bluuebunny/crossref_metadata_2025_split huggingface dataset:
2035 The Feasibility to Staff of Patient Specific Music Choice on Elderly Care Wards - A Post Intervention Survey
Authors: Allfree R , Greenaway A-M , Chatterjee A , McColl A 
Published: January 2024

Abstract

Introduction
Receptive music listening has been shown to reduce depression, anxiety, and agitation in older adults. However, unfiltered and disruptive noise can increase confusion and agitation. Yet, during hospitalization older patients often have little control over when and for how long they are exposed to music, the genre which is heard, or they may have no access to music. Furthermore, older persons have reduced ability to use modern technology to counter this and their sensory and functional impairments may further isolate them. This study aimed to assess the feasibility of offering two one-hour daily sessions of patient specific music (PSM) choices on an elderly-care ward.

Methods
On a district general hospital elderly-care ward a 5-day trial of offering two one-hour daily sessions of PSM, using enhanced wireless speakers optimally positioned with daily amended music playlists based on specific patient choice. Ambient noise was minimised with regular decibel monitoring. A post-intervention staff survey was completed to assess the feasibility of continuing, the perceived impact on staff and patients and potential barriers to continuation. Thematic analyses were completed on the survey.

Results
In the post-intervention feasibility survey (n=14) the majority of staff (86%) agreed that it was possible, implementable and the procedure easy to use. In the impact assessment (n=19) 80% of staff stated it had a positive effect on patients and 89% stated it had a positive effect on staff. Thematic analyses on impact identified benefits to: work, engagement, enjoyment, physical activity and well-being. Barriers that were identified included patient choice, repetition of music, patients unable to engage with the process and staff availability for consistent delivery.

Conclusion
Playing patient specific music choice was feasible and acceptable to staff with a perceived positive influence on both staff and patients. Further studies are now required to assess the impact on patient outcomes.
1840 Expanding undergraduate medical students' understanding of frailty
Authors: Bellhouse E , Maitland R , Alexander R , Colquhoun K 
Published: January 2024

Abstract

Introduction
In response to the recent publication of the new British Geriatrics Society undergraduate medical curriculum (1), the medical education department at Glasgow Royal Infirmary created a session focussing on frailty for medical students. The aim was to introduce the concept to students by exploring and expanding on their experiences of frailty.

Methods
We used a pedagogical approach in a 90-minute, small group session. The session was split into three activities; the first was a case of an older adult presenting acutely with urosepsis. The session dealt with acute treatment for frail patients including polypharmacy, collateral history taking, and consideration of patients wishes. The second activity presented the students with three patients with differing manifestations of frailty; students were asked to discuss the concept of ‘the dying process’, and how each patient requires different support. Finally, students were given a ‘frailty suit’ which included 'visual impairment glasses' and 'reduced dexterity gloves' then asked to complete several activities of daily living. This light hearted activity allowed students to experience reflect upon the effects of frailty.

Results
The session was delivered to 25 students, of which 16 provided feedback. Over 85% of students stated that the session was extremely relevant and well delivered on a Lirkart scale; comments included “...we don’t get taught about it enough in medicine”. Results highlight that students recognise the utility of frailty focussed sessions in medical education.

Conclusions
We show that students are aware of the gap in frailty curriculum and an interactive discussion focussed session is one way to enhance their understanding of frailty. We present details of the session, and further iterations of the project we hope to introduce during the upcoming academic year.

References
1. Grace M E Pearson et al. Age and Ageing 2023; Volume 52: 1–8.
1962 Improving end-of-life care in Acute Medicine: A retrospective review
Authors: Shah S , Hassan H 
Published: January 2024

Abstract

Background
End-of-life (EOL) care aims to anticipate, prevent and treat symptoms experienced by the dying patient. An EOL care strategy described by King’s Health Partners (KHP) outlines the ‘ICARE’ framework, created from the five priorities for the dying patient, giving generalist hospital teams a memorable prompt to consider holistic needs of patients. We aim to reconcile performance of Acute Medical Unit (AMU) in providing EOL care, against KHP's framework, to reduce patient suffering and improve care.

Methods
A prospective review was performed of all AMU deaths from March-September 2021, reviewing resuscitation status and EOL medications. Sudden deaths for full resuscitation were excluded. Following review, teaching to AMU was delivered and a wall poster of the ‘ICARE’ framework was displayed. A second prospective cycle was performed reviewing deaths from March-September 2022.

Results
50 deaths were recorded in cycle one. 21% (12/58) of dying patients were not prescribed EOL medications. Medication omission for 50% (6/12) of patients were due to lack of recognition of EOL. Other reasons included no consultant review, undecided resuscitation status and a missing prescription. In cycle two, 11% of dying patients (6/48 patients) were not prescribed EOL medications, all of which were due to lack of recognition of EOL. 12 deaths had EOL medications prescribed but had an inappropriate resuscitation status.

Conclusion
The second cycle showed a 50% reduction in deaths with EOL medication omissions, when compared to the first cycle. Reasons for medication omissions were less varied in cycle two, highlighting reduction in avoidable causes. Although not affecting patient care, a notable number of patient records had incorrect resuscitation statuses. Overall, improvement in delivery of EOL care within AMU can be seen. Future considerations involve emphasis on keeping electronic patient record up to date to avoid errors and continual provision of education to new and rolling staff.
1969 Assessing the acute hospital care of patients with a diagnosis of a learning disability and hip fracture
Authors: Wilson R , Marlor R , Madan S , Knox V , Wilkinson D 
Published: January 2024

Abstract

Introduction
Patients with learning disabilities (LD) often have complex medical needs resulting in onset of frailty at younger ages. This increases risk of morbidity and mortality following emergency admissions, such as acute fractured neck of femur (FNOF). This risk is further increased by communication difficulties experienced in this group. There is little information about how LD affects the quality of care of patients with FNOF as defined by the national hip fracture standards (NHFS).

Methods
This retrospective audit reviewed notes of patients with LD admitted to a teaching hospital with FNOF over 5 years. The audit examined whether the care of patients with LD complied with the NHFS and best practice tariff guidelines, regardless of age. The audit sought to explore potential disparities between patients with LD and the general population. It assessed whether steps were taken to optimise care as defined by the Royal College of Physicians toolkit for LD.

Results
46 patients were included; 22% were under the age of 60. Operative management was in line with recommendations. However, 37% did not receive appropriate bone strengthening treatment and 37% were not mobilised within the first 24 hours. This correlated with fewer patients remaining freely mobile following the admission (8.7% post-operatively vs 41.3% pre-operatively). Documentation of LD severity LD and usual behaviours was unreliable, as was documentation of key conversations, such as those regarding capacity or resuscitation.

Conclusions
This highlights the importance of addressing the increased needs of patients with LD regardless of age, to better facilitate holistic assessment and treatment of this vulnerable population. Locally we plan to minimise variation by utilising LD nurses and providing comprehensive geriatric review of all patients with LD admitted with FNOF. We recommend that data collection, including 120-day follow-up, be incorporated into routine practice for all patients with LD admitted with FNOF.
2012 The long-term clinical outcomes of older adults with frailty following acute hospital admission in Tanzania
Authors: Davidson S L , Murray A , Hardy J , Randall T , Lyimo G , Kilasara J , Urasa S , Walker R W , Dotchin C L 
Published: January 2024

Abstract

Background
Non-communicable disease, multimorbidity and frailty are posing considerable challenges as global populations age. Healthcare systems in Low- and Middle-Income Countries are having to rapidly adapt services to meet the needs of older people.

Objective
This study, the first of its kind in sub-Saharan Africa, aimed to establish whether screening older people for frailty on admission to hospital could be used to identify those at greatest risk of adverse outcomes.

Methods
At baseline assessment, 308 participants aged ≥60 years, admitted to medical wards at four hospitals in the Kilimanjaro Region of Tanzania, were screened for frailty using the Clinical Frailty Scale (CFS). After 10-12 months, participants, and their informants, were contacted by telephone to establish clinical outcomes. The primary outcome was all-cause mortality. Cox regression was used to estimate hazard ratios ( 95% confidence interval) for mortality, with dichotomised CFS frailty status (frail if ≥5) as the independent variable.

Results
Primary outcome data were obtained for 194 (63.0%) of the original participants after a mean follow-up period of 10.8 ( 0.9) months. Mean age was 75.1 years and 99 (51%) of respondents were female. A total of 100 (51.5%) respondents were deceased and hazard ratios for all-cause mortality demonstrate that those with frailty were at significantly greater risk of mortality (HR 2.27 [CI 1.39 – 3.69], p&lt;0.01), an effect that persisted even after adjustment for age, baseline Barthel Index, education and number of chronic conditions.

Conclusion
For older people living in Tanzania, unplanned admission to hospital is associated with high mortality and frailty is a strong independent predicator. In accurately identifying which older people are at the greatest risk, frailty screening using the CFS could provide a starting point for the development of targeted care pathways and interventions.
1872 Development of an innovative digital questionnaire to screen adults for risks of Osteoporosis and Falls by a Primary Care FCP
Authors: Birch C Y 
Published: January 2024

Abstract

Introduction
Socio-economic costs of hip fractures are formidable. Despite osteoporosis and falls being major risk factors, preventative screening in Primary Care does not occur. Evidence shows screening older women for osteoporosis prevents hip fractures, but to make a greater clinical and economic impact simultaneous screening of falls and fracture risks is logical. This cross-sectional study evaluates an innovative digital questionnaire and computer programme to combine person-reported data with medical data, and auto-calculate fracture and falls risks without the need for clinician time.

Method
Digital questionnaires were distributed via email or SMS to adults aged ≥65 who had consented to receive electronic correspondence over a 16-week period in one medical centre. Excluded were adults in nursing/residential care or receiving palliative care. A computer programme combined patient-reported information with existing medical data required to calculate FRAX® & FRAT scores. A robot computer function retrieved fracture risk scores from the FRAX® online tool. A weekly report showed those at high/medium risk of fracture and high risk of falls. Personalised bone health and lifestyle advice was automatically distributed.

Results
632 (37%) of 1692 questionnaires were returned. Ages ranged from 65 to 92 years (M=72.5, SD=5.7), 47.8% identified as male and 52.2% female. Using NOGG UK Guidelines (2021), 217 (34%) adults were identified at amber and 46 (7%) at red fracture risk. 131 (20.7%) adults had fallen within the previous year and 122 (19%) had a high-risk FRAT score ≥3. Personalised bone health and lifestyle advice was delivered to all 632 adults.

Conclusion
This automated screening process accurately identifies adults who are falling and/or at risk of osteoporosis and enables personalised bone health and lifestyle advice to be distributed without the need for clinician time. Prevention of falls and hip fractures would result in significant savings to the NHS and Social Care budgets.
1978 Donanemab in early symptomatic Alzheimer’s Disease: Efficacy and safety in TRAILBLAZER-ALZ 2, Phase 3 Randomized Clinical Trial
Authors: Mintun M , Ritchie C , Solomon P , Sims J R , Salloway S , Hansson O , Apostolova L G , Zimmer J A , Evans C D , Lu M , Ardayfio P , Sparks J D , Wessels A M , Shcherbinin S , Wang H , Nery E S M , Collins E C , Dennehy E B , Brooks D A , Skovronsky D M ,   TRAILBLAZER-ALZ 2 Investigators, Farquharson (Non-author presenter) A 
Published: January 2024

Abstract

Introduction
In TRAILBLAZER-ALZ donanemab (DONA) cleared brain amyloid plaques, significantly slowing disease progression in early symptomatic Alzheimer’s disease (ESAD). Methods: TRAILBLAZER-ALZ2 enrolled participants with ESAD and amyloid and tau pathology by positron-emission tomography, randomizing (multicenter) those with low/medium-tau (n=1182) and high-tau (n=552) (missing tau n=2). Participants (randomized double-blind,1:1) received DONA (n=860)/placebo (n=876) IV every 4w for 72w. DONA participants meeting amyloid clearance treatment completion criteria at 24/52w had blinded switched to placebo.

Primary outcomes
Integrated AD Rating Scale(iADRS) change from baseline at 76w in low/medium-tau or combined (low/medium- and high-tau) populations. Statistical testing allocated most power (80% α spend) to low/medium-tau population outcomes, with the remainder for combined population outcomes, including clinical and biomarker assessments.

Results
In the low/medium-tau population iADRS change at 76w: −6.02 (DONA) and −9.27 (placebo) (difference 3.25; 95%CI, 1.88-4.62; P&lt;0.001), 35.1% slowing of disease progression. Change in Clinical Dementia Rating Scale (CDR)–Sum of Boxes: 1.20 (DONA) and 1.88 (placebo) (difference −0.67; 95% CI −0.95 to −0.40; P&lt;0.001), 36.0% slowing. Participants receiving DONA experienced 38.6% less risk of progressing to next disease stage vs placebo over 76w (CDR-Global score, HR=0.61; P&lt;0.001). Amyloid clearance at 24/52/76w: achieved in 34.2%/71.3%/80.1% DONA-treated participants. Significant, positive results were observed in the combined population. Serious AEs: 17.4% (DONA), and 15.8% (placebo), with 3 deaths among DONA patients who experienced serious amyloid-related imaging abnormalities (ARIA). AEs with DONA included ARIA-E (24.0%, 6.1% symptomatic); ARIA-H (31.4%); infusion-related reactions (8.7%).

Conclusion
DONA treatment significantly slowed clinical progression at 76w with a safety profile consistent with earlier studies. Presented: AAIC2023.
1983 Exploring barriers to recruiting older people to a white-coat hypertension study
Authors: Mensah E , Ali K , Okorie M , Bremner S , McAlister C , Perry N , Rajkumar C 
Published: January 2024

Abstract

Introduction
There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients &gt;75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow up study, we sought to explore the reasons for not recruiting.

Methods
Using a mixed-methods study design, staff from 29 General Practice (GP) sites and the Clinical Research Network (CRN) in Kent, Surrey, and Sussex (KSS) were sent an online questionnaire about local research facilities and infrastructure, and HYVET-2 study methodology and target population demographics.

Results
Nineteen (19) individuals responded the questionnaires (15 primary care staff, 4 CRN staff). Using a framework approach, we identified six themes summarising challenges to HYVET-2 recruitment. These themes were: established approaches of primary care towards managing WCH in older people, target patient demographics, study design complexity, patient-facing study documents, limited research resources in primary care and identification of eligible patients using existing coding.

Conclusion
Our experience showed that recruiting older people to a WCH study from primary care was not feasible. A national scoping survey amongst primary care physicians in the UK, and a robust patient and public involvement (PPI) targeting older people with WCH might improve recruitment in future studies of WCH in older people.
1901 Determinants of hospital readmissions in older people with dementia: A scoping review
Authors: Browne B , Ali K , Tabet N 
Published: January 2024

Abstract

Introduction
In the UK, fifty-three percent of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmission within 30 days from discharge. Between 20-40% of these readmissions are preventable [1]. Current research focused on the biological causes of readmissions. However, older people with dementia have additional psychosocial factors increasing their risk of readmission. The aim of this scoping review was to identify psychosocial determinants within the context of known biological factors.

Methods
Electronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated readmission. An inductive approach was adopted to map determinants of hospital readmission. Identified themes were described as narrative categories.

Results
Seventeen studies including 7,194,878 participants met our inclusion criteria from a total of 4736 articles. Sixteen quantitative studies included observational cohort and randomised controlled trial designs. One American study was qualitative. Ten studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data in over 2 million patients in one American study. Identified psychosocial determinants included inadequate hospital discharge planning, limited interdisciplinary collaboration, and socioeconomic inequalities among ethnic minorities. Biological determinants included reduced mobility and accumulation of comorbidities. Use of antipsychotic medications might explain the interplay between biological and psychosocial determinants.

Conclusion
Poorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions increase the risk of readmission in older people with dementia.

Reference
1. Godard-Sebillotte C, Strumpf E, Sourial N, et al. L. Primary care continuity and potentially avoidable hospitalization in persons with dementia. J Am Geriatr Soc. 2021;69(5):1208-20.
Beyond the Front Yard: The Dehumanizing Message of Accent-Altering Technology
Authors: Payne Ameena L , Austin Tasha , Clemons Aris M 
Published: January 2024

Abstract
Over the past decade, the artificial intelligence (AI) industry, as it relates to the speech and voice recognition industry, has established itself as a multibillion-dollar global market, but at whose expense? In this forum article, we amplify the current critiques of the architectures of large language models being used increasingly in daily life. Our commentary exposes emerging AI accent modification technology and services as agents of racial commodification and linguistic dominance, as it rests on the perceived superiority of standardized US English. We discuss our concern for such services leaching into academia. We argue that this technology follows a standardized language framework, which poses a fundamental problem of being informed by purist monolingual principles. These principles often help to perpetuate and maintain harmful raciolinguistic ideologies that result in language discrimination and the continual framing of the language practices of racially minoritized speakers as deficient. Thus, we write this piece with the intent to expose the fabricated humanity of accent modification technology whose existence perpetuates capitalism’s reliance on dehumanization for economic advancement and the legacy and reproduction of white language superiority.
Computational insights into the cross-talk between medin and Aβ: implications for age-related vascular risk factors in Alzheimer’s disease
Authors: Huang Fengjuan , Fan Xinjie , Wang Ying , Zou Yu , Lian Jiangfang , Wang Chuang , Ding Feng , Sun Yunxiang 
Published: January 2024

Abstract
The aggregation of medin forming aortic medial amyloid is linked to arterial wall degeneration and cerebrovascular dysfunction. Elevated levels of arteriolar medin are correlated with an increased presence of vascular amyloid-β (Aβ) aggregates, a hallmark of Alzheimer’s disease (AD) and vascular dementia. The cross-interaction between medin and Aβ results in the formation of heterologous fibrils through co-aggregation and cross-seeding processes both in vitro and in vivo. However, a comprehensive molecular understanding of the cross-interaction between medin and Aβ—two intrinsically disordered proteins—is critically lacking. Here, we employed atomistic discrete molecular dynamics simulations to systematically investigate the self-association, co-aggregation and also the phenomenon of cross-seeding between these two proteins. Our results demonstrated that both Aβ and medin were aggregation prone and their mixture tended to form β-sheet-rich hetero-aggregates. The formation of Aβ-medin hetero-aggregates did not hinder Aβ and medin from recruiting additional Aβ and medin peptides to grow into larger β-sheet-rich aggregates. The β-barrel oligomer intermediates observed in the self-aggregations of Aβ and medin were also present during their co-aggregation. In cross-seeding simulations, preformed Aβ fibrils could recruit isolated medin monomers to form elongated β-sheets. Overall, our comprehensive simulations suggested that the cross-interaction between Aβ and medin may contribute to their pathological aggregation, given the inherent amyloidogenic tendencies of both medin and Aβ. Targeting medin, therefore, could offer a novel therapeutic approach to preserving brain function during aging and AD by improving vascular health.