Postcode Lottery in Healthcare? Findings from the Scottish National Comprehensive Geriatric Assessment in Secondary Care Audit 2019

Comprehensive Geriatric Assessment (CGA) is provided differently across Scotland. The Scottish Care of Older People (SCoOP) CGA Audit was a national audit conducted in 2019 to assess this variation in acute hospitals. Two versions of audit questionnaires about the provision of CGA were developed (one each for larger hospitals and remote/rural areas) and piloted. The questionnaires were sent to representatives from all hospitals in Scotland using the REDCap (Research Electronic Data Capture) system. The survey asked each service to provide information on CGA service delivery at the ‘front door’. The questionnaire was open for completion between February and July 2019. Of the 28 Scottish hospitals which receive acute admissions, we received information from 26 (92.9% response rate). Reporting sites included seven hospitals from remote and rural locations in the Scottish Highlands and Islands. Significant variations were observed across participating sites for all key aspects studied: dedicated frailty units, routes of admission, staffing, liaison with other services and rehabilitation provision. The 2019 SCoOP CGA audit highlights areas of CGA services that could be improved and variation in specialist CGA service access, structure and staffing at the front door across Scotland. Whether this variation has an impact on the outcomes of older people requires further evaluation.

Comparison of Embedded Sensor Data for Long-Term Care Residents Before and After Onset of the COVID-19 Pandemic

Older adults have experienced greater isolation and mental health concerns during the COVID-19 pandemic. In long-term care (LTC) settings, residents have been particularly impacted due to strict lockdown policies. Little is known about how these policies have impacted older adults. This study leveraged existing research with embedded sensors installed in LTC settings, and analyzed sensor data of residents (N=30) two months pre/post the onset of the U.S. COVID-19 pandemic (1/13/20 to 3/13/20, 03/14/20 to 5/13/20). Data from three sensors (bed sensors, depth sensors, and motion sensors) were analyzed for each resident using paired t-tests, which generated information on the resident’s pulse, respiration, sleep, gait, and motion in entering/exiting their front door, living rooms, bedrooms, and bathrooms. A 14.4% decrease was observed in front door motion in the two months post-onset of the pandemic, as well as a 2.4% increase in average nighttime respiration, and a 7.6% increase in nighttime bed restlessness. Over half of our sample (68%) had significant differences (p<0.05) in restlessness. These results highlight the potential impact of the COVID-19 pandemic and social distancing policies on older adults living in LTC. While it is not surprising that significant differences were found in the front door motion sensor, the bed sensor data can potentially shed light on how sleep was impacted during this time. As older adults experienced additional mental health concerns during this time, their normal sleep patterns could have been affected. Implications could help inform LTC staff, healthcare providers, and self-management of health approaches among older adults.

A nurse-led day-case gastroenterology service in the emergency department

The incidence of liver disease has been steadily increasing, and patients with severe, symptomatic ascites need paracentesis (drainage) of the ascitic fluid for management. The authors and colleagues have previously developed a nurse-led and nurse-managed day-case gastroenterology service that provides paracentesis and other treatments, such as blood transfusion and specialist biologic infusions to patients with inflammatory bowel disease (IBD) and other gastroenterological conditions. This article describes the development of a similar novel nurse-led day-case service within the emergency department (ED) to provide a front-door urgent service for patients attending ED and needing paracentesis/infusions. It also reflects on the journey to developing this service, as well as the challenges faced during to the COVID-19 pandemic.

Partnership development of the COVID-19 Front Door: a best evidence resource

This project describes the creation of a single searchable resource during the pandemic, called the COVID-19 Best Evidence Front Door, with a primary goal of providing direct access to high-quality meta-analyses, literature syntheses, and clinical guidelines from a variety of trusted sources. The Front Door makes relevant evidence findable and accessible with a single search to aggregated evidence-based resources, optimizing time, discovery, and improved access to quality scientific evidence while reducing the burden of frontline health care providers and other knowledge-seekers in needing to separately identify, locate, and explore multiple websites.

Prototype of an Automatic Entrance Gate Security System Using a Facial Recognition Camera Based on The Haarcascade Method

This article aims to test a facial recognition-based front door security system, which can also convey relevant information to the owner’s mobile phone via an SMS gateway. This system is necessary to prevent unwanted criminal activity by the owner. The method used is Hercascade as face recognition for security. Use a set of webcam settings to compare human face objects in the background with face data already stored in the database. Capture images using a Raspberry PI connected to a USB webcam for the sensor, move the front door using a servomotor as a drive, and own the system in the form of a short message from basic communication process data Notify to. There is also an ultrasonic sensor as an activation system to detect human objects when they approach the door and invade. Based on the results of 90 tests on a system with varying distances of objects on the camera (30 cm, 40 cm, 50 cm), the average pass rate of the tests is 91.11%. We can conclude that face recognition by the Hercassette method can be applied as an entrance security system.

June 14, 2005—Facing, Accepting and Yielding

Nell greets me at the door tonight. She is thin, fading. Therese Schroeder-Sheker has described cancer patients as “disappearing slowly.” Nell’s humor is reserved tonight and her movements are slow and deliberate. She walks cautiously from the front door to the living room, nasal cannula in place, oxygen tube trailing. She offers me a Coke. I follow her to her room holding the oxygen tube and our drinks. We discuss the works of Thich Nhat Hanh and the concept of mindfulness. Nell refers to After the Ecstasy, the Laundry by Jack Kornfield. She notes that for her, after facing death, there are the tasks of daily living such as “getting this damn TV working!” Nell is a brave woman and grateful for the kind people in her life. She believes that kindness will come to her aid as she moves through to the end. She has expressed gratitude since our very first meeting.