bluuebunny/crossref_metadata_2025_split huggingface dataset:
244 Delays in DXAs: an audit on the ordering of DXA scans for fragility fractures in a level 3 university hospital
Authors: Carvalho J , McGurk C , McPartland A , Rooney B , Ong J , O’Malley G 
Published: September 2023

Abstract

Background
Osteoporosis is a serious public health problem due to a rapidly ageing population. One in two women and one in five men will break a bone after the age of 50. Fragility fractures are common, costly and lead to significant changes to a person’s QOL. Many of these fragility fractures can be prevented by timely intervention by a Fracture Liaison Service (FLS). The Royal Osteoporosis Society (ROS) has a Summary of Clinical Standards for FLS’s to inform the best practice of managing bone health risk after a fragility fracture. These standards are underpinned by evidence demonstrating that they are clinically and cost-effective. The standards state that patients aged &gt;50 with a new fragility fracture should be offered an assessment including a quality-assured axial DXA, within 12 weeks of fracture diagnosis.

Methods
The data set of the 847 fragility fractures identified by the FLS was analysed between January 2021 and April 2023. Of these confirmed fragility fractures, it was then assessed who had DXA scans booked and by whom.

Results
Of the 847 patients identified by FLS, 598 (70.6%) had been recommended to the GP to order a DXA scan, 8 (0.94%) had a DXA booked by the FLS, 133 (15.70%) already had a DXA performed and 26 (3.07%) were deemed that a DXA was not necessary and 1 (0.12%) had been booked by the clinical team.

Conclusion
According to this audit, most DXA scans are organised by the FLS writing to the GP to organise the DXA scan. We believe this leads to unnecessary delays in DXA scanning and places more pressure on GPs. This audit highlights the need for the ANP in FLS to collaborate with colleagues in other departments and specialities to help maximise the identification and treatment of people at risk of osteoporosis.
247 Assessing the impact of a new integrated care framework for nursing home residents
Authors: Farrelly A , Faherty L , Garcia R , Saric D , Ryan M , Thavarajah K , Martin R , Kennelly S 
Published: September 2023

Abstract

Background
Nursing home residents represent the frailest patients in our community and are often referred to the Emergency Department (ED) for acute care. These referrals may have limited benefit and are associated with an increased risk of complications. This programme initiated a new acute outreach service providing urgent geriatric care in residential care settings, with the aim of avoiding unnecessary referrals.

Methods
A framework to deliver specialist acute geriatric care to 4 Residential Care Facilities (RCFs) (423 beds) was developed. Direct access by phone to a daily team lead was developed and provided on a Monday–Friday 8 am -5 pm basis. Referrals were triaged and acute response service provided through ANP and consultant geriatrician. Protocols to support iv fluid and antibiotic administration were agreed. Framework RCFs also engaged in specific Quality Improvement (QI) initiatives that focussed on falls reduction, skin integrity assessment, appropriate use of ED and safe staffing. Outcome measures for hospital admissions and 90-day mortality over a 7 month period (April—Oct 2022) was collected from patient’s medical records, electronic data and RCF records.

Results
174 urgent referrals were seen. Of these reviews, 5 (2.9%) required subsequent admission to hospital. Treatment with antibiotics was initiated in 9.8%. 1.7% required iv fluids and palliative measures recommended in 20.7%. The 90-day mortality was 12.9%. A total of 132 patients were referred directly to ED from the same 4 nursing homes over the same time period (4% reduction from 2021). QI initiatives demonstrated improvements in compliance with falls and continence risk assessments.

Conclusion
Specialist acute liaison care to nursing homes complimented with appropriate QI focus could present an opportunity for optimised care in RCF residents and mitigate risk of avoidable transfers.
253 An audit of the inpatient management of Parkinson’s Disease medication in a level four hospital in 2019
Authors: Reidy C , Farrell T , Naylor C , Pope G , Cooke J , Bambrick P , Mello S , O'Regan N , Mulcahy R 
Published: September 2023

Abstract

Background
Parkinson’s Disease (PD) is a progressive, complex neurodegenerative disease characterised by both motor and non-motor symptoms. PD medications are time sensitive, and their correct prescription and administration are crucial in optimal management strategies. Previous work presented at the Irish Gerontological Society showed a lack of knowledge regarding PD and its medications among healthcare staff in a level four hospital.

Methods
Data were collected from a retrospective chart analysis of PD admissions in 2019. 115 admissions coded PD were identified from HIPE data. Subsequently, 10 patients were randomly selected from medical, surgical, and orthopaedic admissions respectively (39 admissions). Patients were excluded if they were not on PD-specific medications or if their drug Kardex was not available. 28 patient Kardex’s were reviewed. Data was collected using a predetermined spreadsheet and analysed using Microsoft Excel.

Results
100% of patients were on levodopa medication. 86% of patients did not receive their appropriate PD medications in the Emergency department. 21% had errors in medication prescription (omitted drug [n = 4, 14%], incorrect timings [n = 2, 7%]) on admission. 75% missed at least one dose of levodopa. 83 doses of levodopa were missed across the 28 admissions. 40% were because the patient was nil by mouth (NPO), while 21% had no reason documented. 64% of patients had doses of levodopa delayed by more than 1 hour, with over 80% of these in the perioperative period. 5 patients (18%) received antidopaminergic drugs.

Conclusion
This review highlighted multiple shortcomings in PD medication management during acute admissions. We introduced hospital guidelines for the management of patients with PD while NPO. This guideline includes information on alternatives to oral route, advice regarding the perioperative period, and medications to avoid. It has been approved by the Medications and Therapeutics committee and will be introduced with education sessions at the changeover. We will reaudit practices after 6 months.
255 Preliminary findings from a prospective cohort study of Ireland’s first community Fibreoptic Endoscopic Evaluation of Swallowing (cFEES) service
Authors: Clancy M , Curran S , Kerins E , Deane U , McCarthy O , Cregg P , Hayes K , Whelan E , Quinn C , Ryan S , Manning M , Griffin A 
Published: September 2023

Abstract

Background
Dysphagia is a common and resource-demanding symptom of many conditions. Dysphagia prevalence increases with age and can affect quality of life, nutritional status, hydration and increase healthcare utilisation/cost. Instrumental swallowing assessment is essential for accurate diagnosis and treatment. FEES is a gold standard diagnostic tool carried out by speech and language therapists (SLTs), typically in the acute setting. The aim of this study is to profile participants who accessed Ireland’s first cFEES service by describing clinical and process outcomes.

Methods
Adult patients referred for cFEES were invited to participate. Demographic, clinical and process data were recorded at index visit. A structured phone interview was completed at six months. Descriptive analysis was completed.

Results
In total, 53 participants were included: 70% were aged &gt;65 years, median age was 72. Diagnoses included progressive neurological conditions such as motor neuron disease, multiple sclerosis and others (23%), Parkinson’s Disease, including Parkinson’s Plus Syndromes (15%), stroke (13%), head and neck cancer (11%), dysphagia unknown aetiology (9%), other (9%), chronic obstructive pulmonary disease (8%), other cancers (6%), and gastro-oesophageal reflux disease (4%). Nutritional status was screened using the Malnutrition Universal Screening Tool (MUST) at index visit for 44 participants. Of those, 23% (N = 10) had a MUST score ≥ 1. Dysphagia Outcome Severity Scale was used to rate swallowing: 43% had some degree of dysphagia (mild to severe). FEES referrals originated mainly from primary care SLTs: 75%, the remaining 25% from older person’s services (community nursing facilities, inpatient rehabilitation and integrated care for older persons). One participant was unable to tolerate the procedure, which was abandoned. Three participants experienced non-limiting gagging or hypersensitivity.

Conclusion
cFEES is a novel service model which was accessed mainly by older people. cFEES was tolerated well by most, leading to evidence-based outcomes including ruling out significant dysphagia in 57% of cases.
307 An audit of dual antiplatelet prescribing after minor ischaemic stroke
Authors: Okpaje B , Reddin C , Walsh T , Waters R 
Published: September 2023

Abstract

Background
The American Heart Association make class 1A recommendation for dual antiplatelet therapy for secondary prevention in patients with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤ 3) or high risk TIA on the basis of evidence from randomised controlled trials, such as POINT and CHANCE, which have demonstrated a lower rate of subsequent stroke compared with single antiplatelet therapy. A number of clinical factors have been shown to influence effectiveness, including time from symptom onset to initiation of dual antiplatelet therapy. We aim to evaluate the rate of dual antiplatelet prescribing in this cohort and whether the rationale not to prescribe was clearly documented.

Methods
We reviewed the electronic records of all stroke patients aged 18 and above, admitted to University Hospital Galway within June 1st to September 29th 2022. Patients who either had a minor ischaemic stroke with a clearly documented NIHSS score of ≤3 were included in the analysis. These records were then assessed for the rate of dual antiplatelet prescribing versus single antiplatelet prescribing and if the rationale was documented.

Results
Of 29 patients admitted with minor ischaemic stroke, 8 were commenced on dual antiplatelet therapy. The mean number of days from symptom onset to presentation was 1.92 for those who were prescribed DAPT and 2.42 for those who were prescribed SAPT. Of those prescribed SAPT, the rationale for not commencing DAPT was documented. Rationale included delay to presentation (&gt;72 hours) and atrial fibrillation.

Conclusion
48.3% (n = 14) DAPT was either prescribed or a documented rationale for SAPT was provided. Our findings are consistent with DAPT prescribing patterns in other studies [1].
315 Financial planning as part of an integrated care comprehensive geriatric assessment
Authors: Lynch A , Murphy D , Loughlin E , Mannion K , Neachtain M Ni , Sheil Edel , Donohue M , McCleane F , Geoghegan J , Canavan M , Murphy R , Costello M 
Published: September 2023

Abstract

Background
Evaluation of a social support network, including the need for support in managing finances independently is an essential component of Comprehensive Geriatric Assessment (CGA). Safeguarding of finances (e.g. third party authorities, enduring power of attorney, will) should be encouraged in all order adults, particularly those with cognitive decline to provide security and protection of their wishes should they lose capacity to manage financial decisions. We sought to evaluate financial competency and preparedness in a population attending our Integrated Care for Older Persons (ICPOP) service.

Methods
Participants included were new patients referred to ICPOP between January and May 2023 with completed CGAs. A retrospective analysis was conducted of patient demographics, ability to independently manage finances, dependency on personal and instrumental activities of daily living.

Results
Of our analytic cohort (n = 85), 56% (n = 48) were female, median age was 81. The most common reason for referral was new change in cognition which accounted for 48% (n = 41/85) of patients. Median Rockwood Clinical Frailty Scale was 5. Median Barthel score was 17. Median Lawton-Brody score was 4/8 with 80% (n = 68) patients scoring 1 in the financial section which indicates their ability to manage their finances partially or completely. 60% (n = 51) of patients collected their own pensions and on specific questioning reported managing their finances independently. No patient had an advanced care directive, 90% (n = 77/85) did not have EPoA and 41% (n = 35/85) did not have a will.

Conclusion
We identified that in those attending our service, very few had EPoA in place with no person having a documented advanced care directive. Over half required some if not total assistance with financial matters. Supported decision making is essential to uphold the right of the older person to make choices on their welfare, property and affairs and CGA provides opportunity for intervention in this remit.
327 A review of patients referred to community rehabilitation (ExWell Medical) from gerontology clinic in a regional hospital
Authors: Conroy K , Sibthorpe L , Goulden E , Donnelly T , McGlynn J 
Published: September 2023

Abstract

Background
ExWell Medical is an established community-based chronic illness rehabilitation programme which was founded in 2006. It is a not-for-profit company with over 2000 in-person patient visits per week, across 22 centres in Ireland. Its referrals stem from hospital consultants, general practitioners and other allied health professionals. The rationale behind ExWell Medical is that a large proportion of the disability that comes with any long-term illness is caused by deconditioning. It is particularly aimed at the ageing population who may find it difficult to engage with local services and have poor motivation. ExWell Medical offers community-based supervised exercise classes, as well as home programmes.

Methods
We performed an audit looking at the number and demographics of patients referred to ExWell Medical from 12/01/2022–22/5/2023 from the Gerontology Frailty Hub in a regional hospital. All patients attending the clinic during this time were included, and data was logged at each appointment. I then performed a retrospective analysis of patients referred to community rehabilitation.

Results
The total number of patients was 656 (322 male (49%), 334 female (51%). Of these, 67 were referred to ExWell Medical, 587 did not warrant referral and 2 were excluded due to lack of data. This correlates with a 10.2% referral rate. We proceeded to assess the demographics of those referred, which showed 67% were female and 33% were male. With regards to age; 4 patients were &lt; 70 (6%), 15 were 70–75 (22.3%), 23 were 76–80 (34.3%), 14 were 81–85 (21%), 10 were 86–90 (15%) and 1 patient was over 95 (1.5%).

Conclusion
The referral rate to ExWell Medical was less than expected, and especially low in men. By highlighting this we hope to increase the number of patients referred in the future, as well as reducing the gender disparity.
341 Auditing the timing of CT-Brain and Angiograms in suspected acute stroke
Authors: O'Loghlin R , O'Malley T 
Published: September 2023

Abstract

Background
Timing of neuroimaging play a key role in the management and ultimate outcomes of patients presenting to hospital with a suspected acute stroke. The NICE Guidelines on the initial management of suspected acute stroke and the NHS National Stroke Service Model set a target of less than 20 minutes between arrival to hospital and having a CT-Brain and CT-Angiogram performed, analysed, and reported. A clinical audit was performed looking at the timing of all CT-Brain studies performed in 2022 at a level three hospital in Ireland where acute stroke was the suspected presentation.

Methods
A total of 206 CT-Brain and CT-Angiogram studies were included in the audit. The time of the patients’ registration in the emergency department was compared to the timestamp on NIMIS of the completion of each CT study and of the time of publication of the radiologist’s report. For patients already admitted on a hospital ward, the time that the CT study was requested was used in lieu of arrival time.

Results
The average time between arrival in the emergency department and the completion of CT-Brain was 82 minutes. The average time between the completion of the CT and the publication of the radiologist’s report was 26 minutes, however many studies had verbal reports delivered to the requesting physician prior to publication of the report. Altogether, the average time for the performance and reporting of a CT-Brain and Angiogram in patients with suspected acute stroke was 108 minutes.

Conclusion
The average of 108 minutes from door to scanner to reported CT-Brain and Angiogram is significantly longer than the 20 minutes recommended by the NICE Guidelines. This hospital serves a large, rural catchment which makes late presentations common, adding to the urgency of neuroimaging for these patients. In future, key areas of in-hospital delay in CT performance and reporting should be identified and given close attention.
345 Integration of care for older adults: an evaluation analysis of the clinical pathways from the emergency department
Authors: O'Neill S , Linehan D , Sankey C , Carville M , Latoza W , Marks M 
Published: September 2023

Abstract

Background
There is an urgency globally to create novel healthcare models for the older adult population considering the ever-growing demographic. Ireland’s Integrated Care Programme for Older People (2016) emphasises the importance of delivering healthcare to older adults in their community with focus on the direct access to services from the Emergency Department (ED). This ‘frailty at the front door’ team sought to evaluate the clinical pathways facilitating direct integration of care into the community following completion of the Comprehensive Older Adult Assessment (COAA) in the ED of a model 3 hospital.

Methods
The team conducted an evaluation analysis of the critical pathways referring patients to the community directly from the ED. The team recorded the quantity of referrals to each community service on discharge over a period of six months from October 2022–March 2023. This included Health Services Executive (HSE) services and voluntary sector services. The results included admission avoidance pathways. The team completed a case study review for individuals readmitting to the ED within 7 days and 30 days.

Results
796 Older Adults were assessed by the team in the ED. 368 Older Adults were discharged directly to the community. From January–March 2023 there were 79 admissions avoided. For those discharged, there were 440 onward referrals made to community-based services. These included 91 referrals to Primary Care Physiotherapy, 83 to Public Health Nurse, 60 to Primary Care OT, 45 to the Community Intervention Team, and 11 referrals to the Dementia Advisor. The 7 day readmission rate ranged from 0–4% per month. The 30 day readmission rate ranged from 5–13%.

Conclusion
There was a high level of integration of care between the ED ‘frailty at the front door’ team and voluntary or HSE community services. The low readmission rate demonstrates the effectiveness of the discharge pathways in enhancing the safety of discharges.
84 What works and why for interprofessional collaboration in older people’s care integration: realist evidence synthesis
Authors: O’Donnell D , Radomska A , Shé É Ní , Davies C , O'Shea M , Devaney C , Donnelly S , O'Donoghue G , De Brún A , Whitty H , Harnett P J , Lang D , Harrison R , McAuliffe E , Ahern E 
Published: September 2023

Abstract

Background
Interdisciplinary Community Specialist Teams for older people (CSTs) are a novel innovation in Irish health service delivery and require, over time, a shift in cultures of care to allow for the development of interprofessional collaboration. However, there is limited international guidance on how to foster, enhance and sustain meaningful interprofessional collaboration in the context of interdisciplinary team-based care integration for older people. This realist review presents initial programme theories of what works and why in fostering competencies for interprofessional collaboration in CSTs for older persons.

Methods
Realist reviews are an interpretive theory-driven approach to evidence synthesis which uses multiple sources of evidence including published peer-reviewed studies, policy documents and grey literature. This evidence is combined with stakeholder theories and explanations of how interventions might work. Four stakeholder cohorts were identified: public and patient representatives of older people and family carers, healthcare professionals who are members of CSTs; team leads responsible for the operational management of CSTs, and healthcare managers responsible for national clinical programme design.

Results
This synthesis resulted in a series of evidence-based Initial Programme Theories (IPT) in the form of statements that explain the Mechanisms (M) and Resources (R), generated within particular Contexts (C) in response to interprofessional collaboration, that are thought to lead enhanced care Outcomes (O). For example: Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross-sectoral communication and trust (M) leading to enhanced continuity of care (O).

Conclusion
The IPTs generated from this realist synthesis of international literature support workforce education, development and planning. They also provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and realise the goals of care integration for older people.
206 Changing needs in a rehabilitation setting—fact or fiction?
Authors: Griffin E 
Published: September 2023

Abstract

Background
Various pathways have been developed for older persons in our region, e.g. Reablement and the Integrated Care Team for Older Persons. Do these developments impact on referrals to our rehabilitation unit? The perception is that our client base is becoming more complex. A service evaluation was completed to examine this. This has implications for the planning of resources for us and the region in line with the National Standards for Safer Better Healthcare (2012).

Methods
A retrospective chart audit was performed on all discharged physiotherapy charts for 2019, 2021 and 2022. Categories were themed for: reason for admission to acute services, transfer ability (bed to chair) preadmission, on admission to the rehabilitation unit and on discharge. Levels of assistance needed were itemised as: independent, assistance of one, assistance of two, use of a Sara Steady and use of a hoist. Discharge destination was reviewed.

Results
A total of 339 charts were reviewed. Reason for admission to acute services was consistent: acute medical reasons, stroke, hip fracture and ‘falls’. The majority of clients were independent in transfers before admission: 93% in 2019 which dropped to 81.5% in 2022. On admission to the rehabilitation ward those needing assistance of two people rose from 16.8% (2019) to 21.8% (2022). The use of a hoist rose by 6%. On discharge, those assessed as being independent dropped from 63% (2019) to 44.6% (2022). Those needing assistance of 1 increased from 21.8% (2019) to 41.1% (2022). Those requiring a hoist rose; 2% (2019) to 7.2% (2022). The majority of clients were discharged home; 75% (2019) which fell to 65% in 2022.

Conclusion
The review highlights that there is a trend towards increased levels of assistance needed for clients admitted onto, and being discharged from, the rehabilitation unit. This has workforce and environmental implications for our unit in terms of planning of resources. Further evaluation is warranted to examine ongoing trends.