bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating Transcutaneous Vagus Nerve Stimulation in Amnestic Mild Cognitive Impairment
Authors: Dolphin Helena , Dyer Adam H , Dukelow Tim , Finucane Ciaran , Gomollo Amparo Zamora , Commins Sean , Kennelly Sean P
Published: September 2024

Background

New treatments are urgently needed for individuals with Mild Cognitive Impairment (MCI) - in particular for those with amnestic MCI, of whom a high proportion have underlying Alzheimer's Disease (AD). Transcutaneous Vagus Nerve Stimulation (tVNS) is a non-invasive neuro-modulatory treatment which has not been extensively examined in older adults with amnestic MCI.

Methods

A single site, single-blind, randomised three-arm crossover pilot trial of acute (60 minutes) tVNS (baseline, sham or active stimulation) was conducted a Regional Specialist Memory Service. Forty participants (age 71.7 ±6.9; 22/40 male) with diagnosed amnestic MCI were recruited. Given the links between AD and neuro-cardiovascular instability, potential adverse effects of active tVNS were assessed using beat-to-beat peripheral (Blood Pressure (BP) and Heart Rate [HR]) and central (via Near Infra-red Spectroscopy) haemodynamic responses to Active Stand (AS). Cognition was assessed between 21.3 ±4.9 and 60.5 ±4.4 minutes using a domain-specific cognitive performance battery with results analysed using mixed-effects linear regression.

Results

In older adults with amnestic MCI, tVNS was safe, tolerable and acceptable with 98% of participants stating they would use the device again. There was no significant effect on BP, or HR responses to AS and cerebral oxygenation remained stable during AS. After tVNS stimulation, performance on tests of spatial navigation were significantly improved compared to both baseline (ß= -8.76; [-14.91, -2.56]; p=0.01) and sham (ß= -4.15; [-7.32, -0.99]; p=0.01) conditions.

Conclusion

tVNS is a safe and tolerable treatment modality in older adults with amnestic MCI. Future studies should explore sustained effects and feasibility of domiciliary use.
Bone-A-Fide Breakthrough: Machine Learning Cracks the Code on Osteoporosis Treatment Using the Irish Hip Fracture Database
Authors: Asri Nur Atikah Mohd , Muslim Azrin , O'Regan Niamh , McEliggott Annette
Published: September 2024

Background

Osteoporosis is a metabolic bone disorder characterised by decreased bone mineral density and mass. Due to its asymptomatic nature, it often remains undiagnosed and untreated until a fracture occurs. Traditionally, treatment decisions for osteoporosis are based on clinical appropriateness while balancing the treatment's risks and benefits. Machine learning (ML) is revolutionising healthcare domains through pattern recognition of previously “unseen” observations. Presently, its application in osteoporosis is limited to early diagnosis. More research is needed to examine its role in guiding osteoporosis treatment. This study aims to identify new predictive attributes for osteoporosis treatment using ML techniques on data from the Irish Hip Fracture Database (IHFD).

Methods

Datasets from January to March 2023 in University Hospital Waterford were sourced from the IHFD. Osteoporosis treatment decisions were obtained from discharge letters. Preliminary data cleaning was performed in Excel with zero-variance and near-zero predictor. Attributes excluded. The dataset was entered into the WEKA 3.8.6 environment for ML processing.

Results

The initial dataset containing 141 instances and 32 attributes was refined using the Correlation Feature Selection and Ranker Search Method, identifying key osteoporosis treatment predictors. The highest correlation attributes are pre-fracture total score, pre-fracture indoor score, and age. Moderately positive correlations are discharge destination, pre-fracture outdoor and shopping score, ASA grade, Length-of-stay, admission code, Admission 4AT score, Frailty scale, and fracture type. The implemented J48 Tree ML-trained model revealed Correctly Classified Instances and Incorrectly Classified Instances of 98.24% and 1.7%, respectively, indicating a high prediction accuracy rate.

Conclusion

This study demonstrates the potential of ML in enhancing osteoporosis treatment decision-making by leveraging datasets from the IHFD. Integrating ML algorithms with traditional approaches can provide a comprehensive, nuanced and personal approach to osteoporosis treatment and patient care. The study opens avenues for future research in applying big data and advanced analytics in healthcare, underscoring the evolving landscape of medical decision-making.
Early Supported Discharge for Older Adults Admitted to Hospital after Orthopaedic Surgery: A Systematic Review and Meta-Analysis
Authors: Williams Susan , Griffin Anne , O'Riordan Clíona , Morrissey Ann-Marie , Galvin Rose
Published: September 2024

Background

Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home, continuing to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. Existing literature demonstrates the concept having a reduced length of stay in stroke inpatients and medical older adults. This systematic review aims to explore the totality of evidence for the use of ESD in older adults hospitalised with orthopaedic complaints.

Methods

A literature search of Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE, CINAHL and MEDLINE in EBSCO was carried out on January 10th, 2024. Randomised controlled trials or quasi-randomised controlled trials were the study designs included. For quality assessment, The Cochrane Risk of Bias Tool 2.0 was used, and GRADE was applied to evaluate the certainty of evidence. Acute hospital length of stay was the primary outcome. Secondary outcomes included the numbers of fallers and function. A pooled meta-analysis was conducted using RevMan software 5.4.1.

Results

Seven studies with a population of older adults post orthopaedic surgery met inclusion criteria, with five studies included in the meta-analysis. Study quality was predominantly of a high risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (REM, MD = -5.57, 95% CI -7.07 to -4.08, I2 = 0%, P < 0.00001). No statistically significant effects favouring ESD interventions were established in secondary outcomes.

Conclusion

In the older adult population with orthopaedic complaints, ESD can have a statistically significant impact in reducing hospital length of stay. This review identifies an insufficient existing evidence base to establish the key benefits of ESD for this population group. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.
Malnutrition Risk Screening and Dietitian Intervention within an Integrated Care Team for Older Persons
Authors: Knox Sinead
Published: September 2024

Background

Malnutrition in older adults increases the risk of frailty. Nutritional interventions can improve frailty. A Senior Dietitian joined our Integrated Care for Older Persons Community Specialist Team (ICPOP-CST) in 2022. Our Complete Geriatric Assessment (CGA) form was redesigned in early 2023 which included the Malnutrition Screening Tool (MST). We commenced measuring handgrip strength (HGS) in late 2023. We measured the prevalence of malnutrition risk among our patients, audited MST use and explored dietetic service provision.

Methods

Data from the first 101 patients with a completed (new) CGA form were obtained from the service’s electronic patient database. Patients with a MST score of 0 or 1 were considered to be at low risk of malnutrition and those with a MST score of 2 or more were considered to be at risk of malnutrition.

Results

The mean age was 84.8±5.3 years and 65% were female. Malnutrition risk was identified in 39 (38.6%) patients. The MST was completed for 96 (95%) patients and completed correctly in 67 (69.8%). The total score was not summed in 26 out of 29 incorrectly completed screening tools (89.7%). Half (51, 50.5%) of the group of older adults received dietetic assessment and intervention. High protein, high calorie advice was provided for 38 (74.5%) of those seen by the ICPOP dietitian and for 29 (93.5 %) of those at risk of malnutrition. Onward referral to primary care dietitians was made for 14 (27.5%) of those seen by the ICPOP dietitian. HGS measurement was performed in 20 patients - 15 (75.0%) were identified to have probable sarcopenia – 11 (73.3%) of these were at risk of malnutrition. All received dietetic intervention in relation to protein and sarcopenia.

Conclusion

Malnutrition risk and probable sarcopenia are common among older adults referred to our ICPOP-CST team. The MST screening tool is practical and identifies those requiring dietetic intervention.
Retracted: Implementation Of A Specialist Geriatric Ward; Outcomes One Year After Inception
Authors: Conlon Chloe , Robinson Stephanie , Small Cliona
Published: September 2024

Background

Older adults being admitted to an acute hospital setting have care needs that would benefit from coordinated care on a Specialist Geriatric Ward (SGW). Prior to May 2023, older patients admitted to our institution received input from geriatric medicine through a variety of avenues. There was a clear need for dedicated and formal access to specialist geriatric services. It was hypothesised that care delivered on a SGW would improve patient access to the Right Care, in the Right Place at the Right Time. It has long been recognised in the literature that a dedicated SGW with appropriate access to Health and Social Care Professionals is the gold standard of care for older adults admitted to the acute setting.

Methods

An evidence based SGW was designed and implemented in May 2023. This consisted of a 32-bed dementia and delirium friendly ward, staffed with a consultant geriatrician, medical team, frailty and dementia Clinical Nurse Specialists, a multidisciplinary team and a dedicated patient flow lead for older persons. Ingress pathways to the ward included emergency department medical admissions, Frailty at the Front door referrals and patients selected from geriatric medicine consults. Egress pathways availed of included offsite rehabilitation, rehabilitation at home services and integrated care team input. All patients received early discharge planning and a comprehensive geriatric assessment was initiated on admission to the ward. Key performance indicators included length of stay (LoS), reduction in “Safari Rounds” which improves Clinician/Patient contact, daily whiteboard rounds, improved predicted discharge date (PDD) compliance. Data and outcomes were reviewed weekly.

Results

After one year, the SGW demonstrated improvements across all metrics with percentage cohorted patients improving by 24% and both average and median LoS reduce by 19 days. Total number of bed days saved was 1,513.

Conclusion

Multidisciplinary care delivered on a SGW improves patient and service outcomes.
What Are the Perspectives and Experiences of Older Adults of Existing Integrated Care Services in the Mid-West Region of Ireland?
Authors: Condon Brian , Manning Molly , Fitzgerald Christine , Hayes Christina , Griffin Anne , Galvin Rose , Robinson Katie
Published: September 2024

Background

Substantial investment has been provided by the HSE in the form of The Integrated Care Programme for Older People (ICPOP) Community Specialist Teams (CSTs) for older people. These teams aim to provide timely specialist multi-disciplinary assessment and intervention to help maintain older adults’ independence and ability to live well at home. Little is known about older adult’s views or experiences of this service. This study aimed to resolve this research gap by exploring older adults’ experiences of CSTs within the Irish Healthcare context.

Methods

A qualitative descriptive research design was employed to explore this research area and a semi structured topic guide was developed. Purposive non-probability sampling was used to recruit 13 older adults who had completed intervention with the CSTs. Individual semi-structured interviews were completed with each participant and were transcribed verbatim. A reflexive approach to thematic analysis was used to guide analysis of the generated data.

Results

Four themes were identified, older people had limited knowledge of the service and experienced accessibility issues in attending CST within a HUB setting (Theme 1). Older people experienced positive and co-ordinated care by CST (Theme 2). Older people described that they valued the self-management education and support from attending CST that enabled to manage their long-term conditions effectively and maintain their independence (Theme 3). Once discharged from CST older people described positive emotional and physiological impact of CST that enabled them to be more confident to manage daily life at home (Theme 4).

Conclusion

It was evident from the data that CST had a positive impact on supporting older people to remain independent at home and increased their confidence in self- management of their long-term conditions. Further research would be beneficial to address ways to improve the delivery of care for the complex needs older persons within CSTs as they describe accessibility issues in attending the service.
Taking the Piss? Using Lean to Review the Process for Provision & Delivery of Continence Disposable Products
Authors: Doyle Cathy , Shé Éidín Ní
Published: September 2024

Background

Urinary incontinence (UI) is the unintentional passing of urine. Its impact on older people varies from a diminished quality of life, to social isolation and frailty. Pads or diapers are commonly employed tools in the care of older people with incontinence. Incontinence is largely underreported and poorly managed among older people in community care settings (Yan et al., 2022). This work reviews the process map of the provision and delivery of continence disposable products in the community by the Health Service Executive in Ireland.

Methods

Lean is a quality improvement approach that consists of the elimination of waste to improve the flow of people, information or goods. We reviewed the process map baseline assessment; captured steps that added value to the patient and the impact on staff in the community.

Results

The initial assessment tool consists of five pages. There are 28 possible steps presented in the process map. There is a gap in the presentation on connectors to associated processes. Eight people are involved in the ordering, approval and delivery process to the older person. The initial assessment and education add value to the patient. If adverse skin or complaints arise an older person can be referred to a continence advisor or the ADPHN. The patient feedback loop is missing following delivery no check-in for education is provided following initial use. Unclear who is the point of contact for the patient to raise issues. The only noted key performance indicator is the processing of a request to order is inputted in one working day. Objectives are not SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound.)

Conclusion

Further in-depth research is required to review if the right staff are making the approvals. Need to review KPIs throughout to improve process and SMART objectives. Perspectives of older people and GP supports require further investigation.
Advancing Loneliness as a National Health Priority: Results of a Multisectoral Roundtable
Authors: Power Joanna McHugh , O'Reilly Aileen , Homeniuk Robyn
Published: September 2024

Background

Ireland has the highest rates of loneliness of all EU countries. Those in the older old category (aged 80+) are at increased risk of developing loneliness, which is in turn a risk factor for many adverse health outcomes. Ireland has a strong tradition of Irish gerontological loneliness research, and it is critical to now know how best to focus research efforts to mitigate the impact of loneliness on older adults.

Methods

We held a roundtable discussion on priorities in Irish loneliness research at the Loneliness Taskforce Research Network inaugural event on 16th April 2024. 75 attendees were present, including those from non-governmental organisations, health and social care professionals, experts by lived experience, academic experts, researchers, and representatives from the private sector and governmental agencies. Of seven tables discussing loneliness research priorities, two tables were devoted to the discussion of priorities in research on loneliness in older people (with 18 participants in total). The priorities were noted, then amalgamated and organised.

Results

There was considerable heterogeneity in priorities raised, with little overlap across the two roundtable outputs. Of particular note was the need to evaluate the many services being delivered across Ireland to reduce loneliness, which operate without an evidence base. Other priorities included:

Conclusion

Results are informative for those planning future research on loneliness among older adults in Ireland and will form the basis for a report from the Loneliness Taskforce to the Irish Government, who have pledged funding for alleviation of loneliness.
Supporting Complex Severely Frail Patients at Home with Community Specialist Team Intervention
Authors: Dunne Aoife , Campbell Claire , Quinn Laura , Murphy Carole , John Shalini , Reilly Amy , Digan Eimear , Martin Ruth
Published: September 2024

Background

The Community Specialist Team for Older Persons (CST-OP) was created to support older people to live well at home. The team primarily aims to reduce ED presentations and admissions into acute facilities for over 65s. The team became the first fully staffed CST-OP in Q3 2022. Referrals are responded to within 24-48 hours and each referral has a comprehensive geriatric assessment completed. Interdisciplinary assessment is used to identify interventional needs which the team then addresses. This abstract specifically examines the success of supporting people with a Clinical Frailty Score (CFS) of 7 and above to remain at home.

Methods

The team consists of a senior 1 WTE Social Worker, Physiotherapist, Therapy Assistant, Consultant Geriatrician, Advanced Nurse Practitioner and Clinical Nurse Specialist. The team also has 0.5 WTE Senior Speech and Language Therapist and Dietician. Referrals are accepted from the FIT team, GPs and Older Persons OPD clinic. The team operates on a 100% domiciliary based assessment. A comprehensive geriatric assessment is completed with each referral. A care plan is generated, and interdisciplinary intervention carried out.

Results

From September 2022 to December 2023 69 patients with a CFS of 7 or above were reviewed by the CST-OP. 60 remained at home, 7 transitioned to LTC and 2 RIP. These figures represent an 86% success rate.

Conclusion

Evidence suggests older people living with severe frailty can be supported to live well at home by Community Specialist Teams via timely interdisciplinary assessment and intervention and appropriate utilisation of community supports.
“What Matters To Me?” Responses from Older People in the Acute Setting
Authors: Toole Diane O , Berry Mary , Bracken Marian , Farrelly Alice
Published: September 2024

Background

The ‘What Matters to Me’ question has been used in many areas of the healthcare. In the context of older persons, the focus is typically on improving patient-centred care in long stay settings or in people living with dementia. It is also synonymous with end-of-life decisions. The question is contextual in itself and can elicit a wide range of responses. In this abstract, it was included in the Comprehensive Geriatric Assessment (CGA) in a section about future care and responses were anticipated to be relevant to that subject.

Methods

The Older Person Specialist Nursing Team developed a CGA document for use in acute care. The “What Matters To Me?” question was included with the intention of discovering and recording older persons’ end of life plans and wishes. The responses to this question were extracted from a random 30 completed CGAs.

Results

A total of 24 responses were gathered, some participants provided multiple answers. Not documented n=6, 3 themes were identified from the responses; Home; Free time and Worries/Concerns. Return home was the most frequently expressed response; n=13. Other responses identified were enjoyment, pass times and pets; n=9. Worries/Concerns were identified in broad terms; “I’m worried out the future” n=7.

Conclusion

“What matters” in this context was a broad query and responses may have been influenced by participants current health status, location and fear of the future and the subjectivity of the question and the practitioner. Participants did not mention dying a concern but did allude to the future in a broad context. The “What Matters To Me” question will now be in the social information section and the Older Person Specialist Nursing Team are considering a targeted question related to end-of-life plans and wishes.
Stepping Stones to Simulation
Authors: Feeney Sara , Monahan Cathy , Dsouza Archana
Published: September 2024

Background

The authors are part of the education and training (E&T) team in the older person directorate. They noted a large influx of new staff and also wanted to develop the learning needs of current staff. This highlighted a need for staff development.

Simulation:

Aims:

Methods

Results

Conclusion
Day Centre Functional Physiotherapy Classes for Older People; Client Survey
Authors: MacDonagh Eugene , Lordan Ruth , Hogan Florence Horsman
Published: September 2024

Background

Our Long-Term Residential Care facility provides physiotherapy services for approximately 117 Day Care clients. As part of our local Quality Improvement Programme, we wished to assess client perception of Day Centre Functional physiotherapy classes to help ascertain their perception regarding exercise intensity of classes, ability to follow guidance in class and ask questions. Emphasis of the class is to promote a learning environment, improve health literacy and functional independence of clients. As Falls Prevention is key re National Programme for older people (NCOP) and National Frailty Education, questions related to falls frequency and fear of falls prevalence.

Methods

This was a survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (> 65 years), This was a qualitative survey distributed to our Day Centre clients who attend physiotherapy. All Older adults (> 65 years)

Results

70% response rate. 100% reported feeling comfortable asking Physio instructor questions & that exercise guidance was clear and understandable. 96% reported being physically able to keep up with class intensity. 80% reported class intensity as moderate, 20% as high, 0% reported class intensity as easy. 84% reported a fear of falling. 17% reported no fall in the previous year. 68% reported 1-3 falls, 15% reported > 3 falls in last year. Class attendances reported: 4% 0-5 classes, 18% 5-10 classes, 78% more than 10 classes.

Conclusion

Results obtained from the survey have provided worthwhile feedback and supports that Falls prevention measures should address fear of falls. Significant findings on client satisfaction/perception of exercise intensity noted. Next steps will include tailoring physiotherapy classes for this demographic to include fear of falling, optimising exercise intensity, promoting health literacy and best practice for exercise prescription. Also, consideration of further objective testing of balance post physio class programme period to ascertain success of exercise classes.
Exploring Allied Health Professionals’ Perceptions and Practice Regarding Recommendations for Intensity of Multidisciplinary Therapy for Stroke Patients: A Qualitative Study
Authors: Foley Gemma , Horgan Frances , Galvin Rose
Published: September 2024

Background

Stroke is a leading cause of death and disability in Ireland; approximately 7,500 Irish people have a stroke every year. Rehabilitation is a key aspect of stroke care; greater amounts of therapy are associated with better recovery. Data from the Irish National Office of Clinical Audit shows that stroke survivors often do not receive recommended amounts of therapy. The recently updated UK and Ireland stroke clinical guidelines now recommend larger amounts of therapy time. This qualitative study explored how allied health professionals (AHPs) feel about the recommendation, and what methods they employ in working to achieve recommended amounts of therapy.

Methods

This study used a qualitative research design employing semi-structured interviews to collect data. Participants were AHPs working in stroke care in Dublin, Ireland, and were recruited using a combination of purposive and snowball sampling. Interviews were audio-recorded, transcribed, and analysed using the Braun and Clarke six-step thematic analysis method. An external validator was utilised for code and theme validation. This research was approved by the Royal College of Surgeons in Ireland Research Ethics committee.

Results

Two main themes emerged: ‘Barriers and enablers to achieving guideline recommended therapy time’ and ‘methods of increasing therapeutic time’. Patient factors and clinical resources impact on the provision of therapy post-stroke. Overall, participants felt positive about the recent guideline recommendation for increased therapeutic time. Various methods are employed to augment patient therapeutic time, including technology and semi-supervised practice. Therapy assistants play an important role in achieving greater amounts of therapy.

Conclusion

AHPs see the new recommendation as challenging but are generally keen to try and achieve it, citing benefits of increased therapy time for patient outcomes. AHPs utilise a wide range of methods to optimise therapeutic time for stroke patients. The role of therapy assistants in supporting delivery of larger amounts of therapy time warrants further evaluation.
An Evaluation Of Social Work Facilitated Peer Support Groupwork With Older Adult Inpatients In Orthopaedic Rehabilitation
Authors: Walsh Mary , Moran Fionnuala , Ward Andrea , O'Connor Marie
Published: September 2024

Background

Social work psychosocial assessments highlighted an elevated prevalence of patients experiencing low mood, isolation, and the impact of their hospital admission. Groupwork is an effective evidenced based social work tool. As psychological factors can impact acute and longer-term recovery, peer support groupwork was piloted to address these issues. This research aims to determine the success of the inclusion of social work facilitated peer support groupwork within the orthopaedic geriatric rehabilitation setting.

Methods

One pilot and three peer support groupwork sessions were held with 4-6 participants per group. Patients were identified with support from multidisciplinary team colleagues. Patients were over 65 years of age, medically stable and were an inpatient on the orthopaedic rehabilitation ward without any contraindications to attendance. A patient led thematic approach informed each session. Structured feedback forms were given to all participants which provided both quantitative and qualitative data.

Results

100% of patients found that peer support groupwork was a beneficial addition to orthopaedic rehabilitation. Patients recognised the benefit of sharing their experiences and emotions with one another. 95% of patients said that they would reattend and many recognised the motivating influence of this forum. 17 out of 19 patients found that the peer support groupwork directly improved their mood. An incidental finding determined a better understanding of the patient and assisted social workers in identifying patients who required more focused holistic support.

Conclusion

Social work facilitated peer support groupwork assists in motivating and improving the mood of older adults engaging with inpatient orthopaedic rehabilitation. It was a resource efficient method which improved the psychological factors experienced by older adults in this setting. The patient led approach and careful consideration and planning generated the groups’ success. This approach has numerous benefits to the overall patient experience and has scope to be utilised within other gerontological settings.
Evaluation of Caru Programme: A National Programme Supporting Palliative, End of Life and Bereavement Care in Nursing Homes in Ireland
Authors: Murphy Siobhán , Steele Kate , Murphy Sheena
Published: September 2024

Background

The aim of the interim evaluation report is to provide the Caru Programme team with information on the impact of the Programme to date and to highlight the outcomes and challenges, whilst reiterating the key aims and objectives of the Programme and the overall evaluation.

Methods

The evaluation utilities’ a combination of quantitative and qualitative methodologies. A pre-post design of baseline, mid-line and end-line primary data collection is used to measure the overall impact of the programme. Secondary data analysis of participant feedback, workshop evaluations and attendance was completed under the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.

Results

The education sessions provided were highly valued, with the majority of participants indicating an increase in baseline knowledge after attending a session. There were very high levels of positive experience with 80-99% of participants strongly endorsing the activities and recommending the programme. Participants who attended the Project ECHO and the QI workshops, indicated an intention to change practice; however, at this stage of the evaluation, there is a lack of specific details on what practice or change would be introduced, or indeed, its timeline. This will be measured in the next phase of the evaluation.

Conclusion

Caru is an innovative continuous learning programme supporting nursing home staff in the delivery of palliative, end-of-life, and bereavement care to residents. The learning components are delivered using a range of approaches, Webinars, Project ECHO online learning, Regional Networks, Quality Improvement Workshops. The interim evaluation report outlines the outcomes from Phase I and the first year of the programme’s delivery. It provides insights into its impact, outcomes, and challenges as well as providing a basis for the next phase of the evaluation. This interim evaluation lays the groundwork for a comprehensive understanding of the Caru Programme model and impact and provides valuable insights into its effectiveness.
Assessing Adherence to Acute Stroke Therapy Guidelines: An Audit Study
Authors: Scanlan Maeve , Harte Emer , Newell Evelyn
Published: September 2024

Background

The 2023 National Clinical Guidelines for stroke for the UK and Ireland recommended that people with motor recovery goals post stroke should receive at least 3 hours (180 minutes) of rehabilitation per day on at least 5 out of 7 days a week. This is a significant change to previous guidelines that recommended that patients receive at least 45 minutes of each therapy for a minimum of 5 days (NICE 2013). In 2022, the UK Sentinel Stroke National Audit Programme found that only 11.9% received more than 45 minutes of physiotherapy. This highlights that many services were not achieving previous recommendations.

Methods

In an Irish hospital, two new stroke assistant posts were funded with the aim to maximise therapy time. An audit was performed on compliance with the 2023 national guidelines on an acute stroke unit in august 2023 for patients that were identified as having motor goals post stroke. Data was collected in the form of minutes of direct patient contact time by each therapy –physiotherapy, occupational therapy, speech and language therapy and therapy assistants. This data was compared against recommended therapy time and presented as a percentage of this.

Results

9 acute stroke patients who were identified as having motor goals were randomly selected. It was found that none of these patients were meeting current therapy guidelines. When compared to the recommendations, the average amount of therapy that patients received per day ranged from 44 minutes – 132 minutes. On average, patients received 49.1% of recommended therapy. It was also found that therapy assistants were providing, on average, 59.3% of the actual therapy received.

Conclusion

Stroke patients are not receiving the recommended amount of therapy as per the most recent guidelines. Although the addition of stroke assistants significantly increased therapy time, guidelines were still not achieved.
A Novel Service: The Role of the Community Connector for Older Persons within ICPOP
Authors: Higgins Aislinn
Published: September 2024

Background

The Community Connector (CC) uses a social prescribing model to work with Older Persons who have recently engaged with ICPOP, complementing the multidisciplinary interventions they receive. A holistic approach is used to support the patient to access a range of community supports to benefit their health and wellbeing and address the social determinants of their health. Reviews show the impact that social prescribing has on the cost implications and healthcare demands. Studies have shown a reduction in GP services, ED attendances and referrals to hospital among those linked with a social prescribing project.

Methods

Results

Conclusion
Time of Brain Imaging In Patients With An Acute Traumatic Intracranial Haemorrhage
Authors: Condon Christine , Mason Colin , Phillips Luke , Ramiah Vinny , Duddy John , Rizzo Paolo , Burns Sorcha
Published: September 2024

Background

We observed variation in timing of CT brain imaging in patients presenting with a history of trauma. The objective of this audit was to determine adherence to local ED CT Head Criteria in patients with a confirmed traumatic ICH.

Methods

Retrospective point prevalence audit of patients with a confirmed intracranial haemorrhage over a five-month period using our neurotrauma work-stream data. Exploration of CT timing between Criteria A (within 60 minutes) and Criteria B (within 8 hours). Characteristics reviewed included Gender, Age, Time of presentation to ED, Day of Arrival, GCS on presentation, Mechanism of Injury and Time of CT completion.

Results

68 patients over the five-month period had a confirmed ICH: 48 male, 20 female. The median age was 62 years (range 17-97). Falls of less than 2 metres were the most frequent cause of injury (n=44, 65%), with 60% of these occurring in patients aged over 65 years of age. 67% (n=31) of patients meeting Criteria A did not have a CT Brain completed within 60 minutes. 14% (n=3) of patients meeting Criteria B did not have a CT Brain completed within 8 hours. Of patients meeting criteria who did not have a timely CT, 11 patients presented out of hours. Patients aged less than 65 years of age were less likely to meet target CT timing; 71% (n=24).

Conclusion

This audit highlights that only 33% of patients meeting Criteria A had brain imaging within one hour. Older adults were more likely to meet target CT timing than younger adults. Lack of ED access to radiology out of hours was deemed to be the main barrier to meeting target CT timing. We are working alongside our radiology department to secure no discussion trauma CT scans in ED out of hours. We plan to re-audit following the implementation of this change.
EDAPT: The Development And Implementation Of A Novel Referral Pathway From The Emergency Department
Authors: Harty Eileen , Walsh Eimear , O'Keeffe Elaine , Dennehy Aoife
Published: September 2024

Background

The Emergency Department Admission Prevention Therapy (EDAPT) service was developed by Therapy staff of the Pathfinder team in order to facilitate timely and appropriate discharges from the Emergency Department (ED) and to maximise capacity for the follow-up team. The aim of this pilot is to provide rapid access to therapy post discharge from ED for older adults with acute decline in function in order to prevent hospital admission. The service provides a short-term reablement approach within the home aiming to facilitate patients to regain pre-acuity baseline. EDAPT was modelled from an existing service but has now been expanded to accepting direct referrals from ED Medical Staff and Advanced Nurse Practitioners (ANPs) outside of standard working hours.

Methods

The pilot was introduced following collaboration and consultation with a number of key stakeholders including respective Therapy Managers, ED Consultants, ANPs and ED Therapists. A new EDAPT referral pathway was created, and documentation including specific referral and assessment forms. A designated area for receipt of referrals in the ED department was chosen and checked daily.

Results

64 patients with a mean age of 80.5 years were referred to the EDAPT service from November ’23 to April ’24. 53 of those patients received face-to-face input and had a mean Clinical Frailty Scale score of 5. 27% (n=17) of referrals were initiated out-of-hours via Medical and ANP staff and 48% (n=31) of referrals were falls related. Patients received an average of 2 follow-up visits during EDAPT involvement.

Conclusion

The EDAPT pilot is successfully facilitating timely and appropriate discharges from the ED, improving patient experience and patient flow from ED to their own home. The pilot integrates acute hospital care and community services, supporting a person-centred approach of the right care, at the right time and in the right place.
The Development And Implementation Of A Multi-Factorial Falls Assessment Tool In A Pathfinder Service
Authors: O'Donoghue Bríd , Burke Dearbhla , Meagher Breda , Griffin Aislinn
Published: September 2024

Background

Falls are a common complaint of older adults who present to the Pathfinder service. Pathfinder offers alternative care pathways to older adults when they phone 999 for low acuity concerns. As part of the service, Occupational Therapists and Physiotherapists provide home-based assessments and interventions. The aims of this project were firstly, to develop a falls assessment tool to assist therapists’ compliance with guidelines relating to older adults who have fallen and secondly, to ensure consistency of assessment and intervention among therapists on the team.

Methods

A falls assessment tool was created in line with the most recent world falls guidelines (Montero-Odasso et al., 2022). The initial roll out began on October 1st, 2024, when the tool was used to assess older adults who presented to the Pathfinder service following a fall. After three months, areas of poor compliance and barriers with usability of the tool were highlighted from a chart review and stakeholder engagement. The document was then revised based on this feedback. From February 1st, 2024, the tool was then used with all older adults who presented to the service. Compliance was re-audited at the end of April 2024 and therapists on the team were surveyed to gather user feedback.

Results

As a result of the falls assessment tool, compliance with the World Falls Guidelines increased initially from 54% to 86% but continued to improve when reviewed seven months post implementation. Qualitative data was universally positive when stakeholders were surveyed with benefits identified as: improving patient care, consistency across the therapy team and a useful means of communication.

Conclusion

The development and implementation of a falls assessment tool into the practice of a Pathfinder service increased compliance with the most recent world falls guidelines and received positive feedback from all key stakeholders.
Oral Symptom Assessment In Older Patients with Frailty Using the Oral Symptom Assessment Scale
Authors: Cleary Niamh , Davies Andrew , Romero-Ortuno Roman , Lavan Amanda
Published: September 2024

Background

Frailty is common in older patients referred to specialist palliative care teams. Its prevalence is estimated at 18% [1]. It is regarded as a “state of vulnerability” [2] in which even a minor stressor may result in adverse health outcomes [3] and mortality [4] independently of chronological age [5]. Oral problems in older patients may also be associated with increased morbidity and mortality [6, 7]. There may be an indirect interplay between oral problems and frailty. Oral symptoms like xerostomia are common in older patients. There is a paucity of research examining oral symptoms specifically in older patients with frailty. Thus, the prevalence of many oral symptoms is not known in this patient group.

Methods

The aims of this study were to determine the prevalence of oral symptoms in older patients with frailty and to determine their clinical features using the Oral Symptom Assessment Scale (with the addition of the symptom of drooling). This prospective observational study was conducted at Our Lady’s Hospice and Care Services, Dublin, and St James’ Hospital, Dublin. Once informed consent was obtained, participants completed the OSAS. Clinical Frailty Scale score, medications, co-morbidities and basic demographics were also recorded.

Results

Data from the first 100 participants recruited to the study is presented. Ninety-one participants reported at least one oral symptom. Two symptoms was the most frequent number of oral symptoms experienced (19%, 19/100). The median number of symptoms present was 4 (range: 0–13 symptoms). Forty participants reported the “new” symptom of “drooling”.

Conclusion

Asking about oral symptoms is important in this patient group. Initial data analysis suggests that many oral symptoms are common (and often of high impact). This study provides a novel insight into the prevalence and clinical features of oral symptoms not previously investigated using a multi-dimensional symptom-specific assessment too.
An Audit Of Health And Ageing Online Resources: Evaluating Information On Periodontitis And Cardiovascular Disease Associations
Authors: Gamble Eugene , Nancoo Tamara , Chami Peter
Published: September 2024

Background

In 2019 the European Federation of Periodontology (EFP) and the World Heart Federation (WHF) organized a review of the literature concerning periodontal disease (PD) and cardiovascular disease (CVD). This was to update the existing evidence from a 2012 review. The consensus report established a strong link between severe PD and CVD, however, this vital information may not be reaching the public who stand to benefit from it.

Methods

A web-based audit to assess the dissemination of information on the PD-CVD association was conducted. Ninety English language websites of foundations, health authorities, and associations focused on aging (54), CVD (21), and general health (15) were included. Dental organisations were excluded. Using Boolean search criteria, websites were examined for webpages informing of the PD-CVD link published in 2019 or later. Pages with the information published before 2019 were also recorded separately. Broken links, paywalled content, and information solely on infective endocarditis were excluded. Pages without metadata on publishing dates were considered older than five years.

Results

Only 8 (8.8%) sites contained information on the PD-CVD link within the past five years of which 5 (5.5%) gave actionable guidance on how to improve oral health. An additional 9 sites (10%) offering the information were recorded but were older than five years.

Conclusion

This study reveals a concerning gap in translating research findings from the highest levels of evidence to online resources accessible to the public. This highlights a missed opportunity to empower individuals. The siloed nature of dentistry, with limited collaboration between dental professionals and other health care providers, might be a contributing factor. These findings highlight the need for improved communication strategies and collaborative efforts to bridge this knowledge gap and empower individuals to make informed decisions about their oral and overall health.
Time-To-Event Analysis Of Factors Influencing Delay In Discharge From A Subacute Complex Discharge Unit During The Pandemic
Authors: Rajendran Nithya , Rameli Puteri Maisarah , Malomo Keneilwe , Byrne Declan , Browne Joseph , Ntlholang Ontefetse
Published: September 2024

Background

Length of stay (LOS) is the most common outcome measure of effectiveness in discharge planning. It refers to the time expressed in days between admission to and discharge from the hospital. During the COVID-19 pandemic, the average inpatient LOS was 5.8 days, representing a slight increase in the average inpatient LOS of 5.7 days between 2016–2019. Tackling delays in patient discharge is an ongoing challenge, and with the emergence of the COVID-19 pandemic, there has been significant disruptions in discharge planning, discontinuity and incoordination between subacute complex discharge units and community care.

Methods

Our study analysed delaying factors amongst patients with LOS > 15 days during the COVID-19 pandemic using time-to-event analysis. Kaplan–Meier’s plot compared factors causing a delay in discharge to the single factors: age, gender, and multimorbidity. A multivariate Cox regression analysis adjusted to age, gender, and multimorbidity predicted factors affecting LOS.

Results

A total of 390 patients were admitted between March 2020 – February 2021 to a subacute complex discharge unit in an Irish tertiary centre hospital: 326 (83.6%) were >65 years of age and 233 (59.7%) were female. The median (IQR) age was 79 (70–86) years with a median (IQR) of 19.4 (10–41) days. A total of 237 (60.7%) events were uncensored, with LOS > 15 days, of which 138 (58.2%) were female and 124 (52.32%) had > 4 comorbidities; 153 (39.2%) were censored into LOS ≤ 15 days, and death occurred in 19 (4.8%).

Conclusion

Our study is the first to analyse common factors delaying discharge from a complex discharge unit. Further research is required to explore multimorbidity as a risk factor for mortality in patients with prolonged LOS within a complex discharge unit and target gender-specific frailty measures to achieve high-quality patient management.