bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Audit Of Falls Admissions Documentation To A University Hospital: Cycle 1
Authors: Fernandez Celia , Cronolly Stacey , Boyle Nichola 
Published: September 2024

Abstract

Background
30% of adults aged 65 years and older experience a fall annually which can result in significant disability. The World Falls Guidelines (WFG) 2022 were developed to guide non-specialist clinicians in undertaking a falls assessment for high vs low/medium risk of further fall.

Methods
The medical admission list from July 2023-October 2023 was reviewed and 165 charts were requested for admissions listed as “fall’, ‘syncope’, ‘collapse’ and ‘pre-syncope’. Of 93 charts reviewed, 60 admissions were included in the audit. Of the 26 criteria listed in the WFG 2022, 10 were included in this audit. The index admission document was assessed for documentation of demographics, description of fall, any falls in preceding year, documentation of syncope, documentation of injury, cardiac and neuro examination, walking aids, comment on the cause of fall, medication review and time to mobility assessment. A pre-morbid Rockwood Clinical Frailty Score (CFS) was assigned on chart review.

Results
40% were male and 60% were female. Mean age of patients was 80.25 years (SD=8.4) with a mean CFS of 3.6 (SD=1.89). 91.7% documented some descriptor of the fall, 50% documented asking about syncope, 33.3% documented asking about previous falls. 96.7% had a documented cardiac exam, while only 71.1% documented a neuro exam and 41,7% documenting mobility baseline. 60% had a medication review documented and 41.6% had mobility assessed in under 72 hours. Only 76.7% of admissions had a documented differential for the fall.

Conclusion
Further education is required to adequately risk stratify patients admitted with falls and help guide appropriate investigation and workup as well as promote thorough documentation. An education session was conducted with Medical SHOs on May 14th, 2024, and Cycle 2 of the audit will commence June 2024.
Exploring Stigma in People with Parkinson’s Disease. A Qualitative Approach
Authors: Gaiera Fran , O'Shea Emma , O'Keeffe Gerard , Timmons Suzanne 
Published: September 2024

Abstract

Background
Parkinson’s disease (PD) is a neurodegenerative disorder characterised by motor and non-motor symptoms, which can considerably compromise people with PD’s (PwP) quality of life and psychological well-being in part due to ongoing stigma. Here, we sought to explore the role of stigma in the experience of living with PD in Ireland.

Methods
Twenty-one participants were recruited through convenience and snowball sampling. Data were collected through 30-50 minute semi-structured interviews face-to-face, via videoconference, or telephone. The interview explored PwP’s symptoms, psychosocial experiences, and support needed in the context of stigma. A thematic analysis was performed on interview transcripts.

Results
PwP do not avoid social situations because of their illness and are generally open to sharing their diagnosis with others. Most can avail of a solid social network and found that this supports them during the process of self-acceptance following their diagnosis. However, most do not feel comfortable sharing their feelings with close ones and would avail of an external emotional outlet, were it to be available. Stigma was experienced in social situations where PwP felt pitied and misjudged.

Conclusion
This study provides a snapshot of the social perceptions and experiences of people with PD in the context of stigma, and the consequential effects on their sense of well-being, identity and social connectedness. These findings may help to inform the development of health and social policies and help educate the general public on the lived experience of PwP.
Examining Post Hip Fracture Bone Protection At 30 days After Admission To An Irish Hospital
Authors: Vallely Shanice , Mullen Mary , Walsh Mary , Kiernan Sinead , Salawu Ade 
Published: September 2024

Abstract

Background
The Irish Hip Fracture Database (IHFD) includes a national standard of bone assessment during the acute episode of care. Furthermore, IV Zoledronic Acid (IVZ) is now recommended after hip fracture to provide longer term bone protection. It is not known however, how many patients commence appropriate bone therapy, by 30 days after admission. This audit aimed to examine commencement of bone protection medication for hip fracture patients across one acute hospital and its associated rehabilitation sites.

Methods
A retrospective audit was conducted. Consecutive patients admitted between December 2022 and December 2023, with hip fracture to a single acute hospital were included. Patients that did not meet IHFD inclusion criteria, were excluded. Patients were contacted in-person or by telephone by a physiotherapist to ask about bone-protection medication at 30 days after hip fracture admission, as part of a broader follow-up.

Results
A total of 146 patients were included for follow-up at 30 days after hip fracture admission. Of these patients, n=13 (9%) had died within this time and n=7 were not contactable at 30 days. A further n=8 (5%) did not receive bone-health follow-up. Only n= 3 patients contacted were not started on bone medication because it was contraindicated. While it is known that many patients were given IVZ as inpatients, it was not possible to determine this information accurately from patient report or current information recorded in the IHFD.

Conclusion
Most participants were administered bone protection medication by day 30 post hip fracture admission, however in some cases this was difficult to determine. The process of conducting the audit has improved commencement and recording of specific medication, in particular IVZ. The introduction of long-term outcomes into the IHFD should facilitate our hospital to benchmark our bone protection coverage nationally.
Optimising Delirium Pathways in Geriatric Care: The Impact of Consultant Led Old Age Psychiatry Liaison Service
Authors: Ahmad Mian Shariq Haseeb , McSorley Aileen , Nirodi Pratibha , Canavan Fintan , Graham Marcus , Keelin Ellis , Hutchinson Mark 
Published: September 2024

Abstract

Background
Delirium is a common and severe condition affecting up to 50% of older adults in hospitals. Delirium is compounded by the noisy and frightening environment of medical wards, often leading to prescription of antipsychotics. There is often no clear plan to monitor effects of these medications. Delirium is also associated with increased rates of institutionalised care on discharge, readmission rates and mortality.

Methods
This QIP examines the effectiveness of interventions for patients with delirium in COE wards, focusing on involvement of consultant led old-age psychiatry liaison service. This 2-cycle process included 106 patients in the 1st cycle (Feb 2020-Sep 202, nurse-led), and 64 patients in the 2nd cycle (Nov 2022-Aug 2023, consultant-led). Outcome measures the number of patients assessed, new antipsychotic prescription, new nursing home placement, follow-up plans, readmission rate, and 1year mortality.

Results
The QIP revealed an increase in the number of inpatients reviewed by the POA team (330%) and planned out-patient POA follow-up (320%). There was an increase in the number of antipsychotics prescribed on discharge (61.5%) and discharge to a new appropriate placement (27.6%). The overall readmissions rates had slightly decreased (2.5%), and readmissions with delirium had further reduced (4%) (not significant, p=0.66). The overall mortality rate increased by 4% since the introduction of these measures (not significant, p=0.63), however, this is small and at a level expected with this population group.

Conclusion
These results suggest that the new consultant led liaison team resulted in an increased use of their expert opinion on challenging patients with delirium. Significantly, more patients received psychiatric follow-up crucial for antipsychotic monitoring. There is a slight reduction in the readmission rates. Although, the increase in the mortality rate is insignificant, this warrants a closer look as antipsychotics are associated with cardiovascular diseases. A larger study over a longer period of time would provide more useful data.
DXA In People Living With HIV
Authors: Clarke Aoibhin , Denieffe Stephanie , Dockery Frances , McNally Cora , Coakley Peter , Byrne Maria , Josy Josie 
Published: September 2024

Abstract

Background
As people with HIV now live a near normal life-span, prevention of fractures is increasingly important. Alongside conventional risk factors for fractures, antiretrovirals and chronic inflammation are believed to contribute to their increased fracture risk compared to the general population.

Methods
We audited a 1-year series of consecutive DXA scans conducted on people living with HIV vs the European AIDS Clinical Society guidelines on bone health. These guidelines specify indications for DXA, for repeat DXA and for osteoporosis treatment. We recorded DXA results, any prior DXA, fracture history, fracture risks and drug treatment history. We assessed frequency of scanning and pharmacological management of low bone mass vs. guidelines.

Results
N=90 referred for DXA, of whom 18% did not attend, leaving n=74; 58% female, 42% male, median age 52 years [36-64] and 56 years [49-69] respectively. Of the 18% (n=14) who were aged under 50, 43% had no clear indication (fracture risk factor) for DXA. Of those aged &gt;50 years (n=60), all scans were indicated as the guidelines advises this in those aged &gt;50 years. Bone density was normal in n=32 (43%), osteopenic in 36 (49%) and osteoporotic in 7 (9%). Fifteen percent overall had a fragility fracture history, none of whom were taking osteoporosis treatment though it was indicated in at least 4 based on their DXA result. N=12 (16%) had a DXA in preceding years, and just 2 of the repeat scans were indicated according to guidelines. For the 12 with serial scans, there was no significant change in T score after a median three-year period.

Conclusion
Through an audit of consecutive DXA referrals, rather than consecutive individuals, low bone mass and fragility fractures are prevalent in people living with HIV. With advancing age, fracture incidence may rise sizeable in this group therefore due attention to bone health guidelines in required.
Frailty Screening and Assessment in the Emergency Department: Meeting the Growing Demand with an Expanded Acute Frailty Team
Authors: Dillon Aoife , Edge Lucinda , Bane Emma-Jane , Flynn Sinead , Molamphy Aoife , Byrne Karol , Kenny Elizabeth , Bell Alexandra , Taylor Yvonne , Keane Barry , Brennan Louise , Bentley Kate , Keogan Fiona , Enright Alison 
Published: September 2024

Abstract

Background
Frailty screening and early comprehensive geriatric assessment (CGA) in the emergency department (ED) is recommended to deliver optimal care for older adults with frailty and to reduce associated pressures on hospital systems.1 Interdisciplinary acute frailty teams (AFT) are best placed to lead these specialist assessments and a newly-expanded AFT was launched in February 2024.2 Activity data from the initial months of the AFT’s operations was analysed to understand the patient profile, service demand vs capacity and the impact of the team expansion.

Methods
A newly-expanded interdisciplinary AFT was launched, including Speech and Language Therapy (SLT) for the first time. Aims were to screen all those aged &gt;70 years in ED for frailty using Clinical Frailty Scale (CFS) and commence CGA where appropriate, during core working hours. Additionally, the team expanded their remit from usually seeing patients pre disposition decision to include those referred for admission. Data reports for AFT activity in the first 55 working days and all-ED &gt;70s presentations in the same time period, including weekends (78 days) were generated and analysed using excel.

Results
N = 920 patients were seen in the first 55 working days, n=513(53%) female, mean age 79.2 (6.7 SD, range 70-100), 65.4% living with frailty (CFS ≥4), admitted n=581(63%) vs discharged n=339(36%). The AFT saw 36% of all &gt;70s ED presentations. On weekdays, there is a mean demand of n=35.9 (1.4 SD) &gt;70s, and the AFT met 42% of this demand (mean n=15 (2.1 SD)). Compared to the same period in 2023, n=622 (313%) more patients were assessed or screened. Novel services provided were CGA and interdisciplinary team assessments commencing in ED for admitted patients and a SLT ED service.

Conclusion
An expanded AFT has increased capacity to screen for frailty and commence CGA. Future work will focus on hospital-wide frailty pathways.
Person Centred Dementia Care Made Simple
Authors: Teague Gillian 
Published: September 2024

Abstract

Background
This poster will outline the development and rollout of our person-centred dementia care microlearning course for all patient-facing staff based in St. James's Hospital, Dublin. Person centred care (PCC) appears to make a difference to how well people with dementia manage on hospital wards (Scerri et al., 2020). The term PCC is used widely in healthcare services and the approach is embedded in St James's nursing professional practice model, standards and policies. Yet there are health professionals who find PCC difficult to define and demonstrate in their practice (Byrne et al., 2020). Through our interactions with staff on wards and in nursing homes, Dementia Services Information Development Centre (DSiDC) are aware that healthcare staff can face difficulties in establishing a rapport with a patient with dementia. Therefore, we identified the need to design a course to facilitate the continued development of meaningful interactions between hospital staff and people with dementia. The course was divided into four stand-alone modules using clear, uncomplicated language and demonstrates how staff can use key elements of Kitwood’s PCC approach in their daily practice.

Methods
It is becoming harder for hospital staff to be released for onsite training courses due to increasing demands on their time. With this in mind, the DSiDC team sought innovative time-efficient ways to provide dementia education to hospital staff and so a microlearning educational tool was adopted. Microlearning delivers short pieces of content in easily understandable ways utilising a variety of methods such as: video, short written text and quizzes. Accessed by a QR code, staff can complete the course on their mobile phone at a time and place that suits the individual. A pilot study of the course was conducted among staff in a nursing home and on a key ward in St. James’s Hospital.

Results
73% of participants found the content ‘extremely helpful’. At start of course, 21% of participants rated their knowledge about person centred dementia care as ‘excellent’. On completion of course, this increased to 50%. One outcome of the pilot study identified an improvement of course design to three modules as opposed to four.

Conclusion
As a result of the positive outcomes from pilot study, it was decided as part of the wider dissemination of the course across St. James’s Hospital, to conduct a focus group to further measure the impact of the training.

References
1. Scerri A, Innes A, Scerri C. Person-centered dementia care in acute hospital wards-The influence of staff knowledge and attitudes. Geriatr Nurs. 2020 May-Jun;41(3):215–221. https://doi.org/10.1016/j.gerinurse.2019.09.001. Epub 2019 Oct 17. PMID: 31630871.
2. Byrne AL, Baldwin A, Harvey C. Whose centre is it anyway? Defining person-centred care in nursing: An integrative review. PLoS One. 2020 Mar 10;15(3):e0229923. https://doi.org/10.1371/journal.pone.0229923. PMID: 32155182; PMCID: PMC7064187.
A Five-Year Review of Dietetic Referral Activity in a Long-Term Residential Care Facility for Older Adults in Ireland: 2019–2023
Authors: Hendroff Una , Hogan Florence , Ahern Adrian 
Published: September 2024

Abstract

Background
Long term care (LTC) settings in Ireland have limited access to dietetic services provided by CORU registered dietitians. HSE guidance for community dietetic service provision recommends one whole time equivalent (WTE) dietitian per 100 nursing home beds[i]. National guidance on nutrition screening[ii] recommends malnourished patients and those at risk of malnutrition require referral to a dietitian to improve outcomes associated with malnutrition and disease. This review highlights the changes in dietetic referrals and service demands prior to, during and post the Covid-19 pandemic, and reflects the increasing complexity in the LTC population. [i] Nutritional Care in Health and Disease, HSE 2017, [ii] National Clinical Guideline 22, 2020.

Methods
Data extracted from Excel spreadsheets were utilized to assess activity from 2019 to 2023. New referrals were categorized as either new cases to the service or returning patients who were re-referred due to a change in their medical condition or nutritional status.

Results
In 2019, a lower percentage of residents required dietetic input: 45% (69 out of 152 beds) compared to 92% (69 out of 75 beds) in 2023. Annual referrals saw an increase from 133 in 2020 to 164 in 2022, then a decrease to 146 in 2023. The average caseload returned to pre-COVID rates in 2023, with 69 residents, compared to a higher caseload from 2020 to 2022, ranging from 74 to 82 residents. The dietetic waiting list grew from 5 in 2019 to 21 in 2023.

Conclusion
The data indicates a growing need for nutritional referrals and monitoring for our residents. This reinforces the recommendation of at least one WTE dietitian per 100 nursing home beds. Additionally, it underscores the necessity for more designated care staff with nutritional training to meet the dietary needs of our older persons in residential care.
Balanced: An Evaluation Of A Newly Established Older Adult Exercise Class
Authors: O'Brien Edwina , Conroy Bronagh , Minogue Annemarie , Collins Enda , O'Donnell Marie 
Published: September 2024

Abstract

Background
Falls are common in older adults and one of the leading causes of morbidity and mortality globally. Evidence based falls exercise programme have been proven to reduce the risk of falling in community dwelling older persons. This study aimed to evaluate the impact of a new falls exercise class for community dwelling older adults.

Methods
This class was based on the Falls Management Exercise (FaME) programme model, implemented by a trained Physiotherapist and Exercise Instructor. It consisted of a twenty-six-week programme which included a once weekly supervised group exercise class (1hour) supplemented by a twice weekly home exercise programme. Participants were recruited from primary care services based in the local region. Those who met the inclusion criteria were assessed by a physiotherapist who collected basic demographic data. A range of outcome measures were completed pre and post intervention, assessing motor and behavioural domains. Participant feedback was collected. Data was analysed using SPSS.

Results
Eleven participants completed this programme. The mean age was 78 years old and 73% of participants were female. Participants completed an average of 22 out of 26 classes. The number of falls reported reduced from 0.8 pre intervention to 0.1 post intervention (p 0.03). Timed Up and Go improved from a mean of 11.28 seconds pre intervention to 9.06 seconds post intervention (p 0.02). Mean Health Today Score was 73.2% pre intervention improving to 82.3% post intervention (p 0.05). Participant feedback was positive.

Conclusion
This study demonstrated the significant positive impact of an evidence-based exercise class on our participants functional ability, quality of life and reducing falls. This is a preliminary evaluation and analysis of further data is essential. These classes may assist in reducing demands on acute healthcare services and should continue to run and be further investigated.
Community Connector Pilot – Review Of A Non-Clinical Programme Within An Integrated Care Programme For Older Persons Team
Authors: Hannan Tina , Sieger-Jamison Lisa 
Published: September 2024

Abstract

Background
A Community Connector is a specialist Social Prescriber for older individuals who often present with complex medical needs and are referred directly by an Integrated Care team. The programme is a collaborative model between this team and a respective community host organisation. Integrated Care, as part of the Sláintecare Programme, places a stronger emphasis on social supports and person-centredness as key elements in healthcare (Goodwin, 2013).

Methods
Referrals are received approximately two to three weeks prior to discharge from the Integrated Care team which allows for relevant feedback from the Community Connector to this team. A coaching approach is utilised as a way of exploring each participant’s individual priorities and their expressed interests and goals in order to enhance their awareness of resources and supports in their own community and their subsequent readiness to engage. This process involves co-creating a personalised wellbeing plan with each individual which can act as the basis for a joint learning journey together.

Results
On referrals received to the programme, ongoing data is recorded regarding the number of individuals participating, the activities undertaken and the outcomes affecting the wellbeing of participants. Social isolation is a key reason for referral among this cohort in addition to cognitive stimulation, reengagement in social outlets and carer stress. Programme participants continue to be referred to a range of community activities, programmes and supports. Preliminary findings show an increase in community connectedness in regard to individuals’ increased knowledge and subsequent participation in local activities.

Conclusion
Key qualitative and quantitative data are the basis for initial and ongoing evaluation of the programme. These include recording any reflections and challenges which then act as key learning tools in delivering a unique person-centred programme for older individuals.
Review of Current Early Bed Positioning Practice by Occupational Therapists With Patients Post-Acute Stroke
Authors: Whyte Ella , Sinnott Eimear , Hunt Lauren , O'Sullivan Eve 
Published: September 2024

Abstract

Background
Many patients experience varied degrees of physical impairments post stroke, which can impact their ability to adjust their posture and position independently. National guidelines state that positioning should be assessed promptly and within 4 hours of arrival to hospital (National Clinical Guideline for Stroke for the UK and Ireland, 2023). Therefore, occupational therapists (OTs) working in stroke should prioritise positioning as early as possible within the intervention process. Aim: To highlight current practice and appraise in line with clinical standards to promote the importance of early bed positioning for acute stroke patients.

Methods
A two-month audit on positioning intervention by OTs was completed locally. Data was collated on a secure logbook.

Results
59 patients were admitted with a stroke between January and February of 2024. 15 patients required bed positioning. Only 2 patients received bed positioning on initial assessment. Documented reasons for not completing bed positioning included time constraints, pain, and resources.

Conclusion
OTs are not meeting current standards in relation to bed positioning in SVUH. Time constraints, referral times and staffing were highlighted as contributing factors. A service development opportunity was identified and rolled out during the completion of this audit. Implications for practice: Ward based education and an information resource booklet on bed positioning was provided to the staff on the stroke ward. This has prompted a review of the OT initial assessment form to include bed positioning as part of the assessment, and the development of a positioning guidelines hand-out for the stroke interdisciplinary team to implement upon admission.