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 Factors Influencing Physical Therapists' Use of Standardized Measures of Walking Capacity Poststroke Across the Care Continuum

2015 ◽  
Vol 95 (11) ◽  
pp. 1507-1517 ◽  
Author(s):  
Kira M. Pattison ◽  
Dina Brooks ◽  
Jill I. Cameron ◽  
Nancy M. Salbach
Keyword(s):  
Acute Care ◽  
Health Care Professionals ◽  
Assessment Tool ◽  
Physical Therapists ◽  
Assessment Tools ◽  
Standardized Assessment ◽  
Assessment Practice ◽  
Telephone Interviews ◽  
Walking Capacity ◽  
Field Notes

Background The use of standardized assessment tools is an element of evidence-informed rehabilitation, but physical therapists report administering these tools inconsistently poststroke. An in-depth understanding of physical therapists' approaches to walking assessment is needed to develop strategies to advance assessment practice. Objectives The objective of this study was to explore the methods physical therapists use to evaluate walking poststroke, reasons for selecting these methods, and the use of assessment results in clinical practice. Design A qualitative descriptive study involving semistructured telephone interviews was conducted. Methods Registered physical therapists assessing a minimum of 10 people with stroke per year in Ontario, Canada, were purposively recruited from acute care, rehabilitation, and outpatient settings. Interviews were audiotaped and transcribed verbatim. Transcripts were coded line by line by the interviewer. Credibility was optimized through triangulation of analysts, audit trail, and collection of field notes. Results Study participants worked in acute care (n=8), rehabilitation (n=11), or outpatient (n=9) settings and reported using movement observation and standardized assessment tools to evaluate walking. When selecting methods to evaluate walking, physical therapists described being influenced by a hierarchy of factors. Factors included characteristics of the assessment tool, the therapist, the workplace, and patients, as well as influential individuals or organizations. Familiarity exerted the primary influence on adoption of a tool into a therapist's assessment repertoire, whereas patient factors commonly determined daily use. Participants reported using the results from walking assessments to communicate progress to the patient and health care professionals. Conclusions Multilevel factors influence physical therapists' adoption and daily administration of standardized tools to assess walking. Findings will inform knowledge translation efforts aimed at increasing the standardized assessment of walking poststroke.

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 What is the evidence base for ambulatory care for acute medical illness?

2018 ◽  
Vol 17 (3) ◽  
pp. 148-153
Author(s):  
Daniel Lasserson ◽  
◽  
C Harris ◽  
TNE Elias ◽  
JST Bowen ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Care Pathway ◽  
Point Of Care ◽  
National Policy ◽  
Healthcare Setting ◽  
Evidence Base ◽  
Policy Support ◽  
Medical Illness ◽  
Home Based ◽  
The Uk

Acute ambulatory care is a critical component of the emergency care pathway with national policy support and a dedicated NHS Improvement network. The evidence base for treating acute medical illness outside hospital is a diverse mix of randomised and observational studies with varying inclusion criteria, prognostic stratification, interventions and healthcare setting which limits synthesis of all available evidence and translation to the UK context. There is little consensus on the level of risk for home-based treatment for acute medical illness. Selection tools for referral to acute ambulatory care have been developed but there is limited evidence for their use. There are still research questions concerning optimal staffing, referral mechanisms, point of care diagnostic portfolio and tools for shared decision making.

scholarly journals Frailty Scores and Their Utility in Older Patients with Cardiovascular Disease

2021 ◽  
Vol 16 ◽  
Author(s):  
Kenneth Jordan Ng Cheong Chung ◽  
Chris Wilkinson ◽  
Murugapathy Veerasamy ◽  
Vijay Kunadian
Keyword(s):  
Cardiovascular Disease ◽  
Older Patients ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Clinical Settings ◽  
Transcatheter Aortic Valve ◽  
Frailty Assessment ◽  
Growing Body ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The world’s population is ageing, resulting in more people with frailty receiving treatment for cardiovascular disease (CVD). The emergence of novel interventions, such as transcatheter aortic valve implantation, has also increased the proportion of older patients being treated in later stages of life. This increasing population burden makes the assessment of frailty of utmost importance, especially in patients with CVD. Despite a growing body of evidence on the association between frailty and CVD, there is no consensus on the optimal frailty assessment tool for use in clinical settings. Previous studies have shown limited concordance between validated frailty instruments. This review evaluates the evidence on the utility of frailty assessment tools in patients with CVD, and the effect of frailty on different outcomes measured.

scholarly journals Identifying Spanish Language Competent Physicians: The Diabetes Study of Northern California (DISTANCE)

2016 ◽  
Vol 26 (4) ◽  
pp. 537 ◽  
Author(s):  
Claudia Chaufan ◽  
Andrew J. Karter ◽  
Howard H. Moffet ◽  
Judy Quan ◽  
Melissa M. Parker ◽  
...  
Keyword(s):  
Health Care ◽  
Assessment Tool ◽  
Care Delivery ◽  
Low Cost ◽  
Weighted Kappa ◽  
Spanish Language ◽  
Assessment Tools ◽  
Self Assessment ◽  
Language Competence ◽  
Patient Reported

<p class="Pa7"><strong>Objectives: </strong>Language barriers negatively impact health care access and quality for US immigrants. Latinos are the second largest immigrant group and the largest, fastest growing minority. Health care systems need simple, low cost and accurate tools that they can use to identify physicians with Spanish language competence. We sought to address this need by validating a simple and low-cost tool already in use in a major health plan.</p><p class="Pa7"><strong>Design, Setting, Participants: </strong>A web-based survey conducted in 2012 among physicians caring for patients in a large, integrated health care delivery system. Of the 2,198 survey respondents, 111 were used in ad­ditional analysis involving patient report of those physicians’ fluency.</p><p class="Pa7"><strong>Main Outcome Measures: </strong>We compared health care physicians’ responses to a single item, Spanish language self-assessment tool (measuring “medical proficiency”) with patient-reported physician language competence, and two validated physician self-assessment tools (measuring “fluency” and “confidence”).</p><p class="Pa7"><strong>Results: </strong>Concordance between medical proficiency was moderate with patient reports (weighted Kappa .45), substantial with fluency (weighted Kappa .76), and moderate-to-substantial with confidence (weighted Kappas .53 to .66).</p><p class="Pa7"><strong>Conclusions: </strong>The single-question self-re­ported medical proficiency tool is a low-cost tool useful for quickly identifying Spanish competent physicians and is potentially suit­able for use in clinical settings. A reasonable approach for health systems is to designate only those physicians who self-assess their Spanish medical proficiency as “high” as competent to provide care without an interpreter.</p><p class="Pa7"><em>Ethn Dis. </em>2016;26(4):537-544; doi:10.18865/ed.26.4.537</p><strong></strong>

scholarly journals Nurses' experiences of pain management in end-of-life dementia care: a literature review

2020 ◽  
Vol 26 (3) ◽  
pp. 110-118
Author(s):  
Kerry May ◽  
Janet Scammell
Keyword(s):  
Pain Management ◽  
End Of Life ◽  
Qualitative Methodology ◽  
Assessment Tool ◽  
Care Delivery ◽  
Dementia Care ◽  
Assessment Tools ◽  
Client Group ◽  
People With Dementia ◽  
Pain Recognition

Background: Nurses play an important role in assessing and managing pain. However, this is often poorly managed for people living with dementia. Aim: To explore nurses' experiences of pain management in end-of-life dementia care. Methods: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic narrative review of research papers published in English between 2008 and 2018 was conducted. Data sources were CINAHL, Medline, PsycINFO, ScienceDirect and SocIndex. Articles focused on nursing at the end of life and pain management in people with dementia. Findings: Eight articles were retrieved that met the search criteria. Four studies used qualitative methodology, two quantitative and two mixed methods. Studies from the UK dominated (n=5), the remainder were from Sweden, Norway and the US. Following thematic analysis, three themes were identified: training and education in pain management at the end of life for people with dementia, challenges in identifying pain and pain assessment tool use. Conclusion: The review revealed inadequate education for nurses concerning end-of-life care for people living with dementia, notably concerning pain recognition and use of assessment tools. It is recommended that specialist education is mandated for all nurses working with this client group to improve care delivery.

The political background to arts in health

2017 ◽  
Author(s):  
Daisy Fancourt
Keyword(s):  
National Policy ◽  
Health Departments ◽  
Arts Funding ◽  
Health And Wellbeing ◽  
The Arts ◽  
Policy And Strategy ◽  
The Usa ◽  
Political Background ◽  
The Uk ◽  
Arts In Health

In recent decades, there has been an increasing number of national policy and strategy papers discussing arts in health in countries around the world. Some of this activity has been driven by national arts bodies, championing the value of the arts in health and wellbeing and advocating for their inclusion within core arts funding and practice. Other activity has been led by health bodies, including health departments within governments and health services themselves. This chapter explores some of the most influential documents and considers their implication for research and practice. It draws on case studies of activity within Ireland, the UK, the USA, Australia, and Nordic countries.

scholarly journals Observations from a small country: mental health policy, services and nursing in Wales

2021 ◽  
pp. 1-12
Author(s):  
Ben Hannigan
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Mental Health Policy ◽  
National Policy ◽  
Ageing Population ◽  
Small Country ◽  
Mental Health Nurses ◽  
Face To Face ◽  
Health Need ◽  
The Uk

Abstract Wales is a small country, with an ageing population, high levels of population health need and an economy with a significant reliance on public services. Its health system attracts little attention, with analyses tending to underplay the differences between the four countries of the UK. This paper helps redress this via a case study of Welsh mental health policy, services and nursing practice. Distinctively, successive devolved governments in Wales have emphasised public planning and provision. Wales also has primary legislation addressing sustainability and future generations, safe nurse staffing and rights of access to mental health services. However, in a context in which gaps always exist between national policy, local services and face-to-face care, evidence points to the existence of tension between Welsh policy aspirations and realities. Mental health nurses in Wales have produced a framework for action, which describes practice exemplars and looks forward to a secure future for the profession. With policy, however enlightened, lacking the singular potency to bring about intended change, nurses as the largest of the professional groups involved in mental health care have opportunities to make a difference in Wales through leadership, influence and collective action.

scholarly journals Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group

2021 ◽  
pp. bjsports-2020-103696
Author(s):  
Richard Weiler ◽  
Cheri Blauwet ◽  
David Clarke ◽  
Kristine Dalton ◽  
Wayne Derman ◽  
...  
Keyword(s):  
Consensus Statement ◽  
Assessment Tool ◽  
Return To Sport ◽  
Position Statement ◽  
Assessment Tools ◽  
Future Research ◽  
Concussion Management ◽  
Rule Changes ◽  
Specific Rule ◽  
And Performance

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.

A study of the role and educational needs of ophthalmic specialist nurses

2021 ◽  
Vol 30 (14) ◽  
pp. 858-864
Author(s):  
Pornjittra Rattanasirivilai ◽  
Amy-lee Shirodkar
Keyword(s):  
Clinical Skills ◽  
Active Role ◽  
Educational Needs ◽  
Assessment Tools ◽  
Standards Of Care ◽  
Learning Needs ◽  
Hands On ◽  
Specialist Nurses ◽  
The Uk ◽  
Training Opportunities

Aims: To explore the current roles, responsibilities and educational needs of ophthalmic specialist nurses (OSNs) in the UK. Method: A survey of 73 OSNs ranging from band 4 to band 8 was undertaken in May 2018. Findings: 73% of OSNs undertake more than one active role, with 59% involved in nurse-led clinics; 63% felt formal learning resources were limited, with 63% reporting training opportunities and 21% reporting time as major barriers to further training. More than 38% emphasised hands-on clinic-based teaching had a greater impact on their educational needs. Some 64% were assessed on their skills annually and 59% felt confident with their skill set. Conclusion: The Ophthalmic Common Clinical Competency Framework provides a curriculum and assessment tools for OSNs to use as a structure to maintain clinical skills and knowledge. Eye departments should use this as guidance to target learning needs and improve standards of care to meet the changing needs of society.

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