bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Challenges in Identifying Atrial Myxoma as a Cause of Transient Ischemic Attacks: A Case Report
Authors: Devlin Kate , McGreal-Bellone Aimee 
Published: September 2024

Abstract

Background
A 67-year-old woman presented to hospital on multiple occasions with transient neurological symptoms over a period of 20 months. Initial diagnostics, including computed tomography (CT), carotid Dopplers, and electrocardiogram, were unremarkable. Magnetic resonance imaging (MRI) was arranged following the third neurological event which revealed multi-territory acute ischemic events, suggestive of a cardioembolic source. Transoesophageal echocardiography identified a large mobile atrial myxoma, histologically confirmed. Atrial myxoma, though rare, is an important cause of thromboembolic stroke, underscoring the need for comprehensive cardiac evaluation in cerebrovascular incidents.

Methods
The patient's case was reviewed, focusing on initial presentations, diagnostic workup, and subsequent management. Initial presentations included transient visual disturbances and transient leg weakness. Routine tests were conducted, including CT brain, carotid Dopplers, and blood tests. MRI and transoesophageal echocardiography were performed which ultimately identified the underlying cause of the patient’s neurological events.

Results
Initial evaluations (CT, carotid Dopplers) were normal. An MRI performed 20 months after her initial presentation revealed small acute infarcts in the right cerebellar hemisphere and left superior parietal lobe. Transoesophageal echocardiography subsequently detected a large atrial myxoma. The patient's transient symptoms and negative initial workup delayed the diagnosis, highlighting the necessity of including cardiac imaging early in the stroke workup, especially in cases of suspected cardioembolic events.

Conclusion
This case illustrates the critical role of thorough cardiac evaluation, including echocardiography, in diagnosing the cause of transient ischemic attacks (TIA) and strokes. The patient’s initial negative findings delayed the identification of a cardioembolic source, emphasizing the importance of comprehensive diagnostic protocols for suspected cerebrovascular events. Urgent surgical resection is essential for atrial myxoma to prevent recurrent embolic events. This report highlights the diagnostic and management challenges of cardiac myxomas, advocating for a more rigorous approach to stroke evaluation and timely intervention.
Response to A Story During Cognitive Screening – Expression of the Inherent Awareness of Survival of Fellow Human Beings
Authors: McHale Cathy , Fallon Aoife , Kennelly Sean 
Published: September 2024

Abstract

Background
The comprehensive assessment of cognition should include the immediate recall of information as well as that provided after delay. The phenomenon of patients providing intrusions is well recognised in the realm of cognitive assessment. Certain intrusions have been found to recur across patient performances.

Methods
Retrospective analysis was undertaken of patients (n=9) screened for dementia using the Repeatable Battery for the Assessment of Neuropsychological Status (Pearson) between 2022 and 2024. Data was sourced from MDT notes cataloguing the results of memory tests undertaken whereby the patient had added information regarding loss of life for persons involved in a fire. Data were elicited regarding List Learning (LL) and Recall; Story Memory and Recall, Figure Copy and Recall. The final sheet was used to elicit scores for each category.

Results
Median age was 76 (range 61-84 years). Male to female was 4:5. Patients were found to make a comment regarding loss of life e.g. ‘nobody was hurt’ where the information did not exist in the original story script. This occurred equally at Story Memory Stage and Story Recall Stage (77.7%). When compared with list and figure copy elements- only one patient also had errors in both LL and memory figure. Six patients had intrusion errors across other elements. Where the story was accentuated in both immediate and delayed recall stages- pts had intrusions in list learning (n=2, 22%) list recall (n=3, 33.3%) but no intrusions on Figure Copy- immediate or delayed.

Conclusion
Although this cohort of patients was small- each one of them included the status of life lost when given a short story to recite and then recall. These comments occurred both on immediate episodic recall and after delay and were not always associated with a replicated intrusion phenomena across other elements. This inherent interest in the survival of other humans is worth highlighting.
Cancer And Stroke - An Irish Centre’s Experience Of Emerging Trends Of Co-Diagnosis
Authors: Walsh Sarah , Doyle Patrick , Walsh Rachel , Greene Suzanne , Cogan Nicola , Murtagh Emma , Corrigan Lynda , Collins Ronan 
Published: September 2024

Abstract

Background
Cancer is an increasingly recognised independent risk factor for the development of stroke, with emerging evidence of stroke, in the context of malignancy being its own pathophysiological subtype (Sonbol et al., 2023). Both cancer and stroke risk are associated with increasing age, with stroke mortality in cancer patients significantly higher (Sanossian et al., 2012). Due to the increasingly ageing population in Ireland, the number of those presenting with dual diagnosis is set to increase. We sought to review numbers presenting with stroke and cancer to our stroke service.

Methods
Patients admitted with confirmed stroke diagnosis were identified through Hospital Inpatient Enquiry (HIPE) data from March 2023 to May 2024. This cohort was then screened for a co-existing oncological diagnosis. The following variables were collected: recency of cancer diagnosis, subtype of stroke, anti-cancer therapy treatment to date, risk factors for developing cardiovascular disease using atherosclerosis cardiovascular disease score (ASCVD) and baseline CRP on admission.

Results
71/320 (22%) patients admitted to our service in the defined period were identified as having a co-diagnosis of stroke and cancer (new or historical). Of those 71 patents, 8(11%) had a new or recent (&lt;1 year) cancer diagnosis at stroke presentation and 63 were found to have a historical diagnosis (&gt;1year). Prostate cancer represented the largest proportion of patients followed by lung and skin. 11(15%) were actively on cancer treatment at time of presentation of stroke. For patients actively on treatment, 5/11 had received platinum-based therapies. Average ASCVD risk factor score was 29.7%.

Conclusion
One in five patients with acute stroke had new or historical diagnosis of cancer in our cohort. A national prospective registry of patients with cancer and stroke could be useful in understanding patterns of stroke in cancer and help plan services and treatments for this specific population.
An Evaluation of The Older Persons Presentation To The Emergency Department (ED) Following A Fall/Syncope/Presyncope
Authors: Mannion Edel , Donnell Martin O , Reddin Catriona , Waters Ruairi 
Published: September 2024

Abstract

Background
Falls events are a leading reason for presentations to the ED, particularly in older adults. Often these events are unwitnessed and unexplained. Therefore, there is strong consensus that the management of unexplained falls should be evaluated in a similar fashion to syncope as outlined by the World Falls and European Society of Cardiology guidelines.

Methods
The aim of this study was to evaluate adherence with current falls/syncope guidelines. Consecutive patients over the age of 75 who presented with a fall or syncope to a university teaching hospital in October 2023 were included. Data was collected on diagnostics completed (ECG, CT Brain, Carotid Doppler Ultrasound, EEG, pro BNP, Troponin, Echocardiogram, and External loop recorder), whether specialist falls review was performed, and readmission within 6 months. Completion of diagnostic tests were compared between those who were and were not reviewed by a specialist service using the Chi squared test.

Results
Falls/syncope/presyncope comprised 17.5% (160/913) of presentations of older people to the ED. Overall, 43% (n=68) had an ECG completed, 15% (n=23) had a pro BNP, and 24% (n=38) had a troponin level measured, 11% (n=17) had an Echo performed, and 10% (n=16) had prolonged cardiac monitoring (R test), 47% (n=74) had a CT Brain performed. Among those who were reviewed by a specialist falls service, (39% n= 62) completion of recommended investigations was significantly higher; ECG (69% v 26%, p&lt;0.01), pro BNP (24% v 8.3%, p&lt;0.01), echocardiogram (21% v 4.2%, p&lt;0.01), cardiac monitoring (18% v 5.2%, p&lt;0.01).

Conclusion
Falls and syncope are common presentations to the ED among older adults. Patients who were seen by a specialist falls team were more likely to have the appropriate diagnostics complete. Therefore, a specialist falls/syncope pathway led by a specialist falls service in the ED could result in better outcomes for patients.
Community Specialist Teams: Are We Making an Impact? Insights from General Practitioners
Authors: Burke Shona , Conlon Chloe , McCleane Fiona , Geoghegan James , Cashen Aoife , Martin Niamh , Mulligan Des , Costello Maria , Canavan Michelle 
Published: September 2024

Abstract

Background
Within our catchment area, General Practitioners (GPs) are the primary source of referral to community specialist teams (CSTs) for older adults and are key stakeholders in supporting the integrated care pathway. We sought to evaluate their experience to inform service development.

Methods
GPs across four healthcare networks were invited to complete an online questionnaire evaluating their experience of the CSTs for older adults.

Results
Twenty-eight GPs responded. Of these, 85.7% (24) found the referral criteria clear, and 89.3% (25) reported ease of access to the service. However, 50% (14) were uncertain about when to refer patients to primary care alone versus the CST. A significant majority, 96.5% (27), felt the service positively impacted the health and well-being of referred patients, and 92.9% (26) were satisfied with communication regarding patient care plans and progress. Identified strengths of the service included the multidisciplinary approach to providing comprehensive, patient-centered care and effective communication with both GPs and patients. Areas for improvement included enhancing access for specialist teams to community radiology and increasing staffing levels to ensure timely assessments. Regarding the impact on unscheduled and emergency care, 71.4% (20) reported a reduced need to refer to the acute medical unit, and 35.7% (10) reported a reduced need to refer to the emergency department due to the ability to refer to CSTs.

Conclusion
GPs value the CST service for the quality of assessment and intervention their patients receive. Targeted areas for operational and clinical improvement include provision of diagnostics and role distinction from primary care teams. This survey also suggests CSTs are providing an alternative care pathway and point of contact for older patients in crisis, resulting in a reduction in unscheduled and emergency care utilisation. The role of the CSTs should be supported and enhanced and warrants more detailed exploration.
Introduction of A Proforma to Improve Communication to General Practitioners from an Acute Orthogeriatric Service
Authors: Morris Eleanor , Whelan Aisling , Bejleri Jorin , Dover Jeremy , Hynes Mary-Kate , Cooney Orla , Conlon Bernadette , Doolan Aoife , Winter Julie , Doyle Patrick , Davey Naomi , O'Brien Helen 
Published: September 2024

Abstract

Background
The National Office of Clinical Audit Irish Hip Fracture Standards 5 and 6 advise “patients with hip fracture should have their bone health assessed to determine their need for therapy to prevent future osteoporotic fractures” and “hip fracture patients should receive a specialist falls assessment and intervention to prevent further falls”. Ideally, these assessments should be communicated clearly via discharge summaries to avoid omission or duplication of treatment.

Methods
An admission proforma for an acute orthogeriatric service assessing inpatients with fragility fractures was developed. We retrospectively audited orthogeriatric patients’ discharge summaries prior and post introduction of the proforma. Patients who had atraumatic fractures were appropriately excluded from audit on their falls assessment.

Results
The total number of patients was 98. There were 70 patients in the pre-orthogeriatric proforma group and 28 patients in the post-orthogeriatric proforma group. The average age was 80.34 (SD 8.78). There were 55 females. The average length of stay was 18.08 days (SD 10.49). In the pre-orthogeriatric proforma group a falls assessment was reported in the discharge summary for 85.29% (n=58), bone protection; 60% (n=42). In the post-orthogeriatric proforma group a falls assessment was reported in the discharge summary for; 96.15% (n=25), bone protection; 61% (n=17). 100% of patients included had a bone protection plan: IV Zoledronic acid for 56 patients, denosumab for 26 patients, DEXA for 4 patients, virtual follow-up for 8 patients, onward specialty referral for 2. One patient was from overseas and for follow-up locally.

Conclusion
An orthogeriatric proforma may improve communication of falls assessment and bone protection plans in discharge summaries. Despite 100% of patients having a bone protection plan, there was a discrepancy of this in the discharge summaries. A dedicated orthogeriatric intern would ensure communication is accurate. This could avoid potential duplication or omission of prescribing of anti-resorptive treatment.
Everyday Ageism experienced by Community-Dwelling Older People with Frailty
Authors: Comerford Saidhbh , O'Kane Ellie , Roe Domhnall , Alsharedah Hamad , O'Neill Bennie , Walsh Michael , Briggs Robert 
Published: September 2024

Abstract

Background
Ageism encapsulates stereotypes, prejudice and discrimination towards others or oneself based on age. While identified as the most frequent form of discrimination, relatively little work has captured the problem of day-to-day ageism faced by older people with frailty in community settings. The aim of this study therefore was to examine the prevalence of everyday ageism experienced by older people attending hospital-based ambulatory care services, and to clarify its association with measures of quality of life (QOL) and frailty.

Methods
A consecutive series (n=100) of patients aged ≥70 years attending ambulatory care completed focused interviews. Day-to-day experience of ageism was measured with the Everyday Ageism Scale, QOL was measured with the Control Autonomy Self-Realisation Pleasure Scale (CASP-19).

Results
Just over half of participants reported exposure to ageist messages; over 5/6 reported experiencing ageism in interpersonal interactions and 2/3 held some ageist beliefs themselves. Logistic regression demonstrated that experiencing ageism in interpersonal interactions was associated with a higher likelihood of internalised ageism (Adjusted Odds Ratio 6.02 (95% CI 1.70, 21.34); p=0.005)). Both ageism in interpersonal interactions (β= -5.22 (95% CI -9.52, -0.91); p=0.018) and internalised ageism (β= -5.36 (95% CI -8.75, -1.97); p=0.002) were associated with significantly lower QOL.

Conclusion
This study highlights the striking prevalence of everyday ageism experienced by a cohort of community-dwelling older people with frailty and multimorbidity. In the context of further projected demographic changes in coming decades, with increasingly higher proportions of older people worldwide, these findings highlight an important societal issue that needs to be addressed.
Impact of Adoption of European Kidney Consortium Equation (EKFC) on CKD Prevalence and CKD Staging in Older Irish Adults
Authors: Tandan Meera , Browne Leonard D , Hayes Peter , Glynn Liam , Callaghan Mike O , Stack Austin G 
Published: September 2024

Abstract

Background
The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation tends to overestimate glomerular filtration rate (GFR) and has limitation in younger and older age groups, while the European Kidney Function Consortium (EKFC) full-age spectrum (FAS) correct for these problems and provide better performance in estimating GFR. We compared the 2017 EKFC- FAS(Scr-CysC) equation with 2012 CKD-EPI(Scr-CysC) for estimating CKD prevalence and staging in a national representative sample of older Irish adults.

Methods
We utilised data from The Irish Longitudinal Study on Ageing (2009-2011), for participants aged 50 to 79 years with complete measurement of serum creatinine (Scr) and Cystatin-C (CysC). Using 2017 EKFC- FAS(Scr-CysC) and 2012 CKD-EPI(Scr-CysC), equations eGFR was calculated. CKD was defined as eGFR below 60 ml/min/1.73 m². Median eGFR, CKD prevalence, concordance correlation coefficient (CCC), and impact of EKFC equation on GFR category reclassification was examined.

Results
A total of 5,092 participants (53.3% women), median age 61 years were included. CKD prevalence varied significantly from 10.8% (9.9% – 11.8%) using 2021 CKD-EPI (Scr -CysC) to 16.7 % (15.5-17.9%) with the 2017 EKFC- FAS(Scr-CysC) equation. The corresponding numbers of CKD increased from 114,867 to 176,439 individuals respectively. The median eGFR for 2021 CKD-EPI (Scr -CysC) was 82.1 ml/min/1.73m2 and 2017 EKFC- FAS(Scr-CysC) was 74.5 ml/min/1.73m2, P&lt;0.001). The net reclassification was 23.1 % based on 2017 EKFC- FAS (Scr-CysC) equation compared to CKD-EPI 2012 (Scr -CysC) and was towards more worsening CKD stage. The CCC between 2012 CKD-EPI(Scr-CysC) and 2017 EKFC- FAS(Scr-CysC) was 0.88 (95% CI, 0.88-0.89).

Conclusion
CKD prevalence varies according to eGFR equation with substantially higher numbers of CKD predicted by the European Kidney Function Consortium than CKD-EPI equations. This has direct implications on healthcare planning, resource allocation, and rates of referral to specialist nephrology services in Ireland.
The Adaptive Physical Activity Study for Stroke: A Feasibility Sequential Multiple Assignment Randomized Trial
Authors: Rocliffe Padraic , Whiston Aoife , O'Reilly Siobhan , Butler Mike , Glynn Liam , Salsberg Jon , Walsh Jane , Richardson Ita , Bradley James G , Hunter Andrew , Paul Lorna , Fitsimmons Claire , Bernhardt Julie , Carr Emma , O'Donoghue Mairead , Cardy Nathan , Carter Daniel , Forbes John , Walsh Cathal , Hayes Sara 
Published: September 2024

Abstract

Background
Between 1990 and 2017, stroke cases nearly doubled, ranking as the second leading cause of death and disability globally. Inadequate physical activity (PA) is a leading risk factor. Recent guidelines advise stroke survivors to follow population-based PA guidelines. Given stroke heterogeneity personalised PA interventions are recommended. Therefore, this study used a Sequential Multiple-Assignment Randomized Trial (SMART) design to develop an adaptive mHealth intervention to improve PA post-stroke.

Methods
This SMART is in progress, with recruitment completed and follow-up data ending November 2024. A 12-week intervention programme was developed incorporating public patient involvement (PPI), empirical evidence and behavioural change theory to increase participation in Structured Exercise (SE), Lifestyle Physical Activity (LPA), or both. The study enrolled 54 ambulatory, community-dwelling people who were randomly assigned to either SE or LPA treatment groups. Participants used Fitbit Inspire 2 devices to monitor step counts and set personalized weekly step goals. At six weeks post-randomisation, participants were evaluated and classified as responders or non-responders based on their step count target achievement. Non-responders were re-randomized to switch treatments or augment their current regime with an additional intervention. Responders maintained their original treatment protocol. Primary outcomes address recruitment, retention and adherence rates. Secondary outcomes encompass overall health.

Results
Preliminary results include 54 participants (56% male) aged 51.58 (± 15.12) with Ischaemic (44%), Haemorrhagic (28%) or unknown (28%) stroke type at baseline. The mean weekly step was 7046 (±3797) while the mean Fatigue Severity Scale score was 38.02 (± 14.60). Participants had a mean Hospital Anxiety and Depression Scale score of 12.33 (± 6.98). Additionally, the mean Stroke Specific Quality of Life was 155.04 (58.84).

Conclusion
This is the first trial to use a SMART to design an adaptive intervention post-stroke internationally. Findings will inform the development of a PA intervention and subsequently will be evaluated against treatment as usual in a definitive trial.
Implementing a Pilot Geriatric Oncology Service at a National Cancer Centre in Dublin
Authors: Hearne Siofra , MacEochagain Colm , Coghlan-Lynch Kelly , Conroy Bronagh , Molamphy Aoife , Kennedy John , Briggs Robert , Lavan Amanda 
Published: September 2024

Abstract

Background
The American Society of Clinical Oncology and International Society of Geriatric Oncology recommend comprehensive geriatric assessment (CGA) for older adults commencing systemic anti-cancer treatments (SACTs) (1, 2). Routine CGA is lacking in cancer centres nationally.

Methods
A pilot, interdisciplinary geriatric-oncology (GO) clinic comprising a geriatric medicine consultant and specialist registrar, medical oncology fellow, physiotherapist and occupational therapist was established Dec 2023. New oncology patient referrals were screened applying the G8 tool; a score of ≤14 triggering referral. Polypharmacy was defined as ≥5 regular medications. Frailty was assessed using Clinical Frailty Scale (CFS) and cognition using Montreal Cognitive Assessment (MoCA).

Results
To date, 30 patients have attended the clinic; mean age 77.2 (SD5) years (range 68-85); 73% female, 50% with a CFS score of ≥4. Sixty-percent (n=18) were due to commence chemotherapy, the remainder hormonal or targeted treatment. Polypharmacy was identified in 66.6% (n=20), with 13.3% (n=4) having an anti-cholinergic burden score of ≥3, MoCAs were completed in 60% (n=18), of whom 77.8% (n=14) had an abnormal result (&lt;26/30 MoCA or &lt;18/22 MoCA blind). Twenty-six percent (n=8) reported ≥1 fall in the preceding six-months. Deprescribing interventions were completed in 40% (n=12); 58.3% (n=7) had ≥2 medications stopped. Medications most commonly deprescribed included opioids (n=2), antihypertensives (n=2), statins (n=2). Ambulatory blood pressure monitors were arranged for 33.3% (n=10) and DEXAs for 40% (n=12) and appropriately actioned. Follow up was arranged in the Falls and Syncope Unit for 7%, day hospital 10%, geriatric outpatients 10%, group psycho-oncology sessions 20%, specialist cancer rehabilitation physiotherapy service 17%. Parkinsons disease and dementia were diagnosed in 1 and 1 patients, respectively. Each patient had a detailed assessment and plan forwarded to their treating oncologist.

Conclusion
The development of a dedicated GO service is in line with international standards. By undergoing CGA, geriatric syndromes amenable to intervention were identified in patients.