bluuebunny/crossref_metadata_2025 huggingface dataset:
236 PREDICTORS OF ADVERSE OUTCOMES IN OLDER PATIENTS DISCHARGED DIRECTLY FROM THE EMERGENCY DEPARTMENT
Authors: Mohamed A , Gabr A , Cassarino M , Leahy A , Ali B , Okpaje B , Saleh A , Mannion M , Carroll I , Hayes C , Peters C , Shanahan E , O'Connor M , Galvin R
Published: February 2023

Background

Over 40% of older patients are discharged directly from the Emergency Department (ED) and this cohort is at increased risk of adverse outcomes.

The purpose of this study was to explore the factors that predict future adverse outcomes in this cohort to inform practice, resource planning and policy.

Methods

A secondary analysis of the OPTIMEND, a single-centre, randomized-controlled trial was completed. OPTIMEND examined the effectiveness of an intervention by a team of Health and Social Care Professionals along with usual care and compared this to standard ED care alone (Dec 2018-May 2019). The inclusion criteria were adults aged 65 years and over presenting to the ED at a University Teaching Hospital with medical complaints and a Manchester Triage System category 2–5.

Results

220 patients were included (median age 79 years; 62% female). Median length of stay in ED was 5.5 hrs. 70 patients re-attended the ED within 6 months with 43 re-hospitalised within 6 months. 9 patients died within six months of discharge.

Multivariant logistic regression was completed. Age was the only independent predictor of mortality within six months of discharge {Odds Ratio (OR) 1.15, p = 0.044}. Past hospitalisation (<6 months) was associated with a lower likelihood of ED re-attendance, and rehospitalization within six months of discharge (OR: 0.452 p = 0.022; OR:0.442, p = 0.046; respectively). Clinical Frailty Score was associated with a significantly higher likelihood of rehospitalization (OR:1.48, p = 0.031) but not with ED revisits (OR: 1.235, p = 0.165).

Conclusion

Older people have a high ED re-attendance rate of 33% after an index visit with 20% hospitalized subsequently. Frailty is a significant predictor of rehospitalisation. Rapid and targeted intervention for frail patients who reattend the ED should be a priority for the integrated care program to enhance admission avoidance.
243 MEASURED FRAILTY AND POTENTIALLY INAPPROPRIATE PRESCRIBING IN ACUTELY HOSPITALISED OLDER ADULTS: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Randles M , Gallagher P , O'Mahony D
Published: February 2023

Background

Frailty characteristics such as compromised response to stressors and accumulation of deficits in physiological systems may leave frailer older adults at higher risk of adverse outcomes from PIP, compared with their non-frail counterparts of the same age. This study aims to examine the relationship between measured frailty and potentially inappropriate prescribing in older adults presenting acutely to hospital.

Methods

A prospective observational study was conducted. Participants were acutely hospitalised older adults. Inclusion Criteria: Age ≥ 65 years old, acute admission <72 hours, expected length of stay >24 hrs. Exclusion Criteria: <65 years of age, actively dying, direct admission to ICU, inability to provide informed consent and next of kin declined consent, patients in isolation for infection control purposes. Medical chart review was carried out, followed by a short interview using a standardised data collection proforma. Frailty was measured using the Clinical Frailty Scale and the Frail-VIG frailty index. Potentially Inappropriate Prescribing was identified using the STOPP/START criteria. Results are presented for the first 200 participants.

Results

The mean (±standard deviation [SD]) age of study participants was 79.25[±7.14], 56.5% were female. The prevalence of frailty measured using the CFS and Frail-VIG were 61.5% and 50.5% respectively. Applying the CFS, the mean number of STOPP criteria in non-frail patients was 1.03 and 1.87 for frail patients (p = 0.001 CI 95%) and 1.14 and 2.10 (p = 0.001 CI 95%) using the Frail-Vig Index.

Conclusion

Frailty is associated with functional decline, falls, hospitalisation and death. Frail patients had a higher mean number of STOPP criteria. As medication side effects are themselves included as part of the frailty syndrome, in-hospital medication review and patient centred medication optimisation should be guided by patient’s frailty status to reduce adverse outcomes.
248 UNINTENDED CONSEQUENCES: DID THE PANDEMIC LEAD TO REDUCED REHABILITATION LENGTH OF STAY POST HIP FRACTURE?
Authors: McDaid E , Tiernan C , Cogan L
Published: February 2023

Background

The aim of this study was to compare hip fracture rehabilitation outcomes during the COVID-19 pandemic (2020 data) against comparable control data (2015–2019). Variables examined included patient demographics, time to transfer (acute length of stay), rehabilitation length of stay and discharge destination.

Methods

An audit was completed using the local anonymised hip fracture data collected during 2020. This data is collected as part of an ongoing quality improvement initiative to improve the hip fracture rehabilitation pathway. A review of previous local annual hip fracture reports was completed to allow comparison of key outcomes.

Results

For the control period (2015–2019) the mean number of hip fractures admitted per year was 98 compared to 59 during 2020 (periods of closure). During the control period, 78% of admissions were female and mean age was 82 which is similar to 2020 with 83% females mean age of 83. Almost half of patients lived alone (49%) which is similar to the control period (48%). Despite the added complexity to the transfer process (swabbing and isolation) the mean time to transfer from acute was reduced by 1 day. The mean post-acute rehabilitation length of stay significantly reduced in 2020 to 37 days compared to 49 days during the control period. There was a reduction in number of patients who discharged home, 88% in 2020 compared to 93% in control period. This is reflected in the increased number who discharged to nursing home care, 7% in 2020 compared to 4% in control period.

Conclusion

There may be multiple contributing factors that led to the significant reduction in rehabilitation length of stay including increased rehabilitation staffing ratios during the pandemic due to reduced occupancy, expedited home support services, increased community response teams and patient and family wish to accelerate discharge secondary to concerns of risk of COVID-19 exposure in the hospital setting.
26 A COLLABORATIVE QUALITY IMPROVEMENT PROJECT BETWEEN AN NHS TRUST AND INDEPENDENT PROVIDER TO DEVELOP A CARE-HOME SPECIFIC ELECTRONIC NURSING HANDOVER
Authors: Trolan C
Published: February 2023

Background

The COVID19 pandemic highlighted deficiencies in information exchange in nursing handover in an intermediate care unit, based in a 30 bed independent care home, into which the hospital organisation assigns a multidisciplinary team to provide post-acute care rehabilitation for adults. Mean length of stay is 20 days and > 75% return home. Weekly bed turnover is approximately 15%. A revised electronic template was developed to complement an Intermediate Care Framework already in use, based on National Audit of Intermediate Care quality indicators.

Methods

Semi-structured interviews with nursing leaders and a weighted questionnaire for the whole nursing team were used to determine baseline levels of confidence around aspects of nursing handover.

An Ishikawa diagram analysed factors contributing to poor documentation and communication. The ‘Chain Of Care’ vision for care home environments incorporated the need for microsystem-tailored, standardised, integrated nursing handover. Four iterations occurred. A post-implementation weighted questionnaire collated qualitative information on confidence change.

Results

Areas of greatest ‘swing’ towards INCREASED or SLIGHTLY INCREASED confidence around...: 70%, addressing questions from residents or relatives; 70%, responding to change in a resident’s health status; 70%, giving handover to ambulance crew or doctor or fellow nurse.

Conclusion

Categorical selections across multiple information domains enabled increased/slightly increased confidence in the nursing team in the quality of the information exchanged in nursing handover in an intermediate care rehabilitation care-home setting. Focussed, free-text options permit narrative if required.

A shared electronic template facilitated accessibility and live-time editing in an environment with relatively higher bed-turnover and frequently changing functional mobility and care needs of residents.

Tailoring the nursing handover to the intermediate care environment with mitigation of variation of information provision/accessibility/language were considered in the iterations. Versions are reposited for inspectors.
28 A COLLABORATIVE QUALITY IMPROVEMENT PROJECT BETWEEN AN NHS TRUST AND INDEPENDENT PROVIDER TO DEVELOP A CARE-HOME SPECIFIC MULTIDISCIPLINARY SAFETY BRIEF
Authors: Trolan C
Published: February 2023

Background

The COVID19 pandemic highlighted deficiencies in interdisciplinary risk-communication in an intermediate care unit, based in a 30 bed independent care home, into which the hospital organisation assigns medical, pharmacy, physiotherapy, occupational therapy and social work teams to provide post-acute care rehabilitation for adults. Mean length of stay is 20 days and > 75% return home. Weekly bed turnover is approximately 15%.

Methods

Semi-structured interviews with nursing leaders and a weighted questionnaire for multidisciplinary team were used to determine baseline levels of confidence around environmental and resident-specific risk awareness.

An Ishikawa diagram analysed factors contributing to risk-communication. The ‘Chain Of Care’ vision for care home environments incorporated a Multidisciplinary Safety Brief. Five iterations occurred before reaching standardisation. A post-implementation weighted questionnaire collated qualitative information on confidence change.

The Safety Brief supplements intra-professional group handover processes. Duration ranged 90-120 seconds, occurring at shift commencement and 12.00 h daily. Retained documentation is available for inspectors.

Results

The Safety Brief as a communication tool: 86% of the team found it useful; 71% found that it had the ‘right amount’ of detail; and 62% found that it was of the ‘right duration’.

Areas of greatest ‘swing’ towards INCREASED or SLIGHTLY INCREASED confidence in awareness of...: 72%, deaths in last 24 hours; 68%, planned discharges today; 67%, residents at risk of falling/had fallen within 48 hours; 67%, residents with same name; 66%, bed-availability; 63%, infection risks; 62%, experiencing delirium; 62%, living with dementia; 59%, scheduled appointments today; and 52%, those receiving palliative care.

Conclusion

A Multidisciplinary Safety Brief increased/slightly increased multidisciplinary team confidence in environmental and resident-specific risks in a care home environment. Risk-communication in any environment is complex especially if subject to frequent change. Communication tools need to be tailored to microsystem, systematic, comprehensive, yet brief and intuitive. Generalisability to non-intermediate care, non-geriatrician supported care home environments was considered iteratively.
36 A YEAR WITHOUT THE FLU: MODELLING THE EFFECTS ON CARDIOVASCULAR MORTALITY FROM INFLUENZA IN IRELAND
Authors: Choo E , Harbison J
Published: February 2023

Background

Cardiovascular diseases (CVDs) are consistently ranked among the leading causes of death among older adults in Ireland. COVID-19 and influenza infection are associated with cardiovascular complications. However, percentage of deaths caused by CVD among adults aged 75 and over in Ireland decreased from 32.9% to 31.0% from 2019 to 2020. Government-imposed social distancing measures resulted in abolition of influenza activity (IA). We analysed population data from the 2010/11–2019/20 influenza seasons to estimate the impact of reduced IA on CVD mortality rates during the COVID-19 pandemic season.

Methods

Quarterly mortality data for acute myocardial infarction (AMI) and cerebrovascular disease from first quarter (Q1) 2010 to fourth quarter (Q4) 2020 was obtained from the Central Statistics Office. Weekly data on influenza-like illness (ILI) rates and positive percentages (PP) (i.e. proportion of influenza-positive sentinel respiratory specimens) from week 40 2010 to week 20 2020 was obtained from the Health Protection Surveillance Centre. Excess mortality rate during influenza season was calculated as the percentage difference between Q4/Q1 and preceding third quarter (Q3) mortality rates. We adopted the Goldstein index (ILI rate × PP) as an indicator of IA. Time series analyses, Pearson correlation coefficients (r) and linear regression models were used to evaluate the relationships between IA and excess AMI and cerebrovascular disease mortality rates.

Results

Statistically significant positive associations were observed between IA and excess AMI (r = 0.557, p = 0.011) and cerebrovascular disease (r = 0.858, p < 0.001) mortality rates. Linear regression models predicted 0.072% (95% confidence interval 0.019%, 0.125%) and 0.095% (0.067%, 0.123%) increases in excess AMI and cerebrovascular disease mortality rates respectively per unit increase in IA levels.

Conclusion

Elimination of IA may have contributed towards limiting the effects of COVID-19 on CVD mortality rates, and consequently total excess mortality, among older adults in Ireland.
39 CAN CARE ROBOTS ASSIST OLDER PEOPLE AND LONG-TERM CARE SYSTEMS? KEY STAKEHOLDERS’ PERCEPTIONS IN HONG KONG SAR, CHINA AND IRELAND
Authors: Kodate N , Donnelly S , Cheung M-c , Maeda Y , Mannan H , Chan WC-h , O'Shea D
Published: February 2023

Background

Robotics is now seen as part of the solution to the ageing population internationally, and is deployed in care settings. Care robots are designed to enable active ageing as well as ageing in place, with support to older persons, their families, and care professionals. The aim of this study was to understand the perceptions of stakeholders in Hong Kong and Ireland regarding the current state of affairs surrounding the use of care robots in their jurisdictions.

Methods

Semi-structured, in-depth interviews were conducted with 30 experts (15 from each jurisdiction). The participants included care professionals, service providers, researchers, and advocacy group representatives and policymakers. The questions explored their knowledge of and perceptions regarding the current use of assistive technologies, long-term care systems, and their own future vision of care provision for old age.

Results

In both jurisdictions, the use of care robots is relatively new, although many respondents were familiar with the seal robot PARO and the humanoid robot Pepper. In Hong Kong, a gerontechnology-specific exposition has become an annual feature in recent years, and the government’s investment has stepped up. In Ireland, a more general ehealth agenda has been adopted within the government’s planned care reform (Sláintecare). Older people in Hong Kong and Ireland are believed to fall through the cracks in their respective two-tier care systems, and many respondents stated that care robots are most needed in order to fill the gaps (e.g. safety monitoring, mobility support). Concerns regarding the impact of using robots included a possible reduction in human-to-human contact and deskilling of older people themselves.

Conclusion

There was a sense of urgency in both jurisdictions that more smart and digital technologies should be utilised to ease the pressures on care professionals and systems. However, a degree of optimism was noted for technological leapfrogging after the pandemic.
43 REDUCED KIDNEY FUNCTION IS ASSOCIATED WITH POORER GLOBAL AND DOMAIN-SPECIFIC COGNITIVE PERFORMANCE IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Dyer A , Laird E , Hoey L , Hughes C , McNulty H , Ward M , Strain J J , Molloy A , Cunnningham C , Sexton D , McCarroll K
Published: February 2023

Background

Chronic Kidney Disease (CKD) is an important risk factor in the development of cognitive impairment. However, the association between reduced estimated Glomerular Filtration Rate (eGFR) and performance on domain-specific cognitive and neuropsychological assessments is less clear and may represent an important target in the promotion of optimal brain health in older adults.

Methods

Participants from the Trinity, Ulster and Department of Agriculture cohort study underwent detailed assessment of cognitive and neuropsychological function using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Mixed-effects Poisson and linear regression was used to assess the relationship between eGFR strata and cognitive/neuropsychological test performance.

Results

4,887 participants were included (73.94 ± 8.25 years; 67.7% female). Reduced eGFR was associated with poorer performance on all three cognitive assessments, most pronounced in those with eGFR <45 mL/mL/1.73m2 (IRR: 1.19; 95% CI: 1.09, 1.29; p < 0.001 for MMSE/IRR: 1.14; 95% CI 1.04, 1.24; p < 0.001 for the FAB/β: -3.23; 95% CI -5.18, −1.30; p = 0.001 for RBANS, fully adjusted). Reduced eGFR was associated with poorer performance on immediate memory, visual–spatial and attention RBANS domains. Associations were strongest in the youngest old (<70 years) with no association observed in those aged >80 years.

Conclusion

Reduced kidney function was associated with poorer global and domain-specific function in community-dwelling older adults. Associations were strongest for those with eGFR <45 mL/min/1.73m2 and the youngest-old, suggesting that this group may be most at risk and may benefit from potential preventative interventions.
50 A COMPARISON OF FRAILTY SCREENING TOOLS WITHIN THE EMERGENCY DEPARTMENT
Authors: Loughlin K M , Lyons C , McGettigan L , Maloney P
Published: February 2023

Background

Increased awareness has been given to the value of identifying frail for risk stratification and to assist in providing frailty attuned care rather than disease specific input.

This increased awareness both nationally and internationally has led to many ED’s introducing the Clinical Frailty Scale (CFS) to triage however as a service we wanted to evaluate which tool would best meet our needs to screen appropriate patients and highlight the current level of frailty within the Emergency Department.

Methods

Over a 3 day period all patients over 75 who present during core hours were screened by a senior FITT member using a number of frailty tools (CFS, THINK frail, InterRai, PRIMSA 7 & compared against our own clinical reasoning if a FITT assessment was indicated).

Results

Total Patient’s over 75 screened by screener & FITT—48.

Average age: 82.

Sex: 51.62% male.

Discharges: 57% d/c’d.

Average CFS (Screener) = 5.

Average CFS (FITT) = 5.

28/48 CFS same = 58.33%.

15/48 CFS differ by 1 point = 31.25%.

Average THINK Frail (Screener): 3. 

Average THINK Frail (FITT): 2. 

17/47 THINK Frail same =36%.

21/47 THINK Frail differ by 1 point = 44%.

80.85% same or within 1 point difference.

Conclusion

The CFS score provided the most consistent when comparing scores by multiple disciplines/grades.

Although the majority of older adults who scored a CFS of 1–3 or deemed non frail at triage were unlikely to benefit from a CGA, those who presented with a new fall often did require FITT input.

This research has led us to move away from our current triage tool of THINK FRAIL to the CFS, whilst continuing to assess any new falls irrespective of score.
57 POTENTIALLY INAPPROPRIATE MEDICATION USE AND MORTALITY IN PATIENTS WITH COGNITIVE IMPAIRMENT
Authors: Buckley E , Jonsson A , Flood Z , Lavelle M , Nurdin N , Dowling P , Duggan E , O'Sullivan N , McGreevy C , Duggan J , Kyne L , McCabe J
Published: February 2023

Background

Potentially inappropriate medications (PIMs are associated with falls, hospitalisation, and cognitive decline. Few studies have investigated the association between PIMs related to cognitive impairment (PIMCog) and mortality in dementia or mild cognitive impairment (MCI).

Methods

This was a retrospective observational study. Patients diagnosed with MCI or dementia (DSM-IV criteria) presenting to a tertiary-referral memory clinic from 2013–2019 were eligible. The primary outcome was all-cause death. Secondary outcomes were vascular death and non-vascular death defined according to formal certification. The primary exposure variable of interest was PIMCog, defined as any medication in the Beers 2015 or STOPP criteria, classified as potentially inappropriate for patients with cognitive impairment. Anticholinergic burden was measured using the anticholinergic cognitive burden (ACB) scale. Polypharmacy was defined as ≥5 medications. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results

There were 418 patients included (n = 261 dementia, n = 157 MCI). The median age was 79 (interquartile range {IQR} 74–82) and median follow-up was 809 days (IQR 552–1,571). One or more PIMCog was prescribed in 141 patients (33.4%). PIMCog use was associated with all-cause mortality after adjustment for age, sex, dementia severity, Charlson Co-morbidity Index, chronic obstructive pulmonary disease, congestive cardiac failure, and peripheral vascular disease (HR 1.96, 95% CI 1.24–3.09). PIMCog use was associated with vascular death (HR 3.28, 95% CI 1.51–7.11) but not with non-vascular death (HR 1.40 95% CI: 0.78–2.52). Neither an ACB ≥3 (HR 0.87, 95% CI: 0.46–1.64) or polypharmacy (HR 1.87, 95% CI: 0.67–5.24) were associated with death.

Conclusion

The burden of PIMCog use in patients with cognitive impairment is high. PIMCog use is independently associated with all-cause mortality and vascular death. This is a potential modifiable risk factor for death in patients with neurocognitive disorders. Further research is required to independently validate this finding.
65 THE IMPACT OF SOCIAL ISOLATION DURING COVID-19 ON COGNITION IN OLDER ADULTS
Authors: McCormack R , McNally S , O'Shea D
Published: February 2023

Background

A correlation between social isolation and poorer cognitive function in later life has been increasingly implied in literature. Research indicates that maintaining a socially active lifestyle can enhance cognitive reserve and benefit cognitive function. Whereas social exclusion has been significantly associated with higher risks of cognitive impairment (Evans, et al., 2019).

Recent studies reviewed the consequences of restrictive living conditions during COVID-19, finding poorer cognitive performance (Ingram, et al., 2021). However, few services have investigated this. This study intended to explore the impact of social isolation on cognitive function of hospitalised older adults.

Methods

Quantitative measures were used. A retrospective review of cognitive results of individuals open to occupational therapy in an acute Care of the Older Person’s service in May 2018 (n = 23) were compared to cognitive results of individuals open to occupational therapy in the same acute Care of the Older Person’s service in May 2021 (n = 62).

Results

For the purpose of this study, cognitive results were compared by means of assessment results which indicated a mild, moderate or significant cognitive impairment. Of the patients seen in May 2021 (n = 62), 9.68% (n = 6) had a mild cognitive impairment, 25.81% (n = 16) had a moderate cognitive impairment and 32.26% (n = 20) presented with a significant cognitive impairment. Comparatively in May 2018 (n = 23), 30.43% (n = 7) had a mild cognitive impairment, 43.38% (n = 10) had a moderate cognitive impairment and just 4.35% (n = 1) presented with a significant cognitive impairment.

Conclusion

A substantial increase in the number of inpatients presenting with a significant cognitive impairment in an acute Care of the Older Person’s service was found between May 2018 (4.35%) and May 2021 (32.26%). This suggests that COVID-19 had a severe impact on cognitive functioning of older adults and implies that this cohort are at a high risk of cognitive decline caused by social isolation. These findings are preliminary and further research is recommended.
67 A BLENDED MODEL OF CARE USED IN THE ROLLOUT OF AN EARLY SUPPORTED DISCHARGE FOR STROKE SERVICE DURING COVID-19
Authors: Reilly E , Jana W , Dwyer S , Donohoe A , Crowley A , Foley S
Published: February 2023

Background

The Health and Social Care Professionals budget was augmented to develop rehabilitation services that facilitated hospital discharges. Early Supported discharge (ESD) for stroke is a proven model of best care for stroke patients with mild to moderate disability (Langhorne et al., 2005). A pilot was implemented with the team consisting of an Occupational Therapist, Speech and Language Therapist, Physiotherapist and Medical Social Worker.

Methods

The service facilitated an early discharge from the hospital with the delivery of specialist stroke rehabilitation in the home. Therapy is provided with the same intensity and expertise that would be received in hospital and is available for up to 8 weeks, it was provided using a blended model of domiciliary care and the introduction of telehealth in response to COVID 19.

Data was recorded for 100 service users using an excel spreadsheet. Data was recorded to measure number of new referrals, length of stay, bed days released back into the hospital system, mode of service delivery and functional outcomes. A cost analysis was completed. Service user experience was captured using questionnaires.

Results

From September 2020 to July 2021, 100 patients accessed ESD with a reduction of 7.2 days in hospital stay per patient. Improvements in pre- and post- rehabilitation scores on the FIM/FAM were evident. Very positive feedback regarding the rehabilitation experience was captured within the patient satisfaction questionnaire. Therapy delivery was 60% face to face, 37% via telehealth and 3% outpatient appointments. Telehealth received good compliance but with varying reports of experience in comparison to face to face.

Conclusion

ESD provided in the home environment facilitated earlier discharge from hospital with positive outcomes for the hospital and service users. Telehealth ensured that rehabilitation was maintained throughout the pandemic. Telehealth increased access for patients residing outside of the catchment area. However service user preference remains face to face.
75 EXPERIENCES OF HEALTH SERVICE USE FOR PEOPLE LIVING WITH PARKINSON’S DISEASE: A NATIONAL SURVEY
Authors: O'Shea E , Rukundo A , Timmons S
Published: February 2023

Background

Despite the growing prevalence of Parkinson’s disease (PD), and the need to plan for future health service provision, very little is known in the Irish context about PD patients’ experience of health services.

Methods

A cross-sectional survey design, with multiple formats, i.e. online, pen-and-paper, and telephone. Data were collected from May 2020–July 2021 using a multipronged recruitment strategy. It could be completed by a person with PD, or a support person on behalf of/with the person. Survey development was informed through literature review, and in consultation with the Parkinson’s Association of Ireland, and a patient advisory group (N = 10).

Results

A total of 1,504 individuals accessed the survey, with 1,402 meeting the eligibility criteria. Over half (53%) were male, and the distribution across Ireland’s provinces was: Leinster (46%); Munster (28%); Connaught (19%); and Ulster (7%). Approx. 5% were diagnosed with young-onset PD. A minority (6%) reported attending only their GP to manage their PD, with the rest attending a specialist outpatient clinic. The mean distance travelled each-way to outpatient clinics was 45.6 km (SD = 49.4, min 1 km, max. 300kms). Most were diagnosed by Neurologists (84%), followed by GPs (8%), and Geriatricians (7%); 1% indicated ‘other’. Of those diagnosed by a Neurologist or Geriatrician, most were diagnosed privately (68%); though 37% of these patients subsequently switched to the public system for ongoing management. The majority (97%) reported currently taking PD medications, but just 52% believed these were working effectively. Just over one-fifth (22%) had access to a PD nurse specialist. Access to the range of other health and social care professionals is also very poor for this patient group.

Conclusion

A number of significant gaps in PD care have been identified, which require urgent attention. A reconfigured model of PD care is necessary to accommodate the growing need for specialist, integrated care at the population level.
CLAIRE: contrastive learning-based batch correction framework for better balance between batch mixing and preservation of cellular heterogeneity
Authors: Yan Xuhua , Zheng Ruiqing , Wu Fangxiang , Li Min
Published: February 2023

Motivation

Integration of growing single-cell RNA sequencing datasets helps better understand cellular identity and function. The major challenge for integration is removing batch effects while preserving biological heterogeneities. Advances in contrastive learning have inspired several contrastive learning-based batch correction methods. However, existing contrastive-learning-based methods exhibit noticeable ad hoc trade-off between batch mixing and preservation of cellular heterogeneities (mix-heterogeneity trade-off). Therefore, a deliberate mix-heterogeneity trade-off is expected to yield considerable improvements in scRNA-seq dataset integration.

Results

We develop a novel contrastive learning-based batch correction framework, CIAIRE, which achieves superior mix-heterogeneity trade-off. The key contributions of CLAIRE are proposal of two complementary strategies: construction strategy and refinement strategy, to improve the appropriateness of positive pairs. Construction strategy dynamically generates positive pairs by augmenting inter-batch mutual nearest neighbors (MNN) with intra-batch k-nearest neighbors (KNN), which improves the coverage of positive pairs for the whole distribution of shared cell types between batches. Refinement strategy aims to automatically reduce the potential false positive pairs from the construction strategy, which resorts to the memory effect of deep neural networks. We demonstrate that CLAIRE possesses superior mix-heterogeneity trade-off over existing contrastive learning-based methods. Benchmark results on six real datasets also show that CLAIRE achieves the best integration performance against eight state-of-the-art methods. Finally, comprehensive experiments are conducted to validate the effectiveness of CLAIRE.

Availability and implementation

The source code and data used in this study can be found in https://github.com/CSUBioGroup/CLAIRE-release.

Supplementary information

Supplementary data are available at Bioinformatics online.
Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials
Authors: Davey Matthew G , Browne Ferdia , Davey Martin S , Walsh Stewart R , Kerin Michael J , Lowery Aoife J
Published: February 2023

Background

At present, there is no consensus on optimal neck wound closure methods after thyroid and parathyroid surgery. The aim of this study was to perform a systematic review and network meta-analysis of RCTs evaluating the optimal neck closure method after thyroid and parathyroid surgery.

Methods

A frequentist random-effects network meta-analysis was performed for RCTs comparing at least two closure methods according to PRISMA-network meta-analysis guidelines. Analysis was performed using R packages and Shiny.

Results

Eighteen RCTs evaluating six closure methods (that is adhesive (28.5 per cent, 404 patients), absorbable subcuticular suture (18.1 per cent, 257 patients), non-absorbable subcuticular suture (16.8 per cent, 238 patients), staples (26.3 per cent, 372 patients), steristrips (8.1 per cent, 115 patients), and conventional suture (2.1 per cent, 30 patients)) in 1416 patients were included. At network meta-analysis, there was no difference in complication, infection, dehiscence, or haematoma rates irrespective of closure method used. Staples reduced closure duration versus absorbable subcuticular suture (mean difference (MD) 8.50, 95 per cent c.i. 6.90 to 10.10) and non-absorbable subcuticular suture (MD 0.30, 95 per cent c.i. 0.23 to 0.37), whereas adhesives (MD −1.05, 95 per cent c.i. −1.31 to −0.79) reduced closure time relative to staples. Cosmesis was improved after non-absorbable subcuticular suture (odds ratio (OR) 3.41, 95 per cent c.i. 1.66 to 7.00) relative to staples. Staples reduced patient satisfaction (OR 0.04, 95 per cent c.i. 0.00 to 0.33) and ability to shower (OR 0.04, 95 per cent c.i. 0.00 to 0.33) relative to adhesives.

Conclusion

Despite staples decreasing closure times, this advantage is offset by reduced patient satisfaction, ability to shower, and cosmesis compared with patients with wounds closed using adhesives, absorbable subcuticular suture, and non-absorbable subcuticular suture. Therefore, these closure methods are favourable for closing neck wounds due to more acceptable patient-reported outcomes, without compromising the safety of the procedure.
Metabolic and microbial changes in light-vented bulbul during recent northward range expansion
Authors: Wu Yun , Xiong Ying , Ji Yanzhu , Cheng Yalin , Zhu Qianghui , Jiao Xiaolu , Chang Yongbin , Zhao Na , Yang Jing , Lei Fumin , Song Gang
Published: February 2023

Endotherms recently expanding to cold environments generally exhibit strong physiological acclimation to sustain high body temperature. During this process, gut microbes likely play a considerable role in host physiological functions, including digestion and thermogenesis. The light-vented bulbul Pycnonotus sinensis represents one such species. It used to be restricted to the Oriental realm but expanded its distribution range north to the Palearctic areas during the past few decades. Here, we explored the seasonal dynamics of the resting metabolic rate (RMR) and microbiota for local and newly colonized populations of the species. Our results showed that the mass-adjusted RMR and body mass were positively correlated with latitude variations in both seasons. Consistently, the gut microbiota showed a corresponding variation to the northern cold environments. In the two northern populations, the alpha diversity decreased compared with those of the two southern populations. Significant differences were detected in dominant phyla, such as Firmicutes, Bacteroidetes, Proteobacteria, and Desulfobacterota in both seasons. The core microbiota showed geographic differences in the winter, including the elevated relative abundance of 5 species in northern populations. Finally, to explore the link between microbial communities and host metabolic thermogenesis, we conducted a correlation analysis between microbiota and mass-adjusted RMR. We found that more genera were significantly correlated with mass-adjusted RMR in the wintering season compared to the breeding season (71 vs. 23). These results suggest that microbiota of the lighted-vented bulbul linked with thermogenesis in diversity and abundance under northward expansion.
Non-hepatic Solid Organ Transplant in Patients with Inflammatory Bowel Disease: An ECCO CONFER Multicentre Case Series
Authors: Ribaldone Davide Giuseppe , Vieujean Sophie , Julsgaard Mette , Armandi Angelo , Zingone Fabiana , Savarino Edoardo , Cañete Fiorella , Aratari Annalisa , Imperatore Nicola , Ramos Laura , Plaza Rocio , Pugliese Daniela , Barberio Brigida , Drobne David , Chaparro María
Published: February 2023

Background and Aims

Solid organ transplantation, with the exception of liver, has rarely been reported in patients affected by inflammatory bowel diseases [IBD].

Methods

This is an ECCO-CONFER project collecting cases of solid organ transplants [with the exclusion of liver] that were performed in IBD patients. We evaluated the change in the IBD therapy, need for bowel resection due to medically refractory IBD, or need for hospitalisation due to IBD relapse [‘severe IBD course’] before and after transplantation.

Results

in total, 34 organ transplantations [28 kidney, five heart, one lung] in 33 IBD patients were collected [67% male, 55% Crohn’s disease, mean age 53 ± 16 years]. The median follow-up was 4.3 years (interquartile range [IQR] 3.2–10.7); 29 patients [87.9%] were treated with tacrolimus, 25 [76%] with systemic steroids, 22 [67%] with mycophenolate mofetil, 11 [33%] with everolimus, six with cyclosporine [18%]. One patient was treated with infliximab, two patients with adalimumab, two patients with vedolizumab, one patient with ustekinumab. Overall, a severe IBD course was observed in three [9.3%] patients before transplantation and in four [11.7%] in the post-transplant setting [p = 0.26]. Three cases of cancer [excluding skin non-melanoma] [9.1%] were recorded in the post-transplantation period versus two in the pre-transplantation period [6.1%, p = 0.04]. Six patients [18.2%] died during the period of observation. No deaths were associated with IBD or complications of the transplant.

Conclusions

In IBD patients, solid organ transplantation does not seem to impact on the IBD severity. However, the risk of malignancy needs further investigation.
Incremental prognostic value of positron emission tomography-derived myocardial flow reserve in patients with and without diabetes mellitus
Authors: Aljizeeri Ahmed , Ahmed Ahmed Ibrahim , Suliman Ihab , Alfaris Mousa Alali , Elneama Awadelkarim , Al-Mallah Mouaz H
Published: February 2023

Aims

We aimed to assess the incremental prognostic value of positron emission tomography (PET)-derived myocardial flow reserve (MFR) among patients with diabetes and those without diabetes.

Methods and results

Consecutive patients with clinically indicated PET MPI for suspected or established coronary artery disease (CAD) were included. Myocardial blood flow (MBF) in mL/min/g was obtained from dynamic images at rest and stress, while MFR was calculated as the ratio of stress to rest MBF. Patients were followed from the date of PET imaging for the occurrence of the primary outcome (composite of all-cause death, myocardial infarction, and un-planned percutaneous coronary intervention/coronary artery bypass graft occurring more than 90 days after imaging). The final cohort consisted of 6019 patients (63% with diabetes) (mean age 61 ± 11 years, 45% female, 55% obese, 76% hypertensive, and 62% dyslipidaemia). Over half (53%) of the patients had an impaired MFR (<2). During a median follow-up of 22.6 (7.8–42.5) months, 619 patients (10%, 3.8 per 1000 person-years) experienced the primary outcome. Impaired MFR (MFR < 2) was significantly associated with the primary outcome in patients with and without diabetes (diabetes: HR 1.8, 95% CI 1.4–2.3, P < 0.001; no diabetes: 1.4, 95% CI 1.0–2.1, P = 0.046). There was no interaction between diabetes status and MFR (P = 0.234). Results were consistent across subgroups of patients with no CAD and normal perfusion study.

Conclusion

PET-derived MFR has a strong independent and incremental prognostic role in patients with diabetes and those without diabetes.
Mixed Hodge Structure on Local Cohomology with Support in Determinantal Varieties
Authors: Perlman Michael
Published: February 2023

We employ the inductive structure of determinantal varieties to calculate the mixed Hodge module structure of local cohomology modules with determinantal support. We show that the weight of a simple composition factor is uniquely determined by its support and cohomological degree. As a consequence, we obtain the equivariant structure of the Hodge filtration on each local cohomology module. Finally, as an application, we provide a formula for the generation level of the Hodge filtration on these modules.
Patterns of Screening Mammography and Breast MRI During the COVID-19 Pandemic: A Retrospective, Chart-Review Study
Authors: Sivanushanthan Shankarapryan , Wu Tianmin , Wahl Anastacia , Li Tengfei , Luta George , Song Judy H , O’Neill Suzanne , Conley Claire C
Published: February 2023

Objective

This study examined patterns of breast cancer screening during the COVID-19 pandemic.

Methods

This retrospective study was approved by the Georgetown University IRB. Review of electronic medical records identified screening mammograms and breast MRIs between March 13, 2018 and December 31, 2020, for female patients aged 18 to 85 years. Descriptive statistics characterized patterns of breast cancer screening before and during the COVID-19 pandemic. Logistic regression analyses examined whether receipt of breast MRI differed over time and demographic and clinical factors associated with receipt of breast MRI in 2020.

Results

Data included 47 956 mammography visits in 32 778 patients and 407 screening breast MRI visits in 340 patients. After an initial decrease following the declaration of the COVID-19 pandemic, both screening mammograms and screening breast MRI demonstrated early recovery. Although the mammography receipt remained sustained, the receipt of screening breast MRI decreased in late 2020. Odds of having a breast MRI did not differ between 2018 and 2019 (OR = 1.07; 95% CI = 0.92%–1.25%; P = 0.384) but were significantly lower in 2020 versus 2019 (OR = 0.76; 95% CI = 0.61%–0.94%; P = 0.011). No demographic or clinical factors were associated with receipt of breast MRI during the COVID-19 pandemic (all P-values ≥0.225).

Conclusion

Breast cancer screening decreased following the declaration of the COVID-19 pandemic. Although both procedures demonstrated early recovery, the rebound in screening breast MRI was not sustained. Interventions promoting return to screening breast MRI may be needed for high-risk women.
Effects of bioturbation by the fiddler crabLeptuca speciosa(Ives, 1891) (Decapoda: Brachyura: Ocypodidae) on mangrove peat in Barnes Sound, Florida, USA
Authors: Neely Samuel H
Published: February 2023

Bioturbation, which includes burrowing and foraging behaviors, is an important component of the functional role of fiddler crabs (Brachyura, Ocypodidae) within mangrove forests because it modifies sediment properties and composition of mangrove substrates. In this study, fiddler-crab population density and burrow architecture were measured to evaluate the influence of bioturbation by the fiddler crab Leptuca speciosa (Ives, 1891) on mangrove peat from Barnes Sound, Florida, USA. Measurements of burrow architecture were used to estimate the contribution of fiddler-crab burrowing to the bioturbation of mangrove peat. Comparisons were made between the total organic matter in bioturbated sediments, including feeding and burrowing pellets. A population density of 12 burrows m–2 was measured with no significant trends in the spatial distribution of fiddler crabs within the site. Although the deepest burrow depth was 18 cm, results show the upper 5 cm of the peat surface was consistently burrowed by crabs. Fiddler crabs were estimated to increase the total below-ground air-peat surface area m–2 by 5% and accounted for 22% of the excavated volume of mangrove peat per year. Fiddler crabs will thus rework the entire peat substrate within five years. Because data on carapace geometric mean size suggested that a juvenile population of L. speciosa was sampled, the bioturbation rate of the peat substrate will accelerate once this population matures. Feeding pellets had significantly lower percentages of total organic matter (P < 0.01) than other bioturbated peat samples, suggesting that fiddler-crab foraging behaviors significantly (P < 0.01) decrease the organic composition of surficial peats. These results imply that fiddler crab burrowing extends the depth of the taphonomically active zone thus enhancing mangrove peat decomposition and changing the bioavailability and distribution of organic matter in mangroves.
Translocation of aberrant right subclavian artery to the ascending aorta—a treatment for dysphagia lusoria
Authors: Chan Stephanie , Fermanis Gary
Published: February 2023

Generally, an aberrantly coursing right subclavian artery (ARSA), also known as ‘arteria lusoria’, is an incidental diagnosis of no clinical consequence. Where correction is indicated, popular practice is for decompression via staged percutaneous +/− vascular methods. Open/thoracic options for correction are not widely discussed. We report the case of a 41-year-old woman with dysphagia secondary to ARSA. Her vascular anatomy precluded staged percutaneous intervention. The ARSA was translocated to the ascending aorta via thoracotomy, utilizing cardiopulmonary bypass. Our technique is a safe option for low-risk patients with symptomatic ARSA. It obviates the need for staged surgery and removes the risk of carotid-to-subclavian bypass failure.
Clinical Approaches for Self-Injury
Authors: Lewis Stephen P. , Hasking Penelope A.
Published: February 2023

This chapter addresses the approaches most often used by clinicians when working with clients who engage in self-injury. It therefore begins by discussing the importance of rapport building, including ways to facilitate building a strong therapeutic alliance with individuals in clinical contexts. From here, it provides an overview of assessment recommendations, including domains that ought to be considered in the context of case formulation. This is followed by an overview of the intervention approaches commonly used to help individuals who self-injure. Also covered in this chapter are approaches that are typically not advised for use in clinical contexts. Collectively, the content is this chapter offers foundational information about how to address self-injury that is built on in Chapter 11, which discusses a person-centered framework with which to conceptualize self-injury, and then in Chapter 12, which discusses how recovery can be fostered by focusing on people’s strengths and resilience.
Building Resilience Through Recovery
Authors: Lewis Stephen P. , Hasking Penelope A.
Published: February 2023

Building on the model outlined in Chapter 11, this chapter discusses how resilience and strength can be realized through recovery. This involves addressing specific components of the framework presented in Chapter 11 and their role in fostering resilience. In doing so, the chapter addresses the need to be realistic about expectations for recovery and the importance of considering residual scarring, future self-injury disclosures, ongoing coping, and finding strengths within the ongoing process of recovery. We aim to offer concrete, practical strategies that therapists, family and friends, and individuals with lived experience of self-injury can use to help foster the recovery process.
Advocating for a Person-Centered, Strengths-Based Approach
Authors: Lewis Stephen P. , Hasking Penelope A.
Published: February 2023

Building on prior chapters, the final chapter in this book focuses on advocacy—in particular, how a person-centered approach can be imbued and accordingly realized in the field. To this end, it initially touches on lived experience initiatives in other areas. It then segues to a discussion of some of the different barriers that may impede such work. From here, it highlights why this work is nonetheless needed, followed by an overview of the current state of the literature concerning lived experience work in the field of self-injury. To conclude, the chapter brings attention to practical ways that address many of the previously mentioned barriers and thus articulate how a person-centered approach, which centers people’s lived experience, can be accomplished in research, clinical work, and outreach efforts.