bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Experience Survey as a Tool to Support Quality Improvement of a Geriatric Service in the Emergency Department (ED)
Authors: Maher Mairin , O'Carroll Susan , Cremin Maria , Carmody Chris
Published: September 2024

Background

The aim of this survey was to valuate patient’s satisfaction with a Frailty Intervention Therapy Team (FITT) and gain insight into their thoughts about the service. Patients’ feedback is a vital component in monitoring and improving the quality of care. The data collected will help develop the service ensuring it’s patient centred and tailored to their needs.

Methods

A qualitative approach was taken in the form of a patient satisfaction survey. To limit bias responses, non-patient facing clerical facilitated the completion of the questionnaire with the patient.

Results

27 surveys were administered over a 5-week period with an 81% response rate (n=22). 91% of patients surveyed felt the purpose of the FITT service was clearly explained to them, the team member had clearly introduced themselves and the team used both written and verbal information well –indicating an effective and efficient style of communication. 100% of patients reported that FITT treated them with dignity and respect. 18% of patients reported they were not involved in decision making relating to the care they received. The ED environment was rated as poor by 14% of patients, long wait time to be seen was also a concern. While some areas of patient concerns cannot be directly targeted by the team alone, we have a duty of care to highlight these concerns to the wider ED staff and hospital group.

Conclusion

A ‘what matters to you’ question has been incorporated into the assessment paperwork, to ensure patients’ wishes are being formally captured and placed centrally within care management planning. Communication to the patient was supported by providing a FITT information leaflet. Additional seating was procured by FITT to promote improvements in comfort and facilitate safe transfers of older patients in the ED. Patient feedback was presented to the ED governance group, including major themes of patient concern.
Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis
Authors: Hayes Christina
Published: September 2024

Background

Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. A knowledge gap exists with regards to what elements of integrated care facilitate effective age-attuned healthcare delivery. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with General Practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study.

Methods

PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE were systematically searched in April 2023. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence and used the Rainbow Model of Integrated Care taxonomy to describe the elements of integrated care used within studies. The primary outcome was functional status. Meta-analyses were performed using Review Manager 5.4.

Results

Twelve trials (14 reports) recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD) 0.21, 95% confidence interval (CI) 0.05-0.37; low certainty evidence), hospitalisation (risk ratio (RR) 0.77, 95% CI 0.63-0.95; very low certainty evidence) and participant satisfaction with care (SMD 0.46, 95%c CI 0.15-0.76; low certainty evidence) from 12-36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, Emergency Department presentation, mortality, health-related quality of life, or nursing home admission were established.

Conclusion

Community-based MDT integrated care with GP participation improves clinical and process outcomes for community-dwelling older adults. Future research should focus on models of integrated care that respond to the needs and preferences of older adults.
Under Pressure: An Audit of Pressure Injury Documentation in Hospitalised Older Adults
Authors: Meyerkort Claire , Gupta Shivangi
Published: September 2024

Background

Pressure injuries are common in hospitalised older adults. They are associated with adverse outcomes including reduced quality of life, pain, insomnia, mood disturbance and secondary infection. They can negatively affect mobility and prolong hospital stay with financial cost to the health service. Pressure injuries represent a geriatric syndrome with multifactorial risk factors, requiring multidisciplinary communication to optimise management.

Methods

Retrospective audit over three months in adults over 65 years, admitted to a geriatric rehabilitation ward. Audit aims were (1) Review medical staff pressure injury written documentation and (2) Review medical staff written communication and handover regarding pressure injuries. Data were gathered from medical records including written notes and discharge letters.

Results

Twenty-six patients had thirty-six individual pressure injuries. The mean age was 83 years, 53% female and 47% male. Total length of stay mean was 50 days (range 16 – 147 days). Thirty-nine percent of pressure injuries were stage 1, 42% stage 2, 3% stage 3, 6% suspected deep and 11% unstageable. Documentation in the medical admission occurred in 21% and medical notes in 33%. Documentation in multidisciplinary team (MDT) meetings occurred in 17% and discharge letters in 22%. The mean time between nursing pressure injury identification, and medical and MDT documentation was 17 and 16 days respectively.

Conclusion

Medical team written documentation of pressure injuries was low. Only one-fifth to one-third of pressure injuries were recorded. Although pressure injuries benefit from multidisciplinary management, they were documented in MDT meetings in under one-fifth of cases. Delays of more than two weeks between nursing and medical documentation occurs. Improving documentation and communication between the MDT can optimise pressure injury management, highlighting the need for ongoing medical education and more effective documentation processes.
Consolidating Integrated Care: A Joint Falls Prevention Initiative between Community and Hospital Based Physiotherapy Services
Authors: Gormley Geraldine , Drury Theresa , Quinn Therese , Cooney Hazel
Published: September 2024

Background

Physiotherapists from Primary Care, Integrated Care Programme for Older Persons (ICPOP) and hospital-based Frailty Intervention Team services came together to establish a community working group with the aim of reducing the incidence of falls of those in their collective catchment area. The agreed objective being to pilot a 6 week falls prevention initiative between community and hospital-based services.

Methods

7 Physiotherapists across 3 services formed a community working group. A 6-week physiotherapy led, multifaceted intervention program involving exercise, education and an opportunity for socializing was developed. The class was accessible to persons over the age of 65 years who had or were at risk of falling. Participants were recruited from the caseloads of the physiotherapists involved. Objective assessments of gait speed, grip strength and balance were carried out via hand grip dynamometry, Timed Up and Go (TUAG) and Short Physical Performance Battery (SPPB). Subjective measures of participant’s quality of life were assessed via the EQ 5D 5L, Falls Efficacy Scale (FES) and Sarc-F. On completion of the intervention participants were retested.

Results

10 participants were recruited to the pilot from both community and hospital based, out-patient services. Over 80% of participants attended 4 out of 6 sessions. Participants grip strength improved by 3.4kg, TUAG by 6.43% (1.03 seconds) and SPPB by 13.3%. EQ 5D 5L scores improved by 15%, FES score improved by 17.81% and SARC-F scores improved by 6%. 40% of participants went on to engage with a follow-on exercise group delivered by the local Sports Partnership.

Conclusion

Overall, there was a notable improvement in participant’s physical function and quality of life and self-efficacy scores post intervention. This highlights the positive impact of multimodal group interventions, which incorporate both exercise and education to promote self-efficacy within frail older population at risk of falling.
Improving Recruitment Of Older Patients For Patient And Public Involvement And Engagement Work (PPIE): Ensuring A Representative Voice
Authors: Liu Lilly , Taylor Nathan , Partridge Judith , Dhesi Jugdeep
Published: September 2024

Background

Older people are under-represented in research, despite this demographic being the biggest users of healthcare resources. Service design needs to be patient-centred and therefore engaging this underserved group is crucial, albeit challenging. We describe a quality improvement project aimed at improving recruitment of patients into a local PPIE group in a perioperative geriatric service.

Methods

Clinicians opportunistically consent patients for the PPIE group during their perioperative geriatric clinic consultations. A baseline level of recruitment was established before implementing a series of PDSA cycles. The interventions were firstly, to adapt the paper clinic proforma making the consent section clearer, secondly to give weekly reminders to clinicians, and finally discussing PPIE with patients while they wait for their appointment. A focus group with clinicians was run using nominal group technique to explore barriers and potential solutions to recruitment.

Results

An average of three patients were being recruited per month from April 2022 to September 2023. Two weeks following the first intervention, no new patients were consented. Two weeks following the second intervention, this improved to two new patients. Following the third intervention, five new patients were recruited after two clinic sessions. From the focus group, the top three barriers to recruitment were forgetting, clinical responsibilities taking priority, and lack of awareness by new staff. The highest rated solution was utilising non-clinical staff to recruit patients in the waiting room.

Conclusion

During busy clinics, it is easy for clinicians to forget about issues not directly related to the patient in front of them. However, PPIE is vital in co-designing healthcare. There are both staff and patient-related barriers in recruiting and maintaining a PPIE group in older patients. From our project, we found a combination of passive (e.g. a tickbox proforma) and active recruitment by dedicated staff the best way to improve PPIE.
Assisted Decision Making in the Acute Hospital Setting – Staff Experiences of Working with Older Adults
Authors: Casey Amanda
Published: September 2024

Background

The Assisted Decision Making (Capacity) Act 2015 was fully implemented in April 2023. This brought changes to how health and social care staff work with patients who may lack decision making capacity for certain decisions. The most significant group impacted by these changes in the acute hospital context is Older People with cognitive impairment. Staff working with these patients have been navigating the complex balance between embracing the guiding principles of the Act, testing the practical requirements of the Act on behalf of patients who require formal decision supports, all in the context of continued demand on unscheduled care.

Methods

The newly developed role of Principal Social Worker for Assisted Decision Making and Adult Safeguarding has enabled regular access to frontline staff working across 11 hospitals in a large hospital group. Both formal and informal feedback was gathered from a cross section of staff via focussed discussion at local implementation meetings and via individual qualitative interviews with key stakeholders from a broad range of professions.

Results

Staff were generally very positive about the introduction of the Act and its rights-based approach to providing health and social care. Themes which emerged from the interviews included the need for further education and training, continued forums for case discussion and review, clarity re roles and responsibilities and improved pathways for patients requiring support.

Conclusion

The enactment of the Assisted Decision-Making Act did not, as many feared, bring the healthcare system to a standstill. However, its impact on resources and time should not be underestimated. Increased investment in staffing, training and supports are needed to ensure continued integration of the Act in the acute hospital setting.
The Lived Experience of Frailty: Are Frailty Intervention Teams Adding to Patient Quality of Life?
Authors: Donlon Kate , Cooney Hazel , Burke Sandra , O'Mara Gerard
Published: September 2024

Background

Numerous clinical tools are used to identify and quantify frailty, but the lived experience of frailty is not consistently measured or considered in clinical practice. The project aim was to understand the health perceptions of older adults treated by the Frailty Intervention Team (FIT) and establish if the team has an impact on care burden.

Methods

Participants were recruited from a hospital based, out-patient Frailty Intervention Clinic over a 4-month period. Older adults were classified as frail by the Clinical Frailty Scale (CFS). The lived experience of frailty was assessed via the EQ 5D 5L a self-rated quality of life measure with a visual analogue scale (EQ VAS). The impact of frailty on carers was examined by the Carer Strain Index (CSI). These subjective measures were recorded on initial assessment and 2 months post intervention.

Results

31 individuals were assessed (male n=13, female n=18). The average CFS was 4.98 (4.91 male, 5.05 female), indicative of ‘Living with Mild Frailty’. 74.19% of participants (male n=9, female n=14) responded to the follow up questionnaires. Pre-intervention, EQ VAS average responses were 42.5/100 for males and 49.33/100 for females. Two months post intervention improvements were observed in both males and females with scores of 72.77/100 and 62.5/100 respectively. CFS ratings remained unchanged post intervention. 29% of carers reported a CSI of greater than 7/12 pre intervention – indicating high level of carer burden. Post intervention this figure reduced to 9.6% of carers.

Conclusion

This FIT model adds positively to the lives of older adults in a holistic manner. The average participant rated their health positively post intervention despite being classified as ‘Living with Mild Frailty’. This underscores that the patient is the expert of their own experience and challenges the negative perceptions of frailty. Highlighting the need for a holistic understanding of frailty beyond classification scales.
A Bibliometric Review of the Utilization of TILDA Data in the Literature
Authors: Stavolo Agostino , Cavrini Giulia , Romero-Ortuno Roman
Published: September 2024

Background

The TILDA dataset refers to the data collected as part of The Irish Longitudinal Study on Ageing. It is a nationally representative longitudinal study of aging in Ireland, focusing on people aged 50 and older and it includes information on demographics, health status, cognitive function, psychological well-being, social support, lifestyle factors, and use of health services.

Methods

Bibliometric methods are used in several research domains to assess the impact of the field, specific researchers, papers, journals, and to identify knowledge inputs, research gaps and future opportunities. The study examines 609 scientific documents from 2011 to 2023 published on Web of Science (WoS) utilizing “TILDA” as keywords, aiming to identify prevalent themes and their evolution over time. Through thematic maps, clusters were generated to visualize thematic shifts. The Sankey plot illustrates temporal trends, revealing significant themes and their development.

Results

We defined three different time slices to clearly distinguish the themes present in scientific production. Initially (2011-2015), there's a focus on treating frailty, orthostatic hypotension, and physical interventions. Emerging themes include the analysis of cognitive functions and return migrants. In the second time slice (2016-2019), mental health concerns like depression, anxiety, and loneliness gain prominence. Essential aspects of aging such as mobility, self-care, and cognitive decline are also explored. Alcohol consumption and retirement experiences become significant topics. In the latest time slice (2020-2023), quality of life and biomarker studies emerge as prominent themes, along with continued exploration of frailty and fundamental health aspects like cancer and diabetes epidemiology.

Conclusion

The analysis shows the shifting research priorities evident in scientific output utilizing the TILDA dataset. These findings contribute to a deeper understanding of the dataset's implications and inform future research directions, emphasizing its significance in advancing scientific knowledge.
Skip The Dip For Urinary Tract Infection in over 65s. A National Initiative To Reduce Antibiotic Prescribing In Older Persons
Authors: Shah Mala , Clancy Aisling , Regan Mary , Armitage Shirley , Ryan Callum , Sheehan Patricia , Mannion Catherine , Gallagher Olivia , Foran Roisin , Donnelly Margaret , Dwyer Nora
Published: September 2024

Background

Urinary tract infection (UTI) is the most common reason for antibiotic use in older persons in residential care. Dipstick urinalysis for UTI is an ingrained practice. Inappropriate use of dipstick urinalysis can lead to inappropriate antibiotic prescribing, contributing to adverse effects and antimicrobial resistance. The ‘Skip the Dip for UTI in over 65s’ quality improvement initiative (QI) aims to raise awareness of best practice for diagnosis and management of suspected UTI to reduce unnecessary antibiotic use. It supports implementation of national guidance stating dipstick urinalysis is not recommended for assessment of evidence of UTI in people 65 years and over.

Methods

Focus groups with nursing staff in older persons residential care facilities (OPRCFs) identified barriers and facilitators for implementing national guidance on dipstick urinalysis for UTI. Supporting resources developed included a resident leaflet on UTI, staff handbook and webinar recording, hosted on www.antibioticprescribing.ie. Antimicrobial pharmacists delivered workshops on improving assessment of suspected UTI in the HSE OPRCFs from September 2023 to March 2024. Monthly monitoring of antibiotic use for UTI was established in all 119 HSE OPRCFs. Surveys to establish dipstick urinalysis practice in the OPRCFs were administered in March 2023 and March 2024.

Results

A baseline survey in 2020/21 indicated 98% HSE OPRCFs (133/135) performed dipstick urinalysis for residents with symptoms of UTI, reducing to 53% (57/107) in March 2023, and 24% (25/103) in March 2024 following this QI. Prevalence of antibiotics for treatment of UTI in the HSE OPRCFs decreased by 38%, from a baseline of 2.6% (114/4,446 residents) in 2020/21, to 1.6% (66/4,222 residents) in March 2024.

Conclusion

The ‘Skip the Dip for UTI in over 65s’ QI has resulted in a change in practice, with the majority of HSE OPRCFs now reporting dipstick urinalysis is not performed for UTI assessment, with a considerable reduction in antibiotics prescribed for UTIs.
Can A Swallow Screen Score Be Used To Prioritise Dysphagia Assessments By A Speech And Language Therapist?
Authors: Maher Jennifer , Sayers Karen , King Lorna , Ryan Siobhan , Donnellan Christina
Published: September 2024

Background

Dysphagia refers to any difficulty or discomfort associated with eating or swallowing. The prevalence is 10-50% in older persons and is associated with increased dependency and mortality. A non-validated Swallow Screen (SwSc) is used by a Community Specialist Team (CST) for older persons during Comprehensive Geriatric Assessment (CGA) to identify patients requiring Speech and Language Therapy (SLT) referral. The SwSc comprises 7 questions with “yes” or “no” answers. “Yes” answers score 1 point and “no” score 0. The SwSc score is the sum of these points. Higher scores indicate the presence of more symptoms of dysphagia. Patients with a SwSc score ≥1 are referred to an SLT. This study aimed to investigate if a higher SwSc score might indicate more severe dysphagia requiring more urgent assessment by an SLT.

Methods

This was a retrospective cohort study of patients ≥64 years referred to SLT by a CST from June 2023 to April 2024 inclusive. The SLT assessment included a Dysphagia Outcome Severity Scale (DOSS) score. The DOSS score ranges from 1-7, a lower score indicating a more severe dysphagia. Data was entered onto an Excel database and analysed. Biographical and CGA data was analysed using descriptive statistics. The SwSc and DOSS scores were ranked and compared using Spearman’s Rank Correlation Coefficient.

Results

Thirty-nine patients attended an SLT assessment. The mean age was 78, (SD=8.04). The mean Clinical Frailty Score 5 (SD=1.16) and mean modified Barthel Index score 16 (SD=3.75). There was a negative correlation between the SwSc and DOSS scores, r (37) = -.438, p=.005. Higher SwSc scores were associated with lower DOSS scores, indicating more severe dysphagia.

Conclusion

The SwSc can be easily administered by non-SLT clinicians. It may be used by an SLT to aid prioritisation of patients for assessment. Further research with a larger sample is required to establish its validity.
Cultivating A Culture Of Continuous Improvement And Teamwork In An ICPOP Hub
Authors: McGrath Keith , McAuliffe Eileen , Lewis Natasha , Murphy Claire , Lombard Eileen , McGrath Vera , O'Leary Rachel
Published: September 2024

Background

The Integrated Care for Older Person’s (ICPOP) Hub is one 3 Hubs in the healthcare region. The success of the ICPOP Hub has been the adaptability, motivation, dedication of the multi-disciplinary team (MDT) using inter-disciplinary methods to achieve best outcomes for people with frailty and complex multi-morbidity in the Community. Referrals have increased - 406 in 2023. There were 2,754 direct patient MDT contacts in 2023. Medical capacity for new patients is limited. Alternative ways of working were needed to meet increasing demand.

Methods

Quality improvement methodologies were employed to enhance efficiency. Existing practices were mapped, deficits highlighted. New practices were trialled in plan-do-study-act format.

Results

The MDT collaborated to develop structured pathways for Falls and Memory. Criteria were established for triaging referrals, assessment standards, management, post diagnostic support using national/international guidelines (Model of Care for Dementia in Ireland, World Falls Guidelines). More patients were seen via direct-to-MDT pathways and discussed at bi-weekly meetings. Direct referral pathway was instituted from the acute hospital Emergency Department (ED) Frailty Front Door Team to the Hub MDT. ‘One-stop-shop’, multiple, consecutive assessments, while comprehensive, resulted in significant patient fatigue. Moving to parallel assessment reduced appointment frequency and time in the Hub. Staff learned from other disciplines and translated knowledge/skills to tailored patient plans. Case management has prevented ED attendance, particularly for patients with delirium and/or dementia with non-cognitive symptoms. Early integration with Community/Voluntary groups was crucial. Visits from these groups promoted education and relationship building. The Community Connector role has been instrumental in linking people with wellbeing activities in their community. Challenges: Blurring boundaries between roles. Insufficient medical cover represents a barrier to timely patient assessment/management, obstacle to early hospital discharge. Demands on MDT intensify daily.

Conclusion

Enthusiasm, flexibility, ownership, teamwork, distributed leadership were essential in developing pathways and overcoming difficulties.
A Systematic Review Of Medication Knowledge In Older Adults
Authors: Malomo Keneilwe , Ntlholang Ontefetse
Published: September 2024

Background

Medication knowledge, as defined by six aspects, is the person's awareness of their medication name, dose, purpose, adverse drug reaction (ADR), administration schedule and special instructions, is essential in the older patient's treatment journey. This review aimed to assess medication knowledge in older adults.

Methods

A systematic search of six electronic databases, grey literature and citation indexes included studies conducted in any setting or any country on those 65 or older, published over the last ten years, reporting primary data with full-text access, and assessing patients' six aspects of medication knowledge. Joanna Briggs Institute Critical appraisal tool was used to evaluate quality of studies.

Results

Of the 67871 articles searched, only 10 cross-sectional studies were included. Medication knowledge data was collected from pharmacies, community, general practices and outpatient clinics. Surveys used face-to-face interviews and electronic, written, and mail questionnaires. Five studies assessed knowledge on single medications. None assessed all six aspects of medication knowledge. One study assessed five aspects, while the rest assessed fewer aspects. The percentage of those who knew their medication names ranged from 41.9% to 97%, dose 19.4%, purpose 15% to 90%, administration schedule 65% to 92.6%, ADR 42% to 80% and special instructions 32.4% to 94.8%. Data lacked the source of medication knowledge or evidence of a patient-centred care approach. There were repeated calls for further education and research.

Conclusion

Research indicates that older adults have a mixed knowledge of their medications, with some areas well grasped and others lacking. Additionally, it appears that medication knowledge is not thoroughly evaluated initially. Despite ongoing advice to employ all six aspects of medication knowledge for assessment and education enhancement, no progress is seen in older adults' medication knowledge. Therefore, there's a need for better research that anticipates the application of these six aspects, concentrating on education for older adults or their caregivers through patient-centred methods.
Teiripe sa Bhaile: ICPOP Early Supported Discharge for Frailty
Authors: Kenny Bláithín , Nee Rory , Laycock Berneen , Hogge Eilish , O'Neill Niamh , Clarke Enda , Keating Sharon , Quinn Aoife , O'Shea Joan , O'Toole Ronan , Bradley Eoin , Higgins Aislinn
Published: September 2024

Background

Older adults and particularly older adults with frailty are high users of acute hospital care which results in overall higher hospital costs and reduced functional independence. Early supported discharge (ESD) was found to have a statistically significant impact in reducing length of stay in older adults admitted for medical reasons. This poster outlines the rehabilitation pathway developed by an ICPOP team to provide early supported discharge for frail older inpatients with SMART rehab goals.

Methods

Suitable patients are identified and assessed prior to discharge from the acute ward. Each patient receives a comprehensive geriatric assessment in their own home. All patients receive at least 2 hours of therapy per week until they have reached their goals. Standardised outcome measures including Functional Assessment Measure (FIM/FAM) and EQ5D5L are captured for each patient. Clients are discharged once they have reached their goals or are at their new functional baseline.

Results

52 patients have been seen on this pathway since 2023. Hip fracture was the most common reason for referral, followed by Falls. Average length of stay on service was 40 days. Average wait time to first assessment was 1.7 days, highlighting the responsiveness of the service. 4 patients seen in 2024 live alone, indicating this service is also appropriate for patients who don’t have supports readily available in the home. FIM/FAM scores increased from 148 to 160 on average- Indicating more functional independence.

Conclusion

This ICPOP Rehabilitation pathway offers a safe, person-centred alternative to traditional inpatient rehabilitation. Readmission rates post discharge were low indicating the programme's safety. Given the large number of hospital bed saved without compromising functional outcomes for the patients, the ICPOP team is working on expanding this pathway.
The Role of the Acute Occupational Therapist in Patients Returning to Driving
Authors: Lawlor Amy , O'Broin Ruairi , Delaney Aidan , McNally Sarah
Published: September 2024

Background

Drving evaluation is a complex process in which Occupational Therapists (OTs) are often viewed as ideally suited to assist with given our extensive cognitive and upper limb assessments and interventions. As per National Guidelines, health professionals have an ethical obligation, and potentially a legal one, to give clear advice to the driver in cases where an illness or injury may elevate risk of impairment while driving. At present, a pathway does not exist to guide OTs on the extent of our role in supporting patients who plan to return to driving; thus, it remains unclear what is current practice for OTs working in the acute setting.

Methods

We completed a cross-sectional survey to determine current practice among the Dublin Academic Teaching Hospitals.

Results

42 occupational therapists across 9 different specialities with varying levels of experience, from new staff grade to clinical specialists responded to the survey. The survey identified several commonly perceived areas of ambiguity for acute OTs, including, (1) if their workplace has a policy or pathway on the subject and, (2) the Road Safety Authority’s Guidelines for healthcare professionals in relation to medical fitness to drive. It highlighted a lack of knowledge in relation to onward services OTs can and/or should be linking their patients with for outpatient follow-up.

Conclusion

It is evident that there is a distinct lack of knowledge among acute OTs in our role in patients returning to driving following an inpatient admission. Additionally, it highlights a need for a resource to bridge this gap and for future work in building a clinical pathway to minimize ambiguity in this area and ensure we are delivering a service that is both legally and morally sound and fulfilling our duty of care.
Optimising Emergency Care for Older Adults: A Case Study of the EDITH Service Following a Proximal Humerus Fracture
Authors: Doyle Cliona , Davis Aisling Jane , Doran Arthur , Hillery Patrick , McNamara Rosa , Delaney Aidan
Published: September 2024

Background

The Emergency Department in the Home (EDITH) service offers emergency Occupational Therapy and medical assessments to older adults at home, thus negating the need for hospital attendances. Mr X, an 86-year-old with vascular dementia and hypertension, sustained a left proximal humerus fracture from a fall. Following assessment in the ED, Mr X was deemed fit for discharge and was referred to EDITH for an acute functional assessment and clinical review.

Methods

Within 72 hours of discharge, Mr X was visited at home by an Occupational Therapist (OT) and an Advanced Nurse Practitioner (ANP). The OT conducted a home environment assessment, falls-risk screening, delirium screening, reviewed social supports, and performed a functional assessment. Education on one-handed dressing techniques and falls prevention was provided. The ANP conducted a clinical review, and reviewed Mr X’s medication and analgesia. Mr X had the support of his wife to assist with Activities of Daily Living (ADLs), functional mobility and medication management. Mr X’s son purchased assistive equipment recommended by the OT, to enhance home safety. Referrals were made to the local memory support service, a Physiotherapist, and his Public Health Nurse to organise formal care supports.

Results

Mr X remained at home with support from his wife, primary care services, and virtual EDITH follow-up. Mr X had a scheduled review at the fracture clinic following his ED attendance.

Conclusion

Emergency care practitioners play a crucial role in addressing acute functional and clinical changes in older adults attending the ED. Supported ED discharges and service integration during the acute phase can prevent hospital admissions. Collaboration between emergency medicine and primary care is essential for addressing acute medical needs and long-term functional outcomes. With adequate social support and timely services, older adults can recover successfully at home.
Medication Use and Falls Risk in Older Adults: Insights from our Integrated Care Programme for Older Person’s Service
Authors: Nash Karen , Wade Ruth , Connolly Warren
Published: September 2024

Background

Falls pose a critical public health challenge for the elderly, often resulting in severe injuries and complications. Some medications have been identified as potential risk factors for falls in this demographic. The National Integrated Care Programme for Older People has prioritised the development of specialised services targeting frailty, dementia, and falls management to address this concern.

Methods

We conducted a retrospective chart review of older adults to explore the relationship between medication use and falls risk. Data on recurrent falls, polypharmacy (defined as concurrent use of five or more medications), and fall frequency were extracted from medical records. Logistic regression analysis assessed the association between STOPPfall medication use and falling risk, calculating odds ratios and p-values to determine significance.

Results

The study cohort comprised 71 older adults, with a median age of 84 years (range 66-95 years), of whom 69% were female. Among the participants, 79% reported experiencing recurrent falls, highlighting the prevalence of this issue within the sample. Additionally, a substantial proportion (90.1%) exhibited polypharmacy, indicating the commonality of multiple medication use among the elderly population studied. Antihypertensives were prescribed to 42 patients (59%), antidepressants to 26 patients (37%), opioids to 15 patients (21%), benzodiazepines to 12 patients (17%), and antiepileptic drugs to 4 patients (6%). Logistic regression analysis demonstrated a significant association between the use of STOPPfall medications and the risk of falling, with an odds ratio (OR) of 1.84 (95% CI: 1.11-4.23, p =0.044).

Conclusion

These findings underscore the importance of medication review and optimization in fall prevention strategies. Targeted interventions to reduce potentially harmful medication use identified by STOPPfall criteria may aid in fall reduction among older adults. Further research is needed to explore the efficacy of such interventions.
British Planetary Science Conference 2024
Authors: Bridges J , Fletcher Leigh , Avdellidou Chrysa
Published: September 2024

The fourth British Planetary Science Conference set down at the mighty National Space Centre in Leicester in June
Combined LC-MS/MS feature grouping, statistical prioritization, and interactive networking in msFeaST
Authors: Mildau Kevin , Büschl Christoph , Zanghellini Jürgen , van der Hooft Justin J J
Published: September 2024

Computational metabolomics workflows have revolutionized the untargeted metabolomics field. However, the organization and prioritization of metabolite features remains a laborious process. Organizing metabolomics data is often done through mass fragmentation-based spectral similarity grouping, resulting in feature sets that also represent an intuitive and scientifically meaningful first stage of analysis in untargeted metabolomics. Exploiting such feature sets, feature-set testing has emerged as an approach that is widely used in genomics and targeted metabolomics pathway enrichment analyses. It allows for formally combining groupings with statistical testing into more meaningful pathway enrichment conclusions. Here, we present msFeaST (mass spectral Feature Set Testing), a feature-set testing and visualization workflow for LC-MS/MS untargeted metabolomics data. Feature-set testing involves statistically assessing differential abundance patterns for groups of features across experimental conditions. We developed msFeaST to make use of spectral similarity-based feature groupings generated using k-medoids clustering, where the resulting clusters serve as a proxy for grouping structurally similar features with potential biosynthesis pathway relationships. Spectral clustering done in this way allows for feature group-wise statistical testing using the globaltest package, which provides high power to detect small concordant effects via joint modeling and reduced multiplicity adjustment penalties. Hence, msFeaST provides interactive integration of the semi-quantitative experimental information with mass-spectral structural similarity information, enhancing the prioritization of features and feature sets during exploratory data analysis.

Availability and implementation

The msFeaST workflow is freely available through https://github.com/kevinmildau/msFeaST and built to work on MacOS and Linux systems.
Multiple glacial refugia during Pleistocene climatic oscillations shape the genetic pattern of Machilus thunbergii across East Asia
Authors: Jiang Kai , Xiao Yue-E , Gaitán-Espitía Juan Diego , Wang Zhengwei , Yu Shuo , Wang Rong , Hu Yonghong , Huang Weichang , Chen Xiaoyong
Published: September 2024

Pleistocene climatic oscillations caused periodic decline and rise of sea levels, leading to dispersion and retraction cycles of island flora. Yet, the role of island refugia in the current Sino-Japanese Floristic Region remains poorly understood. In this study, we investigated the population genetic structure of the widespread Sino-Japanese Floristic Region tree Machilus thunbergii to infer the potential impact of island refugia. We collected 1378 samples from 64 locations across the distribution ranges. Using chloroplast DNA and microsatellite markers, we found a pronounced genetic differentiation between mainland and island populations, which can be divided further into two and three groups, respectively. Furthermore, comparable numbers of private alleles and haplotypes are present in both mainland and island populations. No essential current gene flow was detected between mainland and island populations after their separation 14 000 years ago. Such patterns are hypothesized to result from the influence of multiple glacial island refugia during Pleistocene climatic oscillations, with limited pollen and seed dispersal of the species. Our findings underscore that the islands and submerged land bridge can act as refugia for plants during glacial periods and have essentially shaped the genetic structure of M. thunbergii populations.
A layered microcircuit model of somatosensory cortex with three interneuron types and cell-type-specific short-term plasticity
Authors: Jiang Han-Jia , Qi Guanxiao , Duarte Renato , Feldmeyer Dirk , van Albada Sacha J
Published: September 2024

Three major types of GABAergic interneurons, parvalbumin-, somatostatin-, and vasoactive intestinal peptide-expressing (PV, SOM, VIP) cells, play critical but distinct roles in the cortical microcircuitry. Their specific electrophysiology and connectivity shape their inhibitory functions. To study the network dynamics and signal processing specific to these cell types in the cerebral cortex, we developed a multi-layer model incorporating biologically realistic interneuron parameters from rodent somatosensory cortex. The model is fitted to in vivo data on cell-type-specific population firing rates. With a protocol of cell-type-specific stimulation, network responses when activating different neuron types are examined. The model reproduces the experimentally observed inhibitory effects of PV and SOM cells and disinhibitory effect of VIP cells on excitatory cells. We further create a version of the model incorporating cell-type-specific short-term synaptic plasticity (STP). While the ongoing activity with and without STP is similar, STP modulates the responses of Exc, SOM, and VIP cells to cell-type-specific stimulation, presumably by changing the dominant inhibitory pathways. With slight adjustments, the model also reproduces sensory responses of specific interneuron types recorded in vivo. Our model provides predictions on network dynamics involving cell-type-specific short-term plasticity and can serve to explore the computational roles of inhibitory interneurons in sensory functions.
Preferential Initiation of Long-Acting Injectable Versus Oral HIV Pre-Exposure Prophylaxis Among Women Who Inject Drugs
Authors: Roth Alexis M , Bartholomew Tyler S , Ward Kathleen M , Groves Allison , Mazzella Silvana , Bellamy Scarlett , Amico K Rivet , Carrico Adam W , Ironson Gail , Krakower Douglas
Published: September 2024

Fifty-five of 62 women who inject drugs (WWID) selected long-acting cabotegravir (CAB-LA) over oral PrEP, and 51/55 received a first injection. More recent injection drug use and number of sexual partners were associated with selecting CAB-LA (P < .05). Findings provide preliminary evidence of a strong preference for longer-acting products among WWID.
3D-targeted, electrocardiographic imaging-aided stereotactic radioablation for ventricular tachycardia storm: a case report
Authors: Kaya Yeşim S , Stoks Job , Hazelaar Colien , van Elmpt Wouter , Gommers Suzanne , Volders Paul G A , Verhoeven Karolien , ter Bekke Rachel M A
Published: September 2024

Background

Stereotactic arrhythmia radioablation (STAR) is a promising non-invasive therapy for patients with ventricular tachycardia (VT). Accurate identification of the arrhythmogenic volume, or clinical target volume (CTV), on the radiotherapy (RT) 4D planning computed tomography (CT) scan is key for STAR efficacy and safety. This case report illustrates our workflow of electro-structural image integration for CTV delineation.

Case summary

A 72-year-old man with ischaemic cardiomyopathy and VT storm, despite two (endocardial and epicardial) catheter-based ablations, was consented for STAR. A 3D electro-structural arrhythmia model was generated from co-registered electroanatomical voltage and activation maps, electrocardiographic (ECG) imaging, and the cardiac CT angiography scan (in ADAS 3D), pinpointing the VT isthmus and inferoapical VT exit. At this location, an area with short recovery times was found with ECG imaging. A multidisciplinary team delineated the CTV on the transmural ventricular myocardium, which was fused with the 4D planning CT scan using a digital images and communication in medicine (DICOM) radiotherapy file. The CTV was 63% smaller compared with using the conventional American Heart Association 17-segment approach (11 vs. 24 cm3). A single fraction of 25 Gy was delivered to the internal target volume. After an 8-week blanking period, no VT recurrences or radiation-related side-effects were noted. Eight months later, the patient died from end-stage heart failure.

Discussion

We report a novel workflow for 3D-targeted and ECG imaging-aided CTV delineation for STAR, resulting in a smaller irradiated volume compared with segmental approaches. Acute and intermediate outcome and safety were favourable. Non-invasive ECG imaging at baseline and during induced VT holds promise for STAR guidance.
Smartphone app-based approximation of time spent with atrial fibrillation and symptoms in patients after catheter ablation: data from the TeleCheck-AF project
Authors: Sandgren Emma , Hermans Astrid N L , Gawalko Monika , Betz Konstanze , Sohaib Afzal , Fung Chi Ho , Hillmann Henrike A K , van der Velden Rachel M J , Verhaert Dominique , Scherr Daniel , Sultan Arian , Steven Daniel , Pisters Ron , Hemels Martin , Lodziński Piotr , Chaldoupi Sevasti-Maria , Gupta Dhiraj , Gruwez Henri , Pluymaekers Nikki A H A , Hendriks Jeroen M , Nørregaard Malene , Manninger Martin , Duncker David , Linz Dominik
Published: September 2024

Aims

Reduction of atrial fibrillation (AF) burden is the preferred outcome measure over categorical AF rhythm recurrence after AF ablation. In this sub-analysis of the TeleCheck-AF project, we tested the feasibility of smartphone app-based approximation of time spent with AF and/or symptoms.

Methods and results

Patients scheduled for at least one teleconsultation during the 12-month follow-up after AF ablation were instructed to use a smartphone photoplethysmography-based application for simultaneous symptom and rhythm monitoring three times daily for 1 week. Proxies of time spent with AF and/or symptoms (% recordings, load, and % days), temporal aggregation of AF and/or symptoms (density), and symptom–rhythm correlation (SRC) were assessed. In total, 484 patients (60% male, 62 ± 9.9 years) were included. Adherence, motivation, and patient satisfaction were high. %AF recordings, AF load, and %AF days (rs = 0.88–0.95) and %symptom recordings, symptom load, and %symptom days (rs = 0.95–0.98) showed positive correlations. The SRC correlated negatively with time spent with symptoms (rs = −0.65–0.90) and with time spent with AF (rs = −0.31–0.34). In patients with paroxysmal AF before ablation and AF during the monitoring period, 87% (n = 39/44) had a low-density score <50% (‘paroxysmal AF pattern’) while 5% (n = 2/44) had a high-density score >90% (‘persistent AF pattern’). Corresponding numbers for patients with persistent AF before ablation were 48% (n = 11/23) and 43% (n = 10/23), respectively.

Conclusion

On-demand, app-based simultaneous rhythm and symptom assessment provides objective proxies of time spent with AF and/or symptoms and SRC, which may assist in assessing AF and symptom outcomes after AF ablation.
Fitness consequences of marine larval dispersal: the role of neighbourhood density, arrangement, and genetic relatedness on survival, growth, reproduction, and paternity in a sessile invertebrate
Authors: Barnes Danielle K , Burgess Scott C
Published: September 2024

Dispersal can evolve as an adaptation to escape competition with conspecifics or kin. Locations with a low density of conspecifics, however, may also lead to reduced opportunities for mating, especially in sessile marine invertebrates with proximity-dependent mating success. Since there are few experimental investigations, we performed a series of field experiments using an experimentally tractable species (the bryozoan Bugula neritina) to test the hypothesis that the density, spatial arrangement, and genetic relatedness of neighbours differentially affect survival, growth, reproduction, paternity, and sperm dispersal. We manipulated the density and relatedness of neighbours and found that increased density reduced survival but not growth rate, and that there was no effect of relatedness on survival, growth, or fecundity, in contrast to previous studies. We also manipulated the distances to the nearest neighbour and used genetic markers to assign paternity within known mother–offspring groups to estimate how proximity affects mating success. Distance to the nearest neighbour did not affect the number of settlers produced, the paternity share, or the degree of multiple paternity. Overall, larger than expected sperm dispersal led to high multiple paternity, regardless of the distance to the nearest neighbour. Our results have important implications for understanding selection on dispersal distance: in this system, there are few disadvantages to the limited larval dispersal that does occur and limited advantages for larvae to disperse further than a few 10s of metres.