bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscle Makers: Evaluating a 10-Week Strength and Nutrition Programme's Impact on Sarcopenia
Authors: Forde Grainne , Harte Gillian , Quinn Siobhan , McCarron Cathal , Conaty Sarah , O'Neill Desmond
Published: September 2024

Background

Sarcopenia is a progressive skeletal muscle disorder characterized by loss of muscle mass and strength, leading to adverse outcomes like physical disability, poor quality of life, and death. The European Working Group on Sarcopenia in Older People (EWGSOP) identifies sarcopenia using criteria including low muscle strength, quantity, quality, and performance. This highlights the importance of early detection and intervention strategies, such as the physiotherapy-led Muscle Makers programme —a 10-week outpatient Progressive Resistance Training (PRT) program with fortnightly Clinical Nutrition input. This data collection aimed to evaluate the programme's effectiveness over a 6-month period.

Methods

Data was collected on all participants who attended Muscle Makers (one 1-hour session/week) between September 2023 and February 2024. Analysis included participants with both pre- and post-10-week programme outcome measures completed. Data was collected and analysed using MS Excel. Outcome Measures (OCMsused: Timed Up and Go (TUG) and 5-time sit to stand (5TST).Inclusion: Participants with both pre- and post-OCMscompletedExclusion: Participants without pre/post OCMsNon-normally distributed data was log-transformed prior to statistical testing.Results: Number of participants fitting inclusion criteria: 44 (Male: 20, Female: 24)Average age: 80.6 yearsAverage sarcopenia score (SARC F): 4.04 (probable sarcopenia)Average number of falls in the past 12 months: 1.56Average number of classes attended: 8.12

Data Results

Conclusion

The participants in the Muscle Makers programme achieved significant improvements in both the 5TST and TUG tests, demonstrating enhanced lower body strength, balance, and overall functional mobility. These improvements suggest that the 10-week strength and nutrition intervention effectively mitigates the effects of sarcopenia, highlighting the potential of targeted exercise and nutritional strategies in managing and potentially reversing the progression of this condition.
Determining Inclusion Criteria For Post-Acute Care Rehabilitation – Home Alone Is Not A Barrier To Success
Authors: OConnell Karen , Cashen Aoife , Coen Michelle , Loughnane Hannah , Waldron Eithne , O’Connor Anne , Tynan Michelle , Reddin Catriona , Flattery Valerie , Robinson Stephanie
Published: September 2024

Background

Older adults discharged after acute hospitalisation are at risk for functional decline and adverse health outcomes. With population ageing, traditional approaches to rehabilitation with extended acute care stay are not sustainable. Successful outcomes in home-based rehabilitation relies on appropriate patient selection criteria. Some evidence suggests that older adults living alone are at highest risk for poor health-related outcomes including prolonged hospital admission and high readmission rates due to lack of cohabitants to support their needs.

Methods

Retrospective case analysis of consecutive participants in an older persons home based rehabilitation programme were included. Demographics including age, gender, frailty status, living arrangements, length of inpatient stay savings (days) and functional improvement (FIM) were measured. Logistical regression was used to estimate the relationship between living alone and functional gains.

Results

Eighty-three consecutive cases were reviewed, 10 cases excluded as readmitted (n=8), or clinically deteriorated and unable to complete the programme (n=2). Readmission rate (30 day) was 9.6%. Of 73 cases, 42.5%(n=31) lived alone, and 57.5%(n=42) co-habited during the programme. Mean (SD) clinical frailty score for those living alone was 5.26(1.03) and 4.98(1.07) for those not living alone. Improvements in FIM were similar in both groups, mean (SD) 11.4(7.2) versus 9.0(6.0). There was no statistically significant difference in change in FIM score between groups (-2.40(-5.56 to 0.77), p=0.136). Of 18 items in FIM, greatest benefit was seen in locomotion, bed/chair/toilet transfers, grooming, dressing and bathing skills. Mean bed-day savings was 6.45(2.07) acute inpatient bed-days per participant.

Conclusion

Our findings demonstrate that older adults who live alone benefit equally well from home based rehabilitation programme. Therefore, living alone should not limit enrolment on such programmes. Rehabilitation gains in the home environment were greatest in parameters that are challenging to target in acute care settings.
Exploring the Impact of Animal Assisted Interventions on the Occupational Participation of People Living with Dementia
Authors: Timmons Danielle
Published: September 2024

Background

Animal Assisted Intervention (AAI) is defined as a goal-directed intervention designed to promote improvement in social, emotional, physical and cognitive functioning (AAII 2020). AAIs are a growing area in dementia research and practice (Lai et al. 2019). There is a significant gap in implementing and researching AAI in a UK context (Fine 2019). Caring for pets and service animals is considered an instrumental activity of daily living (AOTA 2008) and AAI has been shown to enhance the occupational participation of other client populations (Winkle et al. 2012; Herlache-Pretzer et al. 2017; Andreasen et al. 2017). It is unclear what impact AAI has on the occupational participation of people living with dementia (PLWD).

Methods

Interpretative Phenomenological Analysis was proposed to facilitate deep level interpretations of the experience of occupational participation for PLWD who have an assistance dog. Over a two-month period, the researcher proposed to complete four thirty-minute video observations capturing PLWD participating in a chosen occupation in their home environment. The researcher further proposed to maintain a reflexive journal and document notable observations throughout the research process to enhance the development of themes.

Results

PLWD have the right to access personally meaningful occupations (WFOT 2006). Assistance dogs may have the potential to facilitate positive occupational experiences such as occupational identity, occupational competence and occupational adaptation.

Conclusion

Occupational therapists who claim to be guided by the principals of client-centred practice (RCOT 2015a) must strive to look beyond traditional interventions to effectively meet the individual needs and preferences of PLWD (Brodrick and Barry 2016). Education and further research (Fine 2019) are required to raise the profile of AAI in a UK context. Future research would benefit from exploring the experience of occupational participation in social environmental contexts for PLWD (who have an assistance dog), to gain whole experiential accounts of this phenomenon.
Understanding “Fear Of Falling” And How It Impacts Older Persons Motivation To Engage In Fall Prevention Exercise Interventions
Authors: Gavin Catherine , Tuite Fiona , Hesnan Alison , McMahon Sarah , Sestak Karolina , O'Malley John , Canavan Michelle
Published: September 2024

Background

Fear of falling can cause older persons to restrict their activities, which drives reduced strength and balance and increases their falls risk. Falls can have a significant effect on older persons in terms of loss of confidence, ongoing falls risk and ultimately, a poorer quality of life (Oliver et al, 2010). Fall prevention exercise interventions can help reduce the risk of falling in older adults by up to 34% (Sherrington et al, 2020). This study aims to explore the prevalence of fear of falling in older adults both before and after attending a community-based fall prevention exercise programme. The programme consisted of an evidence-based Physiotherapy led 10-week strength and balance class, followed by a 16-week exercise instructor led strength and balance class.

Methods

A 2-part qualitative study.

Part 1: Prior to commencing the class each participant completed a rating of their fear of falling measured by ConfBal (a validated 10 item Balance Confidence scale).

Part 2: Questionnaire assessing their experience of the classes and corresponding change in balance scores.

Results

17 older adults completed the programme. Surveys were returned by 8/17 to date (47%). Mean pre-intervention ConfBal score of 20, mean post intervention score of 15 (8/17 participants to date), average 4-point improvement after intervention was statistically significant (p=0.008). Reported benefits of falls prevention exercise classes include peer-peer discussion of functional ability, gaining confidence by exercising in a group environment, practising functional exercises relating to day-to-day tasks, and building social relationships.

Conclusion

Fear of falling amongst community dwelling older adults is common but group exercise improves confidence as well as boosting social interactions. Participation in fall prevention exercise programmes can help to better support older people as they age which may influence better health outcomes in our communities.
Retracted: Risk of Haemorrhage Associated with Direct Oral Anticoagulation Versus Anti-platelet Therapy: A Systematic Review and Meta-Analysis
Authors: Lynch Amy , Coyle Mark , Higgins Maeve , Judge Conor , Reddin Catriona , O'Donnell Martin
Published: September 2024

Background

Among patients with atrial fibrillation, clinicians often prescribe anti-platelet therapy rather than oral anticoagulation which may relate to a concern that direct oral anticoagulants (DOAC) are associated with a higher risk of bleeding. We completed a meta-analysis to determine whether DOAC therapy, compared to single anti-platelet, was associated with an increased risk of major haemorrhage, with a primary focus on intracranial haemorrhage (ICH).

Methods

We searched PubMed and Embase databases up to 7/2/2024. Randomised controlled trials (RCT) that compared DOAC therapy to single anti-platelet agents were included. Trials with follow-up less than 30 days, or sample size less than 200 were excluded. A random-effects meta-analysis model was used to report pooled treatment effects and 95% confidence intervals (CIs). The primary outcome was occurrence of ICH.

Results

A total of 9 RCTs were included (n=45,493). Overall, DOAC therapy was not associated with significantly higher odds of ICH compared to anti-platelet therapy (Odds ratio (OR) 1.14; 95% CI, 0.71-1.82), but there was heterogeneity among trials (I2 = 49.3). In an analysis by DOAC agent, the respective estimates for ICH risk were; Rivaroxaban (OR 2.05; 95% CI, 1.09-3.83); Dabigatran (OR 1.00; 95% CI, 0.61-1.64) and Apixaban OR 0.72; 95% CI, 0.44-1.17). DOAC therapy was associated with higher odds of major haemorrhage compared to aspirin (OR 1.39; 95% CI,1.07-1.80), with the following estimates by agent; Rivaroxaban (OR 1.91; 95% CI 1.22-3.00); Dabigatran (OR 1.21; 95% CI 0.86-1.69); Apixaban OR 1.09; 95% CI 0.73, 1.63). DOAC therapy was associated with higher odds of GI haemorrhage then control (OR 1.39; 95% CI,1.11, 1.73).

Conclusion

DOAC therapy was not associated with a significantly higher risk of ICH compared to anti-platelet therapy, but risks may differ among DOAC agents. DOAC therapy was associated with a higher risk of major haemorrhage, mostly related to GI haemorrhage.
Post-Acute Admission Mortality Rates for Nursing Home Residents
Authors: Noonan Claire , Davey Naomi , Farrelly Angelina , Soh Josephine
Published: September 2024

Background

Nursing home residents (NHRs) constitute a vulnerable demographic with intricate healthcare requirements, often burdened by multiple comorbidities. A specialised geriatrician-led acute care team for NHRs was established in a University Teaching Hospital. This service prioritises the unique needs of NHRs, delivering tailored treatments in environments conducive to their well-being, while also striving to mitigate the adverse effects associated with avoidable hospitalizations.

Methods

An analysis of NHR admissions to a University Teaching Hospital in 2023, showed that 307 out of 343 (89.5%) were discharged back to the community. All discharged NHRs were followed up. Their 3 and 6 month mortality rate post discharge was 8% (n=24) and 13% (n=40) respectively. Majority of these frail NHRs survived beyond six months following hospital admissions, indicative of the potential impact of a specialized gerontological care follow-up.

Results

This specialist team has a post-discharge follow-up protocol for all admitted NHR residents, aimed to detect potential deteriorations and offer alternative avenues of review, minimizing unnecessary emergency department visits, particularly in non-urgent cases. Interventions such as the FastTrack Fracture service, direct ED reviews, and facilitating outpatient appointments were instrumental in this endeavour.

Conclusion

In summary, the establishment of this specialised geriatrician-led acute care team for NHRs marks a substantial stride in addressing the multifaceted needs of frail older adults in nursing homes. By leveraging the expertise of gerontologically attuned practitioners and emphasizing person-centered care approaches, these services provide a holistic and individualized solution to enhance outcomes and elevate the quality of life for this vulnerable population. Sustained investment in the development and expansion of such services is paramount for advancing care standards for older adults and fostering a more age-friendly healthcare milieu.
Risk Prediction Models for Adverse Drug Reactions and Adverse Drug Events in Older Adults – A Systematic Review and Meta-analysis
Authors: Cosgrave Nicole , Ong Woei Shan , Saleh Sooad , Frydenlund Juliane , Cahir Caitriona , Williams David
Published: September 2024

Background

Adverse drug reactions (ADRs) and adverse drug events (ADEs) are common and result in significant morbidity, mortality and healthcare costs. As the world’s population ages, the consumption of medications and healthcare will increase. Models predicting ADR risks in older adults have previously been found to lack reliability and validity. The aim of this systematic review and meta-analysis is to provide an updated, comprehensive quality assessment and analysis of ADR-risk prediction tools in older adults.

Methods

Standard computerised-databases and citations were searched (2012 to 2023) to identify relevant peer-reviewed studies. Studies which developed and/or validated an ADR/ADE prediction model for use in older adults were included. Four studies from a previous systematic review were also included. The TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) guidelines were used to evaluate each of the included studies. Random effects models were used to derive a pooled discrimination estimate (area under the receiver operation curve; AUROC) for model development studies and model validation studies. The prediction model risk of bias assessment tool (PROBAST) was applied to evaluate bias.

Results

Five out of 11,481 titles, plus four previous studies, met all inclusion criteria and underwent TRIPOD evaluation. Meta-analysis resulted in a favourable pooled AUROC 0.75 (95% CI 0.57, 0.87; I-squared= 96.65%) for model development studies and 0.70 (95% CI 0.57, 0.80; I-squared= 90.53%) for model validation studies but there was substantial heterogeneity. Studies had poor adherence (range 32-50%; median 44%; IQR 11.5%) to TRIPOD guidelines. The overall risk of bias was high for all included studies.

Conclusion

Seven risk prediction models were identified, all exhibiting poor adherence to TRIPOD guidelines which may question the investigational rigor of the studies and their usability. This underscores the need for the development of a validated, robust and reliable tool worthy of implementation and testing in a real-world setting.
The Use Of Simulation To Develop, Test And Implement A Multidisciplinary Team Care Pathway Bundle For Inpatients With Parkinson’s Disease
Authors: Hennessy Susanne , Forbes Rebekah , Fleming Emma , Woulfe Cliona , Patel Tariq , Jennings Emma
Published: September 2024

Background

Hospitalised PD patients experience poorer outcomes. Model-2 hospitals lack onsite subspecialty neurology services whilst frequently managing PD inpatients. Aiming to enhance care of PD inpatients our multidisciplinary team (MDT) utilise simulation to design and deliver a new PD care pathway bundle.

Methods

The developed care bundle aims to facilitate i) screening for causes of PD deterioration, ii) identification of time sensitive and contraindicated medications and iii) prioritisation of timely MDT referral within the first 24 hours of admission. Using simulation of the NPO PD patient, usability of the bundle was tested through correct medication conversion (via Parkinsons calculator) and MDT clinical review for NG tube insertion with patient inclusion.

Results

Simulation delivery and structured debrief thereafter, further enhanced development and improvement of the simulation. It reinforced how the care bundle initiated early MDT referral and highlighted the pros/cons of MDT discussion with and without the patient. Once deemed satisfactory by all team members, ward-based simulation facilitated staff education and awareness of the new tool.

Conclusion

Simulation in the test and clinical environment facilitated implementation of a new MDT care pathway bundle at hospital level. Evaluation of effectiveness of the new care pathway require future audits and additional simulation campaigns.
Outcome Measures And Analysis Of Memory Movers- An Exercise Programme For The Brain, Body And Mind
Authors: Lafferty Regina , Boyle Mairead
Published: September 2024

Background

Memory Movers is a six-week early intervention specialist programme designed for implementation in community settings to meet key healthcare needs for individuals experiencing memory difficulties/dementia and their family carers. This programme provides individuals with the knowledge, skills and education to care for their overall health and well-being. It supports mental health and well-being by utilising cognitive stimulation exercises in conjunction with physical health exercises and providing information and basic exercises in mental health.

Methods

The Specialist Mental Health Service for Older People collaborated with an Acute Hospital, local Council, and Sports and Wellbeing Partnership in designing a suitable, accessible programme to promote Mental Health and well-being in the community. The programme incorporates the following aspects of health: Memory, Movement, and Mental Health.

Results

Pre- and post-assessments were undertaken with results highlighting the following: The Life Satisfaction Scale improved by 6%; the Mood Rating Scale improved by 19% and the overall rating of experiencing feelings of anxiety was reduced by 14% within the final week. There was also a 101% increase in the average engagement in physical activity. A range of positive comments received from attendees were recorded on feedback questionnaires.

Conclusion

Findings highlighted that remaining active supports both physical and mental health. According to the HSE (2020), physical exercise can cause chemical changes in the brain, which can help improve mood. Cognitive stimulation is beneficial to brain health and cognition (Schulz 2015). These contribute to the overall well-being of individuals, promoting cognitive functioning and movement, as well as overall mental health and well-being. This programme also provides opportunities for social connection and integration with services.
Impact of a Stroke Physician-Provided Loop Recorder Implant Service in a Model 3 Hospital Investigating Embolic Stroke of Undetermined Source:
Authors: Zeeshan Muhammad , O'Sullivan Ciara , Coghlan Roseann , Flahive Ann , McCormick John , Cotter Paul
Published: September 2024

Background

When Embolic Stroke of Undetermined Source (ESUS) is investigated with an Implanted Loop Recorder (ILR), Atrial Fibrillation (AF) may be detected in about 25%. In Ireland this is usually undertaken by a cardiology service. Non-traditional implanters are now well accepted, though few stroke physicians perform this service. Understanding the expected numbers and workload will allow service planning.

Methods

The study is a prospectively cohort at a model 3 institution. A stroke physician and CNS-provided implant service was initiated in 2017. The Irish National Audit of Stroke and Hospital Inpatient Enquiry was used estimate the numbers of infarcts. The hospital patient management system was used to evaluate the follow-up provided per case. Consultant time was calculated at 45, 30, 30 and 20 mins per implant, explant, in-person review and tele review respectively. CNS time was calculated at 60 and 45 mins per implant and explant. Descriptive statistics were used.

Results

Between March 2017 and February 2024, a total of 63 ILR (Reveal LINQ, Medtronic) were implanted by the team, of which 58 were for ESUS; mean age at implant 66.4 years, 39.6% female. Implants as a proportion of the total infarcts in the years 2017-2023 was 6.51%; range from 3.1-9.9%. Excluding the disrupted Covid years and 1st year the average was 8.8%. Of the implants, 34 (60.3%) have been explanted to date. The total median (IQR) time per implant was 120 (100-150) mins and 105 (60-105) mins for consultant and CNS respectively [145 and 105 mins respectively for explanted (completed) cases]. AF has been identified in 17 cases to date (29.3% of implants).

Conclusion

Implementing an ILR service requires about 2hours of consultant time and 1hour 05 mins of CNS time per case. Expected numbers of implants can be estimate at 8-10% of all infarcts, and a considerable proportion will have AF detected.
Characterisation of Patients with Self-Neglect – `Room to Improve' with a New Potential Geriatric Giant?
Authors: Stanley Eve , O'Connor Kieran , O'Sullivan Catherine , O'Caoimh Ronan , Moloney Elizabeth , McGrath Keith , Alcock Megan , Hayes Mary , Maher Sharon
Published: September 2024

Background

Self-Neglect is an under-reported and often veiled diagnosis which is defined as ‘an adult’s inability due to physical or mental impairment or diminished capacity to perform essential self-care tasks. Self-Neglect is an independent risk factor for death and is associated with morbidity, heavy utilisation of healthcare services and safeguarding issues. Self-Neglect affects more older persons and is more commonly seen in people with cognitive deficits and social isolation.

Methods

Using HIPE data, patients were selected for a Descriptive Retrospective Chart Review with a diagnosis of Self-Neglect and under the care of a Consultant Geriatrician within a 2-year timeframe from April 2022 to April 2024. Data was compiled and demographics were collated. Charlson Co-Morbidity Index, Adult Comorbidity Evaluation-27 and Clinical Frailty Scores were employed.

Results

Twenty patient's charts were reviewed retrospectively. Of the twenty patients 65% were male, 40% are rural dwelling and 70% live alone. 95% of patients have an underlying cognitive impairment, and over 90% have a current or remote history of substance abuse. All 20 patients had significant concerns highlighted about their housing and 60% of patients required alternative accommodation while their home was updated or cleaned. All 20 patients required discharge planning with many requiring complex multi-disciplinary input regarding their safe discharge and had prolonged inpatient stays.

Conclusion

Recognition and resourcing ‘Self Neglect’ pathways will remain an issue in the health service in Ireland and worldwide. Patients presenting to hospitals with Self-Neglect are multi-morbid, socially complex and tread the line between autonomy and public health issues. Creating a service pathway that puts this vulnerable cohort at the centre and that could span both inpatient and community streams would be beneficial to the over-stretched health service but most importantly to the patient.
Enhancing Delirium Recognition: Assessing The Impact Of Educational Interventions In A Model Three Hospital - A Retrospective Analysis
Authors: Scully Padraig , Drumm Breffni , Casey Mary
Published: September 2024

Background

Delirium is a common medical emergency which is well-known to be associated with adverse outcomes but often remains under-recognised in the acute care setting. In recent years, efforts have been made by our gerontology department to increase awareness of the importance of recognising delirium as a medical condition. Initiatives carried out included the roll-out of education sessions at ward level, medical and nursing grand rounds. Utilising HIPE (Hospital Inpatient Enquiry) data, we assessed whether such interventions have translated into increased recognition of delirium in hospital inpatients.

Methods

We collated data from the HIPE department in our hospital. HIPE assessed all hospital inpatient medical charts for patients that were discharged each year to assess whether delirium was recorded as a diagnosis in such patients. The data for each discharge year spanning from 2018 to 2022 inclusively was compared. We assessed the number of patients discharged during those years that had a diagnosis of delirium recorded in their chart. Additionally, in conjunction with the frailty team, we reviewed all formal interventions made in our hospital since 2018 to promote awareness around delirium.

Results

A year-on-year increase in the number of cases of chart-recorded delirium among hospital inpatients between 2018 and 2022 was observed. In 2018, there were 308 diagnoses of delirium made in patients being discharged from hospital that year. This was followed by 342 in 2019, 424 in 2020, 501 in 2021 and 609 in 2022. There were nine different initiatives identified to have been carried out by the gerontology team to increase education around delirium.

Conclusion

Interventions made have shown to increase the recognition and diagnoses of delirium. With diagnoses increasing by nearly 98% over a five-year period, this shows that interventions to improve awareness of delirium can have significant impact. Recognising delirium is the first step to improving outcomes for patients.
The Development and Impact the First Irish Nurse-Led Lumbar Puncture Clinic in a Regional Specialist Memory Clinic
Authors: Crosby Lisa , Garcia-Gallardo Angela , Hutchinson Siobhan , McKenna Mary Clare , Byrne Lisa , Reilly Claire , Oakes Katie , Robinson David
Published: September 2024

Background

A Regional Specialist Memory service assesses complex cases of cognitive impairment, requiring a comprehensive diagnostic assessment. Lumbar punctures (LP's) are the definitive procedure to identify Alzheimer's Disease. The highest limitation to LP access is shortage and availability of specially trained medical staff. Cognitive centres across Europe have been training nurses (Advanced Nurse Practitioner) to perform LPs since 2006. A nurse led service was established in April 2023 in a large Irish teaching hospital.

Methods

This analysis data represents a preliminary 5-month audit of an ANP Led LP service (ALLPS) compared to prior service provision (ALLPS n=40, pre-ALLPS n=20). Waiting time for LP prior to ALLPS averaged 25 weeks, which reduced by over 50% (12 weeks).

Results

CSF results were identified in half the time with ALLPS (3 weeks versus 6 weeks). The initiation of the ALLPS reduced the timeframe to diagnosis from 12 weeks to 5 weeks. This led to an average wait time reduction from date of CSF result to disclosure of diagnosis of 53% (15 weeks pre-ALLPS to 8 weeks). The ALLPS is pioneering the use of a seated upright LP procedural position, reported to be comfortable by this cohort. Analysis of the nurse led LP procedure is comparative with medical LP services. Almost 40% were achieved on 1st attempt, a further 28% on 2nd attempt, with 18% on 3rd attempt. The ANP successfully completed 75% of LPs in this initial cohort with 9 patients requiring supervisor LP performance. One case required x-ray guided LP.

Conclusion

Appointment of a dedicated ALLPS service has reduced waiting times for diagnostic intervention, leading to early diagnosis, accessing post diagnostic support, meeting best practice guidelines outlined by the National Dementia Office.
Symptoms and Psychosocial Factors on Quality of Life and Life Satisfaction in People with Parkinson’s Disease
Authors: Gaiera Fran , O'Shea Emma , O'Keeffe Gerard , Timmons Suzanne
Published: September 2024

Background

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases estimated to touch 9.3 million people worldwide by 2030. Motor and non-motor symptoms of PD have a debilitating effect on people with PD’s quality of life (QoL) and life satisfaction (LS). This study aims to explore the factors influencing people with PD’s lives in Ireland.

Methods

The sample comprised 827 participants, recruited through crowd-sourcing and snowball sampling. Participants were asked to complete a 30-minute survey online or on paper. The survey collected data on motor and non-motor symptoms, social connectedness, self-efficacy, stigma, QoL and LS. A series of linear and multiple regressions assessed the relationships between people with PD’s symptoms, psychosocial factors and their QoL and LS.

Results

Low self-efficacy and high levels of stigma were predictive of low QoL and LS, while low social connectedness was associated only with low QoL. Results showed reduced dexterity with hand/eye coordination, anxiety, apathy, pain and fatigue contributed to LS, whereas reduced dexterity with hand/eye coordination, shaking/tremors, stiffness of movement, freezing of gait, cognitive problems, hallucinations, apathy, compulsive behaviours, sleeping disorders, pain and urinary incontinence were contributors of QoL.

Conclusion

This study can provide insights into the factors influencing people with PD’s QoL and LS. Data can promote the development of therapeutic interventions targeting PD non-motor symptoms, which are often dismissed by clinicians. Finally, findings can inform the development of health and social policies and educate the general public to dissolve the stigma associated with PD.
Adherence to Secondary Preventative Medications One Year Post Stroke
Authors: D'Alton Maeve , Baby Maya , Donaghy Lisa , Hamad Mahmoud , Dolan Eamon , Sheehan Orla
Published: September 2024

Background

Adherence to secondary preventative medications is critical to reduce subsequent vascular events after ischaemic stroke. Many stroke risk factors are modifiable, but adherence is poor in up to 40% of stroke survivors. Guidelines recommend the use of antithrombotic, lipid lowering and antihypertensive medication. We examined adherence to these medications one year post stroke.

Methods

This was a retrospective cohort study of patients admitted to an Irish level 3 hospital with an acute stroke between July 2022 and June 2023. Stroke survivors were interviewed a year after stroke onset, either in clinic or in their home, and asked to show the interviewer all current medications. Adherence to three categories of secondary prevention medications and knowledge of their indication was assessed.

Results

172 stroke patients were contacted and 64% agreed to participate. The cohort included 62% males and average age was 69.9 years. The majority (72/110, 65%) had a modified Rankin score (mRS) of 0-2. The proportion of participants reporting full adherence to all prescribed medications was 81% (89/110) with adherence rates of 81% for lipid lowering agents and 88% for both antithrombotics and antihypertensives. Adherence was higher in participants who had an involved caregiver (85.9% vs 73.9%) and in those with mRS >2 (94.9% vs 73.2%). There was no significant difference between age or gender subgroups. Knowledge of the indication was 62% for antithrombotics and 55% for lipid-lowering drugs.

Conclusion

Self-reported adherence to secondary preventative medications was high in this cohort but one in five stroke survivors reported poor adherence increasing their risk for recurrent stroke. Adherence was highest for antithrombotics and lowest for lipid-lowering drugs. Adherence is higher in more dependent individuals and helped by an involved caregiver. We observed a deficit in patient understanding of secondary prevention medications. Improving this knowledge gap could increase adherence to secondary prevention post stroke.
Incidence of Vestibular Dysfunction in Frail Older Adults Attending an Integrated Care Programme for Older Persons (ICPOP)
Authors: Hassett Patricia
Published: September 2024

Background

The World Falls Guidelines (2022) recommend a vestibular assessment as part of a multifactorial falls risk assessment in older adults. There is a possibility however, of vestibular dysfunction being overlooked because of no subjective complaints in older fallers i.e. vestibular agnosia. This study aimed to determine the prevalence of vestibular dysfunction in older adults presenting to physiotherapy in Integrated Care Programme for Older Persons (ICPOP) regardless of complaints of dizziness.

Methods

This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP over a 4-month period. Patients with a falls history or indicators of vestibular dysfunction (e.g. dizziness, reduced balance on turning) were identified for vestibular assessment. Data was collected from a hospital clinical system using Microsoft Excel. This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP over a 4-month period. Patients with a falls history or subjective indicators of vestibular dysfunction (e.g. dizziness, reduced balance on turning) were identified for vestibular assessment. Data was collected from a hospital clinical system using Microsoft Excel.

Results

A vestibular assessment was carried out on 69% (n=52) of physiotherapy patients with a mean age of 80.9 years and mean Clinical Frailty Score of 5. 75% of patients that underwent a vestibular assessment had vestibular dysfunction with the most prevalent diagnoses being Benign Paroxysmal Positional Vertigo (40%), Unilateral Vestibular Hypofunction (13%) & reduced gain of Vestibulo-Ocular Reflex (13%). 77% of those who tested positively for vestibular dysfunction had a fall within the last 12 months. 48% of those patients that had vestibular dysfunction did not complain of dizziness.

Conclusion

Almost half of patients with vestibular dysfunction had no dizziness highlighting the incidence of vestibular agnosia. This study highlights the high prevalence of vestibular dysfunction amongst older adults and supports vestibular assessments in older fallers regardless of the presence of dizziness.
Employing Shared Decision Making (SDM) to reduce the Anti-Cholinergic Burden (ACB)
Authors: Kinahan Clare
Published: September 2024

Background

Anticholinergic medicines can cause a range of adverse drug reactions (ADRs) including urinary retention, dry mouth, constipation, tachycardia, blurred vision, sedation, dizziness, confusion and delirium. 10% of hospital admissions in those >65 years of age are Adverse Drg Reaction (ADR) related, and approximately 70% of these can be avoided. Shared decision making (SDM) is a joint process in which a healthcare professional works with a person to reach a decision about their care. Medicines should be deprescribed, if a shared decision is reached that the risks outweigh the benefits for the individual.

Methods

Results

Thirty-eight patients, with a mean age of 76 years received a medication review. The mean number of regular medicines pre-review was 10.5 and post review was 9.3. The mean ACB score pre-review was 5.4 and post review was 3.5.

An ACB reduction was achieved in 25 patients (66%) patients. The total ACB score reduction achieved was 73. 90% of the total reduction was achieved by stopping urinary antispasmodics, amitriptyline, quetiapine, promethazine and lansoprazole.

Conclusion

Targeting future SDM interventions to patients on those anticholinergic medicines found to be amenable to deprescribing might be an efficient way to reduce anticholinergic burden and harm.
Unexpected Journeys: Investigating Urgent and Emergency Care Trends of Patients Attending a Community Specialist Team for Older Adults
Authors: Chan Kei Yen , Geoghegan James , McCleane Fiona , Fitzmaurice Cliodhna , Mannion Karen , Neachtain Maire Ni , Shiel Edel , Donohue Mary , Mulligan Des , Ramjohn Joshua , Lyne Maria Louise , Al Fazari Afrah , Reddin Catriona , McDermott Clodagh , Stankard Aidan , Burke Shona , Lynch Amy , Hanrahan Caoimhe , Higgins Meave , Memon Sajjan , Murphy Dearbhla Edwards , Conlon Chloe , Okon Mary , Cashen Aoife , Martin Niamh , Small Cliona , Robinson Stephanie , Costello Maria , Canavan Michelle
Published: September 2024

Background

Transitions of care for older people via ICPOP and Urgent and Emergency Care (UEC) pathways are becoming more complex. Demand for unscheduled care for older adults with complex care needs will increase with an ageing society, requiring proactive case management and practical realisation of integrated care pathways.

Methods

Retrospective analysis of UEC presentations of older patients attending a community specialist team (CST) who underwent Comprehensive Geriatric Assessment (CGA) between January-July 2023. Demographics and functional status [Clinical Frailty Score (CFS), Barthel Index (BI), Lawton-Brody Score (IADL), Montreal Cognitive Assessment (MOCA)] were extracted, along with UEC presentations post-CGA until March 2024.

Results

356 patients underwent CGA and 42% (n=148) had subsequent unscheduled care attendance(s). Of those with an UEC attendance 36% (n=54) lived alone. Median functional scores were: CFS 5, BI 17, IADL 3, MOCA 17. Median time to UEC presentation was 100 days since CGA. There were 283 UEC interactions in total. 39% (n=58) had >1 interaction. 73% (n=206) of interactions resulted in acute hospital admissions, 21% (n=58) were ED visits, and 6% (n=19) were Pathfinder interactions. Falls (31%) and infection (19%) were the leading causes for presentation. Of 206 admissions, 61% were admitted under medical specialties, 26% under Geriatric Medicine, and 13% under Surgery. Average hospital stay was 13 days. 65% (n=134), were discharged home, 11% (n=22) to transitional care beds, 7% (n=15) to rehabilitation, 7% (n=14) to nursing home, 3% (n=5) transferred to other hospitals, 7%(n=15) died.

Conclusion

Over half of patients attending a CST had an UEC presentation, reflecting the complexity of this cohort and their level of healthcare utilisation. Case management roles that complement and pull together existing elements of the older persons pathway are lacking across healthcare settings and are fundamental to successful implementation of a patient-centred age friendly health system.
New developments in the diagnosis and management of motor neuron disease
Authors: O’Brien David , Shaw Pamela J
Published: September 2024

Introduction

Motor neuron disease (MND) is a devastating neurodegenerative disease characterized by progressive muscle weakness.

Sources of data

PubMed, MEDLINE, and Cochrane databases were searched for articles to March 2024. Searches involved the terms ‘motor neuron disease’ or ‘amyotrophic lateral sclerosis’ and ‘epidemiology’, ‘diagnosis’, ‘clinical’, ‘genetic’, ‘management’, ‘treatment’, or ‘trial’.

Areas of agreement

Evidence-based management involves riluzole, multidisciplinary care, provision of noninvasive ventilation and gastrostomy, and symptomatic treatments. Tofersen should be offered to treat SOD1-MND.

Areas of controversy

Edaravone and Relyvrio are approved treatments in the USA, but insufficient evidence was found to support approval in the UK and Europe.

Growing points

The discovery of neurofilaments as MND biomarkers, growth of platform trials and development of novel therapies provide optimism for more powerful neuroprotective therapies.

Areas timely for developing research

Further work should focus on the elucidation of environmental causes of MND, gene–environment interactions, and advanced cellular models of disease.
Towards an integrated network for DHSS
Authors: Spackman J W C
Published: September 2024

The Department of Health and Social Security, in awarding over £40 billion a year in benefits by means of more than 1,000 million separate payments to over 20 million claimants, faces an enormous operational task. In order to reduce the cost of this operation – which engages nearly 120,000 staff and costs more than £1.8 billion a year, while at the same time improving service to the public, the Operational Strategy was conceived. This is a plan for a network to connect the 500 or so Social Security local offices and the 1,000 or so Unemployment Benefit offices to the mainframe computers which will hold the claimant records. It is anticipated that there will be over 35,000 terminals online to this network by 1992.
The Revenue’s experience
Authors: Symons Martin , O’Leary Tim
Published: September 2024

In 1984 the Inland Revenue’s first comprehensive review of its strategy for information technology started a number of initiatives in the area of office systems. This paper describes these and recounts what has been learned over the past couple of years – particularly about the issues which have lead to a fundamental reformulation of the strategy for office systems.
The BCS OA Group
Authors: Levine Bente
Published: September 2024

I have been preaching the automated office gospel since the mid-70’s, and have watched attitudes change from reluctance to enthusiasm, from the spirited ‘we’ll try anything once’ approach to an increased specialisation in applications such as finance, database, graphics, and communications. The most spectacular changes appear to have taken place at opposite ends of the OA spectrum. The networks of large sophisticated organisations are becoming increasingly efficient with the improvements in international communication standards and the rapid growth of personal computers is turning everyone, from the senior managers to the post-room boy, into ‘instant’ experts. So why is there still a need for associations like the OA Specialist Group?
A strategy for office systems in large corporations
Authors: Kellett Geoff
Published: September 2024

Office systems are now being installed in many companies but very few maximise the benefits available to them. To do this, the information within the company needs to be shared, and a suitable strategy is required to do this effectively.

Looking back, the micro revolution seemed to start with the ready availability of spreadsheets. At about the same time came the dedicated word processors, taking advantage of the newly evolved micro-chip. Soon there was a proliferation of personal computers. For the first time, users had tools they could use immediately: no more two year wait, no overnight batch runs and error reports. Naturally, the salesmen took full advantage. There was no need to deal with the data processing manager, they could bypass him and go directly to the finance director, who was probably the man with the ready cash anyway. Who needs standards? Why should I communicate? I have all the data I need here, under my own control at last.
OA: bridging the language gap
Authors: Blaazer Caroline
Published: September 2024

Only Rip van Winkle can have missed the revolution in office communications of the last ten years. We can send memos, letters and reports to almost anyone, anywhere, any time, faster and more accurately: communication is cheaper, easier and more available than ever before. Yet it is a strange paradox to consider that the more technology is used, the less people seem to know about their colleagues, their organisations and what they are trying to achieve.
Telephone-based speech technologies
Authors: Wilson Nick
Published: September 2024

With competition within industry intensifying, more and more businesses are turning to the telephone as a means of interacting with their customers. Telesales departments are increasingly being used to supplement the efforts of mobile workforces -and in some cases, sales staff distributors and retailers are being replaced altogether with CallCentres manned by telephone agents. The fact that there are now upwards of 8,000 CallCentres established in Europe (a figure that is expected to increase to over 35,000 by 1998) bears testimony to this trend.
Automated computed tomography-derived fractional flow reserve model for diagnosing haemodynamically significant coronary artery disease: a prospective validation study
Authors: Bråten Anders T , Fossan Fredrik E , Muller Lucas O , Jørgensen Arve , Stensæth Knut H , Hellevik Leif R , Wiseth Rune
Published: September 2024

Aims

This study aims to assess the diagnostic performance of a novel computed tomography-derived fractional flow reserve (CT-FFR) algorithm and to compare its accuracy at three predefined sites: (i) at the location of invasive FFR measurements (CT-FFRatloc), (ii) at selected sites determined by an automated module integrated within the algorithm (CT-FFRauto), and (iii) distally in the vessel (CT-FFRdistal).

Methods and results

We prospectively recruited 108 consecutive patients with stable symptoms of coronary artery disease and at least one suspected obstructive lesion on coronary computed tomography angiography (CCTA). CT-FFR was validated against invasive FFR as gold standard using FFR ≤ 0.80 to define myocardial ischaemia. CT-FFRatloc showed good correlation with invasive FFR (r = 0.67) and improved the ability to detect myocardial ischaemia compared with CCTA at both lesion [area under the curve (AUC) 0.83 vs. 0.65, P < 0.001] and patient level (AUC 0.87 vs. 0.74, P = 0.007). CT-FFRauto demonstrated similar diagnostic accuracy to CT-FFRatloc and significantly improved specificity compared with CT-FFRdistal (86% vs. 49%, P < 0.001). High end CT quality improved the diagnostic performance of CT-FFRauto, demonstrating an AUC of 0.92; similarly, the performance was improved in patients with low-to-intermediate coronary artery calcium score with an AUC of 0.88.

Conclusion

Implementing an automated module to determine the site of CT-FFR evaluations was feasible, and CT-FFRauto demonstrated comparable diagnostic accuracy to CT-FFRatloc when assessed against invasive FFR. Both CT-FFRatloc and CT-FFRauto improved the diagnostic performance compared with CCTA and improved specificity compared with CT-FFRdistal. High end CT quality and low-to-intermediate calcium burden improved the diagnostic performance of our algorithm.

ClinicalTrials.gov Identifier

NCT03045601
Mechanisms in endocrinology: hypogonadism and metabolic health in men—novel insights into pathophysiology
Authors: Miller Clare , Madden-Doyle Lauren , Jayasena Channa , McIlroy Marie , Sherlock Mark , O’Reilly Michael W
Published: September 2024

Hypogonadism in men is associated with an adverse metabolic phenotype and increased mortality. Reciprocally, obesity and insulin resistance can suppress the hypothalamic–pituitary–gonadal axis in the absence of structural organic disease, further perpetuating a cycle of metabolic dysfunction and low testosterone. The mechanisms underpinning this bidirectional association are complex as hypogonadism is a heterogenous syndrome, and obesity is associated with metabolic perturbations in glucose and lipid metabolism even in the presence of normal testicular function. However, distinct molecular defects specific to testosterone deficiency have been identified in pathways relating to glucose and lipid metabolism in target metabolic depots such as adipose tissue and skeletal muscle. This review discusses the etiology and prevalence of metabolic disease in male hypogonadism, with a specific focus on both disease mechanisms and novel potential approaches to enhance our understanding.