bluuebunny/crossref_metadata_2025_split huggingface dataset:
2297 Impact of creation and subsequent expansion of the acute frailty team at Queen Elizabeth Hospital, Gateshead on patient outcomes
Authors: Brock P , Filler H , Frost L , Maughan K 
Published: August 2024

Abstract

Introduction
An Acute Frailty Team pilot was launched in December 2022 at the QEH. The aim was to reduce unnecessary hospital admissions and length of stay (LOS) by providing interventions in the Emergency Admissions Unit (EAU), through comprehensive geriatric assessment. Following the pilot’s success additional recruitment was made to the multi-disciplinary team (MDT) and the service revaluated. The MDT consists of a Consultant Geriatrician, Specialist Frailty Practitioner, Frailty Fellow, Physiotherapist, Technical Instructor, Occupational Therapist, and Pharmacist.

Method
To allow comparisons a pre-pilot control group audit of 100 patients ≥65 with a clinical frailty score &gt; 5 was undertaken. This data has subsequently then been compared to a phase-1 (Consultant Geriatrician, Specialist Frailty Practitioner team) audit of 121 patients and a phase-2 (full MDT) audit of 133 patients with the same parameters.

Results
The creation and expansion of the acute frailty team has reduced the average length of stay from 13.8 days, pre-pilot, to 9.4 days in phase-1 and subsequently been maintained at 9.56 days during phase-2. More frail patients are now being discharged from the emergency admission unit (EAU). Pre-pilot 7% of patients were discharged from EAU, increasing to 13% during phase-1 and 18.75% phase-2. 16% of patients were originally discharged within 72 hours of admission, this increased to 20% during phase-1 and 24.81% phase-2. This is also reflected in 7-day discharge data (37%, to 39% to 44.36%).

Conclusion(s)
MDT expansion of the acute frailty team at the QEH has resulted in improved recognition and holistic assessment of frail patients’ needs and reduced their length of stay.
2349 How to provide a cost-effective geriatric peri-operative service within general surgery in line with NELA BPT
Authors: Sabbagh H , Abu A , Peck G , Reese G , Koizia L 
Published: August 2024

Abstract

Introduction
More than 50% of patients undergoing emergency general surgery are &gt;65 years. The Emergency Laparotomy and Frailty (ELF) study showed strong associations between frailty (CFS ≥ 5) and increased mortality, risks of complications, and length of hospital stay.

Methods
For nearly 10 years, we have had geriatric liaison input for general surgery and colorectal patients in a tertiary teaching centre. This has transformed into a fully embedded service involving consultant geriatrician, registrars and senior house offices, providing 3-day a week medical input. NELA best practice tariff (BPT) April 2023 emphasises perioperative Geriatric team involvement in frail patients aged 65 and above. The main metrics include CFS, an MDT-based risk assessment, treatment escalation decision making and perioperative geriatrician involvement.

Results
The service has previously demonstrated significant improvement in patient care and holistic management including reducing the length of stay in hospital (average decrease of 5.5 days). Simple job planning, use of current resources and efficiency can mean Trusts can incorporate geriatricians with essential skills to improve patient management and reach NELA BPT.

Conclusion
Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Introducing a multidisciplinary geriatric liaison service into the general surgical department can achieve high levels of compliance with national guidelines, resulting in better outcomes for patients as well as financial benefits for Trusts. This is particularly pertinent given the financial constraints on many services across the NHS, this is an opportunity to increase revenue and build a geriatric workforce.
2311 Doing nothing is NOT an option—successful collaboration as part of wider quality improvement exercise in frailty services
Authors: Acharya J , Manzoor A , Lisk R , Mahmood R 
Published: August 2024

Abstract

Introduction
Population is growing old worldwide and UK is no exception. Health service models designed to cater the needs of service users are under immense pressure due to the ageing phenomenon. With unprecedented demand, their often low acuity, hence low priority and delayed conveyance to hospital and unavailability of services to address their needs due to delayed arrival; frail older patients often have to wait longer in emergency department (ED) to receive care in ED. Innovation and news models of care are therefore need of the hour to address this challenging situation.

Methods
Quality improvement initiative to establish acute frailty service. Development of Older Person assessment unit (OPAU) in Oct 2022 with already established and functional acute frailty team. Plan for direct referral to OPAU from South East coast ambulance service (SECAmb) colleagues. Weekly meetings with SECAmb. Geriatrician of the Day supporting alternative pathways instead of ED. Development of frailty poster with criteria to referral and uploaded on SECAmb work iPads, displayed in ambulances delivery area and ambulance queuing area inside the hospital. Single point of access phone number launched April 2023 to access frailty team & other alternative services from outside the hospital. SECAmb webinar for education and awareness of alternative pathways (UCR, SDEC, frailty, virtual ward), attended by 40 front line SECAMB staff.

Results
October 2022–0 patients. November 2022–2 patients. December 2022–8 patients. January 2023–18 patients. February 2023–32 patients. March 2023–33 patients. April 2023–39 patients.

Conclusion
With sustained efforts and effective collaboration, number of patients being referred to alternate pathway (frailty team) are increasing with anticipated significant reduction to SECAmb conveyance to ED in the long run, addressing overcrowding issues.
2259 Assessing antibiotic usage on a geriatric ward
Authors: Truman M , Ajibola I , Tan W , Rawoo R 
Published: August 2024

Abstract

Introduction
The World Health Organisation lists antibiotic resistance as one of the biggest threats to global health [1]. We contribute to this as clinicians, through errors such as delayed review of prescriptions or prescribing against local trust guidelines.

Method
We have carried out a quality improvement project to improve antibiotic prescriptions on a geriatric ward at Croydon University Hospital. We carried out a fortnightly cross-sectional analysis of the antibiotic prescriptions on a geriatric ward. This included looking at the antibiotic prescribed, indication, duration, route of administration and presence of a review date. These were then compared to trust guidelines. After the first 8-weeks, we delivered a departmental teaching session on antibiotic prescriptions. We then re-audited the prescriptions. Following this, we sent out weekly email reminders on locating trust guidelines and information on prescriptions. We then re-audited following this. Finally, we created an e-learning resource to deliver to the ward on antibiotic prescriptions. We are planning to deliver this to the ward and re-audit afterwards.

Results
Initially, up to 90.0% of prescriptions differed from trust guidelines. Common reasons for differences when compared included incorrect drug prescribed, incorrect frequency of dosing, or non-specific indications leading to difficulty comparing. Following all interventions, approximately 32% of prescriptions differed from trust guidelines. This showed sustained improvement across 2 complete PDSA cycles (plan, do, study, act). A 3rd PDSA cycle is ongoing at present and preliminary data has shown approximately 28% of prescriptions differed from trust guidelines.

Conclusion
This quality improvement project has successfully contributed to a reduction in prescription errors and safe prescribing. We will continue to provide information to our colleagues on antibiotic stewardship, to further encourage safe prescribing. [1]. Antibiotic resistance (2020) World Health Organisation. Available at: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance (Accessed: May 2023).
2322 Passing the baton from emergency visit to community care: factors that impact delivery of targeted geriatric care?
Authors: Espelata WDV , Kee JXL , Koh XY , Loi FC , Ang ASH , Rosario BH 
Published: August 2024

Abstract

Introduction
Older patients attending the Emergency Department (ED) and discharged home are at higher risk of adverse outcomes. Geriatric Ambulatory ED services were developed with the aim to deliver goal-directed care of older patients from ED using onward referral to Community Providers.

Method
A retrospective review was undertaken from 13th January 2022 to 23rd December 2022 in older patients discharged from the ED following a targeted geriatric assessment and recommended community follow-up interventions. Demographic information, functional ability, hospital utilisation and mortality (up to one year), and any post-visit fragility fractures were reviewed. Data collection included identification of osteoporosis or osteopenia during or following the index ED visit.

Results
108 patients were assessed, of whom, 74% were female, average age 76 years, range 61–93 years. 65% of patients were CFS scored, 9% were CFS 6 or 7, 15% CFS 4 or 5 and 41% CFS 1–3. GP review was advised for 76% of patients and 61% attended and therapy interventions were recommended for 9.3%, of whom, 3% attended. The majority presented with falls (82%) and half of those who fell, sustained a fracture. Osteoporosis or osteopenia was newly identified in 30% but in 44% of patients bone health remained unevaluated and only 8% had newly initiated anti-resorptive and 9% existing treatment. 4% experienced fragility fracture following their ED visit. Uptake was low for therapy (30%) and nursing interventions (14%). Following the index ED visit, 7% patients attended ED within 7-days, and 5% admitted to hospital within 30-days. 35% of patients re-attended ED and 22% were hospitalised within one year. One year mortality was 5%.

Conclusion
ED targeted geriatric assessment can identify patients with falls and fragility fractures but better collaboration and communication between primary and secondary care is needed. Recommended bone health assessment occurred in a relatively small proportion of patients.
2289 The association of heart rate and cholinesterase inhibitor use among elders living with dementia: a retrospective cohort study
Authors: Siramongkholkarn S , Suwanlilkit Y , Chongprasertpon R , Ungprasert P , Thanapluetiwong S 
Published: August 2024

Abstract

Introduction
Cholinesterase inhibitors (ChEIs) are the primary medication for dementia treatment. Bradycardia is a potential adverse effect associated with ChEIs. However, the relationship between ChEIs and bradycardia has not been definitively established, particularly in the Asian population. We conducted a study investigating the association between ChEIs and heart rate.

Methods
We retrieved data from electronic medical records (EMR) of patients aged over 60 who were diagnosed with mild cognitive impairment or dementia at Ramathibodi Hospital between January 2009 and December 2022. These patients had outpatient records at 3, 6, and 12 months after the diagnosis. After filtering out by eligibility criterias, patients were categorised into ChEIs and non-ChEIs use, and then were 1:1 matched by baseline characteristics. We compared heart rate changes between the groups using Student’s t-tests or Mann Whitney U test depending on their distribution and Bayesian linear regression. Bradycardia was analysed using Kaplan–Meier Estimates and Cox proportional hazards model.

Results
790 eligible patients were included, with 395 patients in each group. The median of difference of changes from baseline heart rate between group were − 0.5 BPM (p = 0.06), −1.5 BPM (p = 0.12), and − 1.5 BPM (p = 0.002) at 3, 6, and 12 months, respectively. The bradycardia incidence was higher in the ChEIs group (38.5%) compared with the non-ChEIs group (30.6%) at 12 months, but this difference was not statistically significant (p = 0.2). Among all regarded variables, baseline heart rate, age and beta-blocker usage associated with bradycardia, with adjusted hazard ratios (aHR) = 0.888 (95% CI 0.873–0.904, p &lt; 0.001), 1.019 (95% CI 1.001–1.037, p = 0.035) and 1.334 (95% CI 1.045–1.703, p = 0.021).

Conclusions
The use of ChEIs was found to be associated with a decrease in heart rate. However, the changes were minimal and may not have had clinical implications for the patient.
2142 Shared decision-making on treatment escalation planning in the acute medical setting for older patients: a qualitative study
Authors: Warner BE , Wells M , Vindrola-Padros C , Brett SJ 
Published: August 2024

Abstract

Introduction
Shared Decision-Making (SDM) is increasingly expected in most aspects of UK medical practice and can be particularly important for older patients to guide goals of care. Treatment Escalation Plans (TEP) summarise medical intervention to be attempted in the event of acute deterioration. Current guidance advocates SDM in TEP but it is unclear whether this is considered practicable by clinicians. This study aims to understand clinicians’ perspectives on SDM in TEP for older patients in the acute medical setting.

Methods
This was a qualitative study following a relativist constructivist approach. 26 consultant and registrar doctors were recruited from general internal medicine, intensive care, palliative care and emergency medicine. A clinical doctoral student conducted semi-structured interviews including vignettes of older multi-morbid patients with capacity to discuss treatment escalation. Reflexive thematic analysis was performed. Ethics approvals were obtained from the Health Research Authority 22/HRA/4387.

Results
Three themes were generated: ‘An unequal partnership’, ‘Options without equipoise’ and ‘Decisions with shared understanding’. SDM incorporating patient preferences with clinical opinion was seldom perceived to be appropriate. Clinical complexity and use of intuition, together with lack of perceived moral equipoise, motivated clinicians to develop medically acceptable TEPs. Shared understanding with the patient and family and avoiding conflict were important.

Conclusions
Contrary to current guidance, SDM was considered a potential barrier to formulating appropriate TEPs in the acute medical setting. This study suggests potential incompatibility between policies prioritising patient autonomy and the right to make unwise decisions, and those stating clinicians’ prerogative to determine realistic chance of treatment success and not provide intervention considered medically inappropriate.
2252 Competencies required by all hospital doctors caring for older adults: a group concept mapping study
Authors: Buckley E , Barrett A , Bennett D , O'Tuathaigh C , Cooke J 
Published: August 2024

Abstract

Introduction
It is increasingly recognised that for the foreseeable future most hospital inpatient contacts with older adults will be completed by doctors not specifically trained in geriatric medicine. To guarantee the delivery of sufficient healthcare, it is essential that every hospital doctor is equipped with geriatric medicine competencies. Which exact competencies are required and how they should be prioritised for hospital doctors serving the older adult population remains unclear. Allowing for the broad, complex and multidisciplinary nature of geriatric medicine, we carried out a group concept mapping (GCM) study to determine the geriatric medicine competencies required by all hospital doctors.

Methods
GCM is a mixed methods approach utilising six phases to generate expert group consensus, enabling participants to organise and represent their ideas in order to identify a common understanding about competencies required by all hospital doctors. Healthcare professionals, patient advocacy groups and clinical educators generated and sorted ideas and then rated identified competencies. Hierarchical cluster analysis and multi-dimensional scaling were utilised to analyse participant input.

Results
Thirty-four stakeholders generated 88 competencies. Twenty completed the subsequent sorting and rating of competencies. Nine competency domains were identified by participants as integral for all hospital doctors to care for older adults: communication skills, medicolegal affairs, prescribing, delirium, falls and bone health, engaging specialist services, universal principles of care, managing hospitalisation and components of specialist gerontology. Domains rated most important related to interpersonal communication skills, medicolegal concerns, recognition, and management of delirium.

Conclusion
The nine competency domains indicate the diverse skillset required by all doctors to provide comprehensive care to older adults within a hospital setting. This study identifies competencies that may serve as a foundational framework for ensuring quality healthcare for the ageing population. Future initiatives should consider incorporating these competencies to improve inpatient care provided by hospital doctors to older adults.
2144 Improving PA students confidence in managing geriatric patients with a bespoke teaching programme and a novel bleep simulation
Authors: Thompson L 
Published: August 2024

Abstract

Introduction
BGS reports in its ‘Case for more Geriatricians’ that the number of people age over 85 is set to double by 2045. As well as Geriatric specific policies in the Ageing Well programme of the NHS Longterm Workforce Plan there are plans to expand the number of allied health professionals including Physician Associates (PA). We set out to improve PA students’ knowledge of and confidence in managing geriatric patients with a bespoke teaching programme culminating in a novel bleep simulation.

Methods
We identified the students’ needs with a preliminary survey and then created a teaching programme on medical topics and issues common to geriatric wards with weekly lectures and small group work. The programme culminated in a bleep simulation where students were contacted via bleep to come to different parts of the medical education centre and respond to scenarios which would be common on geriatric wards. These included reviewing unwell patients and issues such as aspiration, constipation and urinary retention. The students were required to amend or create prescriptions and interpret test results with access to the BNF and relevant local guidelines.

Results
Students were asked how useful the simulation was and how much it had improved their confidence in working on geriatric wards. The average score for both statements was greater than 9/10. The students were asked before and after the simulation how confident they were responding to bleeps and managing clinical scenarios in geriatric patients. Both scores doubled following the simulation to 6.7/10 (from 2.5 and 3.3 respectively).

Conclusion
The Faculty of Physician Associates curriculum does not necessitate placements in geriatrics and its matrix of core clinical conditions does not include any specific to geriatrics. Through a bespoke teaching programme and a novel bleep simulation we increased PA students’ confidence in managing geriatric patients.
2234 Temporal trends in Parkinson’s disease-related mortality from 1999–2020: a Nationwide cohort study
Authors: Sokhal BS , Menon SPK , Shepherd T , Muller S , Arora A , Mallen C 
Published: August 2024

Abstract

Introduction
Parkinson’s disease (PD) is the most common neurodegenerative movement disorder and is associated with significant disability. The prevalence of PD is increasing and the literature demonstrates potential sex and race disparities in patient outcomes. There is a paucity of data about the demographic trends in PD-related mortality in the United States (US). This descriptive study aimed to report the national demographic trends in PD-related mortality over a 20-year period.

Methods
From January 1999 to December 2020, the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC-WONDER) Underlying Cause of Death database was queried. Data were extracted to determine the PD-related age adjusted mortality rate (AAMR) stratified by age, sex, ethnicity and geographic area, with the 1999 deaths as the reference group. Annual percentage change (APC) for AAMR was then calculated using Joinpoint regression.

Results
From 1999 to 2020, there were 515,884 PD-related deaths in the study period. AAMR increased from 5.3 per 100,000 population in 1999 to 9.8 per 100,000 in 2020. Males had consistently higher AAMR than females and white race had consistently higher overall AAMR (7.6 per 100,000), followed by American Indians/Alaska Natives (4.4 per 100,000), Asians/Pacific Islanders (4.1 per 100,000) and Black/African Americans (3.4 per 100,000). The Midwest had the highest AAMR followed by West, South and Northeast. Utah, Idaho and Minnesota had the highest state-level AAMR.

Conclusion
This study using a national dataset identified significant age, sex, race and geographic disparities in PD-related mortality in the US. Older age, male sex, white race and Midwest locality were associated with the highest AAMR.
2235 National Trends in motor neurone disease-associated mortality from 1999–2020
Authors: Imantalab D , Sokhal BS , Menon SPK , Kara S , Muller S , Mallen C 
Published: August 2024

Abstract

Introduction
Motor Neurone Disease (MND) is a neurodegenerative condition affecting the spinal cord and brainstem, commonly associated with a reduced life expectancy. This study describes demographic trends in MND-associated mortality in the United States over 20 years.

Methods
Data were extracted from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research Underlying Cause of Death database. Death certificates from 1999–2020 with MND (International Classification of Diseases-10th Revision code G12.2) recorded as the cause of mortality were extracted and annual MND-associated crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 persons with 95% confidence intervals (CI) were calculated. Joinpoint regression was used to calculate the annual trends in MND-associated mortality by calculating the annual percentage change.

Results
Between 1999 to 2020, there were a total of 140,945 MND-associated deaths. Overall AAMR was 1.9 per 100,000 persons (95% CI 1.9–1.9). Male sex had a consistently higher AAMR (2.3 per 100,000 95% CI 2.3–2.3) than female sex (1.6 per 100,000 95% CI 1.5–1.6). White patients had higher AAMR (2.1 per 100,000 95% CI 2.0–2.1) than Black/African Americans (1.1 per 100,000 95% CI 1.0–1.1), American Indians/Alaska Natives (0.8 per 100,000 95% CI 0.7–0.9), Asians/Pacific Islanders (0.8 per 100,000 95% CI 0.7–0.9). The 3 US States with the highest AAMR were Vermont, followed by Minnesota and Maine.

Conclusions
This national study demonstrates that there were a significant number of MND-associated deaths in the United States, with higher rates associated with certain patient demographics. The knowledge of these trends facilitates the design of appropriate services in areas of higher need, allowing for the introduction of pathways that support more suitable care and enhanced quality of life.