bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accurate superposition modeling method of grinding-shot peening surfaces
Authors: Chen Jiling , Tang Jinyuan , Shao Wen , Li Xin , Zhao Jiuyue , Li Lin 
Published: January 2024

Abstract
The coexistence of initial surface texture features and shot peening texture features in the final surface topography is a significant feature of shot peening. After the initial surface topography is strengthened by shot peening, the wave peak will produce more substantial deformation relative to the wave valley, which has not been considered in the existing superposition modeling methods. And this will affect the correlation study between surface topography and performance. Taking the surface generated by the grinding-shot peening process as the research object, based on the feature extraction of measured topography, the concept of ‘Shot peening texture depth distribution surface’ is put forward. And the proposed precise superposition method uses the texture depth distribution surface to optimize the characteristic baseline of shot peening based on the existing theory. The measured grinding-shot peening surfaces verify the given method. It is found that the topographical and spatial features of the surfaces superimposed by this method are consistent with those of the measured surfaces, and the error of roughness parameters defined by ISO25178 are all less than 8%. Among them, the percentage errors of the critical parameters Spd, Sdq, and Sdr related to friction and lubrication are significantly reduced to 5%.
A photodetector based on p-GaN/N-MoS2 QDs heterojunction with high responsivity
Authors: Alwehaibi Maymunah A , Khoja Yasmeen A , Alghamdi Reem S , Alsuhaibani Fahdah A , Alshatwi Manar S , Aldamegh Ahmed A , Aldakheel Sarah A , Alromaeh Abdulaziz , Alwadi Norah M 
Published: January 2024

Abstract
Molybdenum disulfide (MoS2) is the most thoroughly investigated for photodetection applications with direct bandgap transition in low-dimensional structures, high light–matter interaction, and good carrier mobility. In this work, MoS2 quantum dots was synthesis by liquid exfoliation and characterized using scanning electron microscopy (SEM), Transmission electron microscopy (TEM), Fluorescence emission spectra (FES), UV–vis spectroscopy, and Photoluminescence (PL). The average size is ∼ 3.6 nm with strong absorption in the UV region and a band gap of 4.49 eV. Moreover, a novel structure of N- MoS2 QDs \ p-GaN heterojunction photodetector was deposited by spray coating. The PL of N- MoS2 QDs \ p-GaN emission spectra expanded from UV to visible light with high responsivity to the visible light of 7.06 mA W−1 and detectivity of 1.24 × 1010 jones.
Dosimetry audit in advanced radiotherapy using in-house developed anthropomorphic head & neck phantom
Authors: Kakade Nitin R , Kumar Rajesh , Sharma S D , Sapra B K 
Published: January 2024

Abstract
The treatment of head and neck (H&N) cancer presents formidable challenges due to the involvement of normal tissue and organs at risk (OARs) in the close vicinity. Ensuring the precise administration of the prescribed dose demands prior dose verification. Considering contour irregularity and heterogeneity in the H&N region, an anthropomorphic and heterogeneous H&N phantom was developed and fabricated locally for conducting the dosimetry audit in advanced radiotherapy treatments. This specialized phantom emulates human anatomy and incorporates a removable cylindrical insert housing a C-shaped planning target volume (PTV) alongside key OARs including the spinal cord, oral cavity, and bilateral parotid glands. Acrylonitrile Butadiene Styrene (ABS) was chosen for PTV and parotid fabrication, while Delrin was adopted for spinal cord fabrication. A pivotal feature of this phantom is the incorporation of thermoluminescent dosimeters (TLDs) within the PTV and OARs, enabling the measurement of delivered dose. To execute the dosimetry audit, the phantom, accompanied by dosimeters and comprehensive guidelines, was disseminated to multiple radiotherapy centers. Subsequently, hospital physicists acquired computed tomography (CT) scans to generate treatment plans for phantom irradiation. The treatment planning system (TPS) computed the anticipated dose distribution within the phantom, and post-irradiation TLD readings yielded actual dose measurements. The TPS calculated and TLD measured dose values at most of the locations inside the PTV were found comparable within ± 4%. The outcomes affirm the suitability of the developed anthropomorphic H&N phantom for precise dosimetry audits of advanced radiotherapy treatments.
2031 Lying and standing blood pressure and ECG for the falling patient
Authors: White C , Boyd L , Teo A 
Published: January 2024

Abstract

Introduction
Many elderly patients admitted to hospital have presented following a fall. Causes for falls are often complex and multifactorial, but causes such as postural hypotension and cardiac arrhythmias are easily diagnosed with lying and standing blood pressure (LSBP) and ECG respectively. Therefore, these investigations should be offered as a minimum to any elderly patient after a fall. We aim to review and improve the number of patients receiving LSBP and ECG after presenting to the Acute Frailty Unit (AFU) with a fall.

Methods
Falls admissions were reviewed over two four-week periods, before and after intervention. We gathered information on whether patients had LSBP and ECG, and whether these were reviewed and documented by a doctor or specialist nurse. Patients who could not stand for LSBP were not included. Interventions included teaching for all staff on AFU about LSBP and ECGs, posters about investigations after falls, flash cards on how and when to perform LSBPs and a daily tick-box to complete at handover confirming investigations had been reviewed.

Results
During the first four weeks, 31 patients were identified who presented with falls. 31 (100%) had LSBP recorded and 25 (81%) of these had documentation that it had been reviewed by doctor or specialist nurse. 26 (84%) received an ECG and 24 (92%) of these had a documented review. After intervention, 42 patients were identified. 40 (95%) had LSBP recorded, 42 (100%) of these were reviewed. 42 (100%) of patients had an ECG and 36 (100%) of these were reviewed.

Conclusion
Multiple simple interventions including education, visual prompts and procedural changes can improve practice and help to ensure that minimum investigations are achieved for all frail patients presenting with falls. These interventions could be applied to other common presentations on the AFU and may be an appropriate next step.
2023 Oral nutritional supplement prescribing in care homes: The benefit of dietetic review
Authors: Taylor K , Hope S , Goodwin V 
Published: January 2024

Abstract

Introduction
Prevalence of malnutrition in care homes is high and oral nutritional supplements (ONS) often prescribed. Prescription and monitoring of ONS use varies considerably within residential settings. Locally dietetics are not funded to visit care homes and input is limited. This project explored dietetic ONS prescribing within care homes in one primary care network within Devon, recording the potential impact on costs.

Methods
All patients prescribed ONS (n=50) across 16 care homes were reviewed, alongside referrals to dietetics (n=39) from November 2022-March 2023. Supplements were switched to first-line formulary supplements where possible, stopped where unnecessary according to dietetic assessment, and a “food first” approach encouraged within homes. Cost of supplements prescribed pre-dietetic assessment, cost of new prescriptions, dietetic staff time and mileage costs were recorded. Supplement cost was calculated from the local formulary and staff cost from NHS oncosts.

Results
Patients seen represented 20% of all residents 20% (89/436) within the 16 care homes, suggesting high suspected clinical need. Mean age was 90 years, ranging from 73-103 years. Female patients accounted for the majority (n=68). Addressing inappropriate prescribing saved £57.62 per day in prescriptions through stopping or changing ONS. Cost of dietetic staff time and milage totalled £3105.80 over the five-month period meaning that after 54 days the dietetic review service was saving money. Patients often preferred first line powder-based supplements, and these were either similar or more appropriate in nutrient content than initially prescribed ONS. For example, one patient affected by pressure ulcers was prescribed a fat emulsion supplement. It contained no protein or micronutrients to promote skin healing (cost £3.15) whilst first--line supplements provided macronutrient and micronutrient needs (cost 52p each and £1.04 total prescription).

Discussion
Dedicated dietetic input for care home residents appears to save costs on ONS prescribing whilst providing specialist nutritional expertise.
1953 Improving access to community palliative care by raising awareness of services, indications for referral and referral pathways
Authors: Knowles B , Springbett P , Hunt C , Ingram O 
Published: January 2024

Abstract

Introduction
40% of 1056 patients discharged from our acute geriatrics ward met Gold Standards Framework (GSF) Prognostic Indicator Guidance for Recognition of Patients approaching End of Life (EOL). 92% were not referred to Community Palliative Care (CPC) services, meaning patients’ needs were not fully met and other services over-stretched. This project aimed to achieve a 10% reduction in missed referrals.

Methods
Highlighting the missed referral rate enabled engagement of key stakeholders including ward and palliative care multidisciplinary teams. This 12-month project comprised four PDSA Cycles: 1. Raising awareness of GSF and CPC through ward-based teaching; 2. Development of posters outlining referral criteria and pathways; 3. Hospital-wide survey of doctors’ understanding of treating patients approaching EOL, with real-time feedback on GSF and CPC; 4. Formal departmental and year-group teaching sessions. The outcome measure was the percentage of patients meeting GSF criteria who were not referred to CPC, as determined by retrospective analysis of discharge letters. Readmission rate was calculated as a marker of quality of life (QoL) and to assess the impact of missed referrals on the Trust.

Results
Interventions led to a sustained reduction in missed referrals (72% from 92%). Certain diagnoses are more readily referred, metastatic malignancy for example, 9x more frequently than advanced Parkinson’s. Patients meeting criteria averaged 3 admissions in the preceding year (compared to 1.7). Of those meeting criteria and still alive, patients not referred averaged 1 re-admission within 6 months compared to 0.3 when referred.

Conclusions
Missed CPC referrals impact patient QoL and increase the burden on acute inpatient services. Significant benefits could be seen if these findings are extended to other inpatient wards. There is also a need for education about the palliative stage of non-malignant diseases such as Dementia and Parkinson’s. Future steps include technology-based active screening of inpatients to facilitate referrals.
1906 Identifying Older Frail Patients Suitable for Same Day Emergency Care (SDEC); The Applicability of Patient Selection Scoring System
Authors: Burgess A J , Collins K , Burberry D J , James K H , Davies E A 
Published: January 2024

Abstract

Aim
Several patient selection scores have been developed to identify patients suitable for SDEC from triage in Emergency Departments (ED) and the acute medical intake. Scores are designed to improve system efficiency, overcrowding and patient experience. Studies have been conducted that compare these; none in frail older adults. This study compared the Glasgow Admission Prediction Score (GAPS), Sydney Triage to Admission Risk Tool (START) and the Ambulatory Score (Amb).

Methods
The Older Person’s Assessment service is ED based, accepting patients with frailty syndromes aged &gt;70 years with same-day discharge for &gt;75% of patients. The OPAS databank was retrospectively analysed from June 2020 to December 2021. Interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside each ambulatory score. ED documentation was used to gain triage data.

Results
748 attendances, 274(36.6%) Male with mean age 82.8(±8.5) years, CFS 5.2(±1.4) and CCI 6.7(±2.6) with 584(78.1%) discharged same day. Mean Amb score 4.2(±1.7), GAPS 21.4(±5.8), START 23.5(±4.7) all within admission range with 29.1% Mortality within 12 months. There was a significant difference between those admitted and discharged with CFS (p&lt;0.001), mortality (p&lt;0.001), Amb score and START score but not GAPS (p&lt;0.001 vs p=0.03 vs p=0.17).

Conclusion
Frailty is an important determinant in identifying whether ambulatory care is appropriate. No score could be reliably used as a screen for suitable patients for SDEC services although the Amb score was the most accurate when assessing each individual variable. We are developing our own SDEC score for older, frailer adults which is currently being validated in the OPAS and SDEC settings.
2015 Identifying and Managing Visual Impairment in Older Patients with Falls on a Care of the Elderly (COTE) ward
Authors: Abbott C , Bristow E , Twiddy L , Warner A , Setchell R , Cavanagh A 
Published: January 2024

Abstract

Introduction
In 2019, the Royal College of Physicians (RCP) advised that all patients should have their vision screened if identified as a falls risk. Our aim was to implement a bedside visual screening test and establish an onward inpatient referral to Hospital Eye Services (HES).

Method
This is a collaborative Quality Improvement project involving Geriatric Medicine, HES and the Royal National Institute of Blind People (RNIB). A pilot study cross referenced falls admissions with previous known ophthalmic data to estimate the proportion of known vision loss in this group. In the second phase of the project, a bedside visual screening test has been introduced for all patients admitted to COTE with a fall. Patients failing the screening are reviewed by an RNIB Eye Clinic Liaison Officer (ECLO) and if necessary, a prompt inpatient HES review is arranged.

Results
Of 182 patients admitted following a fall, in the pilot study, 112 (61%) were known to ophthalmology previously. Of patients known to ophthalmology, 28 (25%) had vision of 6/18 or worse and would be considered to struggle with daily living tasks. 12 (10%) had a certificate of visual impairment (CVI) and 3 (3%) were eligible for CVI but had not been previously registered. One year following implementation of bedside vision testing, 287 patients had been reviewed after failing bedside screening. 97 of these had an onward referral sent or an intervention performed. The first ‘COTE ECLO’ post has been funded as a result of this work.

Conclusion
Assessing vision is a critical element of the assessment of patients with falls. Through collaboration with the RNIB and Ophthalmology a successful pathway has been developed to address visual impairment in this vulnerable group of patients.
1909 Evaluation of awareness and implementation of DNACPR decisions in trauma and orthopaedic Surgery
Authors: Taylor B , Naqvi H 
Published: January 2024

Abstract

Introduction
In-hospital CPR has survival rates of 15-20% [BMA Decisions on CPR, 3rd edition, 2016], further reduced with frailty and multimorbidity. Successful CPR is associated with significant morbidity and prolonged suffering. Do not attempt resuscitation (DNACPR) is an advanced medical decision, aimed at preventing harm where CPR is considered futile. [GMC Guidance.p128-145]

Aims
To reduce the burden of inappropriate CPR within surgical specialties using the following standards: 1. DNACPR status reviewed on admission, and all decisions implemented within 24hours of clerking. 2. DNACPR decisions implemented prior to surgery. 3. To assess clinician perceptions regarding DNACPR decisions.

Methods
This second cycle follows the intervention of a poster and departmental education in January 2020. A survey was sent to clinicians of all grades in Trauma and Orthopaedics (T&O) and General Surgery in January 2023. Data on implementation of DNACPR decisions was retrospectively collected over January and February 2023 for all T&O emergency and elective admissions &gt;60-years-old.

Results
26 survey responses were obtained with all participants having had DNACPR discussions. 80.7% self-reported as confident/very confident in having these discussions. Out of 264 patients included, 80 discussions took place, of which 64 (80%) were implemented. 69% were implemented within 24hours of clerking, a 23% increase from cycle 1. 90% of community DNACPRs (9/10) were applied within 24hours, however the one remaining patient received inappropriate CPR. Of the 47 patients with DNACPR who had surgery, 87% were implemented prior to surgery, a 12% increase from cycle 1.

Conclusion
Improvement was demonstrated on both standards between cycles. This QI focused on implementation of DNACPR following discussions, however, did not consider patients in whom DNACPR may have been appropriate but not discussed. Further areas to explore include appropriateness of CPR/DNACPR decisions in advance of surgical interventions and the understanding behind limitations of treatment offered separate to CPR.
2048 Antipsychotic medication prescription in elderly patients in Royal Gwent Hospital, Wales
Authors: Dineshkumar K , Duric D , Peter E B 
Published: January 2024

Abstract

Introduction
he use of anti-psychotics is higher in older people than their younger adult counterparts due to high prevalence of dementia/delirium. Anti-psychotic drugs cause side effects which include cardiovascular, metabolic, extra pyramidal and risk of falls. So, we set out to do a QIP on antipsychotic medication prescription on our Geriatric wards comparing it with NICE guidelines.

Method
We had 2 approaches to use. Firstly, we prepared a check list for anti-psychotic medication monitoring according to NICE guidelines 2021 and we applied this retrospectively to our patients who had been initiated on anti-psychotics within the last year, the aim being to compare our practice with best practice. Secondly, we prepared a questionnaire for doctors to assess their knowledge about anti-psychotic NICE guidelines and distributed this to our junior doctors in RGH.

Results
• Main Indication for prescription was Behavioural and psychological symptoms of dementia (BPSD) - 94% of the time
• Risperidone was the most commonly prescribed (64%) antipsychotic.
• 83% of them had non-pharmacological methods tried before considering antipsychotic medications.
• 82% had their baseline ECGs checked and falls risk assessments done
• 35% had their lipids checked and 47% had their HbA1c checked
• 52% of the doctors were aware about NICE guidelines on prescribing anti-psychotic medications
• 70% of the doctors had knowledge about the side effects.

Conclusions
Our study showed the most commonly used antipsychotic drug was risperidone. We were good at documenting the indication, trying non-pharmacological methods and discussing side effects with patients/family. Hba1c, lipids and prolactin were not often checked, showing room to develop best practice. We are in the process of finalising stickers as a checklist when starting antipsychotics. To improve knowledge, we have presented the findings and aim to put up posters on wards and to do regular teachings.
1722 A Quality Improvement Project to improve MUST score and food chart completion on Frailty Wards
Authors: Zaki A , Alexander H 
Published: January 2024

Abstract

Introduction
Nutrition is one of the cornerstones of healthy aging. As we age, there are many changes in our bodies including decreased appetite and poor dentition, that contribute to increasing malnutrition. The MUST (Malnutrition Universal Screening Tool) score is a quick and effective tool to assess this. In this project, we reviewed MUST score and food chart completion on the frailty wards at EDGH to attempt to improve the nutrition of elderly patients.

Methods
The charts of seventy-five patients were reviewed over a period of one month. Following this, a training program for all the nursing staff was put in place. Initial results were discussed and the importance of nutrition in the elderly was highlighted. The staff were shown how to fill in the MUST score and follow management guidelines. Also, a reminder was set up on Nervecentre (local electronic patient record) for all staff.

Results
Of the initial seventy-five patients: 1 – a MUST score was completed for only 64% on admission to the ward 2 – 41.3% of patients were eating 50% or less of their meals 3 – In only 27% the reasons why they were not eating were documented. In the second cycle, eighty patients were included, and the results were markedly improved.
1 – The percentage of MUST score completion on admission increased to 91.3%
2 – Management guidelines were followed in 92.5% of the cases 3 – 18.8% with a MUST score of two or more, were referred to dietitians at an early stage

Conclusions
Our quality improvement project significantly increased MUST score completion and prompted action at an early stage. The third cycle in our improvement project is to improve the documentation of patients' food charts and encourage staff to look for and document the reasons why patients are not eating.
1720 Frailty and the impact of Electronic Advance Care Planning records on readmission rates and location of end of life care
Authors: Stapleton L , Marsh L , Rajeevan T 
Published: January 2024

Abstract

Introduction
Older people with severe frailty are 5 times more likely to die in the next 12 months than older non-frail people however prognosis and disease trajectory in frailty remains difficult to predict. Advance care planning (ACP) is often not fully discussed or documented due to these prognostic uncertainties, plus time/workload constraints. This can result in multiple admissions for people with frailty in the last 12 months of life and can lead to care and death in a non-preferred place. Electronic Advance Care Plans (eACP) can be useful in reducing unwanted admissions and promoting care and death in preferred location. This project aimed to improve proportion of patients receiving care in their preferred location and reduce readmission rates.

Method
Identified patients who wished to avoid hospital readmission with clinical frailty score of 6 or more and at least 2 unplanned admissions in the preceding 12 months over a 4-month period at a district general hospital in south London. ACP was discussed with patients and families and an eACP was generated. Patients were then followed up at 3 and 6 months to assess readmission rate and rate of end-of-life care in preferred location. 24 patients consented - 17 women, 7 men. Mean age of 88.3 Mean pre-admission frailty score of 6.1. High level of pre-admission co-morbidity with 80% having 3 or more major comorbidities.

Results
Readmission rate was 8%. One third of patients alive at 3 months all without readmission. 23 patients had died at 6 months. 13% died in hospital versus a national average of around 50%. 70% died in preferred place of death versus national average of around 49%.

Solution
Use of electronic Advance Care plans resulted in a low readmission rate and a higher proportion of people receiving end of life care in their preferred place of death.