bluuebunny/crossref_metadata_2025_split huggingface dataset:
1617 QUALITATIVE STUDY OF PARTICIPANTS OF A FEASIBILITY TRIAL OF REMOTE PHYSIOTHERAPY FOR EARLY STAGE PARKINSON’S DISEASE
Authors: Malik M , McFarlane K , Gordon A , Skelly R , Chadborn N 
Published: July 2023

Abstract

Introduction
Exercise is beneficial for Parkinson’s disease (PD), but many people struggle to achieve the 150 minutes per a week recommendation. Symptoms of PD or co-morbidity may be barriers for exercise; and physiotherapists can provide expert assessment and tailoring of exercise to accommodate these needs.

Method
We developed a remote physiotherapy intervention using videoconference (Attend Anywhere). An ongoing feasibility trial is assessing this intervention, and a process evaluation seeks to understand the broader context and acceptability of the intervention. Here we present a qualitative study of participants of the feasibility study. We invited participants from the feasibility trial to individual semi-structured telephone or videoconference interview. 14 participants were interviewed. Transcripts were analysed by thematic analysis within two main themes: physical activity and use of digital technology. Participants spoke about their attitudes towards their diagnosis.

Results
Individuals who had come to terms with their PD were more engaged with the exercise regime than participants who expressed a sense of denial. Participants who mentioned the benefits of exercise for reducing or delaying PD symptoms were more likely to report a positive attitude to exercise. In contrast, individuals with co-morbidity, or caring roles, found it more difficult to commit to regular exercise; flexibility of the exercise routine was valued. For the theme of digital technology some participants reported struggling with, technical problems such as interruptions in internet connection, having constrained space to exercise and staying in view of the camera for the physiotherapist. Whilst some participants lacked digital confidence, or expressed a preference for in-person treatment, other participants reported no difficulties or found it more convenient than travelling to clinic.
1523 WHAT PATIENT-REPORTED OUTCOME MEASURES ARE USED IN RESEARCH INVOLVING OLDER ADULTS WITH FRAILTY? A RAPID REVIEW
Authors: Long S O , Hope S V 
Published: July 2023

Abstract

Introduction
The need to develop and evaluate frailty-related interventions is becoming more pertinent as life expectancy increases. Patient-reported outcome measures (PROMsare arguably essential in this field of research and can be defined as “any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else” (FDA 2009). Numerous validated questionnaires can be classed as PROMsbut seem inconsistently used, and of uncertain relevance to/for those living with frailty. This rapid review aimed to identify existing PROMsused in research with older people living with frailty.

Method
PubMed and Cochrane were searched (up to 24/11/22). Inclusion criteria were quantitative studies, use of a PROM, and either measurement of frailty or inclusion of older adults as participants. Distinguishing PROMsfrom questionnaire-based clinical assessments was necessary, and criteria were created to do this. 197 records were screened. PROMswere categorised according to the domain they assess, based on a standard set of health outcome measures for older people (Akpan et al, 2018).

Results
90 studies were included. 119 unique PROMswere used 289 times, most frequently the SF-36 (n=23), EQ-5D (n=21) and Barthel Index (n=14). The most frequently assessed outcome domains included “Mood and Emotional Health”, and “Activities of Daily Living”. Outcome domains with fewer usages included “Participation in Decision Making” and “Carer Burden”.

Conclusions
PROM usage in frailty research is highly heterogeneous. The most frequently used PROMsomit outcomes that are important to people with frailty (e.g. Akpan et al 2018, Herrler et al 2021, Mayo et al 2022). Further research should investigate the importance of specific outcomes (and thus identify particularly relevant PROMs to people living at different stages of frailty severity. More consistency of PROM use could facilitate evaluation of different frailty interventions.
1586 OLDER AGE IS AN IMPORTANT PREDICTOR OF NON-REFERRAL TO COMMUNITY ALCOHOL SERVICES FOLLOWING AN INPATIENT EPISODE: FINDINGS FROM
Authors: Phillips C , Band R , Bumpass L , Ghandi S , Sinclair J 
Published: July 2023

Abstract

Introduction
Alcohol use disorder (AUD) in older adults is increasingly common, under-recognised and under-treated within acute hospitals.

Methods
Consecutive patients seen by the Alcohol Care Team (ACT) at an acute NHS trust between January-April 2021 were invited to take part in a service evaluation. Baseline demographic and clinical data was collected in addition to community alcohol service referrals for all patients. For older adults (&gt;64years), Older People’s Mental Health (OPMH) referral and hospital use data (ED attendances and admissions) in the 12 months prior/post index admission were also collected.

Results
Of 280 patients seen by the ACT during the 3-month period, 87 (31%) were older adults and 75% were male. Older adults resided in more affluent neighbourhoods compared to patients under 65 (p = 0.002). Referral to community alcohol services was predicted by younger age (p&lt;0.001), medically assisted withdrawal during admission (MAW) (p &lt;0.001) and scoring as possibly alcohol dependent (p= 0.006) on the Alcohol Use Disorder Identification Test (AUDIT) screening tool. In binary multivariate logistic regression considering age, sex, MAW and AUDIT category, referral onto alcohol services remained highly significant for age, with older adults less likely to be referred (odds ratio 0.029, CI: 0.007 to 0.125, p&lt;0.001). In older adults drinking at higher risk/possibly dependent levels, only 4.3% (n=2/47) were referred to alcohol services compared to 66.2% (n = 96/145) in under 65s. Older adults were more often signposted or not referred due to confirmed/perceived cognitive impairment. No significant difference in use of hospital services was found for the 12 months after the index admission.

Conclusions
Older adults are less likely to be referred to community alcohol services, despite evidence they are drinking at higher risk/dependent levels. Further exploration into the reasons behind this is required to help inform development of appropriate pathways and services for this patient group.
1603 PROACTIVE ADVANCE CARE PLANNING ALONGSIDE COMPREHENSIVE GERIATRIC ASSESSMENT IN CARE HOMES: A QUALITATIVE FEEDBACK ANALYSIS
Authors: Allcock D , Page E , McCracken S , Thorman E , Marchant R , Worth C , Fraser H , 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. We established a multi-disciplinary care home team providing comprehensive geriatric assessment (CGA), structured medication review (SMR) and advance care planning (ACP) to a pilot cohort of frail residents in 17 care homes. We aimed to explore the acceptability and perceptions of proactive ACP alongside CGA from the perspective of resident’s next-of-kin (NOK), primary care staff and care home managers (CHMs.

Methods
Data was collected using standardised questionnaires between February-September 2022. Data were analysed using qualitative content analysis. This was undertaken independently by two lead authors, after which codes and categories were identified through a collaborative approach and triangulation.

Results
Four categories emerged from NOK data: 1) Perceived benefit of frailty specialist review, 2) Perceived improved knowledge of the individual through holistic assessment, 3) Sensitive conversations were perceived to have been handled well, but this was sometimes challenging over the phone, 4) Families felt empowered in shared decision making. Six categories emerged from primary care feedback: 1) Perceived benefit of holistic reviews, 2) Improved information sharing using same clinical system, 3) Specialist frailty involvement supporting GP learning, 4) Challenges with set-up, 5) Perceived avoidance of admissions following reviews, 6) Time and financial savings for NHS. Four categories emerged from CHM feedback: 1) Perception that medical reviews were overdue, 2) Reduced care home staff workload through saving of time, 3) Specialist review and 4) Empowering staff to avoid admissions.

Conclusions
This evaluation identified key feedback themes in relation to the perceived value and acceptability of a dedicated care home team performing CGA based ACP. Stakeholders expressed positive views about the service, suggesting benefits for individual residents, primary and community healthcare staff, and the wider healthcare system.
1610 IMPACT OF THE INTRODUCTION OF A GERIATRICIAN IN PRE-OPERATIVE ASSESSMENT FOR OLDER ADULTS UNDERGOING ELECTIVE COLORECTAL SURGERY
Authors: Than H P , Phyu E E , Thomas C , Stock E , Kaneshamoorthy M , Jegard J 
Published: July 2023

Abstract

Introduction
About 300,000 people living with Frailty undergo operations annually. Current evidence suggests that comprehensive geriatric assessment (CGA) pre-operatively enhances shared decision making (SDM), equity of access to surgery, length of stay (LOS) and mortality. Multiple NCEPOD reports, the National Emergency Laparotomy Audit (NELA) and National Hip Fracture Database (NHFD) programs have highlighted the unmet need in caring for these patients. Our aim was to introduce a novel combined Geriatrician/Anaesthetist pre-assessment clinic to provide better SDM and perioperative optimisation to improve outcomes for elective colorectal surgery.

Method
We performed combined CGA and Anaesthetic pre-operative assessment in patients undergoing elective colorectal surgery aged ≥65 years between July 2021 to August 2022. Data including Clinical Frailty Score (CFS), LOS, Type of surgery, P-POSSUM Score, 30-day mortality and 90-Day mortality were analysed.

Results
We reviewed 48 patients in 14 months. 69% patients underwent surgery and 27% declined after a comprehensive SDM process. The median age of operated patients was 80 (65-94) compared with 74 in 2020-21. 58% of patients operated were over 80, compared to 24% in 2020-21, prior to clinic inception. The median CFS was 4. 55% of patients had a LOS ≤7days (73% in 2020-21), 32% was 8-14days (18%) and 13% was &gt;14days in hospital (9%) respectively. 32% had a P-POSSUM score of ≥5% whereas 10% had a score of &gt;15%. The overall 30-day and 90-day mortality rates for our cohort was 0%, compared with 0% and 3% respectively in 2020-21.

Conclusion
Our data suggests that our clinic has enhanced equity of access to curative colorectal cancer surgery for older adults. 90 days mortality remained 0% owing to excellent patient selection and enhanced perioperative care. Importantly, 27% of patients declined surgery after an extensive process of SDM. Further work needs to be completed assessing decision regret and satisfaction with SDM (SDMQ9).
1657 RELATIONSHIP BETWEEN DELIRIUM AND CO-MORBIDITY IN ACUTELY HOSPITALISED OLDER MEDICAL PATIENTS
Authors: Atia N , Iyida O , Abdelmageed A , Knight S , Dijkstra A , Murfitt J , Onn L V , Obiechina N , Mukherjee B , Nandi A 
Published: July 2023

Abstract

Introduction
Delirium is common in hospitalised older patients. It is associated with increased mortality, poorer functional outcomes and increased length of stay. It has also been shown to be positively associated with level of co-morbidity in older postoperative patients. The aim of the study is to assess the correlation between delirium and co-morbidity in older medical inpatients. It also aims to determine the effect of gender on this association.

Method
This was a prospective, cross-sectional analysis carried out as part of a Quality Improvement Project on screening for delirium in older patients admitted acutely on medical wards from 6th to 12th October 2022. Patients were included if they were 65 years and over. Exclusion criteria were patients younger than 65 years. Patients with incomplete data were also excluded from analysis. Patients were screened for delirium using the 4-AT screening tool which is well validated. In addition, the patients’ co-morbidities were assessed using the age-adjusted Charlson’s Comorbidity Index (CCI). The SPSS 29 IBM software was used for statistical analysis. Baseline characteristics were calculated using descriptive statistics. Pearson’s correlation co-efficient and linear regression analysis were used to calculate correlation.

Results
233 patients in total were assessed - 119 males and 114 females. Median age was 79.4 years in males (Interquartile range – IQR – 11) and 83.5 years in females (interquartile range – IQR – 12). Overall mean age was 81.6 years (SD 8.1). The prevalence of likely delirium was 32.2 %. There was a statistically significant positive correlation between 4-AT and CCI in these patients (r=.236; p&lt;.001). This effect was stronger in male than female patients (r=.275; p=.002) and (r=.197; p=.035) respectively.

Conclusion
There was positive correlation between comorbidity and delirium in this cohort of patients. The association appeared to be stronger in male than female patients. More studies are needed to explore and validate these findings.
1515 EVALUATION OF OUTCOMES ACROSS DELIRIUM SUBTYPES IN HOSPITAL ADMISSIONS IN PATIENTS WITH PARKINSON’S DISEASE
Authors: Rowley M , Kobylecki C , Thomson A 
Published: July 2023

Abstract

Introduction
Delirium is prevalent in patients with idiopathic Parkinson’s disease (iPD) who are admitted to hospital. The hypoactive subtype of delirium is associated with poorer outcomes in hospitalised patients. The aim of this study was to evaluate different outcomes across delirium subtypes in unplanned hospital admissions in patients living with iPD.

Methods
Data was collated prospectively on all patients with idiopathic Parkinson’s disease admitted to our hospital’s medical wards between 1st January 2019 and 30th March 2020. Electronic case-note review and in-person assessments were used to determine a diagnosis of delirium, the delirium subtype, and key outcomes including length of stay (LOS) and mortality. Data was analysed with respect to both index admissions and those readmitted during the study period.

Results
123 patients with iPD (male 52.8 %, mean age 77.9 years) accounted for 189 admissions. Delirium was present in 91/189 admissions (48%). There was no difference in Hoen & Yahr or Clinical Frailty Scale levels between groups with and without delirium. The prevalence of dementia was higher in the delirium group (48.3% vs 25.5%). Hypoactive delirium was the most common subtype (49.5%); hyperactive (13.2%), mixed (11%) and neutral (neither hypo- nor hyperactive) 26.4%. 12-month mortality in the index admissions was highest in the hypoactive subtype (57.1%). Median LOS (all admissions) was 11.5 days in patients with delirium vs 5.5 days in those without. A mixed delirium phenotype had longest LOS (mean 30.7 days) compared with other subtypes.

Conclusions
The hypoactive subtype of delirium predominates in hospitalised patients with iPD. Length of stay was longest in those experiencing a mixture of hyperactive and hypoactive subtypes, and mortality was highest in the hypoactive group. Healthcare settings need robust systems screening for delirium in Parkinson’s patients, with prevention and management processes to reduce morbidity and mortality in this complex group.
1644 FRAILTY AND OUTCOMES AFTER STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Elliott A , Kadicheeni M , Chin K , Divall P , Robinson T , Beishon L 
Published: July 2023

Abstract

Introduction
Frailty is an important clinical syndrome of increased vulnerability to stressors. The impact of frailty on stroke is a growing research area. We carried out a systematic review for an up-to-date picture of the prevalence of frailty and its impact on a wide range of outcomes.

Methods
We searched Medline, Embase and CINAHL for studies referencing frailty and stroke. We assessed quality of studies using National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools. We collated prevalence of frailty and impact on outcomes after stroke or transient ischaemic attack (TIA). Meta-analysis was conducted to determine pooled odds ratios (OR) and 95% confidence intervals (CI). Where possible, we carried out metanalysis on outcome data.

Results
We included 28 studies (n=111,787). Studies used the Clinical frailty scale (CFS), (n=6, 10,967). a frailty index (n=10, 19134), Hospital Frailty Risk Score (HFRS) (n=4, 18,373), frailty phenotype (n=4, 10,838), or other assessment methods (n=8, 50,568). Pooled prevalence of frailty was 36% (95% CI 29-43%). Including pre-frailty, prevalence was 48% (40-56%). Increased CFS (n=738) was associated with increased in-hospital mortality, OR=2.43 (95% (CI 1.54-3.84). Higher frailty was associated with higher 28-day, 90 day and one year mortality, higher stroke severity, and NIHSS, mRS and dependency on discharge.

Conclusion
Increased frailty is associated with multiple adverse outcomes following a stroke, including mortality, worsened functional outcome, and increased dependency at discharge. There was heterogeneity in frailty measures used, precluding meta-analysis.
Do Taxes Affect Marriage? Lessons from History
Authors: Fox Edward 
Published: July 2023

Abstract
I examine how income taxes affected individuals’ marriage decisions in the mid-twentieth century using variations across U.S. states arising from the Revenue Act of 1948. Prior to the Act, the federal income tax produced marriage “bonuses” in some states, but marriage was tax neutral in the rest of the states. The Act extended the same marriage bonuses to the remaining states, without changing the regime in those states already enjoying bonuses. I use a difference-in-difference design to analyze the effect of the Act. I enrich the framework with an additional control group: lower-income Americans. For this group, marriage was income tax neutral throughout the period in every state. Using this additional control group, I employ a triple-difference design. In both the difference-in-difference and triple-difference designs, I find that extending marriage bonuses increased marriage rates among eligible men substantially.
Measurements of airborne asbestos fibres during refurbishing
Authors: Ervik Torunn Kringlen , Hammer Stine Eriksen , Skaugset Nils Petter , Graff Pål 
Published: July 2023

Abstract
Although the use of asbestos fibres in building materials has been prohibited in Norway since 1985, asbestos-containing materials (ACMs) are still found in many buildings. Lack of knowledge and awareness of these materials may lead to exposure during refurbishing. The aim of this study was to investigate the airborne fibre concentration and classify fibres found during the abatement of various ACMs. The release of fibres during short-term work tasks, such as drilling and sawing, was also investigated. Parallel air samples were collected during asbestos abetment of different building materials and analysed with scanning electron microscope (SEM) and phase-contrast microscope (PCM), respectively. Material samples were analysed with SEM. A real-time fibre monitor was used to measure asbestos during short-term work. The highest fibre concentrations were measured for samples collected during the removal of asbestos insulating boards (1.5–4.5 fibres/cm3 [f/cm3]), and the numbers were relatively similar for SEM and PCM. A large difference in asbestos concentrations was found between SEM and PCM when analysing floor materials, which were probably caused by a high number of gypsum fibres that the PCM operator counted. Thin fibres (&lt;0.2 µm in width) were included in the SEM count and constituted up to 50% of the total fibre concentration for the asbestos cement materials. The presence of other inorganic and organic fibres on these samples probably led to similar results between SEM and PCM. Short-term work led to peak concentrations above 30 f/cm3.
Persistence of second-line biologics in psoriasis after first-line biologic failure: a nationwide cohort study from the French health insurance database (SNDS)
Authors: Marcombes Clarisse , Penso Laetitia , Weill Alain , Dray-Spira Rosemary , Zureik Mahmoud , Sbidian Emilie 
Published: July 2023

Abstract

Background
Many biologics are available for psoriasis and have been compared in real-life studies based on their persistence (i.e. time between initiation and discontinuation). However, after first-line biologic failure, data are lacking on the choice of second-line biologic among the four available classes [tumour necrosis factor inhibitors (TNFi); interleukin (IL)-12/IL-23 inhibitor (IL-12/IL-23i); IL-17 inhibitors (IL-17i); and IL-23 inhibitors (IL-23i)].

Objectives
To compare the long-term persistence of available second-line biologics in psoriasis according to prior exposure.

Methods
This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to a hospital discharge database. Participants were adults with psoriasis, defined as having at least two prescriptions of a topical vitamin D derivative within a 2-year period, with initiation of a second-line biologic between 1 January 2015 and 31 December 2021. We included patients who initiated a second-line biologic directly after first-line discontinuation (i.e. without a ‘washout’ period). The end of follow-up was 30 June 2022. Discontinuation was defined as &gt; 90 days without filling a prescription for the same treatment after the period covered by the previous prescription. Comparison of persistence by biologic class involved using propensity score-weighted Cox models (inverse probability treatment weighting) and adjustment of specific systemic nonbiologics (time-dependent variables).

Results
We included 8693 patients [mean (SD) age 50 (14) years; 50.5% male]; 2824 (32.5%) started TNFi, 1561 (18.0%) IL-12/IL-23i, 2707 (31.1%) IL-17i and 1601 (18.4%) IL-23i. Overall, 1- and 3-year persistence rates were 60% and 30%, respectively. After weighting and adjustment, persistence was longer with IL-12/IL-23i [weighted hazard ratio (HRw) 0.68, 95% confidence interval (CI) 0.62–0.76)], IL-17i (HRw 0.70, 95% CI 0.64–0.78) and IL-23i (HRw 0.36, 95% CI 0.31–0.42) than TNFi, except after first-line IL-17i treatment, with no difference between IL-12/IL-23i, IL-17i and TNFi second-line persistence. Persistence was longer with IL-23i as a second-line treatment than IL-12/IL-23i (HRw 0.53, 95% CI 0.44–0.63) and IL-17i (HRw 0.51, 95% CI 0.44–0.60), regardless of first-line treatment, with no difference seen between IL-12/IL-23i and IL-17i (HRw 0.97, 95% CI 0.87–1.09).

Conclusions
This real-life study suggests the longer persistence of IL-23i than TNFi, IL-17i and IL-12/IL-23i as second-line treatment for psoriasis. Persistence rates for all biologics remained low at 3 years.