bluuebunny/crossref_metadata_2025_split huggingface dataset:
1564 INCIDENCE AND HEALTHCARE COST OF FALL-RELATED READMISSIONS AFTER DISCHARGE AMONG OLDER PATIENTS
Authors: Xing Qian X , Hing Chau P , Fong D Y T , Ho M , Woo J 
Published: July 2023

Abstract

Introduction
Older patients are vulnerable to falls after discharge as hospitalization could induce declines in physical function, mobility, and muscle strength. Falls may cause readmissions and subsequent healthcare burden. However, such incidence rates and costs have not been understudied. This study aimed to investigate the incidence and costs of fall-related readmissions in older patients.

Method
A population-based retrospective cohort study was conducted among patients aged 65 or over and discharged from public hospitals in Hong Kong from 2007 to 2017. The administrative data for inpatient admission were obtained from the Hospital Authority Data Collaboration Lab. The fall-related readmissions within 12 months following discharge were identified by the International Classification of Diseases code of diagnosis. The incidence rates were calculated in terms of person-years. The costs were computed based on the public ward maintenance fees adopted since 2007.

Results
In total, 611,349 older patients with a mean (SD) age of 75.3(7.6) were analyzed. Within 12 months after discharge, 18,608 patients (3.0%) had 20,666 fall-related readmissions, giving an incidence rate of 35.2 per 1000 person-years. Meanwhile, such rates (per 1000 person-years) were 44.7 for women, 25.5 for men, 20.5 for patients aged 65-74, 41.0 for patients aged 75-84, and 76.2 for patients aged ≥85. The annual cost exceeded HKD 145.6 million (23.9 million USD PPP in 2018) for older patients, and the mean cost per fall-related readmission was HKD 7,827 (1,286 USD PPP).

Conclusion
The fall-related hospital readmissions were important adverse events during the transitional period and caused a considerable healthcare burden to the patients, family caregivers, and the health system. Health professionals are suggested to implement interventions during hospitalizations or at the early stage after discharge to reduce falls, particularly for women and patients aged ≥85. For instance, increase physical activity during the hospital stay can be considered for fall prevention.
1485 THE TASTE AND ACCEPTABILITY OF A HIGH PROTEIN, FORTIFIED ICE CREAM COMPARED WITH HOSPITAL MILKSHAKE NUTRITIONAL SUPPLEMENT
Authors: Marsh K , Avery A , Sahota O 
Published: July 2023

Abstract

Introduction
Oral nutritional supplement (ONS) prescription is commonly recommended for malnourished patients in hospital. However, compliance with ONS is often low. Ice cream may be a promising nutritional intervention. We undertook a study designed to compare the acceptability of high protein, fortified, ice cream called Nottingham-Ice Cream (N-ICE CREAM) with routinely prescribed milkshake ONS.

Methods
Fifty older (≥ 65 years) inpatients with hip or spine fractures were recruited from Queens Medical Centre, Nottingham. Patients were randomised into two groups, receiving two days of N-ICE CREAM and milkshake ONS. Group A received N-ICE CREAM first and Group B, milkshake ONS first. We measured compliance, acceptability (hedonic characteristics; rating 0 dislike a lot to 7 like a lot), attitudes towards length of prescription (rating 0 very unconfident to 4 very confident) and preference.

Results
Mean (standard deviation, SD) age of patients was 80.6 (7.7) years. The majority (n = 21, 67.7%) preferred N-ICE CREAM. Mean compliance to N-ICE CREAM was greater in both Groups (Group A (n = 22) 69.9 (30.0) % and Group B (n = 26) 56.3 (39.3) %) compared to the milkshake ONS (Group A (n = 22) 43.4 (4.7) % and Group B (n = 26) 53.6 ± (40.2) %). This was statistically significant in Group A (p &lt; 0.05). Mean hedonic ratings were higher for N-ICE CREAM with an overall impression score of 5.8 compared with 4.6 for milkshake ONS. Confidence score for both products decreased with increasing time length. Both had an overall confidence score of 2.9.

Conclusions
High protein N-ICE CREAM is more accepted and preferred by older patients with a hip or spine fracture compared to standard milkshake ONS. Further, research should explore optimal timing for N-ICE CREAM administration and long-term compliance, as well as clinical outcomes.
1531 MULTIPLE MODIFIABLE COMPONENTS OF HOSPITAL SERVICE DELIVERY PREDICT HIP FRACTURE: A NATIONAL RECORD-LINKAGE STUDY
Authors: Patel R , Baji P , Griffin J , Drew S , Johansen A , Chesser T , Javaid M K , Griffin X L , Ben-Shlomo Y , Marques E , Judge A , Gregson C L 
Published: July 2023

Abstract

Introduction
Substantial variations remain in hip fracture care delivery across the UK despite established standards and guidelines. We aimed to predict adverse patient outcomes following hip fracture from modifiable hospital-level organisational factors and develop implementation tools to improve national service delivery.

Method
We used a national record-linkage cohort of 178,757 patients (≥60 years) with a hip fracture in England and Wales (2016–19). We linked patient-level hospital admissions, National Hip Fracture Database and mortality data with 231 metrics from 18 hospital-level organisational-level audits and reports. Multilevel models identified organisational factors, independent of patient case-mix, associated with patient outcomes: length of hospital stay, emergency 30-day readmission, 120-day mobility recovery, days in hospital and health costs over 365-days, and mortality (30- and 365-day) in 172 hospitals across England and Wales.

Results
Over one-year patients with mean (SD) age 83 (8.6) years, spent 31.7 (32.1) days in hospital, costing £14,642 (£9,017), and 50,354 (28.2%) died. We identified 46 key organisational factors independently associated with one or more patient outcome, of which 14 were (a) associated with cost and/or bed-day savings over one year, (b) consistently associated with other positive patient outcomes, and (c) potentially modifiable. Factors included weekend physiotherapy provision (mean saving per patient/year: £676 [95%CI:£67-1285]), orthogeriatrician assessment (£529 [£148-910]), direct admission to a hip fracture ward (3.4 [-0.36-7.07]days), regular dissemination of audit data to staff (0.85 [0.30-1.39]days). These data have informed the development of a hospital-specific cost-benefit calculator, with a model business case for service improvement, specialty checklists, audit and ‘how to’ guides for complex care delivery.

Conclusion
All hospitals should try to provide the best available hip fracture care equally across England and Wales. We identified multiple, potentially modifiable, organisational factors associated with important patient outcomes following hip fracture. Our practical and freely-available toolkit should help reduce variation in service delivery.
1631 ASSOCIATION BETWEEN ADMISSION INFLAMMATORY MARKERS AND 30-DAY MORTALITY IN PATIENTS WITH HIP FRACTURE
Authors: Kolhe S N , Holleyman R , Langford S , Chaplin A , Reed M R , Witham M D , Sorial A K 
Published: July 2023

Abstract

Introduction
Risk prediction tools help guide prognostic conversations and benchmarking in hip fracture care. The Nottingham Hip Fracture Score (NHFS) shows only moderate predictive ability for 30-day mortality. We assessed whether routine markers of inflammation could improve the discriminant ability of the NHFS to predict 30-day mortality following hip fracture surgery.

Methods
We studied consecutive patients admitted with hip fractures at a large-volume trauma unit between 2015 and 2020. Baseline NHFS and postoperative outcome data were extracted from a local registry and linked to routine laboratory data from patients’ electronic clinical records. We selected measurements taken closest to admission pre-operatively. The biomarkers studied were albumin (negative acute-phase reactant), C-reactive protein (CRP), neutrophil count, and neutrophil-lymphocyte ratio (NLR). Univariate and multivariate logistic regression analyses were performed separately for each combination of NHFS and inflammatory marker. C-statistics were calculated to assess the discriminant ability of the NHFS with and without each inflammatory marker for 30-day mortality.

Results
We included 1710 patients, mean age 82.5 years (SD 8.2). 1199 (70.1%) were women. 104 (6.1%) patients died within 30 days of admission. In univariate analysis, admission NHFS, albumin, CRP and NLR were significantly different between those alive and dead at 30 days. Higher admission albumin was an independent predictor of 30-day mortality in multivariate analysis (OR=0.86 [95%CI 0.81-0.91], p≤0.001) as was higher CRP (OR=1.93 [95%CI 1.04-1.44], p=0.013). The addition of albumin significantly improved the discriminant ability of the NHFS for 30-day mortality (p≤0.001) (c-statistic 0.742 [95%CI 0.683-0.800] vs 0.681 [95%CI 0.617-0.745] for the NHFS alone). Other inflammatory biomarkers did not significantly improve discrimination of 30-day mortality when added to the NHFS.

Conclusions
Admission albumin improves the discrimination of 30-day mortality in patients undergoing hip fracture surgery when combined with the NHFS, whereas other markers of inflammation including CRP, neutrophil count and NLR did not.
1505 USING PATIENT AND PUBLIC INVOLVEMENT (PPI), DATA AND DESIGN TO COMMUNICATE ABOUT FRAILTY TO THE GENERAL PUBLIC
Authors: Johnson L , Anand A , Marshall A , Seth S , Bach B 
Published: July 2023

Abstract

Introduction
Despite the high prevalence of frailty among older people, the clinical definitions and implications of frailty are not well understood by the public. Existing communication material is predominantly technical in nature and aimed at healthcare professionals. This project integrated expertise in geriatric medicine, data science, user design and patient and public involvement (PPI) to develop an accessible visual communication resource on frailty that linked data stories, clinical perspectives and public views of frailty in later life.

Methods
We recruited three public contributors from the University of Edinburgh Advanced Care Research Centre’s PPI network to contribute to formulating the aims and objectives of the communication resource. We developed user personas and case scenarios to consider the intended audience for the communication resource and how they might interact with it. To ensure that all key messages were data-driven, we analysed quantitative survey data from the English Longitudinal Study of Ageing (ELSA) (n=7289), which included information on sex, age and health deficits used to calculate standardised Frailty Index scores. We developed a storyboard to present each piece of information.

Results
Using an iterative co-design process with our PPI contributors, we tested different ways of communicating frailty information and ELSA data insights. Visual elements were incorporated to enhance engagement and informativeness. Core themes of the final 6-page resource included placing frailty in the context of resilience, healthy ageing and interactions with common health issues such as living with multiple long-term conditions. The prevalence of frailty and differences between mild, moderate and severe levels were communicated using person-examples inspired by ELSA data.

Conclusions
We produced a communication resource, informed by a co-design process, that addresses a key gap in existing frailty resources. Our work shows the value of integrating user experience research methods, public patient involvement and data insights to enhance health communications.
1600 COMMUNITY-BASED COMPLEX INTERVENTIONS TO SUSTAIN INDEPENDENCE IN OLDER PEOPLE: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Authors: Crocker T F , Lam N , Ensor J , Jordão M , Bajpai R , Bond M , Forster A , Riley R , Gladman J , Clegg A ,   complex interventions review team
Published: July 2023

Abstract

Introduction
Sustaining independence is important for older people, but there is insufficient guidance about which community services to implement.

Methods
Systematic review and network meta-analysis (NMA; PROSPERO CRD42019162195) to synthesise effectiveness evidence from randomised or cluster-randomised controlled trials of community-based complex interventions to sustain independence for older people (mean age 65+) living at home, grouped according to their intervention components. Main outcomes: Living at home, activities of daily living (ADL), care-home placement, and service/economic outcomes at one year. We searched five databases and two registries, and scanned reference lists. A random-effects NMA was used. We assessed risk of bias, inconsistency, and certainty of evidence.

Results
We included 129 studies (74,946 participants). Nineteen intervention components, including ‘multifactorial-action’ (individualised care planning), were identified in 63 combinations. Few studies contributed to each comparison. High risk of bias and imprecision meant results were very low certainty (not reported) or low certainty (unless otherwise stated). Findings may not apply to all contexts. For living at home, evidence favoured ‘multifactorial-action and review with medication-review’ (odds ratio (OR) 1.22, 95% CI 0.93 to 1.59; moderate certainty), and three other interventions: ‘multifactorial-action with medication-review’; ‘cognitive training, medication-review, nutrition and exercise’; and ‘ADL, nutrition and exercise’. Four interventions may reduce odds of remaining at home. For instrumental ADL (IADL), evidence favoured ‘multifactorial-action and review with medication-review’ (standardised mean difference (SMD) 0.11, 95% CI 0.00 to 0.21; moderate certainty). Two interventions may reduce IADL. For personal ADL, evidence favoured ‘exercise, multifactorial-action and review with medication-review and self-management’ (SMD 0.16, 95% CI -0.51 to 0.82). Among homecare recipients, evidence favoured addition of multifactorial-action and review with medication-review (SMD 0.60, 95% CI 0.32 to 0.88). Other findings were inconclusive.

Conclusions
The intervention combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Unexpectedly, some combinations may reduce independence.
1643 LIVING LABS APPROACH TO INTEGRATE DIGITAL CARE PLANS INTO RELATIONSHIP-BASED CARE IN CARE HOMES
Authors: Chadborn N , Astle A , Heath R , Watt J , Gordon A 
Published: July 2023

Abstract

Introduction
Teaching and Research in Care Homes (ToRCH) is a living labs partnership between University of Nottingham and three care homes in Derbyshire and Nottinghamshire. We aim to engage care home teams in research, including knowledge exchange and co-designing research proposals.

Methods
We conducted 7 workshops / focus groups with 10 staff members. These were supplemented by site visits, where the researcher observed staff meetings and met with residents and relatives (for patient and public involvement). We elicited discussion by appreciative inquiry method and recorded findings through field notes. Ideas built over time, iteratively, through ongoing discussion.

Results
Digital care records, in place in all member care homes, were a focus of discussion and we identified three topics for improvement projects and accompanying research: A) Emerging from lockdown, care homes identified newly appointed staff may have missed aspects of training about digital documentation, e.g. using language consistent with the model of care. Additional support may optimise use of digital records consistent with relationship-based practice. B) Using digital care record for benchmarking to support improvement projects. C) Realtime analysis of digital care records to identify deterioration and deliver proactive care. Our partnership is working with the software providers to develop these projects to improve continuity of proactive care and to develop indicators to assess outcomes of improvement projects.

Conclusion
Our living labs partnership has enabled care home teams to reflect on their use of digital care records and how these mediate communication within the care team as well as with family carers and primary care colleagues. Fresh perspectives have emerged which may accelerate the impact of digitalisation of care homes.
1653 THINKING OUTSIDE THE BOX: EXPLORING USER AND CARER PERCEPTIONS OF PHARMACY-FILLED MULTI-COMPARTMENT MEDICATION COMPLIANCE AIDS
Authors: Chin K , Hegarty A , Thielemans L , Schiff R 
Published: July 2023

Abstract

Introduction
Medication non-adherence is estimated to cost the NHS &gt;£500 million a year in preventable morbidity, mortality and health service use. Multi-compartment medication compliance aids (MCAs) are provided in an effort to promote adherence, despite opposing recommendations from NICE and the Royal Pharmaceutical Society. This study aimed to understand the views of patients and carers of MCAs, including those who have declined or discontinued the use of a pharmacy-filled medication compliance aid (pMCA).

Method
A researcher-administered questionnaire survey of older adults (“users”) and carers, who used, declined or discontinued a pMCA. Participants were recruited from inpatient, outpatient and community services at a central London NHS trust. Thematic analysis was conducted by two independent researchers to identify overarching themes.

Results
88 users and 88 carers were interviewed. The majority of pMCAs were started by healthcare professionals or requested by the carer due to polypharmacy. 12 of 61 users (20%) did not know why a pMCA had been provided, with only 6 requesting the aid themselves. 5 (8%) current pMCA users considered returning to taking medicines from their original packaging. Themes common to both groups included polypharmacy and poor product design. A theme identified solely in the patient group was autonomy and independence, while carers commented on time, waste and sustainability, and responsibility and associated mistakes. For the most part, carers and users perceived MCAs as useful tools to assist medication adherence.

Conclusion
pMCAs are often issued to manage complex medication regimens which are cognitively overwhelming, sometimes at the expense of patient autonomy. Healthcare professionals should aim to reduce the need for pMCAs through individualised medication reviews and rationalisation and improvement of pathways to obtain medicines. If their use is unavoidable, the design of the product and healthcare systems surrounding their use should be optimised to improve the user experience.
1492 EFFECTIVENESS OF EXERCISE INTERVENTIONS ON BODY COMPOSITION AND FUNCTIONAL OUTCOMES IN SARCOPENIA: A SYSTEMATIC REVIEW
Authors: Hussain H 
Published: July 2023

Abstract

Background
Sarcopenia is defined as the age-related progressive loss of skeletal muscle mass, strength, and function. Although many different interventions have been suggested for the management of sarcopenia, the effectiveness of such treatments is still uncertain.

Objective
To systematically assess the different interventions strategies currently reported and to evaluate their effects on muscle mass, muscle strength, and physical function outcomes in sarcopenic participants.

Methods
Web of Science, ClinicalTrials.gov, and Scopus were systematically searched for exercise, nutritional, pharmacological, and other randomised controlled trial interventions in participants diagnosed with sarcopenia and ≥50 years of age. Eligibility was assessed through reviewing titles and abstracts, and if a study was found to be eligible the full texts were read for confirmation. Risk of bias was performed on included studies and subsequently data including study, participant, and intervention characteristics, were extracted. Using this data, the studies were subgrouped according to intervention type and outcomes reported, and meta-analysis was performed on exercise interventions.

Results
Database searching retrieved 2558 records. 21 full-texts were assessed for eligibility, of which 7 were included in the meta-analysis. Meta-analysis revealed that exercise interventions significantly improved appendicular skeletal muscle mass (0.5kg, 0.09-0.91CI, P=0.02), timed up and go (-1.67s, -2.43--0.91CI, P&lt;0.0001), grip strength (2.04kg, 0.39-3.70CI, P=0.02), and knee extension strength (12.35Nm, 8.47-16.23CI, P&lt;00001).

Conclusion
Exercise interventions significantly improved many body composition and functional outcomes in sarcopenic participants, and these results are in line with other reviews, however further research is required to consolidate these findings due to the small number of studies with heterogeneous methods.
1601 PUBLIC AND PATIENT INVOLVEMENT AND ENGAGEMENT (PPIE) OF OLDER PATIENTS IN CODESIGN OF RESEARCH INTO PERIOPERATIVE SERVICES
Authors: Hall H , Paveley A , Mudford L , Dhesi J , Partridge J 
Published: July 2023

Abstract

Introduction
Patient and public involvement and engagement (PPIE) is essential to delivering patient centred, quality research. Older adults constitute an increasing proportion of the surgical population but are unintentionally excluded from traditional models of engagement. We describe the process and outputs of conducting PPIE to support future research examining the scale up of CGA-based perioperative services such as POPS (Perioperative medicine for Older People undergoing Surgery).

Method
Patients undergoing elective surgery at four NHS hospitals in England and Wales were asked to consider participation in PPIE. Twenty-two expressed interest; nine offered to participate, six declined due to their own or relative’s ill health, two withdrew, five did not respond. Six were able to participate on proposed dates. Three had access to email and video calling to join a group Microsoft Teams call. Three took part in 30-minute individual telephone calls. A patient representative from Centre for Perioperative Care (CPOC) acted as peer facilitator for the interview structured around five pre-agreed questions.

Results
Six older patients contributed through PPIE to codesign research examining perioperative services for older people, with three volunteers for long-term involvement as part of a research steering group. The group offered insight into their experience of traditional and POPS-led perioperative pathways. This group emphasised the need for coordinated care, delivered by clinicians with a holistic understanding of the whole perioperative pathway, the need to reduce duplication of information provision and diagnostic testing and a proactive approach to hospital discharge planning. Participants agreed that POPS services should be established nation-wide and that research should focus on implementation and scale-up. The need for PPIE in the dissemination of future research findings was highlighted.

Conclusion
Involving older adults in PPIE is possible and necessary to deliver healthcare services, including novel perioperative care pathways, tailored to service users.