The NeoPRINT Survey was designed to assess premedication practices throughout UK NHS Trusts for both neonatal endotracheal intubation and less invasive surfactant administration (LISA).
An online ...survey consisting of multiple choice and open answer questions covering preferences of premedication for endotracheal intubation and LISA was distributed over a 67-day period. Responses were then analysed using STATA IC 16.0.
Online survey distributed to all UK Neonatal Units (NNUs).
The survey evaluated premedication practices for endotracheal intubation and LISA in neonates requiring these procedures.
The use of different premedication categories as well as individual medications within each category was analysed to create a picture of typical clinical practice across the UK.
The response rate for the survey was 40.8 % (78/191). Premedication was used in all hospitals for endotracheal intubation but overall, 50 % (39/78) of the units that have responded, use premedications for LISA. Individual clinician preference had an impact on premedication practices within each NNU.
The wide variability on first-line premedication for endotracheal intubation noted in this survey could be overcome using best available evidence through consensus guidance driven by organisations such as British Association of Perinatal |Medicine (BAPM). Secondly, the divisive view around LISA premedication practices noted in this survey requires an answer through a randomised controlled trial.
•Premedication was used in all UK neonatal units for endotracheal intubation.•Seven different pre-medication combinations were used for analgesia/sedation prior to endotracheal intubation.•Clinicians’ opinion regarding premedication for LISA was divisive because of lack of good quality evidence.
Abstract
Background
The aim of this study was to describe outcomes in hospitalised older people with different levels of frailty and COVID-19 infection.
Methods
We undertook a single-centre, ...retrospective cohort study examining COVID-19-related mortality using electronic health records, for older people (65 and over) with frailty, hospitalised with or without COVID-19 infection. Baseline covariates included demographics, early warning scores, Charlson Comorbidity Indices and frailty (Clinical Frailty Scale, CFS), linked to COVID-19 status.
Findings
We analysed outcomes on 1,071 patients with COVID-19 test results (285 (27%) were positive for COVID-19). The mean age at ED arrival was 79.7 and 49.4% were female. All-cause mortality (by 30 days) rose from 9 (not frail) to 33% (severely frail) in the COVID-negative cohort but was around 60% for all frailty categories in the COVID-positive cohort. In adjusted analyses, the hazard ratio for death in those with COVID-19 compared to those without COVID-19 was 7.3 (95% CI: 3.00, 18.0) with age, comorbidities and illness severity making small additional contributions.
Interpretation
In this study, frailty measured using the CFS appeared to make little incremental contribution to the hazard of dying in older people hospitalised with COVID-19 infection; illness severity and comorbidity had a modest association with the overall adjusted hazard of death, whereas confirmed COVID-19 infection dominated, with a sevenfold hazard for death.
the ageing demographic means that increasing numbers of older people will be attending emergency departments (EDs). Little previous research has focused on the needs of older people in ED and there ...have been no evaluations of comprehensive geriatric assessment (CGA) embedded within the ED setting.
a pre-post cohort study of the impact of embedding CGA within a large ED in the East Midlands, UK. The primary outcome was admission avoidance from the ED, with readmissions, length of stay and bed-day use as secondary outcomes.
attendances to ED increased in older people over the study period, whereas the ED conversion rate fell from 69.6 to 61.2% in people aged 85+, and readmission rates in this group fell from 26.0% at 90 days to 19.9%. In-patient bed-day use increased slightly, as did the mean length of stay.
it is possible to embed CGA within EDs, which is associated with improvements in operational outcomes.
In 2018, the American College of Emergency Physicians (ACEP) began accrediting facilities as “geriatric emergency departments” (EDs) according to adherence to the multiorganizational guidelines ...published in 2014. The guidelines were developed to help every ED improve its care of older adults. The geriatric ED guideline recommendations span the care continuum from out-of-hospital care, ED staffing, protocols, infrastructure, and transitions to outpatient care. Hospitals interested in making their EDs more geriatric friendly thus face the challenge of adopting, adapting, and implementing extensive guideline recommendations in a cost-effective manner and within the capabilities of their facilities and staff. Because all innovation is at heart local and must function within the constraints of local resources, different hospital systems have developed implementation processes for the geriatric ED guidelines according to their differing institutional capabilities and resources. This article describes 4 geriatric ED models of care to provide practical examples and guidance for institutions considering developing geriatric EDs: a geriatric ED–specific unit, geriatrics practitioner models, geriatric champions, and geriatric-focused observation units. The advantages and limitations of each model are compared and examples of specific institutions and their operational metrics are provided.
The clinical identification of frailty is increasingly thought to be important in countries with ageing populations. Understanding how older people labelled as frail make sense of this categorisation ...is therefore important. A number of recent studies have reported negative perceptions of the term among older people themselves. Building on this, we focus on how and why those assessed to be frail make sense of frailty as they do. We draw on a discourse analysis of situated interviews with 30 older people accessing emergency care in an English NHS hospital. Three interpretive repertoire pairs (Frailty is a bodily issue / frailty is about mind-set; Frailty is a negative experience / frailty is an inevitable experience; I'm not frail / I feel frail), identified across the participants' talk, are outlined and discussed in relation to discourses of the fourth age and precarity. We conclude that frailty is often seen in terms what others have referred to as ‘real’ old age and is linked to discourses of dependence and precarity.
•Older people determined to be clinically frail often resist the term frailty.•Older people determined to be clinically frail in this study drew on three interpretive repertoire pairs to make sense of the term and experience ‘frailty’•The shared narrative of the fourth age as ‘real’ old age is associated with a precarious and unwanted identity.
THIRD SIDE OF THE COIN Banerjee, Jay
ASEE prism,
12/2014, Letnik:
24, Številka:
4
Journal Article
Medical schools require internships and residencies for graduation and for entering the profession, yet such valuable learning-by-doing experiences remain optional in engineering - not only for ...earning a degree but also for teaching. ...curriculum studies and educational research rarely count such autobiographical reflections - the "inner drama" of the researcher's intimate experience with himself during his research activities - as valid learning.
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