bluuebunny/crossref_metadata_2025_split huggingface dataset:
268 Can the Swallow Screening Component of a Frailty Assessment be Used to Reliably Direct Clinical Dysphagia Assessment Referrals?
Authors: Maher Jennifer , Pender Ciara , Sayers Karen , Ryan Siobhan , Cooney Eamonn , O'Reilly Aine , Donnellan Christina , Pillay Isweri 
Published: September 2019

Abstract

Background
The prevalence of dysphagia rises with age. It is associated with increased dependency and mortality (Smithard, 2016).
The Irish Association of Speech & Language Therapists (IASLT) only supports swallow screening by trained nursing staff post stroke in acute care settings. Further research is required to establish its use with other clinical populations (IASLT, 2016).
This study was performed to evaluate the use of a swallow screening tool by an interdisciplinary integrated team to identify frail older patients who require a clinical dysphagia assessment.

Methods
This was a prospective cohort study (N=177) of patients admitted through an acute hospital emergency department, between November 2018 and February 2019, 70 years or older, in an acute setting, who were identified as frail based on the Variable Indicative of Placement.
The number of patients referred to SLT due to a positive swallow screen on CGA, conducted by a trained interdisciplinary team was compared with the number referred by the patient’s primary team.
The criteria for dysphagia positive score was to answer yes to any of the swallow screen questions, which were based on risk factors for dysphagia.

Results
Of 177 patients, 47 (26%) screened positive for risk of dysphagia by the interdisciplinary team. Eight, who screened negative for risk of dysphagia, were referred by the patient’s primary team. One out of eight who screened negative, required a diet modification based on an SLT assessment.

Conclusion
A trained interdisciplinary frailty team can reliably screen for and identify risk of dysphagia. This indicates a potential for use of more standardised swallow screening protocols beyond the post stroke population into a broader cohort of patients.
27 Decision-Making Capacity Assessment: Occupational Therapy’s Contribution within a Multidisciplinary Approach
Authors: Usher Ruth , Stapleton Tadhg 
Published: September 2019

Abstract

Background
Increasing age and life expectancy, alongside the growing incidence of chronic conditions and dementia-related diseases, indicate more older individuals are likely to experience challenges regarding decision-making capacity. In Ireland, the Assisted Decision Making (Capacity) Act 2015 provides a statuary framework for adults who are experiencing difficulties with decision-making. This legislation has significant implications for all who work in health and social care, especially those working with older adults. An online survey was conducted to explore occupational therapy practices regarding decision-making capacity assessment and factors impacting on engagement in this area.

Methods
Occupational therapists in Ireland were invited to participate in a cross-sectional online questionnaire.

Results
One hundred and seventy-two occupational therapists responded. Most occupational therapists (65.77%, n=98) reported involvement in decision-making capacity assessments, particularly those working with older adults. Occupational therapists were more frequently requested to contribute to assessments of capacity regarding independent living (79.19%, n=118), driving (45.89%, n=67), and financial management (44.44%, n=64). Occupational therapists reported using a combination of approaches to inform decision-making capacity assessment, including interviews, observations and assessments of cognition and functional performance, and emphasised a strength-based approach.
Many participants reported decision-making capacity assessment is more difficult than other aspects of practice and that they are not satisfied with decision-making capacity assessment procedures in their workplace. A large majority (91.86%, n=113) reported occupational therapists would benefit from additional training and practice resources for decision-making capacity assessment.

Conclusion
The study confirms that occupational therapists have a role to play in assessment of decision-making capacity assessment, particularly regarding independent living. However, the recommended approach to assessment should include all appropriate multidisciplinary team members. There is need for further education, resources and guidelines for occupational therapists and other healthcare professionals to better guide decision-making capacity assessment.
271 Introducing a ‘Do Not Attempt CPR’ and ‘Treatment Escalation Plan’ Form to Improve Patient Care and Decision Making
Authors: O'Keeffe Hannah , Smyth Hannah , Al-Shawee Nora , Tacheva Asya , Bradley Maeve , Mulroy Martin , Lynch Olwyn 
Published: September 2019

Abstract

Background
The HSE National Consent Policy recommends health care professionals ‘develop specific mechanisms for the documentation and dissemination of decisions relating to resuscitation’. We also felt a need to promote a move away from a unidimensional CPR focus more towards documentation of appropriate and inappropriate care for the individual patient.

Methods
In December 2018 we conducted a baseline study of the quality of documentation of patient resuscitation and escalation plans in our hospital. We reviewed the charts of patients on 4 wards on a single day.

Results
Of 80 patients, 19 had some documentation regarding a CPR discussion. Of those 19 one had been determined at time of an arrest call and one at the time of a deterioration. Only 13 of 19 had some documentation of a discussion surrounding the decision. Only 5 had any documentation of the reasoning behind the decision.

Conclusion
Other hospitals in our hospital group had implemented a `Do Not Attempt CPR' and Treatment Escalation Plan form in the last year. With their permission we used their form as a template to develop a form for use across our hospital .This form is to be readily accessible in an emergency and out of hours, and contains quality information regarding the goals of care for an individual patient. The form is a single page, easily identifiable with a red border and filed inside the front cover of the chart.
We have had the form approved by our Lead Clinicians forum and Hospital’s Resus Committee. To promote the successful introduction of the form we have conducted education sessions across the departments of Medicine, Surgery, Anaesthesia and Obstetrics and Gynaecology.
The form has is currently being printed and will be implemented in the coming weeks. We will be closely liaising with users and reviewing its use following implementation.
278 The Acute Spine Fracture in the Emergency Department; a Retrospective Review
Authors: Thorpe Owen , Beirne Avril , Fox Paul , Nic Uidhir Aoife , Dockery Frances 
Published: September 2019

Abstract

Background
As to who should manage osteoporotic spine fractures presenting to Emergency departments (ED) is sometimes debated. We sought to review practice regarding their management in our institution that might inform a clinical pathway.

Methods
We conducted a search of radiology reports for a consecutive series of thoracic or lumbar spine x-rays ordered by ED team only, i.e. a series of patients whose presenting complaint was a suspected acute fracture. We narrowed search to include terms ‘compression’ or ‘wedge’ or ‘end-plate’.

Results
Over 7 months, there were 1,505 such reports; narrowed search and excluding duplicates yielded 168 patients of whom 84 had a fracture. We looked at the acute management of those >50yrs, excluding one metastatic fracture leaving n=64. Of these, 65% occurred following a fall, 14% on twisting/bending/coughing, 14% spontaneous, 7% unclear onset. ED first consulted orthopaedics for 10 cases, neurosurgeons for 2, physicians for 18. A total of 21 were discharged from ED (5 having speciality review pre-discharge). A further 11 were sent home from ED with fracture diagnosis made only when x-ray subsequently reported. Of those admitted, 28 went to physicians with consult to surgeons in 39%, 2 went to orthopaedic surgery, 2 to other specialists. Admission was complicated by pressure ulcer in 13% (4/32), pneumonia in 13%. Overall 24/64 (38%) went on to have MRI/CT (mainly admitted cases). At least 12 were managed with a brace (all records not available). N=7 (11%) had later vertebroplasty. More than half had no documented osteoporosis treatment plans nor GP instruction to address.

Conclusion
Care of spine fractures presenting acutely varies; a high proportion managed by ED solely. Whether outcomes vary as a result is not answered by this audit but there is a need for a pathway to inform best practice. Osteoporosis is inadequately-addressed in this high risk group, highlighting need for fracture liaison services in post-acute management.
285 Inpatient Management of Medications for Parkinson’s Disease
Authors: Doyle Kate , Jonsson Agnes , O'Sullivan Ciara , Gallagher Paul 
Published: September 2019

Abstract

Background
Medication errors during unplanned hospital admissions are common in Parkinson’s Disease, often involving late or missed doses. These errors can result in serious complications and loss of function in these patients. Several Parkinson’s Disease networks and associations have run campaigns aiming to improve medication administration in hospital.

Methods
We reviewed the medical notes and medication charts of 20 patients with Parkinson’s Disease admitted through the Emergency Department. Medication charts were reviewed to assess for levo-dopa containing medications. We assessed whether medication dosing and timing was accurately recorded, if medications were administered on time, and if self-management of medication was considered if the patient was capable during the first 48 hours of admission. We measured our findings against standards from NICE guidelines and Parkinson’s UK.

Results
Only 9 of 20 cases had the times and doses accurately documented on admission. An average of 2.7 doses/patient were missed or delayed in the 48 hour period. Of 152 total doses, 54 (35%) were missed or late. Only 3 out of 20 patients received all their medications on time. Only one out of 20 patients had a documented order to be allowed to self-manage their medication.

Conclusion
Medication errors and omissions during unplanned hospital admissions in patients with Parkinson’s Disease are unsurprisingly common. Many doctors are unaware of the need to provide alternative routes of delivering levo-dopa for patients with Parkinson’s Disease who are fasting or unable to swallow. Patients with Parkinson’s Disease are not being empowered to manage their own medication during hospital admission. Educating doctors on the importance of reducing these medication errors, and the existence of the OPTIMAL Calculator to convert the patients’ usual medications to alternative preparations, is imperative to improve inpatient management of patients with Parkinson’s Disease.
286 Predictors and Outcomes of Older Persons Attending the Emergency Department of a Large Acute Dublin Teaching Hospital
Authors: O'Shaughnessy Íde , Briggs Robert , Timmons Suzanne , Cunningham Conal 
Published: September 2019

Abstract

Background
An emergency department (ED) visit is often considered a sentinel event for an older person due to elevated risks of deleterious outcomes. This prospective cohort study explored factors associated with disposition post ED index visit and unscheduled 30 day revisit.

Methods
Consecutive ED attendees aged ≥70 years, and Manchester Triage System 3-5, in a 6-month period, were eligible for inclusion. Participants underwent an interdisciplinary assessment by a Home FIRsT (Frailty Intervention & Response Team) member. Logistic regression analyses were performed to identify factors predictive of admission post ED index visit and unscheduled revisit. Predictive validity of frailty instruments were performed using receiver operating characteristic (ROC) curves

Results
1,156 ED attendances were included - 59% were female; median age was 80 years; 66% were discharged home post index visit; 17.8% had an unscheduled ED revisit within 30 days. Age and sex did not predict hospital admission. Hospital admission post ED visit was imperfectly predicted by mild-moderate frailty: Clinical Frailty Scale 5-6 (Odds Ratio (OR) 1.83 (95% CI 1.11 – 3.04), p=0.019); ‘Think Frailty’ 3 (OR 1.75 (95% CI 1.07 – 2.85), p=0.025) and 4 (OR 2.32 (95% CI 1.16 – 4.63), p=0.017). Paradoxically, higher frailty scores were not predictive. Cognitive impairment (4AT 1-3) similarly predicted admission (OR 1.62 (95% 1.16 – 2.27, p=0.005), while delirium (4AT ≥4) was the strongest predictor of admission (OR 5.87 (95% CI 3.17 – 10.88, p<0.001). ROC curves of both frailty scales showed moderate ‘diagnostic accuracy’ for admission, but less so for unscheduled revisits.

Conclusion
Home FIRsT operationalised the assessment of frailty and delirium in the ED. Delirium is a strong predictor of admission post ED index visit, more than frailty status. Older persons have a high rate of 30-day unscheduled revisits; however, it is difficult to produce models from patient information available at index visit that can reliably predict unscheduled revisits.
288 Hearing Loss as a Potentially Modifiable Risk Factor in People with Mild Cognitive Symptoms Attending a Specialist Memory Service
Authors: McHale Cathy , Sharkey Jennifer , Coughlan Tara , O’Neill Desmond , Dookhy Joshi , Sheridan Lisa , Kennelly Seán 
Published: September 2019

Abstract

Background
People with mild hearing loss at age 50 are twice as likely to develop dementia increasing to a five times greater risk for those with severe hearing loss. The prevalence of dementia and hearing impairment increase with age. Intact hearing enables cognition, facilitates social interaction and enhances communication. Hearing loss, social isolation and dementia are commonly interwoven. We recently commenced routine audiology screening in our memory service.

Methods
Consecutive patients with mild cognitive impairment attending a tertiary memory assessment and support service were referred for full audiology screening. People were routinely referred on basis of cognitive diagnosis, and not on the basis of perceived hearing loss. Assessment included ENT history, otoscopy, tympanometry, pure tone audiometry and speech audiometry to determine the presence, type and amount of any hearing loss present. This included speech discrimination testing – a functional test to determine processing of 10 phonetically balanced words with 100% being an optimal response.

Results
20 people (12 women), mean age 72.3 (range 57-87) were assessed. The majority had amnestic MCI 18/20 (90%). 9/20 (45%) patients subjectively complained of hearing loss. 7/20 (35%) had history of occupational noise exposure. 12/20 (60%) had occlusion due to ear wax.
Hearing loss identified: Mild 8/20 (40%); Moderate to severe 7/20 (35%); with Normal hearing in 5/20 (25%). High frequency hearing loss was noted in 19/20 (95%). Speech discrimination score was impaired in those with hearing loss: mean 89.4% (range 66-100). 6/20 (30%) received referral for hearing aids.

Conclusion
This study highlights the importance of incorporating an assessment of auditory acuity as part of memory assessment and post-diagnostic care-pathway for people with mild cognitive complaints given the established impact hearing loss has on the future risk for cognitive decline. Hearing loss is frequently unidentified and is a clear modifiable risk factor to promote brain health.
289 Detection of Falls in Older Patients by Medical Professionals on Admission to Hospital: An Audit
Authors: Buckley Emily , Alalawi Mazen 
Published: September 2019

Abstract

Background
A history of a previous fall is one of the best predictors of future falls, increasing its risk 3-fold. The Health Service Executive (HSE) best practice guidelines recommend that all patients aged over 65 years in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the fall-frequency, context and characteristics. The aim of this audit was to increase falls recognition by medical professionals following the implementation of a falls screening questionnaire into the admission proforma of an acute hospital.

Methods
This was a clinical audit. Data was collected on 29 consecutive patients aged > 65 who were admitted via the emergency department of an acute hospital over a 6 day period. Data on falls was collected using the medical admissions hospital proforma during the first 72 hours.
Following the initial audit, a new proforma containing a falls screening questionnaire (as per best practice guidelines) was introduced and an information session provided on its use. A re-audit of 17 admitted medical patients was then completed over the next 72 hours.

Results
The initial audit highlighted poor assessment of falls with only 3 (25%) patients being screened at admission. 1 (33%) had a fall; described as mechanical. Following introduction of a falls screening questionnaire into the admission proforma, a re-audit showed a significant increase, with 58% of admissions now being screened. Of these, 40% had fallen in the last year: 75% of falls were mechanical and 25% due to other causes.

Conclusion
This audit shows that falls in this patient population was largely unrecognised by medical professionals. Following implementation of a screening questionnaire, significant improvements were made. This audit concludes that implementation of a falls screening questionnaire into the medical admissions proforma is an effective method in identifying falls in older patients admitted to hospital.
290 Are Clients Satisfied with Integrated Care? Enhancing Client Feedback on Discharge from a Domiciliary Based Multidisciplinary Integrated Care Service
Authors: Boyle Nichola , McDonnell Sinead , Balasubramanian Subha , Reynolds Niamh , Geary Niamh , O'Shea Diarmuid , Hession Eilis 
Published: September 2019

Abstract

Background
The Integrated Care Programme for Older People has supported the development of integrated care services at pioneer sites in Ireland, each developed to meet local needs. Patient Reported Experience Measures (PREMs have been used to evaluate user experience in intermediate care in the United Kingdom. This project aimed to evaluate client experience of a domiciliary based, multidisciplinary, integrated care service.

Methods
A qualitative audit of the experience of clients of the Older Persons’ Integrated Care Team (OPICT) was performed. This project was undertaken in conjunction with the Royal College of Physicians of Ireland’s Quality Improvement in Action programme. A feedback questionnaire was designed and distributed to consecutively discharged clients from OPICT from February 2019, providing qualitative assessment for service improvement. The results of feedback from the first questionnaire design are reported.

Results
Twenty OPICT clients received a feedback questionnaire following their final interaction with the OPICT service. Eighteen clients responded: 11 males and 9 females with mean age 81 years. Two male clients did not return the questionnaire (mean age 86 years). In terms of the treatment and advice provided by the team, all 18 clients agreed with statements that they were involved in decision making, treatment was explained in a way that they could understand and was effective and met their needs. All clients responding indicated that they were listened to, treated with dignity and had confidence and trust in the team. All 18 respondents would recommend the service to another older person. Respondents also provided individual comments which all indicated satisfaction with the service.

Conclusion
Older people accessing integrated care delivered in their home reported a positive experience and can provide important information on further service development.
303 Integrated Care Hubs for the Older Person: RIGHT TIME, RIGHT PLACE
Authors: O'Donoghue Alice , MacMahon Clare , Bolger Margaret , Roche Suzanne , Phelan Niamh , Murphy Catherine , Grant Emma , O'Donnell Desmond , O'Mahony Anne , Henin Maged , O'Gorman Millie , Masombo Rudo , Doyle Marie , Hartnett PJ , O'Halloran Adriana , Pope George , Mulcahy Ríona , Cooke John 
Published: September 2019

Abstract

Background
Our Integrated Care Hub has been operating since mid-2017 providing patient-centred multidisciplinary team (MDT) care operating via a number of specialised care pathways. There has been an early emphasis on the response to crisis presentations and with the introduction of the Hub we now have an extensive and organised response to such presentations. We wanted to assess does this system result in earlier referral of the ‘Crisis’ patient to an Integrated Care Hub.

Methods
We performed a retrospective quantitative analysis of data comparing two time-periods January to June 2018 with January to April 2019 (year-to-date). The number and type of MDT contacts were classified into 4 categories: Immediate Crisis (would present to the Emergency Department within 48 hrs if not reviewed), Emerging Crisis (would present to the Emergency Department within 2 weeks if not reviewed), Stable Situation (needs optimisation), Stable Situation (no intervention). Data were extracted from File-Maker Pro.

Results
There were 424 MDT contacts in January-June 2018 compared with 658 MDT contacts in the year-to-date 2019. The number of patients in these time-periods presenting in ‘Immediate Crisis’ was reduced in the year-to-date 2019 - 4.41% when compared to the same time-period in 2018 – 11.79%. There was a similar reduction in ‘Emerging’ Crisis presentations in these time-periods: 15.65% in 2019 vs. 24.29% in 2018. While the patients attending that were classified as Stable Situation (needs optimisation) increased in 2019 compared to 2018 – 66.57% vs. 47.88%.

Conclusion
We can see from our data that the creation of our Integrated Care Hub has resulted in an increased demand for our service, however, interestingly we have found that the crisis patient load has, in fact, decreased. This suggests that we are influencing referral patterns by both recognising and intervening at an earlier stage to manage, stabilise and reverse crisis in these patients in an organised manner within the MDT.