bluuebunny/crossref_metadata_2025 huggingface dataset:
284 Improving Adherence to Irish Hip Fracture Database Standards 1 and 2
Authors: Hearne Siofra , Smyth Hannah , Monahan Pheadra , McGowan Hugh , Timmins Shirley , Hillary Paddy , Mahapatra Anant , Walsh Alan , Conlon Ciaran , Dunnill Eithne , Campbell Eleanor , Carolann Danielle , Ahern Tomas , O'Brien Helen
Published: September 2019

Background

The Irish Hip Fracture Database (IHFD) National Report 2017 demonstrated poor performance across all six IHFD standards in our hospital. For the purpose of this study we focused on standards 1 and 2. IHFD standard 1: All patients with hip fracture should be admitted to an acute orthopaedic ward within 4 hours of ED presentation/ brought directly to theatre from ED within 4 hours, and IHFD standard 2: All patients with hip fracture who are medically fit should have surgery within 48 hours of admission and during normal working hours.

Methods

We examined IHFD standards 1 and 2 from August 2017-January 2018 and August 2018-January 2019 after the appointment of an orthogeriatrician and use of the first Hip Fracture Pathway in August 2018. We also analysed data collected from February-April 2019 after amendment of the hip fracture pathway for patients presenting to the ED.

Results

IHFD Standard 1: From August to January 2017, 2.5% of patients were admitted to an orthopaedic ward within 4 hours versus 18.1% in 2018. IHFD Standard 2: in 2017, 64.8% underwent surgery within 48 hours during working hours, versus 65.3% in 2018. From February to April 2019, 32.1% of patients were admitted to an orthopaedic ward within 4 hours (IFHD 1) and 56.6% of patients underwent surgery within 48 hours and during working hours (IFHD 2).

Conclusion

Close collaboration between Emergency Medicine, Orthopaedic Surgery, Radiology, Nursing colleagues, Allied Health Professionals and Orthogeriatrics and amendment of the Hip Fracture Pathway have led to improvements in Standards 1 and 2. The addition of an orthogeriatric service in the hospital has resulted in an improvement in adherence to all IFHD standards. However, there are ongoing challenges to achieving Standard 2 including limited theatre access and increasing numbers of older patients on novel oral anticoagulants.
28 Steps Towards a more “Dementia Friendly” Medicine for the OLDER PERSON Acute Admission Ward
Authors: Lavery Paula , Smith Finola , Peel Michelle
Published: September 2019

Background

A “Dementia Friendly” ward is an environment that has been designed and adapted to take into account the care needs and environmental requirements of dementia patients (Dementia Action Alliance, 2013). Hospitals should be dementia friendly from admission to discharge (National Dementia Strategy 2014).

Occupational Therapists (OT) have unique skills in assessing the environment and understand the influence these have on a person’s engagement in valued occupations.

A one-day patient census on a Medicine for the Older Person Acute admission ward indicated that 60% of patients had an acute delirium. Fifty percent of patients had a documented diagnosis of dementia or mild cognitive impairment. In light of this, the OT team completed an audit to assess how “Dementia Friendly” the ward is.

Methods

The “Is your ward Dementia Friendly” Enhanced Healing Environment Assessment Tool, developed by the Kings Fund (2014) was utilised for the audit. The assessment tool contains seven sections which include “Orientation, Meaningful Interaction and Safe Mobility”. Following the audit, results were calculated in percentile format and long/short term goals for improvement were developed incorporating dementia friendly design principles.

Results

Meaningful Interaction: 35% Well-being: 37% Eating & Drnking: 37% Mobility: 34% Continence and Personal Hygiene: 40% Orientation: 44% Calm, Safety & Security: 53% The overall, average ward score achieved was 40% “Dementia Friendly” environment.

Conclusion

Following audit, the OT provided feedback to the ward manager and a ward committee was established with a wide variety of stakeholders, including, catering, nursing, allied health, and dementia services director. This committee meets on a regular basis with a joint vision to enhance the “dementia friendly” ward environment. Currently, actions are underway to target improvements in orientation and way-finding and social interaction. A re-audit will be completed in May 2019.
32 Exploring the Efficacy of a Discharge to Assess Model using a Combined Approach Involving FITT, OPAT and CIT
Authors: Lawlor Louise , O'Reilly Ciara , Platts Anne , Myler Lorraine
Published: September 2019

Background

Following hospital admission, older patients are at an increased risk of death and admission to nursing home care (Bachmann et al, 2010). Functional deterioration in older patients occurring prior to hospital admission is as a result of acute illness however deterioration following admission can be as a result of polypharmacy, excessive bedrest, sleep deprivation, institutionalisation and inadequate nutrition and may be amenable to changes in the processes of hospital care (Coleman et al, 2012) In terms of reducing costs in an ever-increasing older population, maintaining people in their own homes is more cost effective than high numbers going to residential care.

Methods

Therapists in the hospital identified appropriate patients and referred to FITT therapist’s (0.5 Occupational Therapist and Physiotherapist) and CIT nurses for review. Within 24 hours of discharge, patients were followed up by a home visit by FITT. The therapy team communicated the needs of the patient and the CIT nursing team would complete a visit. Once patient’s immediate needs were met and situation stabilised at home, onward referrals to both community and hospital services were co-ordinated as required.

Results

Sixteen patients over a four-week period were included. The main reason for referrals included: functional review in home environment, pain and medication management, patient and carer support.100% of patients were reviewed at home within 24 hours of discharge and required on average of 5 visits at home which equated to 119 bed days at home. This cross organisational project identified that rapid discharges can be facilitated which reduced length of stay and increased patient and family’s satisfaction with the discharge process.

Conclusion

This alternative model to the traditional hospital-based rehabilitation model needs to be considered in future service planning.
313 Caring for Older Persons with Dementia in an Acute Medical Care Setting: An Exploration of Nurses’ Experiences and Perceptions
Authors: Fitzmaurice Kay , Flynn Angela
Published: September 2019

Background

Presently in Ireland there are 55,000 people with dementia, with figures projected to rise to 130,000 by 2041. In acute hospitals, ensuring the provision of high standard, person-centred care for people with dementia is an essential part of policy and practice development. While nurses are key in implementing safe, effective and evidenced based care it is unclear at this moment what their experiences are, when caring for patients with dementia. It is twelve years since the last study was conducted in Ireland in a purpose-built unit for older patients so will not be reflective of an acute care setting. Therefore, it is timely to gather a current description of nurses’ experiences and perceptions in caring for patients with dementia in an acute care setting.

Methods

A purposeful sample of nine nurses working in an acute medical ward caring for patients with dementia participated in the study. Data was collected using semi-structured interviews, transcribed verbatim and analysed using content analysis.

Results

The findings are current and highlight that nurse’s display immense respect and empathy to patients with dementia and see beyond the dementia to the individuality of the person. This demonstrates positive attitudes towards these patients, despite organisational and environmental constraints. The findings further identify that staffing levels are inadequate and that nurses require specific education on dementia. Furthermore, the organisational culture and environmental design are not conducive for patients with dementia and changes need implementing in line with the Irish National Dementia Strategy and the Dementia Friendly Hospital Design Guideline.

Conclusion

These findings have provided a current view of nurses’ experiences and perceptions of caring for patients with dementia in an acute medical ward and support previous study findings. Strategies are now required to address these issues, with a focus on the six priority action areas from The Irish National Dementia Strategy.
336 GEMS: Geriatric Emergency Service - Home Team Outcomes
Authors: Mulholland Ann , Gibbons Ruth , Reddy Danielle , Hayes Brennan Megan , Cornally Lorna , Gallagher Grainne , O'Callaghan Maureen , Nolan Jane , Normoyle Cathriona , Ahern Emer
Published: September 2019

Background

Frailty is now a key concept in healthcare service planning and delivery and is driving vertical and horizontal integration. Early identification of Frailty and early intervention with Comprehensive Geriatric Assessment (CGA) is fundamental to our GEMS. Older people with Frailty admitted to hospital who receive a CGA early are more likely to return home. Benefits are seen early and are sustained (Ellis et al 2011).

Methods

The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are screened on triage using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. The GEMS Home Team was planned and developed in December 2018 to case manage those identified at risk of adverse outcomes by the Acute Floor Team.

Results

79% (502) of patients who received a CGA were case managed by the Home Team since December 2018. 3% were newly discharged to Long Term Care, 73% to their pre-admission residence. 14% of patients were discharged with an increase in Home Support Services (HSS) and 2% with new HSS. 24% were referred to 3rd sector supports in the community e.g. ALONE, SAGE etc. 48% were identified as appropriate for earlier discharge if supports e.g. Discharge To Assess were available at home.

Conclusion

The GEMS Home Team have developed and delivered a pioneering integrated care approach to the management of the older person. The Team are positively influencing the culture of Home First in the hospital and driving horizontal and vertical integration.
340 The Impact of Medicine Reconciliation by a Clinical Pharmacist Compared to Standard care for Elective Orthopaedic Admissions
Authors: Connell Yvonne , Cheallaigh Sadhbh Ní , O'Connell Charles , Byrne Stephen
Published: September 2019

Background

Medicine reconciliation is defined as ‘The process of creating and maintaining the most accurate list possible of all medications a person is taking’. Medicine reconciliation (MR) is supported by various Irish governmental agencies such as the HSE, HIQA, PSI and the State Claims Agency. In addition, Irish GPs and community pharmacists are strongly in favour of expanding the role of hospital pharmacists in MR at all transitions in care. The aim of this study are to establish the appropriateness of the current MR service in elective surgical admissions in a Dublin based hospital.

Methods

This was a prospective interventional study that included 200 consecutive patients who met the inclusion criteria. The study was conducted between May and June 2018. All patients in the study received standard care in the control arm, followed by enhanced care in the interventional arm with errors noted and rectified after each process, this design allowed patients under standard care to act as a paired control group. Sub group analysis was performed on the following: (1) those >/= 65 years, (2) female patients, and (3) patients with a BMI > 30kg/m2. Ethical approval was obtained for this project.

Results

MR was found to detect a statistically significant number of errors compared to standard care (p=0.039). In the sub-group analysis, those >65 years (p=0.0237) or female (p=0.001), were at statistically higher risk of experiencing a MR error, verses obese patients (p=0.389). The Cornish classification tool was used to assess severity of the MR errors; while 37.5% of patients experienced at least one MR error, only between 1.5% - 3.5% of errors were classified as Class 3 errors.

Conclusion

A full medicine reconciliation service could be of benefit to targeted patients including those aged over 65 years or female, experiencing polypharmacy, or those with communication difficulties.
56 Streamlining Referral Processes at a Tertiary Acute Medical Ambulatory Centre
Authors: O'Donovan Claire , Wright Steve , Towler Simon , Furness Erin
Published: September 2019

Background

The Acute Medical Ambulatory Centre (AMAC) was established with the goals of facilitating early discharge and preventing avoidable medical admissions. 12 months post its introduction, the service was inefficient and operating under capacity. A project aimed to improve the AMAC referral processes and increase the centre’s overall efficiency was undertaken.

Methods

Western Australia Department of Health Clinical Service Redesign methodology (a blend of Lean and Six Sigma methodologies) was used to complete the project. This involved process mapping, root cause analysis and solutions sessions with stakeholders, as well as a semi-structured phone interview with patients.

Results

Transition from a paper-based to an electronic referral system. Creation of an ‘AMAC Quick Reference Guide’ for doctors. Production of an AMAC contact card to be given to patients on discharge if they   have AMAC follow up. Letters detailing the patient review are forwarded on the day of the appointment facilitating timely feedback to GPs. An AMAC information flyer for GPs is now available on the hospital website.

Conclusion

Redesigning the referral process to the AMAC has improved workflow and efficiency with significant improvements in staff satisfaction. The institution is aiming to become paperless and this redesign project has led to the elimination of another paper form. The success of the project is testament to the engagement of the staff involved and demonstrates the need for doctors to not only engage their medical colleagues, but also nursing and clerical staff. The redesign project has helped refocus hospital priorities and should hopefully see further support for the centre; developing the ambulatory model of care as an integral part of the service provided. Other centres can learn valuable lessons from our experience and develop similar strategies to cope with the ever-increasing demands on the public healthcare system.
72 Adult Safeguarding, Abuse of Vulnerable Adults and Mandatory Reporting: A Rapid Realist Review of the Literature
Authors: Donnelly Sarah
Published: September 2019

Background

The continuing evolution of adult safeguarding legislation, policy and practice in relation to the abuse of vulnerable adults reflects a growing awareness of the nature and extent of such abuse in Ireland. The Adult Safeguarding Bill, 2017 represents a progressive step in safeguarding older people and vulnerable adults. The intention of the Bill is to put in place additional protections for adults, in particular, for those who may be unable to protect themselves, such as older people or those lacking capacity. Part 3 provides for mandatory reporting by specified/named persons/professionals. This paper sets out to critically analyse the concept of mandatory reporting within adult safeguarding using international comparators as case studies.

Methods

A rapid realist review of adult safeguarding reporting typologies and systems in five key jurisdictions: Australia, Canada, England, Northern Ireland and Scotland, were explored to answer the question: ‘what works, for whom and in what circumstances?’ [1]

Results

Jurisdictions differ as to who the mandated reporters are, the scope and powers of mandatory reporting, and the types of abuse subject to reporting. Of significance is that the debate on mandatory reporting has increasingly focused on institutional settings, rather than more broadly across services. Key concepts identified are those of protection, empowerment and proportionality. Adult safeguarding legislation must therefore ensure that interventionist and compulsory measures to protect do not excessively restrict the rights of the individual.

Conclusion

Mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults and older people, but this could also change the dynamic of relationships within families, and between families and professionals. Ultimately, the success of any legal approach will rest with professional judgment in balancing autonomy with protection.
77 Behind the Scenes: the Burden Experienced by Informal Carers of People with Dementia
Authors: O'Brien Roisin , Breen Fiona , Gibney Caoimhe , Mackey Laura , Guisado-Fernández Estefanía , Caulfield Brian , Curran Fiona , Power Dermot , O’Shea Diarmuid , Doyle Rachael , Blake Catherine
Published: September 2019

Background

Informal care is undoubtedly a vital to dementia care in Ireland. To date, little research has been carried out exploring the burden experienced by informal carers of people with mild to moderate dementia. The main aim of this quantitative study is to explore the burden experienced by caregivers, relative to dementia severity. The secondary aim is to identify risk factors which may be contributing to this perceived burden.

Methods

Fifty-two people with dementia(PwD) and their informal caregivers were recruited by convenience sampling, and data was collected as part of the ‘CHESS’ research trial. Data was collected during baseline assessments between April 2017 and September 2018. Dementia disease severity was measured using the Mini-Mental State Examination(MMSE), the Neuro-Psychiatric Inventory Questionnaire(NPI-Q), and the Disability Assessment for Dementia(DAD) scale. These outcome measures were then compared to levels of caregiver burden, which was measured using the Zarit-Burden Interview(ZBI). These comparisons were completed using Spearman’s correlations. Socio-demographic characteristics of both the carer and PwD were then compared to caregiver burden, using Mann-Whitney and Kruskal-Wallis tests.

Results

The results of the study substantiate that behavioural disturbances(p=0.000) and increasing disability(p=0.022) of the PwD are associated with higher carer burden. The study also identified potential non-modifiable risk factors for increased carer burden. These include spousal relationship to the PwD(p=0.096), older caregiver age(p=0.208), female carer gender(p=0.083) and higher educational attainment of the caregiver(p=0.035). Some of these differ from factors influencing burden in other international populations.

Conclusion

This preliminary analysis is the first study of its kind to be carried out in Ireland. It sheds light on potential predictors and risk factors for carer burden and shows need for future research to be carried out in this area. Such research would help to clarify interventions which could minimise the prevalence of the burden experienced by informal caregivers.
80 Sleeping Beauty
Authors: Cunningham Nora , McManus John , O'Connor Margaret , Gabr Ahmed , Ryan Sheila
Published: September 2019

Background

The artery of Percheron is a rare anatomic variant of arterial supply to the paramedian thalamus and rostral midbrain, and occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with or without midbrain involvement. Early diagnosis of artery of Percheron infarction can be challenging because it is infrequent and early computed tomography or magnetic resonance imaging may be negative. Thus, it can be confused with other neurological conditions such as tumours and infections.

Methods

This is a retrospective case study of a gentleman admitted to a teaching Hospital in Limerick and diagnosed with an artery of Percheron infarction. Medical records and the neuro-radiological database were reviewed, and the diagnosis was made based on typical symptoms and radiological findings of artery of Percheron infarction.

Results

We report the case of a gentleman who was found unconscious in his car on the roadside during the daytime. He had a decreased GCS and upon arrival in the Emergency Department he was intubated and transferred to ITU

The initial head computed tomography performed on admission was reported as unremarkable. Bilateral ischemia in the paramedian thalamic nuclei was documented on a follow-up computed tomography on day 24 after hospitalization.

He was extubated after 24 hours. He made a full recovery and was discharged home on day 5.

Conclusion

Artery of Percheron infarcts are rare. The radiological diagnosis can initially often be judged as normal and in combination with variability in the neurological symptoms it is a rather difficult condition to diagnose.
89 Geographical Variation of Emergency Hospital Admissions for Ambulatory Care Sensitive Conditions in Older Adults in the Republic of Ireland
Authors: Walsh Mary , Cronin Sinéad , Boland Fiona , Ebell Mark , Wallace Emma , Fahey Tom
Published: September 2019

Background

Hospitalisation for specific conditions considered to be `ambulatory-care sensitive' (ACS) could signify problems with primary or outpatient care access. The aims of this study are to quantify and explore potential causes for geographical variation across emergency hospital admissions for relevant ACS conditions in older adults in Ireland.

Methods

The number of emergency hospital admissions among adults aged 65+ with a diagnosis of an ACS condition between 2012-2016 were extracted from Ireland’s Hospital Inpatient Enquiry system according to condition, sex, age-group, residence area and year. Conditions included chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes complications, angina (excluding therapeutic procedures), pyelonephritis and urinary tract infections (UTI), dehydration and pneumonia. Age-sex standardised discharge rates (SDRs) were calculated for 21 areas. Systematic components of variance (SCV) quantified variation. Regression analyses were conducted between SDRs and year, unemployment rate, % urban population, General Practitioner (GP) supply, and % short emergency hospital stays.

Results

In total, 147,722 emergency hospital admissions (50 per 1,000 eligible population; 49% male) were included. COPD was the most common condition (31%), followed by pneumonia (22%), pyelonephritis/UTI (21%) and CHF (16%). CHF showed low geographic variation (SCV=2-3). COPD, diabetes, pyelonephritis/UTI and pneumonia showed high variation (SCV=4-12). Angina and dehydration showed very high variation (SCV=12-50). In multivariable analysis, higher unemployment was associated with higher SDRs for COPD. Lower GP supply was associated with higher SDRs for CHF, diabetes and pneumonia. Rurality was associated with SDRs for angina.

Conclusion

The rate of emergency admissions for ACS conditions studied is in line with research in the United States, although COPD and angina account for a higher proportion of admissions in our study. There is significant geographical variation in ACS admission rates among older adults in Ireland. Further research should explore local factors influencing emergency admission, particularly in socio-economically disadvantaged areas and those with lower GP supply.
94 A Pathway of Care for Patients with Parkinson’s Disease in Cavan Monaghan Physiotherapy Department
Authors: Sweeney Mary , Creegan Maura , Hall Michelle , McGroarty Donna , Graham Jane
Published: September 2019

Background

New European guidelines for the physiotherapy management of patients with Parkinson's disease were published in 2014. Following on from this publication it was decided to review the current physiotherapy service delivered to our patients with Parkinson's disease across both counties and develop a new pathway of care in line with the guidelines.

Methods

A working group of physiotherapists was selected representing acute, primary care and disability services. This group initially met to review current practice.

Once the service was evaluated, the group created a new assessment form for use across all physiotherapy services in both counties using validated outcome measurements as recommended in the guidelines.

A training program was put in place to improve staff's skill level in using the new assessment form and treatment methods for this client group. It was decided that a yearly assessment would now be carried out on each patient with Parkinson's disease.

Feedback was sought from therapists and any issues were addressed by the working group.

As part of the pathway a new Parkinson's exercise group was created which runs twice yearly in both counties.

Results

In 2018, 18 patients attended an exercise class in Cavan, 16 attended in Monaghan while yearly assessments were also completed.

Patient feedback from the classes has been very positive and outcome measurements have shown an improvement. Patients enjoy the class setting immensely and physiotherapy staff feel their patients are benefiting from receiving a more prolonged period of intervention.

Conclusion

This new pathway of care has been an effective and efficient way of treating patients with Parkinson’s disease.

It has led us to identify changes in disease progression in a more timely fashion.

Outcome measurement is audited yearly to monitor quality of classes and benefit to patients.

We will continue to highlight the pathway with new staff and monitor staff satisfaction with its use.
101 First Steps Towards Tailoring Frailty Specific Clinical Pharmacy Referrals
Authors: O'Reilly Aine , Athanasiyar Vince , Ryan Siobhan , Pender Ciara , Maher Jennifer , Sayers Karen , Cooney Eamonn , Baburaj Binish , Donnellan Christina , Pillay Isweri
Published: September 2019

Background

Interdisciplinary frailty assessment teams are in development throughout Ireland. Clinical pharmacy assessment (CPA) improves patient outcomes. Review is time consuming. Prioritising patients using frailty-specific toolkits should result in the greatest benefit for patients in a resource-limited setting.

Methods

Consecutive acute emergency patients identified as Variable Indicative of Placement positive at triage, underwent standardised interdisciplinary assessment tool. Age, gender, reason for referral and clinical frailty score were recorded in an Excel database. From 7/1/2019 to 31/1/2019, polypharmacy, defined as 5 or more medications triggered CPA. In phase 2, 11/3/2019 to 5/4/2019, a prioritisation toolkit was used. This toolkit identified 4 groups. 1. Regular use of high-risk medication or greater than 10 medications. 2. Patients with specific pharmaceutical concerns eg. desire to reduce their medication burden; 3. Acute/Chronic Kidney Injury; 4. Medication related admission potentially related to medications or admitted with non-mechanical falls.

Results

In phase 1, 57 patients were referred with polypharmacy from 7/1/2019 to 31/1/2019. 49%(n=27) received CPA. The mean age(+/_SD) was 82.8(+/-6.5). The female to male ratio was 1:1. The average CFS score(+/-SD) was 5.8(+/-1.2). In phase 2, 45 patients were prioritised with the toolkit from 11/3/2019 to 5/4/2019. 55%(n=25) received CPA. The mean age was 81.1(+/-8.3). The female to male ratio was higher (2.8:1). The average CFS score was 5.9(+/-0.9).

Conclusion

The prioritisation toolkit slightly reduced the number of referrals for CPA. The total number of CPAs remained constant. Women accounted for a greater percentage of patients in phase 2, consistent with previously published work. Further prioritisation is needed to ensure that patients with the highest risk of medication-related safety issues are identified and reviewed. Further prioritisation will be trialled and analysed using a plan, do, study, act approach. The ultimate aim will be to create and validate a prioritisation toolkit for the frail elderly presenting through an emergency department.
119 The Perceptions of Older Patients and their Family or Caregivers Towards Physical Activity and Exercise in Hospital: A Qualitative Study
Authors: Mealy Bláthnaid , O'Neill Aoife , Danaher Dervilla , French Helen
Published: September 2019

Background

Between 30-60% of older people experience functional decline after hospitalisation which can be accelerated by inactivity in hospital. Family or caregivers can positively affect activity levels of hospitalised older people. We aimed to explore the perceptions of hospitalised older people and their family or caregivers towards physical activity and exercise during an admission to a Specialist Geriatric Ward in an acute hospital

Methods

A qualitative approach was taken, using semi-structured interviews with eleven patient participants and semi-structured focus groups with four family or caregivers. Thematic analysis was utilised to identify key themes.

Results

Three similar themes emerged from both groups: 1) personal feelings towards exercise or inactivity, 2) the role family/caregivers could play in facilitating exercise and 3) the role of hospital staff, which all impacted on participants’ perceptions towards exercise in hospital.

Personal influences including self-efficacy and appreciation of the importance of exercise resulted in more positive views towards activity. There was an acute awareness among some family of the dangers of inactivity.

Uncertainty existed regarding the role family or caregivers have in increasing patient activity levels. Some patient participants believed family involvement may increase activity levels, while others thought it would compromise their independence.

Both groups identified a need for more patient-specific information regarding activity in hospital. Both groups favoured hospital staff encouraging rather than restricting activity and felt that more doctors encouraging exercise would be helpful. The need for more opportunities for meaningful activity in hospital was highlighted.

Conclusion

Physical activity and exercise were perceived as important during hospital admission. Hospital staff should facilitate and enable increased opportunities for patient activity, and empower family or caregiver involvement in this where appropriate.
135 The Impact of an Early Mobilisation Initiative Evidence from an Acute Care Setting
Authors: Horgan Aileen , Carr Michelle , Murphy Aileen
Published: September 2019

Background

Unnecessary bed rest results in a loss of mobility and an increased length of hospital stay. Despite mobilising regularly being acknowledged as an important preventative measure for deconditioning, inpatient functional decline continues to pose a significant challenge in hospital settings. Hospital-based mobility initiatives offer the potential to address issues of functional decline, improve patient outcomes and hospital length of stay. The aim of this research is to examine the impact of an early mobilisation initiative called “End PJ Paralysis”.

Methods

The research design comprises of three elements: (i) an examination of a period that promoted mobility to all patients on one acute unit (ii) an analysis of the reported number of falls during the study period and (iii) an exploration of perceptions and attitudes of nurses, nurse managers, and patients involved with the initiative.

Results

Our study demonstrates that following a 10-week promotion of the initiative from April 17th-June 26th 2018 in an acute care setting in south of Ireland, an increase of 15% of patients were mobilising and a decrease in the number of reported falls. In addition, staff participation was found to increase and self-reported patient satisfaction improved. Factors identified as influencing the impact of the initiative included patient and staff behavior, nurse management leadership, and effective communication.

Conclusion

The study provides evidence to suggest that early mobilisation initiatives can prevent deconditioning and improve patient outcomes. Each day a patient spends in hospital should contribute towards their recovery and discharge and mobilising patients while in hospital has a profound impact on their functional status.
155 The Development of a National Transfer Document for Older Persons, when Transferring Between Residential and Acute Care Settings
Authors: O'Reilly Pauline , Meskell Pauline , Doody Owen , Kiely Michelle , O'Doherty Jane , Dore Liz , Barry Louise , Fahy Anne , Graham Margaret , Murphy Jill , O'Keeffe Jonathon , O'Brien Brid , Tuohy Dympna , Coffey Alice
Published: September 2019

Background

The transition of older persons between care settings is recognised as a particularly critical and vulnerable period (Renom-Guiteras et al. 2014). Appropriate documentation and processes are key in assisting the provision of quality, safe, person-centred care when transferring older persons from residential to acute care settings. This paper reports on the design phase of a national transfer document for older persons. The objective was to inform the development of a draft national transfer document.

Methods

Development consisted of two phases 1) an integrative review and 2) focus group interviews with stakeholders. The review was guided by Whittemore and Knafl‘s (2005) integrative review framework. Data from studies using both quantitative and qualitative methodologies were extracted and thematically analysed. Using a qualitative descriptive approach, focus group interviews (n=8) were conducted with a convenience sample of key stakeholders (n=68) to establish their perspectives regarding transfer documents. Data were analysed using content analysis. Results from both phases were integrated to guide the development of the draft document. A multidisciplinary panel of experts in older persons care, reviewed and provided feedback on the draft transfer document.

Results

Within the review, thirty identified papers focused on transfer documentation between residential and acute care. Results indicated that using a standardised document can potentiate the delivery and acceptance of relevant person-centred information between all parties when transferring an older person between residential and acute care settings. Qualitative interview findings highlighted important aspects for consideration regarding the layout, content and format of future transfer documentation. Following collaboration with the expert panel the transfer document was developed for piloting.

Conclusion

Consistency and clarity of information is key for a successful transfer of older persons from residential to acute settings. Information needs to be evidence-based, current, and subject to response and change in accordance with best available international practice.
158 Malnutrition Screening by an Interdisciplinary Integrated Care Team is an Essential Component of Comprehensive Geriatric Assessment
Authors: Pender Ciara , Sayers Karen , Pillay Isweri , Donnellan Christina , Maher Jennifer , Ryan Siobhan , O'Reilly Aine , Cooney Eamonn
Published: September 2019

Background

Malnutrition plays a key role in the pathogenesis of frailty and nutritional interventions may reduce the incidence. Comprehensive Geriatric Assessment (CGA) is the gold standard in assessment once frailty has been identified. Recent Nutritional Screening Data indicated that only 20% of Irish hospitals screened 76-100% of patients. Twenty-three percent of those aged 60-79 years and 30% of those >80 years were at risk of malnutrition (Russell & Elia, 2011). This emphasises the importance of a validated malnutrition screening tool as an integral component of CGA. This study evaluates the use of the Malnutrition Screening Tool (MST) by an integrated interdisciplinary team aimed at early identification of frail patients at risk of malnutrition.

Methods

A prospective study of consecutive frail patients, admitted through the emergency department (ED) to an acute hospital over five months was performed. Each patient had an interdisciplinary assessment (IA) performed. The IA included a MST tool. Patients were identified as frail using the Variable Indicative of Placement (VIP). Team members, consisting of a physiotherapist, speech and language therapist and advanced nurse practitioner candidates were trained by the team dietitian to use MST. Age, gender, Clinical Frailty Score (CFS) and MST were recorded in an excel datasheet. A patient scoring ≥2 on the MST indicated risk of malnutrition and the need for Dietetic Assessment (Wu et al. 2012).

Results

Three-hundred and sixty CGA’s were completed by an integrated interdisciplinary team over five months. The mean age (+/-SD) was 82.4 (+/-7). The male to female ratio was 1:1. The mean CFS (+/-SD) was 5.5 (+/-1.2) (mildly to moderately frail). Ninety-two percent (n=331) were screened using the MST. Thirty-five percent (n=115) were at risk of malnutrition.

Conclusion

Integrated interdisciplinary team training on the MST, resulted in successful identification of 35% (n=115) of frail patients “At Risk of Malnutrition”. Identification, combined with appropriate dietetic intervention, may reverse frailty in some of these patients.
Enteral and parenteral nutrition considerations in pediatric patients
Authors: Cober Mary Petrea , Gura Kathleen M
Published: September 2019

Purpose

Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed.

The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients.

Conclusion

The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.
Transcending the brain: is there a cost to hacking the nervous system?
Authors: Khan Shujhat , Aziz Tipu
Published: September 2019

Great advancements have recently been made to understand the brain and the potential that we can extract out of it. Much of this has been centred on modifying electrical activity of the nervous system for improved physical and cognitive performance in those with clinical impairment. However, there is a risk of going beyond purely physiological performance improvements and striving for human enhancement beyond traditional human limits. Simple ethical guidelines and legal doctrine must be examined to keep ahead of technological advancement in light of the impending mergence between biology and machine. By understanding the role of modern ethics, this review aims to appreciate the fine boundary between what is considered ethically justified for current neurotechnology.
ApicoTFdb: the comprehensive web repository of apicomplexan transcription factors and transcription-associated co-factors
Authors: Sardar Rahila , Kaushik Abhinav , Pandey Rajan , Mohmmed Asif , Ali Shakir , Gupta Dinesh
Published: September 2019

Despite significant progress in apicomplexan genome sequencing and genomics, the current list of experimentally validated transcription factors (TFs) in these genomes is incomplete and mainly consists of AP2 family of proteins, with only a limited number of non-AP2 family TFs and transcription-associated co-factors (TcoFs). We have performed a systematic bioinformatics-aided prediction of TFs and TcoFs in apicomplexan genomes and developed the ApicoTFdb database which consists of experimentally validated as well as computationally predicted TFs and TcoFs in 14 apicomplexan species. The predicted TFs are manually curated to complement the existing annotations. The current version of the database includes 1292 TFs which includes experimentally validated and computationally predicted TFs, representing 20 distinct families across 14 apicomplexan species. The predictions include TFs of TUB, NAC, BSD, HTH, Cupin/Jumonji, winged helix and FHA family proteins, not reported earlier as TFs in the genomes. Apart from TFs, ApicoTFdb also classifies TcoFs into three main subclasses: TRs, CRRs and RNARs, representing 2491 TcoFs in 14 apicomplexan species, are analyzed in this study. The database is designed to integrate different tools for comparative analysis. All entries in the database are dynamically linked with other databases, literature reference, protein–protein interactions, pathways and annotations associated with each protein. ApicoTFdb will be useful to the researchers interested in less-studied gene regulatory mechanisms mediating the complex life cycle of the apicomplexan parasites. The database will aid in the discovery of novel drug targets to much needed combat the growing drug resistance in the parasites.
Parietooccipital Transventricular Approach for Thalamic Cavernous Malformation: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: September 2019

The highly eloquent nature of the thalamus and the depth of the surgical field make thalamic cavernous malformations exceptionally challenging entities for surgical management, necessitating stereotactic navigation and lighted instruments for successful resection. This case demonstrates a patient with a large right dorsal thalamic cavernous malformation that is approached using the well-tolerated transparietooccipital lobule approach for ventricular access and subsequent resection of the lesion along the intraventricular surface. Stereotactic neuronavigation permits this transcortical approach with minimal transgression of normal parenchyma. The trajectory permits approach to the cavernous malformation along its greatest dimension to augment removal. A complete removal of the lesion is achieved. The patient remained at neurological baseline postoperatively. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Chlorhexidine Gluconate Utilization for Infection Prevention in the NICU
Authors: Beekman Karen , Steward Deborah
Published: September 2019

Background:

Central-line-associated bloodstream infection (CLABSI) contributes to significant morbidity and mortality in the neonatal intensive care unit (NICU). Disinfection of skin is part of bundled cares aimed at prevention of CLABSI. While considered an essential component of insertion and maintenance bundles, the optimal solution to disinfect neonatal skin remains controversial.

Purpose:

The purpose of this project was to survey neonatal nurse practitioners and nursing leaders across NICUs regarding the current use of chlorhexidine gluconate (CHG) in term and preterm infants.

Methods:

This descriptive study involved the collection of survey data to determine NICU practices related to the use of CHG in their infant population. The sample was composed of nursing directors of NICUs and neonatal nurse practitioners who completed an electronic survey via a provided link.

Findings/Results:

Chlorhexidine was reported to be used in 53 (82.81%) of the NICUs and was the primary agent used to prepare the skin for central vascular catheter insertion (53.23%) followed by povidone-iodine (45.16%), and 70% isopropyl alcohol (1.61%). Gestational age or birth weight restrictions for CHG use were reported in 43 (82.69%) NICUs. Trends in the data demonstrated nursing's role in using CHG in the NICU. Adverse events reported from CHG included burns, redness, dermatitis, and other irritations. Concerns included risk of absorption, burns, skin irritation, lack of evidence, and overall safety.

Implications for Practice:

Systematic monitoring by nurse leaders is needed to identify evidence related to skin disinfection and CHG in neonates. Targeted education for nursing staff related to directed to developmental maturation of the skin, safe use of CHG, review of best evidence, rationale for usage of CHG, and potential iatrogenic effects is recommended.

Implications for Research:

Research is needed to evaluate the impact of educational offerings and surveillance for adverse events on CLABSI rates.
Acute Kidney Injury Guidelines Are Associated With Improved Recognition and Follow-up for Neonatal Patients
Authors: Vincent Katherine , Murphy Heidi J. , Ross Julie R. , Twombley Katherine E.
Published: September 2019

Background:

Studies demonstrate that neonatal acute kidney injury (AKI) is associated with increased morbidity and mortality. Acute kidney injury survivors are at risk for renal dysfunction and chronic kidney disease and require long-term follow-up.

Purpose:

To maximize identification of AKI and ensure referral, we created guidelines for diagnosis, evaluation, and management of AKI.

Methods/Search Strategy:

Retrospective cohort study of neonatal intensive care unit patients treated before guideline implementation (cohort 1; n = 175) and after (cohort 2; n = 52). Outcome measures included AKI incidence, documented diagnosis, and pediatric nephrology consultation. Statistical methods included t tests, Fisher exact tests, and Wilcoxon rank sum tests.

Findings/Results:

We found 68 AKI episodes in 52 patients in cohort 1 and 15 episodes in 12 patients in cohort 2. Diagnosis and documentation of AKI improved after guideline implementation (C1:24/68 [35%], C2: 12/15 [80%]; P = .003) as did pediatric nephrology consultation (C1:12/68 [18%]; C2: 12/15 [80%]; P < .001) and outpatient referral (C1: 3/47 [6%], C2:5/8 [63%]; P < .01).

Implications for Practice:

Neonatal AKI guideline implementation was associated with improvements in recognition, diagnosis, and inpatient and outpatient nephrology consultation. Early recognition and diagnosis along with specialist referral may improve outcomes among neonatal AKI survivors, ensuring appropriate future monitoring and long-term follow-up.

Implications for Research:

Future research should continue to determine the long-term implications of early diagnosis of AKI and appropriate subspecialty care with follow-up.