bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Review of Patient Continence and Related Staff Knowledge on Specialist Geriatric Wards
Authors: Healy Anna , Ryan Siobhan , Brewer Linda 
Published: September 2024

Abstract

Background
Incontinence is a common and troublesome feature of frailty (NCPOP 2012), routinely examined in a comprehensive geriatric assessment (CGA). It can impact on life quality, mobility, falls and overall care needs. Patients often develop incontinence during hospital admission and staff knowledge of continence status (CS) and efforts to drive improvements are often poor. We sought to explore these issues on our wards.

Methods
We conducted a point prevalence study, reviewed medical charts and interviewed ward nurses on three specialist geriatric wards. Patients &gt;65y over a six-week period were included. We developed a proforma and recorded current and pre-admission CS, and use of continence wear. Nursing staff awareness of CS was also explored.

Results
104 patients (57% female, mean age 81y) were included. Overall, 34 (32.7%) had urinary incontinence (UI), of whom 22 (64%) developed new UI since admission. 27 (25.7%) patients had a urinary catheter inserted, most (23; 85%) for short-term use. Almost half (46; 44.2%) had faecal incontinence (FI), of which 74% was new FI since admission. Overall, 19 patients (18%) were doubly incontinent. Continence wear was also reviewed; 57 (54%) were in full wrap-around continence wear, 28 (27%) in pull-ups. 26 (25%) wore continence wear despite being continent. Only 28 (27%) had a call bell within reach. Nursing awareness was examined, 85 nurses (81.7%) were aware of their patient’s CS, and 15 (14.4%) were partially aware. In all cases, nursing handover documents were consulted. For 35 patients, (33%) CS impacted on their discharge plan.

Conclusion
Rates of UI and FI were high in our cohort and further increased during hospital admission. Staff knowledge was satisfactory but suboptimal efforts were made to improve CS. Consequently, an education session was delivered to clinical staff to embed continence assessment into CGA. Additionally, continence advocates have been appointed to each ward.
Improving Advanced Care Planning: Documentation of DNA CPR Orders and TEPs in Residential Care Admissions
Authors: Marks Eleanor , Buckley Sophie , O'Connell Orlaith , O'Brien Claire , Buckley Mary 
Published: September 2024

Abstract

Background
Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders and Treatment Escalation Plans (TEPs) are key components of advanced care planning for managing patients with progressive life-limiting illnesses and significant frailty. Our study aimed to determine the proportion of such patients being transferred from residential care facilities with documented TEPs upon medical admission, examine whether these TEPs were revised during the hospital stay, and assess patient outcomes at 14 days post-presentation.

Methods
We reviewed the lists of patients who had been referred for medical admission via the emergency department over a one-month period and identified those presenting from residential care facilities. We excluded those under the age of 65. We reviewed relevant medical notes and collected anonymised data into an Excel spreadsheet on a password protected computer.

Results
We identified 34 patient’s relevant patients. Notes were available for review in 31 cases (17 male; age range 66 to 96 years old, mean age 82.3). Of the 31 cases reviewed, the mean Clinical Frailty Score was 7.4. Residential care facilities sent documentation outlining TEPs in 19/31 cases. In those cases, 4/19 specified full resuscitation. In 3/4 of these cases, the TEP was revised during their admission. In one case, documentation specified that the patient did not want to be transferred to hospital under any circumstances. A total of 14 patients had no documentation regarding TEP. Of those, 7/14 went on to have DNA CPR orders filled out during their admission. At 14 days post presentation, 7 had died in hospital, 16 were discharged back to their residential care facility, and the remainder remained inpatient.

Conclusion
These findings underscore the need for better advance care planning, potentially improving patient management and reducing the emotional burden on patients, healthcare providers and families during critical moments.
Delirium Assessment And Documentation As Part Of An Acute Medical Admission
Authors: Cashen Aoife , Lynch Amy , Cormican Niamh , Chan Kei Yen , Devaney Kathy , Robinson Stephanie , Small Cliona 
Published: September 2024

Abstract

Background
Delirium is a prevalent issue affecting older patients in acute hospitals. National guidelines mandate that all patients &gt;65 years old admitted to an acute hospital setting are screened for delirium. Prompt assessment and management of delirium is vital in delivering optimal care to the older patient. In our institution, delirium can be under recognised and not assessed routinely as part of the medical admission. Our aim was to assess delirium documentation rates and utilising the 4AT as part of the acute medical admission in a service development project.

Methods
A retrospective assessment of patient demographics and documentation of delirium and 4AT in the medical admission was carried out for January, February and March 2023 and compared to the same 3-month period in 2024 post set up of a new specialist geriatric ward (SGW) as part of a service development project. This was in tandem to targeted interventions for improving delirium education and management.

Results
Mean age was 83 years in both groups. 11% (18/157) in the cohort pre SGW and 30% (40/134) post setup of the SGW had a diagnosis of dementia. 13% (20/157) in the pre SGW cohort had delirium documented in the admission note and 23% (31/134) post. 24% (32/134) had a 4AT documented in the admission note post SGW setup compared with 6% (10/157) previously.

Conclusion
There was suboptimal documentation of the 4AT and delirium in the acute medical admission note. An acute medical admission proforma is being developed and implemented in our institution which will include a 4AT delirium screening tool. We will reassess this in 6 months’ time to ascertain whether there is an improvement in delirium and 4AT documentation. We will also give education to the medical NCHD group carrying out the admissions to emphasise the importance of utilising the 4AT and delirium documentation.
Diagnostic Challenges and Outcomes in Transient Loss of Consciousness: A Retrospective Analysis
Authors: Davey Naomi , Kelly Louise , Kerins Yvonne , Connolly Kieron , Soh Josephine 
Published: September 2024

Abstract

Background
Transient loss of consciousness (T-LOC) is a common presenting complaint, posing significant diagnostic challenges. This study explores outcomes for T-LOC.

Methods
Using the Hospital Inpatient Enquiry System, data on patients with T-LOC were collected at a large academic teaching hospital over six months, including demographics, length of stay (LOS), diagnostic tests, and discharge diagnoses.

Results
A total of 160 T-LOC patient visits were analysed, divided into three age cohorts: under 65 (n=66), 65-74 (n=38), and over 75 (n=56). Of the 94 patients aged over 65 (58.75% of the sample), mean age was 76.07 years; 47% were female. Diagnostics varied by age, with higher rates of computed tomography of the brain (87.23%) and lying-standing blood pressure (37.23%) in those over 65. Conversely, those over 65 were less likely to receive electrocardiograms (86.17% vs. 96.97%), telemetry (51.06% vs. 59.09%), magnetic resonance imaging of the brain (21.28% vs. 25.76%), transthoracic echocardiograms (14.89% vs. 25.76%), and exercise stress tests (3.19% vs. 10.61%) compared to those under 65. Carotid ultrasound and electroencephalography were infrequently performed across all age groups. Patients aged over 75 were most likely to have a diagnosis (78.57% vs 60.53% in 65-74 and 60.61% in under 65). Orthostatic hypotension was the most common diagnosis 8.51% (8/94) of those over 65. 33.13% (53/160) of patients had no diagnosis documented. LOS increased with age: averaging 6 days (range 1-19) for those under 64, 7.45 days (range 1-36) for those 65-74, and 9.09 days (range 1-64) for those over 75. Older adults were less likely to receive cardiology (19.15%) and neurology consultations (11.70%) compared to those under 65 (27.27% and 36.36%, respectively).

Conclusion
A considerable number of patients lacked a diagnosis, highlighting the diagnostic complexities of T-LOC. The development of a specialist syncope assessment pathway is underway to improve diagnostics, potentially reducing unnecessary tests and hospital stays.
Don't Forget About Your Memory...Exploring Need And Impact Of A Cognitive Strategies Group On Older Adults Following Comprehensive Geriatric Assessment
Authors: Ronayne Sarah , McDonnell Laura , Bradley Mairead , Croghan Ashling , Malley Tom O , Alexander Marie 
Published: September 2024

Abstract

Background
The increasing prevalence of mild cognitive impairment (MCI) and dementia in older adults in Ireland, with projections of up to 20% of over 80-year-olds affected, is widely documented (TILDA 2023). Due attention is required in service planning to provide tailored non-pharmacological and lifestyle interventions to this growing cohort. This review aims to analyse the need for and impact of a cognitive strategies and brain health intervention group on older adults attending the Integrated Day Hospital (IDH) as part of an ICPOP service.

Methods
Retrospective analysis of the health care record was complete on older adults over 70 years with recent deterioration in cognitive or functional status. Cognitive screening scores and diagnoses received at the IDH were gathered to inform presence of MCI or dementia. Permission was sought from the authors of a cognitive strategies and brain health intervention group which was delivered to a sample of older adults and evaluated as part of the Jog Your Memory Program (HSE 2020).

Results
Preliminary results indicate a cohort of 355 older adults. Analysis of cognitive screening scores reflect prevalence of MCI at 15% and dementia at 35%. The Jog Your Memory program is implemented over 4 sessions. 2 programs were complete in October 2023 and April 2024 with 16 participants. Evaluation was complete with 100% of participants reporting benefits including acquisition of memory strategies, improved confidence and increased knowledge of MCI. Implementing this program optimises therapist time indicating cost saving. Final findings will be available for the purpose of this poster presentation.

Conclusion
The prevalence of cognitive impairment is broadly in keeping with previous audit (2023). The intervention group implementation and evaluation are ongoing. Participant feedback suggests the intervention is meeting the needs of this cohort. Future work will focus on scaling up the intervention group and integrating with other local services.
Introduction of a ‘Post fall assessment’ proforma improves management of patients following a fall in a rehabilitation setting
Authors: Treacy Ciara , McGeady Gemma , Fitzpatrick Eimear , McCarthy Frances 
Published: September 2024

Abstract

Background
Falls are the most frequently reported incident within HSE services. 18,023 falls were reported in acute hospitals in 2021 and resulted in harm in 19% of cases. The HSE patient safety strategy has highlighted patient falls as a priority area for service improvement. One area where improvements could be implemented is the assessment of patients following falls.

Methods
A retrospective audit on medical note documentation of 40 patients following an inpatient fall was carried out, with areas for improvement identified. A multidisciplinary multi-part post fall assessment proforma with embedded guidance, based on best practice guidelines was subsequently introduced. A further retrospective audit was then conducted 6 months following its introduction.

Results
In cycle 1 of the audit, 67.5% of assessed patients did not have the presence or absence of ‘red flags’ documented. 27.5% of reviews did not record a detailed history and 7.5% did not have a formal focused examination documented. 32.5% of patients had a medication review undertaken. 20% of patients had a focused MDT review post fall. In cycle 2 the ‘immediate medical review’ section of the proforma was completed in its entirety in 95% of cases, including documentation of history, examination and ‘red flags’. A follow up review by the primary team, which included prompts to reconsider injury and consider risk reduction for future injurious falls was documented in 50% of cases. A focused review by the wider MDT took place in 75% of cases.

Conclusion
The introduction of a post fall assessment proforma has resulted in improved assessment for potential injuries and a more targeted approach to reducing the risk of future injurious falls.
A Qualitative Exploration of Undergraduate Students’ Experiences of Using Virtual Reality for Dementia Inclusive Education
Authors: Stewart Elisha , Murphy Catriona 
Published: September 2024

Abstract

Background
Dementia prevalence is expected to exponentially increase over the coming decades. Across society, an increased awareness of dementia inclusive environments is important, to promote inclusivity and foster empathy. The aim of this study was to explore the experiences of undergraduate students using virtual reality (VR) for dementia inclusive education.

Methods
Purposive sampling was employed in one University in Ireland to recruit first year undergraduate students who had completed a VR workshop on dementia inclusive environments. Five semi-structured in-person interviews were conducted during February 2024. Interviews were audio-recorded, transcribed, and thematically analysed.

Results
Three themes were identified. The first theme ‘Food for thought’ represented participants’ greater understanding, as a result of using VR, of the potential for design to impact the dementia experience. Participants felt as though they were able to virtually place themselves in someone else’s shoes, which was described as “eye-opening”. The second theme ‘Impact variation’ revealed that although participants’ showed enhanced levels of awareness, empathy and understanding of this global health issue, the depth of learning depended on the participants’ prior exposure to dementia. The final theme related to ‘The VR experience’ as a whole. Students described the VR experience as positive, engaging, easy to use, and revealed that they were excited to take part in the workshops.

Conclusion
The student experience of using VR for dementia inclusive education was positive and enlightening. Using VR to introduce universal design concepts could be integrated into a range of undergraduate programmes to foster understanding and has the potential to empower future designers and policymakers to create environments that are accessible and inclusive for everyone. While this is a small-scale study, the difference in impact of this VR initiative on students with prior personal exposure to people with dementia and those without was an interesting finding and requires further research.
Optimising Outcomes For Those With Chronic Respiratory Disease: Detecting Frailty In The Respiratory OPD
Authors: Scully Padraig , Altayyari Sarah , Alnajjar Ali , Elhassan Mohamed , Finan Katherine 
Published: September 2024

Abstract

Background
Frailty is a treatable trait of relevance to people with various chronic respiratory diseases, especially those with severe COPD and/or lung transplantation. This has been recognised in the 2024 GOLD (Global initiative for chronic Obstructive Lung Disease) report and within recent European Respiratory Society guidelines. Central to optimisation of frailty management in those with chronic respiratory conditions is the identification of frail patients in the respiratory OPD (outpatients department) setting. This study aims to assess the prevalence of frailty among patients attending the respiratory OPD in our hospital.

Methods
A cross-sectional study was conducted over two respiratory clinics over a two-week period. Patients aged 65 and above were screened for frailty using the Clinical Frailty Scale (CFS). A CFS score was assigned to each patient by an assessing NCHD/consultant on the respiratory team. Statistical analysis was then performed to determine the prevalence of frailty amongst such patients. Frailty was defined as those having a CFS score of &gt;5.

Results
A total of 25 patients were included in the study. Frailty (CFS score of &gt;5) was identified in 56% of patients assessed, with 12% of patients being identified as having a CFS score of 7 (severely frail) or higher. Frailty had not previously been diagnosed by the respiratory team in those patients.

Conclusion
This study highlights a high prevalence of frailty among patients aged 65 or over in the respiratory OPD. Implementing systematic frailty screening in the respiratory OPD using the CFS can improve early identification of such patients, potentially enhancing management and clinical outcomes. The CFS is a quick and effective tool in identifying frailty. Integrating frailty assessments into routine clinical practice may help to ensure comprehensive care for this vulnerable population. We are currently looking at options for referral pathways to develop to improve management of frailty in this population.
An Audit of the Fifth Irish Hip Fracture Standard in patients &gt;=70 years following hip fracture
Authors: O'Donnell Graceann , Harte Olivia , McFadden Carole , Gallagher Eleanor , Slevin Aine , Thomas Joseph , Mulpeter Ken 
Published: September 2024

Abstract

Background
Hip fractures are a significant cause of morbidity and mortality in older adults. Bone health assessment is key in the reduction of future fracture risk. The aim of our study was to examine the adherence to the fifth Irish Hip Fracture Standard in patients &gt;=70 years presenting to Letterkenny University Hospital (LUH) with a hip fracture and to examine the number of patients who were commenced on bone protection.

Methods
We included patients &gt;=70 years who were admitted under the Orthopaedic service following a hip fracture between January and June 2023 in LUH and were identified the database maintained by the using Fracture Liaison Nurse. Data collected included age, month in which hip fracture occurred, patient resident in Ireland, patient alive/deceased, patient on bone protection prior to fracture, patient commenced on bone protection or patient declined treatment. Data was recorded in a Microsoft excel spreadsheet and was analysed by the clinical audit facilitator. We measured our data against the British Geriatric Society guideline on the use of IV zoledronate following hip fracture.

Results
76 patients were admitted to LUH with a hip fracture &gt;=70 years between January and June 2023. 100% of patients were reviewed by the fracture liaison service and following this it was recommended that 46 patients (60%) be commenced on bone protection. A letter was sent to each patient’s General Practitioner outlining the recommendation for bone protection. On follow up only 7/46 (15.2%) had been started on treatment.

Conclusion
The fracture liaison service is appropriately identifying patients who require treatment, despite this, patients are not starting the necessary bone protection in the community. This has prompted our service to establish an IV zoledronate clinic for patients following hip fracture and to generate a plan for ongoing treatment of this patient cohort.
Cerebral Hypoperfusion And Future Falls Risk Among Community Dwelling Older Adults with Orthostatic Hypotension
Authors: Claffey Paul , Pérez-Denia Laura , Finucane Ciarán , Kenny Rose Anne , Briggs Robert 
Published: September 2024

Abstract

Background
Falls occur in approximately 33% of those over 65 annually, with 10-20% resulting in injury or hospitalisation. Orthostatic Hypotension (OH) characterised by significant blood pressure (BP) drops upon standing is frequently identified in those with unexplained falls (UF). Cerebral hypoperfusion is regarded as the mechanism by which OH contributes to falls risk. However, work looking at the direct interaction between OH, cerebral perfusion and falls is lacking.

Methods
Near Infrared Spectroscopy (NIRS) derived frontal lobe cerebral oxygenation (reported as tissue saturation index (TSI)) and continuous beat-to-beat BP by finometer were measured in parallel during active standing among participants aged ≥55 at wave3 of TILDA (n=2478). OH, was defined as persisting systolic BP drop ≥20mmHg and/or diastolic BP drop ≥10mmHg at 30, 60 and 90seconds post standing. TSI drop from baseline ≥75th centile at 30seconds informed the “greater TSI drop” variable for longitudinal analysis. Multilevel linear regression models assessed the association between change in TSI from baseline and OH. Multilevel logistic regression models assessed the longitudinal relationship between OH, cerebral perfusion and future UF at 4years follow up (waves 4-5).

Results
Twenty percent had OH and were more likely to be older and have cardiovascular disease. TSI drops from baseline after standing were significantly greater in those with OH at 30 (beta=0.32 [CI 0.15-0.49]; p&lt;0.001), 60 (beta=0.41 [CI 0.23-0.6]; p&lt;0.001), and 90 (beta=0.46 [CI 0.27-0.65]; p&lt;0.001) seconds in fully adjusted models. After robust adjustment, combination of OH with greater TSI drops was strongly associated with future UF (Odds Ratio (OR) 2.23 [CI 1.35-3.69]; p=0.002), while OH and lower TSI drops were not (OR 1.27 [CI 0.87-1.85]; p=0.216).

Conclusion
These novel findings confirm that degree of cerebral hypoperfusion on standing informs risk of future UF in those with OH and has important clinical implications for the risk assessment of older people presenting with falls.
Evaluation Of Medical Registrar Confidence In Approach To Acute Stroke And Experience Of Stroke Teaching
Authors: Ryan Maeve , Yun John Paul , Thomas Niju , Moffatt Una , Hickey Paula , O'Malley Grainne 
Published: September 2024

Abstract

Background
The American Heart Association scientific statement (2022) addressing inpatient stroke recommends the delivery of stroke-response training to all hospital staff. While performing a service evaluation on in-patient stroke metrics, we explored the self-perceived confidence levels of medical registrars at this hospital, and whether formal on-site teaching was received. We explored various components including awareness of local stroke protocol and teaching pedagogy.

Methods
Using Google Forms, a survey was sent to all medical registrars in our hospital. A 5-point Likert scale was used to assess the confidence levels of various topics.

Results
The response-rate was 63% (N=12). Fifty percent (N=6) of participants were on Higher Training Schemes while the remaining 50% (N=6) occupied standalone appointments. Most respondents (83%, N=10) reported experience managing an acute stroke as a registrar. Forty-two percent (N=5) of registrars ‘strongly agreed’ they were confident in assessment of acute stroke, with 50% (N=6) ‘agreeing’, and one respondent remaining ‘neutral’ (N=1). Some registrars were unfamiliar with local stroke protocol (23%, N=3). Half of respondents (50%, N=6) reported no formal teaching on acute stroke. Fifty percent (N=6) of registrars reported that most teaching occurred primarily on ward rounds, with 42% (N=5) reported teaching through lectures. The vast majority (83%, N=10) selected simulation as their preferred teaching method.

Conclusion
While our medical registrars were confident in their ability to assess and manage acute stroke, significant improvements can be made to ensure formal teaching is prioritized. As stroke protocol can change from site-to-site, it is crucial to define expectations and standards for registrars to ensure timely care for patients. There is a clear preference for simulation as a teaching pedagogy, hence we plan on introducing a formal stroke simulation curriculum. Stroke response is a multidisciplinary effort, hence future research directions include exploring stroke training in nurses, junior doctors, and other healthcare professionals.