bluuebunny/crossref_metadata_2025_split huggingface dataset:
39 An audit of Vitamin D status in acute medical patients over the age of 65
Authors: Coelho D , O'Sullivan E 
Published: September 2023

Abstract

Background
Vitamin D is an essential nutrient for older adults in maintaining bone health, prevention and treatment of osteoporosis. It plays a fundamental role in preventing fractures. Vitamin D is seasonal, meaning it is not made during winter, and in summer is subject to the variable sunlight available in Ireland. The Department of Health Guidance in 2020 recommended adults over 65 years should be supplemented with 15 micrograms of Vitamin D daily. 55.5% of adults over 65 years have insufficient/deficient vitamin D levels in winter. The aim of the audit was to highlight the significance of routine Vitamin D testing and its management in all acute medical patients over 65 years.

Methods
A prospective audit of 50 patients aged over 65 years was conducted between December 2022 and March 2023. The data collected were Vitamin D serology results, the presence and type of Vitamin D supplement prescribed, whether the Vitamin D level was mentioned in discharge letters, and if any patient presented with osteoporotic fractures.

Results
48% of older adults were not on any Vitamin D supplement. 64% had insufficient Vitamin D levels of which 32% were truly deficient. Of those insufficient/inadequate of Vitamin D, 44% were not on any Vitamin D. Additionally, only 18% of Vitamin D results were mentioned in medical discharge letters. Overall, 30% of older adults presented with fractures and yet 10% of those were not on Vitamin D.

Conclusion
The audit highlighted the lack of Vitamin D supplementation in older adults. The results revealed insufficient monitoring of Vitamin D levels leading to deficiencies and correlating with presentations with fractures. All of this is detrimental to the older adult population. Highlighting the vital role of Vitamin D in bone health among clinicians and improving communication with colleagues are important areas for improving practice.
58 Review of a pilot Reablement Team service
Authors: Furey S , Lambe A , Macklin G , Richardson M , Bourke L 
Published: September 2023

Abstract

Background
A Reablement Team (RT) was established in a level two hospital for patients who are medically fit for discharge from either Medical Assessment Unit (MAU) or in-patient care, to prevent hospital admission and to support early discharge, through the provision of home rehabilitation. The team consists of senior grade medical social worker, occupational therapist, speech and language therapist, physiotherapist and a rehabilitation assistant. Intensive rehabilitation is provided in the home for up to 6 weeks. This study sought to evaluate service impact and performance in 2022.

Methods
A mixed method design was employed. Quantitative data was used by analysing number and nature of patients seen, discharge outcomes and pre and post outcome measures to determine goals achieved, quality of life and independence levels. Qualitative data included patient satisfaction questionnaires.

Results
In 2022, 78 patients were seen, 41 female and 37 male. Mean age of 79 years. Of the total number of patients, 59 (76%) were discharged early from hospital and 19 (24%) avoided hospital admission after attending the MAU. Underlying diagnosis of patients comprised Stroke (n = 29), progressive neurological disorders (n = 11), respiratory disorders (n = 2) orthopaedic/musculoskeletal (n = 13), falls (n = 20), patients medically unwell (n = 3). Of the patients discharged, 86% remained at home (n = 67), while 14% were readmitted. Using pre/post outcome measures, 89% reported an improvement in quality of life as measured by the ICECAP assessment and the mean increase of all patients in independence was 5.4% measured on the modified Barthel index. 91% of patients achieved one or more primary rehabilitation goals. All patients rated service satisfaction as high.

Conclusion
Findings indicate that a RT service can reduce LOS and prevent unnecessary admissions when intensive rehabilitation is provided by a dedicated team of HSCPs in the home. Additional benefits include reduction of primary care waiting list and integrated home care.
59 The effectiveness of a progressive resistance exercise class for Sarcopenic hospitalised older adults
Authors: Bailey C , Gilmore E , Tobin A , NiChonchubhair C , Speirs C , Newell E , Nolan M 
Published: September 2023

Abstract

Background
Sarcopenia is common in the older inpatient population with an estimated prevalence of 22.6%. A Progressive Resistance Training (PRT) program addressing sarcopenia is recommended to counteract its adverse effects of increased falls and mortality. The delivery of exercise in the acute setting can pose a challenge for health care professionals. Therefore, this study aimed to examine the effectiveness of a PRT exercise class for older adults in an acute setting.

Methods
This was an observational study using a convenience sample of older adults undergoing physiotherapy within the hospital. All participants deemed medically suitable were referred by their primary physiotherapist. Participants underwent PRT including upper and lower body exercises, twice a week. These patients also undertook regular physiotherapy outside of the class. The primary outcome measures were the five times Sit-to-Stand (5STS) and bilateral hand-grip recorded by their primary physiotherapist pre-class attendance and on their last class.

Results
A total of 10 participants engaged in the PRT class. 70% were male and 30% were female with and average age of 77.5 years. The average number of classes attended was 3.1. Participants demonstrated an improvement in sarcopenic measure of 5STS, median change of 7.9 seconds (interquartile range [IQR] 4.88–11.75 seconds), and grip strength, median improvement in left 0.96 kgs (IQR -3.85-5.18) and right 0.1kgs (IQR -1.55-1.68).

Conclusion
This PRT exercise class demonstrated an improvement in sarcopenic measures in hospitalised older adults. These results are not exclusively due to PRT class attendance however this programme is an example of an effective way to address the negative effects of sarcopenia and the identified research gap in providing exercise in the acute setting. Further research is required to examine the effect of combining nutritional education with PRT training as an intervention for older adults with sarcopenia.
79 Aiming to be champions: stroke swallow screen audit
Authors: Ward C , Johnston A-M , Cheannabhain A Ni , Diskin M , Hannon N 
Published: September 2023

Abstract

Background
Dysphagia post stroke has a significant impact on patient’s outcomes including mortality due to stroke associated pneumonia, length of stay, rehabilitation potential and overall quality of life. Evidence derived from both experimental and observational studies demonstrates that swallow screening following stroke has a significant protective health benefit against pneumonia, mortality, dependency and length of stay. Stroke Swallow Screening (SSS) should be completed within 4 hours of patients presenting with stroke. In 2022, 70% of patients presenting with stroke received a SSS with only 43% receiving SSS within the recommended 4 hours. The aim of this audit is to investigate how PUH compares to the international standard and the national audit of stroke findings.

Methods
Retrospective audit using the 2022 HIPE Stroke data for PUH. Audit reviewed data from January to December 2022. Sample size was the entire cohort of strokes in 2022 (88 patients). Data was analysed quantitatively using an excel spreadsheet.

Results
88 patients presented to PUH with stroke in 2022. 44% (39 patients) had a SSS completed, while only 13% (11 patients) had the screen completed within 4 hours.

Conclusion
PUH will use this patient-centred data to improve our stroke care, specifically the SSS standard as per the National Stroke Guidelines (2022). The SLT department is currently collaborating with our stroke colleagues to provide training to relevant staff. A SSS Programme is a priority quality improvement project for 2023, striving to make significant improvements to our standard of stroke care. Our goal is to become champions locally and nationally in SSS, an area that has consistently lagged behind the national and international standards for too long.
95 Do Not Attempt Resuscitation: all or nothing?
Authors: Carvalho J , Gibbons C , Ramjohn J , Ahmed B , Heberger M , Quigley L , Finan K 
Published: September 2023

Abstract

Background
Do Not Attempt Resuscitation (DNAR) orders may be implemented when patients do not wish to receive Cardio-Pulmonary Resuscitation (CPR) or when CPR is deemed non-beneficial. Complex ethical and medical considerations influence these decisions, emphasising the need for accurate documentation as per national policies. Our aim was to assess comprehensive documentation of DNAR decisions and healthcare providers’ opinions on managing patients with DNAR orders.

Methods
We conducted a point-prevalence chart review of adult inpatients with a DNAR order on March 2nd, 2023.We surveyed healthcare providers using a structured tool and analysed the data using Excel.

Results
We identified 22 (n = 22) charts for review. All charts had a DNAR form, but only 31.8% (7) had documented discussion details. 54.5% (12) lacked a discussion with the patient regarding the DNAR decision, and 58.3% (7) lacked documentation explaining the reasoning. 72.7% (16) lacked clear documentation on the reasoning for the DNAR status decision. Regarding healthcare providers’ opinions on patients with DNAR status, we received 46 completed questionnaires (n = 46). Most respondents believed simple bedside investigations and non-invasive interventions were appropriate for DNAR patients. However, there was a discrepancy in opinion regarding more invasive interventions, such as Naso-Gastric Tube placement (52%) or inotropic support (48%). 84.8% (39) of staff believe there is a distinction between palliative patients and those designated as DNAR. 80.4% (37) of nursing staff reported hesitancy in discussing DNAR status with doctors when patients deteriorate. 58.7% (27) of staff believed their approach to care changes when a patient is labelled DNAR.

Conclusion
Our audit demonstrates the need for improved DNAR status documentation. Current practices do not meet national guidelines, creating ambiguity and subsequent confusion during emergencies. This may be exacerbated by disparities in hospital staff opinion regarding DNAR patients, highlighting the importance of establishing local policies to improve staff education and patient care.
140 Introduction of a post fall medical review pro forma for hospital inpatients
Authors: Daly S , Ramjohn J , O'Sullivan F 
Published: September 2023

Abstract

Background
Falls are the most common adverse incident in Irish hospital inpatients. 30–50% of inpatient falls result in injury. Older people are more likely to fall and are more likely to sustain an injury. The post fall medical review is critical to assess why a patient fell and if they sustained any injuries. We aimed to audit the quality of the post fall medical review compared to the ‘HSE Service User Falls’ guideline in a university hospital and if the introduction of a post fall pro forma improved the quality of this review.

Methods
We retrospectively audited the post fall medical review entries of 20 charts of patients who had fallen in hospital. We assessed details such as patient/doctor identifiers, history, examination, management and falls prevention. We introduced a post fall medical review pro forma on two wards in the hospital to aid doctors in their medical review. We then re-audited the quality of the medical review of 9 patients who fell over a two months period and were reviewed using the pro forma. We compared these results to our first audit.

Results
The post fall medical review pro forma improved the quality of the medical review in multiple domains. 30% of doctors asked if there had been a head strike pre pro forma versus 100% who asked with the pro forma. Joint examination improved from 45% pre to 100% post pro forma. Hip strike history taking improved from 15% to 89%. 70% of doctors recorded the date and 15% recorded the time of assessment pre pro forma. 100% recorded both with the pro forma.

Conclusion
The post fall pro forma resulted in quality improvement of the post fall medical review. It is a memory aid and also encourages accurate documentation. This pro forma will be introduced hospital wide to improve patient care.
147 PRIME-COG study: grip strength, anthropometrics and cognitive decline
Authors: McAlinden M , Linden G , McKay G , McEvoy C , Farsi D , Teeling J , Passmore P , Holmes C , Patterson C , McGuinness B 
Published: September 2023

Abstract

Background
Measurement of hand grip strength is a validated measure of physical strength. While anthropometric measurements including waist, hip and mid-upper-arm circumference, are validated for physical health. Evidence has suggested grip strength and anthropometrics to be associated with cognitive impairment and dementia. The relationship between these variables and risk of mild cognitive impairment (MCI) or dementia was investigated in a cohort of 70–90-year-old men residing in Northern Ireland.

Methods
The PRIME-COG study is nested within the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study. Data collection for PRIME-COG included collection of lifestyle and demographic information. A comprehensive cognitive assessment, anthropometric measurements, and hand grip strength were measured by dementia research nurses from the Northern Ireland Clinical Research Network. Logistic regression models were performed to assess the association between hand grip strength and anthropometric measures and the composite cognitive endpoint MCI/dementia.

Results
Analysis identified that low hand grip strength was associated with MCI/dementia, although this did not reach statistical significance (OR 1.39, p = 0.18). Larger hip circumference was associated with reduced risk of MCI/dementia in the study population (fully adjusted model, OR 0.93, P = 0.01), while BMI was non-significantly associated with an increased risk (OR 1.22, p = 0.58).

Conclusion
Within the PRIME-COG cohort, low grip strength was associated with a 39% increased risk of MCI/dementia. Whilst not statistically significant, this supports the importance of grip strength as a clinical tool in the assessment of physical health in older adults. Larger hip circumference was significantly associated with a 7% reduced risk of MCI/dementia, while higher BMI was associated with a 22% increased risk, although this was not significant. Results from this study add to the evidence demonstrating the association between cognitive function and physical well-being.
157 Budget impact analysis of Holter monitors provision in an outpatient clinic
Authors: Marion I , Power D 
Published: September 2023

Abstract

Background
Outpatient clinic attendees (aged &gt;64) commonly present with falls, dizziness, syncope and palpitations. The most common non-invasive investigation ordered includes continuous ambulatory electrocardiography monitoring, namely the Holter monitor. The clinic is outsourcing Holter monitor requests to the Cardiology Department, with a long waiting list. If the patient wishes the test to be done sooner in a private hospital, it costs between 160 to 295 euros, covered by the patient’s private healthcare insurance.

Methods
A budget analysis was carried out to further evaluate by provisioning 5 Holter monitors in the outpatient clinic to quicken patient turnover and reduce the cardiology department waiting list. The intervention scope was limited to the designated clinic of approximately 450 patients a month. The intervention is not for generating revenue for the clinic. The budget analysis doesn’t include sensitivity analysis from the best-case towards worst-case scenarios of Holter frequency usage and duration of Holter monitoring. The objectives of the proposed change are to lessen the turnaround time by 20% for the patients from being assessed until discharge from the clinic without having delayed investigation of the Holter monitor, to have a timely and accurate diagnosis of suspected arrhythmia and the appropriate management within the new intervention.

Results
The decision tree, utilising the Decision analytic modelling, resource identification, cost implication, estimated changes including 2-hour staff training, capital, year one to year five costs, potential cost savings year-on-year, cost-per-wear comparison against the private hospital provider, pre and post-intervention scenario analysis were constructed.

Conclusion
The budget impact analysis designed a simple cost calculator to add additional tests of Holter monitors that rely on the decision model approach. It shows a potential cost saving within a five-year horizon and increases the number of patients’ attendance by optimising patient turnover. Apart from the cost and organisation, there are other positive impacts towards financial and clinical areas, ensuring high-quality service for the population.
158 Delirium as a predictor of admission in the emergency department
Authors: Dillon A , Edge L , Flynn S , Kirwan A , Romero-Ortuno R 
Published: September 2023

Abstract

Background
Frailty intervention teams are now commonplace in Emergency Departments (EDs). A geriatric assessment in the ED should be multidimensional and include demographics, details of the presenting complaint, frailty, and delirium. The aim of the present review was to establish which of these dimensions was most predictive of patient disposition (i.e. admit vs. discharge) in the ED of a large university hospital.

Methods
Data was reviewed from ED attendees aged ≥65 years assessed by the frailty intervention team over a three-month period. Age, sex, and whether the presenting complaint was a fall were recorded. Frailty was measured with the Clinical Frailty Scale (CFS), and delirium with the 4AT. Receiver Operating Characteristic (ROC) curves and Areas Under the Curve (AUC) were compared for the ability of age, CFS and 4AT to predict patient disposition. A multivariate binary logistic regression model was computed to assess how CFS and 4AT independently predicted patient disposition, whilst controlling for age, sex and fall as presenting complaint.

Results
Data from 217 patients was analysed (mean age 81.7, range 67–99 years; 66.4% women; 29.5% presenting with falls; median CFS 5; mean 4AT 1). The AUCs for age, CFS ad 4AT to predict admission were 0.59 (95% CI: 0.51–0.67, p = 0.033), 0.65 (0.58–0.73, p &lt; 0.001), and 0.70 (0.62–0.78, p &lt; 0.001), respectively. In the regression model, the only significant independent predictor of admission was the 4AT (OR 1.70, 95% CI: 1.37–2.12, p &lt; 0.001).

Conclusion
In the ED interface, delirium was a stronger prediction of admission than demographics, fall as the presenting complaint, and frailty. While delirium is a marker of illness acuity, frailty refers to the pre-illness baseline. The measurement of delirium in the ED is important as a predictor of patient disposition, while early delirium assessment may help to improve the time-to-disposition interval.
168 A quality improvement initiative to enhance dementia inclusivity within the physical environment of an older persons’ acute hospital ward
Authors: Sayers J , Ryan C 
Published: September 2023

Abstract

Background
There are currently over 64,000 people living with dementia in Ireland, this number is expected to double by 2045. Direct observation from multiple disciplines highlighted a large cohort of people living with dementia experiencing disorientation, wandering, and falls at ward level. National Guidelines and Strategies state that physical ward environments should be a key consideration for dementia care. Research shows that physical ward environments can be adapted to reduce confusion and agitation and improve wayfinding for those living with dementia.

Methods
An environmental ward audit was conducted through direct observation, using the environmental checklist from the Irish National Audit of Dementia (INAD-2). The results of the audit were compared with national standards which showed reduced compliance. Adaptations and/or modifications including the installation of orientation clocks, orientation whiteboards and increasing signage and labels to the physical ward were implemented to increase compliance. The ward was re-audited to assess change.

Results
The results highlighted increased compliance with national standards. Direct observations from the multidisciplinary team identified increased wayfinding and orientation for patients living with dementia on the ward. Multidisciplinary education on dementia inclusivity is essential in fostering a person centred approach to dementia care in the acute ward environment.

Conclusion
Multidisciplinary collaboration and commitment to dementia inclusive care may enhance the experience of those living with dementia in the acute hospital setting. Barriers such as infection control measures emphasised the need for a collaborative approach to overcome challenges and facilitate change.
177 Embracing choice: perspectives of older workers on extended working lives
Authors: Greene J , Collins M L 
Published: September 2023

Abstract

Background
Proposals to extend working lives are a frequent policy response to increasing older populations and associated pressures on state pension systems. However, all the consequences of a later retirement age are as yet unknown, with the perspectives of people potentially the first cohort of workers encouraged to remain in the workforce under-explored.

Methods
We conducted exploratory semi-structured interviews with 22 people aged between 51 and 63 in service industry occupations in Ireland. Falling just above low-income thresholds, this group were asked about their preparations for retirement, their views on continuing to work beyond anticipated retirement age and what measures, if any, can be implemented to facilitate working later in life. A thematic analysis was performed to provide a rich and detailed account of the perspectives of older workers as they approached retirement age.

Results
We found a general acceptance of working later in life, however this was contingent on several factors. The overarching enabler was continuing in good health with financial status a key underpinning motivator. For participants with insecure housing, patchwork employment histories and inadequate pension provisions, there was an impetus to continue working to generate savings before retirement. Often with less secure employment trajectories than previous generations, a leisurely retirement lifestyle was a diminishing prospect for our study participants. Working in multi-generational workplaces with the opportunity to shift to mentor roles was welcomed. As retirement approaches, measures such as reducing working hours while protecting existing welfare benefits would encourage people to remain in work for longer.

Conclusion
The complex and individual nature of continuing to work beyond expected retirement age requires flexible policy responses. An individualised approach to retirement which recognises the increasingly diverse nature of employment over the life-course is needed. This research contributes to advancing knowledge on how the choices of older workers can be facilitated in the context of our rapidly growing older population.