bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Caru Programme: A National Programme Supporting Palliative, End of Life and Bereavement Care in Nursing Homes in Ireland
Authors: Murphy Siobhán , Steele Kate , Murphy Sheena 
Published: September 2024

Abstract

Background
The aim of the interim evaluation report is to provide the Caru Programme team with information on the impact of the Programme to date and to highlight the outcomes and challenges, whilst reiterating the key aims and objectives of the Programme and the overall evaluation.

Methods
The evaluation utilities’ a combination of quantitative and qualitative methodologies. A pre-post design of baseline, mid-line and end-line primary data collection is used to measure the overall impact of the programme. Secondary data analysis of participant feedback, workshop evaluations and attendance was completed under the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.

Results
The education sessions provided were highly valued, with the majority of participants indicating an increase in baseline knowledge after attending a session. There were very high levels of positive experience with 80-99% of participants strongly endorsing the activities and recommending the programme. Participants who attended the Project ECHO and the QI workshops, indicated an intention to change practice; however, at this stage of the evaluation, there is a lack of specific details on what practice or change would be introduced, or indeed, its timeline. This will be measured in the next phase of the evaluation.

Conclusion
Caru is an innovative continuous learning programme supporting nursing home staff in the delivery of palliative, end-of-life, and bereavement care to residents. The learning components are delivered using a range of approaches, Webinars, Project ECHO online learning, Regional Networks, Quality Improvement Workshops. The interim evaluation report outlines the outcomes from Phase I and the first year of the programme’s delivery. It provides insights into its impact, outcomes, and challenges as well as providing a basis for the next phase of the evaluation. This interim evaluation lays the groundwork for a comprehensive understanding of the Caru Programme model and impact and provides valuable insights into its effectiveness.
Assessing Adherence to Acute Stroke Therapy Guidelines: An Audit Study
Authors: Scanlan Maeve , Harte Emer , Newell Evelyn 
Published: September 2024

Abstract

Background
The 2023 National Clinical Guidelines for stroke for the UK and Ireland recommended that people with motor recovery goals post stroke should receive at least 3 hours (180 minutes) of rehabilitation per day on at least 5 out of 7 days a week. This is a significant change to previous guidelines that recommended that patients receive at least 45 minutes of each therapy for a minimum of 5 days (NICE 2013). In 2022, the UK Sentinel Stroke National Audit Programme found that only 11.9% received more than 45 minutes of physiotherapy. This highlights that many services were not achieving previous recommendations.

Methods
In an Irish hospital, two new stroke assistant posts were funded with the aim to maximise therapy time. An audit was performed on compliance with the 2023 national guidelines on an acute stroke unit in august 2023 for patients that were identified as having motor goals post stroke. Data was collected in the form of minutes of direct patient contact time by each therapy –physiotherapy, occupational therapy, speech and language therapy and therapy assistants. This data was compared against recommended therapy time and presented as a percentage of this.

Results
9 acute stroke patients who were identified as having motor goals were randomly selected. It was found that none of these patients were meeting current therapy guidelines. When compared to the recommendations, the average amount of therapy that patients received per day ranged from 44 minutes – 132 minutes. On average, patients received 49.1% of recommended therapy. It was also found that therapy assistants were providing, on average, 59.3% of the actual therapy received.

Conclusion
Stroke patients are not receiving the recommended amount of therapy as per the most recent guidelines. Although the addition of stroke assistants significantly increased therapy time, guidelines were still not achieved.
A Novel Service: The Role of the Community Connector for Older Persons within ICPOP
Authors: Higgins Aislinn 
Published: September 2024

Abstract

Background
The Community Connector (CC) uses a social prescribing model to work with Older Persons who have recently engaged with ICPOP, complementing the multidisciplinary interventions they receive. A holistic approach is used to support the patient to access a range of community supports to benefit their health and wellbeing and address the social determinants of their health. Reviews show the impact that social prescribing has on the cost implications and healthcare demands. Studies have shown a reduction in GP services, ED attendances and referrals to hospital among those linked with a social prescribing project.

Methods

Results

Conclusion
Time of Brain Imaging In Patients With An Acute Traumatic Intracranial Haemorrhage
Authors: Condon Christine , Mason Colin , Phillips Luke , Ramiah Vinny , Duddy John , Rizzo Paolo , Burns Sorcha 
Published: September 2024

Abstract

Background
We observed variation in timing of CT brain imaging in patients presenting with a history of trauma. The objective of this audit was to determine adherence to local ED CT Head Criteria in patients with a confirmed traumatic ICH.

Methods
Retrospective point prevalence audit of patients with a confirmed intracranial haemorrhage over a five-month period using our neurotrauma work-stream data. Exploration of CT timing between Criteria A (within 60 minutes) and Criteria B (within 8 hours). Characteristics reviewed included Gender, Age, Time of presentation to ED, Day of Arrival, GCS on presentation, Mechanism of Injury and Time of CT completion.

Results
68 patients over the five-month period had a confirmed ICH: 48 male, 20 female. The median age was 62 years (range 17-97). Falls of less than 2 metres were the most frequent cause of injury (n=44, 65%), with 60% of these occurring in patients aged over 65 years of age. 67% (n=31) of patients meeting Criteria A did not have a CT Brain completed within 60 minutes. 14% (n=3) of patients meeting Criteria B did not have a CT Brain completed within 8 hours. Of patients meeting criteria who did not have a timely CT, 11 patients presented out of hours. Patients aged less than 65 years of age were less likely to meet target CT timing; 71% (n=24).

Conclusion
This audit highlights that only 33% of patients meeting Criteria A had brain imaging within one hour. Older adults were more likely to meet target CT timing than younger adults. Lack of ED access to radiology out of hours was deemed to be the main barrier to meeting target CT timing. We are working alongside our radiology department to secure no discussion trauma CT scans in ED out of hours. We plan to re-audit following the implementation of this change.
EDAPT: The Development And Implementation Of A Novel Referral Pathway From The Emergency Department
Authors: Harty Eileen , Walsh Eimear , O'Keeffe Elaine , Dennehy Aoife 
Published: September 2024

Abstract

Background
The Emergency Department Admission Prevention Therapy (EDAPT) service was developed by Therapy staff of the Pathfinder team in order to facilitate timely and appropriate discharges from the Emergency Department (ED) and to maximise capacity for the follow-up team. The aim of this pilot is to provide rapid access to therapy post discharge from ED for older adults with acute decline in function in order to prevent hospital admission. The service provides a short-term reablement approach within the home aiming to facilitate patients to regain pre-acuity baseline. EDAPT was modelled from an existing service but has now been expanded to accepting direct referrals from ED Medical Staff and Advanced Nurse Practitioners (ANPs) outside of standard working hours.

Methods
The pilot was introduced following collaboration and consultation with a number of key stakeholders including respective Therapy Managers, ED Consultants, ANPs and ED Therapists. A new EDAPT referral pathway was created, and documentation including specific referral and assessment forms. A designated area for receipt of referrals in the ED department was chosen and checked daily.

Results
64 patients with a mean age of 80.5 years were referred to the EDAPT service from November ’23 to April ’24. 53 of those patients received face-to-face input and had a mean Clinical Frailty Scale score of 5. 27% (n=17) of referrals were initiated out-of-hours via Medical and ANP staff and 48% (n=31) of referrals were falls related. Patients received an average of 2 follow-up visits during EDAPT involvement.

Conclusion
The EDAPT pilot is successfully facilitating timely and appropriate discharges from the ED, improving patient experience and patient flow from ED to their own home. The pilot integrates acute hospital care and community services, supporting a person-centred approach of the right care, at the right time and in the right place.
The Development And Implementation Of A Multi-Factorial Falls Assessment Tool In A Pathfinder Service
Authors: O'Donoghue Bríd , Burke Dearbhla , Meagher Breda , Griffin Aislinn 
Published: September 2024

Abstract

Background
Falls are a common complaint of older adults who present to the Pathfinder service. Pathfinder offers alternative care pathways to older adults when they phone 999 for low acuity concerns. As part of the service, Occupational Therapists and Physiotherapists provide home-based assessments and interventions. The aims of this project were firstly, to develop a falls assessment tool to assist therapists’ compliance with guidelines relating to older adults who have fallen and secondly, to ensure consistency of assessment and intervention among therapists on the team.

Methods
A falls assessment tool was created in line with the most recent world falls guidelines (Montero-Odasso et al., 2022). The initial roll out began on October 1st, 2024, when the tool was used to assess older adults who presented to the Pathfinder service following a fall. After three months, areas of poor compliance and barriers with usability of the tool were highlighted from a chart review and stakeholder engagement. The document was then revised based on this feedback. From February 1st, 2024, the tool was then used with all older adults who presented to the service. Compliance was re-audited at the end of April 2024 and therapists on the team were surveyed to gather user feedback.

Results
As a result of the falls assessment tool, compliance with the World Falls Guidelines increased initially from 54% to 86% but continued to improve when reviewed seven months post implementation. Qualitative data was universally positive when stakeholders were surveyed with benefits identified as: improving patient care, consistency across the therapy team and a useful means of communication.

Conclusion
The development and implementation of a falls assessment tool into the practice of a Pathfinder service increased compliance with the most recent world falls guidelines and received positive feedback from all key stakeholders.
Oral Symptom Assessment In Older Patients with Frailty Using the Oral Symptom Assessment Scale
Authors: Cleary Niamh , Davies Andrew , Romero-Ortuno Roman , Lavan Amanda 
Published: September 2024

Abstract

Background
Frailty is common in older patients referred to specialist palliative care teams. Its prevalence is estimated at 18% [1]. It is regarded as a “state of vulnerability” [2] in which even a minor stressor may result in adverse health outcomes [3] and mortality [4] independently of chronological age [5]. Oral problems in older patients may also be associated with increased morbidity and mortality [6, 7]. There may be an indirect interplay between oral problems and frailty. Oral symptoms like xerostomia are common in older patients. There is a paucity of research examining oral symptoms specifically in older patients with frailty. Thus, the prevalence of many oral symptoms is not known in this patient group.

Methods
The aims of this study were to determine the prevalence of oral symptoms in older patients with frailty and to determine their clinical features using the Oral Symptom Assessment Scale (with the addition of the symptom of drooling). This prospective observational study was conducted at Our Lady’s Hospice and Care Services, Dublin, and St James’ Hospital, Dublin. Once informed consent was obtained, participants completed the OSAS. Clinical Frailty Scale score, medications, co-morbidities and basic demographics were also recorded.

Results
Data from the first 100 participants recruited to the study is presented. Ninety-one participants reported at least one oral symptom. Two symptoms was the most frequent number of oral symptoms experienced (19%, 19/100). The median number of symptoms present was 4 (range: 0–13 symptoms). Forty participants reported the “new” symptom of “drooling”.

Conclusion
Asking about oral symptoms is important in this patient group. Initial data analysis suggests that many oral symptoms are common (and often of high impact). This study provides a novel insight into the prevalence and clinical features of oral symptoms not previously investigated using a multi-dimensional symptom-specific assessment too.
An Audit Of Health And Ageing Online Resources: Evaluating Information On Periodontitis And Cardiovascular Disease Associations
Authors: Gamble Eugene , Nancoo Tamara , Chami Peter 
Published: September 2024

Abstract

Background
In 2019 the European Federation of Periodontology (EFP) and the World Heart Federation (WHF) organized a review of the literature concerning periodontal disease (PD) and cardiovascular disease (CVD). This was to update the existing evidence from a 2012 review. The consensus report established a strong link between severe PD and CVD, however, this vital information may not be reaching the public who stand to benefit from it.

Methods
A web-based audit to assess the dissemination of information on the PD-CVD association was conducted. Ninety English language websites of foundations, health authorities, and associations focused on aging (54), CVD (21), and general health (15) were included. Dental organisations were excluded. Using Boolean search criteria, websites were examined for webpages informing of the PD-CVD link published in 2019 or later. Pages with the information published before 2019 were also recorded separately. Broken links, paywalled content, and information solely on infective endocarditis were excluded. Pages without metadata on publishing dates were considered older than five years.

Results
Only 8 (8.8%) sites contained information on the PD-CVD link within the past five years of which 5 (5.5%) gave actionable guidance on how to improve oral health. An additional 9 sites (10%) offering the information were recorded but were older than five years.

Conclusion
This study reveals a concerning gap in translating research findings from the highest levels of evidence to online resources accessible to the public. This highlights a missed opportunity to empower individuals. The siloed nature of dentistry, with limited collaboration between dental professionals and other health care providers, might be a contributing factor. These findings highlight the need for improved communication strategies and collaborative efforts to bridge this knowledge gap and empower individuals to make informed decisions about their oral and overall health.
Time-To-Event Analysis Of Factors Influencing Delay In Discharge From A Subacute Complex Discharge Unit During The Pandemic
Authors: Rajendran Nithya , Rameli Puteri Maisarah , Malomo Keneilwe , Byrne Declan , Browne Joseph , Ntlholang Ontefetse 
Published: September 2024

Abstract

Background
Length of stay (LOS) is the most common outcome measure of effectiveness in discharge planning. It refers to the time expressed in days between admission to and discharge from the hospital. During the COVID-19 pandemic, the average inpatient LOS was 5.8 days, representing a slight increase in the average inpatient LOS of 5.7 days between 2016–2019. Tackling delays in patient discharge is an ongoing challenge, and with the emergence of the COVID-19 pandemic, there has been significant disruptions in discharge planning, discontinuity and incoordination between subacute complex discharge units and community care.

Methods
Our study analysed delaying factors amongst patients with LOS &gt; 15 days during the COVID-19 pandemic using time-to-event analysis. Kaplan–Meier’s plot compared factors causing a delay in discharge to the single factors: age, gender, and multimorbidity. A multivariate Cox regression analysis adjusted to age, gender, and multimorbidity predicted factors affecting LOS.

Results
A total of 390 patients were admitted between March 2020 – February 2021 to a subacute complex discharge unit in an Irish tertiary centre hospital: 326 (83.6%) were &gt;65 years of age and 233 (59.7%) were female. The median (IQR) age was 79 (70–86) years with a median (IQR) of 19.4 (10–41) days. A total of 237 (60.7%) events were uncensored, with LOS &gt; 15 days, of which 138 (58.2%) were female and 124 (52.32%) had &gt; 4 comorbidities; 153 (39.2%) were censored into LOS ≤ 15 days, and death occurred in 19 (4.8%).

Conclusion
Our study is the first to analyse common factors delaying discharge from a complex discharge unit. Further research is required to explore multimorbidity as a risk factor for mortality in patients with prolonged LOS within a complex discharge unit and target gender-specific frailty measures to achieve high-quality patient management.
Ensuring Patient Care Continuity: An Audit of Discharge Letter Completeness in Accordance with National Standards
Authors: Shehzad Babar , Nevin John Paul , Aguiar Filipa 
Published: September 2024

Abstract

Background
Discharge letters serve as a crucial communication tool to convey essential patient's healthcare information from hospital teams to general practitioners and step-down institutions. In 2013, the Health Information and Quality Authority (HIQA) introduced the National Standard for Patient Discharge Summary Information guideline.

Reference
1. Health Information and Quality Authority. (2013). National Standard for Patient Discharge Summary Information. Retrieved from https://www.hiqa.ie/hiqa-news-updates/hiqa-publishes-national-standard-patient-discharge-summary-information.

Methods
This audit reviewed the completeness of discharge letters of patients admitted under the geriatric service of a tertiary hospital, covering the period between 1st September and 31st December 2023. Twenty-five variables were selected from the HIQA standards. The discharge letters were audited for completeness based on the inclusion of these recommended variables. An acceptable completeness rate of 80% for each variable was established.

Results
Of the total 89 discharge letters meeting the inclusion criteria, the average age of patients was 80.75 [SD12.95] years, with males comprising 60%. Seventeen out of 25 selected variables were 100% complete as they were automatically included by the electronic software. All discharge letters also invariably included diagnosis and hospital course information. Over 80% of the discharge letters met the acceptable threshold of including the items: discharge medication and future actions/follow-up. However, documentation of allergic status and inclusion radiological and blood investigations were only found in 27% and 49% of the letters, respectively.

Conclusion
The audited discharge letters had acceptable rates of completeness regarding inclusion of important items, while documentation of allergic status and inclusion of blood and radiological investigations fell below the acceptable standard. Of note, those that were automatized achieved 100% compliance. Regular auditing of discharge letters should become standard practice to improve completeness and ensure patient care continuity and safety. Consideration should be given to automatization of inclusion of reports of investigations.
Early Mobilisation Post-Thrombolysis is Safe and Improves Outcomes in Mild-Moderate Acute-Stroke Patients
Authors: Harte Mary , Newell Evelyn , Galvin Trish , Walsh Thomas , Scanlon Maeve 
Published: September 2024

Abstract

Background
Thrombolysis (tPA) is the delivery of a clot-lysing agent used in acute ischemic stroke, typically followed by ≥24-hour bed rest. This study aimed to compare the safety and effectiveness of early mobilisation (≤24 hours post-tPA) versus ≥24-hour bed rest in patients with mild-moderate stroke.

Methods
A literature review was conducted leading to the development of an early mobilisation protocol post-tPA. Retrospective (January-July 2023: pre-early mobilisation protocol) and prospective (July 2023-April 2024: post-early mobilisation protocol) data were analysed. Baseline demographics and outcomes were compared between the two groups. Primary outcome was physical function (Modified Rankin Scale (mRS) at hospital discharge. Secondary outcomes included adverse effects, length of stay (LOS) and discharge destination.

Results
11 patients met the criteria for early mobilisation in both groups. There were no significant differences in age, the National Institutes of Health Stroke Scale (NIHSS) pre-tPA and mRS at baseline between the two groups (p&gt;0.05). 8 patients in the early mobilisation protocol were male (72.73%), the median (IQR) age was 61 (54-78) years, and NIHSS was 6 (3-8) pre-tPA and 1 (0-2) post-tPA. Patients had a median (IQR) mRS score of 0 (0-0) pre-stroke and time to early mobilisation was 12 (12-17) hours. Patients in the early mobilisation group had significantly lower mRS on discharge (p=0.007), shorter LOS (Median (IQR) 5 (4-7) days, P=0.13) and higher rates of discharge directly home compared to those mobilised post ≥24-hour bed rest. No adverse effects of early mobilisation occurred.

Conclusion
Compared with 24-hour bed rest, early mobilisation for mild-moderate stroke patients was safe and associated with significantly better physical function.