Frailsafe: from conception to national breakthrough collaborative

The number of people aged over 60 years worldwide is projected to rise from 605 million in 2000 to almost 2 billion by 2050, while those over 80 years will quadruple to 395 million. Two-thirds of UK acute hospital admissions are over 65, the highest consultation rate in general practice is in those aged 85-89 and the average age of elective surgical patients is increasing. Adjusting medical systems to meet the demographic imperative has been recognised by the World Health Organisation to be the next global healthcare priority and is a key feature of discussions on policy, health services structures, workforce reconfiguration and frontline care delivery

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Capitani coraggiosi’. Gli Eubei nel Mediterraneo

In this paper we intend to present a critical overview of Euboea’s role in the Mediterranean Sea after the Dark Ages and during the historical colonization. The topic is based on historical and archaeological sources and follows a route from 1st-millennium BC Eastern Mediterranean to the 8th-century BC Western Colonies. The first part of this paper focus on two places that are really important in the research on the Euboeans: Al-Mina, at the mouth of the Orontes river, an emporion for which the model of the polanyian ‘port-of-trade’ has been evoked, and Lefkandi, where the famous funerary building was discovered. Both of them make evident the importance of interferences with the Phoenician routes and the movement of luxury goods, ceramic, and metal products; furthermore, the funeral rite has urged interesting considerations about the heroic (Homeric?) culture of that very aristocracy, as well as the political function of the buried couple. As elsewhere in the Greek world, even Euboea knows the formation of poleis: Chalcis and Eretria, which share the first colonial experiences towards the Chalkidike area and the West (via Corcyra). After the Lelantine War (VIII cent. BC) Eretria declines in a local dimension with strong and particular relationship with Boeotian Oropus; Chalcis, however, has long been very active on the Western routes and in particular in three areas: the Gulf of Naples, the region of Aetna in Sicily, the Strait of Messina. We can try to identify some recurring issues that might suggest sort of an ‘Euboic model’ in the Colonization of the West: the frequency of colonies’ colonies, the importance of the straits, the mixed character of the foundations (up to the limit-case of Himera with Ionians and Dorians together). In any case, it is clear the centrality of the Lower Tyrrhenian Sea, starting from the first settlement of Pithecusae and the maritime activity of Etruscans and pirates. The presence of pirates has suggested the final considerations about the peculiarities of the social subject of this experience, to be identified in an aristocracy linked to the land (and the breeding of horses), but capable of expressing great dynamism both politically and in social as well as economic development

Improving patient safety for older people in acute admissions: implementation of the Frailsafe checklist in 12 hospitals across the UK.

Background checklists are increasingly proposed as a means to enhance safety and quality of care. However, their use has been met with variable levels of success. The Frailsafe project focused on introducing a checklist with the aim to increase completion of key clinical assessments and to facilitate communication for the care of older patients in acute admissions. Objectives to examine the use of the Frailsafe checklist, including potential to contribute to improved safety, quality and reliability of care. Methods 110 qualitative interviews and group discussions with healthcare professionals and other specialties, 172 h of ethnographic observation in 12 UK hospitals and reporting of high-level process data (completion of checklist and relevant frailty assessments). Qualitative analysis followed a thematic and theory-driven approach. Results through use of the checklist, hospital teams identified limitations in their existing assessments (e.g. absence of delirium protocols) and practices (e.g. unnecessary catheter use). This contributed to hospitals reporting just 24.0% of sampled patients as having received all clinical assessments across key domains for this population for the duration of the project (1,687/7,021 checklists as fully completed). Staff perceptions and experiences of using the checklist varied significantly, primarily driven by the extent to which the aims of this quality improvement project aligned with local service priorities and pre-existing team communications styles. Conclusions the Frailsafe checklist highlighted limitations with frailty assessment in acute care and motivated teams to review routine practices. Further work is needed to understand whether and how checklists can be embedded in complex, multidisciplinary care