bluuebunny/crossref_metadata_2025_split huggingface dataset:
62 GAITKEEPER- A NOVEL ARTIFICIAL INTELLIGENCE BASED VIDEO GAIT ANALYSIS SYSTEM TO OBJECTIVELY MEASURE HEALTH STATUS
Authors: Kennelly S , Harte G , Boran A 
Published: February 2023

Abstract

Background
Frailty is associated with increased risk of falls, dependency, disability and higher health and social care utilisation. While characterised by a slowly progressive functional deterioration, frailty can be delayed or reversed through timely intervention. Identification of those at risk of new or worsening frailty remains a challenge. How fast we walk (gait-speed) is a reliable correlate of one’s physical, psychological, and cognitive performance. Slow gait speed can discriminate those at high risk of adverse outcomes due to declining health, however current gait-speed assessment instruments are often not feasible in clinical or community settings due to cost, specialist training, and space requirements. Here we introduce GaitKeeper, a system that uses artificial intelligence (AI) to measure gait and step events from video recorded on a mobile phone, thus facilitating identification of those at risk of new or worsening frailty.

Methods
A technical evaluation, in a research setting (n = 30), compared GaitKeeper’s performance capturing accurate positional data in healthy young individuals, versus the Vicon camera motion-capture system as the verification standard.
A subsequent clinical evaluation in people with mild cognitive impairment (n = 30), within an acute hospital, compared GaitKeeper gait speed data with specialist-physiotherapist clinical observational studies, and GaitRite systems during five-meter walking under single and dual-task conditions. Comprehensive measures of frailty (SHARE-FI), cognition (RBANS, MoCA), and physical performance (MiniBEST) were recorded in this clinical evaluation.

Results
The technical evaluation provides evidence of the ability of GaitKeeper to capture accurate gait data from video (n = 30, p &lt; 0.001, error &lt; 3%) versus the Vicon system. The clinical evaluation provides evidence of the accuracy in comparison with the GaitRite gold standard (n = 30, P &lt; 0.001, error &lt; 6%) in clinical setting.

Conclusion
GaitKeeper performance was well validated in comparison to existing gait analysis practices. This innovative AI based solution provides an opportunity to longitudinally monitor and quantify ‘wellness’ in older persons with accessible, accurate gait performance measurements anytime, anywhere, by anyone.
63 USING CO-DESIGN TO DEVELOP A CORE COMPETENCY FRAMEWORK FOR INTERPROFESSIONAL COLLABORATION WITHIN INTEGRATED CARE TEAMS FOR OLDER PEOPLE IN IRELAND
Authors: O'Donoghue G , Shé É N , O'Shea M , Donnelly S , O'Donnell D 
Published: February 2023

Abstract

Background
Fundamental to the successful delivery of integrated care for older people in Ireland and internationally, is sustainable interprofessional collaboration (IPC). Current evidence, however, offers little guidance in terms of how IPC can be fostered and sustained within the context of integrated care and older people. This research aimed to design a framework that describes core competencies for IPC within integrated care teams (ICTs) for older people, and outline mechanisms by which ICTs could start to develop the necessary knowledge, skills and behaviours to demonstrate proficiency.

Methods
Using a co-design approach, academic health systems researchers, members of the National Integrated Care Programme for Older People in Ireland (IPC subcommittee), and public and patient representatives (nominated by Age Friendly Ireland) collaborated across three studies to devise a core competency framework. Study 1 used co-design workshops to develop and gain consensus on core competencies; study 2 employed semi-structured interviews to explore current working practice within two existing interprofessional ICTs and study 3, combined findings from study 1 and 2, validated the agreed upon competencies and finalised the IPC competency framework.

Results
Six competencies, within three domains, were agreed. Domain one, knowledge of the team, includes the competencies, understanding roles and making referrals. Domain two, communication, includes sharing information and communicating effectively and domain three, shared decision-making, includes the final two competencies, supporting decision making with older people and collective clinical decision-making.

Conclusion
This co-designed framework provides the scaffold for curriculum development for the training of health and social care professionals around interdisciplinary team working for the care of older people. The core competencies prioritise mutual respect and active elicitation of input from all disciplines, thereby empowering disciplinary-specific expertise. Finally, and perhaps most critically, the will and preferences of the older person are deemed central to effective integrated interprofessional working within the developed IPC framework.
80 THE EXPERIENCE OF ACCESSING PARKINSON’S DISEASE CARE: A QUALITATIVE INTERVIEW STUDY
Authors: O'Shea E , Rukundo A , Timmons S 
Published: February 2023

Abstract

Background
Little is known about the experience of health service access amongst people living with PD in Ireland.

Methods
Semi-structured telephone interviews were conducted from April 2020–January 2021. Purposive maximum variation sampling was employed, to ensure diversity. Recruitment was multipronged; through voluntary support groups, social media outlets, local newspaper, magazine and radio advertising, and posters in nursing homes and GP offices. Interviews ranged from 30–90 minutes and were audio-recorded. The data were managed using NVivo12. A thematic analysis was applied.

Results
Twenty-two participants were interviewed. Four themes were identified relating to service access: 1) ‘The Two Waitlists’; 2) ‘Geographic Factors’; 3) ‘The Private-Public Switch’; and 4) ‘Discriminatory Practices’. Regarding theme 1, the lengthy public waiting list was a deterrent, leading many to pay out-of-pocket to obtain their PD diagnosis privately. However, many cannot afford to pay out-of-pocket, creating a distinct inequity in terms of timely access for those with fewer resources. Additionally, post-diagnosis, the wait times between outpatient follow-up visits is significantly greater for public patients. The second theme refers to the distribution of PD services across the country; the concept of the ‘postcode lottery’ was recurring. Substantial variation in service provision is evident, with rural areas being particularly under-served. The ‘Private-Public Switch’ refers to a pattern of transfer from the private to the public system, post-diagnosis, to access to the range of HSCPs necessary for optimal PD management. Finally, ‘Discriminatory Practices’ refers to perceived discrimination by referring healthcare professionals, at two levels, on the basis of 1) age, and/or 2) perceived severity of disability. Such practices can affect timely access to diagnosis, and ongoing integrated PD management.

Conclusion
The two-tier health system structure, along with under-provision of integrated, outpatient PD services in certain areas, and biases/lack of knowledge amongst referring healthcare professionals, have contributed differentially to inequities in access for public and private PD patients across Ireland.
102 PROMOTING BRAIN HEALTH IN AN INTEGRATED CARE OUTREACH PROGRAMME
Authors: Mc Carthy C E , O'Malley K , Mannion E , Geoghegan J , Costello M , Conry M , Flanagan L , Corry M , Reddin C , Murphy R , Waters R , O'Donnell M , Robinson S , Canavan M 
Published: February 2023

Abstract

Background
Lifestyle modifications, in older at risk populations, may prevent or slow the rate of cognitive decline. Promotion of brain health has been recommended by the WHO and other governing bodies. Supporting patients in making these lifestyle changes, however, can be complex. Generic guidance may not apply to all in a heterogenous and frail patient cohort, when physical mobility may be limited and weight loss/nutrition a concern. We sought to review current practices and barriers to brain health guidance in a regional integrated care outreach programme (ICOP).

Methods
From March–June’21 the comprehensive geriatric assessment (CGA) of consecutive patients were reviewed. Those presenting with cognitive complaints, for their first assessment, were included. Demographic data and data on screening for hearing impairment and sleep disturbance were collected, in addition to information on physical activity and nutritional risk. Whether information and guidance on aspects of brain health was given was also assessed.

Results
30 patients met the inclusion criteria. The mean age was 80.3 and the mean clinical frailty scale (CFS) was 4.4. Hearing impairment was present in 20% (n = 6), with no information available in 10% (n = 3). All patients were screened for sleep disturbance, with 13% (n = 4) not fully satisfied with their sleep. Mobility aids, assistance or supervision were required in 40% (n = 12), and 23% (n = 7) were at medium or high malnutrition risk. Only 30% (n = 9) cooked their own meals. Generic brain health advice, or advice about sleep was documented in 30 (n = 9), without hearing impairment advice documented in any patient.

Conclusion
There are several barriers to brain health advice in the ICOP setting, with only 30% of patients having brain health advice documented. We are currently developing patient information leaflets on brain health, that will take potential barriers into account. Dedicated and specific information on local hearing services is also in development, as part of an ongoing quality improvement project.
128 THE USE OF THE IRISH NATIONAL EARLY WARNING SCORE TO DOCUMENT NEW CONFUSION
Authors: Quirk L , Daunt R , O'Flynn A M 
Published: February 2023

Abstract

Background
The Irish National Early Warning System (INEWS) V2 has added ‘new confusion/altered mental status/delirium’ as a sign of early deterioration. It is captured as ‘C’ in ACVPU. A ‘C’ score’ should prompt concern regarding possible serious causes and requires urgent clinical review. The objective of this study is to identify the extent to which the INEWS ‘C’ score is used appropriately by healthcare professionals in an Irish hospital.

Methods
This is a cross-sectional study of inpatients over 65 years. Medical records, nursing notes and INEWS charts were reviewed for documentation of ‘new confusion’ during admission. The 4AT, which is a rapid delirium screening tool, was completed on the day of the audit for further confirmation. Descriptive statistics are presented.

Results
20 patients were included, 65% were male, mean age 80 years. 95% of patients had been inpatients for &gt;10 days. No patients had an INEWS ‘C’ score documented in their INEWS chart during admission. ‘New confusion’ was documented in 45% of patients’ nursing notes and 15% of patients’ medical notes. Delirium screening was completed on 45% of patients. On the day of data collection, 65% of patients had a 4AT score greater or equal to 1, and 15% of patients had a score of 4.

Conclusion
Over half the patients reviewed in this study had ‘new confusion’ documented in their medical records or nursing notes during their admission, however, this was never captured on the INEWS chart. Furthermore, 65% of patients had a 4AT score greater than or equal to one on the day of the audit. This study highlights the need for ongoing training, behavioural change and a cultural shift by health care professionals and organisations to ensure adherence with INEWS ‘C’ score and related escalation protocols.
129 MAKING THE CASE FOR ENHANCED INTEGRATION BETWEEN MEMORY ASSESSMENT AND SUPPORT AND COMMUNITY PALLIATIVE CARE SERVICES IN ADVANCED DEMENTIA
Authors: Molloy U , O'Reilly S , Ryan K , Kennelly S 
Published: February 2023

Abstract

Background
In Ireland there are an estimated 64,000 people living with dementia. There is a growing body of evidence that a palliative approach, including access to specialist palliative care in the later stages of dementia is essential for wellbeing and the promotion of holistic, person-centred care. Yet many people living with advanced dementia have limited access to specialist palliative care services and such services often feel ill equipped to meet the unique, complex needs of this cohort.

Methods
This is a case study report of the joint working interface between Memory Assessment and Support (MASS) and Specialist Community Palliative Care (SPPCT). M was a 85 year old lady, with advanced dementia and history of lung cancer. CT Brain showed a large left parietal lobe tumour, probable metastatic lesion. Family agreed that further investigations were inappropriate and care objective was to manage her needs in her home in accordance with her previously known wishes.

Results
A joint initial visit with SCPCT and MASS was carried out which included medication review, symptom management and assessment of additional service need. Regular visits from SCPCT with support from primary care services and MASS ensured that appropriate services were in situ, symptoms were regularly assessed and treatment plan adjusted as needed. M was supported to die at home in the care of her family, as per her wishes.

Conclusion
This case illustrates the value of the partnership between MASS and SCPCT. Services that are responsive to client needs can ensure that appropriate care is given in the right place at the right time in accordance with their will and preference. This is in line with Slainte Care principles and provides an alternative pathway for end of live care for people with advanced dementia away from acute care settings.
136 ASSOCIATIONS OF FRAILTY WITH CONSECUTIVE GAIT SPEED TRAILS MEASURED BOTH WITH AND WITHOUT ADDITIONAL STRESSORS
Authors: Davis J , Knight S P , Rizzo R , Donoghue O A , Kenny R A , Romero-Ortuno R 
Published: February 2023

Abstract

Background
Frailty is associated with gait speed and is defined as increased vulnerability to stressors. While usual gait speed is often measured, gait speed under additional stressors such as simultaneously reciting alternate letters of the alphabet (cognitive dual task) or walking at maximum pace are also measured. Consecutive trials may introduce an additional temporal stressor and we hypothesise that frailty may be associated with a greater reduction in walking speed across trials.

Methods
Data from community-dwelling adults aged 50+ years at Wave 3 of The Irish Longitudinal Study on Ageing were utilized. Using a 32-item frailty index (FI) we derived non-frail, pre-frail and frail groups. Gait speeds were measured using a 4.88 m walkway (GAITRite, CIR Systems, NY, USA). We examined differences in gait speed between two consecutive walks in three conditions (usual pace, cognitive dual task, and maximum pace) for the entire cohort, and by frailty group. Related-samples Wilcoxon signed rank tests were employed, with statistical significance set at P &lt; 0.05.

Results
For the entire cohort, walk 2 speed for usual and cognitive conditions was higher by 1.0 cm/s (N = 4,097) and 1.1 cm/s (N = 3,927) respectively, and lower by 1.9 cm/s for maximum (N = 3,926). Stratified by FI, all groups walked more quickly in normal (1.0, 1.1, 1.2, respectively) and cognitive (1.3, 0.8, 0.5), and more slowly in maximum (−2.2, −1.6, −1.0).

Conclusion
In our analyses, higher frailty seemed to be associated with a higher increase for the usual walk, a smaller increase for the cognitive walk, and a smaller decrease in maximum speed. The clinical significance of the differences was very small. However, our results support that in research and clinical practice, frailty by FI should not be expected to lead to a different pattern of gait speed change across consecutive trials.
138 DELAYED BLOOD PRESSURE RECOVERY AFTER STANDING INDEPENDENTLY PREDICTS FRACTURE IN COMMUNITY-DWELLING OLDER PEOPLE
Authors: Doyle K , Lavan A , Kenny R-A , Briggs R 
Published: February 2023

Abstract

Background
Orthostatic hypotension, characterized by delayed blood pressure recovery (DBPR) after standing, is a risk factor for falls but the longitudinal relationship with fracture is not yet known. The aim of this study was to examine the prospective risk of fracture associated with DBPR.

Methods
This study, embedded within the Irish Longitudinal Study on Ageing (TILDA), examined prospective risk of fracture (hip, wrist or vertebral) associated with DBPR at 8-year follow-up in a population-representative sample of more than 3,000 (54% female) community-dwelling older people. Orthostatic blood pressure (BP) was measured using a finometer during active stand at TILDA Wave 1. DBPR was defined as systolic BP ≤ 20 mmHg lower and/or diastolic BP ≤ 10 mmHg from baseline value at 30, 60 and 90 seconds after standing. Participants with a fracture reported at any of Waves 2–5 were defined as having ‘Incident Fracture’. Logistic regression models were used to estimate odds ratios (ORs) for the association between DBPR and incident fracture.

Results
Seven percent (212/3117) of participants sustained a fracture during follow-up. DBPR at 30 seconds was a significant predictor of any fracture [OR 1.80, 95% confidence interval (CI) 1.28–2.53] and hip fracture (OR 4.44, 95% CI 2.03–9.71) in fully adjusted models. DBPR at 30 seconds did not predict wrist or vertebral fracture. DBPR at 60 seconds also predicted any fracture (OR 1.74, 95% CI 1.19–2.54) and hip fracture (OR 4.66, 95% CI 2.12–10.26) whereas DBPR at 90 seconds predicted any (OR 1.99, 95% CI 1.38–2.87), wrist (OR 1.87, 95% CI 1.19–2.95), and hip fracture (OR 3.39, 95% CI 1.45–7.93) in fully adjusted models.

Conclusion
Delayed BP recovery independently predicts fracture in community-dwelling older people, is potentially modifiable, and can be measured in an ambulatory setting. Given the morbidity and mortality associated with fractures, identification of such risk factors is crucial in order to inform preventative strategies.
140 FAMILY DEMENTIA SUPPORT TRAINING—AN INTEGRATED CARE APPROACH
Authors: McHale C , Fallon A , Donnelly M , Dookhy J , McGuinn C , Domsa M , McNally D , Tobin F , Kennelly S 
Published: February 2023

Abstract

Background
There are approximately 64,000 people living with a diagnosis of dementia in Ireland. This number is expected to double to 150,000 by 2045. The growing need for post diagnostic support has been accentuated by the fact that we are living through an unprecedented Pandemic. Our Dementia Training Network identified the need for a localised educational resource for families supporting those diagnosed with dementia across our service.

Methods
Following a successful pilot in association with the Alzheimer’s Society of Ireland, staff from the Specialist Memory Service, Integrated Care Team, and Primary Care created a service-informed 6 week course aimed at supporting families. A focus group preceded the first course to establish preferred content. The course delivered education on Dementia; Post Diagnostic Steps; Communication; Non cognitive symptoms; Nutrition & hydration; Assistive Technology; Forward planning and Self-care. The multi-dimensional nature of staff delivering the course creates a rich tapestry of advice and information. All staff involved work together to identify, refer and support families living with dementia in the local area. The group takes place in an accessible location and time which accommodates families. Each course attendee completes a questionnaire prior to and after commencing the group. The level of satisfaction will be measured following every course.

Results
By the end of 2021, the group will have delivered education and support to 36 families. The automatic referral of all families to this resource will assist in building up confidence to support and enhance self-care. The combined participants from the catchment area will become a network of families joined together on their journey.

Conclusion
This innovative service collaboration enhances the integrated nature of the Post Diagnostic Care pathway. The Integrated care approach has served to enrich the programme and allow for timely support and advice regarding localised supports.
157 WHOLE HIPPOCAMPAL VOLUMES AND HIPPOCAMPAL SUBFIELD VOLUMES IN MCI-LB AND MCI-ad
Authors: Durcan R , Colloby S J , Donaghy P C , Lawley S , Taylor J-P , O'Brien J T , Thomas A J 
Published: February 2023

Abstract

Background
Mild cognitive impairment with Lewy bodies (MCI-LB) is the commonest prodromal phenotype of Dementia with Lewy Bodies (DLB) and may be challenging to differentiate from MCI due to Alzheimer’s disease (MCI-AD). Preservation of medial temporal lobe structures on MRI is recognised as a supportive biomarker consistent with underlying Lewy body disease rather Alzheimer’s disease (AD).
We investigated whether whole hippocampal volume and differing hippocampal subfield atrophy patterns, could be used as a surrogate biomarker of underlying ad pathology, allowing for differentiation of MCI-LB from MCI-AD.

Methods
Participants were recruited to the following groups’: healthy controls (HC), MCI-LB and MCI-ad, all ≥60 years. Alongside detailed clinical, neuropsychological assessments, all participants underwent 3 T MRI, 123I-FP-CIT SPECT and 123I-MIBG myocardial scintigraphy. Using Freesurfer (v.6.0), a fully automated hippocampal subfield segmentation of the MRI data was performed.

Results
Groups consisted of 31 HC (mean age, 73.7 yrs; mean Mini-Mental state Examination [MMSE] score, 28.4), 34 MCI-LB (mean age, 74.7 yrs; mean MMSE score, 26.6) and 29 MCI-ad (mean age, 75.4 yrs; mean MMSE score, 27.1).
There was no significant difference in whole hippocampal volume between MCI-LB and MCI-ad(Mean (SD) in mm3: MCI-LB 6025 (961) vs MCI-ad 5407 (882), p = 0.12) or between MCI-LB and HC (Mean (SD) in mm3: MCI-LB 6025 (961) vs HC 6355 (962), p = 0.11). Whole hippocampal volume was significantly smaller in MCI-ad compared with HC (p &lt; 0.001).
Comparison between MCI-LB and MCI-ad, showed absolute hippocampal subfield volumes were all lower in MCI-ad. However, the magnitude of the differences were small and no significant difference in hippocampal subfield volumes were noted between these groups, with the exception of the hippocampal tail being significantly smaller in MCI-ad compared to MCI-LB (p = 0.04).

Conclusion
In a well-characterised cohort, whole hippocampal and hippocampal subfield volumes were similarly atrophied in MCI-LB and MCI-ad and did not distinguish between the groups.