bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Cerebrospinal Fluid Biomarkers To Enhance Diagnostic Testing For Alzheimer's Disease In A Tertiary Memory Service
Authors: Crowe Andrew , Garcia-Gallardo Angela , Ferguson Damien , Dunne Jean , Hutchinson Siobhan 
Published: September 2024

Abstract

Background
Cerebrospinal Fluid (CSF) biomarkers are useful in the definitive diagnosis of Alzheimer’s disease (AD) when basic investigations and neuroimaging are inconclusive. In our tertiary memory clinic, the standard CSF biomarker panel consists of Amyloid Beta (AB) 42, Total tau, and Phosphorylated tau. AB42/40 is an additional CSF biomarker which has been shown to improve diagnostic accuracy for AD but is not part of our standard CSF biomarker panel (1). We examined the use of AB42/40 in patients attending our service.

Methods
In our service, diagnosis of dementia is based on a multidisciplinary consensus meeting (including Geriatricians, Neurologists, Psychiatrists) who review clinical presentation and neuroimaging. In a minority of cases, CSF analysis is performed. We retrospectively evaluated how the addition of AB40/42 to our standard CSF panel impacted diagnostic accuracy for AD, taking a ratio of &lt;0.067 to indicate AD (2).

Results
Of 1853 patients attending the Memory service between September 2022 and December 2023, CSF was available for 107 patients. Of these 107, average age was 68. 56 were female (52%) and 51 were male (48%). At the multidisciplinary consensus meeting, 81 of these 107 patients were diagnosed with AD (75%), with the remaining 26 (24%) patients being diagnosed with a non-AD process (Vascular disease, Lewy Body etc) or an inconclusive diagnosis. After the addition of AB42/40 to CSF, 8 of the 26 patients (31%) with non-AD or an inconclusive diagnosis were identified as potential AD. Of the 81 with a diagnosis of AD, none were reclassified after addition of AB42/40. Receiver Operating Characteristic (ROC) curve analysis was performed to determine relevant cut off values.

Conclusion
This study suggests the addition of AB42/40 ratio to our standard CSF biomarker panel improves identification of potential AD cases in our sample. This biomarker is being added to the standard CSF panel for our Memory service.
Retracted: A Pre-Hospital Prediction Tool for Stroke Type Utilising Machine Learning Techniques
Authors: McDermott Clodagh , Krewer Finn , O'Donnell Martin 
Published: September 2024

Abstract

Background
Stroke is a leading cause of death worldwide and leaves most survivors with permanent disability. 12.2 million people suffer strokes annually, of which 70% occur in low- and middle-income countries (LMIC). Stroke presents diagnostic challenges which limits access to effective, but time-sensitive, reperfusion therapies. Currently, stroke is diagnosed by the combination of clinical symptoms and signs and brain imaging. The aim of this study was to develop clinical prediction tools, for differentiating acute ischemic stroke (AIS) and intracerebral haemorrhage (ICH) in the pre-hospital setting without neuroimaging, utilising machine learning (ML).

Methods
We included 5349 patients with confirmed acute stroke who presented within 6 hours of symptom onset, from the INTERSTROKE case-control study. We compared predictions using six commonly used ML algorithms for classification i.e. multivariate logistic regression (MLR), k-nearest neighbour (KNN), support vector machine (SVM), neural networks (NN), random forests (RF), XGBoost. Algorithm inputs included medical history, symptoms and signs, and point-of-care blood tests, with an output of final diagnosis.

Results
The training cohort included 4280 patients with 3084 ischemic stroke and 1196 ICH cases, and the test cohort included 1069 patients with 771 ischemic stroke and 298 ICH cases. From 174 potential variables, we used univariate analyses to select 52 candidate variables for inclusion in the ML algorithms. These were selected based on their ability to predict (p &lt; 0.20) stroke subtype. The AUCs in the test cohort for each of the ML classification models were: MLR 0.819, KNN 0.795, SVM 0.802, NN 0.814, RF 0.814, and XGBoost 0.807.

Conclusion
ML models showed great potential to predict stroke type at the prehospital stage and have comparable predictive abilities to previously developed ML prediction tools. This may facilitate point-of-care decisions and management of stroke in the pre-hospital setting in the future.
Right Care, Right Time, Right Place: Real-life Challenges in Delivering Sláintecare – A Multi-Centre Survey of Multidisciplinary Team Members
Authors: Murphy Robert Allan , Ward Andrea , Moran Fionnula , Walsh Mary , O'Connor Marie 
Published: September 2024

Abstract

Background
Sláintecare launched in 2018 seeks to reform the delivery of healthcare services in Ireland towards equity of access based on patient need1. However, delivering the right care, in the right place at the right time is, as yet an aspirational goal. We sought to identify the on-the ground challenges that exist in delivering Sláintecare in the day-to-day practice of multidisciplinary team members.

Methods
An online survey questionnaire was distributed to medical social workers, occupational therapists, and physiotherapists. Respondents were asked about their experience in applying for community-based care in their practice including home care packages, community occupational therapy and home equipment. Descriptive statistics were applied to numerical data and a thematic analysis was performed on free text responses.

Results
There were 31 respondents from 10 clinical sites including acute and rehabilitation settings. All nine community healthcare organisations (CHOs) were represented. 29/31 (94%) felt that access to community-based care differed based on the patient’s residential address. 23/31 (74%) stated the referral documentation and process for home care packages varied depending on the patients’ CHO. Qualitative analysis identified three core themes; Unfulfilled care hours due to dearth of carer availability differed across CHOs; inconsistencies in the application process that exists between CHO’s and incongruities in the availability of and accessibility to publicly funded services on hospital discharge.

Conclusion
Our survey highlights the practical challenges of delivering Sláintecare currently. It reinforces the health inequities that limits patients’ ability to access quality healthcare because of their geographical location.
A Biomarker Signature Associated With Future Functional Decline And Outcomes On The Frailty-Disability Cascade
Authors: Hernandez Belinda , McCrory Cathal , Kenny Rose Anne , O'Halloran Aisling 
Published: September 2024

Abstract

Background
Biological ageing is a dynamic and heterogeneous process that occurs due to dysregulation at the molecular, cellular, physiological and functional level, manifesting in functional decline. We investigated whether biomarker data across a range of biological systems predicted incident functional decline and frailty-disability cascade outcomes.

Methods
Secondary data analyses were performed on n=4,961 participants aged 50+ years from waves 1-5 of The Irish Longitudinal Study on Ageing (TILDA). We examined 18 blood biomarkers representing key systems that become dysregulated with ageing (inflammatory, cardiovascular, metabolic, renal, cognitive, musculoskeletal and senescence). Model-based clustering classified participants as belonging to one of three biomarker signatures - low, medium and high risk. These biomarker signatures were utilized to predict 4-year functional decline (grip strength, timed up and go test (TUG) and gait speed) using mixed effect models; 8-year frailty and disability using logistic regression models; and 12-year mortality using Cox-Proportional Hazard models. All models were adjusted for age, sex, education, smoking history, lipid lowering and anti-hypertensive medications.

Results
The prevalence of the low, medium and high-risk groups was 58.5%, 9.2% and 32.3%. Medium and high-risk biomarker signatures had progressively increased hazard of 12-year mortality (HR:1.54, 95%CI:1.13-2.10) and (HR:1.89, 95%CI:1.53-2.34) respectively. Participants with the high-risk signature also had significantly higher odds of 8-year incident frailty (OR:2.1, 95%CI:1.60-2.74) and disability (OR:1.72, 95%CI:1.30-2.29), with the medium-risk group showing attenuated associations. The biomarker signatures had a dose response relationship with functional decline; with the high-risk group having lower grip strength, slower walking speed and higher time to complete the TUG over 4-year follow-up (p&lt;0.01). Findings were replicated in a US cohort.

Conclusion
We report a unique biomarker signature that was consistently associated with mortality, incident frailty and disability, and functional decline. This signature may be a useful early indicator and risk stratification tool to predict future functional decline and frailty-disability cascade outcomes.
Parkinson’s Disease (PD) Management in a Tertiary Irish Hospital
Authors: Gibbons Ciara , Dwyer Brendan , Geraghty Tim , O'Riordan Sean , Williams Laura , Hughes Graham 
Published: September 2024

Abstract

Background
There is no Irish platform for operationalizing services for People with Parkinson’s and associated disorders (PwP). The UK-wide Parkinson’s clinical audit was developed in 2009, to address concerns about the quality of care provided to PwP. Our aim was to use the UK Parkinson’s Audit cycles to drive quality improvement in our service, providing the first Irish data on quality of care for PwP.

Methods
The audit’s service descriptor was completed in June 2022. A sample of PwP attending Movement-Disorder clinics completed patient reported experience measure questionnaires between May - July 2022. We retrospectively collected patient data using the audit tool, which was submitted electronically. This was directly compared to our service audit data from 2019.

Results
In 2019, we included 30 patients in our audit – average age 67yrs, 57% male, 100% Caucasian, average duration PD 7yrs. In 2022, we included 40 patients of similar demographics. The data collected showed our services had improved or remained stable across all domains from 2019 to 2022 including medication documentation, advanced care planning, multi-disciplinary team input, non-motor, activities of daily living and bone health assessments. The service user experience remained unchanged. In 2019, our service fell in the lowest quartile of standards amongst the cohort of services audited. We improved to the top half of services audited in 2022. This was achieved by mentoring from exemplar UK services, generating a proforma to standardize assessments in outpatients, providing information to clinicians regarding local services and engaging with patients in an annual ‘Have Your Say’ day.

Conclusion
Our data demonstrates that repeated national audit cycles, with the patient voice at the centre, are crucial in driving quality improvement across services for PwP. As the only Irish participant in the Parkinson’s UK Audit, it's clear a National Irish Audit would be the first step in optimizing care for PwP nationally.
An Occupational Therapy Functional Upper Limb Group Programme on the Acute Stroke Unit: A 3 Month Pilot
Authors: Shinners Dylan , Concannon Emma , McDonagh Philip 
Published: September 2024

Abstract

Background
The 2023 National Clinical Guidelines for Stroke recommend that stroke survivors with motor recovery goals should receive a minimum of 3 hours of rehabilitation 5/7 days a week (National Clinical Guideline for Stroke for the UK and Ireland, 2023). Schneider et al (2019) deem it feasible for stroke survivors to undertake extra upper limb practice (including group sessions) to support in achieving upper limb motor recovery goals. With staffing limitations, creative methods of intervention delivery must be adopted to enhance usual intervention sessions.

Methods
In an Irish hospital, a pilot project hypothesised the benefit of two one-hour Occupational Therapy functional upper limb group intervention sessions to support adherence to effective weekly dosage of upper limb motor recovery. An audit was completed on dosage of usual Occupational Therapy intervention, prior to group formation. Seven patients were identified with an average daily dosage of 35.4 minutes of usual intervention (5/7 days a week). Two one-hour group sessions were adopted in conjunction with usual therapy. Group intervention dosage was recorded. Patient self-reported satisfaction was obtained using a ten-point Likert scale.

Results
A total of twenty-nine patients, over 3 months, attended Occupational Therapy upper limb group interventions during an admission on the Acute Stroke Unit. The addition of two one-hour group intervention sessions supported an average actual increase in dosage of 113 extra minutes per week (36.15% increase). There was a 95% self-reported satisfaction rate among patients.

Conclusion
The addition of two one-hour Occupational Therapy functional upper limb groups increased upper limb motor recovery dosage by 113 minutes per week. Group intervention was a feasible tool that can be used on an Acute Stroke Unit in conjunction with usual therapy to support motor recovery guideline adherence and patient satisfaction. Despite these efforts, patients are not receiving the recommended daily intensity as highlighted by National Clinical Guidelines.
Redesigning Community Dwelling Geriatric Integrated Care Program for Better Care Co-Ordination and Health Outcomes
Authors: Marion Ikhwan , Cribbin Derek 
Published: September 2024

Abstract

Background
Existing health services and care models need to adapt to the increasing ageing population, multimorbidity, and frailty. Thus, diverse healthcare providers and caregivers are demanded to continue living at home. An Integrated Care Program, involving a multidisciplinary team with a patient-centred focus, is being promoted as an alternative model of care. However, uncoordinated existing services put them at risk of fragmented care, leading to adverse outcomes. This study aimed to fill gaps in previous ICP research by introducing a change roadmap into the implementation phase of the program. In addition, the study proposed evaluating the effectiveness and implementation of the pilot project together with the process evaluation.

Methods
The study conducted a systematised literature review to examine the outcomes and different structures of the ICP. Implementation Science was utilised to define, design, and deliver the model of change.

Results
A systematised literature review showed that most ICPs were led by an Advanced Nurse Practitioner with positive outcomes. SWOT analysis, stakeholders’ involvement, existing community service providers, and a population survey provide an in-depth perspective of the target population and set up contextually adapted implementation strategies. An ANP-led MDT was proposed to co-ordinate the ICP. A process evaluation to assess the care model together with health outcomes was outlined.

Conclusion
The study showed that ANP-led MDT, person-centred, co-ordinated care provides the best ICP implementation strategy. The study will further understand the ICP implementation process among frail older people in the community.
Understanding Therapeutic Lying In The Care Of A Person with Dementia: An Evolutionary Concept Analysis
Authors: Long Shirley , Murphy Catriona , Irving Kate 
Published: September 2024

Abstract

Background
Therapeutic lying, described as any verbal or non-verbal behaviour or communication that involves the manipulation of information has been shown to be pervasive in dementia care. However, its theoretical foundation is difficult to underpin and appears to have evolved through practice without a clear definition. The aim of this study is to establish conceptual clarity around the concept of therapeutic lying in the care of a person with dementia.

Methods
Rodgers’ evolutionary concept analysis was used to focus on the contextual qualities of therapeutic lying. This dispositional view recognises that concepts are fluid in nature. The analysis involves deconstructing the concept into surrogate terms, attributes, antecedents, consequences and related terms to generate a greater understanding of its innate features. A systematic search relating to “therapeutic lying” and “dementia” was undertaken. The final study sample consisted of 37 papers.

Results
This analysis revealed therapeutic lying’s surrogate terms, attributes, antecedents, consequences and related terms in the care of a person with dementia. This study highlighted this concept is intended to be used in the person's best interests, for the purpose of doing good. However, its subjective nature makes it an extremely difficult concept to grasp collectively.

Conclusion
Therapeutic lying is highly dependent on individual interpretation and the caregiver’s moral compass. It can potentially damage trust in a caring relationship and may contribute to the “othering” of a person with dementia. The negative consequences surrounding this concept must be studied comprehensively before it is considered in practice. Therapeutic lying should be used only as a last resort when a person with dementia is exhibiting truth related distress. As the therapeutic effect of a therapeutic lie cannot be guaranteed, the term “well intentioned lying” is proposed as a potential alternative for the concept as this term highlights the caregiver’s good intention behind incorporating a lie during care.
Assess, Diagnose and Intervene: Are Hospital Based Out-patient Frailty Intervention Teams Perfectly Positioned to Prevent the Frailty Crisis?
Authors: Cooney Hazel , O'Mara Gerard , Donlon Kate , Burke Sandra 
Published: September 2024

Abstract

Background
This Frailty Intervention Team (FIT) is relatively novel in the sense that it is a hospital based multidisciplinary team (MDT) that provides an outpatient service to community based frail adults. Its main source of referral is from General Practitioners (GP)1, with the average Clinical Frailty Score of those assessed being 4.98 (4.91 men, 5.05 women) 1. Indicating that the mean service user is ‘Living with Mild Frailty’2. Our objective was to establish if this model of service provision is identifying any new diagnoses and what interventions it provides. Our overarching aim is to establish ‘what we are adding to the patient journey’.

Methods
3 independent researchers came together to develop a database for the service that would record new diagnoses made, medical & non-medical interventions provided and frequency of on-wards referral. Standard definitions and codes were agreed upon, and the information inputted by patients facing staff on a daily basis. A descriptive data analysis of this database was carried out after the first quarter.

Results
51 new patients were assessed in 4 months. Of these patients, 37.25% of cases received new diagnoses; Parkinson’s disease (15.68%), Orthostatic Hypotension (11.76%), Cognitive Impairment / Dementia (11.76%) and Idiopathic Normal Pressure Hydrocephalus (iNPH) (5.88%). Subsequently 62.74% had changes made to their medications. 96.08% of new service users received at least 1 non-medical intervention. Onward referral was made for 58.82% of service users, to a total of 22 organizations. The total amount of onward referrals made was 54. 51 new patients were assessed in 4 months.

Conclusion
A hospital-based frailty intervention team adds value to a patient’s journey as it is perfectly placed to make rapid diagnosis due to their MDT nature and access to diagnostics. Furthermore, it provides immediate intervention and appropriate onwards referral. Is this a model of service provision that should be made more readily available nationally?
Assessing Direct Oral Anti-Coagulant And Therapeutic Low Molecular Weight Heparin Prescriptions At A University Teaching Hospital
Authors: Alanza Uchechukwu , Azani Faysal , Samhari Atiq Analily Anwar , Ruane Caitriona 
Published: September 2024

Abstract

Background
A 2017-2018 survey identified anti-thrombotics as the most commonly implicated agents in reported medication incidents across Irish acute hospitals [State Claims Agency, 2020, Medication Incidents Report (2017-2018)]. Of the top 10 anti-thrombotics reported, 2 were Low Molecular Weight Heparins (LMWHs) and 3 were Direct Oral Anti-Coagulants (DOACs). 3 years after the survey results were published, we audited our hospital's compliance with the Health Service Executive's guidelines for prescribing DOACs and LMWHs.

Methods
Over 3 consecutive weeks, data was collected by doctors and clinical pharmacists across 6 wards and the intensive and coronary care units. In-patients on a DOAC or therapeutic LMWH were chosen for kardex and laboratory result review.

Results
83 patients were included. The average age was 79 years. 81%(n=67) were on a DOAC. 91% were being treated for non-valvular atrial fibrillation (NVAF), 3% for pulmonary embolism (PE), 3% for deep vein thrombosis and 3% had no indication documented. 33%(n=22) had indications for dose reduction but only 77%(n=17) of them were prescribed the appropriate reduced dose. 3%(n=2) had no dose reduction indications but were inappropriately prescribed a reduced dose. 3%(n=2) were on dialysis, 1%(n=1) had their creatinine clearance persistently below 15ml/min and 1%(n=1) inappropriately received once daily dosing of apixaban for 3 days. 19%(n=16) of all participants were on therapeutic LMWH. Treatment indications included acute coronary syndrome in 63%, suspected PE in 19%, newly diagnosed NVAF in 6% and bridging anti-coagulation while a DOAC is temporarily held in 13%. 6%(n=1) were inappropriately prescribed an under-dose.

Conclusion
Overall, there was an error rate of 16%(n=11) in DOAC prescriptions and 6%(n=1) in LMWH prescriptions. To address this, we propose an educational intervention for prescribers and the introduction of e-prescriptions with built-in alerts for errors. We plan to re-audit once these recommendations are implemented.