bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proximal Humerus Fractures In The Older Adult: A Retrospective Review Of Proximal Humerus Fractures In The Emergency Department
Authors: Connolly Kieron , Green Natasha Li , Mohamed Behnazir , Coughlan Tara , McCabe Aileen 
Published: September 2024

Abstract

Background
This study aimed to describe the epidemiology and outcomes of older adults diagnosed with proximal humeral fractures (PHFs) in an Irish adult emergency department (ED).

Methods
A retrospective chart review was conducted on all patients (&gt;65) who had a diagnosis of a PHF, in 2022 within an ED of a large suburban academic teaching hospital in Dublin. Assessment by the Frailty at the Front Door (FFD) team (older adults &gt;75) for those with a PHF was also analysed.

Results
A total of 53 older adults (&gt;65) were identified within the study period with a PHF while 43 patients (&lt;65) were identified. In the &gt;65 group, seventy-nine percent (N=42) were female. The mean age was 75.6 years of age (Range 65-95). Only 21% (N=11) had operative management. Two-thirds of PHFs in the &gt;65 group required admission to hospital (N=24) (P&lt;0.001). The mean length of stay (LOS) was 12.9 days compared to only 4.5 days in those under the age of 65 (P= 0.14). There were 26 older adults (&gt;75) diagnosed with a PHF. The FFD team assessed 49% (N=11) of older adults (&gt;75) with a PHF. Only 31% (N=8) presented to ED within FFD team operational hours. The average Clinical Frailty Sale was 5 (N=11). The FFD team completed 22 inpatient MDT referrals, four HSCP community referrals, one Public Health Nurse Referral and one application for increase in home care package.

Conclusion
PHFs tended to occur in older female patients. The majority of PHFs in older adults do not have operative treatment and were associated with higher LOS. FFD teams can play a pivotal role in the assessment and treatment of older adults with a PHF. This may represent opportunities to develop integrated care pathways to maximize an individuals’ independence, to support people at home with PHFs.
Evaluation of New Frailty at the Front Door Service in a Model 3 Hospital
Authors: Breen Paul , Costelloe Niamh , Donnellan Christina 
Published: September 2024

Abstract

Background
Frailty at the Front Door (FFD) is a key component of integrated care for frail older persons who attend an Emergency Department (ED). This service was established in a model 3 hospital in 2023. Variable Indicative of Placement (VIP) was used to screen patients aged ≥70 years for frailty. Interdisciplinary assessments and interventions were provided by a Senior Physiotherapist and Senior Occupational Therapist (OT).

Methods
All assessments by the FFD team from June 2023 to February 2024 inclusive, were included. The variables analysed were age, gender, modified Barthel Index (mBI) score, 4AT score, Clinical Frailty Scale (CFS) score, discharge status, length of stay (LOS), referral pathways and re-presentation within 28 days. Data was analysed in Excel.

Results
There were 490 assessments over the 9-month period, 217 (44%) male and 273 (56%) female, with a mean age of 80 (SD±7.77) years. The median CFS was 5 (range 2-8) and median mBI was 17 (range 4-20). The 4AT score was ≥4 in 44 (9%) cases (indicating possible delirium and possible cognitive impairment). One hundred and eighty-four (38%) patients were discharged home from ED. Seventy (14%) patients re-presented to ED within 28 days. Acute hospital admission was required for 306 (62%) with a mean LOS of 11 (SD±0.5) days. There were 213 referrals to community services for those patients discharged home. These included Dietetics (36%), Physiotherapy (22.5%), ALONE (18%), Delirium Clinic (9.4%), OT (6%) and others (8.1%). There were 238 referrals to acute services for admitted patients, including Physiotherapy (59%), Dietetics (18.5%), OT (17%) and Speech and Language therapy (5.5%).

Conclusion
This evolving FFD service is a positive step towards improving older persons’ care in ED. Recognition of frailty in ED leads to early identification of care needs and timely referral to alternative pathways in the community and acute services as appropriate.
Reconditioning For Discharge; An OT-Led Initiative
Authors: Mahon Ella , Hogan Ellie , Webster Cara , Davis Aisling , McNally Sarah , O'Shea Diarmuid 
Published: September 2024

Abstract

Background
Deconditioning is the loss of functional ability in frail older adults (BGS, 2017). Many initiatives such as #EndPJParalysis address the importance of preventing functional decline in acute settings. Occupational therapists (OTs) are best equipped to lead these initiatives due to the holistic nature of the profession. This initiative aimed to complete an educational campaign among staff, patients and families about the importance of preventing deconditioning. Audit approval was granted by hospital Clinical Audit Committee.

Methods
An observational audit of patient presentation at ward level was completed. Data was gathered on clothing and sitting out status as a baseline measurement. A PR and staff education campaign was instigated. Information leaflets and posters for patients, families and staff were distributed. A re-audit was completed after 1 month.

Results
Patients in their own clothing/pyjamas increased by 8%. Patients sitting out of bed increased by 11%. Informal positive feedback from patients, families and staff suggested a cultural shift on the ward with regards to promoting patients independence.

Conclusion
Improvements post initiative were noted, however, a longer duration of the initiative would be beneficial to further promote reconditioning. OTs’ comprehensive approach is best placed to champion this reconditioning initiative. Further roll out of the campaign throughout the hospital may be of benefit. There is a wealth of educational/PR resources available for same.

Reference
British Geriatrics Society (2017) Deconditioning awareness, British Geriatrics Society. Available at: https://www.bgs.org.uk/resources/deconditioning-awareness (Accessed: 19 April 2024).
Audit of Geriatric Emergency Medicine-Unit staff compliance in providing care in line with the Age Friendly Health Systems Conceptual Framework
Authors: Williams Susan , Synnott Aoife , Murphy Hannah , O'Shaughnessy Ide , Ryan Jessie , McCarthy Aoife , Bailey Claire , Chacko Binu 
Published: September 2024

Abstract

Background
The Geriatric Emergency Medicine Unit (GEMU) in University Hospital Limerick (UHL) is in the Emergency Department for the assessment of those over the age of 75. The unit is staffed by a multi-disciplinary team with specialist skills in older person’s care. The aim of this audit was to determine assessment and documentation compliance with the Age Friendly Health Systems conceptual framework for older persons who present to GEMU.

Methods
A retrospective documentation review took place from patients who attended GEMU between January-March 2023. Medical record numbers were selected at random from the Health and Social Care Professionals (HSCP) team data management system with individual patient records subsequently retrieved from the Therefore Emergency Medicine (EM) patient management system. Patient records were reviewed by SW, which included Nursing, EM Doctors documentation and HSCP documentation.

Results
15 charts were reviewed. Compliance varied across all areas from 0-100%. Compliance was greatest in the domains of the EWS score, mobility assessments, falls history and 4AT. Hydration and the documentation of ‘What Matters’/patient care preference were both 0%. Otherwise, compliance broadly was &gt;50%. The first re-audit of 15 charts took place from December 2023-January 2024. Improvements were noted across all assessments, with 100% compliance additionally achieved in CFS, cognitive status, co-morbidities and nutritional intake. A second re-audit of 15 charts took place from March-April 2024, with further improvements seen in terms of lying and standing blood pressures and polypharmacy assessments.

Conclusion
Results demonstrate the continued improvements made amongst the team in adhering to the Age Friendly Health Systems Framework. Efforts are ongoing to focus specifically on the care preference component, with structured QIPs in place and a view to re-auditing in Q4 2024.
The Establishment of Geriatric Multidisciplinary Service (GEMS) for the Identification and Management of Frailty and Delirium in Emergency Care
Authors: Brick Jacqueline , Brolly Amanda , Randles Mary , O'Carroll Susan , Maher Mairin , Carmody Chris 
Published: September 2024

Abstract

Background
In Ireland the number of people aged 75 and over has grown by greater than 20% in recent years, as a consequence increasing numbers of older adults are presenting to emergency departments. Frailty is a multi-factorial syndrome that diminishes body reserves and impacts on the person's ability to respond to stressors, such as illness or trauma. In October 2023, a Consultant Geriatrician lead GEMS was launched to identify, assess and manage frailty and associated syndromes, this study concentrated on delirium.

Methods
All patients 75 and older are triaged by GEMS using an electronic IPM System against prioritisation inclusion and exclusion criteria, utilising a case management approach and Rockwood Clinical Frailty Scale to screen for frailty. CFS score 1 to 3 is fit and managing well, alternatively a CFS of 4 or greater initiates a Comprehensive Geriatric Assessment. A 4AT assessment identifies patients at risk and screening for delirium.

Results
The results demonstrate a total of 744 patients were reviewed by GEMS from Jan - April 2024, 67% (n=503) had a CGA completed and 72% (n=537) of the population sample are living with frailty. A CFS7 (n=121), CFS8 (n=15) and CFS9 (n=3) are severely frail 26% and moderate frailty CFS6 (n=149) 28%. The 4AT results identified 10% of patients had a positive delirium score (n=60). In addition, a total of (n=61) patients had a formal diagnosis of dementia of which (n=12) patients had a positive 4AT.

Conclusion
The data confirms the prevalence of frailty in emergency care is approximately 70% and the incidence of acute delirium is approximately 10%. These indicators significantly impact on outcomes of care and treatment plans. Therefore, substantiates the need for early identification of frailty and delirium and the requirement for a highly specialised Consultant Geriatrician Lead (GEM) Service to ensure patients are on the right journey.
Exploring The Relationship Between SSRIs, Falls, Fractures, And Bone Mineral Density In Older Irish Adults: Results From The TUDA Study
Authors: Fitzpatrick Donal , Laird Eamon , Lannon Rosaleen , Ward Mary , Hoey Leanne , Hughes Catherine , Strain JJ , McNulty Helene , Cunningham Conal , Molloy Anne , McCarroll Kevin 
Published: September 2024

Abstract

Background
Selective Serotonin Reuptake Inhibitors (SSRIs) are associated with an increased risk of falls and fractures, though the results from studies are inconsistent. SSRIs may cause a decline in bone mineral density (BMD), but this remains unclear. We aimed to explore the relationship between SSRI use and falls, fractures and BMD in older Irish adults.

Methods
Study participants were from a cross-sectional study of adults aged &gt;60 years; Trinity Ulster University Department of Agriculture (TUDA) study. Falls and falls resulting in fracture in the preceding year were self-reported so participants with an MMSE &lt; 24 were excluded. The relationship between SSRIs and falls and falls with fractures was explored in multivariate logistic regression adjusting for relevant covariates and medications: loop and thiazide diuretics, alpha and beta blockers, calcium channel blockers, ACE-inhibitors, benzodiazepines, opioids. In a subgroup with no prior diagnosis of osteoporosis or on medications for same, the relationship with SSRI's and BMD (as assessed with DXA) was explored.

Results
There were 4521 participants, 67.6% female, mean age 73.3 ± 8.1 years, 9.4% (n=427) using SSRIs. SSRI use predicted an increased risk of falls in the last year both before and after multivariate adjustment (OR 1.71, 1.37-2.14, p&lt;0.001). In participants with falls (n=1448), those who had a fall with fracture versus a fall with no fracture were no more likely to be using SSRIs. In a subsample, (n=2178) no relationship was found between SSRI use and BMD at the hip, neck of femur or spine.

Conclusion
SSRIs use was associated with a 71% increased risk of falls though did not predict BMD or fractures. However, duration of SSRI use was not known and there was no prospective follow up. It remains unclear whether increased fracture risk in SSRI users found elsewhere is explained solely by falls risk.
Community Integrated Care Team- Detention Order Outcomes And Indications
Authors: Bradley Eoin , Keating Sharon , Quinn Aoife , O'Shea Joan , Hogge Eilish , O'Neill Niamh , Kenny Blaithin , Clarke Enda , Higgins Aislinn , Laycock Berneen , Kovalyshyn Volodymyr , O'Toole Ronan , Nee Rory 
Published: September 2024

Abstract

Background
Detention orders are the inherent jurisdiction of the high court. Only mechanism to support treatment in those lacking capacity and refusing care. Considered a last resort. Integrated care for older persons teams (ICPOP) often engage with complex cases who require this intervention. I aim to review detention orders enacted on ICPOP patients within 1 year.

Methods
Retrospective review of notes on all patients who required a detention order for transfer of care from March 2023- March 2024. Assessing on review patient’s primary diagnosis, expressed wishes, interventions implemented by the ICPOP team to avoid detention and then reasons for detention order and finally patient outcome.

Results
7 patients. 6 female. Every patient expressed a wish to remain in their home. All 7 patients had dementia. Implemented interventions included, Medical social work, home care packages, Memory resource and technology room referrals, meals on wheels plus family support groups, and legal supports, ward of court and decision-making representatives. Interventions where however unsuccessful and reasons for detention ranged from- Night-time wandering x3. Road safety concerns x 3. Family neglect and abuse x 3. Fire safety x1 and Accidental poisoning/malnutrition x1 and Alcohol excess x2. All bar one patient settled without need for medication or specialist unit when transferred to nursing home.

Conclusion
Outcomes were positive in all cases of detention order being implemented. All 7 patients received better care and avoided serious risk to health. The one patient who required significant intervention to maintain transfer was a behavioural fronto-temporal dementia who required a locked unit and psychotropics. In all cases family supported the decision and patient quality of life improved. Where autonomy and liberty remain paramount concerns for all individuals this review confirms that in some cases doctors must act in the best interests of their patients even if this act is against their wishes.
The Ghost Of Hip Arthroplasties Past: It Takes A Geriatrician To Mine For Metal
Authors: Davey Cathy 
Published: September 2024

Abstract

Background
An 84-year-old female presented to Geriatric Medicine out-patient clinic with many years of persistent right hip pain, generalised myalgia; and several months of constipation, weight loss and persistent elevation of C-reactive protein and Erythrocyte Sedimentation Rate. The General Practitioner's concern was occult neoplasm. History of right hip arthroplasty in 2011. 6 years prior, she had wide local excision and adjuvant radiotherapy for a grade 3, “triple negative”, invasive ductal carcinoma of the right breast. Serial imaging identified a right parasternal, internal mammary chain neurofibroma. A Rheumatologist had administered intra-articular steroid to both glenohumeral joints for plain X-ray confirmed osteoarthritis, in the absence of serological vasculitic or autoimmune rheumatological disease. Benefit was transient. Her Oncologist had arranged MRI spine for “sciatica” demonstrating L3/4 and L4/5 stenosis and a large right adnexal cyst. Subsequently, the Gynaecology team assessed and planned interval MRI pelvis as initial MRI suggested a right partial hydrosalpinx, left internal chain lymphadenopathy and nodule adjacent to sacroiliac joint.

Methods
History, examination and imaging results were checked against the Medical Device Alert number 18 from the Medicines and Healthcare products Regulatory Agency (UK) in 2017. Oxford Hip Score Assessment was 29. Lymphatic drainage from medial hip joint is towards right iliac chain.

Results
In the absence of Gadolinium based contrast agents within 96hours, metal testing demonstrated: Serum Cobalt was 232nmol/L or 13.7 ug/L; Serum Chromium was 78.8nmol/L or 4.1ug/L; Chromium Urine: Creatinine Urine Ratio was 24.54nmol/mmol; and Cobalt Urine: Creatinine Urine Ratio73.96nmol/mmol. These elevated blood and urine results confirmed metal-on-metal hip disease.

Conclusion
Consider symptomatic metal-on-metal hip disease with soft-tissue involvement in patients presenting with post-hip arthroplasty joint pain, generalised myalgia and raised inflammatory markers; particularly if there is unexplained ipsilateral internal iliac chain lymphadenopathy and pelvic fluid collections. If confirmed, metalwork explanation is the treatment.
StrokeCog-R: Protocol for a Pilot Randomised Controlled Trial Of A Novel Cognitive Rehabilitation Intervention For Post-Stroke Cognitive Impairment
Authors: Moran Catherine Nora , Oglesby Megan , McGlinchey Jane , Pender Niall , Bennett Kathleen , Horgan Frances , Kelly Peter J , Merriman Niamh , Williams David , Hickey Anne 
Published: September 2024

Abstract

Background
Post-stroke cognitive impairment (PSCI) affects 50% of patients six months post-stroke and is associated with increased disability, reduced quality of life, diminished independence, and a higher risk of long-term care and dementia. Addressing cognitive impairment is crucial to maximise patient recovery, facilitate the return to pre-stroke activities, and optimise secondary prevention efforts. However, cognitive rehabilitation is underrepresented in standard stroke rehabilitation protocols. This pilot randomised controlled trial (RCT) aims to evaluate a novel cognitive rehabilitation intervention, StrokeCog-R, designed to enhance cognitive function in stroke survivors with PSCI. The primary aims are to assess the feasibility of patient recruitment and retention and to determine the statistical power needed for a definitive trial. A secondary aim is to evaluate the efficacy and acceptability of the intervention for individuals with mild-to-moderate PSCI.

Methods
Sixty-four consecutive stroke patients with mild-to-moderate PSCI will be recruited and randomly assigned to either the intervention group (StrokeCog-R) or the control group (usual care). The intervention involves five weeks of group-based cognitive rehabilitation using “Rehearsal-Based” and “Compensatory-Based” strategies, supplemented with tailored home activities. Cognitive function, self-efficacy, and caregiver psychological wellbeing will be assessed pre- and post-intervention (or control) and at a four-month follow-up. Intervention acceptability will be documented through focus groups following each intervention. Recruitment is ongoing, and the first intervention group has concluded.

Results
Recruitment and retention rates, the feasibility of randomisation, patient acceptability, and resource utilisation will be evaluated. Additionally, the effectiveness of various communication techniques for retaining participants between the intervention period and the four-month follow-up will be assessed. These data will inform recruitment strategies and the determination of necessary effect sizes to power a definitive trial.

Conclusion
This study will provide critical insights for a definitive trial, potentially making a substantial contribution to the evidence base for cognitive rehabilitation in stroke patients.
AntiSox-1 Limbic Encephalitis: When A Movement Disorder Evolves Oddly And Delirium Just Does Not Feel Right
Authors: Trolan Ciarán 
Published: September 2024

Abstract

Background
A 74year old male presented to a Movement Disorder service with a 15year history of a parkinsonian syndrome with asymmetric, akinetic rigidity and prominent axial features. Motor features were stable for almost 13years. Neuropsychiatric features rapidly emerged over several months including: multimodality perceptual hallucinosis, upside down and tilt illusion, akinetopsia, intractable insomnia, emotional incontinence and Othello syndrome. A marked motor, mysaesthenic pattern, deterioration occurred in conjunction with hypoactive delirium, dysphagia, pyrexias, raised inflammatory markers and weight loss, necessitating hospitalisation. Computed tomography (CT) of chest, abdomen and pelvis did not demonstrate infective or neoplastic aetiology. CT brain did not demonstrate cerebellar atrophy. Positron emission tomography did not demonstrate a vasculitis. Drg regimen alterations brought about minor improvements, but he remained very severely frail and discharged to hospice care. Unexpectedly, cognition then markedly improved and neuropsychiatric symptoms resolved over months, and he returned home, albeit now severely frail. There was persistence of hemiparkinsonian symptoms, contralateral to which, dystonia had emerged with new bilateral upper limb ataxia and nystagmus. No mysaesthenic features persisted.

Methods
Cerebrospinal fluid analysis and electroencephalography were not undertaken. MRI brain was not undertaken.

Results
Anti Sox-1 positive. Anti Zic-4 and Recoverin were equivocal. Neuronal antibodies were negative.

Conclusion
Limbic encephalitis as a result of AntiSox-1 onconeural antibodies is most commonly associated with small cell cancer of the lung (prevalence of 36.5% of cases). Lambert-Eaton Mysaesthenic Syndrome is a more common presentation than paraneoplastic cerebellar degeneration. Hindsight raises the possibility of non-convulsive status epilepticus as an explanation for abrupt hypoactive delirium presentation on the background of deteriorating neuropsychiatric features. Oncological or immunotherapeutic intervention was not considered appropriate by respiratory or neurology teams respectively; nor did the patient wish for these to be pursued. Case reports indicate that an underlying neoplasm is not always identified. Non-paraneoplastic autoimmune encephalitis can have a better prognosis.