clinical frailty score was independent of age. 85% of the patients were CFS 6 and above, 15% were CFS 4 and 5.
The mean length of stay was 15 days. The severity of frailty was directly proportionate to the average number of days spent in hospital. Patients with CFS 9 had the highest mean hospital stay of 18 compared to 22 days in the group of CFS 4.
Significant 30-day readmission rate (33%) was seen in patients with clinical frailty score of 5 and 6. Patients with upper extreme end of frailty scores were associated with mortality, 83% in CFS 9. In 5 out of 20 patients with CFS of 7 and above, PEACE was put in place. It might explain the reason why there were relatively lower readmission rates in such groups.

Conclusion
From analysis of our data collection, CFS is a good predictor of duration of hospital stay which is in line with previous studies. Severity of frailty may help indicate the likely risks and frailty-related outcomes and help to plan treatments and interventions which may decrease length of stay. As a part of quality improvement project, we are introducing community early supported discharge team to CFS 5 and above patients.
55 The Case for A Best-Interest Meeting Decision Toolkit to Guide Preferred Place of Care and Interventions For Community Dwelling Older People Who Lack Mental Capacity
Authors: Dar A , Wiltshire R , Wright P N 
Published: March 2021

Abstract

Introduction
The Hammersmith and Fulham Community Independence Service (CIS), runs a “virtual ward” to allow people to remain independent in their own homes where possible.
Place-of-care decisions made for community-dwelling older people who lack capacity are formulated in a best-interest meeting (BIM), involving health and social care professionals, family and carers.
Often BIMs centre around beliefs and wishes of the patient or family but fail to objectively evaluate risks and mitigants of staying at home versus placement.
We observed that BIMs were not being held on a consistent basis, and when held lacked the necessary structure for an effective decision-making forum.
Even experienced professionals find it difficult to chair BIMs because of the complexity of the decision-making process. Not all involved parties may be represented.
We found BIMs more likely to be held, attended and effective when structured to identify the major relevant considerations.

Method
The CIS “virtual ward” team developed a BIM decision toolkit, comprising: a check-list of risks and mitigants for home versus care home; a list of required attendees; who should document and chair the meeting; and who should action the interventions raised.
From 6th January to 25th October 2019, BIMs were held for 48 patients on the CIS “virtual ward”.

Results
234 interventions were carried out following toolkit-led BIMs.
1 month after BIM, 34 of 44 patients’ wishes (77%) were honoured (3 not recorded, 1 died).
3 months after BIM, 23 of 31 patients’ wishes (74%) were honoured (15 not recorded, 2 died).
Case studies are included in the presentation.

Conclusion
We developed a toolkit to support decision-making for older community dwellers who lack capacity regarding their place of care. The toolkit assures standardisation and structure to minimise bias, whilst recognising personal beliefs and preferences. It enables any member of the multidisciplinary team to hold and lead a BIM, to reliably identify appropriate interventions and care plans which may not otherwise have been implemented or recognised.
The majority of the patients reviewed using the BIM toolkit remained in their preferred place of care well after the team’s interventions.
Further evaluation is required to compare CIS BIM toolkit-based outcomes against other community services which do not use this toolkit, and appraise the toolkit in a hospital setting.
60 Front Door Specialist Frailty MDT Working at MFT NHS Trust—The Therapy Team Poster Presentation
Authors: Turner H , Bennett G , Hurst S 
Published: March 2021

Abstract

Introduction
The therapy team consists of physiotherapists, Occupational therapists and therapy technicians working generically to deliver a comprehensive therapy assessment to patients presenting in our Emergency Department, Clinical Decisions Unit and Medical Admissions Unit between the hours of 08:00–18:00 7 days a week. The therapists provide the hospitals frailty service in ED and MAU with early therapy assessment and intervention, supporting the provision of a Comprehensive Geriatric Assessment. The aims of our service are to provide early therapy assessment of our most vulnerable patients to avoid unnecessary hospital admissions and reduce readmission rates, and for those requiring hospital care to provide early mobilisation and discharge planning to reduce length of stay and complications associated with hospital admission. We provide the therapy component of the CGA as part of the specialist frailty MDT service and act as an interface with local community health and social services.

Method
A full review of our frailty MDT service was undertaken and a re-allocation of our resources and staff was piloted in July 2019.
During this pilot our therapy staff presence was re-distributed allowing greater patient numbers to be assessed promptly on their arrival to ED.
This adjustment supported the Frailty MDT actions of:

Results
Data collection showed total referrals to therapy increased from 67 (June 2019) to 160 (July 2019). In July same day discharges were at 43%; discharges ≥72 hours 24%; 7 day readmission at 9%; 28 day readmissions at 11% and 38% were referred to community services.

Conclusion
These changes enabled us to provide a full MDT frailty service to frail older people presenting at our ED in a timely manner and to a larger number of suitable patients.
61 Outcomes of An Advanced Nurse Practitioner-Led Pops Service in A District General Hospital
Authors: Irimia A M , Tennant A , Waldron A , Bashir N 
Published: March 2021

Abstract

Introduction
There is an increased need for geriatrician input to older adults outside of the medical wards. There is a lack of geriatricians to contribute to these services. An example includes the Proactive care of older people undergoing surgery (POPS) service where geriatricians perform comprehensive geriatric assessment (CGA) to identify comorbidities and geriatric syndromes which may lead to poor post-operative outcomes. Advanced nurse practitioners (ANP) are highly skilled staff members and are increasingly used to provide the POPS service. We wanted to review the outcomes of our Nurse Led POPS service.

Methods
Patients aged over 70 admitted as an emergency to upper gastrointestinal and colorectal surgery were assessed by the POPS ANP using CGA. Assessments were completed on a proforma. Data was collected prospectively on a data collection form documenting new issues detected and interventions made. The results were analysed using an Excel spreadsheet.

Results
147 patients were reviewed by the ANP between November 2018 and March 2019. All patients were screened for frailty, cognitive impairment and delirium. 37.41% were clinically frail, 17.72% had cognitive impairment and 11.56% had delirium. New issues were identified in 90.47% of these patients; polypharmacy (80.27%), new catheter (53.74%), weight loss (46.94%), incontinence (36.05%), falls (29.25%) and pain (25.17%). Medical issues were also identified including electrolyte abnormalities (47% patients), acute kidney injury (22% patients), cardiac issues (8% patients) and respiratory problems (7% patients). Additional interventions included stopping medication (27.89%), starting new medication (20.41%), requesting further investigations (97.28%), referring to allied health professionals (95.24%) and advanced care planning (15.65%).

Conclusions
A POPS ANP can effectively conduct CGA identifying new medical issues and geriatric syndromes missed by the surgical teams in an acute setting.
62 A Retrospective Observational Study Into the Correct Administration of Rivaroxaban: Is it Being Taken with Food?
Authors: Spurring E , Donnelly G 
Published: March 2021

Abstract

Intro
In July 2019 the MHRA issued a drug safety update reminding healthcare professionals that rivaroxaban should be taken with food. This came after they received a number of thromboembolic events reported in patients prescribed rivaroxaban, thought to be linked with incorrect ingestion on an empty stomach [1].
Our aim was to establish if the healthcare professionals in our department had this knowledge and to audit our current dispensing practice to assess if our hospitalised patient cohort were being exposed to any increased risk.

Methods
A retrospective study was conducted using electronic data from 21 patients that were prescribed rivaroxaban across 14 medical wards. A questionnaire was used to establish the staff’s knowledge.

Results
Of the surveyed healthcare professionals, 79% knew that rivaroxaban should be taken with food (86% of nurses and 79% of doctors). Despite this only 17% of patients took the tablet with food. 75% of patients had rivaroxaban incorrectly dispensed over an hour post meal and 8% were uncertain due to poor documentation. Only 14% of healthcare professionals were aware that in those with swallowing difficulties, rivaroxaban can be crushed.

Conclusions
In our department most of the healthcare professionals had a good academic knowledge of correct rivaroxaban administration, however we have demonstrated that this is failing to correctly influence clinical practice. 75% of patients taking Rivaroxaban in hospital are being subjected to increased risk due to the hospital environment. This was found to relate to the difference in timing of the drug dispensing round in comparison to meal times. As part of the roll out of electronic prescribing in our trust, a warning now shows when both prescribing and dispensing Rivaroxaban to attempt to improve this highlighted risk. We have also highlighted this to the ward managers and at our governance meeting.

Reference
1. Drug Safety Update volume 12, issue 12: July 2019: 3.
63 Nocturia—An Underappreciated “Symptom” of Obstructive Sleep Apnoea?
Authors: Yeong K , Santiapillai J , Arumainayagam B N , Murray P , Tadtayev S 
Published: March 2021

Abstract

Nocturia (&gt;2 per night) is the most frequent cause of disturbed sleep in older people. Poor sleep results in reduced health related QoL, and is linked to the development of cognitive impairment. Nocturia can result in an increase risk of falls and fractures, and is also an independent risk factor for mortality.
The prevalence of norturia is high in the elderly, and it has been reported to be around 77.1% in elderly women and 93% in men. Historically, this bothersome symptom is thought to be mainly a result of bladder outflow obstruction due to prostatic hypertrophy or overactive bladder. More recently, nocturia has been associated witsh nocturnal polyuria (NPu) and obstructive sleep apnoea (OSA). The relationship between OSA and NPu is not fully understood but it is thought that the negative intrathoracic pressure generated by OSA causes an increase in Atrial Natriuretic Peptide (ANP) secretion, resulting in NPu.
Nocturia is highly prevalent in patients with severe OSA. However, patients are usually unaware that they have sleep apnoea, and are therefore more likely to present to urology or geriatric services. It is important that OSA is not overlooked in these clinics as intervention with CPAP is highly effective in reducing symptoms.
Here, we present the result of using the STOP-Bang questionnaire in 71 consecutive patients presenting to our urology service with nocturia. The average age was 73 years (range 34-88), male-to-female ratio 14:1 and median nocturia frequency of 4. 42 patients were at risk of undiagnosed sleep apnoea (median STOP-Bang Score of 5)—35 were referred for sleep studies, 4 patients declined and 3 patients were not referred. Overall, 31 out of 35 sleep studies (88.6%) demonstrated the presence of OSA; of these 23 (74.2%) confirmed moderate or severe OSA. All patients with OSA were seen and treated by the respiratory service. Overall, median nocturia frequency decreased from 4 to 1 across the whole cohort, from a combination of CPAP therapy, bladder outlet procedures and desmopressin.

Conclusion
At least a third of patients (32%) with bothersome nocturia have an undiagnosed clinically-significant OSA. Identification of OSA improves outcomes across the whole cohort, because nocturia in patients without OSA is more likely to respond to bladder outlet procedures and desmopressin.
64 Improving the Monitoring and Awareness of Fluid Balance on A Hip Fracture Ward
Authors: Pickles H , Addy V 
Published: March 2021

Abstract

Introduction
Fluid balance charts are frequently incomplete and inaccurate. At present our Trust does not offer fluid balance training to all ward staff. In addition, drinks given to patients by visitors are not usually documented on the fluid balance charts. The goals of this quality improvement project were therefore to:

Methods
Using the PDSA model a questionnaire was given to ward staff as a scoping exercise to identify the deficiencies in fluid balance education prior to the intervention and fluid balance charts were analyzed. The intervention involved:

Results
Pre-intervention questionnaires demonstrated that 31% of staff asked were not clear on the meaning of fluid balance and 88% felt that more fluid balance awareness was needed on the ward. In addition, 7/8 randomly selected fluid balance charts were incorrectly completed. Post intervention 87% understood the meaning of “fluid balance” monitoring and 7/8 fluid balance charts were correctly completed.

Conclusion
The intervention educated all ward staff and improved the accuracy of fluid balance monitoring. It also provided information and guidance to non-medical staff and visitors regarding fluid balance monitoring. Following the success of the project the intervention is being rolled out across the Trust alongside education sessions for staff.
66 Is “Medically Fit for Discharge” Ambiguous and Misleading to Patients? A Health Service Study
Authors: Alegbeleye J , Kaneshamoorthy M 
Published: March 2021

Abstract

Introduction
NHS England (2015) Monthly Delayed Transfer of Care Situation Report states that “Medically Fit for discharge” or “Clinically optimized” is used at the point at which care and assessment can safely be continued in a non-acute setting. However, elderly patients are either frail or unlikely to be fit physically or medically before they are discharged from hospitals. A number of complaint meetings with patients and relatives suggested that doctors and healthcare professionals should consider changing the language used during discharges. The aim of the study was to identify the challenges with the use of variable languages and to provide standardization of the discharge Languages that seems appropriate for the patients within our organization.

Method
In February 2019, a discussion with major stakeholders at Basildon and Thurrock University Hospital F. NHS Trust including Medical Director and management teams, suggested the need to conduct a staff survey to explore the need for standardization of discharge languages. The survey was sent by emails to healthcare professionals between 6th June 2019 and 1st July 2019. There were 115 responders.

Results
The proportion of responders between doctors and other allied healthcare professionals was 58% and 42% respectively. 75% of responders reported the use of the term “Medically fit” or “Clinically optimized for discharge” had been challenged by patients or relatives. 61% of staff disapproved the term “Medically Fit for Discharge” and 64% suggested this needed to be changed to “Medically Stable For Discharge” which is more acceptable and meaningful language. Our survey showed that the reasons for the change are that a wrong language is not only ambiguous but misleading amongst our respondents.

Conclusion
This study has shown concern amongst the staff regarding the language used during the discharge process. Not only is “Medically Fit for Discharge” controversial but occasionally causes dispute between patient/relatives and healthcare professionals. Our project has helped standardize the cultural language to “Medically Stable For Discharge”. This resonates better to patients and enhances their experience and also reduces anxiety caused by ambiguous language. Further study will be required to know how this reduces the complaints rate and delayed transfer of care within our Health service.