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Background Delirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes. Methods We conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions. Results The point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21). Conclusions Delirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

The child image has for more than a century been a subject of enormous interest both for writers and for literary critics outside the Chinese world and there is, as a consequence, a vast body of work on the child image in Western fiction. Literary discourse on the child in China is not proportionate with social discourse on childhood and chil-drearing, nor is there a fascination with aspects of the child image on a par with that displayed by critics and theorists in the West. However, there are signs that this is changing as more extensive academic studies of Chinese fiction and the child appear. These are largely focused on two eras: pre-Liberation and post-Mao. Late-twentieth-century fiction has inspired many short commentaries on the child image, particularly in relation to the works of well-known authors such as Yu Hua and Mo Yan, and a few longer studies including He Weiqing’s analysis of short fiction, and research by Xu Lanjun into child tropes in film and fiction.1 But it is the child image as drawn by writers of the May Fourth era which has received most attention. Detailed studies include Andrew Jones’ exposition of the child within the developmental narrative of Republican China,2 and a volume of essays on the child image in pre-1949 culture which extends to the early-1950s translation of Russian children’s fiction.3

This paper is concerned with integrating mobile technology (such as smartphones and tablets) into tactical defence environments. The motivation for and key technologies involved in this research are discussed in detail. The vehicle for conducting this research is the Defence Science and Technology Organisation’s Net Warrior initiative. The initial work conducted on this research program under Net Warrior has investigated how distributed object and publish/subscribe middleware can be incorporated into a smartphone to achieve information interoperability with tactical platforms and systems.

The architecture of complex software systems is a collection of decisions that are very expensive to change. This makes effective software architecture evaluation methods essential in today’s system development for mission critical systems. We have previously developed MEMS for evaluating middleware architectures, which provides an effective assessment of important quality attributes and their characterizations. To provide additional quantitative assessments on the overall system performance using actual runtime data, we employed a set of statistical procedures in this work. Our proposed assessment procedures comprises a standard sensitivity analysis procedure that utilizes leverage statistics to identify and remove influential data points, and an estimator for evaluating system stability and a metric for evaluating system load capacity. Experiments were conducted using real runtime datasets. Results show that our procedures effectively identified and isolated abnormal data points, and provided valuable statistics to show system stability. Our approach thus provides a sound statistical basis to support software architecture evaluation.

Architecture evaluation methods provide general guidelines to assess quality attributes of systems, which are not necessarily straightforward to practice with. With COTS middleware based systems, this assessment process is further complicated by the complexity of middleware technology and a number of design and deployment options. Efficient assessment is key to produce accurate evaluation results for stakeholders to ensure good decisions are made on system acquisition. In this paper, a systematic evaluation method called MEMS is developed to provide some structure to this assessment process. MEMS produces the evaluation plan with thorough design of experiments, definition of metrics and development of techniques for measurement. This paper presents MEMS and its application to a mission critical middleware system.

S S77 future trial should test a physical activity intervention including a supervised component throughout to maximise adherence. http://dx.doi.org/10.1016/j.ejso.2015.03.217 P180. Audit of referrals to a family history clinic Kate Foster, Philippa Dooher, Syed Ahmed, Ashraf Patel 1 Princess Alexandra Hospital NHS Trust, Harlow Essex, UK 2 Southend General Hospital, Southend Essex, UK The London Clinic, London, UK Background: Guidelines were issued by NICE in 2004 and further updated in 2006 and 2013 for the management of women with a family history of breast cancer. This led to the establishment of a dedicated breast cancer family history clinic in this district general hospital. The experience from this risk assessment clinic and how it has evolved is presented here. Material and methods: The clinic was originally set up with a research grant from the QUEST cancer research charity. Women with a family history of breast cancer were referred to this clinic by their general practitioner or breast clinician. Women were asked to complete a family history questionnaire. This questionnaire assisted in creating a pedigree for each woman. Originally in late 2006 these patients’ pedigrees were handwritten, then entered onto Progeny software, but by August 2009 this was replaced by FaHRAS software which is still in use. Using the NICE guidelines the women were categorised into population, moderate and high risk groups and managed accordingly. Results: Between August 2009 and December 2014 a total of 1262 patients have been assessed in the clinic. A further 64 were referred directly to the regional genetics service. An additional 191 were declined at the initial triage stage as population risk. Of those seen, 165 (13%) are near population risk, 474 (38%) are moderate risk and 623 (49%) are high risk. A total of 550 patients were referred to or had been seen by the regional genetics service. Of them, 181 were offered testing for the BRCA gene mutations. Of these, 145 have been tested, 58 BRCA 1 or BRCA 2 mutation carriers were identified, 43 tested negative (including those tested for Ashkenazi Jewish mutations only) and 44 were inconclusive (including variant of unknown significance).Since testing positive for a BRCA mutation, 10 women have undergone bilateral salpingo-oophorectomy (BSO) alone, 5 have had risk-reducing bilateral mastectomy (RRM) alone, and 4 have had both BSO and RRM. Conclusion/Summary: The family history clinic provides a comprehensive service to women with a breast cancer family history encompassing specialised risk analysis, clinical and radiological assessment and appropriate counselling. There is a high demand for this service in a district general hospital A significant proportion of these women will require genetic counselling A number of these women will go on to require further specialist management such as risk-reducing surgery. http://dx.doi.org/10.1016/j.ejso.2015.03.218 P181. Integration of physical activity into breast cancer care pathway “Can-Move” programme Catherine Fitzsimmons, Zahida Saad Salford Royal NHS Foundation Trust, Salford, UK Introduction: Cancer survival is improving due to early diagnosis, and improved treatment. This means that more patients are living with the long term effects of cancer including fatigue, weight gain, psychological issues etc. In the past patients were advised to rest during and after their treatment but there is growing evidence suggesting that staying active during and after treatment can significantly reduce the negative side effects of cancer. Recent review of evidence (Macmillan 2012) demonstrates that moderate exercise can have a beneficial effect. 150 minutes of exercise per week can reduce breast cancer mortality by 40%. A Pilot study “Can-Move” was commenced locally in February 2014 to provide a structured programme of 12 weeks exercise designed for patients diagnosed with breast, colorectal and prostate cancer. It is delivered by an exercise specialist from the active life styles team. Methods: The breast team has been recruiting into this programme. Physical activity is discussed with individual patients during their holistic needs assessment at time of diagnosis. Following agreement between the clinical nurse specialist and the patient appropriate referral is made to the “Active Lifestyles” team. The patient is assessed and a physical activity plan is designed and tailored to suit the individual. Results: 1st MarcheSeptember 2014,129 total number of referrals, (71 Breast patients) 90% report an increase in physical activity levels from the baseline. 86% report enhanced confidence to self-manage their condition using physical activity. 89% report enhanced wellbeing scores on WEMWBS. Conclusion: Staying active/ exercising enhances the wellbeing of patients with cancer. This Pilot study has been extended to March 2016. http://dx.doi.org/10.1016/j.ejso.2015.03.219 P182. Evaluation of the benefits of breast reconstruction information evenings Sandra Cookson, Nick Cawrse, Sisse Olsen Royal Devon and Exeter NHS Foundation Trust, Exeter, UK Introduction: Women considering breast reconstruction face many difficult choices. Breast reconstruction information evenings were initiated at the Royal Devon & Exeter Hospital (RD&E) in 2011 to provide information and peer support for women considering breast reconstruction. They are facilitated by the Breast Reconstruction Nurse Specialist and supported by medical and nursing staff. Information evenings are held three times a year at the local cancer support centre and are advertised in advance. The aim of the audit was assess the value of peer support and the benefit of providing information in a group setting. Method: Questionnaires were handed out to all women at consecutive information evenings between July 2011 and November 2014. The audit was based on the standard hospital design for auditing support groups. Results: 10 meetings have been held at the RD&E attended by a total of 171 women. The response rate was 58%. (100/171) 100% (100) of respondents would recommend the evening to other women considering breast reconstruction. 90% (90) women valued meeting and talking to the patient volunteers and seeing the results of surgery. 80% (80) women valued talking to healthcare professionals in this setting. 60% (60) women felt the evening supported their decision to go ahead with breast reconstruction. Conclusions: Women value peer support fromwomenwho have already had a breast reconstruction. This may help in their decision making. Women valued the opportunity to talk to healthcare professionals. Providing information on breast reconstruction in this format has been well received. http://dx.doi.org/10.1016/j.ejso.2015.03.220 P183. Implementing short-stay major breast surgery e The challenges and the achievements Amanda Snippe, Imelda Hughes, Clare Brearley, Donna Bolton Pennine Acute Hospitals NHS Trust, Manchester, UK Introduction: Short-stay major breast surgery was introduced to Pennine Acute Hospitals NHS Trust in 2011 in answer to the Government’s Quality Improvement programme. The recommendation was for 80% of patients, who were undergoing a mastectomy or wide local excision plus axillary surgery, to have their procedure as a day case. As our Trust covers a wide geographical area and caters for patients who have lower incomes and