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Introduction Call bell within reach of patients is an important part of quality care and standard in the National Inpatient Falls Audit. Initial data collection showed 56% of patients had call bell in reach indicating potential for improvement Understanding the problem: Discussion with stakeholders included: Healthcare support worker, nurses & doctors of all grades, physio, and occupational therapist. Aim We aimed to improve call bell reach-ability from 56% to 95% or more for patients on the ward. Method Data were collected from 2 bays (Total 10 beds) on the ward three times a week for 2 weeks after implementation of each change assuming it should roughly reflect the whole ward. Balancing measure Inpatient falls on the ward (weekly data for the ward). Changes 1st Change: Stickers in medical notes as a reminder 2nd Change: Teaching session to staff nurses 3rd Change: A short video posted in a closed social group of ward 4th Change: Make a component in the safety huddle & reminder in daily nursing handover. Results After the 4th PDSA cycle, the call bell in reach was 93.88% which was sustained improvement. Inpatient fall did not show any specific correlation with call bell reach-ability and specific fall data for those 10 beds was not available separately Learning: • Teaching is effective but it may not be able to involve all the staff especially when staffing is not consistent. Despite attending the teaching, implementation of gained knowledge from the teaching session may not sustain. • Social media can be used to improve patient care provided that it's closed media & no patient confidentiality is hampered but again may not be a solution. • Reminding the staff of the importance was our most effective change, possibly because of its proximity to patient care immediately being delivered afterward. [ABSTRACT FROM AUTHOR]

Background: Over 20,000 75+ years attendances annually in ED with frailty screening in introduced inEDin 2016. Early recognition of frailty is recommended. Accurate estimation of frailty level is important as it contributes to clinical pathway and management. Introduction: Screening rates had fallen and there were concerns about the accuracy.. Our aim was increased frequency and accuracy of screening at triage. Method Frailty screening rates for patients aged 75+ years attending the ED (routine measure) reviewed with ED Frailty Lead. Stakeholder engagement with ED staff and Frailty and Interface Team (FIT). Frailty screening tool revised. Data review March 2020 focused on CFS accuracy (CFS at triage v CFS by FIT in routine assessment). Sampling approach to CFS accuracy during June 2020. Interventions: Small group sessions with ED nursing staff (Jan 2020). Revised electronic screening tool introduced (February 2020). Education sessions (x2) for ED nursing staff (June 2020) focused on CFS. Results Frailty screening increased significantly following revised screening tool introduction from 60% to >80%. In March 2020 agreement of CFS at triage and FIT review in 22% (76/341).The CFS reliability for 10 consecutive patients per day was measured in June 2020 before and following 2 education sessions held on CFS. The reliability of CFS was 0.23 prior to teaching in June and rose to an average of 0.31 following the teaching intervention. Conclusions: Frailty screening frequency and the reliability of the CFS improved following teaching interventions but remains low. Work is continuing to focus on improving this further. Although CFS has been found to be reliable between raters in other hospitals we have found this difficult to replicate. It is not known if this is due to local factors or to more common challenges that others may face in CFS estimation by ED staff. [ABSTRACT FROM AUTHOR]

Background: Hospital Frailty Risk Score (HFRS) has recently been used to predict adverse health outcomes including length of stay (LOS) in hospital. LOS is an important indicator for patient quality of care, the measurement of hospital performance, efficiency and costs. Tools to predict LOS may enable earlier interventions in those identified at higher risk of a long stay. Previous work focused on patients over 75 years of age, but we explore the relationship between HFRS and LOS for all adults., Methods: This is a retrospective cohort study using data from a large acute hospital during the period from 01/01/2010 to 30/06/2018. The study included patients aged 16 years and older. We calculated HFRS for patients who had been previously admitted to the hospital within the previous 2 years. The study developed Logistic Regression models (crude and adjusted) for nine prediction periods of LOS to assess association between (LOS and HFRS) and (LOS and Charlson Comorbidity Index-CCI), using odds ratios, and AUROC to assess model performance., Results: An increase in HFRS is associated with prolonged LOS. HFRS alone or combined with CCI were more important predictor of long LOS in most of periods to predict LOS. However, crude HFRS was superior to the models where HFRS was combined with any other variable for LOS in excess of 21 days, which had AUROCs ranging from 0·867 to 0·890. Regarding eight age groups, crude HFRS remained the first or second most effective predictor of long LOS. HFRS alone or combined with CCI was superior to other models for patients older than 44 years for all periods of LOS; whereas for patients younger than 44 years it was superior for all LOS except 45, 60, and 90 days., Conclusion: This study has demonstrated the utility of HFRS to predict hospital LOS in patients across all ages., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Kutrani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Identifying patients' social needs is a first critical step to address social determinants of health (SDoH)-the conditions in which people live, learn, work, and play that affect health. Addressing SDoH can improve health outcomes, population health, and health equity. Emerging SDoH reporting requirements call for health systems to implement efficient ways to identify and act on patients' social needs. Automatic extraction of SDoH from clinical notes within the electronic health record through natural language processing offers a promising approach. However, such automated SDoH systems could have unintended consequences for patients, related to stigma, privacy, confidentiality, and mistrust. Using Floridi et al's "AI4People" framework, we describe ethical considerations for system design and implementation that call attention to patient autonomy, beneficence, nonmaleficence, justice, and explicability. Based on our engagement of clinical and community champions in health equity work at University of Washington Medicine, we offer recommendations for integrating patient voices and needs into automated SDoH systems., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Substantial gaps remain in our understanding of stroke in Africa as well as in stroke care, practice and policy on the continent. The effective organization of preventative, therapeutic and rehabilitative stroke services continue to be challenging in many African countries., Methodology: In this article we define the nature, function and benefits of effective multidisciplinary team (MDT) working. The experiences and perspectives of members of the MDT were collated by focus group discussions as well as individual and country specific contributions., Results: The experiences and perspectives of multidisciplinary team members from the United Kingdom and Ghana implementing these practices at the first stroke unit in Korle Bu Teaching Hospital, Accra, with a transparent discussion of successes and challenges faced throughout development of the service, is presented. MDT working has improved outcomes for patients and families who use the services, including encouraging better shared treatment planning and compliance. More stroke rehabilitation services are provided than previously, including greater self-management education and better secondary prevention care., Conclusion: It is hoped that this article will provide an inspirational model for others working to provide stroke care in low-resource settings in Africa and worldwide., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Introduction: Exposure to adverse childhood experiences (ACEs) has been associated with poor health in adulthood. Primary care providers can provide more appropriate medical care and intervene if they ask patients about ACEs. The purpose of this study is to determine existing knowledge and attitudes about ACEs among family medicine residents within the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region., Methods: Researchers developed a nine-question survey to assess family medicine residents' knowledge and attitudes about ACEs, and their comfort level in addressing ACEs. The survey was distributed to 540 residents in 22 family medicine residency programs in the WWAMI region., Results: Most residents reported they had some (32%) or moderate (35%) knowledge of the ACEs study. However, 30% reported no knowledge of the ACEs study, and very few (3%) reported significant knowledge. Of 117 respondents reporting at least some prior knowledge of ACEs, 42% had first heard about ACEs during residency. The ACEs topics that respondents felt least comfortable addressing during a patient encounter were a patient's personal history of sexual abuse (75%) and witnessing physical abuse (47%). Most residents (84%) indicated that they would like to see ACEs integrated into their residency curriculum., Discussion: This study demonstrates a gap in residency training on the topic of ACEs in family medicine residencies within the WWAMI region. Residents are uncomfortable addressing ACEs with patients but are receptive to learning about this topic. More teaching about ACEs can increase residents' comfort level with addressing these topics in the primary care setting., (© 2021 by the Society of Teachers of Family Medicine.)

Background: Lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments (CI) have higher mortality rates than similar patients without CI and may be additionally vulnerable to low staffing., Objectives: To explore associations between registered nurse (RN) and nursing assistant (NA) staffing levels, mortality and readmission in older patients admitted to general medical/surgical wards., Research Design: Retrospective cohort., Participants: All unscheduled admissions to an English hospital of people aged ≥75 with cognitive screening over 14 months., Measures: The exposure was defined as deviation in staffing hours from the ward daily mean, averaged across the patient stay. Outcomes were mortality in hospital/within 30 days of discharge and 30-day re-admission. Analyses were stratified by CI., Results: 12,544 admissions were included. Patients with CI (33.2%) were exposed to similar levels of staffing as those without. An additional 0.5 RN hours per day was associated with 10% reduction in the odds of death overall (odds ratio 0.90 [95% CI 0.84-0.97]): 15% in patients with CI (OR 0.85 [0.74-0.98]) and 7% in patients without (OR 0.93 [0.85-1.02]). An additional 0.5 NA hours per day was associated with a 15% increase in mortality in patients with no impairment. Readmissions decreased by 6% for an additional 0.5 RN hours in patients with CI., Conclusions: Although exposure to low staffing was similar, the impact on mortality and readmission for patients with CI was greater. Increased mortality with higher NA staffing in patients without CI needs exploration., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: An acute hospital stay increases the risk of negative outcomes for those living with frailty. This paper describes the application of quality improvement methodology to design and implement a regional audit to gain an understanding of care provision., Methods: Small scale tests of change (Plan-Do-Study-Act cycles) were used to design the audit structure and questions. Data collectors met face to face with 2-3 multiprofessional clinicians on 58 wards in 10 hospitals across the region, using an electronic tool to gather data. Outcomes were analysed manually in Excel by extracting from the electronic audit tool., Results: 58 wards across 10 hospitals participated in the audit, which identified three key themes: lack of awareness and frailty training outside medicine for older people specialties, and significant variability of both frailty identification and comprehensive geriatric assessment., Conclusion: Combining quality improvement methodology with a collaborative, regional approach to design and implementation of a frailty audit creates a reliable tool ensuring all stakeholders are considering improvement from the outset. The results have facilitated an agreed regional approach on how best to use local resources to improve and standardise frailty care provision. By highlighting areas of good practice and significant gaps in frailty identification, personalised care planning and hospital wide provision of frailty training, this region of the UK will now be able to drive up standards of care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Older adults admitted to hospital are often cognitively impaired. It is not clear whether the presence of cognitive impairment conveys an additional risk for poor hospital outcomes in this patient population., Objectives: To determine whether cognitive impairment in hospitalised older adults is independently associated with poor outcomes., Design: Retrospective cohort study using electronic, routinely collected data from linked clinical and administrative databases., Setting: Large, acute district general hospital in England., Participants: 21,399 incident emergency admissions of people aged ≥75, screened for cognitive impairment, categorised to 3 groups: (i) cognitive impairment with a diagnosis of dementia, (ii) cognitive impairment with no dementia diagnosis, (iii) no cognitive impairment., Methods: Multivariable logistic regression and Fine and Gray competing risks survival models were employed to explore associations between cognitive impairment and mortality (in-hospital alone, and in-hospital plus up to 30 days after discharge), time to hospital discharge, and hospital readmission within 30 days of discharge. Covariates included age, severity of illness, main diagnosis, comorbidities and nutritional risk., Results: Twenty-seven percent of patients had cognitive impairment; of these, 61.5% had a diagnosis of dementia and 38.5% did not. Patients with cognitive impairment and no diagnosis of dementia were most likely to die in hospital or be readmitted, they also had the longest hospital stays. Cognitive impairment was independently associated with mortality in hospital (Odds Ratio 1.34 [1.17-1.55] with dementia; Odds Ratio 1.78 [1.52-2.07] without), mortality in hospital or within 30 days of discharge (Odds Ratio 1.66 [1.48-1.86]; Odds Ratio 1.67 [1.46-1.90]); readmission (Odds Ratio 1.21 [1.04-1.40]; Odds Ratio 1.47 [1.25-1.73]), and increased time until discharge (sub-hazard ratio 0.80 [0.76-0.83]; sub-hazard ratio 0.66 [0.63-0.69])., Conclusions: Cognitive impairment is associated with an increased risk of adverse outcomes in hospitalised older people with an unscheduled admission, by increasing hospital mortality, extending hospital stays and increasing frequency of readmissions. Future research should focus on understanding the mechanisms contributing to poorer outcomes in this population., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Understanding the effects of captivity-induced stress on wild-caught animals after their release back into the wild is critical for the long-term success of relocation and reintroduction programs. To date, most of the research on captivity stress has focused on vertebrates, with far less attention paid to invertebrates. Here, we examine the effect of short-term captivity (i.e., up to four days) on self-righting, aggregation, and predator-escape behaviours in wild-caught red sea urchins, Mesocentrotus franciscanus , after their release back into the wild. Aggregation behaviour, which has been linked to feeding in sea urchins, was not affected by handling or captivity. In contrast, the sea urchins that had been handled and released immediately, as well as those that were handled and held captive, took longer to right themselves and were poorer at fleeing from predators than wild, unhandled sea urchins. These results indicate that handling rather than captivity impaired these behaviours in the short term. The duration of captivity did not influence the sea urchin behaviours examined. Longer-term monitoring is needed to establish what the fitness consequences of these short-term behavioural changes might be. Our study nevertheless highlights the importance of considering a suite of responses when examining the effects of capture and captivity. Our findings, which are based on a locally abundant species, can inform translocation efforts aimed at bolstering populations of ecologically similar but depleted invertebrate species to retain or restore important ecosystem functions., Competing Interests: The authors declare there are no competing interests.

The burden of stroke in the developing world is huge and growing. In Ghana, located in West Africa, stroke is in the top five causes of death. Disability resulting from stroke creates many challenges to healthcare staff, patients, their families and the wider society. Health professionals from the South West of England, Ridge Hospital Accra and Korle Bu Teaching Hospital Accra formed an international health partnership to share knowledge of stroke management and service development to support the improvement of stroke care in Ghana., (© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.)

Background: Nationally, little is known about the characteristics of community health assessment (CHA) that contribute to the use of CHA findings in public health program and policy decisions., Methods: To begin identifying these characteristics, the Washington State Department of Health partnered with local health jurisdictions to establish an on-line system for reporting the impacts of CHA projects (eg, use of a CHA to identify health priorities, create an action plan, form a partnership, or develop or modify a health strategy, program, or service). A qualitative review was conducted of 90 reports of CHA impacts submitted by local health jurisdictions., Findings: Common characteristics of CHAs with reported impacts include (1) a focus on a specific subpopulation or health topic; (2) involvement of community and public health agency stakeholders in planning and conducting the CHA; (3) use of multiple data collection methods, sources of data, and approaches to dissemination; and (4) primary data collection at the local level., Conclusions: Although the Washington State CHA Impact Tracking System is an important first step toward understanding characteristics of CHA connected to the use of the results, additional studies are needed to identify evidence-based practices in this field.

Geriatricians are often asked to make decisions about withholding cardiopulmonary resuscitation. This seems to be becoming more difficult and more controversial. There has been increased public concern about this subject recently and a recognition within the profession of the need for more openness and transparency in decision making. The implementation of The Human Rights Act led to updated guidelines from professional bodies, but these are likely to need careful interpretation in light of local circumstances before they can become a practical tool for decision making.