bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a Simulation Educational Programme Within the Department of Stroke Medicine
Authors: McCarthy Kate , Gannon Elizabeth , Ryng Stephanie , James Kirstyn
Published: September 2024

Background

Simulation has been commonly utilised in medical education as both a learning and assessment tool. Its utilisation in stroke medicine helps to facilitate learning in acute pathways, interprofessional communication, communication with family and patient and the application of evidence-based care.

Methods

The programme was initially developed as part of a pilot with University College Cork. The “FAST Call” scenario was seen as an opportunity to test the acute pathway. A simulation coordinator led out on the technical facilitation of simulation. Scenarios were developed to enable education in different facets of stroke.

Key learning areas identified were:

Quarterly feedback from all medical trainees in the department allowed qualitative assessment of the programme.

Results

Trainee feedback yielded positive results with all NCHDs reporting they found the programme beneficial from a clinical skills perspective. It improved confidence in dealing with acute stroke calls and provided a psychologically safe learning environment. The feedback also identified potential barriers and delays in the stroke pathway and allowed the utilisation of simulation as an educational opportunity.

Conclusion

The simulation programme has provided trainees within a stroke department with a psychologically safe learning environment. This has allowed the department to identify areas of physical or technical constraint when delivering care to stroke patients. The department has also gained the opportunity to discuss evidence-based medicine in a non-didactic format, along with providing NCHDs with the opportunity to manage scenarios in a safe manner. Simulation programmes and inclusion of this style of training as a core-component of training can be spread to other components of the geriatric medicine curriculum.
Improving Decision-Making and Documentation on the Acute Medical Post-Take Ward Round
Authors: Thomas Niju , Ocsio Aimee , Yun John Paul , Hogan Clara , Donovan Tomas , Tyulkin Stanislav , Riaz Saad , Ryan Maeve , Hickey Paula , Butler John
Published: September 2024

Background

Frail Older people have a substantial presence on the Acute Medical Take. They also have a large conversion rate to hospital admission after the Post-Take Ward Round (PTWR). They decondition and deteriorate with long delays in the Emergency Department. The PTWR is a particularly important part of the patient journey particularly for capturing senior decision-maker input around key clinical and patient flow parameters. PTWR documentation in Irish hospitals is currently largely captured in an open freehand manner. Decisions made on the PTWR have implications across several domains including quality of care, patient safety, medico-legal outcomes as well as informing patient flow metrics. A structured & standardised approach to PTWR decision-making is anticipated to improve outcomes across these respective domains.

Methods

A standardised PTWR tool (1) was used to replace freehand PTWR case-note entries. All medical consultants were invited to use the tool on their PTWRs. All auditors were trained in gathering data consistently. Spot audits were undertaken on all wards before and two weeks after the introduction of a Standardised PTWR clerking tool. Capture of Key PTWR documentation and evidence of decisions made were identified. The Chi2 test was used to compare outcomes before and after introducing the intervention tool.

Results

138 PTWR patients (number >65y: 124) documentation were assessed before the introduction of the PTWR tool and 74 patients afterwards. Significant improvement was found across 12/16 domains including decisions made relating to Investigations reviewed, Diagnoses made, Thrombo-prophylaxis considered, Ceilings of care reviewed, Discussions with patients and/or advocates and Predicted Date of Discharge (p<0.001).

Conclusion

A standardised PTWR tool significantly improves the capture of key documentation and decisions made on the Acute Medical Take above conventional freehand case-note entries. This may have significant implications for the care of older people clinically both from an individual and overall patient flow perspective.
Validation of a Self- Administration of Medications Assessment Tool for Home Dwelling Older Adults During an Elective Admission for Rehabilitation
Authors: Doyle Mary , Mathew Jincy , Morrin Niamh , Jordan Aoife , Smyth Hannah , Ryan Dan
Published: September 2024

Background

Safe medication management is challenging among older adults due to an increased prevalence of multiple chronic diseases often requiring complex multi-drug pharmacotherapy. Poly-pharmacy can increase the risk of non-adherence to medications in home dwelling older adults, reported as ranging from 6 to 55%. During hospital stays older adults may lose control over their medication management due to the shift in responsibilities from patient to healthcare professionals. Self-administration of medication (SAM) can increase patients’ understanding about their medication and promote independence and autonomy in the hospital setting.

Methods

From January -December 2023, all elective admissions were assessed for inclusion in SAM during their inpatient stay (n-74). An assessment tool, validated for use in the residential care setting was used. The tool, comprising of 17 items assesses the patients experience of self- medication, capability to self-medicate (cognition and function) and knowledge of their medications. Criteria for inclusion in SAM included older adults who self-administered their medication at home prior to admission and assessed as suitable using the assessment tool. Medication reconciliation was undertaken by a pharmacist for all patients prior to commencing SAM.

Results

42% of admissions (n=31) were deemed suitable for SAM during their inpatient stay. Mean age 79 years (age range: 68-96 years). Number of medications > 5 medications daily. 90% (n-28) successfully completed SAM throughout their stay with 10% (n-3) reverting to nurse administration due to changes in medication during their inpatient stay

Conclusion

The use of the assessment tool supported a 90% success rate for SAM in this cohort. Further testing is recommended to evaluate the tool in other in-patient settings. An evaluation of SAM for the prospective of older adults and nursing team is also recommended.
Adult-Child to Older-Parent Coercive Control: A Hybrid Co-constructed Concept Analysis
Authors: Quinlan Freda , Donnelly Sarah , O'Donnell Deirdre
Published: September 2024

Background

In the absence of an established definition, the term filial coercive control is used to denote a relationship between an adult-child and their older-parent(s) which is characterised by a persistent pattern of controlling and abusive behaviour. This study explores how this phenomenon is understood in the literature by identifying and synthesizing the current state of knowledge of in this field of research. The knowledge generated from this concept analysis, along with the tacit knowledge of the author as a practitioner- researcher, was synthesised to produce a tentative conceptual framework. The distinctions between filial coercive control from psychological elder abuse are explained with the use of models and contrary cases. The hypotheses generated from this study will be used to guide semi-structured interviews with safeguarding social workers in a later qualitative study.

Methods

A scoping review methodology was adopted to guide the literature review, while a concept analysis methodology guided data extraction and analysis. Drwing on Rodgers’ evolutionary concept analysis method, a co-constructed research methodology was developed for this study.

Results

The concept of filial coercive control is understood in the context of the following antecedents: ageist norms, a parental relationship (both biological and non-biological), physical proximity and spatiality, along with the controlling characteristics and tendencies of the abusive adult-child. The defining attributes include the exercise of power through control, dependency and entrapment, isolation and confinement, and fear and intimidation. Through a process of reflective thematic analysis, the defining attributes were used to guide the construction of models and contrary cases to illustrate the findings.

Conclusion

Existing bodies of theory fail to adequately describe the phenomenon of filial coercive control. A tentative operational definition and a conceptual model are proposed that provide a starting point for future research and to help to inform professional practice and education.
Predictors Of Loneliness In Older Irish Adults And Its Relationship To Depression
Authors: Sherry Kenneth Mc , Moloney Kevin , Laird Eamon , Ward Mary , Hoey Leane , Hughes Catherine F , Strain JJ , Cunningham Conal , McNulty Helene , Lannon Rosaleen , Molloy Anne M , McCarroll Kevin
Published: September 2024

Background

Loneliness can affect up to 30% of older adults and is associated with increased morbidity and all cause mortality. Loneliness is also a major risk factor for depression. We aimed to explore the predictors of loneliness in older Irish adults and its relationship to depression.

Methods

Study participants were Irish adults aged >60 years in the Trinity Ulster University Department of Agriculture (TUDA) study. Participants with an MMSE <24 were excluded, to prevent the inclusion of individuals with dementia. Loneliness in the last week was identified from the 'loneliness' question in the Center for Epidemiological Studies Depression Scale (CES-D) and considered present when experienced ≥1-2 days in the last week and absent when experienced rarely or none of the time. Depression was defined as a CES-D ≥16. Predictors of loneliness were explored in multinomial regression models as well as its association with depression.

Results

There were 4561 participants, 70% female, mean age 70.1 years and 21.6% experienced loneliness. Positive independent predictors of loneliness were living alone (OR 5.2, CI 4.41-6.14, p<0.001), female sex (OR 1.29, CI 1.07-1.56, p=0.009), timed up and go >12 seconds (OR 1.46-2.32, p<0.001) non-driving status (OR 1.37, CI 1.13-1.67, P=0.001) and lower MMSE (OR 0.57, CI 0.41-0.79, p=0.0006). Those who reported loneliness had a higher prevalence of depression (32.1 vs 3.3%, p<0.0001).

Conclusion

Living alone was, as expected, the greatest predictor of loneliness followed by physical frailty, non-driving status, female sex, and lower cognition. A high proportion (one third) who felt lonely had depression, though low mood may increase the perception of loneliness independent of social engagement. A limitation is that we did not have a specific validated tool to assess loneliness or to distinguish between `emotional' or `social' loneliness.
Flagging Frailty in the Emergency Department: A System to Identify and Visualise Frailty
Authors: Brennan Louise , Bentley Kate , Edge Lucinda , Molamphy Aoife , Keane Barry , Enright Alison , Keogan Fiona
Published: September 2024

Background

Older adults with frailty who present to the Emergency Department (ED) are at increased risk of hospitalisation, prolonged length of stay, deconditioning and loss of independence.1 Early identification of frailty using a validated tool, such as the Clinical Frailty Scale (CFS), is widely recommended to inform clinical decisions, identify the best pathway of care for older adults with frailty, and for potential use as a predictor or an outcome.2 We aimed to develop and implement a system of frailty identification which is highly visible, digitised and integrated with routine ED processes.

Methods

In the ED of a large teaching hospital, an expanded interdisciplinary Acute Frailty Team (AFT) commenced work in the ED in February 2024. The AFT aimed to screen all over 70s presenting within working hours for frailty using CFS. ED consultants collaborated with software developers through iterative design stages to create a ‘Frailty Flag’ for the ED Whiteboard with the requirements that it is highly visible, easy to use and highlights patients with higher frailty scores.

Results

In April 2024, a ‘Frailty Flag’ was launched on the ED Whiteboard, prominently displaying the CFS and using traffic light colouring to highlight those with higher CFS scores. As part of standard work, the AFT populate the CFS on the ED Whiteboard, which is viewed by all staff in ED on large wall-mounted screens. Feedback from ED and inpatient staff indicate that a highly visible frailty score is a valuable addition to the ED Whiteboard which allows them to prioritise care and supports decision making regarding suitability for geriatric care pathways.

Conclusion

A Frailty Flag on the ED Whiteboard allows for easy, accessible communication of frailty scores to the ED multi-disciplinary team. Next steps involve integrating the Frailty Flag with in-patient systems and developing standard work for out of hours use of the system.
Injury Characteristics and Frailty Patterns in Older Patients Admitted with Hip Fractures in an Irish Hospital
Authors: Bradley Eoin , Lannon Rosaleen , McCarroll Kevin , Romero-Ortuno Roman , Fitzpatrick Donal
Published: September 2024

Background

The Irish Hip Fracture Database (IHFD) has played a crucial role in improving hip fracture care over the last ten years. However, the IHFD does not include detailed data on the nature of the injury leading to hip fracture. In this study we examined the characteristics of the injuries leading to hip fractures and their relationship with frailty.

Methods

We conducted a retrospective chart review of all hip fracture patients aged over 60 years old admitted to an acute orthopaedic floor in a tertiary hospital from May 2023 to May 2024. Patients under 60 years old, and those with periprosthetic fractures were excluded. Delirium was based on a composite of clinical diagnosis and/or a 4AT score ≥ 4. Frailty was quantified using the IFHD Frailty Index. The relationships between various injury characteristics were examined with Student T test and χ square.

Results

The study included 168 patients, 73.8% female, mean age was 80.1±11.2 years. Of these, 91.1 % were fragility fractures and 4.8% were atraumatic. Indoor falls accounted for 67.9% of cases. Assault led to hip fracture in 5.4% (n=9) of all fractures and 17.0% (n=8) of outdoor fractures. Frailty Index was higher in those with fragility fracture vs. non fragility fracture (0.19 vs. 0.10, p<0.003), as well as in those with indoor vs. outdoor fractures (0.21 vs 0.16, p<0.001). Indoor fractures were significantly associated with delirium (p=0.012), frailty index (p<0.001), and age (p=0.016).

Conclusion

The great majority of hip fractures were fragility fractures occurring indoors. Patients who suffer hip fractures indoors are frailer and more likely to develop delirium. These findings underscore the importance of targeted falls prevention strategies for frail older adults, including optimizing the home environment and reducing hazards within the home. The number of hip fractures due to assault deserves further examination.
All On One Page: Getting Daily Meal Ordering Right In A Rehabilitation Setting
Authors: Montague Orla , Coleman Kerrie , Fhaolain Aisling Ni , Byrne Hannah
Published: September 2024

Background

Recently the rehabilitation hospital expanded to over 100 beds providing improved access to rehabilitation for older persons in the area. During this time, an increase in incident report forms occurred due to the incorrect provision of diet/fluid to patients at ward level. In collaboration with relevant stakeholders, the Speech and Language Therapy (SLT) and Dietetic teams reviewed the current hospital meal ordering form and process in order to standardise a new system. The aim of this project was to reduce risk for patients and improve collaborative team working and communication.

Methods

A multidisciplinary team (MDT) approach was adapted involving; SLT, dietitians, catering department, nursing team and the patient quality and safety department. The HSE change framework provided scaffolding for this work. A new Daily Meal Order form was created and approved by the Nutrition Steering Committee and the process was agreed using input from all stakeholders. A pilot was carried out, reviewed and rolled out across the campus. The number of incidents recorded at ward level was used to measure if risk was reduced. A staff survey was conducted to gather feedback on the new system.

Results

The new Daily Meal Order form is now being used across the campus. Additional checks are completed each day via email to reduce the risk of errors. No incident reports were filed since launching the new form and process. A staff survey showed that all staff feel the new system and form constitutes an improvement, that it saves clinical time and that they would recommend it to others.

Conclusion

The project aims have been met in reducing patient risk, in line with the HIQA Safer Better Healthcare Programme. It has also improved MDT working and communication. This project is easily replicable to other settings and staff would recommend this approach to others.
The Evolution of Mechanical Thrombectomy for Acute Ischaemic Stroke: A Decade In Dublin
Authors: O'Reilly Aisling , Byrne Muireann , Fearon Patricia , Nicholson Patrick , Liddy Anne Marie , Boyle Karl , Williams David , Power Sarah , Thornton John
Published: September 2024

Background

The advent of mechanical thrombectomy (MT) has entirely transformed hyperacute care for patients with stroke. We studied changing trends in MT provision over a decade, spanning participation in pivotal randomised controlled trials, evolving neuro-interventional techniques, a global pandemic and expanding treatment indications in a comprehensive stroke centre in Dublin.

Methods

Consecutive patients treated with MT were prospectively recorded between January 2012 and December 2022. We compared baseline clinical and imaging data, treatment times and procedural and clinical outcomes both on an annual basis and across the totality of the epoch.

Results

2211 MT patients were recorded. Total annual numbers were: 36 (2012), 53 (2013), 46 (2014), 122 (2015), 172 (2016), 248 (2017), 262 (2018), 306 (2019), 301 (2020), 326 (2021) and 338 (2022). Between 2012 and 2022 patients treated with MT became older (mean age: 65.6yrs (SD:13.8) vs 70.0yrs (SD: 14.6); p=0.017), had greater infarct volumes (median baseline ASPECTS: 10 (IQR:9-10) vs 9(IQR:8-10): p=0.045) and were treated faster (median door-to-recanalisation: 70mins vs 39 mins; p<0.0001). Patients were less likely to have witnessed stroke onset (100% vs 54%; p<0.0001), receive IV tPA (72% vs 38%; p<0.0001) or have thrombus located in the intracranial ICA or M1-MCA (95% vs 65%: P<0.0001). No significant variations in pre-stroke mRS, baseline NIHSS, onset-to-recanalisation times, rates of successful recanalisation (86% vs 91%: p0.29) or 90-day mRS (0-2: 44% vs 50%; p0.68) were observed.

Conclusion

As our service has evolved, patients presenting for MT have become more complex, are treated faster and continue to achieve excellent clinical and radiological outcomes.
Quality Of Care In Parkinson's Disease: Lessons From A National Audit
Authors: Azizi Zahra , O'Shea Emma , Hughes Graham , Bradley David , Browne Patrick , Mulpeter Ken , Timmons Suzanne
Published: September 2024

Background

It is recommended that people with Parkinson’s disease (PD) are treated within specialised services. As part of a research project mapping and evaluating PD services nationally, the first audit of PD services in the Republic of Ireland was conducted.

Methods

A de novo audit tool was developed by an expert group, based on a rigorous review of existing international standards, guidelines and audit tools, with extensive stakeholder input (including people with PD). All 14 specialist PD services in the Republic of Ireland were eligible; up to 30 case-notes were randomly selected per service in 2022/2023, looking at the most recent 2 visits (new patient) or 3 visits (established patient).

Results

In total, 261 case-notes were included, from 11 specialist PD services, led by a geriatrician (n=5) or neurologist (n=6). Overall, 16.8% of patients were seen less often than annually. Motor and mobility assessments were well performed (>75%); but cognition (70%) and pain assessments (64%), saliva management (50%), and bone density determination (18%) were inadequate. Access to PD nurses (65%), physiotherapy (69%), speech and language therapy (53%), and occupational therapy (50%) was inadequate; PD nurses were mainly in Dublin. However, specialist nurse and MDT access was better than reported by people attending generic services for PD care (1). Providing written information following diagnosis (24%), and communication with the carer were infrequently documented (financial support discussion: 12%; availability of support locally: 26%). Gerontology-led services more often screened for malnutrition (99% v 78%) or orthostatic hypotension (94% v 52%).

Conclusion

PD care relating to assessment, multidisciplinary involvement, and information sharing was sub-optimal in some areas, with the caveat that documentation may not reflect actual practice.

Reference

1. O’Shea E, et al. Experiences of Health Service Access and Use for People Living with Parkinson’s Disease in Ireland: A National Survey. Health & Social Care in the Community. 2023 Aug 9;2023.
A Novel Discharge Pathway for Older Adults presenting to the Emergency Department
Authors: McDaid Edel , Dillon Aoife , Ryan Ciara , Daly Eoin
Published: September 2024

Background

A need was identified for an urgent therapy follow-up at home for older adults presenting to the Emergency Department (ED). The acute floor team worked together within an established therapy outreach team (for inpatients) to develop an ED outreach pathway within existing resources. The outreach team members worked within ED to ensure standardisation of assessment, practice and build strong working relationships. A trusted assessor approach was applied. The outreach team had access to the wider acute floor team including ANP for in-reach support if needed.

Methods

A review of the patient group who discharged home from ED using this new pathway was completed including demographics, presenting complaint, clinical frailty score (CFS) and intervention provided.

Results

To date, 30 patients have discharged from the ED with the therapy outreach team. Most (70%) were female and mean age 83. Presenting complaint included fall no fracture (50%, n=15), fall with fracture (26%, n=8), musculoskeletal injury (17%, n= 5) and functional decline (6%, n=2). The mean CFS was 5.1, with most (86%) living with mild to moderate frailty (CFS 4-6). All patients were offered a next clinical day home based functional and environmental assessment, continuing the assessment commenced by the acute floor team in ED. Interventions included transfers and mobility training, activities of daily living (personal/domestic/instrumental) training, carer education, environmental advice, falls education, support with care packages, liaising with other healthcare professionals and equipment provision including mobility aids, bed-levers, toilet-aids and rails.

Conclusion

A therapy lead team, supported by the wider acute floor team, can provide a safe alternative discharge pathway from the ED for older adults that can avoid admission with rapid therapy input at home. Future work will examine re-admission rates, re-presentation rates to ED and patient and stakeholder satisfaction.
Development of a Hospital Wide Inpatient Frailty Screening Pathway in a Model-2 Hospital
Authors: Rochford Shona , Woulfe Cliona , Jennings Emma
Published: September 2024

Background

Our model-2 hospital is experiencing a higher proportion of frail older adults presenting to our medical assessment unit (MAU) and via direct ward admissions. Frailty increases the risk of co-morbidity, falls and mortality during hospital admission. Screening for frailty a point of admission allows early identification of these patients who are at higher risk of adverse outcomes. Early frailty screening also assists healthcare professionals with multidisciplinary team (MDT) management and treatment plans. Our hospital frailty committee established a frailty screening pathway for all inpatients aged 75 years and older to screen for frailty and minimise the risk of adverse outcomes secondary to frailty.

Methods

A hospital wide consultant chaired frailty committee was established with stakeholders from the MDT. Two separate screening pathways were developed, one for MAU admissions and one for direct ward admissions. A standardised frailty policy and standardised operating procedure (SOP) with algorithm illustration were compiled. Hospital wide education emphasised the development of a bespoke Clinical Frailty Score (CFS) sticker in conjunction with referral pathways to the newly established Clinical Nurse Specialist (CNS) For The Older Adult. In each pathway CFS-screening is completed for adults ≥75years at first-point of contact using the CFS, a score ≥6 triggers onward referral, CNS for inpatient and public health nurse for MAU discharged patients.

Results

Both pathways are established and used effectively and routinely on a daily basis. Associated educational sessions have emphasised the importance of frailty in our inpatient cohort.

Conclusion

The developed algorithms have been useful for identifying frailty and improving patient care with onward CNS referral. Future audits will assess effectiveness of screening and support advancement of frailty committee objectives via supporting business cases for resourcing.
Outcomes of Dementia Pathway Referrals Post Comprehensive Geriatric Assessment by a Community Specialist Team for Older Persons
Authors: Ryan Siobhan , Wilkinson Elaine , Maher Jennifer , Sayers Karen , King Lorna , Donnellan Christina
Published: September 2024

Background

The Model of Care for Dementia in Ireland (2023) outlines targets and recommendations for a Dementia service. A Dementia pathway was developed from a Community Specialist Team (CST) for Older Persons service to a local Memory Clinic service and this was evaluated with reference to the model of care.

Methods

All adults aged ≥70 years, who received a Comprehensive Geriatric Assessment (CGA) by a CST in 2022, and were referred to a Memory Clinic service, were included. Data including dates of referral and Memory Clinic attendance, age, gender, Clinical Frailty Scale score (CFS) and diagnosis were entered into Excel. These were analysed using descriptive statistics.

Results

Seventy-nine patients were referred to the Memory Clinic. Twenty-eight (35.5%) attended, with 51 (64.5%) non-attendances. Twenty-seven (34%) cancelled, 13 (16.5%) did not attend, 7 (9%) died before receiving an appointment, and 4 (5%) appointments were deferred at patient request. The mean age of patients referred was 82.39 years (SD=6.876). The male to female ratio of attendees was 1:1.3 and non-attendees was 1:1.9. The median CFS score of both attendees and non-attended was 5 (range 3-7). Eight (21%) of those who did not attend had moved to long term care, representing 10% of total referrals. The median waiting time for attendees was 10.5 months (Range 2-21). Thirteen (46%) patients received a diagnosis of Dementia, 3 (11%) Mild Cognitive Impairment (MCI), 2 (7%) Acquired Brain Injury and 10 (36%) received no memory diagnosis.

Conclusion

This Dementia pathway does not meet target 14 of the Model of Care. The waiting times exceed 6 weeks, resulting in missed opportunities to provide supports. Timely access to the pathway and supports to attend may increase attendance. A dedicated Memory Assessment and Support Service will address this deficit.
How are Brain Health Interventions Implemented in Clinical Settings Internationally? – A Scoping Review
Authors: Connolly Eimear , McFeely Aoife , Kennelly Sean
Published: September 2024

Background

It is estimated that 40% of dementia cases worldwide may be linked to potentially modifiable risk-factors. Evidence suggests multidomain interventions targeting a number of these risk factors can help prevent and delay the development of cognitive decline. However, the optimal way to deliver these interventions in clinical practice is less clear. We conducted a scoping review to explore the implementation of brain health interventions in a clinical setting.

Methods

A scoping review methodology was chosen to allow the consideration of publications from sources outside the confines of a systematic review. A search was conducted and applied to four databases: MEDLINE, Embase, CINHAL, PsychInfo. Grey literature in the form of National Dementia Policy Documents were also considered for inclusion. Publications related to the delivery of brain health interventions in a clinical setting available in English were included, while multidomain interventions delivered for research purposes only were excluded. Results were dual-screened, extracted by two independent reviewers, and reported in line with PRISMA-scr guidelines.

Results

Of 3,035 results, 2,109 remained following de-duplication. Fifty full-text records were screened, with 4 citations referring to 2 clinical services included in the review. The first service (Alzheimer’s Prevention Clinic (APC), Cornell and Puerto Rico) was established in 2013 while the second (Brain Health Scotland) established a clinical service in 2023. Both accept self-referrals and healthcare provider referrals and are distinct from existing memory clinic service models. Both services offered cognitive testing along with risk factor assessment. A detailed suite of interventions offered to patients in the APC was outlined targeting cardiovascular, lifestyle and nutritional risk factors. The clinical interventions offered in the Brain Health Scotland clinical service were not documented.

Conclusion

Within the limitations of the search strategy, there is a paucity of available information on existing, operational brain health intervention clinics, particularly those linked to memory assessment services.
Optimising Care For Nursing Home Residents: Exploring The Potential Of An Emergency Department Avoidance Pathway
Authors: Farrelly Angelina , Davey Naomi , Noonan Claire , Soh Josephine
Published: September 2024

Background

Nursing home residents (NHRs) often face hospital admissions through the emergency department (ED), leading to complications such as delirium, pressure ulcers, and functional decline. To mitigate these risks, ED avoidance models of care are becoming increasingly popular within healthcare systems. These models advocate for ambulatory pathways that provide access to multidisciplinary teams capable of delivering timely care for patients who do not require hospital admission.

Methods

A retrospective review of clinical data spanning 14 months (February 2023 to April 2024) was conducted, focusing on NHRs admitted to hospital for less than three days. Data were collected from electronic patient records, including age, sex, reason for admission, National Early Warning Score (NEWS), Manchester Triage (MT) score at admission, and length of stay in the ED.

Results

325 NHRs were admitted medically during the study period. 18.7% (n=61) had inpatient stays of less than 36 hours. The most common reasons for ED presentation were lower respiratory tract infections, seizures, collapse or falls, and delirium. Of these patients, 51%(n=32) had a NEWS of ≤2, indicating low acuity, while 38% had an MT score of ≤3, suggesting lower urgency. The average patient experience time in the ED was 15.88 hours.

Conclusion

Approximately half of all short stay NHR admissions exhibited low acuity NEWS scores at the time of presentation, indicating the potential for an ambulatory care pathway for over 10% of all our NHR admissions. Implementing an ED avoidance pathway through our Acute Medical Unit could allow many of these patients to receive appropriate care without long periods in the ED, thereby reducing potential complications. These findings highlight opportunities to streamline care pathways and reduce unnecessary hospitalisations for NHRs. Implementing an ED avoidance service tailored to the specific needs of these patients could enhance care efficiency and improve patient outcomes.
A Qualitative Evidence Synthesis Of The Perceptions And Experiences Of Animal Assisted Interventions For People Living With Dementia
Authors: Zhang Dou , Hennessy Marita , Li Qiuxia , Paley Nuala , Paley Gerry , Houghton Catherine
Published: September 2024

Background

Animal assisted intervention (AAI) is a popular type of non-pharmacological psychosocial intervention, which has a potentially positive effect on physical, psychological, and social functioning for people with dementia. However, there is a lack of evidence regarding the experiences and factors of implementing AAI, and its impacts on people with dementia in different contexts. This review aims to synthesise key stakeholders’ experiences and perceptions of AAI for people with dementia in community settings.

Methods

We systematically searched Medline, CINAHL, Embase, Scopus, Web of Science, PsycINFO and AgeLine for potentially eligible studies. Thematic analysis was used to synthesise the data from included records. We assessed the methodological limitations using an adaptation of the Critical Appraisal Skills Programme (CASP) and used GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) to assess confidence in the review findings. Two Patient and Public Involvement (PPI) contributors were involved to enhance the quality and relevance of the research.

Results

We included 14 reports and developed three analytical themes, incorporating a gardening analogy: planting-connecting with animals, growing-engaging in AAI, and nurturing-making AAI work, with 15 key findings. Our review highlights that positive experiences, growing connections, and potential benefits were perceived within AAI. A multicomponent AAI can provide various sensory inputs, attributing to a rich experience. Flexible and individualised AAI tailoring to people’s needs and preferences is important. Additional training and education for staff are necessary to facilitate the intervention, reduce risks, and nurture connections.

Conclusion

This review describes people’s experiences and perceptions of AAI for people with dementia, and provides recommendations on development and implementation of AAI, with moderate to high confidence in its findings. It is important to consider the factors that influence the implementing AAI identified in this review, to facilitate engagement and long-term impacts in future interventions.
The Effect of Ward Level Noise On Anxiety and Sleep In An Inpatient Population Aged Greater Than 65 Years Old
Authors: Morris Eleanor , Sedgwick Gavin , Davey Naomi , Williams Shianna , McCarthy Philomena , McDonagh Ruth , Ryan Daniel , Collins Rónán
Published: September 2024

Background

The term “noise” is derived from the Latin word noxia, meaning “injury”. Excessive noise can negatively affect inpatients, particularly those aged over 65 by increasing stress, disrupting sleep, inducing delirium and prolonging hospital length of stay (LOS). Although the World Health Organization recommends maintaining hospital noise levels between 30-40dB, this is frequently exceeded in inpatient settings.

Methods

This study assessed the impact of ward level noise (WLN) on self-reported anxiety and sleep disturbance among inpatients aged over 65 in two settings: an acute model 4 hospital in an urban area and a rehabilitation ward in a model 2 hospital in a suburban area. Patients were interviewed using a two-part questionnaire, consisting of: (1) the Hospital Anxiety and Depression Scale (HADS) and (2) a four-part structured self-reported questionnaire developed by the authors.

Results

Twenty-eight inpatients were interviewed: 19 from the acute hospital (AH) and 9 from the rehabilitation ward (RW). Patients’ average age was 81 (range: 70-95 years, SD = 6.5), including 15 females. Four had a history of anxiety or depression and seven were on antidepressant or anxiolytic treatment. Average length of stay: 14.1 days in AH versus 52.3 days in RW. In AH 53% (10/19) reported sleep disturbance due to WLN versus 0% in RW (p<0.01). The average HADS anxiety score was higher in AH than in RW (6.6 versus 5.4, p=0.37).

Conclusion

Inpatients in the acute hospital reported more sleep disturbances and trend to higher average HADS scores associated with WLN compared to those in the rehabilitation ward. WLN has the potential to increase anxiety and disrupt sleep in inpatients over the age of 65. Further large-scale research is recommended to explore environmental improvements and noise reduction strategies, such as sound-absorbing materials and designated quiet hours, which could enhance patient care and wellbeing.
Uncovering the physiology and distribution of thallium in Tl-hyperaccumulating and Tl-sensitive populations of Biscutella laevigata L.
Authors: Salinitro Mirko , Isnard Sandrine , Brueckner Dennis , Spiers Kathryn M , Aarts Mark G M , Corzo Remigio Amelia , van der Ent Antony
Published: September 2024

Background and Aims

Thallium (Tl) is extremely toxic to all life forms and is an emerging pollutant. Plants in the Brassicaceae family, including edible crops, have an enhanced capacity for Tl accumulation, even from soils with low thallium concentration. The most extreme Tl hyperaccumulator is Biscutella laevigata, capable of attaining >32 000 μg Tl g−1 dry weight (DW) in its leaves.

Methods

Biscutella laevigata from a non-metallicolous accession (Feltre, Italy) and a metallicolous accession (Les Malines, France) were subjected to a dosing experiment in hydroponics (0, 5 and 30 μm Tl), followed by synchrotron-based micro-X-ray fluorescence analysis to elucidate tissue- and cellular-level Tl distribution.

Key Results

Flow cytometric data on the two accessions showed that the Feltre accession has a genome size twice of that of the Les Malines accession (256 and 125 pg per 2C, respectively), suggesting that they are phylogenetically distant populations. The Feltre accession did not accumulate Tl (125 μg Tl g−1 DW on average in leaves) at the 5 µm Tl dose level, whereas the Les Malines accession had a mean of 1750 μg Tl g−1 DW, with peaks of 24 130 μg Tl g−1 DW, at the 30 µm Tl dose level. At 30 µm Tl, the non-metallicolous accession did not grow, and at 5 µm Tl it showed reduced biomass compared with the metallicolous one. In the Les Malines accession, the synchrotron-based micro-X-ray fluorescence analysis revealed that Tl was localized in the vacuoles of epidermal cells, especially underneath trichomes and in trichome basal cells. Thallium also occurred in solid crystalline deposits (3–5 µm in size, ~40 wt% Tl) that were found mainly in foliar margins and under trichome bases.

Conclusions

Biscutella laevigata is an attractive model for studying Tl hypertolerance and hyperaccumulation on account of the extreme expression of this trait and its marked intraspecific variability.
scEGG: an exogenous gene-guided clustering method for single-cell transcriptomic data
Authors: Hu Dayu , Guan Renxiang , Liang Ke , Yu Hao , Quan Hao , Zhao Yawei , Liu Xinwang , He Kunlun
Published: September 2024

In recent years, there has been significant advancement in the field of single-cell data analysis, particularly in the development of clustering methods. Despite these advancements, most algorithms continue to focus primarily on analyzing the provided single-cell matrix data. However, within medical contexts, single-cell data often encompasses a wealth of exogenous information, such as gene networks. Overlooking this aspect could result in information loss and produce clustering outcomes lacking significant clinical relevance. To address this limitation, we introduce an innovative deep clustering method for single-cell data that leverages exogenous gene information to generate discriminative cell representations. Specifically, an attention-enhanced graph autoencoder has been developed to efficiently capture topological signal patterns among cells. Concurrently, a random walk on an exogenous protein–protein interaction network enabled the acquisition of the gene’s embeddings. Ultimately, the clustering process entailed integrating and reconstructing gene-cell cooperative embeddings, which yielded a discriminative representation. Extensive experiments have demonstrated the effectiveness of the proposed method. This research provides enhanced insights into the characteristics of cells, thus laying the foundation for the early diagnosis and treatment of diseases. The datasets and code can be publicly accessed in the repository at https://github.com/DayuHuu/scEGG.
DeepPBI-KG: a deep learning method for the prediction of phage-bacteria interactions based on key genes
Authors: Wei Tongqing , Lu Chenqi , Du Hanxiao , Yang Qianru , Qi Xin , Liu Yankun , Zhang Yi , Chen Chen , Li Yutong , Tang Yuanhao , Zhang Wen-Hong , Tao Xu , Jiang Ning
Published: September 2024

Phages, the natural predators of bacteria, were discovered more than 100 years ago. However, increasing antimicrobial resistance rates have revitalized phage research. Methods that are more time-consuming and efficient than wet-laboratory experiments are needed to help screen phages quickly for therapeutic use. Traditional computational methods usually ignore the fact that phage-bacteria interactions are achieved by key genes and proteins. Methods for intraspecific prediction are rare since almost all existing methods consider only interactions at the species and genus levels. Moreover, most strains in existing databases contain only partial genome information because whole-genome information for species is difficult to obtain. Here, we propose a new approach for interaction prediction by constructing new features from key genes and proteins via the application of K-means sampling to select high-quality negative samples for prediction. Finally, we develop DeepPBI-KG, a corresponding prediction tool based on feature selection and a deep neural network. The results show that the average area under the curve for prediction reached 0.93 for each strain, and the overall AUC and area under the precision-recall curve reached 0.89 and 0.92, respectively, on the independent test set; these values are greater than those of other existing prediction tools. The forward and reverse validation results indicate that key genes and key proteins regulate and influence the interaction, which supports the reliability of the model. In addition, intraspecific prediction experiments based on Klebsiella pneumoniae data demonstrate the potential applicability of DeepPBI-KG for intraspecific prediction. In summary, the feature engineering and interaction prediction approaches proposed in this study can effectively improve the robustness and stability of interaction prediction, can achieve high generalizability, and may provide new directions and insights for rapid phage screening for therapy.
RNAelem: an algorithm for discovering sequence-structure motifs in RNA bound by RNA-binding proteins
Authors: Miyake Hiroshi , Kawaguchi Risa Karakida , Kiryu Hisanori
Published: September 2024

Motivation

RNA-binding proteins (RBPs) play a crucial role in the post-transcriptional regulation of RNA. Given their importance, analyzing the specific RNA patterns recognized by RBPs has become a significant research focus in bioinformatics. Deep Neural Networks have enhanced the accuracy of prediction for RBP-binding sites, yet understanding the structural basis of RBP-binding specificity from these models is challenging due to their limited interpretability. To address this, we developed RNAelem, which combines profile context-free grammar and the Turner energy model for RNA secondary structure to predict sequence-structure motifs in RBP-binding regions.

Results

RNAelem exhibited superior detection accuracy compared to existing tools for RNA sequences with structural motifs. Upon applying RNAelem to the eCLIP database, we were not only able to reproduce many known primary sequence motifs in the absence of secondary structures, but also discovered many secondary structural motifs that contained sequence-nonspecific insertion regions. Furthermore, the high interpretability of RNAelem yielded insightful findings such as long-range base-pairing interactions in the binding region of the U2AF protein.

Availability and implementation

The code is available at https://github.com/iyak/RNAelem.
Precise synthesis and assembly of π-conjugated polymers enabled by metal–organic frameworks
Authors: Kitao Takashi
Published: September 2024

The π-conjugated polymers hold considerable promise as key materials in various devices because of their advantageous optical, electronic, and magnetic properties; however, their strong interchain π–π interactions render them insoluble without the introduction of solubilizing substituents, making their synthesis highly challenging. Confined synthesis of π-conjugated polymers inside metal–organic frameworks (MOFs) offer a solution to this challenge by isolating the individual polymer chains, effectively addressing solubility issues and regulating polymerization reactions to yield novel π-conjugated polymers that are otherwise inaccessible. This account reviews recent advances in the synthesis and assembly control of π-conjugated polymers within MOFs to enhance physicochemical properties. Additionally, we explore the nanohybridization of π-conjugated polymers with MOFs, leading to sophisticated architectures with intriguing functionalities.
Moment analysis by affinity capillary electrophoresis for study of reaction kinetics between phenylboronic acid and monoccharides
Authors: Miyabe Kanji , Oya Mio , Imaizumi Moeko
Published: September 2024

A moment analysis method was applied to study intermolecular interactions between phenylboronic acid and monosaccharides. The values of first absolute and second central moments of elution peaks, measured by affinity capillary electrophoresis (ACE), were analyzed on the basis of the moment theory to determine those of association equilibrium constant and association and dissociation rate constants of the intermolecular interactions. Their values were fairly in agreement with results reported in previous studies. The moment analysis method using ACE has some advantages in comparison with conventional spectroscopic methods. For example, neither immobilization nor fluorescence labelling of solute and/or ligand molecules is required when ACE data are measured. Because the principles of the method are different from those of ordinary spectroscopic ones, this method contributes to the kinetic study of intermolecular interactions from various perspectives. A comparison was made between intrinsic characteristics of the moment analysis method and those of two historical ones developed by the Whitesides and Krylov groups. Some restrictive features of the moment analysis method were also explained. It is concluded that the moment analysis method using ACE is effective as one experimental method for the analysis of intermolecular interactions.