bluuebunny/crossref_metadata_2025_split huggingface dataset:
1066 INCREASING CONFIDENCE OF FOUNDATION DOCTORS IN MAKING AND DISCUSSING ESCALATION DECISIONS
Authors: Morrison F , Duffty A , Meney C , Paterson E , Warner V 
Published: June 2022

Abstract

Introduction
The Covid-19 pandemic has resulted in renewed emphasis on escalation decisions and discussions, often conducted by junior doctors without any training. Our local Foundation Year (FY) teaching does not address these topics. The distress caused by poor communication regarding escalation is well recognised. Our goal was to improve FY doctors’ confidence in this area and consequently improve quality of patient care.

Method
In PDSA cycle one, email questionnaires established a lack of confidence amongst FY1 doctors. This cycle resulted in the design of a one-hour workshop by middle-grade trainees interested in geriatrics or acute medicine. This workshop included an interactive teaching session, followed by demonstrative and participant role play. Feedback from the first workshop closed cycle two. In cycle three, a subsequent workshop was amended according to feedback. Workshop participants completed anonymous feedback, rating the impact on their confidence.

Results
Thirteen FY1 doctors responded positively to the initial questionnaire, with nine able to attend a workshop. Pre- and post-workshop questionnaires asked respondents to rate their confidence from 1 (low) to 5 (high). Comparison demonstrated an increase in confidence making decisions from an average of 1.8 to 3.7 and discussing decisions with patients from 2 to 3.1. Qualitative feedback emphasised benefit from participant role play and the need for longer workshops.

Conclusion
Our project highlighted the need and desire for FY training in making and discussing escalation decisions. A one-hour workshop increased confidence in this group, though we acknowledge this is a surrogate marker of improved care. Workshop uptake was limited by a small local FY1 cohort, leave and clinical commitments. Though convenient, a one-hour session did not provide adequate time to realise full benefit. We hope to address these issues by integrating longer sessions into the protected teaching for all FY doctors in our health board.
1067 IMPROVING STOOL CHART DOCUMENTATION ON A CARE OF THE ELDERLY WARD
Authors: Adiotomre M , Zuraw N , Leadley A , Athavale N V 
Published: June 2022

Abstract

Introduction
Constipation is a common and often overlooked problem with potentially serious consequences, including patient discomfort, urinary retention, delirium and bowel obstruction. These consequences can lead to prolonged hospital stay, increased healthcare costs and increased morbidity and mortality. Accurate stool chart documentation is an essential part of basic care that helps prevent this. The aim of the project was to increase daily stool chart documentation, including stool type, to 70% on a care of the elderly ward in a medium-sized district general hospital.

Method
We created a proforma to review each patients’ stool chart from the previous 24 hours. Daily data was collected by measuring the number of correctly completed stool charts on the ward. Initial baseline data showed an average daily completion rate of 24%. We tested 3 separate interventions over a 6 week period using Plan-Do-Study-Act (PDSA) methodology: Intervention 1- Increase staff awareness about stool charts via email, posters and at handovers Intervention 2- Complete stool charts every time routine observations are performed Intervention 3- Complete online stool charts.

Results
All interventions led to an improvement in the average daily stool chart completion rate. Intervention 1 caused the most significant improvement with the average daily stool chart completion rate increasing to 77%. Intervention 2 was the least successful change, with an average daily stool chart completion rate of 39%. Intervention 3 had an average daily stool chart completion rate of 64%.

Conclusion
Simple interventions like staff education and prompts to help culture and behaviour change led to a significant improvement in stool chart documentation rates. Paper documentation (intervention 1) fared better than online documentation (intervention 3) most likely due to the former requiring fewer processes to complete. Intense monitoring and documentation (intervention 2) was unsuccessful and was perceived to be burdensome.
1068 QIP ASSESSING ROUTINE RECORDING OF OVERNIGHT VITAL SIGNS (OVS) AND OVERNIGHT MEDICATIONS ADMINISTRATIONS (OMARS) IN ELDERLY CARE
Authors: Rizvi S , McNeela N , Masood I , Akinlade O , Ajaja O , Cole M 
Published: June 2022

Abstract

Introduction
Poor sleep is experienced by up to half of hospital inpatients1, associated with poor cognition, weak immunity, hypertension and increased mortality2. Recent studies recommend fewer sleep interruptions through targeted reductions in routine recording of overnight vital signs (OVS) and overnight medication administrations (OMARS) 3. The following standards were agreed at New Cross Hospital for audit (expected compliance 90%); 1. Routine OVS for stable patients shouldn’t be done overnight (2,200 pm to 0600 am). 2. Routine OMARS shouldn’t be undertaken overnight. These were derived after scrutinizing following; NICE CG1034 and QS635, NSF (Department of health)-4.256, RCP Acute care toolkit 37, CG508.

Method
Retrospective data recorded over 10 days in May and August 2021 from electronic records which included 61 elderly patients in 1st and 53 in 2nd audit cycle. Exclusion was Early Warning Score ≥ 3. We also ran night shift surveys to observe staff perceptions, completed online.

Results
OVS recording showed poor compliance of 0% and 3.77%. OMARS were done in less than half of patients but improved in subsequent audit cycle to about in 1/3rd of patients (77.35% compliance). No patient became unwell or required escalation of care. The estimated time spent on these interventions was 2.5 hours/week or 30 days in 1 calendar year. Almost all survey participants agreed to stop OVS while 66.6% of them agreed to stop OMARS in both cycles. 39.39% in 1st cycle believed that this strategy can cause harm and this misperception was reduced to 22.22% in subsequent cycle.

Conclusion
Our QIP advocates for rationalizing interventions and ensuring we only complete interventions where clinically relevant9. It showed improvement in reducing OMARS but success in stopping OVS couldn’t be fully translated in true spirits, possibly due to common misperceptions which will be further addressed in subsequent audit cycles.
1072 BARRIERS AND MOTIVATORS TO UNDERTAKING PHYSICAL ACTIVITY IN ADULTS ≥ 70—A SYSTEMATIC REVIEW OF THE QUANTITATIVE LITERATURE
Authors: Rutherford M J , Higson J M F , McNiff J A , Mitchell S , Wijayendran A , Lim S E R , Shenkin S D , Kilgour A H M 
Published: June 2022

Abstract

Background
Physical activity (PA) has multiple important benefits for older adults, but many do not undertake the recommended amount. This systematic review examined the quantitative literature detailing barriers and motivators to PA in older adults: a concurrent qualitative review is underway. Previous reviews investigated younger age groups or specific diseases.

Method
We included adults ≥70 years, observational studies and baseline data for randomised controlled trials (RCTs); we excluded studies of specific disease groups, care home residents, and rates of cognitive impairment above population norms. We searched Medline, Embase, CINAHL and PsycINFO on 25th February 2020. We assessed risk-of-bias using ROBANS. We undertook a narrative review; meta-analysis was not possible. The protocol was registered on PROSPERO (CRD42021160503).

Results
We identified 35 papers (24 cross-sectional studies, eight prospective cohort studies, two studies of baseline data from RCTs and one mixed method study); n = 26,264 subjects, median age 77.7 years (range 70–101) and median percentage female 62.1% (range 0–100). Quality assessment identified low risk-of-bias overall, except two studies were identified as having a high risk-of-bias for one section (confounding variables). The most cited barriers were physical health (N = 14 studies), environmental factors (N = 12), fear of falls (N = 7) and lack of interest (N = 4). Other barriers identified were lack of company (N = 1) and urine leakage (in women) (N = 1). Key motivating factors included social aspects of PA (N = 8), intrinsic/psychological (e.g. self-determination, future orientation) (N = 8), health (e.g. doctor’s advice) (N = 7) and environmental (e.g. nearby green space) (N = 4).

Discussion
This review identified key barriers and motivators to PA in older adults. There is a lack of evidence for the oldest old. These findings should be used to create trials of suitable interventions which enable older adults to take up and maintain recommended levels of PA. The wide range of factors we identified indicates an individualised approach may be best.
1074 QUALITY IMPROVEMENT PROJECT AIMED TO REDUCE THE AVERAGE NUMBER OF PATIENTS DEVELOPING CONSTIPATION ON BOURNVILLE WARD IN QEHB
Authors: Vasudev A , Baachaa S , Meakin P , Mohamed I , Nicolson P 
Published: June 2022

Abstract

Introduction
Constipation is an overlooked but frequent problem in elderly patients on geriatrics wards. The prevalence in inpatients aged over 65 years is estimated at about 50%.There are many reasons for this: reduced oral intake due to illness, delirium, immobility, and constipating drugs. If constipation is addressed correctly, we can reduce the rate of unpleasant complications and prolonged hospital stay by increasing awareness of non-laxative methods to be advocated initially to avoid worsening poly-pharmacy with side effects. Queen Elizabeth Hospital Birmingham guidelines advocates use of conservative measures. However these methods can be frequently underutilized and cause of constipation rarely considered to treat. We aimed to identify the barriers to our outcome by tackling lack of awareness, utilization of non-laxative method DRE prior to rapid relief. This included teaching sessions, MDT, posters, introducing constipation booklets.

Method
We used prospective data collection with a standardized questionnaire having a mix of descriptive and quantitative questions based on SMART Aims for the project. This was carried out once a week on alternate beds. Baseline data n44,2ndcycle n44,3rd cycle n43,4thcycle n42.With each cycle we used following interventions to improve constipation prevalence in Bournville ward i.e. individually educate patient/staff during ward rounds, MDT presentations, improve documentation of constipation causes, addition of separate educational posters for staff/patients,identification of at risk patients. Introduced Patient information booklet with documented discussion on hospital online record system.

Results
Following interventions from 1st-4th cycle inpatient constipation prevalence was reduced by 13%,Increased consideration of cause by 38%, significant increase in education by 65%,Increased use of non-laxative approach by 35%,Increased rates of DRE by 35%,reduced use of x-ray prior to DRE by 8.3%,reductions in complication rate by 9%.

Conclusion
Despite increased education, cause consideration, utilization of conservative non-laxative approaches, introduction of new constipation booklet in welcome pack to all new patients a small impact was made in reducing inpatient constipation prevalence and associated complications occurring.
1078 AUDIT TO IMPROVE APPLICATION OF THE MENTAL CAPACITY ACT ON GERIATRIC WARDS
Authors: Chan J , Mifsud R W , Ashton C , Shah K 
Published: June 2022

Abstract

Introduction
The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) are put in place to protect the rights of capacitous patients to make decisions, and in those not deemed to have capacity, the latter ensures that any restrictions are in the patient’s best interests, are appropriate and proportionate. The objective of this audit was to assess whether these tools were being appropriately employed across the four Complex Medical Units (CMU) in the John Radcliffe Hospital, in a patient population in which dementia and delirium are prevalent.

Method
Audit of patient records on CMU wards (first cycle on 15/8/21 n = 74, second cycle on 31/10/21 (n = 74) before and after presentation of the initial audit results. All inpatients were assessed for: AMTS, completion of a MCA (for those with AMTS&lt;8, or an AMTS not done as too unwell), DoLs applications if indicated. Across the wards, baseline patient characteristics and demographics were equal. In the first audit, there were only 16% patients (6) with an MCA out of a possible 38 patients who fulfilled the criteria and out of these, and 2 had a DOLS (5%). After training, involving a presentation given by us about the findings of our audit, together with high level discussions between consultants and registrars, there were 43% patients with an MCA (15 patients), and 14% had appropriate DOLS (5 patients), out of 35 patients. This therefore shows clear improvement in the situation on our wards.

Conclusion
This audit has improved the recognition of patients in whom a capacity assessment is required and the documentation of a MCA being done. Going forward, we suggest all geriatric medicine wards should discuss and audit MCA and DOLS to ensure patients’ rights are suitably protected.
1079 USE OF AN ADVANCE CARE PLAN CHECKLIST TO IMPROVE COMMUNICATION AND ASSESSMENT OF THE IMPACT ON HOSPITAL READMISSIONS
Authors: Adams G , Woodcock J , Barradell V , Pennells D , Narramore R 
Published: June 2022

Abstract

Introduction
Advance care planning (ACP) is a vital part of holistic and person-centred care. It allows formalising of an individual’s wishes and best interests, and avoids unnecessary or unwanted interventions including, potentially, hospital admissions. It is crucial that any decisions or recommendations are communicated to all relevant healthcare professionals to ensure peoples’ wishes are upheld. We developed this project to review and improve documentation and communication on discharge when a decision had been made to limit care to the community and avoid admission.

Method
A checklist was developed comprising 11 criteria to be documented in the discharge letter and actions to disseminate information including; updating the ReSPECT form and alerting the hospital frailty and community out of hours teams. We carried out a closed loop audit of patients where admission should be avoided and reviewed discharge letters against the criteria. Where patients were readmitted we reviewed the notes to determine whether the admission was appropriate.

Results
We compared patients discharged between February 2020–February 2021 and then from March–September 2021. 161 and 27 patients were identified respectively. Average age was 84.6 and 87.3 years respectively. In cohort 2 48.1% of patients were readmitted, up from 8.7% during the previous cycle. 33% of admissions in cohort 2 and 38.9% of readmissions in cohort 1 were deemed appropriate. Documentation improved in 10 of the 11 criteria. Average length of stay for readmissions was reduced from 16.7 to 5.7 days.

Conclusion
As evidenced by our study utilising a checklist has improved documentation and dissemination of ACPs to the Community. This did not lead to a reduction in hospital admissions but this may have been skewed by factors relating to the Covid-19 pandemic. We did find a significant reduction in length of stay for those subsequently readmitted.
Update on Immune Mechanisms in Hypertension
Authors: Navaneethabalakrishnan Shobana , Smith Hannah L , Arenaz Cristina M , Goodlett Bethany L , McDermott Justin G , Mitchell Brett M 
Published: June 2022

AbstractThe contribution of immune cells in the initiation and maintenance of hypertension is undeniable. Several studies have established the association between hypertension, inflammation, and immune cells from the innate and adaptive immune systems. Here, we provide an update to our 2017 American Journal of Hypertension review on the overview of the cellular immune responses involved in hypertension. Further, we discuss the activation of immune cells and their contribution to the pathogenesis of hypertension in different in vivo models. We also highlight existing gaps in the field of hypertension that need attention. The main goal of this review is to provide a knowledge base for translational research to develop therapeutic strategies that can improve cardiovascular health in humans.
An Ecological Study of COVID-19 Infection Rates within the UK Food and Drink Processing Industry
Authors: Mueller William , Loh Miranda , Fletcher Tony , Rhodes Sarah , Pembrey Lucy , Pearce Neil , van Tongeren Martie 
Published: June 2022

Abstract

Objectives
Food processing facilities represent critical infrastructure that have stayed open during much of the COVID-19 pandemic. Understanding the burden of COVID-19 in this sector is thus important to help reduce the potential for workplace infection in future outbreaks.

Methods
We undertook a workplace survey in the UK food and drink processing sector and collected information on workplace size, characteristics (e.g. temperature, ventilation), and experience with COVID-19 (e.g. numbers of positive cases). For each site, we calculated COVID-19 case rates per month per 1000 workers. We performed an ecological analysis using negative binomial regression to assess the association between COVID-19 rates and workplace and local risk factors.

Results
Respondents from 33 companies including 66 individual sites completed the survey. COVID-19 cases were reported from the start of the pandemic up to June 2021. Respondents represented a range of industry subgroups, including grain milling/storage (n = 16), manufacture of malt (n = 14), manufacture of prepared meals (n = 12), manufacture of beverages (n = 8), distilling (n = 5), manufacture of baked goods (n = 5), and other (n = 6), with a total of 15 563 workers across all sites. Average monthly case rates per 1000 workers ranged from 0.9 in distilling to 6.1 in grain milling/storage. Incidence rate ratios were partially attenuated after adjusting for several local and workplace factors, though risks for one subgroup (grain milling/storage) remained elevated. Certain local and workplace characteristics were related to higher infection rates, such as higher deprivation (5 km only), a lower proportion of remote workers, lower proportion of workers in close proximity, and higher numbers of workers overall.

Conclusions
Our analysis suggests some heterogeneity in the rates of COVID-19 across sectors of the UK food and drink processing industry. Infection rates were associated with deprivation, the proportions of remote workers and workers in close proximity, and the number of workers.
Incorporating the Osseous Genioplasty Into Rejuvenation of the Lower Face
Authors: Dekker Paige K , Slamin Robert P , Charipova Karina , Harbour Patrick W , Talbet Joseph H , Abdel Azim Sara , Baker Stephen B 
Published: June 2022

Abstract

Background
The chin plays a critical role in the shape, projection, and soft tissue support of the lower face. Osseous genioplasty is a powerful tool in facial rejuvenation as it allows for optimal control of the resulting chin dimensions and improvement in submental and submandibular laxity. Osseous genioplasty can be used alone or in combination with other facial rejuvenation procedures to achieve an optimal result.

Objectives
The aim of this study was to present the senior author’s approach to skeletal analysis of the lower facial third and propose an algorithm that can be used to optimize skeletal support of the overlying soft tissue laxity while maintaining an aesthetic facial shape and proportion of the chin.

Methods
All patients undergoing cosmetic osseous genioplasty for soft tissue rejuvenation of the lower face and/or perioral region with the senior author between 2010 and 2021 were retrospectively reviewed. Complications, including infection, numbness, and prolonged ecchymosis, were recorded.

Results
A total of 37 patients underwent cosmetic osseous genioplasty. The average age of the cohort was 44.5 years. Twenty-six patients (70.3%) were female. Eleven patients (29.7%) underwent genioplasty alone. In addition to genioplasty, 8 patients (21.6%) underwent orthognathic surgery, 5 patients (13.5%) underwent platysmaplasty and liposuction, and 2 patients (5.4%) underwent facelift. The authors propose an algorithm to guide evaluation of the lower facial third to help determine the possible role of osseous genioplasty for facial rejuvenation based on each patient’s unique facial characteristics.

Conclusions
In properly selected patients, osseous genioplasty can improve lower facial projection, submandibular laxity, and perioral soft tissue support while also optimizing facial shape and proportion.

Level of Evidence: 4
Sensory experience selectively reorganizes the late component of evoked responses
Authors: Bermudez-Contreras Edgar , Schjetnan Andrea Gomez-Palacio , Luczak Artur , Mohajerani Majid H 
Published: June 2022

AbstractIn response to sensory stimulation, the cortex exhibits an early transient response followed by late and slower activation. Recent studies suggest that the early component represents features of the stimulus while the late component is associated with stimulus perception. Although very informative, these studies only focus on the amplitude of the evoked responses to study its relationship with sensory perception. In this work, we expand upon the study of how patterns of evoked and spontaneous activity are modified by experience at the mesoscale level using voltage and extracellular glutamate transient recordings over widespread regions of mouse dorsal neocortex. We find that repeated tactile or auditory stimulation selectively modifies the spatiotemporal patterns of cortical activity, mainly of the late evoked response in anesthetized mice injected with amphetamine and also in awake mice. This modification lasted up to 60 min and results in an increase in the amplitude of the late response after repeated stimulation and in an increase in the similarity between the spatiotemporal patterns of the late early evoked response. This similarity increase occurs only for the evoked responses of the sensory modality that received the repeated stimulation. Thus, this selective long-lasting spatiotemporal modification of the cortical activity patterns might provide evidence that evoked responses are a cortex-wide phenomenon. This work opens new questions about how perception-related cortical activity changes with sensory experience across the cortex.
A core–periphery framework for understanding the place of Latin America in the global architecture of finance
Authors: Cerpa Vielma Nicole , Dymski Gary 
Published: June 2022

Abstract
This paper contributes to the understanding of subordinate financialisation in emerging and developing economies by setting out a novel core–periphery framework that elucidates the place of Latin America in the global architecture of finance. This framework builds on the centre–periphery financial model of uneven regional credit and economic growth, originally proposed by Victoria Chick and Sheila Dow in 1988. In the era of deregulated financial flows and market-based credit, the core–periphery relationship has become a three-level hierarchical system, in which Latin American nations occupy a subordinate place. The key drivers of this structural shift within these nations have been the liberalisation of cross-border financial flows and investment, the deregulation of banking and the adoption of private pension systems. These drivers’ adoption can be traced to both push and pull factors: specifically, recurrent financial crises requiring external intervention (especially by the International Monetary Fund (IMF)), and the possibility of engaging with the financial instruments and megabanks driving the globalisation of finance. Participating in this hierarchical system has required importing elements of the financial architecture that evolved in the 1980s in advanced economies and has also arguably deepened this region’s financial dependency and vulnerability.