Measuring the distress related to delirium in older surgical patients and their relatives

Objective: Delirium is a common postoperative complication with implications on morbidity and mortality. Less is known about the psychological impact of delirium in patients and relatives. This study aimed to; 1. Quantitatively describe distress related to postoperative delirium in older surgical patients and their relatives using the distress thermometer 2. Examine the association between degree of distress and features of delirium on the Delirium Rating Scale (DRS) 3. Examine the association between recall of delirium and features of delirium on the Delirium Rating Scale (DRS) Methods: This prospective study recruited postoperative patients and their relatives following delirium. The distress thermometer was used to examine the degree of distress pertaining to delirium and was conducted during the hospitalisation on resolution of delirium and then at 12 month follow up. Associations between delirium related distress in patient and relative participants and severity and features of delirium ( Delirium Rating Scale) were examined. Results: 102 patients and 49 relatives were recruited. Median scores on the distress thermometer in patients who recalled delirium were 8/10. Relatives also showed distress (median distress thermometer score 8/10). Associations were observed between severity of and phenotypic features of delirium (delusions, labile affect, agitation). Distress persisted at 12 months in patients and relatives. Conclusion: Distress related to postoperative delirium can be measured using a distress thermometer. Alongside approaches to reduce delirium incidence, interventions to minimise distress from postoperative delirium should be sought. Such interventions should be developed through robust research and if effective administered to patients, relatives or carers

The emerging specialty of perioperative medicine: a UK survey of the attitudes and behaviours of anaesthetists

Background: In 2014, the Royal College of Anaesthetists (RCoA) launched the Perioperative Medicine Programme to facilitate the delivery of best preoperative, intraoperative and postoperative care through implementation of evidence-based medicine to reduce variation and improve postoperative outcomes. However, variation exists in the establishment of perioperative medicine services in the UK. This survey explored attitudes and behaviours of anaesthetists towards perioperative medicine, described current anaesthetic-led perioperative medicine services across the UK and explored barriers to anaesthetic involvement in perioperative medicine. / Methods: Survey content based on the RCoA vision document was refined and validated using an expert panel. An anonymous electronic survey was then sent by email to the members of the RCoA. / Results: Seven hundred fifty-eight UK anaesthetists (4.5% of the RCoA mailing list) responded to the survey. Of these, 64% considered themselves a perioperative doctor, with 65% having changed local services in response to the RCoA vision. Barriers to developing perioperative medicine included insufficient time (75%) and inadequate training (51%). Three quarters of respondents advocate anaesthetists leading the development of perioperative medicine. / Conclusions: Despite evidence of emerging services, this survey describes barriers to ongoing development of perioperative medicine. Facilitators may include increased clinical exposure, targeted education and training and collaborative working with other specialties

A survey of the workload generated by older surgical patients referred to on-call medical registrars—SNAP-3

\ua9 2025 The Authors. Background: Older surgical patients who develop medical problems are commonly referred to medical teams, which can be proactive physician-led teams or through reactive referral to the on-call medical registrar. Methods: A cross-sectional survey of on-call medical registrars who received referrals from surgical teams was conducted in March–June 2022 at 140 NHS hospitals. It focused on the workload derived from referrals of older surgical patients to on-call medical registrars, excluding referrals to existing services such as perioperative medicine, orthogeriatric, or medical specialty teams. To minimise recall bias, completion of the survey was encouraged regardless of whether a registrar had received a referral. The aim of this survey was to estimate the unplanned, acute workload generated by older surgical patients requiring referral to on-call medical registrars. The survey also aimed to estimate the prevalence and nature of training in perioperative medicine amongst medical registrars. Results: During an on-call shift, 41.3% (266/644) of medical registrars received at least one referral regarding an older surgical patient. The commonest indications were arrhythmia, acute respiratory problems, electrolyte abnormalities, suspected myocardial infarction, sepsis, and delirium. Three-quarters of registrars reported not receiving training in perioperative management of older patients. Conclusions: The findings highlight the significant workload and training gaps faced by medical registrars in managing older surgical patients. Bridging the gap between national recommendations and local services may reduce demands on on-call registrars and improve care

Codesigning an Intervention to Minimise the Distress Related to Postoperative Delirium for Patients and Relatives; A Mixed Methods Stepwise Approach

Introduction: Postoperative delirium is common and causes distress in patients and relatives with potential impact on long-term psychological health. No standardised approach to minimising delirium related distress exists. This study describes a mixed-methods, stepwise approach to co-designing an intervention to minimise distress related to postoperative delirium.</jats:p

Older patients undergoing emergency laparotomy: observations from the National Emergency Laparotomy Audit (NELA) years 1-4

BACKGROUND: older patients aged ≥65 years constitute the majority of the National Emergency Laparotomy Audit (NELA) population. To better understand this group and inform future service changes, this paper aims to describe patient characteristics, outcomes and process measures across age cohorts and temporally in the 4-year period (2014-2017) since NELA was established. METHODS: patient-level data were populated from the NELA data set years 1-4 and linked with Office of National Statistics mortality data. Descriptive data were compared between groups delineated by age, NELA year and geriatrician review. Primary outcomes were 30- and 90-day mortality, length of stay (LOS) and discharge to care-home accommodation. RESULTS: in total, 93,415 NELA patients were included in the analysis. The median age was 67 years. Patients aged ≥65 years had higher 30-day (15.3 versus 4.9%, P < 0.001) and 90-day mortality (20.4 versus 7.2%, P < 0.001) rates, longer LOS (median 15.2 versus 11.3 days, P < 0.001) and greater likelihood of discharge to care-home accommodation compared with younger patients (6.7 versus 1.9%, P < 0.001). Mortality rate reduction over time was greater in older compared with younger patients. The proportion of older NELA patients seen by a geriatrician post-operatively increased over years 1-4 (8.5 to 16.5%, P < 0.001). Post-operative geriatrician review was associated with reduced mortality (30-day odds ratio [OR] 0.38, confidence interval [CI] 0.35-0.42, P < 0.001; 90-day OR 0.6, CI 0.56-0.65, P < 0.001). CONCLUSIONS: older NELA patients have poorer post-operative outcomes. The greatest reduction in mortality rates over time were observed in the oldest cohorts. This may be due to several interventions including increased perioperative geriatrician input

Establishing a Perioperative medicine for Older People undergoing Surgery (POPS) service for general surgical patients at a district general hospital

Introduction There is growing recognition of the need for perioperative medicine services for older surgical patients. Comprehensive geriatric assessment and optimisation methodology has been successfully used to improve perioperative outcomes at tertiary centres. This paper describes translation of an established model of geriatrician-led perioperative care to a district general hospital (DGH) setting.Methods A mixed methods quality improvement programme was used and included stakeholder co-design, identification of core components, definition of mechanisms for change, and measurement of impact through qualitative and quantitative approaches.Results Within 18 months, a substantive perioperative service for older people was established at a DGH, funded by the surgical directorate. Key outcomes included reduction in length of stay and 30-day readmission and positive staff and patient experience.Discussion This study is in keeping with improvement science literature demonstrating the importance of a mixed-methods approach in translating an evidenced-based intervention into another setting, maintaining fidelity and replicating results

The export base model with a supply-side stimulus to the export sector

In the export-base model, the level of a region’s economic activity is underpinned by the performance of its export sector (Daly, 1940; Dixon and Thirlwall, 1975; Kaldor, 1970; North, 1955). This theory is now almost universally represented as a primitive version of the familiar Input-Output (IO) or Keynesian demand-driven approach, where regional output is linked to regional exports through a rather mechanistic multiplier process (Romanoff, 1974). Further, in a standard IO inter-regional framework, the expansion of output in one region always generates positive impacts on other regions. That is to say, there is always a positive spread, and no negative backwash, effect