Aim To undertake a prospective study of the accuracy of two models (LACE and BOOST) in predicting unplanned hospital readmission in older patients (>75 years). Methods Data were collected from a single centre prospectively on 110 patients over 75 years old admitted to the acute medical unit. Follow-up was conducted at 30 days. The primary outcome was the c-statistic for both models. Results The readmission rate was 32.7% and median age 82 years, and both BOOST and LACE scores were significantly higher in those readmitted compared with those who were not. C-statistics were calculated for both tools with BOOST score 0.667 (95% CI 0.559-0.775, P = .005) and LACE index 0.685 (95% CI 0.579-0.792, P = .002). Conclusion In this prospective study, both the BOOST and LACE scores were found to be significant yet poor, predictive models of hospital readmission. Recent hospitalisation (within the previous 6 months) was found to be the most significant contributing factor.

The Royal College of Pathologists (RCPATH) sets criteria for requesting placental histological examination which allows identification of pathological processes contributing to/causing an adverse obstetric outcome. Maternal intrapartum pyrexia is an essential criterion but is not part of the Guy's and St. Thomas' Trust (GSTT) guideline. There is no current baseline data on this at GSTT. Aim To review current practice of requesting placental histology and amend trust guidelines to follow national recommendations. Birth records from June 2019 were reviewed showing 8%(47/569) of deliveries were eligible for placental histology as per trust criteria but only 60%(28/47) were requested. A survey demonstrated 4% of staff were able to correctly identify all criteria for histology and there was confusion regarding formalin use. Neonatologists and pathologists were contacted to identify views on the usefulness of placental histology and the effect of adopting national criteria. The pathologists confirmed all placentas should be sent in formalin unless specified by the obstetric team. The intrapartum infection guideline was amended to include requesting placental histology after approval by the intrapartum committee. The obstetric theatre posters were amended to include the extended criteria. A training presentation was emailed to all staff on the procedure for requesting placental histology. The trust guidelines were successfully amended to include RCPATH criteria for placenta histology. Birth records from January 2020 identified 13%(63/487) of deliveries were eligible for placental histology, but only 56%(35/63) were requested. The trust guideline for requesting placental histology now follows national recommendations. This may provide answers for adverse obstetric outcomes and reduce trust medicolegal costs. Unfortunately, no improvement in placental histology requests was demonstrated. Exploring potential barriers to improvement will be part of the next change cycle.

Background An aim of the National End of Life Care Strategy (2008) was to improve dignity and respect in end of life care (EoLC). The VOICES survey was commissioned in 2011 as the first national post-bereavement postal survey, a key component of which was to assess dignity and respect at the end of life. The aim of this study was to explore changes in dignity and respect perceived by bereaved relatives over the five-year period that the VOICES survey was commissioned. Methods Aggregate data from VOICES post-bereavement surveys (2011–2015) was obtained from the Office of National Statistics. Information about dignity and respect was extracted and dichotomised into satisfied ('always'and 'most of the time') and unsatisfied ('some of the time'and 'never'). A chi-squared test for trend was used to analyse changes over time in dignity and respect, for each of seven categories of health care professionals. Results There were 1 07 206 responses to the VOICES surveys over 5 years (average response rate 44.4%). Improvements in perceived dignity and respect from 2011 to 2015 were found with respect to five categories of health care professional: GPs (0.7% improvement in satisfaction to 60.9%, p=0.016); hospital doctors (1.7% improvement to 85.0%, p=0.0036); hospital nurses (5.2% improvement to 80.6%, p<0.0001); hospice doctors (0.8% improvement to 95.5%, p=0.0001); hospice nurses (1.9% improvement to 95.2%, p=0.0001). District/community nurses showed a 1.4% decrease in satisfaction to 92.6% (p<0.0001). Care home staff showed no change (p=0.2). Conclusions The data has demonstrated a general trend of improvement with regard to dignity and respect experienced from healthcare professionals. District/community nurses showed a decrease in dignity and respect however, this could be attributed to a regression to the mean or due to their high baseline, therefore this would not be cause for concern. The low satisfaction demonstrated with GPs should be investigated.

Background The Gold Standards Framework (GSF) was established in 2000 to help ensure delivery of high-quality end-of-life care within general practices, and has since been adapted for care homes and hospitals. The GSF has been endorsed by the UK Department of Health, with a national roll-out seeing all UK general practices and 25% of care homes adopting the GSF in some form. The evidence base for the GSF in the community has not been systematically evaluated. The aim of this study was to synthesise the qualitative evidence for the GSF on improving end-of-life care in the community. Method A systematic literature review of published research from 2000 to 2018 using Medline and PubMed databases, in line with PRISMA guidelines. A thematic matrix analyses approach was adopted. Studies were quality assessed using the QualSyt tool. Results Of the 115 studies identified, 19 studies reported on qualitative findings of the GSF implementation in the community setting. All 19 studies collected data from staff members and 4 studies also included patients and/or relatives. The GSF was felt to facilitate improved written and verbal communication in both nursing care homes and primary care teams, and to enhance methods of teamworking. 16 of 19 studies reported increased uptake of a palliative care register to identify end-of-life patients. Barriers to use of the GSF included a lack of sustainability due to high staff turnover, as well as an increased workload and difficulties in discussing end-of-life care with relatives. Conclusions These findings support the use of the GSF in improving the quality of end-of-life care through collaborative working and increased communication across healthcare teams. Further studies are required to understand attitudes of patients and relatives. Challenges for policy makers include ensuring end-of-life care tools are both sustainable and flexible according to local population and workforce needs.

Mutations in SLC34A1, encoding the proximal tubular sodium-phosphate transporter NaPi-IIa, may cause a range of clinical phenotypes including infantile hypercalcemia, a proximal renal Fanconi syndrome, which are typically autosomal recessive, and hypophosphatemic nephrolithiasis, which may be an autosomal dominant trait. Here, we report two patients with mixed clinical phenotypes, both with metabolic acidosis, hyperphosphaturia, and renal stones. Patient A had a single heterozygous pathogenic missense mutation (p.I456N) in SLC34A1, consistent with the autosomal dominant pattern of renal stone disease in this family. Patient B, with an autosomal recessive pattern of disease, was compound heterozygous for SLC34A1 variants; a missense variant (p.R512C) together with a relatively common in-frame deletion p.V91A97del7 (91del7). Xenopus oocyte and renal (HKC-8) cell line transfection studies of the variants revealed limited cell surface localization, consistent with trafficking defects. Co-expression of wild-type and I456N and 91del7 appeared to cause intracellular retention in HKC-8, whereas the R512C mutant had a less dominant effect. Expression in Xenopus oocytes failed to demonstrate a significant dominant negative effect for I456N and R512C; however, a negative impact of 91del7 on [P-32]phosphate transport was found. In conclusion, we have investigated pathogenic alleles of SLC34A1 which contribute to both autosomal dominant and autosomal recessive renal stone disease.