bluuebunny/crossref_metadata_2025_split huggingface dataset:
266 The current rehabilitation needs of an acute tertiary hospital—a point prevalence study
Authors: Gannon E , Healy L , O’Donovan C , Blackburne H 
Published: September 2023

Abstract

Background
Rehabilitation needs are rising worldwide. The World Health Organisation recognises that many countries are not equipped to meet existing rehabilitation needs and has issued a call to action; Rehabilitation 2030 encouraging countries to focus on rehabilitation as a health priority. We sought to identify the rehabilitation needs of patients admitted to a tertiary hospital, measure the complexity of rehabilitation needs, and identify appropriate setting to meet these needs.

Methods
All admitted patients were identified using the electronic patient admissions system on February 17th, 2023. Patients under the care of emergency medicine were excluded. Data was collected by teams of two healthcare professionals familiar with rehabilitation. Data collected: demographics; most appropriate location of care—Hospital, Community, Rehabilitation Unit; Clinical Frailty Score (CFS); Rehabilitation Complexity Score (RCS); estimated Length-of-Stay (LoS).

Results
640 patients identified. Median age was 71. 42% (269/640) &gt;75 years, 47% (127/269) CFS 4–6, 16% (43/640) CFS 7–9. 12% (78/640) identified as having rehabilitation needs best met in a rehabilitation unit. Rehabilitation needs were identified across specialities, majority identified in Medicine 36% (28/78), and Stroke 28% (22/78). Average RCS 9.4, max RCS 18. Highest average RCS 12 identified in Neurosurgery patients. 3% (33/640) estimated LoS of &gt;3 months, 30% (10/33) with primary rehabilitation needs. Average RCS 12.71 in patients with estimated LoS 3–4 months, 12 in LoS &gt; 4 months.

Conclusion
Our study identifies significant and complex rehabilitation needs in the acute hospital setting. Rehabilitation needs were diverse across specialities, with certain areas showing increased complexity of needs and longer estimated lengths of stay. Increased numbers of specialist rehabilitation beds are needed to ensure patients rehabilitations needs are optimised.
290 Documenting medication-related needs of older persons assessed by frailty at the front door teams
Authors: Fitzgerald R , Cahill M , Cronin L , Leonard A , Coakley E , Allen S , Martin L , Condon F , Pillay I 
Published: September 2023

Abstract

Background
Older persons presenting with frailty syndromes, polypharmacy and significant comorbidities to Emergency Departments (ED) have a higher rate of adverse outcomes. The aim of this study was to describe medication related needs of persons over 65 years seen by a Frailty at the Front Door (FFD) team in ED.

Methods
CGAs were performed by an inter-disciplinary team (IDT) between January–December 2022, and included a pharmacy prioritisation toolkit, collecting data including excessive polypharmacy, use of high-risk medications, specific patient or carer medication concerns, fall or medication-related admission and kidney injury. Age, gender, CFS, pharmacy toolkit triggers and specialist Geriatrician review were entered onto Excel and analysed using descriptive statistics.

Results
529 CGAs were included. 60 were excluded due to incomplete data (n = 57) or aged under 65 years (n = 3). Mean (SD) age 82.9 (7.9) years. Female:Male ratio 1.5:1. Mean (SD) CFS = 5.2 (1.1). 25% (n = 131) had a fall or medication-related admission. 20% (n = 109) had an acute kidney injury (AKI) or chronic kidney disease (CKD). 26% (n = 141) had excessive polypharmacy. 53% (n = 284) were on one or more high risk medications. 9% (n = 50) had a specific medication concern. 46% (n = 246) triggered for pharmacy review. 72% (n = 178) required specialist geriatrician review.

Conclusion
Use of high risk medications, excessive polypharmacy and medication or fall related admission are the most common reasons for pharmacy review. Specialist geriatrician review is needed in the majority of cases to assess medication-associated risk and effectively deprescribe. There is a need to develop pathways of care that allow for pharmacy and Geriatrician review of approximately half of older persons seen by an FFD.
304 Increasing the intensity of physiotherapy in a subacute stroke rehabilitation unit—results of audit and intervention
Authors: McClean A 
Published: September 2023

Abstract

Background
The National Clinical Guideline for Stroke (2023) recommend the delivery of high intensity therapy to optimise physical recovery post-stroke. Previous guidelines suggested 45 minutes but now suggest a total of 3 hours daily. The aim of this intervention was to review current practice and implement the stroke guidelines aiming to augment the dosage of therapy sessions.

Methods
Given the guidelines’ recommendation to improve the reporting of exercise prescription, a chart audit was completed comparing the dosage of physiotherapy from 2020–2022 on a random sample of 10 charts per year. Strategies to increase intensity included a restructure of the stroke exercise class, run twice weekly. The class structure moved towards a circuit class of 5x 6-minute stations followed by group outdoor mobility. Use of tally counters, increased semi-supervised practice and introduction of a ‘champions board’ to celebrate individuals’ achievements also contributed to a culture of high intensity therapy.

Results
The chart audit showed an improvement in the recording of repetitions each year. The average recorded repetitions per week for stroke survivors increased from 77.9 repetitions in 2020 to a weekly average of 1,043 in 2022 (2020 range 0–288 repetitions; 2022 range 245–2095 repetitions). The average repetitions in the stroke exercise class in 2022 was 462 and was previously not measured. A review of annual patient statistics from 2021 and 2022 showed that stroke survivors spent more time in physiotherapy in 2022. This was likely affected by variables such as staffing allocation and COVID-19 restrictions limiting the ability to provide gym-based therapy or group classes.

Conclusion
The measurement and recording of intensity has improved and increased in 2022 although this may have been affected by factors outside of this intervention. Future iterations of this project would be to increase dosage of upper limb therapy, and to increase physical activity outside therapy, such as use of pedometers outside therapy hours.
308 The development of a competency toolkit for nurses working in stroke in the Irish healthcare setting
Authors: Connaughton F , Coleman S , Breen C , Keane J , Flahive A , Grenham E , Noone I , Lynch J , Donaghy L , Diskin M , Donovan M , Cunningham N , Daly P , Gallagher S , Galvin T , Collins R 
Published: September 2023

Abstract

Background
Stroke Unit Nurses require multifaceted competencies to manage the complex needs of the stroke patient. The National Clinical Programme for Stroke (NSP) set out to develop a competency toolkit for stroke nurses. A modified-Delphi format was used, the questionnaire was developed by an Irish expert advisory group. The development was informed by the group experience and review of existing stroke unit nurse competency toolkits In Ireland and abroad.

Methods
Round one of the Survey was conducted using a semantic differential question, with a 3 point score scale. The survey was sent to a subject matter expert group (32 Clinical Nurse Specialists & Advanced Nurse Practitioners). In round two, the participants were given controlled structured feedback based on the overall feedback from round one, which allowed for adjusted responses. The advisory group looked at themes that emerged in the answers in round one. This formed the basis for the questions in round two, a multiple-choice format, with one answer.

Results
Response rates for round one was 66%, Individual opinions were combined into a group consensus, which lead to the completion of the questionnaire for round two. A consensus definition of at least 80% agreement for each item was decided a priori, in round one, 75% of items reached consensus. Round two response rate was 71%, with 49% of items reaching consensus.

Conclusion
Development of a standardised competency toolkit for stroke unit nursing is a strategic goal of the NSP. While round one lead to considerable consensus, it is clear that what is not agreed initially can be difficult to reach a consensus on, with only 49% consensus in round two. A third round will be required, but if consensus remains elusive, additional methodology techniques such as a focus group may be used. Challenges are response exhaustion and availability of busy ‘experts’ in their fields.
309 Sensory function impairment as a falls risk factor of patients on a Frailty Intervention Team pathway
Authors: Magner S , Holman J , Katiri R , O'Caheny C , Byrne C 
Published: September 2023

Abstract

Background
The world guidelines for falls published in 2022 provide a patient-centred framework to support the identification, prevention, and management of falls in older adults, and suggest measuring sensory function with regards to falls risk factors including dizziness, vision, and hearing. This audit applied the falls risk stratification recommendations and reviewed the individual risk factor variables predictive of falls in those assessed by the Frailty Intervention Team (FIT) in our Emergency Department (ED).

Methods
Patients aged 65+ who attended the ED and who had a Comprehensive Geriatric Assessment (CGA) carried out by FIT between January and April 2023 were included. Sensory function status data was retrieved from the CGA completed for patients seen. Analysis of the data controlled for factors such as age, gender, clinical frailty score, delirium, cardiac risk, orthostatic hypotension, motor function, and medicines reconciliation and optimisation.

Results
During this period, 116 (33.4%) attendances were due to falls. Following removal of those missing key data, almost all attendees were in the ‘high’ risk of falls category (n = 140, 48.6%), or the ‘low’ category (n = 134, 46.5%). Very few people were in the ‘intermediate’ category (n = 14, 4.9%). The most prominent impairments in the high and low groups were balance (80.8 & 57.8%) and vision (73.7 & 67.3%). Hearing status was significantly predicted by risk grouping, whereas balance and vision were not. Most older adults in the high-risk category had an intervention in place for their mobility, hearing, and/or vision.

Conclusion
Most older adults that attended ED in quarter one of 2023 fall into the low or high-risk categories. While impaired balance function and vision were the most common impairments, hearing status alone was related to risk group. These results give valuable insight through a practical application of guidelines and pose questions for the application of three falls risk groups and the capacity for additional sensory intervention.
321 The barriers and enablers to an effective integrated care programme for older persons: a qualitative study
Authors: Fitzgerald A , McDonnell Ó , Daly B , Dukelow T , Jennings A , Foley T 
Published: September 2023

Abstract

Background
In line with Slaintecare goals, the Integrated Care Programme for Older Persons (ICPOP) South Lee Hub, Cork, was developed to provide onsite access to geriatrician and specialist nurse-led clinics, allied healthcare professionals, and an outreach service. ICPOP aims to avoid unnecessary hospital admissions and maximise collaboration between primary and secondary healthcare teams locally. An effective interface between primary and secondary care is, therefore, fundamental to the functioning of ICPOP. However, no research to date has examined this interface from the perspective of the clinical staff in the hubs and primary care providers in the community. This study aims to explore the barriers and enablers to the effective functioning of an ICPOP service from the perspective of both Primary Care Team (PCT) members and the ICPOP hub team.

Methods
Semi-structured interviews were conducted with healthcare professionals working in the ICPOP service in Cork and in primary care. All interviews were analysed thematically by two independent researchers.

Results
29 semi-structured interviews were conducted; 14 with members of the ICPOP team and 15 with GP’s and members of the PCT in the ICPOP catchment area. The challenges of communicating patient information both into and out of the ICPOP hub was highlighted by both primary and secondary care teams. The GPs and other members of the PCT felt ‘on the outside’ with all the contextual knowledge of the individual patient but without a clear understanding of the functioning of the ICPOP hub. Conversely, the clinical team in the ICPOP hub found it challenging to retrieve the contextual knowledge of the patient and were challenged by administrative frustrations.

Conclusion
In the context of a newly emerging ICPOP service, it is essential that collaboration between primary care and the clinical hub is maximised, to provide optimal patient care.
331 Patient experience in a Falls and Syncope service in a large Irish teaching hospital
Authors: Lisa B , Dymphna H , Ciara R , Kelly D E , Joseph L , Poulose B , Keirnan C , Romero-Ortuno R , O'Callaghan S , Briggs R , Lavan A , Kenny R A , Cunningham C 
Published: September 2023

Abstract

Background
The measurement of patient satisfaction provides valuable information about patients’ perceptions of their received healthcare. It is an excellent measure of the quality of care delivered by a healthcare facility. This allows service providers to continue to move towards patient-centred care. A positive patient experience is an important aim that leads to better clinical outcomes.

Methods
A 20-question patient satisfaction survey was developed for an outpatient Falls and Syncope Unit in order to assess the patient’s perception of service delivery. All patients attending the service were invited to complete the survey over a 2-month period in 2022.

Results
71 responses were received. 76% of respondents found their appointment beneficial, and 94% felt their appointment was necessary. Satisfaction with staff ranged between 97–99%. 98% of patients felt they were treated with respect and 88% felt free to express complaints, with 97% satisfactory telephone interaction with the service. 60% of patients received a patient information leaflet, with 97% of patients finding the information leaflets provided useful. Twenty-five respondents (31%) indicated further information on their care would have been beneficial.

Conclusion
This patient satisfaction survey provided positive feedback for all staff on care delivered in the Falls and Syncope service. Recommendations for changes in practice included increased use of patient information leaflets, in order to improve patients’ experience, since 97% of patients found information leaflets useful and 40% of patients did not receive a leaflet.
342 Psychotropic medication prescriptions in a long term care setting
Authors: Heywood S , McGoohan A 
Published: September 2023

Abstract

Background
Current practice in Ireland suggests an overreliance on psychotropic medication to treat the non-cognitive symptoms of dementia. Although it is estimated that about 30% of residents in long term care in Ireland are prescribed psychotropic medication, it appears that the process of prescribing these medications including a follow up review of the prescription could be improved.

Methods
16 patients in the residential unit known to be prescribed psychotropic medication were randomly selected. All data was collected between November and December 2022.

Results
Overall we found that documentation was poor related to the prescription of psychotropic medications. Twenty five percent of patients had no documented indication for use of psychotropic medication. In twenty five percent of cases there was no documentation of when to give psychotropic medication. Forty three percent of patients had no specific behaviour care plans in place. Sixty eight percent of prescriptions had not been discussed at psychotropic review meeting. Seventy five percent of cases had no documentation of the risk or benefits of psychotropic use. Only one of sixteen patients had documentation of a risk benefit discussion with patient and family. Psychotropic review meetings infrequently. However this audit did demonstrate that in this long term care unit psychotropic medications were administered infrequently with only 31% of patients receiving as required psychotropic medication within the previous six weeks.

Conclusion
While as required psychotropic medication was infrequently administered in this long term care unit, the documentation around the prescription of these medications was poor and needs to improve. Implantation of an education programme for staff will be required prior to re-audit.
347 Competency frameworks for non-geriatric medicine physicians caring for older adults: a scoping review
Authors: Buckley E , Barrett A , Bennett D , O'Tuathaigh C , Cooke J 
Published: September 2023

Abstract

Background
The scale of our ageing demographic is such that specialist geriatric medicine services are unable to keep pace with the growing demand. An exclusive reliance on geriatricians to treat older adults is not always appropriate as their care may necessitate the involvement of other specialties. Consequently, many of the interactions with frail older adults will be carried out by professionals who have not received specialised training in gerontological principles. There is an urgent requirement to ensure that all physicians are trained in the competencies to care for older adults. We aimed to summarise the available literature on the competencies required by non-geriatric medicine physicians caring for older adults.

Methods
We undertook a scoping review following Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) as a guide. We systematically searched the electronic databases PubMed, Cochrane, Cinahl, PsycInfo, ERIC and Embase for eligible records from January 2012 to December 2022. Studies related to physician or doctor or resident and competencies or curriculum or education or entrustable professional activities and geriatric medicine or gerontology were included.

Results
We identified 5,177 records. Four hundred and forty-six full texts were screened for eligibility. Thirty sources of evidence were included in the review. Most studies were from the United States and used quantitative methods. Competency frameworks primarily focused on internal medicine trainees with few targeting other specialties. Seventeen cited the purpose as addressing a specific competency. The most common competencies explored related to medication management, palliative care and cognitive impairment followed by bone health, transitions of care and falls and syncope.

Conclusion
Many frameworks attempt to outline gerontological competencies for specific specialties. However it is evident that a dedicated competency framework is necessary to define the required competencies for all non-geriatric medicine physicians caring for older adults.
13 Exploring the success of older female directors: creativity and resilience of old age in the face of cultural barriers
Authors: Fitzpatrick N , O’Neill D 
Published: September 2023

Abstract

Background
Ageism is pernicious in the film industry, particularly in large-scale Hollywood productions. Its effect is also underestimated in comparison to other forms of discrimination. Older women are disproportionately discriminated against in the workplace compared with older men, and there is evidence if disproportionate ageism towards women in the film industry specifically. Women comprise a much smaller proportion of film directors overall, with only 13% of the top-grossing films in the US in 2020 directed by women.

Methods
We look at three distinct works from older female directors (The Power of The Dog, Jane Campion; Faces Places, Agnès Varda; High Life, Claire Denis). We examine how the directors’ age and experience informed their creative process and how they overcame the barriers set against them. In particular, we pay attention to ways in which they incorporate strategies of achievement in later life, such as the selection, optimisation and compensation model.

Results
The diversity of these pieces also allows us to highlight not only the heterogeneity of ageing, but the rich artistic rewards of the longevity dividend.

Conclusion
Cinematic output of older women directors allows to explore the not only the richness of ageing, but also the gendered nature of ageing and the creative arts.
15 Hospital at home—a potential alternative option to acute hospital admission for older adults
Authors: Conlon C , Murphy R , Small C 
Published: September 2023

Abstract

Background
Novel ways to respond to the acute care needs of older adults are needed. Hospital at Home (H@H) could be a viable alternative to emergency hospitalisation. We developed inclusion and exclusion criteria for selected medical conditions that could theoretically be treated in a hospital at home setting if supported by a geriatric medicine multidisciplinary team with a consultant, Advanced Nurse Practitioner (ANP), Physiotherapist (PT) and Cccupational Therapist (OT).

Methods
We completed a retrospective cohort study of unselected medical admissions over a two week period in a level four hospital. We developed illness specific criteria for stable patients that if met could allow a patient to be treated in a hospital at home environment. These conditions included community acquired pneumonia, congestive cardiac failure, COPD exacerbation and urinary tract infection.

Results
There were 307 medical admissions over the study period, with 144 over the age of 75 (47%). Mean age 83.2. 59 patients met our inclusion criteria for a potential H@H service (41%). All patients were clinically stable based on admission vital signs. The mean length of stay was shorter for patients eligible for H@H than patients who did not meet the criteria (9 days vs 14 days, p 0.01), and patients meeting the H@H criteria were more likely to be discharged home directly. They were less likely to have needed occupational therapy (32% vs 52%, p = 0.02) or medical social worker input (22% vs 42%). There was no difference in frailty category or readmission rates by whether or not a patient met the H@H criteria.

Conclusion
Over 40% of unselected medical take patients were of a low acuity that could have theoretically met our inclusion criteria for a supported hospital at home model. Strategies are needed to support expansion of this model of care.