scholarly journals Frailty in major trauma study (FRAIL-T): a study protocol to determine the feasibility of nurse-led frailty assessment in elderly trauma and the impact on outcome in patients with major trauma

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038082
Author(s):  
Heather Jarman ◽  
Robert Crouch ◽  
Mark Baxter ◽  
Elaine Cole ◽  
Bebhinn Dillane ◽  
...  
Keyword(s):  
Older People ◽  
Best Practice ◽  
Major Trauma ◽  
Assessment Tool ◽  
Traumatic Injury ◽  
Time Frame ◽  
Mortality And Morbidity ◽  
Frailty Assessment ◽  
The Uk ◽  
The Impact

IntroductionThe burden of frailty on older people is easily recognisable by increasing mortality and morbidity, longer hospital stays and adverse discharge locations. In the UK, frailty screening has recently become part of the best practice commissioning tariff within National Health Service England, yet there is no evidence or consensus as to who should carry out this assessment or within which time frame. As major trauma is an increasing burden for older people, there is a need to focus clinician’s attention on early identification of frailty in the emergency department (ED) in patients with major trauma as a way to underpin frailty specific major trauma pathways, to optimise recovery and improve patient experience. Throughout the patient with major trauma pathway, nurses are perhaps best placed to conduct timely clinical assessments working with the patient, family and multidisciplinary team to influence ongoing care. This study aims to determine the feasibility of nurse-led assessment of frailty in patients aged 65 years or more admitted to major trauma centres (MTCs).Methods and analysisThis is a prospective observational study conducted across five UK MTCs, enrolling 370 participants over 9 months. The primary aim is to determine the feasibility of nurse-led frailty assessment in MTC EDs in patients aged 65 years or more following traumatic injury. The prevalence of frailty and the best assessment tool for use in the ED will be determined. Other outcome measures include quality of life and frailty assessment 6 months after injury, mortality and discharge outcomes.Ethics and disseminationThe study was given ethical approval by the Social Care Research Ethics Committee (REC no 19/IEC08/0006). Findings will be published in scientific journals and presented to national and international conferences.Trial registration numberISRCTN10671514.

scholarly journals 251 The frailty in major trauma study (FRAIL-T): feasibility of nurse lead frailty assessment in elderly trauma and the impact on outcomes

2020 ◽  
Vol 37 (12) ◽  
pp. 840.2-840
Author(s):  
Heather Jarman ◽  
Robert Crouch ◽  
Mark Baxter ◽  
Bebhinn Dillane ◽  
Chao Wang ◽  
...  
Keyword(s):  
Best Practice ◽  
Major Trauma ◽  
Frailty Index ◽  
Kappa Statistic ◽  
Trauma Team ◽  
Trauma Patients ◽  
Clinical Frailty Scale ◽  
Frailty Assessment ◽  
Trauma Population ◽  
The Impact

Aims/Objectives/BackgroundFrailty screening for major trauma patients has recently become part of the best practice commissioning tariff within NHS England, yet there is no consensus as to who should carry out this assessment or which tool best identifies frailty in the Emergency Department (ED). As the trauma population ages there is a need for accurate early identification of frailty in the ED to underpin frailty specific major trauma pathways. The primary aim of this study was to determine the feasibility and accuracy of ED nurse-led frailty assessment in patients ≥ 65 years admitted to Major Trauma Centres (MTCs).Methods/DesignA prospective observational study was conducted across five UK MTCs, enrolling 370 participants over nine months. Eligible patients were aged 65 or more requiring trauma team activation. Frailty was assessed in the ED using three different tools: Trauma Specific Frailty Index (TSFI); Clinical Frailty Scale (CFS); PRISMA-7. ED nurse frailty assessment was correlated with Geriatrician assessment within 72 hours of admission using Spearman’s correlation coefficient and kappa statistic for measuring the interrater agreement.Results/ConclusionsComplete frailty assessments were calculated for CFS in 99.4% of patients, PRISMA7 in 95.9% and TSFI in 37.58%. Rates of frailty differed between tools: CFS 32%, PRISMA7 57% and TSFI 92% whilst Geriatrician determined frailty was 37%. In all tools frail patients were older (p<0.001) and falls <2 m were the leading mechanism of injury (p<0.05). CFS showed both strong correlation (rs 0.639,p<0.001) and substantial agreement (kappa 0.637,p<0.001) with Geriatrician assessment within 72 hours of admission.ED nurses can accurately assess older major trauma patients for frailty using the Clinical Frailty Scale. These findings support assessment of frailty in the ED in order to identify patients who would benefit from early frailty specific care.

Infection control: current status. risks, research, rules and recycling

2021 ◽  
Vol 14 (2) ◽  
pp. 59-66
Author(s):  
Jennifer Haworth ◽  
Jonathan Sandy ◽  
Anthony J Ireland
Keyword(s):  
Infection Control ◽  
Best Practice ◽  
Mainland China ◽  
Current Status ◽  
Infectious Agents ◽  
Emerging Infections ◽  
Healthcare Waste ◽  
Control Procedures ◽  
The Uk ◽  
The Impact

We are living through a period of immense change following the outbreak of the COVID-19 pandemic in mainland China in December 2019. Even before the pandemic, the cost of managing healthcare-associated infections in the UK was considerable. The risk of acquiring any infection from the dental environment must be reduced to a minimum. As we have observed in recent years, new infectious agents emerge frequently, and the dental profession must be ready to respond appropriately and quickly. Orthodontic practice presents unique challenges in relation to infection control procedures. The impact of healthcare waste on the environment must also be considered. CPD/Clinical Relevance: This paper describes the range of infectious agents posing a risk to dental team members and patients. The aim is to place the recent coronavirus pandemic in the context of other recent emerging infections. Some of the latest research regarding infection control procedures is reviewed. Current best practice is described.

Strong governance: a result of evolutionary and revolutionary processes

2014 ◽  
Vol 4 (2) ◽  
pp. 99-109 ◽  
Author(s):  
Lorna Collins ◽  
Ken McCracken ◽  
Barbara Murray ◽  
Martin Stepek
Keyword(s):  
Family Business ◽  
Best Practice ◽  
Family Dynamics ◽  
Family Businesses ◽  
Formal Structure ◽  
Governance Mechanisms ◽  
Content Type ◽  
The Family ◽  
The Uk ◽  
The Impact

Purpose – This paper is the first in a regular series of articles in JFBM that will share “a conversation with” thought leaders who are active in the family business space. The world of family business is, like many other arenas, constantly evolving and as the authors learn more about how and why families “do business” the approaches and tools for working with them also evolve. The purpose of this paper is to stimulate further new research in areas that practically affect family businesses and to “open the door” to practical insights that will excite researchers and provide impetus for new and exciting study. The specific purpose of this paper is to explore “what is strong governance.” There has been much interest in governance lately yet there is a tendency to treat governance in a formulaic way such that, at the moment, the notion that every family business must have a family council or a formal structure in order to be considered “effective” and “successful” predominates. The authors’ panel challenges and discusses this notion drawing on the experience and knowledge as family business advisors, consultants and owners. Design/methodology/approach – The impetus for this particular conversation is a result of a brainstorming conversation that Lorna Collins and Barbara Murray held in February 2014 where they focussed on “how JFBM can encourage and stimulate researchers to engage in aspects of research that makes a difference to the family business in a practical way.” This paper reports a conversation between Barbara Murray (Barbara), Ken McCracken (Ken) and Martin Stepek (Martin), three leading lights in the UK family business advising space, all of whom have been involved in running or advising family businesses for more than three decades, held in August 2015. The conversation was held via telephone and lasted just over 60 minutes. Lorna Collins acted as moderator. Findings – Strong governance is not just about instituting a “family council” or embedding formal governance mechanisms in a family business. Evolutionary adaption by family members usually prevails such that any mechanism is changed and adapted over time to suit and fit the needs of the family business. Many successful family businesses do not have recognized “formal” governance mechanisms but, it is contended, they are still highly successful and effective. Future areas of research in governance are also suggested. Originality/value – This paper contributes to the family business discourse because the debate it reports challenges the basic assumptions upon which much consulting and advisory practice is conducted. It also challenges the notion of “best practice” and what is “new best practice” and how is it that any “best practice” is determined to be “best.” Furthermore, the panel provides insights in to the “impact of family dynamics on governance” and “the impact of family dynamics on advisors.” The paper content is original in that it provides an authentic and timely narrative between active family business practitioners who are also scholars and owners.

scholarly journals The impact of the COVID-19 lockdown on orthopaedic emergency presentations in a remote and rural population

2020 ◽  
Vol 1 (10) ◽  
pp. 621-627
Author(s):  
Ahmed S. Elhalawany ◽  
James Beastall ◽  
Gerard Cousins
Keyword(s):  
Healthcare Providers ◽  
Local Area ◽  
Time Frame ◽  
Healthcare Provision ◽  
Proportional Increase ◽  
Minor Injuries ◽  
The Uk ◽  
A Minor ◽  
The Impact ◽  
Second Wave

Aims COVID-19 remains the major focus of healthcare provision. Managing orthopaedic emergencies effectively, while at the same time protecting patients and staff, remains a challenge. We explore how the UK lockdown affected the rate, distribution, and type of orthopaedic emergency department (ED) presentations, using the same period in 2019 as reference. This article discusses considerations for the ED and trauma wards to help to maintain the safety of patients and healthcare providers with an emphasis on more remote geography. Methods The study was conducted from 23 March 2020 to 5 May 2020 during the full lockdown period (2020 group) and compared to the same time frame in 2019 (2019 group). Included are all patients who attended the ED at Raigmore Hospital during this period from both the local area and tertiary referral from throughout the UK Highlands. Data was collected and analyzed through the ED Information System (EDIS) as well as ward and theatre records. Results A total of 1,978 patients presented to the ED during the lockdown period, compared to 4,777 patients in the same timeframe in 2019; a reduction of 58.6%. Orthopaedic presentations in 2020 and 2019 were 736 (37.2%) and 1,729 (36.2%) respectively, representing a 57.4% reduction. During the lockdown, 43.6% of operations were major procedures (n = 48) and 56.4% were minor procedures (n = 62), representing a significant proportional shift. Conclusion During the COVID- 19 lockdown period there was a significant reduction in ED attendances and orthopaedic presentations compared to 2019. We also observed that there was a proportional increase in fractures in elderly patients and in minor injuries requiring surgery. These represented the majority of the orthopaedic workload during the lockdown period of 2020. Given this shift towards smaller surgical procedures, we suggest that access to a minor operating theatre in or close to ED would be desirable in the event of a second wave or future crisis.

Socio-economic disadvantage and poverty

2020 ◽  
pp. 105-114
Author(s):  
Alisoun Milne
Keyword(s):  
Older People ◽  
Later Life ◽  
Poverty Line ◽  
Developed Countries ◽  
Economic Disadvantage ◽  
Fundamental Building Block ◽  
Age Related ◽  
The Uk ◽  
State Pension ◽  
The Impact

Chapter 5 is the first of three chapters exploring the impact of age related risks affecting particular sub populations of older people. Socioeconomic disadvantage in later life tends to reflect a lifecourse status. It amplifies what is already present. In 2016/17 one million older people were living in poverty; an additional 1.2 million were living just above the poverty line. These numbers are rising. Those aged 85 years or over, frail older people, older women and single older people are particularly at risk. Poor older people are also more likely to live in poor housing and be exposed to fuel poverty. Being poor - and its concomitants - compromises mental health in a number of profound ways. It undermines an older person’s capacity to make choices, retain independence, save for a crisis, maintain social contacts and be digitally included. It is linked with worry, loss of control over life and shame. Poor older people are at heightened risk of isolation and loneliness, stress, anxiety and depression. The UK has a weak policy record, compared with other developed countries, of sustainably and coherently addressing poverty in later life. One of the cornerstones of doing so is a continued commitment to the basic state pension as a fundamental building block of a secure old age. Addressing poor housing is also pivotal.

scholarly journals Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England Trauma Audit and Research Network dataset

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027845 ◽  
Author(s):  
Nick Dodds ◽  
Rowena Johnson ◽  
Benjamin Walton ◽  
Omar Bouamra ◽  
David Yates ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Research Network ◽  
Lower Limb Injury ◽  
Helmet Use ◽  
Mortality And Morbidity ◽  
National Cohort ◽  
The Uk ◽  
The Impact

ObjectivesIn the last 10 years there has been a significant increase in cycle traffic in the UK, with an associated increase in the overall number of cycling injuries. Despite this, and the significant media, political and public health debate into this issue, there remains an absence of studies from the UK assessing the impact of helmet use on rates of serious injury presenting to the National Health Service (NHS) in cyclists.SettingThe NHS England Trauma Audit and Research Network (TARN) Database was interrogated to identify all adult (≥16 years) patients presenting to hospital with cycling-related major injuries, during a period from 14 March 2012 to 30 September 2017 (the last date for which a validated dataset was available).Participants11 192 patients met inclusion criteria. Data on the use of cycling helmets were available in 6621 patients.Outcome measuresTARN injury descriptors were used to compare patterns of injury, care and mortality in helmeted versus non-helmeted cohorts.ResultsData on cycle helmet use were available for 6621 of the 11 192 cycle-related injuries entered onto the TARN Database in the 66 months of this study (93 excluded as not pedal cyclists). There was a significantly higher crude 30-day mortality in un-helmeted cyclists 5.6% (4.8%–6.6%) versus helmeted cyclists 1.8% (1.4%–2.2%) (p<0.001). Cycle helmet use was also associated with a reduction in severe traumatic brain injury (TBI) 19.1% (780, 18.0%–20.4%) versus 47.6% (1211, 45.6%–49.5%) (p<0.001), intensive care unit requirement 19.6% (797, 18.4%–20.8%) versus 27.1% (691, 25.4%–28.9%) (p<0.001) and neurosurgical intervention 2.5% (103, 2.1%–3.1%) versus 8.5% (217, 7.5%–9.7%) (p<0.001). There was a statistically significant increase in chest, spinal, upper and lower limb injury in the helmeted group in comparison to the un-helmeted group (all p<0.001), though in a subsequent analysis of these anatomical injury patterns, those cyclists wearing helmets were still found to have lower rates of TBI. In reviewing TARN injury codes for specific TBI and facial injuries, there was a highly significant decrease in rates of impact injury between cyclists wearing helmets and those not.ConclusionsThis study suggests that there is a significant correlation between use of cycle helmets and reduction in adjusted mortality and morbidity associated with TBI and facial injury.

scholarly journals The impact of a spinal best practice tariff on compliance with the British Spine Registry

2021 ◽  
Vol 2 (3) ◽  
pp. 198-201
Author(s):  
Awais Habeebullah ◽  
Harshadkumar Dhirajlal Rajgor ◽  
Adrian Gardner ◽  
Morgan Jones
Keyword(s):  
Spinal Surgery ◽  
Best Practice ◽  
Financial Incentive ◽  
Future Research ◽  
Electronic Patient Records ◽  
Spine Registry ◽  
Patient Consent ◽  
Surgical Data ◽  
The Uk ◽  
The Impact

Aims The British Spine Registry (BSR) was introduced in May 2012 to be used as a web-based database for spinal surgeries carried out across the UK. Use of this database has been encouraged but not compulsory, which has led to a variable level of engagement in the UK. In 2019 NHS England and NHS Improvement introduced a new Best Practice Tariff (BPT) to encourage input of spinal surgical data on the BSR. The aim of our study was to assess the impact of the spinal BPT on compliance with the recording of surgical data on the BSR. Methods A retrospective review of data was performed at a tertiary spinal centre between 2018 to 2020. Data were collated from electronic patient records, theatre operating lists, and trust-specific BSR data. Information from the BSR included operative procedures (mandatory), patient consent, email addresses, and demographic details. We also identified Healthcare Resource Groups (HRGs) which qualified for BPT. Results A total of 3,587 patients were included in our study. Of these, 1,684 patients were eligible for BPT. Between 2018 and 2019 269/974 (28%) records were complete on the BSR for those that would be eligible for BPT. Following introduction of BPT in 2019, 671/710 (95%) records were complete having filled in the mandatory data (p < 0.001). Patient consent to data collection also improved from 62% to 93%. Email details were present in 43% of patients compared with 68% following BPT introduction. Conclusion Our study found that following the introduction of a BPT, there was a statistically significant improvement in BSR record completion compliance in our unit. The BPT offers a financial incentive which can help generate further income for trusts. National data input into the BSR is important to assess patient outcome following spinal surgery. The BSR can also aid future research in spinal surgery. Cite this article: Bone Jt Open 2021;2-3:198–201.

scholarly journals Frailty assessment and acute frailty service provision in the UK: results of a national ‘day of care’ survey

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas Knight ◽  
Catherine Atkin ◽  
Finbarr C Martin ◽  
Chris Subbe ◽  
Mark Holland ◽  
...  
Keyword(s):  
Acute Care ◽  
Assessment Tool ◽  
Care Delivery ◽  
Care Pathway ◽  
National Policy ◽  
Assessment Tools ◽  
Screening Policy ◽  
Frailty Assessment ◽  
Care Survey ◽  
The Uk

Abstract Background The incorporation of acute frailty services into the acute care pathway is increasingly common. The prevalence and impact of acute frailty services in the UK are currently unclear. Methods The Society for Acute Medicine Benchmarking Audit (SAMBA) is a day of care survey undertaken annually within the UK. SAMBA 2019 (SAMBA19) took place on Thursday 27th June 2019. A questionnaire was used to collect hospital and patient-level data on the structure and organisation of acute care delivery. SAMBA19 sought to establish the frequency of frailty assessment tool use and describe acute frailty services nationally. Hospitals were classified based on the presence of acute frailty services and metrics of performance compared. Results A total of 3218 patients aged ≥70 admitted to 129 hospitals were recorded in SAMBA19. The use of frailty assessment tools was reported in 80 (62.0%) hospitals. The proportion of patients assessed for the presence of frailty in individual hospitals ranged from 2.2 to 100%. Bedded Acute Frailty Units were reported in 65 (50.3%) hospitals. There was significant variation in admission rates between hospitals. This was not explained by the presence of a frailty screening policy or presence of a dedicated frailty unit. Conclusion Two fifths of participating UK hospitals did not have a routine frailty screening policy: where this existed, rates of assessment for frailty were variable and most at-risk patients were not assessed. Responses to positive results were poorly defined. The provision of acute frailty services is variable throughout the UK. Improvement is needed for the aspirations of national policy to be fully realised.

scholarly journals 670 Documentation and Communication of National Emergency Laparotomy Audit (NELA) Mortality and Morbidity Scoring with Patients Prior To Consenting: Are We Following the Best Practice?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Barghash ◽  
J Rehman ◽  
F Salimi ◽  
M Mansour
Keyword(s):  
Best Practice ◽  
District General Hospital ◽  
Management Plan ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Retrospective Audit ◽  
Risk Of Mortality ◽  
The Uk ◽  
National Emergency ◽  
Management Alternatives

Abstract Aim Patients presenting as an emergency have a greater risk of dying than those admitted electively. The ability to stratify risk and calculate a percentage chance of death, not only gives the clinical team a common language to be able to formulate a management plan but also enables them to communicate this with patients and their families. This includes a full explanation of potential risks, benefits, a ceiling of care and management alternatives. In this project, we assessed if the NELA score has been properly calculated, documented prior to surgery for every emergency laparotomy patient and whether such patients were aware of NELA risk predictions prior to consenting. Method This was a retrospective audit based on the NELA guidelines of pre-operative risk stratification and the fifth report NELA recommendations. We assessed 50 case notes of patients who had laparotomies from January 2019 to April 2020 in a busy district general hospital in the UK. Results We noted that NELA risk prediction score was not utilised/documented in most of the patients with compliance of only 26%. We also found that, in the majority of notes, no NELA score discussion with the patient/family was documented, even with patients who had their NELA score calculated preoperatively. Compliance was only 14% in relation to this category. Conclusions A formal assessment of the risk of mortality and morbidity should be made explicit to each patient and should be recorded clearly in the consent form and medical record.

scholarly journals A Qualitative Study on How Social Workers From Regional and Metropolitan Queensland, Australia Perceive the Impact of the National Prioritisation System on Hospital Discharge Planning: A Study Protocol

2020 ◽  
Vol 19 ◽  
pp. 160940692097354
Author(s):  
Bernadette Dimla ◽  
Denise Wood ◽  
Lynne Parkinson
Keyword(s):  
Qualitative Study ◽  
Home Care ◽  
Older People ◽  
Social Workers ◽  
Study Protocol ◽  
Best Practice ◽  
Discharge Planning ◽  
Home Care Services ◽  
Dissemination Strategy ◽  
The Impact

In 2012, the Australian Commonwealth Government introduced a series of reforms for the aged care sector including the implementation of the National Prioritisation System for a flexible, accessible and demand-driven approach to home care services for older people. Nevertheless, an increasing number of older people continue to wait for months to be assigned home care packages on the national prioritisation queue, a component of the National Prioritisation System. There is limited evidence on the impact of the national prioritisation queue on discharge planning practices of social workers in supporting older people returning home from hospital admission. The aim of the research described in this paper is to explore the perceptions of social workers from rural and urban health services areas on how the introduction of the national prioritisation queue has influenced discharge planning of older people who are still waiting assignment of home care packages. This study protocol establishes the need for this qualitative study and provides an overview of the theoretical framework underpinning the research; discusses and describes the methods for sampling/recruitment and data collection, the approach to be utilised for qualitative analysis and the planned dissemination strategy. Understanding how social workers respond to the perceived challenges to discharge planning posed by the national prioritisation queue and the implications arising from the research have the potential to inform the development of best practice approaches and further enhance social work response to identified issues.

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