bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chemical and thermal stability of electrospinned polyvinylidene fluoride/graphene composite membranes
Authors: Yang Heshan , Zhang Xingying , Ni Haitao 
Published: January 2024

Abstract
The effect of graphene content, spinning flow rate, and distance on the chemical and thermal stability of electrospinned polyvinylidene fluoride (PVDF)/graphene composite membranes was systematically investigated. Long-duration soaking experiments by three typical solution media, diluted hydrochloric acid, dimethyl sulfoxide, and mixed-solution of lithium hexafluorophosphate/methyl ethyl carbonate, were used to evaluate the chemical stability of the selected samples. The relevant results of relative mass change rate all indicate that the chemical stability of PVDF composite materials increases with increasing graphene content as well as flow rate or decreasing distance. Moreover, there is a clear consistency between thermal stability and chemical stability. The results of the thermal shrinkage rate evidence that the thermal stability of the samples could be enhanced by increasing graphene content, flow rate, and decreasing spinning distance.
Variability aware ultra-low power design of NOR/NAND gate using non-conventional techniques
Authors: Sharma Uma , Jhamb Mansi 
Published: January 2024

Abstract
Fundamental to digital signal processing applications such as the Arithmetic Logic Unit (ALU), logic gates serve as the foundational components. This paper presents NOR and NAND gates engineered for operation within the ultra-low voltage (LV) and low power domains (LP). Utilizing the floating gate MOSFET (FGMOS) approach, this study adopts a strategy to enhance performance, focusing on reducing design complexity and minimizing power consumption.The proposed FGMOS-NAND/NOR gate design is investigated for important device parameters such as power (pwr), delay (tp), power delay product (PDP), and energy delay product (EDP). At 0.7 V supply, the overall power consumption of the FGMOS NOR and NAND gates is 0.442 nW and 0.323 nW, respectively. Further, carbon nanotube field effect transistor (CNTFET) technology is used to implement NOR and NAND gates in this research work. A rigorous comparative analysis was conducted in this research study to assess the performance of non-conventional technologies, specifically field-effect transistors with floating gate (FGMOS) and carbon nanotube field-effect transistors (CNFET), in comparison to the conventional complementary metal-oxide-semiconductor (CMOS) technology. Notably, our investigation revealed that when carbon nanotube field-effect transistor (CNTFET) technology is synergistically employed in conjunction with FGMOS technology, the overall circuit performance is significantly enhanced. Furthermore, in order to estimate the robustness and reliability of the proposed designs, comprehensive analysis pertaining to delay and power-delay product (PDP) variability were meticulously carried out within the scope of this research article.
1874 Developing a pathway direct to elderly medicine clinic for frail patients referred via colorectal fast-track: pilot and outcomes
Authors: Nixon A , Memery T , Morgan J , Brown A , Scampion C 
Published: January 2024

Abstract

Introduction
It is increasingly recognised within oncogeriatrics that standard fast-track pathways for suspected malignancy can be inappropriate for frail and elderly patients (Thomas et. al.; Age and Ageing; 2021; 50; ii8-ii13). Specifically for colorectal referrals, following standard pathways can mean undergoing invasive and expensive endoscopic investigations which may be unwanted and not alter overall management. Streaming frail patients to elderly medicine may increase opportunities for comprehensive geriatric assessment whilst reducing unwanted invasive tests and time spent on fast-track pathways.

Methods
A 3-month retrospective audit of frail patients seen in colorectal fast-track clinic was conducted to evaluate existing practice at Bradford Teaching Hospitals. This informed the design of a new pathway streaming frail patients directly to elderly clinic within 2 weeks. This was implemented in a 3-month pilot with data prospectively collected to compare outcomes.
Cohorts: - 26 patients (median age 79, WHO performance status 3) seen by colorectal team March-June 2022.
- 20 patients (median age 85, WHO performance status 2) streamed to elderly medicine clinic October 2022- March 2023.

Results
- Median time to fast-track pathway removal was 62 days for patients managed via colorectal clinic compared to 31 days via elderly medicine. - Invasive tests and imaging (CT/endoscopy) fell from 1.4 tests per patient in colorectal clinic to 0.4 patients in the pilot. - 2 diagnoses of cancer made via colorectal clinic, but no further treatment for either patient. 1 diagnosis of lung cancer in pilot group, patient undergoing radiotherapy. - Patients seen in elderly clinic had greater rates of positive diagnosis for symptoms (e.g: infective/iatrogenic).

Conclusions
Streaming frail elderly patients referred via colorectal fast-track to elderly medicine reduced the number of invasive investigations undertaken and time spent on fast-track pathways. Expanding this successful pilot could improve long-term clinical quality in the service and more widely if disseminated.
1891 Role of telemetry in detecting atrial fibrillation in acute ischaemic stroke
Authors: Gan L , Adhiyaman V 
Published: January 2024

Abstract

Introduction
Atrial Fibrillation (AF) causes 15% of ischaemic strokes. The National Clinical Guideline for Stroke recommends at least 24 hours of cardiac monitoring and a longer duration if cardio-embolic stroke is suspected. The British Heart Rhythm Society suggests up to 72 hours of cardiac monitoring. Currently, there is little data on the use of telemetry in detecting AF in acute strokes. Our study aims to evaluate the detection rate of new onset AF in acute stroke with telemetry and to determine if there was any correlation between the duration of telemetry and the detection rate of AF.

Method
All patients with ischaemic stroke who were admitted to stroke ward over a 3-month period were retrospectively analysed. Exclusion criteria were patients who were known to have AF, had new AF on admission electrocardiogram, patients receiving palliative care, patients who were discharged home early without having a telemetry and patients with missing records.

Results
61 patients met the inclusion criteria and 5 (8.2%) had AF on telemetry. Two patients had AF on day 1, one on day 2 and two on day 3. All of these patients were anticoagulated. The duration of telemetry ranged between 1- 19 days however no AF was detected beyond the third day of this study.

Conclusions
AF was detected in 8% of patients with ischaemic stroke within the first 72 hours of admission. Among the patients in whom AF was detected, 5% were detected between 24 hours and 72 hours of admission. Studies (EMBRACE and CRYSTAL trials) have shown that prolonged cardiac monitoring (30 days and 6 months to a year respectively) resulted in higher detection rates of AF. This study suggests that patients with ischaemic stroke should be monitored for at least 72 hours due to a higher detection rate of AF.
1853 Improving treatment for urinary tract infections for older adults in the Health and Ageing Unit
Authors: Petho H , Maruthan S , Poole-Wilson O 
Published: January 2024

Abstract

Introduction
A suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Therefore, correct recognition and documentation of UTIs, as well prescribing of antibiotics, is important for optimising patient care.

Methods
We reviewed UTI antibiotic prescribing practice across the Health and Ageing Unit (HAU) wards at Kings College Hospital over a two-month period. Weekly data we collected from all patients commenced on antibiotics for a suspected UTI highlighted key areas for improvement. We designed and delivered a multifaceted educational intervention to all healthcare professionals caring for older adults across the HAU. This consisted of teaching sessions, distribution of posters, and board round reminders.

Results
A further two months of data post-intervention showed improvements in several outcomes. Correct prescribing rose from 61% to 93%. The number of prescriptions with stop dates went up from 50% to 68%. The number of patients with urine samples processed in the laboratory rose from 64% to 93%. We also saw an improvement in the management of patients with catheter associated UTIs.

Conclusions
A multidisciplinary team intervention of teaching and visual cues improved the management of UTIs. This shows the power of multifaceted educational interventions for improving the care of older adults.
2020 Improving pain management in non-verbal patients
Authors: Babar L , Hodges G , Dudley I , Sessani M , Currie H , Nicolson P 
Published: January 2024

Abstract

Introduction
Identification of pain generally relies on patient self-reporting of symptoms. Patients with limited communication, advanced dementia or learning disabilities are unable to self-report pain. This results in pain being under-recognised and under-treated. Consequences of this are serious and include physical and psychological distress, longer length of stay and worse outcomes.1

Methods
Abbey Pain Score (APS) [Figure 1] was introduced on a single Healthcare of the Older Person ward.2,3 It was used as the primary means of assessing pain in non-verbal patients (NVP) in place of the usual verbal pain scale (scored 0-10). [Figures 2 and 3] Ward-based teaching for all doctors, nurses and healthcare assistants was conducted before introduction of the APS. Data was collected for 20 consecutive NVP.
Figure 1: Abbey Pain Score (Six items observed & Score)
Vocalisation: 0-3;
Facial expression: 0-3;
Change in body language: 0-3;
Behavioural change: 0-3;
Physiological change: 0-3;
Physical changes: 0-3.
Scoring scale: No Pain (0-2); Mild Pain (3-7); Moderate Pain (8-13); Severe (14+).

Results
At baseline we identified that pain as a symptom was missed in 54 % of NVP using the verbal pain score. With introduction of APS this dropped only slightly at 3 months but there was an increased uptake in scoring NVP on APS. With persistent engagement there was a significant decline in number of patients with un-managed pain needs. Figure 3: Abbey pain score (All patients with any pain)

Baseline
Pre-intervention: 21 / 39 (54 %); Post-intervention (3 months): 10 / 20 (50 % Post-intervention (12 months): 1 / 19 (5 %)

Conclusion
ABP is an effective means of addressing pain in NVP. It is simple to implement and can lead to significant improvements in patient care.
1868 Eight to Hydrate: Promoting oral hydration of elderly patients in hospital
Authors: Williams M , Anketell R , Georgiakakis E , Mizoguchi R 
Published: January 2024

Abstract

Introduction
Dehydration is associated with prolonged hospital admissions and complications. Elderly patients are more susceptible due to physiology, dexterity and cognition. The British Dietetic Association recommends minimum 7 beverages per day whilst The British Nutrition Foundation advises proactive dehydration risk management in hospital. This project aimed to reduce the proportion of elderly patients at risk of dehydration in hospital.

Methods
Staff documented oral hydration over 24 hours for patients on the Care of the Elderly ward. Additional factors obtained retrospectively included demographics, dementia diagnosis, fluid prescriptions and fluid restriction. Criteria adapted from a ‘Hydration Care Assessment Tool’ defined risk of dehydration by daily intake as low (&gt;1500mls), medium (800-1500mls), high (400-800mls) or very high (&lt;400mls). Approximating each drink as 200mls, we set a daily target of 8 beverages; equating to low risk. Visual hydration trackers were placed at patients' bedsides and junior doctors reminded the multi-disciplinary team each morning. Data collection was repeated after 2 weeks.

Results
First cycle recruited 13 males, 16 females with mean age 78.5. Over 50% were Very High Risk (5/29) or High Risk (12/29) of dehydration whilst the remainder were Medium Risk (10/29), or Low risk (2/29). 4/5 (80%) at Very High Risk received intravenous fluids. Of the High-Risk group, more than half had a diagnosis of dementia and 3/12 (25%) received fluids intravenously. Following intervention, 12 males and 7 females were recruited with mean age 76. Proportion at highest risk was reduced: Very High Risk (5/29 to 0/19; -100%), High Risk (12/29 to 3/19; -61%). Therefore, more were at Medium Risk (10/29 to 13/19; +101%) and Low Risk (2/29 to 3/19; +131%).

Conclusion
Though improved, few patients meet hydration recommendations. However simple visual reminders are an effective starting point. Further interventions could include oral fluid prescriptions and reflect staff and patient feedback.
1804 Feedback fatigue in the Foundation Year 1 Older Person's Unit cohort: A quality improvement project
Authors: Moore S 
Published: January 2024

Abstract

Introduction
On designing and leading the Foundation Year 1 (FY1) Older Person’s Unit (OPU) teaching programme at St Thomas’ Hospital, London (STH), it was identified that the method of feedback collation was inefficient and yielding poor quality feedback from FY1s. Feedback fatigue was high.

Plan
FY1 trainees were initially asked to complete feedback for their FY1 OPU teaching on paper forms. This yielded a high response rate (100% of forms completed), but feedback quality was poor. The time taken to collate responses from the paper feedback forms was disproportionate to the quality of feedback received.

Intervention 1
An online feedback form was designed and emailed to the FY1 trainees after each teaching session. This collated responses automatically into a password protected Excel spreadsheet.

Study
The online feedback form initially yielded a high response rate, along with constructive feedback. Time taken to collate responses was reduced to zero. However, was noted that the response rate fell gradually to approximately 20%. The two main factors inhibiting responses were a heavy email burden and forgetting to fill in the feedback form.

Intervention 2
A QR code linked to the online feedback form was designed, with the intention of being shown at the end of each teaching session. This was emailed out to all presenters in advance and incorporated into their teaching presentations.

Study
Feedback response rate attained 100% consistently over a 2-month period. The feedback quality received was higher, with constructive comments being fed back in a timely matter.

Conclusion
Timely recognition of feedback fatigue in the FY1 trainee cohort is extremely important. Designing and implementing methods by which to negate and overcome this is important in obtaining feedback such that future teaching sessions can be continually improved and tailored to FY1 learning needs.
1879 On a knife's edge: role of a Clinical Nurse Specialist on balancing complex treatment decisions in acute surgery
Authors: Norridge F , Anand K , Grundy P , Mullins A , Patel H P , Hewertson E 
Published: January 2024

Abstract

Introduction
1 in 4 older individuals having emergency general surgery live with frailty, are more likely to have a longer hospital stay, readmission rate, morbidity and mortality. This underscores the importance of individualised approaches to care through Shared Decision Making (SDM). We introduced SDM into our surgical liaison service aiming to measure effectiveness and patient outcomes.

Methods
Between October 2021 and September 2022, patients aged &gt;70 years living with frailty admitted to the surgical unit were identified by an Older Persons Clinical Nurse Specialist (CNS). Involvement in treatment decisions was measured by using the patient and clinician SDM-Q9 questionnaire. Pre-admission as well as follow-up quality of life scores at 6 months using the EQ-5D-5L (0-100) as well as Decision Regret were obtained on subsets of patients.

Results
Of a total of 76 patients seen by the CNS, follow-up data were available for 61 patients, clinician and patient SM-Q9 were completed in 54 patients. Clinicians were 10% more likely to strongly or completely agree that they explained choice available, 16% more likely to feel they explained treatment options compared with patients. Patients were less likely to feel completely involved in decision making. However, they were more likely to agree they understood clinical information presented them. Low levels of decision regret were ascertained at follow up where 18 patients agreed and 32 patients strongly agreed that a right decision was made of their care. Of 15 patients who underwent emergency laparotomy, mean EQ-5D scores across all domains from improved from baseline (69 vs 78).

Conclusions
CNS led implementation of SDM is feasible, acceptable. Patients felt involved in their care and had lower levels of decisional regret. Encouraging and investing in an environment where health professionals take time to determine what is important to their patient can be associated with better outcomes.
1726 Vitamin D single dose loading regimen in neck of femur fracture patients
Authors: Blackburn S , McIntyre R , Williams M , Asumang J , Gandee A , Khinder S , Sharma A 
Published: January 2024

Abstract

Introduction
The best practice tariff for Neck of Femur Fractures (NOFF) was designed to improve patient outcomes and includes establishing and implementing a bone protection plan (BPP). Optimal management is often delayed due to insufficient vitamin D levels. Here we reviewed the administration of anti-resorptive therapies (AR) when giving vitamin D loading doses over 7 weeks compared to stat high dosing followed by maintenance therapy.

Method
Pre-intervention, we reviewed vitamin D levels, the treatment given and the bone protection therapy administered in all new NOFF admissions over 3 months. We introduced once only high dose vitamin D therapy in vitamin D deplete individuals over the subsequent 3 months; deplete (Vit D &lt;50) patients received 140,000 units stat colecalciferol and adcal maintenance, patients with insufficient levels (Vit D 50-70) received 60,000 units stat colecalciferol and adcal maintenance and replete individuals received adcal maintenance. Patients were then given in-patient AR therapy or referred to fracture liaison service (FLS) for further BPP assessment.

Results
Pre-intervention included 64 patients, of which 61% (N=39) had low vitamin D levels (deplete and insufficient combined). These patients were loaded with once weekly 40,000 units of vitamin D for 7 weeks and referred to FLS, with 51% (N=24) receiving an appointment within 4 months. Only 14% (N=9) received in-patient AR treatment. Post intervention, 84 patients were reviewed. Vitamin D replacement was required in 69% (N=59) of patients, of which 83% (N=49) received loading regimen as per protocol. This allowed 53% (N=20) of eligible patients to receive in-patient AR therapy with 43% (N=11) of those not receiving therapy being impacted by junior doctor strikes.

Conclusion
Administrating high dose vitamin D to NOFF patients allowed us to increase in-patient AR therapy treatment 3.7 times. This simple intervention results in less out-patient appointments and treatment is given before an opportunity to re-fracture.
1996 The use of electronic 4AT delirium identification tool in inpatient care
Authors: Jabir Z , Alićehajić-Bečić D 
Published: January 2024

Abstract

Introduction
Delirium is an acute, fluctuating change in mental status, with inattention, disorganised thinking and altered levels of consciousness. This has serious consequences including the increased risk of dementia, death, length of hospital stay and increased chance of new admission to long term care. Therefore, prompt identification and management are essential. NICE recommends the use of the 4AT score in identification of delirium to improve subsequent management.

Method
A retrospective descriptive study was done identifying all patients admitted to Wigan infirmary who received a 4AT during the 1/4/22-30/9/22. Patients were excluded if aged &lt;64, 4AT score of 1-3 (a score over 4 is positive for delirium) and had multiple admissions. This reduced the sample size to 275 from 8648 patients, of these data was collected from the individual electronic records from the first 110 patients.

Results
The average age of patients within the sample is 81, average 4 AT score of 6 and the average CSF was 5. There was a diagnosis of delirium in 32 (29%), and 'confusion' in 10 (15%), a past medical history of dementia in 49 (45%) and cognitive impairment/suspected dementia in a further 10 (9%), PD was found in 9 (8%) of patients. A basic blood test screen to identify a cause for delirium was done in 50 (45%) of patients. DNA CPR was present in 59 (54%) of patients, and a DOLS in 43 (39%) during the admission reviewed. Patients were on a significant number of medication (mean of 10 on discharge) and had an average of 3 ward moves. Length of stay was 20.3 days and 51 (46%) were deceased within a year of admission.

Conclusion
Embedding 4AT in electronic records improves recognition of delirium. Further work will be undertaken to improve management of this condition once it is recognised.
1808 QIP to improve the board round process on a general geriatric medicine ward
Authors: Crofts J , Baguneid C , Hillarious A 
Published: January 2024

Abstract

Introduction
Effective board rounds improve the patient’s experience and reduce the risks associated with a prolonged hospital stay. Ward C54 at Queen’s Medical Centre is a 30-bedded ward dedicated to the provision of care for older, frail (CFS ≥ 6) patients. Board round on C54 was unstructured and could take over an hour. The project team set out to reduce the duration of board round, improve the quality of information handed over and improve staff satisfaction with board round.

Method
Pre- and post-intervention data on the daily duration of board round were collected by the junior doctors on the ward. PDSA methodology was then used to test the following interventions: 1. Nerve centre updated daily by the junior doctor responsible for that bay 2. Junior doctors to present information using 4Q approach 3. Staff nurse in each bay highlighting any issues for that bay. Pre- and post-intervention surveys were also distributed to staff working on C54.

Results
The duration of board round was reduced from an average of 52 minutes to an average of 38 minutes post-intervention. Over 90% of survey respondents believed the board round to be more efficient and over 80% were either satisfied or very satisfied with board round duration.

Conclusions
The findings have shown it is possible to improve the duration of and staff satisfaction with board round by giving MDT members a framework to help structure handover of written and verbal information. Future considerations include providing teaching sessions to staff on the board round process.