bluuebunny/crossref_metadata_2025_split huggingface dataset:
965 INTEGRATED CARE HOME OWNERSHIP AND FINANCIAL VULNERABILITY
Authors: Dolphin H , Lynch A , McNally D , Keating J , Doyle M , Domsa M , Kennelly P 
Published: June 2022

Abstract

Introduction
Lack of home ownership is associated higher rates of mental and physical ill-health and death1. According to longitudinal data in Ireland, 92% of persons aged 75 and over own their homes outright with approximately 8% living in rented accommodation2. We sought to compare characteristics of a cohort of patients open to our Integrated Care for Older Persons (ICOP) team with this national Irish dataset.

Method
A convenience sample of 50 patients reviewed by the ICOP team in a University Teaching Hospital was analysed. Data was anonymised and stored via encrypted key. Analysis was performed using SPSS v.27.

Results
The average age was 82.5 (±8.1) with 70% women in the sample. There was a lower prevalence of home ownership in this group of patients than the national norm (66% vs 92%) ie 34% were living in rental accommodation, majority Local Authorities. Those living in Local Authority accommodation had lower overall time spent in full time education than those who owned their own home (9.3 ± 3.1 vs 11.5 ± 3.3 p = 0.013), they were more likely to require external assistance with finances (54.5% v 88.2% p = 0.026) and less likely to have a Will (63.6% vs 35.2% p = NS) or EPOA (33.3% vs 23.5% p = 0.053) established. There was no significant difference in age, CFS, MMSE, Waterlow or polypharmacy rates between these groups.

Discussion
This report highlights a divergence between community dwelling older adults referred to ICOP teams and national standard data. Targeted social work interventions should be operationalised to assist financially vulnerable older adults. 1: Marmot M, Geddes I, Bloomer E, Allen J, Goldblatt P. The health impacts of cold homes and fuel poverty. London: Friends of the Earth. 2011. 2: Orr, J, Scarlett S, Donoghue, O, McGarrigle, C. Housing conditions of Ireland’s older population. Implications for physical and mental health, 2016. Available from https://tilda.tcd.ie/publications/reports/pdf/Report_HousingConditions.pdf
969 ACUTE FRAILTY MODEL: A DISTRICT GENERAL HOSPITAL EXPERIENCE OF DELIVERING COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Budihal D , Andrews S , Settle S , Alexander H , Haslam S 
Published: June 2022

Abstract

Introduction
Under the NHS Long Term Plan1, every hospital with a Type 1 Emergency Department (ED) has been asked to provide Acute Frailty Services for at least 70 hours a week. We have adopted a liaison model to ensure Comprehensive Geriatric Assessment at the front door. The Frailty Team now includes two Frailty Practitioners, a Specialist Registrar based in ED and the Acute Medical Unit (AMU) with Consultant Physician of the Week support.

Method
The team attend multi-disciplinary meetings in ED and AMU on a daily basis. Frail patients are reviewed and Comprehensive Geriatric Assessments are undertaken together with appropriate signposting. The aim being, to enhance the care of frail patients at the earliest opportunity.

Results
High bed utilisation comes at a cost and a longer length of stay (LOS) is associated with an increased risk of deconditioning. Since introducing incremental changes to our working model, the average LOS of patients on AMU has been reduced from a mean of 1.33 days to 0.82 days. This represents a 38.3% reduction from September 2020 to August 2021. This reduction has been sustained, while 30-day readmission rates have not increased. Feedback has been very positive from all the other teams involved.

Conclusion
Our service has established a more positive working culture to efficiently manage frail patients. The AMU team now feel empowered to make patient-centric decisions regarding patient flow and discharges. Since this data was analysed we have implemented a further change to help enhance the care of frail patients. A list of appropriate patients is emailed to the hospital site team every afternoon to aid getting the right patients into the right beds. The impact of LOS on the frailty wards will then be reviewed following this introduction.

Reference
1. nhs-long-term-plan-june-2019.pdf (longtermplan.nhs.uk).
976 QUALITY OF DISCHARGE SUMMARIES FROM A CARE OF THE ELDERLY WARD—A QUALITY IMPROVEMENT PROJECT
Authors: Bajwa R , Belludi G 
Published: June 2022

Abstract

Introduction
Deficits in transfer of information between secondary and primary care are common but can have significant impact on patient care and can often be dangerous as well. It’s hard to quantify the quality of a discharge summary but certain parameters can be reasonably used as its surrogate.

Method
After review of literature from multiple sources, we identified 6 key indicators to assess quality of discharge summaries for patients discharged from a Care of the Elderly ward. In round 1, we collected data from 129 discharge summaries created over a period of 12 months. After analysis of data, a plan including education of doctors, posters display in wards and emphasis on compliance in ward rounds and MDTs was implemented. Round 2 of the QIP was performed 4 months later and data was collected from 50 discharge summaries.

Results
Significant improvement in compliance seen in all areas assessed which include; 1. Main diagnosis during admission—improved from 93% to 100% 2. Mobility at discharge—Improved from 31% to 82% 3. Resuscitation status—improved from 6% to 86% 4. Medication changes during admission and their rationale—20% to 62% 5. Discharge destination—66% to 96% 6. Social care requirements e.g. package of care etc.—59% to 82%.

Conclusion
Plan implemented after round 1 has led to a significant improvement in quality of discharge summaries which consequently results better communication between secondary and primary care. This improvement especially surrounding medication changes translates into better continuity of care and patient safety.
990 ADVANCE CARE PLANS IN UK CARE HOME RESIDENTS: AN IMPLEMENTATION STUDY
Authors: Garden G , Usman A , Readman D , Storey L , Wilkinson L , Wilson G , Dening T , Gordon A , Gladman J 
Published: June 2022

Abstract

Introduction
Research shows delivery of advance care planning (ACP) in care homes is highly acceptable, increases the proportion of residents dying in their preferred place, and reduces hospital admissions. We examined whether implementation of a service delivering ACP to care homes in Lincoln (UK) realised the research outcomes in routine practice.

Method
Implementation of a service undertaking ACP in care homes was evaluated using routine data. Outcomes included proportion of care homes agreeing to participate; proportion of residents agreeing to put ACPs in place; characteristics of residents with and without ACPs, and place of death of those dying with or without ACPs. Effect on hospital admissions was examined comparing pre- and post-implementation admissions in participating homes.

Results
Fifteen (63%) of 24 eligible care homes participated. ACPs were prepared for 404/516 (78%) residents. Those with ACPs were older, frailer, more cognitively impaired, and malnourished than those without. For those with ACPs (384/404; 95%), care homes were the preferred place of death. 219/248 (88%) of residents with ACPs who died did so in their care home compared to 33/49 who died without ACPs (33/49, (67%) (relative risk 1.35, 95%CI 1.1–1.6, p &lt; 0.01). In the 15 participating homes, there were 717 hospital admissions over 360 pre-intervention care home months (mean 2.11 admissions per care home month). In the post intervention phase, there were 789 admissions over 341 care home months (mean 2.29 admissions per care home month).

Conclusion
Most residents wished to have ACPs, which appeared to have influenced place of death. However, the population value of the service was limited because not all care homes participated. Hospital admissions were not reduced. Future work should aim to ensure services are universally available to residents, and to identify why reductions in hospital admissions seen in research studies may not be replicated in clinical practice.
991 COMPREHENSIVE GERIATRIC ASSESSMENT FOR BEGINNERS: AN EDUCATIONAL TOOL TO AID THE IDENTIFICATION OF FRAIL PATIENTS & IMPROVE CARE
Authors: Scarlett L , Bafadhel L 
Published: June 2022

Abstract

Introduction
COVID-19 heavily impacted the way in which medical education was and is delivered due to social distancing and concerns over safety. E learning is an increasingly important tool to use in being able to continue to educate our current and future doctors but there are significant gaps in the market with tools aimed at educating healthcare professionals regarding issues that affect the older person. This project aimed to compare 3 different learning tools to establish the minimum acceptable requirements for trainees to improve self-perceived competence in the assessment of an older person.

Method
Mixed method study comparing three types of educational resources in Comprehensive Geriatric assessment: low fidelity and high-fidelity e-learning modules and in person training. How do the interventions improve trainee’s confidence and knowledge of the CGA?

Results
Total number of participants n = 23. 39% had previously had some teaching on CGA and 61% had not. All three education interventions were well received by trainees and helped to increase their self perceived confidence in the assessment of an elderly patient and recognising signs of frailty in a patient presenting to the acute medical take. 83% of trainees would recommend the in person session, 100% would recommend both the high fidelity e-learning module and low fidelity e-learning modules.

Conclusion
This project showed that there are still significant gaps in the education of junior doctors regarding matters specific to an elderly population and there are limited electronic educational resources that aim to tackle this problem. The study showed the unilaterally trainees preferred the high-fidelity e-learning module to improve their confidence but still appreciated in person teaching where able due to increased enjoyment. As a result this high-fidelity module has been adapted for all healthcare staff and has been incorporated onto the trust’s online learning platform and has been received well.
998 IMPROVING COMMUNICATION ON MEDICAL WARD ROUNDS IN PATIENTS WITH LIMITED ENGLISH BY IMPLEMENTING MEDICAL COMMUNICATION CHARTS
Authors: D'Souza A , Canoso A , Smith L J 
Published: June 2022

Abstract

Aim
To improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart.

Introduction
King’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations.

Method
Face-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Pre-intervention and post-intervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles.

Results
At baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only 2/8 doctors felt they could communicate effectively with patients. In PDSA 1, 4/5 patients reported high satisfaction in communicating physical symptoms, anxieties or concerns pre-intervention with 5/5 post-chart implementation. 5/5 patients reported high satisfaction in communicating ongoing needs pre-intervention but only 3/5 post-intervention. In PDSA 2, 2/5 patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with 4/4 doctors reporting improved satisfaction in communication in PDSA 2 and 2/3 doctors reporting higher satisfaction in communication in PDSA 3.

Conclusion
Medical communication charts can help in delivering high-quality, patient-centred care in multicultural and multilingual healthcare settings within the NHS.
1042 COMPARISON BETWEEN CAMRY AND JAMAR DYNAMOMETERS IN MEASURING HAND GRIP STRENGTH AMONG OLDER POST-ACUTE COVID-19 OUTPATIENTS
Authors: Tai M H , Wan S N , Engkasan J , Ong T 
Published: June 2022

Abstract

Introduction
Hand grip strength is a useful measure of muscle function. Many hand dynamometers that are less costly than the gold standard Jamar dynamometer are available but their use in clinical outpatient setting has yet to be validated. This study aimed to determine the inter-instrument reliability between Camry electronic and Jamar hydraulic dynamometers.

Method
A cross-sectional study was conducted on patients aged ≥65 years during their post COVID-19 follow up clinic visit. Hand grip strength was assessed using both Jamar and Camry dynamometers following standard protocol while information on participants’ demographics, health and COVID-19 hospitalizations were collected from hospital electronic medical records. Reliability between both devices was determined using intraclass correlation coefficient (ICC) and devices were compared based on subcategories of participants’ demographics and clinical characteristics.

Results
Ninety-three participants (mean age: 73 ± 6 years, 52.7% males) were recruited in this study. Average grip strength recorded with Jamar dynamometer (18.1 ± 7.4 kg) was higher than Camry dynamometer (19.5 ± 6.6 kg). Sub categorical comparison depicted no significant discrepancy between the devices discovered among male participants (p = 0.262), Malay participants (p = 0.243) and participants aged &gt;70 years (p = 0.090). According to the diagnostic cut-off recommended by Asian Working Group for Sarcopenia (AWGS) 2019, similar number of participants had low grip strength using Jamar (n = 69, 74.2%) and Camry (n = 68, 73.2%) dynamometers. The odds of Camry detecting low grip strength was 0.946 times (95% CI: 0.493–1.817) as compared to Jamar dynamometer. Readings measured using both dynamometers were highly correlated to each other (r = 0.88) with ICC of 0.92, indicating an excellent inter-instrument reliability.

Conclusion
Comparable measures between Jamar and Camry hand dynamometers support the interchangeable use of the devices among older population. Hence, the alternative use of Camry dynamometer is appropriate for the outpatient setting.
1055 SIMPLE APPROACHES TO CHARACTERISING MULTIPLE LONG-TERM CONDITIONS (MULTIMORBIDITY) AND RATES OF HOSPITAL ADMISSION IN UK BIOBANK
Authors: Dodds R M , Bunn J G , Hillman S , Granic A , Murray J , Witham M D , Robinson S M , Cooper R ,   ADMISSION Research Collaborative, Sayer A A 
Published: June 2022

Abstract

Introduction
Multiple approaches are used to describe MLTC, including counts and indices (weighted counts). However, few studies have directly compared different approaches which would be helpful for the design of future MLTC studies. We therefore aimed to compare the prevalence of MLTC and association with emergency hospital admission characterised using different approaches within the same dataset.

Method
We used baseline data from 501,596 UK Biobank participants (age 37-73y) combined with linked hospital episode statistics to characterise MLTC using four approaches: count of body systems affected (CB); count of 43 conditions (CC); Byles index (BI); and Charlson comorbidity index (CCI). For each we performed survival analyses to test associations to a combined endpoint of first emergency admission or death over five years from baseline interview, adjusting for age and sex. We used Harrell’s C-index to compare the discriminant value of the four approaches for the combined endpoint.

Results
Prevalence of two or more positive responses (indicating the presence of MLTC) was 45% for CB, 33% for CC, 6% for BI and 2% for CCI. 95,812 (19%) participants had one or more emergency admission or died in the first five years. All four approaches were associated with greater rates of admission/death. For example, using CC, compared to those with zero conditions those with one had 1.42 (95% CI 1.39,1.45), those with two 1.94 (95% CI 1.90,1.98), and those with 3+ conditions had 3.11 (95% CI 3.05,3.17) times greater rates. The predictive value of the four approaches was modest (C-indices ranging from 0.60 to 0.63).

Conclusion
The counts classified a greater proportion of the sample as having MLTC than the indices, highlighting that prevalence estimates of MLTC may vary depending on the approach used. All approaches had strong statistical associations with admission, but only moderate ability to identify individual participants at risk.
A Canonical Neighborhood Theorem for Mean Curvature Flow in Higher Codimension
Authors: Naff Keaton 
Published: June 2022

Abstract
In dimensions $n \geq 5$, we prove a canonical neighborhood theorem for the mean curvature flow of compact $n$-dimensional submanifolds in $\mathbb {R}^N$ satisfying a pinching condition $|A|^2 &lt; c|H|^2$ for $c = \min \{ \frac {3(n+1)}{2n(n+2)},\frac {1}{n-2}\}.$
Critical Even Unimodular Lattices in the Gaussian Core Model
Authors: Heimendahl Arne , Marafioti Aurelio , Thiemeyer Antonia , Vallentin Frank , Zimmermann Marc Christian 
Published: June 2022

AbstractWe consider even unimodular lattices that are critical for potential energy with respect to Gaussian potential functions in the manifold of lattices having point density $1$. All even unimodular lattices up to dimension $24$ are critical. We show how to determine the Morse index in these cases. While all these lattices are either local minima or saddle points, we find lattices in dimension $32$, which are local maxima. Also starting from dimension $32$ there are non-critical even unimodular lattices.
Hispanic Knowledge and Attitudes About Transgender Individuals [A327]
Authors: Ortiz-Ramos Kevin J. , Muns Sofía , Oliver Ariadna Ramírez , Morales Rivera Shadaira N. , García-Rivera Enid , Romaguera Josefina 
Published: June 2022

INTRODUCTION:
Transgender individuals belong to one of the most stigmatized and discriminated groups in society. Despite the importance of this issue, few studies have been devoted to quantitatively examine knowledge and attitudes about transgender individuals. This study aimed to assess knowledge and attitudes about transgender individuals among Hispanic individuals living in Puerto Rico (HLPR) to help identify areas in need of educational interventions aimed at increasing knowledge and improving quality of life for those in the transgender community.

METHODS:
After institutional review board approval, a sample of HLPR were invited to complete a pre-tested self-administered online questionnaire aimed to address demographics, transgender knowledge, and attitudes. Responses were analyzed using STATA version 13 frequency analysis.

RESULTS:
To date, 413 participants have completed the questionnaire, of which 68.72% were female. Of the participants: 72.17% had at least a bachelor’s degree, 57.39% knew a transgender person, and 62.20% were exposed to transgender-related topics throughout their education. Most respondents correctly defined sex (67.7%), sexual orientation (88.1%), and gender identity (62.8%). Moreover, 74.27% of participants strongly agreed that transgender individuals bring great value to their communities, and are a valuable part of society, and 89.95% even reported they strongly agreed with welcoming transgender people in the workplace.

CONCLUSION:
Consistent with the literature, younger individuals with higher levels of education and sensitivity towards the transgender community were more willing to participate in the study, displaying high levels of knowledge about and positive attitudes toward transgender individuals. Future studies with a larger and more diverse sample should be done to minimize sampling bias.
Pregnancy Outcomes in Multifetal Gestation Who Underwent In-Vitro Fertilization (IVF) as Compared to Spontaneous Conceptions [A332]
Authors: Mandourah Samar , Badeghiesh Ahmad , Baghlaf Haitham , Dahan Michael H. 
Published: June 2022

INTRODUCTION:
This study’s aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic.

METHODS:
This is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3,219 IVF conceptions, from 2008-2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, while adjusting for confounding variables. Subject was conducted using ICD-9 codes 651.X and 76.1 for multifetal gestation and ICD-9 code 23.85 for IVF. Each pregnancy was included once.

RESULTS:
IVF multifetal gestations had increased risk of pregnancy induced hypertension (adjusted odds ratio [aOR]:1.31, 95% CI, 1.20–1.43), gestational hypertension (aOR: 1.21, 95% CI, 1.04–1.41), preeclampsia (aOR: 1.31, 95% CI, 1.19–1.45), gestational diabetes (aOR: 1.26, 95% CI, 1.13–1.41) and placenta previa (aOR: 1.7, 95% CI, 1.32–2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR: 1.21, 95% CI, 1.10–1.33), preterm premature rupture of membranes (aOR: 1.33, 95% CI, 1.16–1.52), chorioamnionitis (aOR: 1.71, 95% CI, 1.37–2.14), postpartum hemorrhage (aOR: 1.44, 95% CI, 1.26–1.63) and transfusions (aOR: 1.48, 95% CI, 1.26–1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR: 1.26, 95% CI, 1.12–1.41) and congenital anomalies (aOR: 1.82, 95% CI, 1.29–2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise.

CONCLUSION:
Women with IVF multifetal pregnancies were more likely to have complications, with risks increased 20% to 70%. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.