distress may be a simple and easily identified marker of unmet need in people with dementia in hospital. However, modifiable and unmodifiable barriers are suggested that reduce the chance of distress being identified or acted on. Improving our understanding of how distress is identified in this environment, and in turn developing systems that overcome these barriers, may improve the accuracy with which distress is identified on hospital wards.
Introduction Handheld ECG monitors are increasingly used by both healthcare workers and patients to diagnose cardiac arrhythmias. There is a lack of studies validating the use of handheld devices against the standard 12 lead ECG. The Kardia 6 L is a novel handheld ECG monitor which can produce a 6 lead ECG. In this study we compare the 6 L ECG against the 12 lead ECG. Methods A prospective study consisting of unselected cardiac inpatients and outpatients at Leeds Teaching Hospital NHS Trust. All participants had a 12 and 6 Lead ECGs. All ECG parameters were analysed by using a standard method template for consistency between independent observers. ECGs from the recorders were compared by the following statistical methods: linear regression, Bland Altman, receiver operator curve and kappa analysis. Results There were 1015 patients recruited. The mean differences between recorders were small for PR, QRS, cardiac axis, with receiver operator analysis area under the curve of > 80%. Mean differences for QT and QTc (between recorders) were also small, with AUCs for QT leads of > 75% and AUCs for QTc leads of > 60%. Key findings from Bland-Altman analysis demonstrate overall an acceptable agreement with few outliers instances (<6%, Bland Altman analysis). Conclusion Several parameters recorded by the Kardia 6 L (QT Interval in all six leads, rhythm detection, PR Interval, QRS duration, cardiac axis) perform closely to the gold standard 12 lead ECG. However, that consistency weakens for left ventricular hypertrophy, QRS amplitudes (Lead I & AVL) and ischaemic changes.
Psychiatric hospital beds for people with dementia are a limited resource. The number of people with dementia requiring inpatient psychiatric care is expected to increase as the population ages, but there is a striking lack of data informing these services. 1,2 We found almost no mention of inpatient mental health admissions in UK dementia policy or guidance. Previous literature suggests the main reasons for admission are neuropsychiatric symptoms which pose a risk of harm. 3 There is frequently a resistance to accepting care, tight legal frameworks which govern treatment and high levels of physical and psychiatric morbidity. The majority of published data is from audits of single wards or localities which means variability between units is unknown. 4,5 Our aim was to describe the clinical characteristics of patients admitted to inpatient dementia units, to establish their journey to and from the unit and describe workforce and clinical practice. | METHODSWe performed a multi-centre retrospective service evaluation, using routinely collected data from four diverse sites in the United Kingdom. Participating sites provided routinely collected service data for calendar years 2018 and 2019. This study was approved as a service evaluation. All data was anonymised at the patient level. | RESULTSResults are presented in Table 1. Three of the sites had one bed for every 200-250 people with a dementia diagnosis, though site 3 had less. Admissions averaged one per week per site. Alzheimer's disease was the most common diagnosis, followed by vascular dementia.Patients were predominantly male. Bed occupancy was high between 80% and 90%. Admissions were long with a mean duration of 100 days. There is a cohort on each ward who have longer admissions, one in six patients still remained in hospital after 6 months, and 2.5% had admissions of over 1-year duration. Most admissions were made using the Mental Health Act. Source of admission was commonly from acute hospitals or the patients' homes. Admissions levels only otherwise seen at the height of the coronavirus pandemic in the NHS. 9 Extra shifts were mostly to cover 1:1 observations, these were mostly covered through bank and agency unqualified staff, which might provide an argument for increasing staff establishment.In summary, we provide a study of nearly 500 admissions to psychiatric dementia inpatient beds and describe long lengths of stay, frequent placement in institutional care on discharge, high rates of falls and assaults and some heterogeneity of service provision. We found little previous literature on this topic and given the vulnerability and complexity of these patients suggest a larger and more detailed study to confirm these findings and inform the development of standards of optimal care.
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