bluuebunny/crossref_metadata_2025_split huggingface dataset:
172 ‘NCHD’S UNDERSTANDING OF THE ‘DYING WITH DIGNITY BILL”
Authors: Ahern E , McGurk C , Claffey P 
Published: February 2023

Abstract

Background
The Dying with Dignity Bill is potential legislation that would permit terminally ill people to avail of medical assistance to die in certain circumstances. It would give a medical practitioner the legal right to provide assistance to a qualifying person to end their life, thus changing the medical landscape as we know it. This project aimed to assess current understanding in non-consultant hospital doctors (NCHDs) of the Dying with Dignity Bill.

Methods
An online survey was distributed to NCHD’s across a range of disciplines to ascertain current knowledge of the Dying with Dignity Bill. Descriptive analysis of data was conducted on Excel.

Results
The survey was completed by 80 NCHDs. Of respondents 67.5% (n = 54) of respondents had heard of the Bill and 32.5% (n = 26) of them knew what it was. The Bill had not been read by 88% (n = 71) of respondents. Fifty seven per cent (n = 46) did not understand what was entailed in the Bill. The majority agreed (61.3%; n = 49) that it would impact their work as a clinician. Some 70.1% (n = 56) agreed that legislation was needed in this area. The majority answered neutral (45%; n = 35) that their profession were consulted in the creation of the Bill. It is believed that the Bill will not require a vote however 48% (n = 37) believed it would. However, the majority (72.7%, n = 56) answered correctly that the Bill had not been enacted yet. This Bill does not define the length of a ‘terminal illness’ yet 36.8% (n = 28) believed it to be within six months. It also states that it is the practitioner’s role to decide when somebody is palliative and only 54.5% (n = 42) knew this.

Conclusion
The Dying with Dignity Bill is poorly understood by NCHDs, despite it potentially having an impact on the role of hospital doctors in Ireland. Discussion and involvement of NCHD’s in the potential formation of this Bill is crucial.
173 SYSTEMATIC REVIEW-BASED FINDINGS TO GUIDE THE DEVELOPMENT AND REPORTING OF CONSENSUS-BASED CRITERIA FOR INAPPROPRIATE PRESCRIBING IN OLDER ADULTS
Authors: Ali A , Alshareefy F , McMahon N , Ryder S 
Published: February 2023

Abstract

Background
Formal consensus development methods are widely employed to develop inappropriate medication assessment criteria for older adults. However, standards for conducting and reporting these methods are lacking. This study aims to summarise findings on consensus attainment across published explicit criteria.

Methods
A systematic literature review of criteria for assessing inappropriate medications in older adults was conducted in PubMed, CINAHL, EMBASE and Scopus (1991 to 2020). Search terms pertained to the concepts of inappropriate prescribing, criteria development/validation, and older patients (aged 65 years or more). Articles were included for the current subanalysis if they represented a consensus based explicit list, assessing appropriateness of medications in older adults.

Results
From 73 tools identified in the systematic review, 58 tools (79%) had been developed and/or validated by formal consensus methods. 51 criteria sets were reported as having been developed using Delphi (n = 30) and modified Delphi (n = 21) methods. However, most (29/30) of the reported Delphi methodologies had actually been modified by introducing an initial literature-based questionnaire. The criteria for achieving consensus between experts were pre-specified for 42 criteria sets, while the remainder did not report or prespecify consensus definitions. Where available, consensus definitions varied considerably. Arbitrary levels of proximity to a central tendency (e.g. mean +/− 95% confidence interval, median +/− interquartile range) defined consensus in 22 criteria. Seven more criteria followed the RAND/UCLA consensus definition (i.e. three-point region containing the median) (1). Only one set addressed consistency of agreement between rounds. Likert scales or categories for ranking ranged from three-point to 100-point scales.

Conclusion
The development and reporting of formal consensus-based criteria varies substantially, particularly in distinguishing between Delphi methods and their modifications. This highlights the need for standards for conducting and reporting consensus attainment.
1. Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual: RAND Corporation, 2001.
18 SEDATIVE LOAD IN COMMUNITY-DWELLING OLDER ADULTS WITH MILD–MODERATE ALZHEIMER’S DISEASE: LONGITUDINAL RELATIONSHIPS WITH ADVERSE EVENTS, DELIRIUM AND FALLS
Authors: Dyer A , Murphy C , Lawlor B , Kennelly S 
Published: February 2023

Abstract

Background
Older adults are frequently prescribed medications with sedative effects, which are associated with numerous adverse consequences. However, the use and longitudinal associations of sedative medication use in older adults with mild–moderate Alzheimer Disease (AD), has not been explored to date.

Methods
The association between Sedative Load (SL) and adverse events, unscheduled healthcare utilisation, delirium and falls over 18 months was assessed in older adults with mild–moderate AD from 9 Countries. Additionally, the impact of SL on dementia progression was evaluated.

Results
Over half (52.35%; 267/510) of those with mild–moderate ad (72.8 ± 8.26 years, 61.89%) were prescribed a regular medication with sedation as a primary effect or prominent side effect with 17.65% (90/510) having a high SL (≥3). The most common medications contributing to SL were antidepressants, antipsychotics, anxiolytics and hypnotics. Over 18 months, greater SL was associated with adverse events (IRR 1.18, 1.14–1.23, p &lt; 0.001)/serious adverse events (IRR 1.32, 1.18–1.49, p &lt; 0.001) and unscheduled GP visits (IRR 1.26, 1.15–1.38, p &lt; 0.001). Further, increasing SL was associated with greater likelihood of incident delirium (IRR 1.47, 1.25–1.73, p &lt; 0.001) and falls (IRR 1.25, 1.06–1.48, p = 0.007) which persisted after covariate adjustment. SL was not associated with accelerated cognitive decline or ad progression.

Conclusion
Most adults with mild–moderate ad are prescribed at least one drug with a sedative effect and a significant minority have a high SL. Increasing SL was associated with a greater likelihood of experiencing adverse events, delirium and falls, highlighting the need for optimal prescribing in this vulnerable cohort.
180 NURSING HOMES DURING THE COVID-19 PANDEMIC: A NARRATIVE REVIEW OF CHALLENGES AND RESPONSES
Authors: Giri S , Chenn L M , Romero-Ortuno R 
Published: February 2023

Abstract

Background
COVID-19 has caused unprecedented challenges in nursing homes. In this narrative review, we aimed to describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented to try to overcome such challenges.

Methods
The MeSH terms ‘Nursing homes’ and ‘COVID-19’ were searched in MEDLINE Ovid, and English language articles were retrieved that were published between 1 March 2020 and 31 January 2021. Article titles and abstracts were screened by two reviewers, and the results of included articles were grouped by themes.

Results
The search retrieved 348 articles, of which 76 were included in the thematic review. 8 articles related to COVID-19 disease characteristics (e.g. asymptomatic transmission), 24 to resident-related factors (e.g. comorbidities, nutrition, cognition), 13 to facility characteristics (e.g. physical space, occupancy, for-profit status), 21 to staffing (e.g. staffing levels, staff-to-resident ratio, staff multi-employment), and 10 to external factors (e.g. availability of personal protective equipment, prevailing health and social care policies). In terms of responses, identified themes included widespread testing, isolation and cohorting of residents, staff protection and support, promotion of residents’ well-being, and technological innovations.

Conclusion
COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Numerous strategies were employed to attempt to mitigate the negative impacts. Substantial learning occurred that may not only aid future pandemic preparedness but improve quality of care for nursing home residents at all times.
187 A QUALITATIVE EXPLORATION OF PLACE AND PERSONHOOD IN DEMENTIA
Authors: Hennelly N , Walsh K , Urbaniak A , O'Shea E 
Published: February 2023

Abstract

Background
In dementia research, supporting personhood is seen as a corner stone of person-centred care. However, little is understood about how personhood is conceptualised in the context of the home and communities that people living with dementia reside within, and how place may constitute a key dimension of, or a determining factor of someone’s sense of self. This study seeks to explore these relationships by examining the intersection between place and personhood through the lens of Rowles (1983) work on place and personal identity in old age.

Methods
Qualitative secondary analysis of datasets from two separate studies was conducted. The first study examined the perspectives of people living with dementia on place across the life course, while the second study examined the perspectives of people living with dementia on personhood in formal care. In total, 15 interviews with people with dementia were analysed using theoretical framework analysis.

Results
Participants reflected on the meaning of place, and its iterative relationship with personhood across the life course. They used the residential life course, to convey and narrate their life story, locating themselves and major events in time and place. Participants also spoke about the impact of the physical environment on their sense of personhood, conceptualising personhood in relation to attachment to the physical landscape, location and their own homes. Finally, participants referred to the close link between place, relationships, and community. In particular, how important feelings of community and belonging to place are to their sense of personhood.

Conclusion
This research shows the role of place in interpreting understandings of personhood from the perspectives of people living with dementia. This is critical for understanding the nature and orientation of community-based interventions, and designing supports and services which appropriately harness place-based relationships of people living with dementia.
190 FACTORS ASSOCIATED WITH ADHERENCE TO COVID-19 PUBLIC HEALTH GUIDELINES AMONG OLDER ADULTS IN IRELAND
Authors: Hennelly N , Lalor G , Gibney S , Murphy R , Kenny R A , Ward M 
Published: February 2023

Abstract

Background
Older adults are at high risk from coronavirus 2019 (COVID-19). Even with the introduction of a widespread vaccination programme, adherence to public health guidelines continue to be of vital importance to reducing the spread of COVID-19. This study examines the factors associated with adherence to two public health guidelines, social distancing and mask wearing, among older adults (50 years and over) in Ireland.

Methods
Data from the Irish Longitudinal Study on Ageing (TILDA) COVID-19 study and previous waves of TILDA was used. The COVID-19 study data was collected between July 2020 and November 2020. Logistic regression analysis was conducted separately to examine the relationship between the independent variables and social distancing and mask wearing respectively. Along with socio-demographic variables, the Health Belief Model (HBM) was used to identify variables for inclusion in the analysis.

Results
In total, 2,816 participants were included in this study. Females were more likely than males to adhere to social distancing and mask wearing guidelines. Those most concerned about COVID-19 were more likely to adhere to both behaviours. Education levels were associated with adherence to both behaviours but the direction of the relationship differed. Those who trusted the Health Service Executive as a news source were more likely to socially distance, while those with less understanding of government guidance and those who trusted in government news sources were less likely to socially distance. Participants who were working were less likely to socially distance than those who weren’t. While, participants who were over 70 and those who returned the survey after the introduction of mandatory mask wearing were more likely to wear a mask. Participants who lived outside of Dublin were less likely to wear a mask.

Conclusion
Factors associated with adherence to public health guidelines vary according to the guideline. Differences between groups need to be considered when implementing policy around public health guidelines.
192 USING A COLLABORATIVE APPROACH TO IDENTIFY WAYS TO STRENGTHEN ENHANCED CARE PRACTICES IN A GENERAL HOSPITAL WHILE BUILDING RESEARCH CAPACITY
Authors: Daly L , White P , Harris E , Carroll A F , Murphy A 
Published: February 2023

Abstract

Background
The Nursing department within an acute general hospital wished to illuminate and build on positive local enhanced care practices. A collaborative research team was formed between academics in the linked higher education institution and nurses within the hospital to address this intent by building nurse-led research capacity, while addressing the practice derived research question.

Methods
A mixed methods approach was employed involving; site visits, audit of enhanced care staffing requirements, documentary and activity box analyses and use of appreciative inquiry (AI) methodology. AI is a collaborative and strengths-oriented approach supporting organisational development. It was implemented via three World Café events (www.theworldcafe.com 2021) bringing together hospital stakeholders (n = 17) with direct experience of delivering enhanced care, to consider pre-defined questions. Thematic analysis was used to analyse the resultant data. Ethical approval was obtained.

Results
Overall, the findings demonstrated a positive focus on implementing therapeutic enhanced care within the hospital in contrast to a more passive primarily observational orientation. The site visits facilitated shared learning. Thematic findings from the World Cafés identified positive care practices and enabled a multidisciplinary, inclusive approach, which facilitated pragmatic suggestions on how to plan for, and build on existing foundations of, enhanced care practice.

Conclusion
Both the study approach and outcome resulted in positive impacts. Working collaboratively supported research capacity building for hospital-based members of the research team. Using AI supported constructive and inclusive stakeholder participation in the World Cafés with a focus on good practices and ways in which they could be strengthened. One year post completion, study recommendations have led to:
194 TIA IMAGING: ARE WE FOLLOWING NICE 2020 GUIDELINES?
Authors: Egan A , Kearns J , Khalil M , O'Connor M 
Published: February 2023

Abstract

Background
CT brain imaging is customary in clinical practice after Transient Ischemic Attack (TIA). However, NICE (2020) guidelines recommend MRI brain with diffusion weighted and blood-sensitive sequences; to be completed on the same day as the assessment. The purpose is to detect the ischemic territory, haemorrhage, or other pathology. The aim of this audit was to assess the diagnostic radiology investigations performed on patients, over the age of sixty-five years, presenting with TIA to a university teaching hospital.

Methods
We conducted a retrospective audit of all patients coded as TIA on the Hospital Inpatient-Enquiry (HIPE) system between July 2019 to July 2020. Data on brain imaging was accessed using the National Integrated Medical Imaging System (NIMIS) system. Hospital attendance records were accessed via the Emergency Department patient database. Data was analysed using Microsoft Excel.

Results
Eighty patients had brain imaging performed (n = 38 CT brain only; n = 1 MRI only; n = 41 CT and MRI). Of these patients, only three had an MRI brain completed within twenty-four hours where thirty-nine patients had an MRI scans outside of twenty-four hours. Forty-one patients had both a CT and MRI brain imaging performed. The median time to MRI brain was three days and one and a half hours and the median time to CT brain was two hours and forty-nine minutes.

Conclusion
This audit confirms duplication of TIA brain imaging and CT as the primary imaging tool for TIA which is not in keeping with best practice (NICE, 2020). This has implications for resources, radiation exposure and patient’s length of stay. Development of dedicated ambulatory care pathways for TIA must incorporate rapid MRI access as the primary imaging modality.
209 NEURO-MEDICAL COMPLICATIONS OF STROKE—TRENDS OVER THE DECADES IN AN ACUTE STROKE UNIT
Authors: McGarvey C , Hobson H , Greene S , Cogan N , McCabe D , McCarthy A , Murphy S , O'Dowd S , Walsh R , Coughlan T , O'Neill D , Kennelly S , Mello S , Coveney S , Ryan D , Collins R 
Published: February 2023

Abstract

Background
Neuro-medical complications post-stroke are common and often serious [1]. We first described complications in our stroke cohort in 1998 and sought to assess whether the severity and the nature of neuro-medical complications may have changed over time due to changes in presentation and the processes of care [2].

Methods
Analysis of stroke service database, which captures all neuro-medical complications as part of its portal for the Irish National Audit of Stroke (INAS), was completed. The frequency of each of the 19 complications was expressed as the percentage of patients that developed each complication over a certain year and over 5 years. Historical comparison was made with dataset from 1998, which captured six complications.

Results
Data on 1,283 patients presenting over 5 years between 2015–2019 was collected. The median age of all patients was 71 years (Range 21–101). In all, 19 different post-stroke complications were recorded; 48% (n = 622) had post-stroke pain, while 23.85% (n = 306) had cognitive decline. Data on 100 patients from 1998 was compared for a number of common metrics including; 21.82% (n = 275) of patients developed an LRTI in the 2015–2019 cohort compared with 14%(n = 14) in the 1998 cohort (p = 0.09) while 16.29% (n = 209) of patients developed a swallow disorder compared to 21% (n = 21) in 1998 (p = 0.22).

Conclusion
There are high levels of neuro-medical complications in stroke patients. Twenty years has seen extensive investment in hyperacute stroke care yet post-acute care complications did not appear to reduce significantly between this time, albeit with low numbers. Direction of future funding may consider the full spectrum of stroke care.
212 BUILT ENVIRONMENT OF NURSING HOMES AND INFECTION CONTROL AND PANDEMIC PREPAREDNESS
Authors: Murphy E , Burke E , O'Donoghue J , Xidous D , Grey T , Kennelly S , O'Neill D 
Published: February 2023

Abstract

Background
The disproportionately high death rate of nursing home (NH) residents from COVID-19 in many countries, including Ireland, has focussed attention on infection prevention and control, including the built environment, in nursing homes. This has been a poorly researched topic to date, and we undertook a systematic review of evidence for architectural design measures which support infection control and pandemic preparedness.

Methods
Databases were screened for keywords related to NHs, built environment, infection prevention and control, and COVID-19; relevant papers were uploaded onto Covidence and screened for relevance. Data extracted from included articles was tabulated under 8 specific aspects of the built environment.

Results
Of 17 papers included in the final analysis, four studies found that larger nursing homes carried an increased risk of COVID-19 infection. Crowding in NHs was also a risk factor for infection, with a high crowding index associated with COVID-19 infection in five studies. Green House care homes, which are based on small clusters of domestic dwellings, fared better than traditional NHs. Two papers found an association between the location of NHs and the risk of COVID-19 infection, with urban NHs and those in areas of high prevalence being more at risk. Two papers identified internal fittings as a target for infection prevention and control. Seven papers highlighted the role of adequate ventilation in NHs in the prevention of spread of COVID-19. Only one paper described easy access to the outdoors as beneficial to infection control.

Conclusion
Residents of NHs are amongst the most vulnerable to COVID-19 infection. When designing and building NHs, the role of the built environment in controlling the spread of the virus should not be underestimated.
This research supported by Science Foundation Ireland.
214 CARE OF THE LGBT OLDER ADULT: A NARRATIVE REVIEW
Authors: O’Malley K , Waters R 
Published: February 2023

Abstract

Background
The number of older Irish adults who identify as Lesbian Gay Bisexual or Transgender (LGBT) is growing. Various barriers exist which can deter LGBT older adults from effectively engaging with healthcare services. These include, and are perpetuated by, heteronormative (and cis-normative) culture within the healthcare setting, and inadequate physician knowledge of LGBT healthcare needs.

Methods
The aim of this research is to enhance our awareness and understanding of the challenges experienced by LGBT adults in later life. Key electronic databases were interrogated using a considered search strategy and selected based on specific inclusion criteria.

Results
Key themes which emerged were; health disparities of LGBT older adults compared with the wider non-LGBT population; the impact of minority stress on the burden of chronic disease; the role of marginalisation/discrimination as a barrier to engagement with health services; institutional erasure of sexuality, particularly in the setting of long term care; the importance of non-biological chosen family, particularly in the context of advance care planning and preparation for end of life; heteronormativity, cis-normativity and physician bias in the healthcare setting.

Conclusion
It is imperative for physicians and allied health professionals to familiarise themselves with the many barriers faced by LGBT older adults when interacting with healthcare services, as well as their unique concerns in later life. In doing so, we can ensure the provision of inclusive and culturally-competent care for all LGBT older adults in Ireland, enabling them to age well in a health system that is sensitive to their needs.