The National Falls and Bone Health Audit: Implications for UK emergency care

Introduction: The National Clinical Audit of Falls and Bone Health, coordinated by the Royal College of Physicians, assesses progress in implementing integrated falls services across the UK against national standards and enables benchmarking between service providers. Nationally, falls are a leading contributor towards mortality and morbidity in older people and account for 700 000 visits to emergency departments and 4 million annual bed days in England alone. Methods: Two rounds of national organisational audit in 2005 and 2008 and one national clinical audit in 2006 were carried out based on indicators developed by a multidisciplinary group. Results: These showed that management of falls and bone health in older people remains suboptimal in emergency departments and minor injury units and opportunities are being missed in carrying out evidence-based risk assessment and management. Conclusions: Older people attending emergency departments in the UK following a fall are receiving a poor deal. There is an urgent need to ensure more effective assessment and management to prevent further falls and fractures

Winter Wheat Grain Yield Response to Fungicide Application is Influenced by Cultivar and Rainfall

Winter wheat is susceptible to several fungal pathogens throughout the growing season and foliar fungicide application is one of the strategies used in the management of fungal diseases in winter wheat. However, for fungicides to be profitable, weather conditions conducive to fungal disease development should be present. To determine if winter wheat yield response to fungicide application at the flowering growth stage (Feekes 10.5.1) was related to the growing season precipitation, grain yield from fungicide treated plots was compared to non-treated plots for 19 to 30 hard red winter wheat cultivars planted at 8 site years from 2011 through 2015. At all locations, Prothioconazole + Tebuconazole or Tebuconazole alone was applied at flowering timing for the fungicide treated plots. Grain yield response (difference between treated and non-treated) ranged from 66-696 kg/ha across years and locations. Grain yield response had a positive and significant linear relationship with cumulative rainfall in May through June for the mid and top grain yield ranked cultivars (R2=54%, 78%, respectively) indicating that a higher amount of accumulated rainfall in this period increased chances of getting a higher yield response from fungicide application. Cultivars treated with a fungicide had slightly higher protein content (up to 0.5%) compared to non-treated. These results indicate that application of fungicides when there is sufficient moisture in May and June may increase chances of profitability from fungicide application

The importance of different frailty domains in a population based sample in England

Background: The aim was to estimate the prevalence of frailty and relative contribution of physical/balance, nutritive, cognitive and sensory frailty to important adverse health states (falls, physical activity levels, outdoor mobility, problems in self-care or usual activities, and lack of energy or accomplishment) in an English cohort by age and sex. Methods: Analysis of baseline data from a cohort of 9803 community-dwelling participants in a clinical trial. The sample was drawn from a random selection of all people aged 70 or more registered with 63 general practices across England. Data were collected by postal questionnaire. Frailty was measured with the Strawbridge questionnaire. We used cross sectional, multivariate logistic regression to estimate the association between frailty domains and known correlates and adjusted for age. Some models were stratified by sex. Results: Mean age of participants was 78 years (sd 5.7), range 70 to 101 and 47.5% (4653/9803) were men. The prevalence of overall frailty was 20.7% (2005/9671) and there was no difference in prevalence by sex (Odds Ratio 0.98; 95% Confidence Interval 0.89 to 1.08). Sensory frailty was the most common and this was reported by more men (1823/4586) than women (1469/5056; Odds Ratio for sensory frailty 0.62, 95% Confidence Interval 0.57 to 0.68). Men were less likely than women to have physical or nutritive frailty. Physical frailty had the strongest independent associations with adverse health states. However, sensory frailty was independently associated with falls, less frequent walking, problems in self-care and usual activities, lack of energy and accomplishment. Conclusions: Physical frailty was more strongly associated with adverse health states, but sensory frailty was much more common. The health gain from intervention for sensory frailty in England is likely to be substantial, particularly for older men. Sensory frailty should be explored further as an important target of intervention to improve health outcomes for older people both at clinical and population level.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.08/14/41/DH_/Department of Health/United Kingdom Project number 08/14/41/Health Technology Assessment Programmepre-print, post-print, publisher's version/PD

Does the timed up and go test predict future falls among British community-dwelling older people? Prospective cohort study nested within a randomised controlled trial

Background Falling is common among older people. The Timed-Up-and-Go Test (TUG) is recommended as a screening tool for falls but its predictive value has been challenged. The objectives of this study were to examine the ability of TUG to predict future falls and to estimate the optimal cut-off point to identify those with higher risk for future falls. Methods This is a prospective cohort study nested within a randomised controlled trial including 259 British community-dwelling older people ≥65 years undergoing usual care. TUG was measured at baseline. Prospective diaries captured falls over 24 weeks. A Receiver Operating Characteristic curve analysis determined the optimal cut-off point to classify future falls risk with sensitivity, specificity, and predictive values of TUG times. Logistic regression models examined future falls risk by TUG time. Results Sixty participants (23%) fell during the 24 weeks. The area under the curve was 0.58 (95% confidence interval (95% CI) = 0.49-0.67, p = 0.06), suggesting limited predictive value. The optimal cut-off point was 12.6 seconds and the corresponding sensitivity, specificity, and positive and negative predictive values were 30.5%, 89.5%, 46.2%, and 81.4%. Logistic regression models showed each second increase in TUG time (adjusted for age, gender, comorbidities, medications and past history of two falls) was significantly associated with future falls (adjusted odds ratio (OR) = 1.09, 95% CI = 1.00-1.19, p = 0.05). A TUG time ≥12.6 seconds (adjusted OR = 3.94, 95% CI = 1.69-9.21, p = 0.002) was significantly associated with future falls, after the same adjustments. Conclusions TUG times were significantly and independently associated with future falls. The ability of TUG to predict future falls was limited but with high specificity and negative predictive value. TUG may be most useful in ruling in those with a high risk of falling rather than as a primary measure in the ascertainment of risk

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Winter Wheat Grain Yield Response to Fungicide Application is Influenced by Cultivar and Rainfall

Winter wheat is susceptible to several fungal pathogens throughout the growing season and foliar fungicide application is one of the strategies used in the management of fungal diseases in winter wheat. However, for fungicides to be profitable, weather conditions conducive to fungal disease development should be present. To determine if winter wheat yield response to fungicide application at the flowering growth stage (Feekes 10.5.1) was related to the growing season precipitation, grain yield from fungicide treated plots was compared to non-treated plots for 19 to 30 hard red winter wheat cultivars planted at 8 site years from 2011 through 2015. At all locations, Prothioconazole + Tebuconazole or Tebuconazole alone was applied at flowering timing for the fungicide treated plots. Grain yield response (difference between treated and non-treated) ranged from 66-696 kg/ha across years and locations. Grain yield response had a positive and significant linear relationship with cumulative rainfall in May through June for the mid and top grain yield ranked cultivars (R2=54%, 78%, respectively) indicating that a higher amount of accumulated rainfall in this period increased chances of getting a higher yield response from fungicide application. Cultivars treated with a fungicide had slightly higher protein content (up to 0.5%) compared to non-treated. These results indicate that application of fungicides when there is sufficient moisture in May and June may increase chances of profitability from fungicide application

Winter Wheat Grain Yield Response to Fungicide Application is Influenced by Cultivar and Rainfall

Winter wheat is susceptible to several fungal pathogens throughout the growing season and foliar fungicide application is one of the strategies used in the management of fungal diseases in winter wheat. However, for fungicides to be profitable, weather conditions conducive to fungal disease development should be present. To determine if winter wheat yield response to fungicide application at the flowering growth stage (Feekes 10.5.1) was related to the growing season precipitation, grain yield from fungicide treated plots was compared to non-treated plots for 19 to 30 hard red winter wheat cultivars planted at 8 site years from 2011 through 2015. At all locations, Prothioconazole + Tebuconazole or Tebuconazole alone was applied at flowering timing for the fungicide treated plots. Grain yield response (difference between treated and non-treated) ranged from 66-696 kg/ha across years and locations. Grain yield response had a positive and significant linear relationship with cumulative rainfall in May through June for the mid and top grain yield ranked cultivars (R2=54%, 78%, respectively) indicating that a higher amount of accumulated rainfall in this period increased chances of getting a higher yield response from fungicide application. Cultivars treated with a fungicide had slightly higher protein content (up to 0.5%) compared to non-treated. These results indicate that application of fungicides when there is sufficient moisture in May and June may increase chances of profitability from fungicide application