bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Audit of Carotid Dopplers in Sligo University Hospital
Authors: Altayyari Sarah , Butt Zaran , Eltahir Mohammed , Khan Mariam , O’Malley Grainne 
Published: September 2024

Abstract

Background
Stroke is a common and often disabling condition impacting thousands of individuals in Ireland annually 1. Timely screening for underlying etiologies is important in all patients presenting with stroke or transient ischaemic attack (TIA) to reduce recurrence risk. Carotid artery disease is frequently implicated as the cause 3. The 2023 National Clinical Guideline for Stroke for the United Kingdom and Ireland recommends carotid imaging be completed within one week of diagnosis of ischemic stroke or TIA for patients in whom potential carotid intervention would be appropriate. We aimed to assess the timing of Carotid Doppler scans in our hospital for patients presenting clinically with stroke or TIA.

Methods
The National Integrated Medical Imaging System (NIMIS) was used to generate a list of patients that had a Carotid Doppler scan over a six- month period (1st July 2022 to 31st December 2022). NIMIS was also used to identify the indication, setting, requesting department and timeliness of scans.

Results
A total of 96 Carotid & Vertebral Dopplers were performed. Majority of studies were performed on males (65%). The mean age of patients was 70 (±11.5) years. Most studies (55%) were done in an inpatient setting. Of all Carotid Dopplers performed, 94 (97%) had an appropriate indication. With regards to timeliness of carotid imaging, the median time from order to study completion varied between inpatients [2 days (IQR 1-3)] and outpatients [16 days (IQR 9-38)]. The majority (95%) of inpatient studies were completed within 7-days of order, while only 14% of outpatient studies were performed in this timeframe. Of the untimely outpatient scans done to investigate stroke or TIA, 2/33 (6%) had significant carotid stenosis.

Conclusion
Majority of Carotid Dopplers were done for appropriate indications. While inpatients studies were largely done in a timely manner, there is a significant delay in the completion of most outpatient studies.
The Assisted Decision Making (Capacity) Act 2015 in Action: Ireland East Hospital Group Marks 1 Year Milestone
Authors: Casey Amanda , Kilgannon AnnMarie 
Published: September 2024

Abstract

Background
In Ireland, the Assisted Decision Making (ADM) (Capacity) Act 2015 was enacted in April 2023. The Act supports a new progressive rights-based system of supported decision making that requires all healthcare staff to make some changes in their clinical practice. The Health Service Executive (HSE) developed an implementation plan to support organisations to meet the legislative requirements of the Act.

Methods
Assessing implementation progress across ten acute hospital sites using the HSE Implementation Framework (HSE, 2015). Progress was evaluated across seven thematic areas: Operational Implementation, Communication Strategy, Learning Strategy, Alignment of Current Operational Approaches, Quality and Compliance, Risk Consideration and Resources.

Results
Significant progress has been made across all seven domains with strong engagement from all sites. Acknowledging variation is important given the breadth of services provided across these hospitals. Implementation is an ongoing process given the cultural changes needed, the resource implications and the interplay with external stakeholders.

Conclusion
Further development in key areas includes tailoring education to suit the specific needs of individual units within hospitals and embedding this education into existing education programmes. It is crucial to monitor resource requirements and adapt to regulatory requirements to ensure compliance. Moving forward sustained efforts will be necessary to embed the principles of supported decision making firmly within healthcare delivery, ultimately promoting dignity and autonomy for all patients.
Gerontological Simulation Lab: Process Mapping a New Virtual Ward for the Nursing Home Liaison Service
Authors: Coen Neville , Mello Sarah , Power Leslee , Mahoney Niamh O , Buckley Emily , Cooke John 
Published: September 2024

Abstract

Background
Simulation-based training is an increasingly accepted way for multidisciplinary teams to learn together. Its use in geriatric departments around Ireland is increasingly visible. The application of simulation to pathway and process development however is less common. We decided therefore to deploy a simulation lab to test a new virtual ward platform for local nursing homes.

Methods
We developed, in partnership with a digital provider, a piece of software that could enable the efficient and safe operation of a virtual ward. Our simulation was conducted in two phases. Phase 1 involved bench simulation of the platform in order to identify any obvious software issues. Phase 2 involved the development of two simulated patient scenarios that would specifically test the operation of the pathway. Nursing staff from our local nursing homes and specialist MDT members from our own department were invited to the Sim lab in order to work through the developed scenarios.

Results
Bench simulation of the software during phase 1 identified three significant limitations to the software developed. These were resolved before progressing to phase II testing. The simulated scenarios at our lab worked well and participants shared positive feedback regarding the pathway and technology. They found the software easy to navigate, practical and agreed unanimously to its future use. There were further minor technical issues identified that have been fed back to the software company for resolution. The simulation facilitated training using the “live” system for both the staff at our nursing homes and our own team members.

Conclusion
The simulation lab proved to be an ideal environment for testing both our new virtual ward pathway and the digital technology developed for its enablement. It facilitated the creation of a comprehensive process map and ensures that all stakeholders had a clear understanding of the new pathway.
Not All Antihistamines Are Created Equal: Alimemazine As A Cause Of Drug Induced Parkinsonism
Authors: Trolan Ciarán 
Published: September 2024

Abstract

Background
A 67year old female presented to a Movement Disorder Service for assessment of tremor. She had a history of presbycusis, dermatitis herpetiformis, bronchiectasis, osteoporosis and stage A chronic lymphocytic leukaemia. History elucidated hypophonia, somniloquy, REM-sleep behaviour disorder, bruxism, presence hallucinosis, insidious bradykinesia and of titubation of increasing prevalence and amplitude over 20years. Examination demonstrated cognitive impairment (Montreal Cognitive Assessment 12+1/30) in the domains of visuospatial function, executive thinking, naming, attention, language, abstraction and anterograde recall. Luria test was 0/6. Also found was: micrographia, left exotropia, reduced left arm and leg swing, kinetic tremor asymmetry, decrement of amplitude and frequency of rapid repetitive movements asymmetrically, mandibular and lingual tremor, positive Kinnier-Wilson test and orthostatic deterioration in yes-yes titubation. Drg history identified use of Alimemazine 10mg for insomnia for approximately 20years.

Methods
Modified Simpson Angus Scale score was 6 indicating a clinically significant degree of extrapyramidal side effects. Unified Parkinson’s Disease Rating Scale part III was 17.

Results
Functional dopamine uptake imaging did not indicate a parkinsonian syndrome. Drg induced parkinsonism was diagnosed. 0.0097% of the Northern Ireland population were prescribed Alimemazine in 2022 for non-dermatological reasons, representing 73.49% of all dispensed preparations. In the first financial quarter of 2024 in Northern Ireland, all dispensed prescriptions cost £218,395.

Conclusion
Not all antihistamines are created equal. Alimemazine is an older phenothiazine derivative antihistamine with central sedative effects equivalent to Chlorpromazine but without anti-adrenaline action. It is rarely prescribed and easily overlooked as “just another antihistamine”. It is commonly prescribed by dermatologists for urticaria. It has substantial pharmacoeconomic implications given its cost disparity with other antihistamines. Extrapyramidal features of tremor, akinesia and hypertonicity are more common in older people; usually developing within weeks or months of commencement. Stopping the drug is the first-line intervention. Resolution of symptoms is not guaranteed.
CANVAS For A Diagnosis: Can You Hear The Hooves Of Zebras?
Authors: Davey Cathy 
Published: September 2024

Abstract

Background
A 75year old male presented to a Movement Disorder Service with complex multimorbidity including: chronic pain, type 2 diabetes mellitus, hypoventilatory obesity syndrome, biliary calculus, moderate aortic stenosis, marked orthostatic hypotension, pulmonary hypertension, coronary artery bypass grafting, permanent pacemaker for complete atrioventricular block, carpal tunnel release bilaterally, polypharmacy and bilateral cataracts. History elucidated a distal to proximal sensory loss over 20years and neuropathic pain without nerve conduction confirmation; and progressively ataxic gait over several years. He also complained of hypophonia, bruxism, excessive daytime somnolence, passages, transitions, visual agnosia, textural illusion, oscillopsia, irritability, inflexibility, hoarding, impulsivity, disorganisation, inattention, apathy, depression and aspontaneity. He was intolerant of nocturnal continuous positive airway pressure device. Epworth score was 21.

Methods
Examination demonstrated: marked orthostatic hypotension, preserved cognition, hypersomnolence, dyspraxic dysgraphia, palmar and antecubital agraphaesthesia, downbeat horizontal nystagmus at eccentric gaze positions, square wave jerks, bidirectionally impaired head impulse test, dysmetric saccades, asymmetric cerebellar signs in upper and lower limbs, rightward Pisa syndrome, kinesigenic dystonic axial posturing, rightward laterocollis and equivocal Babinski/Oppenheim reflexes. Gait assessment demonstrated sensory and cerebellar ataxic features with marked apraxia. No pes cavus.

Results
Computed tomography of brain had Fazekas 1 small vessel disease, Medial temporal atrophy score 1, Koedam 1 and age-commensurate cerebral and cerebellar atrophy. RFC1 gene testing confirmed biallelic intronic AAGGG repeat expansion disorder.

Conclusion
Cerebellar Ataxia Neuropathy and Vestibular Areflexia Syndrome (CANVAS) should be considered in patients with presentations from mid-life of progressive sensory ataxic neuropathy, altered vestibular ocular reflex, gaze evoked nystagmus and prominent dysautonomia. CANVAS is a rare autosomal recessive genetic disorder with a protean presentation. Referral to Genetics Services should be undertaken for family counselling. Keeping an open mind in complex, multimorbid patients to a potentially unifying diagnosis is important to guide prognostication. The rumble of hooves in the distance is not always that of horses.
Audit of Medication Reconciliation by Admitting NCHDs in a Sample of Older Adults in a Model 2 Hospital
Authors: O'Regan James , Hayes Patricia , Hart Ceara , Jennings Emma , O'Flynn AnneMarie 
Published: September 2024

Abstract

Background
Medication reconciliation is the process of creating and maintaining the most accurate list possible of all medications a person is taking. Aim: To assess the completion by medical doctors of the 5 subsections of the medication reconciliation page within the MAU admission booklet for a sample of older adults admitted to a model 2 hospital.

Methods
An education session on medication reconciliation was carried out with NCHDs. Subsequently the admission booklets of 29 patients were reviewed over a 4-week period. They included older adults that had been admitted by an SHO or registrar. The medication reconciliation page is divided into 5 sections. These include details on the medication history source, how the patient takes their medication, who completed the medication reconciliation page, a full list of the medications and if the patient brought their own supply with them. Each section was reviewed and documented as completed, partially completed or not completed.

Results
The average age of the patients included in this audit was 79.9 years. Just 1 medication reconciliation page was found to be fully completed across all subsections. 26 were partially completed and 2 were not completed. The section most likely to be fully completed was section 4 which documents the patient's full list of medication with names, doses and frequency. Seven booklets had section 4 fully completed, while 20 had this section partially completed. Two booklets did not have section 4 completed at all. Overall results were similar to a previous audit carried out following the introduction of the medication reconciliation page into the admission booklet.

Conclusion
No significant improvements were evident on the completion of this audit. This highlights a low level of importance given to medication reconciliation by admitting doctors. Further educational sessions and reaudit are planned to address this.
Retracted: Where are they now? Career Trajectories of Geriatricians after being awarded Certificate of Successful Completion of Training in Geriatric Medicine
Authors: Murphy Robert , Dennehy Karen , Reddin Catriona , Cooke John 
Published: September 2024

Abstract

Background
A Certificate of Successful Completion of Specialist Training (CSCST) is awarded on completion of Higher Specialist Training (HST) in Geriatric Medicine. A yearly list of doctors completing training and being awarded CSCST is published by the Royal College of Physicians of Ireland since 2018. In this observational study we examined the current professional status of Geriatricians who recently completed the HST program in Geriatric Medicine and were awarded CSCST.

Methods
We reviewed the current status of Geriatricians awarded CSCST since 2018 and cross referenced with the medical council register to examine what proportion are currently working as Geriatricians in Ireland. We examined what was the primary university of graduation and time from graduation to being awarded CSCST.

Results
CSCST was awarded to 46 doctors from 2018 to 2023 inclusive. 67% (n = 31) were female. The median number of years from entry on the medical council to being awarded CSCST was 11 years (IQR 10 – 11, range 9-21). 96% (n = 44) of geriatricians completed their primary medical degree in Ireland. University College Cork was the University from which most Geriatricians had graduated (32% of Irish graduates). 87% (n = 40) of Geriatricians are currently on the specialist register for Geriatric medicine in Ireland. Of the six not currently on the specialist register, two are undertaking research in Ireland, two are completing international fellowships, one doctor is working as a consultant in Australia, and one doctor is on maternity leave.

Conclusion
There is a high rate of retention of graduates of the Geriatric medicine HST program. Most graduates of the program went to an Irish medical school with a median time of 11 years from primary degree qualification to CSCST. To build on this we plan to complete a wider study examining individual factors that influence job satisfaction and retention of Geriatricians.
Changes in Proportion of International Patients Attending An Urban Stroke Service Over 10 Years
Authors: Bhujwalla Shireen , Donlon Noel , Harbison Joseph 
Published: September 2024

Abstract

Background
The population of Ireland has become increasingly ethnically diverse. St James’s Hospital is a large inner-city hospital with a diverse multi-ethnic catchment and, because of its location, also admits quite a large number of tourists and international visitors. About 30% of the population of the St James’s catchment were not born in Ireland. We evaluated the effect of this in 2014 and repeated the study in 2024 to determine the how this has changed over the succeeding decade.

Methods
We reviewed admissions with primary or secondary diagnoses of ischaemic stroke or primary intracerebral haemorrhage (ICD 10 i61 or i63) over 4-year periods, identified by HIPE. Data for the period 2010-2013 were compared with that for the period 2020-2023. Data were confirmed from patient records. International patients (non-Irish/UK) were identified, and demographic details noted.

Results
Between 2010 and 2013 there were 1550 admission of which 62 (4.0%) were international. Between 2020 and 2023 1266 patients were admitted of which 101 (8.0%) were international (Chi Sq 19.5, p&lt;0.0001). Mean age of the international population increased from 52 to 56 years over the period compared to an increase from 71 to 73 for the indigenous population. Mean length of stay (LoS) for the international population had reduced for international patients (2010-13: 20.9 days. 2020-23: 12.2 days. Between 2020 and 2023, LoS was significantly shorter for the international than the indigenous population (Mean LoS 12.2 days, vs. 19.6 days, p&lt;0.0003 t test). The international population had a higher proportion of males (67.3% vs. 53.9%, Chi Sq 6.8, p=0.009).

Conclusion
Over the 10-year period the number of international patients admitted doubled. As a proportion of admissions, they remain low and represent a lower proportion than in the community. Length of stay of international stroke patients is lower and there are a higher proportion of males.
A Summary of Videofluoroscopy Findings Compared with Chest X-Rays of Older Persons in a Model 3 Hospital
Authors: Linehan Sophie , Cheannabháin Aisling Ní , Ward Colette 
Published: September 2024

Abstract

Background
Oropharyngeal dysphagia (OD) is increasingly prevalent among the older population. OD may give rise to complications such as aspiration pneumonia, malnutrition and/or dehydration. Videofluoroscopy is a gold standard tool for the management of dysphagia. Videofluoroscopy is a moving x-ray of the swallow in which aspiration can be directly visualised. Videofluoroscopy is only a ‘snapshot’ and the swallow function can improve or decline over time. Not every aspiration event leads to respiratory complications. There is a lack of diagnostic criteria for the diagnosis of Aspiration Pneumonia. It is challenging for Speech and Language Therapists (SLTs) to determine clinical outcomes. Despite this, the primary reason for referral to SLT in acute care is to assess for aspiration risk. The aim of this review is to compare patients’ Chest X-ray findings with Videofluoroscopy results.

Methods

Results

Conclusion
Aspiration pneumonia is a diagnostic challenge - further research in the area of dysphagia associated aspiration pneumonia in Older persons is required. The focus of dysphagia management in Older Persons should move towards the person's nutrition, hydration, oral hygiene, quality of life as well as possible dysphagia related respiratory implications.
Recognition Of Frailty In Patients 75 Years And Older, Presenting To The Emergency Department Of A Level Three Hospital
Authors: Brennan Catriona , Flynn Gail , Popoola Taiwo Olukunle 
Published: September 2024

Abstract

Background
Ireland is experiencing the challenges and opportunities with an ageing population. When these needs remain unmet, older patients with frailty may present to the emergency department. It is important to put processes in place to improve the management of older persons presenting to the Emergency Department. The variable indicative of placement risk is a tool to identify older people at risk of adverse health outcomes at the time of hospital admission. Determination of frailty status is useful to inform clinical decisions, as frailty scores can predict multiple adverse health-related outcomes following hospitalisation. The aim is for every patient to leave in a better condition, and to add value with every interaction.

Methods
A retrospective service evaluation, over a specified time period, ascertained provision prior to the implementation of frailty specific initiatives. 39 charts were selected for the clinical audit. The audit tool was devised utilising the NCAA 2023 guidelines. Reliability was assured through quality patient safety and support of clinical audit facilitation. Data collected and analysed utilising an excel audit tool.

Results
100 percent of validated indicative placement risk is completed by nursing staff at triage. 92 percent of patients aged 75 years and older were triaged at 3. Cognition assessment was not standardized across assessment, with 26 percent of presentations with confusion observed, with collateral received on twenty eight percent. Overall, 34.8 percent of presentations had frailty recognition utilising agreed frailty terms.

Conclusion
The aim is to introduce clinical frailty assessment for all patients presenting aged seventy-five years and older. Delirium assessment is not standardized across assessment. The rapid clinical test for delirium (4AT) in line with national delirium assessment will be introduced. Frailty service is in position to support these changes. Ongoing education of Delirium and Frailty recognition for all Emergency department personal.
Exploring Barriers to Timely Administration of Intravenous Zoledronic Acid following Hip Fracture
Authors: Bhujwalla Shireen , Johansen Antony , Tham YuenKang , Dockery Frances 
Published: September 2024

Abstract

Background
In the Age & Ageing paper “Call to action: A five nations consensus on the use of intravenous zoledronate after hip fracture” 2023, the authors addressed key reasons that might underpin orthogeriatricians’ reluctance to offer intravenous zoledronate (IV Zol) while patients were still in hospital after a hip fracture.

Methods
The paper was presented at the Global Congress of the Fragility Fracture Network (FFN), October 2023, the Orthogeriatrics day of the British Geriatrics Society (BGS) Autumn conference 2023 and the Bone Health Special interest group meeting at the Irish Gerontological Society (IGS) 2023. At the start of each meeting, a survey of attendees was carried out on their attitudes to, and current use of IV Zol following hip fracture. Here we present results IGS survey results.

Results
N=37 responded, 85% were concerned that early administration of IV Zol might impair its effectiveness, similarly to FFN and BGS respondents but 42% said they would not administer IV Zol within 14 days of a hip fracture vs. 29% of FFN, 24% of BGS respondents. Forty-two percent also said they would not give vitamin D loading without blood levels vs. 24% of FFN, 24% of BGS respondents and 29% acknowledged that laboratory waiting times for Vitamin D frequently delay IV Zol. There were 8% using a CrCl threshold of 30ml/min, 35% using eGFR threshold of 30ml/min and 41% an eGFR of 35mls/min. eGFR overestimates CrCl, suggesting that the vast majority of clinicians already use IV Zol at below licenced CrCl threshold of 35ml/min.

Conclusion
Following hip fracture, IV Zol appears widely-used used in those with CrCl of 30-35ml/min, in line with threshold in the original clinical trial. We identified a number of factors impeding early administration however, one being the perceived need for vitamin D results beforehand. Education around its safe use will enable more patients to benefit.