bluuebunny/crossref_metadata_2025_split huggingface dataset:
113 Pharmacist Interventions at Discharge and the Quality of Older Patients' Care: A Systematic Review
Authors: Kalim Reham , McMahon Niamh , Ryder Sheila 
Published: September 2019

Abstract

Background
Discharge and transfer between healthcare facilities put older adults at risk of medication-related problems and early readmission. This review examined the evidence for pharmacist interventions at discharge and patients’ care quality.

Methods
Eight databases were searched systematically from inception to date, using the appropriate search strategy for each. A search for grey literature was conducted on eight further websites. No filters (e.g. language/dates) were applied.
Only prospective randomized/quasi-randomized controlled studies involving patients > 65 years of both genders, discharged alive from hospital, were included. The criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions formed the basis of the assessment, conducted using RevMan 5.3.

Results
9738 articles were obtained: 8120 unique articles after duplicate removal. Following screening, 12 studies were identified for inclusion. Interventions comprised follow up, medication review and patient counselling at discharge. Of these, 10 were delivered by pharmacists alone, while the remainder were delivered by pharmacists within a multidisciplinary team. Outcome measures included readmission rates, length of stay, medication adherence and care quality.
Nine studies showed significant improvements over standard care, e.g. a decrease in hospital admissions (0.68 OR, p=0.002), improved compliance (P<0.001) and a 47% reduction in emergency department visits (95% CI, 0.37-0.75).
However, three studies did not report positive results: Two reported non-significant improvement but the third reported poorer readmission rates. Risk of bias was low but the high baseline standard of care reduced the scope for improvement in two of these studies.

Conclusion
The review summarizes pharmacist interventions’ efficacy and their effect on care quality indicators where possible. The majority of interventions at discharge significantly enhanced patients’ care quality.
The findings should prove valuable to decision-makers when planning or improving discharge and post-discharge services.
117 AusTOMs An Outcome Measure to Determine the Impact of Environmental Adaptations on Functional Performance
Authors: Cannon Elaine , Delaney Siobhan 
Published: September 2019

Abstract

Background
Occupational Therapists routinely perform pre-discharge home assessment visits. The import of a supportive home environment to successful ageing has been established in the literature (Tanner, Tilse & Desleigh de Jonge, 2008), with housing adaptations and aids recognised as a method of promoting independence within the home (Stark et al, 2009).
In this hospital, home assessment visits review functional mobility, functional transfers and assess for environmental barriers within the home. The purpose of this study was to detect any change in functional performance following a pre-discharge home assessment visit and implementation of OT recommended aids/railings or both. The AusTOMs (Australian Therapy Outcome Measures) for Occupational Therapy scale was used as the outcome measurement tool.

Methods
The study was applied to a cohort of 20 consenting inpatients over 65 years of age. Convenience sampling was used for the purposes of the study. Inclusion criteria comprised of patients that attended a minimum of one pre-discharge OT home assessment visit. It was conducted over a ten week period in 2018.
The study was conducted by two occupational therapists (OTs) on the general rehabilitation team.
The scale was applied to review the following functional transfers within the home environment on initial home assessment visit and following the implementation of OT recommended aids/railings. 1. Access2. Stairs3. Bed4. Toilet5. Bath/Shower6. Seating

Results
The group Average AusTOMs Resultant score at initial home assessment was 3.05. The group average score following implementation of recommendations was 4.08. This indicates a change in performance from a Moderate Limitation experience to a Mild Limitation experience. This is reflected in Paired T test results. The two-tailed P value is less than 0.0001.

Conclusion
The AusTOMs Activity Limitation/Transfer scale indicated there is a positive correlation with the provision of OT recommended aids and equipment at improving functional transfer performance within the home context.
122 Are We Effective Prescribers? A Retrospective Audit of DOAC Prescribing Post Embolic Stroke for Non Valvular Atrial Fibrillation
Authors: Dennehy Karen , Morris Joseph , Hughes Diarmaid , Donlon Kate , Walsh Thomas 
Published: September 2019

Abstract

Background
Direct oral anticoagulants (DOAC) are indicated for stroke prophylaxis in non-valvular atrial fibrillation, which is responsible for up to 20% of all ischaemic strokes(1). We performed a retrospective audit of all consecutive stroke patients in an Irish teaching hospital over a 1-year period to investigate the rate of incorrect dosing and any risk factors for this occurring.

Methods
We assessed our hospital stroke database from January to December 2017. Our research focused on DOAC prescribing in non valvular atrial fibrillation post embolic stroke. We collected data on baseline characteristics, choice of anticoagulation, dosing, and assessment of renal function, with follow up renal function if available. We reviewed electronic discharge summaries, online laboratory systems and completed a chart review.

Results
There was a total of 116 people with atrial fibrillation who developed an embolic stroke in our centre, of which 68 were eligible for anticoagulation using a DOAC (59). The main reasons for omission were CKD and haemorrhagic transformation. Patients were discharged on either Apixaban (32 patients), Rivaroxoban (32 patients), or Dabigatran (4 patients).
Following our review, we established that 54/68 (79%) of patients were correctly anticoagulated. Over 20% of patients were incorrectly dosed and there was a clear tendency to under-dose 13/14 (93%). There were significant differences between the correct and incorrect dosing groups, with the latter group of patients being older and more at risk of polypharmacy. Renal function did not differ significantly between the groups at discharge or follow up and none of the incorrectly dosed patients were on a concurrent anti platelet.

Conclusion
A significant number of patients prescribed DOAC in hospital were not appropriately anticoagulated (21%), a majority of which were under-dosed. The patients who were under-dosed were older and more likely to be on 5 or more medications.
123 Empowering Patients after Stroke: Development of a Stroke Information Booklet
Authors: Dennehy Karen , Synnott Padraig , Murphy Robert , Galvin Patricia , Canavan Michelle , Walsh Thomas , O' Donnell Martin 
Published: September 2019

Abstract

Background
Patient involvement in healthcare is key to the provision of patient centred care. The national patient experience survey 2018 found that up to 40% of patients did not get adequate information about their condition after discharge.(1) As the planning phase in introducing a stroke information booklet, we sought to examine what patients, families and healthcare professionals feel are important components in such an information booklet.

Methods
We performed a cross sectional cohort study. A questionnaire was developed after a panel discussion among physicians, allied health professionals, and clinical nurse specialists about what would be important facets to include. Thirteen items were shortlisted and assessed using a Likert scale.

Results
There were 76 respondents to the questionnaire including nurses (17), allied health professionals (13), doctors (28), stroke patients (10) and relatives (8). Items viewed as most important to include were: an introduction to stroke, future stroke risk, and effects of stroke on daily life. Items viewed as least important to include were - an overview of medical treatments for stroke and information on equipment needs post stroke. A Mann Whitney U test found that patients/families rated information about future stroke risk as more important to include than healthcare professionals (p=0.021). Free text found that psychological effects of stroke, and sexual health post stroke were commonly suggested.

Conclusion
Patients/Families are keen to receive information regarding stroke, particularly about future risk of stroke. Empowering patients with information about stroke that is relevant to them and their care providers is a fundamental part of secondary stroke prevention. We also need to focus more on the psychological impact of stroke. Our booklet will incorporate information we have gathered in this study to make it a truly patient centred resource.
126 Urinary Incontinence: Prevalence, Clinical Characteristics and Impact on Quality of Life of Older People in Ireland
Authors: Claffey Paul , Sullivan Rachel , Anne Kenny Rose , McNicholas Triona , Briggs Robert 
Published: September 2019

Abstract

Background
Urinary incontinence (UI) is one of the ‘giants’ of gerontological care, associated with early mortality, depression and falls in later life. It is often amenable to treatment, yet clinical experience suggests that older people with urinary incontinence often go undiagnosed and therefore untreated.
The aim of this study therefore was to ascertain the prevalence of UI in a large population representative sample of Irish adults ≥50 years; to examine how often participants report UI to healthcare professionals; to profile factors associated with UI and its impact on quality of life (QOL).

Methods
This study was embedded within the Irish Longitudinal Study on Ageing.
Participants were a population-representative sample of almost 7,000 Irish adults aged ≥50 years.
UI was defined as any involuntary loss of urine from the bladder within the last 12 months, based on the International Continence Society Definition.
QOL was measured using the Control, Autonomy, Self-realisation and Pleasure-19 Scale (CASP-19).

Results
Fifteen % (1,061/6,996) of participants had UI within the last 12 months; 9% (269/3,162) of males and 21% (792/3,834) of females.
Almost half (486/1,061) of participants with UI had not reported it to a healthcare professional, with one fifth (240/1,061) reporting UI limited everyday activities.
Logistic regression modelling demonstrated UI was associated with advancing age, female sex, alcohol excess, polypharmacy, chronic disease and depression.
Linear regression models showed that UI was associated with significantly lower self-rated QOL, as measured by CASP-19 (β =-1.13 (95% CI: -1.69 - -0.57), p <0.001).

Conclusion
UI affects 1 in 7 people aged ≥50 years.
It is closely associated with other geriatric syndromes such as polypharmacy, depression and multimorbidity and impacts significantly on QOL.
Despite this, almost half of those with UI do not report symptoms to a healthcare professional, highlighting the need for structured assessment of UI as part of comprehensive age-attuned care.
131 Meta-analysis of Primary Care Interventions to Address Frailty Among Adults Aged 65+
Authors: Macdonald Steve , Travers John , Shé Éidín Ní , Bailey Jade , Romero-Ortuno Roman , Keyes Michael , O'Shea Diarmuid , Cooney Marie Therese 
Published: September 2019

Abstract

Background
Frailty can contribute to poor clinical outcomes including disability, illness, and death. Intervention against frailty may help older adults maintain overall health and independence, and a growing body of recent literature describes interventions specifically targeting frailty. The diversity of measurement constructs and intervention types raises a challenge for those seeking to identify best-practice strategies to manage frailty in the primary care setting, therefore this study aimed to quantify the relative effectiveness of reported interventions.

Methods
PubMed, CINAHL, Cochrane Register of Controlled Trials, and PEDr databases were interrogated, and reference lists of retrieved studies were also examined. For comparisons, articles were grouped by intervention and meta-analysis using the random effects model was performed wherever two or more studies examined the same outcome measure using similar interventions.

Results
29 studies with a total of 4430 participants were included in this series of meta-analyses. Interventions included exercise (alone or plus nutrition supplementation or education), nutrition supplementation alone, comprehensive geriatric assessment (CGA), and hormone supplementation. Outcome measures included frailty (Fried criteria), physical performance, leg strength, and grip strength, among others. Interventions varied in relative effectiveness. When comparing studies that assessed frailty status using Fried’s criteria, exercise alone (n=3, RR=0.63 (CI 0.47–0.85), I2=0%) appeared effective versus control in improving status, as did exercise plus nutritional supplementation (n=2, RR=0.62 (CI 0.48–0.79), I2=0%), and exercise plus nutritional education (n=3, RR=0.69 (CI 0.58–0.82), I2=0%). CGA also appeared effective in improving frailty status (n=3, RR=0.77 (CI 0.64–0.93), I2=0%).

Conclusion
This series of meta-analyses indicates that several intervention types are associated with positive improvements in frailty status, and frailty-associated indicators. These results agree with previous findings, and represent an up-to-date quantitative synthesis of available literature on primary care interventions addressing frailty among older adults.
133 Prospective Audit of Adherence to Current Guidelines for Urinary Catheterisation on a Dedicated Geriatric ward in a Tertiary Hospital
Authors: Comber Ruth 
Published: September 2019

Abstract

Background
A review of current practice in urinary catheterisation of geriatric patients on admission to hospital in respect of current HSE guidelines; looking at adherence to prescribed indications.

Methods
A consecutive sample of inpatients (age >65 years) were included from a geriatric ward in a tertiary hospital. Medical notes and admission pro-forma were reviewed. Relevant demographic and clinical information was extrapolated and analysed descriptively using the Statistical Package for the Social Sciences software.

Results
Data from thirty-one patients was included. Mean age of the cohort was 81.58 years (SD=6.67) and 51.6% (n=16) were female (SD=6.67). The primary reasons for admission were increased care needs (n=6, 19.4%), and collapse/weakness (n=6, 19.4%), thereafter stroke (n=4, 12.9%). Urinary catheters were inserted in 45.2% (n=14); for output monitoring (n=4, 28.57%), diuresis (n=4, 28.57%) and management of acute urinary retention (n=3, 21.42%). The insertion was warranted as per guidelines in only 42.85% (n=6); for urinary retention (n=3, 21.42%), sepsis/ICU (n=2, 14.28%) and at patient's request for comfort (n=1,7.14%). Urinary incontinence was present in 25.8% (n=8). This was found to be poorly documented in medical admission notes (n=2, 6.5%). Mean hospital admissions in the previous twelve months was 1.61 (SD=2.20) and mean urinary tract infection in the same timeframe was 1.00 (SD=1.57). Trial without catheter was unsuccessful in 3.2% (n=1). Healthcare associated infection was recorded in 6.5% of cases (n=2).

Conclusion
Although this audit represents a small cohort, the results demonstrate a high rate of urinary catheter insertion without adequate indication. This audit should be repeated using a larger sample size. Appropriate education at ward level and with admitting NCHDs about: appropriate catheterisation practice should be performed with a view to re-auditing subsequently. Update of current guidelines is warranted.
136 Early Ambulatory Blood Pressure Monitoring Post Stroke
Authors: D'Alton Maeve , Donaghy Lisa , Farrell Sarah , Hartigan Denise , Leguis Flordelie , Long Shirley , McAteer Claire , Morrison Laura , O'Connor Marie , Dolan Eamon 
Published: September 2019

Abstract

Background
While hypertension is the leading cause of stroke, early blood pressure (BP) management post event can be a challenge. Adjustment of antihypertensive medications is largely based on daytime ward readings. Abnormal nocturnal BP patterns may go undetected with increased risk to the patients from either extreme of BP. 24-hour ABPM has been shown to provide additional prognostic information over routine clinic measurements. We evaluated stroke patients for abnormal circadian BP profiles early after their event.

Methods
Patients admitted with a stroke, whose BP had normalised for at least 48 hours, were invited to participate. ABPM was fitted for 24 hours and readings compared with routine ward BP measurements. Daytime BP was calculated between 9am-9pm; nighttime midnight-6am. Additional information was gathered on medical history, cardiovascular risks and neuroimaging.

Results
Twenty-nine patients were recruited (median 6 days post event) with mean age 70.5, 62% male. The majority (86.2%) had ischaemic stroke or TIA. Seventeen had diagnosed hypertension and were taking median of 2 medications. Mean baseline ward systolic BP was 129mmHg (range 104-148 mmHg). Mean systolic BP on ABPM was 126mmHg (range 92-154 mmHg) and 123mmHg (range 93-181 mmHg) for daytime and nighttime respectively. Patients with a history of atrial fibrillation (N=13) had a higher prevalence of a non-dipping pattern, with an average 10.4 mmHg rise in their nighttime systolic BP compared with a 3mmHg fall in those without atrial fibrillation (p = 0.011). They also exhibited greater BP variability.

Conclusion
In this pilot study, through the use of early ABPM we found high rates of non-dipping nocturnal BP in patients following stroke, particularly in those with underlying atrial fibrillation. The availability of 24-hour BP might allow for more individualised antihypertensive management particularly at this high-risk acute stage. Furthermore the presence of abnormal circadian patterns might be a marker for conditions such as atrial fibrillation and obstructive sleep apnoea that compound stroke risk.
139 Prevalence of Hypernatraemia in the West of Ireland during 2018 Heatwave: A Retrospective Cross-sectional Study
Authors: Brennan Michelle , Murray Orla , Shea Paula O , Mulkerrin Eamon 
Published: September 2019

Abstract

Background
Hypernatraemia is a surrogate marker of morbidity and mortality, particularly in the older person.(1) Met Eireann defines a heatwave as 5 consecutive days >25°C. HSE guidelines outline preventative strategies for community-dwelling adults and inpatients during heatwaves.(2) Our objective was to compare the prevalence of hypernatraemia (Na>145mmol/l), in biochemical samples during the heatwave of 2018 to the same period in 2017

Methods
A retrospective cross-sectional study using patient demographics, biochemical data from Laboratory Information System and meteorological data from Met Éireann was performed. A ten-day period from 24thJune to 3rdJuly was assessed in 2017 and 2018. Patients aged >65 with at least one biochemical sample were included. Only the first sample from each patient was included. Predictor variables of age, gender and source of sample were measured.

Results
Maximum air temperatures were higher in 2018 than 2017 (mean 27 v 16.8°C, p<0.0001). Hypernatraemia had 3.6% prevalence (66/1840 samples) during the heatwave of 2018 in comparison to 1.4% prevalence (23/1593 samples) in 2017. This corresponds to a prevalence ratio of 2.5 in heatwave 2018 compared with 2017. In 2018 hypernatraemic samples: 56%(n=37) were male, mean age was 75 with 71(n=47) General Practitioner(GP) samples,12%(n=8) inpatients and 17%(n=11) from outpatient department(OPD). In 2017 hypernatraemic samples: 30%(n=7) were male, mean age was 75 and 74%(n=17) were GP samples,17%(n=4) were inpatients, 9%(n=2) from OPD. The sources of total samples (regardless of Na level) were 63% GP, 7% inpatients and 30% outpatients.

Conclusion
Hypernatraemia was 2.5 times more prevalent during the heatwave in 2018 than the previous year in patients aged over 65. Hypernatraemia is more prevalent in GP and inpatients taking into account the usual distribution of samples by source. Current guidelines are either not being adhered to or ineffective, a matter which merits further evaluation.
140 The Use of the Variable Indicative of Placement risk (VIP) as a Frailty Identification Tool
Authors: Sayers Karen , Pender Ciara , Maher Jennifer , Ryan Siobhan , Cooney Eamonn , O'Reilly Aine , Donnellan Christina , Pillay Isweri 
Published: September 2019

Abstract

Background
The Variable Indicative of Placement risk (VIP) was developed in order to identify, at the time of hospital admission, those who need liaison geriatrics and those who do not (Vandewoude et al, 2008). It was derived from physical and cognitive measures of known risk factors for frailty. This supports its face and content validity as an indicator of frailty. The Clinical Frailty Score (CFS) is a validated measure of frailty (Rockwood et al, 2005), recommended as part of a patient’s Comprehensive Geriatric Assessment (CGA). Construct validity and inter-rater reliability of the VIP, as a frailty identification tool, have not been evaluated.

Methods
A prospective analysis was undertaken of 232 consecutive people, 70 years and older, presenting to an acute hospital. The VIP is administered by a triage nurse in the Emergency Department. A VIP-positive patient (2 or more “Yes” answers) triggers a CGA by a member of the Integrated Inter-Disciplinary team. The VIP screen is undertaken again by the team member, prior to commencing CGA. The VIP and CFS of each patient was entered onto an Excel spreadsheet. Inter-rater agreement was evaluated by looking at percentage agreement between raters. Validity was explored by looking at the relationship between VIP and CFS.

Results
Inter-rater agreement of the VIP was 90%; 78% of VIP positive people were mild, moderate or severely pre-frail, as measured by the CFS. A further 18% of people were categorised as vulnerable.

Conclusion
The VIP is a quick, easy to use tool that doesn’t require training. It shows agreement between raters. It predominantly identifies people who are mildly to severely frail. It may not be valid in identifying those who are pre-frail. Further evaluation of the validity and reliability of the VIP, as a frailty identification tool, is required.