bluuebunny/crossref_metadata_2025_split huggingface dataset:
745 PROACTIVE INPUT FROM GERIATRICIAN LED SURGICAL LIAISON SERVICE FOR OLDER SURGICAL PATIENTS AT ROYAL BERKSHIRE HOSPITAL, READING
Authors: Castaneda-Caicedo E , Khwaja M , Alam S , Warrior S 
Published: March 2022

Abstract

Introduction
Need for a geriatrician in the peri operative care of older surgical patients is evident by the NCEPOD reports in 2010 and 2011. Funding for Consultant Geriatrician led surgical liaison service for RBH was approved in 2014.We present a comparative review of the service during 2019/2020.

Methods
A retrospective audit of elective and emergency surgical patients over 65 years of age from January to March 2019 and June to September 2020 was done. Geriatrician input was provided on weekdays by Less than full time (80%) equivalent Consultant, 1 full time equivalent physician associate and a Gerontology Registrar on pro rota basis.

Results
We reviewed 76 patients in 2019 (Emergency 74/76 = 95% Vs Elective 2/76 = 3%) and 161patients in 2020 (Emergency134/161 = 83% Vs Elecetive27/161 = 17%). Majority of emergency presentations were small bowel obstruction, acute cholecystitis, and pancreatitis while laparoscopic right hemi colectomy was the commonest elective surgical admission. The average age of patients was 72 years (2019) and 79 years (2020). Length of stay up to 5 days reduced from 75% (51/76) in 2019 to 43% (70/161) in 2020. The overall length of stay reduced from 12 days to 8.5 days in 2019 and 2020, respectively 30 days readmission rate increased from 21% (16/76) in 2019 to 25.5% (41/161) in 2020. 75% (2019) and 96% (2020) of patients were discharged back to their usual residence and death rates reduced from 14% to 1% between the 2 audits.

Conclusion
There is an increase in patient number, age, and complexity. Number of elective surgical admissions after the 1st Covid wave has risen. Even with less than full time Consultant Geriatrician cover the service has helped to reduce the overall length of hospital, mortality rate and added to cost saving. There is need for senior cover for service to work efficiently and to meet its ever-increasing demand.
748 HEARING AIDS AND GLASSES: BEDSIDE SIGNS PROMPT ASSESSMENT OF SENSORY NEEDS, AN AUDIT
Authors: Laws E , Currie H , Batra R 
Published: March 2022

Abstract

Introduction
It is widely acknowledged that older adults with hearing or visual impairment are at higher risk of developing delirium. The National Institute for Clinical Excellence (NICE) guideline for delirium prevention in the hospital setting emphasises the importance of considering sensory impairment in the clinical assessment of patients at risk of delirium, yet it is often overlooked. This audit aimed to determine doctors’ documentation of sensory needs in a geriatrics department and the effect of bedside signs on this documentation.

Method
This study analysed documentation for all patients on three elderly care wards. Pre-defined search terms relating to hearing, visual and cognitive impairment were used to analyse whether sensory needs were mentioned during the patients’ hospital stay to study date. After the first round of data collection, bedside signs to indicate whether patients have hearing aids or glasses were installed, complemented by ward teaching on sensory impairment and delirium. Documentation was re-audited using the same pre-defined search terms as in the first round.

Results
The first round of data collection included 71 patients with an average age of 79 years. Only 30% of patients had documentation regarding sensory needs (hearing and/or vision) and 49% were documented as having delirium and/or dementia. The second round of data collection was completed one month after intervention and included 71 patients with an average age of 82 years. After intervention of bedside signs and ward teaching, doctors’ documentation of sensory impairment increased by 81%.

Conclusion
Installing bedside signs to indicate whether patients have hearing aids or glasses has improved documentation of sensory impairment, in turn prompting its consideration in assessment and care of patients at risk of delirium.
779 IMPROVING USE OF COORDINATE MY CARE USING A QUALITY IMPROVEMENT APPROACH FOR MEDICAL PATIENTS ADMITTED TO BARNET HOSPITAL
Authors: Goffe K , Wilson J , Gluck T , Brady J , Burns A , Bergbaum C , Petra H , Stewart M , Wilson E 
Published: March 2022

Abstract

Introduction
Coordinate My Care (CMC) is a digital care plan for communicating person-centred urgent and advance care planning. We recognised that it was not being consistently accessed on admission, nor updated on discharge, leading to a risk of ignoring patient wishes and previously clinician-agreed care plans. We used a quality improvement approach to increase use of CMC.

Method
We gathered baseline data on the number of users utilising their account, and explored current practice and barriers. A driver diagram was developed, a Steering Group met regularly, and interventions were tested using Plan, Do, Study, Act. Interventions began in January 2021, including electronic circulation of a guide to gain access to CMC, posters about CMC, departmental teaching, and drop-in training. A Core Group of clinicians repeatedly surveyed 12 medical ward areas and offered on-the-spot troubleshooting. To mitigate effects of staff turnover, we developed e-classroom training for new starters.

Results
53 people attended departmental teaching and drop-ins. The number of users utilising their account each month showed a steady increase, rising from 25 to 42 users. Monthly views of CMC records are increasing, with 167 in May 2021 compared to an average of 105 in the 5 months prior to the project. We have still to examine patient feedback.

Conclusion
Use of CMC is becoming more established. Future actions will concentrate on training (including in the emergency department and during junior doctor changeover), helping clinicians hold conversations, and establishing mentoring. Recording Advance Care Planning on CMC is a final step in a complex process of identifying that a patient may be in the last year of their life, starting conversations and taking actions. It follows that varied and sustained actions are needed to improve this, in order to realise the benefits of person-centred planning for our patients and those caring for them.
780 IMPROVING NUTRITIONAL SUPPORT FOR POST-SURGICAL FEMUR FRACTURE PATIENTS AT ST MARY’S HOSPITAL, LONDON
Authors: Donnelly L , Sharpe S , Heber I , Morgan C 
Published: March 2022

Abstract

Introduction
Malnutrition represents a common complication in femur fracture patients and is primarily caused by poor dietary intake. Malnutrition is associated with poor clinical outcomes, and is the strongest independent risk factor for recurrent femur fracture. High protein oral nutrition supplements (ONS) have been associated with improved clinical outcomes after femur fracture, including reduced complications, length of hospital stay, mortality and bone mineral density loss, and increases in functional status and quality of life (Volkert, Beck, Cederholm et al., Clinical Nutrition, 38, 10–47)). Accordingly, the European Society for Clinical Nutrition and Metabolism (ESPEN) advocates the use of ONS with all femur fracture patients in hospital.
Aim To improve nutritional support for post-surgical femur fracture patients at St Mary’s Hospital, London.

Methods
We plan to carry out three PDSA cycles to evaluate whether two separate interventions are effective in increasing the prescription rate of ONS in post-surgical femur patients. Each PDSA cycle included all patients who underwent surgical treatment for femur fracture during a one month period.

Results
‘Cycle 1’ included 18 patients (mean age: 84.6 years; range: 68–98 years) treated in March 2021. ONS were prescribed in 11% (2/18) post-surgical femur fracture patients. ‘Intervention 1’ comprised a dietician-led presentation during the Geriatric department weekly teaching session on 17/05/21. ‘Cycle 2’ data will be collected one month after ‘Intervention 1’.

Conclusion
‘Cycle 1’ results revealed low rates of ONS prescriptions for post-surgical femur patients. We anticipate higher ONS prescription rates following ‘Intervention 1’. We believe that doctors’ and dieticians’ awareness of the importance of nutritional support for post-surgical femur fracture patients is key to the success of this quality improvement project.
797 IMPROVING GERIATRIC CARE IN THE EMERGENCY DEPARTMENT; TREATT PROJECT: THE RAPID EARLY ASSESSMENT THERAPY TEAM
Authors: Foxley H , Colby C , Swin J , Leyland R 
Published: March 2022

Abstract

Introduction
At University Hospital Southampton (UHS) on average 400 elderly patients attend the emergency department (ED) each month following a fall with an estimated cost to the NHS of £2.3 billion a year. 50% of over 80’s fall at least once a year, after a first fall, 2/3 will fall again within the year. Since the creation of the Same Day Emergency Care (SDEC), treatment of those attending ED with frailty conditions has improved. However, the current therapy service cannot adequately assess these patients, leading to longer length of stay (LOS) and suboptimal functional outcomes. An initial 3-month pilot in ED identified those seen by a therapist had a reduced LOS compared with those who did not receive therapy (6.9 days vs 8.5 days). The data identified that 253 patients presenting later in the day received a substandard service.

Methods
An extended hours trial across a 2-month period was conducted. During this period therapists provided a proactive, responsive service to support comprehensive geriatric assessments (CGAs) in ED. Data was collected including demographics, diagnosis, response time, interventions, community referrals and LOS. The key outcome measures identified within the pilot were LOS, reduction in 1 night hospital stays, appropriate onward referrals, readmission rates and CGAs including falls reviews.

Results
This improvement project is in progress and the trial will be completed August 2021. The key areas for analysis will be LOS, readmission rates and the impact of early frailty assessments on discharge destination and admission avoidance.

Conclusion
With the aging population and local demographics in West Hampshire and Southampton city, frailty conditions are increasing. The demand on ED outweighs the current therapy service. The trial aims to avoid multiple admissions following falls, improve patients’ outcomes through reduced LOS and ensure appropriate referrals are made to ensure continuity of care into the community.
775 IMPROVING ADVANCE CARE PLANNING DISCUSSIONS AND COMMUNICATION WITH PRIMARY CARE IN GERIATRIC MEDICINE IN A DISTRICT GENERAL
Authors: Twigg M , Robins-Piotrowski D , Jenkin R 
Published: March 2022

Abstract

Introduction
Advance care planning and Respect forms are useful tools in the care of patients in geriatric medicine. Prior projects locally in acute medicine identified gaps in engaging appropriate patients in advance care planning. This quality improvement project aims to improve the identification and completion of Respect forms and how this information is passed on to primary care. NICEQS13 states there must be evidence to support conversations and care planning with relevant care agencies to ensure coordinated care.

Methods
The Supportive and Palliative Care Indicator Tool (SPICT) was utilised to identify patients who would benefit from RESPECT forms. Patient notes were reviewed prospectively to see if RESPECT forms were completed during admission and discharge summaries assessed to determine whether RESPECT information was included and communicated to primary care. Following PDSA cycle 1 the medical team were provided with structured education in advance care planning and importance of communicating RESPECT forms to primary care. Reminder notes were attached to all computer work stations as an aid memoire when completing discharge summaries. Following cycle 2 there was a change of staffing and RESPECT form communication was included in the induction pack alongside further informal ward based teaching.

Results
Identification of patients needing advance care planning improved from 80% to 100% of these patients being discharged with Respect forms. In the initial data collection 8% of Respect forms were communicated to primary care. This improved to 96% by the third cycle with sustained improvement across junior doctor rotations.

Conclusion
A sustained education program for geriatric medicine staff led to an increase in communication of advance care planning to GP’s. The NICE QS13 standards have been met and the methodology will be transferrable to other departments in the hospital. A more integrated platform with primary care would help improve communication with primary care further.
682 IMPACT OF DISCHARGE INTERVENTIONS FOR OLDER PATIENTS LEAVING HOSPITAL: A SYSTEMATIC REVIEW OF REVIEWS
Authors: O’Connell Francischetto E , Jones J , Davies S , Allen K , Combes G , Damery S 
Published: March 2022

Abstract

Introduction
The UK has an aging population and there is an increasing need for additional care and support services for elderly patients discharged from hospital. Despite a large evidence base on different discharge services there is inconsistent findings on their effectiveness. This systematic review of reviews aimed to evaluate the impact of a variety of discharge interventions on older people leaving hospital.

Method
Ten databases were searched (including Medline and The Cochrane Library) using multiple key search terms related to ‘systematic reviews’, ‘older people’ and ‘discharge’. Only systematic reviews of interventions for people aged over 60 years that provided additional support or adapted their discharge processes were included. Outcomes of interest included mortality, readmissions, length of hospital stay, patient health status and costs. Abstract, title and full-text screening was conducted independently by two reviewers. Interventions were categorised by intervention type and a narrative synthesis was conducted on data extracted.

Results
Of the 8,748 title and abstracts reviewed, 859 full texts were assessed for eligibility, of these 91 were taken forward to quality assessment and 66 moderate or high-quality reviews were included in the final synthesis. Interventions were categorised into 10 types and had varying impact on outcomes. A statistically significant positive impact on the outcomes of interest was found for: Interventions providing ‘rehabilitation, therapy or care at home (or in the community) around the time of discharge’ reducing length of stay; ‘primary care interventions’, ‘Discharge planning/coordination or case management’ and ‘patient education’.

Conclusion
This systematic review of reviews shows that different types and configurations of discharge interventions can benefit older patients in multiple ways when compared to usual care and highlights which intervention types make no difference or have negative impacts. These findings will help to inform the development of new discharge interventions and the direction of future research.
696 UNDERSTANDING INDEPENDENCE—OLDER PEOPLE’S PERSPECTIVES
Authors: Taylor E , Goodwin V , Clegg A , Ball S , Frost J 
Published: March 2022

Abstract

Introduction
Independence is an important personal goal for many older people. Achieving this goal in practice requires a shared-understanding of independence between older people and those supporting them, but a consensus of understanding remains elusive. This study aims to provide a basis for a person-centred understanding of independence by identifying which factors are important to the meaning, and experience, of independence for older people.

Method
In-depth interviews were conducted to explore the understandings of community-dwelling older people. Participants were purposively sampled from the Community Ageing Research 75+ cohort study. Analysis was guided by the Framework approach. Themes were identified through deductive and inductive exploration of the transcripts.

Results
Fourteen older people were interviewed ranging from 76–98 years old, six were male. Five themes were identified. The first three themes: participation, autonomy and control, underpinned participants’ understandings of independence. Engaging in meaningful activities, making decisions, and having control over help received were fundamental to participants’ understandings of independence. These three themes provided the common building blocks for unique configurations of independence. The importance of psychological qualities to the facilitation of independence, as they enabled participants to navigate environmental and social set-backs, presented a fourth theme, ‘Mind over Matter’. The final theme, ‘Participation reinforces psychological qualities’ represented the virtuous circle through which participation in meaningful activities reinforced the psychological attributes necessary to maintain independence.

Conclusion
Meanings of independence are as diverse as the people who develop them, whatever the age group. For the older participants of this study, despite differences, the meaning and facilitation of independence comprised several common themes. Achieving independence was a case of ‘Mind over Matter’ requiring personal effort, irrespective of environmental supports. Participation in meaningful activities was both a goal of independence and a means to reinforce the psychological qualities and energy needed to maintain it.
719 THE EFFECT OF LOCKDOWN ON THE INCIDENCE OF VTE IN HIP FRACTURE PATIENTS DURING THE COVID-19 PANDEMIC
Authors: Huque S , Robinson A , Singh N 
Published: March 2022

Abstract

Introduction
COVID-19 is associated with an increased risk of venous thromboembolism (VTE). We compared the incidence of VTE on a busy hip fracture unit during 2020 with previous years to identify factors that may have played a role in its development.

Methods
Data were retrospectively obtained by notes review for patients admitted with neck or shaft of femur fracture. This included baseline characteristics, comorbidities and operative risk factors for VTE.

Results
11 of 420 patients (2.6%) were diagnosed with VTE in 2020, compared with 25 of 2,115 patients (1.2%) between January 2015 and December 2019 (RR 2.2 [95% CI 1.1 to 4.5, p &lt; 0.05]). Only one patient in 2020 had confirmed COVID-19. Retrospective data between 2015–2019 were incomplete, and so statistical analysis of demographic and operative risk factors was not conducted. Descriptive statistics show there were comparable proportions of smokers and malignancy in both groups, and the majority of patients in both groups received either mechanical or pharmacological VTE prophylaxis. A higher proportion of patients were independently mobile prior to admission in 2020 (72.7% vs 28%). There was a shorter interval to development of VTE in 2020 (mean 12 days in 2020 vs 25 days in 2015–2019).

Conclusion
Following hip fracture surgery patients were twice as likely to develop venous thromboembolism in 2020 than in the previous five years. There was also a shorter time to development of VTE. This was despite a higher reported level of premorbid mobility in 2020 in otherwise similar patient groups. We hypothesise that isolation due to the COVID-19 lockdown contributed to this result. This suggests a need for enhanced vigilance and prompt VTE prophylaxis in this vulnerable population in the event of further pandemic waves and lockdowns.
815 FRAILTY AND MULTIMORBIDITY ARE ASSOCIATED WITH LONGER LENGTH OF STAY IN OLDER UROLOGY PATIENTS
Authors: Ibitoye S , Parry F , Rideway A , Nitharsan R , Grange R , Braude P , Warren K , Shipway D 
Published: March 2022

Abstract

Introduction
Frailty and geriatric syndromes are becoming common place in surgical services. In general surgery, frailty has been shown to be associated with longer length of hospital stay. The effect of frailty on outcomes in Urology patients is not well described. We aimed to evaluate the effect of frailty and multimorbidity on length of stay in older patients admitted for emergency Urology care.

Methods
Adults aged 65 years and older admitted as an emergency to the Urology service during 4 months of 2020/21 were included. The primary outcome was time to discharge; analyses were adjusted for Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), age, gender, and surgical procedure (yes/no).

Results
142 patients were included, of these 60 (42.3%) were living with frailty (CFS ≥5), 32 (22.5%) were multimorbid and 59 (41.5%) underwent a surgical procedure. Longer length of stay was associated with frailty (adjusted-HR 0.560; 95% CI 0.376–0.835; p 0.004) and multimorbidity (adjusted-HR 0.556; 95% CI 0.367–0.842; p 0.006).

Conclusion
In this single-centre study we found frailty and multimorbidity to be associated with longer length of stay in patients admitted for emergency Urology care. Geriatric perioperative care interventions in other surgical specialties have been shown to reduce length of stay, the effect of such services within urology has yet to be established. Identification of frail and multimorbid patients could help to develop targeted strategies to improve outcomes, and ultimately reduce hospital stay.
Prevalence of Occasional Hypertension and Its Association With Overweight and Obesity in Children Aged 5–6 Years in Tianjin
Authors: Zhang Tao , Qiao Yi-juan , Li Wei-qin , Pan Lei , Liu En-qing , Liu Hong-yan , Wang Yue , Liu Jin , Wang Shu-ting , Guo Lu , Leng Jun-hong 
Published: March 2022

Abstract

Background
To investigate occasional hypertension in preschool children aged 5–6 years, and to analyze its association with overweight or obesity to provide the basis for early prevention.

Methods
Cluster random sampling was used to select 63 out of 1,802 kindergartens in 16 districts of Tianjin from 2016 to 2018. Blood pressure, height, and weight were measured among 21,393 children aged 5–6 years. A retrospective questionnaire survey was conducted to collect environmental factors. A multivariate logistic regression model was used to analyze the association between overweight or obesity and occasional hypertension, after adjustment for environmental factors.

Results
The prevalence of high blood pressure in preschool children of Tianjin was 11.9%, and the rate of occasional hypertension was 17.5%. The detection rate of abnormal blood pressure in overweight and obese children was significantly higher than that in normal weight children (P &lt; 0.01). After adjusted for environmental factors, overweight and obesity were positively associated with high blood pressure and occasional hypertension. The odds ratio (95% confidence interval) of overweight for high blood pressure and occasional hypertension was 1.61 (1.41–1.83) and 1.79 (1.61–1.99), respectively; and odds ratio (95% confidence interval) of obesity for high blood pressure and occasional hypertension was 2.15 (1.85–2.50) and 3.16 (2.82–3.53), respectively.

Conclusions
Overweight and obesity increase the risk of occasional hypertension in preschoolers.
Automation Anxiety
Authors: Dinnen Zara 
Published: March 2022

Abstract
On “Amazon Prime Day” in 2019, Amazon workers across the globe went on strike to protest working conditions; protesters held up banners demanding “Human Workloads,” with the message “We Are Not Robots.” The fantasy of automation—its promises and pitfalls—is a mainstay of contemporary public discourse, organizing the ways we work and live. In this review essay, Zara Dinnen reads three recent scholarly, political, and artistic contributions to knowledge of automation: Smart Machines and Service Work: Automation in an Age of Stagnation by Jason E. Smith; Furious: Technological Feminism and Digital Futures by Caroline Basset, Sarah Kember and Kate O’Riordan; and Atlas of Anomalous AI edited by Ben Vickers and K Allado-McDowell. Each book offers a critical standpoint from which to apprehend and witness the situation of automation as it determines material and imaginary conditions of labor today. In conversation, the three works contest the ethical and political terrain of automation as a signifier of growth and progress under late capitalism.