Scientific Research

Septum pellucidum is a double-membrane separating the frontal horns of the lateral ventricles of the brain. [1] Cavum septum pellucidum (CSP) refers to a potential space between these membranes. CSP is associated with some psychiatric disorders. [2] Radiological CSP has been evaluated as a possible in-vivo biomarker for chronic traumatic encephalopathy (CTE), a neurodegenerative condition affecting, particularly, retired athletes who experienced repetitive, low impact head trauma. [3]

Our study evaluated the incidence of radiological CSP among a cohort undergoing investigation for cognitive impairment in memory clinic. A list of patient Community Health Index (CHI) numbers corresponding to patients referred to CT brain from a community memory clinic in North West Glasgow between October 2019 and March 2020 was generated. Approval for use of imaging for research purposes was granted by local imaging department.

Images were viewed by first author following a session from second author on basic relevant anatomy. Positive cases were defined as those with a visible CSP. There were twenty-eight (n=28) cases in total. CSP was observed in one (n=1) case.

Radiological CSP has been suggested as a potential biomarker for CTE. While this study does not involve review of the clinical or personal history of the subjects, it does include a cohort with clinically-relevant symptoms. We included CT only, while current evidence makes observations on MRI [3]. Locally CT is more available and the initial assessment of such patients uses CT in the first instance. Further evidence is required to establish CSP as a reliable in vivo biomarker of CTE.

[1] Das et al, in StatPearls [Internet], 2022 [2] Wang et al, J Neuropsychiatry Clin Neurosci. 2020; 32(2):175-184 [3] Alosco et al Neurotherapeutics. 2021; 18(2):772-791

Background: Older adults are the fastest-growing and most sedentary group in society. With sedentary behaviour associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. Adults aged ≥75 years are underrepresented in sedentary behaviour research, and tailored strategies to reduce sedentary time may be warranted for this subset of older adults. The development of an intervention to reduce sedentary behaviour in adults aged ≥75 years using co-production and behaviour change theory is reported.

Methods: Four co-production workshops with community-dwelling older adults aged ≥75 years were held between October-December 2022. The intervention development process was informed by the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). Audio recordings and workshop notes were iteratively analysed, with findings used to inform subsequent workshops.

Results: The co-production group consisted of six community-dwelling older adults aged ≥75 years and two researchers. The developed intervention consists of four components (activity monitoring, educational material, group sessions and researcher follow-up), maps to 24 behaviour change techniques and targets barriers to reducing sedentary time. Participants were receptive of the co-production process.

Conclusions: Integrating co-production with the BCW can provide several benefits, with the BCW providing structure to the intervention development process, and co-production increasing the likelihood of the developed intervention being viewed as feasible by older adults. Furthermore, coding intervention components to the BCW may further our understanding of what approaches are successful or unsuccessful at influencing behavioural change. Transparent reporting of the intervention development process may benefit researchers developing interventions with older adults. Future research will pilot the co-produced intervention.

Introduction

There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients >75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow up study, we sought to explore the reasons for not recruiting.

Methods

Using a mixed-methods study design, staff from 29 General Practice (GP) sites and the Clinical Research Network (CRN) in Kent, Surrey, and Sussex (KSS) were sent an online questionnaire about local research facilities and infrastructure, and HYVET-2 study methodology and target population demographics.

Results

Nineteen (19) individuals responded the questionnaires (15 primary care staff, 4 CRN staff). Using a framework approach, we identified six themes summarising challenges to HYVET-2 recruitment. These themes were: established approaches of primary care towards managing WCH in older people, target patient demographics, study design complexity, patient-facing study documents, limited research resources in primary care and identification of eligible patients using existing coding.

Conclusion

Our experience showed that recruiting older people to a WCH study from primary care was not feasible. A national scoping survey amongst primary care physicians in the UK, and a robust patient and public involvement (PPI) targeting older people with WCH might improve recruitment in future studies of WCH in older people.

Introduction: Meaningful involvement of experts by experience in the design of health and care research is now well-established as good practice (Staniszewska, 2018). For example, it is essential that the voices of residents and staff are properly heard in care homes research, since they provide important perspectives not necessarily shared by the wider multidisciplinary team (Shepherd et al. 2017). Nevertheless, there are concerns that involvement can be tokenistic, or vulnerable to power imbalances (Baines & de Bere, 2017; Jennings et al., 2018).

Methods: A care home in north east England is working with researchers to pioneer a new approach to involvement, with residents and staff at the centre. The care home has helped to shape a number of research projects, for example a feasibility study of mealtime care training. In this study, an advisory group was set up initially within the care home itself, comprising residents, staff and family carers. Subsequently the group was joined by people from other care homes in the area, with support from the local authority. In parallel to this, health and social care professionals have contributed to the advisory group through one-to-one meetings with the researcher.

Results: Advisory group meetings in the care home have provided an inclusive and equitable platform for residents and staff to share their views on the research topic and design. Other stakeholders have been able to input into the project, but separately and in a way that has left room for key voices to be properly heard. Contributors have felt valued and are keen to continue in the process.

Conclusions: This study offers an alternative and authentic model for the involvement of experts by experience in social care research, inverting the more typical approach so that residents and staff are at the centre not the periphery.

Introduction

Iron Deficiency Anaemia (IDA) is a highly prevalent co-morbidity in older patients with advanced frailty. It’s associated with adverse outcomes and heightened all-cause mortality. IDA is frequently multifactorial and can stem from various gastrointestinal causes. The British Society of Gastroenterology and National Institute for Health and Care Excellence advocate a combination of endoscopy and computerised tomography (CT) as the gold standard investigations for IDA. The aim of this review was to evaluate oesophagogastroduodenoscopy (OGD) findings and management outcomes of clinically frail patients with IDA.

Methods

We review notes for patients referred for OGD to investigate IDA without additional symptoms over a six month period. The inclusion criteria were IDA, age of 65 years or greater and a clinical frailty score of 5 or greater.

Results

53 patients met the inclusion criteria. A single case (1.8%) UGI malignancy using OGD was identified prior to CT. Thus, demonstrating low yield of OGD in malignancy. 35.6% of patients underwent CT scanning 3 months prior to OGD. Approximately 90% of OGD findings were benign. 23% of patients died within 90 days of OGD. No significant adverse events during OGD or significant complications were recorded in our cohort. It is therefore highly unlikely that the undergoing of an OGD had a direct impact on mortality.

Conclusion

This review shows there is a low yield of UGI malignancy on OGD following a negative CT. Benign upper GI condition is the most common finding. Thus, CT imaging alone may be an adequate investigation to rule out UGI malignancy in this group. Considering there is a high mortality rate in older patients with frailty, following an OGD, we suggest considering starting empirical treatment with PPI and iron replacement as a suitable and less invasive alternative to OGD after a negative CT in frail patients.

Introduction: Care home residents often have multiple long-term conditions and experience polypharmacy. Deprescribing is the reduction or stopping of prescription medicines that may no longer be providing benefit. Previous research has found that deprescribing is generally safe but it is unknown how to make it work well in practice, like care homes.

Methods: Using the findings from the NIHR-funded STOPPING project, which aimed to support the development of better deprescribing practice approaches within care homes, considering different views and environments, recommendations for designing a deprescribing approach for care homes were developed. The STOPPING project included interviews with residents and their family members/friends, care home staff, and healthcare professionals about their experiences and beliefs about what influences deprescribing in 15 different care homes, and in-depth interviews with care home staff assessing current deprescribing tools/approaches about their acceptability, feasibility, and suitability for use in care homes.

Results: The developed approach included four implementation aspects: (1) plan and coordinate, (2) communicate and collaborate, (3) access and share information, and (4) monitor and evaluate. Proposed actions to encourage deprescribing in care homes were identified for each aspect (e.g., communication with residents and families about medication changes addressing concerns and offering clear instructions about observations).

Conclusion: Deprescribing within care homes is a complex and collaborative process, which involves many individuals with unique clinical and care skills, knowledge, and beliefs. To ensure it is successful, these different people need to be involved and contribute their specific knowledge and views. Communication and collaboration between care homes and healthcare professionals (such as GPs, nurses, and pharmacists) are essential to ensure deprescribing is done well. Information sharing and integrated working may support better communication and collaboration. Further work is needed to develop tools and approaches, and this work must include input from care home staff and residents.

Introduction:

Frailty is a condition that makes it increasingly difficult for individuals to recover from adverse health events and gradually erodes independence. NHS interventions in England have focused on those with more severe frailty. We tested HomeHealth, a home-based, tailored, multi-domain (six-session) behaviour change intervention to promote independence in the over-65s living with mild frailty, in a RCT recruiting 388 people (intervention 195; control 193). HomeHealth was delivered by the voluntary sector in three diverse areas and addressed mobility, nutrition, socialising, and psychological goals, among other domains. We aimed to explore acceptability, participant engagement, and experiences of delivering and receiving the service.

Methods:

Following a mixed-methods approach, we extracted quantitative data on types of goals and progress towards goals from Health and Wellbeing plans and appointment checklists. Between July 2022 and May 2023, we interviewed 49 older participants, 7 HomeHealth workers and 8 stakeholders. Older people were purposively sampled for diversity in socio-demographic characteristics, cognitive and physical functioning, intervention adherence and allocated HomeHealth worker. Interviews explored their motivations to engage; experience of participation, delivery and study support followed by their suggestions for improvement. We analysed qualitative data thematically and quantitative data descriptively.

Results:

Most participants set mobility goals (49%), followed by a combination of goals (31%), and made moderate progress towards these. The intervention (completed by 93.3% participants) was positively received, boosted participants’ confidence, and provided emotional support. Participants reported that sometimes behaviour was maintained post-intervention, but further appointments would have been welcomed to fill the gap in other services. However, some people found it difficult to identify goals to work on, particularly when they already felt independent and well supported.

Conclusions:

Services to support older people with mild frailty are acceptable, have good engagement, and can lead to behaviour change, particularly among those who self-identify a need for change.

Introduction

The PROMOTe trial was conducted entirely remotely, which aimed to enable a wider recruitment of participants, minimise risk of Covid-19 exposure and adhere to former travel restrictions. Participant experiences with remote clinical trials are not well understood. This work aimed to characterise participant perspectives on the remote delivery of the PROMOTe trial.

Methods

The trial involved remote measurement of short physical performance battery and grip strength, and remote collection of stool, urine, saliva, and capillary blood. Equipment including a dynamometer was posted to participants. Participants returned biological samples by post. A mixed methods approach was used, whereby participants were invited to complete an online questionnaire consisting of Likert, multiple-choice and open-ended questions upon trial completion.

Results

Of 72 trial participants, mean age 73.1, 80.6% (n = 58) completed the questionnaire. 53.5% (n = 31) had no preference between remote or in-person participation. Of those who preferred to take part remotely, 57.1% (n = 4) stated this was because there was no need to travel. 57.1% (n = 12) of those who preferred to take part in-person stated this was because they preferred to talk to the staff and ask questions face-to-face. Participants found that taking 5 out of the 8 physical measures were of similar difficulty over video teleconferencing compared to in-person. 100% (n = 58) of participants found it “easy” or “average” to collect stool, urine, and saliva, while 63.2% (n = 36) of participants thought it was “easy” or “average” to collect capillary blood. All participants found packaging and returning all four sample types of “easy” or “average” difficulty.

Conclusion

These findings suggest that the majority of participants found remote trial delivery, including handling equipment and collecting biological samples, both acceptable and manageable. Remote trial delivery has potential for increasing access of older people to trial participation.

Introduction

When COVID-19 first entered our world in March 2020 and the country went into lock down the NHS braced itself for one of its biggest challenges of this century. Older, frail patients were in the highest risk group, with those in care homes not only at higher risk of death, but higher risk of contracting COVID-19, often suffering more psychological disturbances (Hewitt et al., 2020; Numbers & Brodaty, 2021). This study was conceived by two nurse researchers working throughout the pandemic on a COVID ward for predominantly older people, aiming to capture the experiences of patients, families/carers and staff members.

Methods 

Phenomenology was the most appropriate methodology to provide an in-depth lived experience perspective. Full ethical approval was obtained and participants were sampled purposively. In-depth unstructured interviews were conducted and transcribed in full before being analysed hermeneutically using the four steps outlined by Fleming et al. (2003).

Results 

30 participants were recruited (10 patients, 10 relatives, including several bereaved and 10 staff members). Whilst experience varied between and within groups, core themes emerged:

1. Communication difficulties were poignantly expressed, with staff acting as intermediaries between patients and their family members who were kept apart through visiting restrictions, whilst managing clinical care and their own emotional responses.

2. Challenges of care were experienced by all groups, with anxiety around contagion conflicting with feelings of guilt and long-term psychological impact described by staff.

3. Collective experiences of grief and loss were described as participants grappled with coming to terms with encountering death and dying on an unprecedented scale and under such extraordinary conditions.

Conclusion

This study adds to the growing evidence base around experience of the COVID pandemic, adding insight into the triangulated experience of those affected and highlighting the profound effect on patients, relatives and staff.

Introduction:

Infection caused by the SARS-CoV-2 has been found to have serious consequences for the cardiovascular system. Among these, the development of heart failure (HF) has been stipulated; however, its causality has not yet been established. Therefore, the purpose of this study is to evaluate the role of clinical and laboratory parameters in determining the risk of developing HF in patients infected with SARS-CoV-2.

Methodology:

151 electronic medical records were taken from hospitalized patients with confirmed SARS-CoV-2 infection and pneumonia, from 03/11/20 to 10/02/21. HF was diagnosed by signs and symptoms, elevated NTproBNP and echocardiogram. Nonparametric statistical tests were applied due to the lack of normality in the data distribution.

Results were considered statistically significant at p<.05. uncorrelated clinical and laboratory indicators were selected to predict hf validated with separate samples. confidence intervals (95% ci) calculated for all listed metrics. oversampling was used in the training set. resulting binary classification model showed validity evaluated metrics roc curves. results: study included 46 patients 105 without hf. median age 66.2 (50-92) years, a predominance of women 91 (60.3%). most both groups had concomitant diseases, however group more ≥4 diseases (63%). significant risk predictors ≥66 years (p < 0.001), procalcitonin level ≥0.09 ng />ml (p <.001), thrombocytopenia ≤220-10^9 />l (p = 0.01), neutrophil-to-lymphocyte ratio ≥4,11% (p =0,010), history of chronic kidney disease (p =0.018).

Conclusion:

A possible predictive model including age, procalcitonin, creatinine, bilirubin, C-reactive protein, lactate dehydrogenase, platelets, international normalized ratio, neutrophil-to-lymphocyte ratio, as well as QTc interval on electrocardiogram and history of chronic kidney disease has been found that could identify patients with COVID-19 at risk of developing heart failure, which will allow more effective and earlier care