bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remote sensing for monitoring tropical dryland forests: a review of current research, knowledge gaps and future directions for Southern Africa
Authors: David Ruusa M , Rosser Nick J , Donoghue Daniel N M 
Published: March 2022

AbstractClimate change, manifest via rising temperatures, extreme drought, and associated anthropogenic activities, has a negative impact on the health and development of tropical dryland forests. Southern Africa encompasses significant areas of dryland forests that are important to local communities but are facing rapid deforestation and are highly vulnerable to biome degradation from land uses and extreme climate events. Appropriate integration of remote sensing technologies helps to assess and monitor forest ecosystems and provide spatially explicit, operational, and long-term data to assist the sustainable use of tropical environment landscapes. The period from 2010 onwards has seen the rapid development of remote sensing research on tropical forests, which has led to a significant increase in the number of scientific publications. This review aims to analyse and synthesise the evidence published in peer review studies with a focus on optical and radar remote sensing of dryland forests in Southern Africa from 1997–2020. For this study, 137 citation indexed research publications have been analysed with respect to publication timing, study location, spatial and temporal scale of applied remote sensing data, satellite sensors or platforms employed, research topics considered, and overall outcomes of the studies. This enabled us to provide a comprehensive overview of past achievements, current efforts, major research topics studies, EO product gaps/challenges, and to propose ways in which challenges may be overcome. It is hoped that this review will motivate discussion and encourage uptake of new remote sensing tools (e.g., Google Earth Engine (GEE)), data (e.g., the Sentinel satellites), improved vegetation parameters (e.g., red-edge related indices, vegetation optical depth (VOD)) and methodologies (e.g., data fusion or deep learning, etc.), where these have potential applications in monitoring dryland forests.
Analysis of the Li-ion battery industry in light of the global transition to electric passenger light duty vehicles until 2050
Authors: Usai Lorenzo , Lamb Jacob J , Hertwich Edgar , Burheim Odne Stokke , Strømman Anders Hammer 
Published: March 2022

Abstract
The decarbonization of the transport sector requires a rapid expansion of global battery production and an adequate supply with raw materials currently produced in small volumes. We investigate whether battery production can be a bottleneck in the expansion of electric vehicles and specify the investment in capital and skills required to manage the transition. This may require a battery production rate in the range of 4–12 TWh/year, which entails the use of 19–50 Mt/year of materials. Strengthening the battery value chain requires a global effort in many sectors of the economy that will need to grow according to the battery demand, to avoid bottlenecks along the supply chains. Significant investment for the establishment of production facilities (150–300 billion USD in the next 30 years) and the employment of a large global workforce (400k–1 million) with specific knowledge and skillset are essential. However, the employment and investment required are uncertain given the relatively early development stage of the sector, the continuous advancements in the technology and the wide range of possible future demand. Finally, the deployment of novel battery technologies that are still in the development stage could reduce the demand for critical raw materials and require the partial or total redesign of production and recycling facilities affecting the investment needed for each factory.
702 COMMUNICATION CHALLENGES BETWEEN DOCTORS & RELATIVES DURING THE COVID-19 PANDEMIC: SIMPLE INTERVENTIONS WITH MEANINGFUL IMPACT
Authors: Patani B , Hudson M , Khan M , Head N , Long S 
Published: March 2022

Abstract

Background
& Aims Visiting restrictions during the COVID-19 pandemic resulted in reduced and inconsistent communication with the next-of-kin of elderly inpatients. This project aimed to improve communication between doctors and patients’ relatives in accordance with the GMC Good Medical Practice guidelines which outline that doctors ‘must be considerate to those close to the patient and be sensitive and responsive in giving them information and support’.

Methods
We created a virtual whiteboard on an elderly care ward in an inner London hospital documenting patient demographics, details of named next-of-kin and when they had been contacted. We aimed to update next-of-kin within 48-hours of ward admission and subsequently twice weekly. The outcome was measured via identical ‘pre- and post-intervention’ questionnaires recording the next-of-kin’s satisfaction with communication from the doctors. Questionnaires included 11 questions utilising a 5-point Likert scale for satisfaction. Results were anonymised and analysed using Microsoft Excel.

Results
Satisfaction with communication improved in 10 of the 11 domains of the questionnaire following intervention. Cumulative satisfaction scores post-intervention (N = 13) in comparison to pre-intervention (N = 25) were closer to the total possible satisfaction score per question for these 10 domains. The mean cumulative satisfaction score across all domains was 60% post-intervention compared with 44% pre-intervention. Satisfaction following intervention was particularly improved in the domains of frequency of communication (60% post-intervention.
32.8% pre-intervention) and how adequately questions and concerns were addressed (69.2% post-intervention; 45.6% pre-intervention).

Conclusion
During the COVID-19 pandemic healthcare professionals have had to adapt in communicating with patients’ next-of-kin. Our Introduction of robust standards and a virtual whiteboard to track communication resulted in improved satisfaction and proved useful in adapting to remote communication. We propose that similar practice and standards are extended across additional wards to encourage widespread optimal and consistent communication between doctors and patients’ relatives, an integral part of patient care.
727 BOOSTING BONE HEALTH: IMPROVING JUNIOR DOCTORS’ CONFIDENCE IN ASSESSING AND MANAGING FRAGILITY FRACTURES
Authors: Ge Y , Dennis L M 
Published: March 2022

Abstract

Introduction
Fragility fractures are a major disease burden in the UK. With an ageing population and number of fragility fractures predicted to double in 50 years, prevention in this high-risk population needs to be addressed. This audit aimed to examine the assessment of fracture risk in patients presenting with fragility fractures and improve awareness amongst trainee doctors through education.

Methods
A retrospective study was conducted on patients over 65 years admitted with fragility fractures, excluding neck of femur, from January to March 2021 (n = 51). Data was collected on Fracture Risk Assessment Tool (FRAX) scores, dual energy X-ray absorptiometry (DEXA) scans, and risk factors including body mass index (BMI), previous fragility fracture, smoking, alcohol intake, and serum calcium and vitamin D. A teaching seminar for junior doctors was delivered to increase confidence in assessing and managing fragility fractures.

Results
The mean age of patients was 79, with most common presentations being proximal humerus, distal femur and ankle fractures. 46% of patients had a previous fragility fracture. Smoking and alcohol history were documented in 72% and 60% of patients respectively, and 29% had BMIs calculated. 68% had calcium and 45% had vitamin D checked. DEXA scans occurred in 12%, all of whom had osteopenia or osteoporosis. Over half of patients were already on bone protection and 28% were subsequently started on bisphosphonates. A teaching session was delivered to junior doctors (n = 10), leading to improved confidence in assessing fracture risk by 30%, and improved confidence in managing fragility fractures by 35%. Knowledge of FRAX score increased from 62% to 100%.

Conclusion
A significant proportion of the over-65 population are likely to present with fragility fractures. Improving awareness and confidence amongst junior doctors can lead to identification of risk factors and help better prevent and manage fragility fractures in this high-risk population.
747 THE DIAGNOSIS AND MANAGEMENT OF HYPERKALAEMIA IN MEDICAL AND ELDERLY CARE INPATIENTS AT A DISTRICT GENERAL HOSPITAL
Authors: Broadhurst C , Thompson K , Tan W 
Published: March 2022

Abstract

Introduction
Severe hyperkalaemia is a dangerous and potentially life-threatening condition. Despite this knowledge, the incidence of hyperkalaemia in hospital inpatients remains high. On review of the acute management of hyperkalaemia at Croydon University Hospital, only 50% of medical and elderly care inpatients were managed correctly in line with hospital guidelines, and 50% of surveyed doctors did not feel confident managing acute hyperkalaemia—highlighting an urgent requirement for improvement. The project objectives were to improve management in line with hospital guidelines, overall prescription accuracy and the confidence of junior doctors in managing acute hyperkalaemia.

Methods
Two PDSA cycles; cycle one involved teaching sessions to doctors and the creation and circulation of information posters. Cycle two involved the development and implementation of a new electronic order prescription set for the management of acute hyperkalaemia.

Results
Post-intervention results showed an improvement in the correct management of hyperkalaemia from 50% to 80%. Prescription accuracy improved from 90% to 100%. Doctors reported an improvement in their overall confidence from 50% to 64%. Sub-group analysis identified no post-intervention improvement in the correct management of hyperkalaemia in care of the elderly (COTE, &gt;80 years) patients. COTE patients were also less likely to be managed correctly (45% vs 57%) and to have accurate prescriptions (71% vs 100%). However, prescription accuracy did improve in the COTE group (50% to 100%).

Conclusion
This project achieved its initial objectives. However, COTE patients were less likely to be managed correctly. This may be secondary to being more complex patients, having multiple co-morbidities or significant polypharmacy, which may further contribute to hyperkalaemia. Doctors may feel less confident suspending or modifying medications in these cases and seek input from specialist teams prior to doing so. Future interventions will focus on delivering teaching sessions on hyperkalaemia in complex cases to improve confidence and understanding.
760 IMPROVING THE MANAGEMENT AND DURATION OF RESOLUTION OF ACUTE KIDNEY INJURY IN THE ELDERLY
Authors: Ghaddar Y , Stevens A , Pearl M , Sivagnanam T , Sheriff S P 
Published: March 2022

Abstract

Introduction
Acute Kidney Injury (AKI) is prevalent in elderly populations due to several factors: polypharmacy, anatomic/physiologic changes of the kidneys associated with aging. AKI can contribute to increased length of stay, morbidity and mortality. This audit sets out to establish if the guidance established by NICE is being followed and how it may be better implemented.

Method
This study audited patients ≥65 years, who were admitted with AKI/developed an AKI during admission. Patients were excluded if they were on renal replacement therapy or under palliative care. Data was collected from case notes and Clinical Work Station. Data collection points used included: senior review within 24 hours; assessment of fluid status; medication review; strict fluid balance; examine for retention +/− catheter; daily U&E and appropriate imaging. Our independent variable was an AKI sticker, this included a revised checklist for above data collection points that was applied to patients’ medical notes. In addition to this, we used posters on appropriate wards which explained the guidance and management of AKI. Awareness was continued by presenting at Care of The Elderly teaching and medical grand round. Then re-audited the following month.

Results
Both cycles involved 45 patients. After implementation, improvements in urine analysis (5%vs35%), assessments of retention (0%vs38%) and assessments of fluid balance (55%vs78%) were seen. In cycle 2, medication was reviewed more frequently, specifically a 30% increase in the review of nephrotoxics. While senior review within 24 hours remains high in both cycles. We measured the outcome by checking the resolution time of AKI. Mean Resolution time was reduced by 1.4 days.

Conclusion
This audit has demonstrated an increase in the optimisation of the management of AKI through ensuring all appropriate interventions and examinations are completed and reducing resolution time by using stickers and the posters.
774 KEEP SMILING! IMPROVING ORAL HEALTH ON AN ACUTE MEDICINE FOR THE ELDERLY WARD
Authors: Livie V , Livie J , McCulloch A 
Published: March 2022

Abstract

Good oral health in older patients is important for numerous reasons including facilitating fluid and nutritional intake, communication and quality of life. It is an essential component of providing holistic care and should be a daily care requirement during a hospital admission. Poor oral health leads to adverse outcomes including periodontitis, tooth loss, pneumonia and cardiovascular disease. Frail, elderly and those with dementia are at increased risk of poor oral health. Our group decided to undertake quality improvement work to improve our patient’s oral health care during their hospital stay.
Baseline data was collected in our acute medicine for the elderly ward which looked at a variety of factors which influence good oral health. This included access to drink, nursing assessment of dentition on admission and daily review of mouth care documented by nursing and medical staff. Following this, we implemented an educational session for medical staff to promote good oral care.

Results
showed an improvement in ensuring patients had their drink within arm’s reach (94% to 100%). Daily medical review of a patient’s oral health also increased from 0% to 24%.

Conclusion
We have made small steps in improving medical review and documentation of our patient’s oral health whilst in hospital. There is still a need for further improvement in assessment and documentation in order to minimise complications associated with poor mouth care. We have undertaken further educational sessions to our nursing colleagues and we plan to introduce a ward ‘oral health champion’ as part of our ongoing improvement work.
678 THE MENTAL HEALTH NURSE EXPERIENCE OF PROVIDING CARE FOR PEOPLE WITH DELIRIUM SUPERIMPOSED ON DEMENTIA
Authors: Pryor C 
Published: March 2022

Abstract

Introduction
People with severe dementia are frequently cared for by registered mental health nurses due to their often complex cognitive or psychological care needs. This study aimed to explore and describe the experiences of mental health nurses who provide care for people with delirium superimposed on dementia.

Methods
Activity Theory was used to inform, a mixed methods design. Commencing with semi structured interviews, before further quantitative exploration using a questionnaire. Framework analysis was used for qualitative analysis, followed by descriptive statistical analysis of questionnaire data. Robust integration of data was undertaken, and findings presented in an activity system graphic. Participants were registered mental health nurses working in 24-hour care settings for people with dementia.

Results
Five key themes emerged: 1. For RNMHs to use tools (such as scores or guidelines), they need to see them as useful and contextually relevant. Whilst they are aware of tools, they may choose not to use them if they do not see the value in them. 2. Knowing the person for whom they provide care is central and personal. The RNMHs favour aesthetic ways of knowing and use this to guide their care provision. 3. Hierarchy within the multidisciplinary team remains, however this is not seen as a negative. The RNMHs feel supported and secure within their wider MDT. 4. Burdens of care felt by the RNMHs is driven by the care environment and care context. 6. There remains a disconnection of mental and physical health in both care environments and how the RNMHs see their role.

Conclusion
This study is the first to explore the complexities of specifically the mental health nurse context in relation to DSD. The novel application of Activity Theory as a lens offered a unique frame to support exploration of the mental health nurses working environments and experiences.
709 IMPACT ON HEALTHCARE UTILISATION OF A GENERAL PRACTITIONER-LED MODEL OF CARE FOR PATIENTS WITH FRAILTY
Authors: Jones H E , Morrison I , Hurding S , Wild S , Anand A , Shenkin S D 
Published: March 2022

Abstract

Introduction
Primary care has a significant role to play in the identification and management of frailty. MidMed is a new dedicated GP-led service developed by a large practice in Midlothian for patients living at home with moderate or severe frailty. MidMed comprises a full-time GP performing a comprehensive geriatric assessment (CGA) adapted for primary care. Patients receive direct access to all appointments with the named GP. The aim of this study was to assess the impact of MidMed on healthcare utilisation in this patient group.

Methods
Patients with moderate or severe frailty at the MidMed practice were identified by the electronic Frailty Index (&gt;0.24). After 16 months, patients who had been accepted into MidMed (MidMed group) were compared with those yet to be enrolled and who continued to receive usual care (non-MidMed group). Routinely collected data were used to identify outcomes including unscheduled hospital admissions, primary care consultations, continuity of care, outpatient attendances and mortality. Adjusted rate ratios were estimated using regression models.

Results
510 patients with moderate or severe frailty were identified (290 in MidMed, 220 in non-MidMed). Patients in each group were just as likely to have at least one hospital admission per year but those in MidMed had a reduced risk of further hospital admission compared to the non-MidMed group (adjusted RR 0.46 [95%CI 0.30–0.71]). MidMed was also associated with statistically significant higher usage of primary care (adjusted RR 1.52, [95%CI, 1.30–1.75]) and better continuity of care. There was no difference in mortality or the number of outpatient appointments when adjusted for co-variates.

Conclusion
A GP-led service for frailty is associated with lower risk of hospital readmission and improved continuity of care. Further studies are now required to better understand why use of such primary care services increase and whether this changes over time.
743 THE THIRD NATIONAL SURVEY OF UNDERGRADUATE TEACHING IN AGEING AND GERIATRIC MEDICINE AND ITS IMPACT ON STUDENTS’ ATTITUDES
Authors: Pearson G M E , Blundell A G , Gordon A L , Masud T , Ben-Shlomo Y , Henderson E J 
Published: March 2022

Abstract

Introduction
The British Geriatrics Society’s (BGS) recommended undergraduate curriculum was conceived in 2008 and mapped to the General Medical Council’s (GMC) standards [1]. Subsequently, two national surveys have described how geriatric medicine is taught in the UK and both identified areas for improvement [2,3]. In 2018, the GMC updated their statutory learning outcomes, therefore it is timely that the BGS remap their curriculum to this new guidance, with repeat surveys of UK institutions and students.

Methods
We will undertake a three-stage study of undergraduate education in geriatrics. Firstly, we will map the BGS recommended curriculum to the GMC’s ‘Outcomes for Graduates’. Secondly, we will survey UK medical schools on the content, methodology, timing and duration of teaching in geriatrics. Thirdly, we will assess medical students’ attitudes towards older people and a potential career in geriatric medicine.

Results
Descriptive analysis will be used for quantitative data. ‘White space’ questions will be analysed qualitatively using a framework approach. Medical school data will be compared to the BGS recommended curriculum to identify gaps in the current provision of education in geriatrics. We will test whether teaching exposure to geriatrics is associated with students’ attitudes and career intentions, conditional on student characteristics.

Conclusion
In order to meet the demands of the ageing population, it is essential that medical schools nurture doctors furnished with the knowledge, skills and values required to look after older adults with complex care needs. This study is an opportune evaluation of current UK teaching provision and student attitudes that will inform future iterations of the BGS recommended undergraduate curriculum and innovations in geriatric medicine education.

References
1. Forrester-Paton C, Forrester-Paton J, Gordon AL et al. Undergraduate teaching in geriatric medicine: mapping the British geriatrics society undergraduate curriculum to Tomorrow's doctors 2009. Age Ageing 2014; 43: 436–9.
2. Gordon AL, Blundell AG, Gladman JRF, Masud T. Research letter. Age Ageing 2010; 39: 385–8.
3. Gordon AL, Blundell AG, Dhesi JK et al. UK medical teaching about ageing is improving but there is still work to be done: the second National Survey of undergraduate teaching in ageing and geriatric medicine. Age Ageing 2014; 43: 293–7.
666 EFFECT OF PERINDOPRIL ON PHYSICAL PERFORMANCE, MUSCLE MASS AND QUALITY OF LIFE IN OLDER PEOPLE WITH SARCOPENIA: RESULTS: FROM THE
Authors: Witham M D , Adamson S , Avenell A , Band M M , Donnan P T , George J , Hapca A , Hume C , Kemp P , McKenzie E , Pilvinyte K , Smith K , Struthers A D , Sumukadas D ,   for the LACE study group
Published: March 2022

Abstract

Introduction
Angiotensin-converting enzyme inhibitors such as perindopril have been proposed as treatments to improve muscle mass and physical performance but have not been tested in randomised controlled trials enrolling patients with sarcopenia.

Methods
We conducted a placebo-controlled, parallel group, double-blind, randomised two-by-two factorial trial. Participants aged 70 and over with low muscle mass by bioimpedance and either low grip strength or low walk speed, were recruited from 14 UK sites. Participants were randomised to receive one year of perindopril 4 mg once daily or matching placebo, and to receive leucine powder 2.5 g three times a day or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery, measured at baseline, 6 and 12 months, analysed using repeated-measures mixed models. Secondary outcomes included grip strength, quadriceps strength, six-minute walk distance, appendicular muscle mass measured by dual x-ray absorptiometry, quality of life measured using the EQ5D tool, falls rates and adverse events.

Results
We screened 320 people and randomised 145 participants, mean age 79 (SD 6) years; 78 (54%) were women and the mean SPPB was 7.0 (SD 2.4). 73 were randomised to perindopril and 72 to placebo. Median adherence was lower for perindopril (76% vs 96%; p &lt; 0.001). Perindopril had no significant effect on the primary outcome (adjusted treatment effect −0.1 points [95%CI -1.2 to 1.0]). No significant treatment effect was seen for any secondary outcome except for worse EQ5D thermometer scores in the perindopril group (treatment effect −12 points [95%CI -21 to −3]). More adverse events were seen in the perindopril group (218 vs 165) but falls rates were similar (perindopril 2.0 [95%CI 1.1 to 3.0] per year; placebo 2.8 [95%CI 0.6 to 5.1] per year).

Conclusion
Perindopril did not improve measures of physical performance, muscle mass or quality of life in older people with sarcopenia.