bluuebunny/crossref_metadata_2025_split huggingface dataset:
2656 Healthcare professionals’ views on optimising pain services for older adults living with frailty: preliminary findings from the POPPY study
Authors: Wright A , Harrison N , Brown L 
Published: January 2025

Abstract

Introduction
Frailty and persistent pain are both common among older adults (OAs) and together contribute to disability and emotional distress. The impact of pain on everyday life is potentially modifiable with appropriate pain management techniques, but current services do not always take account of the needs of frail OAs. The Pain in Older People with Frailty Study (POPPY) is a mixed-method study to develop the content and implementation strategies for services to optimise the support available for OAs living with frailty and pain. Initial objectives of the POPPY study included seeking views from healthcare professionals (HCPs) and commissioners on existing local services including their experiences of the barriers faced by OAs with frailty accessing these services, and views on how resources might be best deployed to support OAs with frailty.

Methods
In-depth qualitative interviews were conducted with HCPs from across England, based in specialist, secondary care and community services. Interviewees included commissioners, GPs, physiotherapists, occupational therapists, psychologists, nurses, doctors, and health coaches. A thematic approach to data analysis was used.

Results
Forty-two HCPs and 2 commissioners from 9 pain services and 2 generic community services were interviewed. HCPs recognised that OAs living with frailty and pain formed a distinct group, experiencing shared facilitators and barriers to engagement. Meeting the needs of this group was challenging for services. Most HCPs thought a dedicated pain service for frail OAs was impractical and disagreed with the concept of age-based pain services. HCPs thought the needs of frail OAs were most likely to be met by community-based services, staffed with appropriately skilled multi-disciplinary teams, interacting effectively with other specialist services, and delivering holistic individualised approaches.

Conclusion
Pain services need to be responsive to the specific needs of OAs with frailty and recognise the importance of adapting content and delivery of interventions to reflect this.
2833 Quality improvement project on increasing antimicrobial stewardship and patient safety
Authors: Tarkas T , Suthahar Y 
Published: January 2025

Abstract

Introduction
National surveillance shows an estimated 58,224 people in England had antibiotic-resistant infections in 2022, a rise of 4% since 2021 (ESPAUR report). Between 2022–23, our Trust had 2nd highest C.difficile rates in the country. Geriatric population is particularly vulnerable to inappropriate antimicrobial prescribing, leading to prolonged hospital stays. As part of anti-microbial stewardship (AMS), a Quality improvement project was carried out between February–May 2024.

Methods
Six geriatric wards (n = 168) were audited between 14-16th February 2024. Indication, route, duration, choice of antibiotic and compliance to Microguide was measured. Interventions included introducing weekly microbiology consultant led ward rounds, junior doctor, nurse and consultant education (individual and group) and streamlining IT access to Microguide were implemented. AMS meetings were introduced, which included lead microbiology consultants, chair of medicines safety group, lead antimicrobial pharmacist, geriatric consultants and incorporating prescribing into simulation sessions were sought. Plan-do-study-act (PDSA) cycle was carried out, with repeat cycle carried out in June 2024.

Results
In total, 99 patients were on antibiotics with compliance to Microguide ranging from 39–65% (mean = 53%) in 1st cycle. Co-amoxiclav (n = 45) and Tazocin (n = 14) were the most used antibiotics. After the PDSA cycle with interventions implemented, compliance increased from range 70 to 90% (mean = 83%m n = 71). Areas such as prescribing of co-amoxiclav for UTI, Tazocin use without micro approval were targeted. There was increase in the indications and duration mentioned on drug charts (89 to 95%).

Conclusion
Local drivers of change with existing resources can significantly improve AMS. This ultimately leads to less C.difficile infections and improved patient safety. Junior doctor education and weekly ward rounds can be implemented in other areas of our trust to improve AMS.
2849 Managing acute hyperkalaemia in frail individuals using a modern potassium binder sodium zirconium Cyclosilicate (Lokelma®)
Authors: Suman S , Debnath V 
Published: January 2025

Abstract

Background
Hyperkalemia is a common life-threatening electrolyte abnormality present in acutely unwell frail patient, often in context of Acute Kidney Injury (AKI), background of Chronic Kidney Disease (CKD) and a variety of medications such as renin-angiotensin-aldosterone system (RAAS) inhibitors. NICE TA 599 guidance recommends the use of a modern K+ binder such as Sodium Zirconium Cyclosilicate (SZC) in the acute setting alongside standard of care. This case series was carried out with a view to gain clinical experience specifically in acutely unwell frail older individuals presenting to a District General Hospital in UK.

Methods
Eight patients presenting to ED at Medway NHS Foundation Trust over 3-week period between 7th June—11th July 2023 with Hyperkalemia were treated with SZC, data was collected retrospectively.

Results
AKI present in 6/8, Sepsis present in 4/8.

Management
SZC 10 g tds was managed to correct hyperkalemia alongside established standard of care measures for acute hyperkalemia management. Fluid resuscitation, antibiotics and discontinuation of culprit medications was carried out where indicated.

Effectiveness of SZC

Conclusions
2625 Navigating morally challenging scenarios in advance care planning: a survey study
Authors: Yu CC , Tang JY , Goh SF , Low JAYH , Ng CJ , Chong R , Cheung KYK , Ho AHY , Menon S , Cruz MT , Ng R 
Published: January 2025

Abstract

Introduction
There are abundant anecdotal reports of healthcare professionals undergoing strain, specifically moral distress, in advance care planning (ACP) related work. This study measured perceptions of morally challenging scenarios (MCS) faced by ACP facilitators and frontline clinicians.

Method
An online survey, which is currently ongoing, was sent to the ACP community and also frontline clinicians in Singapore. Purposive and snowballing sampling approaches were employed.

Result
Participants rated their opinions on 23 MCS in ACP-related work that were earlier identified from 30 interviews. Findings showed that the top three MCS perceived to go against one’s conscience were: (i) providing treatment not in concordance with wishes of patient, (ii) being uncertain if decisions by family members were driven by ulterior motives and (iii) taking the view of dominant family members as the final decision. Most commonly encountered MCS were dilemmas related to (i) perceived medical best interest, (ii) honouring of patient’s preferred place of death, and (iii) having to deal with collusion. Each of 14 MCS were encountered by at least 50% of our participants and 66% of all who had encountered at least one MCS agreed that their psychological health was affected. Guidance from mentors and support from peers were rated most favourably out of the 15 coping strategies to deal with moral dilemma in ACP work. Coping strategies were largely positive with only a minority favouring the use of alcohol or giving in to demands of patients and families.

Conclusion
Findings show those who engaged in ACP-related work encountered a wide variety of MCS and perceived their psychological health as being affected. There is a pressing need to address the sources and risk factors of moral distress in such work, and to enhance the protective factors which can help ACP facilitators and frontline clinicians cope with moral distress successfully.
2644 Falls and physical function in older patients with benign paroxysmal positional Vertigo (BPPV)
Authors: Huang X , De KCW , Shi SMP , Yuen HW , Min DLY , Poongkulali A , Iqbal A , Rosario BH 
Published: January 2025

Abstract

Introduction
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo in older adults. Due to the high incidence of BPPV in older adults presenting with falls, vestibular assessment, and diagnosis of BPPV and other vestibular disorders has become a recommendation in the World Guidelines for Falls Prevention. There has been a paucity of evidence in well conducted randomised controlled trials (RCTs) to evaluate vitamin D for prevention of BPPV recurrence and its relation to falls and function.

Method
This is a Phase IIa single centre, placebo controlled, double blind RCT to evaluate vitamin D supplementation together with diet and Canalith Repositioning Procedure [Group A] or diet alone combined with CRP [Gorup B] can reduce recurrence rates of BPPV. Post hoc analyses were performed evaluating BPPV recurrence, falls and function.
53 participants were recruited. 14 were vitamin D replete at baseline [Group C- diet alone], the remaining 39 were randomised into Groups A and B. Group A was associated with 0.75 fewer clinical BPPV recurrences per one person year (IRD -0.75, 95% CI -1.18 to −0.32, P = 0.035).

Findings
Older adults in the study who suffered a fall during the 12 month follow up had lower Activities of Daily Living scores. They also had poorer Short Physical Performance Battery scores at baseline. Participants in Group A had better 5x sit to stand time compared to Group B even accounting for underlying frailty scores. 25% of participants who fell in the 12 month follow up reported fear of falling compared to 43% in those with no falls in the 12 month follow up.
Vitamin D supplementation improved physical performance in 5xchair stand test.

Conclusion
In this study population, more participants without an incident fall during follow up experience fear of falling, prompting further consideration into the complex concept that is fear of falling.
2891 Persistent drop in haemoglobin after the insertion of an intramedullary nail following a neck of femur fracture
Authors: Thangaraj L , Seedher A , Titiloye A 
Published: January 2025

Abstract
An 85-year-old male presented with a hip fracture following an accidental fall. His background included chronic kidney disease, hypertension, high cholesterol, and type 2 diabetes mellitus. He underwent a intramedullary nail for a subtrochanteric fracture. Post-op he had 4 units of red blood cells for post-op anaemia. Despite multiple transfusions, his haemoglobin levels gradually decreased and there was no evidence of visible bleeding from the wound or other sites. He complained of persistent swelling and pain limiting his mobility. Pelvic x-rays revealed stable fixation. Patient developed a deep vein thrombosis and was started on low molecular weight heparin. Further acute drop in his haemoglobin prompted for an ultrasound of his hip, which identified an intramuscular haematoma. This was confirmed on a CT angiogram which revealed an active haemorrhage within the right vastus intermedius muscle with associated haematoma, which appeared to arise from a branch of the profunda femoris. The patient underwent coil embolization under radiological guidance which successfully achieved complete haemostasis. It was also revealed that he had a large pseudoaneurysm arising from the descending branch of the right lateral circumflex artery. Post-procedure his haemoglobin remained stable, pain controlled adequately and tolerating anticoagulation without further drop in haemoglobin. Furthermore, his mobility improved and he was deemed medically fit to be discharged to rehabilitation. Although pseudoaneurysms are very rare, persistent drop in haemoglobin, pain, swelling and poor a stable fixation of an intrameduallary nail should raise suspicion of a haematoma, and requires further investigations with a CT angiogram.
2835 Evaluation of Paceycuff as a novel treatment for male stress urinary incontinence: the first UK experience
Authors: Musabyimana C , Yang B 
Published: January 2025

Abstract

Background
Prostate cancer and bladder outlet obstruction, often treated surgically, are increasing in the ageing population, leading to more cases of stress urinary incontinence (SUI). While implantable continence devices are beneficial for many, a growing number of frail patients are unsuitable for surgery and rely on incontinence pads or penile clamps, which are limited to three-hour use to prevent tissue ischaemia. We present the first UK evaluation of the new PaceyCuff penile clamp, designed for 24-hour wear while maintaining blood flow, to assess its efficacy, safety, and impact on patient quality of life.

Method
Men with urodynamically-proven SUI were identified. Baseline penile and finger peripheral oxygen saturation (SpO2), three-hour pad weight, 24-hour pad count and patient-reported outcomes (ICIQ-UI, QoL) were measured. Participants were then fitted with the PaceyCuff, and reassessed immediately, at three hours post-application and (via telephone) after two weeks.

Results
13 men (average age 74, range 62–82) were recruited. ICIQ-UI scores decreased from 17 to 10, and QoL scores from 13 to 9. Average three-hour pad weight dropped from 94 g to 10 g and daily pad usage decreased from 4 to 0.9 pads. Participants reported good tolerance, with an average pain score of 1.8/10 and only 2 minor adverse effects (skin abrasion, transient pain). Penile SpO2 remained stable before, immediately after, and three hours post-use (76%, 82%, and 81% respectively). Sub-group analysis of patients over the age of 80 (n = 4) confirmed equal effectiveness. (ICIQ-UI decreased 18 to 10, QoL decreased 13 to 9, three-hour pad weight decreased 77 g to 9 g, daily pad usage decreased 4 to 1.5 pads, average pain 1.5/10).

Conclusions
The PaceyCuff has demonstrated both efficacy and tolerability in managing SUI in a UK cohort for the first time and offers a potential treatment option for elderly patients who are ineligible for surgical intervention.
2678 Small vessel disease contributions to acute delirium: a pilot feasibility MRI study
Authors: Clancy U , Jardine C , Doubal F , Maclullich A , Wardlaw J 
Published: January 2025

Abstract

Background and aims
Delirium carries an eightfold risk of future dementia. Small vessel disease (SVD), best seen on MRI, increases delirium risk, yet delirium is understudied in MRI research. We aimed to determine MRI feasibility, tolerability, image usability, and prevalence of acute and chronic SVD lesions in acute delirium.

Methods
This case–control feasibility study performed MRI (3D T1/T2-weighted, FLAIR, Susceptibility-weighted, and Diffusion-weighted imaging (DWI) on 20 medical inpatients &gt;65 years: 10 with delirium ≥3 weeks and 10 without delirium, matched for vascular risk, Clinical Frailty Scale (CFS), and cognitive status. We excluded acute stroke, agitation necessitating sedation, assistance of &gt;2 staff to mobilise, and MRI contraindications. We measured scan duration, tolerability, image usability, acute infarcts on DWI, and chronic SVD features. Six months later, we recorded CFS and cognitive diagnoses.

Results
Mean age was 83.5 years (delirium 78.7 vs non-delirium 88.4); 13/20 were female; 17/20 had premorbid cognitive decline/impairment or dementia. Acquisition took mean 26.8 minutes. MRI was well-tolerated in 16/20 (7/10 in delirium arm; 9/10 in non-delirium arm). 4/20 had early scan termination but 20/20 had clinically interpretable images. We detected DWI-hyperintense lesions in 3/10 (33.3%) with delirium (2/10 small subcortical and 1/10 cortical) and in 3/10 (33.3%) without delirium (2/10 small subcortical; 1/10 cortical). Mean SVD score was 2.4 in delirium vs 3.3 without.

Conclusions
MRI is feasible, usable, and tolerable in delirium, and we detected DWI hyperintense lesions in one third of patients overall. This study indicates acute vascular contributions, including SVD, to delirium, supporting the need for larger studies.
2839 Decision aids for the Care of Patients with multimorbidity: a systematic review
Authors: Chen Y , He R , Chen Z , Huang J , Bai Y , Yang C 
Published: January 2025

Abstract

Introduction
Clinical decision making for older adults with multimorbidity can be complex and demanding. When facing complex decision-making, patients may experience decisional conflicts, leading to low treatment adherence, adverse health outcomes, and increased utilisation of health services, etc. To address these issues, patient decision aids (DAs) have been developed and utilised in the decision-making process to facilitate informed decisions. The aim of this study is to identify DAs developed for patients with multimorbidity and assess their quality.

Method
We searched full-text papers on nine databases. Any article utilising a DA for patients with multimorbidity was eligible and DAs for making medical decisions at any point were eligible. We used the International Patient Decision Aid Standards (IPDAS) checklist to assess the quality of DAs.

Results
In total, ten articles including six DAs were included. Two DAs targeted for the older patients with multimorbidity. Most DAs didn’t focus on specific treatment choices but rather aimed at improving the overall quality of life for patients with multimorbidity. The targets of these DAs are including setting goals about health care, preparing for conversation with doctors and taking ownership for the decisions. IPDAS checklist revealed that only one DA met all qualifying criteria and provided comprehensive choice. Three DAs were deemed to have poor quality due to their failure to provide the pros and cons of decisions. The quality of the remaining DAs was difficult to judge due to incomplete versions.

Conclusions
DAs for patients with multimorbidity were few and had poor quality. Designing DAs for this patient population presents challenges given the complex nature of multimorbidity and its lack of specific treatment options. Future development should focus on adhering to the IPDAS checklist, provide more information and possibility, and aim at improving the quality of life for patients with multimorbidity.
2483 Hyponatremia In elderly: a systematic review and Meta-analysis
Authors: Shah S , Barot A 
Published: January 2025

Abstract

Introduction
Hyponatremia is the most common electrolyte imbalance caused by serum sodium level of less than 135 mmol/L, prevailing 15 and 30% among hospitalised patients.

Methods
PRISMA guidelines were followed for this study. Pubmed was searched with the search term: (hyponatremia) AND (treatment OR control OR management [MeSH]) AND (elderly [MeSH]) with filters, timeline: 2000 to 21/07/2023, free full text articles and human species. Data extraction was done using Covidence app and depicted in PRISMA Flow diagram. Quality assessment was done by Cochrane Risk of Bias version 1. Odd’s ratio with 95% confidence interval was calculated for dichotomous outcomes. Mantel–Haenszel statistical method along with random effects model was used. Cochrane Q test was employed and I2 index was computed. Forest and Funnel plots were plotted. The analysis was done by Cochrane Review Manager.

Results
Out of 3222 results, 9 studies were included with total 980 patients. Eight were of vaptans and 1 of empagliflozin. Three studies had low risk of bias and were included in meta-analysis. Mean age and BMI were 70.55(SD = 14.5) years and 24.73(SD = 3.95) kg/m2 respectively. Most frequently occuring aetiology, comorbidity and symptom were congestive heart failure, hypertension and fatigue/malaise respectively. Mean baseline serum sodium was 124.89 mmol/L and mean rise was 9.142 mmol/L. Meta-analysis showed that placebo was significantly associated with achieving normonatremia as compared to treatment group (OR = 2.5, 95%CI:1.54,4.04, p = 0.0002,I2 = 0%). The most frequent reported side effects were nausea, dry mouth, pyrexia and thirst. Side effects both mild/moderate (OR = 1.12, 95%CI:0.69,1.81, p = 0.65, I2 = 0%) and serious (OR = 1.51, 95%CI: 0.77,2.98, p = 0.23, I2 = 0%) showed no difference between treatment and placebo groups. Treatment was not associated with rapid risk of overcorrection (OR = 1.65, 95% CI:0.57,4.81, p = 0.36, I2 = 0%). None showed osmotic demyelination syndrome.

Conclusion
We conclude that vaptans and Empagliflozin, although safe, show limited efficacy in hyponatremia treatment.

Reference
1. Zhang X, Li XY. Eur Geriatr Med. 2020;11(4):685–692.
2629 A feasibility study examining the use of wearable technology among older delirious adults recovering from acute illness
Authors: Stoodley I , Cheston H , Hogan P , Tsui A 
Published: January 2025

Abstract

Introduction
Wearable technology that continuously monitors physiological metrics has become increasingly popular and allows remote patient monitoring in virtual ward settings. Wearable technology has been shown to be effective in disease monitoring among younger adults. However, its use among older adults, including those with cognitive impairment, is yet to be explored.

Aim
We aim to explore the acceptability of remote monitoring using wearable technology among older adults with delirium.

Methods
Participants were recruited from an in-patient rehabilitation unit. Inclusion criteria included documented delirium and age over 65 years. Participants were enrolled until delirium resolved or until discharge. Wearable technology was worn continuously, except when being charged or the patient was washing. Device data was recorded every minute. Premorbid Barthel index and Hierarchical Assessment of Balance and Mobility (HABAM) was collected for each participant. Participants were assessed daily for delirium and mobility using the Memorial Delirium Assessment Scale and HABAM respectively. At point of discharge from the study, participants completed a questionnaire to gather feedback on their experience.

Results
20 participants were included, with a mean age of 83.0 years and an average premorbid Barthel’s index of 72. 6. Mean data capture from the wearable technology was 44.1% (12.8–65.8). None of the participants could independently manage the device. Three participants stated that the device interfered with their normal activities with five reporting the device uncomfortable to wear. However, nine participants stated they would wear the device again if asked to by a healthcare professional.

Conclusions
Our findings demonstrate that wearable devices are tolerated by delirious older adults with delirium. We found that this group cannot manage these devices independently and need support from either a carer or healthcare professional. These results provide useful information to help pilot these devices among older adults with delirium in virtual ward settings.