bluuebunny/crossref_metadata_2025_split huggingface dataset:
2004 How confident are we in decision making? The quantitative analysis of ambulance response to older adult fallers: A pilot survey
Authors: Gunson I , Bullock L , Kingstone T , Bucknall M 
Published: January 2024

Abstract

Introduction
The number one reason for older people to be taken to hospital emergency departments is a fall1. An “Ambulance Improvement Programme Pillar”2 is trying to reduce conveyance to hospital for falls, however it is not understood how the attending clinician’s confidence impacts decision-making. The objectives were to assess recruitment rate and feasibility of online survey delivery, and determine the experiences and confidence of frontline emergency clinicians in attending older adults who have fallen.

Method
Online cross-sectional survey, undertaken in one English ambulance service in May 2023. Items included participant demographics and 5-point Likert scales of confidence. Data were summarised using descriptive statistics and Chi-square analyses to compare confidence between localities and years’ experience.

Results
81 responses were received from across the regional ambulance service’s 16 localities, supporting online survey delivery to be feasible in this population. 76% of respondents were paramedics, and 53% were aged 25-34. 60% of respondents rated being ‘Somewhat confident’ in assessing older adults who have fallen, with responses ranging between ‘Neither confident nor unconfident’ to ‘Completely confident’. No significant difference was found between the locality and confidence levels for assessing this patient population. However, there appeared to be significant variation between confidence levels relating to utilisation of hospital pathways and localities (p-value=.0045). Length of experience in both frontline ambulance and overall healthcare provision was not significantly associated with different levels of confidence.

Conclusion
Online survey delivery is an effective method in this population. Locality of work had a relationship with confidence in utilising hospital avoidance pathways, however, it did not relate to assessing this population. Confidence levels were not found to be related to the number of years providing care.

References
1. Dewhirst. (2023). National Falls Prevention Coordination Group. https://committees.parliament.uk/writtenevidence/117837/pdf/
2. NHS England and NHS Improvement. (2019). Ambulance Improvement Programme. https://www.england.nhs.uk/wp-content/uploads/2019/09/planning-to-safetly-reduce-avoidable-conveyance-v4.0.pdf
2005 How do emergency ambulance clinicians decide what to do for older adults who have fallen? An analysis of qualitative survey data
Authors: Gunson I , Bullock L , Kingstone T , Bucknall M 
Published: January 2024

Abstract

Introduction
Around 10% of calls received by English ambulance services are for older adults who have fallen1; with an ageing population there are significant care provision needs. Decision-making on the treatment for people who fall, can impact their future physical and mental health. Previous research in decision-making of ambulance staff found perception of role, confidence, service demands and training to be key drivers2. The previous work highlighting drivers, but not the experiences that explain why they occur, leads this study aim to determine the experiences and confidence of frontline emergency clinicians in attending older adults who have fallen.

Method
Online cross-sectional survey of frontline emergency clinicians from one English ambulance service in May 2023. Open questions generated qualitative data for thematic analysis3. Ethical and regulatory approvals, and informed consent, were obtained. Results: 81 participants completed the survey. Analysis identified three themes. Care Provision: Provision of hospital avoidance pathways varies throughout the region. Concerns arose from not knowing what different areas had and reduced accessibility out of hours. Communication: Decision-making confidence was impacted by the participants’ experiences; positive experiences encouraged use of hospital avoidance pathways, whilst negative experiences impeded willingness to avoid hospital for fear of repercussion. Shared Decision-Making: Patients, family and clinicians were all valued as part of shared decision-making, with past feedback on decision-making informing future practice.

Conclusion
Confidence of frontline ambulance staff was impacted by the challenge of a regional and 24/7 ambulance service not having consistent pathways available. This variation led to concerns when responding to patients outside of the clinician’s usual area, and further challenges ambulance clinicians must balance in their practice.

References
1. Snooks, Anthony, Chatters. et al. Health Technology Assessment 2017; 21: 1–218.
2. Simpson, Thomas, Bendall. et al. BMC Health Services Research. 2017; 17: 299.
3. Braun and Clarke. (2022) Thematic Analysis: A practical guide.
2075 Systematic review of ‘Ageing well’ interventions to improve and maintain independent living for community housebound populations
Authors: Thomas D , Voss S , Hoskins R 
Published: January 2024

Abstract

Introduction
The housebound population are growing in number, with a large proportion living rurally or in coastal areas, which increases the risks of isolation and health inequalities. This population are an under researched and underserved group (Public Health England, 2019). Being unable to leave the home is a factor for living in the poorest of health, which contributes to advancing levels of frailty, Curtis et al (2018). Considering the current focus of empowerment to ‘age well’ (NHS England Long Term Plan, 2019), a granular understanding of community focused ageing well interventions is the focus of this systematic review to empower clinicians to ‘make every contact count’ (NHS England 2020).

Method
A narrative evidence review of findings has been completed entitled ‘ageing well interventions to improve and maintain independent living for community housebound populations.’ The review was registered with PROSPERO international prospective register of systematic reviews (CRD 42022371047) and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA). Data screening was undertaken by two reviewers at each stage to ensure accuracy, quality, and reliability.

Results
The results have identified key health interventions designed and delivered by community clinicians, including benefits of exercise, medication review, oral health, and health empowerment to improve outcomes for the housebound population. The results have outlined a total of twenty-nine outcome measures, which have been examined intrinsically and extrinsically to explore greatest impact for housebound health.

Conclusion
At the time of the Autumn conference, the research study will have completed the systematic review and be able to present findings to illustrate areas of intervention synthesized for the target population. Key to this will be understanding application, effectiveness, and generalizability for community delivery. The poster presentation will share progress of the wider study with opportunities to take part in the next Delphi panel stage.
1892 Non-governmental organisations’ digital engagement in providing services for older people's needs: a scoping review
Authors: Bhattacharjee S , Kebede A , Raja M , Sandic-Spaho R , Uhrenfeldt L , Kymre I G , Galvin K 
Published: January 2024

Abstract

Introduction
Digital technologies can play a significant role in addressing care needs of older people. The process of establishing an effective and efficient digital engagement with older people demands multi-sectoral collaboration from various stakeholders including non-governmental organisations. The role non-governmental organisations play in such digital programs, their process of engagement with older people and factors which influence such multi-sectoral collaboration is an under researched area.

Methods
A scoping review was performed to map existing literature on older people’s engagement with digital health technologies delivered through NGOs. The focus was on exploring the factors influencing the process of digital engagement, delineating modes of digital engagement and exploring the caring needs of older people. Multiple databases and grey literature sources were searched to retrieve articles from 2000 till 2023. JBI methodology for scoping reviews was adopted for this review.

Results
Out of 8970 citations, 50 articles (27 original articles, 9 reports, 12 website sources, 1 handbook and 1 research summary) were included in the final review. NGOs engage with older people either directly by delivering the program or indirectly through other program stakeholders through various inter-organisational processes (collaboration, co-ordination, partnership, delegation, sector-wide participation and association). Different types of NGOs (national, regional, provincial and local) were involved in this process of delivering care. Majority of the studies implemented programs through smartphone or tablet based digital applications. Individual factors, organisational factors, technological factors and system-wide factors influence the process of digital engagement between older people and NGOs.

Conclusion
The number of studies included in this scoping review, concerning older people’s engagement with digital health technologies, through NGOs were informative, but limited information was present on the process of engagement. Acknowledgement of NGOs work, and the societal role they play do also indicate that our developing digital societies more or less depend on these organisations.
1947 Process evaluation of a home-based intervention to promote independence among older people living with mild frailty
Authors: Barrado-Martín Y , Frost R , Catchpole J , Rookes T , Gibson S , Hopkins J , Gardner B , Gould R , Chadwick P , Jowett C , Kumar R , Drennan V M , Elaswarapu R , Kharicha K , Avgerinou C , Marston L , Walters K 
Published: January 2024

Abstract

Introduction
Frailty is a condition that makes it increasingly difficult for individuals to recover from adverse health events and gradually erodes independence. NHS interventions in England have focused on those with more severe frailty. We tested HomeHealth, a home-based, tailored, multi-domain (six-session) behaviour change intervention to promote independence in the over-65s living with mild frailty, in a RCT recruiting 388 people (intervention 195; control 193). HomeHealth was delivered by the voluntary sector in three diverse areas and addressed mobility, nutrition, socialising, and psychological goals, among other domains. We aimed to explore acceptability, participant engagement, and experiences of delivering and receiving the service.

Methods
Following a mixed-methods approach, we extracted quantitative data on types of goals and progress towards goals from Health and Wellbeing plans and appointment checklists. Between July 2022 and May 2023, we interviewed 49 older participants, 7 HomeHealth workers and 8 stakeholders. Older people were purposively sampled for diversity in socio-demographic characteristics, cognitive and physical functioning, intervention adherence and allocated HomeHealth worker. Interviews explored their motivations to engage; experience of participation, delivery and study support followed by their suggestions for improvement. We analysed qualitative data thematically and quantitative data descriptively.

Results
Most participants set mobility goals (49%), followed by a combination of goals (31%), and made moderate progress towards these. The intervention (completed by 93.3% participants) was positively received, boosted participants’ confidence, and provided emotional support. Participants reported that sometimes behaviour was maintained post-intervention, but further appointments would have been welcomed to fill the gap in other services. However, some people found it difficult to identify goals to work on, particularly when they already felt independent and well supported.

Conclusions
Services to support older people with mild frailty are acceptable, have good engagement, and can lead to behaviour change, particularly among those who self-identify a need for change.
2036 “I didn’t personally think it would change my life, but it has”: The experience following emergency laparotomy for older people
Authors: Price A , Pearce L , Smith J , Martin P , Griffiths J 
Published: January 2024

Abstract

Introduction
Older people living with frailty are at high risk of adverse clinical outcomes following emergency laparotomy, including early death, hospital readmission and functional decline. Despite this, there is a paucity of literature exploring patient experience of surgery in this group, particularly following hospital discharge. As a result, there is limited information to guide the development of service delivery models that support optimal post-operative recovery and improve overall experience.

Methods
Twenty older people, aged ≥65 years, with a Clinical Frailty Scale score of ≥ 4 and who had undergone emergency laparotomy were recruited from eight participating hospital sites. Participants were interviewed at 3 weeks following their surgery, or the earliest convenient date. Semi-structured interviews were undertaken either face to face or via telephone and explored the peri-operative and early recovery experience. Data were analysed using reflexive thematic analysis.

Results
Participants described physical, psychological, and social implications following emergency laparotomy which extended further than hospital discharge. Recovery was perceived to be an ongoing and slow process of returning to ‘normal self’ however participants displayed resilience towards achieving this by ‘knuckling down’ and ‘pushing forward’. The experience of hospital care was generally positive, but lack of access to discharge advice and community follow up left some participants feeling ‘abandoned’ and uncertain once they returned home. Many were reliant on family support during this period.

Conclusions
Older people living with frailty experience multifaceted consequences of emergency laparotomy that result in a prolonged recovery period. Multi-disciplinary post-operative care pathways are essential in addressing the holistic care needs of this group following surgery. The provision of robust discharge information and enhanced access to support in the community could improve patient experience and facilitate ongoing recovery at home.
1743 Frailty is associated with poor cardiopulmonary resuscitation outcomes in the COVID-19 pandemic
Authors: Gurney J 
Published: January 2024

Abstract

Background
This study aims to investigate the relationship between frailty and in-hospital cardiopulmonary resuscitation (CPR) outcomes in the COVID-19 pandemic.

Methods
The study was carried out in a tertiary hospital in Scotland and included all patients over the age of 18 who had an in-hospital CPR attempt between April 2020 and March 2022. Patients were identified via the pre-existing National Cardiac Arrest Audit Database which was collected prospectively. Data collected from this included age, sex, initial arrest rhythm, return of spontaneous circulation (ROSC) and in-hospital mortality. The electronic and paper patient notes were retrospectively reviewed to calculate a Rockwood clinical frailty scale (CFS) and Charlson comorbidity index (CCI). The data was stratified in to frail (CFS ≥5) and non-frail (CFS &lt;5) groups.

Results
65 patients were included in the study. In univariate analysis, there was a significant difference between the frail and non-frail groups in age (p=0.006), ROSC (p=0.02) and survival to discharge (p=0.004). Only 10 out of 34 (29.4%) frail patients had ROSC and of those only 3 (8.8%) survived to discharge compared to 12 out of 31 (35.3%) of non-frail patients. In a binary logistic regression, there was a significant association between frailty and both ROSC (adjusted OR 3.31 [95% CI: 1.12-9.78}) and survival to discharge (adjusted OR 6.33 [95% CI: 1.48-27.13]) and no significant association with age, CCI or sex.

Conclusion
The findings support the relationship between frailty and poor CPR outcomes independent of age and co-morbidity during the COVID-19 pandemic.
2007 Willingness of older adults and their informal caregivers to deprescribe medication: UK survey study
Authors: Garnett R , Barnes R , Buckell J , McManus R , Sheppard J 
Published: January 2024

Abstract

Introduction
Reducing inappropriate polypharmacy is a major public health goal and deprescribing is considered one potential solution. Although patient attitudes towards deprescribing have been well studied, little consideration has been given to the informal caregiver perspective, how this differs from the views of patients and how that might influence care.

Method
A survey including demographic questions and the revised Patients’ Attitude Towards Deprescribing (rPATD) questionnaire was undertaken. The primary outcome was to identify the willingness of respondents to deprescribe. This survey was distributed as online, telephone or paper versions, via social media, community centres, day care centres, local organisations, and personal networks. It had two sections composed of equivalent questions: one for the ‘patient’ (age 65+, based in England, taking 1 prescription medication) and one for their ‘informal caregiver’ (age 18+). Data were analysed using descriptive statistics and binomial logistic regression.

Results
After exclusion of ineligible respondents, a total of 1,307 survey responses were received (861 patients and 446 caregivers). The average patient was 76±9 years, female (526; 61.6%), white (831; 97%), and educated to degree level (482; 56.9%). The average informal caregiver was 73±14 years, female (278; 62.9%), white (426; 96.4%) and educated to degree level (258; 58.2%). A total of 77.1% patients agreed that they were willing to deprescribe medications if their doctor said it was possible. In contrast, significantly fewer informal caregivers were happy for their patient to have medications deprescribed (59.7%; p-value for difference &lt;0.001). Trust in physician, concerns about stopping medication and belief in the appropriateness of withdrawal were all associated with respondent willingness to deprescribe.

Conclusion
This large study suggests patients are more willing to deprescribe than their informal caregivers. Better understanding of these attitudes and how they differ between patients and informal caregivers, will help inform interventions to improve involvement in medication-related decisions.
1992 Long-term condition reviews in General Practice: The experiences of people with Dementia and their informal carers
Authors: Cole J , Parretti H M , Hanson S , Hornberger M 
Published: January 2024

Abstract
“I would imagine it needed a review…” A Qualitative Study Exploring the Experiences of People with Dementia and their Informal Carers of Long-term Condition Reviews in Primary Care

Introduction
Multimorbidity is common for people with dementia (PWD) and is associated with increased healthcare utilisation and poorer outcomes. Part of the management of long-term conditions (LTCs) occurs through annual LTC reviews conducted in primary care. Little is known about the experiences or needs of people with dementia and informal carers in regard to LTC reviews.

Aim
To explore the experiences of PWD and their informal carers of the review and management of LTCs in primary care.

Method
Qualitative research study, protocol informed by discussion with people with lived experience as an informal carer. Institutional ethical approval (ref ETH2122-1035, University of East Anglia) was granted 25/3/2022. Semi-structured interviews were conducted with PWD and informal carers recruited through Join Dementia Research and local (to Norfolk, UK) charities. Thematic analysis was undertaken with reference to Braun and Clarke (2006).

Results
16 participants were interviewed: two PWD, 10 informal carers and two informal care/PWD dyads. Our findings fall into four main themes: 1) What matters to people; medication optimisation and holistic care 2) What is a review; the diversity of experiences 3) The importance of communication and 4) Preference for shared decision making.

Conclusion
Consideration should be given to ensuring patients and carers are aware when a LTC review will take place and providing an opportunity to be involved, thus allowing shared decision making and patient centred care. Further research into the clinician experience and their views on patients’ needs and how to meet them is required to inform how LTC reviews for people with dementia can be optimised.
Deep brain stimulation does not modulate resting-state functional connectivity in essential tremor
Authors: Awad Amar , Grill Filip , Blomstedt Patric , Nyberg Lars , Eriksson Johan 
Published: January 2024

Abstract
While the effectiveness of deep brain stimulation in alleviating essential tremor is well-established, the underlying mechanisms of the treatment are unclear. Essential tremor, as characterized by tremor during action, is proposed to be driven by a dysfunction in the cerebello-thalamo-cerebral circuit that is evident not only during motor actions but also during rest. Stimulation effects on resting-state functional connectivity were investigated by functional MRI in 16 essential tremor patients with fully implanted deep brain stimulation in the caudal zona incerta during On-and-Off therapeutic stimulation, in a counterbalanced design. Functional connectivity was calculated between different constellations of sensorimotor as well as non-sensorimotor regions (as derived from seed-based and data-driven approaches), and compared between On and Off stimulation. We found that deep brain stimulation did not modulate resting-state functional connectivity. The lack of modulation by deep brain stimulation during resting-state, in combination with previously demonstrated effects on the cerebello-thalamo-cerebral circuit during motor tasks, suggests an action-dependent modulation of the stimulation in essential tremor.
Local structure of concentrated NaFSA solutions in propylene carbonate studied by X-ray and neutron diffraction methods
Authors: Kameda Yasuo , Kowaguchi Misaki , Amo Yuko , Usuki Takeshi , Nawa Kazuhiro , Sato Taku J 
Published: January 2024

Abstract
The microscopic structure of 10 mol% NaFSA [FSA: bis(fluorosulfonyl)amide]-propylene carbonate (PC) solution has been investigated by means of X-ray and neutron diffraction techniques. The solvation structure of Na+ has been determined from least-squares fitting analysis of X-ray intermolecular difference interference terms observed for 10 mol% NaFSA-PC solution and pure liquid PC. In the present solution, onaverage, 6(1) PC molecules are involved in the first solvation shell of Na+ with intermolecular distance rNaO = 2.26(7) Å, and bond angle ∠Na+…O = C = 169(9)°. Intermolecular correlation between neighboring PC molecules in the solution has been derived from simultaneous least-squares fitting analysis of observed H–H, H–X, and X–X (X: atoms except for H) intermolecular partial structure factors determined from neutron diffraction data for H/D isotopically-substituted sample solutions. An indication of anti-parallel configuration of the nearest neighbor PC molecules has been suggested.