bluuebunny/crossref_metadata_2025 huggingface dataset:
Parkinson’s Disease (PD) Management in a Tertiary Irish Hospital
Authors: Gibbons Ciara , Dwyer Brendan , Geraghty Tim , O'Riordan Sean , Williams Laura , Hughes Graham
Published: September 2024

Background

There is no Irish platform for operationalizing services for People with Parkinson’s and associated disorders (PwP). The UK-wide Parkinson’s clinical audit was developed in 2009, to address concerns about the quality of care provided to PwP. Our aim was to use the UK Parkinson’s Audit cycles to drive quality improvement in our service, providing the first Irish data on quality of care for PwP.

Methods

The audit’s service descriptor was completed in June 2022. A sample of PwP attending Movement-Disorder clinics completed patient reported experience measure questionnaires between May - July 2022. We retrospectively collected patient data using the audit tool, which was submitted electronically. This was directly compared to our service audit data from 2019.

Results

In 2019, we included 30 patients in our audit – average age 67yrs, 57% male, 100% Caucasian, average duration PD 7yrs. In 2022, we included 40 patients of similar demographics. The data collected showed our services had improved or remained stable across all domains from 2019 to 2022 including medication documentation, advanced care planning, multi-disciplinary team input, non-motor, activities of daily living and bone health assessments. The service user experience remained unchanged. In 2019, our service fell in the lowest quartile of standards amongst the cohort of services audited. We improved to the top half of services audited in 2022. This was achieved by mentoring from exemplar UK services, generating a proforma to standardize assessments in outpatients, providing information to clinicians regarding local services and engaging with patients in an annual ‘Have Your Say’ day.

Conclusion

Our data demonstrates that repeated national audit cycles, with the patient voice at the centre, are crucial in driving quality improvement across services for PwP. As the only Irish participant in the Parkinson’s UK Audit, it's clear a National Irish Audit would be the first step in optimizing care for PwP nationally.
An Occupational Therapy Functional Upper Limb Group Programme on the Acute Stroke Unit: A 3 Month Pilot
Authors: Shinners Dylan , Concannon Emma , McDonagh Philip
Published: September 2024

Background

The 2023 National Clinical Guidelines for Stroke recommend that stroke survivors with motor recovery goals should receive a minimum of 3 hours of rehabilitation 5/7 days a week (National Clinical Guideline for Stroke for the UK and Ireland, 2023). Schneider et al (2019) deem it feasible for stroke survivors to undertake extra upper limb practice (including group sessions) to support in achieving upper limb motor recovery goals. With staffing limitations, creative methods of intervention delivery must be adopted to enhance usual intervention sessions.

Methods

In an Irish hospital, a pilot project hypothesised the benefit of two one-hour Occupational Therapy functional upper limb group intervention sessions to support adherence to effective weekly dosage of upper limb motor recovery. An audit was completed on dosage of usual Occupational Therapy intervention, prior to group formation. Seven patients were identified with an average daily dosage of 35.4 minutes of usual intervention (5/7 days a week). Two one-hour group sessions were adopted in conjunction with usual therapy. Group intervention dosage was recorded. Patient self-reported satisfaction was obtained using a ten-point Likert scale.

Results

A total of twenty-nine patients, over 3 months, attended Occupational Therapy upper limb group interventions during an admission on the Acute Stroke Unit. The addition of two one-hour group intervention sessions supported an average actual increase in dosage of 113 extra minutes per week (36.15% increase). There was a 95% self-reported satisfaction rate among patients.

Conclusion

The addition of two one-hour Occupational Therapy functional upper limb groups increased upper limb motor recovery dosage by 113 minutes per week. Group intervention was a feasible tool that can be used on an Acute Stroke Unit in conjunction with usual therapy to support motor recovery guideline adherence and patient satisfaction. Despite these efforts, patients are not receiving the recommended daily intensity as highlighted by National Clinical Guidelines.
Redesigning Community Dwelling Geriatric Integrated Care Program for Better Care Co-Ordination and Health Outcomes
Authors: Marion Ikhwan , Cribbin Derek
Published: September 2024

Background

Existing health services and care models need to adapt to the increasing ageing population, multimorbidity, and frailty. Thus, diverse healthcare providers and caregivers are demanded to continue living at home. An Integrated Care Program, involving a multidisciplinary team with a patient-centred focus, is being promoted as an alternative model of care. However, uncoordinated existing services put them at risk of fragmented care, leading to adverse outcomes. This study aimed to fill gaps in previous ICP research by introducing a change roadmap into the implementation phase of the program. In addition, the study proposed evaluating the effectiveness and implementation of the pilot project together with the process evaluation.

Methods

The study conducted a systematised literature review to examine the outcomes and different structures of the ICP. Implementation Science was utilised to define, design, and deliver the model of change.

Results

A systematised literature review showed that most ICPs were led by an Advanced Nurse Practitioner with positive outcomes. SWOT analysis, stakeholders’ involvement, existing community service providers, and a population survey provide an in-depth perspective of the target population and set up contextually adapted implementation strategies. An ANP-led MDT was proposed to co-ordinate the ICP. A process evaluation to assess the care model together with health outcomes was outlined.

Conclusion

The study showed that ANP-led MDT, person-centred, co-ordinated care provides the best ICP implementation strategy. The study will further understand the ICP implementation process among frail older people in the community.
Understanding Therapeutic Lying In The Care Of A Person with Dementia: An Evolutionary Concept Analysis
Authors: Long Shirley , Murphy Catriona , Irving Kate
Published: September 2024

Background

Therapeutic lying, described as any verbal or non-verbal behaviour or communication that involves the manipulation of information has been shown to be pervasive in dementia care. However, its theoretical foundation is difficult to underpin and appears to have evolved through practice without a clear definition. The aim of this study is to establish conceptual clarity around the concept of therapeutic lying in the care of a person with dementia.

Methods

Rodgers’ evolutionary concept analysis was used to focus on the contextual qualities of therapeutic lying. This dispositional view recognises that concepts are fluid in nature. The analysis involves deconstructing the concept into surrogate terms, attributes, antecedents, consequences and related terms to generate a greater understanding of its innate features. A systematic search relating to “therapeutic lying” and “dementia” was undertaken. The final study sample consisted of 37 papers.

Results

This analysis revealed therapeutic lying’s surrogate terms, attributes, antecedents, consequences and related terms in the care of a person with dementia. This study highlighted this concept is intended to be used in the person's best interests, for the purpose of doing good. However, its subjective nature makes it an extremely difficult concept to grasp collectively.

Conclusion

Therapeutic lying is highly dependent on individual interpretation and the caregiver’s moral compass. It can potentially damage trust in a caring relationship and may contribute to the “othering” of a person with dementia. The negative consequences surrounding this concept must be studied comprehensively before it is considered in practice. Therapeutic lying should be used only as a last resort when a person with dementia is exhibiting truth related distress. As the therapeutic effect of a therapeutic lie cannot be guaranteed, the term “well intentioned lying” is proposed as a potential alternative for the concept as this term highlights the caregiver’s good intention behind incorporating a lie during care.
Assess, Diagnose and Intervene: Are Hospital Based Out-patient Frailty Intervention Teams Perfectly Positioned to Prevent the Frailty Crisis?
Authors: Cooney Hazel , O'Mara Gerard , Donlon Kate , Burke Sandra
Published: September 2024

Background

This Frailty Intervention Team (FIT) is relatively novel in the sense that it is a hospital based multidisciplinary team (MDT) that provides an outpatient service to community based frail adults. Its main source of referral is from General Practitioners (GP)1, with the average Clinical Frailty Score of those assessed being 4.98 (4.91 men, 5.05 women) 1. Indicating that the mean service user is ‘Living with Mild Frailty’2. Our objective was to establish if this model of service provision is identifying any new diagnoses and what interventions it provides. Our overarching aim is to establish ‘what we are adding to the patient journey’.

Methods

3 independent researchers came together to develop a database for the service that would record new diagnoses made, medical & non-medical interventions provided and frequency of on-wards referral. Standard definitions and codes were agreed upon, and the information inputted by patients facing staff on a daily basis. A descriptive data analysis of this database was carried out after the first quarter.

Results

51 new patients were assessed in 4 months. Of these patients, 37.25% of cases received new diagnoses; Parkinson’s disease (15.68%), Orthostatic Hypotension (11.76%), Cognitive Impairment / Dementia (11.76%) and Idiopathic Normal Pressure Hydrocephalus (iNPH) (5.88%). Subsequently 62.74% had changes made to their medications. 96.08% of new service users received at least 1 non-medical intervention. Onward referral was made for 58.82% of service users, to a total of 22 organizations. The total amount of onward referrals made was 54. 51 new patients were assessed in 4 months.

Conclusion

A hospital-based frailty intervention team adds value to a patient’s journey as it is perfectly placed to make rapid diagnosis due to their MDT nature and access to diagnostics. Furthermore, it provides immediate intervention and appropriate onwards referral. Is this a model of service provision that should be made more readily available nationally?
Assessing Direct Oral Anti-Coagulant And Therapeutic Low Molecular Weight Heparin Prescriptions At A University Teaching Hospital
Authors: Alanza Uchechukwu , Azani Faysal , Samhari Atiq Analily Anwar , Ruane Caitriona
Published: September 2024

Background

A 2017-2018 survey identified anti-thrombotics as the most commonly implicated agents in reported medication incidents across Irish acute hospitals [State Claims Agency, 2020, Medication Incidents Report (2017-2018)]. Of the top 10 anti-thrombotics reported, 2 were Low Molecular Weight Heparins (LMWHs) and 3 were Direct Oral Anti-Coagulants (DOACs). 3 years after the survey results were published, we audited our hospital's compliance with the Health Service Executive's guidelines for prescribing DOACs and LMWHs.

Methods

Over 3 consecutive weeks, data was collected by doctors and clinical pharmacists across 6 wards and the intensive and coronary care units. In-patients on a DOAC or therapeutic LMWH were chosen for kardex and laboratory result review.

Results

83 patients were included. The average age was 79 years. 81%(n=67) were on a DOAC. 91% were being treated for non-valvular atrial fibrillation (NVAF), 3% for pulmonary embolism (PE), 3% for deep vein thrombosis and 3% had no indication documented. 33%(n=22) had indications for dose reduction but only 77%(n=17) of them were prescribed the appropriate reduced dose. 3%(n=2) had no dose reduction indications but were inappropriately prescribed a reduced dose. 3%(n=2) were on dialysis, 1%(n=1) had their creatinine clearance persistently below 15ml/min and 1%(n=1) inappropriately received once daily dosing of apixaban for 3 days. 19%(n=16) of all participants were on therapeutic LMWH. Treatment indications included acute coronary syndrome in 63%, suspected PE in 19%, newly diagnosed NVAF in 6% and bridging anti-coagulation while a DOAC is temporarily held in 13%. 6%(n=1) were inappropriately prescribed an under-dose.

Conclusion

Overall, there was an error rate of 16%(n=11) in DOAC prescriptions and 6%(n=1) in LMWH prescriptions. To address this, we propose an educational intervention for prescribers and the introduction of e-prescriptions with built-in alerts for errors. We plan to re-audit once these recommendations are implemented.
Experiences After Stroke-Who Needs An Interdisciplinary Clinic Anyway?
Authors: Lawson Susan , Harte Gillian , Walsh Rachel , Ryan Daniel
Published: September 2024

Background

Unmet needs, including access to rehabilitation, support and information, are experienced by a high proportion of stroke survivors after discharge from acute and rehabilitation services (McKevitt et al.,2011). All stroke patients should be offered a structured health and social care review six-months post-diagnosis (UK Guidelines on Stroke 2016). We aim to describe patients profile including their unmet needs who attended an Interdisciplinary Stroke Clinic situated within a Dublin teaching hospital.

Methods

Data was collected for all patients attending an Interdisciplinary Stroke Clinic from March 2023-April 2024, including demographic information, self-reported unmet needs and residual deficits identified using modified Greater Manchester Stroke Assessment Tool (GMSAT). Access to post-acute rehabilitation was recorded. Analysis was conducted using Microsoft Excel.

Results

Clinic attendance: 251 patients, 13-month period (150males, 101females; mean age 68.7yrs; range 17.27-95.5yrs). Majority of patients attended their appointment alone (n=144). Ischaemic stroke was most prevalent stroke-type of attendees (n=160). Post-acute stroke rehabilitation was accessed in 27% of cases (68/251). Group mean Clinical Frailty Scale score was 3.5 (scale 0-8) equating to ‘managing well/vulnerable’. Regarding patient-reported unmet needs, the following themes were identified, mobility (18%), fatigue (13.5 %), pain (8.5%), memory (5.5%), speech (5%) and mood (3.6%). On GMSAT assessment, fatigue (64%), mobility (49%), falls (44%), dysphagia (30%) was the most frequently identified chronic issues. As a clinical-specialist lead clinic, most issues were dealt at clinic-level with physiotherapy intervention targeting mobility/gait/spasticity (45.4%) and speech and language therapy for swallow/language management (20%) initiated.

Conclusion

Data from this novel Interdisciplinary Stroke Clinic supports previous research indicating many stroke survivors continue to experience chronic issues, frequently mobility, swallowing and fatigue; some of which can be addressed by stroke-specific therapists. The importance of establishing clinical-specialist led post-acute stroke review clinics/pathways in the Irish setting is highlighted. Analysis of data pertaining to stroke patient readmission is underway.
Níos Fearr Le Chéile/Together is Better: ICPOP Case Review of Intervention for an Older Carer of a Referred Patient
Authors: O'Shea Joan , Quinn Aoife
Published: September 2024

Background

The Integrated Care Programme for Older Persons (ICPOP) aims to implement integrated services and care pathways for older adults with complex health and social care needs. The aim is to place patients at the center of their healthcare decision making and to support them to live well in their homes and communities. A Comprehensive Geriatric Assessment (CGA), which is the gold standard for the management of frailty in older persons, is carried out on all referred patients at the initial home visit. It is often as an ICPOP assessor delves deeply into the family unit that frailty makers such as decreased mobility, declining cognition, poor appetite, polypharmacy is identified in the non-referred cohabitating person who is also over 65 years of age (Potier et al., 2018).

Methods

The purpose of this poster is to demonstrate how a holistic approach to care within a household led to the incidental finding of frailty in a family carer who was also an older adult. This case review will illustrate how the referral of one half of a married couple led to opportunistic multi-disciplinary intervention for the second person. Following discussion, at MDT level, of both the referred patient and their spouse, a request for a formal referral to ICPOP for the second person was made to the GP, as it is a referral criteria for ICPOP referrals.

Results

ICPOP intervention ultimately led to home supports being put in place for both parties along with medical reviews, rationalisation of medications and assistive technology supports, this enabled both patients to live well and safely at home.

Conclusion

A comprehensive geriatric assessment using a holistic approach resulted in intervention for both parties with a positive outcome for the entire family.
“Pathfinder Filled The Gap And Linked In With The Necessary Services” Service User Perceptions Of The Pathfinder Service
Authors: Burke Dearbhla , O'Donoghue Brid , Griffin Aislinn , Meagher Breda , Lowry Pat , O'Shea Tadhg
Published: September 2024

Background

Pathfinder is a service designed to keep older adults who phone 999 at home by utilising alternative care pathways, when it is safe to do so. Pathfinder responds to adults aged 65 and older who present with low acuity complaints. The service is delivered by Occupational Therapists, Physiotherapists and Advanced Paramedics and is embedded between acute and community care. The aim of this study is to capture how the service user found their interaction with this novel service.

Methods

As part of routine service evaluation, semi-structured brief telephone interviews with closed and open-ended questions were completed with a number of service users (the patient or their primary care giver). Interviews were completed at least one week after their discharge from the service, by a member of the team who had not been involved in their care. Interviews were then analysed using Microsoft Excel® for closed ended questions and thematic analysis for open ended questions.

Results

One hundred service users were contacted, of which 76 completed the brief telephone interviews. 99% of respondents felt Pathfinder treated them with respect and dignity, 100% felt Pathfinder communicated clearly and 97% rated the service as excellent. Five key themes were identified from open-ended questions (1) the prompt arrival of care, (2) the thorough examination and reassurance provided, (3) the benefit of follow-up after the initial 999 call, (4) the domino effect of onward referrals and (5) the holistic approach to care given.

Conclusion

There was universal positive feedback for the Pathfinder service reported by both older adults who engaged with the service and their primary care givers. Key elements of the service delivery were complimented including the assessment, the follow up service provided and the onward referral to acute and community services.
An Audit of Time to Inpatient Bed In Patients With A Suspected Delirium
Authors: Condon Christine , Byrne Colm , Bowden Helen , Ali Shammy Rashid , Ramiah Vinny
Published: September 2024

Background

Our local Dementia/Delirium Combined Pathway and Care Bundle for Emergency Department (ED) and Acute Medical Assessment Unit sets a target door to ward admission in patients aged over 65 years with a suspected delirium at less than 6 hours. This audit assessed if this target is being met in patients with a suspected delirium.

Methods

Retrospective point prevalence audit of 240 randomly selected patients who were assessed by the Frailty Intervention Team (FIT) in the Mater Misericordiae University Hospital ED in 2022, aged ≥ 65 years with a suspected delirium (4AT ≥4) and no delirium (4AT=0). Time of presentation to ED, time of admission to ward bed, ward name and length of hospital stay were recorded.

Results

The median age in patient's with a 4AT ≥4 was 86 years (range 65-99). There was an equal spread across gender groups in patient's with a 4AT ≥4; 55.3% (n=52) females and 44.7% (n=42) male. The median wait time in ED for patients with a 4AT ≥4 was 25.26 hours (range 6.75-83.73) vs 21.65 hours (range 5.98-50.53) in patients with a 4AT=0. Only 19% (n=18) of patients with a 4AT ≥4 were admitted to a Specialist Geriatric Ward. The mean length of stay in patients with a 4AT ≥4 was 28.457 days vs 14.132 days in those with a 4AT=0 (p value=0.002, Mann-Whitney U test).

Conclusion

Older adults with a delirium spend prolonged periods of time in the ED. We are not meeting our local target of 6 hours from ED presentation to ward bed. Length of hospital stay is prolonged in patients with delirium. Our aim is to create a dedicated delirium bed on our Geriatric Specialty Ward so that we can provide delirium specific care and reduce overall length of hospital stay.
Atrial Fibrillation Prevalence In Ischemic Strokes In An Irish Hospital. Spotlight On Anticoagulation Failure In Patients On Direct Oral Anticoagulants
Authors: Sohail Arslan Ali , Ramsamy Kumaren , Varghese Bency , Ahmad Hafiz Anis
Published: September 2024

Background

Global atrial fibrillation (AF) burden in acute ischemic stroke patients approximates at 30%. An Audit in 2022, in the concerned hospital identified lack of compliance and under-dosing as major causes of ischemic strokes whilst on direct acting anticoagulants (DOACs). This year, we sought repeat the audit of process with focus on ischemic strokes with pre-existing AF patients established on DOACs, to study trends related to anticoagulation failure.

Methods

The study was a retrospective observational audit study of all patients admitted with a diagnosis of acute ischemic stroke to the concerned hospital from January 2023 to December 2023 who had known diagnosis of atrial fibrillation and were prescribed a DOAC prior to their admission in the concerned hospital with an ischemic stroke. Patients were identified via HIPE coding and in-hospital stroke registry. Data was collected via charts review, compiled via flow charts, graphs and excel sheets, and studied.

Results

143 patients were admitted to the hospital’s stroke service with ischemic stroke in the set time frame. 46 (32%) had Atrial Fibrillation (AF) which was deemed to be the cause of their stroke. 29 (20.2%) had pre-existing diagnosed AF, and 22 of those patients were prescribed DOACs. In all patients already on DOACs, compliance was found questionable or lack of in 11 (50%). 8 (36.3%) patients were on low dose (adjusted dose DOACs). 3 patients were diagnosed with DOAC failure without cause. All new and existing AF patients not anticoagulated, were commenced on anticoagulation.

Conclusion

The audit showed under dosage and poor compliance were major causes of anticoagulation failure in stroke patients who were anticoagulated with DOACs. Similar results were noted as secondary results in last year’s audit in the concerned hospital. As part of quality improvement process, a specialist DOAC clinic was being set up with further audit process planned for the coming year.
Role of MRI in Diagnosis of Rapidly Progressive Cognitive Impairment- A Case Of Sporadic Creutzfeldt Jakob Disease (sCJD)
Authors: Haq Ijazul , Sohail Arslan Ali , Rasheed Mujahid
Published: September 2024

Background

The role of neuroimaging in dementia extends beyond its traditional role of excluding neurosurgical lesions. Radiological findings may support the diagnosis of specific neurodegenerative disorders and aid differentiation from other neurodegenerative conditions e.g. CJD1. sCJD is a fatal neurodegenerative disease, which typically presents with neuropsychiatric symptoms, myoclonus, cerebellar and pyramidal/extrapyramidal symptoms. The diagnosis often is quite difficult, requiring high degree of suspicion, advanced neuroimaging and biochemical markers. Confirmation is only possible via brain biopsy. The condition can result in rapidly progressive dementia/neurocognitive decline and death, usually within a year from onset.

Methods

We report a case of a rapidly progressive dementia in a 79-year-old male who was diagnosed with probable sCJD, after having an MRI which picked up suspicious characteristic findings leading to the eventual diagnosis confirmation via further workup. The patient presented with acute rapid progressive forgetfulness and functional decline of 2 weeks with initial workup unyielding.

Results

A contrast MRI Brain eventually showed focal increased T2 and flair signals in the right parafalcine and parietal cortex demonstrating mild fluid restriction without any focal contrast enhancement, a pattern highly suspicious for sCJD. A CSF sample subsequently revealed RT-QulC positivity confirming the diagnosis. The patient eventually passed away despite ward-based care after 4 weeks of admission due to rapid neurological decline. A brain biopsy was not deemed feasible given patient’s condition.

Conclusion

The case highlights a relatively atypical symptomology of sCJD and, highlights the role of MRI imaging in assessment and diagnosis of dementias and specifically in sCJD. Increasing use of advanced neuroimaging may aid in diagnosis of specific/rare causes of rapidly progressive dementias.

Reference

Vitali, P., Maccagnano, E., Caverzasi, E., Henry, R.G., Haman, A., Torres-Chae, C., Johnson, D.Y., Miller, B.L. and Geschwind, M.D., 2011. Diffusion-weighted MRI hyperintensity patterns differentiate CJD from other rapid dementias. Neurology, 76(20), pp. 1711-1719.
Perceptions of Behaviour Change Interventions for Physical Activity in People with Chronic Obstructive Pulmonary Disease: A Survey
Authors: Hanrahan Ciara , McVeigh Joseph G , O'Connor Terence , Troosters Thierry , Broderick Julie
Published: September 2024

Background

Physical inactivity in chronic obstructive pulmonary disease (COPD) is common and behaviour change interventions could help improve physical activity (PA). This survey aimed to explore perceptions of behaviour change interventions for physical activity in people with COPD.

Methods

An anonymous cross-sectional electronic and paper survey was distributed among people with COPD in the Republic of Ireland (n=150) via relevant gatekeepers. Descriptive statistics, means, medians, percentages and frequencies, were used to summarise and describe the findings. Chi- squared t-tests (where P was set at 0.05) were used to investigate relationships between variables.

Results

Responses were received from n=113 people with COPD (75.33% response rate, 113/150) and most respondents (83.03%, n= 93/112) were aged over 61 years. 90.53% (n=86/95) of respondents agreed/strongly agreed that PA helps them to manage their COPD. There was a strong statistically significant relationship between those who wear PA monitoring devices and those who believe that being physically active can help them to manage their lung disease (p<0.001), however, in this survey, the use of PA monitors in those over 61 years was proportionally lower (21.11%, n=19/90) than those under 60 years (61.53%, n= 8/13). Respondents perceived social support as the most effective behaviour change intervention to influence PA behaviour (67.62%, n= 71/105), with counselling for PA perceived to be the least effective (13.33%, n=14/105).

Conclusion

People with COPD perceived that social support can influence their PA behaviour. The spontaneous use of PA monitoring devices was lower in older respondents than in younger respondents, however a strong relationship between using monitoring devices and perceived benefits of PA on COPD may exist overall.
Investigating Skeletal Muscle Pump Function Using Thigh EMG, Thigh NIRS, And Stroke Volume Data In The FRAILMatics Physiological Cohort
Authors: Knight Silvin , Duggan Eoin , Xue Feng , Romero-Ortuno Roman
Published: September 2024

Background

The pioneering female physiologist Frances Hellebrandt first highlighted the significance of the skeletal muscle pump in circulation in the 1930s. However, the mechanisms underlying the muscle pump's function remain elusive, particularly in older individuals. It is thought that during muscle contraction, increased intramuscular pressure facilitates the expulsion of blood from the muscle's veins, aiding venous return. This contraction-induced pressure gradient assists in pushing blood towards the heart, increasing preload, and subsequently stroke volume (SV). In this study we investigated muscle pump activity using continuous measurements of thigh muscle activity, thigh total haemoglobin concentration (Hb), and cardiac SV.

Methods

22 individuals (aged 70.8±5.3 years, 77.3% female) recruited from a Falls and Syncope Unit (St James’s Hospital, Dublin) underwent non-invasive measurements of Hb (NIRS PortaLite, Artinis Medical Systems, The Netherlands), electromyography (EMG) (Shimmer3, Research Ltd, Ireland), and SV (Finapres Nova, Finapres Medical Systems, The Netherlands) during a 10-second thigh squeeze test. Pre-processing involved data quality checks, alignment, and resampling. 60-second regions of interest were extracted, normalised, and processed using MATLAB (R2023a, TheMathWorks, Inc., Natick, MA, USA). Cross-correlation and Granger causality analyses were conducted to explore relationships between signals.

Results

Thigh Hb and EMG signals lagged 8.4 and 8.5 seconds behind SV, respectively. Granger Causality analysis revealed a significant causal relationship from both Hb and EMG to SV in 68% of participants at measured lags.

Conclusion

The observed ~8.5-second lag between thigh measurements and SV implies a plausible temporal relationship between muscle activation and venous return, further supported by significant causal relationships found in a substantial portion of participants using Granger causality analysis. These findings underscore the importance of continued research in this area, not only for advancing our understanding of physiological mechanisms but also for informing potential clinical applications aimed at optimising cardiovascular health and function.
Evaluation of a Nutrition and Exercise Group Intervention for Older Adults with Frailty and Probable Sarcopenia
Authors: Sayers Karen , King Lorna , Maher Jennifer , Ryan Siobhan , Donnellan Christina
Published: September 2024

Background

The prevalence of probable sarcopenia in frail older adults attending a Community Specialist Team (CST) is 52%. Resistance exercise and optimising nutrition are recommended interventions. The aim of this study was to evaluate a nutrition and exercise group for frail older adults with probable sarcopenia.

Methods

Adults aged ≥65 years, with probable sarcopenia identified through Comprehensive Geriatric Assessment (CGA) by a CST over 18 months were included. At CGA (baseline), sarcopenia infographics and 2 attendances at Dietetic and Physiotherapy group were offered. Group intervention comprised nutrition and exercise information and individualised goal setting. Clinical Frailty Scale (CFS) score, grip strength and 5 Times Sit-to-Stand (5TSS) were measured. Participants' needs and perceived changes in knowledge were evaluated using open questions and Likert Scales. Data was analysed using thematic analysis, descriptive and inferential statistics.

Results

Intervention was offered to 82 people. Twenty-nine (35%) attended an initial group (18 women, 11 men), with mean age 80.7 years (SD=7). Nine (30%) attended the second group. Participants were significantly less frail (median CFS 4, IQR 4, 6) than non-participants (median CFS 6, IQR 5, 7) (p= 0.002). Male grip strength improved significantly from baseline (mean 22kg, SD=4.21) to first group (mean 27.8kg, SD=4.36) (p=0.007) and to second group (mean 29kg, SD=4.21) (p=0.012). Female grip strength increased non-significantly from baseline (mean 12.6kg, SD=3.38) to first group (mean 14.5kg, SD=5.85), (p=0.127) and to second group (mean 14.83kg, SD=4.21) (p=0.890). Participant’s 5TSS did not change significantly (mean 19.75 sec, SD=6.38 to mean 20.78 sec, SD=7.73) (p=0.782). Nutrition and exercise knowledge improved significantly (p=0.004, p=0.003 respectively). Access to clear information was an identified theme.

Conclusion

Educational resources and tailored plans within group interventions can improve grip strength and knowledge in older adults living with very mild frailty. Further research is required to design an accessible intervention for more frail cohorts.
‘I Just Felt A Bit Faint’: The Role Of Physiotherapists In Older Adults Presenting With Transient Loss Of Consciousness (T-LOC)
Authors: Connolly Kieron , Davey Naomi , Kelly Louise , Kerins Yvonne , Soh Josephine
Published: September 2024

Background

Clinical presentation of transient loss of consciousness (T-LOC) in older adults presents significant diagnostic challenges, especially in those with frailty or multi-morbidity. This study analysed T-LOC presentations in individuals over the age of 75 and assess the impact of physiotherapy in this cohort.

Methods

A retrospective review was conducted on 56 older adults (>75 years), who presented with T-LOC to a large academic teaching hospital, over a six-month period in 2023. Data on demographics, presenting complaints, diagnostic tests, physiotherapy input and discharge diagnoses was collected and analysed.

Results

The analysis included 56 older adults, 57% (N=32) were male, with an average age of 81.6 years (75 – 94 years). The average length of stay was 9.1 days (1-64 days). Physiotherapy was provided to 59% (n=33) of the patients, with those in the physiotherapy group more likely to have a history of falls (55% compared to 4%) and a diagnosis of dementia (27% compared to 9%). Patients with T-LOC presentations were five-times more likely to be referred to physiotherapy if they had at least two diagnoses of recurrent falls, dementia or stroke (24% vs 4%). Of those who received physiotherapy, the number of sessions ranged from 1-25 (averaging 4.5 sessions per patient). Outcome measures were completed for 73% (n=24) of these patients, and 70% were discharged at their mobility baseline. Education on syncope, orthostatic hypotension or falls was documented for only 12% (N=4). 79% (N=26) were discharged directly home and 50% (N=13) were referred for community follow up.

Conclusion

Physiotherapy is often required for older adults with T-LOC, particularly those with a history of falls and dementia. Physiotherapy should be considered a fundamental component in the multi-disciplinary management strategy to improve healthcare efficiency and clinical outcome for this cohort.
A Roadmap for Assisted Decision-Making Capacity Assessment: Developing a Guide for Occupational Therapists in an Acute Setting
Authors: Webster Cara
Published: September 2024

Background

The Assisted Decision-Making (Capacity) Act (ADMA) has been in effect since April 2023. Under the ADMA, Occupational Therapists (OTs) are a prescribed class of healthcare professionals capable of assessing a person's decision-making capacity (DMC). OTs must adapt their practice to comply with the new legislation. OTs in an acute hospital reported poor understanding and low confidence using the ADMA. The aims were to enhance OTs knowledge and understanding of the ADMA, how to adapt their practice and to improve OTs documentation of DMC assessment in healthcare records.

Methods

OTs were surveyed to ascertain their current understanding of the ADMA, confidence using its guiding principles and to identify specific learning needs to address in education sessions. A multi-modal approach including tailored in-service education and 1:1 coaching sessions enhanced OTs knowledge and confidence in using the ADMA. Template documents were developed to guide OTs documentation of DMC assessment in healthcare records. A post-education survey was administered to determine if education sessions and guidance documents had benefitted OTs.

Results

Knowledge in using the ADMA improved post-education. 67% reported their understanding as ‘good’ compared to 14% pre-education. 0% reported knowledge as 'poor' or 'very poor' post-education compared to 24%. Confidence improved with 8% reporting they feel ‘very comfortable’ assessing DMC post-education compared with 0%. 0% reported 'not at all comfortable' post-education compared to 18%. 100% of OTs who availed of 1:1 coaching reported benefitting from mentoring. 100% of OTs reported guidance documents benefit their practice. 85% reported the education met their expectations.

Conclusion

OTs are continuing to learn how to use the ADMA in their practice. OTs require ongoing education and training to improve their skills in DMC assessment and documentation of this process. Changing practice in accordance with the ADMA may take time as this change needs to occur at a national and local level.
Swallow Screening in SUH Acute Stroke Service
Authors: Carney Margaret , Moffatt Una , Finnerty Cliona , Nolan-Shaw Dorothy , Hickey Paula
Published: September 2024

Background

Irish National Audit of Stroke [INAS] (2021) found that 68% of patients with a stroke received a swallow screen and 43% had it completed within 4 hours of admission. Figures are below the key quality indicator (KQI) metric of 100% for both targets set by INAS. Recommendation from the National Clinical Programme for Stroke recommends a QI project to improve swallow screening rated.

Methods

From HIPE data, KQI for swallow screening in all stroke patients in Sligo University Hospital (SUH) stood at 86% compliance and KQI for swallow screening within 4 hours of arrival at hospital was 33% compliance. QI project commenced in June 2023 and completed in Oct 2023. Aim for the QI project was to achieve 100% compliance in KQI for all stroke patients receiving a swallow screen in SUH.

Results

Cycle 1 was 100% compliance, cycle 2 was 100% compliance, all stroke patients admitted to SUH receiving swallow screen assessment. KQI for swallow screens completed with 4 hours of arrival to hospital, percentage of compliance increased. Starting compliance was 33% and in cycle 2 this increased to 60%.

Conclusion

Main reasons for the success of our QI project:
Advancing Specialist Geriatric Medicine Training: A Successful Introduction to Simulation-Based Training
Authors: Buckley Emily , Dennehy Karen , O'Regan Niamh , Cooke John
Published: September 2024

Background

Simulation-based education (SBE) has been adopted by various specialties and is used to complement other aspects of education. Geriatric medicine is a diverse specialty, requiring healthcare professionals (HCPs) to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach making SBE the ideal vehicle to train geriatric medicine trainees. SBE is currently not a formal component of geriatric medicine training in Ireland and trainees experience varying levels of exposure to SBE. To address this, WICOPSIM in collaboration with the Royal College of Physicians (RCPI) facilitated a study day for geriatric medicine trainees demonstrating the design and implementation of gerontological SBE.

Methods

A faculty consisting of RCPI Irish Clinician Educator Track (ICET) training fellow, WICOP simulation fellow and two Consultant Geriatricians coordinated the event. All geriatric medicine trainees were invited to a one-day SBE event hosted by WICOPSIM. Lectures on simulation theory and application preceded a simulation scenario demonstration focusing on the interdisciplinary management of a patient whose capacity was in question; followed by a SBE participant workshop.

Results

Fifty-two trainees attended the event. Forty-five trainees completed the post-event survey. 98% (n=44) were satisfied with the variety of topics presented and felt more prepared to design and run a scenario. The simulation demonstration, debrief and design workshop met 100% trainees’ expectations. All trainees indicated that SBE should be a routine element of geriatric medicine training. 69% (n=31) intend to run SBE within their own department in the future.

Conclusion

This event successfully introduced geriatric medicine trainees to the design principles and practices of gerontological SBE. SBE offers trainees the opportunity to practice the technical and non-technical skills required to navigate complex, interdisciplinary and challenging scenarios, in a protected environment. The positive feedback generated suggests SBE is a useful tool to enhance the specialist geriatric medicine training experience and warrants further exploration.
Implementation Of A Novel And Integrated Community Flexible Endoscopic Evaluation Of Swallowing (FEES) Service Model For Older Persons
Authors: Clancy Monica , Curran Sarah , Kerins Elaine , Cregg Paula , Hayes Kate , Whelan Elaine , Deane Una , Galvin Rose , Griffin Anne , McGowan Caoimhe Hunter , Quinn Colin , Ryan Stephen , McCarthy Oonagh , Manning Molly
Published: September 2024

Background

FEES is a gold standard Speech & Language Therapy (SLT) led diagnostic instrument that facilitates evidence-based dysphagia care. A novel community-based FEES service for older persons’ services was recently established in Ireland's Mid-West. New pathways, integrated across divisions, were designed and implemented to complement existing dysphagia pathways within Integrated Care Programme for Older Persons (ICPOP), inpatient rehabilitation for older persons and primary care. An integrated pathway was also established with acute services (Otolaryngology). The aim of this abstract is to describe the implementation process for this novel community FEES service.

Methods

An SLT-led FEES team engaged with a range of community- and acute-based stakeholders across policy and practice: SLTs, Otolaryngologists, management teams, ICPOP teams, Gerontology Consultants, General Practitioners, Infection Prevention and Control (IPC) teams. Normalisation Process Theory (NPT), an empirically tested and theoretically-sound implementation science framework, scaffolded discussion across a range of implementation and consultation activities including co-design workshops and educational presentations and training, using Health Service Executive (HSE) Change Management tools.

Results

Stakeholders co-developed a shared understanding of current and new pathways to identify and enact implementation strategies at individual, discipline and system-levels. The project involved stakeholder mapping, communication/engagement planning, risk management, resource planning, and large-scale targeted education/training across settings and disciplines. A FEES working group was formed to coordinate, sustain, monitor, and futureproof implementation activities.

Conclusion

This collaborative project generated interdisciplinary vision and action to enact an innovative dysphagia care pathway for older people in the community. Articulated through an NPT lens, the project provides insights into the collaboration needed to implement truly integrated care and to identify enablers at individual, disciplinary, and organisational levels. Such knowledge is essential for enhancing integrated care and enacting change and innovation in the Irish health service.
Discharge Destination, Mortality Outcomes and Rehabilitation Utilization, a One Year Follow Up of Frail Older Medical Inpatients
Authors: McCarthy Kate , Healy Liam
Published: September 2024

Background

Patients with increasing frailty constitute a large proportion of acute hospital admissions. Deconditioning is a known complication of acute medical admission. This study reviews the outcomes for a population identified as frail during their admission, including utilisation of formal rehabilitation and discharge destination. Mortality rates at 6 and 12 months are also reviewed to assess if frailty could be used as a prognostication tool.

Methods

The patients selected were included in a hospital wide point prevalence study in 2023. Patients included were over 70 years of age and admitted under a medical team. Clinical frailty scale (CFS) score was recorded on all patients. The hospital electronic record provided information on transfer for formal rehabilitation, discharge home with home care package or discharge to long term care. The cohort were coded based on discharge destination. Mortality outcome at 6 and 12 months were also obtained via electronic record and RIP.ie.

Results

233 patients were included, 177 (75.9%) were identified as frail. Only 8 (3.43%) of the group were discharged to formal rehabilitation. 52 (22.3%) were transferred directly to Long term care from hospital without a trial of formal rehabilitation. 8 of this group had specific rehab needs documents, all 8 were alive at 6 and 12 months. Approximately 40% of the total group had died within 12 months.

Conclusion

Rehabilitation benefits the individual patient and the health service as a whole, by impacting care needs and facilitating discharge home (Van Craen et al., 2010). This study has shown that approximately 1 in 4 patients over 70 were discharged directly to long term care without appropriate rehabilitation. Just over 3.4% of the group received formal rehabilitation outside of the acute hospital. This has highlighted the need to radically act on egress pathways to provide appropriate rehabilitation and care for our patients.
Retracted: Do Specialised Geriatric Wards Improve Patient Outcomes
Authors: Lynch Amy , Cormican Niamh , Cashen Aoife , Chan Kei Yen , Devaney Kathy , Robinson Stephanie , Small Cliona
Published: September 2024

Background

Older adults demonstrate a unique set of needs in an acute healthcare setting. Admissions increase risk of hospital acquired disability including delirium, infections and functional decline with heightened risk of institutionalisation. As per national guidelines, acute hospital care of older patients should be carried out on a specialised geriatric ward (SGW). This aligns with Slainte cares “right care, right time, right place”. An organisational change project was implemented to set up an SGW in a tertiary centre. Assessment and documentation of delirium along with length of stay (LOS) were assessed as a surrogate marker for improvement in patient outcomes.

Methods

A retrospective assessment of patient demographics, LOS and delirium documentation for a 3-month period in 2023 was reviewed and compared to the same 3-month period in 2024 post inception of the SGW as part of a service development project.

Results

Mean age was 83 in both groups. 11% (18/157) pre SGW and 30% (40/134) post had dementia. 91% (122/134) had a collateral history and CGA during their stay on the SGW compared to 78% (123/157). 89% (119/134) had a 4AT documented at any point in the admission post SGW compared with 16% (26/157) previously. 80% (107/157) had a 4AT documented by nursing compared with 0% prior. It was estimated that there were 1,514 bed-days saved.

Conclusion

The implementation of a novel SGW is a complex service development project that utilised organisational development and had a focus on the people underpinning the project at all levels in planning for success. A significant improvement was seen in delirium recognition and documentation using the 4AT at all levels. The most significant improvement was seen in nursing documentation of the 4AT. A significant improvement in “bed days” and patient LOS was observed. This project serves as the business case for further development and sustainability of our SGW.