bluuebunny/crossref_metadata_2025_split huggingface dataset:
184 Paying attention to the feasibility of daily delirium screening in an acute hospital setting
Authors: O'Donnell N , Doyle M , Laffan S , Sheehan M , Gardener P , Hearne S , Doyle P , O'Regan N 
Published: September 2023

Abstract

Background
Delirium is highly prevalent, yet two-thirds of cases remain undetected. Irish national guidance recommends daily delirium screening for all acute hospital in-patients at risk of delirium, including older patients. We conducted a series of stakeholder workshops to identify the screening tool considered most feasible for daily delirium screening by staff nurses in our hospital.

Methods
We identified four tools validated for daily delirium screening from the Scottish Intercollegiate Guidelines Network guidelines on ‘Risk Reduction and Management of Delirium’. These included the DOS-13 (Delirium Observation Screening Scale); RADAR (Recognising Acute Delirium As part of your Routine); mRASS (modified Richmond Agitation Screening Scale); and SQiD (Single Question in Delirium). Two workshops for local nursing delirium champions were held to discuss the feasibility of each of these instruments. Workshops commenced with teaching on delirium prevention, management and the rationale for daily screening. Factors relating to the time taken to conduct the assessment, training required, suitability for nursing staff use, diagnostic accuracy, and other issues relating to feasibility were explored.

Results
The RADAR was considered the instrument with the best balance between feasibility of implementation and diagnostic accuracy. The mRASS was preferred as the next best option, however there was concern that this instrument would require significantly more training. The DOS-13 was considered too time-consuming and too detailed, however it was proposed as a useful behavioural charting tool in patients with known delirium. Although the SQiD was considered the quickest test to conduct, it was felt that staff changeover would lead to reduced diagnostic accuracy.

Conclusion
RADAR was deemed the test of choice for daily delirium assessment in UHW acute wards. A delirium care bundle incorporating the RADAR was hence developed and training of staff has commenced. The next steps will be to evaluate its feasibility and efficacy in the real-world setting.
186 Experiences of implementing a group intervention targeting sarcopenia in an integrated care for older persons hub
Authors: Grant E , Phelan N , Bambrick P 
Published: September 2023

Abstract

Background
Sarcopenia is associated with declining mobility, falls, frailty, and increased mortality. Research suggests resistance exercises and ensuring adequate protein intake can improve muscle mass, strength and function.

Methods
Screening for probable sarcopenia was introduced as part of the comprehensive geriatric assessment in the hub. Suitable candidates who screened as having probable sarcopenia were offered a group intervention facilitated by a physiotherapist and a dietitian, followed by an 8 week at home self-management programme. Alongside objective assessments of outcomes, the clinicians conducting the program also undertook a process of reflection on the experience, to provide a qualitative analysis that might inform future work.

Results
The main barrier identified to the group intervention was enrolment. The primary reason for this appeared to be the presence of other comorbidities that precluded participation. These included active medical conditions, complex social issues, advanced cognitive impairment, complex falls, or malnutrition requiring more specialist intervention. The main facilitator identified was an engaged multidisciplinary team (MDT), willing to upskill to screen for sarcopenia and proactive about discussing the intervention with potential participants. Another facilitator was the practice of contacting participants at the midpoint, to check on compliance and provide encouragement.

Conclusion
Several conclusions were achieved through a qualitative reflection on the experience. Engaging and upskilling team members and therapist support were seen as facilitators, whilst recruitment was the most significant barrier. During reflection it was suggested that excluding those that did not screen for probable sarcopenia (53% of all screened) may have been a missed opportunity for promotion and prevention. These learnings will be used to inform the design of future such interventions. Despite the challenges encountered, there was a consensus among the MDT that offering a group intervention is a practical way to begin to address sarcopenia within the limited resources of a community hub.
212 Sarcopenia case finding: impact of body mass index on calf circumference measure
Authors: Salawu A , Glynn M , Kelly K , Dragos C , Cabansay C , Lowther K 
Published: September 2023

Abstract

Background
Calf Circumference (CC) is recommended by the European Working Group on Sarcopenia in Older People (EWGSOP) as part of the sarcopenia assessment algorithm. Clinicians’ are concern about accuracy of use in patients with high Body Mass Index (BMI) 25- 40 kg/m2 and low BMI &lt; 18.5 kg/m2. The aims of this study are to: (1) Compare prevalence of sarcopenia using Raw and BMI adjusted CC measures and (2) Examine CC association with gait speed and Clinical Frailty Score (CFS).

Methods
An observational study of over 65 years in rehabilitation setting. All data collected as part of routine physiotherapy care. Premorbid CFS recorded and Gait speed (m/s) over 6meters calculated. The fattest part of the calf was measured to give Raw CC corrected to the nearest centimetres (cm). Raw CC measures of patients with BMI &lt; 18.5, 25–29, 30–39 and ≥ 40 kg/m2 were adjusted for by adding 4 cm, subtracting 3, 7,12 cm respectively (Gonzalez et al, 2021) to give Adjusted CC. Cut off values for sarcopenia by gender as recommended by EWGSOP. Data was analysed using Pearson’ correlation and t- test. Significant values set at p ≤ 0.05 and r = 1.

Results
n = 99, 54% female. Low BMI and high BMI was 13% and 37% respectively with mean CFS of 5.4. Walking speed was slow, mean = 0.21 m/s. Moderate positive correlation observed between Raw and Adjusted CC measures (r = 0.713, p = 0.0001). Sarcopenia prevalence was 30% using Raw CC compared to 54% with Adjusted CC (p &lt; 0.004). Weak association recorded for CC measures with gait- speed and with CFS; (r = 0.124 and 0.123). No significant difference in Raw and Adjusted CC measures in Frail (5,6,7) and Non- frail (1,2,3,4) groups; [33.9(4.8) vs 32.3(4.16)]; p = 0.26 and [34.1(5.7) vs 32.4(4.6)]; p = 0.07.

Conclusion
Sarcopenia prevalence was higher with Adjusted CC. Clinicians’ awareness of impact of BMI on calf circumference is important in sarcopenia screening.
221 A one-year audit of intracranial haemorrhages that presented to a level 4 hospital and died within 30 days
Authors: Casey R , Whittle C , Jones B , O’Regan N , Cooke J , Mulcahy R , Pope G 
Published: September 2023

Abstract

Background
Spontaneous Intra-Cerebral Haemorrhage (ICH) constitutes 15% of all strokes and has a 1 month mortality of 40%. Different prognostic models are used but the most widely used model is the ICH score. Predictors for 30-day mortality include greater ICH volume, infratentorial location of ICH, low Glasgow Coma Scale (GCS), older age, and intraventricular extension. We audited all non-traumatic ICH that presented to a level 4 Hospital and died within 30 days in 2021.

Methods
We retrospectively collected all adult patients with imaging-confirmed (CT- or MRI-scan) non-traumatic ICH and died within 30 days. Patients were identified via FAST Call register. Exclusion criteria were traumatic ICH or non-parenchymal haemorrhage, haemorrhagic transformation of ischemic stroke, brain tumour associated haemorrhage. Data included age, GCS on admission, co-morbidities, Modified Rankin Score (MRS) pre admission, oral anticoagulation/anti-platelet use/time, patient’s blood pressure recordings. If the patient was referred to Neurosurgery, advice was collated. Haemorrhagic properties were measured on CT: supra- or infratentorial, intraventricular extension, and ICH volume (ABC/2 method). ICH Scores were calculated.

Results
29 ICH were identified with a 30 day mortality of 37.9%(11/29) and a mean age of 80.9 years. Median-MRS pre-admission was 3, GCS on arrival was 9(3–13). 5/11(45%) were admitted to the Stroke Unit. 5 patients were on anticoagulation and 3 received a reversal agent. 8 patients had a systolic BP 150-220 mmHg on arrival of whom 3/8(38%) achieved a target BP of ≤140 mmHg at 2 hours of diagnosis. Mean volume of ICH was 45.6mls. Median ICH score was 3.

Conclusion
29 patients presented with an ICH with a 30 day mortality of 37.9%. These were frail and multi-morbid patients. 45% were admitted to the stroke unit and 38% achieved optimal blood pressure control within 2 hours. This highlight two areas that could be improved to ensure optimum patient care.
233 Residents’ experiences of COVID-19 pandemic in a Long-Term Care Facility in Ireland: a qualitative study
Authors: Savolainen K , Ahern A 
Published: September 2023

Abstract

Background
COVID-19 fundamentally impacted Long-Term Care Facilities (LTCFs) in Ireland and worldwide. The pandemic resulted in a series of restrictions and limited older people in LTCFs in their daily lives. Learning and understanding the impact COVID-19 had on older people in LTCFs is crucial for future care delivery planning, as those in LTCFs are some of the frailest in society. This study aimed to provide a perspective of that understanding.

Methods
The study’s objective was to capture a description of the residents’ in-depth experience of COVID-19 in a communal long-term care facility for older people. Individual semi-structured interviews with residents who could consent were held between September to November 2021.

Results
Ten residents participated in the interview study. Their average stay in the LTC facility at the time of the interview was 3.25 years, with the shortest stay being 1.5 years and the longest being seven years. The gender distribution was 50/50 among the ten residents interviewed. Four main themes were concluded from the transcriptions; coping, loss & grief, resilience and social activities. The themes are interlinked and provide insight into residents’ ability to adapt to critical changes in the LTC facility in an extremely challenging period.

Conclusion
Although residents mentioned loss, not only about people but also the loss in doing activities, being active within the LTC facilities was essential and helped with coping with COVID-19 restrictions. Understanding residents’ experiences of COVID-19 in nursing homes is crucial to implement improvements as well as acknowledging the impact of COVID-19. Older people in LTCFs are already marginalised by their need for care. Further understanding of older people in LTC experience of a pandemic such as COVID-19 is required. This requires innovative solutions to capture the experience of all living in LTC facilities.
252 An audit of the inpatient course of patients with Parkinson’s Disease in a level four hospital in 2019
Authors: Reidy C , Farrell T , Pope G , Mello S , Bambrick P , O'Regan N , Cooke J , Mulcahy R 
Published: September 2023

Abstract

Background
Studies show that patients with Parkinson’s Disease (PD) are more often admitted to acute hospitals and have increased Length-of-Stay (LoS) compared to age-matched controls associated with higher morbidity and mortality. This review was undertaken as the outcomes of patients with PD have not been evaluated in this level 4 hospital. Previous work locally has shown a lack of knowledge regarding the inpatient management of PD.

Methods
Data was collected from a retrospective chart review (115 admissions coded with PD in 2019). 10 patients were selected from medical, surgical, and orthopaedic admissions respectively (36 admissions). Charts were reviewed recording demographics, LoS, Emergency Department (ED) management, complications, outcomes, and readmission rates. Data was collected, stored, and analysed using Microsoft Excel.

Results
Median age of patients was 80 years. 44% were female. Median length of stay was 15.5 days. PD was documented in 97% of patients in ED, of whom 11% of patients received their PD medications in ED. 78% of patients had a history of falls, but only 20% had lying and standing blood pressure recorded. 38% had delirium as an inpatient. 42% of patients were made nil by mouth (NPO) during their stay, 87% of these secondary to peri-procedural fasting. Medications were held in 71% of procedures. Only 69% of discharge summaries were readily available. 6 patients (20%) were readmitted within 3 months.

Conclusion
This review highlights several areas for improvement in the management of inpatients with PD in a level four hospital. Initial interventions include education sessions for healthcare staff and review of ED pathways. PD medication management will also be reviewed. Accessible electric discharge summaries are also a key area for improvement. We aim to assess patients with PD experience of their inpatient journey as the next step in our quality improvement project. We will reaudit in 6 months.
268 Specialist stroke rehabilitation needs in a tertiary hospital—are needs being met?
Authors: Gannon E , Healy L , O’Donovan C , Blackburne H , Arrigen G , Barry P , James K 
Published: September 2023

Abstract

Background
Stroke specific rehabilitation is essential to recovery and return to independence following acute stroke. With increasing cases and improvements in stroke care rehabilitation needs are rising, placing significant pressures on acute stroke units and acute hospital services. We used a point prevalence study to assess the rehabilitation needs of our stroke service.

Methods
Patients admitted under the stroke service were identified using the electronic patient admissions system on February 17th, 2023. Data was collected by teams of two healthcare professionals. Data collected: demographics, ward location; most appropriate location of care—Hospital, Community, Rehabilitation Unit; Clinical Frailty Score (CFS); Rehabilitation Complexity Score (RCS); estimated Length of Stay (LoS).

Results
53 patients admitted under the stroke service, 60% (32/53) patients were on the stroke unit, 40% (21/53) on an outlier ward, 9% (5/53) in the emergency department. Female 45% (24/53) Male 55% (29/53). Of patients &gt;75 years 67% (22/32) had a CFS &gt; 4. 41% (22/53) had primary rehabilitation needs, 30% (16/53) community, and 28% (15/53) hospital care. 17% (9/53) had an estimated LoS &gt; 3 months of those 55% (5/9) had primary rehabilitation needs that could be in a rehabilitation unit. Average RCS 9.7, average RCS 12.6 for patients with an estimated LoS &gt; 3 months.

Conclusion
Our study shows that limited access to suitable rehabilitation facilities has a direct impact on the coordination of stroke services in the acute setting. A high proportion of patients were not located on the stroke unit, an intervention shown to reduce mortality and disability. This study highlights the importance of ongoing improvement of rehabilitation services.
280 Prevalence of prescribing high anticholinergic scoring medications among over 65-year-old patients in primary care
Authors: O'Hagan L 
Published: September 2023

Abstract

Background
The effects of anticholinergic drugs are widespread because acetylcholine is involved in regulating various bodily functions, both in the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). By blocking the action of acetylcholine at CNS muscarinic receptors, anticholinergic drugs can lead to cognitive effects such as impaired attention, decreased learning ability, and memory difficulties. Blocking the PNS muscarinic receptors with anticholinergic drugs can lead to side effects such as urinary retention, constipation, and alterations in heart rate. Considering these issues, it is generally advisable to use anticholinergic drugs with caution in the elderly population as an anticholinergic score of 3 or more is associated with increased risk of confusion, falls and death. This audit seeks to determine the prevalence of the higher scoring Anticholinergic drugs (3) among the older population in a city centre GP Practice.

Methods
The website www.acbcalc.com provides a comprehensive list of medications with an Anticholinergic burden score of 3. Using this list of 48 commonly prescribed medicines, each one was searched on the practice clnical system individually and the number of patients currently prescribed each medicine documented.

Results
Approximately 5.45% of patients over 65 yrs (N = 2,770) are currently prescribed a medicine with an Anticholinergic score of 3. The most commonly prescribed are Amitriptyline (1.52%), Solifenacin (1.01%), Quetiapine (0.79%), Olanzapine (0.61%).

Conclusion
While anticholinergic medications can prove useful clinical interventions in certain patients, it is generally accepted that a burden score of 3 or more increases the patient’s risk of confusion, falls and death. Patients who have a high Anticholinergic score should have their medicines optimised through a shared decision making framework regularly, to ensure current therapy is beneficial and alternatives considered. An automated audit tool could be created within the primary care clinical system to score each patient’s anticholinergic burden and thus help target polypharmacy reviews.
285 ‘To communicate or not, that is not the question!’
Authors: Higgins S , Duggan A , Loughlin E , Waters R , Walsh T 
Published: September 2023

Abstract

Background
Safe patient care necessitates accurate and timely patient communication between acute, community, and primary care services. Given the complexities of care of older adults, including polypharmacy and deprescribing, reliable communication between all services is essential. This has been identified as a requirement prior to discharge. This audit aimed to assess compliance with discharge communication across the Geriatrics Service.

Methods
This audit was carried out from 10th–17th April 2023. Consecutive patient discharges across Stroke and Acute Geriatrics Services were assessed for data including age, gender, date of admission, date of discharge, discharge summary completion, and date and time of validation of the discharge summary. The Electronic Discharge Summary (EDS) and Inpatient Patient Management Systems (IPMS) systems were used for data collection. Data was analysed descriptively. Standards used were The Integrated Care Guidance: A Practical Guide To Discharge And Transfer From Hospital (HSE), and the National Standard For Patient Discharge Summary Information (HIQA).

Results
107 patient records were assessed, median age 72.2 years (IQR 29.1), 48.6% female (n = 52). 91.5% (n = 98) patients had discharge summaries completed, 86.7% (n = 85) of which were validated. When including all validated discharge summaries, the median time to validation was 0.4 hours (IQR 79.43) post discharge. Median time to validation pre-discharge was 1.5 hours (IQR 3.1) and represented 54.2% (n = 58) of patients. Median time to validation post discharge was 21.8 hours (IQR 149.76) and represented 31.7% (n = 27) of patients.

Conclusion
This audit highlights a high level of compliance with discharge summary completion. Areas for improvement include higher levels of completion prior to discharge, and ensuring that all summaries are validated to allow for printing and distribution. This will help ensure seamless and safe communication between all levels of care of older adults.
310 Identifying and characterising the ‘Bermuda Triangle’ in older adults referred for Comprehensive Geriatric Assessment: its association with falls and polypharmacy
Authors: Madders G , Sayers K , King L , Donnellan C 
Published: September 2023

Abstract

Background
The Bermuda Triangle comprising orthostatic hypotension (OH), cognitive impairment (CI) and mobility impairment (MI) is independently associated with a 4 fold risk of future falls. The objective of this study was to evaluate the prevalence of this triad in older persons attending for Comprehensive Geriatric Assessment (CGA) by a Community Specialist Team. The baseline characteristics of patients with and without the triad were compared. We examined the association of this triad with incident falls and polypharmacy.

Methods
A cross-sectional retrospective descriptive study was undertaken on all patients &gt;65 years referred for CGA between September 2022 and March 2023 (n = 166). The standard criteria for OH detection was used. A positive AD8 in ≥2 domains signified a CI. Gait abnormality or use of a gait aid defined MI. Polypharmacy was defined as ≥5 prescribed medications. The data was analysed using descriptive statistics.

Results
The prevalence of the ‘Bermuda Triangle’ was 12% (n = 21). Within this cohort, 66.6% had fallen in the past year. The mean number of falls was 4. These patients were twice as likely to be more functionally dependent (Modified Barthel Index ≤15) and clinically frail (CFS ≥ 5). The prevalence of polypharmacy was 86% (n = 18) compared with 80% in patients without the triad. A high Anticholinergic Burden Score was identified in 57% (n = 12). Specialist pharmacy intervention was required in 67% (n = 14) of this cohort.

Conclusion
The Bermuda Triangle increases falls risk. Factors contributing to these syndromes may be modifiable. Identification of this cohort may help with prioritisation of multifaceted interventions for this high risk group.
311 Nutrition and dietetics on a Frailty at the Front Door Team, what does it look like?
Authors: Cronin L 
Published: September 2023

Abstract

Background
A dietitian was introduced to the Frailty at the Front Door team (FFDT) in January 2022. The introduction of the Malnutrition Screening Tool (MST) to the Comprehensive Geriatric Assessment (CGA) resulted in a 47% increase in dietetic referrals. The aim of this study was to understand the characteristics of this population and how intervention was initiated.

Methods
Over a five month period, data was collected from the CGAs administered. Gender, Clinical Frailty Score (CFS), MST score (high risk of malnutrition is defined as MST ≥2), method of referral, patients admitted under a specialty, referrals to Community Nutrition and Dietetics Services (CNDS) and those discharged from dietetics. The data was prospectively entered into an excel spreadsheet and analysed using descriptive statistics.

Results
206 frail older adults (≥ 75 yrs) were referred and seen for dietetic intervention. Male to female ratio was 1: 1.75.The mean CFS was 5.8. 89% (n = 183) had MST ≥2. 83% (n = 171) of referrals were made by FFDT, 6% (n = 12) were referred via the hospitals’ electronic referral system. 64% (n = 132) were admitted to the acute hospital while a further 20% (n = 41) were referred to CNDS. The remaining 16% were either transferred to a different hospital or discharged from the dietetics service. Of those admitted, the data was broken down into the top 5 specialities; Geriatrics: 18% (n = 37), Acute Medicine: 16.5% (n = 34), Endocrinology: 12% (n = 25), General Medicine: 10% (n = 20) and Respiratory: 8.2% (n = 17).

Conclusion
High risk of malnutrition is highly prevalent in frail older adults presenting to the ED and through a number of medical specialties. Increased awareness identifies these patients so that targeted interventions early can reduce adverse outcomes in hospital or the community. Screening for malnutrition with a dietitian embedded in the FFDT identifies a much bigger proportion of those who need intervention than the traditional referral method.