bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Contexts and Resources that Support Effective Interprofessional Collaboration in Community Care for Older People: A Realist Synthesis
Authors: O'Donnell Deirdre , Davies Carmel , Devaney Catherine , Radomska Apolonia , O'Shea Marie , O'Donoghue Gráinne , De Brún Aoife , Donnelly Sarah , Whitty Helen , Harnett Patrick John , Lang Deirdre , Ahern Emer , Shé Éidín Ní 
Published: September 2024

Abstract

Background
Interprofessional collaboration (IPC) is widely accepted as important to enable quality, safe care integration for older people. There is limited understanding of how IPC can be fostered, enhanced, or sustained within the various contexts of team-based care integration for older people. This review describes the contextual factors and resources that support IPC in interdisciplinary community care teams for older people.

Methods
A five-step process guided the realist synthesis. This involved exploratory scoping (steps 1-2) including a cross-sectional descriptive survey of members of the 30 specialist community teams for older people in Ireland (n=65). Four stakeholder workshops with operational leads, healthcare professionals, policymakers, older people and caregivers (n=25); a systematic evidence retrieval and synthesis phase (40 academic and 5 grey literatures included) (steps 3-4) and finally the development of programme theories via expert advisory panel (n=10) (steps 5).

Results
We generated 14 initial programme theories from the exploratory scoping phase, and these were refined into 7 programme theories following realist evidence synthesis. The programme theories describe the contexts and resources required to enable IPC within community care teams for older people under the following headings: 1. Professional identity and role awareness; 2. Information sharing and communication across boundaries of care; 3. Enabling Effective Operational and Clinical Governance; 4. Developing team competence in IPC; 5. Meaningful inclusion of older people and caregivers; 6. Monitoring and reviewing team performance for quality improvement and system development. 7. Capacity development and workforce planning.

Conclusion
The exploratory stakeholder process with local experts, including older people and caregivers, added a rich contextual depth to this realist review. The seven areas of programme theory convey the complex multifaceted contexts and resources that enable IPC in care integration for older people. Work has commenced to test these theories across four interdisciplinary community specialist teams for older people in Ireland.
A Systemic Review & Meta-Analysis of the Impact of Vascular-Geriatric Service Models on Short-Term Outcomes in Vascular Surgery Inpatients
Authors: Foley Megan Power , Walsh Stewart 
Published: September 2024

Abstract

Background
Vascular surgeons are treating progressively older, frailer and more medically complex patients. Care models including both surgeons and geriatricians have improved peri-operative outcomes in orthopaedics and surgical oncology. This meta-analysis investigates the impact of “vascular-geriatric” services on short-term inpatient outcomes.

Methods
Search strategy included PubMed, Scopus and Embase databases, conference abstracts and clinical trial registries. All study methodologies comparing outcomes before and after the introduction of a dedicated vascular-geriatrics service were eligible. Meta-analyses compared the relative risk (RR) of mortality, complications and 30-day readmission using a random-effects model. Risk of bias was assessed with the MINORS tool.

Results
Eight studies were identified, including one randomised trial and seven ‘before & after’ observational studies. 2074 patients were included, 1065 in the “Vascular-Geriatrics” cohort and 1009 in standard care. Care models included comprehensive geriatric assessment as part of the pre-operative review process before elective aortic surgery, inpatient geriatric liaison services and formal vascular-geriatric co-management arrangements. Source studies were of moderate to high risk of bias. A meta-analysis of five studies demonstrated vascular-geriatrics models were significantly associated with lower mortality rates than standard care (pooled 2.4% vs 4.9%) (RR 0.51, 95% CI 0.28-0.94, p=.03) (I2=0%). Vascular-Geriatrics models were also significantly associated with lower risk of infective complications (RR 0.49, 95% CI 0.36–0.66, p&lt;.001) (I2=0%) and delirium (RR 0.58, 95% CI 0.35–0.97, p=.04) (I2=48%). There was no difference in mean length of stay (SMD -2.20, 95% CI -4.6-0.19, p=.07) (I2=86%). or 30-day readmission rates between Vascular-Geriatrics models and standard care (RR 1.10, 95% CI 0.81-1.51, p=.54) (I2=38%).

Conclusion
While the source data is heterogenous and of limited quality, this meta-analysis suggests that dedicated geriatric intervention may reduce adverse peri-operative outcomes in vascular patients compared to traditional care models. Further studies are needed to investigate the most effective design of geriatrician-surgeon partnership.
An Early Supported Discharge Model of Care for Older Adults Admitted to Hospital: A Descriptive Cohort Study
Authors: Williams Susan , Whiston Aoife , Morrissey Ann-Marie , O'Riordan Clíona , O'Connor Margaret , Hartigan Deirdre , Devlin Collette , Galvin Rose 
Published: September 2024

Abstract

Background
Early supported discharge (ESD) facilitates an early discharge from hospital with continued rehabilitation in the home environment from a multi-disciplinary team at the same intensity as would be received in the inpatient setting. Evidence suggests it can have a positive impact on older adults discharging from the acute setting to home. This study aims to characterise an inreach model of ESD for older adults discharged from four hospitals in the Mid-West of Ireland and describe its impact on clinical and process outcomes at 30 days and 180 days.

Methods
Consecutive older adults referred for ESD from four hospitals in the Mid-West of Ireland were recruited over a six-month period. Baseline assessments were carried out on initial review and patients were followed up at 30 days and 180 days by an independent outcome assessor. Outcomes measured include functional status, frailty, health related quality of life, mortality, and healthcare utilisation.

Results
130 older adults (mean age 76.623 years, SD 9.812 years) were recruited over six months, 44 due to surgical and 86 for medical complaints. The ESD service was provided over a median of 31 (medical) - 44 (surgical) days. The incidence of functional decline was 16.406% at 30 days and 27.5% at 180 days. There was a significant improvement in self-reported function from index visit 72.939 (19.502) mean (SD) to 30 days 84.046 (21.078) mean (SD) which was maintained at 180 days 80.534 (30.930) mean (SD). Frailty was independently associated with incidence of functional decline at 30 days (OR 2.061, 95%CI 1.386 to 3.062) and 180 days (OR 1.7, 95%CI 1.292 to 2.236).

Conclusion
An ESD model of care can have significant effects on patient outcomes for older adults admitted to hospital at 30 and 180 days. Future research should explore the impact of an ESD model of care on specific cohorts, using RCT methodology.
Can Avatar Robots Assist Older People and Care Professionals? Evaluation of an Intervention Study in Eight Nursing Homes in Tokyo
Authors: Obayashi Kazuko , Kodate Naonori , Ishii Yoko , Okamoto Yoshimi , Kondo Hiromasa , Kurishima Sae , Masuyama Shigeru 
Published: September 2024

Abstract

Background
Securing human resources to meet increasing demand for older people's care is challenging, particularly in Japan, where the pace of ageing is accelerating. Central and local government have been seeking partial solutions in assistive technologies such as robotics. Against such a background, the study was conducted in 8 nursing care homes in Tokyo, where avatar robots were tested to examine whether and how these robot interventions can affect the daily life of older people and care professionals.

Methods
Four different types of avatar robot (ORIHIME, NEWME, Piyokame and BOCCO) were introduced to and used in eight nursing care facilities, in order to create conversational opportunities over 12 weeks. Before–after studies were conducted, and a variety of data was collected (interpersonal communication, self-care and depressive tendencies using the International Classification of Functioning, Disability and Health (ICF) and InterRAI assessments). System usability scores (SUS) were collected from care professionals, who also performed a time-on-task analysis.

Results
Study participants who consented to taking part were 136 older adults (88.4±6.6 years old, 18 men and 118 women) and 63 care professionals. Participants with a high degree of dependency accounted for 31 percent. In total, 136 avatar robots were used. There was an overall, yet marginal, improvement for older people. While the SUS scores were poor, the majority (90 percent) responded that such devices would prove useful in the future. The time-on-task analysis indicates that more time can be secured for ‘person-to-person’ care.

Conclusion
Positive impacts of avatar robots (to increase the level of social interaction and communication) were observed. However, the results are inconclusive, and more needs to be done with regard to technology skills, competence enhancement and data collection methods for this type of research. The study was funded in part by the Tokyo Metropolitan Government.
Community Initiatives and the Use of Welfare Technologies in Super-Aged Areas: A Case Study from Japan
Authors: Maeda Yurie , Kodate Naonori 
Published: September 2024

Abstract

Background
Community initiatives are seen as a solution to issues such as social isolation of older people and the lack of formal care. The study examines the use of welfare technologies in two municipalities in southern Japan to enhance their community-based care systems amidst challenges like underfunding and coordination. One case, an agriculture-led town with a handful of administrators, and the other, a manufacturing-led 'Tokku' (national strategic special zone) with active central and local government involvement, provide contrasting approaches.

Methods
Using a case study approach, the initiatives taken by the two municipalities were identified from ’grey’ literature and examined to see what types of welfare technologies have been introduced and how, and what impacts the overall projects had on older people’s lives, well-being and care delivery.

Results
The current average ageing rate in Japan is 29.2%. Town A, with a population of 13,878 and a significant ageing population of 43.3%, has initiated various ICT projects since 2011. For example, recognising the difficulties older people have in accessing information, adopting a familiar ICT solution and taking time to explore new applications together contributed to the overall wellbeing during the initiation process. In contrast, ‘Tokku’ B, with a population of 916,003 and an ageing rate of 31.5%, the highest among 25 ‘Tokku’, prioritises Digital Transformation from cradle to grave. They are committed to sustainable development and improving the well-being of their residents (all ages) through collaborative strategies and a forward-looking perspective. The overall impact remains uncertain, however.

Conclusion
These findings shed light on Japan's technology-driven strategies to address age-related challenges, which resonate with age-friendly city initiatives worldwide. However, challenges remain, particularly in depopulated areas with limited resources and skilled care professionals. Further research, including comparative studies between Japan, Ireland and beyond, is essential to understand the impact of welfare technology integration in supporting ageing in place.
Unmet Needs Post Stroke: Level of Unmet Need According to Discharge Destination
Authors: Harte Gillian , Lawson Susan , Walsh Rachel , Ryan Dan 
Published: September 2024

Abstract

Background
Stroke survivors often face unmet needs after leaving acute and rehabilitation services (McKevitt et al., 2011). UK and Ireland stroke guidelines (2023) advise a 6-month health and social care review for all patients, yet resource access in hospital and community settings hinder this. Targeting those with the most unmet needs could improve service delivery. Consequently, we examined unmet needs of stroke patients post-rehabilitation, comparing those who were discharged to rehabilitation (RG) to the non-rehabilitation group (NRG).

Methods
Participants: All patients attending a post-stroke review clinic between March 2023 and April 2024. Groups: RG included patients discharged to Early Supported Discharge or inpatient rehabilitation; NRG included patients not discharged to these services. Data: Collected demographic information and assessed unmet needs using a modified Greater Manchester Stroke Assessment Tool. Analysis: Using Microsoft Excel, group comparisons were made using chi-squared tests and t-tests, with log transformation applied to non-normally distributed data.

Results
251 patients attended during the data collection period (69 patients (27%) in RG, 182 patients (73%) in NRG). The average age was 68 in both groups. The RG had a longer mean length of stay (23 days) compared to the NRG (19 days) (p=0.0007). The RG also had a higher mean score on the clinical frailty scale (RG 4, NRG 3, p=0.05). In the RG, 97% reported no follow-up after discharge, compared to 78% in the NRG. A greater proportion of RG patients reported swallow difficulties (12% vs. 3%, p=0.03), mobility difficulties (46% vs. 30%, p=0.02), and falls (41% vs. 30%, p=0.008) compared to NRG patients.

Conclusion
Data from this exploratory study suggests substantial unmet needs among post-stroke patients with a significantly higher level of unmet needs among patients who were discharged to post-acute rehabilitation. Despite this, the majority of these patients were not seen by community services at the time of 6-month review.
End of Life Care, It’s a Journey
Authors: Healy Sarah , Monahan Cathy , Donlon Josephine 
Published: September 2024

Abstract

Background
The Hospice Friendly Hospital (HFH) approach was adopted by an urban academic hospital in 2010 which involved the roll out of the Final Journeys Workshops. in 2019 a review of nursing and healthcare attendant’s (HCA) education and training within geriatric department, alongside patient feedback, identified the need for greater focus to be made on End-of-Life Care. In 2022, it was then decided by the department’s Assistant Director of Nursing that the Final Journeys Workshops was a mandatory requirement for the nursing and HCA staff working in the geriatric inpatient areas.

Methods

Results
Workshops are ongoing with nine having been completed so far. As of April 2024, 34 HCA’s and 70 nurses have now completed the workshop within the directorate. Oral feedback received from the 2023’s attendees highlighted the need for a more interprofessional approach so it was decided that the workshop would be offered to all staff who are working in older person’s services from 2024. Since then, 8 members of staff outside nursing and HCA roles attended the workshop. This had a positive impact on the learning experience but also solidifies that much needed multi-disciplinary approach to EOLC.

Conclusion
At the end of each session, attendees were asked to complete an evaluation. Post reviewing these evaluations the following themes emerged:
By having our geriatric directorate facilitators, we can create more awareness surrounding the culture and practices of EOLC for the older person thus improve the quality of EOLC within the directorate in line with HFH approach.
Is there a Solution to Lengthy Hospital Stays for Nursing Home Residents? Our Nursing Home Liaison Team Are Virtually There
Authors: Coen Neville , Power Leslee , Mahoney Niamh O , Buckley Emily , Mello Sarah 
Published: September 2024

Abstract

Background
Research indicates that Nursing Home residents frequently undergo transfers to acute care, leading to adverse events and functional decline (Brucksch et al., 2018). Local data from highlights the significance of this issue, with 447 admissions averaging 11.1 days in 2022 (HIPE, 2023). Hospital at Home is recognised as a cost-effective alternative for older patients (Singh et al., 2022). The proposed solution involves implementing Virtual Wards, remote telemetry, and a Nursing Home Liaison team led by a Consultant Geriatrician. This initiative targets Early Supported Discharge to reduce the hospital length of stay for Nursing Home patients. The study aimed to investigate the feasibility of using the Virtual Ward platform in this service.

Methods
The study aimed to investigate the feasibility of using the Virtual Ward platform, primarily utilising the Telehealth Usability Questionnaire (TUQ) (Parmanto et al., 2016). A Simulation Lab was also used to test the digital solution before its clinical implementation. Additionally, debriefing sessions were conducted to assess clinicians' perceptions of the technology and identify any potential issues.

Results
The TUQ scores for clinicians using a Virtual Ward for Nursing Home patients show a notably positive outcome. With an average score of 120.5 out of 147, the system received significant approval. The range of scores, from 111 to 139, demonstrates a consistent positive perception among respondents. After simulation-based training in the Simulation Lab, participants reflected on their experiences with Virtual Ward technology. They found it useful, easy to navigate and committed to future use. However, they also identified areas, such as information retrieval, needing refinement. Increased training was suggested to address these concerns.

Conclusion
The Virtual Ward system demonstrates significant approval. In light of these promising results, we are proceeding with the plan to launch the Virtual Wards in May 2024 to complement the existing team.
“Understanding Dementia Together”: The Design, Delivery and Evaluation of a Collaborative Inter-professional Dementia Workshop for Healthcare Students
Authors: O'Sullivan Trish , Moore Niamh , McVeigh Joseph G , Timmons Suzanne , Foley Tony 
Published: September 2024

Abstract

Background
A collaborative, multi-disciplinary team input is crucial for the optimal management of a person with dementia. Interprofessional learning (IPL) has benefits at undergraduate level. Allowing students to engage in IPL pre-qualification enables them to understand the value of a collaborative approach in improving patient care, and this insight may cultivate future collaboration. The aim of this study was to develop, deliver and evaluate an IPL dementia workshop for healthcare students across a broad range of relevant disciplines. A secondary aim was to determine the extent of perceived clinical application of learned knowledge in students who completed the workshop and subsequently underwent clinical placement.

Methods
This study adopted a social constructivist pedagogical approach. A steering group was formed which included faculty members from 11 healthcare disciplines. Disciplines represented included medicine, nursing, dentistry, physiotherapy, radiography, radiation therapy, audiology, speech and language therapy, pharmacy, occupational therapy and paramedicine. Kern's map for the development of a curriculum in medical education informed the development of the intervention. The Alzheimer's Disease Knowledge Scale questionnaire was used to assess students’ knowledge.

Results
102 students completed the pre and post workshop surveys. There was a statistically significant increase in student's knowledge (t (11) = -5.251, p≤0.001) and communication scores (Z=-7.792, p≤0.001) post workshop. The follow up of students on clinical placement showed a perceived behavioural change in communication modification, with 79% of students stating that they have changed the way they communicate with a person with dementia.

Conclusion
The findings of this study provide insight into the optimum modes of design and delivery of an IPL dementia workshop, state of knowledge, confidence, and role recognition across a broad spectrum of healthcare students. The longitudinal follow up of students on clinical placement established perceived behavioural change due to the training.
The Effectiveness of a Community Specialist Team for Older Persons in Preventing Emergency Department Attendances 30 and 90 Days Post-Intervention
Authors: Dunne Aoife , Quinn Laura , Digan Eimear , Campbell Claire , Reilly Amy , John Shalini , Murphy Carole , Everdeen Tara , Martin Ruth 
Published: September 2024

Abstract

Background
Population ageing is prevalent throughout Ireland and its impact is evident particularly in acute hospitals with long Patient Experience Times (PETs) in the emergency department. A Community Specialist Team for Older Persons (CSTOP) was established in our area in 2018 with expansion under Sláintecare in 2022. The main goal is to improve access in the community to age attuned services, and thus prevent Emergency Department (ED) presentations and admissions and improving health outcomes for older people. The team provides a comprehensive geriatric assessment and resultant interventions required for each patient. The cohort of patients includes (Frail Intervention Team) FIT referrals from the ED, Geriatrician referrals from Outpatient clinics and GP referrals. Many of these patients have either presented to the Emergency Department or are at risk of same.

Methods
Data for all CSTOP patients is recorded including medical record numbers. All medical records for patient admitted in 2023 were analysed using the integrated patient management system (IPIMS) in our local hospital. ED presentations and admissions were reviewed at 30 and 90 days post intervention.

Results
232 referrals were received in 2023. 42 (18%) had an ED presentation 30 days post discharge and 48 (21%) had a presentation 90 days post discharge. 11 RIPs.

Conclusion
This study shows the effectiveness of the CSTOP team at preventing ED presentations and resultant admissions. The number of bed days is estimated at 2000. One limitation to our study is data could only be analysed from our hospital system, patients could attend other public or private hospitals during the follow up period. Our results are found to be in keeping with reviews by similar services. Our team provide a rapid access interdisciplinary assessment and intervention to people who may otherwise experience fragmented care within primary care services.