bluuebunny/crossref_metadata_2025_split huggingface dataset:
152 Implementation of Older Persons Rapid Assessment Hub (OPRAH) in the Emergency Department (ED)
Authors: Adedokun Comfort , McNamara Rosa , O’Herlihy Nessa 
Published: September 2019

Abstract

Background
The Emergency Department (ED) is where most people, including older adults in crises, seek care. OPRAH was introduced in order to meet the needs of our changing population. The unit was developed out of existing resources within the ED and cohorts both older patients and staff to an area more suitable to carry out assessments.

Methods
We used a quality improvement framework to develop our service. OPRAH is led by an ED GEM (Geriatric Emergency Medicine) consultant, staffed using the existing ED team, housed within footprint of the ED as part of the Clinical Decision Unit (CDU) with the addition of an HCA (healthcare assistant) as required. To determine the impact of the service on admissions of older adults, we collated patient records prospectively. These were reviewed and coded by senior ED professionals blinded to outcomes, to determine medical-referral rate for admission in these cohort.

Results
In the first 3 weeks of implementation, 76 patients were assessed. Four were admitted and 2 transferred to other hospitals. Mean age was 83 years ranging 66-103 years with an average of 262 minutes in the ED prior to OPRAH admission.
Blinded coders review determined 53 (76%) of these patients would have been referred for admission. The majority of the remainder would have completed their care in the ED, as they were not eligible for admission to CDU.

Conclusion
Introduction of OPRAH to the ED has improved access for older people to short-stay ED led care and reduced admission rates. We have identified a trend towards fewer episodes where care by in-house teams is completed within the ED.
We are in an early phase of this project. Nonetheless, it is evident that by redesigning how we assess older people in the ED and using available outpatient resources, we could impact on admission rate and length of stay in the ED without compromising patient care. Implementation has increased the use of the integrated care team, hospital and community MDT (multidisciplinary team).
156 Review of Outcomes of a Dedicated Geriatric Surgical Liaison Service
Authors: Coary Roisin , McCarthy Kathryn , Sumrien Haytham , Shipway David 
Published: September 2019

Abstract

Background
In the United Kingdom, the 2010 National Confidential Enquiry into Patient Outcome and Death report ‘An Age Old Problem’ outlined significant shortcomings in the perioperative care of older people. Other than hip fractures, the care of older patients under surgical specialities is largely devoid of routine geriatrician input. In August 2018, we introduced daily geriatric reviews (GR) on the gastrointestinal surgical wards, aiming to improve length of stay (LOS) and mortality.

Methods
All acute general surgery admissions for patients ≥70 years were reviewed between September and October 2017 (pre-introduction) and 2018 (post-introduction), and outcomes compared. For 2018, comparisons were also made between those who had GR and those who didn’t.

Results
There were 173 admissions in 2017, vs 190 in 2018. In both 2017 and 2018, median age was 80, median LOS was 4 days, and clinical frailty scale (CFS) 4. Twenty-two percent (38/173) of patients had a surgical procedure in 2017, vs 33% (63/190) in 2018. Inpatient mortality was 8% (13/173) in 2017 (median CFS 6), vs 6% (11/190) in 2018 (median CFS 6).
In 2018, 21% (40/190) of patients had GR: median time to review 3 days. 54% (n=22) of the patients with GR underwent a surgical procedure, 37% (n=15) were admitted to ICU, and inpatient mortality was 5% (n=2), vs 28% (n=42), 4% (n=6) and 6% (n=9) respectively for those without GR. 30 day readmission for those with GR was 12.5% (n=5), vs 18.4% (n=28) for those not seen.

Conclusion
While more surgical procedures were performed in 2018 (post-introduction), overall LOS remained unchanged and improved mortality was observed compared to 2017. Geriatricians are seeing more post-operative and ICU patients, and despite presumed increased complexity, both mortality and readmission rates remain low. Screening for frailty and specific inclusion criteria may improve rates of GR.
163 Rehabilitation to Nursing Home - The Waiting Period
Authors: Salawu Adefunke , Palatty Jaimon , Glynn Marian 
Published: September 2019

Abstract

Background
The average application processing time for the National Nursing Home Support Scheme (NHSS) has seen drastic improvement from 15 weeks in 2014 to 4 weeks in 20161. There is no available data of the duration of stay in rehabilitation beds after approval of NHSS application and reasons for delay in transition to nursing home.

Aims
(1) To examine average length of stay in rehabilitation before multidisciplinary team (MDT) decision is made for nursing home care.
(2) To examine average length of stay in rehabilitation bed from the time of NHSS approval to discharge into nursing home.
(3) To examine reasons for delay in discharge to nursing home after NHSS approval.

Methods
A retrospective chart review of patients discharged into nursing homes between January to June, 2018 from geriatric rehabilitation units.
Data collected include age, length of stay in rehabilitation unit before multidisciplinary decision was made in conjunction with patients/family to seek nursing home care (LOS1), Length of stay in rehabilitation bed following decision for nursing home care (LOS 2). Reasons for the delay in the transition from rehabilitation bed to nursing home bed were also documented.

Results
Seventeen patients were discharged into nursing homes, LOS1 of 43.12 days and LOS2 of 50 days. Complexity of application in terms of financial evaluation especially for patients who were deemed cognitively incapable of managing their finances, lack of suitable nursing homes for patients with complex needs/challenging behaviours, family dynamics with regards to choice of nursing homes and medical stability to facilitate such transfers were reasons for delay in transition to nursing home beds.

Conclusion
Transitional care beds, which are generally acknowledged to be more appropriate to these patients' care needs and are less expensive than rehabilitation beds, need to be utilized more.
Education of healthy adults over 65 years to proactively plan for future care needs and promote awareness of legislatures regarding capacity and decision making.
164 Dementia, a Familial Affair
Authors: Qureshi Aqueel , Gabr Ahmed , Zulkifli Daniel , Chaila Elijah , O'Connor Margaret 
Published: September 2019

Abstract

Background
In Ireland, there are approximately 55,000 cases of dementia. One of the rare causes of dementia is Creutzfeldt-Jakob disease (CJD), affecting one person per million each year worldwide. It is a rapidly progressive degenerative fatal disorder with an estimated mortality of 70% within one year. In this case report we present a rare case of possible familial-CJD which presented initially as a stroke mimic.

Methods
A 64-year old female referred via GP with abnormal left arm athetoid movements and in-coordination. MRI brain demonstrated a small sub-acute hyper-intense lesion in the right basal ganglia on diffusion weighted imaging. Her symptoms were atypical for acute stroke, however an alternative cause was not evident. She was monitored closely with early supported discharge. However the left sided athetoid movements worsened and were associated with intermittent myoclonic jerks and dystonic posturing. She was reassessed with a wider differential including focal impaired seizures, Rasmussen’s encephalitis, and CJD. EEG showed periodic lateralizing epileptic discharges, however patient failed to show any response to anti-epileptic treatment and her clinical course was one of rapid deterioration. Clinical findings and subsequent MRI findings showed new areas of hyperintensity supporting CJD.

Results
Ultimately our patient deteriorated rapidly resulting in an akinetic and abulic state, resulting in death. A final diagnosis of sporadic-CJD was made based on rapid progressive deterioration and findings on MRI as well as confirmation on post-mortem brain pathology. A deeper review of family history revealed a sister who had passed away years prior with rapid progressive neurological illness. Her work-up showed clinical signs and EEG findings supporting CJD, however there was no post mortem to confirm her diagnosis.

Conclusion
This case highlights the importance of genetics shaping phenotypes and that consideration should always be given to a full relevant family history. It also shows a rare case of rapidly progressive dementia confirmed due to CJD with a likely underlying familial predisposition.
167 An Alternative to the Emergency Department for Frail Older People
Authors: Shanahan Elaine , Antonenko Alisa , Kennelly Siobhan , Fan Chie Wei , McCarthy Frances 
Published: September 2019

Abstract

Background
53% of hospital inpatient beds are occupied by patients >/= 65 years. These patients often experience functional decline. In those transferred to our post-acute rehabilitation unit the average length of stay prior to transfer is 16 days and 38 days post transfer. Our hospital has a Community Response Unit (CRU) which provides an alternative to this care pathway, offering direct admission to a 15 bed unit with 24-hour medical cover and full multidisciplinary input. This study reviews the use of this unit over a one year period.

Methods
We retrospectively reviewed the discharge letter or medical notes of patients admitted to the CRU during 2018. The referral source, indication for admission, length of stay and discharge destination were recorded.

Results
One-hundred and fourteen patients were admitted over the one year period. Source of referral was identified for 81 patients and included day hospitals (53.1%), acute hospitals (14.8%), respite/ transitional care wards (12.3%), nursing homes (8.7%), home visits (6.2%), community sources (3.7%) and other speciality clinics (1.2%).
The most common indications for admission were-mobility/functional decline (26.3%), falls (17.5%), requirement for medical investigations (14.9%), cognitive decline with behavioural issues (11.4%), blood transfusion (10.5%), pain management (7%), general deterioration (7%), requirement for increased home supports (7%), treatment of infection (6.1%), rehab post fracture (5.3%), wound management (4.4%), alcohol detoxification (1.8%) and self-neglect (1.8%). Multifactorial reasons for admission frequently occurred.
The median length of stay was 24 days (1-176 days), 67% of patients were discharged to their original residence, 17.4% were newly admitted to residential care, 9.2% required transfer to an acute hospital and 6.4% died during their admission.

Conclusion
The CRU provides comprehensive Geriatrician led care for a wide variety of indications. This model of care offers a valid alternative to Emergency Department presentation and acute hospital admission.
Pharmacokinetic considerations in pediatric pharmacotherapy
Authors: Lim Sin Yin , Pettit Rebecca S 
Published: September 2019

AbstractPurposeThe changes in physiological functions as children grow and organ systems mature result in pharmacokinetic alterations throughout childhood. These alterations in children result in absorption, distribution, metabolism, and excretion of drugs that are different from those seen in the typical adult diseased population.SummaryChanges in gastrointestinal motility and gastric pH in neonates and infants affect the absorption rate and bioavailability of drugs. Skin absorption rate and extent can be altered by different skin structures and perfusion in young children. Intramuscular and rectal absorption become less predictable in children due to erratic absorption site perfusion and other factors. Children’s body compositions also differ greatly from that in adults. Water-soluble drugs distribute more extensively in newborns due to larger water content than in older children and adults. Drug elimination and excretion are also affected in pediatric population due to differences in liver and renal function. Immature enzyme development and renal function result in reduced clearance of drugs in young children. There are limited pharmacokinetic data available for many drugs used in children.ConclusionConsidering the changes in pharmacokinetics in children can help pharmacists optimize the dosing and monitoring of drugs and do the best they can to help this vulnerable population.
Pediatric medication safety considerations for pharmacists in an adult hospital setting
Authors: Kennedy Audrey R , Massey Lindsay R 
Published: September 2019

Abstract

Purpose
Risks and vulnerabilities of the medication-use process in nonpediatric institutions that also serve pediatric patients are reviewed, and guidance on risk mitigation strategies is provided.

Summary
There are many risks and vulnerabilities in the medication-use process as it relates to pharmacotherapy for pediatric patients admitted to adult institutions. Mitigation of these risks is critical and should encompass various available resources and strategies. Special emphasis should be placed on use of technology to improve overall safety. Available literature recommends optimization of technology and resource use, institutional support for pediatric pharmacists’ involvement in managing pediatric medication use, and provision of early exposure to pediatric patients in pharmacist training programs as additional methods of mitigating risks associated with pediatric medication use in adult institutions. Adult hospitals that provide care for pediatric patients should assess their processes in order to identify hospital-specific interventions to promote pediatric medication safety.

Conclusion
Pediatric medication safety frameworks in U.S. adult institutions vary widely. Treating pediatric patients involves risks in all areas of the medication-use process. Optimizing technology, utilizing external resources, supporting a pediatric pharmacist, and providing early-career exposure to pediatric patients are methods to mitigate risks in institutions that primarily serve adult patients.
The Real Facts Supporting Jeanne Calment as the Oldest Ever Human
Authors: Robine Jean-Marie , Allard Michel , Herrmann François R , Jeune Bernard 
Published: September 2019

Abstract

Background
The 122 years and 164 days age claim of Jeanne Calment, the world oldest person who died in 1997, is the most thoroughly validated age claim. Recently the claim that families Calment and Billot organized a conspiracy concerning tax fraud based on identity fraud between mother and daughter gained international media attention.

Methods
Here, we reference the original components of the validation as well as additional documentation to address various claims of the conspiracy theory and provide evidence for why these claims are based on inaccurate facts or unrelated to the death of Yvonne Billot-Calment, the daughter of Jeanne Calment, in 1934.

Results
Also, countering the contention that the occurrence of a 122 year old person is statistically impossible, mathematical models are presented which also supports the hypothesis that though extremely rare, as would be expected for the oldest person ever, Jeanne Calment’s age claim is plausible.

Conclusions
In total, the quality of the investigation supporting the claim of conspiracy as well as the mathematical analysis aiming to back it do not reach the level expected for a scientific publication.
Differential responses by urban brown rats (Rattus norvegicus) toward male or female-produced scents in sheltered and high-risk presentations
Authors: Parsons Michael H , Deutsch Michael A , Dumitriu Dani , Munshi-South Jason 
Published: September 2019

Abstract
Wild rats (Rattus norvegicus) are among the most ubiquitous and consequential organisms in the urban environment. However, collecting data from city rats is difficult, and there has been little research to determine the influence, or valence, of rat scents on urban conspecifics. Using a mark-release-monitor protocol, we previously learned rats can be attracted to remote-sensing points when baited with mixed-bedding from male and female laboratory rats. It was thus essential that we disambiguate which scents were eliciting attraction (+ valence), inspection, a conditioned response whereby attraction may be followed by avoidance (–valence), or null-response (0 valence). We used radio-frequency identification tagging and scent-baited antennas to assess extended (>40 days) responses to either male or female scents against two risk presentations (near-shelter and exposed to predators). In response to male scents, rats (n = 8) visited both treatments (shelter, exposed) more than controls (0.2 visits/day treatment vs. 0.1/day; P < 0.05) indicating scents accounted for response more so than risk. Dwell-times, however, did not differ (1.2 s/visit treatment vs. 0.9 s/visit; P > 0.5). These outcomes are consistent with inspection (–valence). In response to female scents, rats (n = 7) increased visitation (5.02 visits/day vs. 0.1/day controls; P < 0.05), while dwell-times also increased 6.8 s/visit vs. 0.2 s/visit in both risk-settings. The latter is consistent with persistent attraction (+valence), but was also influenced by shelter, as runway visits (1.1 visits/day) were a magnitude more common than predator-exposed (0.1 visits/day). Further understanding and exploiting the mobility of city rats is necessary for improvements in basic and applied research, including city pathogen-surveillance and urban wildlife management.
Right Orbitozygomatic Craniotomy for Clip Wrapping of an A2 Fusiform Aneurysm: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F 
Published: September 2019

Abstract
Distal anterior cerebral artery aneurysms often rupture at a small size and are associated with overall higher operative morbidity relative to other anterior circulation aneurysms. This patient had an incidentally identified anterior cerebral artery proximal A2 segment fusiform aneurysm that did not respond to endovascular treatment and required open surgical management. The fusiform dilation was mobilized and isolated circumferentially within the interhemispheric fissure, and a Gore-Tex clip-wrapping was planned. A permanent clip was applied along the aneurysmal dilation parallel to the vessel directly prior to completing the wrapping to attempt to establish native flow dynamics through the aneurysmal segment. The clip-wrapping was then completed, and intraoperative indocyanine green fluoroscopy demonstrated good distal flow through the aneurysmal segment. The patient gave informed consent for surgery and video recording. The institutional review board approval was deemed unnecessary. Used with permission from the Barrow Neurological Institute, Phoenix, Arizona.
Giant Cervical Cavernous Malformation: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F 
Published: September 2019

Abstract
Cervical spinal cord cavernous malformations are rare but can be neurologically devastating lesions and, when symptomatic, are best treated with gross total resection to prevent progressive neurologic decline related to recurrent hemorrhage. This patient had a large high cervical cord cavernous malformation with evidence of recent hemorrhage. A midline myelotomy was utilized to enter the cavernous malformation. The cavernous malformation was then circumferentially separated from the spinal parenchyma and removed in a piecemeal manner. Postoperative imaging confirmed gross total resection of the lesion with preservation of the surrounding spinal cord. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Women and Their Mothers-in-Law: Triangles, Ambiguity, and Relationship Quality
Authors: Greif Geoffrey L , Woolley Michael E 
Published: September 2019

AbstractEach marriage is the beginning of multiple intergenerational in-law relationships. Drawing on a survey of 351 women about their relationships with their mothers-in-law (MILs), this article reports on the impact of family triangles and boundary ambiguity on the quality of the relationship. In a three-block regression analysis, predicting a seven-item relationship quality scale, the first block included six demographic variables. The second and third blocks included three survey items each of reported relationship triangles and boundary ambiguity in a woman’s interactions with her MIL. Results revealed that although the couple having children predicted worse relationship quality in the demographic block, that result was no longer significant once family triangle measures were entered. All three measures of boundary ambiguity were also significant. The three measures of boundary ambiguity eclipsed two of the three family triangles when entered in the third block, leaving only the daughter-in-law feeling comfortable going directly to the MIL about important issues still significant.
Outcomes Following Transcanal Endoscopic Lateral Graft Tympanoplasty
Authors: Creighton Francis X. , Kozin Elliot , Rong Anni , Cohen Michael , Lee Daniel 
Published: September 2019

Outcome Objectives:
Demonstrate feasibility of performing endoscopic transcanal lateral graft tympanoplasty.
Compare audiometric and clinical outcomes of transcanal endoscopic lateral graft with previously reported outcomes of microscopic post-auricular lateral graft tympanoplasty.

Methods:
A retrospective review of sequential pediatric and adult endoscopic transcanal lateral graft tympanoplasties (type I) performed between May 2014 and August 2015 at a single institution by two experienced otologists. Rate of perforation closure and audiometric outcomes (pure-tone average [PTA] and word recognition scores [WRS]) were obtained and compared with previous published outcomes of post-auricular microscopic lateral grafts.

Results:
Twenty patients, five right and 15 left ears, met criteria. Ninety percent of patients had successful closure of their perforation. One patient had a residual central perforation; active acute otitis media was noted intraoperatively in this case. One patient had graft lateralization. Mean follow up was 10.5 months (standard deviation [SD] = 141 d). Mean operative time was 160 (SD = 26.1) minutes. Mean improvement in PTA was 18 dB (SD = 10.3). Two patients had worsening of audiometric outcomes with <15 dB decreases in PTA and unchanged WRS; all other patients showed improvement or no change in audiometric outcomes. These results are similar to previously published outcomes for post-auricular microscopic approaches.

Conclusion:
Transcanal endoscopic lateral graft tympanoplasty is a novel technique for closure of anterior and subtotal perforations that avoids a postauricular incision. Outcomes in this cohort were similar to historical results for post-auricular microscopic approaches. Prospective studies with larger cohorts will be crucial to understanding the advantages and limitations of this new surgical approach.