bluuebunny/crossref_metadata_2025_split huggingface dataset:
2341 Qualitative assessment of introducing bone health assessment for Parkinson’s disease patients in a university hospital setting
Authors: Challoner F , Cox C , Richards G , Amar K , Tiwari D 
Published: August 2024

Abstract

Introduction
Parkinson’s disease (PD) patients with or without psychosis are at higher risk of recurrent falls and fracture and, as a consequence, higher mortality and morbidity NICE (13) Henderson et al. (2019). We conducted a qualitative study to understand barriers and facilitators of introducing ‘bone health assessment’ for PD patients.

Method
We conducted a pilot study to identify and implement a bone health assessment tool to communicate falls and fracture risks to GPs. • SWOT and Stakeholder analysis was conducted to identify an appropriate bone health assessment tool. • PDSA cycles were completed to assess barriers and facilitators of bone health assessment in all PD clinical areas. • 4 Participants were identified from all possible PD clinical settings and trained on how to use the FRAX assessment tool. • Semi structured interviews were conducted to explore themes from 6-week pilot study.

Results
Bone health assessments were not conducted routinely in PD clinical settings in our Trust Literature review/SWOT and Stake holder analysis identified ‘FRAX’ score as an appropriate bone health assessment tool for PD patients. Interviews with participants identified time constraints during the clinical consultation as a major barrier to conducting bone health assessment using the FRAX assessment tool. All participants agreed that this improved communication with patients and GPs in understanding bone health and risk of falls and fractures. Face to face PD Nurse Clinics were deemed the most appropriate clinical settings for these assessments.

Conclusion
As a result of this service improvement project bone health is now assessed in all PD Nurse clinics. This has enabled GPs to start the most appropriate bone protection treatment for PD patients.
2317 Geriatrician-led perioperative services: an example of value-based care
Authors: Thorburn M , Liu L , Taylor N , Hodgson L , Redburn C , Thorburn P , Venn R 
Published: August 2024

Abstract

Background
Perioperative services must adapt to the needs of an increasingly older surgical population. Perioperative medicine for Older People undergoing Surgery (POPS) services integrate geriatric medicine teams into surgical pathways to provide quality and cost-effective medical care. This project aims to examine value-based outcomes (clinical and financial impact) of embedding a POPS service at a district general hospital.

Methods
Following a period of implementation on an acute Trauma and Orthopaedic (T&O) ward, a two-week pilot was undertaken. All emergency fragility fracture admissions aged over 65 years with Clinical Frailty Scores (CFS) of ≥5 were included. Patients with hip fractures were excluded. The POPS service provided medical consultation, medicine rationalisation, proactive treatment escalation planning and shared decision making, as well as leading multidisciplinary team meetings. Outcome metrics: geriatric medicine consults, medical emergency team (MET)/cardiac arrest calls, staff/patient satisfaction and clinical coding. The REDUCE trial cost calculator was used to estimate savings.

Results
35 patients were included, mean age 84 years, mean CFS score 7. Ward MET calls and cardiac arrest calls were reduced from a weekly average of 2.5 to 0, and weekly referrals to geriatric medicine reduced from 3 to 0. Experience-based design surveys identified thematic improvements relating to leadership, communication, dignity and respect. Improved quality of documentation resulted in the comorbidity score tariff increasing from £3325 to £6096 per patient. For services introduced by POPS including Comprehensive Geriatric Assessment and delirium assessments, the REDUCE trial cost calculator estimated an additional saving of £2926 per patient totalling hospital savings of £2 million per year (for an estimated 700 patients per year).

Conclusion
Implementation of a POPS service at a district general hospital can lead to cost savings, improved patient and staff experience, and improved clinical outcomes within a sustainable workforce model.
2203 Avoiding therapeutic nihilism in critically ill older adults: a single Centre approach to enhanced care in patients with frailty
Authors: Gavartin M , Jennings C , He F , Pleming J , Steel A , Carr E 
Published: August 2024

Abstract

Introduction
Enhanced care units (ECU) are a novel concept, targeting the gap between ward-level and critical care. They care for patients requiring intensive medical or nursing care, who may not require, desire, or be suitable for, escalation above ward care (Society of Acute Medicine and Intensive Care Society, 2022). The ECU at Barnet Hospital opened in March 2022, and, because of the local population demographic, admits a high number of older patients living with frailty. We aimed to assess the performance of the ECU for this subset of patients.

Methods
A retrospective audit of electronic records of 75 randomly selected patients admitted to ECU between March and August 2023. Data were gathered on Clinical Frailty Score (CFS) at baseline, comorbidity, escalation status, APACHE II illness severity score, and outcome measures.

Results
The majority of patients in the sample, 52 of 75 (69.3%), were over 65 years of age with an average of 69.1 years. Baseline frailty score was high, with a modal CFS of 6. Of these patients, 32 (61.5%) had a DNACPR, and 17 (32.7%) had treatment ceiling at ECU level. Illness severity was similar across CFS groups, with a mean APACHE II score of 15.2 (representing a 25% mortality risk). Overall mortality in the over 65 s was 23.1% (12/52), without significant change when stratified by CFS. Mortality in the under 65 s was 8.7% (2/23).

Conclusions
Acutely unwell patients with frailty may benefit from ECU level care. In our centre, we found no significant increase in mortality linked to a higher frailty score. We suggest that this may represent good case selection by clinicians experienced in working with frailty: admitting patients with more reversibility and targeting therapies towards reversible causes. Limitations remain, especially in assessing illness severity, as the assessment tools are not targeted to this cohort.
2216 Geriatric overactive bladder and botulinum toxin a: feasibility and tolerability in the outpatient setting under local anaesthetic
Authors: Lavigne A , Foley S , Evans K , Yang B 
Published: August 2024

Abstract

Introduction
Urinary incontinence significantly impacts the lives of older adults increasing their susceptibility to falls, social isolation and long term care Intravesical Botulinum Toxin A (Botox) offers a well-established treatment for overactive bladders in women. In select centres, it can be administered under local anaesthetic, allowing access for frailer patients at higher risk from general anaesthetic and in whom anti-muscarinic therapies are best avoided. This project performed an analysis of geriatric patients who underwent intravesical Botox under local anaesthetic in an outpatient setting and assessed the tolerability and feasibility.

Method
50 women (mean age 66, range 34–88) with overactive bladders underwent Botox administration in 2023. The procedure utilised local anaesthesia (Instillagel) while patients held a supine position with abducted hips on an outpatient couch. A LiNA OperaScope and injeTAK® needle facilitated administration. A sub-analysis focused on patients aged 75+. Pain levels were compared to past cervical smear experiences for reference.

Results
All 50 patients successfully completed the procedure. 15 were aged 75+ (mean 80.8, range 76–88), with 8 classified as ‘frail’ based on the Prisma 7 score (mean 2.3, range 0–5). The geriatric cohort reported lower average pain levels (1.8/10, range 1–3) compared to the non-geriatric group (2.2/10, range 1–5). Both groups pain perception was also lower than for past smears (2.9/10, range 1–4 vs. 3.4/10, range 1–7). Total ‘operative’ time was &lt;3 minutes for all patients. Two non-geriatric participants experienced post-procedure UTIs, successfully treated with oral antibiotics (Clavien-Dindo II).

Conclusion
Intravesical Botox under local anaesthesia demonstrated promise as a safe and well-tolerated treatment for geriatric patients with overactive bladder, where lower levels of pain were reported compared to their younger counterparts. Tolerability was also better than previous smear tests and notably offers a relatable and novel comparison point to facilitate clearer counselling for patients and their families regarding this procedure.
2285 Medicines and falls—what does the audience participation indicate about future learning needs?
Authors: Alićehajić-Bečić Ð , Smith H 
Published: August 2024

Abstract

Introduction
On behalf of National Falls Prevention Coordination Group, we were tasked with creating a user-friendly guide on Medicines and Falls. We delivered two sessions on this topic one at British Geriatric Society Conference in November 2022 and another to Specialist Pharmacy Service audience in January 2024.

Method
Audience participation was used in both sessions as part of the discussion on ‘What do you consider important when completing a medication review in a person who is at risk of falls?’ and ‘Which group of medicines do you prioritise for deprescribing discussion in patients at risk of falls?’. The results from slido contribution were analysed for trends and future learning needs.

Results
In the SPS audience, greater level of importance was imparted on individual drug classes when considering question of ‘what is important when reviewing a person at risk of falls’ with anticholinergic burden being quoted most frequently and patient goals being second. Reducing risk and patient goals were the two items which the BGS audience prioritised. In terms of groups of medication to prioritise for deprescribing discussion, SPS audience once again chose anticholinergic medication followed by sedatives while BGS categorised antihypertensives and diuretics most commonly.

Conclusion(s)
When completing falls medication reviews, medication groups were generally thought to be important by pharmacy-focused audience, with patient goals the second most important aspect whilst the BGS audience prioritised reducing risk and patient goals. There should be greater emphasis on managing risk as part of teaching offerings to teams where therapeutics is the core focus. In terms of groups of medications to deprescribe, better guidance around reviewing antihypertensives and diuretics would facilitate more effective falls medication reviews. The difference observed between prioritising anticholinergic burden reduction indicates that general geriatric audience would benefit from further awareness raising of their contribution to falls risk.
2150 Understanding the COTE lingo: a quality improvement project
Authors: Havard M , Sarto R , Rowlands S , Long S 
Published: August 2024

Abstract

Introduction
The terminology surrounding manual-handling equipment and discharge planning is rarely taught in medical school. Yet, it is crucial for medical staff, particularly those working on Care of the Elderly (COTE) wards, to comprehend these terms to accurately assess a patient’s function and optimise discharge planning.

Methods
A 17-question survey was distributed to establish the baseline knowledge of medical staff in a district general hospital, with the aim of using PDSA (plan, do, study, act) cycles for improvement as needed. Following preliminary data analysis, a lunchtime hospital teaching session was designed to educate individuals on these key terms and equipment. Ten clinicians attended and took part in a mentimeter quiz reassessing knowledge post-teaching.

Results
Seventeen participants, ranging from physician associates and junior doctors to consultants, completed the initial survey anonymously. Knowledge varied widely, with scores ranging from 15% to 91%. All participants accurately identified a Zimmer frame, 15 (88%) correctly labelled a PAT slide and 13 (76%) a hoist. Reassuringly, all knew that the acronym ‘POC’ stood for Package of Care. Poorly recognised equipment included turn discs, standing hoists and hover jacks. Furthermore, the term ‘reablement’ and the healthboard-specific ‘complex needs booklet’ lacked clear definitions. While many participants could define fast track discharge, they could not distinguish between the two types. The average score per question increased from 53% in the pre-teaching survey to 59% post-teaching, however this was not statistically significant (P = 0.57).

Conclusions
Although medical staff were familiar with certain equipment, they lacked understanding of more specialist aspects of discharge planning and less commonly used equipment. Unfortunately, these results did not significantly change post-teaching, likely due to low attendance; however, we are hopeful that the survey distribution and teaching will spark discussion throughout the hospital. We have now adapted the teaching content into posters for the next PDSA cycle.
2275 Enhancing delirium awareness among patients’ relatives: a quality improvement project in elderly care
Authors: MohdDaud WNM , Bharathi D , Blazy L , McKeever C , Ford J 
Published: August 2024

Abstract

Aim
This Quality Improvement Project (QIP) addressed the pressing need for increased awareness of delirium among patients’ relatives. With a 26% rise in the elderly population in Cambridgeshire, surpassing the 18.6% national average, the project provides crucial information to enhance patients’ relatives access to information about delirium, a condition affecting up to 50% of older hospitalised patients.

Method
This prospective QIP was conducted across seven Cambridge University Hospital (CUH) geriatric wards. Qualitative surveys determined delirium awareness, understanding, interest and perception of information availability among patients’ relatives with delirium. Measurements included data on the views of online Trust delirium information. Interventions included designing a new eye-catching delirium information poster with a QR code linked to the Trust delirium information leaflet, strategically placing QR code-enabled posters in wards, awareness campaigns targeting healthcare professionals, liaison with the inpatient Dementia team, and targeted communication at Dementia and Delirium Champion training sessions for nursing and healthcare staff.

Results
Pre- and post-intervention questionnaires, involving 13 relatives visiting these wards, showed a 16%, 10% and 20% respective increase in respondents’ awareness, understanding, and interest in delirium. There was a 29% increase in awareness of location of delirium information post intervention. After the interventions, views of the Trust delirium website increased by 132%. Cycles of the QIP highlighted the importance of laminated posters to comply with infection control measures and the need liaison with ward teams about strategic poster placement.

Conclusion
this QIP successfully demonstrated the effectiveness of QR code enabled access to patient/relative information and that a multi-faceted approach is required to facilitate effective information provision. We also demonstrated these measures increased delirium awareness in relatives. Future recommendations include continuous monitoring of the availability of posters within clinical areas, content evaluation, and work with the Dementia team to roll this out to all wards with older people within Trust.
2342 A comprehensive profile of a retrospective care home cohort using linked health and social care data
Authors: Knight M , Clegg A , Todd O 
Published: August 2024

Abstract

Introduction
Many UK care home (CH) residents live with multiple long-term conditions, leading to high levels of healthcare utilisation. Previous studies have used routine data to describe their health and social care characteristics separately. Accurately identifying when an individual is admitted to a CH from routine data is challenging. This study aims to provide a combined health and social care profile of a cohort of long-stay CH residents, at the point of admission, using linked primary, secondary and social care data.

Methods
Individuals aged 65 and over registered to a GP practice contributing to the ‘Connected Bradford’ dataset who were admitted to a CH between January 2016 and December 2019 were included. Start and end dates for social care packages (nursing and residential) were identified from local authority social care data. Respite and reablement packages were excluded. Complete self-funders were not identified with this method. Linked secondary and primary care data were used to describe health characteristics. CH residents identified using primary care records and local authority data will be compared.

Results
2801 individuals were admitted to a CH during the study period of whom 2048 (73%) were long-stay residents (&gt;6 weeks). Only 70% of participants identified using local authority data, had a primary care code indicating CH residency in their primary care records. Median length of stay was 272 days (IQR 63 to 480). Mean age at admission was 85 years (SD 8), median Index of Multiple Deprivation decile five. 59% of residents required nursing care from admission. 79% of individuals were taking 5 or more medications.

Conclusions
Using local authority data offers a novel way to identify and characterise CH residents. Linkage of primary care records to local authority data improves identification of CH residents using routine data. Additional linkage with address history would further improve accuracy.
2293 Targeted geriatric assessment in the emergency department: does it make a difference?
Authors: Barrera VC , Kee JXL , Tan-Patanao RT , Koh XY , Loi FC , Seah CYE , Mon HT , Rosario BH 
Published: August 2024

Abstract

Introduction
Older people represent between 21 to 40% of Emergency Department (ED) users and proportionally use more ED services than any other age group.

Method
Retrospective review was undertaken from 13th January 2022 until 23rd December 2022 in older patients discharged from the ED ambulatory area following a targeted geriatric assessment and recommended follow-up interventions at the geriatric clinic. Two groups were identified, those compliant to follow-up interventions (GpC) and those that defaulted (GpD). Demographic information, hospital utilisation and mortality (up to one year), and any post-visit fragility fractures were reviewed. Data collection included identification of osteoporosis or osteopenia and cognitive decline during or following the visit and findings were compared across the 2 groups.

Results
137 patients were reviewed, and 79 patients (58%) compliant to geriatric follow-up (GpC) and 58 patients (42%) non-compliant (GpD). Age and sex were similar, 80 vs 80 years, range 65–98 years and female s 58% vs 62%. ED 7-day re-attendances were similar, 9% vs 12%, but 30-day hospital admissions were lower 10% vs 16%, although 1 year ED attendances were higher in the compliant group, 56% vs 45%, which did not translate to more 1 year hospital admissions 35% vs 33%. Mortality was 11% vs 14%. More patients were identified as having osteoporosis 30% vs 21% or high-risk osteopenia 18% vs 9%, and a larger number of patients had unevaluated bone health in the non-compliant group 19% vs 47%. However, fragility fractures were similar, 9% vs 7%. AMT was 7.94 vs 5.02, range 0–10 and cognitive impairment identified in 43% vs 33%, with dementia in 24% vs 14%, Mild Cognitive Impairment in 15% vs 7% and suspected but not evaluated in 4% vs 12%.

Conclusion
Targeted geriatric assessment has shown earlier and improved identification of underlying frailty and geriatric syndromes.
2224 What are we teaching UK medical students about ageing? Results of the third BGS national curriculum survey
Authors: Watson A , Pearson GME , Fisher G , Redgrave M , Khoshnaghsh A , Winter R , Masud T , Blundell A , Gordon AL , Henderson EJ 
Published: August 2024

Abstract

Introduction
The ageing population means all doctors, regardless of specialty, will need knowledge, skills, and attitudes to care for older people with complex health conditions. An essential component of preparing the medical workforce to best care for older people is by including teaching on ageing and geriatric medicine in undergraduate medical curricula. Here we present results of the British Geriatrics Society (BGS) national curriculum survey 2021–22, highlighting progress made in undergraduate teaching in geriatric medicine.

Methods
All 35 UK GMC-registered medical schools at the time of data collection were invited to participate in an online survey on content, methodology, timing, and duration of teaching in ageing and geriatric medicine. The survey was structured around the 2013 BGS recommended undergraduate curriculum, for consistency with previous surveys.

Results
30/35 of UK medical schools responded (83% response rate). Most teaching occurred in the fourth year of study (21/30, 70%). The majority (15/30, 50%) reported a discrete module for geriatric medicine lasting 4–8 weeks, an increase on previous surveys. However, several programmes have reduced the amount of in-person teaching since the COVID-19 pandemic. Notably, three schools reported geriatric medicine exposure lasting &gt;12 weeks. Of these, two were integrated clerkships and one a dedicated geriatric medicine module. There is increasing focus on multidisciplinary education, with emphasis on combining virtual or simulated teaching with other healthcare professions (n = 7). Every school (n = 30) taught at least one topic as small-group or case-based learning.

Conclusion
There is a trend towards increasing exposure to geriatric medicine compared to previous surveys in 2008 and 2013. However, several of the programmes reporting greater exposure incorporate geriatric medicine in an integrated clerkship rather than as a dedicated module. Programmes demonstrated a move from didactic teaching towards small-group and case-based learning, employing a wider variety of assessment methods than previous.
2165 Barriers perceived by medical students when considering a career in geriatric medicine.
Authors: Fisher G , True S 
Published: August 2024

Abstract

Introduction
Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality.

Method
The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine.

Results
Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly.

Conclusion
The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians. We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.