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(OutRef). Systemic inflammation was assessed by concentrations of



and suPAR. Associations were investigated by multiple

regression analyses, adjusted for age, sex, cognitive impairment, and

severity of acute illness, estimated by CRP and VitalPAC Modified Early

Warning Score (ViEWS).


The cohort included 369 patients with a median age of 77.9

years. In adjusted analyses, IL-6 was associated handgrip strength

(p = 0.007); TNF


with DEMMI (p < 0.001) and handgrip strength

(p = 0.004), and suPAR with all physical performance measurements

(p < 0.001). All three inflammation markers were associated with

OutRef (p < 0.001). OutRef was associated with all physical perform-

ance measurements (p < 0.001) in analyses adjusted for age, sex,

cognitive impairment and ViEWS.


Systemic inflammation seems to be mediating both organ

dysfunction and low physical performance in acutely admitted older

medical patients and thus could be a clinical feasible modality for

systematically assessment of vulnerability in this population.


Do we follow the national and international guidelines on

thromboprophylaxis in patients with atrial fibrilation

D. Kondova, R. Damani, K. Musarrat.

Department of Geriatric Medicine,

University Hospitals of Leicester NHS Trust, UK

Atrial fibrillation (AF) is the most common sustained heart rhythm

disturbance in the UK. With the ageing population the prevalence of

AF is anticipated to double by 2050. The current statistics are that one

of six ischemic strokes is associated with atrial fibrillation. Stroke

directly attributed to AF can have a devastating consequences. Up to

50% of people who have a stroke related to AF die within one year. AF

related stroke is preventable, but many patients currently do not

receive optimal prevention therapy.


To identify the percentage of patients with AF admitted in

our hospital who were anticoagulated. To find if hospital doctors

considered thromboprophylaxis in patients with AF who are eligible as

per National and European guidelines. To find out if there is enough

documentation in the patients records in support decisions for or

against anticoagulation.


This was a prospective audit. We audited the notes of all

surgical and medical patients admitted in our hospital at the time.


The notes of 450 patients were reviewed. Of those there were

50 patients with AF.96% were at an age of above 65. All patients

had CHADS-VASc score of 2 and above but only 40% of the admitted

patients were anticoagulated. 50% from the rest were on antiplatelet.

Only 22% of patients with AF who were not anticoagulated had a

plan for thromboprophylaxis documented. There was no evidence of

calculation of CHADS-VASc score. Only in 30% of those not antic-

oagulated the reason for omission of anticoagulationwas documented.


Improvingmultidisciplinary teammeetings in geriatric emergency


S. Kumar


, M. Ren


, T. Morris


, A. Kaval


, S. Madi


, A. Matin


, S. Turpin




University Hospitals of Leicester, United Kingdom


Multidisciplinary team (MDT) communication is key to

providing comprehensive geriatric assessment. Leicester

s Emergency

Frailty Unit (EFU) aims to deliver two brief MDT meetings per day to

aid communication and efficient patient assessment and manage-

ment. Historical meeting attendance rates were variable. A quality

improvement (QI) project was designed to optimise the frequency

and attendance at meetings, aiming to improve communication and

reduce variability.


Quality improvement methodology was used (PDSA cycles).

Baseline data collection was continuous during this period and

included the number of handovers per day, attendance of MDT

members and length of meeting. Two planned interventions occurred:

1. MDTmeeting rates and attendancewere published and an email was

sent to all MDT members explaining the rationale for the project

(Intervention 1). 2. All teammembers were encouraged to take shared

ownership and initiation of the MDT meetings (Intervention 2).


Both interventions resulted in a measurable improvement in

the frequency and attendance of MDT meetings.

Occurrence of an MDT on any given day improved from 25% to


Proportion of MDT present during a meeting improved from 25% to


Length of meetings decreased from 88.7 seconds to 79.1 seconds

per patient.

Key conclusions:

Using established QI methodology, this project has

identified that the frequency and attendance of rapid MDT meetings

in an emergency medicine setting can be improved with no adverse

impact on the duration of the meeting.


Hospital acquired urinary tract infections in a community hospital

Y. Latief


, C. Lisk




Potters Bar Hospital, Hertfordshire Community NHS



Barnet Hospital, Royal Free NHS Foundation Trust


Hospitalised patients are predisposed to a variety of

nosocomial infections; these may include multidrug resistance

organisms. Since initial treatment is empirical, prior knowledge of

bacterial prevalence as well as resistant patterns in healthcare settings

is essential. The aim of the study was to determine the local prevalence

of bacterial strains and the antibiotic sensitivity of nosocomial

acquired urinary tract infections in a 29 bedded rehabilitation unit

for older adults in order to guide empirical antibiotic choice when

antibiotic sensitivities are still unknown in the first 48 hours of



We analysed the data of all patients with positive urine

culture defined as more than 100,000 bacteria per ml following 48 hrs

of admission to the community hospital.


53 patients with urinary tract infections were identified. 62%

(33) were aged 81

90 years with a female preponderance 66%(35).

Gram negative bacteria were the cause in the majority of cases with

Escherichia Coli 60% (32/53), Klebsiella Pneumoniae 17% (9/53),

Pseudomonas 9% (5/53) and Proteus 6% (3/53) being the commonest

pathogens. Extended Spectrum Beta-Lactamases (ESBL) accounted

for 5 cases of Escherichia Coli urinary tract infections with sensitivities

to Nitrofurantoin (3), Gentamicin (1), Fosfomicin (1) and Ertapenem

(1). Most bacteria were sensitive to Nitrofurantoin 49% (26/53),

Trimethoprim 25% (13/53) and Gentamicin 15% (8/53). There was

low sensitivity to cephalexin and amoxicillin.


This study suggests that the best antibiotic to start

empiric treatment of nosocomial urinary tract infections is

Nitrofurantoin which is in line with our hospital antibiotic guidelines.


Defensive medicine and the impact on senior population

I. Sandu


, N. Lefter


, A. Rusu


, I.D. Alexa


, G.I. Prada


, A.I. Pâslaru




Dr. C.I. Parhon

Hospital, Iaşi,


Department of Internal Medicine,

University of Medicine and Pharmacy

Grigore T. Popa

, Iaşi,



of Geriatry and Gerontology, University of Medicine and Pharmacy



, Bucuresti


Defensive medicine is an increasing phenomenon in

the medical practice due to physicians

need to reduce or prevent

complains or criticism by patients or their families. However,

performing defensive medicine in senior population will increase

the risk of exposing the patient to multiple interdisciplinary consults,

aggressive investigations, and poly-medication with disastrous iatro-

genic results.

Case presentation:

We report the case of a 72 years old male patient

from rural area who was brought to the emergency room by

ambulance for respiratory and digestive symptoms. As there were no

life-threatening symptoms, he had to wait for six hours before being

seen by a physician. Due to the digestive symptoms, an ultrasound was

Poster presentations / European Geriatric Medicine 7S1 (2016) S29