bluuebunny/crossref_metadata_2025 huggingface dataset:
Detect small object based on FCOS and adaptive feature fusion
Authors: Wu Ziang
Published: September 2023

Object identification has always been a difficult issue in the field of computer vision, where the objective is to identify the location and kind of particular objects in images. Convolutional neural networks have achieved significant advancements in accuracy and speed, and this is mostly due to their quick evolution. However, in practical applications, the detection of small objects is still an unresolved problem. Due to the sparse pixel information of small target, it is relatively difficult to extract small target features effectively. Although many methods have made significant progress, the detection rate and recall rate both have space for improvement under various conditions. This study suggests a small object detection technique that utilizes feature map weight self allocation and single-stage detection model FCOS to further increase the recall and accuracy of small object detection., which is used in aerial photography dataset and airport foreign object dataset respectively. The average detection accuracy and recall of the technique are roughly 10% higher than the baseline, as shown by the quantitative and qualitative trial findings, demonstrating the effectiveness of the adaptive feature fusion approach.
The configuration optimization of the plants in vertical farming by 3D modeling
Authors: Tan Kege , Zhang Ying
Published: September 2023

Vertical farming, a terminology in landscape architecture, is designed to cater for the demand of vegetation under the impact of excessive exploid of land, especially in densely-populated areas. The study takes vertical farming in Singapore as an example, applies 3D modeling to investigate the effect of different arrangement patterns on plant light absorption in vertical farms, and proposes some measures. Through the 3D simulation process, each square of the soil for planting can be quantified in sunlight-exposure hour. The experiment result shows that configuration with an array piling up is judicious and feasible for greenhouse growth, especially for commercial usages. Different configurations of plants influence the efficiency of utilizing sunlight, and there is a better layout for a particular site in different usages. For some cities far away from tropical areas, this configuration may alleviate the impact of lacking sunlight exposure. The main advantage of vertical farms is efficiency, as they require less land and water with more yield per acre compared to conventional farms.
Simulation of using of markov decision processes in restaurant robots
Authors: Wu Shenglin , Yang Xulong
Published: September 2023

In order to make restaurant services more intelligent and complete basic services, the robot’s forward path needs to be planned. The whole restaurant could be regarded as a probabilistic model and Markov decision process (MDP) can help solve this problem. This paper proposes has a more appropriate approach - Stoical shortest path (SSP), a form of MDP. SSP can update the value of the paths iteratively and compare them to find the path with the lowest cost and could instruct the shortest way for the robot.
Application of reinforcement learning algorithm on robot motion control and navigation in webots simulator
Authors: Tao Sizhe , Hu Yuanzhe , Huang Heen
Published: September 2023

Covid-19 has changed people’s way of life since its outbreak in December 2019. The transmission of the virus mainly relies on droplets or aerosols produced by infected people while they breathe, talk, cough or sneeze. The infection can occur over a long distance, especially indoors. To reduce connectivity between the people indoors such as in restaurants, the application of robots for food delivery may be one of the solutions. In this research, a reinforcement learning algorithm is applied to the motion control and navigation of a robot which can be modified into a robot food runner to maintain social distances in restaurants. In this project, we test the algorithm’s ability to explore the environment and find a suitable path to the target point through learning by comparing its trajectories to the shortest theoretical path. The results obtained through the simulation on Webots show that the algorithm works well to find a destination from a randomly selected starting point even though a random obstacle is presented. However, still it has great potential to be extended to a continuous environment.
Multi-Point path planning for robots based on deep reinforcement learning
Authors: Fan Zeyu
Published: September 2023

Motion Planning is a key technology for mobile robots, which decomposes a Motion task that cannot be completed by a single action into multiple discrete actions that can be performed. This paper aims to design a robot motion planning algorithm based on reinforcement learning and make a robot carry out continuous multi-objective point motion planning. Motion planning network is a planning algorithm based on a neural network, and DQN is a classical algorithm in the field of reinforcement learning. Based on the two kinds of algorithm for motion planning, the Deep Q - learning algorithm chooses the robot’s next target, and then through the motion planning of the network between the current coordinates to the next target path planning. This paper analyzes the performance of the multi-point motion planning algorithm, and the results show that the algorithm is able to a higher success rate of successful completion of the task planning, but the reward strategy derived from the experiment still has the possibility of optimization.
Danger-zone and maximum entropy deep inverse reinforcement learning for human-robot navigation
Authors: Fang Linghan
Published: September 2023

As a result of the development of artificial intelligence in recent years, scientists have gone further in the field of human-robot interaction (HRI), and one of the remaining problems is how to achieve a safe and human comfort-satisfying navigation when it comes to crowd-robot interaction (CRI). This article explores two existing deep learning reinforcement (DRL) methods, Danger-zone (DZ) and Maximum Entropy Deep Inverse Reinforcement Learning (MEDIRL). The former method proposes a Danger-Zone to predict the trajectory of pedestrians, using the DRL network to achieve obstacle avoidance and combining advanced algorithms with it to summarize the most effective combination. The latter method collects expert demonstrations in an uncontrolled environment. It uses DNN networks to predict human behavior and compares the results with the actual trajectories to demonstrate their validity. This article summarizes and evaluates these two methods. Moreover, this article also gives various outlooks on the direction of human-computer interaction.
Research on a hypothesis of performance optimization for Op-amp circuit-based neural network models
Authors: Liu Yu
Published: September 2023

The operational amplifier (Op-amp) plays a significant role in the circuit design. This article proposes a topology of the multi-stage Op-amp circuit design and the theoretical calculations and LTSpice simulations are also involved in terms of the performance including the differential input resistance, voltage gain, output impedance, total current consumption. Since these performances are affected by some resistors and other devices in the circuit, optimization below the design specifications can be achieved by changing the corresponding parameters. This paper proposes a hypothesis that (Op-amp) can be optimized by establishing a linear regression model, and on the other hand, the paper claim that (Op-amp) can be optimized by building a neural network model, which can be achieved through Python.
Research on operation optimization problem of energy storage station in microgrid based on improved particle swarm optimization
Authors: Fan Yikun
Published: September 2023

In many microgrids with a lot of uncontrollable DGs, a well-planned operation of the energy storage station is an important guarantee for the stability and economy of the microgrid. To solve the operation optimization problem, the Chaos mechanism, differential evolution, and random inertia weight were introduced to propose the traditional PSO algorithm. A mathematical model for minimizing the running cost of Microgrid is established, and through MATLAB simulation, both algorithms are used to solve the same problem to observe the improvement of the algorithm. The experimental results show that the IPSO algorithm achieves performance improvement.
Based on Gaussian filter to improve the effect of the images in Gaussian noise and pepper noise
Authors: Yu Jingning
Published: September 2023

Gaussian filter is one of the important research topics. Researchers find that Gaussian filter can suppress noise, but there is still a gap in the completeness of Gaussian filter for denoising. Therefore, the author optimized the Gaussian filter to achieve better filtering effect. By collecting SNR and PSNR data and comparing and analysing different noise types of the data under the same condition, the author explored the denoising effect of Gaussian filter method on Gaussian noise and Salt and pepper noise, and improved the Gaussian filter method. According to the comparison of SNR and PSNR data, the author found that under the default condition, the SNR value of Gaussian noise after optimization is 57.69201, and the SNR value of Salt and pepper noise is 31.5896. The PSNR value of Gaussian noise is 31.5021, and the PSNR value of Salt and pepper noise is 19.7872. The SNR and PSNR values of Gaussian noise are much larger than those of Salt and pepper noise, indicating that the denoising effect of Gaussian filter on Gaussian noise is obviously better than that of Salt and pepper noise under the same condition. The SNR value and PSNR value of Gaussian noise in the two groups of experiments are larger than Salt and pepper noise, which indicates that under the same condition, Gaussian filter is conducive to suppressing Gaussian noise and has a more significant impact on Gaussian noise.
A handbook for graphitic carbon nitrides: revisiting the thermal synthesis and characterization towards experimental standardization
Authors: Fidan Tuçe , Arat Refik , Bayazit Mustafa Kemal
Published: September 2023

Graphitic carbon nitrides (g-C3N4s) have continued to attract attention as metal-free, low-cost semiconductor catalysts. Herein, a systematic synthesis and characterization of g-C3N4s prepared using four conventional precursors (urea (U), dicyandiamide (DCDA), semicarbazide hydrochloride (SC-HCl), and thiosemicarbazide (TSC)) and an unexplored one (thiosemicarbazide hydrochloride (TSC-HCl)) is presented. Equal synthesis conditions (e.g. heating and cooling rates, temperature, atmosphere, reactor type/volume etc) mitigated the experimental error, offering fair comparability for a library of g-C3N4s. The highest g-C3N4 amount per mole of the precursor was obtained for D-C3N4 (∼37.85 g), while the lowest was for S-C3N4 (∼0.78 g). HCl addition to TSC increased the g-C3N4 production yield (∼5-fold) and the oxygen content (T-C3N4
∼
3.17% versus TCl-C3N4
∼
3.80%); however, it had a negligible effect on the level of sulphur doping (T-C3N4
∼
0.52% versus TCl-C3N4
∼
0.45%). S-C3N4 was the darkest in color (reddish brown), and the band gap energies were S-C3N4(2.00 eV) < T-C3N4(2.74 eV) < TCl-C3N4(2.83 eV) ≤ D-C3N4(2.84 eV) < U-C3N4(2.97 eV). The experimentally derived conduction band position of S-C3N4(−0.01 eV) was closer to the Fermi energy level than the others, attributable to high oxygen atom doping (∼5.11%). S-C3N4 displayed the smallest crystallite size (∼3.599 nm by XRD) but the largest interlayer distance (∼0.3269 nm). Furthermore, BET surface areas were 138.52 (U-C3N4), 22.24 (D-C3N4), 18.63 (T-C3N4), 10.51 (TCl-C3N4), and 9.31 m2 g−1 (S-C3N4). For the first time, this comprehensive handbook gives a glimpse of a researcher planning g-C3N4-based research. It also introduces a novel oxygen-sulphur co-doped g-C3N4 (TCl-C3N4) as a new halogen-free catalyst with a relatively high production yield per mole of precursor (∼24.09 g).
Biharmonic conjectures on hypersurfaces in a space form
Authors: Fu Yu , Hong Min-Chun , Zhan Xin
Published: September 2023

We apply the Murnaghan-Nakayama rule in the representation theory of symmetric groups to develop new techniques for studying biharmonic hypersurfaces in a space form. As applications of the new techniques, we settle the well-known Chen’s conjecture on biharmonic hypersurfaces in

R

6

\Bbb R^6

and BMO conjecture on biharmonic hypersurfaces in

S

6

\mathbb S^6

.
16 Drug prescribing in older patients with reduced kidney function—how do we fair?
Authors: Teh J W , Okon M , Tan T , Waters R , Canavan M , Walsh T
Published: September 2023

Background

The population is getting older and projected to rise over the coming decades. Chronic Kidney Disease (CKD) will also become more prevalent as CKD is more prevalent in older people. Patients with CKD tends to have multiple comorbidities, and this is compounded by ageing. Both these factors increase their risk of polypharmacy due to altered pharmacokinetics and pharmacodynamics. We aim to identify the rate of polypharmacy (≥5 medications) and hyper-polypharmacy (≥10 medications) in patient age ≥ 75 with reduced kidney function and to identify prescribing of medications requiring renal dose adjustment.

Methods

A cross-sectional audit was performed across 3 days in August 2022. Patients age ≥ 75 admitted were identified using PIMS. We reviewed their Kardex for medications prescribed, EVOLVE for kidney function parameter and medical notes for indications for medication prescribed and need for sick day rule.

Results

N = 74 patients included with a mean age 82.9 years, 39/74(52.7%) male and 51/74(68.9%) of weights recorded. Mean number of medications prescribed was 11.4. The rate of polypharmacy was 72/74(97.3%) while hyper-polypharmacy was 43/74(58.1%). 36/74(48.6%) have eGFR<60 mL/min/1.73m2. In this cohort with reduced kidney function, the rate of polypharmacy was 35/36(97.2%) while hyper-polypharmacy was 22/36(61.1%). 27/74(36.5%) were on DOACs. Of those on apixaban, 4/19(21.1%) incorrectly prescribed while 3/19(15.8%) may be on the wrong dose, due to missing weight. Other medications include sitagliptin; 1/2 were over-dosed, alendronate; 1/2 prescribed 35 mg weekly with end-stage kidney disease and nitrofurantoin; 1/1 over-dosed. Sick day rule is applicable in 10/74(13.5%); 9/10(90%) complied.

Conclusion

The prevalence of polypharmacy and hyper-polypharmacy among inpatient population age ≥ 75 is high and hyper-polypharmacy is more prevalent with reduced kidney function. There was incomplete and inaccurate prescribing of medications, weight and indications on Kardexes. There needs to be improved awareness regarding prescribing in an already vulnerable population with multiple co-existing chronic disease.
22 Point prevalence study of therapeutic anticoagulation dosage based on renal function in an older population
Authors: Connellan D , Cronin C , Finnan K , Power D , Sadlier D
Published: September 2023

Background

Older patients (age > 65 years) are frequently prescribed Therapeutic Anticoagulation (TA), most commonly for Atrial Fibrillation (AF) and Venous Thrombo-Embolism (VTE). Importantly, advanced age (> 80 years) increases the risk of anticoagulation-associated major haemorrhage.

Methods

A point prevalence observational study of all patients admitted to a Post-Acute Care Unit (PACU) was undertaken. In addition to demographic information, prescribing data and indication for TA was collected. Laboratory data collected included serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) using the MDRD formula. Dosing of anticoagulation based on renal function, age and weight was assessed and compared to the Health Products Regulatory Authority (HPRA) recommended guidelines.

Results

70 patients were admitted to PACU on the day of study. 34.3% (n = 24) were prescribed TA, these patients were older (age 83.7 ± 7.9 years) and majority were male (M:F = 66%:34%), median weight was 60.45 kg (range = 41.3–91.6 kg). Indications for anticoagulation were AF 71% (n = 17), VTE 17% (n = 4), mixed AF/VTE 8% (n = 2) and mechanical valve replacement 4% (n = 1). Apixaban was the most commonly prescribed anticoagulant (66%, n = 16), followed by Rivaroxaban (12.5%, n = 3), Dabigatran (8%, n = 2), Enoxaparin (8%, n = 2) and Warfarin (4%, n = 1). In 66.7% (n = 16), the CrCl resulted in lower renal function than the eGFR, and in over 40% of cases the difference resulted in a dose adjustment of TA prescribed. Overall, CrCl was <50 mL/min in 58.3% (n = 14); CrCl 30–50 mL/min in 33% (n = 8), CrCl 15–29 mL/min in 21% (n = 5) and CrCl <15 mL/min in 4% (n = 1). In 25% of patients (n = 6), the dose of TA was incorrect with lower CrCl more likely to result in dose reduction of TA.

Conclusion

TA is an important treatment in older patients and this study showed that reduced renal function is likely to result in reduced dosing, which may produce a subtherapeutic response.
23 Rapid access stroke prevention clinic, are we adhering to international recommendations?
Authors: McCarthy K , James K
Published: September 2023

Background

Transient Ischaemic attack (TIA), accounted for over 2000 hospital admissions in Ireland in 2020. 25% of all TIA presentations develop stroke. The European Stroke Organisation (ESO) and National Stroke Strategy have recommended the development of rapid access stroke prevention (RASP) clinics, to reduce morbidity associated with devastating stroke event and reduce unnecessary hospital admissions. This project reviews the functionality of a RASP clinic in an Irish hospital and compares it to international recommendations.

Methods

A retrospective chart review of patients who had been referred to the clinic over a three month period was performed. The initial referral date, clinic review date, date of any appropriate investigations and final diagnosis were collected and compared against the current recommendations. Quantitative analysis was performed on this data.

Results

A total of 43 patients were included, 18 were referred by the emergency department (ED), 25 by general practitioners (GP). On average GP referrals were waiting 5.8 days, and ED referrals 3.5 days, to be seen by a specialist. Current ESO recommendation is for specialist review within 24 hours. Of those referred, 34 underwent the recommended carotid imaging. 7 of the 43 were diagnosed with TIA, highlighting the poor sensitivity of the current risk stratification tool (ABCD2). The average time from symptom onset to referral was 3.7. With 15 patients waiting 35 days prior to seeking medical advice.

Conclusion

It is clear that, at present, the RASP clinic is not meeting the international recommendations. A number of improvements to the referral process have been proposed. The move to an electronic referral process would reduce unnecessary steps in the current pathway and would ensure the appropriate investigations were carried out, at the time of initial contact. Improved patient education on symptoms of TIA is needed. A repeat audit will take place to review if these changes have had a significant impact.
36 A comparison of the MNA® and MUST tools for nutritional screening of older patients in a day hospital setting
Authors: Connolly M , O'Brien C , Barnes L
Published: September 2023

Background

The aim of this audit was to compare the ability of the Malnutrition Universal Screening Tool (MUST) and the Nestle Short Form Mini Nutritional Assessment (SF-MNA®) to identify malnutrition in the older person in a Day Hospital setting. Factors such as feeding difficulty, reduced mobility and psychological distress can result in higher risk of malnutrition for the older person. An accurate screening tool for the nutritional assessment of the older person is key to preventing and managing malnutrition so that the best clinical outcomes can be achieved.

Methods

This audit was carried out over a three week period. Data from SF-MNA forms and MUST were collected prospectively on the older person (>65 year old) upon visiting the day hospital. Statistical analysis was carried out to compare the results.

Results

This audit includes 92 patients (n = 92). Over the three-week period, 21 patients were referred for dietetic consultation using the SF-MNA scores in comparison to 6 patients who had a MUST ≥2 which results in referral to dietetics. Based on the SF-MNA scores, 7% of patients were malnourished, 41% were at risk of malnutrition and 52% were of a normal nutritional status.

Conclusion

In conclusion, it appears that the SF-MNA would be a more appropriate and sensitive screening tool in comparison to the MUST in identifying malnutrition in the older person Day Hospital setting. The SF-MNA includes a greater variety of questions compared to the MUST (including questions on cognitive decline, psychological distress and mobility). As a result, the SF-MNA could be considered better at identifying those at risk of malnutrition compared to the MUST.
111 Normal Pressure Hydrocephalus—a disease made for frailty clinics
Authors: O'Mara G , Donlon K , Morrissey F , Burke S , Dwyer R , Crean N , Finneran F
Published: September 2023

Background

NPH is one of the few reversible causes of dementia and gait disturbance. Multidisciplinary assessment is vital for diagnosis. CT findings are variable but scoring systems are available. Trial of high volume CSF drainage can be technically difficult in this population and even if there is measurable improvement after CSF drainage, referral for VP shunting can take months to years.

Methods

We present a Case Series of 10 cases of Probable NPH presenting to RFIT (Roscommon Frailty Intervention Team) over a 1 year period. Diagnosis was based on ‘Radscale’ CT Brain criteria (1) (used to differentiate from ventriculomegaly ex-vacuo) with presenting Gait and Cognitive deficits and positive response to high volume CSF drainage. Pre- and post-LP (up to 40 mL CSF drained) Gait and Cognitive findings are presented.

Results

Ten patients were diagnosed as having probable NPH using the Imperial College London diagnostic pathway. Three patients were deemed not to be fit for VP shunt. One elected to have a trail of CSF drainage for diagnostic reasons. Seven patients had high volume CSF drainage. Five patients showed improvement of >15% in timed up and go. Two patients showed no improvement post-LP. Five patients were referred for VP shunt. Three patients have had shunts inserted and have improved. Two still await VP shunt insertion.

Conclusion

10 cases of probable NPH were diagnosed by the RFIT team in 1 year. We feel that as one of the very few reversible causes of progressive cognitive impairment and gait disturbance it is imperative that NPH be diagnosed as early and as definitively as possible. We highlight the utility of the Radscale CT Brain scoring system as an initial diagnostic prompt. We feel that this can be used by non-radiologist doctors, Frailty CNS or ANP, Physiotherapists in order to prompt teams to consider NPH in the differential diagnosis of Gait and cognitive abnormalities.
139 Emerging trends in the Emergency Department of a level three hospital using the Clinical Frailty Scale
Authors: Carthy D , Bell A , Cafferty G , Murphy K , Noone T , Brennan L
Published: September 2023

Background

The Clinical Frailty Scale (CFS) is a highly regarded and well validated diagnostic instrument used to measure frailty in older adults in the emergency department (ED). The purpose of this review is to highlight emerging trends between the CFS and length of stay (LoS) in older adults in a level three hospital over a 2 year period.

Methods

We performed a systematic literature review to identify research that used the CFS in the ED. In conjunction with the literature, we completed a retrospective data analysis of patients over 75 admitted and discharged within a 2 year period. A comparison was made with patients reviewed by the Frailty Intervention Therapy Team (FITT) who received an interdisciplinary assessment.

Results

Over a 2 year period, 11, 961 patients over 75 years were triaged in the ED and 3,076 (26%) of these patients were assessed by the FITT. The average length of stay (LOS) for patients assessed by the FITT was 6.8 days in 2021 and 6.6 days in 2022. This is significantly lower than the hospital average for over 75 years (10 days). On closer review, it was apparent that patients scoring a CFS of 6 had a direct correlation with longer length of stay. In 2021 and 2022, a patient with a CFS 6 had a 10 day LOS, CFS 5 had an 8 day average and CFS 4 had a 5 day average. In addition, CFS 6 presentations were notably climbing. 13% of patients assessed in 2021 scored a CFS 6 (143). This rose sharply in 2022 to 24% (473).

Conclusion

Our results are consistent with other well documented studies on the relationship between CFS and increased LOS. The increase in presentations of patients with a CFS6 will increase demand on EDs; increase inpatient bed days and inevitably the associated cost and resource implications on the acute sector.
148 Urinary incontinence: a hospital inpatient point prevalence study
Authors: Murphy E , Joyce R , Roche A , Osman O , Rasheed M U , O’Connor M
Published: September 2023

Background

Urinary incontinence is a common, although under-reported, problem in hospitalised older adults. One Irish study reported that 26% of hospitalised patients had urinary incontinence. Hospital-acquired urinary incontinence is associated with prolonged hospital stays, infection, poorer functional outcome, and poorer quality of life. We undertook a point prevalence study of all inpatients in a Level 3 hospital, as part of an audit focused on documentation and awareness of urinary incontinence.

Methods

Data were gathered on all inpatient at a single timepoint. The Emergency Department and Intensive Care Unit were excluded. Biographical data, admission diagnoses, diagnosis of dementia, delirium and urinary incontinence, use of diuretics and urinary incontinence medications, toileting plans, continence care bundles and mobility status were gathered from medical notes, nursing notes and drug Kardexes.

Results

The dataset compromised 309 patients. 11% were < 50 years old, 8% aged 50–59, 15% aged 60–69, 29% aged 70–79, 29% aged 80–89 and 8% were > 90 years old. 24% had a diagnosis of dementia, and 25% had delirium. Pre-admission continence status was known for 81% of patients; 8% catheterised, 12% incontinent, 12% had occasional accidents and 68% of patients were continent. At the time of data collection, 21% were catheterised. 14% incontinent, 18% had occasional accidents and 48% of patients were continent. 10% of patients were prescribed medications for urinary incontinence and 22% diuretics. 12% of patients with dementia were continent and 18% of patients with delirium. 40% of patients were independently mobile, 32% required assistance of one person, 17% assistance of two and 11% required a hoist. Dependent mobility was associated with increased rates of incontinence.

Conclusion

Our study found a high prevalence of urinary incontinence in hospitalised patients. Risk factors identified included older age, reduced mobility, long duration of admission, presence of dementia and or delirium and use of diuretics. These risk factors could be targeted as quality improvement initiative to promote continence in hospitalised patients,
164 Association between medications and increased fall risk among older adults: implications for medication management and fall prevention interventions
Authors: Wade R , Burke K , Surendrannair U , Devitt A , Dore F , Cooney F , Ciuba D , Connolly W
Published: September 2023

Background

Falls among older adults are a significant public health concern, and certain medications have been identified as potential risk factors. The National integrated care programme for older people is prioritising services to be developed for older people in the areas of frailty, dementia and falls.

Methods

Information on recurrent falls, polypharmacy, and the number of falls experienced by each patient was collected retrospectively via chart review. Logistic regression analysis was performed to assess the association between STOPPfall medication use and the risk of falling, with odds ratios and p-values reported.

Results

Data was available on 48 patients (median age 79, range 65–92) of a total of 73 patients seen. The gender distribution was 62.5% female. Among the patients included, 31 experienced recurrent falls, and polypharmacy was observed in 35 patients. The distribution of falls in the previous year was as follows: 8 patients had three or more falls, 5 patients had two falls, 18 patients had one fall, and 14 patients did not experience any falls. Logistic regression analysis revealed that the use of antihypertensive medications was associated with an increased risk of falling, with an odds ratio of 3.85 (CI =1.08–13.75, p = 0.037). There was no statistically significant association between falls and other STOPPfall medication.

Conclusion

In this study, antihypertensive medications were found to be significantly associated with an increased risk of falling among older adults. These findings emphasise the importance of considering medication-related factors when assessing fall risk in this population. Further research is warranted to determine whether appropriate medication management strategies can mitigate fall risk. Effective fall prevention interventions should incorporate comprehensive medication reviews, particularly for patients on antihypertensive therapy, to optimise patient safety and reduce the burden of falls in older adults.
193 A review of the bed rail use and use of a bed rail risk assessment tool in a rehabilitation unit
Authors: O'Connor A , Elsheikh N , Doyle M , Morris E , Ryan D , McDonagh R
Published: September 2023

Background

Bed rails are used frequently throughout acute, community and home care environments to reduce the risk of bed occupants falling out of bed and causing injury. The use of risk assessment, along with patient preference, has been advised by HSE.

Methods

A chart review in a rehabilitation ward was undertaken to determine consideration and compliance of a Bed Rail Risk Assessment Tool (BRRAT) by nursing staff during inpatient stay.

Results

44 patients were assessed. 31(70%) used a bed rail, with documented hourly observation noted in 97% of these charts. Of the 31, 30 patients (71%) voiced preference for a bed rail, specifying safety (n = 5) or fear of falling (n = 3) as a reason. Patient preference for no bed rail was documented in the majority (n = 7/9). Where bed rails were used, no patients were deemed at high risk of injury or entrapment. 4 patients at medium risk elected not to use a bed rail with the remaining 3 patients at medium risk choosing to have a bed rail despite the risk, due to fear of falling. All patients at low risk chose to have a bed rail (n = 25). Four patients had no BRRAT documented. 82% of decisions were documented to have been discussed with the patient. 18% were not assessed by the BRRAT as patient preference was taken solely into account.

Conclusion

A high proportion of patients were involved in decision-making, and the majority chose to use bed rails in a rehabilitation setting. Most had documented hourly observation of rails. The use of a BRRAT tool allows one to assess the risk of bed rails also on an individual basis, to ensure a well-rounded decision can be made. A full assessment should be carried out however, to inform the patient of their risk before taking their final decision into account.
229 OPTI-3S (criteria for optimising medicines by stopping, stepping down, or switching to safer alternatives): consensus validation via a Delphi method
Authors: Ali A A H , McMahon N , Ryder S
Published: September 2023

Background

No consensus-based criteria set exists specifically for Potentially Inappropriate Medications (PIMs in hospitalised frail older adults. This study aimed to develop the OPTI-3S core criteria for optimising medicines, using a modified Delphi method.

Methods

The OPTI-3S preliminary list was developed by the research team based on an extensive literature review. A modified Delphi method was conducted to validate a subset (‘core list’) of these preliminary statements. The Clinical Frailty Scale (CFS) was used to differentiate between frailty levels. Eleven practising experts reviewed the core list and full preliminary list in the first round. Participants were asked to rate their agreement with the core list of statements, using a 5-point Likert scale, and suggest additional statements from the full list, or based on their own knowledge. Statements with a median rating of 1 or 2 (i.e. strongly agree or agree) and 75th percentile of 2 or less were included in the final set.

Results

Nine experts completed the three rounds, after which consensus was reached on the inclusion of 45 statements: 17 statements in the first round, 25 in the second round, and three in the third round. These statements suggest optimising and/or deprescribing antidiabetic agents (n = 7), central nervous system (CNS) medications (n = 7), genito-urinary medications (n = 7), antithrombotic agents (n = 5), statins (n = 4), antihypertensives (n = 4), osteoporosis medications (n = 3), heart failure medications (n = 2), perioperative analgesia (n = 2), diuretics (n = 1), proton-pump inhibitors (n = 1), vitamins and supplements (n = 1), and anticholinergic medications (n = 1). 22 statements apply to a specific CFS frailty level, while the remainder apply to all frail older persons (i.e. CFS of 4 or more).

Conclusion: The literature- and consensus- based OPTI-3S core criteria comprise 45 statements relating to PIMsand suggest preferential medications in hospitalised frail older adults. The OPTI-3S criteria may be a useful guide for medication optimisation in frail older people.
240 Reviewing time-to-surgery for acute hip fractures in older adults to develop ‘SipTilSend’ policies
Authors: Mullen M , Koay W J , Duggan J
Published: September 2023

Background

Current international guidelines for pre-operative fluid fasting is 2 hours. Patients presenting with hip fractures often fast indeterminately from the midnight prior to day of surgery. Prolonged oral fluid deprivation is unpleasant for patients and is associated with patient discomfort, malaise, dissatisfaction, nausea and vomiting, dehydration and possibly delirium. Our aim was to review the times-to-surgery with a view of implementing ‘SipTilSend’. ‘SipTilSend’ aims to shorten pre-operative fluid deprivation by allowing patients to sip water or other clear fluids until they are sent to theatre.

Methods

Data of patients over the age of 65 admitted with a hip fracture collected as part of the Irish Hip Fracture Database over a five month period from December 2022 to April 2023 was analysed. This included age, time-to-surgery, reasons for delay in surgery as well as 4AT scores on day1 and day3.

Results

Of the 55 patients presenting with hip fracture, the average age was 79, with a mean time-to-surgery of 34.8 hrs. 83.6% of patients (n = 46) achieved time-to-surgery of <48 hours, with a mean of 25.2 hrs. The shortest time-to-surgery was 8.3 hrs, longest 46.9 hrs. 9 patients underwent surgery after 48 hours from time of presentation, five were delayed due to being on anticoagulants, two due to theatre overrun, one required a pacemaker check and one had experienced polytrauma. The incidence of delirium (4AT score > 4) was 14.5% (n = 8), the mean time-to-surgery for these patients was 32.9 hours.

Conclusion

Time to surgery for patients over the age of 65 presenting with acute hip fractures can be varied and extended. Despite efforts of proactive trauma list planning to improve fasting times, this effect in practice was small. Our plan is to implement ‘SipTilSend’ and perform a re-audit on the overall risk for aspiration and patient comfort.
265 Polypharmacy and potentially inappropriate medication prescriptions in older Nursing Home Residents presenting to the Emergency Department
Authors: Fallon A , Noonan C , Kennelly S P
Published: September 2023

Background

Nursing Home Residents (NHR) have high rates of polypharmacy and Potentially Inappropriate Medication (PIM) prescriptions. Emergency Departments (ED) are an access point to acute hospitals for unwell NHRs. Attendance is associated with adverse outcomes. This project aims to identify polypharmacy and PIMsin older NHRs presenting to ED and associations with adverse outcomes.

Methods

A prospective cohort study including all NHR aged≥50 years presenting to ED over one year (01/10/2019–30/09/2020). Data collected included demographics, medications at attendance, Charlson Comorbidity Index (CCI), Clinical Frailty Score (CFS), modified Barthel Index (BI), continence, falls history, ED presentation details, ED Length of Stay (LoS), hospital LoS and 6-and 12-month mortality. Polypharmacy was defined as ≥5medications. The Screening Tool of Older Persons’ Prescriptions version2 (STOPP), STOPPFrail and Beers’ Criteria were used to identify PIMs

Results

There were 516 attendances by 343 individual NHRs. Mean age was 78.6 years (50–103; ±10.9). Prescriptions were available for 93.0% (480/516). A mean of 12.4 (0–31,±5.24) medications were prescribed per patient, with polypharmacy present in 96.0% (461/480). Mean age of the polypharmacy group was lower (76.2 vs 83.7; p < 0.001). There were no significant differences in CCI, CFS or modified BI scores. STOPP identified 99% (n = 475) as having ≥1 PIM(mean 7.47[0–19; ± 3.67] per patient). All had ≥1PIM according to STOPPFrail(mean 8.59[0–26; ±3.90] per patient). Beers’ classified 97.5% (n = 468) as having ≥1PIM (mean 4.32[0–13,±2.41] per patient). STOPPFrail identified continence (71.9% vs 65.8%) and intellectual disability (76.7% vs 67.5%) as significantly associated with a higher proportion of PIMsp < 0.001). Beers’ identified delirium and hospital admission as associated with a lower proportion of PIMs31.7% vs 36.8%, 33.2% vs 38.1% respectively; p < 0.001). All tools showed NHRs who died at 6-and 12-months had a lower proportion of PIMs

Conclusion

Polypharmacy and PIMsare common in NHRs attending ED and should be considered at presentation. NH liaison services may facilitate medication review and deprescribing.
287 Profile of patients receiving physiotherapy within an Integrated Care Programme for Older Persons (ICPOP) service covering a large geographical area
Authors: Gavin C , Walsh L , Fitzmaurice C , Rogan M , Sestak K , Canavan M , Costello M
Published: September 2023

Background

The Physiotherapist is a key member of the ICPOP team and the need for intervention is identified through Comprehensive Geriatric Assessment (CGA) and interdisciplinary collaboration which includes effective communication with Primary Care to avoid duplication. Our aim was to: (1) Examine the profile of those who received Physiotherapy within ICPOP and (2) Identify those known to Primary Care (PC) Physiotherapy.

Methods

We conducted an audit of 85 patients who received ICPOP Physiotherapy from January 2023—April 2023. Key demographics were obtained along with Clinical Frailty Scale (CFS) score, reason for referral to ICPOP and rationale for Physiotherapy intervention.

Results

Of this cohort 59% were Female (n = 50) with Median age of 83 years. One third were referred to ICPOP for evaluation of Falls, one third for Frailty, 21% for evaluation of cognition and the remainder were a combination of two or more of the above. Of those requiring Physiotherapy, 28% had a recent decline in mobility, 28% had overall deconditioning, 26% had falls, and the remainder had balance and pain issues. Median CFS score was 5. Timed Up and Go (TUG): median 19.85 s, median grip strength: 14 kg. Initial mobility assessment showed 65% requiring gait assistance. 76% of initial assessments took place in a domiciliary setting. 58% of people were previously known to PC Physiotherapy.

Conclusion

CGA can identify a need for Physiotherapy intervention for older adults not outlined as a concern at initial referral. We identified, an unmet need for patients with reversible frailty and the importance of a close working relationship with PC Physiotherapists to ensure timely and appropriate service provision to this cohort. This audit identified two main challenges-the large geographical area currently covered and the lack of dedicated ICPOP hubs for assessment and optimal intervention.
297 Assessing continence care in a rehabilitation unit: insights from an audit
Authors: Davey N , Merron G , El Eraky N , Pereppadan B , Fallon A , McDonough A
Published: September 2023

Background

Urinary incontinence, a prevalent condition and one of the original geriatric giants, remains a taboo topic and is frequently underreported. Urinary incontinence significantly impacts patients and often times their discharge destination. However, urinary incontinence is neither inevitable nor always irreversible. This audit aimed to assess continence and incontinence wear in a rehabilitation facility.

Methods

The continence care quality in a medical gerontology ward was assessed using the Royal College of Physicians (RCP) National Audit of Continence Care (NACC) standard. A prospective audit was conducted over a five-day period, documenting incontinence wear and urinary continence on a medical gerontology ward. Two interventions were implemented prior to re-auditing. Firstly, continence was incorporated as a teaching topic on the Non-Consultant Hospital Doctor (NCHD) teaching schedule. Secondly, the Multi-Disciplinary Team (MDT) proforma was adjusted to include a patient-specific continence record. A snapshot re-audit was conducted to evaluate any changes resulting from these interventions.

Results

In the initial audit, 31 patients were included. Among them, 26 (83.9%) wore incontinence wear, with 21 (80.8%) voluntarily opting for it. Urinary incontinence was documented in 13 patients (41.9%). In the re-audit, 40 patients were included. Among them, 27 (67.5%) wore incontinence wear, with 19 (70%) choosing it. Urinary incontinence was documented in 18 patients (45.7%).

Conclusion

The re-audit revealed a slight decrease in incontinence wear usage (67.5% compared to 83.9% initially). Many patients wearing incontinence wear expressed a preference for it in both audit cycles. The prevalence of urinary incontinence remained similar between audits (41.9% and 45.7% respectively). The persisting prevalence of urinary incontinence calls for effective strategies to address this issue. Additionally, the patients’ preference for incontinence wear emphasises the importance of engaging not only the MDT but also the patients themselves in future interventions. Future projects should focus on gaining a deeper understanding of patients’ perspectives on continence care and evaluating the impact of incontinence on patient outcomes.
32 An evaluation of a 6 week physiotherapy strength and balance intervention for the older person in primary care
Authors: Kennedy N , Daniels M , Sayers K
Published: September 2023

Background

Ageing is associated with a decline in skeletal muscle mass, strength and function, resulting in sarcopenia and frailty. Guidelines for physical activity in older adults recommend multimodal exercise. The aim of this study was to evaluate a group exercise intervention for older adults attending Primary Care Physiotherapy.

Methods

Participants were over 65 years, independently mobile with or without an aid, and deemed suitable by the referring Physiotherapist. The 6 week intervention based on the Otago programme, with additional upper limb strength training. It was delivered once weekly with additional independent home sessions advised. Outcome measures included SARC-F (Sarcopenia Screening Tool), grip strength, 5 Times Sit to Stand (5XSTS), and Timed Up and Go (TUG). Data was analysed using descriptive statistics.

Results

31 participants completed the intervention (22 women and 9 men). Mean age 80 years (SD = 5.6). 52% of participants (n = 16) had a score of ≥4 greater using the SARC-F Tool indicating a need for further evaluation. The mean grip strength for women was 15.70 kg (SD 4.4) suggestive of probable sarcopenia based on EWGSOP2 definition. Mean grip for men of 29 kg (SD = 8) was within normal range. Mean TUG was 13.8 seconds, indicating falls risk. Mean 5XSTS in all age categories was lower than aged matched norms suggesting functional impairment (60–69 years = 11.14 sec, 70–79 years = 18.58 sec, 80–89 years = 17.2 sec). Following intervention, mean grip strength for men improved (33.5 kg, SD = 8.8). Mean grip strength for women improved to within normal range (18.4 kg, SD = 4.3). Mean TUG score improved to 12.6 sec. Mean 5XSTS improved but remained lower than age matched norms (60–69 years 9.84 sec, 70–79 years 16.72 sec, 80–89 years 15.52 sec).

Conclusion

The study demonstrated the accessibility, feasibility and benefits of a Physiotherapy group strength and balance intervention in Primary Care.
209 The experiences of native Irish speaking older adults in navigating healthcare services in Ireland: a generic qualitative inquiry
Authors: Breathnach C , Hynes S
Published: September 2023

Background

Research on the impact of language barriers in healthcare is well-developed. However, limited evidence includes the patient perspective. Furthermore, there is an absence of qualitative literature on the healthcare experiences of native Irish speaking older adults, despite the population’s recent and predicted growth. This study aims to provide insight into the healthcare experiences of native Irish speaking older adults, who dwell in Gaeltacht areas, and to explore their perspectives on what promotes or hinders their access to healthcare services in Ireland.

Methods

Participants were recruited through poster and radio advertisement. Convenience sampling was used. The researcher conducted semi-structured interviews in the Irish language with seven participants. Interviews were conducted in a health unit, audio recorded and transcribed. Data was coded using Nvivo software and analysed thematically through the Irish language. Quotations were presented in both Irish and English to illustrate findings.

Results

Participants reported their experiences of Irish healthcare services, and preferences for healthcare interactions. Shared communications preferences included using pidgin Irish, English, or interpreters. Participants preferred if healthcare providers were proficient in both Irish and English, and valued a long-standing therapeutic relationship with healthcare providers. In addition, participants commented that communicative difficulties they experienced must be exacerbated for monoglot Irish speakers.

Conclusion

Native Irish speaking older adults’ healthcare experiences aren’t ‘black and white’. Each participant had individual preferences for communication during healthcare interactions, speaking from both negative and positive experiences. To cater for the native Irish speaking older adult population in Gaeltacht areas, a consensus among participants was that healthcare providers working in these areas should be fluent in Irish and English, and have a long-term contract. This study highlights the need for language concordant care to be available for native Irish speaking older adults living in rural Gaeltacht areas, and further emphasises the importance of language concordant care for minority language speaking populations.