bluuebunny/crossref_metadata_2025_split huggingface dataset:
217 DO THE FRAIL EXPERIENCE ADVERSE EVENTS FROM INTENSIVE BLOOD PRESSURE CONTROL? FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING(TILDA)
Authors: O'Donoghue P , Romero-Ortuno R , O'Halloran A , Kenny R A 
Published: February 2023

Abstract

Background
The 2018 ESC/ESH guidelines for the management of arterial hypertension in adults aged ≥65 years recommend a blood pressure (BP) treatment target of 130–139/70–79 mmHg if tolerated. Randomised controlled trials have recommended lower BP. However, low BP may cause adverse outcomes, especially in the frail.We aimed to identify if older adults, frail and non-frail, in wave 1 of TILDA being treated intensely for hypertension experienced more adverse events by wave 2.

Methods
Data from participants aged ≥65 years treated for hypertension in Wave 1 was analysed.Frail/non-frail was identified by Frailty Phenotype (FP) and the Clinical Frailty Scale (CFS).Two blood pressure thresholds defined intensive control:&lt;130/70 and &lt; 110/70 mmHg.We formulated 16 baseline participant groups based on frailty-BP combinations.Outcomes at wave 2 were analysed with adjusted binary logistic regression models.

Results
1,920 participants at Wave 1 were aged ≥65 years and treated for hypertension. 1,229 participants had full BP/FP data, while 1,288 had complete BP/CFS data.The frail by FP with treated BP &gt;130/70 or &gt; 110/70 had a statistically significant risk of new TIA or stroke by Wave 2.The frail by CFS with treated BP &gt;130/70 or &gt; 110/70 had a statistically increased risk of recurrent falls and/or fractures, as did the frail by FP with treated BP &gt;110/70. FP with treated BP &lt;130/70 was associated with new heart failure. None of the frail-BP groups was independently predictive of cognitive decline,myocardial infarction, syncope or hospitalization. For the non-frail-BP groups,there was no increased risk of any of the outcomes.

Conclusion
Frail older adults treated to higher BP thresholds seemed to have more adverse short-term health outcomes compared to the frail treated more intensely. Overall, a BP of &lt;130/70 did not seem associated with more adverse outcomes. This 2-year prospective study’s results of a community-dwelling cohort may not be generalisable to clinical populations.
221 PREVALENCE AND DOCUMENTATION OF DELIRIUM IN A UNIVERSITY HOSPITAL
Authors: Kajawo S , Flynn D , Buckley M 
Published: February 2023

Abstract

Background
Delirium can complicate approximately 10% of all medical admissions and prevalence increases in those with cognitive impairment, increasing age and medical complexity. Delirium is associated with increased morbidity and mortality as well as increased length of stay. Prompt recognition and treatment is essential. The National Delirium Care Bundle suggests assessment and recognition at the earliest opportunity and documentation of delirium if patients screen positive.

Methods
We carried out an audit among patients admitted in all medical wards to identify delirium and assess if it was documented and a care bundle opened. All patients were screened using the 4AT tool at least once over the space of one week. Medical notes were also screened to assess for documentation of delirium.

Results
95 patients were screened and 32 (33%) of these screened positive. Of these only 11 patients had a diagnosis of delirium documented in medical/nursing notes and a delirium care bundle opened. 50% of CCU patients were delirious. The Geriatric Medicine Ward had a lower prevalence of 19% with 66% identified in medical notes.

Conclusion
These results are disappointing with only 34% of patients identified as having a delirium. This audit is part of a quality improvement project with education sessions ongoing and roll out of the national delirium/dementia pathways across the medical wards. We hope to present our interventions and completed audit loop shortly.
233 BISPHOSPHONATES: ANOTHER COMPLEX DRUG TO PRESCRIBE
Authors: Mustafa W , O'Byrne R , Okpaje B , Gabr A , Ali B , Mohamed A , Cameron S , Leahy A , Fernandes L , Mannion M , Ryan P , Ryan S , Peters C , Shanahan E , Galvin R , O'Connor M 
Published: February 2023

Abstract

Background
Bisphosphonates provide effective treatment for osteoporosis. They accumulate a bone reservoir lasting for 3 years and beyond. The 2021 NICE guidelines recommend a medication review and a ‘drug holiday’ after 5 years of oral bisphosphonate therapy for low-fracture risk patients. Continuing treatment for high risk individuals is advised: age=/&gt;75, previous hip or vertebral fracture, one or more fractures during treatment, recent DEXA scan with T score =/&lt;−2.5, and/or current treatment with oral glucocorticoids. This retrospective audit aimed to assess compliance with NICE guidelines in a primary care setting.

Methods
Data were collected using the Health One online medical record system in an urban general practice. Inclusion criteria: all patients =/&gt; 65 years old, prescribed oral bisphosphonate therapy for osteoporosis for &gt;5 years. Exclusion criteria: deceased, did not attend clinic &gt;1 year, patients on bisphosphonate treatment for conditions other than osteoporosis.

Results
137 patients with a history of bisphosphonate therapy were identified. 76 patients were on bisphosphonate treatment for greater than 5 years. Of the 76 patients, 33 were classified as low-fracture risk and appropriately commenced a drug holiday, while 22 correctly remained on bisphosphonates due to a high fracture risk. The remaining 21 patients inappropriately continued therapy without receiving a medication review, repeat DEXA or fracture-risk assessment.

Conclusion
One third of patients on bisphosphonates beyond 5 years were not assessed for a drug holiday. The aim of a bisphosphonate ‘drug holiday’ is to reduce poly-pharmacy and prevent rare but serious long-term adverse events (such as atypical fractures, osteonecrosis of the jaw, gastric cancer and atrial fibrillation). Factors which had an impact on inappropriate prescribing should be assessed. Incorporating computer-based prescribing alerts could support safe prescribing practices.
24 EXPERIENCES OF EARLY SUPPORTED DISCHARGE SERVICES FOLLOWING A STROKE: A QUALITATIVE EVIDENCE SYNTHESIS
Authors: Connor E O , Dolan E , Horgan F , Robinson K , Galvin R 
Published: February 2023

Abstract

Background
Early supported discharge (ESD) facilitates people with a stroke to be discharged from the hospital environment earlier than conventional care to continue their rehabilitation within the home with a multi-disciplinary team. From Randomised Controlled Trials, benefits of ESD include reducing long term dependency, the length of hospital stay and cost savings. This systematic review and qualitative synthesis explores the experiences of those involved in ESD including people with stroke, family members, caregivers as well as the healthcare professionals.

Methods
A literature search was completed in 11 databases which generated 3,425 articles. Qualitative or mixed methods studies that included qualitative data on the experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service were included. Methodological quality was appraised using the Critical Appraisal Skills Programme checklist. Findings were synthesised using thematic synthesis.

Results
A total of fourteen studies were identified. The methodological quality of the studies was good overall. Four key themes emerged: 1) ESD is experienced by people with stroke as a goal-focused and supportive process leading to positive outcomes, 2) ESD eases the transition from the hospital to the home environment but the transition from ESD to social and community services is often problematic, 3) Organisational, logistical and inter-professional factors are critical to the success of ESD and 4) The home environment enhances rehabilitation.

Conclusion
Our findings highlight the importance of home in the rehabilitation process post stroke. Key practice implications point to the need for increased attention to periods where care transitions occur.
246 IMPROVING LUMBAR PUNCTURE TECHNIQUE AMONG INTERN TRAINEES TO ENHANCE QUALITY OF CARE FOR PATIENTS
Authors: Antonenko A , Shanahan E , Slattery N , Leahy A , Gabr A , Condon J , Ahern E , O'Connor M 
Published: February 2023

Abstract

Background
Lumbar puncture (LP) is a common procedure performed on older adults in acute medical settings. A higher peri-procedural risk has been shown in older patients. Non-consultant doctors (NCHDs) often lack confidence and competence in performing LP. Simulation based training using task trainers has been shown to improve confidence, preplanning skills and technique.

Methods
A simulation based teaching session was developed in a university teaching hospital (training structure was adapted from the LP training guide published in MedEdPortal). Small group teaching (with 6–8 learners) was delivered to 25 NCHDs with no prior exposure or experience with lumbar puncture completion. Trainees completed one LP simulation without practice to mastery level. On-demand and post-performance feedback was delivered to learners. An assessment checklist was completed by the supervisor. Learners completed an anonymised quantitative and qualitative questionnaire using Qualtrics XM software at a later date to evaluate self-perceived teaching outcomes.

Results
16 doctors completed the questionnaire (64% response rate). 55% rated the LP workshop as a ‘strongly positive’ impact on their learning, while 18% indicated a ‘positive’ impact on a 5-point Likert scale. 19% of trainees reported they were ‘very comfortable’ at performing the procedure post training, with 56.5% ‘comfortable’ to perform an LP in their clinical practice. Qualitative learner feedback included ‘more hands on practice’ on the mannequin, ‘smaller groups for the workshops’ and ‘more practice tips’ during the simulation workshop.

Conclusion
This pilot study demonstrated interest and positive feedback for the LP simulation training from novice doctors with improved self-assessed confidence. Formal development of an LP simulation training curriculum is underway. The impact of this training on patient care should be assessed in practice.
249 A SURVEY OF IRISH DOCTORS VIEWS ON FLEXIBLE TRAINING
Authors: Loughlin E , McNamara R , Antonenko A , O'Regan A , O'Connor M 
Published: February 2023

Abstract

Background
We aimed to establish the views of non consultant hospital doctors working in Ireland on the options available for ‘Flexible Training’ or ‘Less-Than-Full-Time-Training’. Our population is ageing rapidly, and an expanding workforce will be required. Difficulties with doctor retention and recruitment are growing challenges in Ireland.

Methods
An anonymised survey of 9 questions was carried out using Survey Monkey®. Question format included multiple choice, yes/no or a free text box. This was disseminated via the Royal College of Physicians of Ireland to 1,557 trainees of the Institute of Medicine, the national postgraduate body for medical specialties. It was also circulated to members of the Irish Medical Organisation, the national medical organisation, and to approximately 200 doctors across two hospitals on social media.

Results
There were 674 (84.3%) respondents in training- 46.3% BST, 53.7% HST; and 125 (15.6%) non-training respondents. Doctors overwhelmingly felt trainees should have access to flexible training (n = 849, 99.41%), with 82.39% reporting they would apply (n = 702). Most (92.5%) felt that 16 WTE positions was inadequate (n = 789). Reasons chosen for not applying for flexible training included- 36.1% (n = 169) felt it could impact their career, 25.4% (n = 119) identified they did not meet the criteria, 14.32% (n = 67) reported no interest, while 24.1% (n = 113) gave ‘other’ reasons including lengthy training, salary impacts, and not having a requirement for flexible training. When asked about suggestions for improving flexible training, 19.7% chose ‘offer more places’, 6.7%-‘remove eligibility criteria’, 19.6% -‘offer job sharing options’, 9.5%- ‘allow more flexible training years’, 17.7% -‘regional based training’, 22.5% -‘all of the above’, 4.9%—‘other’.

Conclusion
Our survey suggests non consultant hospital doctors in Ireland strongly desire an expansion of current flexible training options. This is essential to ensure Ireland is an attractive place for doctors to work, to support their health and wellbeing, and to ensure an adequate workforce to care for an ageing population.
254 OPTIMISING COMMUNICATION WITH FAMILIES OF PATIENTS ON ACUTE STROKE AND GERIATRIC MEDICINE WARDS IN A LARGE TERTIARY HOSPITAL
Authors: Killeen E , Doherty R , Higgins M , O'Reilly A , Brewer L 
Published: February 2023

Abstract

Background
Good communication with patients and families is important for older adults admitted to acute stroke or geriatric medicine wards, particularly with COVID19-related restricted visiting. These patients often have communication difficulties including aphasia, delirium, cognitive or hearing impairment, limiting their own communication with relatives. Using the Plan, Do, Study, Act (PDSA) approach we undertook a quality improvement project to optimise communication with families of patients on above wards in a large tertiary hospital.

Methods
PDSA cycle 1: Staff were surveyed to identify satisfaction level with communication and ways to optimise communication. Inpatients on study wards were identified, we recorded demographic and clinical details and prevalence of communication difficulties. We created a designated folder with individual ‘communication sheets’ in conjunction with ward doctors and the nurse manager. PDSA cycle 2: We performed a rapid interval audit of the communication folder use. ‘Outlier’ patients were excluded as their teams did not receive education about folder use.

Results
PDSA cycle 1: A total of 90 inpatients on three wards were included, mean age 78y (SD ±14.4y), 47% were male. Three-quarters (73%) had a communication difficulty noted, reported by nursing staff. Two patients were intubated and six had stroke-related aphasia. Half of surveyed staff reported communication with families was suboptimal. Most (86%) suggested a centrally-located communication logbook would be helpful. PDSA cycle 2: Over two weeks, communication sheets were reviewed for all included patients. Median frequency of calls to families was 4 days (range 0–14). Most (79%) had the name of the primary contact clearly documented. Many (52%) included no contact number. Only 9% had secondary contact information documented.

Conclusion
Communication with families of patients on acute stroke and geriatric medicine wards was suboptimal. Over a short interval this improved with regular phone calls using specific centrally-located communication folders. Further optimisation of their use is needed.
33 ARE CLINICAL TRIALS RANDOMISING HOUSEHOLDS TO LIFESTYLE INTERVENTIONS FOR THE PREVENTION OF COGNITIVE DECLINE FEASIBLE?
Authors: Costello M , McCarthy C , Bosch J , Robinson S , Canavan M , O'Donnell M 
Published: February 2023

Abstract

Background
Dementia is increasing in prevalence worldwide. Several lifestyle factors have been identified as targets for dementia prevention, which may be more effective if targeted at households instead of an individual. To date there have been no clinical trials randomising households to lifestyle interventions of sleep, diet and/or physical activity to prevent cognitive decline. To inform future studies, qualitative approaches can give valuable in-depth insights into the values and beliefs of all household members towards behavioural change.

Methods
Semi structured interviews were carried out among eight households affected by cognitive impairment. Interview content was analysed, and important themes identified.

Results
Eighteen participants were interviewed within household pods. Among those, eight had cognitive impairment and the remainder were spouses or first-degree relatives living in the same home. Several themes of interest emerged including household members without dementia were more likely to report poor sleep habits; sleep was perceived the hardest behaviour to change; although most participants had healthy diets, most were interested in making a change and felt there was a strong link with nutrition and cognition; physical activity is challenging to adapt due to lack of motivation and focus when individuals are cognitively impaired and motivation to pursue physical activity in households centred on relaxation and social interaction.

Conclusion
This study identified beliefs and preferences of households towards lifestyle intervention trials. Barriers to study participation including risk of harm, complexity of intervention and deviation from routine emerged during discussions. Findings from this study should be used to inform future clinical trial protocols and future qualitative studies should explore acceptability and feasibility of digital intervention applications.
46 MEASURING THE IMPACT OF COVID-19 RESTRICTIONS ON MOBILITY IN OLDER ADULTS WITH FRAGILITY FRACTURES USING THE NEW MOBILITY SCORE
Authors: O'Riordan F , Murphy J , Egan G , Ahern E 
Published: February 2023

Abstract

Background
The WHO declared COVID-19 a pandemic in March 2020. Specific public health measures were implemented for older adults who were advised to ‘cocoon’. While this has a positive effect on disease spread, reduced activity increases the risk of falls and fractures as well as all-cause mortality [1]. The New Mobility Score(NMS) stratifies patients according to pre-fracture mobility and predicts 6-month functional level and 1-year mortality [2]. Using the NMS, we evaluated patient mobility pre and post-restrictions. We also obtained basic data, frequency of falls and Clinical Frailty Scale (CFS).

Methods
We prospectively studied 50 patients admitted with a fracture and reviewed by our Orthogeriatric team between August–October 2020.

Results
Mean age was 80 years [range 53–99], 41(82%) were over 70 years and 43 (86%) were female. A hip fracture, 39 (78%) was the most common admission and mean CFS was 4 [Range 1–7] classifying the cohort as mildly frail. Mean NMS was significantly lower post-restrictions compared to pre-restrictions [5 [SD 2.19] vs 6.5 [SD 2.15] [P = 0.0074]]. There was no difference in falls pre and post-restrictions [1.1 [S.D 2.3] vs 1.9 [S.D 1.9] [P = 0.0609].

Conclusion
Our study shows that in a vulnerable cohort, COVID-19 restrictions have significantly impacted mobility over a short time period. As a result, our patients are less likely to regain pre-fracture functional level and are at increased risk of all-cause mortality. As further restrictions are implemented, public health strategies for older adults should be prioritised to maintain mobility and prevent adverse outcomes.

References
1. Cunningham C et al. Consequences of physical inactivity in older adults: a systematic review of reviews and meta-analyses. Scand J Med Sci Sports. 2020;00:1–12. 10.1111/sms.13616.
2. Kristensen MT et al. Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop. 2010;81(3):296–302. 10.3109/17453674.2010.487240.
49 ASSESSING EFFECTIVENESS OF AN OUTREACH VISIT PATHWAY FROM ED & REQUIRING FURTHER FOLLOW UP IN THEIR OWN ENVIRONMENT
Authors: Loughlin K M , Lyons C , McGettigan L , Maloney P 
Published: February 2023

Abstract

Background
Falls are a leading cause of presentation to the Emergency Department for older adults. They often are at higher risk of admission to hospital which can lead to other complications of frailty such as development of delirium or deconditioning. The risks of admission were further complicated in the past year due to COVID and its adverse outcomes on our older frail population which further highlighted the need to manage their needs at home where possible.
These above changes have led to FITT reviewing the scope of our outreach service with a focus not just on facilitating discharge but preventing further presentation or deconditioning.

Methods
The aim of the project was to identify appropriate FITT patients to provide an Outreach visit from ED within 72 hours of discharge pending needs. This service was in conjunction with the existing Integrated Care Teams/community services but an outreach visit direct from ED may have been indicated due to; staffing levels, response time, catchment area or existing rapport with the individual patient. This was pending staffing levels with reconfiguration of existing staff to support the outreach therapist.
Appropriate patients included.
-Recurrent falls.
-Unresolved delirium/advanced dementia with ongoing therapy needs.—Bridging gap while awaiting community teams.
-Equipment provision.

Results
Over 10 months 34 outreach visits completed.
Average CFS: 6.
Reasons for:
12 for safety checks.
15 equipment provision/fitting.
6 mobility reviews.
Onward referrals:
22 (PCCC OT, Physio, PHN & day hospital & ICT).
Represent within 7 days = 0.
Represent within 30 day = 14 (41%).

Conclusion
The provision of an outreach services allowed a swift therapy review in the patient’s own home & onwards referrals as indicated. Often these patients were likely to be admitted however the outreach provided a safety net to facilitate direct discharge from the ED with no representations within the first 7 days.
51 TO EXPLORE EMERGENCY MEDICINE SPRS UNDERSTANDING, IDENTIFICATION AND MANAGEMENT OF FRAILTY WITHIN THE EMERGENCY DEPARTMENT
Authors: Loughlin K M , McNamara R , Timmons S 
Published: February 2023

Abstract

Background
Our frail cohort of older adults represent a large proportion of those presenting to our Emergency Departments. This has led to the introduction of diverse teams in many Emergency Departments to support their complex care needs. However, it is not known if Emergency Clinicians have a clear understanding of frailty identification and management or feel this is part of their own role.
The aim of this study was to engage with Emergency Medicine Senior Trainees on the national training scheme in Ireland to explore their understanding of frailty and what they feel their role is in its identification and management.

Methods
Following a literature review based on defined criteria, a number of focus groups were held with ED PGY4 and above doctors working in various Emergency Departments throughout the country, with thematic analysis of the transcripts of the focus groups.

Results
In total, 13 Emergency Medicine PGY4 and above doctors partook in the focus groups with an overall view that frailty identification was part of their role within the Emergency Department; however there was agreement they have limited insight into the core principles of frailty identification and management. There was also an overall desire for future formal education on frailty to be provided. Three themes in the form of frailty recognition and assessment, education on frailty, and the role of the multidisciplinary team were identified as well as a number of subthemes for further exploration.

Conclusion
The consequences of frailty often lead to presentation to the Emergency Department. There is an increased awareness of its presentation but the core providers of emergency care feel there is a lack of the education required for them to manage the consequences of frailty which they encounter on daily basis and they have a clear desire to increase the knowledge base and skill set.