bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiography In Acute Stroke - A Precious Resource
Authors: O'Grady Ross , O'Reilly Aine , Lee Doctor Tom 
Published: September 2024

Abstract

Background
Echocardiography (Echo) is frequently utilized as part of the work up for ischemic stroke. National guidelines suggest using echo to assess for source of unexplained stroke “if detection of a structural cardiac abnormality would prompt a change of management”. This study aims to describe the use of Echocardiography post-stroke in Mayo University Hospital (MUH).

Methods
The study population was derived from a list of strokes admitted to MUH from July to December 2023 which was compiled by the Stroke ANP. The radiology system was consulted to assess time to echo and findings.

Results
86 ischemic strokes were identified. 77 (89%) had echocardiography ordered as inpatient. 61 of 77 echoes ordered were filmed during admission. The mean wait for echo was 6.4 days. No PFO or LV thrombus was detected. In 52% (n=32) of echo’s performed for work up of aetiology of stroke there was no mention of intra-atrial septum (IAS) in the report. 24% had Modified Rankin Scale on discharge of 4 or above. Of these, 75% had echo ordered as inpatient despite 60% already having atrial fibrillation diagnosed.

Conclusion
Echocardiography appeared to be an over-utilised resource in ischemic strokes in MUH. The vast majority of patients with stroke, even if frail, elderly, or severely disabled, had echocardiography ordered despite national guidelines suggesting usage of echo only when diagnosis of structural heart disease was likely to change management. The intra-atrial septum wasn’t even mentioned in the majority of studies. The wait for echocardiography appears to be extending bed days for patients putting strain on hospital inpatient capacity and emergency departments. A more nuanced approach to ordering echo in the setting of acute stroke could be advocated for, this will take a collaborative effort between Cardiology and Stroke Medicine in order to prioritise that will most benefit from this precious resource.
Community-based Geriatric Assessments: Is There an Urban/Rural Divide?
Authors: Stankard Aidan , Neachtain Máire Ní , Abed Aishling , Brehony Alma , McCleane Fiona , Canavan Michelle , Costello Maria , Campbell Judith , Walsh Loretta , Munnelly Patricia , Rogan Mary , Fitzmaurice Clíodhna 
Published: September 2024

Abstract

Background
There is a paucity of literature describing urban/rural differences in baseline demographic factors and patterns of referral for those undergoing community based comprehensive geriatric assessment (CGA) in Ireland. We analysed differences in baseline demographics, referral sources and referral reasons among older persons who underwent CGA with a community specialist team, which accepts referrals from one predominantly rural community health network (CHN) and one predominantly urban CHN.

Methods
Data including baseline demographic characteristics, reasons for referral, referral sources, clinical frailty score (CFS), prevalence of polypharmacy (more than 10 prescribed medicines) and location of CGA was prospectively collected on all persons referred to an older persons' integrated care service from February 2023 to March 2024 and who underwent CGA. Data was stored on a secure database. Persons were categorised as either urban dwelling or rural dwelling, based on their local CHN. Descriptive statistics were used to describe differences between the urban and rural cohorts.

Results
235 persons characterised as urban underwent CGA and 191 persons characterised as rural underwent CGA. There was a higher median CFS score amongst rural persons (CFS = 5, IQR=2) compared to urban persons (CFS=4, IQR=2). Urban persons were more likely to be referred by their G.P. (81% of total referrals) compared with rural persons (67%). Rural persons were more likely to be male (48% vs 37%) and experience polypharmacy (33% vs 27%) than urban persons. A similar proportion of persons underwent initial CGA in their home (20% rural vs 19% urban).

Conclusion
Here we describe the characteristics of urban and rural users attending an integrated care service. Future research should examine how these differences might affect healthcare utilisation and outcomes and provide opportunity to inform regional health and social care planning.
“For the Care of the Underserved” A Descriptive Analysis of MTOA Admitted Under the Non-Trauma Specialties in a MTC
Authors: McGurk Clara , O'Shea Alanna , Fitzgerald Rachel , Hannon Evelyn , Ahern Emer 
Published: September 2024

Abstract

Background
The recent NOCA report highlights a significant portion of major trauma cases resulting from falls among older adults, who often face limited access to trauma centres and age-related biases in treatment. Existing protocols and services for older trauma patients are lacking. This study aimed to audit the incidence and outcomes of MTOA admitted under the non-trauma specialties at a Major Trauma Centre.

Methods
Data from handover documents between January 2019 and December 2023 were screened for cases of “older trauma” (patients &gt;65 with new trauma injuries) and analysed using Microsoft Excel.

Results
Between 2019 and 2023, 992 older patients were admitted under non-trauma specialties, with a mean age of 83 years and a majority being female 73% (N=170). The mean length of stay was 14 days, with pelvis injuries being most common 31% (N=307). Falls from standing height accounted for 83% (N=823) of injuries. Only 28% (N=217) of patients at immediate risk of further fragility fractures received bone protection. Most patients were discharged home 49% (N=456), while 6% (N=55) were institutionalized. The total mortality rate in hospital was 7% (N=66). The total mortality at one year was 17% (N=121). The injury with the highest mortality in hospital 24% (N=21) and at one year 40% (N=35) was traumatic brain injuries.

Conclusion
This audit reveals disparities in trauma care for older patients, despite advances in the field. While initiatives like the hip fracture database have improved care for specific injuries, pathways for older trauma patients not requiring surgery are lacking. Given the excess morbidity and mortality among this population, establishing a Geriatric Trauma Service is imperative. This is in line with literature supporting the idea that older trauma patients demand specialist attention; they are not just older adults.
DNAR: All or Nothing: Impact of Education Sessions Re-Audit in a Model 3 Hospital
Authors: Ramjohn Joshua , Kelly Joseph , Abdalla Amal , Hamad Ahmed , Carvalho Juliana , Gibbons Ciara , Quigley Lynn , Finan Katherine 
Published: September 2024

Abstract

Background
Do Not Attempt Resuscitation (DNAR) orders are implemented to obviate inappropriate Cardio-Pulmonary Resuscitation (CPR) in patients with low chances of survival post-CPR. However, ambiguity regarding ceilings of care for patients with a DNAR order can arise. This re-audit aimed to review DNAR and ceilings of care documentation according to national HSE guidelines after education sessions, comparing results with the pre-education audit in a Model 3 Hospital.

Methods
A point-prevalence chart review of thirty-one adult medical inpatients with a DNAR order was conducted after two education sessions were held for Non-Consultant Hospital Doctors (NCHDs) and Consultants.

Results
Of all thirty-one charts, 35% documented DNAR status in the medical notes, with 32% documenting the reasoning for DNAR status, both of which were unchanged from the first audit cycle. There was an increase in documentation of patient discussion (61% versus 45%) and reasons if this was excluded (66% versus 41%). There was no change in documentation of patient relatives’ discussion (48%) but there was an increase in the reasons if this was excluded (25% versus 18%). There was an overall increase in ceilings of care documentation for ICU admission (three-fold increase), intubation (two-fold increase), inotropic support, and comfort measures, but rates of documentation were still less than 15%. This elucidates the efficacy of education sessions in improving DNAR documentation adherence. Recent studies have highlighted uncertainty among NCHDs regarding treatment escalation in acutely unwell patients in the absence of adequately filled DNAR orders and clear documentation of ceilings of care. Therefore, we posit the introduction of a Ceilings of Care document, akin to the United Kingdom’s Medical Advance Plan.

Conclusion
Accurate recording of DNAR status and ceilings of care is essential for quality care and treatment escalation. While simple education strategies have proven beneficial in enhancing compliance, additional efforts are needed to enhance ceilings of care documentation.
Clinical, Patient And Service Outcomes For Patients In A Rehabilitation Hospital With An Onsite Flexible Endoscopic Evaluation Of Swallowing Service
Authors: Flaherty Kara , Lawlor Aideen , Douglas Laura 
Published: September 2024

Abstract

Background
Dysphagia has been reported in almost half of hospital patients who are over 65 years.1 In 2023 a Flexible Endoscopic Evaluation of Swallowing (FEES) service was introduced into the hospital. The purpose of this study was to profile the patients who were referred for FEES and determine the prevalence and severity of dysphagia.

Methods
Information on patient diagnosis, dysphagia related clinical outcome measures and waiting times when compared to Videofluoroscopy referral were collected from 30 patients who attended for FEES assessment in a rehabilitation hospital from August 2023 - May 2024.

Results
97% of the patients who engaged in FEES were above the age of 65. Patients presented with a range of diagnoses including frailty (20%), progressive neurological conditions (18%), other (16.6%), stroke (13.3%), Chronic Obstructive Pulmonary Disease (13.3%), Acquired Brain Injury (3%), Gastroenterology (3%), and surgical (3%). Dysphagia was identified in 97% of patients, with 60% presenting within the moderate to severe range on the Australian Therapy Outcome Measures. 33% of patients presented with silent aspiration, with a third of these patients presenting as clinically asymptomatic. Following FEES evaluation, 40% of patients were recommended a change in diet texture or fluid consistency, with 54% and 70% of these patients being recommended a downgrade in diet or fluids respectively. The service has allowed for more timely access to instrumental swallow assessment with completion of FEES within an average of 4 days compared to referral for Videofluoroscopy; 24 days average.

Conclusion
This study has enabled us to profile patients accessing FEES. FEES facilitates quicker access to instrumental swallow assessment and identification of aspiration. It has also enabled targeted person centered dysphagia rehab.

Reference
1. Doan, T.N et al (2022) Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis. Journal of Clinical Medicine, 11(9), p.2605.
Assessing the Impact of the Introduction Of Advance Care Planning In Nursing Home Residents Admitted to Hospital
Authors: Dowling Michael , Garcia Ryan , Saric Denis , Kennelly SM , Thavarajah Kowshika 
Published: September 2024

Abstract

Background
Nursing home residents may present inappropriately to the Emergency Department at the end of life (EOL). Appropriate advance care planning (ACP) may reduce these presentations. Inpatient teams are in a position to discuss, document and support these ACPs for nursing home residents admitted under their care.

Methods
Building on existing inpatient and outreach specialist pathways in a model three hospital, formal ACPs were introduced for all inpatients from Jan 2024 admitted from a nursing home where it was deemed clinically appropriate. The completed advance care plan included decisions re cardiopulmonary resuscitation, level of intervention (including hospital transfer), antibiotics, fluids, nutrition plan and medications to support EOL care. ACP discussions took place with the consultant geriatrician, patient, nominated family/patient support and director of nursing. Data on discharged patients (including presence of ACP on discharge) was collected and analysed for emergency re-presentations.

Results
Of 137 patients discharged back to their nursing homes in the first 4 months of 2024, 41 (30%) had an ACP in place while 96 (70%) did not. Of those with ACP in place, 6/41 re-presented to Emergency Department within this timeframe vs 17/96 who were discharged without an ACP (15% vs 18%, p=0.66). However, only 3/41 with ACP were re-admitted to hospital from the emergency department vs 15/96 without an ACP (7% vs 16%, p=0.19). No patients discharged with an ACP re-presented and subsequently died in hospital, while 1/96 (1%) of those discharged without an ACP died in hospital after re-presentation.

Conclusion
ACP discussion did not reduce re-presentations to hospital but there was a non-significant trend towards a reduction in re-admissions. Overall, there was an extremely low rate (1/137, 0.7%) of patients re-presenting to hospital and dying during that admission. Further work is ongoing to examine the criteria that would prompt ACP discussion in nursing home residents admitted to hospital.
Optimising The Implementation Of A Dementia Care Education Programme For Healthcare Assistants (Home Support): Lessons From A Qualitative Study
Authors: Pierce Maria 
Published: September 2024

Abstract

Background
Healthcare Assistants (Home Support) provide a significant level of non-clinical formal care to people with dementia at home. Training is paramount if this workforce is to provide care effectively and achieve the ideals of the Irish National Dementia Strategy. This study examined the process of implementing a QQI-FET level 5 accredited dementia home care education programme for Healthcare Assistants (Home Support), specifically designed with an emphasis on self-development and ethical and strengths-based approaches to care.

Methods
This study was primarily a qualitative study conducted over five months. Semi-structured interviews were conducted with stakeholders (n=16) involved in the programme’s implementation. Focus groups (n=3) were conducted with 11 programme learners. Data on programme take-up, completion and retention rates were available for review, as were reports from external reviewers, and a sample of evaluation forms completed by learners.

Results
The programme content and its delivery were highly regarded. Implementing the programme took much longer than planned due to the Covid-19 pandemic, putting recruitment processes in place, and problems recruiting and retaining healthcare professionals to facilitate supervisory sessions. Organizational support, and motivated healthcare assistants with positive attitudes towards training were perceived to facilitate programme uptake and completion. A range of barriers were perceived to act as disincentives to programme participation, e.g. lack of opportunities for career progression. There was strong support for rolling out the accredited programme nationwide and maintaining its in-person format. An alternative shortened non-accredited version of the programme would be welcomed by stakeholders in some areas.

Conclusion
This qualitative study provides a rich and nuanced perspective on a dementia home care education programme for healthcare assistants (Home Support), challenges encountered during programme implementation and changes needed to optimize implementation. The findings can be used to support strategic and operational decision-making for enhancing programme implementation.
Prevalence of Osteoporosis and Indications for Bone-Treatment In Older Adults Living with Frailty Enrolled in a Local Integrated Care Programme
Authors: Hamza Alaa , Koay Wen Jie , Alvarez Via , Leahy Aoife 
Published: September 2024

Abstract

Background
Osteoporosis is estimated to affect more than 250,000 adults in Ireland, with 29.4% (€463.3 million) of the total healthcare cost attributable to osteoporosis-related fracture management, resulting in significant health and economic impact.(1,2) As such, early identification of osteoporosis and addressing associated risk factors are crucial steps in reducing osteoporosis-associated morbidity and mortality. This retrospective audit aims to assess the prevalence of osteoporosis and indications for initiating bone treatment among older adults living with frailty enrolled in the Limerick Integrated Care Programme for Older Persons (ICPOP).

Methods
All older adults attending ICPOP between 01/06/2023 to 29/02/2024 were included in the data collection. Data collected included patient age, gender, presence of vitamin D deficiency (&lt;50), presence of osteopenia or osteoporosis via DEXA scan results, history of fragility fractures, and bone health treatment and its indication.

Results
A total of 310 patients (192 female, 118 male; age 70–98) attended ICPOP during the specified time period. DEXA scans identified osteopenia in 109 patients and osteoporosis in 69 patients. 86 patients experienced a history of fragility fractures, of which 30 were confirmed to have osteoporosis on DEXA. 93 patients (30.3%) displayed vitamin D deficiency, with the majority (81.7%) not previously receiving vitamin D supplementation. 151 patients were in receipt of bone treatment, of which 86 patients (56.9%) were newly commenced on bone treatment following interaction with ICPOP. The indications were osteoporosis on DEXA scan (44 patients), history of recent fragility fracture (20 patients), and high FRAX score (22 patients).

Conclusion
The increase in detection of risk factors and presence for osteoporosis, and initiating bone health treatment, achieved by way of an integrated care programme for older persons highlights the importance of proactive screening and timely initiation of treatment.
The Prevalence of Sarcopenia and its Impact on Function In Older Adults In a Rehabilitation Unit
Authors: Mullins Claire , King Lorna , Sayers Karen , Donnellan Christina 
Published: September 2024

Abstract

Background
Sarcopenia is the leading cause of declining physical functioning and is a significant component of frailty, sharing similar characteristics. It is prevalent among older adults undergoing rehabilitation and is a negative predictor of functional recovery.

Methods
A retrospective cohort study was undertaken in a Rehabilitation Unit from January to March 2024. Variables included age, gender, mBarthel Index (mBI), Clinical Frailty Scale (CFS), hand grip strength and Timed Up and Go (TUG). The European Working Group on Sarcopenia for Older People criteria was utilised to interpret hand grip strength and TUG scores.

Results
Sixty-four patients, 33 (52%) male and 31 (48%) female were included. The mean age was 78 years (SD = 8.13). Fifty-five (86%) had their grip strength assessed, of which 20 (36%) had probable sarcopenia. Nineteen patients (95%) with probable sarcopenia had a TUG completed with a mean of 59.88 (SD = 28.86) seconds. In the non-sarcopenia group, 33 (94%) had a TUG assessment with a mean of 53.21 (SD = 39.82) seconds. The median CFS was 6 (IQR: 6, 6.5) in the probable sarcopenia group and also 6 (IQR: 5, 7) in the non-sarcopenia group. The median mBI of those with probable sarcopenia was 10 (IQR: 7, 14) compared to 12 (IQR: 8, 14) in the non-sarcopenia group. The probable sarcopenia group was significantly older (mean: 81.7, SD = 7.92) than the non-sarcopenia group (mean: 75.8, SD = 8.05), (P = 0.011). There was no significant difference in the median length of stay (LOS) between the probable sarcopenia group: 29 days (IQR: 24.5, 42.5), and the non-sarcopenia group: 28 days (IQR: 18, 49), (P = 0.51). There was no difference in rate of home discharge between the probable sarcopenia group (80%) and the non-sarcopenia group (82.8%), (P = 1.00).

Conclusion
Sarcopenia is often overlooked in clinical practice, however, it is reversible with multi-component targeted interventions such as nutritional care and resistance training.
Phase transition and ionic conductivity of pyrrolidinium-based ionic plastic crystals with magnesium salts
Authors: Hirotsu Yoshifumi , Sekiguchi Ryotaro , Takeoka Yuko , Rikukawa Masahiro , Yoshizawa-Fujita Masahiro 
Published: September 2024

Abstract
Despite being safe for use in secondary Mg batteries, solid electrolytes exhibit lower ionic conductivities than those of traditional liquid electrolytes. Organic ionic plastic crystals—soft crystals with excellent thermal and electrochemical stabilities and ionic conductivities—are promising solid electrolytes. Herein, we investigated the effects of various anion species and Mg salt concentrations on the properties of pyrrolidinium-based organic ionic plastic crystals (N,N-diethylpyrrolidinium bis(fluorosulfonyl)amide [[C2epyr][FSA]] and N,N-diethylpyrrolidinium bis(trifluoromethylsulfonyl)amide [[C2epyr][TFSA]]) upon Mg(TFSA)2 addition. The Mg-ion transference number (tMg2+) was measured using the Vincent–Bruce method; ionic conductivity via impedance measurements; and phase transition via differential scanning calorimetry. The phase transition behavior, dissociation state of the Mg salt, and electrochemical properties varied with the organic ionic plastic crystal anionic structure. The FSA system became liquid when the Mg salt concentration exceeded 15 mol%. The ionic conductivity of the pyrrolidinium-based organic ionic plastic crystals increased substantially with the Mg salt concentration. In the solid state, [C2epyr][FSA]/Mg(TFSA)2 (5 mol%) (FT5) showed the highest ionic conductivity (2.9 × 10−4 S cm−1 at 25 °C). The tMg2+ of FT5 at 60 °C was 0.29. Mg exhibited redox behavior in FT5 but not in [C2epyr][TFSA]/Mg(TFSA)2 (5 mol%). The FSA− structure is suitable for Mg electrochemistry and will aid in developing high-performance secondary Mg batteries.
Information management – the realities
Authors: Bales Vivienne 
Published: September 2024

Abstract
Information management (IM) has been promoted as the panacea for all evils in recent times. I am sure yon all remember the early days of IT when it was the answer to all the problems of industry worldwide. I would like to give you my definition of IM and what it can do rather than what the media would lead you to believe. IM is one of the oldest professions, it may be better known as librarianship or information science, Under any name the science of managing information is a necessary part of life today. Unfortunately this protession has an image problem: to many people the bespectacled mouse of a librarian as played by Ronnie Corbett in the television sitcom ‘Sorry’ is a true representation, But there have been a great many advances made by the information profession in recent years. The information professionals have embraced the benefits which are promised by computers and they have taken the lead in research into these benefits,
Continuous speech processing - myth or reality?
Authors: Woollaston Bernie 
Published: September 2024

Abstract
The IT industry has become used to the concept of computers recognising human voice commands. There is still however, a wide lack of understanding of the difference between recognising voices, or isolated words and, more recently, true continuous speech recognition. At present, all commercially available voice recognition systems are only able to recognise individual words, requiring the author to use unnaturally punctuated speech to dictate.