bluuebunny/crossref_metadata_2025_split huggingface dataset:
247 BENCHMARKING STROKE SERVICES TO INFORM A QUALITY IMPROVEMENT INIAITIVE
Authors: Loughlin E , Gannon E , Coughlan A , Cunningham N , Paulose S , O'Brien I , Ryan R , Leahy A , Lyons D , Peters C , McManus J , O'Connor M 
Published: February 2023

Abstract

Background
Stroke is a leading cause of death and disability in Ireland. Continuous audit and quality improvement is essential in the delivery of stroke care where the evidence basis is constantly changing. This helps to ensure the delivery of high quality stroke care and compliance with evidenced based guidelines. We aimed to assess stroke care at an Irish university teaching hospital.

Methods
Patients with a HIPE discharge diagnosis of Cerebral Infarction or Cerebral Haemorrhage (1st January-31st December 2019) were identified through both the HIPE database and the institutional Stroke Portal. Data was benchmarked against national (Irish National Audit of Stroke 2019) and international (6th SSNAP Annual Report; American Heart Association, 2013) practice and used to inform a quality improvement strategy.

Results
419 patients were included (56.6% male, median 57 years). 75.9% were aged 65 years or older. We compared favourably with Irish National Audit of Stoke national indicators on the following: thrombolysis rates-10%; median door to needle time-60 mins; stroke unit admissions- 78.5%; median duration of symptoms- 3 hours 6 minutes; swallow assessment- 81.1%; in-patient mortality- 10.5%; rates of institutionalisation- 3.8%. Areas identified for improvement were: thrombectomy rates- 1.9%; median length of stay- 12 days; door to imaging time- median 104 minutes; mood screening- 11.5%.

Conclusion
International and national data is a useful benchmark against which local hospitals can assess the quality of their service. By completing this quality improvement initiative we identified areas to target resources in our centre, including mood screening, swallow screening, thrombectomy rates, length of stay and time to neuroimaging. An ongoing quality improvement process using ‘PDSA’ methodology is being carried out with an annual audit to monitor progress.
250 EXPANSION OF THE ORTHOGERIATRIC SERVICE: EARLY EXPERIENCES
Authors: Stankard A , Conlon B , O'Brien H 
Published: February 2023

Abstract

Background
The introduction of hip fracture standards has led to improvement in outcomes for hip fracture patients. Other osteoporotic fragility fractures also lead to significant morbidity. They are associated with a high risk of future hip fracture. The Orthogeriatric Service at a model 3 hospital was expanded to proactively undertake comprehensive geriatric assessment(CGA) for patients over 65 with non-hip fragility fractures(NHFF) admitted to the Orthopaedic Ward. Electronic discharge summaries were created for all patients. This study aimed to characterise patients reviewed by Orthogeriatrics and review discharge summary documentation of CGA.

Methods
Patients reviewed by Orthogeriatrics during the period Jan-June 2021 were retrospectively analysed. Discharge summaries of these patients were retrospectively reviewed. The prevalence of documentation of frailty status, delirium screening and bone health plan was recorded.

Results
A total(n = 126) of 91 patients with hip fractures and 35 with NHFF were included. Other fracture types were excluded. The mean age of hip fracture patients was 82.43 compared to 78.2 in the NHFF group. 71%(n = 65) of hip fracture patients were female compared to 80% (n = 28) of NHFF. 80%(n = 73) of hip fracture patients were reviewed within 48 hours of admission, compared to 65%(n = 23) of NHFF. 52.7%(n = 48)of hip fracture patients had frailty status documented on their discharge summary, compared to 37.1%(n = 13) of NHFF. Delirium screening was documented for 58.2%(n = 53) of the hip fracture patients, compared to 40%(n = 14) of NHFF. Bone health plans were documented for 62.6%(n = 57) of hip fracture patients compared to 60%(n = 21) of NHFF.

Conclusion
Expansion of the Orthogeriatric Service to proactively review all NHFF patients will lead to reduced incidence of repeat fracture for this population. A lower percentage of NHFF patients had clear discharge documentation of CGA outcomes and a lower percentage were reviewed within 48 hours. Expansion of hip fracture standards to include all fragility fracture patients should be considered to incentivise improved care for all.
256 USE OF PROTON PUMP INHIBITORS ON SPECIALIST GERIATRICS UNITS
Authors: Mohamed B K , Swar M , Sheehan O 
Published: February 2023

Abstract

Background
Proton Pump Inhibitors (PPIs) prescriptions have increased more than 100% in the past decade. Prior research estimates that only a third of PPI prescriptions are appropriate in older adults. Geriatric patients have increased rates of polypharmacy and adverse drug events. PPIs are associated with significant harms including a higher fracture risk, increased risk of infection and vitamin and electrolyte abnormalities. We aimed to examine the PPI prescribing practice in a Specialist Geriatric Unit (SGU), identify patterns of inappropriate use and reduce inappropriate prescriptions.

Methods
Medical records, kardexes and prescriptions were reviewed for 66 patients admitted in the Special Geriatric Units between April and May 2021. Variables included gender, age, ordinary residence (nursing home or home) and diagnosis on admission. PPI indication was grouped according to symptoms, OGD in the last year, H. Pylori testing in last year and reason/diagnosis leading to PPI prescription. Name and dose of PPI, route of administration and duration of treatment were noted.

Results
38 patients (57.6%) were on a PPI. The mean age was 81.7 years. 79% of the patients were on the PPI at the time of hospital admission. Over 85% of the patients on PPI had no OGD or H. Pylori testing in the last year. Only 42% had a diagnosis justifying the use of PPI (only 25% of whom had their diagnosis confirmed by appropriate investigations). 90% of the patients were on PPI for more than a year.

Conclusion
Inappropriate use of PPIs remains common in the Specialist Geriatric Units. PPI prescriptions need to be optimized so as to reduce harmful effects on geriatric patients. Following a multifaceted PPI deprescribing intervention repeat audit is now planned.
37 ‘FRAIL’ BY DIFFERENT MEASURES: A COMPARISON OF 8-YEAR MORTALITY IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: Romero-Ortuno R , Hartley P , Kenny R A , O'Halloran A 
Published: February 2023

Abstract

Background
Frailty is a state of dysregulation in multiple physiological systems and vulnerability to stressors. Many frailty identification tools exist that differ in their conceptualisation vis-à-vis morbidity, disability, cognition, and other geriatric assessment dimensions. We compared the ability of four different frailty identification tools to predict 8-year mortality in TILDA.

Methods
We included TILDA Wave 1 (2010) participants who had data for frail state classification according to four tools: the Fried’s physical Frailty Phenotype (FP: frail if ≥3 features present), Morley’s FRAIL scale (frail if ≥3), a 32-item Frailty Index (FI ≥ 0.25), and the Clinical Frailty Scale classification tree (CFS ≥ 5). Mortality was ascertained at Wave 5 (2018). Binary logistic regression models controlling for age and sex were computed for the extraction of Odds Ratios (OR) and 95% Confidence Intervals (CI).

Results
At Wave 1, there were 5,700 participants (mean age 63, range 50–98 years, 54% women) with data for frailty classification according to all four tools. The prevalences of frailty were 2.3% by FRAIL, 3.8% by FP, 10.9% by CFS, and 12.8% by FI. 8-year mortality proportions were 41.2%, 44.9%, 25.3% and 27.0%, respectively. The highest age and sex-adjusted OR for 8-year mortality was for FRAIL (OR 4.86, 95% CI 3.18–7.41, P &lt; 0.001), followed by FP (OR 3.72, 95% CI 2.64–5.23, P &lt; 0.001), FI (OR 2.20, 95% CI 1.76–2.74, P &lt; 0.001), and CFS (OR 1.95, 95% CI 1.53–2.47, P &lt; 0.001).

Conclusion
All four frailty tools significantly predicted 8-year mortality in TILDA, but FRAIL and FP seemed more specific. Different frailty identification tools may suit different population screening purposes.
44 BONE HEALTH AND FRACTURE RISK: KNOWLEDGE, OPINION AND PRACTICE OF PHYSIOTHERAPISTS
Authors: Sayers K , Maher J , King L , Ryan S , Murphy R , Pillay I 
Published: February 2023

Abstract

Background
Osteoporotic-related fractures are responsible for excess mortality, morbidity, chronic pain, reduction in quality of life, admission to long-term care and health and social care costs (Papaioannou et al, 2010).
Evidence for using Fracture Risk Assessment Tool (FRAX®) based community-screening in older people is increasing (Kanis et al, 2020). There is no published evidence on the use of FRAX® by Physiotherapists.

Methods
A questionnaire was sent to South Eastern Branch members of the Irish Society of Chartered Physiotherapists (ISCP).
Survey themes were: participant characteristics, knowledge and opinion in the areas of Bone Health and Fracture Risk. Responses were downloaded from Survey Monkey and analysed using descriptive statistics.

Results
The response rate was 27% (n = 56). 72% (n = 40) of those surveyed had at least 10 years clinical experience. For 65% (n = 37) of participants, older people made up more than half of their clinical caseload. 96% (n = 54) of participants treated people with frailty and other bone health risk factors; falls (93%), osteoporosis (89%), fracture or reduced mobility (87%).
On a scale of 1–10 (1 = least confident, 10 = most confident) 49% of respondents rated confidence in prescribing Bone Health Physiotherapy interventions at ≤5.
When interpreting results of a DEXA scan; 80% reported confidence to be ≤5.
Half (49%) of participants had never heard of FRAX®.
95% of respondents felt fracture risk was under addressed in clinical practice. All felt it was within their professional responsibility to discuss fracture risk with patients.

Conclusion
This is the first evaluation of bone health and fracture risk knowledge, opinion and practice of physiotherapists. The need for more knowledge of DEXA, FRAX® and bone health was highlighted. The use of FRAX® may improve fracture risk assessment in patients attending Physiotherapy. Based on these results, FRAX® has been introduced into a Rehabilitation Unit by Physiotherapists as part of Quality Improvement Project.
53 HEALTHCARE PROVISION FOR OLDER PEOPLE IN KILKENNY THROUGH THE IMPLEMENTATION OF THE INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE
Authors: Finegan T , White P J , Casey B 
Published: February 2023

Abstract

Background
An increase in the cost of healthcare provision is directly related to an ageing demographic nationally and internationally. It is, therefore, imperative that the system of health and social care provision for the older person is reformed. The Integrated Care Programme for Older People (ICPOP) envisages moving the locus of care from the acute system to primary and community health and social care. This research looks at the implementation and benefits of ICPOP from a clinicians and third sector organisations perspective.

Methods
Semi-structured interviews were conducted with six clinicians within the acute and community healthcare systems and, with two representatives from older persons third sector organisations. The interviews were held online through conferencing software and recorded. They were transcribed manually to gain a greater understanding of what was said and the context. Using a grounded theory approach, quotes were extracted, clustered together into categories or themes and, through theoretical sampling and comparison an in-depth understanding was gained, and theory developed.

Results
An organisational culture of innovative and collaborative practice is essential to the delivery of ICPOP as it leads to the empowerment of staff to develop integrated healthcare across disciplines and services. It is vital that funding for home support packages that provide both health and social care assistance with an adequate number of carers evenly distributed nationwide be provided. In addition, the ‘Living Well at Home’ piece of ICPOP with its important local community and social connectedness emphasis, needs to be sufficiently funded.

Conclusion
A culture of collaborative and innovated practice of healthcare provision exists in Kilkenny. Implementation of ICPOP is commiserate with appropriate funding for, and even distribution of, home care support packages and carers, as well as support for services that combat loneliness and social isolation enabling older people to age well at home.
55 APPLYING MACHINE LEARNING TO DIFFERENTIATE PREDICTORS OF SYNCOPE, SIMPLE AND COMPLEX FALLS IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: Tang Y T , Romero-Ortuno R 
Published: February 2023

Abstract

Background
Falls in older adults are clinically heterogeneous and can be classified as simple (accidental), complex (recurrent, unexplained, injurious), and due to syncope. The aim of this study was to generate machine learning models for these fall types in TILDA using the Syncope-Falls Index (SYFI), a 40-deficit index covering a wide range of risk factors (Fitzpatrick & Romero-Ortuno, 2021).

Methods
New self-reported events of simple, complex falls, and syncope were recorded in participants two-yearly between Wave 1 (2010) and 4 (2016). The 40 SYFI features, age and sex, were entered into three separate random forest models. The dataset for each model was balanced by equalising the number of participants who did and did not have each event. Feature importances were derived and those with scores of ≥0.05 are reported below.

Results
For simple falls (217 events, balanced dataset N = 434), the most important predictors were age (0.13), pre-existing hypertension (0.07), presence of urine incontinence (0.07), polypharmacy (0.06) and MMSE&lt;24 (0.05) (model accuracy: 0.53). For complex falls (1,077 events, balanced dataset N = 2,154), top predictors were age (0.14), gender (0.07), osteoporosis (0.07), osteoarthritis (0.06) and unsteadiness getting up from a chair (0.05) (accuracy: 0.58). For syncope (185 events, balanced dataset N = 370), top predictors were age (0.16), osteoporosis (0.07), unsteadiness getting up from a chair (0.06) and previous myocardial infarction (0.05) (accuracy: 0.50).

Conclusion
In keeping with the literature, advancing age was the most important feature in all models. Further, a more nuanced understanding emerged highlighting possible roles of reduced cognition in simple falls, musculoskeletal disease in complex falls, and orthostatic intolerance and heart disease in syncope. Many predictors identified as relevant are modifiable, and this ranked approach could help prioritise interventions for maximum population benefit. The accuracy of the models however was moderate, underscoring the known difficulty in predicting falls even when attempting to break their clinical heterogeneity.
59 IMPROVED OUTCOMES WITH DELAYED ADMISSION TO POST-ACUTE CARE: RESULTS OF A NATURAL EXPERIMENT
Authors: McGettigan S , Farrell A , Murphy R , MacGearailt C , O'Keeffe S , Mulkerrin E 
Published: February 2023

Abstract

Background
In Ireland, the national Health Service Executive developed a post-acute care (PAC) scheme in 2016 to provide funds to acute hospitals for beds in nursing homes to allow discharge of patients who would benefit from a period of recovery in a nursing home before returning home when medically fit for discharge with no need for rehabilitation or long-term care (LTC). However, budgetary restrictions introduced from June 2019 resulted in a delay in access to funding. This change in funding was used as a natural experiment of the effectiveness of this scheme in a single large general hospital before and after delays due to funding restrictions.

Methods
Data regarding PAC admissions for those aged 65 years or more from July to October 2017, when there were no budgetary restrictions, and from July to October 2019, when funding was delayed, were compared. Chi-square tests were used to compare proportions, and the nonparametric Mann–Whitney U test was used to compare continuous data.

Results
Compared with the 2017 cohort, those in 2019 spent 6 days longer in the acute hospital following a delay in 2019 between being approved clinically as needing PAC and subsequent admission to a facility. However, readmissions to hospital within 90 days of discharge and directly from PAC were significantly higher in 2017, as was discharge from PAC directly to LTC.

Conclusion
This retrospective study demonstrates restrictive practices regarding discharge to PAC introduced for budgetary reasons caused longer acute bed LOS with reduced LOS in PAC, reduced hospital RAR and reduced admissions to LTC suggesting that a pre-existing liberal selection process may result in poorer identification of appropriate patients for PAC.
60 EVALUATING THE TIME THAT PATIENT’S WITH DEMENTIA/DELIRIUM SPEND IN THE EMERGENCY DEPARTMENT PRIOR TO TRANSFER TO A WARD
Authors: Gibbons C , Diffley K , Riches R , Ramiah V , Byrne C , Kyne L , Gaynor E 
Published: February 2023

Abstract

Background
Patients with dementia and delirium are often waiting long times in the emergency department (ED) prior to being transferred to a ward bed during an acute hospital admission. This may be associated with increased morbidity and mortality. Best practice is for rapid triage to an appropriate bed via a delirium/dementia pathway.
Our aim was to document the patient experience time (PET) for older patients with a diagnosis of dementia or delirium in ED in an urban tertiary-referral hospital.

Methods
Over a two-week period 07/12/20–21/12/20, we identified all patients admitted under a general medical specialty through ED, aged ≥65 years, with a diagnosis of dementia or delirium on the admission sheet. Patients admitted with a stroke or hip fracture were excluded. ED PET was recorded, as well as final ward destination.

Results
We included 29 patients in the study—median age was 82 years (range 71–92); 19 (66%) were female. Delirium was the presenting complaint in 79.31% (n = 23) of cases.
Sixteen (55%) patients presented between 8 am-5 pm. The average time spent from triage to ED doctor review was 1 hour 48 minutes; from ED doctor review to medical referral −1 hour 27 minutes; from medical referral to decision for medical admission—2 hours 28 minutes; from decision for medical admission to ward admission- 5 hours. Overall, the average ED PET for these patients was 10 hours 42 minutes.
Five patients (17%) were admitted directly to a Specialist Geriatric Ward (SGW). Twenty patients (69%) did not reach a SGW during the study period.

Conclusion
Patients with dementia and delirium may spend prolonged periods of time in the ED putting them at risk for multiple complications. We hope that by introduction of a dementia/delirium combined pathway and care bundle that we can reduce PET for these vulnerable patients.
64 MANAGING FRAILTY IN AN IRISH PRIMARY CARE SETTING: A QUALITATIVE STUDY
Authors: Kennedy F , Horgan F , Galvin R 
Published: February 2023

Abstract

Background
Frailty is a complex, age-related condition which confers a risk of adverse outcomes. Evidence supports the effectiveness of screening and Comprehensive Geriatric Assessment (CGA) to meet the needs of frail older people. Little is known about the views of key stakeholders on frailty in a Primary Care context. This study explored the views of healthcare professionals and patients on frailty management in Primary Care in Ireland.

Methods
A qualitative descriptive study using semi-structured interviews was conducted. Healthcare professionals and patients were recruited using purposive sampling. Patients were recruited through the Frailty Intervention Team at the local acute hospital. Patients with cognitive impairment were excluded. Written informed consent was provided. Data were audio-recorded, transcribed and analysed using thematic analysis. The research was approved by the local Ethics Committee.

Results
Three patients and 17 healthcare professionals from general practice, public health nursing, physiotherapy, occupational therapy and social work participated. Three themes emerged. (i) Perceptions of Frailty (ii) Current Management of Frailty and (iii) CGA in Primary Care. Results demonstrated variability of perspectives on the concept of frailty, with limited knowledge of screening and CGA. Healthcare professionals described a fragmented service with sub-standard care for frail older patients. Critical weaknesses were: absence of essential services, uni-disciplinary working, inadequate IT systems and integration. Support for screening and CGA in Primary Care was evident. The general consensus was that frailty management required an adequately resourced Primary Care and the suitability of the current pathway for patients requiring CGA should be reviewed.

Conclusion
This study highlights an absence of a complete understanding of frailty among healthcare professionals. Inter-professional training and education is advocated. Further development of a frailty pathway and investment in Primary Care is required to improve care for frail older people. An intermediate interface service with a dedicated frailty management team is suggested.
66 BRAIN HEALTH CLINIC: DEVELOPING INNOVATIVE OPPORTUNITIES TO INTERVENE IN MODIFIABLE VASCULAR RISK FACTORS (VRF) TO IMPROVE COGNITIVE AGEING
Authors: Dookhy J , Hale C M C , Dolphin H , Dukelow T , Fallon A , Kennelly S P 
Published: February 2023

Abstract

Background
It is now well established that VRF place immense burden on cognition, including white matter changes, decreased cerebral perfusion and neuro-inflammation.
An innovative Brain Health Clinic (BHC) was developed aligned to a specialist memory service to educate people at risk of or living with mild cognitive symptoms, about positive brain health and subsequently design a ‘Personalised Prevention Plan’ to optimise cognitive ageing.
The aim of this study is to report the opportunities identified and addressed to mitigate vascular risk-related cognitive decline in people attending the Brain Health Clinic.

Methods
Modifiable VRF (including HbA1c, cholesterol, Body Mass Index (BMI), smoking, alcohol intake and hypertension) were examined in people who attended the BHC between October 2019 and July 2021. In addition to VRFs, sleep, physical activity, sensory, social, and psychological measures are measured and reported to individuals.
The VRF values were examined based on current guidelines from the European Society of Cardiology (2018).

Results
Forty-five people (mean age 72.6 years, 62.2% females) were included. The average number of modifiable VRF’s per person was 3, and a total of 119 VRF’s were identified overall. One patient had six modifiable VRF’s identified, and 2/45 had none.
The most common VRF was elevated BMI present in 33/45 (73.3%). 12/45 (27%) patients were ex-smokers, while 5/45 (11%) still smoked. 5/45 (11%) consumed excess alcohol. 15/45 (33.3%) had elevated cholesterol.
29/45 (64.4%) had elevated systolic blood pressure. Of these, 10/45 (22.2%) were known but poorly-controlled and 19/45 (42.2%) were identified de novo. Similarly, only 1/45 (2.2%) had known diabetes but poorly-controlled, while 9/45 (20.0%) had impaired glucose tolerance identified de novo.

Conclusion
The BHC aligned to a memory service provides an opportunity to identify modifiable VRF for declining cognition, and supports people in addressing these by sign-posting to relevant services.