bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences After Stroke-Who Needs An Interdisciplinary Clinic Anyway?
Authors: Lawson Susan , Harte Gillian , Walsh Rachel , Ryan Daniel 
Published: September 2024

Abstract

Background
Unmet needs, including access to rehabilitation, support and information, are experienced by a high proportion of stroke survivors after discharge from acute and rehabilitation services (McKevitt et al.,2011). All stroke patients should be offered a structured health and social care review six-months post-diagnosis (UK Guidelines on Stroke 2016). We aim to describe patients profile including their unmet needs who attended an Interdisciplinary Stroke Clinic situated within a Dublin teaching hospital.

Methods
Data was collected for all patients attending an Interdisciplinary Stroke Clinic from March 2023-April 2024, including demographic information, self-reported unmet needs and residual deficits identified using modified Greater Manchester Stroke Assessment Tool (GMSAT). Access to post-acute rehabilitation was recorded. Analysis was conducted using Microsoft Excel.

Results
Clinic attendance: 251 patients, 13-month period (150males, 101females; mean age 68.7yrs; range 17.27-95.5yrs). Majority of patients attended their appointment alone (n=144). Ischaemic stroke was most prevalent stroke-type of attendees (n=160). Post-acute stroke rehabilitation was accessed in 27% of cases (68/251). Group mean Clinical Frailty Scale score was 3.5 (scale 0-8) equating to ‘managing well/vulnerable’. Regarding patient-reported unmet needs, the following themes were identified, mobility (18%), fatigue (13.5 %), pain (8.5%), memory (5.5%), speech (5%) and mood (3.6%). On GMSAT assessment, fatigue (64%), mobility (49%), falls (44%), dysphagia (30%) was the most frequently identified chronic issues. As a clinical-specialist lead clinic, most issues were dealt at clinic-level with physiotherapy intervention targeting mobility/gait/spasticity (45.4%) and speech and language therapy for swallow/language management (20%) initiated.

Conclusion
Data from this novel Interdisciplinary Stroke Clinic supports previous research indicating many stroke survivors continue to experience chronic issues, frequently mobility, swallowing and fatigue; some of which can be addressed by stroke-specific therapists. The importance of establishing clinical-specialist led post-acute stroke review clinics/pathways in the Irish setting is highlighted. Analysis of data pertaining to stroke patient readmission is underway.
Níos Fearr Le Chéile/Together is Better: ICPOP Case Review of Intervention for an Older Carer of a Referred Patient
Authors: O'Shea Joan , Quinn Aoife 
Published: September 2024

Abstract

Background
The Integrated Care Programme for Older Persons (ICPOP) aims to implement integrated services and care pathways for older adults with complex health and social care needs. The aim is to place patients at the center of their healthcare decision making and to support them to live well in their homes and communities. A Comprehensive Geriatric Assessment (CGA), which is the gold standard for the management of frailty in older persons, is carried out on all referred patients at the initial home visit. It is often as an ICPOP assessor delves deeply into the family unit that frailty makers such as decreased mobility, declining cognition, poor appetite, polypharmacy is identified in the non-referred cohabitating person who is also over 65 years of age (Potier et al., 2018).

Methods
The purpose of this poster is to demonstrate how a holistic approach to care within a household led to the incidental finding of frailty in a family carer who was also an older adult. This case review will illustrate how the referral of one half of a married couple led to opportunistic multi-disciplinary intervention for the second person. Following discussion, at MDT level, of both the referred patient and their spouse, a request for a formal referral to ICPOP for the second person was made to the GP, as it is a referral criteria for ICPOP referrals.

Results
ICPOP intervention ultimately led to home supports being put in place for both parties along with medical reviews, rationalisation of medications and assistive technology supports, this enabled both patients to live well and safely at home.

Conclusion
A comprehensive geriatric assessment using a holistic approach resulted in intervention for both parties with a positive outcome for the entire family.
“Pathfinder Filled The Gap And Linked In With The Necessary Services” Service User Perceptions Of The Pathfinder Service
Authors: Burke Dearbhla , O'Donoghue Brid , Griffin Aislinn , Meagher Breda , Lowry Pat , O'Shea Tadhg 
Published: September 2024

Abstract

Background
Pathfinder is a service designed to keep older adults who phone 999 at home by utilising alternative care pathways, when it is safe to do so. Pathfinder responds to adults aged 65 and older who present with low acuity complaints. The service is delivered by Occupational Therapists, Physiotherapists and Advanced Paramedics and is embedded between acute and community care. The aim of this study is to capture how the service user found their interaction with this novel service.

Methods
As part of routine service evaluation, semi-structured brief telephone interviews with closed and open-ended questions were completed with a number of service users (the patient or their primary care giver). Interviews were completed at least one week after their discharge from the service, by a member of the team who had not been involved in their care. Interviews were then analysed using Microsoft Excel® for closed ended questions and thematic analysis for open ended questions.

Results
One hundred service users were contacted, of which 76 completed the brief telephone interviews. 99% of respondents felt Pathfinder treated them with respect and dignity, 100% felt Pathfinder communicated clearly and 97% rated the service as excellent. Five key themes were identified from open-ended questions (1) the prompt arrival of care, (2) the thorough examination and reassurance provided, (3) the benefit of follow-up after the initial 999 call, (4) the domino effect of onward referrals and (5) the holistic approach to care given.

Conclusion
There was universal positive feedback for the Pathfinder service reported by both older adults who engaged with the service and their primary care givers. Key elements of the service delivery were complimented including the assessment, the follow up service provided and the onward referral to acute and community services.
An Audit of Time to Inpatient Bed In Patients With A Suspected Delirium
Authors: Condon Christine , Byrne Colm , Bowden Helen , Ali Shammy Rashid , Ramiah Vinny 
Published: September 2024

Abstract

Background
Our local Dementia/Delirium Combined Pathway and Care Bundle for Emergency Department (ED) and Acute Medical Assessment Unit sets a target door to ward admission in patients aged over 65 years with a suspected delirium at less than 6 hours. This audit assessed if this target is being met in patients with a suspected delirium.

Methods
Retrospective point prevalence audit of 240 randomly selected patients who were assessed by the Frailty Intervention Team (FIT) in the Mater Misericordiae University Hospital ED in 2022, aged ≥ 65 years with a suspected delirium (4AT ≥4) and no delirium (4AT=0). Time of presentation to ED, time of admission to ward bed, ward name and length of hospital stay were recorded.

Results
The median age in patient's with a 4AT ≥4 was 86 years (range 65-99). There was an equal spread across gender groups in patient's with a 4AT ≥4; 55.3% (n=52) females and 44.7% (n=42) male. The median wait time in ED for patients with a 4AT ≥4 was 25.26 hours (range 6.75-83.73) vs 21.65 hours (range 5.98-50.53) in patients with a 4AT=0. Only 19% (n=18) of patients with a 4AT ≥4 were admitted to a Specialist Geriatric Ward. The mean length of stay in patients with a 4AT ≥4 was 28.457 days vs 14.132 days in those with a 4AT=0 (p value=0.002, Mann-Whitney U test).

Conclusion
Older adults with a delirium spend prolonged periods of time in the ED. We are not meeting our local target of 6 hours from ED presentation to ward bed. Length of hospital stay is prolonged in patients with delirium. Our aim is to create a dedicated delirium bed on our Geriatric Specialty Ward so that we can provide delirium specific care and reduce overall length of hospital stay.
Atrial Fibrillation Prevalence In Ischemic Strokes In An Irish Hospital. Spotlight On Anticoagulation Failure In Patients On Direct Oral Anticoagulants
Authors: Sohail Arslan Ali , Ramsamy Kumaren , Varghese Bency , Ahmad Hafiz Anis 
Published: September 2024

Abstract

Background
Global atrial fibrillation (AF) burden in acute ischemic stroke patients approximates at 30%. An Audit in 2022, in the concerned hospital identified lack of compliance and under-dosing as major causes of ischemic strokes whilst on direct acting anticoagulants (DOACs). This year, we sought repeat the audit of process with focus on ischemic strokes with pre-existing AF patients established on DOACs, to study trends related to anticoagulation failure.

Methods
The study was a retrospective observational audit study of all patients admitted with a diagnosis of acute ischemic stroke to the concerned hospital from January 2023 to December 2023 who had known diagnosis of atrial fibrillation and were prescribed a DOAC prior to their admission in the concerned hospital with an ischemic stroke. Patients were identified via HIPE coding and in-hospital stroke registry. Data was collected via charts review, compiled via flow charts, graphs and excel sheets, and studied.

Results
143 patients were admitted to the hospital’s stroke service with ischemic stroke in the set time frame. 46 (32%) had Atrial Fibrillation (AF) which was deemed to be the cause of their stroke. 29 (20.2%) had pre-existing diagnosed AF, and 22 of those patients were prescribed DOACs. In all patients already on DOACs, compliance was found questionable or lack of in 11 (50%). 8 (36.3%) patients were on low dose (adjusted dose DOACs). 3 patients were diagnosed with DOAC failure without cause. All new and existing AF patients not anticoagulated, were commenced on anticoagulation.

Conclusion
The audit showed under dosage and poor compliance were major causes of anticoagulation failure in stroke patients who were anticoagulated with DOACs. Similar results were noted as secondary results in last year’s audit in the concerned hospital. As part of quality improvement process, a specialist DOAC clinic was being set up with further audit process planned for the coming year.
Role of MRI in Diagnosis of Rapidly Progressive Cognitive Impairment- A Case Of Sporadic Creutzfeldt Jakob Disease (sCJD)
Authors: Haq Ijazul , Sohail Arslan Ali , Rasheed Mujahid 
Published: September 2024

Abstract

Background
The role of neuroimaging in dementia extends beyond its traditional role of excluding neurosurgical lesions. Radiological findings may support the diagnosis of specific neurodegenerative disorders and aid differentiation from other neurodegenerative conditions e.g. CJD1. sCJD is a fatal neurodegenerative disease, which typically presents with neuropsychiatric symptoms, myoclonus, cerebellar and pyramidal/extrapyramidal symptoms. The diagnosis often is quite difficult, requiring high degree of suspicion, advanced neuroimaging and biochemical markers. Confirmation is only possible via brain biopsy. The condition can result in rapidly progressive dementia/neurocognitive decline and death, usually within a year from onset.

Methods
We report a case of a rapidly progressive dementia in a 79-year-old male who was diagnosed with probable sCJD, after having an MRI which picked up suspicious characteristic findings leading to the eventual diagnosis confirmation via further workup. The patient presented with acute rapid progressive forgetfulness and functional decline of 2 weeks with initial workup unyielding.

Results
A contrast MRI Brain eventually showed focal increased T2 and flair signals in the right parafalcine and parietal cortex demonstrating mild fluid restriction without any focal contrast enhancement, a pattern highly suspicious for sCJD. A CSF sample subsequently revealed RT-QulC positivity confirming the diagnosis. The patient eventually passed away despite ward-based care after 4 weeks of admission due to rapid neurological decline. A brain biopsy was not deemed feasible given patient’s condition.

Conclusion
The case highlights a relatively atypical symptomology of sCJD and, highlights the role of MRI imaging in assessment and diagnosis of dementias and specifically in sCJD. Increasing use of advanced neuroimaging may aid in diagnosis of specific/rare causes of rapidly progressive dementias.

Reference
Vitali, P., Maccagnano, E., Caverzasi, E., Henry, R.G., Haman, A., Torres-Chae, C., Johnson, D.Y., Miller, B.L. and Geschwind, M.D., 2011. Diffusion-weighted MRI hyperintensity patterns differentiate CJD from other rapid dementias. Neurology, 76(20), pp. 1711-1719.
Perceptions of Behaviour Change Interventions for Physical Activity in People with Chronic Obstructive Pulmonary Disease: A Survey
Authors: Hanrahan Ciara , McVeigh Joseph G , O'Connor Terence , Troosters Thierry , Broderick Julie 
Published: September 2024

Abstract

Background
Physical inactivity in chronic obstructive pulmonary disease (COPD) is common and behaviour change interventions could help improve physical activity (PA). This survey aimed to explore perceptions of behaviour change interventions for physical activity in people with COPD.

Methods
An anonymous cross-sectional electronic and paper survey was distributed among people with COPD in the Republic of Ireland (n=150) via relevant gatekeepers. Descriptive statistics, means, medians, percentages and frequencies, were used to summarise and describe the findings. Chi- squared t-tests (where P was set at 0.05) were used to investigate relationships between variables.

Results
Responses were received from n=113 people with COPD (75.33% response rate, 113/150) and most respondents (83.03%, n= 93/112) were aged over 61 years. 90.53% (n=86/95) of respondents agreed/strongly agreed that PA helps them to manage their COPD. There was a strong statistically significant relationship between those who wear PA monitoring devices and those who believe that being physically active can help them to manage their lung disease (p&lt;0.001), however, in this survey, the use of PA monitors in those over 61 years was proportionally lower (21.11%, n=19/90) than those under 60 years (61.53%, n= 8/13). Respondents perceived social support as the most effective behaviour change intervention to influence PA behaviour (67.62%, n= 71/105), with counselling for PA perceived to be the least effective (13.33%, n=14/105).

Conclusion
People with COPD perceived that social support can influence their PA behaviour. The spontaneous use of PA monitoring devices was lower in older respondents than in younger respondents, however a strong relationship between using monitoring devices and perceived benefits of PA on COPD may exist overall.
Investigating Skeletal Muscle Pump Function Using Thigh EMG, Thigh NIRS, And Stroke Volume Data In The FRAILMatics Physiological Cohort
Authors: Knight Silvin , Duggan Eoin , Xue Feng , Romero-Ortuno Roman 
Published: September 2024

Abstract

Background
The pioneering female physiologist Frances Hellebrandt first highlighted the significance of the skeletal muscle pump in circulation in the 1930s. However, the mechanisms underlying the muscle pump's function remain elusive, particularly in older individuals. It is thought that during muscle contraction, increased intramuscular pressure facilitates the expulsion of blood from the muscle's veins, aiding venous return. This contraction-induced pressure gradient assists in pushing blood towards the heart, increasing preload, and subsequently stroke volume (SV). In this study we investigated muscle pump activity using continuous measurements of thigh muscle activity, thigh total haemoglobin concentration (Hb), and cardiac SV.

Methods
22 individuals (aged 70.8±5.3 years, 77.3% female) recruited from a Falls and Syncope Unit (St James’s Hospital, Dublin) underwent non-invasive measurements of Hb (NIRS PortaLite, Artinis Medical Systems, The Netherlands), electromyography (EMG) (Shimmer3, Research Ltd, Ireland), and SV (Finapres Nova, Finapres Medical Systems, The Netherlands) during a 10-second thigh squeeze test. Pre-processing involved data quality checks, alignment, and resampling. 60-second regions of interest were extracted, normalised, and processed using MATLAB (R2023a, TheMathWorks, Inc., Natick, MA, USA). Cross-correlation and Granger causality analyses were conducted to explore relationships between signals.

Results
Thigh Hb and EMG signals lagged 8.4 and 8.5 seconds behind SV, respectively. Granger Causality analysis revealed a significant causal relationship from both Hb and EMG to SV in 68% of participants at measured lags.

Conclusion
The observed ~8.5-second lag between thigh measurements and SV implies a plausible temporal relationship between muscle activation and venous return, further supported by significant causal relationships found in a substantial portion of participants using Granger causality analysis. These findings underscore the importance of continued research in this area, not only for advancing our understanding of physiological mechanisms but also for informing potential clinical applications aimed at optimising cardiovascular health and function.
Evaluation of a Nutrition and Exercise Group Intervention for Older Adults with Frailty and Probable Sarcopenia
Authors: Sayers Karen , King Lorna , Maher Jennifer , Ryan Siobhan , Donnellan Christina 
Published: September 2024

Abstract

Background
The prevalence of probable sarcopenia in frail older adults attending a Community Specialist Team (CST) is 52%. Resistance exercise and optimising nutrition are recommended interventions. The aim of this study was to evaluate a nutrition and exercise group for frail older adults with probable sarcopenia.

Methods
Adults aged ≥65 years, with probable sarcopenia identified through Comprehensive Geriatric Assessment (CGA) by a CST over 18 months were included. At CGA (baseline), sarcopenia infographics and 2 attendances at Dietetic and Physiotherapy group were offered. Group intervention comprised nutrition and exercise information and individualised goal setting. Clinical Frailty Scale (CFS) score, grip strength and 5 Times Sit-to-Stand (5TSS) were measured. Participants' needs and perceived changes in knowledge were evaluated using open questions and Likert Scales. Data was analysed using thematic analysis, descriptive and inferential statistics.

Results
Intervention was offered to 82 people. Twenty-nine (35%) attended an initial group (18 women, 11 men), with mean age 80.7 years (SD=7). Nine (30%) attended the second group. Participants were significantly less frail (median CFS 4, IQR 4, 6) than non-participants (median CFS 6, IQR 5, 7) (p= 0.002). Male grip strength improved significantly from baseline (mean 22kg, SD=4.21) to first group (mean 27.8kg, SD=4.36) (p=0.007) and to second group (mean 29kg, SD=4.21) (p=0.012). Female grip strength increased non-significantly from baseline (mean 12.6kg, SD=3.38) to first group (mean 14.5kg, SD=5.85), (p=0.127) and to second group (mean 14.83kg, SD=4.21) (p=0.890). Participant’s 5TSS did not change significantly (mean 19.75 sec, SD=6.38 to mean 20.78 sec, SD=7.73) (p=0.782). Nutrition and exercise knowledge improved significantly (p=0.004, p=0.003 respectively). Access to clear information was an identified theme.

Conclusion
Educational resources and tailored plans within group interventions can improve grip strength and knowledge in older adults living with very mild frailty. Further research is required to design an accessible intervention for more frail cohorts.
‘I Just Felt A Bit Faint’: The Role Of Physiotherapists In Older Adults Presenting With Transient Loss Of Consciousness (T-LOC)
Authors: Connolly Kieron , Davey Naomi , Kelly Louise , Kerins Yvonne , Soh Josephine 
Published: September 2024

Abstract

Background
Clinical presentation of transient loss of consciousness (T-LOC) in older adults presents significant diagnostic challenges, especially in those with frailty or multi-morbidity. This study analysed T-LOC presentations in individuals over the age of 75 and assess the impact of physiotherapy in this cohort.

Methods
A retrospective review was conducted on 56 older adults (&gt;75 years), who presented with T-LOC to a large academic teaching hospital, over a six-month period in 2023. Data on demographics, presenting complaints, diagnostic tests, physiotherapy input and discharge diagnoses was collected and analysed.

Results
The analysis included 56 older adults, 57% (N=32) were male, with an average age of 81.6 years (75 – 94 years). The average length of stay was 9.1 days (1-64 days). Physiotherapy was provided to 59% (n=33) of the patients, with those in the physiotherapy group more likely to have a history of falls (55% compared to 4%) and a diagnosis of dementia (27% compared to 9%). Patients with T-LOC presentations were five-times more likely to be referred to physiotherapy if they had at least two diagnoses of recurrent falls, dementia or stroke (24% vs 4%). Of those who received physiotherapy, the number of sessions ranged from 1-25 (averaging 4.5 sessions per patient). Outcome measures were completed for 73% (n=24) of these patients, and 70% were discharged at their mobility baseline. Education on syncope, orthostatic hypotension or falls was documented for only 12% (N=4). 79% (N=26) were discharged directly home and 50% (N=13) were referred for community follow up.

Conclusion
Physiotherapy is often required for older adults with T-LOC, particularly those with a history of falls and dementia. Physiotherapy should be considered a fundamental component in the multi-disciplinary management strategy to improve healthcare efficiency and clinical outcome for this cohort.