Multiple Conditions Research Articles

Monitoring heart rhythms in adult males with X-linked ichthyosis using wearable technology: a feasibility study.

The rare dermatological condition X-linked ichthyosis (XLI) is associated with a substantially-increased risk of cardiac arrhythmias. Arrhythmias predispose to multiple serious health conditions, and there is a need to identify them at an early stage, ideally using non-invasive, convenient, cost-effective, and reliable wearable technology methods. We tested the feasibility of monitoring heart rhythms using an Apple Watch in five adult males from the United Kingdom diagnosed with XLI. Participants returned routine electrocardiogram (ECG) traces from the watch three times per week for eight weeks (plus any traces associated with 'watch alerts' indicating arrhythmic episodes) for cardiologist review. Participant feedback was also obtained on the perceived usability/wearability of the watch/app, and on the study requirements. Participants were generally happy with the study conduct, found the watch/app straightforward to use, and there was a > 95% data return rate. Minor protocol improvements were suggested. There were few issues reported with wearability of the watch. Three participants exhibited no ECG abnormalities, but two presented with ventricular ectopic beats (VEs). Only one watch 'alert' ECG was returned, and this was considered normal sinus rhythm, suggesting the possibility of 'false positive' calls. Based on our small sample, smartwatch-based screening for cardiac rhythm abnormalities in the high-risk male XLI population appears useful, feasible, and acceptable to patients and a larger-scale clinical trial is warranted. Potentially, such devices may be more suited to detecting persistent abnormalities rather than unpredictable, acute, arrhythmic episodes. The high VE burden in some participants with XLI is consistent with septal defects underlying arrhythmia risk.

Dupilumab in children with eosinophilic esophagitis: a retrospective multicenter study

BackgroundEosinophilic esophagitis (EoE) is a chronic inflammatory disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. Dupilumab is a human monoclonal antibody that targets both IL-4 and IL-13 signaling. It is currently indicated for the treatment of asthma, atopic dermatitis, and EoE. This study aimed to describe children with EoE that is difficult to treat using conventional treatment and to identify symptomatic, histological, and endoscopic improvements after dupilumab treatment.Materials and methodsWe conducted a retrospective multicenter study in children with confirmed EoE and performed a chart review of patients prescribed dupilumab for EoE. Demographic information, symptoms, and medications including dupilumab treatment were collected. The endoscopic findings, histopathological features, and treatment results were analyzed. We calculated the change in EoE endoscopic reference scoring system (EREFS) scores from the baseline to 3 months.ResultsEleven patients were included in this study. The study population comprised seven boys (64%) and four girls (36%). The median age at presentation was 11.6 years (8–13 years). Dupilumab at a dose of 200–300 mg was administered to all patients as second-line therapy for children with EoE refractory to conventional therapy (proton pump inhibitors, corticosteroids, and dietary restrictions). Dupilumab efficacy regarding symptom relief, and endoscopic and histological improvements was 82%, 73%, and 90%, respectively. The mean EoE endoscopic reference scoring system scores changed from a baseline of 6.9 (before dupilumab) to 0.3 (after dupilumab). In addition to the improvement in EoE, the use of corticosteroids in EoE and inhaled corticosteroids in asthma was decreased for all patients, suggesting that dupilumab may be effective in patients with multiple concurrent atopic conditions. Dupilumab had a well-tolerated safety profile, except for one patient who developed conjunctivitis.ConclusionThis pediatric study demonstrates the effectiveness of dupilumab as a second-line therapy for symptom relief, and endoscopic and histological improvements of EoE that is refractory to current treatment. A longitudinal, large prospective study is necessary to guide the initiation of dupilumab treatment for childhood EoE, and long-term follow-up data on dupilumab are required.Clinical trial numberNot applicable.

High-fidelity image reconstruction in multimode fiber imaging through the MITM-Unet framework

Using a single multimode fiber for both illumination and imaging offers notable advantages in developing ultra-thin imaging probes. However, uneven speckle illumination introduces additional noise, complicating high-precision reconstruction of complex grayscale images, which remains challenging for traditional methods. In this study, we first optimize the image reconstruction framework by combining the inverse transmission matrix approach with deep neural networks, enhancing interpretability and delivering exceptional performance in reconstructing complex images. To address the noise introduced by uneven speckle illumination, we increase the target exposure and effectively integrate information from multiple illumination conditions. Results show that our proposed Multi-speckle Illumination type Inverse Transmission Matrix-Unet (MITM-Unet) method significantly outperforms the Single-speckle illumination type (SITM-Unet). Specifically, images reconstructed with MITM-Unet achieve a structural similarity index of 0.59 and a Pearson correlation coefficient of 0.91, compared to SITM-Unet’s 0.38 and 0.77. These findings underscore the effectiveness of the MITM-Unet method in achieving high-quality imaging of complex grayscale targets, providing valuable insights into the imaging capabilities of single multimode fiber systems. This work holds promise for advancing simpler, more compact wide-field endomicroscopic imaging using multimode fibers.

Entangled Illnesses: Embodied Experiences of Managing Multimorbidity.

Multimorbidity, meaning multiple long-term conditions impacting a person's health, has become a rising societal and public health issue. The article contributes to the sociological study of chronic illness and multimorbidity by analysing how the blurriness of illnesses and entanglement of symptoms in multimorbidity is experienced and negotiated by people with coexisting chronic conditions. Drawing on qualitative interviews with people who live with endometriosis, fibromyalgia or hormonal migraine in Finland, we show how people with multiple chronic conditions distinguish between evolving symptoms based on past embodied experiences to make decisions about how to best manage their health. We argue that coexisting illnesses become entangled in ambiguous and open-ended ways, which, if left unaddressed, complicates treatment. Our analysis of illness experiences is aligned with the growing body of literature that argues that the single-disease model underlying healthcare systems fails to address the needs of patients living with multiple chronic conditions. Our emphasis on evolving entanglements between illnesses and the blurriness of conditions makes visible crucial discrepancies between lived illness and existing biomedical models and healthcare structures.

CTNet: Improving the non-stationary predictive ability of remaining useful life of aero-engine under multiple time-varying operating conditions

Remaining useful life (RUL) estimation has been widely studied in prognostics and health management. Multiple time-varying operating conditions explicitly influence the measured performance parameters of the aero-engine, which results in non-stationarity and impedes the predictive ability of deep learning models. Previous data-driven studies primarily ignore the causality between operating condition descriptors and measured performance parameters, which is inconsistent with practical aero-engine engineering applications. To address this issue, we propose a causality Transformer network (CTNet), which improves the prediction stability of non-stationary series under multiple operating conditions. First, a novel graph structure is used to capture the connectivity relationship between operating condition descriptors and measured sensor nodes. Then the causality attention is proposed to inject additional causality information into the self-attention module without affecting the similarity computations of query and key values within the window. The causality attention can generate distinguishable attention for operating conditions, which properly release the predictive potential for non-stationary series. Extensive experiments are performed on public datasets (CMAPSS, N-CMAPSS), showing that CTNet outperforms existing state-of-the-art methods. We have also conducted experiments on the real-world quick access recorder (QAR) data, which validates the performance of the proposed model in perceiving time-varying operating conditions.

Building ADMISSION - A research collaborative to transform understanding of multiple long-term conditions for people admitted to hospital.

Multiple long-term conditions (MLTCs; commonly referred to as multimorbidity) are highly prevalent among people admitted to hospital and are therefore of critical importance to hospital-based healthcare systems. To date, most research on MLTCs has been conducted in primary care or the general population with comparatively little work undertaken in the hospital setting. To describe the rationale and content of ADMISSION: a four-year UK Research and Innovation and National Institute of Health and Care Research funded interdisciplinary programme that seeks, in partnership with public contributors, to transform care for people living with MLTCs admitted to hospital. Based across five UK academic centres, ADMISSION combines expertise in clinical medicine, epidemiology, informatics, computing, biostatistics, social science, genetics and care pathway mapping to examine patterns of conditions, mechanisms, consequences and pathways of care for people with MLTCs admitted to hospital. The programme uses routinely collected electronic health record data from large UK teaching hospitals, population-based cohort data from UK Biobank and routinely collected blood samples from The Scottish Health Research Register and Biobank (SHARE). These approaches are complemented by focused qualitative work exploring the perspectives of healthcare professionals and the lived experience of people with MLTCs admitted to hospital. ADMISSION will provide the necessary foundations to develop novel ways to prevent and treat MLTCs and their consequences in people admitted to hospital and to improve care systems and the quality of care for this underserved group.

Metal coordination bond and rough interface enhanced triboelectric nanogenerator aiming for multiple complex conditions

Triboelectric nanogenerator (TENG) is widely used in the fields of sustainable green energy harvesting, self-powered motion parameter and tactile sensing, However, it still fails to meet the requirements under various complex conditions, such as low temperatures, self healing after destruction, punching, long-term placement, soaking in acid or alkali solution, scorch, continuous work. Herein, based on metal coordination, Zr4+ ions are introduced to enhance the first network k-carrageenan (k-CG) for achieving double enhancement in mechanics and electricity of the gel electrode layer, poly (N-hydroxyl acrylamide)/k-CG (PKZ) double network organic conductive gel enhanced by multiple hydrogen bonds and metal coordination bond is designed, and the gel exhibits high tensile strength, high conductivity, fast self-recovery, excellent self-repairing and low-temperature resistance. Based on simple sandpaper templates with different mesh numbers Ecoflex film with rough surfaces is designed for efficient triboelectric contact interface, and TENG with PKZ double network organic conductive gel as electrode layer is constructed, and possesses excellent resistant to multiple complex conditions. With high short-circuit current, open-circuit voltage and output power, the TENG is capable of powering electronic devices, and it can also be sensitive and stable sensing in writing recognition, real-time monitoring of motion parameters involving acceleration, speed and distance. The TENG is stable and reliable for sustainable green energy harvesting, motion parameter and tactile sensing in multiple complex environments. Thus, we provide novel ideas for designing energy harvesting and sensing for future wearable electronics under multiple complex conditions.

Anthropometric and Sociodemographic Correlates of Dental Caries and Gingival Health in Children With Special Healthcare Needs at a Saudi Tertiary Care Hospital.

To evaluate the impact of anthropometric and sociodemographic factors on dental caries and gingival health among children with special healthcare needs (SHCN). This cross-sectional study involved 108 children, aged 4-14 years, with congenital heart disease, childhood cancer, bleeding disorders, various syndromes, and multiple conditions. Caregivers completed a sociodemographic questionnaire, and children underwent dental examinations to assess caries, gingival health, and oral hygiene. Anthropometric measures-weight, height, and body mass index (BMI)-were obtained and categorized into percentiles (<10, 10-90, >90) using age- and gender-specific growth charts. Dental caries was highly prevalent (93.5%), with a mean dmft/DMFT value of 7.70 (SD ± 5.22). The mean gingival index was 0.43 (SD ± 0.52). Total dmft/DMFT values were significantly higher in children ≤6 years and those with fathers of lower educational levels. Poor oral hygiene was a strong predictor of adverse outcomes for both caries and gingival health. Higher gingival indices correlated with children in the >90th weight percentile. The findings highlight the need for comprehensive oral health interventions that integrate meticulous oral hygiene, paternal education, and holistic growth monitoring beyond BMI. The results support implementing a 3-month recall program for professional dental care, combined with individualized oral hygiene instruction for caregivers. This approach is particularly crucial for the younger age group (≤6 years) where targeted early intervention could significantly reduce caries risk.

The polarity of high-definition transcranial direct current stimulation affects the planning and execution of movement sequences.

Noninvasive brain stimulation of the primary motor cortex has been shown to alter therapeutic outcomes in stroke and other neurological conditions, but the precise mechanisms remain poorly understood. Determining the impact of such neurostimulation on the neural processing supporting motor control is a critical step toward further harnessing its therapeutic potential in multiple neurological conditions affecting the motor system. Herein, we leverage the excellent spatio-temporal precision of magnetoencephalographic (MEG) imaging to identify the spectral, spatial, and temporal effects of high-definition transcranial direct current stimulation (HD-tDCS) on the neural responses supporting motor control. Participants (N = 67) completed three HD-tDCS visits (anode, cathode, sham), with each involving 20 minutes of left primary motor cortex stimulation and performance of a simple/complex motor sequencing task during MEG. Whole-brain statistical analyses of beta oscillatory responses revealed stimulation-by-task interaction effects in the left primary motor cortex, right occipitotemporal, and the right dorsolateral prefrontal cortices. Broadly, anodal stimulation induced significantly stronger beta oscillatory responses in these regions during simple movement sequences, while neural responses to complex sequences were not affected by stimulation. En masse, these data suggest that the beta oscillations serving motor planning (i.e., pre-movement) are particularly sensitive to the polarity of noninvasive stimulation and that the impact varies based on the difficulty of the movement sequence.

Intersecting Structural and Psychosocial Conditions: Investigating Injection Drug Use and HIV Among Transgender Women.

Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women than among cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women with a general sample of persons who inject drugs. Participants from the National HIV Behavioral Surveillance were recruited through respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics. Among 1561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (adjusted prevalence ratio = 1.5, 95% confidence interval: 1.2 to 1.8) than among those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (adjusted prevalence ratio = 0.8, 95% confidence interval: 0.7 to 1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%). Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to nonjudgmental and culturally competent harm reduction services.

Air Pollution and Oral Health: An Overall Insight From Genetic Causality.

A growing body of epidemiological data consistently links air pollution to various adverse health outcomes. However, the potential connection between air pollution and the risk of oral diseases remains underexplored. This study utilized a two-sample Mendelian randomization approach to assess the causal relationship between air pollution and oral diseases. Six categories of air pollution were considered as exposures: nitrogen oxides (NOx), nitrogen dioxide (NO2), particulate matter (PM2.5, PM2.5-10, PM10), and PM2.5 absorbance. The outcomes included 18 oral health-related diseases drawn from the Finngen R10 dataset, the Gene-Lifestyle Interactions in Dental Endpoints consortium, and the Oncoarray oral cavity and oropharyngeal cancer consortium. Sensitivity analyses were performed to validate the primary inverse-variance weighted estimates using methods such as weighted median, weighted mode, and MR Egger. The inverse-variance weighted analysis demonstrated a detrimental effect of air pollution on multiple oral health conditions, yielding 5 positive associations including PM2.5 with oral leukoplakia, gingivitis and periodontitis; PM2.5-10 with pulp and periapical diseases, and NO2 with gingivitis and periodontitis, and oral cavity, salivary glands and jaws diseases. Sensitivity tests showed no evidence of heterogeneity or pleiotropy, affirming the robustness of the findings. This study highlights the detrimental impact of air pollution on oral health, emphasizing the need for further research into the underlying mechanisms and interactions. These findings reinforce the importance of implementing environmental interventions to mitigate the associated risks for oral health.

TELEHEALTH PROGRAM CREATES EXERCISE HABIT FOR NON-ADHERENT PATIENT WITH ORTHOSTATIC INTOLERANCE

INTRODUCTION Orthostatic Intolerance (OI) impacts patients’ ability to perform activities of daily living (ADLs) often leading to symptom exacerbation and significant deconditioning over time. Exercise aids symptom control by increasing cardiac output and venous return. Creating and maintaining an exercise routine often requires additional supports. CASE PRESENTATION A 15-year-old female was referred for a 6-month history of postural dizziness and presyncope. At the initial clinic visit, orthostatic testing was completed which showed a 27-bpm increase in heart rate. Baseline ECG showed sinus rhythm with normal intervals and review of systems was unremarkable. Patient history, symptoms and testing were noted to be consistent with OI. Initial interventions included general exercise resources and education materials, such as a daily aerobic walking plan (begin with 5-minute duration and increase by 5 minutes/week until 60 minutes total is achieved per day). Quarterly to bi-yearly clinic follow-ups showed no improvement in symptoms, despite reinforcing exercise recommendations and education at each visit. Follow up repeat testing, predicted aerobic capacity assessment, muscular endurance assessment, and surveys were completed. Exercise physiologist (ExP) initiated telehealth exercise sessions. OUTCOME Prior to intervention, patient physical activity consisted of walking at work. ExP conducted eleven telehealth exercise sessions over a 3-month period (30 min duration, 2 times/week). Sessions included education on form, safety, exercise components, &amp; intensity progression. Resistance exercises were completed with real-time supervision and feedback. Following completion of the telehealth program, testing showed decrease in symptom severity (-110%), increase in predicted aerobic capacity (+28%), maintenance of lower extremity muscular endurance (-6%), decrease in fatigue (-62%), and maintenance of mobility (-27%). One month post completion of telehealth intervention patient remained adherent to exercise prescription of aerobic exercise (2 times/week) &amp; strength training (2 times/week). DISCUSSION Early clinic education emphasized the importance of exercise for this patient; however, neither education nor clinic resources resulted in adherence to an exercise routine. Virtually delivering high quantity, synchronized exercise sessions, allowed the patient to experience improvement in functional capacity and reduction in symptom intensity. Virtual delivery of exercise medicine sessions can be applied to multiple clinical conditions and wider delivery to varied patient populations should be explored.

Aeroelastic flutter correlation analysis and structure optimization of wind turbine blades under multiple operating conditions based on aerodynamic damping

Aeroelastic flutter correlation analysis and structure optimization of wind turbine blades under multiple operating conditions based on aerodynamic damping

Behavior of simple closed ecological systems; lower nutrient concentrations allow longer persistence of grazer populations.

We expect to develop self-sustaining extraterrestrial colonies, and they will approach being closed ecological systems. Using simple closed ecosystems containing Daphnia magna, three species of algae, and microbes, we tested multiple conditions to study long-term organism survival, which is only possible with adequate nutrient recycling. Closed and open systems behaved differently from one another at high nitrate concentrations; in closed systems, the animals were dead by day 14; in open systems, the Daphnia populations persisted beyond 273 days. Daphnia deaths were associated with increased pH and O2 caused by greater algal photosynthesis and the lack of exchange with the atmosphere. Replicate variability that used small Daphnia suggested that inadequate grazing capability allowed algae to create conditions unfavorable to Daphnia survival. Over months, algal and Daphnia abundance decreased, presumably because of inadequate nutrient recycling; these populations increased temporarily after the addition of nutrients. The addition of natural lake organisms did not increase the nutrient-recycling capabilities of the systems. Understanding the mechanisms of closed systems will be useful in implementing biological processes in managing life support systems.

Dual data fusion fault diagnosis of transmission system based on entropy weighted multi-representation DS evidence theory and GCN

Power transmission reliability of drivelines guarantees fast maneuverability of heavy vehicles. During health monitoring, multi-sensor data fusion technology has been widely used in the improvement of fault diagnosis accuracy of long-link multi-structure drivelines. However, in multi-sensor fusion and joint fault diagnosis scenarios where multiple conditions coexist, it is still challenging to fuse multi-sensor data and extract generalized fault intrinsic features for any combination of operating conditions under multi-sensor monitoring. In this paper, a dual fusion graph convolutional network (DFGCN) is proposed for multi-sensor-multi-condition fault diagnosis of the transmission system. First, considering the data structure and the correlation of different sensors, DFGCN constructs multi-sensor intrinsic links synchronously from the data and feature levels by using multi-branch parallel GCN. Second, considering the susceptibility to over-confidence when the feature space of multi-condition data is inconsistent, an entropy-weighted multi-representation Dempster-Shafer (EWMR-DS) evidence theory fusion strategy is designed to extract the condition-shared features by increasing the label space diversity. Finally, an end-to-end lightweight diagnosis framework is scalable to multi-sensor and multi-working conditions in engineering practice, and the dual information fusion improves the fusion efficiency of fine-grained features with distributional differences. Using experimental datasets collected from two typical transmission fault test benches, the effectiveness of the proposed DFGCN method in multi-sensor-multi-condition scenarios is verified. The results indicate that DFGCN achieves an average diagnostic accuracy of more than 99.7% and superior noise resistance under different degrees of environmental noise.

2773 Co-designing an intervention for older adults with multiple conditions, using changes in physical activities to predict decline

Abstract Introduction Multiple long-term conditions (MLTCs) are common in the population, which increase with age and are associated with increased hospital admissions. Identifying early signs of decline, such as restricted physical activity, could help reduce avoidable hospitalisations, however it is not clear how best to do this. Aim To co-design with patients, caregivers and primary care professionals (PCPs), an intervention aimed at identifying changes in activity in order to recognise decline in older adults with MLTCs. Methods The Person-Based Approach was followed to plan and develop this intervention. Qualitative interviews were conducted with older patients with MLTCs, caregivers, and PCPs to examine perspectives on an intervention measuring changes in physical activity. A prototype app was developed, using these results and patient and public involvement. This was further optimised through iterative think-aloud interviews with patients, caregivers, and PCPs. Results Thirty-six interviews were conducted comprising of 17 patients (mean age 79-years, 23% female), eight caregivers and 11 PCPs (GPs, nurses, occupational therapists, and pharmacists). Interviews were recorded, transcribed, and thematically analysed. Findings highlighted the importance of restricted activity as an indicator of decline. Patients often described their experiences of decline through non-specific symptoms, including changes in physical activity. PCPs emphasised the value of knowing about such changes to clinical decision-making. Different technology options for measuring activity were explored, considering data quality, and acceptability of passive/active data collection. The initial prototype intervention was designed for iterative testing and think-aloud interviews will be completed by November and presented. Conclusion This study highlights the utility of measuring changes in activity in older patients, and some benefits and lessons learned from co-design. A proactive approach to detecting early decline within community settings may provide opportunities to unplanned hospital admissions.

2783 Addressing depression and loneliness in older adults: findings from the BASIL+ randomised control trial

Abstract Background Older adults were more likely to be socially isolated during the COVID-19 pandemic, with increased risk of depression and loneliness. The Behavioural Activation in Social Isolation (BASIL+) trial investigated whether a Behavioural Activation (BA) intervention delivered remotely could mitigate depression and loneliness in at-risk older people during the COVID-19 pandemic. Methods We undertook a multicentre randomised controlled trial [ISRCTN63034289] of BA to mitigate depression and loneliness among older adults (65+) with multiple long-term health conditions, including low mood or depression. BA was delivered remotely (telephone or video call) with intervention participants (n = 218). Control participants received usual care, with existing COVID wellbeing resources (n = 217). Results Participants engaged with an average of 5.2 (SD 2.9) of 8 remote BA sessions. Adjusted mean difference (AMD) for depression (Patient Health Questionnaire-9, PHQ-9) at 3 months [primary outcome] was −1.65 (95% CI -2.54 to −0.75, p &amp;lt; 0.001). There was an effect for BA on emotional loneliness at 3 months (AMD -0.37, 95% CI -0.68 to −0.06, p = 0.02), but not social loneliness (AMD -0.05, 95% CI -0.33 to 0.23, p = 0.72). For participants with lower severity depression symptoms (5–9 on the PHQ-9) at baseline, there was an effect AMD PHQ9 1.13 (95% CI –2.26 to 0.01, p = 0.051), though this was less pronounced than for those scoring 10 or more at baseline (−2.48, 95% CI -3.81 to 1.16, p = 0.0002). Conclusion Behavioural activation is an effective and potentially scalable intervention that can reduce symptoms of depression and emotional loneliness in at-risk groups in the short term. The findings of this trial add to the range of strategies to improve the mental health of older adults with multiple long-term conditions. These results can be helpful to policy makers beyond the pandemic in reducing the global burden of depression and addressing the health impacts of loneliness, particularly in at-risk groups.

2875 The association between multiple long-term conditions, person- and disease-related factors and adverse inpatient outcomes

Abstract Introduction People living with multiple long-term conditions (MLTC) are more likely to experience hospital admission, which is often associated with unintended consequences. Preventing or providing alternatives to admission by predicting adverse admission-related outcomes is important. This study aims to provide an overview of the association between MLTCs and adverse outcomes following hospital admission through a systematic review of systematic reviews. Method We searched Medline, Embase, CINAHL, Web of Science and PsycINFO for systematic reviews assessing risk factors/predictors of functional decline (FD), nursing home admission (NHA), or changes in quality of life among adults (≥18 years) experiencing unscheduled acute hospital admission. Eligible reviews had to assess MLTC (LTC counts, indices, or individual LTCs), either alone or with other predictors. Titles/abstracts and full texts were screened in duplicate and candidate predictors were extracted. Results 14 systematic reviews assessed predictors of FD (n = 8) or NHA (n = 6). Reviews focused on studies of general inpatients/mixed presentations (n = 8: 6 FD, 2 NHA); hip fracture (n = 2: 1 FD, 1 NHA); stroke (n = 2: 1 FD, 1 NHA) and cognitive impairment (n = 1, NHA) or delirium (n = 1, NHA). Assessment of MLTC was heterogenous: comorbidity indices (n = 4), counts of LTC (n = 2), specific LTC (n = 8), and ‘comorbidity’ without further qualification (n = 3). Higher comorbidity indices, higher counts, and a range of specific comorbidities (most notably dementia) were associated with FD and NHA. Reviews assessing MLTC alongside other predictors highlighted a broad range of sociodemographic, functional, social, and admission-related factors that were associated with FD and NHA. In general, reviews did not assess the relative importance of MLTC alongside other predictors. Conclusion While MLTC may predict unwanted outcomes following admission their qualification is often inconsistent and their relative importance as predictors, alongside broader factors such as social complexity, is rarely assessed in existing systematic reviews.

2786 Defining advanced multimorbidity: a scoping review of research, policy and practice

Abstract Introduction As people are living for longer with multiple long-term health conditions (MLTCs), there are also more people dying with and from MLTCs. Dying with/from MLTCs can be unpredictable, lead to uncertainty for patients, caregivers and healthcare professionals, and hinder timely conversations around future care planning. There is no universally accepted definition informing the identification of individuals with MLTCs who may be approaching the end of life (advanced multimorbidity). This scoping review synthesised how advanced multimorbidity is defined in research, policy and practice. Methods Using the Arksey and O’Malley framework and relevant updates, scoping review methodology was used to search multiple databases and Grey Literature, summarised via the PRISMA-ScR. Two reviewers selected final study texts, which underwent content analysis. Stakeholder consultations with clinicians, academics and public participants ensured context and relevance of findings. Results From 10,316 unique publications, 38 final texts were included. Most (33/38) were published in the last decade. Many were quantitative (18/38) though a variety of other study types were included. Participants were mainly elderly—mean age 78.5 years. Only 4/38 studies integrated patient and public involvement. Forty-four different definitions of advanced multimorbidity were identified across the 38 studies, with only 2 definitions used across multiple studies. Definitions varied in the type and number of conditions included. Twenty-six definitions incorporated multiple variables to define advanced multimorbidity, while the remaining 18 used a single variable. Variables were conceptualised as discrete (functional assessments, age, healthcare utilisation etc) or holistic (self-assessment, clinician assessment, assessment tools). Stakeholders preferred definitions that were user-friendly and clinically driven. Conclusions The lack of consensus around an advanced multimorbidity definition creates unwarranted heterogeneity and barriers to advancing research in this field. This review highlights the need for a standardised approach that is context-appropriate and meaningful to practice and care, to facilitate proactive realistic conversations and decision-making.

2763 Process evaluation of the BASIL+ trial: addressing low mood among older people

Abstract Introduction During the COVID-19 pandemic, older adults were at risk of being socially isolated or experiencing loneliness, increasing the risk of depression. We adapted the delivery of Behavioural Activation (BA), an effective evidence-based intervention for depression in older adults and people with multiple long-term conditions (LTCs), so it could be delivered remotely under COVID-19 restrictions. Method The qualitative study was nested within the BASIL+ definitive randomised controlled trial (https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00238-6/fulltext). Semi-structured telephone interviews were conducted with 24 older adults, two caregivers and 16 BASIL Support Workers (BSWs). They were digitally recorded and transcribed professionally. Data were analysed thematically using constant comparison. Results Conclusion Findings suggest a BASIL+ style intervention should become more widely available for older adults with LTCs and low mood, given its positive impact on most participants and its remote delivery by non-specialist practitioners.