bluuebunny/crossref_metadata_2025_split huggingface dataset:
1998 Advance care planning on the Same Day Emergency Care Older People's Unit - a quality improvement initiative
Authors: Kondo M , Stothard C , Nair S , Handalage C , Gould D , Harris J , Mukokwayarira C , Ferris T , Bowden A , Harrison L 
Published: January 2024

Abstract

Introduction
Same Day Emergency Care (SDEC) at St James’ Hospital, Leeds provides urgent care at the interface between primary and secondary care, offering comprehensive geriatric assessment (CGA) to those living with frailty, aiming to prevent hospitalisation and delay frailty progression. Advance care planning (ACP) is a vital component of prioritising care preferences including at end-of-life, but timing often falls short in practice. This quality improvement (QI) initiative aims to proactively open ACP discussions, allowing patients to consider their care goals, ensuring our care is aligned with their priorities.

Method
Between July 2022 and April 2023, the project involved 1039 patients. Led by Advanced Clinical Practitioners with support from consultant geriatricians and a palliative care specialist nurse, ACP discussions were encouraged through prompts in daily staff huddles and drop-in teaching sessions.

Results
ACP uptake increased from 7.8 % to 19.3%. Insights from a perception survey involving 83 healthcare professionals revealed key barriers including clinical workload, limited space, lack of experience and confidence as well as prognostic uncertainty and patient factors. Education and training, clinical supervision, patient information leaflets and a conducive environment were positively associated with ACP.

Conclusion
There has been a cultural shift in the department as the practitioners now routinely prompt staff to undertake ACP in safety huddles. Key catalysts for ACP initiation were found to be progression of frailty, terminal diagnoses, dementia, and recurrent hospital admissions. As a new SDEC unit is scheduled to open in the coming months, with provision of space and privacy, our aim is to improve the quality and quantity of ACP discussions with the patient at the centre of all decision-making. In line with these endeavours, parallel support within the community through our home (virtual) ward will further enhance proactive care planning in older people living with frailty.
1989 Improving accuracy of Clinical Frailty Scale (CFS) scoring on geriatric and oncology wards in Hull University Teaching Hospitals
Authors: Martin S , Asiwe R , Young J , Amusan M , Lim A , Stapley S 
Published: January 2024

Abstract

Introduction
The Rockwood Clinical Frailty Scale (CFS) is a tool that assesses global frailty, validated for use in people aged over 65. It assesses an individual’s functional status to assign a number from 1 (very fit) to 9 (terminally ill). Hull University Teaching Hospitals has integrated mandatory CFS assessment on admission for inpatients aged over 65. This project aimed to improve the accuracy of CFS scoring in an oncology and a geriatric ward by empowering ward nurses to better recognise frailty.

Methods
Phase 1. Baseline data was collected from admission CFS scores from inpatients on one geriatrics ward and one oncology ward. We then individually reviewed admission CFS scores for the same patients. We recorded concordance if the same score was assigned.
Phase 2. We surveyed nursing teams on both wards, as they assign the initial CFS score during a patient admission. This revealed unanimous recognition of the pivotal role accurate frailty recognition plays in targeting individualised frailty intervention and called for more staff training in frailty/CFS. Following this, we introduced a pictographic version of the Rockwood CFS scale to nursing stations where admission documentation takes place and re-assessed CFS score concordance.

Results
A substantial improvement in CFS score concordance was demonstrated within the geriatric ward, from 41% at baseline to 56%. However, only minimal change was observed within the oncology ward remaining static at 11.1% from baseline 8.3%.

Conclusions
We have worked with the two wards to disseminate knowledge and use of the NHS CFS app. Through collaboration with the trust’s frailty leads, the CFS app is now being incorporated into the electronic recording system, encouraging routine use of the app when calculating CFS scores. Once this change is implemented, we will recollect data again.
1908 Documentation in Clinical Frailty scores in patients aged &gt;65 admitted to surgical assessment unit
Authors: Basharat B , Fayyaz A , Alkaissy R 
Published: January 2024

Abstract

Introduction
According to the latest NELA report, frailty doubles the risk of mortality in patients &gt;65 and above, but review by a geriatrician can significantly reduce this risk. To identify patients at risk, the report recommended that a formal frailty assessment for all patients&gt;65 should be performed. The aim of this audit was to check compliance with this recommendation.

Methods
Data were collected retrospectively from a prospectively maintained electronic hospital records. Patients &gt; 65 years admitted acutely under general surgery were identified from handover lists spanning a period of two weeks. The admission documents were reviewed to check for a formal assessment of clinical frailty score (CFS) had been completed. Following initial results, posters were put up in the SAU doctors’ office and all clerking doctors made aware via e-mails, WhatsApp groups and teaching to complete a CFS for patients &gt;65 years.

Results
In the first cycle, 50 patients were identified and compliance rate was 18%. Following intervention, 51 patients were identified in the subsequent cycle with a compliance rate of 47%. After a second intervention, 99 patients were identified with a compliance rate of 61%.

Discussion
The NELA report highlighted only 23% of patients had a CFS documented and this was similar to the results of the initial audit. The main reason was lack of awareness, which was addressed by creating an awareness among the colleagues via poster, group chats and emails. This brought compliance up to 47%. Another reason was doctors being unable to locate the CFS on the electronic clerking document. A second round of intervention by poster, group chat, email communication and teaching achieved a 61% completion rate. The recommendation is to continue to improve the documentation of CFS further and utilize this to get input from geriatricians.
1912 Reviewing the effect of COVID pandemic on changing clinical practice of administrating Zoledronic Acid to hip fracture patients
Authors: Tun Z L , Melrose R , Saharia R , Tazeen U 
Published: January 2024

Abstract

Introduction
Reduction in outpatient appointments during the COVID-19 pandemic and patient concern surrounding risk of contracting COVID-19 by attending day-case settings, resulted in delayed or cancelled medical treatments including Zoledronic Acid infusions as management for Osteoporosis. This, alongside recent research concluding that these treatments can be given safely as early as 1-2 weeks post-fracture, lead to the adaptation of protocol at Hull University Teaching Hospitals Trust in 2021, to provide rapid loading of Cholecalciferol over 6 days, prior to administration of Zoledronic Acid on day 7. However, some concerns remain surrounding the potential interference with bone remodelling and healing. This completed audit cycle evaluates the logistics and safety of this new protocol.

Methods
All patients over 60, admitted with neck of femur fracture who received Zoledronic Acid infusion as inpatient or outpatient in 2019 and 2021 were included in the initial and repeat audit respectively. Electronic records for the following 12 months were analysed evaluating for further fragility fracture and mortality rate.

Results
There was an increase in patients receiving Zoledronic Acid as an inpatient treatment from 21% in the initial audit to 97% in the repeat audit. There was a slight increase in mortality rate at one year from 14% to 19%. The percentage of a further fragility fracture within one year, remained stable at 7%.

Conclusion
The increase in inpatient infusions suggests more patients with significant frailty who would otherwise not have been able to attend outpatient settings, have been able to receive treatment. The mortality results reflect this frailer audit population. The absence of a substantial increase in the rate of further fragility fracture at one year; supports the earlier administration of Zoledronic Acid as a management protocol.
1938 Prevention of herpes zoster infection with a recombinant zoster vaccine to support healthy ageing in older adults
Authors: Ankobia A ,   on behalf of, Curran D , Doherty T M , Lecrenier N , Breuer T 
Published: January 2024

Abstract

Introduction
In the European Union, life expectancy has increased from 74 to 81 years between 1990 and 2018. Time spans living in ill health are also increasing. Vaccine recommendations focus primarily on vaccines that prevent death thereby extending length of life. The focus should also include vaccines that promote healthy ageing (HA), improving the quality of longer lifespans. The aims of this review are to describe the impact of herpes zoster (HZ) in adults ≥50 Years of Age (YOA), and to summarise the available evidence on how the recombinant zoster vaccine (RZV) contributes to HA.

Methods
We conducted a narrative review of published literature on the impact of developing HZ on HA and the ability of vaccination to prevent the subsequent burden of disease. Specifically, we describe HZ impact on functioning ability and quality of life, and impact of RZV on reducing the burden of HZ in adults ≥50 YOA.

Results
One in three people develop HZ in their lifetime. Approximately, 15 million cases of HZ occur annually worldwide in adults ≥50 YOA. Post-herpetic neuralgia (PHN, pain persisting for ≥ 90 days) occurs in up to 30% of patients, with HZ ophthalmicus affecting up to 25% of patients. HZ presents as a unilateral, vesicular rash with pain scored as “worst pain imaginable” in ≥15% of patients. Treatment options for HZ and its complications are limited and suboptimal with only 14% of patients with PHN satisfied with their treatment. Pain significantly impacts sleep, mood, physical, social and mental functioning. RZV elicits a strong and long-lasting immune response, targeting the decline in cellular immunity. RZV reduced the burden of HZ pain and interference on activities on daily living by &gt;90% in adults aged ≥50 YOA.

Conclusion
RZV, by preventing HZ episodes, supports maintenance of functional ability contributing to wellbeing in older age.
1709 Comparative performance of six multimorbidity indices to discriminate intrinsic capacity impairments among older adults
Authors: Yang C , Cao X , Mo Y , Zhang J , Wang X 
Published: January 2024

Abstract

Introduction
Optimal intrinsic capacity (IC) is crucial for preserving the functional abilities of older adults. The presence of multimorbidity is closely associated with IC impairments. Various multimorbidity indices have been developed for diverse health outcomes. This study aimed to compare the performance of six commonly used multimorbidity indices to discriminate IC impairments among community-dwelling older adults.

Method
We used data from a multidimensional geriatric assessment program including 627 community-dwelling older adults in five cities of Hunan, China. Six multimorbidity indices were extracted from the data, including disease counts, Functional Comorbidity Index (FCI), the Deyo Charlson comorbidity index, two indices (total score and comorbidity index) derived from the Cumulative Illness Rating Scale-Geriatric (CIRS-G), and medication counts. The IC was measured with five individual domains, i.e., locomotion, vitality, sensory, cognition, and psychological capacity. Individuals were regarded as having IC impairments if they had impairments in one or more domains. Associations between multimorbidity indices and IC impairments were examined using logistic regression analyses. The discriminative ability of multimorbidity indices for IC impairments was compared using the c-statistics.

Results
A total of 374 (59.6%) participants had IC impairments. All multimorbidity indices were significantly associated with IC impairments after adjusting for confounding factors. All indices showed acceptable discriminative power (c-statistic ranged from 0.711 to 0.759) for IC impairments. The comorbidity index derived from CIRS-G resulted in the highest c-statistic, followed by the total score of CIRS-G and FCI.

Conclusions
Our study results suggest that multimorbidity indices differed in their ability to discriminate IC impairments. The comorbidity index derived from CIRS-G performed better than other multimorbidity indices included in this study. The comorbidity index has the potential as a simple proxy measure of indicating the need for interventions to optimise IC for older adults in community settings.
1851 Increasing number of deaths related to Parkinson’s disease (PD) and Parkinsonism
Authors: Adhiyaman V , Hobson P 
Published: January 2024

Abstract

Introduction
The burden of PD has exponentially risen from 2.5 million in 1990, to 6.1 million in 2016 (PD Collaborators. Lancet Neurol. 2018; 17(11):939-53). This is due to ageing population, increased longevity, increased duration of the disease and improved diagnosis. The aim of our study was to identify the trend on deaths related to PD and Parkinsonism over the last decade.

Methods
We collected our data from the Office of the National Statistics, using codes G20 (PD), G21 (Secondary Parkinsonism) and G22 (Parkinsonism classified elsewhere), to extract the number of deaths coded under these conditions from 2013 to 2021. The data was only available for England and Wales.

Results
Total number of deaths including all codes from 2013 to 2021 were 4518, 4950, 5542, 5734, 5936, 6508, 6207, 7414 and 7117. Deaths coded under G.20 are far higher compared to deaths coded under the others.

Conclusion
The number of deaths related to PD has been gradually increasing and has nearly doubled over the last 9 years. Although Covid 19 may have contributed to this increase over the last two years, there is an overall rising trend. We think this is primarily due to people with PD living longer leading to an increased prevalence and duration of the condition. This is linked to sarcopenia, frailty, immobility, cognitive impairment and dysphagia contributing to increased mortality in later years. Another reason could be due to more accurate documentation in death certificates. Even though there has been concerns that deaths certificates have not been accurately coded to include PD, (Hobson, Meara. 2018; 8(2):e018969), there is probably an improvement after the introduction of Medical Examiner services. It is important to recognise the increasing burden of PD to enable us to plan and invest in resources to improve the care of these patients.
Correction of Lying Ear and Aesthetic Modification of Helix and Ear Lobule With Hyaluronic Acid Filler Injection: Experience in Chinese Patients
Authors: Li Yiming , Dong Weiwei , Zhang Lingmei , Yang Ying , Song Yang , Shi Ning , Li Shiyi , Mohd Hayati Mohd Firdaus Bin , Ling Sophia Heng Si , Tang Yujun 
Published: January 2024

Abstract

Background
Large and long ears are regarded as symbols of wealth and health in East Asian culture, and people with lying ears often want their ears to be more exposed and prominent. Surgeries to correct lying ears have been documented.

Objectives
The aim of this study was to report the correction of lying ears and the aesthetic modification of helix and ear lobule with hyaluronic acid (HA) injections.

Methods
HA injections were performed at the auriculocephalic sulcus to increase the cranioauricular angle (CA) and correct lying ears. The injections at helix and lobule were case specific. The CA was measured and photographs were taken at baseline and at 1-, 3-, 6-, and 10-month follow-ups. Efficacy was assessed with the 5-point Global Aesthetic Improvement Scale (GAIS). Adverse events were recorded.

Results
Forty-six patients (92 ears) received HA injections and completed follow-ups. Instant correction outcomes were observed. Sixteen (34.8%) patients received 1 touch-up injection, the clinical efficacy of which persisted for 1 to 1.5 years. For over 90% of cases with touch-up treatment the GAIS was “very much improved” or “much improved” at all follow-ups. The GAIS for over 70% of cases without touch-up treatment was “very much improved” or “much improved” at 1-, 3-, and 6-month follow-ups. CA increased significantly compared with the baseline. Patients also reported “more V-shaped face shape” and “lifted jawline” effects. No serious adverse events occurred.

Conclusions
As an alternative technique to surgeries, HA filler injections at the auriculocephalic sulcus effectively corrected lying ears. This technique produced immediate, long-lasting, and aesthetically pleasing results. The side effects and downtime were minimal.

Level of Evidence: 3
Pedicle Selection and Design in Reduction Mammaplasty: The Role of Preoperative Fluorescence Imaging
Authors: Lin Yan , Li Haoran , Li Zhengyao , Chen Lin , Xing Wenshan , Zhang Xiaoyu , Mu Dali 
Published: January 2024

Abstract

Background
Breast reduction has a wide selection of pedicles but often relies on the surgeon’s preference and experience. Necrosis of the nipple-areola complex (NAC) is a catastrophic complication of breast reduction surgery.

Objectives
To solve the above problem objectively, we applied fluorescence imaging technology to the pedicle selection and design of breast reduction surgery for the first time, so that the dominant vessels of the NAC were included in the designed pedicle.

Methods
We retrospectively enrolled 120 patients with breast reduction (a total of 239 breasts). We compared 60 patients who underwent breast reduction without fluorescence imaging for pedicle selection (Group A) with 60 patients who underwent pedicle selection with fluorescence imaging (Group B). The NAC blood supply was monitored after the operation.

Results
In this study, 60 Group A cases (119 breasts) and 60 Group B cases (120 breasts) were analyzed. There were no statistically significant differences in patient demographic data or intraoperative resection weights. There were 7 cases of NAC necrosis in Group A (1 case of complete necrosis and 6 cases of partial necrosis), while no NAC necrosis occurred in Group B. There was a significant difference in the rate of NAC necrosis between the 2 groups.

Conclusions
Preoperative fluorescence imaging can guide the selection and design of breast reduction, significantly reducing postoperative NAC blood supply obstacles and necrosis.

Level of Evidence: 3
Expression, purification, and biological activity evaluation of cathepsin L in mammalian cells
Authors: Zhou Wenwen , You Baoqing , Zheng Yifan , Si Shuyi , Li Yan , Zhang Jing 
Published: January 2024

ABSTRACT
Cathepsin L (CTSL) could cleave and activate SARS-CoV-2 Spike protein to promote viral entry, making it a hopeful therapeutic target for COVID-19 prevention and treatment. So CTSL inhibitors are considered to be a promising strategy to SARS-CoV-2 infection. CTSL has previously been expressed in inclusion body in Escherichia coli. In order to prepare CTSL with high purity and activity in soluble active form, we transformed HEK-293T cells with a recombinant mammalian expression plasmid. CTSL was purified to a purity about 95%, found to migrate at approximately 43 kDa and exhibited substrate specificity against Z-Phe-Arg-AMC with specific activity of no less than 85 081 U/mg, characteristic of active CTSL. Although eukaryotic purified CTSL is commercially available, our study for the first time reported the details of the expression, purification, and characterization of active, recombinant CTSL in eukaryocyte system, which laid an experimental foundation for the establishment of high-throughput screening model for anti-coronavirus drugs targeting CTSL.
Inhibition of melanoma cell proliferation by strobilurins isolated from mushrooms and their synthetic analogues
Authors: Tanaka Tomoya , Takahashi Kenji , Inoue Yuki , Endo Naoki , Shimoda Emiko , Ueno Kotomi , Ichiyanagi Tsuyoshi , Ohta Toshio , Ishihara Atsushi 
Published: January 2024

ABSTRACT
Strobilurins A and X, isolated from Mucidula venosolamellata culture extracts, demonstrated potent inhibition of human melanoma G-361 cell proliferation. Strobilurin X exhibited milder inhibitory effects on human fibroblast cells (NB1RGB) compared to strobilurin A. Additional strobilurin-related compounds were isolated from the other mushroom species. Oudemansins A and B displayed weaker activities on G-361 cells than strobilurins A and B, respectively, emphasizing the importance of a conjugated double-bond structure. Among isolated compounds, strobilurin G showed the lowest IC50 value for G-361 cells. Additional strobilurins bearing various substituents on the benzene ring were synthesized. Synthetic intermediates lacking the methyl β-methoxyacrylate group and a strobilurin analogue bearing modified β-methoxyacrylate moiety showed almost no inhibitory activity against G-361 cells. The introduction of long or bulky substituents at the 4′ position of the benzene ring of strobilurins enhanced the activity and selectivity, suggesting differential recognition of the benzene ring by G-361 and NB1RGB cells.
epidecodeR: a functional exploration tool for epigenetic and epitranscriptomic regulation
Authors: Joshi Kandarp , Wang Dan O 
Published: January 2024

Abstract
Recent technological advances in sequencing DNA and RNA modifications using high-throughput platforms have generated vast epigenomic and epitranscriptomic datasets whose power in transforming life science is yet fully unleashed. Currently available in silico methods have facilitated the identification, positioning and quantitative comparisons of individual modification sites. However, the essential challenge to link specific ‘epi-marks’ to gene expression in the particular context of cellular and biological processes is unmet. To fast-track exploration, we generated epidecodeR implemented in R, which allows biologists to quickly survey whether an epigenomic or epitranscriptomic status of their interest potentially influences gene expression responses. The evaluation is based on the cumulative distribution function and the statistical significance in differential expression of genes grouped by the number of ‘epi-marks’. This tool proves useful in predicting the role of H3K9ac and H3K27ac in associated gene expression after knocking down deacetylases FAM60A and SDS3 and N6-methyl-adenosine-associated gene expression after knocking out the reader proteins. We further used epidecodeR to explore the effectiveness of demethylase FTO inhibitors and histone-associated modifications in drug abuse in animals. epidecodeR is available for downloading as an R package at https://bioconductor.riken.jp/packages/3.13/bioc/html/epidecodeR.html.