bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Simulation Educational Programme Within the Department of Stroke Medicine
Authors: McCarthy Kate , Gannon Elizabeth , Ryng Stephanie , James Kirstyn 
Published: September 2024

Abstract

Background
Simulation has been commonly utilised in medical education as both a learning and assessment tool. Its utilisation in stroke medicine helps to facilitate learning in acute pathways, interprofessional communication, communication with family and patient and the application of evidence-based care.

Methods
The programme was initially developed as part of a pilot with University College Cork. The “FAST Call” scenario was seen as an opportunity to test the acute pathway. A simulation coordinator led out on the technical facilitation of simulation. Scenarios were developed to enable education in different facets of stroke.
Key learning areas identified were:
Quarterly feedback from all medical trainees in the department allowed qualitative assessment of the programme.

Results
Trainee feedback yielded positive results with all NCHDs reporting they found the programme beneficial from a clinical skills perspective. It improved confidence in dealing with acute stroke calls and provided a psychologically safe learning environment. The feedback also identified potential barriers and delays in the stroke pathway and allowed the utilisation of simulation as an educational opportunity.

Conclusion
The simulation programme has provided trainees within a stroke department with a psychologically safe learning environment. This has allowed the department to identify areas of physical or technical constraint when delivering care to stroke patients. The department has also gained the opportunity to discuss evidence-based medicine in a non-didactic format, along with providing NCHDs with the opportunity to manage scenarios in a safe manner. Simulation programmes and inclusion of this style of training as a core-component of training can be spread to other components of the geriatric medicine curriculum.
Improving Decision-Making and Documentation on the Acute Medical Post-Take Ward Round
Authors: Thomas Niju , Ocsio Aimee , Yun John Paul , Hogan Clara , Donovan Tomas , Tyulkin Stanislav , Riaz Saad , Ryan Maeve , Hickey Paula , Butler John 
Published: September 2024

Abstract

Background
Frail Older people have a substantial presence on the Acute Medical Take. They also have a large conversion rate to hospital admission after the Post-Take Ward Round (PTWR). They decondition and deteriorate with long delays in the Emergency Department. The PTWR is a particularly important part of the patient journey particularly for capturing senior decision-maker input around key clinical and patient flow parameters. PTWR documentation in Irish hospitals is currently largely captured in an open freehand manner. Decisions made on the PTWR have implications across several domains including quality of care, patient safety, medico-legal outcomes as well as informing patient flow metrics. A structured & standardised approach to PTWR decision-making is anticipated to improve outcomes across these respective domains.

Methods
A standardised PTWR tool (1) was used to replace freehand PTWR case-note entries. All medical consultants were invited to use the tool on their PTWRs. All auditors were trained in gathering data consistently. Spot audits were undertaken on all wards before and two weeks after the introduction of a Standardised PTWR clerking tool. Capture of Key PTWR documentation and evidence of decisions made were identified. The Chi2 test was used to compare outcomes before and after introducing the intervention tool.

Results
138 PTWR patients (number &gt;65y: 124) documentation were assessed before the introduction of the PTWR tool and 74 patients afterwards. Significant improvement was found across 12/16 domains including decisions made relating to Investigations reviewed, Diagnoses made, Thrombo-prophylaxis considered, Ceilings of care reviewed, Discussions with patients and/or advocates and Predicted Date of Discharge (p&lt;0.001).

Conclusion
A standardised PTWR tool significantly improves the capture of key documentation and decisions made on the Acute Medical Take above conventional freehand case-note entries. This may have significant implications for the care of older people clinically both from an individual and overall patient flow perspective.
Validation of a Self- Administration of Medications Assessment Tool for Home Dwelling Older Adults During an Elective Admission for Rehabilitation
Authors: Doyle Mary , Mathew Jincy , Morrin Niamh , Jordan Aoife , Smyth Hannah , Ryan Dan 
Published: September 2024

Abstract

Background
Safe medication management is challenging among older adults due to an increased prevalence of multiple chronic diseases often requiring complex multi-drug pharmacotherapy. Poly-pharmacy can increase the risk of non-adherence to medications in home dwelling older adults, reported as ranging from 6 to 55%. During hospital stays older adults may lose control over their medication management due to the shift in responsibilities from patient to healthcare professionals. Self-administration of medication (SAM) can increase patients’ understanding about their medication and promote independence and autonomy in the hospital setting.

Methods
From January -December 2023, all elective admissions were assessed for inclusion in SAM during their inpatient stay (n-74). An assessment tool, validated for use in the residential care setting was used. The tool, comprising of 17 items assesses the patients experience of self- medication, capability to self-medicate (cognition and function) and knowledge of their medications. Criteria for inclusion in SAM included older adults who self-administered their medication at home prior to admission and assessed as suitable using the assessment tool. Medication reconciliation was undertaken by a pharmacist for all patients prior to commencing SAM.

Results
42% of admissions (n=31) were deemed suitable for SAM during their inpatient stay. Mean age 79 years (age range: 68-96 years). Number of medications &gt; 5 medications daily. 90% (n-28) successfully completed SAM throughout their stay with 10% (n-3) reverting to nurse administration due to changes in medication during their inpatient stay

Conclusion
The use of the assessment tool supported a 90% success rate for SAM in this cohort. Further testing is recommended to evaluate the tool in other in-patient settings. An evaluation of SAM for the prospective of older adults and nursing team is also recommended.
Adult-Child to Older-Parent Coercive Control: A Hybrid Co-constructed Concept Analysis
Authors: Quinlan Freda , Donnelly Sarah , O'Donnell Deirdre 
Published: September 2024

Abstract

Background
In the absence of an established definition, the term filial coercive control is used to denote a relationship between an adult-child and their older-parent(s) which is characterised by a persistent pattern of controlling and abusive behaviour. This study explores how this phenomenon is understood in the literature by identifying and synthesizing the current state of knowledge of in this field of research. The knowledge generated from this concept analysis, along with the tacit knowledge of the author as a practitioner- researcher, was synthesised to produce a tentative conceptual framework. The distinctions between filial coercive control from psychological elder abuse are explained with the use of models and contrary cases. The hypotheses generated from this study will be used to guide semi-structured interviews with safeguarding social workers in a later qualitative study.

Methods
A scoping review methodology was adopted to guide the literature review, while a concept analysis methodology guided data extraction and analysis. Drwing on Rodgers’ evolutionary concept analysis method, a co-constructed research methodology was developed for this study.

Results
The concept of filial coercive control is understood in the context of the following antecedents: ageist norms, a parental relationship (both biological and non-biological), physical proximity and spatiality, along with the controlling characteristics and tendencies of the abusive adult-child. The defining attributes include the exercise of power through control, dependency and entrapment, isolation and confinement, and fear and intimidation. Through a process of reflective thematic analysis, the defining attributes were used to guide the construction of models and contrary cases to illustrate the findings.

Conclusion
Existing bodies of theory fail to adequately describe the phenomenon of filial coercive control. A tentative operational definition and a conceptual model are proposed that provide a starting point for future research and to help to inform professional practice and education.
Predictors Of Loneliness In Older Irish Adults And Its Relationship To Depression
Authors: Sherry Kenneth Mc , Moloney Kevin , Laird Eamon , Ward Mary , Hoey Leane , Hughes Catherine F , Strain JJ , Cunningham Conal , McNulty Helene , Lannon Rosaleen , Molloy Anne M , McCarroll Kevin 
Published: September 2024

Abstract

Background
Loneliness can affect up to 30% of older adults and is associated with increased morbidity and all cause mortality. Loneliness is also a major risk factor for depression. We aimed to explore the predictors of loneliness in older Irish adults and its relationship to depression.

Methods
Study participants were Irish adults aged &gt;60 years in the Trinity Ulster University Department of Agriculture (TUDA) study. Participants with an MMSE &lt;24 were excluded, to prevent the inclusion of individuals with dementia. Loneliness in the last week was identified from the 'loneliness' question in the Center for Epidemiological Studies Depression Scale (CES-D) and considered present when experienced ≥1-2 days in the last week and absent when experienced rarely or none of the time. Depression was defined as a CES-D ≥16. Predictors of loneliness were explored in multinomial regression models as well as its association with depression.

Results
There were 4561 participants, 70% female, mean age 70.1 years and 21.6% experienced loneliness. Positive independent predictors of loneliness were living alone (OR 5.2, CI 4.41-6.14, p&lt;0.001), female sex (OR 1.29, CI 1.07-1.56, p=0.009), timed up and go &gt;12 seconds (OR 1.46-2.32, p&lt;0.001) non-driving status (OR 1.37, CI 1.13-1.67, P=0.001) and lower MMSE (OR 0.57, CI 0.41-0.79, p=0.0006). Those who reported loneliness had a higher prevalence of depression (32.1 vs 3.3%, p&lt;0.0001).

Conclusion
Living alone was, as expected, the greatest predictor of loneliness followed by physical frailty, non-driving status, female sex, and lower cognition. A high proportion (one third) who felt lonely had depression, though low mood may increase the perception of loneliness independent of social engagement. A limitation is that we did not have a specific validated tool to assess loneliness or to distinguish between `emotional' or `social' loneliness.
Flagging Frailty in the Emergency Department: A System to Identify and Visualise Frailty
Authors: Brennan Louise , Bentley Kate , Edge Lucinda , Molamphy Aoife , Keane Barry , Enright Alison , Keogan Fiona 
Published: September 2024

Abstract

Background
Older adults with frailty who present to the Emergency Department (ED) are at increased risk of hospitalisation, prolonged length of stay, deconditioning and loss of independence.1 Early identification of frailty using a validated tool, such as the Clinical Frailty Scale (CFS), is widely recommended to inform clinical decisions, identify the best pathway of care for older adults with frailty, and for potential use as a predictor or an outcome.2 We aimed to develop and implement a system of frailty identification which is highly visible, digitised and integrated with routine ED processes.

Methods
In the ED of a large teaching hospital, an expanded interdisciplinary Acute Frailty Team (AFT) commenced work in the ED in February 2024. The AFT aimed to screen all over 70s presenting within working hours for frailty using CFS. ED consultants collaborated with software developers through iterative design stages to create a ‘Frailty Flag’ for the ED Whiteboard with the requirements that it is highly visible, easy to use and highlights patients with higher frailty scores.

Results
In April 2024, a ‘Frailty Flag’ was launched on the ED Whiteboard, prominently displaying the CFS and using traffic light colouring to highlight those with higher CFS scores. As part of standard work, the AFT populate the CFS on the ED Whiteboard, which is viewed by all staff in ED on large wall-mounted screens. Feedback from ED and inpatient staff indicate that a highly visible frailty score is a valuable addition to the ED Whiteboard which allows them to prioritise care and supports decision making regarding suitability for geriatric care pathways.

Conclusion
A Frailty Flag on the ED Whiteboard allows for easy, accessible communication of frailty scores to the ED multi-disciplinary team. Next steps involve integrating the Frailty Flag with in-patient systems and developing standard work for out of hours use of the system.
Injury Characteristics and Frailty Patterns in Older Patients Admitted with Hip Fractures in an Irish Hospital
Authors: Bradley Eoin , Lannon Rosaleen , McCarroll Kevin , Romero-Ortuno Roman , Fitzpatrick Donal 
Published: September 2024

Abstract

Background
The Irish Hip Fracture Database (IHFD) has played a crucial role in improving hip fracture care over the last ten years. However, the IHFD does not include detailed data on the nature of the injury leading to hip fracture. In this study we examined the characteristics of the injuries leading to hip fractures and their relationship with frailty.

Methods
We conducted a retrospective chart review of all hip fracture patients aged over 60 years old admitted to an acute orthopaedic floor in a tertiary hospital from May 2023 to May 2024. Patients under 60 years old, and those with periprosthetic fractures were excluded. Delirium was based on a composite of clinical diagnosis and/or a 4AT score ≥ 4. Frailty was quantified using the IFHD Frailty Index. The relationships between various injury characteristics were examined with Student T test and χ square.

Results
The study included 168 patients, 73.8% female, mean age was 80.1±11.2 years. Of these, 91.1 % were fragility fractures and 4.8% were atraumatic. Indoor falls accounted for 67.9% of cases. Assault led to hip fracture in 5.4% (n=9) of all fractures and 17.0% (n=8) of outdoor fractures. Frailty Index was higher in those with fragility fracture vs. non fragility fracture (0.19 vs. 0.10, p&lt;0.003), as well as in those with indoor vs. outdoor fractures (0.21 vs 0.16, p&lt;0.001). Indoor fractures were significantly associated with delirium (p=0.012), frailty index (p&lt;0.001), and age (p=0.016).

Conclusion
The great majority of hip fractures were fragility fractures occurring indoors. Patients who suffer hip fractures indoors are frailer and more likely to develop delirium. These findings underscore the importance of targeted falls prevention strategies for frail older adults, including optimizing the home environment and reducing hazards within the home. The number of hip fractures due to assault deserves further examination.
All On One Page: Getting Daily Meal Ordering Right In A Rehabilitation Setting
Authors: Montague Orla , Coleman Kerrie , Fhaolain Aisling Ni , Byrne Hannah 
Published: September 2024

Abstract

Background
Recently the rehabilitation hospital expanded to over 100 beds providing improved access to rehabilitation for older persons in the area. During this time, an increase in incident report forms occurred due to the incorrect provision of diet/fluid to patients at ward level. In collaboration with relevant stakeholders, the Speech and Language Therapy (SLT) and Dietetic teams reviewed the current hospital meal ordering form and process in order to standardise a new system. The aim of this project was to reduce risk for patients and improve collaborative team working and communication.

Methods
A multidisciplinary team (MDT) approach was adapted involving; SLT, dietitians, catering department, nursing team and the patient quality and safety department. The HSE change framework provided scaffolding for this work. A new Daily Meal Order form was created and approved by the Nutrition Steering Committee and the process was agreed using input from all stakeholders. A pilot was carried out, reviewed and rolled out across the campus. The number of incidents recorded at ward level was used to measure if risk was reduced. A staff survey was conducted to gather feedback on the new system.

Results
The new Daily Meal Order form is now being used across the campus. Additional checks are completed each day via email to reduce the risk of errors. No incident reports were filed since launching the new form and process. A staff survey showed that all staff feel the new system and form constitutes an improvement, that it saves clinical time and that they would recommend it to others.

Conclusion
The project aims have been met in reducing patient risk, in line with the HIQA Safer Better Healthcare Programme. It has also improved MDT working and communication. This project is easily replicable to other settings and staff would recommend this approach to others.
The Evolution of Mechanical Thrombectomy for Acute Ischaemic Stroke: A Decade In Dublin
Authors: O'Reilly Aisling , Byrne Muireann , Fearon Patricia , Nicholson Patrick , Liddy Anne Marie , Boyle Karl , Williams David , Power Sarah , Thornton John 
Published: September 2024

Abstract

Background
The advent of mechanical thrombectomy (MT) has entirely transformed hyperacute care for patients with stroke. We studied changing trends in MT provision over a decade, spanning participation in pivotal randomised controlled trials, evolving neuro-interventional techniques, a global pandemic and expanding treatment indications in a comprehensive stroke centre in Dublin.

Methods
Consecutive patients treated with MT were prospectively recorded between January 2012 and December 2022. We compared baseline clinical and imaging data, treatment times and procedural and clinical outcomes both on an annual basis and across the totality of the epoch.

Results
2211 MT patients were recorded. Total annual numbers were: 36 (2012), 53 (2013), 46 (2014), 122 (2015), 172 (2016), 248 (2017), 262 (2018), 306 (2019), 301 (2020), 326 (2021) and 338 (2022). Between 2012 and 2022 patients treated with MT became older (mean age: 65.6yrs (SD:13.8) vs 70.0yrs (SD: 14.6); p=0.017), had greater infarct volumes (median baseline ASPECTS: 10 (IQR:9-10) vs 9(IQR:8-10): p=0.045) and were treated faster (median door-to-recanalisation: 70mins vs 39 mins; p&lt;0.0001). Patients were less likely to have witnessed stroke onset (100% vs 54%; p&lt;0.0001), receive IV tPA (72% vs 38%; p&lt;0.0001) or have thrombus located in the intracranial ICA or M1-MCA (95% vs 65%: P&lt;0.0001). No significant variations in pre-stroke mRS, baseline NIHSS, onset-to-recanalisation times, rates of successful recanalisation (86% vs 91%: p0.29) or 90-day mRS (0-2: 44% vs 50%; p0.68) were observed.

Conclusion
As our service has evolved, patients presenting for MT have become more complex, are treated faster and continue to achieve excellent clinical and radiological outcomes.
Quality Of Care In Parkinson's Disease: Lessons From A National Audit
Authors: Azizi Zahra , O'Shea Emma , Hughes Graham , Bradley David , Browne Patrick , Mulpeter Ken , Timmons Suzanne 
Published: September 2024

Abstract

Background
It is recommended that people with Parkinson’s disease (PD) are treated within specialised services. As part of a research project mapping and evaluating PD services nationally, the first audit of PD services in the Republic of Ireland was conducted.

Methods
A de novo audit tool was developed by an expert group, based on a rigorous review of existing international standards, guidelines and audit tools, with extensive stakeholder input (including people with PD). All 14 specialist PD services in the Republic of Ireland were eligible; up to 30 case-notes were randomly selected per service in 2022/2023, looking at the most recent 2 visits (new patient) or 3 visits (established patient).

Results
In total, 261 case-notes were included, from 11 specialist PD services, led by a geriatrician (n=5) or neurologist (n=6). Overall, 16.8% of patients were seen less often than annually. Motor and mobility assessments were well performed (&gt;75%); but cognition (70%) and pain assessments (64%), saliva management (50%), and bone density determination (18%) were inadequate. Access to PD nurses (65%), physiotherapy (69%), speech and language therapy (53%), and occupational therapy (50%) was inadequate; PD nurses were mainly in Dublin. However, specialist nurse and MDT access was better than reported by people attending generic services for PD care (1). Providing written information following diagnosis (24%), and communication with the carer were infrequently documented (financial support discussion: 12%; availability of support locally: 26%). Gerontology-led services more often screened for malnutrition (99% v 78%) or orthostatic hypotension (94% v 52%).

Conclusion
PD care relating to assessment, multidisciplinary involvement, and information sharing was sub-optimal in some areas, with the caveat that documentation may not reflect actual practice.

Reference
1. O’Shea E, et al. Experiences of Health Service Access and Use for People Living with Parkinson’s Disease in Ireland: A National Survey. Health & Social Care in the Community. 2023 Aug 9;2023.
A Novel Discharge Pathway for Older Adults presenting to the Emergency Department
Authors: McDaid Edel , Dillon Aoife , Ryan Ciara , Daly Eoin 
Published: September 2024

Abstract

Background
A need was identified for an urgent therapy follow-up at home for older adults presenting to the Emergency Department (ED). The acute floor team worked together within an established therapy outreach team (for inpatients) to develop an ED outreach pathway within existing resources. The outreach team members worked within ED to ensure standardisation of assessment, practice and build strong working relationships. A trusted assessor approach was applied. The outreach team had access to the wider acute floor team including ANP for in-reach support if needed.

Methods
A review of the patient group who discharged home from ED using this new pathway was completed including demographics, presenting complaint, clinical frailty score (CFS) and intervention provided.

Results
To date, 30 patients have discharged from the ED with the therapy outreach team. Most (70%) were female and mean age 83. Presenting complaint included fall no fracture (50%, n=15), fall with fracture (26%, n=8), musculoskeletal injury (17%, n= 5) and functional decline (6%, n=2). The mean CFS was 5.1, with most (86%) living with mild to moderate frailty (CFS 4-6). All patients were offered a next clinical day home based functional and environmental assessment, continuing the assessment commenced by the acute floor team in ED. Interventions included transfers and mobility training, activities of daily living (personal/domestic/instrumental) training, carer education, environmental advice, falls education, support with care packages, liaising with other healthcare professionals and equipment provision including mobility aids, bed-levers, toilet-aids and rails.

Conclusion
A therapy lead team, supported by the wider acute floor team, can provide a safe alternative discharge pathway from the ED for older adults that can avoid admission with rapid therapy input at home. Future work will examine re-admission rates, re-presentation rates to ED and patient and stakeholder satisfaction.