bluuebunny/crossref_metadata_2025_split huggingface dataset:
229 Advancing Physiotherapy Competence in Dementia Care. A Service Development Initiative
Authors: Jones Claire 
Published: September 2019

Abstract

Background
Older adults are among the most frequent of health service users and often require physiotherapy input. Since the prevalence of dementia rises with age, physiotherapists regularly treat older adults with dementia in the acute setting. However advancing competence in the area of dementia care represents a significant cultural shift for the physiotherapy profession. Dementia education which specifically addresses both the learning needs of physiotherapists and the cultural context in which they work may be the first step to advancing competence and enabling best practice.

Methods
A learning needs analysis was conducted within a physiotherapy department in an acute, level three hospital. An educational programme was subsequently designed and delivered over six weeks. The programme aimed to equip physiotherapists with both the knowledge and skills to best support the person with dementia in the acute care setting. Careful consideration was given to the social construct of dementia, inclusion of the voice of the person with dementia and the historical barriers experienced when accessing therapy services in the acute care environment.

Results
The perceived benefit of the education programme was evaluated by means of a participant survey. 100% of respondents felt that undergraduate training did not sufficiently prepare them to work with adults with dementia. As a result of the educational programme, 100% of participants reported increased competence when treating adults with dementia and a subsequent positive impact on physiotherapy practice. 88% of respondents agreed that ongoing professional development in this area of dementia care would be beneficial and 100% reported that they would recommend the educational programme to a colleague.

Conclusion
The changing landscape of healthcare delivery has opened up new ways of working. Physiotherapists are in a unique position to support the person with dementia in the acute care setting. Participants of this educational programme demonstrated high motivation to advance their knowledge and skills in the area of person-centred dementia care.
234 An Evaluation of Two Frailty Intervention Therapy Team’s (FITT) in the Emergency Department Pilot Services
Authors: Walsh Ciara , McCullagh Ruth , O'Connor Kieran , Higgans Anna , O’Callaghan Donal , Timmons Suzanne 
Published: September 2019

Abstract

Background
Frailty is an important marker of adverse outcomes for older people accessing the Emergency Department (ED). Older patients with frailty have a higher attendance rate to the ED, spend longer in the ED and have a higher rate of admission (HSE, 2017). Frailty Intervention Therapy Teams (FITT) are designed to screen and assess this population in the ED setting, with the aim of early assessment to help decrease length of stay or avoid admission. Two different FIT Teams have recently been formed within the Cork-Kerry region. The aim of this study was to evaluate staff’s experience of these teams.

Methods
This was a mixed methods study. Structured surveys were developed to collect qualitative and quantitative data. The surveys were constructed using themes listed by Proctor et al., (2011) around implementation and service outcomes. Ward and ED staff were provided with paper surveys within the hospital setting and community staff were surveyed via post. Quantitative survey data was analysed using descriptive statistics and qualitative data was analysed with thematic content analysis.

Results
Data from 117 surveys was included for analysis (response rate 49%). Results showed that the majority of staff (89%) reported ED was a suitable setting for the FITT, with 85% reporting the information collected by the FITT impacted their involvement. Other themes emerging from staff’s experience included timeliness, safety and comprehensive assessment.

Conclusion
Overall, staff reported the FITT provided a timely service that assisted with decision making and planning. This involved earlier comprehensive assessment, prompt identification of issues which lead to decreased workload for ward staff. It also created an increased volume of referrals to community and ward staff received in a timelier manner.
242 “I Want to Break Free”: Harming Older Patients Through Restraint, Isolation and Tethering
Authors: Heywood Sarah , Fitzpatrick Donal , Doyle Kate , Finn Ger , Gallagher Paul 
Published: September 2019

Abstract

Background
The older inpatient population is a particularly frail cohort with high rates of delirium, falls and immobility. These patients require skilled gerontological nursing with high levels of supervision. Despite this, restraints such as bed rails continue to be common. Tethering through intravenous drips and urinary catheters are another form of restraint.

Methods
We performed a chart review and a bedside observation of patients aged ≥75 on medical wards admitted for ≥72 hours. We excluded patients who were critically unwell or imminently dying. We used the open source software package PSPP to complete the statistical analysis.

Results
We reviewed 100 patients, of whom 25 were restrained in some way (most commonly by bed rails 80%), 10 were tethered (through intravenous drips, oxygen tubing, urinary catheters and others), 7 were in isolation for infection control reasons. Restraint was associated with greater dependence in mobility and function, reduced time out of bed (Mann Whitney, P< 0.05), delirium and incontinence (chi square, p <0.05). Isolation was associated with greater physical dependence (Mann Whitney, P< 0.05), and tethering was associated with incontinence (chi square, p <0.05). The relatively low number of isolated and tethered patients reduced the power of the study. 50% of patients with a urinary catheter did not have a clear indication and only 14% of catheterised patients had leg bags

Conclusion
Patients who are restrained are clearly frailer, more dependent, spend more time in bed, have higher rates of delirium and incontinence. These are particularly vulnerable patients who need high levels of attention from both medical and nursing staff. Supervision is always superior to restraint but requires investment in staff and resources. Patients who are isolated are also more physically dependent. Tethering should be minimised. Simple measures such as leg bags are underused.
245 Delirium Incidence in Hip Fracture Patients: Awareness on the Orthopaedic Ward
Authors: Jeanne Bermingham Rebecca , McLaughlin Paul , O'Brien Helen 
Published: September 2019

Abstract

Background
Postoperative delirium is a serious neuropsychiatric condition that occurs in up to 65% of hip fracture patients(1). However, it remains poorly recognised as a postoperative surgical complication despite its association with increased mortality, longer length of stay (LOS), cognitive decline and increased risk of discharge institutionalisation.

Methods
As part of the delirium audit, all hip fracture patient notes were reviewed from Oct-Nov 2017 pre-implementation of an Orthogeriatric Service and Oct-Nov 2018 post-implementation. Documentation of delirium or use of the terms ‘new confusion, altered attention, change in behaviour’ in the orthopaedic, orthogeriatric and allied health professional notes were reviewed. The 4AT was used to routinely screen for delirium in the pre-and post-operative period by the Orthogeriatrics team(2).

Results
The number of patients in the 2017 group was 24, mean age 78, female 76% compared with 25 in the 2018 group, mean age 75.9, female 81%. In 2017, delirium was diagnosed in 4% of patients by the Orthopaedic surgeons and 37.5% by Allied Health Professionals. In 2018 delirium was diagnosed in 4% by the Orthopaedic surgeons, 40% by Allied Health Professionals and 44% by the Orthogeriatrics team in 2018. Pre-operative delirium occurred in 16% of patients and postoperative delirium occurred in 44% of patients in 2018. A clear delirium management plan was documented in 0% of charts in 2017 versus 100% in 2018. LOS in 2017 was 12.7 days vs 12.4 in 2018. However, discharge location varied greatly with 33.3% discharged to convalescence in 2017 versus 19% in 2018, 12.5% to Longterm care in 2017 versus 4% in 2018, 20.8% to rehabilitation in 2017 vs 52% in 2018 and 16.7% home in 2017 vs 24% in 2018.

Conclusion
Prompt diagnosis and management of delirium is essential in optimising postoperative cognitive function and preserving independence. Our study highlights the need for routine delirium screening and improved awareness of delirium amongst all healthcare professionals.
269 Early Identification of Frailty: Developing an International Delphi Consensus for a Definition of Pre-frailty
Authors: Sezgin Duygu , O’Donovan Mark , Wong Jean Woo , Bandeen-Roche Karen , Liotta Giuseppe , Fairhall Nicola , Laso Angel Rodríguez , Apóstolo João , Clarnette Roger , Holland Carol , Roller-Wirnsberger Regina , Illario Maddalena , Mañas Leocadio Rodríguez , Vollenbroek-Hutten Miriam , Yavuz Burcu Balam , Balci Cafer , Pernas Francisco Orfila , Paul Costança , Ahern Emer , Romero-Ortuno Roman , Molloy William , Cooney Maria Therese , O’Shea Diarmuid , Cooke John , Lang Deirdre , Hendry Anne , Rockwood Kenneth , Clegg Andrew , Liew Aaron , O’Caoimh Rónán 
Published: September 2019

Abstract

Background
Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent condition before frailty becomes established. Despite this, there is no widely accepted definition of pre-frailty to support its early identification and management. This study applied an international consensus approach to define and better understand pre-frailty.

Methods
A modified electronic two-round Delphi Consensus study was conducted. In all, 23 experts from 12 countries with different backgrounds participated. The questionnaire was developed following a systematic literature review. An online consensus meeting was conducted with eight Delphi participants and two external experts. Qualitative and quantitative methods were employed for data analysis. An agreement level of 70% was applied for accepting statements.

Results
A total of 71 statements were circulated in Round 1. Of these, 52.8% were accepted. Fifty-one statements were re-circulated in Round 2, of which 92.1% were accepted. The online consensus meeting produced a consensus statement describing the concept, multi-factorial nature, and mechanism of pre-frailty as well as assessment, prevention and management approaches. All experts agreed that physical and non-physical factors such as psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life outcomes. Practitioners should regard pre-frailty as a multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It might be reversed or attenuated by targeted interventions. Brief, feasible and validated tools are recommended for opportunistic screening or case-finding followed by confirmation with multi-dimensional assessment.

Conclusion
It is difficult to establish consensus on one compact definition of pre-frailty, which is a multi-dimensional concept not only associated with physical impairment, but also with cognitive, nutritional, socioeconomic and other aspects of frailty. However, it may be too early to agree on an operational definition of pre-frailty since none yet exists for frailty.
275 A Case Study of Retinal Artery Occlusion Following Mechanical Thrombectomy via Direct Carotid Puncture.
Authors: Woods Brian , Thorpe Owen , Boyle Karl 
Published: September 2019

Abstract

Background
This case study reviews the role of carotid puncture as arterial access in mechanical thrombectomy and an associated rare complication.

Methods
This case reviews the management of a 74-year-old gentleman who presented with a left MCA ischaemic stroke. On presentation NIHSS was 21 consistent with a left total anterior circulation stroke syndrome (TACS) with a very severe clinical deficit. He underwent IV thrombolysis and attempted mechanical thrombectomy via femoral puncture. However the intracranial middle cerebral artery (MCA) occlusion could not be reached as a near occlusion at the internal carotid artery (ICA) origin could not be passed. A carotid puncture was successfully attempted followed by mechanical thrombectomy with complete recanalization of occluded MCA. Despite carotid puncture occurring in the setting of IV thrombolysis there were no post procedure bleeding complications. On day 2 post-procedure, the NIHSS score was 1 (residual facial droop) representing remarkable neurological recovery. On day 4 post-procedure, acute left eye vision loss developed with subsequent diagnosis of left central retinal artery occlusion (CRAO). The mechanism of this retinal artery occlusion may have been a direct delayed complication of carotid artery puncture propagating clot into the ophthalmic artery, or may have been due to the underlying stroke mechanism such as new embolism from ICA origin or failure of collaterals.

Results
Persistent residual left eye blurred vision and right facial droop.

Conclusion
Proximal intracranial occlusion can effectively be treated with mechanical thrombectomy. Carotid puncture is a rarely used but effective alternative method of arterial access (11 out of 498 procedures between August 2016 and August 2018). Retinal artery occlusion is a possible complication from mechanical thrombectomy with carotid puncture.
282 A Time to Wean: An Audit on Benzodiazepine and Z-drug Use Amongst Patients Attending a Geriatric Ambulatory Care Day Hospital
Authors: Dowling M J , Doyle Patrick , Kennelly S P 
Published: September 2019

Abstract

Background
Benzodiazepine prescription is common among the Irish patient cohort. 23% of medical card holders have been prescribed a benzodiazepine or Z-drug, with a third of these being for a period longer than three months. This is despite these drugs being associated with addiction, falls, cognitive and psychomotor impairment, mood disorder, sleep automatism and drug interactions. We performed an audit looking at the repeat prescriptions of patients attending a geriatric day hospital.

Methods
The repeat prescriptions of all patients currently enrolled at a day hospital were analysed for benzodiazepines or Z-drugs. Medical records were then analysed to look for indication and whether these patients were currently attending psychiatric services. Subsequent to this, notices were placed in the patient consult room in direct line of sight of the registrar reminding them to consider weaning these drugs and detailing the negative side effects and guidelines for weaning from the Canadian National Pain Centre.

Results
59 patients were enrolled at the day hospital when the audit was performed. 11 (19%) had either a benzodiazepine or Z-drug as part of their repeat prescription (benzodiazepine-5, Z-drug-5, both-1). The most common benzodiazepines prescribed were diazepam and clonazepam (2 patients on each). Of those prescribed a benzodiazepine, none were currently being weaned. Of those on benzodiazepines, 4 of 6 had a documented psychiatric diagnosis, and 1 of 6 had documented that they were currently attending psychiatric services. A re-audit three months later showed no change in those prescribed benzodiazepines (5/59), and a non-significant increase in those on Z-drugs (9/59, p=0.26).

Conclusion
This audit showed a significant number of patients attending our day hospital are being prescribed long term benzodiazepines or Z-drugs, and highlights that this setting is an opportune time and place to establish a supported program to wean people off these medications.
292 Palliative Care for Older People in Residential Care: From the Inside Out
Authors: Molloy Una , Phelan Amanda 
Published: September 2019

Abstract

Background
To enhance the quality of care of older people living and dying in nursing homes, it has been suggested that palliative care should be integrated into this care. This study aims to explore what palliative care means in the context of older person residential care.

Methods
Action research, using a co-operative inquiry (CI) approach was used. A total of 18 healthcare assistants (HCAs) and 16 registered nurses (RGNs) in two residential older person care units, participated. A reflection on deaths that occurred on the units over a six-month period N=23 took place. This facilitated reflection on care given to the residents and assisted in developing an understanding of how palliative care is understood and integrated into caring for residents.

Results
A number of actions took place. A debriefing group, acknowledging the importance of relationships and a sense of loss experienced by staff on the death of a resident, a group reflection on recognising dying and how this might impact on care a resident receives, and a healthcare assistant group which contributed to developing an understanding of the unique role HCA’s have in this context. Categories that evolved to describe palliative care include, communication, decision making, transitions in care, grief, relationships, experience and the importance of knowing a resident.

Conclusion
This study has illustrated that palliative care in older person care, is often aligned with dying. In general, end of life care and person-centred care were more commonly used terms. It was suggested that palliative care is an inherent part of this care. There is a need to value the expertise and experience of the nurses and healthcare assistants caring for older people living and dying in residential care. There is also a need to improve the interdisciplinary roles between older person care and specialist palliative care.
296 Risk-prediction in the Emergency Department: Comparing the Accuracy of Short Frailty Screens to Identify Adverse Healthcare Outcomes among Older Adults
Authors: O'Caoimh Rónán 
Published: September 2019

Abstract

Background
Multiple instruments are available to screen for frailty in the Emergency Department (ED). Despite this, few studies have compared their predictive validity among older adults attending ED. This study aimed to investigate the diagnostic accuracy of a variety of different short frailty and risk-prediction instruments to predict 30-day readmission, length of stay (LOS), one-year mortality and institutionalisation.

Methods
Consecutive patients aged ≥70 attending a university hospital ED were screened and assessed for frailty. Outcomes were obtained from hospital records. The following instruments were compared: the Clinical Frailty Scale (CFS), PRISMA-7, Identification of Seniors at Risk tool, FRAIL scale, Groningen Frailty Indicator (GFI) and Risk Instrument for Screening in the Community (RISC).

Results
In all, 193 patients were included, median age 79+/-9; 55% were female. Based upon a CGA, 60% (116/193) were classified as frail. Those identified as frail were significantly older (p=0.03) and reported lower quality of life scores (p<0.001). There was no significant difference in co-morbidity using the Charlson Index (p=0.15). The ED conversion rate was 77%, median LOS 8+/-9 days and 20% were re-admitted within 30 days. At one-year, 13.5% were accepted for long-term care and 17% had died. Comparing instruments, the combined RISC was had the highest accuracy based on the area under the ROC curve (AUC) scores for predicting mortality and nursing home admission at one year, AUC 0.77 (95% CI:0.68-0.87) and 0.73 (95% CI:0.64-0.82), respectively. The GFI, CFS and PRISMA-7 had statistically similar, albeit lower scores. No instrument was accurate in predicting 30-day readmission after discharge (AUC <0.70).

Conclusion
Short frailty screening instruments applied in ED have poor-modest predictive validity for important healthcare outcomes, particularly hospital re-admission. The RISC score had the highest diagnostic accuracy for institutionalisation and death but this was fair at best, suggesting that instrument selection should be pragmatic with the expectation of identifying frailty.
297 Re-audit of Swallow Assessment in Acute Stroke Patients Following Introduction of a Full-time Speech Specialist
Authors: Buckley Emily , Alalawi Mazen 
Published: September 2019

Abstract

Background
The National Clinical Guidelines and Recommendations for the Care of People with Stroke recommend that if an initial screen of a patient with an acute stroke indicates swallowing difficulties, the patient should have a specialist swallow assessment within 24 hours of admission and not more than 72 hours afterwards. The aim of this audit was to reassess the rate of specialist assessment in this patient group following the introduction of a full-time speech specialist in an acute hospital.

Methods
This was a clinical audit where all patients who presented with acute stroke, where initial swallow screening indicated problems were reviewed. Data was collected from medical records over a twelve week period from January 2019-April 2019.

Results
Twenty patients presented with an acute stroke, with initial assessment indicating swallow problems; 12 male, 8 female. Mean age was 72 years (ranging from 41 to 96). Eight of these were seen by a speech and language therapist (SALT) within 72 hours; 7 were assessed by SALT <24 hours and 1 was assessed within the 48-72-hour window. Of those seen by SALT; -2 were placed on a normal diet, 2 nil by mouth (NPO), 4 were placed on a modified diet. Two patients were reassessed (3 and 2 times respectively). Of the patients assessed by SALT, 1 passed away and 7 were discharged home (2 referred to community SALT follow-up).
When compared with a previous audit in 2018, swallow assessment by SALT < 72 hours has increased from 14% to 40%. The National Stroke Audit has recorded rates of 37%.

Conclusion
Introduction of a full-time speech and language specialist has increased the rates of swallow assessment in line with the national average. The overall rates of SALT interventions in dietary regimens highlights the need to increase overall assessment rates in patients with acute stroke.