bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental determination of the sulfur K-shell fundamental parameters employing the holistic approach
Authors: Hönicke Philipp
Published: September 2024

Sulfur and its compounds are both very abundant in the environment and very important for technological applications such as batteries. X-ray spectroscopic characterizations of sulfur compounds for a quantitative determination of the present amount of sulfur often requires a good knowledge on the atomic fundamental parameters involved. These quantitatively describe the processes of photoionization and x-ray fluorescence emission, making them crucial for x-ray spectroscopy-based quantifications. By employing the recently demonstrated holistic approach, the atomic fundamental parameters of the sulfur K-shell were experimentally determined using the radiometrically calibrated instrumentation of the Physikalisch-Technische Bundesanstalt. The transition probabilities of the main K-shell fluorescence lines, the K-shell fluorescence yield, the K-shell Auger yield, the subshell photoionization cross section and fluorescence production cross section were determined by means of photon energy dependent x-ray fluorescence and transmission measurements on a thin InS coated silicon nitride membrane. The results are also downloadable from Zenodo as plain text.
Electrically switchable behavior in coupled EIT-like meta-molecule and Fabry-Pérot cavity
Authors: Yang Lei , Gao Lei , Jiang Rui , He Wenzhe , Wang Jun , Wu Qian , Sun Yong , Wu Quanying , Chen Yongqiang
Published: September 2024

In this paper, we propose a microstrip Fabry–Pérot (FP) cavity embedded with an active electromagnetically-induced-transparency-like (EIT-like) meta-molecule to investigate the electrically switchable behavior. The phenomenon of EIT is achieved by coupling a ‘bright’ comb-line resonator with a ‘dark’ split-ring resonator. The FP cavity is fabricated by etching two narrow slots on a microstrip line. With two different resonance mechanisms working together, the proposed composite EIT-cavity design is shown to exhibit the enhanced EIT-like transmission characteristics, accompanied by two sharp Fano-type line-shapes. By incorporating PIN diodes into the composite EIT-cavity structure, we can dramatically modulate the transmission spectrum via external DC voltage. In particular, we show the multi-band unity modulations through biasing the proposed active samples. Moreover, the slow light on-to-off switching processes are also obtained with modifying the state of PIN diode from dielectric to conductive. Our results may open important opportunities for fabricating dynamic functional photonic devices in the future.
Disconnection of edge coherent modes between the outer midplane and divertor target in EAST H-mode plasma
Authors: Zhou Z.Q. , Zhang T. , Long F.F. , Zhou Z. , Geng K.N. , Ye K.X. , Zhong F.B. , Shi Q.Q. , Li G.S. , Huang J. , Yu L. , Yang S.Q. , Wen F. , Ma J.Y. , Meng L.Y. , Liu H.Q. , Zhao H.L. , Ye Y. , Wang L. , Gao X. ,   the EAST Team
Published: September 2024

The edge coherent mode (ECM) is considered a highly attractive pedestal mode because it extends the duration of edge-localized modes and increases particle and impurity transport without significantly affecting energy transport. Moreover, it operates compatibly with high-performance plasma discharges. The ECM can also be detected using Langmuir probes on the divertor target plate, indicating that it extends from the pedestal region into the SOL and resulting in a connection to the divertor target plate via magnetic field lines. In this work, the distribution of ECM on divertor target plates is investigated by analyzing 215 upper single null discharges on the EAST tokamak. The coherence analysis of plasma fluctuations between the electron cyclotron emission signal in the pedestal region of the outer midplane and the ion saturation current measured by Langmuir probes in the divertor region reveals that the ECM is hardly detected by the divertor probe close to the outer strike point but can be observed at far SOL. This finding indicates the presence of an ECM quiescent region near the SOL on the divertor plate, and the extent of the quiescent region in the poloidal flux coordinate (Δ) has been statistically analyzed. A pronounced relationship between Δ and triangularity (δ) has been observed, that is Δ increasing with δ. Further analysis reveals that this relationship can be attributed to the average magnetic shear in the SOL. This result is consistent with the physical picture, which states that strong magnetic shear close to X-point significantly squeezes the cross-section of flux tubes down to scales dominated by collisions.
Quantum positive matrix-positive matrix multiplication algorithm
Authors: Yang Jinchuan , He Shiping , Bai Mingqiang , Mo Zhiwen
Published: September 2024

In quantum computing, matrix multiplication occurs as a subroutine in more complex algorithms. We improve the quantum linear system algorithm (Harrow et al 2009 Phys. Rev. Lett.
103 150502) to perform sparse matrix-matrix multiplication and propose a subroutine for parallel vector addition. Based on them, a quantum algorithm is exhibited for N × N positive matrix-positive matrix multiplication. For some small ratio of the maximum element to the minimum element of the positive matrices (i.e.

O

(
poly
log
⁡

N

)), this algorithm achieves exponential acceleration.
Detection of carbon monoxide using a polarization-multiplexed erbium dual-comb fiber laser
Authors: Collin Aldia P E , Chen Jiayang , K C Ballentin Jonas , W Perner Lukas , Heckl O H
Published: September 2024

We present a simple method to develop a compact, reliable, and robust free-running erbium single-cavity dual-comb (DC) laser via polarization multiplexing. The key features of our design include dynamic tuning in the difference in repetition rates of the laser, long-term stability, and the use of off-the-shelf components. Polarization multiplexing exploits the fast and slow axes of the fiber, while modelocking is achieved through a nonlinear amplifying loop mirror scheme using readily available components. The laser operates at a repetition rate of around 74.74 MHz with a tuning capability in the difference in repetition rates from 500 Hz to 200 kHz. This tunability makes the system more flexible for DC spectroscopy experiments. Consequently, using this laser, we demonstrated a proof-of-principle DC spectroscopy of carbon monoxide, operating without any active stabilization.
The Fourth Symphony, Musically Considered
Authors: Korstvedt Benjamin M
Published: September 2024

This chapter is an in-depth exploration of the music of the Fourth. It begins by considering the challenges Bruckner’s music poses for listeners and analysts. The chapter then discusses the form and content of each movement in detail, pinpointing essential elements of Bruckner’s musical vocabulary and structural devices that operate throughout the symphony. Building on ideas drawn from the work of the Swiss music theorist Ernst Kurth, the chapter emphasizes the dynamic nature of Bruckner’s musical designs. It concludes by identifying a network of “subthematic” musical connections that span the entire symphony and provide the work with a level of musical continuity and emotional affirmation that has not previously been recognized.
An Audit of Carotid Dopplers in Sligo University Hospital
Authors: Altayyari Sarah , Butt Zaran , Eltahir Mohammed , Khan Mariam , O’Malley Grainne
Published: September 2024

Background

Stroke is a common and often disabling condition impacting thousands of individuals in Ireland annually 1. Timely screening for underlying etiologies is important in all patients presenting with stroke or transient ischaemic attack (TIA) to reduce recurrence risk. Carotid artery disease is frequently implicated as the cause 3. The 2023 National Clinical Guideline for Stroke for the United Kingdom and Ireland recommends carotid imaging be completed within one week of diagnosis of ischemic stroke or TIA for patients in whom potential carotid intervention would be appropriate. We aimed to assess the timing of Carotid Doppler scans in our hospital for patients presenting clinically with stroke or TIA.

Methods

The National Integrated Medical Imaging System (NIMIS) was used to generate a list of patients that had a Carotid Doppler scan over a six- month period (1st July 2022 to 31st December 2022). NIMIS was also used to identify the indication, setting, requesting department and timeliness of scans.

Results

A total of 96 Carotid & Vertebral Dopplers were performed. Majority of studies were performed on males (65%). The mean age of patients was 70 (±11.5) years. Most studies (55%) were done in an inpatient setting. Of all Carotid Dopplers performed, 94 (97%) had an appropriate indication. With regards to timeliness of carotid imaging, the median time from order to study completion varied between inpatients [2 days (IQR 1-3)] and outpatients [16 days (IQR 9-38)]. The majority (95%) of inpatient studies were completed within 7-days of order, while only 14% of outpatient studies were performed in this timeframe. Of the untimely outpatient scans done to investigate stroke or TIA, 2/33 (6%) had significant carotid stenosis.

Conclusion

Majority of Carotid Dopplers were done for appropriate indications. While inpatients studies were largely done in a timely manner, there is a significant delay in the completion of most outpatient studies.
The Assisted Decision Making (Capacity) Act 2015 in Action: Ireland East Hospital Group Marks 1 Year Milestone
Authors: Casey Amanda , Kilgannon AnnMarie
Published: September 2024

Background

In Ireland, the Assisted Decision Making (ADM) (Capacity) Act 2015 was enacted in April 2023. The Act supports a new progressive rights-based system of supported decision making that requires all healthcare staff to make some changes in their clinical practice. The Health Service Executive (HSE) developed an implementation plan to support organisations to meet the legislative requirements of the Act.

Methods

Assessing implementation progress across ten acute hospital sites using the HSE Implementation Framework (HSE, 2015). Progress was evaluated across seven thematic areas: Operational Implementation, Communication Strategy, Learning Strategy, Alignment of Current Operational Approaches, Quality and Compliance, Risk Consideration and Resources.

Results

Significant progress has been made across all seven domains with strong engagement from all sites. Acknowledging variation is important given the breadth of services provided across these hospitals. Implementation is an ongoing process given the cultural changes needed, the resource implications and the interplay with external stakeholders.

Conclusion

Further development in key areas includes tailoring education to suit the specific needs of individual units within hospitals and embedding this education into existing education programmes. It is crucial to monitor resource requirements and adapt to regulatory requirements to ensure compliance. Moving forward sustained efforts will be necessary to embed the principles of supported decision making firmly within healthcare delivery, ultimately promoting dignity and autonomy for all patients.
Gerontological Simulation Lab: Process Mapping a New Virtual Ward for the Nursing Home Liaison Service
Authors: Coen Neville , Mello Sarah , Power Leslee , Mahoney Niamh O , Buckley Emily , Cooke John
Published: September 2024

Background

Simulation-based training is an increasingly accepted way for multidisciplinary teams to learn together. Its use in geriatric departments around Ireland is increasingly visible. The application of simulation to pathway and process development however is less common. We decided therefore to deploy a simulation lab to test a new virtual ward platform for local nursing homes.

Methods

We developed, in partnership with a digital provider, a piece of software that could enable the efficient and safe operation of a virtual ward. Our simulation was conducted in two phases. Phase 1 involved bench simulation of the platform in order to identify any obvious software issues. Phase 2 involved the development of two simulated patient scenarios that would specifically test the operation of the pathway. Nursing staff from our local nursing homes and specialist MDT members from our own department were invited to the Sim lab in order to work through the developed scenarios.

Results

Bench simulation of the software during phase 1 identified three significant limitations to the software developed. These were resolved before progressing to phase II testing. The simulated scenarios at our lab worked well and participants shared positive feedback regarding the pathway and technology. They found the software easy to navigate, practical and agreed unanimously to its future use. There were further minor technical issues identified that have been fed back to the software company for resolution. The simulation facilitated training using the “live” system for both the staff at our nursing homes and our own team members.

Conclusion

The simulation lab proved to be an ideal environment for testing both our new virtual ward pathway and the digital technology developed for its enablement. It facilitated the creation of a comprehensive process map and ensures that all stakeholders had a clear understanding of the new pathway.
Not All Antihistamines Are Created Equal: Alimemazine As A Cause Of Drug Induced Parkinsonism
Authors: Trolan Ciarán
Published: September 2024

Background

A 67year old female presented to a Movement Disorder Service for assessment of tremor. She had a history of presbycusis, dermatitis herpetiformis, bronchiectasis, osteoporosis and stage A chronic lymphocytic leukaemia. History elucidated hypophonia, somniloquy, REM-sleep behaviour disorder, bruxism, presence hallucinosis, insidious bradykinesia and of titubation of increasing prevalence and amplitude over 20years. Examination demonstrated cognitive impairment (Montreal Cognitive Assessment 12+1/30) in the domains of visuospatial function, executive thinking, naming, attention, language, abstraction and anterograde recall. Luria test was 0/6. Also found was: micrographia, left exotropia, reduced left arm and leg swing, kinetic tremor asymmetry, decrement of amplitude and frequency of rapid repetitive movements asymmetrically, mandibular and lingual tremor, positive Kinnier-Wilson test and orthostatic deterioration in yes-yes titubation. Drg history identified use of Alimemazine 10mg for insomnia for approximately 20years.

Methods

Modified Simpson Angus Scale score was 6 indicating a clinically significant degree of extrapyramidal side effects. Unified Parkinson’s Disease Rating Scale part III was 17.

Results

Functional dopamine uptake imaging did not indicate a parkinsonian syndrome. Drg induced parkinsonism was diagnosed. 0.0097% of the Northern Ireland population were prescribed Alimemazine in 2022 for non-dermatological reasons, representing 73.49% of all dispensed preparations. In the first financial quarter of 2024 in Northern Ireland, all dispensed prescriptions cost £218,395.

Conclusion

Not all antihistamines are created equal. Alimemazine is an older phenothiazine derivative antihistamine with central sedative effects equivalent to Chlorpromazine but without anti-adrenaline action. It is rarely prescribed and easily overlooked as “just another antihistamine”. It is commonly prescribed by dermatologists for urticaria. It has substantial pharmacoeconomic implications given its cost disparity with other antihistamines. Extrapyramidal features of tremor, akinesia and hypertonicity are more common in older people; usually developing within weeks or months of commencement. Stopping the drug is the first-line intervention. Resolution of symptoms is not guaranteed.
CANVAS For A Diagnosis: Can You Hear The Hooves Of Zebras?
Authors: Davey Cathy
Published: September 2024

Background

A 75year old male presented to a Movement Disorder Service with complex multimorbidity including: chronic pain, type 2 diabetes mellitus, hypoventilatory obesity syndrome, biliary calculus, moderate aortic stenosis, marked orthostatic hypotension, pulmonary hypertension, coronary artery bypass grafting, permanent pacemaker for complete atrioventricular block, carpal tunnel release bilaterally, polypharmacy and bilateral cataracts. History elucidated a distal to proximal sensory loss over 20years and neuropathic pain without nerve conduction confirmation; and progressively ataxic gait over several years. He also complained of hypophonia, bruxism, excessive daytime somnolence, passages, transitions, visual agnosia, textural illusion, oscillopsia, irritability, inflexibility, hoarding, impulsivity, disorganisation, inattention, apathy, depression and aspontaneity. He was intolerant of nocturnal continuous positive airway pressure device. Epworth score was 21.

Methods

Examination demonstrated: marked orthostatic hypotension, preserved cognition, hypersomnolence, dyspraxic dysgraphia, palmar and antecubital agraphaesthesia, downbeat horizontal nystagmus at eccentric gaze positions, square wave jerks, bidirectionally impaired head impulse test, dysmetric saccades, asymmetric cerebellar signs in upper and lower limbs, rightward Pisa syndrome, kinesigenic dystonic axial posturing, rightward laterocollis and equivocal Babinski/Oppenheim reflexes. Gait assessment demonstrated sensory and cerebellar ataxic features with marked apraxia. No pes cavus.

Results

Computed tomography of brain had Fazekas 1 small vessel disease, Medial temporal atrophy score 1, Koedam 1 and age-commensurate cerebral and cerebellar atrophy. RFC1 gene testing confirmed biallelic intronic AAGGG repeat expansion disorder.

Conclusion

Cerebellar Ataxia Neuropathy and Vestibular Areflexia Syndrome (CANVAS) should be considered in patients with presentations from mid-life of progressive sensory ataxic neuropathy, altered vestibular ocular reflex, gaze evoked nystagmus and prominent dysautonomia. CANVAS is a rare autosomal recessive genetic disorder with a protean presentation. Referral to Genetics Services should be undertaken for family counselling. Keeping an open mind in complex, multimorbid patients to a potentially unifying diagnosis is important to guide prognostication. The rumble of hooves in the distance is not always that of horses.
Audit of Medication Reconciliation by Admitting NCHDs in a Sample of Older Adults in a Model 2 Hospital
Authors: O'Regan James , Hayes Patricia , Hart Ceara , Jennings Emma , O'Flynn AnneMarie
Published: September 2024

Background

Medication reconciliation is the process of creating and maintaining the most accurate list possible of all medications a person is taking. Aim: To assess the completion by medical doctors of the 5 subsections of the medication reconciliation page within the MAU admission booklet for a sample of older adults admitted to a model 2 hospital.

Methods

An education session on medication reconciliation was carried out with NCHDs. Subsequently the admission booklets of 29 patients were reviewed over a 4-week period. They included older adults that had been admitted by an SHO or registrar. The medication reconciliation page is divided into 5 sections. These include details on the medication history source, how the patient takes their medication, who completed the medication reconciliation page, a full list of the medications and if the patient brought their own supply with them. Each section was reviewed and documented as completed, partially completed or not completed.

Results

The average age of the patients included in this audit was 79.9 years. Just 1 medication reconciliation page was found to be fully completed across all subsections. 26 were partially completed and 2 were not completed. The section most likely to be fully completed was section 4 which documents the patient's full list of medication with names, doses and frequency. Seven booklets had section 4 fully completed, while 20 had this section partially completed. Two booklets did not have section 4 completed at all. Overall results were similar to a previous audit carried out following the introduction of the medication reconciliation page into the admission booklet.

Conclusion

No significant improvements were evident on the completion of this audit. This highlights a low level of importance given to medication reconciliation by admitting doctors. Further educational sessions and reaudit are planned to address this.
Retracted: Where are they now? Career Trajectories of Geriatricians after being awarded Certificate of Successful Completion of Training in Geriatric Medicine
Authors: Murphy Robert , Dennehy Karen , Reddin Catriona , Cooke John
Published: September 2024

Background

A Certificate of Successful Completion of Specialist Training (CSCST) is awarded on completion of Higher Specialist Training (HST) in Geriatric Medicine. A yearly list of doctors completing training and being awarded CSCST is published by the Royal College of Physicians of Ireland since 2018. In this observational study we examined the current professional status of Geriatricians who recently completed the HST program in Geriatric Medicine and were awarded CSCST.

Methods

We reviewed the current status of Geriatricians awarded CSCST since 2018 and cross referenced with the medical council register to examine what proportion are currently working as Geriatricians in Ireland. We examined what was the primary university of graduation and time from graduation to being awarded CSCST.

Results

CSCST was awarded to 46 doctors from 2018 to 2023 inclusive. 67% (n = 31) were female. The median number of years from entry on the medical council to being awarded CSCST was 11 years (IQR 10 – 11, range 9-21). 96% (n = 44) of geriatricians completed their primary medical degree in Ireland. University College Cork was the University from which most Geriatricians had graduated (32% of Irish graduates). 87% (n = 40) of Geriatricians are currently on the specialist register for Geriatric medicine in Ireland. Of the six not currently on the specialist register, two are undertaking research in Ireland, two are completing international fellowships, one doctor is working as a consultant in Australia, and one doctor is on maternity leave.

Conclusion

There is a high rate of retention of graduates of the Geriatric medicine HST program. Most graduates of the program went to an Irish medical school with a median time of 11 years from primary degree qualification to CSCST. To build on this we plan to complete a wider study examining individual factors that influence job satisfaction and retention of Geriatricians.
Changes in Proportion of International Patients Attending An Urban Stroke Service Over 10 Years
Authors: Bhujwalla Shireen , Donlon Noel , Harbison Joseph
Published: September 2024

Background

The population of Ireland has become increasingly ethnically diverse. St James’s Hospital is a large inner-city hospital with a diverse multi-ethnic catchment and, because of its location, also admits quite a large number of tourists and international visitors. About 30% of the population of the St James’s catchment were not born in Ireland. We evaluated the effect of this in 2014 and repeated the study in 2024 to determine the how this has changed over the succeeding decade.

Methods

We reviewed admissions with primary or secondary diagnoses of ischaemic stroke or primary intracerebral haemorrhage (ICD 10 i61 or i63) over 4-year periods, identified by HIPE. Data for the period 2010-2013 were compared with that for the period 2020-2023. Data were confirmed from patient records. International patients (non-Irish/UK) were identified, and demographic details noted.

Results

Between 2010 and 2013 there were 1550 admission of which 62 (4.0%) were international. Between 2020 and 2023 1266 patients were admitted of which 101 (8.0%) were international (Chi Sq 19.5, p<0.0001). Mean age of the international population increased from 52 to 56 years over the period compared to an increase from 71 to 73 for the indigenous population. Mean length of stay (LoS) for the international population had reduced for international patients (2010-13: 20.9 days. 2020-23: 12.2 days. Between 2020 and 2023, LoS was significantly shorter for the international than the indigenous population (Mean LoS 12.2 days, vs. 19.6 days, p<0.0003 t test). The international population had a higher proportion of males (67.3% vs. 53.9%, Chi Sq 6.8, p=0.009).

Conclusion

Over the 10-year period the number of international patients admitted doubled. As a proportion of admissions, they remain low and represent a lower proportion than in the community. Length of stay of international stroke patients is lower and there are a higher proportion of males.
A Summary of Videofluoroscopy Findings Compared with Chest X-Rays of Older Persons in a Model 3 Hospital
Authors: Linehan Sophie , Cheannabháin Aisling Ní , Ward Colette
Published: September 2024

Background

Oropharyngeal dysphagia (OD) is increasingly prevalent among the older population. OD may give rise to complications such as aspiration pneumonia, malnutrition and/or dehydration. Videofluoroscopy is a gold standard tool for the management of dysphagia. Videofluoroscopy is a moving x-ray of the swallow in which aspiration can be directly visualised. Videofluoroscopy is only a ‘snapshot’ and the swallow function can improve or decline over time. Not every aspiration event leads to respiratory complications. There is a lack of diagnostic criteria for the diagnosis of Aspiration Pneumonia. It is challenging for Speech and Language Therapists (SLTs) to determine clinical outcomes. Despite this, the primary reason for referral to SLT in acute care is to assess for aspiration risk. The aim of this review is to compare patients’ Chest X-ray findings with Videofluoroscopy results.

Methods

Results

Conclusion

Aspiration pneumonia is a diagnostic challenge - further research in the area of dysphagia associated aspiration pneumonia in Older persons is required. The focus of dysphagia management in Older Persons should move towards the person's nutrition, hydration, oral hygiene, quality of life as well as possible dysphagia related respiratory implications.
Recognition Of Frailty In Patients 75 Years And Older, Presenting To The Emergency Department Of A Level Three Hospital
Authors: Brennan Catriona , Flynn Gail , Popoola Taiwo Olukunle
Published: September 2024

Background

Ireland is experiencing the challenges and opportunities with an ageing population. When these needs remain unmet, older patients with frailty may present to the emergency department. It is important to put processes in place to improve the management of older persons presenting to the Emergency Department. The variable indicative of placement risk is a tool to identify older people at risk of adverse health outcomes at the time of hospital admission. Determination of frailty status is useful to inform clinical decisions, as frailty scores can predict multiple adverse health-related outcomes following hospitalisation. The aim is for every patient to leave in a better condition, and to add value with every interaction.

Methods

A retrospective service evaluation, over a specified time period, ascertained provision prior to the implementation of frailty specific initiatives. 39 charts were selected for the clinical audit. The audit tool was devised utilising the NCAA 2023 guidelines. Reliability was assured through quality patient safety and support of clinical audit facilitation. Data collected and analysed utilising an excel audit tool.

Results

100 percent of validated indicative placement risk is completed by nursing staff at triage. 92 percent of patients aged 75 years and older were triaged at 3. Cognition assessment was not standardized across assessment, with 26 percent of presentations with confusion observed, with collateral received on twenty eight percent. Overall, 34.8 percent of presentations had frailty recognition utilising agreed frailty terms.

Conclusion

The aim is to introduce clinical frailty assessment for all patients presenting aged seventy-five years and older. Delirium assessment is not standardized across assessment. The rapid clinical test for delirium (4AT) in line with national delirium assessment will be introduced. Frailty service is in position to support these changes. Ongoing education of Delirium and Frailty recognition for all Emergency department personal.
Exploring Barriers to Timely Administration of Intravenous Zoledronic Acid following Hip Fracture
Authors: Bhujwalla Shireen , Johansen Antony , Tham YuenKang , Dockery Frances
Published: September 2024

Background

In the Age & Ageing paper “Call to action: A five nations consensus on the use of intravenous zoledronate after hip fracture” 2023, the authors addressed key reasons that might underpin orthogeriatricians’ reluctance to offer intravenous zoledronate (IV Zol) while patients were still in hospital after a hip fracture.

Methods

The paper was presented at the Global Congress of the Fragility Fracture Network (FFN), October 2023, the Orthogeriatrics day of the British Geriatrics Society (BGS) Autumn conference 2023 and the Bone Health Special interest group meeting at the Irish Gerontological Society (IGS) 2023. At the start of each meeting, a survey of attendees was carried out on their attitudes to, and current use of IV Zol following hip fracture. Here we present results IGS survey results.

Results

N=37 responded, 85% were concerned that early administration of IV Zol might impair its effectiveness, similarly to FFN and BGS respondents but 42% said they would not administer IV Zol within 14 days of a hip fracture vs. 29% of FFN, 24% of BGS respondents. Forty-two percent also said they would not give vitamin D loading without blood levels vs. 24% of FFN, 24% of BGS respondents and 29% acknowledged that laboratory waiting times for Vitamin D frequently delay IV Zol. There were 8% using a CrCl threshold of 30ml/min, 35% using eGFR threshold of 30ml/min and 41% an eGFR of 35mls/min. eGFR overestimates CrCl, suggesting that the vast majority of clinicians already use IV Zol at below licenced CrCl threshold of 35ml/min.

Conclusion

Following hip fracture, IV Zol appears widely-used used in those with CrCl of 30-35ml/min, in line with threshold in the original clinical trial. We identified a number of factors impeding early administration however, one being the perceived need for vitamin D results beforehand. Education around its safe use will enable more patients to benefit.
Competencies Required By All Hospital Doctors Caring for Older Adults: A Group Concept Mapping Study
Authors: Buckley Emily , O'Tuathaigh Colm , Barrett Aileen , Bennett Deirdre , Cooke John
Published: September 2024

Background

The number of older adults accessing the healthcare service far exceeds the available geriatric specialist services. It is recognised that for the foreseeable future most hospital inpatient contacts with older adults will be completed by doctors not specifically trained in geriatric medicine. To ensure the provision of adequate healthcare, it is imperative that that all hospital doctors are trained in the minimum geriatric competencies. Allowing for the broad, complex, and multidisciplinary nature of geriatric medicine, we conducted a group concept mapping (GCM) study to permit multiple stakeholders with various expertise to convey their thoughts on the competencies required by all hospital doctors caring for older adults.

Methods

GCM is a mixed methods approach utilising six phases to generate expert group consensus, enabling participants to organise and represent their ideas. We invited healthcare professionals, patient advocacy groups and clinical educators to participate in GCM via an online platform. Hierarchical cluster analysis and multi-dimensional scaling were utilised to analyse participant input regarding competencies required by doctors caring for older adults.

Results

Forty-eight participants completed the brainstorming stage, generating eighty-eight statements, and twenty-two participants took part in the subsequent sorting stage. Participants included hospital doctors, general practitioners, allied health professionals and patient advocacy groups. Nine competency domains were identified as integral for all hospital doctors to care for older adults. Domains rated most important related to interpersonal communication skills, ethical and legal matters relating to older adults, recognition and management of delirium and medication management.

Conclusion

The twelve competency domains indicate the diverse skillset required by all doctors to provide comprehensive care to older adults within a hospital setting. This study identifies competencies that may serve as a foundational framework for ensuring quality healthcare for the ageing population. Future initiatives should consider incorporating these competencies to improve inpatient care provided by hospital doctors to older adults.
An Evaluation of Patient Profiles and Outcomes in an Off-Site Rehabilitation Unit in 2023 Compared to 2019
Authors: Brennan Finlay , Hashim Mohammad Shahril , Peters Catherine
Published: September 2024

Background

Our off-site inpatient rehabilitation unit accepts patients from many different referral centres. Demographic shifts have occurred in the last 4 years with the Covid-19 pandemic resulting in several practice changes and frailty admissions increasing at our primary referral centre by 11%. We compared the number of patients, their demographics and dependency in 2023 in comparison with 2019 and hypothesised a longer length of stay could be explained by increased dependency as defined by Barthel score on admission.

Methods

Data regarding patients’ age, admission and discharge dates, referral source and discharge destination were extracted from the rehabilitation unit's database. Weekly MDT records were examined to identify the patients’ presentation and dependency level. Presentations were categorised as stroke, hip fracture, other fracture, acute medical and surgical presentations, and elective surgical procedures.

Results

Discharges decreased to 89 in 2023 compared to 125 in 2019. Mean length of stay increased to 35.1 from 29.5. Mean age reduced from 85 to 83. Mean Barthel on admission was unchanged at 10. 21 Patients were admitted following elective orthopaedic surgery in 2019 compared to 2 in 2023 with a mean length of stay of 16 days. Length of stay for stroke patients increased from 33 to 50. Excluding both led to a length of stay of 32 in both years.

Conclusion

The reduction of bed days could be explained by increased frequency of outbreaks and more robust isolation strategies reducing total bed availability. A significant reduction in patients admitted following elective orthopaedic surgery impacted the average length of stay as did an increase in length of stay for stroke patients. Patient dependency defined by Barthel score was not increased and did not explain the increased length of stay. A more comprehensive score such as the Rehabilitation Complexity Score may be more predictive of complexity and thus length of stay.
Use of Two Pain Assessment Tools to Improve Pain Recognition in Post Stroke Patients: A Quality Improvement Project
Authors: Seebah Shelina , Fan Chie Wei
Published: September 2024

Background

Post stroke patients can suffer from a variety of complex pain syndromes. These are often associated with decline in function, cognitive impairment, impaired quality of life and mood disturbances. Pain identification can be challenging in this population, due to stroke deficits that impair communication, and associated medical conditions that can affect the patient’s ability to self-report pain. This Quality Improvement (QI) project aims at implementing two pain assessment tools to support clinicians assess pain in a structured manner, and thereby improve pain management.

Methods

An initial audit was performed to identify whether post stroke pain (PSP) was being recorded in a reliable manner in St Mary's hospital. A pain assessment proforma was then designed, incorporated in the admission proforma and rolled-out for use. This included two pain assessment tools: the Numerical Pain Scale for patients who could self-report pain, and the Abbey Pain Scale for patients with communication difficulties. A second audit was performed to analyse the compliance to documentation and a qualitative evaluation of its use was also conducted in semi-structured staff interviews.

Results

The first audit showed pain being under reported with only 25% of patients having formal pain assessment documented on admission. The second audit showed improvement in pain assessment with 72.7% pain documentation. Qualitative evaluation revealed staff expressing challenges with pain identification in post stroke patients and viewed the proforma as a useful prompt. Limitations to the use of observational tools included time constraints, lack of familiarity with tools and potential inaccuracy of scores.

Conclusion

Identification of PSP is key to optimising treatment, and hence improving function and quality of life of stroke patients. This QI project shows that the use of pain assessment tools, in combination with detailed clinical assessment can help pain assessment. Clinician awareness and continuous training are required to support this challenging task.
Perioperative Management Of Diabetes Mellitus In Older Hip Fracture Patients
Authors: Ashraf Mubashra , Mehammednur Miriam Hassen , O'Regan Niamh
Published: September 2024

Background

Hip fracture is one of the most serious injuries sustained by older adults worldwide, associated with increased morbidity and almost 25% mortality at one year. Pre-existing comorbidity worsens prognosis, e.g. hip fracture patients with Diabetes Mellitus (DM) have increased mortality rates, worse functional outcomes, and higher post-operative complications rates. Perioperative blood glucose optimisation may improve outcomes, however this can be challenging due to periods of fasting and reduced intake, as well as complications such as infection. Local guidelines for the peri-operative management of DM have been developed and are sign-posted in our hip fracture integrated admission document. This audit aimed to compare current practice with those recommended in local guidance.

Methods

Since 1st January 2024, 31 hip fracture patients aged ≥65 years with DM have been admitted. Charts were available on twenty patients, and hence reviewed.

Results

Of 20 patients, four were on insulin; 13 on metformin; four on sulphonylureas; five on SGLT2 inhibitors; and six on DPP4 inhibitors. No intraoperative hypoglycemic events nor episodes of Diabetic Ketoacidosis were documented; however, ketones were not checked in the majority of patients during admission. Eleven (55%) had HbA1C either done in the previous six months or during admission. Blood Sugar Levels were checked on admission in 9/20 (45%). The protocol was followed in only one patient on insulin; and 5/13 metformin patients. The protocol was followed in all Sulphonylurea prescriptions, and in 4/5 SGLT2 inhibitor prescriptions, however these medications were not held by the Orthopaedic team, rather by nursing staff while the patient was fasting pre-operatively.

Conclusion

This audit demonstrates poor adherence to local guidance on peri-operative management of diabetes, particularly perioperative insulin adjustments. We aim to develop an educational intervention (including group teaching, plus distribution of flashcards and posters) for Orthopaedic SHOs and interns and re-audit in the coming months.
Impact of Early Comprehensive Geriatric Assessment on Unscheduled Acute Medical Admissions through an Age Related Assessment Unit
Authors: Farrelly Angelina , Kelly Louise , Davey Naomi , Soh Josephine , Hayden Derek
Published: September 2024

Background

Older patients often face prolonged hospital stays, leading to increased healthcare costs and potential complications. Comprehensive geriatric assessment (CGA) at the point of hospital entry may reduce length of stay (LOS) by addressing the multifaceted needs of older patients promptly. This study evaluates the potential impact of early targeted CGA on the length of hospital stay for older patients admitted unscheduled to our hospital.

Methods

A retrospective review of all admissions by our Age Related Assessment Unit (ARAU) Team was conducted from January to April 2024. A total of 82 admissions were analysed. Two patient pathways were identified: 84% (69 patients) were admitted via Pathway 1 for acute medical intervention only. 16% (13 patients) were admitted via Pathway 2 requiring acute medical admission plus additional care needs/supports to facilitate discharge. These 13 patients had inpatient stays exceeding 20 days, either requiring additional support for discharge (long-term care/home care package), or a period of rehabilitation.

Results

Patients on Pathway 1 had an average LOS of 6.6 days, in contrast to those on Pathway 2 who had an average LOS of 35.2 days. According to our annual hospital report from 2022, patients over 75 years old typically had an average LOS of 16.3 days.

Conclusion

Early commencement of a CGA enables a targeted approach for the effective treatment of older adults presenting via unscheduled care, significantly reducing the length of stay for patients on Pathway 1. This positively impacts patient outcomes by mitigating the risks associated with prolonged hospital admissions and lowering related costs. However, additional focus and resources are needed to further reduce the length of stay for patients requiring extra support to facilitate discharge from the acute care setting.
Mobility Matters: The Association Between Current Level Of Frailty And The Elderly Mobility Scale In An Acute Older Population
Authors: Boyce Roisin , Samuel Thomas , Nolan Mary
Published: September 2024

Background

Evidence has shown that the 4Ms What Matters most?, Mentation, Medication and Mobility are essential elements of the provision of high-quality care for older adults. The Elderly Mobility Scale (EMS) is a standardised and validated scale for the assessment of mobility in frail older adults in an acute hospital. In addition, frailty has shown a strong predictive ability for adverse health outcomes, demonstrating a higher risk of mortality, disability, institutionalisation and hospitalisation in frail older persons. This study aimed to examine the relationship between current Clinical Frailty Scores (CFS) and EMS scores in order to enhance its interpretation in clinical practice and become more patient centered.

Methods

A convenience sample of acute older adults undergoing physiotherapy was used in this study. Baseline demographics of age, gender, level of assistance required to mobilise and if the participants were at their baseline mobility was recorded. The participants CFS and EMS was measured a one single time point during their admission. The correlation between these was examined.

Results

A total of 21 participants were examined, of which 52.4% (n= 11) were male and 47.6% (n=10) were female. The median age of the population was 82 years and 14.3% (n=3) were independent with their mobility. The median CFS was 6 (moderately frail) and EMS was 8 points. A Spearman’s rank correlation showed a strong negative correlation (r=-0.88, p=0) between current CFS and their current EMS.

Conclusion

Although this study has a small sample, it gives an insight into the use of the CFS and EMS in clinical practice. A better knowledge of the interaction of frailty on mobility among the acute older population is essential for understanding the healthcare needs and delivery of age friendly healthcare services.
Identifying Locations Where Self-Reported Dizziness Occurs In Patients With Vestibular Disorders In A Day Hospital Setting
Authors: Merrick Catherine , Grennan Eva , Alexander Marie , O'Malley Tom
Published: September 2024

Background

World falls guidelines recommended that where vestibular issues are identified such as Benign Paroxysmal Positional Vertigo (BPPV), therapeutic interventions should always be sought, as potential benefits to health-related quality of life are high (Montaro-Odasso et al., 2022). Identifying potential BPPV in older adults, however, can be challenging, as many older adults experience BPPV as vague unsteadiness rather than dizziness, leading to under diagnosis of the condition (Li et al., 2023). This audit aimed to identify the locations where patients with self- reported dizziness and falls experienced dizziness, and if they subsequently were diagnosed with vestibular disorders. If potential high-risk locations for experiencing dizziness with vestibular issues are identified, this may aid in the timely identification of vestibular disorders.

Methods

A retrospective chart audit was undertaken in a multidisciplinary day hospital setting, where patients aged 75 years and older attend for assessments. Paper charts of patients discharged from the day hospital between January and March 2024 were reviewed. A Microsoft excel sheet was used to track data. Data on self-reported dizziness and falls as well as the location of dizziness occurring was gathered.

Results

A total of 103 patient charts were reviewed. Of those, 39 reported experiencing dizziness, with 90% of those patients also reporting a history of falls. 18 of these patients were subsequently diagnosed with vestibular disorders. 78% of patients diagnosed with BPPV reported experiencing dizziness getting out of bed or in their bedroom with 28% also reporting dizziness on getting up from a chair. However, 100% of patients with dizziness and falls without vestibular disorders reported dizziness on getting out of their bed.

Conclusion

People with all cause dizziness reported dizziness on getting out of bed. Based on the results of this audit, vestibular screening is not aided by questions surrounding location of dizziness occurring.
The Goldilocks Effect Of Hydration For Patients In A Sub-Acute Rehabilitation Setting: Too Warm, Too Cold Or Simply Not Nice
Authors: Crowe Aoife , Fagan Claire
Published: September 2024

Background

Older adults are considered at risk of becoming dehydrated. Risk of dehydration is increased during a hospital stay. Offering a range of preferred drinks frequently during the day can improve total fluid intake and minimise the risk of low intake dehydration. A survey of patient access to and consumption of water on an inpatient ward for older adult rehabilitation was undertaken.

Methods

A point prevalence survey was conducted on each patient on an inpatient ward for the following six situations:

Results

All inpatients (n=26, 15 female and 11 male) completed the survey for each of the six situations. 85% of patients surveyed had access to water (n=22). 85% of patients (n=22) surveyed were able to reach the water and 85% (n=22) could pour the water independently. 15% of patients surveyed (n=4) required assistance to drink (modified consistency (n=2) or physical assistance (n=2). Only 35% of patients (n=9) reported drinking the available water. Of the 17 patients who reported not drinking the water accessible to them, 59% (n=10) reported the water was too warm and 29% of patients (n=5) reported the water didn’t taste nice.

Conclusion

Low intake dehydration is associated with adverse outcomes in older adults. The root causes of low fluid intake need to be established in order to minimise the risk of dehydration during a period of hospitalisation. Further research is required to establish the root causes of low intake dehydration and development of quality improvement initiatives to minimise low intake dehydration in a hospital setting.