bluuebunny/crossref_metadata_2025_split huggingface dataset:
258 FLEXIT: Geriatric Muscle on the Orthopedic Ward
Authors: Reddin Catriona , Murphy Robert , Dempsey Aoife , Kissane Bláithín , Waters Ruairi , Murphy Colin , Egan Ciara , O'Keeffe Shaun , Mulkerrin Eamon , O'Donnell Martin , Walsh Thomas , Byrne Fergus , Robinson Stephanie , Canavan Michelle 
Published: September 2019

Abstract

Background
Older patients post hip fracture benefit from specialist orthogeriatric care. Best practice tariffs incentivising compliance with the Irish Hip Fracture Standards (IHFS) have been introduced in Ireland(1). We compared levels of compliance to IHFS before and after introduction of a dedicated orthogeriatric service in a tertiary referral hospital. We also hypothesized that improved continuity of care by regular orthogeriatric review would result in less general medical consults to medical teams. We looked at the number of inpatient consults sent for each time period and compared the number of general medical consults sought by orthopaedic teams for similar time periods.

Methods
Data was prospectively collected on all hip fracture patients seen by the orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb2018.

Results
Similar numbers of patients were seen in each time period (n=146 v n=139) with similar age profiles (81.8 vs 79.6 years). Improvements were seen in all of the six IHFS. The most significant improvements were an increase from 31.2% to 96.5% in the proportion of patients seen by a Geriatrician, and an increase from 7.4% to 98.5% in those who had a formal falls assessment.
Fewer patients required medical team consults after the service began (32.2% vs 46.8%, p=0.016). The resultant total number of consults sent fell from 120 consults to 59 consults.

Conclusion
Introduction of an orthogeriatric service has substantially improved compliance with IHFS. The reduction in the number of medical consults requested by orthopaedic teams reflects the improved quality and continuity of care for these patients.
266 Patient and Carers Experience of an Acute Care at Home Team: A Service Evaluation
Authors: Toal Deborah , McCaffrey DrPatricia 
Published: September 2019

Abstract

Background
The Aim of the Acute Care at Home Team is to provide acute care to over 65's in the patient's own home, providing assessment and treatment of acute conditions such as pneumonia, urinary sepsis and heart failure. It is a multidisciplinary team that works together to streamline services to enable a patient to stay safely in their own home. A full comprehensive geriatric assessment is carried out in all patients to help improve patient outcomes. The patients have full access to in patient services such as scans, and x-rays. All blood tests are treated as urgent to ensure the patient is in no way disadvantaged by being treated by acute care at home compared with hospital care.
The aims and objectives are to explore patient and family experiences and identify any areas for improvement.

Methods
A service users and carers experience Questionnaire (N=31) was used to gain insight into how satisfied the patient or family were with the service and what the experience was like having the team come into their home.

Results
Patient satisfaction with this Acute Care at Home Team was reported at 100%. Patients were happy with the care they received, 100% of patients were happy with staff's knowledge of their condition and treatment plan. All of the respondents stated they would both recommend the service and use it again. The qualitative responses were in keeping with 100% satisfaction in that they were positive in nature.

Conclusion
This service evaluation has shown that patient and carer experience of this Acute Care at Home Team is a positive one, with 100% satisfaction levels. There are some small areas to be improved upon, however the results show this service is providing the over 65 population with a good experience of being treated at home as an alternative to hospital care when acutely unwell.
279 Quality Improvement Audit on Bone Health Assessment and Secondary Prevention of Patients Discharged from an In-patient Rehabilitation Unit Post Fracture
Authors: Synnott Pádraig , Brennan Michelle , O'Keeffe Shaun , Canavan Michelle 
Published: September 2019

Abstract

Background
Osteoporosis accounts for more disability-adjusted life years than many non-communicable diseases. Identification and treatment is important to reduce morbidity and mortality associated with further fracture.(1)
National Osteoporosis Guideline Group recommends all patients with a fragility fracture should undergo a bone health assessment and commence pharmacological therapy if indicated.(2)

Methods
Electronic discharge summaries of all patients with a diagnosis of fracture discharged from an off-site rehabilitation unit from 1st January 2018 to 31st December 2018 were reviewed.
Patient details, location and mechanism of fracture, bone health assessment and discharge prescription were assessed.
Following data collection, an education session directed at NCHDs was performed and a discharge checklist prompting bone health review and consideration of pharmacological therapy was introduced. A re-audit was performed at 4 months to assess change following this intervention.

Results
74 patients had a diagnosis of fracture. 4 were excluded as fracture resulted from high impact trauma.
100% had corrected calcium measured.
93%(n=65) had Vitamin D(OH) measured.
91%(n=64) had PTH measured.
55%(n=39) were discharged on calcium/vitamin D(OH) supplementation. 33%(n=23) were discharged on Vitamin D(OH) alone.
66%(n=46) were discharged on antiresorptive therapy: 28%(n=13) bisphosphonate, 67% (n=31) denosumab, 4% others.
33%(n=23) were not prescribed any bone protection on discharge. 4 had advanced chronic kidney disease.
6%(n=4) were discharged without calcium/Vitamin D or antiresorptive therapy.
A re-audit from January to April 2019 of 15 patients post NCHD education has shown an increase in antiresorptive therapy prescription 86%(n=13)

Conclusion
Bone health assessment and prescribing practices of antiresorptive therapy in patients undergoing rehabilitation post fracture is sub-optimal. Education of non-consultant hospital doctors can substantially improve rates of antiresorptive therapy prescription.
295 Characteristics of Older Hip Fracture Adults Admitted to a Dublin Hospital
Authors: Maher Niamh , Steen Georgina , Fallon Nessa , Carroll Claire O , Rafferty Máire , Walsh J B , McCarroll Kevin , Lannon Rosaleen 
Published: September 2019

Abstract

Background
Hip fractures are common in older adults and are associated with increased mortality and morbidity resulting in medical and socioeconomic burden for healthcare system and patient alike.

Methods
A retrospective study was conducted on patients admitted to a Dublin hospital for hip fracture repair between October 2018 and February 2019. Data on sociodemographic characteristics such as; gender; age; pre-admission residence; fracture history; bone protection medication use; pre-fracture mobility; discharge mobility and destination; length of stay and mortality rate was collected.

Results
50 patients admitted between 01/10/19 and 31/01/2019. 2:1 female to male. Average age 78 ranging from 48-93. 88% admitted from home. 44% had previous fractures. Vertebral (36%), wrist (23%) and pelvic (23%) most common fractures. 27% of these were on bone protection medication on admission. 41% were taking Calcium and Vit D or Vitamin D only. 70% of participants were independently mobile pre-fracture. 94% required some form of mobility aid on discharge. The average length of stay was 32 days ranging from 2 to 160 days. 38% went home whilst 36% were discharged to rehabilitation. 88% were discharged on bone protection medication - 70% received IV Zoledronic acid as inpatients, 14% commenced Prolia 6 monthly injections and 4% on oral bisphosphonates. Mortality rate was 6%

Conclusion
Hip fractures have a negative effect on a person’s mobility. Whilst many guidelines for the assessment and treatment of osteoporosis recommend intervention be considered in men and women who have sustained a fragility fracture, it is clear from this study that an osteoporosis care gap exists and further work is required to better identify, assess and treat patients following their first fracture in the hope of reducing further fractures, particularly hip and vertebral fractures.
301 Older Farmers' Experiences of Musculoskeletal Disorders
Authors: Cunningham John , Kerin Austin , Galvin Rose , Robinson Katie 
Published: September 2019

Abstract

Background
Almost a third (n=41,000) of all Irish farm holders are aged 65 years or older. Older farmers are vulnerable to Musculoskeletal Disorders (MSD’s) both by virtue of the nature of their work and their age. MSD’s are a known risk factor for workplace accidents and farming is the highest risk occupation in Ireland.
This study aimed to explore older farmers’ experiences of living with and accessing healthcare for MSD’s.

Methods
A qualitative study design employing semi-structured interviews was employed. Nine Irish farmers aged 65 years and over with current or previous experience of MSD's were recruited. All participants continued to farm on either a full-time or part-time basis. Data were analysed using thematic analysis.

Results
Four themes describing older farmers' experiences of MSD’s and healthcare were identified; (1) acceptance of MSD’s as inevitable (2) biomechanical and biological beliefs about MSD’s (3) resilience and a commitment to continuing work in response to MSD’s (4) scepticism and avoidance of healthcare.

Conclusion
To the best of our knowledge this is the first qualitative study of older Irish farmers’ experiences of MSD’s. Findings reveal that older farmer’s experiences differ significantly from those reported by other occupational groups. Commitment to continue working permeated the findings of this study and shaped older farmers' experiences and responses to MSD's. Older farmers accept MSD’s and pain as inevitable consequences of farming, and they respond to MSD’s with stoicism. Lack of healthcare provider knowledge about farming culture and practices contributes to older farmers' negative healthcare experiences and avoidance of healthcare. Given the prevalence of MSD’s in this population future research should focus on developing and evaluating appropriate health promoting and patient-centered interventions to support continued safe farming for older Irish farmers.
319 Appropriate Duration of Extended Cardiac Monitoring for Atrial Fibrillation in Cryptogenic Stroke
Authors: Donlon Kate , Murphy Robert , Mannion Edel , Waters Ruairi 
Published: September 2019

Abstract

Background
Strokes due to cardio embolism are generally more severe and prone to early and long term recurrence. All forms of anticoagulant therapy are associated with a two thirds risk reduction in acute ischaemic stroke associated with atrial fibrillation.
Establishing a diagnosis of paroxysmal atrial fibrillation can be a challenging one.
Our study will attempt to answer the question as to what duration of extended cardiac monitoring is required when screening for atrial fibrillation in cryptogenic stroke.

Methods
We examined the time of atrial fibrillation initial diagnosis in 50 patients with an original working diagnosis of cryptogenic stroke but later have atrial fibrillation confirmed on extended monitoring.
All patients wore the external loop recorder from 1 day to 3 weeks’ duration. On return of the device, data from the external loop recorder was downloaded, and reviewed by a consultant cardiologist.
The total duration of monitoring using the external loop recorder was recorded. The time to first episode of algorithm detected atrial fibrillation was recorded.

Results
The mean duration of extended cardiac monitoring using the external loop recorder was 120.1days
By seven days, atrial fibrillation had been detected in 94% of patients. By 72 hours, atrial fibrillation had been detected in 78% of patients.
The mean age of participants was 58.3 years. 54.4% were female. The mean time to detection of atrial fibrillation was 52.9 hours. The median time to detection of atrial fibrillation was 34.2 hours.

Conclusion
External loop recorders present an opportunity for detection of paroxysmal atrial fibrillation in high risk individuals. Our study shows the feasibility and accuracy of a screening duration of seven days in the high risk post ischaemic stroke population.
A one week screening timeframe allows us to screen twice as many patients for paroxysmal atrial fibrillation. Successful screening for atrial fibrillation in this high risk group allows the commencement of acceptable and safe anticoagulant therapy.
337 Falls Pathway and Assessment, an Audit
Authors: McCarthy Kate , Hannon Evelyn , Carroll Jennifer 
Published: September 2019

Abstract

Background
Falls remain a common presentation to emergency departments and medical assessment units. They can result in serious injuries requiring surgical intervention and prolonged hospital admission. Conversely a fall may have minimal injury yet still result in prolonged hospital admission. The frailty intervention therapy team (FITT) aims to complete a comprehensive assessment physical and social needs in a time efficient manner.

Methods
We reviewed the medical notes of a cross-section of patients, aged over 65 years, on medical wards admitted with a fall. The service, under which, the patient was admitted was noted. We looked at the length of time between admission and physiotherapy review, undertaking bedside tests for postural hypotension and assessment of bone health, with commencement of appropriate therapy pre discharge. We also reviewed medications and if anti hypertensives were stopped or adjusted.

Results
Of the 30 patients included, the average length of time from admission to physiotherapy review was 2.6 days. 7 of the patients were seen on the same day, however 3 were awaiting review.
Postural blood pressures were requested in one third of the group, predominately in those patients admitted under a geriatric service.
A similar pattern was seen in assessment of bone health, although of the patients included, half of them were on at least a single agent for osteoporosis.

Conclusion
Development of FITT is of benefit to the health service as a whole and improves early mobilisation, extension for weekend cover should be considered.
Interventions such as adjustments to anti hypertensives and opportunistic assessment of bone health should be highlighted to all medical teams.
A concise falls pathway encompassing these interventions and FITT assessment does not seem obscure in this age of over-crowding and crisis.
351 Integration of Auditory and Visual Information is Associated with Ageing, Sex and Cognitive Performance
Authors: Setti Annalisa , Hernández Belinda , Anne Kenny Rose , Newell Fiona N 
Published: September 2019

Abstract

Background
In ageing, multisensory integration, i.e. the ability to combine efficiently information from different sensory modalities, is emerging as a stand-alone contributor to explaining cognitive and functional deficits. Experimental evidence shows that inefficient multisensory integration is associated with cognitive impairment, falls and balance maintenance; however these findings need to be supported by large population representative studies. We utilised the Sound-induced flash illusion (SIFI) as test of multisensory efficiency; the test was conducted on a population representative sample from the Irish Longitudinal Study on Ageing (TILDA). We hypothesized that Susceptibility to the SIFI would increase with ageing and would be associated with poorer Montreal Cognitive Assessment (MoCA) scores.

Methods
Participants: 3,955 adults aged 50 years and over. Participants provided informed consent. Data were drawn from the third wave of the TILDA study, in which participants took part in a Computer Assisted Interview and a Health Assessment.
The SIFI test was part of the Health Assessment; SIFI is a computer-based test in which participants see a series of white dots appearing quickly on the screen, which participants are required to count; the dots (flashes) can be paired with 0, 1 or 2 beeps; when one dot is paired with two beeps, there is the illusory perception that two dots are presented.
A hierarchical Bayesian, ordinal-regression model was used to determine which variables predicted audio-visual integration (SIFI proportion of correct responses, i.e. no illusions). We controlled for a range of covariates.

Results
As predicted, higher susceptibility to the SIFI, indicating higher integration of audio-visual information, was associated with older age, and poorer scores at MoCA. Female sex was also associated with higher susceptibility, which represents a novel result in the literature.

Conclusion
The present study presents the first findings on multisensory integration in a large population representative study. They confirm that inefficient integration is associated with ageing, poorer cognition and, unexpectedly, being female.
43 Addressing Polypharmacy in the Frail Older Person - the WIDE (Wholistic, Integrated, Deprescribing, Evaluation) Review
Authors: Kinahan Clare , Soomro Nazir , Daniels Florrie , Hussain Wafaa , Heery Helen 
Published: September 2019

Abstract

Background
People are living longer, with more chronic conditions and are prescribed more medications according to disease specific guidelines. The WIDE Review is an innovative model of comprehensive medication review devised to treat the whole patient. Frail patients are twice as likely to be prescribed inappropriate medications and are more vulnerable to their harmful effects. Use of the STOPP/START criteria and the Medication Appropriateness Index (MAI) have been shown to improve patient outcomes. This study examined the impact and cost effectiveness of pharmacist led WIDE Reviews.

Methods
This quantitative prospective cohort study was conducted over 8 weeks in a Model 3 hospital. Inclusion criteria: inpatients age > 65 years; prescribed > 6 regular medications and screened positive for frailty (PRISMA 7 score >3). Critically ill patients were excluded. Eligible patients were randomly allocated to intervention or control group. The intervention group received a pharmacist led WIDE Review: Wholistic (establishing patients' priorities), Integrated (collaborating with primary care providers), Deprescribing Evaluation of medication harms versus benefits. Medications were screened using the STOPP/START criteria and the MAI was calculated. In conjunction with the patients and their consultants, deprescribing plans were devised and communicated to their GPs and community pharmacists

Results
A total of 20 intervention and 20 control group patients were enrolled. Patient characteristics (age, sex and length of stay) were similar for both groups. 65% of STOPP and 62% of START criteria were addressed in the intervention group versus 12% and 5% respectively in the control group. In the intervention group 83 medications were stopped, 23 dose reduced and the total MAI score was reduced by 64%. Cost savings to the annual drug budget alone represented a 9:1 return on investment of hospital pharmacist time.

Conclusion
Pharmacists performing WIDE Reviews significantly improved medication appropriateness and realised compelling cost savings. A larger scale study of this innovative approach to medication review is planned.
50 My Healthcare Information Folders
Authors: Deasy James , Griffin Josephine , Hayes Mary , Cotter Suzanne 
Published: September 2019

Abstract

Background
For many people an admission to an acute hospital can be a stressful and overwhelming experience. During admission it can be difficult to process and understand the information provided by members of the multi-disciplinary team (MDT). Patient information leaflets (PILS) are important in educating and empowering patients in the management of their own health and wellbeing. PILs are frequently provided to patients by MDT members during their admission. These valuable resources are not always consulted by patients or their families and in many cases are not brought home from hospital.

Methods
Using Plan Do Study Act (PDSA) methodology patient information folders named “My healthcare information” were provided to in-patients by MDT members. Patients were encouraged to put all PILs provided by the MDT in these folders and bring them home for future reference. Questionnaires were administered to patients to ascertain if they found the folders useful and would be likely to use them going forward. Two PDSA cycles have been completed to date.

Results
​The results were largely positive. A significant amount of those questioned found it difficult to understand and remember what was said to them by hospital staff (5 of 15 respondents or 33%) and felt they did not receive enough written information about their condition (6 of 15 respondents or 40%). A high proportion of those asked stated they found the folder useful and would be likely to use it at home going forward (22 of 23 respondents or 96%).

Conclusion
My healthcare information folders are a potentially useful tool in empowering patients and educating them about their own health and wellbeing. Further PDSA cycles and staff education is required to continue the project. The next PDSA cycle will focus on the MDT member’s experience of using the folders.
57 The Workload Distribution and Response Times of FAST Scans in a Level 3 Hospital in Ireland
Authors: McGarvey Caoimhe , O'Brien Paul 
Published: September 2019

Abstract

Background
With the advent of time sensitive treatments like thrombolysis and thrombectomy for acute ischaemic stroke, it would be expected that stroke CT would place an increased demand on CT services out of hours. Our aim is to demonstrate the change in the workload distribution in the investigation and management of acute stroke over the last year.

Methods
Data was collected from the radiology systems used in our hospital (NIMIS/PACS). Firstly, CT multiphase angiograms done between 17/10/2017 and 17/10/2018 were examined, followed by all FAST-positive CT brains in the same period. Arrival times for FAST positive patients were collected from the ED Symphony system. These details were used to calculate time to CT and time to report in hours and minutes. Scans were categorised into 5-time windows, in and out of hours. The process was repeated for CT brain and all other CT scans for comparison.

Results
58.14% of all FAST-positive CT scans were performed out of hours. FAST positive scans accounted for 9.49% of all out of hour CT scans, this rose to 20% when examining the out of hour scans from Monday to Friday. The most common indication for non-FAST positive CT was trauma. There was a higher likelihood of receiving a CTA during hours as opposed to out of hours, (73.33% vs 66.94%). Median time to CT in FAST positive patients: window 1 – 30mins, window 2 – 49mins, window 3 – 49mins, window 4 – 34mins, window 5 – 39mins.

Conclusion
Stroke CT will continue to increase the out of hours work load for CT departments across the country especially with our ageing population. It is vital that services, particularly in level 3 stroke centres, are adequately equipped in terms of staffing to meet the highest standard of care in the management of acute stroke.