bluuebunny/crossref_metadata_2025_split huggingface dataset:
10 Interdisciplinarity and joint working in cultural gerontology
Authors: Waldron E , Wakefield K , O'Neill D 
Published: September 2023

Abstract

Background
Cultural gerontology—understanding ageing through the lens of arts and humanities—is an important element of epistemology of ageing. As a boundary area between geriatric medicine/gerontology and arts/humanities disciplines, joint-working/interdisciplinarity is desirable. This project aims to assess the degree of joint-working manifested in cultural gerontology by authorship and acknowledgements in papers dedicated to cultural gerontology in five journals.

Methods
Observational survey of authorship in 5 journals from the founding of the specific sections on cultural gerontology or specific dedicated journals, assessing number of authors, disciplinary identities, and evidence of joint working within cultural gerontology.

Results
Of 591 papers, 481 (81%) were single authors. There was a spread of disciplinary affiliations, 247 (41.8%) gerontology/age-studies, 169 arts/humanities/social sciences (28.6%) and 133 of uncertain affiliation (22.5%): only 38 papers had a clear indication of joint working across the disciplines (6.4%). In the two geriatric medicine journals, European Geriatric Medicine and Journal of the American Geriatrics Society, authorship was almost exclusively from geriatric medicine/gerontology. There was extremely limited use of acknowledgements.

Conclusion
Our study indicates that single authorship is the most frequent mode of peer-reviewed publishing in cultural gerontology, while acknowledging that some authors may have scholarly training in multiple fields but are listed as uni-disciplinary. Leaders in the field and editors of relevant journals/section need to consider ways of encouraging and recognising joint working, through fuller descriptions of multiple affiliations, brief author biographies, fuller use of acknowledgements and consideration of brief accompanying discussant responses from complementary disciplines.
99 Pathfinder: a retrospective review of the first sixty patients
Authors: Meagher B , Griffin A , O'Donoghue B , Burke D , O'Shea T , Cox T , Allen T 
Published: September 2023

Abstract

Background
Pathfinder is designed to safely keep older adults who phone 999 at home by utilising alternative care pathways rather than taking them to a hospital Emergency Department (ED). Pathfinder began as a pilot initiative from a collaboration with Beaumont Hospital and the National Ambulance Service (NAS) in 2018. Due to its success a permanent team was set up in March 2020. The NAS began to roll Pathfinder out nationally and this team went live in the first quarter of 2023.

Methods
The first 60 patients who were seen by this Pathfinder service were included in a retrospective review. Data was collected using a Microsoft Excel® worksheet. The data recorded included: age, gender, Clinical Frailty Scale (CFS), the presenting complaint and the outcome of the assessment.

Results
Of the first 60 patients the mean age was 79 years, 48% (n = 29) were male and 52% (n = 31) were female. The median CFS was 6 indicating a moderately frail cohort. A total of 58% (n = 35) of patients remained at home after initial assessment, 74% (n = 26) received follow-up from the Pathfinder team, and 26% (n = 9) were treated and discharged at the scene. A total of 94% (n = 33) remained at home within 24 hours after initial review, and 80% (n = 28) remained at home after 7 days. A remaining 42% (n = 25) of patients were conveyed to ED at initial assessment. Of these patients, 76% (n = 19) were admitted and six patients were discharged home from the ED, of which four (67%) received follow-up from the Pathfinder team.

Conclusion
This new Pathfinder service to the area provides a safe alternative pathway to older adults who contact emergency services, with 58% of patients remaining at home post Pathfinder intervention. Further research is required to investigate the patient experience of the service.
103 Impact of dedicated consultant geriatrician involvement on direct discharge of frail patients from the emergency department (ED): a pilot study
Authors: Marks E , Lyons C , Thomas N , Dockery F , Brewer L 
Published: September 2023

Abstract

Background
Timely assessment and tailored intervention by a dedicated multi-disciplinary Frailty Intervention Therapy Team (FITT) in ED helps facilitate direct discharge from ED of frail older people who may otherwise be admitted. We assessed the impact of additional consultant geriatrician involvement on safe admission avoidance in suitable older patients.

Methods
A consultant geriatrician, registrar and an ANP worked in conjunction with FITT, ED colleagues, and teams on call. This pilot service ran 9 am-5 pm Tuesdays to Thursdays. All patients &gt;75y in the ED were recorded and discussed at regular huddles. Frail patients at high risk for admission had consultant geriatrician review, to facilitate discharge where possible.

Results
We completed 27 days over a 9-week period, with both registrar and ANP present on 17/27 (63%) days. 315 patients were discussed. Commonest reasons for presentation included falls (57%), generally unwell (15%) and abdominal pain (12%). Of those actively reviewed (165), 116 were discharged (70.3%; 4.3 patients daily). Mean age was 76y (75–101), 44% were &gt; 80y and 71% were female. CFS was 5–8 in 64%. Most came from home (68%) or nursing home (29%). Rapid follow-up was arranged for outpatient/day hospital (38;33%), NH outreach (18;16%), ICPOP (8; 7%), falls/fracture clinics (6;5%), community allied professionals (4;3%) and Palliative services (2;1.7%). Of those discharged, 11 returned to ED within four weeks (9.5% return rate).

Conclusion
Geriatrician input with FITT and ANP services in ED efficiently facilitated additional daily discharges of frail patients who were at high risk for unnecessary admission. With a mean of 4.3 discharges a day, a five day service should achieve 1,118 discharges a year. Allowing for a return rate of 9.5% and a mean length of stay of 14 days, such annual discharges would result in 14,168 bed days saved annually, well in excess of the annual bed-days activity on a 35 bed ward.
207 What is the association between psychotropic medication use and orthostatic hypotension in community-dwelling older people: data from TILDA
Authors: O’Donnell D , Moriarty F , Lavan A , Kenny R A , Briggs R 
Published: September 2023

Abstract

Background
Psychotropic medications increase the risk of falls among older people. The aim of this study is to examine the link between psychotropic medication use and Orthostatic Hypotension (OH), a frequent cause of falls in later life.
Methods: Participants ≥65 years at TILDA Wave 1 had an active stand to assess orthostatic blood pressure. OH was defined as a blood pressure (BP) drop ≥20 mmHg systolic and/or ≥ 10 mm Hg diastolic beyond 30 seconds post-standing. Medication lists were examined for the following anatomic therapeutic chemical classification codes: N06A (Antidepressants); N05BA, N05CD, N03AE (Benzodiazepines); ‘N05CF (‘Z’ Drugs); N05A (Antipsychotics) and medications with ‘definite’ anticholinergic effects on the Anticholinergic Cognitive Burden Scale. Logistic regression models, reporting odds ratios (OR), assessed the association between psychotropic medication use and OH. Analyses were adjusted for age, sex, educational attainment, alcohol excess, depression, cognitive impairment, chronic disease burden, heart disease and sleep quality.

Results
Of the 1,875 participants (mean age 71 years, 52% female), 12% were prescribed ≥1 psychotropic medication (234/1,875), while 4% (78/1,875) were prescribed ≥2. Psychotropic medication use was associated with a larger drop in systolic BP at 30 seconds (7.81 (95% CI 5.61–10.02) vs 3.46 (95% CI 2.61–4.32) mm Hg; p &lt; 0.001) and 60 seconds (4.02 (95% CI 1.82–6.21) vs 1.28 (0.44–2.13); p = 0.025) post standing. In fully adjusted models, psychotropic medication use was associated with a higher likelihood of OH (OR 1.50 (95% CI 1.10–2.08; p = 0 0.013), with a stronger association noted for those taking ≥2 psychotropics (OR 2.19 (95% CI 1.34–3.57); p = 0.002).

Conclusion
Psychotropic medication use is independently associated with delayed BP recovery after standing. Older people prescribed psychotropics have a 50% higher likelihood Of OH related to their use, highlighting the importance of reviewing these medications as part of a comprehensive geriatric assessment, particularly in older people with falls.
260 Using participatory action research to examine attitudes and awareness of adult safeguarding practices in the acute hospital context
Authors: Donnelly S , Casey A , Lynch C , Deaveney S , Scanlon T , McKenzie L 
Published: September 2023

Abstract

Background
The investigation of, and interventions on, the alleged abuse of vulnerable adults has become an important feature of social work and other professional practices in Ireland. This implies important organisational challenges in ensuring that adult safeguarding responsibilities are delivered in ways that ensure positive outcomes for all stakeholders. Many factors can influence staff responses to concerns in acute care contexts. This can relate to awareness of the many forms of abuse and reporting obligations, attitudes to adult safeguarding and understanding the impact of abuse. Acute hospitals offer unique opportunities to intervene in abusive situations and to offer support to those at risk. This study set out to explore the awareness, understanding and attitudes towards safeguarding practices of staff in a large Dublin teaching hospital using a Participatory Action Research Approach (PAR).

Methods
A PAR methodology was utilised involving a social work academic and six members of the Medical Social Work team as co-researchers in the study design, data collection and data analysis. A quantitative, descriptive study design was adopted, which utilised a cross-sectional online survey of hospital staff which generated 100 responses from a variety of hospital staff including nurses, doctors and health and social care professionals.

Results
Findings indicate that acute care staff have varying levels of awareness of different categories of abuse. 59% of respondents reported being ‘somewhat confident’ in recognising and reporting suspected harm, neglect or abuse of a patient they were treating. 66% of respondents reported being aware of their mandated reporting requirements under the Criminal Justice (Withholding of Information on Offences against Children and Vulnerable Persons) Act 2012.

Conclusion
Many staff in acute care contexts lack confidence and knowledge in detecting and reporting the abuse of adults at risk, including their mandated reporting obligations with 90% of respondents stating that they need further training in this area.
300 Older persons in early supported discharge: an exploration of their experiences
Authors: Duddy S , Breen C , Chawke M , Burke C , Cosgrove C , Corry M , Waldron E , Walsh T , Deery M 
Published: September 2023

Abstract

Background
Early Supported Discharge (ESD) for Stroke is a complex intervention which enables people with new onset stroke to realise an accelerated discharge with rehabilitation in their home setting. ESD is supported with a robust evidence base, yet less is known about the specific experience of older adults. This paper aims to explore the experience and outcomes of patients over 65 years old in 2022 in a single stroke ESD site.

Methods
A password-encrypted database is held onsite, on which data for all ESD patients is inputted and updated during the time the patient is in the ESD service or shortly thereafter. The database was retrospectively reviewed to look at pertinent characteristics of the subgroup of ESD patients over 65 in 2022. Descriptive statistics were used to describe demographic details, functional outcomes, and predicted Length of Stay (LoS) saving in the acute hospital and LoS on the programme.

Results
Of 75 patients availing of ESD in the period, 47 were over 65 (62.6%). 63.8% of the over 65 cohort were female in contrast to 48% of the under 65 s. The Functional Independence Measure/Functional Assessment Measure (FIM/FAM) and Extended Activities of Daily Living (EADL) tools were used on admission and discharge. The FIM/FAM produced improvement score median of 6.08% and EADL, median score 12% among those over 65. The estimated LOS saving was the same across both groups (9.4 days). Average time on ESD programme was 29 days for this population, while those under 65 averaged at 46.6 days.

Conclusion
Older adults demonstrated functional gains in this ESD service, as measured by FIM/FAM and EADL measures, and they required less time in ESD than those under 65. Age did not influence acute LOS saving in this cohort. A larger review is indicated to determine trends over time and across ESD sites.
323 A service evaluation of a new initiative; the Mercers Acute Medical Assessment Unit for Older Adults (MASU)
Authors: Gallagher E , O'Donnell D , Doyle K , McCormick J , Finnegan E , Ryan M , Khan P , Briggs R , Keane B , Cunningham C , Lavan A 
Published: September 2023

Abstract

Background
Mercers Acute Medical Assessment Unit for Older Adults (MASU), a new service, was developed to expedite diagnosis, reduce delays in treatment and avoid unnecessary admissions in older adults presenting to hospital.

Methods
This was a retrospective review of the MASU service which included a dedicated registrar and consultant geriatrician assessing adults &gt; = 70 years with geriatric needs in the emergency department. Adults reviewed by the MASU team over a 16-week period (June 20th–Oct 9th 2022) were reviewed. MASU operated between 9.00–17.00 (Monday–Thursday) and 9.00–16.00 (Friday). The usual on-call service operated outside these hours.

Results
Over 16-weeks, 348 patients were admitted; 166 (47.7%) by MASU, 182 (52.3%) by out of hours (OOH). Patients’ average age was 83.1 years, 57.8% were female and median length of stay was 11 days (9.3 MASU vs 14.4 OOH). Twenty-four hour discharge rates were 13.2% for MASU vs 3.7% for OOH, 48-hour discharge rates were 18% MASU vs 9.8% OOH and 72-hour discharge rates 23.4% MASU vs 17.7% OOH. Four-week data for (July 2022) were compared to the same 4-week period in 2019; Day time admissions were higher in 2022 (70% vs 50.3%). Of those admitted by MASU, 14.3% were accepted directly from triage avoiding ED review and delays in specialist input. Despite admissions in 2022 being on average 3.6 years older (85.7 years vs 82.1 years) and frailer (85.7% &gt; =5CFS vs 54% &gt; =5CFS), more were discharged ≤24 hours after presentation (14.3% vs 8.1%) with 30-day readmission rates (26.2% vs 29.7%) and 30-day mortality (7.1% vs 8.1%) remaining static.

Conclusion
Having a dedicated consultant geriatrician and registrar allocated to review older adults with geriatric needs attending the emergency department lead to earlier discharges, thus potentially avoiding hospital associated morbidity.
340 Dementia knowledge and attitudes among undergraduate medical students- a cross-sectional study
Authors: Loughlin E , Lynch A , Murphy R , Costello M 
Published: September 2023

Abstract

Background
With our ageing population, medical students should expect to encounter and treat growing numbers of patients with dementia throughout their careers. This must be reflected during their preclinical and clinical training. This study aimed to assess knowledge and attitudes towards patients with Alzheimer’s Disease (ad) and dementia among undergraduate medical students in Ireland.

Methods
A cross-sectional study was carried out of medical students undergoing hospital-based clinical attachments using the Alzheimer’s Disease Knowledge Scale (ADKS) and Dementia Attitudes Scale (DAS). These were distributed electronically. The ADKS is a 30-point true/false questionnaire covering 7 areas of knowledge of ad. The DAS is a 20-item scale using a 7-point Likert scale assessing attitudes towards patients with dementia across two domains: ‘dementia knowledge’ and ‘social comfort’. Demographics were collected including age, gender, academic year, student type (undergraduate or postgraduate) and desired field of future study. Data was collected and analysed via Qualtrics.

Results
The survey was distributed to 415 students, with a 21.7% respondent rate (n = 90). 64.7% (n = 54) were female, mean age of 23.3 years. 68.6% of students were in their first phase of clinical attachment (n = 59), undergraduate students represented 95.4% of respondents (n = 82). Mean percentage of correct answers on the ADKS was 83.7%. The domain with the highest correct scores was ‘Assessment and Diagnosis’ at 93.6%. The mean score on the DAS was 7.4% (108.4/140); when analysed by subgroup, mean score on ‘comfort’ was 68.1% (47.7/70) and mean score on ‘knowledge’ was 88.2% (61.7/70).

Conclusion
Participating medical students demonstrated high levels of ad knowledge and high positive attitudes scores towards patients with dementia. Scores were higher for ‘knowledge’ than ‘comfort’. Limitations included volunteer bias and social-desirability bias. This study identifies areas of deficits in students’ experience and attitudes and provides useful insights to inform training requirements for medical students to ensure they are adequately trained for these major demographic changes.
Smooth vs Textured Expanders: Patient Factors and Anatomic Plane Are Greater Factors in Determining First-Stage Breast Reconstruction Outcomes
Authors: Dahmus Emma S , Ruffino Amanda E , Madera Joshua D , Long Alexandra , Wang Shengxuan , Kauffman Christian A , Devitt Sean , Sanders Christopher , DeSantis Joseph 
Published: September 2023

Abstract

Background
Textured implants and expanders are associated with an increased risk of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). As a result, plastic surgeons are utilizing smooth expanders, but many perceive these produce undesirable outcomes including infection, seroma, and lateral displacement.

Objectives
The aim of this study was to compare clinical outcomes of smooth and textured expanders.

Methods
Breast reconstruction patients from January 2018 to May 2021 were retrospectively reviewed. Included patients underwent placement of tissue expanders at the time of mastectomy. Primary outcomes included postoperative seroma, infection, malposition, days to final reconstruction, explantation, and the need for capsulorrhaphy.

Results
In total, 233 patients were reviewed, of whom 167 met both inclusion and exclusion criteria. There was no statistically significant difference in poor outcomes comparing smooth and textured expanders. Days to final reconstruction was lower with smooth expanders per breast (P = .0424). The subpectoral group was associated with an increased likelihood of undergoing capsulorrhaphy (P = .004). Prepectoral placement was associated with more seromas (P = .0176) and infections (P = .0245). Demographic factors included older age as a protective factor for undergoing capsulorrhaphy (odds ratio [OR] = 0.962, P = .038), obesity increased the risk of infection (OR = 5.683, P = .0279) and malposition (OR = 6.208, P = .0222), and radiation was associated with malposition (OR = 3.408, P = .0246).

Conclusions
There was no significant difference in poor outcomes between smooth and textured expanders. Patient demographics and anatomical plane placement had greater effects on infection, seroma, and the need for capsulorrhaphy compared with tissue expander texturing.

Level of Evidence: 3
Comparing the Efficacy of Large Language Models ChatGPT, BARD, and Bing AI in Providing Information on Rhinoplasty: An Observational Study
Authors: Seth Ishith , Lim Bryan , Xie Yi , Cevik Jevan , Rozen Warren M , Ross Richard J , Lee Mathew 
Published: September 2023

Abstract

Background
Large language models (LLMs) are emerging artificial intelligence (AI) technologies refining research and healthcare. However, the impact of these models on presurgical planning and education remains under-explored.

Objectives
This study aims to assess 3 prominent LLMs—Google's AI BARD (Mountain View, CA), Bing AI (Microsoft, Redmond, WA), and ChatGPT-3.5 (Open AI, San Francisco, CA) in providing safe medical information for rhinoplasty.

Methods
Six questions regarding rhinoplasty were prompted to ChatGPT, BARD, and Bing AI. A Likert scale was used to evaluate these responses by a panel of Specialist Plastic and Reconstructive Surgeons with extensive experience in rhinoplasty. To measure reliability, the Flesch Reading Ease Score, the Flesch–Kincaid Grade Level, and the Coleman–Liau Index were used. The modified DISCERN score was chosen as the criterion for assessing suitability and reliability. A t test was performed to calculate the difference between the LLMs, and a double-sided P-value &lt;.05 was considered statistically significant.

Results
In terms of reliability, BARD and ChatGPT demonstrated a significantly (P &lt; .05) greater Flesch Reading Ease Score of 47.47 (±15.32) and 37.68 (±12.96), Flesch–Kincaid Grade Level of 9.7 (±3.12) and 10.15 (±1.84), and a Coleman–Liau Index of 10.83 (±2.14) and 12.17 (±1.17) than Bing AI. In terms of suitability, BARD (46.3 ± 2.8) demonstrated a significantly greater DISCERN score than ChatGPT and Bing AI. In terms of Likert score, ChatGPT and BARD demonstrated similar scores and were greater than Bing AI.

Conclusions
BARD delivered the most succinct and comprehensible information, followed by ChatGPT and Bing AI. Although these models demonstrate potential, challenges regarding their depth and specificity remain. Therefore, future research should aim to augment LLM performance through the integration of specialized databases and expert knowledge, while also refining their algorithms.

Level of Evidence: 5
Single-cell insights into development of the bovine placenta
Authors: Davenport Kimberly M , O’Neil Eleanore V , Ortega M Sofia , Patterson Amanda , Kelleher Andrew M , Warren Wesley C , Spencer Thomas E 
Published: September 2023

Abstract
A central determinant of pregnancy success is proper development of the conceptus (embryo/fetus and associated extraembryonic membranes including the placenta). Although the gross morphology and histology of the bovine placenta have been well studied, the cellular and molecular mechanisms regulating placenta development and trophoblast differentiation and function remain essentially undefined. Here, single-cell transcriptome (scRNA-seq) analysis was performed on the day 17 bovine conceptus and chorion of day 24, 30, and 50 conceptuses (n = 3–4 samples per day) using the 10X Genomics platform. Bioinformatic analyses identified cell types and their ontogeny including trophoblast, mesenchyme, and immune cells. Loss of interferon tau–expressing trophoblast uninucleate cells occurred between days 17 and 30, whereas binucleate cells, identified based on expression of placental lactogen (CSH2) and specific pregnancy-associated glycoprotein genes (PAGs), first appeared on day 24. Several different types of uninucleate cells were present in day 24, 30, and 50 samples, but only one (day 24) or two types of binucleate cells (days 30 and 50). Cell trajectory analyses provided a conceptual framework for uninucleate cell development and binucleate cell differentiation, and bioinformatic analyses identified candidate transcription factors governing differentiation and function of the trophoblasts. The digital atlas of cell types in the developing bovine conceptus reported here serves as a resource to discover key genes and biological pathways regulating its development during the critical periods of implantation and placentation.