bluuebunny/crossref_metadata_2025 huggingface dataset:
304 Increasing the intensity of physiotherapy in a subacute stroke rehabilitation unit—results of audit and intervention
Authors: McClean A
Published: September 2023

Background

The National Clinical Guideline for Stroke (2023) recommend the delivery of high intensity therapy to optimise physical recovery post-stroke. Previous guidelines suggested 45 minutes but now suggest a total of 3 hours daily. The aim of this intervention was to review current practice and implement the stroke guidelines aiming to augment the dosage of therapy sessions.

Methods

Given the guidelines’ recommendation to improve the reporting of exercise prescription, a chart audit was completed comparing the dosage of physiotherapy from 2020–2022 on a random sample of 10 charts per year. Strategies to increase intensity included a restructure of the stroke exercise class, run twice weekly. The class structure moved towards a circuit class of 5x 6-minute stations followed by group outdoor mobility. Use of tally counters, increased semi-supervised practice and introduction of a ‘champions board’ to celebrate individuals’ achievements also contributed to a culture of high intensity therapy.

Results

The chart audit showed an improvement in the recording of repetitions each year. The average recorded repetitions per week for stroke survivors increased from 77.9 repetitions in 2020 to a weekly average of 1,043 in 2022 (2020 range 0–288 repetitions; 2022 range 245–2095 repetitions). The average repetitions in the stroke exercise class in 2022 was 462 and was previously not measured. A review of annual patient statistics from 2021 and 2022 showed that stroke survivors spent more time in physiotherapy in 2022. This was likely affected by variables such as staffing allocation and COVID-19 restrictions limiting the ability to provide gym-based therapy or group classes.

Conclusion

The measurement and recording of intensity has improved and increased in 2022 although this may have been affected by factors outside of this intervention. Future iterations of this project would be to increase dosage of upper limb therapy, and to increase physical activity outside therapy, such as use of pedometers outside therapy hours.
308 The development of a competency toolkit for nurses working in stroke in the Irish healthcare setting
Authors: Connaughton F , Coleman S , Breen C , Keane J , Flahive A , Grenham E , Noone I , Lynch J , Donaghy L , Diskin M , Donovan M , Cunningham N , Daly P , Gallagher S , Galvin T , Collins R
Published: September 2023

Background

Stroke Unit Nurses require multifaceted competencies to manage the complex needs of the stroke patient. The National Clinical Programme for Stroke (NSP) set out to develop a competency toolkit for stroke nurses. A modified-Delphi format was used, the questionnaire was developed by an Irish expert advisory group. The development was informed by the group experience and review of existing stroke unit nurse competency toolkits In Ireland and abroad.

Methods

Round one of the Survey was conducted using a semantic differential question, with a 3 point score scale. The survey was sent to a subject matter expert group (32 Clinical Nurse Specialists & Advanced Nurse Practitioners). In round two, the participants were given controlled structured feedback based on the overall feedback from round one, which allowed for adjusted responses. The advisory group looked at themes that emerged in the answers in round one. This formed the basis for the questions in round two, a multiple-choice format, with one answer.

Results

Response rates for round one was 66%, Individual opinions were combined into a group consensus, which lead to the completion of the questionnaire for round two. A consensus definition of at least 80% agreement for each item was decided a priori, in round one, 75% of items reached consensus. Round two response rate was 71%, with 49% of items reaching consensus.

Conclusion

Development of a standardised competency toolkit for stroke unit nursing is a strategic goal of the NSP. While round one lead to considerable consensus, it is clear that what is not agreed initially can be difficult to reach a consensus on, with only 49% consensus in round two. A third round will be required, but if consensus remains elusive, additional methodology techniques such as a focus group may be used. Challenges are response exhaustion and availability of busy ‘experts’ in their fields.
309 Sensory function impairment as a falls risk factor of patients on a Frailty Intervention Team pathway
Authors: Magner S , Holman J , Katiri R , O'Caheny C , Byrne C
Published: September 2023

Background

The world guidelines for falls published in 2022 provide a patient-centred framework to support the identification, prevention, and management of falls in older adults, and suggest measuring sensory function with regards to falls risk factors including dizziness, vision, and hearing. This audit applied the falls risk stratification recommendations and reviewed the individual risk factor variables predictive of falls in those assessed by the Frailty Intervention Team (FIT) in our Emergency Department (ED).

Methods

Patients aged 65+ who attended the ED and who had a Comprehensive Geriatric Assessment (CGA) carried out by FIT between January and April 2023 were included. Sensory function status data was retrieved from the CGA completed for patients seen. Analysis of the data controlled for factors such as age, gender, clinical frailty score, delirium, cardiac risk, orthostatic hypotension, motor function, and medicines reconciliation and optimisation.

Results

During this period, 116 (33.4%) attendances were due to falls. Following removal of those missing key data, almost all attendees were in the ‘high’ risk of falls category (n = 140, 48.6%), or the ‘low’ category (n = 134, 46.5%). Very few people were in the ‘intermediate’ category (n = 14, 4.9%). The most prominent impairments in the high and low groups were balance (80.8 & 57.8%) and vision (73.7 & 67.3%). Hearing status was significantly predicted by risk grouping, whereas balance and vision were not. Most older adults in the high-risk category had an intervention in place for their mobility, hearing, and/or vision.

Conclusion

Most older adults that attended ED in quarter one of 2023 fall into the low or high-risk categories. While impaired balance function and vision were the most common impairments, hearing status alone was related to risk group. These results give valuable insight through a practical application of guidelines and pose questions for the application of three falls risk groups and the capacity for additional sensory intervention.
321 The barriers and enablers to an effective integrated care programme for older persons: a qualitative study
Authors: Fitzgerald A , McDonnell Ó , Daly B , Dukelow T , Jennings A , Foley T
Published: September 2023

Background

In line with Slaintecare goals, the Integrated Care Programme for Older Persons (ICPOP) South Lee Hub, Cork, was developed to provide onsite access to geriatrician and specialist nurse-led clinics, allied healthcare professionals, and an outreach service. ICPOP aims to avoid unnecessary hospital admissions and maximise collaboration between primary and secondary healthcare teams locally. An effective interface between primary and secondary care is, therefore, fundamental to the functioning of ICPOP. However, no research to date has examined this interface from the perspective of the clinical staff in the hubs and primary care providers in the community. This study aims to explore the barriers and enablers to the effective functioning of an ICPOP service from the perspective of both Primary Care Team (PCT) members and the ICPOP hub team.

Methods

Semi-structured interviews were conducted with healthcare professionals working in the ICPOP service in Cork and in primary care. All interviews were analysed thematically by two independent researchers.

Results

29 semi-structured interviews were conducted; 14 with members of the ICPOP team and 15 with GP’s and members of the PCT in the ICPOP catchment area. The challenges of communicating patient information both into and out of the ICPOP hub was highlighted by both primary and secondary care teams. The GPs and other members of the PCT felt ‘on the outside’ with all the contextual knowledge of the individual patient but without a clear understanding of the functioning of the ICPOP hub. Conversely, the clinical team in the ICPOP hub found it challenging to retrieve the contextual knowledge of the patient and were challenged by administrative frustrations.

Conclusion

In the context of a newly emerging ICPOP service, it is essential that collaboration between primary care and the clinical hub is maximised, to provide optimal patient care.
331 Patient experience in a Falls and Syncope service in a large Irish teaching hospital
Authors: Lisa B , Dymphna H , Ciara R , Kelly D E , Joseph L , Poulose B , Keirnan C , Romero-Ortuno R , O'Callaghan S , Briggs R , Lavan A , Kenny R A , Cunningham C
Published: September 2023

Background

The measurement of patient satisfaction provides valuable information about patients’ perceptions of their received healthcare. It is an excellent measure of the quality of care delivered by a healthcare facility. This allows service providers to continue to move towards patient-centred care. A positive patient experience is an important aim that leads to better clinical outcomes.

Methods

A 20-question patient satisfaction survey was developed for an outpatient Falls and Syncope Unit in order to assess the patient’s perception of service delivery. All patients attending the service were invited to complete the survey over a 2-month period in 2022.

Results

71 responses were received. 76% of respondents found their appointment beneficial, and 94% felt their appointment was necessary. Satisfaction with staff ranged between 97–99%. 98% of patients felt they were treated with respect and 88% felt free to express complaints, with 97% satisfactory telephone interaction with the service. 60% of patients received a patient information leaflet, with 97% of patients finding the information leaflets provided useful. Twenty-five respondents (31%) indicated further information on their care would have been beneficial.

Conclusion

This patient satisfaction survey provided positive feedback for all staff on care delivered in the Falls and Syncope service. Recommendations for changes in practice included increased use of patient information leaflets, in order to improve patients’ experience, since 97% of patients found information leaflets useful and 40% of patients did not receive a leaflet.
342 Psychotropic medication prescriptions in a long term care setting
Authors: Heywood S , McGoohan A
Published: September 2023

Background

Current practice in Ireland suggests an overreliance on psychotropic medication to treat the non-cognitive symptoms of dementia. Although it is estimated that about 30% of residents in long term care in Ireland are prescribed psychotropic medication, it appears that the process of prescribing these medications including a follow up review of the prescription could be improved.

Methods

16 patients in the residential unit known to be prescribed psychotropic medication were randomly selected. All data was collected between November and December 2022.

Results

Overall we found that documentation was poor related to the prescription of psychotropic medications. Twenty five percent of patients had no documented indication for use of psychotropic medication. In twenty five percent of cases there was no documentation of when to give psychotropic medication. Forty three percent of patients had no specific behaviour care plans in place. Sixty eight percent of prescriptions had not been discussed at psychotropic review meeting. Seventy five percent of cases had no documentation of the risk or benefits of psychotropic use. Only one of sixteen patients had documentation of a risk benefit discussion with patient and family. Psychotropic review meetings infrequently. However this audit did demonstrate that in this long term care unit psychotropic medications were administered infrequently with only 31% of patients receiving as required psychotropic medication within the previous six weeks.

Conclusion

While as required psychotropic medication was infrequently administered in this long term care unit, the documentation around the prescription of these medications was poor and needs to improve. Implantation of an education programme for staff will be required prior to re-audit.
347 Competency frameworks for non-geriatric medicine physicians caring for older adults: a scoping review
Authors: Buckley E , Barrett A , Bennett D , O'Tuathaigh C , Cooke J
Published: September 2023

Background

The scale of our ageing demographic is such that specialist geriatric medicine services are unable to keep pace with the growing demand. An exclusive reliance on geriatricians to treat older adults is not always appropriate as their care may necessitate the involvement of other specialties. Consequently, many of the interactions with frail older adults will be carried out by professionals who have not received specialised training in gerontological principles. There is an urgent requirement to ensure that all physicians are trained in the competencies to care for older adults. We aimed to summarise the available literature on the competencies required by non-geriatric medicine physicians caring for older adults.

Methods

We undertook a scoping review following Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) as a guide. We systematically searched the electronic databases PubMed, Cochrane, Cinahl, PsycInfo, ERIC and Embase for eligible records from January 2012 to December 2022. Studies related to physician or doctor or resident and competencies or curriculum or education or entrustable professional activities and geriatric medicine or gerontology were included.

Results

We identified 5,177 records. Four hundred and forty-six full texts were screened for eligibility. Thirty sources of evidence were included in the review. Most studies were from the United States and used quantitative methods. Competency frameworks primarily focused on internal medicine trainees with few targeting other specialties. Seventeen cited the purpose as addressing a specific competency. The most common competencies explored related to medication management, palliative care and cognitive impairment followed by bone health, transitions of care and falls and syncope.

Conclusion

Many frameworks attempt to outline gerontological competencies for specific specialties. However it is evident that a dedicated competency framework is necessary to define the required competencies for all non-geriatric medicine physicians caring for older adults.
13 Exploring the success of older female directors: creativity and resilience of old age in the face of cultural barriers
Authors: Fitzpatrick N , O’Neill D
Published: September 2023

Background

Ageism is pernicious in the film industry, particularly in large-scale Hollywood productions. Its effect is also underestimated in comparison to other forms of discrimination. Older women are disproportionately discriminated against in the workplace compared with older men, and there is evidence if disproportionate ageism towards women in the film industry specifically. Women comprise a much smaller proportion of film directors overall, with only 13% of the top-grossing films in the US in 2020 directed by women.

Methods

We look at three distinct works from older female directors (The Power of The Dog, Jane Campion; Faces Places, Agnès Varda; High Life, Claire Denis). We examine how the directors’ age and experience informed their creative process and how they overcame the barriers set against them. In particular, we pay attention to ways in which they incorporate strategies of achievement in later life, such as the selection, optimisation and compensation model.

Results

The diversity of these pieces also allows us to highlight not only the heterogeneity of ageing, but the rich artistic rewards of the longevity dividend.

Conclusion

Cinematic output of older women directors allows to explore the not only the richness of ageing, but also the gendered nature of ageing and the creative arts.
15 Hospital at home—a potential alternative option to acute hospital admission for older adults
Authors: Conlon C , Murphy R , Small C
Published: September 2023

Background

Novel ways to respond to the acute care needs of older adults are needed. Hospital at Home (H@H) could be a viable alternative to emergency hospitalisation. We developed inclusion and exclusion criteria for selected medical conditions that could theoretically be treated in a hospital at home setting if supported by a geriatric medicine multidisciplinary team with a consultant, Advanced Nurse Practitioner (ANP), Physiotherapist (PT) and Cccupational Therapist (OT).

Methods

We completed a retrospective cohort study of unselected medical admissions over a two week period in a level four hospital. We developed illness specific criteria for stable patients that if met could allow a patient to be treated in a hospital at home environment. These conditions included community acquired pneumonia, congestive cardiac failure, COPD exacerbation and urinary tract infection.

Results

There were 307 medical admissions over the study period, with 144 over the age of 75 (47%). Mean age 83.2. 59 patients met our inclusion criteria for a potential H@H service (41%). All patients were clinically stable based on admission vital signs. The mean length of stay was shorter for patients eligible for H@H than patients who did not meet the criteria (9 days vs 14 days, p 0.01), and patients meeting the H@H criteria were more likely to be discharged home directly. They were less likely to have needed occupational therapy (32% vs 52%, p = 0.02) or medical social worker input (22% vs 42%). There was no difference in frailty category or readmission rates by whether or not a patient met the H@H criteria.

Conclusion

Over 40% of unselected medical take patients were of a low acuity that could have theoretically met our inclusion criteria for a supported hospital at home model. Strategies are needed to support expansion of this model of care.
92 ‘Greenprint’ for integrated care clinics—the hub and spoke model
Authors: Murphy D E , Geoghegan J , Reddin C , McCleane F , Neachtain M Ni , Mannion K , Shiel E , O'Malley K , Lynch Amy , Okon M , Okpaje B , Griffith V , Hanrahan C , Loughlin E , Robinson S , Murphy R , Waters R , Costello M , Canavan M
Published: September 2023

Background

Climate change is a major public health crisis requiring attention at an individual, local and national policy level. Transport is the largest source of energy related carbon emissions in Ireland. The development of integrated care occurs alongside climate emergency. Care previously delivered in hospital outpatients, or a central ‘hub’ is now being delivered in integrated care clinics, ‘spokes’. We aimed to assess the environmental impact of transport to integrated care clinics compared to travel to hospital clinic.

Methods

Geriatric Medicine Integrated Care attendances from January 2023 to March 2023 were included. Distance from the patient’s home address to the location of Integrated Care Clinic (spoke), and to the affiliated hospital (hub) were recorded in kilometres. For the primary analysis we have not considered staff travel as there was heterogeneity in number of staff per clinic and distance travelled per staff member. Where more than one route was available, the shortest distance was recorded. Carbon emissions were estimated based on kilometres travelled by a standard new passenger car.

Results

Among 206 clinic attendances, the mean distance to ‘spoke’ clinic was 16.06 km (15.98). The mean distance to the ‘hub’ clinic was 39.29 km (17.82). The estimated total distance travelled by patients to integrated care clinics was 3293.45 km, whereas the distance which would have been travelled to ‘hub’ clinics was 8055.85 km. Total carbon emissions for 3 month travel to ‘spoke’ clinics were estimated at 371 kg, compared to 907 kg to the ‘hub’.

Conclusion

The development of integrated care services, which provides necessary care to older adults, may also have an environmental advantage. Healthcare’s contribution to climate change action is another incentive to invest in integrated care services.
102 Decision making around Eating and Drinking with Acknowledged Risk (EDAR)
Authors: Donders-Seóighe C
Published: September 2023

Background

Life expectancy in Ireland has increased, leading to older adults with increasingly complex health needs, including dysphagia. Reportedly, dysphagia affects 30% of older adults in hospital and 68% of nursing home residents. Speech and Language Therapists (SLT) in a large teaching hospital, identified a need to develop a pathway or policy to help guide decision making around older adults who wish to eat and drink despite the presence of Dysphagia.

Methods: A comprehensive literature review compared different approaches to the management of Eating and Drinking with Acknowledged Risk (EDAR), exploring the following questions: (1) Should eating and drinking with acknowledged risk be outlined in a policy?, (2) Should it include a capacity assessment?, (3) Who is the final decision maker?, (4) What is the optimal timing of a conversation around this subject? The evidence was presented to relevant stakeholders from disciplines where EDAR arose most often e.g. other SLT’s, Geriatric medicine, General surgery and Palliative Care.

Results

Given the need for patient-centred care, there was a preference for a care pathway, as opposed to a policy for EDAR. General consensus was that the patient should be the final decision maker, with senior medical support. Optimal timing for EDAR decisions can be complex: Hospital SLTs struggle with limited time resources, acute illness can affect patient’s ability to engage, or a patient might benefit from a swallow rehab program first. Community therapists work in isolation and might lack medical support. Nursing home residents have least access to SLT and often lack any opportunity to discuss EDAR.

Conclusion

The EDAR approach varies from traditional SLT practices. It can evoke strong opinions, especially around final decision making. Timing of discussions around EDAR presents with unique challenges in different healthcare settings. A care pathway in the acute setting can streamline decision making, support SLTs, and allow for individual patient choice.
198 How comprehensive is our Comprehensive Geriatric Assessment in clinical practice?
Authors: Dennehy K , Lynch A , Reddin C , Costello M , Canavan M , Murphy R
Published: September 2023

Background

No gold standard exists for what should be included within a Comprehensive Geriatric Assessment (CGA). Consensus is that a CGA assessment should assess physical, functional, psychological and social well-being. We sought to examine the specific content of CGA that are being delivered across integrated care teams in Ireland.

Methods

We completed a cross sectional study of what domains are included in different integrated care CGA proformas. All operational leads for each integrated care hub were contacted and invited to share their local CGA. We examined what components across the domains of physical, psychological, functional and social assessment were included.

Results

We examined 16 different CGAs. The median length of a CGA was 14 pages (range: 4–28 pages). Common areas in all CGAs included assessments of frailty, cognition, mobility, falls, continence and social assessment, but there was variability in how these assessments were carried out. The Rockwood Clinical frailty scale the most common diagnostic tool for frailty (15/16 CGAs) with sarcopenia assessed in 75% of CGAs. The 4AT tool was used in 56% of CGAs, with a more detailed tool (e.g MMSE or MOCA) used in 56% of CGAs. Mood was assessed in 15 CGAs, sleep assessed in 10 CGAs and pain assessed in 7 CGAs. The widest variability was in the social assessment section with inconsistent assessments of caregiver strain (completed in 50%) and assessments of formal advanced care supports such as enduring power of attorney included in 44% of CGAs. Sexual health was not explicitly addressed in any CGA.

Conclusion

While there is considerable overlap with the core components of a CGA across integrated care sites there is significant variability across individual sites. Our results highlight the opportunity for consensus building across different integrated care teams to harmonise the delivery of CGA.
237 Drug–drug interactions and the risk of adverse drug reaction hospital admissions in the older population: a prospective cohort study
Authors: Hughes J E , Moriarty F , Cahir C , Bennett K E
Published: September 2023

Background

Drg–Drg Interactions (DDIs) can lead to medication-related harm; the older population is at greatest risk. We estimate DDI prevalence and the average causal effect of DDI exposure on adverse drug reaction (ADR)-related hospital admission in an older (≥65 years) population admitted acutely to hospital in Ireland. We also examine the effect of DDI exposure on health-related quality of life (HRQoL) and Length of Stay (LoS) in hospital.

Methods

Prospectively collected (2016–17) data from the Adverse Drg Reactions in an Ageing PopulaTion cohort were used (N = 798). Medication (current/recently-discontinued/over-the-counter) and objective clinical data (e.g. renal function) were available. DDIs (which may result in a life-threatening event/permanent detrimental effect) were identified using the BNF and Stockley’s. Causal inference models were developed using directed acyclic graphs. HRQoL was measured using the EQ-5D-5L. Multivariable logistic regression was performed using SAS (v9.4).

Results

N = 782 patients using ≥2drugs were included, mean age = 80.9(±7.5); 52.2% female; 92.2% polypharmacy (≥5drugs); 45.1% had an ADR-related hospital admission. N = 316 (40.4% [95% Confidence Interval (CI):37.0–43.9]) patients with at least one DDI at hospital admission. After controlling for confounding, the average causal effect of DDI exposure on ADR-related hospital admission was Odds Ratio (OR) = 1.2 [95% CI: 0.9–1.6]. This risk was significantly increased for patients exposed to DDIs which increase bleeding risk (OR: 2.0 [1.3–3.1]); for aspirin-warfarin (OR: 2.8 [1.4–5.7]) and esomeprazole-escitalopram (OR: 3.2 [1.1–10.3] DDIs. Patients with a DDI had a lower HRQoL (mean EQ-5D: 0.49 [±0.39]) compared to those with none (mean EQ-5D: 0.58 [±0.41], p = 0.08). Patients with an ADR-related hospitalisation and DDI had a significantly greater LoS in hospital (8 [Interquartile Range:5–17] days) compared to those with no DDI (6[Interquartile Range: 3–13] days, p = 0.02).

Conclusion

DDIs are prevalent among older adults on acute admission to hospital, and increase the risk of ADR-related hospitalisation, significantly for patients with DDIs that increase bleeding risk. Patients with a DDI had lower HRQoL, and prolonged LOS in hospital.
257 Chronic pain is associated with mobility impairment and falls among community-dwelling older people: data from TILDA
Authors: Lalor P , Swanton A , Lavan A , Kenny R A , Briggs R
Published: September 2023

Background

Chronic pain is prevalent among older people in Ireland and can have a profound impact on health outcomes. The aim of this study is to assess the relationship between chronic pain and mobility impairment and falls risk in a population-representative sample of older people.

Methods

Participants ≥70 years at TILDA Wave 1 were asked ‘Are you often troubled with pain?’ and if yes, were then asked ‘How bad is it most of the time? Mild, moderate, or severe?’. Mobility was assessed with Timed Up and Go (TUG). Data was collected on falls and unexplained falls (falls not due to a slip/trip, with no apparent cause) within the last 12 months. Linear regression models, reporting β-coefficients, assessed the independent relationship between chronic pain and TUG; logistic regression models, reporting Odds Ratios (OR) and 95% Confidence Intervals (95% CI) assessed the association with falls.

Results

Over 1/3 of participants reported chronic pain as follows: mild (10%, 221/2,308); moderate (17%, 396/2,308) and severe (10%, 222/2,308). Participants with moderate (TUG: 12.67 [95% CI 11.83–13.51]) and severe chronic pain (TUG 13.98 [95% CI 12.32–15.64]) had a prolonged TUG, compared to those who were pain-free (TUG 10.94 [95% CI 10.61–11.25]). In fully-adjusted linear regression models, both moderate (β = 1.11 [95% CI 0.28–1.93]; p = 0.008) and severe pain (β = 1.63 [95% CI 0.48–2.77]; p = 0.005) were independently associated with prolonged TUG. Participants with chronic pain also had a higher likelihood of total (OR 1.30 [95% CI 1.00–1.6]); p = 0.049) and unexplained falls (OR 1.81 [95% CI 1.18–2.76]; p = 0.006) in fully-adjusted models.

Conclusion

Chronic pain confers significant limitations on mobility among older people: participants with severe pain take on average 3 seconds longer to complete the TUG. Further, chronic pain is associated with falls, particularly unexplained falls, highlighting the need to assess and treat pain as part of the comprehensive geriatric assessment.
343 Sustainability of area-based, community-driven post-diagnostic support services for people with dementia: evidence from a mixed-methods study
Authors: Pierce M , Golden J
Published: September 2023

Background

Supporting people with dementia to live at home in their communities post-diagnosis is a goal of national and international policy. Local area-based, community driven services can play a key role in supporting people with dementia post-diagnosis, and have demonstrated their role in helping to move the existing care system to a personalised model. Sustaining such services over the long-term can be a struggle. This study aimed to understand the factors affecting the sustainability of dementia post-diagnostic support services, how these can best be addressed, and what are the lessons for policymakers and others.

Methods

This mixed-methods study of one area-based, community driven dementia post-diagnostic service was conducted between September 2022 and February 2023. Qualitative methods were used to explore the perspectives of 47 study participants on the value of the service and its sustainability. The study included focus groups (n = 2) with service staff, interviews with people with dementia (n = 8), family carers (n = 16) and national and locally-based stakeholders (n = 16), and a review of seven years of service activity and expenditure data.

Results

The study found that the service was widely regarded as a valuable addition to the dementia care landscape, in high demand, well integrated into the service landscape and an important resource for other services. A range of factors were found to affect service sustainability including funding levels, resource allocation mechanisms, working relationships between key organisations, managerial change, organisational restructuring, staff capacity and strategic planning.

Conclusion

Despite demonstrated value to dementia care landscape, service sustainability cannot be taken for granted. Strategies that will help sustain dementia post-diagnostic services in the long-term need to be adopted. The results will be of interest to policy-makers and a range of other actors involved in planning, implementing and supporting post-diagnostic services as well as service users and healthcare professionals.
Analysis of Complications in Patients With a History of Cannabis Use and Tobacco Use Undergoing Implant-Based Breast Reconstruction
Authors: Garoosi Kassra , Lee Nayun , Tuano Krystle R , Lee Elliot L H , Cohen Justin , Winocour Julian , Mathes David W , Iorio Matthew L , Kaoutzanis Christodoulos
Published: September 2023

Background

There is limited information regarding the perioperative effects of marijuana in breast reconstructive surgeries.

Objectives

The objective of this study was to explore the association between a history of cannabis use and postoperative complications in the setting of implant-based breast reconstruction.

Methods

Two databases, TriNetX and PearlDiver, were queried for patients undergoing implant-based breast reconstruction. Patients were divided into 4 groups based on active ICD-10 diagnostic codes: (1) cannabis use only, (2) tobacco use only, (3) cannabis and tobacco use, and (4) neither cannabis nor tobacco use. Associations with postoperative complications were analyzed with a logistic regression test.

Results

TriNetX search revealed that 327 patients had an active diagnosis of cannabis use only and 1118 had an active diagnosis of tobacco use only. Patients in the cannabis only cohort had a significantly increased risk of developing surgical site infection. Patients in the tobacco only cohort had significantly increased risk of developing wound dehiscence, need for debridement, and surgical site infection. The PearlDiver search included 472 patients who had an active diagnosis of both cannabis and tobacco use and 17,361 patients with a diagnosis of tobacco use only. Patients with a diagnosis of cannabis and tobacco use had a significantly increased risk of developing postoperative complications including surgical site infection, wound dehiscence, need for incision and drainage, and debridement.

Conclusions

Patients undergoing implant-based breast reconstruction with an active diagnosis of cannabis with or without tobacco use were at increased risk of developing postoperative complications, and the risk was even higher in patients using both tobacco and cannabis.

Level of Evidence: 3
Analyzing the Impact of Social and Psychiatric Factors in Patients Who Undergo Body Contouring Procedures
Authors: Glenney Anne E , Mocharnuk Joseph W , Humar Pooja , Zhang Casey , Rubin J Peter , Gusenoff Jeffrey A
Published: September 2023

Background

As the prevalence of obesity increases, the number of patients seeking body contouring procedures after bariatric surgery for massive weight loss is increasing. Although the positive impact of bariatric surgery on physical and emotional health is well-described, few studies have reported on the psychosocial well-being of patients undergoing body contouring procedures. Psychosocial well-being can impact patient satisfaction and maintenance of weight loss, and is an important area to study.

Objective

The aim of this study was to characterize social and psychiatric factors of patients undergoing body contouring surgery, and to evaluate their impact on maintenance of weight loss.

Methods

A retrospective review was performed of patients who presented to a single institution for body contouring procedures between 2002 and 2018. Demographic details, medical history, psychosocial support, and operative details were collected. Univariate analysis and multinomial logistic regressions were performed with R statistical software (version 1.3.1093).

Results

A total of 1187 patients underwent at least 1 body contouring procedure during the study time frame. Mean BMI at presentation was 31.21 ± 10.49 kg/m2. Patients diagnosed with obesity at age 18 or older had significantly greater odds of suffering from generalized anxiety disorder (odds ratio [OR] 1.08 [95% CI, 1.02-1.15], P = .008). Patients with spousal support had 1.93 times higher odds of having maintained postbariatric weight loss at their 6-month follow-up (OR 1.93 [95% CI, 1.84-2.01], P = .028).

Conclusions

Social support and age of obesity diagnosis impact psychological well-being and maintenance of weight loss following body contouring procedures.

Level of Evidence: 3
Enhanced tight junction in Caco-2 cells by the pretreatment with Lactobacillus johnsonii strain MG
Authors: Bai Yuying , Miyanaga Kazuhiko , Yamamoto Naoyuki
Published: September 2023

We investigated roles of Lactobacillus johnsonii MG (MG) isolated from mice with interaction with tight junction on gut barrier function with Caco-2 cell model. Pretreatment with MG enhanced barrier function and showed protective effect against Enterococcus faecium provided damage. MG treatment increased the gene expressions of transcriptional regulator NFKB and major tight junction protein, ZO-1.
The Free Lunch is not over yet—systematic exploration of numerical thresholds in maximum likelihood phylogenetic inference
Authors: Haag Julia , Hübner Lukas , Kozlov Alexey M , Stamatakis Alexandros
Published: September 2023

Maximum likelihood (ML) is a widely used phylogenetic inference method. ML implementations heavily rely on numerical optimization routines that use internal numerical thresholds to determine convergence. We systematically analyze the impact of these threshold settings on the log-likelihood and runtimes for ML tree inferences with RAxML-NG, IQ-TREE, and FastTree on empirical datasets. We provide empirical evidence that we can substantially accelerate tree inferences with RAxML-NG and IQ-TREE by changing the default values of two such numerical thresholds. At the same time, altering these settings does not significantly impact the quality of the inferred trees. We further show that increasing both thresholds accelerates the RAxML-NG bootstrap without influencing the resulting support values. For RAxML-NG, increasing the likelihood thresholds ϵLnL and ϵbrlen to 10 and 103, respectively, results in an average tree inference speedup of 1.9 ± 0.6 on Data collection 1, 1.8 ± 1.1 on Data collection 2, and 1.9 ± 0.8 on Data collection 2 for the RAxML-NG bootstrap compared to the runtime under the current default setting. Increasing the likelihood threshold ϵLnL to 10 in IQ-TREE results in an average tree inference speedup of 1.3 ± 0.4 on Data collection 1 and 1.3 ± 0.9 on Data collection 2.

Availability and implementation

All MSAs we used for our analyses, as well as all results, are available for download at https://cme.h-its.org/exelixis/material/freeLunch_data.tar.gz. Our data generation scripts are available at https://github.com/tschuelia/ml-numerical-analysis.
Immuno-metabolic signaling in leishmaniasis: insights gained from mathematical modeling
Authors: Khandibharad Shweta , Singh Shailza
Published: September 2023

Motivation

Leishmaniasis is a global concern especially in underdeveloped and developing subtropical and tropical regions. The extent of infectivity in host is majorly dependent on functional polarization of macrophages. Classically activated M1 macrophage can eliminate parasite through production of iNOS and alternatively activated M2 macrophages can promote parasite growth through by providing shelter and nutrients to parasite. The biological processes involved in immune signaling and metabolism of host and parasite might be responsible for deciding fate of parasite.

Results

Using systems biology approach, we constructed two mathematical models and inter-regulatory immune-metabolic networks of M1 and M2 state, through which we identified crucial components that are associated with these phenotypes. We also demonstrated how parasite may modulate M1 phenotype for its growth and proliferation and transition to M2 state. Through our previous findings as well as from recent findings we could identify SHP-1 as a key component in regulating the immune-metabolic characterization of M2 macrophage. By targeting SHP-1 at cellular level, it might be possible to modulate immuno-metabolic mechanism and thereby control parasite survival.

Availability and implementation

Mathematical modeling is implemented as a workflow and the models are deposited in BioModel database. FactoMineR is available at: https://github.com/cran/FactoMineR/tree/master.
ChromNetMotif: a Python tool to extract chromatin-sate marked motifs in a chromatin interaction network
Authors: Soibam Benjamin
Published: September 2023

Motivation

Analysis of network motifs is crucial to studying the robustness, stability, and functions of complex networks. Genome organization can be viewed as a biological network that consists of interactions between different chromatin regions. These interacting regions are also marked by epigenetic or chromatin states which can contribute to the overall organization of the chromatin and proper genome function. Therefore, it is crucial to integrate the chromatin states of the nodes when performing motif analysis in chromatin interaction networks. Even though there has been increasing production of chromatin interaction and genome-wide epigenetic modification data, there is a lack of publicly available tools to extract chromatin state-marked motifs from genome organization data.

Results

We develop a Python tool, ChromNetMotif, offering an easy-to-use command line interface to extract chromatin-state-marked motifs from a chromatin interaction network. The tool can extract occurrences, frequencies, and statistical enrichment of the chromatin state-marked motifs. Visualization files are also generated which allow the user to interpret the motifs easily. ChromNetMotif also allows the user to leverage the features of a multicore processor environment to reduce computation time for larger networks. The output files generated can be used to perform further downstream analysis. ChromNetMotif aims to serve as an important tool to comprehend the interplay between epigenetics and genome organization.

Availability and implementation

ChromNetMotif is available at https://github.com/lncRNAAddict/ChromNetworkMotif.
Aging and Alzheimer’s disease have dissociable effects on local and regional medial temporal lobe connectivity
Authors: Hrybouski Stanislau , Das Sandhitsu R , Xie Long , Wisse Laura E M , Kelley Melissa , Lane Jacqueline , Sherin Monica , DiCalogero Michael , Nasrallah Ilya , Detre John , Yushkevich Paul A , Wolk David A
Published: September 2023

Functional disruption of the medial temporal lobe-dependent networks is thought to underlie episodic memory deficits in aging and Alzheimer’s disease. Previous studies revealed that the anterior medial temporal lobe is more vulnerable to pathological and neurodegenerative processes in Alzheimer’s disease. In contrast, cognitive and structural imaging literature indicates posterior, as opposed to anterior, medial temporal lobe vulnerability in normal aging. However, the extent to which Alzheimer’s and aging-related pathological processes relate to functional disruption of the medial temporal lobe-dependent brain networks is poorly understood. To address this knowledge gap, we examined functional connectivity alterations in the medial temporal lobe and its immediate functional neighbourhood—the Anterior-Temporal and Posterior-Medial brain networks—in normal agers, individuals with preclinical Alzheimer’s disease and patients with Mild Cognitive Impairment or mild dementia due to Alzheimer’s disease. In the Anterior-Temporal network and in the perirhinal cortex, in particular, we observed an inverted ‘U-shaped’ relationship between functional connectivity and Alzheimer’s stage. According to our results, the preclinical phase of Alzheimer’s disease is characterized by increased functional connectivity between the perirhinal cortex and other regions of the medial temporal lobe, as well as between the anterior medial temporal lobe and its one-hop neighbours in the Anterior-Temporal system. This effect is no longer present in symptomatic Alzheimer’s disease. Instead, patients with symptomatic Alzheimer’s disease displayed reduced hippocampal connectivity within the medial temporal lobe as well as hypoconnectivity within the Posterior-Medial system. For normal aging, our results led to three main conclusions: (i) intra-network connectivity of both the Anterior-Temporal and Posterior-Medial networks declines with age; (ii) the anterior and posterior segments of the medial temporal lobe become increasingly decoupled from each other with advancing age; and (iii) the posterior subregions of the medial temporal lobe, especially the parahippocampal cortex, are more vulnerable to age-associated loss of function than their anterior counterparts. Together, the current results highlight evolving medial temporal lobe dysfunction in Alzheimer’s disease and indicate different neurobiological mechanisms of the medial temporal lobe network disruption in aging versus Alzheimer’s disease.
Acquired diffuse telangiectasias with an unequivocal immunohistochemistry
Authors: Flor Duarte , Xará Joana , Martins Francisco , Coutinho Inês , Cardoso José C
Published: September 2023

A 56-year-old woman presented with abdominal, lumbar and thoracic livedo with 2 years of evolution, consisting of violaceous poikilodermatous patches with scattered petechiae on a base of erythema and telangiectasia, accompanied by diffuse and mild skin atrophy. Histological analysis revealed vasodilation of the superficial dermis and thickening of capillary walls, highlighted by periodic acid–Schiff stain and immunohistochemistry for collagen type IV.
Case report of progressive renal dysfunction as a consequence of amiodarone-induced phospholipidosis
Authors: Duineveld Mirjam D , Kers Jesper , Vleming Louis-Jean
Published: September 2023

Background

Amiodarone is associated with a range of unwanted effects on pulmonary, thyroid, and liver function. However, the nephrotoxic side effect caused by renal phospholipidosis has hardly received any attention up to now.

Case summary

This is a case of an 86-year-old Caucasian male with an acute on chronic kidney disease 4 months after the initiation of amiodarone. A renal biopsy demonstrated the intracellular accumulation of phospholipids that have previously been demonstrated in association with organ dysfunction because of amiodarone use. Serum creatinine levels subsequently improved from 388 to 314 µmol/L after stopping amiodarone over the course of 2 months.

Discussion

In this case, a diagnosis of partially reversible acute on chronic kidney disease caused by lysosomal phospholipidosis due to amiodarone use was deemed highly likely. Lysosomal dysfunction leads to the accumulation of intra-lysosomal phospholipids (phospholipidosis). This accumulation is accompanied by progressive organ damage and dysfunction, including renal dysfunction, in rare instances. Guidelines advise regular surveillance for liver, lung, and thyroid toxicity during amiodarone treatment but do not mention the potential for renal toxicity. This case suggests that it might be prudent to include screening for renal toxicity in this surveillance.