bluuebunny/crossref_metadata_2025_split huggingface dataset:
Competencies Required By All Hospital Doctors Caring for Older Adults: A Group Concept Mapping Study
Authors: Buckley Emily , O'Tuathaigh Colm , Barrett Aileen , Bennett Deirdre , Cooke John 
Published: September 2024

Abstract

Background
The number of older adults accessing the healthcare service far exceeds the available geriatric specialist services. It is recognised that for the foreseeable future most hospital inpatient contacts with older adults will be completed by doctors not specifically trained in geriatric medicine. To ensure the provision of adequate healthcare, it is imperative that that all hospital doctors are trained in the minimum geriatric competencies. Allowing for the broad, complex, and multidisciplinary nature of geriatric medicine, we conducted a group concept mapping (GCM) study to permit multiple stakeholders with various expertise to convey their thoughts on the competencies required by all hospital doctors caring for older adults.

Methods
GCM is a mixed methods approach utilising six phases to generate expert group consensus, enabling participants to organise and represent their ideas. We invited healthcare professionals, patient advocacy groups and clinical educators to participate in GCM via an online platform. Hierarchical cluster analysis and multi-dimensional scaling were utilised to analyse participant input regarding competencies required by doctors caring for older adults.

Results
Forty-eight participants completed the brainstorming stage, generating eighty-eight statements, and twenty-two participants took part in the subsequent sorting stage. Participants included hospital doctors, general practitioners, allied health professionals and patient advocacy groups. Nine competency domains were identified as integral for all hospital doctors to care for older adults. Domains rated most important related to interpersonal communication skills, ethical and legal matters relating to older adults, recognition and management of delirium and medication management.

Conclusion
The twelve competency domains indicate the diverse skillset required by all doctors to provide comprehensive care to older adults within a hospital setting. This study identifies competencies that may serve as a foundational framework for ensuring quality healthcare for the ageing population. Future initiatives should consider incorporating these competencies to improve inpatient care provided by hospital doctors to older adults.
An Evaluation of Patient Profiles and Outcomes in an Off-Site Rehabilitation Unit in 2023 Compared to 2019
Authors: Brennan Finlay , Hashim Mohammad Shahril , Peters Catherine 
Published: September 2024

Abstract

Background
Our off-site inpatient rehabilitation unit accepts patients from many different referral centres. Demographic shifts have occurred in the last 4 years with the Covid-19 pandemic resulting in several practice changes and frailty admissions increasing at our primary referral centre by 11%. We compared the number of patients, their demographics and dependency in 2023 in comparison with 2019 and hypothesised a longer length of stay could be explained by increased dependency as defined by Barthel score on admission.

Methods
Data regarding patients’ age, admission and discharge dates, referral source and discharge destination were extracted from the rehabilitation unit's database. Weekly MDT records were examined to identify the patients’ presentation and dependency level. Presentations were categorised as stroke, hip fracture, other fracture, acute medical and surgical presentations, and elective surgical procedures.

Results
Discharges decreased to 89 in 2023 compared to 125 in 2019. Mean length of stay increased to 35.1 from 29.5. Mean age reduced from 85 to 83. Mean Barthel on admission was unchanged at 10. 21 Patients were admitted following elective orthopaedic surgery in 2019 compared to 2 in 2023 with a mean length of stay of 16 days. Length of stay for stroke patients increased from 33 to 50. Excluding both led to a length of stay of 32 in both years.

Conclusion
The reduction of bed days could be explained by increased frequency of outbreaks and more robust isolation strategies reducing total bed availability. A significant reduction in patients admitted following elective orthopaedic surgery impacted the average length of stay as did an increase in length of stay for stroke patients. Patient dependency defined by Barthel score was not increased and did not explain the increased length of stay. A more comprehensive score such as the Rehabilitation Complexity Score may be more predictive of complexity and thus length of stay.
Use of Two Pain Assessment Tools to Improve Pain Recognition in Post Stroke Patients: A Quality Improvement Project
Authors: Seebah Shelina , Fan Chie Wei 
Published: September 2024

Abstract

Background
Post stroke patients can suffer from a variety of complex pain syndromes. These are often associated with decline in function, cognitive impairment, impaired quality of life and mood disturbances. Pain identification can be challenging in this population, due to stroke deficits that impair communication, and associated medical conditions that can affect the patient’s ability to self-report pain. This Quality Improvement (QI) project aims at implementing two pain assessment tools to support clinicians assess pain in a structured manner, and thereby improve pain management.

Methods
An initial audit was performed to identify whether post stroke pain (PSP) was being recorded in a reliable manner in St Mary's hospital. A pain assessment proforma was then designed, incorporated in the admission proforma and rolled-out for use. This included two pain assessment tools: the Numerical Pain Scale for patients who could self-report pain, and the Abbey Pain Scale for patients with communication difficulties. A second audit was performed to analyse the compliance to documentation and a qualitative evaluation of its use was also conducted in semi-structured staff interviews.

Results
The first audit showed pain being under reported with only 25% of patients having formal pain assessment documented on admission. The second audit showed improvement in pain assessment with 72.7% pain documentation. Qualitative evaluation revealed staff expressing challenges with pain identification in post stroke patients and viewed the proforma as a useful prompt. Limitations to the use of observational tools included time constraints, lack of familiarity with tools and potential inaccuracy of scores.

Conclusion
Identification of PSP is key to optimising treatment, and hence improving function and quality of life of stroke patients. This QI project shows that the use of pain assessment tools, in combination with detailed clinical assessment can help pain assessment. Clinician awareness and continuous training are required to support this challenging task.
Perioperative Management Of Diabetes Mellitus In Older Hip Fracture Patients
Authors: Ashraf Mubashra , Mehammednur Miriam Hassen , O'Regan Niamh 
Published: September 2024

Abstract

Background
Hip fracture is one of the most serious injuries sustained by older adults worldwide, associated with increased morbidity and almost 25% mortality at one year. Pre-existing comorbidity worsens prognosis, e.g. hip fracture patients with Diabetes Mellitus (DM) have increased mortality rates, worse functional outcomes, and higher post-operative complications rates. Perioperative blood glucose optimisation may improve outcomes, however this can be challenging due to periods of fasting and reduced intake, as well as complications such as infection. Local guidelines for the peri-operative management of DM have been developed and are sign-posted in our hip fracture integrated admission document. This audit aimed to compare current practice with those recommended in local guidance.

Methods
Since 1st January 2024, 31 hip fracture patients aged ≥65 years with DM have been admitted. Charts were available on twenty patients, and hence reviewed.

Results
Of 20 patients, four were on insulin; 13 on metformin; four on sulphonylureas; five on SGLT2 inhibitors; and six on DPP4 inhibitors. No intraoperative hypoglycemic events nor episodes of Diabetic Ketoacidosis were documented; however, ketones were not checked in the majority of patients during admission. Eleven (55%) had HbA1C either done in the previous six months or during admission. Blood Sugar Levels were checked on admission in 9/20 (45%). The protocol was followed in only one patient on insulin; and 5/13 metformin patients. The protocol was followed in all Sulphonylurea prescriptions, and in 4/5 SGLT2 inhibitor prescriptions, however these medications were not held by the Orthopaedic team, rather by nursing staff while the patient was fasting pre-operatively.

Conclusion
This audit demonstrates poor adherence to local guidance on peri-operative management of diabetes, particularly perioperative insulin adjustments. We aim to develop an educational intervention (including group teaching, plus distribution of flashcards and posters) for Orthopaedic SHOs and interns and re-audit in the coming months.
Impact of Early Comprehensive Geriatric Assessment on Unscheduled Acute Medical Admissions through an Age Related Assessment Unit
Authors: Farrelly Angelina , Kelly Louise , Davey Naomi , Soh Josephine , Hayden Derek 
Published: September 2024

Abstract

Background
Older patients often face prolonged hospital stays, leading to increased healthcare costs and potential complications. Comprehensive geriatric assessment (CGA) at the point of hospital entry may reduce length of stay (LOS) by addressing the multifaceted needs of older patients promptly. This study evaluates the potential impact of early targeted CGA on the length of hospital stay for older patients admitted unscheduled to our hospital.

Methods
A retrospective review of all admissions by our Age Related Assessment Unit (ARAU) Team was conducted from January to April 2024. A total of 82 admissions were analysed. Two patient pathways were identified: 84% (69 patients) were admitted via Pathway 1 for acute medical intervention only. 16% (13 patients) were admitted via Pathway 2 requiring acute medical admission plus additional care needs/supports to facilitate discharge. These 13 patients had inpatient stays exceeding 20 days, either requiring additional support for discharge (long-term care/home care package), or a period of rehabilitation.

Results
Patients on Pathway 1 had an average LOS of 6.6 days, in contrast to those on Pathway 2 who had an average LOS of 35.2 days. According to our annual hospital report from 2022, patients over 75 years old typically had an average LOS of 16.3 days.

Conclusion
Early commencement of a CGA enables a targeted approach for the effective treatment of older adults presenting via unscheduled care, significantly reducing the length of stay for patients on Pathway 1. This positively impacts patient outcomes by mitigating the risks associated with prolonged hospital admissions and lowering related costs. However, additional focus and resources are needed to further reduce the length of stay for patients requiring extra support to facilitate discharge from the acute care setting.
Mobility Matters: The Association Between Current Level Of Frailty And The Elderly Mobility Scale In An Acute Older Population
Authors: Boyce Roisin , Samuel Thomas , Nolan Mary 
Published: September 2024

Abstract

Background
Evidence has shown that the 4Ms What Matters most?, Mentation, Medication and Mobility are essential elements of the provision of high-quality care for older adults. The Elderly Mobility Scale (EMS) is a standardised and validated scale for the assessment of mobility in frail older adults in an acute hospital. In addition, frailty has shown a strong predictive ability for adverse health outcomes, demonstrating a higher risk of mortality, disability, institutionalisation and hospitalisation in frail older persons. This study aimed to examine the relationship between current Clinical Frailty Scores (CFS) and EMS scores in order to enhance its interpretation in clinical practice and become more patient centered.

Methods
A convenience sample of acute older adults undergoing physiotherapy was used in this study. Baseline demographics of age, gender, level of assistance required to mobilise and if the participants were at their baseline mobility was recorded. The participants CFS and EMS was measured a one single time point during their admission. The correlation between these was examined.

Results
A total of 21 participants were examined, of which 52.4% (n= 11) were male and 47.6% (n=10) were female. The median age of the population was 82 years and 14.3% (n=3) were independent with their mobility. The median CFS was 6 (moderately frail) and EMS was 8 points. A Spearman’s rank correlation showed a strong negative correlation (r=-0.88, p=0) between current CFS and their current EMS.

Conclusion
Although this study has a small sample, it gives an insight into the use of the CFS and EMS in clinical practice. A better knowledge of the interaction of frailty on mobility among the acute older population is essential for understanding the healthcare needs and delivery of age friendly healthcare services.
Identifying Locations Where Self-Reported Dizziness Occurs In Patients With Vestibular Disorders In A Day Hospital Setting
Authors: Merrick Catherine , Grennan Eva , Alexander Marie , O'Malley Tom 
Published: September 2024

Abstract

Background
World falls guidelines recommended that where vestibular issues are identified such as Benign Paroxysmal Positional Vertigo (BPPV), therapeutic interventions should always be sought, as potential benefits to health-related quality of life are high (Montaro-Odasso et al., 2022). Identifying potential BPPV in older adults, however, can be challenging, as many older adults experience BPPV as vague unsteadiness rather than dizziness, leading to under diagnosis of the condition (Li et al., 2023). This audit aimed to identify the locations where patients with self- reported dizziness and falls experienced dizziness, and if they subsequently were diagnosed with vestibular disorders. If potential high-risk locations for experiencing dizziness with vestibular issues are identified, this may aid in the timely identification of vestibular disorders.

Methods
A retrospective chart audit was undertaken in a multidisciplinary day hospital setting, where patients aged 75 years and older attend for assessments. Paper charts of patients discharged from the day hospital between January and March 2024 were reviewed. A Microsoft excel sheet was used to track data. Data on self-reported dizziness and falls as well as the location of dizziness occurring was gathered.

Results
A total of 103 patient charts were reviewed. Of those, 39 reported experiencing dizziness, with 90% of those patients also reporting a history of falls. 18 of these patients were subsequently diagnosed with vestibular disorders. 78% of patients diagnosed with BPPV reported experiencing dizziness getting out of bed or in their bedroom with 28% also reporting dizziness on getting up from a chair. However, 100% of patients with dizziness and falls without vestibular disorders reported dizziness on getting out of their bed.

Conclusion
People with all cause dizziness reported dizziness on getting out of bed. Based on the results of this audit, vestibular screening is not aided by questions surrounding location of dizziness occurring.
The Goldilocks Effect Of Hydration For Patients In A Sub-Acute Rehabilitation Setting: Too Warm, Too Cold Or Simply Not Nice
Authors: Crowe Aoife , Fagan Claire 
Published: September 2024

Abstract

Background
Older adults are considered at risk of becoming dehydrated. Risk of dehydration is increased during a hospital stay. Offering a range of preferred drinks frequently during the day can improve total fluid intake and minimise the risk of low intake dehydration. A survey of patient access to and consumption of water on an inpatient ward for older adult rehabilitation was undertaken.

Methods
A point prevalence survey was conducted on each patient on an inpatient ward for the following six situations:

Results
All inpatients (n=26, 15 female and 11 male) completed the survey for each of the six situations. 85% of patients surveyed had access to water (n=22). 85% of patients (n=22) surveyed were able to reach the water and 85% (n=22) could pour the water independently. 15% of patients surveyed (n=4) required assistance to drink (modified consistency (n=2) or physical assistance (n=2). Only 35% of patients (n=9) reported drinking the available water. Of the 17 patients who reported not drinking the water accessible to them, 59% (n=10) reported the water was too warm and 29% of patients (n=5) reported the water didn’t taste nice.

Conclusion
Low intake dehydration is associated with adverse outcomes in older adults. The root causes of low fluid intake need to be established in order to minimise the risk of dehydration during a period of hospitalisation. Further research is required to establish the root causes of low intake dehydration and development of quality improvement initiatives to minimise low intake dehydration in a hospital setting.
Do Not Attempt Resuscitation (DNAR) Status Awareness Among Healthcare Staff For Patient's Under Their Care: A Clinical Audit
Authors: McEnteggart Tara , Seni Nikitha , Ioana Iulia 
Published: September 2024

Abstract

Background
The HSE National Consent policy recommends service providers should develop specific mechanisms for the documentation and dissemination of decisions relating to resuscitation. The local hospital guidelines state DNAR orders should be clearly documented in the patient’s records and communicated to relevant staff at nursing handover and clinical rounds. This audit aims to ensure DNAR status is known or easily accessible by healthcare staff if a cardiac arrest occurs. The population age of the wards audited are predominantly &gt;80 years.

Methods
A questionnaire was distributed to all nursing and medical staff working on the designated wards over a two-week period via SurveyMonkey QRcode (33 responses). The questionnaire contained five multiple choice questions with rating scale responses. Charts containing DNAR forms were reviewed alongside corresponding nursing handover sheet during this period (27 charts).

Results
6% of healthcare staff were very confident of DNAR status of patients under their care at the time of survey without accessing medical notes/handover sheet, increasing to 24% with access. 18% reported DNAR status is very easily found in both the medical chart and nursing notes. 82% report the coloured DNAR form (used 56% of the time) is much easier to locate than the photocopy. 89% of forms were attached to the front of medical charts, 7% attached to admission note and 4% unfiled. 33% of patients with signed DNAR forms did not have DNAR status recorded on the nursing handover sheet.

Conclusion
The confidence among healthcare staff regarding DNAR status of patients under their care is low. This audit highlights that an explicit and reproducible system to relay DNAR information between healthcare staff is not in place. Recommendations for this clinical site include; only keeping original coloured DNAR forms on the ward, ensuring completed forms are at the front of patient charts and creating a DNAR status column on medical and nursing handover sheets.
Mortality and Place of Residence One Year Post Stroke in an Irish Cohort
Authors: Hamad Mahmoud , D'Alton Maeve , Baby Maya , Donaghy Lisa , Dolan Eamon , Sheehan Orla 
Published: September 2024

Abstract

Background
Transition from hospital to community post stroke is a critical period in a patient's recovery. Understanding where post-stroke patients are living a year after discharge can provide valuable insights into the effectiveness of discharge planning and rehabilitation strategies. We aimed to identify location of patients one year post stroke and examine the influences on that location.

Methods
We performed a retrospective cohort study of stroke patients admitted to an acute hospital over a one-year period. Data on demographics, function, length of stay, stroke severity, mortality and discharge location were obtained from the in-hospital stroke registry. Patients were interviewed one year post stroke and follow up data on place of residence obtained.

Results
260 strokes occurred during the 1-year period. 11% died as inpatients and 5% were uncontactable leaving 206 stroke patients included in this study. Twenty-five patients (12%) died between discharge and 1 year follow up. 150 (73%) returned home post discharge rising to 157 (76%) one year post stroke. 32 (16%) were discharged to nursing homes falling to 22 (11%) at one year. Patients in nursing homes were older (80 vs 68 years, p = 0.001), had longer inpatient stays (37 vs 9 days, p = 0.000) and had higher Modified Rankin Scores (5 vs 2, p=0.0001).

Conclusion
Almost one in four stroke patients died within the first year of stroke consistent with international data. Mortality was highest in the acute post stroke period, but half of all deaths occurred post hospital discharge highlighting the importance of secondary vascular prevention and advanced care planning in this population. Older age, higher functional dependence and longer length of hospital stay were all associated with nursing home admission. Post stroke morbidity and mortality remains high after hospital discharge. Further study is needed to understand cause of death in the post discharge period in this population.
An Audit of Best Medical Therapy Adherence Among Patients with Carotid Artery Stenosis Attending a Tertiary Stroke Centre
Authors: Albusaidi Alsalt , Cosgrave Nicole , Jonsson Agnes , Durcan Rory , Fearon Patricia , Liddy Anne-Marie , Boyle Karl , Williams David 
Published: September 2024

Abstract

Background
Carotid artery stenosis (CAS) is estimated to cause 11-28% of ischaemic strokes annually. The primary objective of this audit was to assess current adherence to best medical therapy (BMT) to patients with CAS in a tertiary stroke centre. Our secondary aim was to assess stability, regression or progression of CAS whilst on BMT.

Methods
A retrospective chart review was conducted in a tertiary stroke centre over a six-week period. Patients were included if they were aged over 18 years, presenting to an outpatient stroke clinic, and had a known diagnosis of either symptomatic or asymptomatic CAS. The European Stroke Organisation Guidelines were used to define BMT.

Results
A total of 56 charts were reviewed at three weekly outpatient clinics. Of the 27 patients meeting our inclusion criteria 66% (n=18) were male, median degree of CAS was 50-70% and 78% (n=20) had symptomatic CAS. 89% were on BMT but only 56% achieved a low-density lipoprotein cholesterol (LDL-C) target of &lt;1.8 (median 1.6 (range: 0.7-4.2) and only 66% (n=18) had a documented smoking status. 81% of patients with symptomatic CAS on BMT had stable stenosis, 5% had regression and 14% had progression of stenosis. 50% of asymptomatic patients had progression of the degree of their stenosis.

Conclusion
Overall adherence to BMT was good at 89% but there is room for improvement particularly in terms of lipid target level and documentation of risk factor status. BMT resulted in stable stenosis and low progression rates particularly in patients with symptomatic CAS. BMT and early detection are essential for management to control progression of CAS, but we have highlighted the opportunity to improve LDL-C targets. Further research is needed to evaluate if the results of this study are translatable to the stroke population in general.