bluuebunny/crossref_metadata_2025_split huggingface dataset:
53 Improving Door to Needle Times in Acute Stroke
Authors: Khalil Dzulkarnain , Connaughton Fiona , Carolan Danielle , Sirbu Mihaela , Lynch Bernadette , Daries Juanine , Sullivan Patrick , Stringer Tony , Carter Shane , Fleming Thomas , Kelly Conor , Basit Mian , Mulroy Martin , Lynch Olwyn 
Published: September 2019

Abstract

Background
During an acute stroke, 2 million neurons are lost every minute. When compared with aging, 2 million neurons are lost every 22 days. Prompt reperfusion of an acute stroke, in the form of intravenous thrombolysis (IV tPA) or intraarterial thrombectomy (IAT) would save these neurons and result in saving significant disability. We endeavoured as part of a quality improvement (QI) project to improve our times.

Methods
A local QI steering group was formed which comprised of representatives from the stroke team, radiology, emergency, laboratory, telephone and clerical departments. We outlined our stroke pathway from when the patient arrives to when the patient received IVtPA or IAT. Data was collected prospectively and retrospectively from real time, chart reviews, radiology Picture Archiving Communication System (PACS) and Hospital Inpatient Patient Enquiry (HIPE) stroke data system. We recorded times from door to computed tomography (CT), CT to issue of report and CT report to IVtpA or IAT. The data was reviewed to ascertain if there were any delays at each stage of the pathway.

Results
There were steps in the pathway that were non-variable and those that were highly variable. In general, steps from door to CT, were consistent each time. In contrast, steps from CT completion to IVtPA or IAT, was highly variable dependent on a patient’s clinical condition and decision making expertise available.
We addressed duplication of tasks and additional non-urgent investigations. The presence of the stroke team for IVtPA and IAT made decision making faster.
The overall median door to CT time reduced by 9 minutes, from 22 to 13 minutes. The overall median door to IVtPA time decreased by 24 minutes, from 83 to 59 minutes.
Our hospital had the fastest door to CT time for IAT patients in 2018 nationally.

Conclusion
Delays in the stroke pathway were rectifiable by change of practice. Most changes were simple without need of any additional resource.
79 Physical Activity Promotion Using mHealth: A Systematic Review and Meta-synthesis of Adults’ Experiences
Authors: Carter Daniel , Robinson Katie , Forbes John , Hayes Sara 
Published: September 2019

Abstract

Background
Well-documented health benefits are associated with 150 min/week of moderate-to-vigorous physical activity (PA). However, a majority of older adults do not follow this guideline and calls to address this disparity with technology have been made (1). Recommendations from the wider PA literature suggest the incorporation of mobile and wireless technology, i.e. mobile health (mHealth), into PA interventions (2). This study aims to identify and synthesise the evidence base on the experiences of adults using smartphone applications for the promotion of PA.

Methods
A systematic search of CINAHL, Embase, ERIC, Medline and PsycINFO was conducted in October 2017. Primary qualitative studies with extractable data on the experiences of adults using mHealth for the promotion of PA were included. Data were analysed in NVivo using a meta-ethnographic approach.

Results
The initial search yielded 4,420 articles. After screening, fifteen articles were included, of which three included young adults, two included young and middle-aged adults, six included middle-aged and older adults and three included young, middle-aged and older adults, while one study did not report age. Because findings were not stratified by age, data were analysed collectively. Our inductive findings included the idea that end-users value the experience of personalisation offered by smartphone applications. Furthermore, mHealth raised awareness of individuals’ PA level, supporting them to strategise ways of incorporating PA into their routines. Finally, negative experiences were not uncommon, though were largely caused by poor design and technical faults (e.g. battery life/ inaccurate data).

Conclusion
Our review provides evidence of the paucity of studies focused on the experiences of older adults using mHealth for the promotion of PA. Given recommendations for PA interventions to be tailored, particularly across the lifespan (2), and the positive findings noted in the current study, further primary qualitative studies exploring the perspectives of older adults are warranted.
106 Optimising Early Assessment and Intervention by Health and Social Care Professions in the ED: Preliminary Findings from the OPTIMEND RCT
Authors: O'Shaughnessy Íde , White Stephan , Smalle Eimear , Cassarino Marica , Robinson Katie , Quinn Rosie , Fiona Boland , Ward Marie , McNamara Rosa , McCarthy Gerard , O'Connor Margaret , Ryan Damien , Galvin Rose 
Published: September 2019

Abstract

Background
Older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care. There is some evidence to suggest that Health and Social Care Professions (HSCP) teams working in the emergency department (ED) can enhance the care of older adults but the quality of these studies is mixed. This randomised controlled trial (Trial registration: NCT03739515) explores the impact of early assessment and intervention by an ED-based HSCP team on the quality, safety and cost-effectiveness of care of older adults.

Methods
Consecutive ED attendees aged ≥65 years were considered eligible for inclusion to the trial and were screened for eligibility based on pre-defined inclusion criteria. Participants were randomised to either early assessment/intervention by interdisciplinary team comprising a senior occupational therapist, senior physiotherapist and senior medical social worker or usual care. Primary outcomes included: ED length of stay and hospital admission rates. Secondary outcomes included: patient satisfaction, function, quality of life, incidence of ED re-visits, hospital admissions, nursing home admission, healthcare utilisation and mortality at 30-day and 6-month follow-up

Results
Considering the first 140 participants, the intervention group spent significantly shorter time in the ED than the control group (7.5 vs. 15.2 median hours, p<0.001) and experienced lower admission rates (18.6% vs. 64.3%). At 30-day follow up, healthcare utilisation rates were higher in the intervention than control group (77.2% vs. 61.4%, p=0.04). There were no significant differences between the groups regarding satisfaction with their ED visit, function, quality of life of incidence of adverse outcomes at 30 days. Our cost-effectiveness analysis is ongoing.

Conclusion
Preliminary findings from our trial indicates that HSCPs working in the ED can contribute to improved older patients’ care by reducing their duration of stay in the ED and increasing rates of discharge home. Participant recruitment and six month follow-up is continuing.
111 Adding Nuance to the Rockwood Clinical Frailty Scale
Authors: McKeown William , Wright Simon , Kelly Rosemary 
Published: September 2019

Abstract

Background
The Rockwood Clinical Frailty Score (CFS) is a well validated tool for assessing frailty. However, there is a paucity of data in the literature demonstrating how severity of clinical frailty correlates with adverse outcomes. This gap in the literature limits the ability of physicians, who predominantly use measures of frailty in day-to-day practice such as CFS, to fully construe the implications of increasing frailty for patients in their care.

Methods
In this prospective cohort study, patients (n=186) aged >65 years admitted for unscheduled medical care to a district general hospital, were assigned a clinical frailty score within 24 hours of admission. Patients were then followed up for 12 months and assessed in terms of mortality, discharge to institutional care, length of hospital admission, polypharmacy and re-admission rate.

Results
This study found significant differences between frail and non-frail populations in terms of adverse patient outcomes including mortality, length of hospital admission, polypharmacy, co-morbidity and re-admission rates. Of greater importance still, this study found that increasing risk of adverse outcomes correlated with increasing CFS. For CFS ≤4, 5, 6, 7, 8, 9 12-month mortality rates were 7.55%, 28.6%, 31.4%, 37.14%, 87.5% and 100% respectively. For CFS ≤4, 5, 6, 7, 8, 9 rates of discharge to institutional care were 1.88%, 6.12%, 34.3%, 41.66%, 50% and 40% respectively.

Conclusion
These results are important as they begin to help physicians form a more nuanced interpretation of CFS. With growing emphasis on individualising patient care, binary categorisation of patients into ‘frail’ and ‘non-frail’ groups is felt to be an increasingly inadequate way of viewing frailty. This study adds information to the discourse which helps both physicians and patients to make more informed decisions regarding their on-going medical care. Larger prospective cohort studies will now be required to understand correlation between severity of frailty and patient outcomes.
148 Orthogeriatrics, Just the Beginning
Authors: Smyth Hannah , Hearne Siofra , Monahan Pheadra , Bermingham Rebecca , Nawab Sidra , Ameen Hadeer , Timmons Shirley , Mahapatra Anant , Bhuachalla Bláithín Ní , Lynch Olwyn , Basit Mian , Mulroy Martin , O'Brien Helen 
Published: September 2019

Abstract

Background
The most common cause of admission to the orthopaedic ward are low trauma falls resulting in a hip fracture. These fragility fractures occur in older, frail, multi-morbid patients and they are associated with a high mortality rate and significant loss of independence. The Irish Hip Fracture Database is a national clinical audit that aims to improve hip fracture care and patient outcomes. Using the Irish Hip Fracture Standards, we aimed to audit the care of hip fracture patients in an Irish Model 3 Hospital pre- and post- implementation of an orthogeriatrics service.

Methods
Local Irish Hip Fracture Database was reviewed to assess the six Irish Hip Fracture Standards prior and 4 months following the introduction of a consultant-led dedicated orthogeriatrics service.

Results
There were 63 hip fracture patients (mean age 81) in the pre-service group and 69 (mean age 81) in the post-service group. Standard 1: 3.2% of hip fractures were admitted to the orthopaedic ward within 4 hours in the pre-service group versus 18.8% post-service introduction (national average 11%, 2017). Standard 2: 67.9% underwent surgery within 48 hours and during working hours versus 67.8% (national average 69%, 2017). Standard 3: 3.5% developed a pressure ulcer during their stay pre-service versus 1.6% post-service (national average 3%, 2017). Standard 4: 4.8% were assessed by a Geriatrician pre-service versus 84% post-service (national average 50%, 2017). Standard 5: 24.6% received a bone health assessment versus 87.5% post-service (national average 73%, 2017). Standard 6: 1.8% received a falls assessment prior to discharge versus 82.8% post-service (national average 47%, 2017).

Conclusion
The introduction of a dedicated orthogeriatrics service has led to a more collaborative multi-disciplinary approach to patient care with evidence of improvements in all Irish Hip Fracture Standards. Commitment to a resourced orthogeriatric service providing rapid comprehensive geriatric assessments is essential to advance improvements in older patients’ care.
172 Sarcopenia, Frailty and Malnutrition in the Older Adults in the Emergency Department Setting
Authors: Brady Deirdre , Boyle Orla , Kelly Louise , Ryan Maeve , Wade Ruth , Whelan Caitriona , Doherty Orlaith , Murphy Maeve , Mello Sarah , McElwaine Paul , Kennelly Sean , Gray James , Hayden Derek 
Published: September 2019

Abstract

Background
The physical phenotype of frailty shows significant overlap with sarcopenia, and sarcopenia phenotype is associated with malnutrition. Integrating screening of these interrelated conditions, could help identify those most vulnerable in the Emergency Department (ED) setting.

Methods
Patients ≥75 were screened in the Emergency department (ED) by an interdisciplinary Gerontological ED team using a standardised assessment tool, incorporating the Clinical Frailty Scale (CFS) and the mini-nutritional assessment short form (MNA-SF). Patients at risk of malnutrition ( MNA-SF <12) were referred for Dietetics assessment and screened for sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm for case finding, followed by grip strength and calf muscle measurement.

Results
In a convenience sample of patients referred to dietetics following initial screen in ED, 57% were female (25/44) and the mean age was 83 years (range 75-94). Eighty-eight percent (39/44) were at risk of malnutrition/malnourished and 25% (11/44) were diagnosed with malnutrition (MNA-SF score 0-7). Seventy-three percent (32/44) scored ≥4 on the CFS. Fifty-two percent of all patients (23/44) had a Sarc-F ≥ 4, suggestive of sarcopenia, while 45% (20/44) had a probable diagnosis of sarcopenia and 39% (17/44) met diagnostic criteria for sarcopenia.
Risk of malnutrition was more commonly observed in those patients with a CFS score ≥4 (94% vs. 75%), as was risk of sarcopenia (81% vs. 17%). Fifty percent (22/44) of all patients screened positive for suspicion of both frailty and sarcopenia (frailty score≥4 and Sarc-F score≥4).
Patients with a probable diagnosis of sarcopenia and concomitant frailty had more ED attendances, falls and longer lengths of stay.

Conclusion
Frailty, malnutrition and sarcopenia are frequently observed in older patients in the acute setting. The integration of screening measures for malnutrition, frailty and sarcopenia in clinical practice can facilitate the identification of patients for multi-component targeted interventions.
217 Investigating the Delivery of Falls Prevention Interventions to Older People Following Multi-Factorial Risk Assessment: A Cross-sectional Study
Authors: Dennehy Rebecca , Barry Patrick J , O'Connor Kieran A , Cronin Finola , Turvey Spencer , Moriarty Eileen , O'Reilly Éilis J , Browne John P , McHugh Sheena 
Published: September 2019

Abstract

Background
Falls are one of the most common threats to older peoples’ independence. In Ireland, approximately one in three adults aged ≥65 years fall each year. Multifactorial interventions, which include an assessment of an individual's risk of falling followed by customised interventions or referral have been shown to reduce the rate of falls among community-dwelling older people. As part of an Integrated Falls Prevention Pathway initiated in 2016, six multidisciplinary risk assessment clinics were established in Cork city and county. The aim of this study is to examine whether recommended follow-on interventions were received following a falls risk assessment in the community.

Methods
Routinely collected administrative data for clients who attended a falls risk assessment clinic are being collated. Data include client demographics, onward referrals, waiting times and receipt of intervention. A process map of the patient pathway following a falls risk assessment is under development and will be refined based on the study findings.

Results
Preliminary analysis of a two-year implementation period (April 2016-2018) indicates that following assessment, clients received an average of 2.4 onward referrals. Most referrals were made to general practice (29%, n=315), community physiotherapy (25%, n=272), and community occupational therapy (15%, n=165). Other referrals were to public health nurses (n=104, 10%) and falls prevention classes (n=60, 6%). Further analysis will identify the percentage of individuals who receive interventions, the type of interventions received, the percentage of patients who do not attend and the waiting lists.

Conclusion
The Integrated Falls Prevention Service is the sole example of an operational integrated falls pathway in Ireland. This research will identify potential roadblocks for providers and clients along the pathway and will identify opportunities to. The results will also be used to inform service planning and resource allocation to ensure that this model of care is sustainable.
224 Dance Artist and Physiotherapist Collaboration in Stroke Rehabilitation
Authors: Harte Gillian , Claffey Ailish , O’Neill Desmond 
Published: September 2019

Abstract

Background
Many studies have measured the benefits of dance for patients, in particular those with Parkinson's disease, with positive effects demonstrated in functional measures, wellbeing and patient experience. However, neither the value of dance when used as an adjunct to stroke rehabilitation nor the act of collaboration between dance artist and physiotherapist has previously been studied.
Aim: To explore the experience and process of collaboration between the physiotherapist and dance artist when dance is used as an adjunct to conventional physiotherapy post-stroke in a geriatric medicine and stroke service in a university teaching hospital.

Methods
The study used a descriptive qualitative design and a convenience sample of 8 participants were recruited from the stroke rehabilitation ward. The physiotherapist advised the dance artist on specific movement goals for each session. The physiotherapist and dance artist kept individual diaries which included subjective and professional assessment of sessions. Exploratory analysis was used to discover emerging themes.

Results
Themes identified fell into the categories of physiotherapist learning, dance artist learning, collaborative process, language, and the therapeutic relationship.
While benefits such as greater liberation of patients’ movements and higher endurance rates were recorded, what was particularly of note was the communication between the physiotherapist and the dance artist. The language used was key: physiotherapy discourse tends to be more specific to particular movements whereas the dance artist relates more to the overall movement of the individual, identifying movement patterns and habits.
The dance artist uses the lens of choreological studies (the science of movement) when working with patients and this way of working was particularly beneficial. In particular the use of motif writing became an invaluable resource in terms of communication.

Conclusion
Within this study we questioned: what is required to create successful collaboration within a medical context? We hope that describing how this particular collaboration was successful will benefit those interested in similar collaborations.
255 An Exploration of the Feasibility and Acceptability of Wearable Technology in Parkinson’s Disease
Authors: Kenny Lorna , O'Riordan Clíona , Wilkinson Tony , O’Sullivan Mary , Agurjanovs Janis , Tedesco Salvatore , Sica Marco , Crowe Colum , Barton John , Timmons Suzanne 
Published: September 2019

Abstract

Background
Wearable technology is increasingly used to diagnose, monitor and manage neurological disorders such as Parkinson’s Disease (PD). This study aims to gain information about the views and needs of people with Parkinson’s (PwP’s) regarding wearable technology for monitoring the disease and assisting its management.

Methods
The study employed a mixed methods parallel design, wherein focus-groups and questionnaires were concurrently conducted with people with PwP’s in Munster. Questionnaires and topic guides were developed with significant input from PwP’s. The participants for focus-groups were purposively sampled for variation in PD stage, age (all >50 years) and sex. Questionnaire and focus-group results were analysed together, using a pragmatic triangulation protocol.

Results
Thirty-two questionnaires were completed by PwP’s. Four semi-structured focus-groups were held (n=24 participants). Participants were overall positive about wearable technology in PD, and perceived benefits in wearable technology for improved management of symptoms. Wearables should be user-friendly, have an appealing design, and demonstrate clinical usefulness. Comfort and discrete design were emphasised for greater usability.
The value of sharing information between PwP’s and health professionals for improved outcomes was highlighted. PwP’s perceived that increased patient data in the form of reliable information from a wearable device may allow for more accurate management of PD. Participants also felt that a device could help increase physical activity, and potentially track compliance with medication. There was little focus on device safety and privacy/ownership of data. While participants anticipated that there may be challenges for some in wearing a device, they believed overall potential benefits would outweigh these.

Conclusion
Engagement of PwP’s in the design of wearable technology is vital for the development of devices that improve the management of PD. This study will directly inform a multi-country feasibility study of wearable devices for older people, with a particular focus on the needs of PwP’s.
280 Acute Hospital Presentations among Nursing Home Residents: A Retrospective Observational Analysis
Authors: Waters Ruairí , Murphy Robert , Mannion Edel , Gaffney Laura , Donlon Kate , Canavan Michelle , O'Keeffe Shaun T 
Published: September 2019

Abstract

Background
Nursing home residents are prone to acute illness due to their advancing age, underlying illnesses and immobility. The decision to refer a nursing home resident for acute hospital admission is a complex one, and there is no consensus among health care professionals about what constitutes an ‘appropriate admission’ to hospital from a nursing home. We aimed to explore patterns of acute nursing home patient presentations to the emergency department.

Methods
This was a retrospective cohort study of emergency hospital admissions to a tertiary university teaching hospital. Emergency admissions through the emergency department were included. Elective admissions, outpatient admissions, or inter-hospital transfers were excluded. Cases were validated by scrutiny of the patient medical records, and where possible an assessment of the Rockwood clinical frailty scale (CFS) was carried out.

Results
There were 126 nursing home residents who presented to ED over a two month period for emergency assessments. 87.3% (n=115) presented via ambulance. Just over half had a GP referral letter (53.2%). 72.3% of patients who presented to ED were admitted. 25.2% of patients were re-referred to ED within 30 days of hospital discharge. All patients were classified as frail. 21.3% of patients had died at the 90 day follow up mark. 66% of those with a CFS 8 or 9 died, in comparison to 16% of those with a CFS or either 6 or 7.

Conclusion
We noted high numbers of patients from nursing homes attending our emergency department. A very high proportion were admitted, along with a high number of subsequent re-presentations. Death rates were higher in those with more advanced frailty status. We would suggest advanced care planning and strategies to improve the patient experience.
This study highlights the requirement for improved advance care planning in the nursing home setting. This is however a complex issue. Early discussion about end of life preferences with patients and family is required.