bluuebunny/crossref_metadata_2025_split huggingface dataset:
962 FROM DIRTY WORK TO MEANINGFUL WORK: A PHOTOVOICE STUDY OF RESIDENTIAL AGED CARE IN HONG KONG
Authors: Law S , Yau S , Li S , Lee Y , Lee L , Lai S , Huang S 
Published: June 2022

Abstract

Introduction
Caregiving work in ‘residential care homes for the elderly’ (RCHEs) has long been devalued as ‘dirty work’, which contributes to RCHE’s acute shortages of health care staff in Hong Kong. This study aims to unearth the voice of the RCHEs workers by delineating their insider perspectives of RCHE work.

Method
Adopting the Photovoice method, a participatory methodology, 30 RCHEs care workers (i.e. Registered Nurses, Enrolled Nurses, Health Workers, and Personal Care Workers) were invited to take photos that showcase their perspectives of doing aged care work. Two in-depth interviews were conducted with each research participant before and after the photo-taking procedure. Thematic analysis is then conducted to analyse the visual and verbal data.

Results
Findings show that RCHEs care workers perceive and revitalize the nature and meaning of their work in four ways: conducting ‘dirty tasks’ to help the elderly; valuing and engaging in long-term relationships; learning in work; and cultural meaning of working with the elderly. Contrary to public devaluation, RCHE care workers normalize the delivery of ‘dirty tasks’ (i.e. handling human excreta and wounds) as being helpful to both the elderly and the family members. Besides the routine caring tasks on paper, care workers highlight that they spend a lot of unrecognized labor to build rapport and provide emotional support to the elderly and their family members in their work. They also report that learning and self-development are an important part of residential care work, both in terms of professional knowledge and personal growth. Taking care of the elderly also conveys positive cultural meanings in Chinese society.

Conclusion
Policy, professional and educational initiatives of geriatric care primarily emphasize the delivery of clinical tasks (caring for), while undermining the emotional and relational aspects of aged care work.
The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China. (UGC/FDS16/M12/20).
963 THE IMPACT OF AGE, SEX AND MORBIDITY COUNT ON EARLY TERMINATION: A META-ANALYSIS OF INDIVIDUAL PATIENT DATA FROM CLINICAL TRIALS
Authors: Lees J S , Hanlon P , Butterly E , Wild S H , Mair F S , Taylor R S , Guthrie B , Gillies K , Dias S , Welton N , McAllister D A 
Published: June 2022

Abstract

Introduction
Multimorbidity is found in around half of people with any long-term condition but is substantially less common in randomised controlled trials (‘trials’). Multimorbidity may diminish a participant’s ability to complete a trial. However, empirical estimates of the association between individual patient characteristics and early termination are lacking.

Method
Individual patient-level data were obtained from Phase 3/4 trials contained within two clinical trial repositories. Eligible trials for inclusion were identified according to pre-specified criteria (PROSPERO CRD42018048202). Within each trial, the association between morbidity count and early termination (failure for any reason to complete the final trial visit) was estimated in logistic regression models, adjusting for age and sex. These estimates were meta-analysed in Bayesian linear models, with partial pooling across index conditions and drug classes. Using these estimates, the impact of morbidity count on early termination was modelled for a set of notional trials.

Results
In 92 trials across 20 index conditions and 17 drug classes, the mean morbidity count ranged from 0.3–2.7. Neither age nor sex was associated with early termination (OR 1.04, 95% CI 0.98–1.11; OR 1.00, 95% PI 0.95–1.07 respectively). Morbidity count was associated with early termination (OR per additional morbidity: 1.11, 95% CI: 1.07 to 1.14). There was no evidence of non-linearity in the association between morbidity count and early termination, and there was minimal variation across drug classes and index conditions. For a notional trial with high level of early termination in individuals without multimorbidity, doubling the mean morbidity count from 1 to 2 increases risk of early termination from 29% to 31%.

Conclusion
Multimorbidity, irrespective of age and sex, is associated with a relatively modest increased odds of early termination of trial participation. The benefit of increased generalisability of trials by including patients with multimorbidity appears likely to outweigh the disadvantages of lower retention.
977 IMPLEMENTATION OF THE FIRST FRAILTY UNIT IN WESTERN AUSTRALIA
Authors: Lee S , Horrocks A , Mandal B 
Published: June 2022

Abstract

Background
Implementation of the first Frailty Unit in Western Australia within the tertiary Hospital—Fiona Stanley. The Frailty Unit was based within the Acute Medical Unit and included a Geriatrician, Medical team, Multidisciplinary Allied Health (AH) Team and Acute Medical Nursing Staff to manage a 12 bed Frailty Unit.

Introduction
Evidence shows that a prolonged hospital stay can be a risk factor for hospital acquired complications, deconditioning, loss of independence and early entry into residential care. This is especially evident amongst the frail population. This leads to poor outcomes of patients, high costs from complications and prolonged hospital admissions. The primary goal of this unit was to provide comprehensive Geriatric assessment from a multidisciplinary team at the front door of the hospital which will improve patient centered care and allow earlier discharges with a multitude of issues being addressed on day 1.

Method
included the allocation of staffing as documented above which provided earlier Geriatric assessment as well as comprehensive AH input. The intent was to redirect patients out of the hospital and back into the community to utilise nursing, medical and AH staff who can further assess and support patients in their own home environment and out of the busy hospital system.

Results
The impact of this change comparing 2018 (calendar year) with 2020/21 (financial year) has included: Readmission rates (0–7 day readmission) reduced from 8.5% to 6% Increase of 7% (182 patients) returning to their usual residence For those returning home, significant reduction in length of stay on this ward by 30%.

Conclusion
The effect on length of stay and higher quality assessments of elderly patients on day 1 has been clear not only from the data but also from staff experience who have seen a difference in the impact of this model.
982 ARE POST FALL CT HEAD SCANS DONE ACCORDING TO TRUST GUIDELINES
Authors: Rahman M M , Ezeigwe O 
Published: June 2022

Abstract

Introduction
Falls are a major public health concern, which poses a high risk of injury and even death. Due to fears regarding increased morbidity and mortality post fall, we have noticed that there is a tendency for junior doctors to request computerized tomography (CT) head scans beyond clinical reasoning and indications that are not found in the trusts post falls protocol. In addition, we discovered significant delays in completion of inpatient CT head scans resulting in delayed management. We therefore embarked on an audit with the aim of improving post falls assessment. We assessed compliance with trust post fall protocol regarding suspected head injury and requesting of urgent CT head scans, if urgent CT had scan are done within 1 hour and carrying out neurological observations post fall. The initial audit outcomes demonstrated poor compliance with the audited standards. As a result we introduced a new comprehensive post falls assessment proforma.

Results
We re-audited after the introduction of the new falls proforma, assessing inpatient falls from 20th January to 27th February 2021 at the William Harvey Hospital. 69% of falls cases have CT head scans requested as per trust policy, an improvement of 77% from the initial audit. 50% of patients who met the criteria for urgent CT head scans had it done within one hour of the request being made, an improvement of 150%. 84% of patient’s had neurological observations recorded as part of post fall assessment, an improvement of 12% from the initial audit.

Conclusion
The improvements seen in the audited standards are indicative that the new post falls proforma improves compliance with the trusts post falls protocol. We recommend that the new post falls proforma be a part of the trusts post fall protocol and for it to be included in the trust induction to new doctors.
984 ADVANCE CARE PLANNING ON THE COMPLEX CARE WARDS AT ROYAL BOLTON HOSPITAL
Authors: Green S , Oates R , Lim V-H , Lennon R , Woods S 
Published: June 2022

Abstract

Introduction
Advance care planning (ACP) is an important aspect of geriatric medicine, giving patients the opportunity to express their wishes and identify their preferred place of care and death whilst reducing unwanted hospital admissions. At Royal Bolton Hospital we reviewed the Complex Care department’s performance in engaging with ACP discussions with appropriate patients and considered how this could be improved.

Method
In October 2020, patients were identified from the current inpatients on the Complex Care wards using the following criteria: nursing home resident, clinical frailty score (CFS) 7 or above, or CFS 6 with 3 or more hospital admissions in the last 6 months. We reviewed the patient notes to ascertain whether any ACP had occurred and then followed the patients up at 6 and 12 months. At 6 and 12 months we identified the mortality and readmission rates to quantify whether the patients had been appropriate for ACP.

Results
35 patients identified as appropriate for ACP. ACP had been conducted in 10 patients. At 6 months, 13 patients had died and 17 had had hospital readmissions, totalling 196 readmission days. At 12 months, 8 patients had died, and 8 patients had been readmitted to hospital, totalling 85 readmission days. Combining the data for the 6- and 12-month results revealed 21 patients had died and 25 had been readmitted to hospital, totalling 281 readmission days. Only 4 of the 35 patients had neither died nor been readmitted to hospital.

Conclusion
Appropriate patients were accurately identified for ACP as confirmed by their subsequent mortality and readmission rates. However, there is scope for improving the quantity of ACP discussions by the Complex Care department in these patients. Further education for the medical staff, a patient leaflet and poster aimed at the ward juniors will be introduced with the aim of doing this.
986 IMMUNOSENESCENCE PROFILES AND MULTIPLE LONG-TERM CONDITIONS IN VERY OLD ADULTS: THE NEWCASTLE 85+ STUDY
Authors: Granic A , Martin-Ruiz C , Rimmer L , Dodds R M , Robinson L , Spyridopoulos I , Kirkwood T B L , Zglinicki T , Sayer A A 
Published: June 2022

Abstract

Introduction
Immunosenescence, a decline in immune system function, has been linked to several age-related diseases and geriatric syndromes, including cardiovascular diseases and frailty. Very old adults (aged ≥85 years) live with multiple long-term conditions (MLTC) or multimorbidity—a complex phenomenon of poor health defined by either counts (≥2 diseases), indices, or patterns. However, little is known about the relationship between immunosenescence and MLTC in this age group. We utilised baseline data from the Newcastle 85+ Study to investigate the association between previously defined immunosenescence profilesa and MLTC.

Method
We used data from 703 participants who had multimorbidity and complete data for 16 chronic diseases and geriatric syndromes (i.e. analytic sample). MLTC counts were derived from the number of conditions and categorised into &lt;median and ≥ median MLTC groups. We used the SPSS Two Step clustering with all 16 conditions to define MLTC patterns. Two immunosenescence profiles (‘Senescent-like phenotype’ and ‘Less senescent-like phenotype’) were defined previously from 13 lymphocyte compartments. We used multivariable regression analyses to investigate the association between immunosenescence profiles and MLTC counts, groups, and patterns.

Results
In the analytic sample only 6.8% participants had 2 conditions, whilst 79.1% had 3–7, and 14.1% had ≥8 conditions, a median of 5, and 62.2% were in ≥median MLTC group. Three distinct MLTC patterns emerged by clustering: ‘Low cardio-cerebro-metabolic diseases’ (n = 209), ‘High geriatric syndromes-arthritis’ (n = 240), and ‘Hypertensive-renal impairment’ pattern, (n = 254). Having ‘Senescent-like phenotype’ characterised by higher frequency of CD4 and CD8 senescence-like effector memory cells and lower CD4/CD8 ratio was not significantly associated with either MLTC counts, ≥median MLTC group, or patterns compared with ‘Less senescent phenotype’.

Conclusion
No cross-sectional associations between immunosenescence and MLTC were found in the very old. Further studies are needed to determine whether immunosenescence drives change in MLTC counts and patterns and influences MLTC burden in late adulthood.
993 IMPROVING ADVANCE CARE PLANNING ON A GERIATRICS WARD: A QUALITY IMPROVEMENT PROJECT
Authors: Miles H , Athavale N , Olaniyan M , Al-Alzubaidi F 
Published: June 2022

Abstract

Introduction
Despite ongoing improvement work in our hospital regarding Advance Care Planning (ACP) in the community and specialist palliative care settings, our team was concerned that ACP was underutilized for inpatients. We aimed to increase the number of ACPs (specifically focusing on re-admission avoidance) made on our geriatrics ward, and to communicate these effectively with community colleagues.

Method
We retrospectively reviewed 26 deaths on our ward during a three-month period, and found significant missed opportunities to discuss ACP, e.g. 54% of patients had more than one admission in the six months prior to death. We developed a novel co-morbidity score to help support our decision-making, and used aspects of the Gold Standards Framework’s Proactive Identification Guidance. Our working group, led by a consultant geriatrician, focused on increasing the team’s engagement with ACP, including use of an ‘ACP Champion’, and we worked to align our documentation with that used elsewhere in the Trust. We used a paper form, resembling a DNACPR, to prompt community teams to re-consider whether admission was necessary. We made ACPs for six patients during this four-month pilot phase, and followed them up over the next five months.

Results
Following our interventions, follow-up of our patients showed 83% had ACP described in their discharge letter; 33% had ACP mentioned on their Summary Care Record (SCR); 0% of patients who had died re-presented to hospital prior to death.

Conclusion
Our project showed that diligent attention to making ACPs for suitable patients was successful in preventing re-admission. Despite this, communication about ACPs in the discharge letters and transfer of this information to the SCR was suboptimal. This demonstrates that even with a focused team, mistakes can happen. I’m now working on a subsequent project focusing on improving understanding of ACP amongst junior doctors.
1075 THE EFFECTIVENESS OF INTERVENTIONS TO REDUCE ADVERSE OUTCOMES AMONG OLDER ADULTS FOLLOWING EMERGENCY DEPARTMENT DISCHARGE
Authors: Conneely M , Leahy S , Dore L , Trépel D , Robinson K , Jordan F , Galvin R 
Published: June 2022

Abstract

Background
Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED.

Method
Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and grey literature was searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed and an algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied to outcomes.

Results
Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate.

Conclusion
Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The evidence for the effectiveness of ED interventions for older adults is limited. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended.
1081 A COMPARISON OF THE ISAR TOOL AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED REATTENDANCE IN A COHORT OF ED ATTENDER
Authors: Leahy A , Corey G , O’Neill A , Higginbotham O , Devlin C , Barry L , Cummins N , Shanahan E , Shchetkovsky D , Ryan D , O'Connor M , Galvin R 
Published: June 2022

Abstract

Background
Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department.

Method
This was a prospective cohort study. Patients over 65 were recruited, baseline.
demographics were obtained and a research nurse assessed them using both the Clinical Frailty Scale and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation.

Results
419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). The median ISAR and CFS score was 2,5 respectively at baseline. The mortality rate was 5.4% and rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score &gt;/= 2 more was 1.84 (1.12, 3.02) and CFS &gt; 4 was 1.85 (1.08, 3.16). The ISAR tool &gt;/= 2, had a sensitivity of 74.29 (95% CI = 62.44, 83.99) and specificity of 41.18 (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS &gt; 4 had a sensitivity of 71.43 (95% CI = 57.79, 82.70) and specificity of 45.23 (95% CI = 39.33, 51.23) for the same outcome.

Conclusion
The ISAR tool &gt;/= 2 was the more sensitive at predicting ED reattendance at one month in comparison to the Clinical Frailty Scale. We would advocate using this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.
1083 A REVIEW OF FAST DATA IN TALLAGHT UNIVERSITY HOSPITAL, AND THE IMPACT OF COVID ON TREATMENT
Authors: O’Connor A , Hobson H , Collins R 
Published: June 2022

Abstract

Introduction
Stroke is a leading cause of morbidity. Current guidelines advise maximum of 4.5 hours post symptom onset for thrombolysis, and 24 hours for thrombectomy. (1) Delay between symptom onset and treatment is associated with an inferior outcome. Thrombolysis is available in 27 Irish centers. Average rate of thrombolysis is 11%. (3) Fewer than half of stroke patients arrived in hospital within three hours of symptom onset in 2019. (4) Median door-to-needle time is 48 minutes.

Method
FAST calls in Tallaght University Hospital, from 2/7/19–1/7/21, were included in this analysis (n = 594).

Results
160 FAST calls took place pre-Covid (20/month), and 434 post-Covid (27.12/month). Time of symptom onset was recorded in 390 cases. Time patients last seen well was known in 185 cases, unknown time of onset in 19. After review by the stroke clinician, FAST imaging was obtained in 78% of cases (n = 464). Of these, 34 cases of FAST imaging were performed for inpatients. Average time from registration to CT was 35:24 minutes pre covid, and 45:52 minutes post. 9.7% of patients were thrombolysed. The median door-to-needle time was 41 minutes pre-Covid(n = 21, 2.625/month), and 54 minutes after (n = 37, 2.3/month). Thrombectomy was performed in 46 cases. 222 patients were diagnosed with an ischaemic stroke, 50 had TIA and 48 had haemorrhagic strokes. Other diagnoses included migraine (6.7%, n = 40), seizures (6.7%, n = 40) and Bells Palsy (3.7%, n = 22). 55% (n = 330) of cases were registered to ED with FAST call between the hours of 9 am-5 pm. 27% (n = 161) of cases occurred during the night shift.

Conclusion
The median door-to-needle times were below national median pre-Covid, and longer post-pandemic, with an increase in the rate of presentation in the same time-frame. This report highlights the effect of the pandemic on time-critical patient interventions in stroke and the need to stratify services to respond to structural challenges.
Deriving homing sequences for Finite State Machines with timeouts
Authors: Tvardovskii Aleksandr , Yevtushenko Nina 
Published: June 2022

Abstract
State identification is the well-known problem in the automata theory that is aimed to determining the current or initial state of a system under test and this fact is widely used in the model-based testing of software and hardware systems. When modern systems are modeled, it is necessary to take into account the timed aspects and for this reason classical Finite State Machines (FSM) are extended by clock variables. In this work, we study the homing problem for FSMs with timeouts (TFSM). For this purpose, we introduce the notion of a timed homing sequence (HS) that is different from that for classical FSMs and propose a method for checking the existence and deriving a timed HS if it exists. A proposed method is based on the FSM abstraction of a TFSM, i.e. on a classical FSM that partially describes the behavior of a corresponding TFSM and inherits many of its properties. Since timeouts allow the system to move from state to state without input impact, we define a timed HS as a sequence that sets a TFSM to a stable state where the system can stay infinitely long waiting for an input.