bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Not Attempt Resuscitation (DNAR) Status Awareness Among Healthcare Staff For Patient's Under Their Care: A Clinical Audit
Authors: McEnteggart Tara , Seni Nikitha , Ioana Iulia
Published: September 2024

Background

The HSE National Consent policy recommends service providers should develop specific mechanisms for the documentation and dissemination of decisions relating to resuscitation. The local hospital guidelines state DNAR orders should be clearly documented in the patient’s records and communicated to relevant staff at nursing handover and clinical rounds. This audit aims to ensure DNAR status is known or easily accessible by healthcare staff if a cardiac arrest occurs. The population age of the wards audited are predominantly >80 years.

Methods

A questionnaire was distributed to all nursing and medical staff working on the designated wards over a two-week period via SurveyMonkey QRcode (33 responses). The questionnaire contained five multiple choice questions with rating scale responses. Charts containing DNAR forms were reviewed alongside corresponding nursing handover sheet during this period (27 charts).

Results

6% of healthcare staff were very confident of DNAR status of patients under their care at the time of survey without accessing medical notes/handover sheet, increasing to 24% with access. 18% reported DNAR status is very easily found in both the medical chart and nursing notes. 82% report the coloured DNAR form (used 56% of the time) is much easier to locate than the photocopy. 89% of forms were attached to the front of medical charts, 7% attached to admission note and 4% unfiled. 33% of patients with signed DNAR forms did not have DNAR status recorded on the nursing handover sheet.

Conclusion

The confidence among healthcare staff regarding DNAR status of patients under their care is low. This audit highlights that an explicit and reproducible system to relay DNAR information between healthcare staff is not in place. Recommendations for this clinical site include; only keeping original coloured DNAR forms on the ward, ensuring completed forms are at the front of patient charts and creating a DNAR status column on medical and nursing handover sheets.
Mortality and Place of Residence One Year Post Stroke in an Irish Cohort
Authors: Hamad Mahmoud , D'Alton Maeve , Baby Maya , Donaghy Lisa , Dolan Eamon , Sheehan Orla
Published: September 2024

Background

Transition from hospital to community post stroke is a critical period in a patient's recovery. Understanding where post-stroke patients are living a year after discharge can provide valuable insights into the effectiveness of discharge planning and rehabilitation strategies. We aimed to identify location of patients one year post stroke and examine the influences on that location.

Methods

We performed a retrospective cohort study of stroke patients admitted to an acute hospital over a one-year period. Data on demographics, function, length of stay, stroke severity, mortality and discharge location were obtained from the in-hospital stroke registry. Patients were interviewed one year post stroke and follow up data on place of residence obtained.

Results

260 strokes occurred during the 1-year period. 11% died as inpatients and 5% were uncontactable leaving 206 stroke patients included in this study. Twenty-five patients (12%) died between discharge and 1 year follow up. 150 (73%) returned home post discharge rising to 157 (76%) one year post stroke. 32 (16%) were discharged to nursing homes falling to 22 (11%) at one year. Patients in nursing homes were older (80 vs 68 years, p = 0.001), had longer inpatient stays (37 vs 9 days, p = 0.000) and had higher Modified Rankin Scores (5 vs 2, p=0.0001).

Conclusion

Almost one in four stroke patients died within the first year of stroke consistent with international data. Mortality was highest in the acute post stroke period, but half of all deaths occurred post hospital discharge highlighting the importance of secondary vascular prevention and advanced care planning in this population. Older age, higher functional dependence and longer length of hospital stay were all associated with nursing home admission. Post stroke morbidity and mortality remains high after hospital discharge. Further study is needed to understand cause of death in the post discharge period in this population.
An Audit of Best Medical Therapy Adherence Among Patients with Carotid Artery Stenosis Attending a Tertiary Stroke Centre
Authors: Albusaidi Alsalt , Cosgrave Nicole , Jonsson Agnes , Durcan Rory , Fearon Patricia , Liddy Anne-Marie , Boyle Karl , Williams David
Published: September 2024

Background

Carotid artery stenosis (CAS) is estimated to cause 11-28% of ischaemic strokes annually. The primary objective of this audit was to assess current adherence to best medical therapy (BMT) to patients with CAS in a tertiary stroke centre. Our secondary aim was to assess stability, regression or progression of CAS whilst on BMT.

Methods

A retrospective chart review was conducted in a tertiary stroke centre over a six-week period. Patients were included if they were aged over 18 years, presenting to an outpatient stroke clinic, and had a known diagnosis of either symptomatic or asymptomatic CAS. The European Stroke Organisation Guidelines were used to define BMT.

Results

A total of 56 charts were reviewed at three weekly outpatient clinics. Of the 27 patients meeting our inclusion criteria 66% (n=18) were male, median degree of CAS was 50-70% and 78% (n=20) had symptomatic CAS. 89% were on BMT but only 56% achieved a low-density lipoprotein cholesterol (LDL-C) target of <1.8 (median 1.6 (range: 0.7-4.2) and only 66% (n=18) had a documented smoking status. 81% of patients with symptomatic CAS on BMT had stable stenosis, 5% had regression and 14% had progression of stenosis. 50% of asymptomatic patients had progression of the degree of their stenosis.

Conclusion

Overall adherence to BMT was good at 89% but there is room for improvement particularly in terms of lipid target level and documentation of risk factor status. BMT resulted in stable stenosis and low progression rates particularly in patients with symptomatic CAS. BMT and early detection are essential for management to control progression of CAS, but we have highlighted the opportunity to improve LDL-C targets. Further research is needed to evaluate if the results of this study are translatable to the stroke population in general.
Diagnostic Challenges in Identifying Atrial Myxoma as a Cause of Transient Ischemic Attacks: A Case Report
Authors: Devlin Kate , McGreal-Bellone Aimee
Published: September 2024

Background

A 67-year-old woman presented to hospital on multiple occasions with transient neurological symptoms over a period of 20 months. Initial diagnostics, including computed tomography (CT), carotid Dopplers, and electrocardiogram, were unremarkable. Magnetic resonance imaging (MRI) was arranged following the third neurological event which revealed multi-territory acute ischemic events, suggestive of a cardioembolic source. Transoesophageal echocardiography identified a large mobile atrial myxoma, histologically confirmed. Atrial myxoma, though rare, is an important cause of thromboembolic stroke, underscoring the need for comprehensive cardiac evaluation in cerebrovascular incidents.

Methods

The patient's case was reviewed, focusing on initial presentations, diagnostic workup, and subsequent management. Initial presentations included transient visual disturbances and transient leg weakness. Routine tests were conducted, including CT brain, carotid Dopplers, and blood tests. MRI and transoesophageal echocardiography were performed which ultimately identified the underlying cause of the patient’s neurological events.

Results

Initial evaluations (CT, carotid Dopplers) were normal. An MRI performed 20 months after her initial presentation revealed small acute infarcts in the right cerebellar hemisphere and left superior parietal lobe. Transoesophageal echocardiography subsequently detected a large atrial myxoma. The patient's transient symptoms and negative initial workup delayed the diagnosis, highlighting the necessity of including cardiac imaging early in the stroke workup, especially in cases of suspected cardioembolic events.

Conclusion

This case illustrates the critical role of thorough cardiac evaluation, including echocardiography, in diagnosing the cause of transient ischemic attacks (TIA) and strokes. The patient’s initial negative findings delayed the identification of a cardioembolic source, emphasizing the importance of comprehensive diagnostic protocols for suspected cerebrovascular events. Urgent surgical resection is essential for atrial myxoma to prevent recurrent embolic events. This report highlights the diagnostic and management challenges of cardiac myxomas, advocating for a more rigorous approach to stroke evaluation and timely intervention.
Response to A Story During Cognitive Screening – Expression of the Inherent Awareness of Survival of Fellow Human Beings
Authors: McHale Cathy , Fallon Aoife , Kennelly Sean
Published: September 2024

Background

The comprehensive assessment of cognition should include the immediate recall of information as well as that provided after delay. The phenomenon of patients providing intrusions is well recognised in the realm of cognitive assessment. Certain intrusions have been found to recur across patient performances.

Methods

Retrospective analysis was undertaken of patients (n=9) screened for dementia using the Repeatable Battery for the Assessment of Neuropsychological Status (Pearson) between 2022 and 2024. Data was sourced from MDT notes cataloguing the results of memory tests undertaken whereby the patient had added information regarding loss of life for persons involved in a fire. Data were elicited regarding List Learning (LL) and Recall; Story Memory and Recall, Figure Copy and Recall. The final sheet was used to elicit scores for each category.

Results

Median age was 76 (range 61-84 years). Male to female was 4:5. Patients were found to make a comment regarding loss of life e.g. ‘nobody was hurt’ where the information did not exist in the original story script. This occurred equally at Story Memory Stage and Story Recall Stage (77.7%). When compared with list and figure copy elements- only one patient also had errors in both LL and memory figure. Six patients had intrusion errors across other elements. Where the story was accentuated in both immediate and delayed recall stages- pts had intrusions in list learning (n=2, 22%) list recall (n=3, 33.3%) but no intrusions on Figure Copy- immediate or delayed.

Conclusion

Although this cohort of patients was small- each one of them included the status of life lost when given a short story to recite and then recall. These comments occurred both on immediate episodic recall and after delay and were not always associated with a replicated intrusion phenomena across other elements. This inherent interest in the survival of other humans is worth highlighting.
Cancer And Stroke - An Irish Centre’s Experience Of Emerging Trends Of Co-Diagnosis
Authors: Walsh Sarah , Doyle Patrick , Walsh Rachel , Greene Suzanne , Cogan Nicola , Murtagh Emma , Corrigan Lynda , Collins Ronan
Published: September 2024

Background

Cancer is an increasingly recognised independent risk factor for the development of stroke, with emerging evidence of stroke, in the context of malignancy being its own pathophysiological subtype (Sonbol et al., 2023). Both cancer and stroke risk are associated with increasing age, with stroke mortality in cancer patients significantly higher (Sanossian et al., 2012). Due to the increasingly ageing population in Ireland, the number of those presenting with dual diagnosis is set to increase. We sought to review numbers presenting with stroke and cancer to our stroke service.

Methods

Patients admitted with confirmed stroke diagnosis were identified through Hospital Inpatient Enquiry (HIPE) data from March 2023 to May 2024. This cohort was then screened for a co-existing oncological diagnosis. The following variables were collected: recency of cancer diagnosis, subtype of stroke, anti-cancer therapy treatment to date, risk factors for developing cardiovascular disease using atherosclerosis cardiovascular disease score (ASCVD) and baseline CRP on admission.

Results

71/320 (22%) patients admitted to our service in the defined period were identified as having a co-diagnosis of stroke and cancer (new or historical). Of those 71 patents, 8(11%) had a new or recent (<1 year) cancer diagnosis at stroke presentation and 63 were found to have a historical diagnosis (>1year). Prostate cancer represented the largest proportion of patients followed by lung and skin. 11(15%) were actively on cancer treatment at time of presentation of stroke. For patients actively on treatment, 5/11 had received platinum-based therapies. Average ASCVD risk factor score was 29.7%.

Conclusion

One in five patients with acute stroke had new or historical diagnosis of cancer in our cohort. A national prospective registry of patients with cancer and stroke could be useful in understanding patterns of stroke in cancer and help plan services and treatments for this specific population.
An Evaluation of The Older Persons Presentation To The Emergency Department (ED) Following A Fall/Syncope/Presyncope
Authors: Mannion Edel , Donnell Martin O , Reddin Catriona , Waters Ruairi
Published: September 2024

Background

Falls events are a leading reason for presentations to the ED, particularly in older adults. Often these events are unwitnessed and unexplained. Therefore, there is strong consensus that the management of unexplained falls should be evaluated in a similar fashion to syncope as outlined by the World Falls and European Society of Cardiology guidelines.

Methods

The aim of this study was to evaluate adherence with current falls/syncope guidelines. Consecutive patients over the age of 75 who presented with a fall or syncope to a university teaching hospital in October 2023 were included. Data was collected on diagnostics completed (ECG, CT Brain, Carotid Doppler Ultrasound, EEG, pro BNP, Troponin, Echocardiogram, and External loop recorder), whether specialist falls review was performed, and readmission within 6 months. Completion of diagnostic tests were compared between those who were and were not reviewed by a specialist service using the Chi squared test.

Results

Falls/syncope/presyncope comprised 17.5% (160/913) of presentations of older people to the ED. Overall, 43% (n=68) had an ECG completed, 15% (n=23) had a pro BNP, and 24% (n=38) had a troponin level measured, 11% (n=17) had an Echo performed, and 10% (n=16) had prolonged cardiac monitoring (R test), 47% (n=74) had a CT Brain performed. Among those who were reviewed by a specialist falls service, (39% n= 62) completion of recommended investigations was significantly higher; ECG (69% v 26%, p<0.01), pro BNP (24% v 8.3%, p<0.01), echocardiogram (21% v 4.2%, p<0.01), cardiac monitoring (18% v 5.2%, p<0.01).

Conclusion

Falls and syncope are common presentations to the ED among older adults. Patients who were seen by a specialist falls team were more likely to have the appropriate diagnostics complete. Therefore, a specialist falls/syncope pathway led by a specialist falls service in the ED could result in better outcomes for patients.
Community Specialist Teams: Are We Making an Impact? Insights from General Practitioners
Authors: Burke Shona , Conlon Chloe , McCleane Fiona , Geoghegan James , Cashen Aoife , Martin Niamh , Mulligan Des , Costello Maria , Canavan Michelle
Published: September 2024

Background

Within our catchment area, General Practitioners (GPs) are the primary source of referral to community specialist teams (CSTs) for older adults and are key stakeholders in supporting the integrated care pathway. We sought to evaluate their experience to inform service development.

Methods

GPs across four healthcare networks were invited to complete an online questionnaire evaluating their experience of the CSTs for older adults.

Results

Twenty-eight GPs responded. Of these, 85.7% (24) found the referral criteria clear, and 89.3% (25) reported ease of access to the service. However, 50% (14) were uncertain about when to refer patients to primary care alone versus the CST. A significant majority, 96.5% (27), felt the service positively impacted the health and well-being of referred patients, and 92.9% (26) were satisfied with communication regarding patient care plans and progress. Identified strengths of the service included the multidisciplinary approach to providing comprehensive, patient-centered care and effective communication with both GPs and patients. Areas for improvement included enhancing access for specialist teams to community radiology and increasing staffing levels to ensure timely assessments. Regarding the impact on unscheduled and emergency care, 71.4% (20) reported a reduced need to refer to the acute medical unit, and 35.7% (10) reported a reduced need to refer to the emergency department due to the ability to refer to CSTs.

Conclusion

GPs value the CST service for the quality of assessment and intervention their patients receive. Targeted areas for operational and clinical improvement include provision of diagnostics and role distinction from primary care teams. This survey also suggests CSTs are providing an alternative care pathway and point of contact for older patients in crisis, resulting in a reduction in unscheduled and emergency care utilisation. The role of the CSTs should be supported and enhanced and warrants more detailed exploration.
Introduction of A Proforma to Improve Communication to General Practitioners from an Acute Orthogeriatric Service
Authors: Morris Eleanor , Whelan Aisling , Bejleri Jorin , Dover Jeremy , Hynes Mary-Kate , Cooney Orla , Conlon Bernadette , Doolan Aoife , Winter Julie , Doyle Patrick , Davey Naomi , O'Brien Helen
Published: September 2024

Background

The National Office of Clinical Audit Irish Hip Fracture Standards 5 and 6 advise “patients with hip fracture should have their bone health assessed to determine their need for therapy to prevent future osteoporotic fractures” and “hip fracture patients should receive a specialist falls assessment and intervention to prevent further falls”. Ideally, these assessments should be communicated clearly via discharge summaries to avoid omission or duplication of treatment.

Methods

An admission proforma for an acute orthogeriatric service assessing inpatients with fragility fractures was developed. We retrospectively audited orthogeriatric patients’ discharge summaries prior and post introduction of the proforma. Patients who had atraumatic fractures were appropriately excluded from audit on their falls assessment.

Results

The total number of patients was 98. There were 70 patients in the pre-orthogeriatric proforma group and 28 patients in the post-orthogeriatric proforma group. The average age was 80.34 (SD 8.78). There were 55 females. The average length of stay was 18.08 days (SD 10.49). In the pre-orthogeriatric proforma group a falls assessment was reported in the discharge summary for 85.29% (n=58), bone protection; 60% (n=42). In the post-orthogeriatric proforma group a falls assessment was reported in the discharge summary for; 96.15% (n=25), bone protection; 61% (n=17). 100% of patients included had a bone protection plan: IV Zoledronic acid for 56 patients, denosumab for 26 patients, DEXA for 4 patients, virtual follow-up for 8 patients, onward specialty referral for 2. One patient was from overseas and for follow-up locally.

Conclusion

An orthogeriatric proforma may improve communication of falls assessment and bone protection plans in discharge summaries. Despite 100% of patients having a bone protection plan, there was a discrepancy of this in the discharge summaries. A dedicated orthogeriatric intern would ensure communication is accurate. This could avoid potential duplication or omission of prescribing of anti-resorptive treatment.
Everyday Ageism experienced by Community-Dwelling Older People with Frailty
Authors: Comerford Saidhbh , O'Kane Ellie , Roe Domhnall , Alsharedah Hamad , O'Neill Bennie , Walsh Michael , Briggs Robert
Published: September 2024

Background

Ageism encapsulates stereotypes, prejudice and discrimination towards others or oneself based on age. While identified as the most frequent form of discrimination, relatively little work has captured the problem of day-to-day ageism faced by older people with frailty in community settings. The aim of this study therefore was to examine the prevalence of everyday ageism experienced by older people attending hospital-based ambulatory care services, and to clarify its association with measures of quality of life (QOL) and frailty.

Methods

A consecutive series (n=100) of patients aged ≥70 years attending ambulatory care completed focused interviews. Day-to-day experience of ageism was measured with the Everyday Ageism Scale, QOL was measured with the Control Autonomy Self-Realisation Pleasure Scale (CASP-19).

Results

Just over half of participants reported exposure to ageist messages; over 5/6 reported experiencing ageism in interpersonal interactions and 2/3 held some ageist beliefs themselves. Logistic regression demonstrated that experiencing ageism in interpersonal interactions was associated with a higher likelihood of internalised ageism (Adjusted Odds Ratio 6.02 (95% CI 1.70, 21.34); p=0.005)). Both ageism in interpersonal interactions (β= -5.22 (95% CI -9.52, -0.91); p=0.018) and internalised ageism (β= -5.36 (95% CI -8.75, -1.97); p=0.002) were associated with significantly lower QOL.

Conclusion

This study highlights the striking prevalence of everyday ageism experienced by a cohort of community-dwelling older people with frailty and multimorbidity. In the context of further projected demographic changes in coming decades, with increasingly higher proportions of older people worldwide, these findings highlight an important societal issue that needs to be addressed.
Impact of Adoption of European Kidney Consortium Equation (EKFC) on CKD Prevalence and CKD Staging in Older Irish Adults
Authors: Tandan Meera , Browne Leonard D , Hayes Peter , Glynn Liam , Callaghan Mike O , Stack Austin G
Published: September 2024

Background

The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation tends to overestimate glomerular filtration rate (GFR) and has limitation in younger and older age groups, while the European Kidney Function Consortium (EKFC) full-age spectrum (FAS) correct for these problems and provide better performance in estimating GFR. We compared the 2017 EKFC- FAS(Scr-CysC) equation with 2012 CKD-EPI(Scr-CysC) for estimating CKD prevalence and staging in a national representative sample of older Irish adults.

Methods

We utilised data from The Irish Longitudinal Study on Ageing (2009-2011), for participants aged 50 to 79 years with complete measurement of serum creatinine (Scr) and Cystatin-C (CysC). Using 2017 EKFC- FAS(Scr-CysC) and 2012 CKD-EPI(Scr-CysC), equations eGFR was calculated. CKD was defined as eGFR below 60 ml/min/1.73 m². Median eGFR, CKD prevalence, concordance correlation coefficient (CCC), and impact of EKFC equation on GFR category reclassification was examined.

Results

A total of 5,092 participants (53.3% women), median age 61 years were included. CKD prevalence varied significantly from 10.8% (9.9% – 11.8%) using 2021 CKD-EPI (Scr -CysC) to 16.7 % (15.5-17.9%) with the 2017 EKFC- FAS(Scr-CysC) equation. The corresponding numbers of CKD increased from 114,867 to 176,439 individuals respectively. The median eGFR for 2021 CKD-EPI (Scr -CysC) was 82.1 ml/min/1.73m2 and 2017 EKFC- FAS(Scr-CysC) was 74.5 ml/min/1.73m2, P<0.001). The net reclassification was 23.1 % based on 2017 EKFC- FAS (Scr-CysC) equation compared to CKD-EPI 2012 (Scr -CysC) and was towards more worsening CKD stage. The CCC between 2012 CKD-EPI(Scr-CysC) and 2017 EKFC- FAS(Scr-CysC) was 0.88 (95% CI, 0.88-0.89).

Conclusion

CKD prevalence varies according to eGFR equation with substantially higher numbers of CKD predicted by the European Kidney Function Consortium than CKD-EPI equations. This has direct implications on healthcare planning, resource allocation, and rates of referral to specialist nephrology services in Ireland.
The Adaptive Physical Activity Study for Stroke: A Feasibility Sequential Multiple Assignment Randomized Trial
Authors: Rocliffe Padraic , Whiston Aoife , O'Reilly Siobhan , Butler Mike , Glynn Liam , Salsberg Jon , Walsh Jane , Richardson Ita , Bradley James G , Hunter Andrew , Paul Lorna , Fitsimmons Claire , Bernhardt Julie , Carr Emma , O'Donoghue Mairead , Cardy Nathan , Carter Daniel , Forbes John , Walsh Cathal , Hayes Sara
Published: September 2024

Background

Between 1990 and 2017, stroke cases nearly doubled, ranking as the second leading cause of death and disability globally. Inadequate physical activity (PA) is a leading risk factor. Recent guidelines advise stroke survivors to follow population-based PA guidelines. Given stroke heterogeneity personalised PA interventions are recommended. Therefore, this study used a Sequential Multiple-Assignment Randomized Trial (SMART) design to develop an adaptive mHealth intervention to improve PA post-stroke.

Methods

This SMART is in progress, with recruitment completed and follow-up data ending November 2024. A 12-week intervention programme was developed incorporating public patient involvement (PPI), empirical evidence and behavioural change theory to increase participation in Structured Exercise (SE), Lifestyle Physical Activity (LPA), or both. The study enrolled 54 ambulatory, community-dwelling people who were randomly assigned to either SE or LPA treatment groups. Participants used Fitbit Inspire 2 devices to monitor step counts and set personalized weekly step goals. At six weeks post-randomisation, participants were evaluated and classified as responders or non-responders based on their step count target achievement. Non-responders were re-randomized to switch treatments or augment their current regime with an additional intervention. Responders maintained their original treatment protocol. Primary outcomes address recruitment, retention and adherence rates. Secondary outcomes encompass overall health.

Results

Preliminary results include 54 participants (56% male) aged 51.58 (± 15.12) with Ischaemic (44%), Haemorrhagic (28%) or unknown (28%) stroke type at baseline. The mean weekly step was 7046 (±3797) while the mean Fatigue Severity Scale score was 38.02 (± 14.60). Participants had a mean Hospital Anxiety and Depression Scale score of 12.33 (± 6.98). Additionally, the mean Stroke Specific Quality of Life was 155.04 (58.84).

Conclusion

This is the first trial to use a SMART to design an adaptive intervention post-stroke internationally. Findings will inform the development of a PA intervention and subsequently will be evaluated against treatment as usual in a definitive trial.
Implementing a Pilot Geriatric Oncology Service at a National Cancer Centre in Dublin
Authors: Hearne Siofra , MacEochagain Colm , Coghlan-Lynch Kelly , Conroy Bronagh , Molamphy Aoife , Kennedy John , Briggs Robert , Lavan Amanda
Published: September 2024

Background

The American Society of Clinical Oncology and International Society of Geriatric Oncology recommend comprehensive geriatric assessment (CGA) for older adults commencing systemic anti-cancer treatments (SACTs) (1, 2). Routine CGA is lacking in cancer centres nationally.

Methods

A pilot, interdisciplinary geriatric-oncology (GO) clinic comprising a geriatric medicine consultant and specialist registrar, medical oncology fellow, physiotherapist and occupational therapist was established Dec 2023. New oncology patient referrals were screened applying the G8 tool; a score of ≤14 triggering referral. Polypharmacy was defined as ≥5 regular medications. Frailty was assessed using Clinical Frailty Scale (CFS) and cognition using Montreal Cognitive Assessment (MoCA).

Results

To date, 30 patients have attended the clinic; mean age 77.2 (SD5) years (range 68-85); 73% female, 50% with a CFS score of ≥4. Sixty-percent (n=18) were due to commence chemotherapy, the remainder hormonal or targeted treatment. Polypharmacy was identified in 66.6% (n=20), with 13.3% (n=4) having an anti-cholinergic burden score of ≥3, MoCAs were completed in 60% (n=18), of whom 77.8% (n=14) had an abnormal result (<26/30 MoCA or <18/22 MoCA blind). Twenty-six percent (n=8) reported ≥1 fall in the preceding six-months. Deprescribing interventions were completed in 40% (n=12); 58.3% (n=7) had ≥2 medications stopped. Medications most commonly deprescribed included opioids (n=2), antihypertensives (n=2), statins (n=2). Ambulatory blood pressure monitors were arranged for 33.3% (n=10) and DEXAs for 40% (n=12) and appropriately actioned. Follow up was arranged in the Falls and Syncope Unit for 7%, day hospital 10%, geriatric outpatients 10%, group psycho-oncology sessions 20%, specialist cancer rehabilitation physiotherapy service 17%. Parkinsons disease and dementia were diagnosed in 1 and 1 patients, respectively. Each patient had a detailed assessment and plan forwarded to their treating oncologist.

Conclusion

The development of a dedicated GO service is in line with international standards. By undergoing CGA, geriatric syndromes amenable to intervention were identified in patients.
The Value of VFA (Vertebral Fracture Assessment) in Routine DXA Scanning
Authors: Byrne Maria , Jose Josy , Mulholland Doug , Darby Sharon , Dockery Frances
Published: September 2024

Background

Low-trauma vertebral fractures are strongly predictive of future fracture risk so are generally given osteoporosis treatment regardless of bone density readings, and for every vertebral fracture presenting clinically, it is estimated that there are another two which are ‘silent’ or may have been ascribed to mechanical back pain. VFA (vertebral fracture assessment) during DXA scanning is a means of assessing the lateral spine for evidence of fractures which may have been undiagnosed prior. The International Society of Clinical Densitometry (ISCD) recommends a VFA in those with a T score <-1.0 plus one of: women ≥70 years, men ≥80 years, historical height loss >4cm, self-reported but undocumented prior vertebral fracture, regular use of steroids.

Methods

We developed a nurse-led DXA service in late 2021, conducting all scans in according with ISCD and HIQA guidelines however we do VFA on all patients aged over 50 years as it adds minimal time and negligible radiation exposure. In 2023 we commenced recording whether VFA fractures were previously diagnosed, in order to evaluate the benefits of VFA and so determine ongoing practice. To this end, we reviewed all DXA results since service launch for VFA evidence of fractures, and for patients from the calendar year 2023, we noted questionnaire responses and referral information as to whether any vertebral fracture was known of prior.

Results

There were 3,759 DXA scans conducted over the 24-month period 2022-2023 of whom n=3,299 had VFA performed. N=470/3,299 (14%) had a fracture identified on VFA. In the year 2023 only, of the n=289/1,795 (16%) who had a fracture on VFA, n=96 of these had not been diagnosed previously, representing a screening pick up rate of 5%.

Conclusion

VFA is a high-yield investigation for detecting undiagnosed vertebral fractures. As these fractures have definite treatment implications, wider use of VFA should be considered with routine DXA.
SENSE-Cog Lewy: Investigating the Impact of Sensory Loss on the Diagnosis, Clinical Features and Prognosis of Lewy Body Dementia
Authors: Roche Adam , Fitzpatrick Rachel , Chai Sin , Leroi Iracema
Published: September 2024

Background

Lewy Body Dementia (LBD) accounts for 20% of the nearly 65,000 people with dementia in Ireland, but fewer than 5% of those affected receive a formal diagnosis. LBD includes both Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) and can be characterised by fluctuating and progressive cognitive difficulties, vivid visual hallucinations and REM sleep behaviour disturbances. Sensory function such hearing, vision and olfactory function declines with age—but increasing evidence shows that abnormal patterns of sensory dysfunction can be one of the earliest clinical signs and predictors of progression of neurodegenerative diseases such as Lewy body dementia and Parkinson’s disease dementia.

Methods

A scoping review was undertaken using Embase, CINAHL, PsychINFO and PubMed. Only reports on people with LBD (DLB and PDD) from any stage, prodromal to late stage were considered. Papers primarily addressing other forms of neurocognitive disorders were excluded. Sensory loss was conceptualised as the loss of smell, vision and hearing. Two reviewers independently assessed each study for inclusion, and disagreements were resolved by a third reviewer.

Results

Reports on sensory loss in LBD were very few and most often were comparing sensory loss across different dementia types. Strong associations were observed between olfactory loss and particular visual impairment patterns and the severity of both cognitive and non-cognitive DLB symptoms. Olfactory impairment is a potential early biomarker of DLB and PDD and severity of olfactory dysfunction can predict cognitive decline. Visual hallucinations, for example, were found to be closely linked to visual impairment patterns such as pareidolia.

Conclusion

This study highlights a knowledge gap regarding the patterns of sensory loss in LBD and their relationship with cognitive and non-cognitive LBD symptoms. Sensory assessments represent potentially valuable diagnostic and prognosis tool in LBD, with further research required to understand the aetiological mechanisms underlying sensory impairment in LBD and other dementias.
Untangling poikilohydry and desiccation tolerance: evolutionary and macroecological drivers in ferns
Authors: Aros-Mualin Daniela , Kessler Michael
Published: September 2024

Background and Aims

Poikilohydry describes the inability of plants to internally regulate their water content (hydroregulation), whereas desiccation tolerance (DT) refers to the ability to restore normal metabolic functions upon rehydration. The failure to clearly separate these two adaptations has impeded a comprehensive understanding of their unique evolutionary and ecological drivers. Unlike bryophytes and angiosperms, these adaptations in ferns are sometimes uncorrelated, offering a unique opportunity to navigate their intricate interplay.

Methods

We classified ferns into two syndromes: the Hymenophyllum-type (H-type), encompassing species with filmy leaves lacking stomata that experience extreme poikilohydry and varying degrees of DT, and the Pleopeltis-type (P-type), consisting of resurrection plants with variable hydroregulation but high DT.

Key Results

The H-type evolved during globally cool Icehouse periods, as an adaptation to low light levels in damp, shady habitats, and currently prevails in wet environments. Conversely, the P-type evolved predominantly under Greenhouse periods as an adaptation to periodic water shortage, with most extant species thriving in warm, seasonally dry habitats.

Conclusions

Out study underscores the fundamental differences between poikilohydry and DT, emphasizing the imperative to meticulously differentiate and qualify the strength of each strategy as well as their interactions, as a basis for understanding the genetic and evolutionary background of these ecologically crucial adaptations.
Using Neuropsychological Profiling to Tailor Mental Health Care for Children and Youth: a Quality Improvement Project to Measure Feasibility
Authors: Blais Angelica , Holahan Anne-Lise , Helleman Amanda , Pajer Kathleen , Honeywell Christina , Salehi Roxana , Anderson Peter , Vasserman Marsha
Published: September 2024

Objective

Precision child and youth mental healthcare has great potential to improve treatment success by tailoring interventions to individual needs. An innovative care pathway in a pediatric mental health outpatient clinic was designed to allow for neuropsychology data to be integrated in psychotherapeutic care. This paper describes the feasibility of this new pathway, including implementation outcomes, acceptability, and potential for future integration.

Method

The target population was outpatients 6–17 years old referred for individual treatment to a tertiary outpatient mental health (OPMH) clinic. The new care pathway was co-developed by neuropsychologists and mental health practitioners. A logic model was created to guide the evaluation, which was informed by the Reach Effectiveness Adoption Implementation Maintenance framework. As part of the logic model, a stepped assessment protocol was implemented, and reports on neuropsychological function were shared with patients, caregivers, and care providers. Evaluation data were collected from phone surveys, questionnaires, a focus group, and administrative records.

Results

Forty-two patients scheduled to receive therapy over a 6-month period were offered the opportunity to participate in the new care pathway and 39 (93%) agreed. Self-reported outcome data showed that 83% of patients and 94% of caregivers valued neuropsychology-informed care, with some describing it as transformative. Almost all practitioners (91%) reported that the project added value to their clinical care. There were no adverse effects on participants nor the flow of patients through the system.

Conclusions

Neuropsychology-informed pediatric OPMH care was feasible and well-received. Clinical effectiveness should be studied in an experimental trial.
Quantum gravity in the skies?
Authors: Trivedi Oem
Published: September 2024

A look at how astrophysical data could point towards quantum gravity and new physics
Towards the accurate modelling of antibody−antigen complexes from sequence using machine learning and information-driven docking
Authors: Giulini Marco , Schneider Constantin , Cutting Daniel , Desai Nikita , Deane Charlotte M , Bonvin Alexandre M J J
Published: September 2024

Motivation

Antibody−antigen complex modelling is an important step in computational workflows for therapeutic antibody design. While experimentally determined structures of both antibody and the cognate antigen are often not available, recent advances in machine learning-driven protein modelling have enabled accurate prediction of both antibody and antigen structures. Here, we analyse the ability of protein−protein docking tools to use machine learning generated input structures for information-driven docking.

Results

In an information-driven scenario, we find that HADDOCK can generate accurate models of antibody−antigen complexes using an ensemble of antibody structures generated by machine learning tools and AlphaFold2 predicted antigen structures. Targeted docking using knowledge of the complementary determining regions on the antibody and some information about the targeted epitope allows the generation of high-quality models of the complex with reduced sampling, resulting in a computationally cheap protocol that outperforms the ZDOCK baseline.

Availability and implementation

The source code of HADDOCK3 is freely available at github.com/haddocking/haddock3. The code to generate and analyse the data is available at github.com/haddocking/ai-antibodies. The full runs, including docking models from all modules of a workflow have been deposited in our lab collection (data.sbgrid.org/labs/32/1139) at the SBGRID data repository.
DockQ v2: improved automatic quality measure for protein multimers, nucleic acids, and small molecules
Authors: Mirabello Claudio , Wallner Björn
Published: September 2024

Motivation

It is important to assess the quality of modeled biomolecules to benchmark and assess the performance of different prediction methods. DockQ has emerged as the standard tool for assessing the quality of protein interfaces in model structures against given references. However, as predictions of large multimers with multiple chains become more common, DockQ needs to be updated with more functionality for robustness and speed. Moreover, as the field progresses and more methods are released to predict interactions between proteins and other types of molecules, such as nucleic acids and small molecules, it becomes necessary to have a tool that can assess all types of interactions.

Results

Here, we present a complete reimplementation of DockQ in pure Python. The updated version of DockQ is more portable, faster and introduces novel functionalities, such as automatic DockQ calculations for multiple interfaces and automatic chain mapping with multi-threading. These enhancements are designed to facilitate comparative analyses of protein complexes, particularly large multi-chain complexes. Furthermore, DockQ is now also able to score interfaces between proteins, nucleic acids, and small molecules.

Availability and implementation

DockQ v2 is available online at: https://wallnerlab.org/DockQ.
Higher proportion of cellulitis in severe lymphoedema
Authors: Wall James , Sutherland Melanie , Levell Nick J , Venables Zoe C , Mistry Khaylen
Published: September 2024

We read with interest the article by Burian et al. discussing the prevalence and risk factors of cellulitis in chronic leg oedema. We conducted a 12-year service evaluation at the Norfolk and Norwich University Hospital to investigate the applicability of these results in a real-world setting. Our study found that episodes of cellulitis were more common in patients with more severe lymphoedema, reinforcing the findings of Burian et al. and highlighting the importance of controlling lymphatic swelling to reduce the risk of cellulitis.
Waifs and strays of office automation
Authors: Williams John
Published: September 2024

Think of a department in your company. It is staffed by highly paid professionals who are responsible for ensuring the profitable exploitation of company assets worth millions of pounds. The results of their efforts can give your company an edge over your competitors either in new products or in more efficient operation of the company as a whole. And yet this department probably makes less use of office automation to help it than, say, your accounts department. Who is this waif of office automation; this group whose contribution to the company is being limited by the tools they use? Surprisingly, it’s the Management Information Systems department. They have probably been pioneering office automation within the company but have often got left behind themselves, using tools that are inadequate, and rarely reflect the needs of the department today. The tragedy is that it is not their fault; with limited resources they have put their customers – the user departments – first, and most of the office automation systems around just haven’t met their special requirements.
IPSE: the office of the educated professional
Authors: Sartain David
Published: September 2024

Automated office systems used to conjure up a picture of typists and clerical workers sitting in front of keyboards and screens. Effectively, their main activity was word processing. The chief benefit of such an arrangement, for most professional staff, was probably to eliminate the need for accuracy in the preparation of manuscript drafts or in dictation! Obviously there are many cases where the use of word processors has resulted in a genuine increase in productivity. However, whilst it is desirable to increase productivity and job satisfaction of typing staff, are we addressing those areas which lead to the greatest financial saving? In most office environments, certainly in education, the typists are amongst the lowest paid. In addition the number of typists may be small when compared with the number of professionally qualified staff. Thus it is surely more sensible to increase the productivity of the latter; since they are more expensive and frequently scarce.
The effect of technology on organisations
Authors: Tuffield David
Published: September 2024

Technology is purported to be either benign and beneficial or harmful and socially retrogressive. Whether we are on one side or the other of this argument there is little doubt that we are in the early phases of a radical change in our lives due to electronic technologies. Some people are afraid that work itself may be under threat. Jeremy Seabrook has written ‘In the 1930’s, those who wanted work had a sense that they only had to wait before their labour would be required again… Now, on the other hand, there is a terminal sense of the extinction of work itself.’ [1], while the American economist Wassily Leontieff in a recent New Scientist article has written ‘Human labour from time immemorial has played the role of the principal factor of production. There are reasons to believe that human labour may not retain this status in the future.’[2]
Distributed speech recegnition
Authors: Ellis Chris
Published: September 2024

The latest experimental speech recognition systems can take dictation at normal speed, with no special techniques required of the speaker, and they can support large, generalised vocabularies. Some of these systems may soon appear as commercial offerings. However, they must run on powerful workstations to deliver anything like real-time performance, and they need bundreds of megabytes of RAM and large amounts of disk storage. This puts full-function speech recognition in a cost class of its own, compared with any other office application.
Climatic variation and risk assessment in a highly seasonal mammal
Authors: Sanchez McKenna , Martin Julien G A , Blumstein Daniel T
Published: September 2024

Climate change and its resulting effects on seasonality are known to alter a variety of animal behaviors including those related to foraging, phenology, and migration. Although many studies focus on the impacts of phenological changes on physiology or fitness enhancing behaviors, fewer have investigated the relationship between variation in weather and phenology on risk assessment. Fleeing from predators is an economic decision that incurs costs and benefits. As environmental conditions change, animals may face additional stressors that affect their decision to flee and influence their ability to effectively assess risk. Flight initiation distance (FID)—the distance at which animals move away from threats—is often used to study risk assessment. FID varies due to both internal and external biotic and physical factors as well as anthropogenic activities. We asked whether variation in weather and phenology is associated with risk-taking in a population of yellow-bellied marmots (Marmota flaviventer). As the air temperature increased marmots tolerated closer approaches, suggesting that they either perceived less risk or that their response to a threat was thermally compromised. The effect of temperature was relatively small and was largely dependent upon having a larger range in the full data set that permitted us to detect it. We found no effects of either the date that snow disappeared or July precipitation on marmot FID. As global temperatures continue to rise, rainfall varies more and drought becomes more common, understanding climate-related changes in how animals assess risk should be used to inform population viability models.