Making difficult decisions about the benefits and risks of thrombolysis treatment

Dr Aoife De Brun is a Research Associate at the Institute of Health & Society at Newcastle University

An online survey investigating factors that influence clinical decision-making regarding intravenous thrombolysis for patients with acute ischaemic stroke has been launched. The project is funded by the NIHR Health Service and Delivery Research Programme and is led by researchers from Newcastle University.

We are recruiting clinicians who are involved in making the final decision regarding thrombolysis for patients with acute ischemic stroke.  By understanding how clinicians make difficult trade-offs between the potential benefits and risks of thrombolysis, we can design strategies to better support risk communication, consent and decision-making with patients in clinical practice.

Frailty and delirium – the Scottish approach

Christine McAlpine is a consultant geriatrician at Glasgow Royal Infirmary. She served on the Working Group which developed the BGS’ Fit for Frailty guidance and was Chairman for some years, of the BGS Clinical Effectiveness and Quality Committee.

10% of patients admitted to hospital as an emergency stay more than two weeks, using 55% of all hospital bed days, and 80% of that group are aged over 65 years.

The average age of a hospital inpatient is over 80. Good care for older people in acute care is a key priority for health services.

In 2012 Healthcare Improvement Scotland (HIS) was asked by the Scottish Government to “improve acute care for older people by March 2014”. A review of the published evidence plus the themes coming from the inspections of acute care services for older people suggested there were opportunities for improvement in the care of frail older people coming in to hospital, and that in particular delirium was often undetected with resulting poor outcomes for patients (including higher risks of death or institutionalisation).

The Older People in Acute Care (OPAC) improvement programme was therefore set up.

Social media in geriatrics

Katherine Walesby is an ST5 and is the BGS Trainees Committee Communications Representative. She tweets at @kewdoc

Over recent years, the popularity of social media has spiralled. Not merely amongst celebrities and news channels, but also within the medical profession. It is often wrongly associated as being of “no use to the medical profession” or something that “should be avoided”.

I hope to convince you, if not to embrace it yourself, that it can be a valuable asset within medicine and particularly within our speciality. It is something that many geriatricians and the British Geriatrics Society are harnessing professionally for education, learning and disseminating key messages promoting care for older people.

Deprivation of liberty safeguards

In March this year, the Supreme Court handed down its judgement on two cases which will have significant impact in determining whether arrangements made for the care and/or treatment of an individual lacking capacity to consent to those arrangements amount to a deprivation of liberty.

Key points of the Supreme Court Judgement: The Court ruled that there is a deprivation of liberty in terms of Article 5 of the European Convention on Human Rights if the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements. Whether the person objects to the arrangement or not is irrelevant, as is the ‘relative normality of the placement in the context of the person’s needs.’

Calling all Rising Stars!

Do you have a colleague who does  excellent work in geriatric medicine, and deserves to be recognised for it? Do you feel that you do outstanding work and would like to be recognised for it?

Well, the BGS is launching an award today  which can help that to happen!

Nominations for the BGS Rising Star Award 2014 open today. We would like to make two Rising Star Awards each year:

1. One for research contributions that have translated into, or are in the process of being translated into, improvements to the care of older people.
2. One for a clinical quality project which improves the care of older people with frailty in your locality.

Announcing Eileen Burns as President Elect of the BGS

The British Geriatrics Society is pleased to announce that Dr Eileen Burns has been elected its twenty-first President Elect. Dr Burns will succeed Professor David Oliver when he assumes the President’s mantle at the BGS Annual General Meeting in October.

Eileen has been a geriatrician in Leeds for twenty-two years, was clinical director for a large teaching hospital department in the first decade of the noughties and is currently clinical lead for integration in Leeds. She is well known amongst those BGS members who have been active on the Society’s various committees, having served on several of these over the years. She currently sits on the Policy and Communications Committee and she has contributed to numerous consultations on behalf of the Society. She has also served as Chairman of the Community Geriatrics Special Interest Group for many years, presiding over one very successful stand alone community geriatrics event and several parallel sessions on the subject at our scientific meetings.

Hard Truths after Francis

Professor Paul Knight is Director of Medical Education and a Consultant Geriatrician for the Elderly at the Royal Infirmary in Glasgow. He is also President of the British Geriatrics Society.

The Westminster Government’s response to the second Francis Report was published as I was preparing to go to Harrogate for the BGS biannual conference and co-incidentally where I was due to speak on what the BGS had done and would do “After Francis”. So it wasn’t until a few days later that I managed to read in detail “Hard Truths. The Journey to Putting Patients First”.

EUGMS Meetings in Budapest

A report from the European Union Geriatric Medicine Society (EUGMS) meetings in Budapest:

A seminar on geriatric long-term care was hosted for the participation of representatives of EUGMS and other Hungarian participants. Also invited were members of the ELTECA working group; Profs. Katarzyna Wiecorzowska-Tobis from Poznan, Poland, Debbie Tolson from Glasgow, UK, Cecilia Rokusek of Fort Lauderdale Florida, USA, and Iva Holmerová from Prague, CZ, who happily met again to continue their discussions on long-term geriatric care and the opportunities for cooperation.

It takes heart to donate a brain

Paul Francis is Professor of Neurochemistry and Director of Brains for Dementia Research at the Wolfson Centre for Age-Related Diseases, King’s College

Brains for Dementia Research, an initiative by Alzheimer’s Society and Alzheimer’s Research UK in association with the Medical Research Council seeks to address the shortage of high quality brains from people with and without dementia, available to researchers. This is a good opportunity for BGS colleagues to contribute to an important research function in an area of medicine that is part of their day to day work.

A new kind of geriatrician – introducing interface geriatricians

Gillian Fox, Alison Cracknell, Sadia Ismail and Eileen Burns are all Consultants in Interface Geriatrics at Leeds Teaching Hospitals NHS Trust

Leeds Teaching Hospitals has a 60 bedded general adult medical admissions unit and a 60 bedded Elderly Admissions Unit with comprehensive geriatric assessment (CGA) embedded to either facilitate discharge to community services with ongoing assessment and/or rehabilitation where needed or begin treatment and investigation before transfer to an elderly care ward.

As part of the Leeds acute care model, 2012 saw the introduction of Interface Geriatricians (IGs). This service was developed with initial funding from the PCT (later CCGs) aiming to avoid admission where appropriate. We have developed a model for working for the IG that covers 3 key areas of interface – community, PCAL (primary care access line) and the emergency department (ED).