bluuebunny/crossref_metadata_2025 huggingface dataset:
Don't Forget About Your Memory...Exploring Need And Impact Of A Cognitive Strategies Group On Older Adults Following Comprehensive Geriatric Assessment
Authors: Ronayne Sarah , McDonnell Laura , Bradley Mairead , Croghan Ashling , Malley Tom O , Alexander Marie
Published: September 2024

Background

The increasing prevalence of mild cognitive impairment (MCI) and dementia in older adults in Ireland, with projections of up to 20% of over 80-year-olds affected, is widely documented (TILDA 2023). Due attention is required in service planning to provide tailored non-pharmacological and lifestyle interventions to this growing cohort. This review aims to analyse the need for and impact of a cognitive strategies and brain health intervention group on older adults attending the Integrated Day Hospital (IDH) as part of an ICPOP service.

Methods

Retrospective analysis of the health care record was complete on older adults over 70 years with recent deterioration in cognitive or functional status. Cognitive screening scores and diagnoses received at the IDH were gathered to inform presence of MCI or dementia. Permission was sought from the authors of a cognitive strategies and brain health intervention group which was delivered to a sample of older adults and evaluated as part of the Jog Your Memory Program (HSE 2020).

Results

Preliminary results indicate a cohort of 355 older adults. Analysis of cognitive screening scores reflect prevalence of MCI at 15% and dementia at 35%. The Jog Your Memory program is implemented over 4 sessions. 2 programs were complete in October 2023 and April 2024 with 16 participants. Evaluation was complete with 100% of participants reporting benefits including acquisition of memory strategies, improved confidence and increased knowledge of MCI. Implementing this program optimises therapist time indicating cost saving. Final findings will be available for the purpose of this poster presentation.

Conclusion

The prevalence of cognitive impairment is broadly in keeping with previous audit (2023). The intervention group implementation and evaluation are ongoing. Participant feedback suggests the intervention is meeting the needs of this cohort. Future work will focus on scaling up the intervention group and integrating with other local services.
Introduction of a ‘Post fall assessment’ proforma improves management of patients following a fall in a rehabilitation setting
Authors: Treacy Ciara , McGeady Gemma , Fitzpatrick Eimear , McCarthy Frances
Published: September 2024

Background

Falls are the most frequently reported incident within HSE services. 18,023 falls were reported in acute hospitals in 2021 and resulted in harm in 19% of cases. The HSE patient safety strategy has highlighted patient falls as a priority area for service improvement. One area where improvements could be implemented is the assessment of patients following falls.

Methods

A retrospective audit on medical note documentation of 40 patients following an inpatient fall was carried out, with areas for improvement identified. A multidisciplinary multi-part post fall assessment proforma with embedded guidance, based on best practice guidelines was subsequently introduced. A further retrospective audit was then conducted 6 months following its introduction.

Results

In cycle 1 of the audit, 67.5% of assessed patients did not have the presence or absence of ‘red flags’ documented. 27.5% of reviews did not record a detailed history and 7.5% did not have a formal focused examination documented. 32.5% of patients had a medication review undertaken. 20% of patients had a focused MDT review post fall. In cycle 2 the ‘immediate medical review’ section of the proforma was completed in its entirety in 95% of cases, including documentation of history, examination and ‘red flags’. A follow up review by the primary team, which included prompts to reconsider injury and consider risk reduction for future injurious falls was documented in 50% of cases. A focused review by the wider MDT took place in 75% of cases.

Conclusion

The introduction of a post fall assessment proforma has resulted in improved assessment for potential injuries and a more targeted approach to reducing the risk of future injurious falls.
A Qualitative Exploration of Undergraduate Students’ Experiences of Using Virtual Reality for Dementia Inclusive Education
Authors: Stewart Elisha , Murphy Catriona
Published: September 2024

Background

Dementia prevalence is expected to exponentially increase over the coming decades. Across society, an increased awareness of dementia inclusive environments is important, to promote inclusivity and foster empathy. The aim of this study was to explore the experiences of undergraduate students using virtual reality (VR) for dementia inclusive education.

Methods

Purposive sampling was employed in one University in Ireland to recruit first year undergraduate students who had completed a VR workshop on dementia inclusive environments. Five semi-structured in-person interviews were conducted during February 2024. Interviews were audio-recorded, transcribed, and thematically analysed.

Results

Three themes were identified. The first theme ‘Food for thought’ represented participants’ greater understanding, as a result of using VR, of the potential for design to impact the dementia experience. Participants felt as though they were able to virtually place themselves in someone else’s shoes, which was described as “eye-opening”. The second theme ‘Impact variation’ revealed that although participants’ showed enhanced levels of awareness, empathy and understanding of this global health issue, the depth of learning depended on the participants’ prior exposure to dementia. The final theme related to ‘The VR experience’ as a whole. Students described the VR experience as positive, engaging, easy to use, and revealed that they were excited to take part in the workshops.

Conclusion

The student experience of using VR for dementia inclusive education was positive and enlightening. Using VR to introduce universal design concepts could be integrated into a range of undergraduate programmes to foster understanding and has the potential to empower future designers and policymakers to create environments that are accessible and inclusive for everyone. While this is a small-scale study, the difference in impact of this VR initiative on students with prior personal exposure to people with dementia and those without was an interesting finding and requires further research.
Optimising Outcomes For Those With Chronic Respiratory Disease: Detecting Frailty In The Respiratory OPD
Authors: Scully Padraig , Altayyari Sarah , Alnajjar Ali , Elhassan Mohamed , Finan Katherine
Published: September 2024

Background

Frailty is a treatable trait of relevance to people with various chronic respiratory diseases, especially those with severe COPD and/or lung transplantation. This has been recognised in the 2024 GOLD (Global initiative for chronic Obstructive Lung Disease) report and within recent European Respiratory Society guidelines. Central to optimisation of frailty management in those with chronic respiratory conditions is the identification of frail patients in the respiratory OPD (outpatients department) setting. This study aims to assess the prevalence of frailty among patients attending the respiratory OPD in our hospital.

Methods

A cross-sectional study was conducted over two respiratory clinics over a two-week period. Patients aged 65 and above were screened for frailty using the Clinical Frailty Scale (CFS). A CFS score was assigned to each patient by an assessing NCHD/consultant on the respiratory team. Statistical analysis was then performed to determine the prevalence of frailty amongst such patients. Frailty was defined as those having a CFS score of >5.

Results

A total of 25 patients were included in the study. Frailty (CFS score of >5) was identified in 56% of patients assessed, with 12% of patients being identified as having a CFS score of 7 (severely frail) or higher. Frailty had not previously been diagnosed by the respiratory team in those patients.

Conclusion

This study highlights a high prevalence of frailty among patients aged 65 or over in the respiratory OPD. Implementing systematic frailty screening in the respiratory OPD using the CFS can improve early identification of such patients, potentially enhancing management and clinical outcomes. The CFS is a quick and effective tool in identifying frailty. Integrating frailty assessments into routine clinical practice may help to ensure comprehensive care for this vulnerable population. We are currently looking at options for referral pathways to develop to improve management of frailty in this population.
An Audit of the Fifth Irish Hip Fracture Standard in patients >=70 years following hip fracture
Authors: O'Donnell Graceann , Harte Olivia , McFadden Carole , Gallagher Eleanor , Slevin Aine , Thomas Joseph , Mulpeter Ken
Published: September 2024

Background

Hip fractures are a significant cause of morbidity and mortality in older adults. Bone health assessment is key in the reduction of future fracture risk. The aim of our study was to examine the adherence to the fifth Irish Hip Fracture Standard in patients >=70 years presenting to Letterkenny University Hospital (LUH) with a hip fracture and to examine the number of patients who were commenced on bone protection.

Methods

We included patients >=70 years who were admitted under the Orthopaedic service following a hip fracture between January and June 2023 in LUH and were identified the database maintained by the using Fracture Liaison Nurse. Data collected included age, month in which hip fracture occurred, patient resident in Ireland, patient alive/deceased, patient on bone protection prior to fracture, patient commenced on bone protection or patient declined treatment. Data was recorded in a Microsoft excel spreadsheet and was analysed by the clinical audit facilitator. We measured our data against the British Geriatric Society guideline on the use of IV zoledronate following hip fracture.

Results

76 patients were admitted to LUH with a hip fracture >=70 years between January and June 2023. 100% of patients were reviewed by the fracture liaison service and following this it was recommended that 46 patients (60%) be commenced on bone protection. A letter was sent to each patient’s General Practitioner outlining the recommendation for bone protection. On follow up only 7/46 (15.2%) had been started on treatment.

Conclusion

The fracture liaison service is appropriately identifying patients who require treatment, despite this, patients are not starting the necessary bone protection in the community. This has prompted our service to establish an IV zoledronate clinic for patients following hip fracture and to generate a plan for ongoing treatment of this patient cohort.
Cerebral Hypoperfusion And Future Falls Risk Among Community Dwelling Older Adults with Orthostatic Hypotension
Authors: Claffey Paul , Pérez-Denia Laura , Finucane Ciarán , Kenny Rose Anne , Briggs Robert
Published: September 2024

Background

Falls occur in approximately 33% of those over 65 annually, with 10-20% resulting in injury or hospitalisation. Orthostatic Hypotension (OH) characterised by significant blood pressure (BP) drops upon standing is frequently identified in those with unexplained falls (UF). Cerebral hypoperfusion is regarded as the mechanism by which OH contributes to falls risk. However, work looking at the direct interaction between OH, cerebral perfusion and falls is lacking.

Methods

Near Infrared Spectroscopy (NIRS) derived frontal lobe cerebral oxygenation (reported as tissue saturation index (TSI)) and continuous beat-to-beat BP by finometer were measured in parallel during active standing among participants aged ≥55 at wave3 of TILDA (n=2478). OH, was defined as persisting systolic BP drop ≥20mmHg and/or diastolic BP drop ≥10mmHg at 30, 60 and 90seconds post standing. TSI drop from baseline ≥75th centile at 30seconds informed the “greater TSI drop” variable for longitudinal analysis. Multilevel linear regression models assessed the association between change in TSI from baseline and OH. Multilevel logistic regression models assessed the longitudinal relationship between OH, cerebral perfusion and future UF at 4years follow up (waves 4-5).

Results

Twenty percent had OH and were more likely to be older and have cardiovascular disease. TSI drops from baseline after standing were significantly greater in those with OH at 30 (beta=0.32 [CI 0.15-0.49]; p<0.001), 60 (beta=0.41 [CI 0.23-0.6]; p<0.001), and 90 (beta=0.46 [CI 0.27-0.65]; p<0.001) seconds in fully adjusted models. After robust adjustment, combination of OH with greater TSI drops was strongly associated with future UF (Odds Ratio (OR) 2.23 [CI 1.35-3.69]; p=0.002), while OH and lower TSI drops were not (OR 1.27 [CI 0.87-1.85]; p=0.216).

Conclusion

These novel findings confirm that degree of cerebral hypoperfusion on standing informs risk of future UF in those with OH and has important clinical implications for the risk assessment of older people presenting with falls.
Evaluation Of Medical Registrar Confidence In Approach To Acute Stroke And Experience Of Stroke Teaching
Authors: Ryan Maeve , Yun John Paul , Thomas Niju , Moffatt Una , Hickey Paula , O'Malley Grainne
Published: September 2024

Background

The American Heart Association scientific statement (2022) addressing inpatient stroke recommends the delivery of stroke-response training to all hospital staff. While performing a service evaluation on in-patient stroke metrics, we explored the self-perceived confidence levels of medical registrars at this hospital, and whether formal on-site teaching was received. We explored various components including awareness of local stroke protocol and teaching pedagogy.

Methods

Using Google Forms, a survey was sent to all medical registrars in our hospital. A 5-point Likert scale was used to assess the confidence levels of various topics.

Results

The response-rate was 63% (N=12). Fifty percent (N=6) of participants were on Higher Training Schemes while the remaining 50% (N=6) occupied standalone appointments. Most respondents (83%, N=10) reported experience managing an acute stroke as a registrar. Forty-two percent (N=5) of registrars ‘strongly agreed’ they were confident in assessment of acute stroke, with 50% (N=6) ‘agreeing’, and one respondent remaining ‘neutral’ (N=1). Some registrars were unfamiliar with local stroke protocol (23%, N=3). Half of respondents (50%, N=6) reported no formal teaching on acute stroke. Fifty percent (N=6) of registrars reported that most teaching occurred primarily on ward rounds, with 42% (N=5) reported teaching through lectures. The vast majority (83%, N=10) selected simulation as their preferred teaching method.

Conclusion

While our medical registrars were confident in their ability to assess and manage acute stroke, significant improvements can be made to ensure formal teaching is prioritized. As stroke protocol can change from site-to-site, it is crucial to define expectations and standards for registrars to ensure timely care for patients. There is a clear preference for simulation as a teaching pedagogy, hence we plan on introducing a formal stroke simulation curriculum. Stroke response is a multidisciplinary effort, hence future research directions include exploring stroke training in nurses, junior doctors, and other healthcare professionals.
Echocardiography In Acute Stroke - A Precious Resource
Authors: O'Grady Ross , O'Reilly Aine , Lee Doctor Tom
Published: September 2024

Background

Echocardiography (Echo) is frequently utilized as part of the work up for ischemic stroke. National guidelines suggest using echo to assess for source of unexplained stroke “if detection of a structural cardiac abnormality would prompt a change of management”. This study aims to describe the use of Echocardiography post-stroke in Mayo University Hospital (MUH).

Methods

The study population was derived from a list of strokes admitted to MUH from July to December 2023 which was compiled by the Stroke ANP. The radiology system was consulted to assess time to echo and findings.

Results

86 ischemic strokes were identified. 77 (89%) had echocardiography ordered as inpatient. 61 of 77 echoes ordered were filmed during admission. The mean wait for echo was 6.4 days. No PFO or LV thrombus was detected. In 52% (n=32) of echo’s performed for work up of aetiology of stroke there was no mention of intra-atrial septum (IAS) in the report. 24% had Modified Rankin Scale on discharge of 4 or above. Of these, 75% had echo ordered as inpatient despite 60% already having atrial fibrillation diagnosed.

Conclusion

Echocardiography appeared to be an over-utilised resource in ischemic strokes in MUH. The vast majority of patients with stroke, even if frail, elderly, or severely disabled, had echocardiography ordered despite national guidelines suggesting usage of echo only when diagnosis of structural heart disease was likely to change management. The intra-atrial septum wasn’t even mentioned in the majority of studies. The wait for echocardiography appears to be extending bed days for patients putting strain on hospital inpatient capacity and emergency departments. A more nuanced approach to ordering echo in the setting of acute stroke could be advocated for, this will take a collaborative effort between Cardiology and Stroke Medicine in order to prioritise that will most benefit from this precious resource.
Community-based Geriatric Assessments: Is There an Urban/Rural Divide?
Authors: Stankard Aidan , Neachtain Máire Ní , Abed Aishling , Brehony Alma , McCleane Fiona , Canavan Michelle , Costello Maria , Campbell Judith , Walsh Loretta , Munnelly Patricia , Rogan Mary , Fitzmaurice Clíodhna
Published: September 2024

Background

There is a paucity of literature describing urban/rural differences in baseline demographic factors and patterns of referral for those undergoing community based comprehensive geriatric assessment (CGA) in Ireland. We analysed differences in baseline demographics, referral sources and referral reasons among older persons who underwent CGA with a community specialist team, which accepts referrals from one predominantly rural community health network (CHN) and one predominantly urban CHN.

Methods

Data including baseline demographic characteristics, reasons for referral, referral sources, clinical frailty score (CFS), prevalence of polypharmacy (more than 10 prescribed medicines) and location of CGA was prospectively collected on all persons referred to an older persons' integrated care service from February 2023 to March 2024 and who underwent CGA. Data was stored on a secure database. Persons were categorised as either urban dwelling or rural dwelling, based on their local CHN. Descriptive statistics were used to describe differences between the urban and rural cohorts.

Results

235 persons characterised as urban underwent CGA and 191 persons characterised as rural underwent CGA. There was a higher median CFS score amongst rural persons (CFS = 5, IQR=2) compared to urban persons (CFS=4, IQR=2). Urban persons were more likely to be referred by their G.P. (81% of total referrals) compared with rural persons (67%). Rural persons were more likely to be male (48% vs 37%) and experience polypharmacy (33% vs 27%) than urban persons. A similar proportion of persons underwent initial CGA in their home (20% rural vs 19% urban).

Conclusion

Here we describe the characteristics of urban and rural users attending an integrated care service. Future research should examine how these differences might affect healthcare utilisation and outcomes and provide opportunity to inform regional health and social care planning.
“For the Care of the Underserved” A Descriptive Analysis of MTOA Admitted Under the Non-Trauma Specialties in a MTC
Authors: McGurk Clara , O'Shea Alanna , Fitzgerald Rachel , Hannon Evelyn , Ahern Emer
Published: September 2024

Background

The recent NOCA report highlights a significant portion of major trauma cases resulting from falls among older adults, who often face limited access to trauma centres and age-related biases in treatment. Existing protocols and services for older trauma patients are lacking. This study aimed to audit the incidence and outcomes of MTOA admitted under the non-trauma specialties at a Major Trauma Centre.

Methods

Data from handover documents between January 2019 and December 2023 were screened for cases of “older trauma” (patients >65 with new trauma injuries) and analysed using Microsoft Excel.

Results

Between 2019 and 2023, 992 older patients were admitted under non-trauma specialties, with a mean age of 83 years and a majority being female 73% (N=170). The mean length of stay was 14 days, with pelvis injuries being most common 31% (N=307). Falls from standing height accounted for 83% (N=823) of injuries. Only 28% (N=217) of patients at immediate risk of further fragility fractures received bone protection. Most patients were discharged home 49% (N=456), while 6% (N=55) were institutionalized. The total mortality rate in hospital was 7% (N=66). The total mortality at one year was 17% (N=121). The injury with the highest mortality in hospital 24% (N=21) and at one year 40% (N=35) was traumatic brain injuries.

Conclusion

This audit reveals disparities in trauma care for older patients, despite advances in the field. While initiatives like the hip fracture database have improved care for specific injuries, pathways for older trauma patients not requiring surgery are lacking. Given the excess morbidity and mortality among this population, establishing a Geriatric Trauma Service is imperative. This is in line with literature supporting the idea that older trauma patients demand specialist attention; they are not just older adults.
DNAR: All or Nothing: Impact of Education Sessions Re-Audit in a Model 3 Hospital
Authors: Ramjohn Joshua , Kelly Joseph , Abdalla Amal , Hamad Ahmed , Carvalho Juliana , Gibbons Ciara , Quigley Lynn , Finan Katherine
Published: September 2024

Background

Do Not Attempt Resuscitation (DNAR) orders are implemented to obviate inappropriate Cardio-Pulmonary Resuscitation (CPR) in patients with low chances of survival post-CPR. However, ambiguity regarding ceilings of care for patients with a DNAR order can arise. This re-audit aimed to review DNAR and ceilings of care documentation according to national HSE guidelines after education sessions, comparing results with the pre-education audit in a Model 3 Hospital.

Methods

A point-prevalence chart review of thirty-one adult medical inpatients with a DNAR order was conducted after two education sessions were held for Non-Consultant Hospital Doctors (NCHDs) and Consultants.

Results

Of all thirty-one charts, 35% documented DNAR status in the medical notes, with 32% documenting the reasoning for DNAR status, both of which were unchanged from the first audit cycle. There was an increase in documentation of patient discussion (61% versus 45%) and reasons if this was excluded (66% versus 41%). There was no change in documentation of patient relatives’ discussion (48%) but there was an increase in the reasons if this was excluded (25% versus 18%). There was an overall increase in ceilings of care documentation for ICU admission (three-fold increase), intubation (two-fold increase), inotropic support, and comfort measures, but rates of documentation were still less than 15%. This elucidates the efficacy of education sessions in improving DNAR documentation adherence. Recent studies have highlighted uncertainty among NCHDs regarding treatment escalation in acutely unwell patients in the absence of adequately filled DNAR orders and clear documentation of ceilings of care. Therefore, we posit the introduction of a Ceilings of Care document, akin to the United Kingdom’s Medical Advance Plan.

Conclusion

Accurate recording of DNAR status and ceilings of care is essential for quality care and treatment escalation. While simple education strategies have proven beneficial in enhancing compliance, additional efforts are needed to enhance ceilings of care documentation.
Clinical, Patient And Service Outcomes For Patients In A Rehabilitation Hospital With An Onsite Flexible Endoscopic Evaluation Of Swallowing Service
Authors: Flaherty Kara , Lawlor Aideen , Douglas Laura
Published: September 2024

Background

Dysphagia has been reported in almost half of hospital patients who are over 65 years.1 In 2023 a Flexible Endoscopic Evaluation of Swallowing (FEES) service was introduced into the hospital. The purpose of this study was to profile the patients who were referred for FEES and determine the prevalence and severity of dysphagia.

Methods

Information on patient diagnosis, dysphagia related clinical outcome measures and waiting times when compared to Videofluoroscopy referral were collected from 30 patients who attended for FEES assessment in a rehabilitation hospital from August 2023 - May 2024.

Results

97% of the patients who engaged in FEES were above the age of 65. Patients presented with a range of diagnoses including frailty (20%), progressive neurological conditions (18%), other (16.6%), stroke (13.3%), Chronic Obstructive Pulmonary Disease (13.3%), Acquired Brain Injury (3%), Gastroenterology (3%), and surgical (3%). Dysphagia was identified in 97% of patients, with 60% presenting within the moderate to severe range on the Australian Therapy Outcome Measures. 33% of patients presented with silent aspiration, with a third of these patients presenting as clinically asymptomatic. Following FEES evaluation, 40% of patients were recommended a change in diet texture or fluid consistency, with 54% and 70% of these patients being recommended a downgrade in diet or fluids respectively. The service has allowed for more timely access to instrumental swallow assessment with completion of FEES within an average of 4 days compared to referral for Videofluoroscopy; 24 days average.

Conclusion

This study has enabled us to profile patients accessing FEES. FEES facilitates quicker access to instrumental swallow assessment and identification of aspiration. It has also enabled targeted person centered dysphagia rehab.

Reference

1. Doan, T.N et al (2022) Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis. Journal of Clinical Medicine, 11(9), p.2605.
Assessing the Impact of the Introduction Of Advance Care Planning In Nursing Home Residents Admitted to Hospital
Authors: Dowling Michael , Garcia Ryan , Saric Denis , Kennelly SM , Thavarajah Kowshika
Published: September 2024

Background

Nursing home residents may present inappropriately to the Emergency Department at the end of life (EOL). Appropriate advance care planning (ACP) may reduce these presentations. Inpatient teams are in a position to discuss, document and support these ACPs for nursing home residents admitted under their care.

Methods

Building on existing inpatient and outreach specialist pathways in a model three hospital, formal ACPs were introduced for all inpatients from Jan 2024 admitted from a nursing home where it was deemed clinically appropriate. The completed advance care plan included decisions re cardiopulmonary resuscitation, level of intervention (including hospital transfer), antibiotics, fluids, nutrition plan and medications to support EOL care. ACP discussions took place with the consultant geriatrician, patient, nominated family/patient support and director of nursing. Data on discharged patients (including presence of ACP on discharge) was collected and analysed for emergency re-presentations.

Results

Of 137 patients discharged back to their nursing homes in the first 4 months of 2024, 41 (30%) had an ACP in place while 96 (70%) did not. Of those with ACP in place, 6/41 re-presented to Emergency Department within this timeframe vs 17/96 who were discharged without an ACP (15% vs 18%, p=0.66). However, only 3/41 with ACP were re-admitted to hospital from the emergency department vs 15/96 without an ACP (7% vs 16%, p=0.19). No patients discharged with an ACP re-presented and subsequently died in hospital, while 1/96 (1%) of those discharged without an ACP died in hospital after re-presentation.

Conclusion

ACP discussion did not reduce re-presentations to hospital but there was a non-significant trend towards a reduction in re-admissions. Overall, there was an extremely low rate (1/137, 0.7%) of patients re-presenting to hospital and dying during that admission. Further work is ongoing to examine the criteria that would prompt ACP discussion in nursing home residents admitted to hospital.
Optimising The Implementation Of A Dementia Care Education Programme For Healthcare Assistants (Home Support): Lessons From A Qualitative Study
Authors: Pierce Maria
Published: September 2024

Background

Healthcare Assistants (Home Support) provide a significant level of non-clinical formal care to people with dementia at home. Training is paramount if this workforce is to provide care effectively and achieve the ideals of the Irish National Dementia Strategy. This study examined the process of implementing a QQI-FET level 5 accredited dementia home care education programme for Healthcare Assistants (Home Support), specifically designed with an emphasis on self-development and ethical and strengths-based approaches to care.

Methods

This study was primarily a qualitative study conducted over five months. Semi-structured interviews were conducted with stakeholders (n=16) involved in the programme’s implementation. Focus groups (n=3) were conducted with 11 programme learners. Data on programme take-up, completion and retention rates were available for review, as were reports from external reviewers, and a sample of evaluation forms completed by learners.

Results

The programme content and its delivery were highly regarded. Implementing the programme took much longer than planned due to the Covid-19 pandemic, putting recruitment processes in place, and problems recruiting and retaining healthcare professionals to facilitate supervisory sessions. Organizational support, and motivated healthcare assistants with positive attitudes towards training were perceived to facilitate programme uptake and completion. A range of barriers were perceived to act as disincentives to programme participation, e.g. lack of opportunities for career progression. There was strong support for rolling out the accredited programme nationwide and maintaining its in-person format. An alternative shortened non-accredited version of the programme would be welcomed by stakeholders in some areas.

Conclusion

This qualitative study provides a rich and nuanced perspective on a dementia home care education programme for healthcare assistants (Home Support), challenges encountered during programme implementation and changes needed to optimize implementation. The findings can be used to support strategic and operational decision-making for enhancing programme implementation.
Prevalence of Osteoporosis and Indications for Bone-Treatment In Older Adults Living with Frailty Enrolled in a Local Integrated Care Programme
Authors: Hamza Alaa , Koay Wen Jie , Alvarez Via , Leahy Aoife
Published: September 2024

Background

Osteoporosis is estimated to affect more than 250,000 adults in Ireland, with 29.4% (€463.3 million) of the total healthcare cost attributable to osteoporosis-related fracture management, resulting in significant health and economic impact.(1,2) As such, early identification of osteoporosis and addressing associated risk factors are crucial steps in reducing osteoporosis-associated morbidity and mortality. This retrospective audit aims to assess the prevalence of osteoporosis and indications for initiating bone treatment among older adults living with frailty enrolled in the Limerick Integrated Care Programme for Older Persons (ICPOP).

Methods

All older adults attending ICPOP between 01/06/2023 to 29/02/2024 were included in the data collection. Data collected included patient age, gender, presence of vitamin D deficiency (<50), presence of osteopenia or osteoporosis via DEXA scan results, history of fragility fractures, and bone health treatment and its indication.

Results

A total of 310 patients (192 female, 118 male; age 70–98) attended ICPOP during the specified time period. DEXA scans identified osteopenia in 109 patients and osteoporosis in 69 patients. 86 patients experienced a history of fragility fractures, of which 30 were confirmed to have osteoporosis on DEXA. 93 patients (30.3%) displayed vitamin D deficiency, with the majority (81.7%) not previously receiving vitamin D supplementation. 151 patients were in receipt of bone treatment, of which 86 patients (56.9%) were newly commenced on bone treatment following interaction with ICPOP. The indications were osteoporosis on DEXA scan (44 patients), history of recent fragility fracture (20 patients), and high FRAX score (22 patients).

Conclusion

The increase in detection of risk factors and presence for osteoporosis, and initiating bone health treatment, achieved by way of an integrated care programme for older persons highlights the importance of proactive screening and timely initiation of treatment.
The Prevalence of Sarcopenia and its Impact on Function In Older Adults In a Rehabilitation Unit
Authors: Mullins Claire , King Lorna , Sayers Karen , Donnellan Christina
Published: September 2024

Background

Sarcopenia is the leading cause of declining physical functioning and is a significant component of frailty, sharing similar characteristics. It is prevalent among older adults undergoing rehabilitation and is a negative predictor of functional recovery.

Methods

A retrospective cohort study was undertaken in a Rehabilitation Unit from January to March 2024. Variables included age, gender, mBarthel Index (mBI), Clinical Frailty Scale (CFS), hand grip strength and Timed Up and Go (TUG). The European Working Group on Sarcopenia for Older People criteria was utilised to interpret hand grip strength and TUG scores.

Results

Sixty-four patients, 33 (52%) male and 31 (48%) female were included. The mean age was 78 years (SD = 8.13). Fifty-five (86%) had their grip strength assessed, of which 20 (36%) had probable sarcopenia. Nineteen patients (95%) with probable sarcopenia had a TUG completed with a mean of 59.88 (SD = 28.86) seconds. In the non-sarcopenia group, 33 (94%) had a TUG assessment with a mean of 53.21 (SD = 39.82) seconds. The median CFS was 6 (IQR: 6, 6.5) in the probable sarcopenia group and also 6 (IQR: 5, 7) in the non-sarcopenia group. The median mBI of those with probable sarcopenia was 10 (IQR: 7, 14) compared to 12 (IQR: 8, 14) in the non-sarcopenia group. The probable sarcopenia group was significantly older (mean: 81.7, SD = 7.92) than the non-sarcopenia group (mean: 75.8, SD = 8.05), (P = 0.011). There was no significant difference in the median length of stay (LOS) between the probable sarcopenia group: 29 days (IQR: 24.5, 42.5), and the non-sarcopenia group: 28 days (IQR: 18, 49), (P = 0.51). There was no difference in rate of home discharge between the probable sarcopenia group (80%) and the non-sarcopenia group (82.8%), (P = 1.00).

Conclusion

Sarcopenia is often overlooked in clinical practice, however, it is reversible with multi-component targeted interventions such as nutritional care and resistance training.
Who wants to be a geophysicist?
Authors: Jenkins J , Gilligan Amy , Bie Lidong
Published: September 2024

Why aren't students signing up to study geophysics? Are they unaware of how in-demand it is? Or are they just too cool for geophysics school?
Phase transition and ionic conductivity of pyrrolidinium-based ionic plastic crystals with magnesium salts
Authors: Hirotsu Yoshifumi , Sekiguchi Ryotaro , Takeoka Yuko , Rikukawa Masahiro , Yoshizawa-Fujita Masahiro
Published: September 2024

Despite being safe for use in secondary Mg batteries, solid electrolytes exhibit lower ionic conductivities than those of traditional liquid electrolytes. Organic ionic plastic crystals—soft crystals with excellent thermal and electrochemical stabilities and ionic conductivities—are promising solid electrolytes. Herein, we investigated the effects of various anion species and Mg salt concentrations on the properties of pyrrolidinium-based organic ionic plastic crystals (N,N-diethylpyrrolidinium bis(fluorosulfonyl)amide [[C2epyr][FSA]] and N,N-diethylpyrrolidinium bis(trifluoromethylsulfonyl)amide [[C2epyr][TFSA]]) upon Mg(TFSA)2 addition. The Mg-ion transference number (tMg2+) was measured using the Vincent–Bruce method; ionic conductivity via impedance measurements; and phase transition via differential scanning calorimetry. The phase transition behavior, dissociation state of the Mg salt, and electrochemical properties varied with the organic ionic plastic crystal anionic structure. The FSA system became liquid when the Mg salt concentration exceeded 15 mol%. The ionic conductivity of the pyrrolidinium-based organic ionic plastic crystals increased substantially with the Mg salt concentration. In the solid state, [C2epyr][FSA]/Mg(TFSA)2 (5 mol%) (FT5) showed the highest ionic conductivity (2.9 × 10−4 S cm−1 at 25 °C). The tMg2+ of FT5 at 60 °C was 0.29. Mg exhibited redox behavior in FT5 but not in [C2epyr][TFSA]/Mg(TFSA)2 (5 mol%). The FSA− structure is suitable for Mg electrochemistry and will aid in developing high-performance secondary Mg batteries.
Information management – the realities
Authors: Bales Vivienne
Published: September 2024

Information management (IM) has been promoted as the panacea for all evils in recent times. I am sure yon all remember the early days of IT when it was the answer to all the problems of industry worldwide. I would like to give you my definition of IM and what it can do rather than what the media would lead you to believe. IM is one of the oldest professions, it may be better known as librarianship or information science, Under any name the science of managing information is a necessary part of life today. Unfortunately this protession has an image problem: to many people the bespectacled mouse of a librarian as played by Ronnie Corbett in the television sitcom ‘Sorry’ is a true representation, But there have been a great many advances made by the information profession in recent years. The information professionals have embraced the benefits which are promised by computers and they have taken the lead in research into these benefits,
Continuous speech processing - myth or reality?
Authors: Woollaston Bernie
Published: September 2024

The IT industry has become used to the concept of computers recognising human voice commands. There is still however, a wide lack of understanding of the difference between recognising voices, or isolated words and, more recently, true continuous speech recognition. At present, all commercially available voice recognition systems are only able to recognise individual words, requiring the author to use unnaturally punctuated speech to dictate.
Voyaging through strange seas
Authors: Tatham Peter
Published: September 2024

‘Forget all the advertising hype -just how practical and how effective is a word processor driven by an automatic speech recogniser?’

That was the question I set myself having obtained the use of a PC-based Automatic Speech Recogniser (ASR) loaded with Dragon Dictate Software. (see p22)
Document creation by voice
Authors: Hunt Melvyn
Published: September 2024

This paper is concerned with one of the major applications of speech recognition, namely speech input for text generation, and it describes DragonDictate, a commercial product designed for this task.
Sudden Cardiac Death Initiative: A National Campaign to Raise Awareness of Sudden Cardiac Death
Authors: Sobhy Mohamed , Khamis Hazem , Mehanna Radwa , Elshal Ahmed , Ghanem Noha
Published: September 2024

Introduction

Moderate aerobic exercise is widely recognized for lowering the risk of coronary heart disease and mortality. However, for individuals with certain heart conditions, exercise can paradoxically increase the risk of sudden cardiac death (SCD), the leading cause of sudden death among athletes. Despite its rarity, with an estimated occurrence of 1 in every 40,000 to 80,000 athletes annually, SCD has a profound emotional and social impact on communities.

Aim

The Sudden Cardiac Death Initiative aims to reduce the incidence of SCD in Egypt by enhancing community health education and raising awareness among the public and athletes about the risks and preventive measures associated with SCD. The initiative also seeks to provide essential first aid and CPR training and equip sports facilities with Automated External Defibrillators (AEDs).

Methods

The initiative is a collaboration between the Cardiovascular Research Education and Prevention (CVREP) Foundation, Wadi El Neel Hospital, the Egyptian Ministry of Health and Population, the Ministry of Youth and Sports, and Expand (one of ICOM Group). It was launched on June 14, 2024, during the CardioAlex 2024 Conference at Bibliotheca Alexandrina. The event featured educational videos, presentations on SCD cases, and discussions on cardiovascular disease risks and prevention strategies led by Dr. Mohamed Sobhy and Dr. Hazem Khamis.

Key activities included:Awareness sessions with over 300 attendees, assessed through pre- and post-session evaluations.First aid and CPR training programs.Supplying sports facilities with AEDs and other critical medical equipment.

Results

Initial outcomes indicated a significant increase in awareness and engagement from sports club presidents and representatives. The initiative highlighted the importance of addressing SCD through community education and improved medical alertness in sports facilities.

Conclusion

The Sudden Cardiac Death Initiative is a crucial step toward reducing SCD risks in Egypt. By focusing on awareness, education, and equipping sports facilities with advanced medical equipment, the initiative aims to save lives and enhance the safety and well-being of athletes and the general population. Continued collaboration among the Ministry of Health and Population, Ministry of Youth and Sports, CVREP, Wadi El Neel Hospital, and Expand is essential to the sustained impact of this initiative.
V-pipe 3.0: a sustainable pipeline for within-sample viral genetic diversity estimation
Authors: Fuhrmann Lara , Jablonski Kim Philipp , Topolsky Ivan , Batavia Aashil A , Borgsmüller Nico , Baykal Pelin Icer , Carrara Matteo , Chen Chaoran , Dondi Arthur , Dragan Monica , Dreifuss David , John Anika , Langer Benjamin , Okoniewski Michal , du Plessis Louis , Schmitt Uwe , Singer Franziska , Stadler Tanja , Beerenwinkel Niko
Published: September 2024

The large amount and diversity of viral genomic datasets generated by next-generation sequencing technologies poses a set of challenges for computational data analysis workflows, including rigorous quality control, scaling to large sample sizes, and tailored steps for specific applications. Here, we present V-pipe 3.0, a computational pipeline designed for analyzing next-generation sequencing data of short viral genomes. It is developed to enable reproducible, scalable, adaptable, and transparent inference of genetic diversity of viral samples. By presenting 2 large-scale data analysis projects, we demonstrate the effectiveness of V-pipe 3.0 in supporting sustainable viral genomic data science.
Altered Lignin Accumulation in Sorghum Mutated in Silicon Uptake Transporter SbLsi1
Authors: Rivai Reza Ramdan , Yamazaki Kiyoshi , Kobayashi Masaru , Tobimatsu Yuki , Tokunaga Tsuyoshi , Fujiwara Toru , Umezawa Toshiaki
Published: September 2024

Sorghum [Sorghum bicolor (L.) Moench] has been receiving attention as a feedstock for lignocellulose biomass energy. During the combustion process, ash-containing silicon (Si) can be produced, which causes problems in furnace maintenance. Hence, lowering Si content in plants is crucial. However, limiting Si supply to crops is difficult in practice because Si is abundant in the soil. Previously, an Si uptake transporter (SbLsi1) has been identified, and an Si-depleted mutant has also been generated in the model sorghum variety BTx623. In this study, we aimed to investigate the changes induced by a mutation in SbLsi1 on the accumulation and structure of lignin in cell walls. Through chemical and NMR analyses, we demonstrated that the lsi1 mutation resulted in a significant increase in lignin accumulation levels as well as a significant reduction in Si content. At least some of the modification was induced by transcriptional changes, as suggested by the upregulation of phenylpropanoid biosynthesis-related genes in the mutant plants. These findings derived from the model variety could be useful for the future development of practical cultivars with high biomass and less Si content for bioenergy applications.
Naringenin chalcone carbon double-bond reductases mediate dihydrochalcone biosynthesis in apple leaves
Authors: Yauk Yar-Khing , Dare Andrew P , Cooney Janine M , Wang Yule , Hamiaux Cyril , McGhie Tony K , Wang Mindy Y , Li Pengmin , Atkinson Ross G
Published: September 2024

Dihydrochalcones (DHCs) are flavonoids produced as a side branch of the phenylpropanoid pathway. DHCs are found at high concentrations in apples (Malus spp.) but not in pears (Pyrus spp.) or other members of the Rosaceae. Biosynthesis of DHCs in apple has been hypothesized to occur via reduction of p-coumaroyl CoA by a Malus × domestica hydroxycinnamoyl CoA double-bond reductase (MdHCDBR) followed by the action chalcone synthase to produce phloretin or via direct reduction of naringenin chalcone to phloretin via an unknown enzyme. In this study, we report that genetic downregulation of MdHCDBR does not reduce DHC concentrations in apple leaves. We used comparative transcriptome analysis to identify candidate naringenin chalcone reductases (NCRs), designated MdNCR1a–c, expressed in apple leaves but not fruit. These MdNCR1 genes form an expanded gene cluster found exclusively in apple. Transient expression of MdNCR1 genes in Nicotiana benthamiana leaves indicated they produced DHCs at high concentrations in planta. Recombinant MdNCR1 utilized naringenin chalcone to produce phloretin at high efficiency. Downregulation of NCR genes in transgenic apple reduced foliar DHC levels by 85% to 95%. Reducing DHC production redirected flux to the production of flavonol glycosides. In situ localization indicated that NCR proteins were likely found in the vacuolar membrane. Active site analysis of AlphaFold models indicated that MdNCR1a–c share identical substrate binding pockets, but the pockets differ substantially in related weakly active/inactive NCR proteins. Identifying the missing enzyme required for DHC production provides opportunities to manipulate DHC content in apple and other fruits and has other applications, e.g. in biofermentation and biopharming.