bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Innovative Approach To Increasing Speech And Language Therapy Intensity For Stroke Patients
Authors: Donders-Seoighe Cathelijne 
Published: September 2024

Abstract

Background
Different national guidelines exist for the provision of Speech and Language Therapy (SLT) intensity for stroke patients. The National Institute for Health and Care Excellence (NICE) guidelines on stroke rehabilitation in Adults (2023) advises 3 hours of multidisciplinary therapy a day, five days a week. The National Clinical guideline for Stroke for the UK and Ireland (2023) does not include SLT in this 3-hour provision of motor therapy, but advises 45 minutes of SLT a day, 5 days a week. Poor SLT staffing levels are commonplace, more recently exacerbated by the HSE recruitment embargo, posing significant challenges to rehabilitation provision.

Methods
A Speech and Language Therapist in a stroke service assessed whether the use of Therapy assistants could add to the delivery of the targeted 45 minutes of SLT. Training was provided in the execution of speech, language and swallow rehabilitation exercises, using patient specific exercise packs. A month of data collection started on 8 patients. Intensity was measured in 3 percentage groups:

Results
When rehabilitation was provided by SLT alone, 7 patients received insufficient therapy intensity. One patient scored in the moderate group. With the added input of stroke assistants, 4 patients received sufficient therapy time, 3 patients scored in the moderate group and only one patient received insufficient therapy.

Conclusion
Use of Stroke assistants for the provision of SLT rehabilitation exercises, can be an effective tool in increasing SLT intensity. Training is time intensive, but essential to make assistants knowledgeable and competent in their abilities. All rehabilitation should be under direct supervision of SLT. However, we should not use stroke assistants to mask or minimise the need for adequate SLT resourcing, as specified in international standards.
Impact of Geriatricians on the Outcome of Patients in the Acute Medical Unit at the Largest Acute Academic Teaching Hospital
Authors: Hassan Haswadi , Rowan Aoife , Mazlam Ahmad Zainalabidin , Flynn Ellen , Ntlholang Onte , Zainal Tariq , Browne Joseph 
Published: September 2024

Abstract

Background
The Acute Medical Unit (AMU) forms part of our institution's acute medical pathways. Through the Senior Intervention Flow Triage system in our Emergency Department (ED), medically stable patients likely to complete investigations and treatment within 48 to 72 hours are referred to the AMU for management. Acute medicine geriatricians cover three out of five days in the AMU. This paper aims to study the characteristics and outcomes of patients referred to our AMU.

Methods
Our institution’s innovation and research office approved the study, ref: 8731, on 24/01/2024. Medical notes from patients who attended the AMU from 11 December 2023 to 30 January 2024 were examined. Collected data included demographics, presenting complaints, admissions avoided and converts. Patients were divided into age groups: ≤64, 65-74, and ≥75. Admission avoidance is any intervention by the AMU that results in the patient's discharge. A convert is an on-call team medically admitted patient in the ED who was taken over and successfully discharged by the AMU with appropriate follow-up.

Results
345 patients attended AMU over the six-week period. Of those, 217 (62.9%) were ≤64, 65 (18.8%) were 65-74, and 63 (18.3%) were ≥75 years old. More than 50% of the patients were female in each age group. The ≤ 64 years group had the highest admission avoidance, 72%, followed closely by the ≥ 75 years group, 65% and the 65-74 years group, 57%. The ≥ 75 years group had the highest rate of converts at 11%, followed by the ≤ 64 years group at 10% and the 65-74 years group at 6%. There were similar admission rates across the 3 age groups of 7 to 8%.

Conclusion
This study found that the ≥ 75-year-old group was not inferior to other groups regarding admission rates and avoided hospital admissions.
Work of ART: Profiling the First 100 Patients Discharged Home From an Acute Hospital with the Active Recovery Team (ART)
Authors: McDaid Edel , Ryan Ciara , Daly Eoin 
Published: September 2024

Abstract

Background
The Active Recovery Team (ART) is a new therapy lead rehabilitation team that offers supported discharge and admission avoidance from a large acute hospital. This interdisciplinary team consists of a physiotherapist, occupational therapist, medical social worker and two therapy assistants. ART accepts referrals from all services within the hospital including the emergency department.

Methods
As ART is a new service, a retrospective audit of the first 100 patients who discharged on the pathway was completed. Demographics included age, sex, referring specialty, presenting complaint, frailty (measured by the Clinical Frailty Score) and level of input received. ART use the coding of low, medium and high intensity to describe the intervention provided based on dosage (visits) and complexity.

Results
Most (67%) of the group were female and mean age was 77 years. Only 8% were pre-frail (CFS 0-3), 86% were living with mild to moderate frailty (CFS 4-6) and 6% considered severely frail (CFS 7-9). The type of intervention patients received was 31% low, 33% medium and 36% high intensity. Referrals came from a range of specialties, but the highest percentage of referrals were from emergency medicine (29%), medicine (20%), orthopaedics (18%) and geriatric medicine (16%). Most (53%) initially presented post a fall at home. Most frequent reason for ART referral (78%) was that the patient was discharging home not at their functional baseline but had potential to an achieve a specific goal(s) with further input (most frequently within domains of mobility indoors/outdoors, transfers, stairs and activities of daily living).

Conclusion
This is an effective pathway that improves the transition from hospital to home. ART offer patients an opportunity for further rehabilitation at home with continuity of care from the acute hospital. Future work will examine the impact of ART on length of stay, readmission rate and explore patient satisfaction with this service.
Communicating, Eating And Drinking With Dementia
Authors: Moloney Abbie 
Published: September 2024

Abstract

Background
Problems with eating and drinking can put patients at risk of malnutrition. Hospitalised patients with dementia are at a higher risk for eating/drinking difficulties and inadequate food/fluid intake. Dysphagia in dementia can contribute to malnutrition, dehydration, weight loss, choking episodes, repeat chest infections, pneumonia, and recurrent hospitalisations - all of which can cause strain on relationships between the person with dementia and carers. Where communication (and eating/drinking/swallowing) are impacted, the person with dementia can experience a decrease in quality of life, wellbeing, sense of personhood, and quality of relationships. Direct training and indirect feeding support for care staff results in fewer mealtime difficulties, more time spent assisting at mealtimes, and a positive changes in staff attitudes towards assisting in mealtimes for people with dementia. Using observational instruments to identify eating/drinking difficulties can lead to a positive influence for staff knowledge and skills to support patients/residents.

Methods
Create a Departmental Information Leaflet on “Communicating, Eating and Drnking with Dementia” for staff, visitors, service users, and their families.Select a tool to be used by nursing staff to better inform on behaviours around eating and drinking with dementia (Edinburgh Feeding Evaluation in Dementia Scale (EdFED-Q)).Create a training Powerpoint for Staff on “Communicating, Eating and Drnking with Dementia” and using the EdFED-Q tool.

Results
Departmental Information leaflet created.Selection of the EdFED-Q tool.Training programme for nursing staff developed on Communicating, Eating and Drnking with Dementia and using the EdFED-Q tool.

Conclusion
As outlined in the Irish National Dementia Strategy (2014), all people who provide care or interact with those with dementia should be trained and upskilled in working with and communicating with those with dementia. It is important to continue to develop our services and build on quality initiatives to do this.
Development and Validation of the IDS-TILDA FI; A Novel Frailty Instrument for People with Intellectual Disability
Authors: McFeely Aoife , McCarron Mary , Romero-Ortuno Roman , McCallion Philip , Connolly Eimear , Fitzpatrick Darren , Kennelly Sean 
Published: September 2024

Abstract

Background
Adults with Intellectual Disabilities (ID) are a vulnerable population, experiencing higher rates of multimorbidity, polypharmacy and healthcare inequities. Pre-existing functional disability and dependency complicates frailty measurement in ID. This study aimed to develop an ID-specific Frailty Index (FI), and compare frailty measurements between adults with and without ID.

Methods
This cross-sectional study was conducted using the Intellectual Disability Supplement to The Irish Longitudinal Database of Aging (IDS-TILDA). A 31-item IDS-TILDA FI was developed. Markers of functional dependence were excluded avoid disability bias. The index was applied to 745 adults with ID, with results compared to the general population. Statistical analysis included multivariate regression on frailty controlling for age, sex, level of ID and presence of Down syndrome (DS). Multivariate logistic regression on Mortality controlling for age, Level of ID and DS was also conducted. Predictive validity was tested using receiver operating characteristic (ROC) curves and evaluated the area under the curve (AUC).

Results
FI scores ranged from 0.00 to 0.59; median 0.16 and mean 0.19. These scores are lower than in other studies of frailty in ID, but higher than seen in the general population. Increasing frailty score was associated with older age (p&lt;0.05), female sex (p&lt;0.05) and severe/profound ID (p&lt;0.05). Increasing frailty was associated with mortality, even when controlling for age (p&lt;0.05). This association was lost when ID severity was included in analysis. FI score demonstrated moderate predictive validity for mortality (controlling for age, sex and Level of ID) with an AUC of 0.6101 (p&lt;0.05, 95% CI: 0.564-0.656).

Conclusion
It is possible to measure frailty without measuring functional dependence. Frailty is more prevalent among adults with ID compared to the general population. The IDS-TILDA FI is associated with age and mortality, though the impact of severe ID could not be overcome highlighting the complexity of medical needs for adults with ID.
Developing An Online Course To Increase Staff Awareness And Responses To Unwanted And Illegal Sexual Behaviour Perpetrated Against Older People
Authors: Donnelly Sarah , Ward Marie , Josephine Donlon , Geary Una , Markey Paula , O'Hara Sharon , Healy Una , McGarry Sinead 
Published: September 2024

Abstract

Background
The idea that older people can be victims of unwanted sexual behaviour or sexual assault in health and social care settings is relatively recent. In the Irish context, 165 reports of sexual abuse of older people were made to the HSE National Safeguarding and Protection teams in 2022. The prevalence of sexual abuse against older people in health and social care settings is poorly understood and there is an acknowledgement that hospital staff require additional training to understand and manage incidents.

Methods
In response to the need for training and support for staff, an online awareness-raising course based on a pre-developed course from Australia ‘Preventing unwanted sexual behaviour against older people in health and social care settings’ will be adapted, trialled and tested in a large acute teaching hospital. This course sets out to support acute care staff to identify and manage incidents of sexualised behaviour, to seek expert help and to ensure that older people are protected from unwanted and at times, what may constitute illegal sexual behaviour.

Results
The adapted course ‘Understanding and Responding to Unwanted or Illegal Sexual Behaviour Perpetrated against Older People in Health and Social Care Settings’ utilises a trauma-informed lens and key themes covered include defining unwanted sexual behaviours, understanding older people and sexual behaviour, risk factors for sexual abuse, barriers to recognising and reporting abuse and managing incidents.

Conclusion
The ‘trial and test’ will involve a feedback survey (N=50 respondents) and focus groups with participating healthcare professionals from the hospital site informing further refinement of the course content in preparation for wider rollout and implementation across Ireland's health and social care settings.
Establishing The Role Of The Clinical Nurse Specialist For The Older Adult In A Model 2 Hospital
Authors: Woulfe Cliona , Moloney Patricia , Jennings Emma 
Published: September 2024

Abstract

Background
On average 87.5% of inpatients in our Model-2 Hospital are aged sixty-five years or above. Equally 57.5% of inpatients have medium to maximum dependency care needs. In order to meet the needs of this cohort of patients a new post “Clinical Nurse Specialist (CNS) For The Older Adult” was established in September 2023.

Methods
Using an online referral system, criteria for referral included i) new onset confusion or delirium, ii) clinical frailty score (CFS) of six or greater, iii) known Parkinson’s disease and iv) nursing or medical team clinical judgement. All reviewed patients received a comprehensive geriatric assessment using the Geriatric 5M framework (Mobility, Medications, Multi-Complexities, Mind and Matters Most) ensuring all aspects of patient care were assessed and promoting timely input from our multi-disciplinary team (Physiotherapy, Dietitian, Speech and Language Therapy, Occupational Therapy and Pharmacy).

Results
Over a period of 207 days the newly established CNS service received a total of 317 referrals. Two thirds (n=206, 65%) received CNS review, one third (n=111, 35%) did not; 45 (14%) were under the care of a consultant Geriatrician and not reviewed to avoid duplication and 66 (21%) were discharged before review could occur.

Conclusion
Referral numbers received since the established of the CNS post emphasises the need for the service in our hospital inpatient population. Development of the post has ensured that two-in-three referred patients receive a CNS lead CGA. Results from this pilot highlights the need to further develop and expand the service to target the one-in-five who missed review and further extension of the referral criteria.
Establishment of Registered Advanced Nurse Practitioners (RANP) Gerontology Clinics in Two Ambulatory Day Units
Authors: McShane Nicola , Monaghan-Tyer Fiona , Toner Rebecca 
Published: September 2024

Abstract

Background
Ireland is experiencing substantial growth in the older population. Data from The Irish Longitudinal Study on Ageing (TILDA) suggests that up to 25% of older people in Ireland are living with frailty while a further 45% are at risk of being pre-frail (Roe L et al, 2017). Frailty in older adults can be a predictor to adverse health outcomes including hospitalization, falls, and increased mortality risk. Ambulatory day units proactively identify older adults at risk of frailty living in the community using a comprehensive geriatric assessment (CGA), potentially reducing adverse outcomes.

Methods
Plan-Do- Study-Act (PDSA) cycle was used. Waiting lists were reviewed with Consultant Geriatricians for the ambulatory units. Referral pathways for RANP Gerontology Clinics with inclusion and exclusion criteria were developed. RANP clinics were established in 2023 in the ambulatory day units utilising Slaíntecare’s strategy. Referrals were triaged by Consultants Geriatricians resulting in the RANP clinic caseload.

Results
During 2023, 844 older adults were reviewed in the RANP clinics. This contributed to a reduction in Consultant Geriatricians’ waiting lists and allowed reduced wait times for new Consultant Geriatricians’ referrals. This service also enhanced communication pathways between primary and secondary care settings and became a point of contact for families in crisis, with rapid access review and care planning to avoid unnecessary Emergency Department attendances. Patients attending the RANP clinics, if admitted to hospital, were seen by the RANP during their admission, ensuring continuity of care.

Conclusion
Overall, establishment of RANP Gerontology clinics resulted in a better streamlined service for the older adult. This service ensures continuity of patient care through a working knowledge of patient cohort and rapid access for those known to the service, potentially avoiding an Emergency Department attendance.
Symptomatic Cerebellar Thrombosed Developmental Venous Anomaly: A Case Report
Authors: Feely Owen , Byrne Muireann , Fearon Patricia , Nicholson Patrick 
Published: September 2024

Abstract

Background
With the rising prevalence of advanced neuroradiological imaging, detection of incidental developmental venous anomalies (DVAs) is more commonplace. DVAs are rarely symptomatic (&lt;2%). Typically, symptoms arise due to flow-related complications or mechanical effects. Of particular concern is venous thrombosis, a frequent flow-related complication, which can cause venous ischemia or haemorrhage. Thus, early recognition and intervention is important.

Methods
We describe a case of a 54-year-old male, with background of hypertension, presenting three days after sudden onset headache, ataxia, and diplopia. Initial clinical examination revealed bidirectional horizontal gaze-evoked nystagmus, skew deviation, and decreased temperature sensation of the left face. Ophthalmological examination identified left inferior rectus limitation.

Results
Initial non-contrast CT brain identified hypoattenuation in the right pons, suggestive of sub-acute infarction. Secondary prevention was initiated. Subsequent MRI performed 5 days later revealed hyperattenuation on T2 and FLAIR in the pons, right middle cerebellar peduncle, and right cerebellar hemisphere without restricted diffusion. SWI sequences identified an abnormal venous structure in the right cerebellum, with increased signal within it, suggestive of thrombus. The patient was diagnosed with a thrombosed DVA with associated venous oedema. Symptoms had resolved on dual antiplatelet therapy, without anticoagulation.

Conclusion
This case highlights the potential for DVAs, generally considered a benign entity, to become symptomatic with associated parenchymal damage and a rare, but important, stroke mimic. Moreover, it underscores the pivotal role of MRI imaging; while a CT scan might have led to the assumption of a subacute infarct, MR imaging led to a complete re-evaluation of the diagnosis in this case.
A Multidisciplinary Prospective Audit of Practices of Providing Hydration to Patient in An Acute Care Setting. Stop, Think and Drink
Authors: Kidney Deirdre , Jackson Nicola , Clancy Alice , Harrington Sarah , Hendy Lydia , Joubert Tayla , Murphy Ciara , Dooley Sarah , Murphy Becky , Grygielewicz Kate 
Published: September 2024

Abstract

Background
In the Dementia Friendly Hospital Guidelines 2018, it recommends we support patient safety, health and well-being. This can be facilitated by supporting diet, nutrition and hydration in a calm, accessible and usable space with appropriate lighting, and clearly visible and easily understood furniture and tableware. We have audited our practices across the hospital to ensure we have practices that promote hydration in all our wards. As we are an MDT team we bring a unique broad perspective on the issue of availability, accessibility and assistance.

Methods
We prospectively audited the provision and accessibility of drinks of any kind across our hospital. This was carried out on two separate occasions, once in the morning and once in the afternoon. We developed a unique audit tool. We used the HIQA nutrition and hydration standards to develop this tool. This was carried out on two separate occasions, once in the morning and once in the afternoon.

Results
Total number audited - 131
Availability
Accessibility
Assistance
- 38% required prompting/reminding to drink.

Conclusion
Almost all of our patients in St. Michael’s Hospital had a drink and water jug available, however not all patients were able to access or independently hydrate themselves. Through making improvements, we aim to improve the hydration for our patients. According to the Food, Nutrition and Hydration policy for adults in acute hospital, by improving patient hydration, we are supporting the reduction of malnutrition amongst our patient cohort, in turn reducing their susceptibility to disease and improving their rate of recovery.
Quality Improvements in Dementia Care in an Acute Hospital Setting
Authors: Allen Yvonne , Timmons Suzanne , Galvin Noreen 
Published: September 2024

Abstract

Background
Dementia care in acute hospital settings requires targeted quality improvement initiatives based on national standards. This poster highlights key interventions to enhance care, aligning with local hospital group key performance indicators (KPIs), in one large teaching hospital.

Methods
Delirium screening (4AT) was implemented in the Emergency Department and geriatric ward, with education to increase staff awareness of delirium screening, prevention, and management. Audits assessed compliance with the 4AT tool. An audit evaluated the geriatric ward environment, including dementia-friendly painting, decorating, and signage, at baseline. Psychotropic prescribing practices were audited in 20 inpatient charts. A Life story Information tool (Sunflower Tool) was implemented to display personalized patient information at the end of the bed. Semi-annual audits assessed usage and effectiveness in the geriatric ward.

Results
The initial audit showed 85% compliance with the 4AT tool, dropping to 40% in a repeat audit after 6 months. Initially, 17 of 20 charts had complete 4AT scores; in the re-audit, 11 of 20 had scores recorded, with only 8 fully completed. The first environmental audit revealed poor compliance with dementia-friendly standards, especially in signage, clutter, and bedroom colour contrasts. Best compliance was seen with colour contrast in bathroom toilets and handrails. A quality improvement plan was developed to address gaps. The adoption and impact of the Sunflower tool improved patient-staff interactions and personalized care. All ward staff were trained in using the Sunflower tool.

Conclusion
A robust quality improvement plan, with measurable, achievable, relevant, and time-defined actions, aligned with national standards and local KPIs, is crucial to achieve and sustain positive audit results. Continuous education, resource allocation, and regular audits are required to ensure high-quality care for patients with dementia. Future efforts will focus on addressing identified challenges, refining interventions based on audit feedback, and maintaining care improvements.