bluuebunny/crossref_metadata_2025_split huggingface dataset:
2253 Establishing a national network of trainee representatives in geriatric medicine higher specialty training
Authors: True S , O'Brien V 
Published: August 2024

Abstract

Introduction
This study demonstrates how a network of geriatric medicine trainee representatives was established across the UK. The intention of the network was threefold: accurately represent the interests of trainees by gathering national feedback, develop a job description of deanery trainee representatives and create a community of practice between representatives.

Method
Deanery trainee representatives were identified through TPDs then contacted to participate in an online questionnaire which also consented for whatsapp group invitation. Results: Deanery representatives were identified for 12 out of 13 deaneries, the final post was vacant. The survey response rate was 83% and all respondents gave permission to be added to the whatsapp group. We gathered information regarding eligibility, appointment and the role of deanery trainee representatives.

Results
Most deaneries (73%) do not require representatives to be a minimum grade whereas 27% required representatives to be ST4 or above. Over half (55%) were appointed following an expression of interest without an election, 27% required an election and 9% were approach and appointed directly either by the TPD or current representative. Once appointed 82% had no fixed term whilst 18% would have a term limited to two years. Once appointed the role entails an invitation to the local higher specialty training committee for 73% of respondents and 73% also reported a role in organising regional training.

Conclusions
The aim of this project to create a network between deanery representatives has been achieved and produced an engaged network of representatives facilitating accurate representation of trainees at a national level. Further applications include collaboration between trainees to share training practices. In a period of training recovery following the Covid-19 pandemic and a new geriatric medicine curriculum a community of practice between trainee representatives has enormous potential to improve training quality and experiences for geriatric medicine trainees in the UK.
2191 Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture
Authors: Adams J , Jones G , Sadler E , Guerra S , Sobolev B , Sackley C , Sheehan K 
Published: August 2024

Abstract

Introduction
to investigate physiotherapists’ perspectives of effective community provision following hip fracture.

Methods
qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented.

Results
four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented.

Conclusion
physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.
2218 Experience of family caregivers for older patients with delirium: a qualitative study
Authors: Mahmoud A , Raghuraman S , Richards E , Allan L , Anderson R ,   on behalf of the RECOVERED Study team, Trimmer SM 
Published: August 2024

Abstract

Background
Delirium is associated with psychological and cognitive complications that have impacts beyond the patients. Although family members and carers can play a significant role in the management and recognition of delirium, there is limited research on the experience of family caregivers in the context of delirium. This study aims to explore the needs and experiences of family caregivers for a person with delirium and offer suggestions to support them.

Method
A qualitative interview study with family caregivers of persons with delirium. Data were analysed using an abductive analysis approach.

Results
Fourteen family caregivers were interviewed. Carers explained their feeling of responsibility to support their loved ones with delirium, however, they perceived their caregiving role negatively because of increasing demands and the lack of sufficient support. Carers attributed their emotional exhaustion and distress to the onset of delirium, change in the personality of the person with delirium, confusion and progression of delirium. Additionally, carers indicated the negative impact of caregiving on the quality of the relationship between them and person with delirium. This highlights the need to enhance the support provided to carers to mitigate the emotional and relationship impact of caregiving on the carer. We identified the needs of carers for people with delirium including: education on delirium, reassurance, information on care pathways and support from formal carers to take breaks.

Conclusions
Viable solutions to assist family caregivers include more support for the carer in formulating care plans for people with delirium, the development of support groups for family caregivers of people with delirium, and a case worker. These solutions may help to decrease re-hospitalisation and admission to care homes. Future research should focus on approaches to better support carers of people with delirium, and to shift the care plan from person-centred into person and family-centred approach.
2225 Geriatric patients in virtual wards; technology adoption style, ease of use, and adherence to remote monitoring technology
Authors: Pugmire J , Wilkes M , Kramer A , Zaniello B , Zahradka N 
Published: August 2024

Abstract

Introduction
NHS England is committed to the expansion of virtual wards, necessitating patient engagement with home care technology. Literature suggests there is a technology adoption lag among older populations. We investigated if this lag was evident in geriatric virtual ward patients.

Methods
Data from three NHS trusts using a virtual care platform (March 2021–August 2023) were aggregated to assess differences in perceived ease of use, technology adoption style, and measures of adherence. All patients received the Telehealth Usability Questionnaire Ease of Use (EOU) subsection (higher scores indicate higher EOU). Patients completed surveys via tablet, wore monitoring devices, and took blood pressure readings. We dichotomised age (&lt;75 vs. 75+) and used Fisher’s exact and Wilcoxon-Mann–Whitney tests.

Results
Of 857 patients, 36.9% were geriatric (mean age 81.5 years). The younger group (mean age 59.1 years) had 541 patients. Gender was evenly split between age groups (p = 0.62). Median EOU scores were 5.5 (geriatric) and 6.2 (younger) (p &lt; 0.001). Geriatric patients were more likely to avoid or delay technology adoption (82% vs. 56% in younger patients, p &lt; 0.001). Geriatric patients had higher adherence to the wearable device (median 95.3%) compared to younger patients (93.3%, p &lt; 0.001). Blood pressure (median 81.6%) and survey adherence (median 83.3%) did not significantly differ between groups (p = 0.076, p = 0.0501).

Conclusions
Despite perceptions and literature suggesting older patients are less comfortable with technology, our findings demonstrate high engagement in virtual ward technology. While differences exist in technology adoption and EOU scores, geriatric patients exhibit equal or higher adherence to remote monitoring tasks. These results challenge stereotypes and underscore the importance of incorporating technology in geriatric care.
2249 Exploring the experiences of sedentary behaviour in older adults aged ≥ 75 years
Authors: Tadrous R , Forster A , Farrin A , Coventry P , Clegg A 
Published: August 2024

Abstract

Introduction
Older adults are the fastest growing and most sedentary group in society. With sedentary behaviour associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. Adults aged ≥75 years are underrepresented in sedentary behaviour research. This study aimed to qualitatively profile the sedentary behaviour of adults aged ≥75 years. This included ascertaining older adults’ understanding of sedentary behaviour; identifying the activities performed in sitting and standing and identifying the barriers and facilitators towards reducing sedentary time.

Methods
Four focus groups with community-dwelling older adults aged ≥75 years were held between October–December 2022. Audio recordings and workshop notes were transcribed verbatim and inductive and deductive thematic analyses were conducted.

Results
Six community-dwelling older adults with a mean age of 83 were recruited. Group members were largely unaware of their sedentary behaviour, and the risk associated with prolonged sedentary behaviour. The activities performed in sitting and standing, and barriers and facilitators to reducing sedentary time were charted to the Capability Opportunity Motivation-Behaviour (COM-B). Analytical themes explored sedentary behaviour throughout older adulthood, the influence of sedentary behaviour on sleep, and the importance of social connectedness to reduce sedentary time.

Conclusions
This study provided novel insights into older adults’ reports of sedentary behaviour progressing throughout older adulthood. Sedentary behaviour in adults aged ≥75 years present similarly to a younger subset of older adults with regards to the activities performed in sitting, and the barriers and facilitators to reducing their sedentary time. However, the activities performed in sitting may be performed for longer, and the barriers to reducing sedentary behaviour may present more frequently. Social support appears valuable when attempting to reduce sedentary time, however, further research is necessary to explore the views of older adults who are socially isolated.
2250 A mixed-method feasibility study of an intervention to reduce sedentary behaviour in community-dwelling older adults aged ≥ 75 years
Authors: Tadrous R , Forster A , Farrin A , Coventry P , Clegg A 
Published: August 2024

Abstract

Introduction
Older adults are the fastest growing and most sedentary group in society. With sedentary behaviour associated with negative health outcomes, reducing sedentary time may improve overall wellbeing. This single-arm mixed-method feasibility study explored the acceptability of an intervention to reduce sedentary behaviour in community-dwelling older adults aged ≥75 years.

Methods
Participants were recruited from the Community Ageing Research 75+ Study (CARE75+) cohort, with factors such as age, frailty status, living arrangements and levels of sedentariness being considered. The intervention consisted of an educational booklet including advice on how to reduce sedentary behaviour, a smartwatch with a sedentary reminder function, educational group sessions and follow up phone calls. The 9-week intervention was conducted from June–August 2023. Reach, uptake, adherence, and adverse events were recorded, and the acceptability of the intervention was explored through semi-structured exit interviews.

Results
Of the 39 eligible participants, 10 consented (5 M:5F) and had a mean age 84.3 years. The intervention had an uptake and reach of 25.6%, and retention of 100%. No falls, hospitalisations or deaths occurred, and three cases of mild irritation were reported which resolved during the study. 100% adherence was observed for the group sessions and follow-up phone calls, and 65% for self-monitoring. Qualitative data suggests that participants were receptive of the intervention according to the domains of the Theoretical Framework of Acceptability, and suggestions were provided on refining the intervention components.

Conclusion
Strategies to reduce sedentary behaviour were tested on a diverse sample of community-dwelling older adults in the oldest old age group, with varying levels of sedentary behaviour and frailty status. The presented strategies appear to be acceptable, appropriate, safe, and high levels of adherence were observed. Participant feedback will be used to refine the intervention.
2352 Disease burden of respiratory syncytial virus (RSV) in adults 60+ in the United Kingdom: targeted literature review (TLR)
Authors: Malmenas M , Bayerl B , Carroll S , Desai M , Balogh O , Ahmed T 
Published: August 2024

Abstract

Introduction
It is increasingly clear that RSV infections in older adults significantly impact the UKs already strained public health system. However, the true burden remains underestimated (Korsten K, Eur Respir J, 2021, 57, 2,002,688; Sharp A, Influenza Other Respir Viruses, 2022, 16, 125–131). We conducted a TLR to scrutinise the available data and reveal evidence gaps.

Methods
A TLR search was conducted in OVID Medline, Embase, and ECON Lit to identify existing literature from Jan 2011-Aug 2023 and grey literature. Eligibility criteria were defined based on population (intervention/comparator (no limit), outcomes (clinical, epidemiological, economic and QoL) and limited to UK-only results.

Results
Despite the broad criteria, only 14 out of 1013 studies were included. Nine studies reported on epidemiological outcomes, one on epidemiology and costs, and four on model outcomes. Due to the small number of studies and the heterogeneity in study design and outcomes, it was not possible to draw reliable conclusions on incidence, prevalence, and mortality. One model paper showed that a hypothetical RSV vaccine could be cost effective in the UK, depending on incidence, vaccine effectiveness and cost. All identified studies emphasise the challenges in estimating the true burden due to limitations in testing and a lack of standardised disease definition in older adults. There is a lack of evidence for risk groups, particularly clinical and economic consequences for RSV patients at a higher risk of infection and severe sequelae.

Conclusion
Only a limited number of studies meeting the criteria focused on RSV infection in older adults were found, with nearly no data on risk groups and related cost. It is imperative that surveillance and testing are improved to understand the true burden. This will serve as a basis for evaluating cost-effectiveness and decisions on the most effective measures to lower the burden, including vaccination programmes.
2146 Evaluation of pulmonary hypertension by echocardiogram in geriatrics patients with SARSCOV2 from a Latin American cohort
Authors: Gomez MC , Gomez JA , Gomez JA , Castillo SF , Blanco EC , Dulcey LA , Ciliberti MP , Lizcano AP , Medina MJ , Estevez MJ , Hernandez CJ , Martínez JC , Acevedo DA , Arias AF , Gutierrez EY , Amaya MC , Ramos GS 
Published: August 2024

Abstract

Introduction
Pulmonary hypertension evaluated by echocardiography and ROX index in older patients with COVID-19 could be linked to worse outcomes.

Methods
We conducted a retrospective cohort of adult patients with COVID-19. The main objective was to evaluate pulmonary hypertension as an echocardiographic finding and its association with hard outcomes in patients with COVID-19 infection. In the inferential statistical analysis, the OR with confidence intervals greater than 95% was used as a measure of association. Qualitative variables were evaluated using the Chi square test or Fisher’s exact test. In quantitative variables, the Student’s T test, or Mann–Whitney test, was used.

Results
306 individuals with COVID-19 infection were included; the majority of these were men (78% vs. 22% women). Patients who died had lower ROX values at 2 hours compared to survivors (4,5 with a SD of 3,6–5,6, vs. 5,8 with a SD of 4,7–6,1, respectively). This trend was maintained at 12 hours (4,9 with a SD of 3,8–6,0 for deceased patients vs. 7,8 with a SD of 5,2–8,7 for survivors). For the ROX index at 2 hours, an OR adjusted for age and gender of 8,5 with a CI of 2,0–91,4 was found, and at 12 hours, an OR of 17,6 with a CI of 2,8–93,6 was found. Low values of the ROX index were associated with pulmonary hypertension (p = 0.048) and higher mortality (p = 0.037).

Conclusions
In patients with COVID-19, the presence of pulmonary hypertension estimated by ecocardiography and the ROX index is associated with worse outcomes, including a higher rate of comorbidities and mortality in patients over 70 years of age. Prospective studies with a more representative population sample are required to validate the results found here.
Effect of different durations of treatment with antihypertensive drugs with anticholinergic effects on the risk of dementia: a target trial emulation study
Authors: Aguado Jaume , Gutierrez Lia , Forns Joan , Vila-Guilera Julia , Rothman Kenneth J , García-Albéniz Xabier 
Published: August 2024

Abstract
Studying the effect of duration of treatment on prognostic outcomes using real-world data is challenging because only people who survive for a long time can receive a treatment for a long time. Specifying a target trial helps overcome such challenge. We aimed to estimate the effect of different durations of treatment with antihypertensive drugs with anticholinergic properties (AC AHT) on the risk of vascular dementia and Alzheimer’s disease by emulating a target trial using the UK CPRD GOLD database (2001-2017). Comparing treatment for 3-6 years vs ≤3 years yielded null results for both types of dementia. Comparing a longer duration of treatment, &gt;6 years vs ≤3 years, yielded a 10-year risk ratio of 0.69 (95% CI, 0.54-0.90) for vascular dementia and 0.91 (95% CI, 0.77-1.10) for Alzheimer’s disease. For illustration, we performed an analysis that failed to emulate a target trial by assigning exposure categories using postbaseline information, obtaining implausible beneficial estimates. Our findings indicate a modest benefit of longer duration of treatment with AC AHT on vascular dementia and highlight the value of the target trial emulation to avoid selection bias in the evaluation of the effect of different durations of treatment.
This article is part of a Special Collection on Pharmacoepidemiology.
Common Good Constitutionalism and the Individual—A Property Perspective
Authors: Walsh Rachael 
Published: August 2024

Abstract
This paper probes the position of the individual, and of their interests and rights, within a common good constitutionalism framework. To do so, it draws on long-running debates within property law and theory concerning the relative priority to be afforded to the individual and to the common good, with many of the concerns of Common Good Constitutionalism already in the mainstream of property law and theory. It compares debate about the existence, nature, and content of property’s “social function,” and its doctrinal manifestations, to Vermeule’s broad arguments about the common good dimensions of constitutionalism. Specifically, it analyzes the effectiveness and purpose of an “internal limitation” strategy, and the risk of excessive individual subordination to collective interests. Finally, it assesses how central a role coercive legal measures should play in encouraging virtuous conduct within a common good constitutionalism framework.
Confusing boundaries of the Labrador tea species: dispersal history explains the lack of clear species structure
Authors: Iunusova D R , Polezhaeva M A , Marchuk E A 
Published: August 2024

Abstract

Background and Aims
The Labrador teas (genus Rhododendron, subsection Ledum) are a complex of species widely distributed in the Northern Hemisphere. They occupy cold-resistant plant communities from highlands to forest understorey and wetland habitats almost circumboreally and they are especially abundant in Northeast Asia and northern North America, yet there are no clear species boundaries in this group. The genetic structure of species of subsect. Ledum from Eurasia and North America as well as the dispersal history of the group require clarification.

Methods
The phylogeny and biogeography of subsect. Ledum of the genus Rhododendron were assessed using phylogenetic trees constructed based on the analysis of variation in chloroplast petB-petD, trnV-ndhC, trnH-psbA, K2R-K707, atpB oligo2 – rbcL oligo5 and nuclear (ITS1) markers of four Eurasian and one American species (65 populations, 408 individuals). The data were evaluated with maximum parsimony and Bayesian analysis. Molecular dating and reconstruction of ancestral areas were performed.

Key Results
Dense sampling revealed widespread presence of shared haplotypes and ribotypes among Ledum populations and species. Two American, three mixed and one Eurasian lineage diversified during the Neogene climate cooling and then rapidly dispersed during the Pleistocene. The ability to accumulate high genetic diversity and to preserve it across distribution ranges and generations prevented Ledum from lineage sorting. As a result, a species complex with a reserve of genetic variability appeared.

Conclusions
Although no clear phylogenetic inference can be obtained at present, the plastid genealogy is consistent with the nuclear genealogy and demonstrates the processes involved in speciation in the Ledum species complex.