bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding resource consumption and sustainability in the built environment
Authors: Stillwell Ashlynn S , Cominola Andrea , Beal C D 
Published: July 2023

Abstract
The built environment and the communities that contribute to its infrastructure, services, and systems are important aspects of human life. As urbanization increases, time spent indoors also increases, with urban residents spending most of their time indoors. This indoor lifestyle concentrates the effects of water, energy, and food consumption in the built environment, with local, regional, and global implications for interconnected resources and their supply chains. As such, resource consumption in the built environment has sustainability implications, especially with increasing populations and living standards.
This focus issue, ‘Resource Consumption and Sustainability in the Built Environment’, examines infrastructure and sustainability from many perspectives. The articles investigate water, energy, and/or food consumption across various scales, ranging from a single household to nationwide supply chains to global climate models. Each paper in this issue considers essential elements of context, since water, energy, and food have local and global sustainability considerations, along with multi-sector dependencies within urban metabolism. Digital technologies, data, and modeling approaches are opening new opportunities for better monitoring and understanding of the built environment. In an uncertain future, understanding resource consumption in the built environment and its implications for the environment and society is a critical aspect of overall human health and well-being. In-depth knowledge of the dynamics shaping the built environment is paramount to supporting adaptive infrastructure planning and management, including supply and demand interventions to help cities and communities become climate neutral while increasing equity in access and affordability of resources and services.
1500 ASSESSMENT OF OSTEOPOROSIS AND FUTURE FRAGILITY FRACTURE RISK IN PATIENTS ADMITTED TO HOSPITAL WITH FALLS
Authors: Eltayeeb M , Mathew P 
Published: July 2023

Abstract

Introduction
NICE guidelines state that assessment of osteoporosis risk is a part of multifactorial fall assessment in older people who present with a fall (NICE clinical guidelines: fall in older people, June 2013). This audit was conducted to examine and improve our practice in assessing osteoporosis risk in patients admitted with fall to Care of Elderly department.

Method
FRAX or QFracture are the recommended tools to evaluate the risk of osteoporosis and future fragility fracture. We have checked if any of these assessment tools has been used in patients who were admitted with a diagnosis of fall.

Results
Baseline data was collected for 30 random patients admitted between 1st January 2022 – 31st March 2022, it showed only in 3.3% the assessment tool (FRAX/QFracture) was used. Following attempts to improve the practice by increasing the awareness of the importance of using FRAX/QFracture tools (lecture presentation and email reminders), a significant improvement has been achieved in cycle 2 which checked 21 random patients between 1st June 2022 and 15th August 2022. This showed 48% of patients have documented risk of osteoporosis and future fragility fracture checked with an assessment tool (FRAX was the tool used in all patients). As a result, osteoporosis treatment was started in 9.8%, DXA scan was requested in 4.8% and only lifestyle advice was given to 33.6% of all fall patients included in cycle 2.

Conclusion
A significant improvement in using the assessment tools (FRAX/Qfracture) in fall patients has been achieved. With continuing to implement the same measures (educating doctors and sending reminders), we are expecting a better result in the future.
1440 IMPROVING COMMUNICATION WITH PATIENTS' RELATIVES ON AN AGING AND COMPLEX MEDICINE (ACM) WARD DURING THE COVID-19 PANDEMIC
Authors: Thompson A , Lim C K , Gibbon F 
Published: July 2023

Abstract

Introduction
During the COVID-19 pandemic, restricted hospital visitation policies were implemented to reduce the spread of the viral infection. As a result, telephone has become the main communication method despite the complexity of the elderly patients’ medical and psychosocial issues. This has heightened anxiety and reduced satisfaction among patients and their families. This quality improvement project aimed at improving communication with patients’ families. We introduced several strategies with the aim to update patients’ families within 48 hours of admission and then at least once a week during patient’s journey from admission to discharge.

Method
Retrospectively, all patients who were admitted to the ACM ward during the study period were included. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented. As the first intervention, we added a new section on “Update patients’ families” in our weekly harm free care document to identify patients’ families who were not updated. Also, reminder emails were sent to all medical doctors to ensure that we record all discussions with families using “Discussions with patients and families’ document”. As the second intervention, a poster on “Harm Free Thursday and Update Friday” was displayed in the doctor’s office. Face-to-face education was provided to new trainees to emphasise the importance of good communication with patients’ families. Data was collected from electronic patient record (EPR) and Microsoft Excel was used for data collection and analysis.

Results
189 patients were included in the baseline audit which showed that only 49% of patients’ families were updated weekly throughout the admission. Compliance in communication with families after the first and second cycle was 62% and 69% respectively. Following the second PDSA cycle, the percentage of patients’ families who were updated within 48 hours of admission increased from 50% to 56%.

Conclusion
The project showed significant improvement in communication with patients’ families with each cycle.
1594 MULTIDISCIPLINARY ADVANCE CARE PLANNING IN CARE HOMES IS ASSOCIATED WITH FEWER AMBULANCE CALL-OUTS AND HOSPITAL CONVEYANCES
Authors: Fraser H , Thorman E , Marchant R , Page E , Allcock D , Worth C , McCracken S , Shipway D 
Published: July 2023

Abstract

Introduction
The Enhanced Health in Care Homes Framework recognises personalised advance care planning (ACP) as a key component of optimal healthcare for care home residents (1). Documented ACP discussions guide decision-making in acute situations and may facilitate avoidance of inappropriate hospital admissions.

Methods
We established a multidisciplinary care home service which aimed to provide comprehensive geriatric assessment (CGA) based ACP to all residents within three pilot care homes. We evaluated the effect of proactive, systematic CGA and ACP. Ambulance call-out and conveyance data for the pilot care homes were compared for three months before and after our intervention.

Results
122 residents were reviewed during the pilot period and 61 new ACPs were completed. Amongst the 61 new ACPs, 41 new decisions were made during the pilot to avoid future hospital admission and to prioritise comfort in the community. Total ambulance callouts to the 3 pilot care homes were observed to fall from 55 to 33 in the 3 months following our intervention: a reduction of 40%. Additionally, when an ambulance attended the scene, conveyance to an acute hospital was observed to fall by 50% (pre-n =40 vs post-n=19), in favour of discharging into the community.

Conclusion
The provision of systematic CGA-based advance care planning in care homes may be associated with a lower frequency of ambulance call-outs and lower rates of conveyance of care home residents to hospital. Proactive advance care planning may influence GP, care home, and paramedic decision-making.
1. NHS England and NHS Improvement. The Framework for Enhanced Health in Care Homes. 2020 Mar.
1668 CAN PROACTIVE, COLLABORATIVE AND CO-PRODUCTIVE ANTICIPATORY CARE PLANS IMPROVE FRAIL HIGH INTENSITY PATIENT OUTCOMES?
Authors: Lowe G , Arora A , Lockett A 
Published: July 2023

Abstract

Background
The High Intensity Users (HIU) Team supports individuals with single or multi-morbidities or complex care needs who are high users of Health and Social Care Services.

Introduction
Stoke-on-Trent has an aged population rising: 65 years plus by 17% increase to 280853; 85 years plus by 38% increase to 39425. Frail older people are the most frequent cohort of patients converted to admissions from ED. From April 2021 to October 2022 there has been an increase of 18% in inpatient length of stay which may be detrimental to the older person. HIU was developed to support this cohort of patients by creating an MDT to create personalised anticipatory care plans.

Methods
Individuals who have had three or more acute admissions and forty days non-elective in-patient days during the previous twelve months were included. An MDT facilitated by a Case Manager formulated an action plan to streamline the care; this includes the Frailty Passport which will identify the advanced/anticipatory care wishes of the individual. This is shared across all relevant teams. Once the actions are complete the patient is then monitored, if stable the patient then has an identified case worker to manage their on-going care.

Results
In the twelve months post consent: ED attendances reduced by 108; Admissions reduced by 477; Length of Stay reduced by 7086 (bed days); Cost saving £2,480,100; Service Cost £400,000; Qualitative feedback 93% patients would recommend; Staff 88% feel there are benefits for patients/services.

Conclusion
The results quite clearly demonstrate the benefits of patient centred care and approach when introducing an anticipatory care plan, including: Raised patient, family and staff satisfaction/ reassurance; Improved access to services; Right care, right time, right professional; Value for money.

Next steps
Useful tool. More studies needed. Expand and share learning with others.
1636 BONE HEALTH ASSESSMENT AUDIT CYCLE AT QUEEN ALEXANDRA HOSPITAL, PORTSMOUTH (AUDIT ID 5474)
Authors: Aperis G , Balaji J , Raheja A 
Published: July 2023

Abstract

Background
Conducted in the department of General Internal Medicine. Our focus group was elderly patients, especially women aged 65 and above and men 75 years and above as per NICE guidelines since these patients should have their bone health assessment done ideally. Local problems: Osteoporosis is very common affecting approximately 3 million people. Over 5,00,000 fragility fracture occurs in UK each year. The purpose of our audit was to find the percentage of patients who underwent bone health assessment and got bone protection treatment appropriately thus checking our compliance to NICE guidelines. Hence keeping in lines with patient safety.

Methods
A total of 45 patient’s data was collected from the medical wards in both the audit and re-audit. Data was collected from patient’s case notes, previous clinical documents and medication charts. A questionnaire was used which entailed patient details, risk factors for osteoporosis and whether or not bone health assessment had been done.

Interventions
We identified patients at risk of osteoporosis. Performed BHA with FRAX score calculation. Started them on appropriate treatment based on NOGG 2021 guidelines. Additionally, a teaching session was held after each audit to implement changes in the department and raise awareness about the importance of bone health assessment. Results: The first audit showed that only 29 out of 45 patients had their assessment done. A total of 41 patients had their assessment done in the re-audit showing a significant improvement by 26%.

Conclusions
Bone health is often overlooked and affects millions of people across the UK with high risk of mortality and morbidity in turn affecting patients’ quality of life. Based on the comparative analysis, 26% more patients benefitted from the completed audit cycle.
1555 AUTOMATED ELECTRONIC HEALTH RECORD FRAILTY ASSESSMENT FOR OLDER CARDIAC PATIENTS
Authors: Ho Z X , Soon R A , Johnston S , MacLullich A M J , Shenkin S D , Mills N L , Anand A 
Published: July 2023

Abstract

Background
Hospital Electronic Health Records (EHRs) increasingly capture health and functional deficits. We report outcomes for acute cardiac patients in relation to an automated frailty measure derived from these EHR data.

Methods
We conducted a retrospective observational cohort study of consecutive cardiology admissions aged ≥70 years between April 2016 and August 2020, to three hospitals across Edinburgh, Scotland. The Continuous Dynamic Evaluation of Frailty (CODE-f) is an automated score between 0 (no markers present) and 1 (all present) representing 12 deficits generated from 31 admission EHR data points. This includes measures of cognition, functional dependence, mobility and falls risk. The primary outcome was mortality at 1 year. The secondary outcome was days alive and out of hospital (‘home time’) in the year after discharge for hospital survivors. In a nested cohort of 318 consecutive patients, the Clinical Frailty Scale (CFS) was determined from manual EHR review blinded to CODE-f scores.

Results
2,406 patients were included (mean 79±6 years old, 60% male). A CODE-f score could be generated in 2,158 (90%) patients, with a median score of 0.13 (IQR 0–0.33). There were 352 (15%) deaths by 1 year. Patients in the highest CODE-f quartile (&gt;0.35) had three times greater risk of death at one year than in the lowest quartile after adjustment for age and sex (27% versus 9%, adjusted odds ratio 3.44, 95% CI 2.47–4.82, p&lt;0.001). 16% of patients from the highest CODE-f quartile lost &gt;90 days home time in the year after discharge, compared to 6% in the lowest two quartiles (p&lt;0.001). CODE-f scores correlated moderately well with CFS (Spearman’s r=0.50, 95% CI 0.41–0.58, p&lt;0.001).

Conclusion
An automated EHR measure can identify older adults at risk of death and poorer recovery after acute cardiac illness. This could inform treatment decisions and future care planning. Funding: Chief Scientist Office (PCL/18/05).
1459 HANDGRIP STRENGTH AS A PREDICTOR OF POST-OPERATIVE OUTCOMES FOLLOWING HIP FRACTURE
Authors: Jaiswal S K , Prowse J , Chaplin A , Sinclair N , Langford S , Reed M , Sayer A A , Witham M D , Sorial A K 
Published: July 2023

Abstract

Introduction
Sarcopenia is common in patients with hip fracture, but few studies have examined whether assessment of sarcopenia improves prediction of adverse post-operative outcomes. We examined whether sarcopenia, diagnosed using hand grip strength (HGS), could predict outcomes after hip fracture.

Methods
Routinely collected data from the National Hip Fracture Database were combined with locally collected HGS data from a high-volume orthopaedic trauma unit. Patients aged ≥65years with surgically managed, non-pathological hip fracture with grip strength measured on admission were included. The European Working Group on Sarcopenia in Older People (EWGSOP2) thresholds were used to identify patients with or without sarcopenia; those unable to complete grip strength testing were also included in analyses. Outcomes examined were 30-day and 120-day mortality, residential status and mobility, prolonged length of stay (&gt;15 days) and post-operative delirium. Binary logistic regression models were used to examine prognostic value of HGS, and discriminant ability for the Nottingham Hip Fracture Score (NHFS) alone and on adding sarcopenia status were compared using c-statistics.

Results
We analysed data from 282 individuals; mean age 83.2 (SD 9.2) years; 200 (70.9%) were female. 99 (35.1%) patients had sarcopenia and 109 (38.7%) were unable to complete testing. Sarcopenia predicted higher 120-day mortality (OR 13.0, 95%CI 1.7-101.1, p=0.014), but not 30-day mortality (OR 1.5, 95%CI 0.1-16.9, p=0.74). Patients unable to complete HGS testing had higher 30-day mortality (OR 13.5, 95%CI 1.8-103.8, p=0.012) and 120-day mortality (OR 34.5, 95%CI 4.6-258.7, p&lt;0.001). Sarcopenia status did not significantly improve discrimination for mobility but improved prediction of 120-day residential status (c-statistic 0.89 [95%CI 0.85-0.94] for NHFS+sarcopenia vs 0.82 [95%CI 0.76-0.87] for NHFS alone) and post-operative delirium (c-statistic 0.91 [95%CI 0.87-0.94] vs 0.78 [95%CI 0.73-0.84]).

Conclusions
Sarcopenia assessment via HGS testing may provide additional prognostic information to existing risk scores in older patients with hip fracture.
1542 IMPLEMENTATION OPPORTUNITIES FOR A GARMENT-INTEGRATED SENSOR SYSTEM FOR EARLY DETECTION OF STRESS IN PEOPLE LIVING WITH DEMENTIA
Authors: Adam E , Meiland F , Frielink N , Meinders E , Smits R , Embregts P , Smaling H 
Published: July 2023

Abstract

Introduction
Stress and communication difficulties, both prone in people with dementia, are risk factors for challenging behaviour. Challenging behaviour negatively impacts the quality of life of people with dementia and their caregivers. Technology can help caregivers detect stress in people with dementia. However, implementation of these technologies is not always successful. The aim of this study is to explore the implementation opportunities for a garment-integrated sensor system that enables caregivers to identify early signs of stress in people with dementia.

Methods
A qualitative design with online focus groups (n=9) and interviews (n=21) with persons living with dementia (n=4), family (n=10) and professional caregivers (n=9) was used to collect stakeholders’ perceptions towards the sensor system and requirements for its implementation into long-term care. Participants took part in three focus groups or interviews, of which the last round focused on implementation. Qualitative data were analysed using inductive conventional content analysis.

Results
Participants were positive about the idea of a garment-integrated sensor system and could see several groups in both intramural and extramural healthcare settings benefit from the system. Besides early stress detection, participants also saw an added value of the system for the identification of triggers for challenging behaviour or for diagnostic purposes. According to participants, implementing the system in long-term care requires clear guidelines and agreements for its use, a trial period and educating caregivers. The sensor system needs to meet several requirements (e.g. customizability, ease of use) to increase user acceptance and thereby implementation success.

Conclusions
Participants perceive the idea of a garment-integrated sensor system for people with dementia in long-term care as positive. To increase implementation success, it is important to create an easy-to-use, tailor-made system, educate stakeholders, and establish clear guidelines for its use. The next step is to validate and implement the system in long-term care.
1625 MELATONIN MODESTLY IMPROVES SLEEP EFFICIENCY IN PATIENTS WITH NEUROCOGNITIVE DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Germain N , Rouabhia D , Morin M , Archambault P 
Published: July 2023

Abstract

Introduction
The administration of melatonin and melatonin receptor agonists (MRA) may result in a small improvement in sleep quality among middle-aged and older adults living with neurocognitive disorders, but debate remains as to whether effects are clinically meaningful. The purpose of this PROSPERO-registered systematic review and meta-analysis (CRD42022373972) was to synthesise evidence from randomized controlled trials (RCTs) of melatonin or MRA against placebo and other interventions for the treatment of sleep disturbances in adults with neurocognitive disorders.

Method
CENTRAL, MEDLINE, EMBASE, AMED, CINAHL and PsycINFO were systematically searched on November 4th 2022, examining the effect of melatonin and MRA on sleep efficiency: the percentage of time spent asleep while in bed. Results were analysed using Review Manager 5.4. Risk of bias was assessed using RoB 2 and the certainty of evidence was assessed with the GRADE framework.

Results
Among the 1,579 references evaluated, 13 RCTs were selected, corresponding to 16 studies, none including MRA, with a total of 592 patients. Compared with placebo, bright light treatment, or clonazepam, sleep efficiency significantly improved with melatonin administration (MD = 2.85, 95% CI: 0.88 to 4.81, p = 0.004). In subgroup analyses, only low doses of melatonin (&lt; 5 mg) yielded a statistically significant improvement to sleep efficiency (MD = 3.81, 95% CI: 1.13 to 6.49, p = 0.005, I2 = 34%), and melatonin administration statistically significantly improved sleep efficiency in patients with Mild Cognitive Impairment, Parkinson's Disease, or Multiple Sclerosis (MD = 3.27, 95% CI: 0.11 to 6.43, p = 0.04, I2 = 41%), but not patients with Alzheimer's Disease. We found the overall quality of evidence to be moderate according to GRADE.

Conclusion
Melatonin may modestly ameliorate sleep quality in patients with neurocognitive disorders by improving sleep efficiency, which may be clinically significant to patients and those who care for them.
1447 DELIVERY OF RESISTANCE EXERCISE FOR OLDER PEOPLE LIVING WITH PROBABLE SARCOPENIA OR FRAILTY – FINDINGS FROM THE BEPOP PROJECT
Authors: Caulfield L , Arnold S , Buckland C , de Biase S , Hurst C , Sayer A A , Witham M D 
Published: July 2023

Abstract

Introduction
Resistance exercise is an effective intervention for older people at risk of, or living with, sarcopenia and frailty. Surveys of current UK practice in exercise prescription for these conditions found that resistance exercise was offered in only 9% of departments and was often not optimised for sarcopenia and frailty. The Benchmarking Exercise Programmes for Older People (BEPOP) project is a joint British Geriatrics Society and AGILE initiative to promote best practice in the prescription of resistance exercise for older people.

Methods
Using an online data collection tool, 10 services delivering exercise interventions to older people from across the UK submitted anonymized details of baseline assessment (including demographics), exercise prescription and progression, and outcomes, for up to 20 consecutive patients referred to their services with probable sarcopenia, frailty, falls, and reduced mobility. Descriptive data were reviewed and analysed by an expert panel comprising physiotherapists, geriatricians, and exercise specialists.

Results
Data were analysed for 188 patients with a mean age of 80 years (range 60-101). At the time of referral, 154 (83%) patients did not have a diagnosis of sarcopenia. At baseline, 115 (61%) patients received an objective assessment of muscle strength. The most common modality of resistance exercise prescribed was bodyweight exercises (n=173, 92%) followed by resistance bands (n=49, 26%). Progression of exercise programmes was predominantly through increased repetitions (n=163, 87%) rather than increased load. Forty-one (24%) patients did not undergo any review to inform progression of exercise dose. Fifty patients (30%) patients did not have re-assessment of the outcome measures recorded at baseline on completion of the prescribed exercise programme.

Conclusion
Multiple opportunities exist to improve both the diagnosis and assessment of sarcopenia, and the prescription, delivery, and monitoring of resistance exercise. BEPOP will provide individualized benchmarking reports to each site to facilitate quality improvement and local service development.