Objectives Population ageing has been associated with an increase in comorbid chronic disease, functional dependence, disability and higher health care costs. Frailty Syndromes have proposed as a way to define this group within older persons. We explore whether frailty syndromes are reliable methodology quantify clinically significant hospital settings, measure trends geospatial variation using English secondary data set Hospital Episode Statistics (HES). Setting National Secondary Care...

<h3>Background</h3> Falls are a common cause of morbidity and hospitalisation in older people. Inappropriate prescribing polypharmacy contribute to falls risk elderly patients. This study9s aim was quantify the problem find out if medication review hospital setting led deprescribing medicines associated with risk. <h3>Methods</h3> Admissions records for patients were examined identify those whose presenting complaint included fall. Inpatient charts, pharmaceutical care notes, medical notes...

Objectives Population ageing may result in increased comorbidity, functional dependence and poor quality of life. Mechanisms pathophysiology underlying frailty have not been fully elucidated, thus absolute consensus on an operational definition for is lacking. Frailty scores the acute medical care setting predictive power clinically relevant outcomes. We explore utility syndromes (as recommended by national guidelines) as a risk prediction model elderly setting. Setting English Secondary...

Background: Between 10% and 15% of hypothyroid patients experience persistent symptoms despite achieving biochemical euthyroidism. Unexplained can be a sign somatization. This is associated with distress high health care resource use classified as somatic symptom disorder (SSD). Prevalence rates for SSD differ depending on classification criteria how they are ascertained, varying between 4% 25%. As this has not been studied in before, the aim study was to document somatization people...

<h3>Objectives</h3> Our aim was to explore junior doctors' attitudes and awareness around concepts related medication review, in order find ways change the culture for reviewing, altering stopping inappropriate or unnecessary medicines. Having already demonstrated value of team working with senior doctors pharmacists use a review tool, we are now looking engage first year clinicians undergraduates process. <h3>Method</h3> An online survey about distributed among all 42 foundation one (FY1)...

Abstract Context Between 10% and 15% of people with hypothyroidism experience persistent symptoms, despite achieving biochemical euthyroidism. The underlying causes are unclear. Type D personality (a vulnerability factor for general psychological distress) is associated poor health status symptom burden but has not been studied in hypothyroidism. Objective To investigate type explore associations other characteristics patient-reported outcomes. Design Multinational, cross-sectional survey....

Objective We seek to address gaps in knowledge and agreement around optimal frailty assessment the acute medical care setting. Frailty is a common term describing older persons who are at increased risk of developing multimorbidity, disability, institutionalisation death. Consensus has not been reached on practical implementation this concept assess clinically manage Design Modified Delphi, via electronic questionnaire. Questions included ranking items that best recognise frailty, timing,...

Objectives Patients diagnosed with pancreatic cancer have the poorest survival prognosis of any cancer. This survey aimed to describe their experiences care and supportive needs inform future service provision. Design Cross-sectional questionnaire patients in UK. Setting Individuals at stage along pathway were recruited via five National Health Service sites UK, online, from January June 2018. Participants 274 individuals completed (78% (215) online). Approximately half participants within...

Background: Hypothyroid patients often report dissatisfaction and poor quality of life. This survey explored the impact hypothyroidism on patient satisfaction, everyday living, experiences with health care professionals, influence demographic socioeconomic factors. Methods: Cross-sectional questionnaire targeting an international population hypothyroid patients. Multilevel regression modeling was used for analyses. Results: The total number responses 3915 from 68 countries. Satisfaction...

Disease prevalence can be spatially analysed to provide support for service implementation and health care planning, these analyses often display geographic variation. A key challenge is communicate results decision makers, with variable levels of Geographic Information Systems (GIS) knowledge, in a way that represents the data allows comprehension. The present research describes combination established GIS methods software tools produce novel technique visualising disease admissions help...

Quality Improvement and Implementation (QI&I) initiatives face critical challenges in an era of evidence-based, value-driven patient care.Whether frontline staff, large organisations, or government bodies design run QI&I, there is increasing need to demonstrate impact justify investment time resources implementing scaling up intervention.Decisions about sustaining, up, spreading initiative can be informed by evidence causation the estimated attributable effect intervention on observed...

checklists are increasingly proposed as a means to enhance safety and quality of care. However, their use has been met with variable levels success. The Frailsafe project focused on introducing checklist the aim increase completion key clinical assessments facilitate communication for care older patients in acute admissions.to examine checklist, including potential contribute improved safety, reliability care.110 qualitative interviews group discussions healthcare professionals other...

Research into the practice of medication review is developing across world in response to ever-increasing burden inappropriate polypharmacy. Education, training and support undergraduates novice practitioners equip them participate process could lead long-term shifts practice. The purpose this study was explore awareness pharmacy medical about review, deprescribing polypharmacy, order inform improvement strategies. In November 2016, all final-year students at a London (UK) university were...

Continuous data collection and analysis have been shown essential to achieving improvement in healthcare. However, the required for local initiatives are often not readily available from hospital Electronic Health Record (EHR) systems or routinely collected. Furthermore, teams restricted time funding thus requiring inexpensive rapid tools support their work. Hence, informatics challenge healthcare consists of providing a mechanism modelling domain by non-informatics experts, including...

This study aims to identify patient and treatment factors that affect clinical outcomes of community psychological therapy through the development a predictive model using historic data from 2 services in London. In addition, assess completeness collection, explore how are discriminated current criteria for classifying recovery, feasibility need undertaking future larger population analysis.Observational, retrospective discriminant analysis.2 London mental health provide therapies common...

Objectives Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies transitions healthcare. We introduced a team approach the process an acute with aim improving provision information documentation reliable medication lists enable clear, timely communications on discharge. Setting An 400-bedded teaching in London, UK. Participants The effects change were measured simple random sample 10 adult patients week...

Recent advances in imaging have improved our understanding of the role brain painful conditions. Discoveries morphological changes been made patients with chronic pain, little known about functional consequences when they occur areas associated 'number-sense'; thus, it can be hypothesized that pain impairs this sense.First, an audit use numbers gold-standard assessment tools acute and was undertaken. Secondly, experiments were conducted healthy controls. Participants marked positions on...

Hospital board members are asked to consider large amounts of quality and safety data with a duty act on signals poor performance. However, in order do so it is necessary distinguish from noise (chance). This article investigates whether English National Health Service (NHS) acute care hospital papers presented way that helps the role chance their decisions.Thirty NHS trusts were selected at random retrieved. Charts depicting identified. Categorical discriminations then performed document...

Improving access to psychological therapies (IAPTs) services deliver evidence-based care people with depression and anxiety. A quality improvement (QI) initiative was undertaken by an IAPT service improve referrals providing opportunity evaluate equitable access.QI methodologies were used the clinical team service. The collection of geo-coded data allowed be mapped small geographical areas according deprivation.A total 6078 patients referred during period analysis 120 unique lower super...

To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by quality improvement (QI) initiative. Retrospective service evaluation health outcomes; data analysed ANOVA, chi-squared and Statistical Process Control. A Westminster, London, UK. People living the Borough attending (from either healthcare professional or self-referral) between February 2009 May 2012. Social marketing interventions were used to increase referrals, including...

Background: Chelsea and Westminster Hospital introduced the Early Warning Score (CEWS) in 2007 to aid recognition of acutely unwell patients. The Royal College Physicians subsequently recommended a National (NEWS) for implementation across NHS. aim this study was evaluate local adherence CEWS identify potential obstacles consistent NEWS. Method: Emergency Department (ED) Acute Assessment Unit (AAU) notes were retrospectively reviewed convenience sample 102 patients admitted AAU. Outcome...

The XmR chart is a powerful analytical tool in statistical process control (SPC) for detecting special causes of variation measure quality. In this analysis statistic called the average moving range used as dispersion data. This approach correct data with natural underlying order, such time series There however conflict literature over appropriateness to analyse without an inherent ordering. We derive maxima and minima ordering, show how calculate any set. permute real world set limits based...