Comprehensive Assessment Research Articles

Initial Frontal Sinus and Orbit Tumor Signaling Late Distant Metastasis in Kidney Cancer.

Although metastases to the paranasal sinuses are exceedingly rare, when they do occur, renal clear cell carcinoma is the most frequent primary tumor involved. The aim of this work was to present a case of metastatic clear cell renal carcinoma in the frontal sinus and orbit region, 7 years after the initial diagnosis and treatment. The patient was referred to our clinic due to drooping of the left eyelid and displacement of the left eyeball. Computed tomography revealed an expansive lesion in the left frontal sinus and orbit, causing destruction of its anterior, lateral, and roof walls. Profuse bleeding from the tumor and left orbit hindered a comprehensive assessment of tumor extension into the orbit and residual tumor size. Therefore, complete tumor removal was not possible; instead, reduction was achieved. Subsequent histopathologic and immunohistochemical analysis confirmed the lesion as a metastasis of renal cell carcinoma in the sinonasal tract. Unfortunately, 10 weeks later, the patient passed away. Treatment of metastatic clear cell renal carcinoma depends on the localization of the disease as well as the overall condition of the patient. If there is a solitary metastatic lesion, as in the case of the sinonasal region, surgical treatment is recommended. Metastasis of clear cell renal carcinoma to the sinonasal region is a rare occurrence; however, it is essential to consider it in cases of rapidly growing tumor masses, typically presenting with symptoms such as epistaxis and nasal obstruction.

Exploring biometric attendance technology in the Arab academic environment: Insights into faculty loyalty and educational performance in policy initiatives

This study provides insights for decision-makers contemplating the implementation of Biometric Attendance Technology (BAT) for faculty in educational institutions. We conducted a comprehensive assessment of BAT’s impact on Arab educational systems, focusing on its influence on faculty loyalty and satisfaction, which are integral to enhancing overall organizational performance. Using SMART-PLS, we analyzed data from an electronic questionnaire distributed to 296 participants. Our findings highlight the importance of fostering faculty loyalty and satisfaction through training and education initiatives alongside BAT implementation strategies. Despite these efforts, there was no significant improvement in the relationship between loyalty, satisfaction, and educational system performance (ESP) following the introduction of BAT. Slope analysis indicated no significant correlations between Faculty Member Satisfaction (FMS), Faculty Member Loyalty (FML), and ESP. However, slight improvements in R-square values were observed: FML increased from 0.512 to 0.514, and ESP from 0.433 to 0.438 with the BAT moderator. These results are crucial for guiding informed decisions regarding the integration of modern technologies into educational systems.

Widely Untargeted Metabolomics Profiling Combined with Transcriptome Analysis Provides New Insight into Amino Acid Biosynthesis at Different Developmental Stages of Rubus Chingii Hu (Chinese Raspberry).

The composition and profile of amino acids in Rubus chingii (R. chingii) Hu serve as critical indicators of its nutritional quality. A comprehensive understanding of the amino acid metabolism within R. chingii is instrumental in the formulation and innovation of functional foods derived from this species. Utilizing advanced techniques such as wide-ranging untargeted metabolomics, transcriptome analysis, interaction network mapping, heat map analysis, and quantitative real-time PCR, we conducted a comprehensive assessment of the quality attributes across four distinct developmental stages of R. chingii. Our meticulous analysis uncovered a rich tapestry of 76 distinct amino acids and their derivatives within the developmental stages of R. chingii. The spectrum of essential amino acids was not only broad but also displayed a high degree of variety. Notably, leucine, lysine, and phenylalanine stood out as the most abundant amino acids, underscoring their significant presence throughout the growth cycle of R. chingii. The proportion of essential amino acids relative to the total amino acid content in R. chingii exhibited a notable trajectory of change throughout its developmental stages. It began with 30.92% in the immature green phase, advanced to 31.04% during the transition from green to yellow, peaked at 33.62% in the yellow to red stage, and then moderated to 30.43% in the full red phase. This pattern suggests a strategic modulation of amino acid composition, aligning with the evolving nutritional requirements and metabolic shifts as the fruit matures. Concurrent analysis of interaction networks and heat maps, alongside comprehensive profiling of amino acid metabolism and transcriptomic examination, was conducted to elucidate the intricate dynamics of cellular processes. The results showed that seven differentially expressed genes (DEGs) played important roles in amino acid metabolism, including PFK, BCAT1, TSB, ASA, ACO, TOM2AH3, and BCAT2. The expression patterns of seven DEGs conformed closely to the findings revealed by the preceding RNA-seq analysis. In this investigation, we elucidated the regulatory mechanisms underlying amino acid metabolism across the four distinct developmental stages of R. chingii through comprehensive amino acid profiling and transcriptomic analysis. These insights lay the groundwork for the development of novel functional food applications utilizing R. chingii.

Using Systems Engineering and Implementation Science to Design an Implementation Package for Preoperative Comprehensive Geriatric Assessment Among Older Adults Having Major Abdominal Surgery: Protocol for a 3-Phase Study.

Older Americans, a growing segment of the population, have an increasing need for surgical services, and they experience a disproportionate burden of postoperative complications compared to their younger counterparts. A preoperative comprehensive geriatric assessment (pCGA) is recommended to reduce risk and improve surgical care delivery for this population, which has been identified as vulnerable. The pCGA optimizes multiple chronic conditions and factors commonly overlooked in routine preoperative planning, including physical function, polypharmacy, nutrition, cognition, mental health, and social and environmental support. The pCGA has been shown to decrease postoperative morbidity, mortality, and length of stay in a variety of surgical specialties. Although national guidelines recommend the use of the pCGA, a paucity of strategic guidance for implementation limits its uptake to a few academic medical centers. By applying implementation science and human factors engineering methods, this study will provide the necessary evidence to optimize the implementation of the pCGA in a variety of health care settings. The purpose of this paper is to describe the study protocol to design an adaptable, user-centered pCGA implementation package for use among older adults before major abdominal surgery. This protocol uses systems engineering methods to develop, tailor, and pilot-test a user-centered pCGA implementation package, which can be adapted to community-based hospitals in preparation for a multisite implementation trial. The protocol is based upon the National Institutes of Health Stage Model for Behavioral Intervention Development and aligns with the goal to develop behavioral interventions with an eye to real-world implementation. In phase 1, we will use observation and interviews to map the pCGA process and identify system-based barriers and facilitators to its use among older adults undergoing major abdominal surgery. In phase 2, we will apply user-centered design methods, engaging health care providers, patients, and caregivers to co-design a pCGA implementation package. This package will be applicable to a diverse population of older patients undergoing major abdominal surgery at a large academic hospital and an affiliate community site. In phase 3, we will pilot-test and refine the pCGA implementation package in preparation for a future randomized controlled implementation-effectiveness trial. We anticipate that this study will take approximately 60 months (April 2023-March 2028). This study protocol will generate (1) a detailed process map of the pCGA; (2) an adaptable, user-centered pCGA implementation package ready for feasibility testing in a pilot trial; and (3) preliminary pilot data on the implementation and effectiveness of the package. We anticipate that these data will serve as the basis for future multisite hybrid implementation-effectiveness clinical trials of the pCGA in older adults undergoing major abdominal surgery. The expected results of this study will contribute to improving perioperative care processes for older adults before major abdominal surgery. DERR1-10.2196/59428.

FP5.4 - Improving Assessment of General Surgical Trainees in Multidisciplinary Team Working as a Capability in Practice: Perceptions of General Surgical Trainees and Trainers

Abstract Aim To explore how Higher Surgical Trainees (HST) and Trainers feel multidisciplinary team (MDT) working as a capability in practice (CiP) can be improved. Methods Within a deanery, 8 General Surgical HST and 4 Consultants were recruited to participate in virtual semi-structured interviews. Once transcribed, reflexive thematic analysis was performed. Ethical approval was granted. Results MDT is not worked into most trainees’ rotas. Participants felt that by formalising MDT, as with other CiP, it could be better assessed. Trainers, half of whom are MDT leads, stated that responsibility for MDT training and assessment should be placed on all consultants, rather than solely the leads. Participants explored how pathways could be instituted for HST to maintain ‘ownership’ of some patients from assessment clinic to MDT meetings to fully engage. In order to build to this level, a baseline of preparing patients but not presenting was suggested by one of the consultants. While, with one exception, no participants favoured a further work-based assessment, it was advocated by all that further clarification from ISCP regarding expectations of trainees at MDT would allow for more comprehensive assessment in the future. Most participants proposed that all members of MDT contributed to an assessment rather than relying on the Multi-Consultant Report. To prevent issues with timing or resources, a shadow or simulated MDT was suggested for HST. Conclusion General HST and consultants expressed concerns with the current way in which MDT is assessed as a CiP however they proposed ways in which it could be improved in the future.

Imputing Metagenomic Hi-C Contacts Facilitates the Integrative Contig Binning Through Constrained Random Walk with Restart.

Metagenomic Hi-C (metaHi-C) has shown remarkable potential for retrieving high-quality metagenome-assembled genomes from complex microbial communities. Nevertheless, existing metaHi-C-based contig binning methods solely rely on Hi-C interactions between contigs, disregarding crucial biological information such as the presence of single-copy marker genes. To overcome this limitation, we introduce ImputeCC, an integrative contig binning tool optimized for metaHi-C datasets. ImputeCC integrates both Hi-C interactions and the discriminative power of single-copy marker genes to group marker-gene-containing contigs into preliminary bins. It also introduces a novel constrained random walk with restart algorithm to enhance Hi-C connectivity among contigs. Comprehensive assessments using both mock and real metaHi-C datasets from diverse environments demonstrate that ImputeCC consistently outperforms other Hi-C-based contig binning tools. A genus-level analysis of the sheep gut microbiota reconstructed by ImputeCC underlines its capability to recover key species from dominant genera and identify previously unknown genera.

Analytical method of incorporating failure probability to predict the fatigue life of ultra-high-performance concrete (UHPC)

This study predicted the fatigue life (N) of UHPC incorporated with different volume fractions (Vf = 0.0%, 0.5%, 1.0%, 1.5% and 2.0%) of steel fiber under flexural cyclic loading at various stress levels (S). The Weibull distribution, a two-parameter model, was utilized to estimate the distribution of fatigue life in UHPC. Subsequently, three methods were employed to calculate the parameters: the graphical method, the method of moments, and the method of maximum likelihood. The averaged values of these parameters were then obtained to enhance the accuracy of the estimation. The results are presented in the form of S-N diagrams, which depict the quantitative relationship between stress (S) and fatigue life (N). This relationship was determined using the Wohler equation, the modified Wohler equation, and the power equation. By employing these equations, the flexural fatigue strength of UHPC can be accurately predicted. Subsequently, the fatigue failure probability (Pf) was incorporated to enhance the reliability of the S-N quantitative relation. The fatigue testing results were presented in the form of S-N-Pf curves, which comprehensively reflect the relationship between stress, fatigue life, and failure probability. Furthermore, the mathematical relation of the S-N-Pf curves was derived to predict the fatigue life of UHPC with a given failure probability, providing a more comprehensive and accurate assessment of its fatigue behavior.

FP7.6 - Comprehensive Analysis of Emergency Laparotomy in the Geriatric Population: A Retrospective Study

Abstract Aims The British Society of Geriatrics recommends that all patients undergoing emergency laparotomy aged >= 65 who score more than 5 on Clinical Frailty Score (CFS) or >= 80 years with any CFS should receive comprehensive geriatric assessment within 72 hours of admission to a ward or step down from critical care. Despite substantial evidence outlining an improvement in postoperative outcomes, efforts to refer patients and record CFS are still insufficient. The aim of our study is to evaluate the use of CFS assessment in patients aged ≥ 65 years undergoing emergency laparotomy. Methods This was a retrospective audit of 94 patients aged ≥ 65 years old undergoing emergency laparotomy between September 2022 to October 2023. Results The mean age of the cohort was 75 years old. The average length of hospital stay was 21 days. 50% of patients were referred for an in-patient geriatrician review. The interval between surgery and geriatrician referral averaged 7 days. However, the average duration between geriatrician referral and assessment only spanned 1 day. CFS were recorded for only 11% of patients during their hospitalisation, pointing to an area for potential improvement. Conclusion Understanding the factors contributing to prolonged stays is pivotal in enhancing postoperative care. These insights not only shed light on the procedural intricacies surrounding emergency laparotomies in the elderly but also highlight opportunities for refining patient care pathways and optimising interdisciplinary care.

Risk assessment of patients with underlying health conditions who present for IVF treatment.

The increasing number of women with underlying health conditions seeking in vitro fertilization (IVF) necessitates a comprehensive risk assessment framework tailored to their needs. This review aims to provide a practical framework for IVF specialists to systematically assess and manage the risks associated with medically complex patients. The GRASP mnemonic (Genetics, Retrieval, Anaesthetics, Stimulation, Pregnancy) is introduced to facilitate a thorough risk assessment process. The review emphasizes the importance of obtaining detailed medical histories, corroborating information from other healthcare providers, and involving maternal medicine specialists in pre-pregnancy counselling. Furthermore, it highlights the ethical considerations of informed consent, advocating for fertility specialists to take a central role in coordinating care and ensuring patient understanding of risks. Continuous health evaluation throughout the IVF process and clear communication of risks are crucial for improving patient outcomes.

Structure of Restricted Repetitive Behaviors of Individuals Referred for Autism Spectrum Disorder Assessment.

Restricted and/or repetitive displays of behavior, interests, or activities (RRBs) are one of the core symptom domains of autism spectrum disorder (ASD). Current and past research indicates two 'clusters' of RRBs in children with ASD: repetitive sensorimotor (e.g., hand/finger and more complex motor mannerisms) and insistence on sameness (e.g., resistance to changes in the environment) behaviors. The current study aims to fill a gap by examining how RRBs may diverge in individuals with ASD and with other neurodevelopmental disorders (ONDD) in a clinical sample. A total of 558 individuals were seen at a tertiary care clinic for a comprehensive clinical assessment of ASD. The sample was split into ASD (n = 292 individuals) and ONDD (n = 266) groups based on clinical diagnosis. Exploratory factor analyses were conducted using Autism Diagnostic Interview-Revised (ADI-R) RRB item scores for the overall sample, the ASD group, and the ONDD group. Exploratory factor analysis of ADI-R RRB items indicated a 2-factor solution for the full sample and ASD group. Items loaded onto two factors comprised of "Repetitive Sensorimotor" and "Insistence on Sameness" behaviors, consistent with previous literature. Results demonstrated a unique loading pattern for the non-ASD group, with items clustering into "Higher Order" (e.g., circumscribed interests) and "Lower Order" (e.g., hand and finger mannerisms) behaviors. The results of the current study may point towards using RRBs to guide screening of children who are referred for an ASD evaluation to better identify children who are at higher risk of having ASD.

Integrated Geospatial and Geostatistical Multi-Criteria Evaluation of Urban Groundwater Quality Using Water Quality Indices

Groundwater contamination poses a severe public health risk in Lahore, Pakistan’s second-largest city, where over-exploited aquifers are the primary municipal and domestic water supply source. This study presents the first comprehensive district-wide assessment of groundwater quality across Lahore using an innovative integrated approach combining geographic information systems (GIS), multi-criteria decision analysis (MCDA), and water quality indexing techniques. The core objectives were to map the spatial distributions of critical pollutants like arsenic, model their impacts on overall potability, and evaluate targeted remediation scenarios. The analytic hierarchy process (AHP) methodology was applied to derive weights for the relative importance of diverse water quality parameters based on expert judgments. Arsenic received the highest priority weight (0.28), followed by total dissolved solids (0.22) and hardness (0.15), reflecting their significance as health hazards. Weighted overlay analysis in GIS delineated localized quality hotspots, unveiling severely degraded areas with very poor index values (>150) in urban industrial zones like Lahore Cantt, Model Town, and parts of Lahore City. This corroborates reports of unregulated industrial effluent discharges contributing to aquifer pollution. Prospective improvement scenarios projected that reducing heavy metals like arsenic by 30% could enhance quality indices by up to 20.71% in critically degraded localities like Shalimar. Simulating advanced multi-barrier water treatment processes showcased an over 95% potential reduction in arsenic levels, indicating the requirement for deploying advanced oxidation and filtration infrastructure aligned with local contaminant profiles. The integrated decision support tool enables the visualization of complex contamination patterns, evaluation of remediation options, and prioritizing risk-mitigation investments based on the spatial distribution of hazard exposures. This framework equips urban planners and utilities with critical insights for developing targeted groundwater quality restoration policies through strategic interventions encompassing treatment facilities, drainage infrastructure improvements, and pollutant discharge regulations. Its replicability across other regions allows for tackling widespread groundwater contamination challenges through robust data synthesis and quantitative scenario modeling capabilities.

WP3.10 - Variability of frailty scoring during unplanned surgical admissions in older persons - why accuracy matters

Abstract Introduction The Clinical Frailty Score (CFS) is a reliable predictor of outcomes for older patients in the acute hospital setting and is used to guide management decisions. Our hospital routinely calculates the CFS for older adults on admission to the Emergency Department (ED). Patients admitted under general surgery will then be referred for a Comprehensive Geriatric Assessment (CGA) by our Perioperative Medicine for the Older Patients undergoing Surgery (POPS) team who also calculate CFS. This study aimed to compare the CFS calculated in ED and CGA for these patients. Methods We performed a single centre prospective study of emergency general surgical admissions who were reviewed as an inpatient by our POPS team between August 2022 and September 2023. CFS from ED documentation was compared to that after CGA. A two tailed, paired t test was performed to compare the CFS on admission and after CGA using GraphPad Prism version 10.0. Results A total of 293 patients were identified with a mean age of 79 years(65-102). There was a difference between the admission CFS [4.2 (3.9-4.4 95%CI)] and the CFS following POPS review [4.5 (4.3-4.7 95%CI)] which was statistically significant (p<0.0001). Univariate analysis showed that CFS was predictive of length of hospital stay. Conclusion CFS calculated in the ED can both over and underestimate the degree of frailty when compared to the CFS calculated during the CGA. As evidence suggests that CFS is predictive of outcomes in this cohort, we suggest staff are adequately trained in undertaking an accurate assessment of this score.

SP9.5 - Peri-operative Comprehensive Geriatric Assessment (CGA): A new benchmark for Acute General Surgery patients

Abstract Aims More than 50% of patients undergoing emergency general surgery are over 65 years of age. NICE guidelines emphasise frailty assessment in acute surgical settings, particularly in the preoperative period. Similarly, the Emergency Laparotomy and Frailty (ELF) study showed associations between frailty (CFS ≥ 5) and 90-day mortality, increased complication and length of hospital stay in older emergency laparotomy patients. NELA best practice tariff (BPT) April 2023 heavily focuses on perioperative team involvement in frailer, older patients. This is an audit from a city teaching hospital, with a surgical liaison team against standards set by NELA. Methods Review of patients aged ≥ 65 undergoing emergency laparotomies between August and November 2023 (pre-intervention) then December and January 2024 (post-intervention). Data collected includes whether patients had a documented frailty score, a clearly documented CPR decision & treatment escalation plan (TEP), pre- or post-operative medical review, and advanced-care planning (ACP) post-operatively. Intervention included dedicated members of surgical liaison team following patients throughout admission, weekly meetings to discuss laparotomy patients, older patient template being created capturing ceilings of care, frailty score, and social history. Results Post intervention, improvement in clear documentation regarding escalation, frailty level. Greater level of MDT collaboration with regards to older patients undergoing laparotomies. Conclusion Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Even a basic surgical liaison service can achieve high levels of compliance with a few simple strategies, resulting in better outcomes for patients as well as financial benefits for Trusts.

Long-term longitudinal analysis of 4,187 participants reveals insights into determinants of clonal hematopoiesis

Clonal hematopoiesis of indeterminate potential (CHIP) is linked to diverse aging-related diseases, including hematologic malignancy and atherosclerotic cardiovascular disease (ASCVD). While CHIP is common among older adults, the underlying factors driving its development are largely unknown. To address this, we performed whole-exome sequencing on 8,374 blood DNA samples collected from 4,187 Atherosclerosis Risk in Communities Study (ARIC) participants over a median follow-up of 21 years. During this period, 735 participants developed incident CHIP. Splicing factor genes (SF3B1, SRSF2, U2AF1, and ZRSR2) and TET2 CHIP grow significantly faster than DNMT3A non-R882 clones. We find that age at baseline and sex significantly influence the incidence of CHIP, while ASCVD and other traditional ASCVD risk factors do not exhibit such associations. Additionally, baseline synonymous passenger mutations are strongly associated with CHIP status and are predictive of new CHIP clone acquisition and clonal growth over extended follow-up, providing valuable insights into clonal dynamics of aging hematopoietic stem and progenitor cells. This study also reveals associations between germline genetic variants and incident CHIP. Our comprehensive longitudinal assessment yields insights into cell-intrinsic and -extrinsic factors contributing to the development and progression of CHIP clones in older adults.

Parental Perception of Vulnerability, Child’s Temperament, and Health Locus of Control: Who Made You Boo-Boo?

Background: In Pakistan, where unintentional injuries among toddlers pose a significant public health challenge, understanding the factors that contribute to elevated injury risks is crucial. A two-dimensional approach including parental factors (internal/external health locus of control and perceived vulnerability) and child factors (the child’s temperament) is explored as contributing to the unintentional injury behaviors of toddlers. Method: The study involved 241 parents of toddlers aged 18–36 months from daycare centers in three major Pakistani cities who had observed multiple recent injuries in their children. The comprehensive online assessment, lasting 15–20 minutes, incorporated the child vulnerability scale, injury behavior checklist, parent health locus of control questionnaire, and early childhood behavior questionnaire. Demographic details included child and parent age distributions, with a focus on educational backgrounds. The participants comprised both fathers and mothers, and the data analysis employed Smart-PLS software for structural equation modeling. Result: The results suggested there is no direct relationship between parental health locus of control (internal/external) and injury behaviors in children. However, an indirect and significant path was observed from the parental health locus of control (internal/external) to perceived child vulnerability and injury behaviors through moderation of temperamental characteristics. Conclusion: Our research underscores the indirect link between parental factors, child temperament, and toddler injuries in Pakistan. Culturally sensitive interventions targeting parental awareness can play a pivotal role in safeguarding the well-being of the youngest members of society.

Recent Trends and Advancements in Green Synthesis of Biomass-Derived Carbon Dots

The push for sustainability in nanomaterials has catalyzed significant advancements in the green synthesis of carbon dots (CDs) from renewable resources. This review uniquely explores recent innovations, including the integration of hybrid techniques, such as micro-wave-assisted and ultrasonic-assisted hydrothermal methods, as well as photocatalytic synthesis. These combined approaches represent a breakthrough, offering rapid production, precise control over CD properties, and enhanced environmental sustainability. In addition, the review emphasizes the growing use of green solvents and bio-based reducing agents, which further reduce the environmental footprint of CD production. This work also addresses key challenges, such as consistently controlling CD properties—size, shape, and surface characteristics—across different synthesis processes. Advanced characterization techniques and process optimizations are highlighted as essential strategies to overcome these hurdles. Furthermore, this review pioneers the integration of circular economy principles into CD production, proposing novel strategies for sustainable material use and waste reduction. By exploring innovative precursor materials, refining doping and surface engineering techniques, and advocating for comprehensive life cycle assessments, this work sets a new direction for future research. The insights provided here represent a significant contribution to the field, paving the way for more sustainable, efficient, and scalable CD production with diverse applications in optoelectronics, sensing, and environmental remediation.

Is 'Cardiopulmonary' the New 'Cardiometabolic'? Making a Case for Systems Change in COPD.

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) have a syndemic relationship with shared risk factors and complex interplay between genetic, environmental, socioeconomic, and pathophysiological mechanisms. CVD is among the most common comorbidities in patients with COPD and vice versa. Patients with COPD, irrespective of their disease severity, are at increased risk of CVD morbidity and mortality, driven in part by COPD exacerbations. Despite these known interrelationships, CVD is underestimated and undertreated in patients with COPD. Similarly, COPD is an independent risk-enhancing factor for adverse cardiovascular (CV) events, yet it is not incorporated into current CV risk assessment tools, leading to under-recognition and undertreatment. There is a pressing need for systems change in COPD management to move beyond symptom control towards a comprehensive cardiopulmonary disease paradigm with proactive prevention of exacerbations and adverse cardiopulmonary outcomes and mortality. However, there is a dearth of evidence defining optimal cardiopulmonary care pathways. Fortunately, there is a precedent to support systems-level change in the field of diabetes, which evolved from glycemic control to comprehensive multi-organ risk assessment and management. Key elements included integrated multidisciplinary care, intensive risk factor management, coordination between primary and specialist care, care pathways and protocols, education and self management, and disease-modifying therapies. This commentary article draws parallels between the cardiometabolic and cardiopulmonary paradigms and makes a case for systems change towards multidisciplinary, integrated cardiopulmonary care, using the evolution in diabetes care as a potential framework.

ThP6.7 - Early assessment by a specalist geriatric team reduces length of stay in unplanned surgical admissions

Abstract Intro A comprehensive geriatric assessment (CGA) performed by the Perioperative medicine for Older People undergoing Surgery (POPS) team has been shown to reduce length of stay(LOS) for unplanned hospital admissions in the older population. This study investigates whether timing of POPS review reduces LOS for older adults admitted under the acute general surgical team. Methods We performed a single centre, prospective study of all older adult patients (aged 65 or above) admitted acutely to the general surgical team between August 2022 and September 2023. Timing of POPS review and LOS was calculated, and Mann Whitney-U test was performed. Results Three hundred and nine patients were identified. Of these, 207 patients were reviewed by POPS within 48 hours (early) and 151 of these patients were reviewed within 24 hours (very early) of admission. There was a statistically significant difference (p<0.001) in LOS between those who were assessed by POPS within 48 hours [Median 5 days (IQR 3,9)] versus those beyond 48 hours [Median 9 days (IQR 6,19)]. Very early POPS review (less than 24 hours) resulted in a statistically significant reduction in length of stay compared to POPS review between 24 and 48 hours [Median 5 days (IQR 2,8) versus 6 days (IQR3,9)] p<0.02. Conclusions POPS review within 48 hours reduces length of stay for older patients who have had an acute general surgical admission. Furthermore, this data suggests that very early POPS review (within 24 hours) is associated with a shorter hospital admission. Further research into this will help service planning.

Frailty Detection in Older Adults with Diabetes: A Scoping Review of Assessment Tools and Their Link to Key Clinical Outcomes.

Objectives: With the increasing prevalence of diabetes and frailty among older adults, there is an urgent need for precision medicine that incorporates comprehensive geriatric assessments, including frailty detection. This scoping review aims to map and synthesize the available evidence on validated tools for detecting pre-frailty and frailty in community-dwelling elderly individuals with diabetes and outpatient diabetes patients. Specifically, it addresses: (1) What validated tools are available for detecting pre-frailty and frailty in this population? (2) How are these tools associated with outcomes such as glycemic control, hypoglycemia, and metabolic phenotypes? (3) What gaps exist in the literature regarding these tools? Methods: The review followed PRISMA-ScR guidelines, conducting a systematic search across PubMed, Cochrane Library, and Web of Science. The inclusion criteria focused on studies involving individuals aged 70 years and older with diabetes, emphasizing tools with predictive capacity for disability and mortality. Results: Eight instruments met the inclusion criteria, including the Frailty Index, Physical Frailty Phenotype, and Clinical Frailty Scale. These tools varied in domains such as physical, psychological, and social aspects of frailty and their association with glycemic control, hypoglycemia, and metabolic phenotypes. The review identified significant gaps in predicting diabetes-related complications and their clinical application. Conclusions: Routine management of older adults with diabetes should incorporate frailty detection, as it is crucial for their overall health. Although widely used, the reviewed tools require refinement to address the unique characteristics of this population. Developing tailored instruments will enhance precision medicine, leading to more effective, individualized interventions for elderly individuals with diabetes.

Everyday Executive Functioning Profiles in Adults with Down Syndrome.

Research on everyday executive functions in individuals with Down Syndrome (DS) has focused mostly on children and adolescents. The current study examined everyday executive functions in DS adults. 27 DS adults (aged 22.00 to 42.00 years) were tested using the Behaviour Rating Inventory of Executive Function-Adult Informant Version (BRIEF-A). Findings revealed that DS adults exhibited greater impairments in Global Executive Composite (GEC), Working Memory, Plan/Organise, Task-Monitor and the Metacognition Index (MI) relative to typically developing adults in the normative sample. Substantial variabilities were found in all everyday executive function abilities among DS adults. Findings highlight the importance of making comprehensive assessments of everyday executive functions in DS individuals in order to identify problem areas and plan individualised support programmes.