bluuebunny/crossref_metadata_2025_split huggingface dataset:
175 Navigating the transient ischaemic attack pathway—unveiling the gaps and developing a standard solution
Authors: McDermott C , Murphy D , Hanrahan C , Murphy R , Walsh T 
Published: September 2023

Abstract

Background
Hyperacute management of a Transient Ischemic Attack (TIA) is necessary to decrease subsequent stroke. We examined our current management of TIA patients to inform a quality improvement initiative to bring our practice in line with the 2023 UK and Ireland Clinical Guidelines for Stroke.

Methods
We completed a retrospective cohort study of patients who attended our hospital between December 1st 2022 and February 28th 2023. Patients with a primary diagnosis of TIA were identified though the Hospital In-Patient Enquiry (HIPE). Each diagnosis was verified with electronic records review, with exploration of key investigations and management parameters.

Results
41 patients were coded as TIA from HIPE. 39 were a verified TIA diagnosis, with a mean age of 68.7 years. 10.2% were seen by direct GP referral to the Acute Medical Unit (AMU), with the rest attending ED initially. The median length of Stay (LoS) in hospital was 2.75 days. Most patients were admitted under the AMU (33%) or Stroke service (26%), with a shorter LoS if the patient was admitted under these services. 38 patients underwent neuroimaging; 94.8% CT Brain, 84.6% MRI Brain, and 82.1% both CT and MRI imaging. 1 patient went directly for MRI Brain without CT imaging. 82.1% were reviewed by a stroke specialist. Dual Anti-Platelet Therapy (DAPT) was used in 3 patients, single antiplatelet in 21, and oral anticoagulation in 9. 3 patients were discharged without any anti-thrombotic therapy.

Conclusion
This study highlights areas for improvement in the management of TIA in our facility. Our results have informed the development of a new TIA pathway, which will encourage an ambulatory approach to investigations and management of patients with a TIA. Improved patient-centred outcomes may include improved selection for DAPT, improved neuroimaging efficiency with increased direct to MRI imaging and higher numbers of patients being reviewed by a stroke specialist clinician.
183 Pathfinder emergency response to urgent urinary catheter issues in older adults; a service profile
Authors: Hogan L , Howard W , Corcoran G , Riordan Y O , McGettigan L 
Published: September 2023

Abstract

Background
Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is growing evidence for alternative care pathways at the time of a low acuity Emergency Medical Services (EMS) call. The Pathfinder service is a collaboration between the National Ambulance Service and acute hospital Occupational Therapy and Physiotherapy Departments. The service responds to low acuity 999/112 calls for people aged 365 years within the hospitals catchment area, including low acuity calls for blocked or dislodged indwelling urinary catheters.

Methods
A retrospective analysis of the service’s database was completed (1/1/22–26/5/23). All of the patients seen where the reason for 999 call was recorded as ‘blocked catheter’, ‘dislodged catheter’ or ‘urinary issues’, were identified and analysed.

Results
One hundred patients were identified, with urinary catheter related issues. Of these patients, 70% were male. The average age was 81 years. The average Clinical Frailty Scale score was 7 (severely frail). Ninety One percent of these patients remained at home as a result of the services’ intervention at the time of the 999 call. Of these 91 patients, 54% were classified as ‘treat and discharge’ (no further input or onward referral required), and 37% were ‘treat and refer’ (with onward referral to other services including Hospital Urodynamics Team, Public Health Nursing, GP). Seventy five percent remained at home without representation at 24 hours; 90% at 7 days and 75% at 28 days.

Conclusion
The Pathfinder service is safely and effectively managing urgent indwelling catheter issues, at the time of a 999 call, in older peoples’ homes instead of the ED. This upskilling project was made possible by excellent cross-organisational collaboration with the Hospital Urology and Urodynamics Department. The next phase of upskilling will focus on the management of urgent suprapubic catheter related issues.
185 Outcomes from a nutrition and exercise group targeting sarcopenia in older adults attending an integrated care for older persons hub
Authors: Grant E , Phelan N , Bambrick P 
Published: September 2023

Abstract

Background
Sarcopenia refers to the generalised loss of skeletal muscle mass, strength and function. It is closely related to physical frailty, and is a common contributor to the presentation of older adults to integrated care teams. Research has shown that resistance exercises combined with adequate dietary protein intake can reverse sarcopenia.

Methods
Screening for probable sarcopenia using handgrip strength was introduced as part of the routine comprehensive geriatric assessment. Suitable candidates meeting the inclusion criteria were offered an 8-week program, led by a physiotherapist and a dietitian, incorporating a home-based resistance exercise and nutrition intervention. Measures of strength (using handgrip), muscle mass (using BIA [bioelectrical impedance analysis]) and physical performance (using ‘Timed Up & Go’ [TUG], and gait speed) were taken pre and post intervention.

Results
10 participants (2 female, 8 male) completed the program. Following the 8 week intervention, changes were observed in measures of grip strength (median 1.5 kg, P = 0.04), and in physical performance using gait speed (median − 0.355 seconds, P value = 0.8). This was not seen when using TUG to measure physical performance (median + 0.02 seconds). Issues measuring muscle mass in routine clinical practice using BIA were encountered making analysis non uniform within the group. Frailty scores using the fried frailty scale were taken for 6 out of 10 participants in which the median change was −1 on the Fried scale (p = 0.025).

Conclusion
Participation in this self-directed nutrition and exercise program over an 8 week period was associated with improvements in measures of muscle strength, physical performance (to a lesser extent), and frailty scores. Future work will aim to explore the feasibility of a longer duration of intervention, and to examine whether this results in a greater treatment effect.
194 Weekend warrior: a structured self-directed physiotherapy exercise programme that enhances weekend exercise in older persons inpatient rehabilitation
Authors: Cusack G , McDonnell I , O'Quigley K , Gilheany A 
Published: September 2023

Abstract

Background
Strength and mobility exercise improve functional recovery in older persons rehabilitation. Internal audits and patient feedback show that exercise levels are lower on weekends where no physiotherapy service is available. Weekend physiotherapy intervention reduces length of stay in older persons rehabilitation. Additional interventions may be cost-effective, improve function and quality of life on discharge. This quality improvement project investigates the effect of a structured, self-directed weekend exercise programme on perceived exercise levels and satisfaction with weekend exercise levels. This project also investigates the workload of the programme for ward staff.

Methods
Surveys were completed after patients’ first weekend of admission. Patients self-reported time spent exercising at the weekend and their satisfaction. Weekend Warrior programmes (WWP) were given on week two of admission. Programmes matched manual handling guidelines with a traffic light system (seated = red, standing independently = amber, walking independently = green). Patients completed follow-up surveys after completing 3–4 weeks of WWP. Surveys were given to healthcare assistants to assess WWP workload burden.

Results
Before completing WWP, patients’ (n = 23) self-assessed exercise times were: 0-10mins exercise n = 8;10-20mins n = 7; 20-30mins n = 6 and &gt; 40mins n = 2. N = 9 reported satisfactory exercise levels on weekends. After completing WWP, patients (n = 17) self-assessed exercise times were: 0-10mins n = 1; 10-20mins n = 11 and 20-30mins n = 5. N = 11 reported satisfactory exercise levels on weekends. N = 14 patients enjoyed participating in WWP. All staff (n = 6) reported that WWP did not significantly increase workload burden and supported the programme’s continuation. No adverse events were reported.

Conclusion
Weekend Warrior structured, self-directed exercise programme is safe and feasible in this setting. Patients reported enjoying WWP. This programme did not additional workload burden for ward staff.
210 Screening for frailty in the Acute Medical Admissions Unit and examining referral patterns to physiotherapy
Authors: Nash K , Keogan F , Browne J , Murphy N , Walsh M E 
Published: September 2023

Abstract

Background
Frailty predisposes older people to adverse outcomes following hospitalisation. Physiotherapy can reduce the risk of adverse frailty-related outcomes including functional decline. Research examining frailty and physiotherapy referral in Acute Medical Units is limited. The objective of this study was to estimate the prevalence of frailty in older adults admitted to an Acute Medical Admissions Unit (AMAU), and to explore factors associated with early physiotherapy referral in the frail group.

Methods
A prospective cohort study was conducted in the AMAU of a large acute hospital in Ireland. Participants were those over 65 years who were admitted to the AMAU. All participants underwent frailty screening on admission using both the Clinical Frailty Scale and Program of Research to Integrate Services for the Maintenance of Autonomy-7 questionnaire. They were defined as frail if positive on at least one of the tools. Referral to physiotherapy and time to referral during hospitalisation was recorded. Multivariable logistic regression was used to explore factors associated with early physiotherapy referral (within 24 hours) for frail participants.

Results
210 participants (mean age = 78.3 years, 51.9% female) were included. Frailty prevalence was 71% (n = 149) (95% CI = 64.3–77.0%). Within the frail group, 61.1% (n = 91) experienced early referral to physiotherapy, 15.4% (n = 23) were referred after &gt;24 hours and 23.5% (n = 35) were not referred during hospitalisation. Falls history (Odds Ratio [OR]: 4.08; 95% Confidence Interval [CI]: 1.82–1.94), older age (OR: 1.05; 95%CI: 1.00–1.10) and mobilising with an aid or assistance (OR: 2.42; 95% CI: 1.11–5.27) were associated with early physiotherapy referral in the frail group. Sex and living alone were not.

Conclusion
Frailty screening in AMAU may increase identification of older people at risk of experiencing adverse outcomes. Routine referral to physiotherapy for people who are deemed frail would ensure more equal access to physiotherapy assessment and treatment which could reduce the risk of adverse outcomes including falls, functional decline, and frailty progression.
225 The pattern of ICPOP service use according to the clinical frailty scale
Authors: Mannion K , Shiel E , O'Malley K , Donohue M , Cleary A , Neachtain M Ni , Gavin C , Walsh L , Hanrahan C , Cosgrove J , Sestak K , McDonnell C , Fitzmaurice C , Geoghegan J , McClean F , Costello M , Canavan M 
Published: September 2023

Abstract

Background
We are a specialist integrated team working with older people to co-ordinate and provide enhanced health and social care services through Comprehensive Geriatric Assessment (CGA) and intervention working across a large geographical region.

Methods
New patients who underwent CGA from January–May 2023 were suitable for inclusion in this retrospective study. Key parameters including demographics, cognitive and functional status were recorded and analysed according to the following categories of clinical frailty scale (CFS); 1–3 (non-frail), 4–6 (frail) and ≥ 7 (severely frail).

Results
Of 249 patients who underwent CGA, 64% (n = 159) were female with a mean age of 82, and median MOCA score of 17. Reasons for referral were new or unexpected change in cognition (52%) frailty (40%) and falls (37%). Among this cohort 20% (n = 51) were non-frail, 71% (n = 177) were frail and 8.4% (n = 21) were severely frail. There was no significant difference in mean MOCA score by level of frailty (p = 0.49). Impairment in Instrumental Activities of Daily Living (IADL) was identified in 26% of non-frail, 77% of frail and 100% of severely frail patients. 27% of non-frail, 43% of frail and 33% of severely frail patients were living alone with carer strain reported in 70% of those with severe frailty. Informal care was regularly provided to 35% of non-frail, 60% of frail and 90% of severely frail patients.

Conclusion
Patients attending our service are frail, older and predominantly female. We identified a cohort who are not classified as frail but have cognitive impairment, are dependent for support in IADLs and reliant on informal care to allow them to live independently. In addition, we are supporting a severely frail, heavily dependent cohort and their caregivers. This demonstrates the complex case load within our ICPOP service which requires ongoing evaluation to ensure delivery of high quality person-centred interventions.
231 An evaluation of the dietetic service in a Geriatric Assessment Unit—nutritional status and outcomes
Authors: Mulligan Ú , Stone S , Basit M 
Published: September 2023

Abstract

Background
In 2021 the Geriatric Assessment Unit (GAU) was established, a 0.5 WTE dietitian was appointed to the multidisciplinary team. The Comprehensive Older Age Assessment (COAA) developed by the MDT included two nutritional screening tools—Malnutrition Universal Screening Tool (MUST) and the SARC-F questionnaire for sarcopenia. A MUST score of ≥2 and a SARC-F score of ≥4 were automatic dietetic referrals, referrals were also sent if a clinical concern was identified by the MDT. The aim of this review is to investigate the dietetic referral rates, nutritional status and compile a summary clinical outcomes.

Methods
A review of the dietetic excel database for the GAU, 2021 and 2022 was completed. The review included statistics on: (1) Referral rate, (2) Total number of dietetic interventions and a breakdown of new versus review patients, (3) MUST and SARRC- F score, (4) Body Mass Index (BMI) & weight status and (5) Review of the dietetic outcome following intervention e.g. follow up versus discharge rate and weight status at review appointments.

Results
The data for 2021 and 2022 were combined—77.5% of patients attending the GAU were referred to the dietitian, 80% of patients referred attended a one to one consultation. 55% of all dietetic interventions were for new patients and 45% review patients. Average BMI was 25.5 kg/m2 and 27.7 kg/m2 in 2021 and 2022 respectively. 13% had a MUST score of ≥2. 49.8% had a SCAR –F score ≥ 4. 41% of patients had reported or documented weight loss. 70% required dietetic review. At dietetic review 39.5% had desirable weight gain, 39.5% were weight stable, with only 16% having an undesirable weight loss.

Conclusion
The requirements and benefits of a dietetic service can be seen in the high referral rate, documented concerns of weight loss and percentage of patients with a SARC-F score ≥ 4, leading to patient specific dietetic intervention, with a stable or improved weight status at dietetic review.
232 A scoping review of Interprofessional collaboration for people over 65 with dementia living in the community
Authors: Egan A , Griffin L , Boland P 
Published: September 2023

Abstract

Background
Inter-Professional Collaboration (IPC) has gained prominence for current and future community-based dementia services, as they transition to integrated care. IPC aims to improve patient outcomes by coordinating care across multiple Healthcare Professionals (HCPs) and facilitating informed decision-making. This scoping review examined the nature and extent of evidence on IPC for People with Dementia (PwD) in community settings.

Methods
The methodology process was guided by the PRISMA-ScR checklist, which aligned with the research question. This involved reviewing eligibility criteria and information sources, establishing a search strategy using PICO, removing duplicates using EndNote, and screening articles in Rayann. The selected articles were then charted in a PRISMA flow chart, critically appraised using CCAT, and synthesised into a data extraction table to complete the process. After screening and evaluation, 15 articles were selected for the scoping review from an initial pool of 1,584 articles.

Results
Findings were grouped into two main themes: (1) IPC in Community Dementia Care: significance, team building, challenges and opportunities, the role of interprofessional education (IPE) and (2) Community Care Networks: barriers to implementing IPC and region-specific care models and guidelines.

Conclusion
The scoping review found that IPC in the community can provide high-quality care for PWD, resulting in earlier detection, disease management, and continuity of care. These benefits, however, are contingent upon effective communication, interprofessional coordination and local and national resources. Furthermore, a universal lack of standardised training for HCPs was identified as a key challenge in this. The review also discussed specific roles of IPC teams in dementia care, such as utilising other members of the team to address the shortage of physicians.
267 Survey of knowledge and medications Management of Patients with Parkinson’s Disease among non- consultant hospital doctors
Authors: Ragab I , Doherty R , Abdalla Y E , Brewer L 
Published: September 2023

Abstract

Background
Parkinson’s Disease is a progressive neurodegenerative movement disorder. is the second most common neurodegenerative condition after Alzheimer Disease. The incidence is 1–2:1000 of the general population and 1:100 of the over 80’s, therefore estimating that there are approximately 12,000 people living with Parkinson’s in Ireland. Providing care services and best management for Parkinson’s disease patients needs to be ensured through training staff and continuously auditing the service to meet international standards and patient satisfaction.

Methods
This study was conducted using an anonymous online survey completed by hospital doctors from all levels and specialties of Non-Consultant Hospital Doctors (NCHD) in a tertiary hospital. The survey contained two sections, the first asked questions on confidence and how commonly NCHD manage patients with Parkinson’s Disease. The second section contained questions to assess general knowledge on medications.

Results
Of the 40 respondents of non-consultant hospital doctors (NCHD) 50% were SHOs, 30% Interns 20% Registrars. 38% reported to lack confidence in managing patients with Parkinson’s and 50% somewhat confident and only 12% were confident. 77% weren’t familiar with medication side effect and 90% weren’t aware about rescue medications. 82% weren’t familiar with conversion methods. 95% felt that they needed more training.

Conclusion
Parkinson’s disease patients are commonly admitted to hospitals under medical and surgical teams, and ensuring every patient gets the best management should be our goal. More training is required among hospital doctors, in addition to other continuous easily accessible supportive materials, such as information leaflets, links to be included into hospital’s mobile phone application, Parkinson’s nurse specialist as a point of contact, and regular education.
269 Profiling frail patients assessed by the rapid access frailty team in the emergency Department of a Level 3 hospital
Authors: Brady A , Benson A M , Donnelly T , McGlynn J , O'Neill A , Moore A 
Published: September 2023

Abstract

Background
The Rapid Access Frailty Team (RAFT) in the Emergency Department (ED) currently consists of 2 physiotherapists. The aim of the team is to review frail patients presenting to the ED during core working hours. Key roles of the team include facilitating a safe discharge and providing early intervention to assist patient flow and a safer, more positive patient experience.

Methods
For the purpose of this study, frail patients were defined as those with a score of 4 or greater on the Clinical Frailty Scale (CFS). Data was manually recorded after each episode of care using data entry points including demographic details, interventions, outcome etc. Data was analysed from a 5 month period between January–May 2023.

Results
The RAFT Team reviewed an average of 100 patients per month. (Age range 44-98 yrs). 51% were over 75 years old. Gender distribution was not significantly different. 57% were female versus 43% male. The main presenting complaint of frail patients assessed by RAFT was falls. 69% of those reviewed were discharged. Approximately 36% of this group lived alone. 61% were female (Mean age 81y). 39% were males (Mean age 77y). CFS scores of those living alone ranged from 4–7. 37.5% of those reviewed had formal care in place at home. 10% of carers showed evidence of carer stress. 88% of patients had a falls assessment and equipment was provided to 65%. Physiotherapy (65%), Occupational Therapy (28%) and PHN were the most common community referrals required. 30% were referred to our Rapid Access Frailty Hub.

Conclusion
The number of frail patients presenting to our ED is growing. Increasing numbers of frail under 75yo patients are requiring RAFT input. Many frail patients continue to live at home alone. The RAFT team play a vital role in improving quality of care for this patient group and facilitate rapid, safe discharge home where possible.
283 An online portal to monitor trends of patients clinically deteriorating or requiring transfer from a rehabilitation hospital for older persons
Authors: Prendergast F , Cogan L 
Published: September 2023

Abstract

Background
Due to advances in Healthcare, more medically complex Older Persons are admitted to our Rehabilitation Hospital for Older Persons following an inpatient stay in an Acute Hospital. We created a deteriorating patient working group along with an online portal in July 2022 to ensure hospital wide procedures are in place for the early identification, escalation and management of deteriorating patients. Our online portal monitors patients clinically deteriorating or requiring transfer to an Acute Hospital following admission to our Rehabilitation Hospital for Older Persons.

Methods
Patients clinically deteriorating and patients requiring transfer to an Acute Hospital are captured in separate electronic databases respectively on our secure online portal. We present patient data from August 1st 2022 to June 1st 2023 following the creation of the online portal.

Results
A total of 143 patient episodes at risk of clinical deterioration were entered into the portal from August 1st 2022 to June 1st 2023. A total of 61 patient episodes requiring transfer back to an acute Hospital were entered into the portal from August 1st 2022 to June 1st 2023.

Conclusion
Our Rehabilitation Hospital for Older Persons assesses the suitability of patients for rehabilitation a local acute hospital prior to accepting their care. Most patients who clinically deteriorate can be managed in our hospital but due to our limited access to more advanced treatments and diagnostics, some patients require transfer back to the acute hospital from which they were referred. The creation of a secure online portal has been a very useful means of monitoring trends in our Hospital of both patients who clinically deteriorate and those who require transfer.