bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can A Swallow Screen Score Be Used To Prioritise Dysphagia Assessments By A Speech And Language Therapist?
Authors: Maher Jennifer , Sayers Karen , King Lorna , Ryan Siobhan , Donnellan Christina 
Published: September 2024

Abstract

Background
Dysphagia refers to any difficulty or discomfort associated with eating or swallowing. The prevalence is 10-50% in older persons and is associated with increased dependency and mortality. A non-validated Swallow Screen (SwSc) is used by a Community Specialist Team (CST) for older persons during Comprehensive Geriatric Assessment (CGA) to identify patients requiring Speech and Language Therapy (SLT) referral. The SwSc comprises 7 questions with “yes” or “no” answers. “Yes” answers score 1 point and “no” score 0. The SwSc score is the sum of these points. Higher scores indicate the presence of more symptoms of dysphagia. Patients with a SwSc score ≥1 are referred to an SLT. This study aimed to investigate if a higher SwSc score might indicate more severe dysphagia requiring more urgent assessment by an SLT.

Methods
This was a retrospective cohort study of patients ≥64 years referred to SLT by a CST from June 2023 to April 2024 inclusive. The SLT assessment included a Dysphagia Outcome Severity Scale (DOSS) score. The DOSS score ranges from 1-7, a lower score indicating a more severe dysphagia. Data was entered onto an Excel database and analysed. Biographical and CGA data was analysed using descriptive statistics. The SwSc and DOSS scores were ranked and compared using Spearman’s Rank Correlation Coefficient.

Results
Thirty-nine patients attended an SLT assessment. The mean age was 78, (SD=8.04). The mean Clinical Frailty Score 5 (SD=1.16) and mean modified Barthel Index score 16 (SD=3.75). There was a negative correlation between the SwSc and DOSS scores, r (37) = -.438, p=.005. Higher SwSc scores were associated with lower DOSS scores, indicating more severe dysphagia.

Conclusion
The SwSc can be easily administered by non-SLT clinicians. It may be used by an SLT to aid prioritisation of patients for assessment. Further research with a larger sample is required to establish its validity.
Cultivating A Culture Of Continuous Improvement And Teamwork In An ICPOP Hub
Authors: McGrath Keith , McAuliffe Eileen , Lewis Natasha , Murphy Claire , Lombard Eileen , McGrath Vera , O'Leary Rachel 
Published: September 2024

Abstract

Background
The Integrated Care for Older Person’s (ICPOP) Hub is one 3 Hubs in the healthcare region. The success of the ICPOP Hub has been the adaptability, motivation, dedication of the multi-disciplinary team (MDT) using inter-disciplinary methods to achieve best outcomes for people with frailty and complex multi-morbidity in the Community. Referrals have increased - 406 in 2023. There were 2,754 direct patient MDT contacts in 2023. Medical capacity for new patients is limited. Alternative ways of working were needed to meet increasing demand.

Methods
Quality improvement methodologies were employed to enhance efficiency. Existing practices were mapped, deficits highlighted. New practices were trialled in plan-do-study-act format.

Results
The MDT collaborated to develop structured pathways for Falls and Memory. Criteria were established for triaging referrals, assessment standards, management, post diagnostic support using national/international guidelines (Model of Care for Dementia in Ireland, World Falls Guidelines). More patients were seen via direct-to-MDT pathways and discussed at bi-weekly meetings. Direct referral pathway was instituted from the acute hospital Emergency Department (ED) Frailty Front Door Team to the Hub MDT. ‘One-stop-shop’, multiple, consecutive assessments, while comprehensive, resulted in significant patient fatigue. Moving to parallel assessment reduced appointment frequency and time in the Hub. Staff learned from other disciplines and translated knowledge/skills to tailored patient plans. Case management has prevented ED attendance, particularly for patients with delirium and/or dementia with non-cognitive symptoms. Early integration with Community/Voluntary groups was crucial. Visits from these groups promoted education and relationship building. The Community Connector role has been instrumental in linking people with wellbeing activities in their community. Challenges: Blurring boundaries between roles. Insufficient medical cover represents a barrier to timely patient assessment/management, obstacle to early hospital discharge. Demands on MDT intensify daily.

Conclusion
Enthusiasm, flexibility, ownership, teamwork, distributed leadership were essential in developing pathways and overcoming difficulties.
A Systematic Review Of Medication Knowledge In Older Adults
Authors: Malomo Keneilwe , Ntlholang Ontefetse 
Published: September 2024

Abstract

Background
Medication knowledge, as defined by six aspects, is the person's awareness of their medication name, dose, purpose, adverse drug reaction (ADR), administration schedule and special instructions, is essential in the older patient's treatment journey. This review aimed to assess medication knowledge in older adults.

Methods
A systematic search of six electronic databases, grey literature and citation indexes included studies conducted in any setting or any country on those 65 or older, published over the last ten years, reporting primary data with full-text access, and assessing patients' six aspects of medication knowledge. Joanna Briggs Institute Critical appraisal tool was used to evaluate quality of studies.

Results
Of the 67871 articles searched, only 10 cross-sectional studies were included. Medication knowledge data was collected from pharmacies, community, general practices and outpatient clinics. Surveys used face-to-face interviews and electronic, written, and mail questionnaires. Five studies assessed knowledge on single medications. None assessed all six aspects of medication knowledge. One study assessed five aspects, while the rest assessed fewer aspects. The percentage of those who knew their medication names ranged from 41.9% to 97%, dose 19.4%, purpose 15% to 90%, administration schedule 65% to 92.6%, ADR 42% to 80% and special instructions 32.4% to 94.8%. Data lacked the source of medication knowledge or evidence of a patient-centred care approach. There were repeated calls for further education and research.

Conclusion
Research indicates that older adults have a mixed knowledge of their medications, with some areas well grasped and others lacking. Additionally, it appears that medication knowledge is not thoroughly evaluated initially. Despite ongoing advice to employ all six aspects of medication knowledge for assessment and education enhancement, no progress is seen in older adults' medication knowledge. Therefore, there's a need for better research that anticipates the application of these six aspects, concentrating on education for older adults or their caregivers through patient-centred methods.
Teiripe sa Bhaile: ICPOP Early Supported Discharge for Frailty
Authors: Kenny Bláithín , Nee Rory , Laycock Berneen , Hogge Eilish , O'Neill Niamh , Clarke Enda , Keating Sharon , Quinn Aoife , O'Shea Joan , O'Toole Ronan , Bradley Eoin , Higgins Aislinn 
Published: September 2024

Abstract

Background
Older adults and particularly older adults with frailty are high users of acute hospital care which results in overall higher hospital costs and reduced functional independence. Early supported discharge (ESD) was found to have a statistically significant impact in reducing length of stay in older adults admitted for medical reasons. This poster outlines the rehabilitation pathway developed by an ICPOP team to provide early supported discharge for frail older inpatients with SMART rehab goals.

Methods
Suitable patients are identified and assessed prior to discharge from the acute ward. Each patient receives a comprehensive geriatric assessment in their own home. All patients receive at least 2 hours of therapy per week until they have reached their goals. Standardised outcome measures including Functional Assessment Measure (FIM/FAM) and EQ5D5L are captured for each patient. Clients are discharged once they have reached their goals or are at their new functional baseline.

Results
52 patients have been seen on this pathway since 2023. Hip fracture was the most common reason for referral, followed by Falls. Average length of stay on service was 40 days. Average wait time to first assessment was 1.7 days, highlighting the responsiveness of the service. 4 patients seen in 2024 live alone, indicating this service is also appropriate for patients who don’t have supports readily available in the home. FIM/FAM scores increased from 148 to 160 on average- Indicating more functional independence.

Conclusion
This ICPOP Rehabilitation pathway offers a safe, person-centred alternative to traditional inpatient rehabilitation. Readmission rates post discharge were low indicating the programme's safety. Given the large number of hospital bed saved without compromising functional outcomes for the patients, the ICPOP team is working on expanding this pathway.
The Role of the Acute Occupational Therapist in Patients Returning to Driving
Authors: Lawlor Amy , O'Broin Ruairi , Delaney Aidan , McNally Sarah 
Published: September 2024

Abstract

Background
Drving evaluation is a complex process in which Occupational Therapists (OTs) are often viewed as ideally suited to assist with given our extensive cognitive and upper limb assessments and interventions. As per National Guidelines, health professionals have an ethical obligation, and potentially a legal one, to give clear advice to the driver in cases where an illness or injury may elevate risk of impairment while driving. At present, a pathway does not exist to guide OTs on the extent of our role in supporting patients who plan to return to driving; thus, it remains unclear what is current practice for OTs working in the acute setting.

Methods
We completed a cross-sectional survey to determine current practice among the Dublin Academic Teaching Hospitals.

Results
42 occupational therapists across 9 different specialities with varying levels of experience, from new staff grade to clinical specialists responded to the survey. The survey identified several commonly perceived areas of ambiguity for acute OTs, including, (1) if their workplace has a policy or pathway on the subject and, (2) the Road Safety Authority’s Guidelines for healthcare professionals in relation to medical fitness to drive. It highlighted a lack of knowledge in relation to onward services OTs can and/or should be linking their patients with for outpatient follow-up.

Conclusion
It is evident that there is a distinct lack of knowledge among acute OTs in our role in patients returning to driving following an inpatient admission. Additionally, it highlights a need for a resource to bridge this gap and for future work in building a clinical pathway to minimize ambiguity in this area and ensure we are delivering a service that is both legally and morally sound and fulfilling our duty of care.
Optimising Emergency Care for Older Adults: A Case Study of the EDITH Service Following a Proximal Humerus Fracture
Authors: Doyle Cliona , Davis Aisling Jane , Doran Arthur , Hillery Patrick , McNamara Rosa , Delaney Aidan 
Published: September 2024

Abstract

Background
The Emergency Department in the Home (EDITH) service offers emergency Occupational Therapy and medical assessments to older adults at home, thus negating the need for hospital attendances. Mr X, an 86-year-old with vascular dementia and hypertension, sustained a left proximal humerus fracture from a fall. Following assessment in the ED, Mr X was deemed fit for discharge and was referred to EDITH for an acute functional assessment and clinical review.

Methods
Within 72 hours of discharge, Mr X was visited at home by an Occupational Therapist (OT) and an Advanced Nurse Practitioner (ANP). The OT conducted a home environment assessment, falls-risk screening, delirium screening, reviewed social supports, and performed a functional assessment. Education on one-handed dressing techniques and falls prevention was provided. The ANP conducted a clinical review, and reviewed Mr X’s medication and analgesia. Mr X had the support of his wife to assist with Activities of Daily Living (ADLs), functional mobility and medication management. Mr X’s son purchased assistive equipment recommended by the OT, to enhance home safety. Referrals were made to the local memory support service, a Physiotherapist, and his Public Health Nurse to organise formal care supports.

Results
Mr X remained at home with support from his wife, primary care services, and virtual EDITH follow-up. Mr X had a scheduled review at the fracture clinic following his ED attendance.

Conclusion
Emergency care practitioners play a crucial role in addressing acute functional and clinical changes in older adults attending the ED. Supported ED discharges and service integration during the acute phase can prevent hospital admissions. Collaboration between emergency medicine and primary care is essential for addressing acute medical needs and long-term functional outcomes. With adequate social support and timely services, older adults can recover successfully at home.
Medication Use and Falls Risk in Older Adults: Insights from our Integrated Care Programme for Older Person’s Service
Authors: Nash Karen , Wade Ruth , Connolly Warren 
Published: September 2024

Abstract

Background
Falls pose a critical public health challenge for the elderly, often resulting in severe injuries and complications. Some medications have been identified as potential risk factors for falls in this demographic. The National Integrated Care Programme for Older People has prioritised the development of specialised services targeting frailty, dementia, and falls management to address this concern.

Methods
We conducted a retrospective chart review of older adults to explore the relationship between medication use and falls risk. Data on recurrent falls, polypharmacy (defined as concurrent use of five or more medications), and fall frequency were extracted from medical records. Logistic regression analysis assessed the association between STOPPfall medication use and falling risk, calculating odds ratios and p-values to determine significance.

Results
The study cohort comprised 71 older adults, with a median age of 84 years (range 66-95 years), of whom 69% were female. Among the participants, 79% reported experiencing recurrent falls, highlighting the prevalence of this issue within the sample. Additionally, a substantial proportion (90.1%) exhibited polypharmacy, indicating the commonality of multiple medication use among the elderly population studied. Antihypertensives were prescribed to 42 patients (59%), antidepressants to 26 patients (37%), opioids to 15 patients (21%), benzodiazepines to 12 patients (17%), and antiepileptic drugs to 4 patients (6%). Logistic regression analysis demonstrated a significant association between the use of STOPPfall medications and the risk of falling, with an odds ratio (OR) of 1.84 (95% CI: 1.11-4.23, p =0.044).

Conclusion
These findings underscore the importance of medication review and optimization in fall prevention strategies. Targeted interventions to reduce potentially harmful medication use identified by STOPPfall criteria may aid in fall reduction among older adults. Further research is needed to explore the efficacy of such interventions.
Combined LC-MS/MS feature grouping, statistical prioritization, and interactive networking in msFeaST
Authors: Mildau Kevin , Büschl Christoph , Zanghellini Jürgen , van der Hooft Justin J J 
Published: September 2024

Abstract

Summary
Computational metabolomics workflows have revolutionized the untargeted metabolomics field. However, the organization and prioritization of metabolite features remains a laborious process. Organizing metabolomics data is often done through mass fragmentation-based spectral similarity grouping, resulting in feature sets that also represent an intuitive and scientifically meaningful first stage of analysis in untargeted metabolomics. Exploiting such feature sets, feature-set testing has emerged as an approach that is widely used in genomics and targeted metabolomics pathway enrichment analyses. It allows for formally combining groupings with statistical testing into more meaningful pathway enrichment conclusions. Here, we present msFeaST (mass spectral Feature Set Testing), a feature-set testing and visualization workflow for LC-MS/MS untargeted metabolomics data. Feature-set testing involves statistically assessing differential abundance patterns for groups of features across experimental conditions. We developed msFeaST to make use of spectral similarity-based feature groupings generated using k-medoids clustering, where the resulting clusters serve as a proxy for grouping structurally similar features with potential biosynthesis pathway relationships. Spectral clustering done in this way allows for feature group-wise statistical testing using the globaltest package, which provides high power to detect small concordant effects via joint modeling and reduced multiplicity adjustment penalties. Hence, msFeaST provides interactive integration of the semi-quantitative experimental information with mass-spectral structural similarity information, enhancing the prioritization of features and feature sets during exploratory data analysis.

Availability and implementation
The msFeaST workflow is freely available through https://github.com/kevinmildau/msFeaST and built to work on MacOS and Linux systems.
Multiple glacial refugia during Pleistocene climatic oscillations shape the genetic pattern of Machilus thunbergii across East Asia
Authors: Jiang Kai , Xiao Yue-E , Gaitán-Espitía Juan Diego , Wang Zhengwei , Yu Shuo , Wang Rong , Hu Yonghong , Huang Weichang , Chen Xiaoyong 
Published: September 2024

Abstract
Pleistocene climatic oscillations caused periodic decline and rise of sea levels, leading to dispersion and retraction cycles of island flora. Yet, the role of island refugia in the current Sino-Japanese Floristic Region remains poorly understood. In this study, we investigated the population genetic structure of the widespread Sino-Japanese Floristic Region tree Machilus thunbergii to infer the potential impact of island refugia. We collected 1378 samples from 64 locations across the distribution ranges. Using chloroplast DNA and microsatellite markers, we found a pronounced genetic differentiation between mainland and island populations, which can be divided further into two and three groups, respectively. Furthermore, comparable numbers of private alleles and haplotypes are present in both mainland and island populations. No essential current gene flow was detected between mainland and island populations after their separation 14 000 years ago. Such patterns are hypothesized to result from the influence of multiple glacial island refugia during Pleistocene climatic oscillations, with limited pollen and seed dispersal of the species. Our findings underscore that the islands and submerged land bridge can act as refugia for plants during glacial periods and have essentially shaped the genetic structure of M. thunbergii populations.
A layered microcircuit model of somatosensory cortex with three interneuron types and cell-type-specific short-term plasticity
Authors: Jiang Han-Jia , Qi Guanxiao , Duarte Renato , Feldmeyer Dirk , van Albada Sacha J 
Published: September 2024

Abstract
Three major types of GABAergic interneurons, parvalbumin-, somatostatin-, and vasoactive intestinal peptide-expressing (PV, SOM, VIP) cells, play critical but distinct roles in the cortical microcircuitry. Their specific electrophysiology and connectivity shape their inhibitory functions. To study the network dynamics and signal processing specific to these cell types in the cerebral cortex, we developed a multi-layer model incorporating biologically realistic interneuron parameters from rodent somatosensory cortex. The model is fitted to in vivo data on cell-type-specific population firing rates. With a protocol of cell-type-specific stimulation, network responses when activating different neuron types are examined. The model reproduces the experimentally observed inhibitory effects of PV and SOM cells and disinhibitory effect of VIP cells on excitatory cells. We further create a version of the model incorporating cell-type-specific short-term synaptic plasticity (STP). While the ongoing activity with and without STP is similar, STP modulates the responses of Exc, SOM, and VIP cells to cell-type-specific stimulation, presumably by changing the dominant inhibitory pathways. With slight adjustments, the model also reproduces sensory responses of specific interneuron types recorded in vivo. Our model provides predictions on network dynamics involving cell-type-specific short-term plasticity and can serve to explore the computational roles of inhibitory interneurons in sensory functions.
Preferential Initiation of Long-Acting Injectable Versus Oral HIV Pre-Exposure Prophylaxis Among Women Who Inject Drugs
Authors: Roth Alexis M , Bartholomew Tyler S , Ward Kathleen M , Groves Allison , Mazzella Silvana , Bellamy Scarlett , Amico K Rivet , Carrico Adam W , Ironson Gail , Krakower Douglas 
Published: September 2024

Abstract
Fifty-five of 62 women who inject drugs (WWID) selected long-acting cabotegravir (CAB-LA) over oral PrEP, and 51/55 received a first injection. More recent injection drug use and number of sexual partners were associated with selecting CAB-LA (P &lt; .05). Findings provide preliminary evidence of a strong preference for longer-acting products among WWID.
3D-targeted, electrocardiographic imaging-aided stereotactic radioablation for ventricular tachycardia storm: a case report
Authors: Kaya Yeşim S , Stoks Job , Hazelaar Colien , van Elmpt Wouter , Gommers Suzanne , Volders Paul G A , Verhoeven Karolien , ter Bekke Rachel M A 
Published: September 2024

Abstract

Background
Stereotactic arrhythmia radioablation (STAR) is a promising non-invasive therapy for patients with ventricular tachycardia (VT). Accurate identification of the arrhythmogenic volume, or clinical target volume (CTV), on the radiotherapy (RT) 4D planning computed tomography (CT) scan is key for STAR efficacy and safety. This case report illustrates our workflow of electro-structural image integration for CTV delineation.

Case summary
A 72-year-old man with ischaemic cardiomyopathy and VT storm, despite two (endocardial and epicardial) catheter-based ablations, was consented for STAR. A 3D electro-structural arrhythmia model was generated from co-registered electroanatomical voltage and activation maps, electrocardiographic (ECG) imaging, and the cardiac CT angiography scan (in ADAS 3D), pinpointing the VT isthmus and inferoapical VT exit. At this location, an area with short recovery times was found with ECG imaging. A multidisciplinary team delineated the CTV on the transmural ventricular myocardium, which was fused with the 4D planning CT scan using a digital images and communication in medicine (DICOM) radiotherapy file. The CTV was 63% smaller compared with using the conventional American Heart Association 17-segment approach (11 vs. 24 cm3). A single fraction of 25 Gy was delivered to the internal target volume. After an 8-week blanking period, no VT recurrences or radiation-related side-effects were noted. Eight months later, the patient died from end-stage heart failure.

Discussion
We report a novel workflow for 3D-targeted and ECG imaging-aided CTV delineation for STAR, resulting in a smaller irradiated volume compared with segmental approaches. Acute and intermediate outcome and safety were favourable. Non-invasive ECG imaging at baseline and during induced VT holds promise for STAR guidance.