bluuebunny/crossref_metadata_2025_split huggingface dataset:
264 Incorporating Neurolinguistics and the Role of Speech and Language Therapy in a Specialist Memory Service
Authors: Sheridan Lisa , McHale Cathy , Dookhy Joshi , Coughlan Tara , O'Neill Desmond , Collins Ronan , Ryan Dan , Kennelly Sean 
Published: September 2019

Abstract

Background
Speech and Language Therapy (SLT) is recognised as having a unique role in contributing to the overall neuropsychological assessment of people living with dementia and cognitive impairment. The role of the SLT within a memory clinic has become more widely understood. It is now recognised that speech and language characteristics are reported to be amongst the most reliable behavioural markers for distinguishing amongst different dementia subtypes, and specific analysis of a language production and delivery facilitates timely and more accurate diagnosis.

Methods
Patients with a language predominant presentation or those with subjective complaints of speech/language difficulties were referred for SLT assessment through the tertiary memory assessment and support service from January 2018 – March 2019. Assessment of speech and language skills, and overall cognitive communications skills were reviewed, and this information was used to aid with differential diagnosis and contribute to the person’s overall cognitive profile. The SLT attends weekly memory service interdisciplinary consensus diagnosis conference. Data was collected on these patients to observe the profiles of those patients referred to SLT.

Results
22 patients were seen for full SLT assessment during this period, 13 women, 9 men; mean age 69.5 (range 48- 80). Diagnoses include: AD (32%), FTD behavioural variant (14%), Primary Progressive Aphasia (14%), Non-amnestic MCI (18%), Amnestic MCI (14%), Other neurological disorder (8%). 68% of these patients required ongoing SLT intervention for their cognitive communication difficulties following diagnosis.

Conclusion
SLTs fulfil an integral role in supporting both the diagnostic and post-diagnostic care pathways of people living with dementia and cognitive impairment attending memory services. SLTs have a unique role and skillset in identifying the specific nature of language difficulties for a person with dementia or cognitive impairment and in reducing the impact of the communication difficulties for the person and for their family members.
272 Clinical Audit on Transient Ischaemic Attack Investigations in Acute Medical Unit
Authors: Karpinski Sylvia , Collins Orla , Kelly Emer , Therese Cooney Mary , McGrath Emett 
Published: September 2019

Abstract

Background
TIA (Transient Ischaemic Attack) is a transient episode of neurologic dysfunction.
Patients with a TIA have a high early risk of recurrent stroke. These patients need urgent initial evaluation with brain imaging, neurovascular imaging and cardiac evaluation. We conducted retrospective audit in our Acute Medical Unit (AMU) to assess waiting time and type of investigations completed as per TIA guidelines

Methods
All consecutive admissions with suspected TIAs were evaluated on length of stay, type of imaging tests obtained and how long they awaited for these tests. This was assessed by reviewing discharge summaries, and times and dates of scans on hospital imaging system.

Results
There was a total of 28 patients admitted to AMU with suspected TIA’s. Of these, 16 were female and 12 were male. Mean age was 70. All patients had CT brain done on admission, two out of 28 had to wait more than 12 hours. 25 out of 28 (89%) patients got US Carotid Dopplers, and two had CT intracranial angiograms. Average waiting time for US Carotid Dopplers was 33 hours, shortest wait was 6 hours and longest was 72 hours. 14 out of 24 (58%) had inpatient heart monitoring (24h telemetry or 24h Holter) two were excluded with known atrial fibrillation, one had PPM in situ and one refused monitoring. Average length of stay in AMU was 3 days.

Conclusion
Patients admitted to AMU with suspected TIAs had relevant imaging and tests completed as per guidelines. 89 % had US Carotid Dopplers which were on average done 33h from admission. 58% of patients had inpatient heart monitoring. The average length of stay was 3 days but three patients stayed in AMU for up to 5 days. Protected imaging slots for AMU would expedite investigations and reduce inpatient stay.
281 Collateral Damage: The Cost of Failing to Take a Comprehensive Collateral History for Older Adults with Cognitive Impairment
Authors: Doyle Kate , Fitzpatrick Donal , Finn Gerard , Gallagher Paul 
Published: September 2019

Abstract

Background
Age-related syndromes of cognitive impairment, including delirium and dementia, are becoming more prevalent in our hospitals. Patients with cognitive impairment are often unable to provide information relating to their pre-morbid cognition and function as well as their admission diagnosis. Such information is essential to correctly identifying delirium and dementia, as well as making an accurate diagnosis and planning appropriate treatment. It is the standard of care recommended by both the Irish National Audit of Dementia 2014 and the UK National Audit of Dementia Care 2017 that a collateral history is obtained.

Methods
We reviewed the medical notes and conducted brief structured interviews with nursing staff for 100 medical inpatients aged ≥75.

Results
Only 44% of patients with cognitive impairment had a collateral history. Half of patients described as having dementia did not have any further detail on the severity of dementia documented. 80% of collateral histories were sourced by the admitting NCHD; if the collateral history was not obtained on admission, it was unlikely to be obtained at all. Among those for whom a collateral history was obtained, the level of detail regarding pre-morbid cognition, function, mobility and continence was sparse. The most common informant was the patient’s son or daughter (66%), followed by spouse (16%). Only 13% of patients had formal cognitive testing.

Conclusion
Acute illness characteristically causes significant impairments in cognition and function in frail older patients. Identifying and reversing these impairments is impossible without a comprehensive collateral history. It is alarming that such an essential component of clinical assessment is so often disregarded and highlights the lack of awareness from clinicians of the importance of collateral history in the management of patients with dementia and delirium. This must be emphasised in both undergraduate and postgraduate teaching. An appropriate admission proforma would also promote competent collateral history taking.
291 The Impact of a Frailty Team Liaison Service on Nursing Home Attendances in an Emergency Department
Authors: Cooney Eamonn , Donnellan Christina , Baburaj Binish 
Published: September 2019

Abstract

Background
Up to 50% of referrals from nursing homes to emergency departments (ED) are considered inappropriate. Interventions such as the introduction of advanced practice registered nurses to nursing homes, and community matrons in other jurisdictions have reduced inappropriate referrals.

Methods
A liaison service with nursing homes was initiated by a candidate Advanced Nurse Practitioner (cANP) supported by the frailty multidisciplinary team in January 2019. It focused on nursing home residents aged 70 years and older. A single point of contact was provided. ED presentations were assessed if possible, and telephone consultations were also available. A database was maintained and the data from the first 3 months of this service was analysed.

Results
The service provided from 7th January and 31st March 2019 was studied. Referrals of patients aged 70 years and over from nursing homes to ED for this period in 2018 were 100. In 2019 it was 73, representing a 27% decrease in referrals. The total number of patients referred in 2019 was 51. Twenty one (41%) patients had an assessment by the cANP. Interventions by the cANP and team included rapid access to other specialties, medication reconciliation, and prescription of antibiotics, diagnostics and referral to the Community Intervention Team (CIT). Telephone liaison from nursing homes resulted in referrals to the palliative care service in 2 cases, prescription of antibiotic in another, rapid access comprehensive geriatric assessment in another case and rapid access to ED for catheter change in another, hence admission avoidance's in all of these cases.

Conclusion
The early experience of this service is that it facilitated more nursing home residents to receive care and support within their care setting. It contributed to reduced referrals of this vulnerable cohort of the population to ED, and also resulted in admission avoidance in some cases.
309 The Growing Need for Advance Care Planning Discussion: An Admission to Die for?
Authors: McFeely Aoife , Small Cliona , Hyland Susan , O'Keeffe Jonathan , Hughes Graham , O'Shea Diarmuid 
Published: September 2019

Abstract

Background
Older people living in nursing homes (NHs) are among the most frail and vulnerable in our community. Over the last 5 years, a review of our local NH admission database revealed a 7% increase in the number of unscheduled hospital attendances from NHs (1015 in 2012/13 vs 1435 in 2016/17). Additionally we have seen an increase in the number of NH residents experiencing ≥2 unscheduled re-admissions within one year (21.1% in 2012/13 vs 30.45% in 2016/17). Our aim was to examine the proportion of patients from NHs who died within 24 hours of presentation, prompting a review of methods that could prevent inappropriate hospital transfers and promoting dignified and comfortable end of life care.

Methods
A prospective database was collected between 01/01/2016 - 31/12/2017. This recorded all emergency admissions of older people from NHs recording length of stay, readmission rates and mortality. The data was retrospectively analysed, looking specifically at patients who died in hospital ≤ 24 hours

Results
Of 1435 ED admissions, 49 patients (3.4%) died in hospital ≤ 24 hours after presentation.
Of these, 31 patients (61%) died in palliative care suites. 8 patients (16.3%) died in the ED.

Conclusion
A small number of NH residents presenting to our hospital died within 24 hours. A large proportion of these patients died in a palliative care suite, suggesting poor prognosis was identified rapidly after presentation. We wonder if some of these hospital transfers were avoidable and could certain patients have experienced less disruptive deaths in their NHs?
Advanced Care Planning can be difficult for all involved. However, it plays an essential role in ensuring people receive the right care, at the right time, in the right place, from the right team.
We support the collaborative roles of a palliative care CNS or Geriatric ANP, and integration with NH Outreach services, to facilitate early decision-making and promote better end of life care.
314 Audit on Prescription Legibility in an Irish University Teaching Hospital
Authors: McCarthy Christine E , Sebaoui Salim , Saif Kiran , Murphy Elizabeth , Roy Amrita , Hynes Jason , Leahy Aoife , Mohd Asri Nur Atikah , Quinn Colin , Peters Catherine , Lyons Declan , O'Connor Margaret 
Published: September 2019

Abstract

Background
Illegible prescribing can lead to medication error and adverse drug reactions. The HSE Standards and Recommended Practices for Healthcare Records Management and the Practice Standards and Guidelines for Nurses for Prescriptive Authority have highlighted criteria which should be adhered to in relation to prescribing. We set out to audit compliance with these standards in relation to legibility of prescriptions in an Irish University Teaching Hospital.

Methods
Over a 48 hour period, drug kardexes were reviewed on 14 separate in-patient wards. Legibility was judged by a single assessor on each ward. A drug kardex was deemed legible if all of the following criteria were met:
The chi squared test was used to determine the significance of the difference in proportions for categorical variables.

Results
285 drug kardexes were reviewed over the 48 hour period. 41% were on surgical wards, 59% were on medical wards. The median patient age was 70 (IQR:55-78), and 56% were male. 48% of drug kardexes were deemed legible. A higher proportion were deemed legible on medical wards compared to surgical wards (68% vs 19% p<0.05). Upper case was used in 13% of kardexes, with similar proportions on medical and surgical wards.

Conclusion
Poor legibility of drug kardexes may increase risk of medication errors and adverse drug reactions. We plan to commence targeted prescribing education sessions to highlight the current deficiencies and improve current practice. Changes to kardex layout may also aid legibility. Long term planning for electronic prescribing would also help resolve issues in this area.
321 Review of Statin Therapy in Frail Older Patients over 75 Years Old Residing in Long Term Care
Authors: Reilly Eimear O , Everard Cormac , Cogan Lisa 
Published: September 2019

Abstract

Background
Statins are frequently prescribed in older patients for prevention of cardiovascular disease and treatment of hypercholesterolemia. However, there is little evidence to indicate that statins have any benefit in older patients with life expectancy less than 10 years and of those patients in long term care whose average life expectancy is approximately 3-5 years. In addition, statins are associated with significant adverse side effects and contribute to the burden of polypharmacy in older patients.

Methods
Patients residing in a long term care facility were reviewed and data was collected from their medical notes and medication records in order to; (1) Quantify the proportion of patients on statin therapy (2) Review the indication for statin therapy (3) Investigate the inappropriate prescribing of statins in nursing home patients.

Results
55 patients were included in the study. Of the 55 patients, 7 [12.7%] patients were on a statin. Average age of patients on a statin was 77.8 years[SD 9.4]. Of the 7 patients, 2 were on a statin for primary prevention and 5 patients were on for secondary prevention. Average cholesterol in primary prevention group was 3.3mmol/L, average LDL was 1.3 mmol/L. Of the 7 patients on statin for secondary prevention, indications included ischaemic stroke[n= 4] and ischaemic heart disease [n=3]. Average Total cholesterol in secondary prevention group was 3.8 mmol/L and average LDL was 1.91 mmol/L. The average Rockwood Clinical Frailty Scale Score of the patients on statin therapy was 7.

Conclusion
Firstly, this study highlights the incidence of inappropriate prescribing of statins for primary prevention in frail older patients in long term care. It also raises the question surrounding the indication of statin therapy in secondary prevention where cholesterol level are within target range highlighting the need for further studies examining the benefit of statins in frail older patients in LTC.
341 The Prevalence and Factors Associated with Anti-psychotic Prescribing on Admission to a Dementia Specific Nursing Home
Authors: Eustace Andrew , Murray Elaine , Daly Kelley 
Published: September 2019

Abstract

Background
The use of psychotropic medications and their adverse effects in frail adults has been debated extensively. However, it is unclear if antipsychotics are initiated in a nursing home or if the new resident arrives with the medication prescribed. The purpose of this study is to ascertain how many residents arrive already on antipsychotics and which factors, make them more likely to be on this medication.

Methods
All admission notes to the centre between 1st Jan 2018 and 31st Dec 2018 were reviewed. Inclusion criteria was any person admitted with a diagnosis of dementia. Exclusion criteria was anyone who had psychiatric diagnosis such as bipolar disorder or schizophrenia. We collected data on age, gender, referral pathway (hospital or community), MMSE, Barthel, Cohen Mansfield Agitation Inventory (CMAI) For comparisons of characteristics between the two groups (psychotropic drugs at admission: yes/no), the independent samples t-test (normally distributed data) or the Mann-Whitney U test (non-normally distributed data) was used for continuous variables and Fisher’s exact test was used for categorical variables.

Results
There was a statistically significant relationship between source of admission and whether or not the patient was receiving psychotropic drugs on admission (p=0.017). 88.0% of patients on psychotropic drugs on admission came from an acute hospital setting. In contrast, only 4.0% of patients receiving psychotropic drugs on admission came from home Patients on psychotropic drugs at admission had higher CMAI scores compared to patients not on psychotropic drugs. Patients on psychotropic drugs at admission were younger (mean(SD): 76.2(8.7) years) than patients not of psychotropic drugs (mean(SD): 82.9(8.3).

Conclusion
Prevalence of prescribing antipsychotics outside of nursing homes is high with many residents being admitted already on these medications. Efforts should be put in place on admission to nursing homes to reduce and stop antipsychotics which have been initiated in the community and hospital setting.
347 Numeracy Performance and the Relationship to Age and Retirement among Community-Dwelling Adults
Authors: Mickus Maureen , Carpenter Craig , Loveridge Scott 
Published: September 2019

Abstract

Background
Remaining in the workforce in later life may be based on financial need, role fulfillment or opportunities for social participation. Employment can also provide intellectual stimulation, including the use of everyday math skills. Normal age-related decline in numeracy performance has been documented, but the role of retirement in the capacity to perform these functions is less understood. This research uses population-based telephone surveys to analyze whether the interaction of age and retirement influences the ability of community-dwelling adults to calculate simple math problems.

Methods
Data was drawn from three independently sampled surveys in 2006 (n=991), 2010 (n=1,023) and 2014 (n=997). In addition to standard demographic questions, the survey measured individuals’ ability to perform basic computations. Three questions were asked regarding temporal (now or 5 years later) preferences about jobs, a community bond, and an inheritance payout. Respondents were then asked to calculate the amount needed to select the other option instead. Deficient numeracy performance was defined as either no response or an irrational choice (e.g. a lesser amount of inheritance with the alternative choice.)

Results
Approximately 30% of persons age 65+ chose not to perform the follow-up calculations for these questions. Moreover, a 1% increase in age decreased the likelihood of rationally calculating the discount rate by between 0.15 and 0.25 percentage points, depending on the scenario. A sharp decline in numeracy was observed starting at age 66 with the addition of an age x retirement interaction, even when controlling for key variables such as education and income.

Conclusion
Retirement may reduce the opportunity for intellectual challenges afforded in the workplace and consequently, the ability to perform math calculations may decline. Alternatively, decisions to retire may be due to declining health, including cognitive impairments. The timing of retirement has major implications for public policy. Future research more deeply exploring the causal influence of retirement on health and well-being is warranted.
352 Grey and White Matters – Designing and Implementing an Acute Stroke Program in a level 3 Hospital
Authors: Daly Bart , Liston Richard , Griffin Susan 
Published: September 2019

Abstract

Background
Following the publication of the National Stroke Audit in 2015 with below the national average rates of thrombolysis – 3.3% versus 11% - there has been a number of initiatives launched to improve stroke care in this hospital.
In 2018 we enrolled in the National Quality Improvement Project for the care of Patients with Acute Ischaemic Stroke run by the RCSI. A stroke steering committee was established consisting of a multi-disciplinary group encompassing all areas of acute stroke care.

Methods
Acute stroke care practice and factors causing sub-optimal management were examined by the committee and compared with national standards.
A ‘3 jobs’ proforma for management and communication of Fast positive cases was designed to address the difficulties identified in stroke care and tailored to the resources available in this hospital. These simplified and standardised roles for all staff members involved, many of whom were unfamiliar with the practical delivery of thrombolysis and thrombectomy. Educational sessions were initiated for all those involved in acute stroke management.
The acute stroke program was implemented as a 6 month pilot before official launch in April 2019 with necessary changes assessed weekly by the stroke committee. Stroke data is continually audited with the National Stroke Register. Key Performance Indicators (KPI’s) in the pilot were thrombolysis/thrombectomy rates and door to needle time.

Results
There were 164 patients admitted to the stroke unit in 2018. In 2018 prior to this initiative, the hospital had a 3% thrombolysis rate in 2018 and a 1% thrombectomy rate.
Amongst FAST positive patients during the pilot period, 10/68 patients were thombolysed (15%) and 6/68 thrombectomies (9%). Average door to needle time for patients was 96 minutes.

Conclusion
The redesigning of the acute stroke care program has led to significant improvements in the identified KPI’s although door to needle times remain below the national target of 30 minutes.
47 Respite Care for People with Dementia and their Carers: A Qualitative Study with Multiple Stakeholders
Authors: O'Shea Emma , O'Shea Eamon , Timmons Suzanne , Irving Kate 
Published: September 2019

Abstract

Background
Traditional models of respite, particularly those based within residential care settings, may not always be effective, and there is evidence of low acceptability for some people with dementia and carers. The aim of this study was to synthesise multiple stakeholders’ experiences of respite services for dementia and their perspectives on respite service development.

Methods
Purposive sampling was employed. Semi-structured interviews were conducted with 35 key stakeholders, including people with dementia (n=6), carers (n=9), front-line staff (n=7), managers (n=8), policy-makers/academics (n=5). Data were interpreted inductively using thematic analysis, with a focus on latent patterns of meaning.

Results
Three salient themes were identified (‘Phases of Transition’, ‘Person-centred Respite Care’; and ‘Recalibrating Respite’). Three distinct phases of respite transitions for people with dementia and carers are discussed. Respite services that actively support transitions through empathic communication regarding clients’ concerns, support needs and preferences are highly valued. Clients described care resembling a ‘person-centred’ approach as their ideal, without using that term, but people with dementia do not always experience this type of care. The majority of providers indicated that they provide ‘person-centred care’, but many demonstrated a poor understanding of the concept; many of these providers have a biomedical view of dementia and the personhood status of people with dementia. Regarding service development, clients would prefer more choice, flexibility and responsiveness, including a shift away from residential provision towards an integrated continuum of personalised, strengths-focused community-based and in-home supports.

Conclusion
Any recalibration of respite towards a home/community focus will require a transformation in how dementia is constructed by society, as well as a significant financial investment. Other implementation considerations include: staffing and staff competency; and the co-ordination, integration and regulation of personalised, home-based care models. Finally, it may be necessary to replace the outdated term ‘respite’ with an alternative nomenclature that is not discordant with person-centred care principles.