bluuebunny/crossref_metadata_2025 huggingface dataset:
From inference processes to situations of misunderstanding
Authors: Kohler Alaric , Mehmeti Teuta
Published: February 2023

In this paper, we describe inferences on a school task, which are reconstructed by the mean of two perspectives from argumentation theory: The pragma-dialectical model and Grize’s natural logic. Both analyses focus on the same item of mathematics, issued from a PISA survey, in order to discuss their specific contribution in elucidating the actual reasoning involved in both the student's answer and the evaluator’s expectations. The mismatch between these two points of view allow us to discuss the potentiality of a situation of misunderstanding.

Investigating how specific tasks in particular contexts are interpreted provides a contribution to methodological approaches treating thinking processes as situated and socially negotiated from a diversity of points of views, as for example Inhelder’s (1962) microgenetic approach. In order to extend such analysis to interpretations of discourse, an interdisciplinary approach combining argumentation theory and socio-cognitive psychology is needed.

Here, we observed for instance that students may provide the expected answers and still interpret the question or problem differently from the task’s designers (or “teacher”). The meaning of language and other signs, such as graphs or mathematical symbols, cannot be taken for granted when several interlocutors are involved. This issue chiefly concerns argumentation theory, since it raises the question of the integration of specific contexts and points of view in the analysis of argumentation. Therefore, argumentation should be analysed also as a process, and not only as a product; For more detail on this distinction, see for instance Grize (1996) and Kuhn & Udell (2003, 2007).
Investigation of the interference phenomenon between ultrashort pulses based on an all-fiber laser
Authors: Duan Lina , Wang Yishan , Guo Huinan , Wang Hushan , Fan Wei , Li Yan , Hao Minru , Liu Pandi
Published: February 2023

We experimentally report on the interference phenomenon between ultrashort pulses in fiber media. When the pulse interval goes further to a certain small scale, the interference effects can arise. As a result, the spectrum appears to be a modulation phenomenon. Different from the phenomenon of bound-state pulses in a fiber laser cavity, the relationship between the modulation period of the spectrum and the pulse interval in the time domain seems to go against the interference principle. At the same time, the time interval between the two pulses is far greater than the time difference caused by the optical path difference. We are very confused. It seems that when two pulses overlap by a certain proportion in time, they will push each other apart to increase the time interval. Moreover, when the pulse interval becomes smaller and the two pulses are overlapped in time, the corresponding autocorrelation trace exhibits only one peak with regular modulation instead of the conventional three peaks with equal spacing, which looks very strange and is hard to explain. Limited by our technical tools, we could not illustrate the physical causes, but there is no doubt that it will be very meaningful to research what happens. Our observations have found some novel optical phenomena in experiment, which may provide some reference for further exploration of interference phenomena between ultrashort pulses.
Global trigger versatile module for ATLAS phase-II upgrade
Authors: Filimonov V. , Bauss B. , Büscher V. , Schäfer U. , Ta D.
Published: February 2023

The Global Trigger Versatile Module (GVM) has been developed within the framework of the ATLAS detector Phase-II upgrade. The GVM acts as an auxiliary hardware component that can be used for development, testing and operational purposes within and beyond the ATLAS Global Trigger in projects requiring high bandwidth and processing capabilities. The module is designed to host an advanced Xilinx Ultrascale+ VU13P FPGA and Finisar BOA optical modules, running at high data rates up to 25.8 Gb/s, as well as other hardware resources needed for the Global Trigger, located on a high-density PCB, optimized for high-speed data transmission. A testing program of the Global Trigger Versatile Module includes verification of the main hardware functionality of the module, performance evaluation of the high-speed optical modules and the FPGA, and Global Common Module development firmware tests.
Irradiation testing of ASICs for the HL-LHC ATLAS ITk Strip Detector
Authors: Dandoy J.R. , Dressnandt N.C. , Gosart T.C. , Gutierrez Zagazeta L.F. , Keener P.T. , Krizka K. , Kroll J. , Lipeles E. , Lu S. , Mayers G. , McGovern R.P. , Newcomer F.M. , Nikolica A. , Reilly M.B. , Thomson E. , Wall A.
Published: February 2023

For the high-luminosity upgrade to the LHC, the ATLAS Inner Detector will be replaced by an all-silicon tracker (ITk) consisting of two systems: pixels and strips. HCC and AMAC are ITk Strip ASICs vital for performing the system readout, monitoring, and control. To ensure these ASICs will successfully operate in the high-radiation environment of the HL-LHC, they need to be tested for radiation tolerance, and tests have been performed using both heavy ions and protons. The ASIC designs were shown to protect against single event effects due to radiation.
Artificial neural network on-chip and in-pixel implementation towards pulse amplitude measurement
Authors: Koziol A. , Szczygiel R. , Kuznar D. , Strzalka K. , Wielgosz M. , Otfinowski P. , Maj P.
Published: February 2023

We present the design of an in-pixel artificial intelligence (AI) for extraction of an amplitude of a pulse generated in semiconductor detector. The AI is design with traditional multi-level perceptron scheme having 6 layers and the total number of 420 parameters. The implementation shows 0.34% measurement accuracy. The AI block is fed by the 6-bit ADC at 5 MHz sampling rate. Standard front-end is optimized for low-noise pulses carrying 1000–3000 electrons. The methodology was tested using FPGA and results are promising. The design is intended to be fabricated and verified in the prototype solution.
Evaluation of GBT-FPGA for timing and fast control in CBM experiment
Authors: Sidorenko V. , Müller W.F.J. , Zabolotny W. , Fröhlich I. , Emschermann D. , Becker J.
Published: February 2023

Timing and Fast Control (TFC) system for the Compressed Baryonic Matter (CBM) experiment is being developed with focus on low and deterministic data transmission latency. This helps to minimize data corruption in the free-streaming Data Acquisition (DAQ) system during occasional data bursts caused by the expected beam intensity fluctuations. Proven in latency-optimized experimental data transport applications, the GBT-FPGA core is expected to positively contribute to the TFC system performance. In this work, the core has been integrated as the primary communication interface and its effect on transmission latency and quality of time distribution has been evaluated.
Fractal and statistical characterization of brushstroke on paintings
Authors: Bigerelle Maxence , Guibert Robin , Mironova Anna , Robache Frederic , Deltombe Raphael , Nys Ludovic , Brown Christopher A
Published: February 2023

Identification of an individual artist’s touch on paintings is studied using surface metrology. Paintings’ topographies were measured using focus variation and stitching, creating 13 × 13 mm maps with 1 μm sampling intervals, and 169 megapixels, with a 10X objective lens. Topographic characterization parameters were analyzed for their ability to differentiate different painters’ renderings. Statistical treatments from data mining were used to discriminate, by optimization, multiscale topographic signatures characterized by a multitude of areal texture parameters. It appears that a fractal dimension can define 3 characteristic scale ranges. One from 3 to 70 μm corresponds to brushstroke details. Another, from 70 to 700 μm, corresponds to the topography of the material of the canvas fabric. Finally, scales greater than 700 μm correspond to undulations of the canvas. For scales less than 50 μm, the fractal structure of the topography left by brushstrokes follows a power law characterized by the slopes of the topography. The topography of the clouds painted on the canvas has an Sdq (topographic slopes) increasing with the clarity of the clouds at scales of 3–500 μm. According to the Torrance-Sparrow theory, the higher the Sdq, the more diffuse the light on the surface. The painter therefore wanted to show, by his brushstroke, that the light clouds diffuse more light giving an impression of local brightness. This study is confirmed by the analysis of the painting of Max Savy, a French painter from Carcassonne (1918–2009), which was measured with a white light interferometer Zygo NewView 7300, a X100 objective lens giving a 517 μm × 517 μm stitched surface, with a sampling interval of 0.109 μm. The box-counting method for estimating the fractal dimension of the topography of an oil painting appears optimal by the fact that it morphologically integrates scale variations of the local slopes of the surface morphology. This method thus characterizes the multiscale aspects, as well as the scale changes, of the topography.
Quality assurance of stereolithography based biocompatible materials for dental applications
Authors: Krishna Amogh V , Reddy Vijeth V , Dexter Dyall W , Wälivaara Dan-Åke , Abrahamsson Peter , Rosen B-G , Anderud Jonas
Published: February 2023

Additive Manufacturing (AM) is increasingly being used in healthcare sectors for its potential to fabricate patient-specific customized implants, and specifically in dentistry, AM finds its applications in maxillofacial implants, dentures, and other prosthetic aids. However, in most applications, AM is largely being used for prototyping purposes. The full-scale realization of AM can only be achieved if the downsides of AM are addressed and resolved. Hence this paper focuses on providing a detailed analysis of surface quality, dimensional accuracy, and mechanical properties of the biocompatible material produced, using the Stereolithography (SLA) method for a dental application. For quality analysis, test artefacts were produced, and the quality was assessed before and after the sterilization process. The results suggest that micro-surface roughness essential for cell growth is similar for all build inclinations and well within the control limit required for effective bone regeneration. Multi-scale surface characterization revealed that the sterilization process involving heat can potentially alter the micro-roughness features of resin-based materials. The results from the dimensional analysis show that the SLA parts produced had negligible dimensional deviations from the CAD model to the printed parts and were unaffected by the sterilization process. The tensile test results suggest that the part orientation does not affect the tensile strength and that the sterilization process seems to have an insignificant effect on the tensile properties of the SLA parts. Furthermore, the results were validated by producing a membrane barrier for Guided Bone Regeneration (GBR). The validation results showed that excess resin entrapment was due to the geometrical design of the membrane barrier. In conclusion, this paper provides an overview of quality variations that can help in optimizing the AM and sterilization process to suit dental needs.
The Jury: A Very Short Introduction
Authors: Lerner Renée Lettow
Published: February 2023

Many cultures in different times and places have used jurors to decide cases. This book shows why and how, in both historical and comparative perspective. Almost every society has professional judges, but from ancient Athens to medieval England to modern Japan, cultures have wanted ordinary persons involved. English-speaking countries are the best-known for developing the jury. The American founders celebrated jury nullification of laws and put rights to jury trial into their new constitutions; American juries continue to nullify laws today. The use of jurors has spread far beyond the English-speaking world, to Europe, Latin America, Africa, and Asia. Many societies are now reaping the benefits, and coping with the challenges, of using jurors. A number of countries have mixed panels of professional judges and lay jurors to decide cases—a practice which is widespread but not familiar to many in the English-speaking world. The book provides a balanced view of juries, exploring both their strengths and limitations. It addresses questions of how jurors are selected, for what cases they are used, their power to nullify the law, how they are guided or avoided, and how they make decisions.
Addiction: A Very Short Introduction
Authors: Humphreys Keith
Published: February 2023

Addiction: A Very Short Introduction presents the basic facts about addiction. What is addiction? How and why do some people become addicted and others do not? This VSI explores the what, why, and how of addiction and its corresponding treatment and societal response. Addiction involves public and personal interests; societal and criminal justice issues; and family, social, and medical responses. The VSI also assesses how laws and regulations on drugs influence the frequency and experience of addiction, and analyses how addiction may change as society continues to evolve.
178 A RETROSPECTIVE EVALUATION OF PROCESS OUTCOMES OF OLDER ADULTS REFERRED TO A COMMUNITY RE-ENABLEMENT TEAM FROM THE EMERGENCY DEPARTMENT
Authors: Synnott A , Ryan C , O'Connell P , Steed F , Reale S , Carey L , English S , Fitzgibbon K , O'Connell Á , Smalle E , Ryan D , Shchetkovsky D , McCarthy A , Moran B , Murphy H , O'Shaughnessy Í
Published: February 2023

Background

Emergency Departments (ED) are complex and challenging environments to provide care to older adults. There is currently a paucity of high quality methodological research investigating the effectiveness of interventions focused on transitions of care from the ED to primary care services (Hughes et al, 2019). This study aims to evaluate the impact of a collaborative model of care between primary and secondary care services for older adults discharged home following ED index visit.

Methods

This was an observational retrospective study. Participants aged ≥65 years discharged home from the ED of a University Teaching Hospital and referred to a Multidisciplinary Community Intervention Team (MDCIT) were included. Referral pathways were via the OPTIMEND team (Cassarino et al, 2021) and MDCIT, which is a rapid access re-enablement team based in the community and compromises nursing staff, an occupational therapist, physiotherapist, therapy and healthcare assistants. Descriptive statistics were used to profile the baseline characteristics of study participants and to summarise data related to process outcomes. Ethical approval was granted for this study (020/2021).

Results

In the study period, January—December 2020, 54 patients were referred to the MDCIT. The mean age of participants was 80.1 years (SD 8.2), 57% were female, and the most common Manchester Triage System presenting complaint was ‘limb problems’. The median Patient Experience Time within the ED was 7.4 hours (IQR 13.1); 55% of participants were seen in their home within 24 hours of discharge. A mean of 10 interventions were delivered by the MDCIT. A 9.1% incidence rate of 30 day unscheduled hospital readmission was recorded.

Conclusion

Integrated care programmes have been advocated to improve the continuum of care from the ED into the community. This evaluation has demonstrated the feasibility of implementing such a model of care. However, further methodologically robust research is required to advance the evidence base and should also focus on patient outcomes.
224 METABOLIC SYNDROME ASSOCIATED WITH INCREASED LIKELIHOOD OF INCIDENT FRAILTY
Authors: McCarthy K , O'Halloran A , Laird E , Ortuño R R , Kenny R A
Published: February 2023

Background

Frailty and metabolic syndrome (MetS) are both associated with increased mortality. This study aimed to examine the association between MetS and incident frailty in older adults in Ireland over a 4-year follow-up period.

Methods

This study used data from wave 1 and 3 of The Irish Longitudinal Study of Ageing (TILDA). Frailty status was operationalised using Fried’s frailty phenotype (FP). FP was determined at both waves. MetS was determined at wave 1, according to the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the International Diabetes Foundation (IDF) criteria. Those who were frail/pre-frail at wave 3 having been classified as non-frail at wave 1 were deemed to have ‘worsening frailty’, while those non-frail at both waves were deemed ‘stable non-frail’. Logistic regression models examined the association between MetS and worsening frailty compared to stable non-frail.

Results

FP was determined for 3,317 participants at both wave 1 and wave 3 of TILDA, of which 970 (29%) and 1,201 (36%) had MetS at wave 1 according to ATPIII and IDF criteria respectively. 664 (20%) had worsening frailty, while 1,624 (49%) were stable non-frail. Adjusted for age, sex and education, MetS was associated with an increased likelihood of worsening frailty, for both ATPIII and IDF criteria, OR 1.70 (p < 0.001) and OR 1.63 (p < 0.001) respectively. This association persisted when further adjusted for smoking history, chronic conditions (excluding diabetes and hypertension), renal function and micronutrients [OR 1.50, p = 0.001 (ATPIII) and OR 1.46, p = 0.001 (IDF)].

Conclusion

MetS increases the likelihood of incident frailty/pre-frailty by approximately 50% over a 4-year period. MetS should be considered a risk factor for frailty and should be considered in any comprehensive geriatric assessment given the dynamic nature of frailty and the potentially modifiable nature of MetS.
260 EXPLORING OLDER PEOPLE’S EXPERIENCES OF SHIELDING DURING THE COVID-19 PANDEMIC
Authors: Phelan A , Daly L , Brian K
Published: February 2023

Background

COVID-19 has resulted in large scale infection rates, significant death rates and an economic crisis for many countries. Older people were identified as being in a high-risk group in terms of morbidity severity and mortality rates. This led to many governments recommending older people shield as a protective, public health measure. This study considers how older people experienced shielding in an urban area of Ireland.

Methods

Twenty participants were recruited through nursing services in one Community Healthcare Organisation. Semi-structured interviews were conducted between 14/1/21 to 8/3/21 and analysed using thematic analysis (Braun & Clarke, 2006).

Results

Two overarching themes were identified: 1) Shielding experienced as a social disruption: Compliance resulted in transformed lives with marked impacts on social roles, identities, ways of living as well as the personal consequences of adhering to restrictions. Older participants spoke of careful strategies of self-protection and acute awareness of the personal and societal effects of the ongoing pandemic. 2) Coping with and countering social disruption: Participants described strategies they engaged in to adapt to, resist, address or avoid the impacts of shielding that challenged pre-COVID-19 social roles, identities, or ways of living.

Conclusion

As global societies slowly emerge from the pandemic, particularly in the context of vaccination roll out, older people’s experiences are important to acknowledge. In this study, there was evidence of both the resilience of older people but also the multi-faceted negative impact on their health and welfare. In addition, the experience of the pandemic has highlighted pre-existing service issues (home care service provision fragmentation), digital divides and the lack of older people’s voices in political decision making. This points to the need to have robust, and accessible rehabilitation services incorporating comprehensive geriatric assessment and to reform health care delivery to enhance capacity to sustain services in pandemic times.
87 PREDICTIVE VALIDITY OF SCREENING TOOLS USED BY A FRAILTY INTERVENTION TEAM IN AN IRISH EMERGENCY DEPARTMENT: A RETROSPECTIVE COHORT STUDY
Authors: O'Carroll S , Cremin M , Meehan E , O'Leary H , Galvin R , Fitzgerald L , O'Connell P , Mukherjee P
Published: February 2023

Background

Various screening tools exist to identify frail and at-risk older adults in the emergency department (ED). This can facilitate targeted assessment and management, leading to improve outcomes. This study evaluated the predictive validity of four screening tools used by an ED-based team of allied health professionals.

Methods

The Variable Indicative of Placement (VIP) tool, Think Frailty Tool, Clinical Frailty Scale (CFS) and 4AT were administered to adults aged ≥75 years as part of assessment by the Frailty Intervention Therapy Team in an Irish ED. Outcomes were hospital admission; re-attendance within 28 or 90 days; and death within 28 or 365 days. Scores were dichotomised, and for each outcome, relative risks and sensitivity, specificity, positive and negative predictive values were calculated.

Results

Over the six-month period, 429 individuals (median age:82 years) were assessed. Of these, 59% were VIP-positive, 81% screened at-risk of frailty on the Think Frailty Tool, 56% screened positive for frailty on the CFS, and 16% screened positive on the 4AT. Hospital admission, re-attendance at 28 and 90 days, and death within 28 and 365 days were 56%, 12%, 27%, 5%, and 23%, respectively. Positive screens on the VIP, Think Frailty Tool, CFS and 4AT were associated with significantly increased risk of hospital admission and death within 28 or 365 days (p < 0.05). Positive screens on the Think Frailty Tool and CFS were also associated with increased risk of 90-day re-attendance (p < 0.05). Of the four tools, the Think Frailty Tool had the highest sensitivity (86%–100%) for all outcomes. The CFS showed high sensitivity for detecting death within 28 or 365 days (95% and 84%, respectively), but lower sensitivity (68%–75%) for other outcomes. The 4AT demonstrated the lowest sensitivity for all outcomes (20%–46%).

Conclusion

The Think Frailty Tool and CFS were the most useful for predicting adverse outcomes in this group.
118 EVALUATION OF PATIENTS ADMITTED UNDER GERIATRICS FROM SEPTEMBER TO NOVEMBER 2020: GUIDE TO ESTABLISHING A HOSPITAL AT HOME SERVICE
Authors: Cummiskey A G , Nee R
Published: February 2023

Background

Studies have shown that home hospital care is as effective as hospital management and improve patient satisfaction. Up to date guidelines recommends that patients who do not require care uniquely proved in hospitals should be treated at home when possible. We aim to assess the need for a new Hospital At Home (HAH) with Comprehensive Geriatric Assessment (CGA) pathway under Integrated Care Programme for Older People (ICPOP).

Methods

We conducted a retrospective medical chart review of all patients admitted under Geriatrics from September 2020 to November 2020. Demographic data and admission notes were used to assess the patient’s eligibility. Information on dementia and delirium, length of stay, discharge destination, readmission rates, number of previous admissions, length of time at home prior to readmission, use of multidisciplinary team members during admission was also collected.

Results

Over the 3 months 358 patients were admitted and 36 patients met the inclusion criteria. The average age is 84.9 years, 33% were males. 10 patients had a diagnosis of Mild Cognitive Impairment and 5 with Dementia. No patients were delirious on admission, but 7 developed delirium as an inpatient. The average length of stay was 14.8 days, with a total of 534 bed days. Discharge destination was home for 91.7%, 1 patient passed away and 2 were discharged to Long Term Care. 22 patients were readmitted. The average time to readmission was 55 days, with a median of 35 days.

Conclusion

Given the aging population, and continued bed shortage in acute hospitals, the development of a HAH service will aim to alleviate some of this pressure. We aim to provide a holistic service to our patients, focused on medical care, but also improved quality of life, reduction in delirium, continued home living and reduced carer stress.
124 OUTCOME OF SPEECH AND LANGUAGE THERAPY CLINICAL DYSPHAGIA ASSESSMENT FOLLOWING AN INTERDISCIPLINARY SWALLOW SCREEN
Authors: Maher J , Ryan S , King L , Sayers K , Donnellan C , Pillay I
Published: February 2023

Background

A 7 question non-validated swallow screen (Any reported swallowing difficulties? Any coughing with food or fluids? Any choking? Does food get stuck when eating? Any recurrent chest infections? Any pain when swallowing? Any difficulty swallowing tablets?) is used by an integrated care team for older persons to prioritise referrals to the Speech and Language Therapy (SLT) service.

This study identified the proportion of patients screened who appropriately required a clinical dysphagia assessment and intervention.

Methods

This was a retrospective study from September 2020 to June 2021. Patients were assessed by the Clinical Specialist SLT who determined if swallow impairment was present and whether intervention was required. Age, gender and clinical frailty score were documented. Patients who resided out of the catchment area or who had already received an SLT service were excluded.

Results

The average age was 80 years, range 67–103. The male to female ratio was 2:1 and the average clinical frailty score (CFS) was 5. N = 42(32%) screened positive. N = 29(69%) attended for SLT assessment. N = 27(93.1%) had a swallow impairment identified. N = 20 were discharged following a single intervention and 9 required further SLT intervention.

Conclusion

Presbyphagia is generally asymptomatic and results from age related anatomical and physiological changes, reduced functional reserve and sarcopenia. Older adults compensate for these difficulties and do not seek assistance. Presbyphagia may progress to dysphagia, resulting in adverse outcomes. The high rate of SLT confirmed swallow impairment and need for SLT intervention highlights a need to prospectively refine and validate this 7 question swallow screen.
147 ‘CHAMPIONING CONTINENCE’—ESTABLISHMENT OF A MULTIDISCIPLINARY CONTINENCE PROMOTION WORKING GROUP IN AN ACUTE TEACHING HOSPITAL
Authors: Howard M , Peppard S , O'Dwyer E , McLoughlin K , McLoughlin L , Carolan N , Walsh N , Chukwureh W , Russell E , Wilson L , Kottackal L M , Kelly M , Sheeran G , Maeri C
Published: February 2023

Background

In line with the National Frailty Programme1, patients over the age of 75 admitted to hospital should have a comprehensive geriatric assessment including the assessment of current continence status and any history of incontinence. Up to 39% of adults are reported to develop new onset urinary incontinence during admission to hospital2,3, however studies show that is it a problem not always identified by staff members,4. In response to these observations within an acute teaching hospital, a continence working party was formed involving members of nursing, physiotherapy and occupational therapy colleagues to explore the current practice and culture relating to continence management.

Methods

The group established key objectives which were broken into four strands;

1. Audit of documentation of baseline continence on admission (therapy and nursing).

2. Obtaining access to additional types of continence wear.

3. Staff education.

4. Pre and post education survey.

Results

1. Audit of documentation demonstrated poor standards of documentation of baseline continence. This led to an amendment to questioning prompts on therapy initial assessment forms and a plan to further evaluate the nursing documentation.

2. A wider array of continence wear has been made available on the wards providing greater options for patients.

3. Staff education session was compiled by a specialist physiotherapist and is widely available for staff to access on the hospitals online training portal.

4. Pre-education surveys have been completed with a view to re-administering following education roll-out.

Conclusion

The aim of this multidisciplinary working group is to equip staff with the correct resources, knowledge, and confidence to ensure best practice promotion of continence on the targeted wards. This project is the first strand of a wider culture changed that is needed around continence promotion for older adults in the acute setting.
163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION
Authors: Lynch A , Quinn L , Briggs R , Tan T , Thorpe O , Romero-Ortuno R , Byrne T , Cunningham C , Lavin A
Published: February 2023

Background

The geriatric day hospital (GDH) provides outpatient geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians.

Methods

Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH.

Results

One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p < 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p < 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p < 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p < 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468).

Conclusion

Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.
186 OPTIMAL MANAGEMENT OF COVID-19 IN NURSING HOME PATIENTS: A QUALITY IMPROVEMENT PROJECT IN AN IRISH UNIVERSITY HOSPITAL EMERGENCY DEPARTMENT
Authors: Foley J , Menzies D , Boyle N , McNamara R
Published: February 2023

Background

The Sars-CoV-2 global pandemic placed an unprecedented demand on acute health services and led to significant morbidity and mortality in older populations. Nearly half of attendances to this ED are over the age of 65 years and there are over 80 nursing homes in the catchment area. A pilot study in January 2021 showed that nursing home attendances increased significantly during the third wave of COVID-19 with many of these attendances potentially avoidable and suitable for optimised care in the nursing home.

The primary objective of this quality improvement project was to enhance the older person’s care and experience when presenting to ED or being reviewed in the community with symptoms and signs of COVID-19. Secondary aims were reduced nursing home attendances to ED and subsequent admissions from these attendances.

Methods

A guideline was constructed based on the RCEM standard for Quality Care for Older People and using the HSE guidelines for managing COVID-19 in nursing home patients. The guideline was introduced to staff and implemented in ED and via the EDITH service.

Results

Two PDSA cycles were undertaken post guideline implementation. There were substantial improvements in the frequency of discussion and documentation of advanced directives with increased numbers of patients being discharged directly back to the nursing home or treated in the nursing home using the guideline. There was a decrease in the number of nursing home attendances throughout the project.

Conclusion

This successful QIP shows the importance of manging older patients appropriately, while considering their wishes. Post-COVID work should centre on managing all older patients with optimised treatment and considering how they will benefit most from their attendance to ED.
188 IMPROVING THE ASSESSMENT AND MANAGEMENT OF FALLS IN OLDER PEOPLE BY THE EMERGENCY DEPARTMENT IN THE HOME
Authors: Sheehan M , Mulcaire J , McNamara R
Published: February 2023

Background

Falls among older adults are the injury pattern that causes the most morbidity and mortality. Assessing and managing these in the patients’ homes is challenging; it requires a comprehensive, systematic approach. This quality Improvement Project used a Comprehensive Geriatric Assessment for older adults who have suffered fall, carried out by an Emergency Department in the Home (EDITH) practitioner in the patient’s home.

Aim: To improve the evaluation and management of older people who have fallen and are attended to by the Emergency Department in the Home.

Methods

This OD project was carried out using the HSE People’s Needs Defining Change model. A new, streamlined version of the Comprehensive Geriatric Assessment tool was developed and introduced, and this was implemented and altered over two PDSA cycles.

Results

Documentation of falls improved dramatically, from a median of three out of 12 domains included to a median of 11 domains included. Users’ feedback helped the CGA evolve and was incredibly positive about the change.

Conclusion

This project shows that a CGA can be used successfully in patients’ own homes to assess risk factors for falling. The HSE’s People’s Needs Defining Change can be used to implement community-based projects. The community CGA tool could be explored by other areas and organisations in the future.
202 THE SILVER TRAUMA CLINIC—A MULTIDISCIPLINARY CLINIC FOR FRAIL OLDER PATIENTS FOLLOWING TRAUMATIC INJURY
Authors: Ramiah V , Byrne C , Ramakrishnan J , Morgan P
Published: February 2023

Background

Increasing numbers of older individuals are presenting to Irish emergency departments following trauma. Advances in the care of chronic diseases have increased the number of older people with active lifestyles, predisposing them to injury. ‘Silver trauma’ has been a relatively neglected despite deficits of traditional trauma care for this vulnerable cohort.

The Silver trauma clinic was developed in conjunction with the Frailty Intervention Team, Geriatric services and HSCP service in May 2021. The goal of the clinic is to provide a comprehensive multidisciplinary management for frail older patients following non operative injuries.

Methods

Frail older patients discharged from the ED can be referred for short interval multidisciplinary trauma review.

A trauma tertiary survey is carried out by an emergency physician with specialist interest in geriatric trauma. Rapid access to imaging ensures timely definitive diagnosis. The service integrates virtually with specialist services, such as spinal orthopaedic services and musculoskeletal interventional radiology.

Physiotherapists initiate a tailored early rehabilitation plan. Consultant geriatrician and frailty ANP screen for complications of injury as well as bone health, falls risk and cognitive screening. The clinic integrates with existing outpatient and community services for older persons.

Results

The clinic has seen 30 patients since commencement in May 2021. Median patient age: 85. Injuries: 25% vertebral fractures, 30% limb fracture, 20% thoracic trauma, 30% pelvic trauma. Mean number assessments: 2. Disposition outcomes: Primary care 50%, Geriatric clinic 30%, Integrated Care Team 10%, specialist clinic 10%.

Conclusion

The Silver trauma clinic is a new approach of patient focused multidisciplinary trauma care for frail older patients following non operative trauma in the Irish health system.
218 INCREASING PREVALENCE OF METABOLIC SYNDROME IN OLDER ADULTS IN IRELAND
Authors: McCarthy K , O'Halloran A , Laird E , Ortuño R R , Kenny R A
Published: February 2023

Background

Metabolic syndrome (MetS) is a cluster of inter-related risk factors of metabolic origin, occurring together more often than by chance alone. MetS is a recognised risk factor for cardiovascular disease, several other chronic medical conditions and mortality. This study aimed to describe the prevalence of MetS in older adults in Ireland and to examine if this changed over a 4-year follow-up period.

Methods

This study used data collected as part of wave 1 and 3 of The Irish Longitudinal Study of Ageing (TILDA). Using objective measurements of triglycerides, high-density lipoprotein cholesterol, blood pressure, height, weight, waist circumference and glycated haemoglobin (HbA1c), in addition to medication usage, the prevalence of MetS using both the National Cholesterol Education Program Third Adult Treatment Panel criteria (ATPIII) and the International Diabetes Foundation criteria (IDF) were determined. Weights were used to allow the sample to be representative of the population. Weights for wave 3 included an adjustment for attrition between wave 1 and wave 3. Weighted logistic regression models were undertaken to examine the odds ratios for age, sex and educational attainment.

Results

32.5% of the community-dwelling population aged ≥50 years at wave 1 had MetS according to the ATPIII criteria, with 39.3% according to the IDF criteria. Males were 36% (ATPIII) or 53% (IDF) more likely than females to have MetS at wave 1. MetS was increasingly prevalent with age, and lower educational attainment at both waves. Prevalence had increased by wave 3 with 35.1% and 41.3% meeting the ATPIII and IDF criteria respectively.

Conclusion

The prevalence of MetS, a modifiable disorder, is very high and increasing in older adults in Ireland, with nearly 400,000 of the community-dwelling population ≥ 54 years at wave 3 meeting either the ATPIII or IDF criteria. More public health interventions are warranted.
219 IMPROVING DELIRIUM SCREENING AND MANAGEMENT IN POST-ACUTE REHABILITATION: A MULTI-STAGE QUALITY IMPROVEMENT INITIATIVE
Authors: McDaid E , Harte A , Reynolds A , Hearne S , Synnott E , Buckley E , Delaney S , Cogan L
Published: February 2023

Background

There is risk of delirium among older patients on transition from acute care to post-acute rehabilitation (Marcantonio et al. 2003). The 4AT is the recommended delirium detection tool for clinical practice (Tieges et al. 2020). A multi-disciplinary led quality improvement project was undertaken to standardise and improve delirium screening and management in the older person’s rehabilitation service of a post-acute rehabilitation hospital.

Methods

A retrospective audit of medical charts was completed for all patients admitted to a post-acute older person’s rehabilitation service from October 2019 to December 2019. Following that audit, there was a staff education intervention focusing on delirium awareness, screening and management. Furthermore, a dedicated ‘Delirium Champions Group’ was formed with representatives from the multi-disciplinary team. A Delirium Screen pro-forma was developed and implemented by this group. It included an attached 4AT sticker for all new admission medical charts. A post intervention medical chart audit was completed for all admissions to the same ward from October to December 2020.

Results

The pre-intervention chart audit showed 0% compliance with any form of formal delirium screening tool. The majority of patients had at least 2 delirium risk factors at the time of admission. The post-intervention audit recorded 92% compliance with 4AT use at the time of admission as well as full completion of the Delirium Screen pro-forma which included the documentation of risk factors for delirium. The Delirium Champions Group provide ongoing staff education, resources and are now exploring hospital environmental design and its role in delirium prevention.

Conclusion

This initiative lead to a significant improvement in the completion of delirium screening in post-acute rehabilitation. This project had the secondary benefit of prompting the formation of a dedicated delirium improvement group focusing on delirium awareness, screening, documentation, management and ultimately prevention.
222 OLDER ADULT INPATIENTS’ PERCEPTIONS OF PROGRESSIVE RESISTANCE TRAINING IN A SPECIALIST GERIATRIC REHABILITATION SETTING
Authors: Burke C , O'Neill E , Timmons S , Kurian S , Mello S , Fitzgerald M
Published: February 2023

Background

Progressive resistance training (PRT) has the potential to reduce age-related disability and has been proven to benefit the older adult in a variety of ways. PRT is prescribed routinely by physiotherapists for frail older adults in an inpatient setting. To date little is known of their experiences engaging in PRT. This study aimed to explore older adult inpatients’ perceptions and experience of PRT as part of their overall physiotherapy program in a Specialised Geriatric Rehabilitation Unit.

Methods

The study had a qualitative design. Semi-structured interviews explored experiences and perceptions of PRT along with motivators and barriers to participation. Interviews were face to face and conducted in the unit. Data was analysed using thematic analysis. 11 frail older inpatients with orthogeriatric (n = 5), neurological (n = 2), general surgical (n = 2) and general medical (n = 2) diagnoses were interviewed.

Results

The study identified three overarching themes: Acceptability, Facilitators and Barriers. In the category of Acceptability participants identified the subthemes: (1) PRT is challenging, (2) PRT is Rewarding and (3) PRT is Enjoyable. In the category of Facilitators, the following subthemes emerged: (4) Positive outcomes as motivators and (5) Supervision is necessary for engagement. In the category of Barriers, (6) Low self-efficacy beliefs and (7) the Negative effects of PRT, such as pain and fatigue affected participation.

Conclusion

Frail older inpatients find PRT to be an acceptable form of exercise. It is perceived to be challenging, but rewarding and enjoyable for most. Participants were motivated to participate in PRT by the positive outcomes (improved strength, general health, function, independence, confidence) they experienced. They felt supervision from professionals with medical expertise was essential to participation; and had low self-efficacy beliefs surrounding independent practice; fearing falling and causing harm. Pain and fatigue also impacted participation.
231 ESTABLISHING AN INTERVENTIONS BUNDLE TO IMPROVE INPATIENT CARE FOR PATIENTS WITH PARKINSON’S DISEASE: A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT
Authors: Penugonda M , Walsh J , Barry J J , Govern R M , Bradley D , Bolger M , English G , Moore J , Nolan N , Treacy E , Burke J , Dwyer N , Gallagher D , Macken S , McCaffrey S , Moloney S , Murphy R , Murray M , Hanlon E O'
Published: February 2023

Background

Patients with Parkinson’s (PwP) are at a higher risk of complications once admited to hospital compared to their age-matched peers. Medication mismanagement is a well-known obstacle, which puts PwP at risk of sub-optimal treatment leading to an unnecessary deterioration of baseline and potentially increases risk of adverse sequelae.

Methods

Retrospective electronic patient records (EPR)/chart review of 47 admissions was conducted, across three hospital sites.

Data attaining to correct prescribing of medication on admission and discharge, prescribing of contraindicated medications, reasons for medication lapses and complications of inpatient stay were collected. EPR of 17 patients’ were reviewed to assess if Parkinson’s disease (PD) medication administrations occurred within 30 minutes of patient schedule, as recommended by NICE guidelines. Key areas for improvement were identified based on the results.

Results

47 charts (30 Males, 17 Females) with mean age 72 (range:57–90), were reviewed. Average number of co-morbidities:4.5 and Clinical Frailty Scale ranged 5–9 (n = 30). LOS averaged 12.4 days and 43% of patients had ≥2 hospital admissions in the preceeding year.

38% (17/44) of admissions correctly documented patient specific medication times. Only 48% of patients (n = 638) received their medications within 30 minutes of the scheduled time. 47% (22/47) experienced complications attributable to PD. Contraindicated medications were noted in 5 cases. 84% of discharging prescriptions did not mention timing of PD medication and 3 prescriptions had errors with regards to dosage/omission of medication.

Conclusion

We implemented across two sites: 1) Care protocol flag in patient’s chart highlighting simple avoidable complications. 2) Laminated over the bed signpost alerting ‘time critical medication’. 3) ‘Time critical medication’ stickers in drug kardex 4) Education sessions for Medical, Nursing and Ward staff. 6) Establishing out of hours access to PD medications and protocols for NPO/poor swallow. We plan to reassess significance of efforts post intervention.
235 THROMBOLYSIS DOSING AND WEIGHT ESTIMATION IN ACUTE STROKE: A SINGLE CENTRE AUDIT
Authors: Mannion M , Gabr A , Cunningham N , Leahy A , Paulose S , O'Brien I , Saleh A , Prendiville T , Okpaje B , Mohamed A , Ali B , Ryan R , Lyons D , Quinn C , Peters C , Shanahan E , Kennedy C , McManus J , Galvin R , O'Connor M
Published: February 2023

Background

Stroke is a leading cause of death and disability. Thrombolysis with intravenous (IV) alteplase is the mainstay management of ischaemic stroke. It has a narrow therapeutic window with a high potential for adverse outcomes such as intracranial haemorrhage. The efficacy of alteplase is time and dose dependent with weight-based dosing. National clinical guidelines recommend a dose of 0.9 mg/kg, up to a maximum of 90 mg. (Irish Heart Foundation Council for Stroke 2015). In most hospitals in Ireland however, patients are not weighed prior to thrombolysis. Time pressure and lack of available suitable equipment are factors.

Methods

This retrospective clinical audit evaluated the dosing of alteplase, estimated and actual weight for a convenience sample of stroke thrombolysis patients treated between 2016–2020 at an Irish University Teaching Hospital.

Results

107 patients were audited (62 males, 45 females). Actual and estimated weights were available in 92/107. Weight was not documented (n = 15) due to severe stroke/palliative management (n = 6) or omission (n = 9). 21% (19/92) received the correct dose of 0.9 mg/kg. A further 54% (50/92) received a dose within the range of 0.81–0.99 mg/kg (±10%). 25% received a dose outside this range (> ± 10%). 11% (10/92) were under-thrombolysed and 14% (13/92) over-thrombolysed. 17/92 patients had an intracranial haemorrhage. 35% (n = 6/17) of patients who had an intracranial haemorrhage received a higher dose of thrombolysis (>10%).

Conclusion

A quarter of patients received inappropriate dosing of alteplase that was outside the range of ±10% of 0.9 mg/kg. While stroke thrombolysis must be completed urgently, an accurate weight should be determined to avoid errors in dosing. A process evaluation of stroke thrombolysis would provide information on how best to incorporate an objective means of weight measurement without delaying treatment.