1,720,995 research outputs found
The unpopular researcher: how can researchers and clinicians work together to make the best use of unexpected research findings
No full textUnplanned admissions and readmissions in older people: a review of recent evidence on identifying and managing high-risk individuals
No full textRising unplanned hospital admissions are a problem in ageing populations worldwide. These admissions are associated with poor outcomes for older people, contribute to rising health care costs and impede the provision of planned care. Policy and practice in recent years has focused on identification of those at risk of unplanned admission and early intervention via a range of admission avoidance services. Despite this, unplanned admissions in older people continue to rise, and managing demand for unplanned care remains a priority. Questions remain about the risk factors for unplanned admission and the best approaches to identifying and intervening with those at risk. This review explores recent evidence on admission rates, risk factors for unplanned admission in older people, identification of those at highest risk and interventions to avert unplanned admission
A randomised controlled trial: comparing nurse-led with standard care for post-acute medical patients
No full textThis study was carried out in the context of increased pressure on acute medical beds, increasing demand for alternatives to acute medical care and the need to reduce junior doctors' working hours. Nurse-led in-patient care has been advocated as a response to these pressures that also has the potential to improve patient outcomes. However, evidence to support the safety and effectiveness of this model of care was limited and came from Nursing Development Units, making it difficult to predict how well the model of care would perform in routine NHS practice. The nurse-led in-patient service was compared with standard care on the acute wards via a randomised controlled trial. Recruitment for the trial took 17.5 months. Key outcomes were length of stay following randomisation, discharge destination and change in physical functioning. Secondary outcomes were mortality, re-admissions within thirty days of discharge, falls, complications of hospitalisation. The process of care was explored by comparing medical reviews, therapy reviews, changes to medication and numbers of tests and investigations during the trial period. The nurse-led service did not demonstrate any improvement in outcomes, but substantially increased the length of stay in the treatment arm of the trial. The apparently higher rate of therapy reviews and rates of some complications were diminished when these outcomes were controlled for length of stay. Daily rates of medical reviews, medical investigations and changes to medications were lower for the treatment arm of the trial. The findings of this study do not support the limited benefit reported in previous studies. The widespread introduction of this model of care cannot, therefore, be advocated on the basis of improved outcomes for post-acute patients. However, the nurse-led intervention was not shown to be worse than standard care and may result in organisational benefits, such as reduced medical input. From the poor outcomes observed in this study, it would appear that neither nurse-led nor standard care is meeting the needs of this patient group. Further research is needed to identify and evaluate appropriate nursing interventions for post-acute medical patients
OP52 Dementia progression in the ageing population: a computer simulation accounting for individual cognitive and functional decline variability
No full textPrevalence and severity of frailty amongst middle-aged and older adults conveyed to hospital by ambulance between 2010-2017 in Wales
No full textBackground: ambulance services are commonly used by older adults. The scope of services continues to adapt in response to more non-life-threatening calls, often due to the acute consequences of chronic illness. Frailty increases with increasing age, but it is not known how common or severe it is within patients conveyed to hospital by ambulance. Methods: open cohort of people aged ≥50 living in Wales between 2010-2017. Routinely collected electronic data on ambulance attendances resulting in conveyance were linked to primary care data within the SAIL Databank, and the electronic Frailty Index (eFI) calculated. The prevalence and severity of frailty according to patient and incident characteristics was described. Results: of 1,264,094 individuals within the cohort, 23.8% were taken to hospital between 2010-2017, of which frailty was present in 84.3% of patients. There was an upward trend in the number of conveyances for patients with moderate and severe frailty across the years in all age groups. The distribution of frailty was similar across call categories, deprivation quintiles and out-of-hours incidents. Patients conveyed from residential homes had a higher level of frailty and comprised 8.7% of the total conveyances.Conclusions: the high prevalence of frailty within adults aged ≥50 with emergency conveyances suggests upskilling ambulance crews with frailty training to enhance their assessment and decision making may improve patient outcomes. The high proportion of conveyances from residential homes indicates scope for increasing integration of community services to provide more patient-centred care pathways. <br/
Design of a prospective clinical study on the quantification of lipid and leucocyte filtration and the effects on cerebral and renal injury markers and pulmonary function during cardiopulmonary bypass
No full textBackground: Neurological complications are common following cardiothoracic surgery using cardiopulmonary bypass; these can range from episodes of temporary delirium to severely debilitating strokes. Despite strong evidence showing the involvement of lipid microemboli, there is currently no established method for the effective removal of these particles. We conceived the study described here to evaluate the clinical use of a new integral lipid filter in reducing lipid microemboli and to determine the impact on markers of cerebral and renal injury and pulmonary dysfunction during the cardiopulmonary bypass period.Methods/Design: Fifty patients undergoing routine coronary artery bypass grafting using cardiopulmonary bypass will be randomised to either the intervention group, receiving the integral lipid filter during surgery, or a control group which does not. All clinicians and patients will be blinded as to their method of treatment. Measurements of lipid emboli will be taken throughout the surgical period with biochemical markers measured throughout the surgical and postoperative period. Discussion: Limited success has been found in removing lipid microemboli using currently available methods. An integral lipid filter may well fulfill this role and help reduce the associated morbidity. This paper reports the design and methods for a randomized controlled trial comparing the outcomes of the RemoweLL lipid and leucocyte removing filter with standard equipment for patients undergoing coronary artery bypass grafting using cardiopulmonary bypass.Trial registration: International Standard Randomised Controlled Trial Number Register: ISRCTN56462370EudraCT Number: 2009-011503-2
Inflammation in aging part 2: implications for the health of older people and recommendations for nursing practice
No full textAging is accompanied by declining function and remodeling of body systems. In particular, changes to the immune and endocrine systems have far-reaching effects that cause an increase in cytokine release and decrease in anti-inflammatory feedback systems. The chronic inflammation that ensues has been named ‘‘inflammaging.’’ Inflammaging is associated with many detrimental effects that combine to increase morbidity and mortality. The sickness behavior that arises from inflammatory processes and the side effects of chronic diseases lead to a constellation of symptoms that decrease quality of life and affect the well-being of the individual. Part 2 of this two-part article provides an overview of the health effects of inflammaging, addressing the extent to which it contributes to the syndromes of frailty and disability with aging. <br/
Reducing avoidable hospital admission in older people: health status, frailty and predicting risk of ill-defined conditions diagnoses in older people admitted with collapse
No full textEmergency hospital admissions for patients with ill-defined conditions International Classification of Diseases-10 R codes (ICD-10 R codes) are rising. Policy literature has suggested that they are attributable to 'social' problems and could potentially be avoided yet there is no research evidence to support this view. Therefore, this study sought to describe patients with ill-defined conditions and determine clinical and demographic factors predicting assignment of such codes. Patients aged over 70 admitted to a hospital acute admissions unit with collapse or falls were recruited in one hospital. Measures of functional status, frailty, depression, routine blood tests, demographic and service use data were collected. 80 patients were recruited, 35 were discharged with ill-defined conditions codes. Functional limitations were common in patients with ill-defined conditions and 77% had frailty. Blood profiles did not indicate acute medical problems. Deprivation was the only significant independent predictor of assignment of ill-defined conditions codes at discharge (OR 0.64, 95% CI: 0.45-0.93). Whilst our data confirm policy suppositions that patients with ill-defined conditions have functional impairment and frailty, it is the social and organisational factors that are important in determining risk of ill-defined conditions rather than clinical indicators
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