bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cultural Influences on Early Childhood Education in India
Authors: Mathur Smita 
Published: August 2024

Abstract
India’s cultural heritage and linguistic diversity influence the availability and quality of childhood education and teacher preparation programs for early childhood educators. Government policies, political persuasions, socioeconomic conditions, and educational philosophies also play a role. This chapter explores ancient and contemporary educational philosophies and their impact on early childhood education. Access to quality early childhood education remains a concern, particularly in rural areas and marginalized communities. There is a need for trained and qualified teachers who can provide developmentally appropriate and culturally responsive education. Standardized teacher training programs for early childhood education still need to be improved. Additionally, the chapter explores areas that should be addressed to enhance the quality of teacher preparation programs for early childhood teachers.
Cultures of Play in Early Childhood Education and Care
Authors: Lecusay Robert , Nilsson Monica 
Published: August 2024

Abstract
This chapter considers questions concerning how pedagogues in Swedish preschool settings conceive of and act with respect to play in early childhood. It surveys part of the history and research on the role of preschool pedagogues in children’s play, situating this history in relation to recent Swedish policy and research debates about if and how adults should understand and be involved in play in preschool. As an illustrative case, the survey is grounded in a discussion of the practice and research on playworlds, an early childhood play pedagogy developed by Swedish preschool education researcher Gunilla Lindqvist. The chapter concludes by discussing preliminary observations from an ongoing case-based research project characterizing the perspectives and practices of preschool pedagogues in Sweden as they voluntarily integrate the playworld approach into their everyday preschool activities. The data reveal the complexities and contradictions that Swedish pedagogues are negotiating as they define and work with the concepts of play, teaching, education, and bildung.
Nguyễn Mạnh Tường’s Montaignean Solace
Authors: Pham Kevin D 
Published: August 2024

Abstract
This chapter shows how Nguyễn Mạnh Tường (1909–1997), the first Vietnamese to receive two doctorates from France, had a very different vision of national dignity than Hồ Chí Minh. In the mid-1950s, Tường was excommunicated from society by the party for criticizing revolutionary leaders for becoming dogmatic and authoritarian. Tường turned to the sixteenth-century French essayist Michel de Montaigne for solace and developed a distinctly Montaignean understanding of dignity based on the individual (rather than the nation), and on skepticism and love of diversity. For him, national dignity required defending and celebrating the individual right to freedom of thought.
Nguyễn An Ninh’s Tagorean Call
Authors: Pham Kevin D 
Published: August 2024

Abstract
This chapter examines how a leading anticolonialist in the 1920s, Nguyễn An Ninh (1900–1943), argued that the Vietnamese should not revive Confucianism but should instead abandon it to create the Vietnamese identity anew. He believed that the Vietnamese had only badly parroted what they believed to be Confucianism, thus failing to nurture their national dignity through genuine, original efforts to be creative. Ninh drew on Rabindranath Tagore and other foreign thinkers to shame his fellow Vietnamese and to harness this shame for the productive purpose of creating a national identity from scratch.
Conclusions
Authors: Berruezo-Sánchez Diana 
Published: August 2024

Abstract
The conclusions follow on from the chapters above and challenge the established understanding about the cultural agency of black Africans in early modern Spain. The conclusions are twofold. First, black Africans contributed collectively, anonymously, and largely without acknowledgement to the literary texts of the period. Starting with the identification of a corpus of more than four hundred literary texts with black characters, this book has contested the traditional analysis of sixteenth- and seventeenth-century Spanish literature and focused on how black Africans exerted cultural agency by collectively shaping and contributing to the literary texts of the period. Second, black Africans used creativity and innovation for their own benefit, particularly as musicians, dancers, and poets. Further expanding the notion of black cultural agency, this book has explored the role of black Africans as creators and spectators who navigated a restrictive, coercive slave society and negotiated their own physical and cultural spaces.
2226 Assessing quantitative sonographic changes in the muscle mass of geriatric patients hospitalised using point of care ultrasound
Authors: Reinoso-Párraga PP , Arain SJ , Perkisas S , Colino RM , Montalvo JIG , Deniz VM , Vilches-Moraga A 
Published: August 2024

Abstract

Introduction
One of the most important consequences of hospitalisation in older patients is sarcopenia. This study aims to determine the impact of hospitalisation on the muscle mass, functional status, nutritional status, and short-term clinical outcomes.

Methods
A prospective study of patients admitted to an Acute Geriatric Ward between 1st November and 30th December 2022. Muscle ultrasound, utilising Point of Care Ultrasound (POCUS) at bedside, was employed to estimate rectus femoris muscle thickness (MT), area (Ar), pennation angle (PA), and fascicle length (FL) at the time of hospital admission, 3 days post-admission, and at hospital discharge.

Results
30 patients included, with a median age of 84 years (SD 72–93), 63.3% male, and 70% Clinical Frailty Scale score ≥ 4. Barthel Index and Functional Ambulation Category revealed median values of 72.33 and 3.87 respectively. Global Deterioration Scale median was 2.47. Mini Nutritional Assessment Short-Form (MNA) and total serum protein showed median values of 7.40 and 6.35 respectively. The median length of hospital stay was 5.79 days, with inpatient mortality rate of 10% and 53.3% incidence of delirium. Ultrasound showed a decrease in PA by 36.31%, Ar by 34.30%, and MT by 24.50%, and increase in FL by 10.47%. Sarcopenia classification at admission and discharge revealed an increase in mean index from 5.04 to 7.74.

Conclusions
In our cohort of patients admitted to an acute geriatric unit, POCUS identified real-time decreases in MT, Ar, and PA at the muscular level before these manifested as functional changes. It demonstrated an inverse relationship between frailty and muscle morphology as living with frailty associated further decreases in muscle mass at discharge. The study also established a direct relationship between MNA, muscle thickness, PA, and fascicles length at discharge. POCUS assessment of muscle mass could indirectly predict outcomes and guide decisions to address muscle mass abnormalities.
2256 Assessing vision as part of the CGA in frail patients admitted with fractures
Authors: Knox R , Balakrishnan S 
Published: August 2024

Abstract

Introduction
Falls are a common cause of morbidity and mortality in frail patients, with visual impairment doubling the risk of falls. NICE advises a multifactorial approach to identify risk factors to be treated, improved and managed. This includes sensory/visual assessment, which is poorly done in practice. The aim is for 50% of relevant patients admitted with fractures following falls to have a vision assessment within 5 days of admission.

Methods
A modified RCP ‘Look out! Bedside vision check for falls prevention’ aid for healthcare professionals was utilised. Patients excluded were those with significant delirium/dementia or medically unwell. We regularly collected data on how many patients had a vision assessment performed whilst implementing interventions such as Teaching Sessions, Posters and including visual assessments in the Comprehensive Geriatric Assessment (CGA).

Results
Initial results demonstrated poor rate of visual assessments in patients. With implementation of the modified tool, rates of visual assessments improved from 11%(n = 1) to an average of 22%(n = 4). Further interventions increased the overall average to 80%(n = 36). The most effective intervention was including a visual assessment checkbox in the CGA. This improved rates of visual assessment in a subgroup of patients considered to have had falls due to visual impairment, from 33% to consistent rates of 100%. Additionally, the average days to assessment greatly reduced from 10.2 days to consistently under 5 days.

Conclusion
Identification of visual impairment reduces recurrent falls and hospital admissions. The project demonstrated the clinical significance of vision assessments—aiding the diagnosis of PSP, prescribing eye drops, and optician follow-up. Utilisation of the modified ‘Look Out’ tool is a simple way to assess vision on the ward. Posters and teaching sessions improved clinicians’ confidence. However, implementing sensory impairment in the CGA proforma proved the most sustainable effort. Next steps include implementation in other Geriatric wards and Falls clinics.
2210 The adjustable Transobturator male system (ATOMS) for urinary incontinence: 9 year sub analysis within the geriatric population
Authors: Lavigne A , Rosser S , Foley S , Yang B 
Published: August 2024

Abstract

Introduction
The ongoing rise in prostate cancer rates and consequent prostatectomy have led to an increase in rates of male stress urinary incontinence. ATOMS is an adjustable sling requiring no manual input and suitable for frailer patients. We investigated the long term efficacy of the ATOMsin managing SUI and performed a sub-analysis within the geriatric population (aged 75+).

Method
69 men (mean: 70.2, range 50–81) underwent an ATOMS insertion between 2015–2019. Follow up data for up to 9 years were analysed (mean: 5.8, range 5–9 years). Out of the 69 men in the original cohort, 19 were aged 75+ (mean: 76.5, range: 75–81). 17 had SUI post radical prostatectomy, 1 post TURP and 1 post AP resection.

Results
Out of the 19 men, 14 (74%) were dry post ATOMsimplant insertion (ie using maximum one pad per day for reassurance). This rate is lower compared with the original cohort (79.7%). The average number of top ups to achieve dryness was 3 (same as the initial cohort). Out of the 14 men who remained incontinent in the initial cohort, 5 were 75+. Of these, 2 reported a significant improvement in their incontinence without meeting the ‘dry’ criteria. 1 had his ATOMsdevice removed due to infection. 1 was switched to an artificial urinary sphincter. 1 remains incontinent and is being managed with botox injections. There were no cases of mechanical failure.

Conclusions
ATOMS appears to be an efficacious and safe procedure in the geriatric population, with only marginal difference in dry rates compared to the non-geriatric cohort. The main benefit over an artificial sphincter is that it exerts a passive effect to prevent incontinence and requires no patient input for every void. This is especially prudent as geriatric patients may lose hand dexterity or cognitive ability over time.
2242 Retrospective study of inpatient falls resulting in patient harm April–September 2023. Comparing our care to the BSG guidelines.
Authors: Quartano M , Alićehajić-Bečić D 
Published: August 2024

Abstract

Objective
To identify good practices and highlight areas for improvement in the prevention and management of inpatient falls.

Method
Fifteen patients had serious inpatient falls between April and September 2023 within the hospital. Electronic notes and fall panel meeting minutes were used to provide an analysis of the ‘pre-fall’ and ‘post-fall’ assessments. Data was collected and analysed using AMaT and then compared to the standards set by RCP National Audit of Inpatient Falls (NAIF)—from KPI overview, 25% of patients had good quality Multi Factorial Risk Assessment (MFRA) in our Trust compared to National average of 33%.

Results
70% of patients had been identified as high risk of falls at admission. Patients were prescribed a median of 10 medications, with a median of 3 falls-risk increasing drugs (FRID). Before the inpatient fall: the majority of patients received an ECG and mobility assessment early in admission. Only 40% of patients had a lying/standing blood pressure (LSBP) 100% of those that showed a deficit were acted on appropriately. Only 20% had a documented medication review. Following the inpatient fall: A LSBP was done in only 33% of patients. A medication review was completed in 53% yet the average patient was discharged with 3 more medications. 73% of patients suffered fragility fractures due to the fall however bone protection was only considered in 40%.

Conclusion
This audit highlights that there are areas of MFRA that require improvement, specifically LSBP, and a medication review. 33% of falls occurred in ‘medically-optimised’ patients—resulting in at least 60 additional inpatient days. The results have been discussed with the multi-disciplinary team—intervention to improve performance will be piloted in two areas with the highest incidence of inpatient falls, with continuous learning and sharing of lessons embedded into our Falls Collaborative Initiative.
2308 A pilot project implementing a dysphagia screening tool for femoral fracture patients.
Authors: Paxton D , Buist M , Bradley R 
Published: August 2024

Abstract

Background
Evidence suggests 30–40% of patients with a neck of femur fracture (NOF#) develop oropharyngeal dysphagia (OPD) during the perioperative period. 1–2 Our data, collected over two months, shows our Speech and Language Therapy Team (SLT) identified only 12% of cases. Given the importance of nutrition and medication in the perioperative period, early identification of OPD is critical. We launched a new dysphagia screening tool for all patients admitted to our hospital with a NOF#.

Methods
A retrospective review of patient notes allowed collection of data regarding age, hip injury, frailty score, comorbidities, and staff compliance with tool. Patients with a completed screening tool had outcomes recorded (low, medium, high risk), timeliness of referral to SLT if appropriate, and if OPD was present on assessment. Balancing measures included length of time kept nil by mouth. We completed four PDSA cycles over 5 months.

Results
During this period, 157 patients were admitted with a NOF# and 58 had a completed screening tool. By producing a training pack and expanding into the emergency department, compliance improved by 33% over the 4 cycles. 19 of the 58 patients with a completed screening tool had OPD; 79% had mild, 14% moderate and 7% severe. The screen was adjusted during each cycle improving the suitability of SLT referrals from a 25% identification rate in cycle 1 to 100% in cycle 4. No patients were kept nil by mouth.

Conclusions
The screening tool has increased OPD identification by 21%. However, this requires staff training and high compliance rates to be effective. Next steps include adding the tool to the NOF# proforma, creating a training pack for the wider MDT, and improving the specificity of the tool.

References
1. Love et al. Age and Ageing, 2013. 42(6):782–5. 2. Mateos-Nozal J et al. Age and Ageing, 2021. 28;50(4):1416–1421.
2307 ICPOP community rehabilitation service
Authors: Kenny B , Laycock B , Nee R , O’Toole R , Hogge E , O’Neill N , Clarke E , Keating S , O’Shea J , Quinn A , Higgins A 
Published: August 2024

Abstract
Hip fractures are a major public health issue due to ageing populations and Ireland has one of the highest hip fracture rates in Europe1. The cost of acute hip fracture care was 48.5 million euros in 20221. The Irish Hip Fracture Database in 2022 revealed that 84% of people presenting to acute hospitals with hip fracture were admitted from home, however only 29% were discharged directly home1. NICE guidelines recommend early supported discharge for patients who are medically stable and mentally fit to participate with rehabilitation and who can transfer and mobilise short distance but have not yet achieved their full potential2. The National Integrated Care Programme for Older Persons (NICPOP) improves the life of older people by providing access to integrated care and support that is planned around their needs and choices, supporting them to live well in their own homes3.
This poster outlines the rehabilitation pathway established by the SJH ICPOP team to provide early supported discharge for hip fracture patients.
2222 Individual telephone calls to frail older adults improve outpatient clinic attendance rates
Authors: Thorn N , Tullo E 
Published: August 2024

Abstract

Introduction
The multidisciplinary assessment clinic (MDAC) is an outpatient service for older people at a district general hospital. Patients are triaged to the MDAC clinic if they have geriatric syndrome (for example falls) plus comorbidity and/or mobility, social or cognitive concerns. The service had a high ‘did not attend’ (DNA) rate compared with other geriatric outpatient clinics. This project aimed to reduce MDAC DNA rates and improve cost effectiveness through implementation of a new pre-appointment telephone service.

Method
We analysed six months of attendance data prior to establishing the pre-appointment telephone service. The existing system consisted of a standardised trust appointment letter and a text message reminder. For the new system a healthcare assistant (HCA) telephoned patients the day before their appointment to confirm attendance and discuss any concerns. We analysed six months of attendance data following the implementation of the new system and compared DNA rates.

Results
Prior to implementation of the new pre-appointment telephone service, 29 of 268 patients DNA (11%). From the second data set, following implementation of the new telephone system, 11 of 253 patients DNA (4%). Successful contact was made with 72% of those phoned, allowing confirmation or cancelled appointments to be rebooked. Chi square analysis found a significant difference between the two systems, with a p value of &lt;0.01 indicating an improvement in attendance rates with the new system.

Conclusion
Telephoning frail older patients prior to an outpatient clinic appointment significantly reduces DNA rates—a similar system could be implemented in other geriatric medicine outpatient settings.
2159 Feasibility study: the use of the Edmonton frail scale in a psychiatric inpatient facility
Authors: Shah P , Khongsueb K , Gathii E , Breen K 
Published: August 2024

Abstract

Introduction
Frailty is an important consideration in the health and wellbeing of older adults, particularly as it is associated with a risk of falls, and mental health difficulties such as depression. There has been no validation of frailty assessment tools among older adults with Psychiatric disorders. This was a feasibility study exploring the use of the Edmonton frail scale (EFS) among patients with highly complex mental health needs within a Psychiatric Inpatient Setting with a view to develop a service integration process leading to further research.

Methods
45 participants were recruited from 8 older adult wards across Neuropsychiatry and Medium Secure divisions. EFS assessments were completed every six months by trained members of Multidisciplinary Teams over a 12-month period.
Results: About 118 assessments were administered to approximately 45 patients, regardless of a patient’s length of stay at the hospital during the 12-month period. There was a 55% assessment completion rate. This was largely the result of difficulties in administering the cognitive domain of the EFS (Clock Drwing test) to patients with highly complex mental health needs, as the completion rate was 32%. It was also quite challenging for patients to understand and comply with the assessment instructions in the Functional Performance Domain (Timed Get Up and Go Test). As a result, many assessments in this domain were conducted through covert observation of patients’ movement during the course of the day. 29 of the 45 patients were found to have at least moderate level of frailty.

Conclusion
Older adults with psychiatric disorders may benefit from having an adapted assessment of the cognitive domain to promote complete administration of assessments. Prevalence of frailty is high in this setting. Continuous support towards staff engagement and education would be beneficial in promoting EFS use in determining frailty and integrating it into care planning.
2184 QIP: to assess the effect of education, timesheets and timers on the administration times of Parkinson’s medications
Authors: Miller G , Rybka E , West K 
Published: August 2024

Abstract

Background
NICE guidance for administration of dopaminergic medications is within thirty minutes of the prescribed time. Patients with Parkinson’s Disease are frequent attenders of the ED, often leading to admission for a variety of reasons. Medication timing as an inpatient is frequently sub optimal, leading to potential harm of the patient and prolonged inpatient stays. Interventions previously seen to be beneficial include medication posters and alarms, tested across multiple wards at a different trust. This project aims to assess three interventions looking to improve the administration time of dopaminergic medication at Aintree University Hospital.

Method
Three interventions were assessed: education, medication timesheets ad medication timers. These were assessed on one surgical and one medical ward. Baseline data was collected prior to implementation, then following each data was recollected. Nursing staff opinion and knowledge were also assessed using surveys at baseline, following education and at the end of the project.

Results
Baseline data showed an average of 18.75% of doses given out of range on the surgical unit. Education proved to be useful, reducing the average to 12.5%. Medication timers were the most promising intervention, improving the average to 10.7%. However, when plotted on a control chart the changes appear unconvincing for significance. Surveys showed an initial reluctance for the use of timers, but following their use they then became the preferred intervention. Obstacles to their use were identified, such as loss of instructions and difficulty in changing the settings.

Conclusion
This project has found evidence to support the use of medication timers to facilitate more accurate administration of dopaminergic medications. However further assessment is required with a follow up QI project given the uncertainty seen on the control charts.