bluuebunny/crossref_metadata_2025_split huggingface dataset:
293 Advance Care Planning in older persons mental health, insights from interdisciplinary healthcare professionals
Authors: Allen J , Donnelly S , Morton S , Murphy S 
Published: September 2023

Abstract

Background
Later life can be time where older persons face increasing health challenges and major decisions relating to future care. ‘Advance Care Planning’ (ACP) refers to a process of discussion and reflection about a person’s values, goals, and preferences for future care in case they lose the capacity to make decisions and communicate these in the future. The aim of this three-stage action research study is to collaboratively explore the perceptions and understanding of interdisciplinary team members and attendees of Mental Health Services for Older Persons (MHSOP) and their family carers in relation to ACP and to identify ways of improving decision-making practice considering the newly commenced Assisted Decision-Making (Capacity) Act (2015).

Methods
This presentation focuses on findings from stage one, which involved a survey administered via survey monkey, 3 focus groups and a feedback session with 22 interdisciplinary team members of a MHSOP from the fields of nursing, occupational therapy, psychology, psychiatry, and social work.

Results
Whilst there is already a culture of facilitating ACP with service users and their family carers within the MHSOP, however this is not routine practice. While clinicians largely recognised the value of ACP, 95% reported a lack of education, 52% a lack of knowledge of ACP tools, and limited experience in engaging with service users (53%) and family carers (47%). Identified barriers to engagement included lack of allocated time, clinician’s confidence, capacity issues and ‘a dedicated pathway across services with joined up conversation’.

Conclusion
Interdisciplinary professionals overwhelmingly recognised the importance of ACP with service users and family carers, and the positive impact ACP can have on end-of-life care. All indicated an eagerness for additional ACP guidelines and skills training for MHSOP staff.
298 An atypical presentation of Creutzfeldt-Jakob Disease as a stroke mimic—experience from an Irish tertiary centre
Authors: Altaie H , Nasehi A , O'Malley T , Vasandani N 
Published: September 2023

Abstract

Background
Sporadic Creutzfeldt-Jakob Disease (sCJD) is a rare neurodegenerative prion disease that presents with symptoms of rapid neuropsychiatric decline including dementia, behavioural abnormalities and loss of higher cortical function. Patients commonly present with rapidly-progressive neuromotor symptoms such as ataxia and myoclonus. Very few cases of CJD have been reported in which the patient initially presents with stroke symptoms such as hemiparesis as their primary presenting symptom. We present a case of a 56 year old male who initially presented to the stroke unit with waxing and waning left sided weakness and a non-corresponding ipsilateral left-sided acute parietal infarct on diffusion-weighted MRI. Over four weeks, his condition progressively worsened with declining cognitive function, motor dysfunction, sphincter dysfunction and eventual death.

Methods
Methods used to confirm the suspected diagnosis included: (1) Periodic sharp wave complexes are the most classical EEG finding for CJD and are seen in two third of the patients diagnosed with sporadic CJD, (2) The presence of the 14–3-3 protein in CSF has been found to be a sensitive and specific marker for sporadic CJD, (3) Neuroimaging plays a vital role in the diagnosis of CJD including serial MRIs and EEG sufficient to exclude other differential diagnoses.

Results
MRI brain revealed an acute cortical infarct within left parietal lobe measuring 3 mm.A n EEG demonstrated periodic sharp wave complexes occurring maximally in the left centro-temporal region. EEG finding was suggestive of a diagnosis of a prion disease. CJD Surveillance Unit confirmed the cerebrospinal fluid analysis was positive for RT-QuIC indicating sporadic CJD.

Conclusion
In cases of patients presenting with clinical signs and symptoms of a stroke with subsequent ipsilateral neurological findings on MRI, CJD should be included as a differential diagnosis. Additionally, a lumbar puncture, not routinely recommended in stroke patients, should be performed early to aid in early detection of CJD in order to confirm diagnosis and optimise the ceiling of care.
301 Role of comprehensive geriatric assessment in determining appropriateness of admission to long term care
Authors: Merron G , O’Neill D 
Published: September 2023

Abstract

Background
The benefit of comprehensive geriatric assessment (CGA) in supporting discharge to home from hospital for older people has been identified. When discharge to long term care (LTC) is considered by generalist teams, through determination of potential for further remediation and support, as well as vigilance for elder abuse and inappropriate third-party pressure, CGA supports continued living at home. Although European guidelines recommend, and Irish policy mandates, CGA prior to consideration of entry to LTC, it is not clear to what extent this is routinely undertaken. We aimed to determine the value of CGA in supported continued living at home when entry to LTC is proposed by referring clinical teams.

Methods
Review of electronic system of geriatric medicine consultations for assessment for LTC in a Level 4 teaching hospital. Information on discharge destination was retrieved from discharge summaries and electronic patient management systems.

Results
Of 740 consultations over 14 months between 2020 and 2021, 99 were for assessment for LTC. At review at 8 months, of 49 (49%) discharges to LTC, 42 (42%) were discharged as new residents, 4 (4%) were existing residents and 3 (3%) were discharged for end of life care. Of those for whom CGA recommended alternatives, 22 (22%) went directly home, 7 (7%) were discharged to offsite rehabilitation, 10 (10%) remained inpatients, and 8 (8%) died during admission.

Conclusion
This review highlights the importance and value of the role of CGA in planning discharge destination, a key if under-emphasised role for Irish geriatricians. Only 42% of the consults were discharged to LTC as a new permanent residence. This supports previous recommendations to routinely incorporate CGA when entry to LTC is considered, ensuring the most appropriate discharge destination for patients with significant multi-morbidity and complex care needs.
303 The influence of social constructivism on children and young adults perspectives of parental young-onset dementia
Authors: Blake C , Hopper L 
Published: September 2023

Abstract

Background
Western countries have a significant cohort of children (≤ 18) and young adults who live with a parent with a life limiting condition. Children and young adults perspectives of certain parental illnesses have been well documented. However, the perspectives of children and younger adults of parental young onset dementia tend to be absent from the academic literature. Older adult children have reported on the impact parental young onset dementia, however, there is a necessity for research with younger adult children and children under the age of eighteen in relation to their perspectives of the condition. Utilising cultural transmission theory, the current research explored if the social and cultural perspective influences the narratives of children and younger adults of parental young onset dementia.

Methods
One-to-one semi-structured interviews were held with children and younger adults (n = 17) who currently live with (or have lived with) a parent with a formal diagnosis of young onset dementia (with various subtypes). The participants ranged in age from 14 to 33 years old (mean = 21·18 years old). Participant narratives were analysed using inductive qualitative thematic analysis.

Results
Five main themes (with related subthemes) emerged from the narratives: (1) Making sense, (2) Lack of representation, (3) Threat to the family system, (4) Life has completely changed, (5) Systemic psychosocial support and education.

Conclusion
It is clear from the current data that the social and cultural perspective can significantly influence the narratives of children and younger adults of parental young onset dementia. Children are faced with more responsibility, shifting roles, changing relationships, and may be forced to postpone educational or employment plans. Furthermore, the social perception of dementia as can act as a barrier to children and young adults accessing and using health and social care providers.
305 Assessing patient attire in a medical gerontology ward: impact of an ‘End PJ Paralysis’ audit
Authors: Merron G , Davey N , George A , McDonough A , Fallon A 
Published: September 2023

Abstract

Background
Richard Asher’s influential essay, ‘The Dangers of Going to Bed’, highlighted the risks of bed rest for inpatients, including deconditioning and pressure areas. This audit evaluates whether patients are sitting out of bed and wearing personal clothes during mealtimes.

Methods
Using the ‘End PJ Paralysis’ campaign as the audit standard, a single-day audit recorded patients’ positioning and attire at breakfast and lunch. All inpatients on our medical gerontology ward were included. Interventions involved staff education on pyjama (PJ) paralysis implications, promoting the day room’s use at lunchtime, facilitating communication with patients/relatives regarding personal clothes/footwear, and organising a clothing donation drive. A re-audit occurred after one month.

Results
The initial audit included 39 patients (mean age: 81.8 years). At breakfast, 38.5% sat out, with 25.6% in their own clothes, 69.2% in pyjamas, and 5.1% in hospital gowns. The lunchtime audit included 38 patients: 84.2% sat out, with 78.9% in their own clothes, 25% in pyjamas, and 2.6% in a hospital gown. In the re-audit with 44 patients, 56.8% sat out at breakfast, with 18.2% in their own clothes and 81.8% in pyjamas. For lunch, 81.8% sat out, with 75% in their own clothes and 25% in pyjamas. No patients wore hospital gowns in the reaudit.

Conclusion
The re-audit demonstrated an improvement with 18.3% more patients sitting out at breakfast. In both audits, most patients opted for pyjamas at breakfast (69.2% in the initial audit and 81.8% in the re-audit) and their own clothes at lunch (78.9% in the initial audit and 75% in the re-audit). Hospital gowns were eliminated in the re-audit. Overall, this suggests that the ‘End PJ Paralysis’ campaign has positively influenced patients sitting out and the use of hospital gowns. Future plans involve education sessions for the broader multidisciplinary team, displaying posters, developing patient information leaflets, and conducting a re-audit to assess sustained impact.
312 Paying attention to daily delirium screening in an acute hospital setting, an audit of implementation on orthopaedic wards
Authors: Doyle P , Laffan S , Khokhar A S , Doyle M , Sheehan M , Gardiner P , McManus C , Donnell Niamh O , Hearne S , O'Regan Niamh 
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. In this audit, we aimed to assess efficacy of implementation of a Delirium Care Bundle (DCB), incorporating delirium screening, risk factor assessment, and management, on two Orthopaedic wards.

Methods
Following a detailed feasibility assessment by a multidisciplinary group, the RADAR (Recognising Acute Delirium As part of your Routine) was chosen for daily delirium screening locally. This was incorporated into a DCB and an online training module was developed. Online training of staff was supplemented by in-person training on the wards. Three months post-implementation on two Orthopaedic wards, we audited DCB use. Additionally, we reviewed if patients were screened for delirium on admission (4AT) in the Emergency Department (ED), also recommended in national algorithms.

Results
Of 57 inpatients on the wards, eight were excluded (seven were too young to meet screening criteria; one was in theatre), leaving 49 patients eligible for audit. Seven (16.6%) patients had been screened in the ED at presentation. Thirty-five patients (71.4%) patient had the DCB commenced. Despite awareness, although the RADAR should be administered twice daily, we estimate that it was completed to 46% of target utilisations. Eleven (22.4%) patients had a positive RADAR at some point, four of whom had a negative 4AT screen in the emergency department. In those with a positive RADAR, documentation of consequent actions and preventative strategies was suboptimal.

Conclusion
The DCB was commenced appropriately in most patients. This audit identified that the RADAR use can be improved and that action steps following a positive screen were not being taken. Next steps include identifying barriers and facilitators to the use of the DCB and enhancing staff training in its use.
313 Audit of adherence to the National Standards of acute stroke metrics in a tertiary hospital in Dublin, Ireland
Authors: Alshehhi S , Durcan R , Lynch J , Liddy A-M , Boyle Karl , Williams D , Bejleri J 
Published: September 2023

Abstract

Background
Acute stroke is a medical emergency defined as a sudden neurological event of vascular origin caused by decreased cerebral perfusion, preventing oxygen and nutrient supply to parts of the brain, leading to neuronal cell death. The annual cost for the management of stroke patients in Ireland is approximately €489–€805 million. Treatment of ischaemic stroke is very time-dependent and the two main therapies currently available, are intravenous thrombolysis with tissue plasminogen activator (tPA), and endovascular thrombectomy. The aim of this study is to assess the adherence to key performance parameters, but not limited to, such as the onset of symptoms to hospital arrival, time of hospital arrival to imaging, time of hospital arrival to tPA, and time of symptoms onset to recanalization in a tertiary stroke unit as compared to the 2021 Irish National Audit of Stroke report.

Methods
We carried out a retrospective chart review of 100 stroke patients admitted from 1st January 2022 until 31 December 2022 who were identified using The Hospital In-Patient Enquiry (HIPE). We accessed various hospital sources including PIPE, thrombectomy software, McKesson Radiology and medical charts to retrieve data of interest. This audit was registered with the Hospital Audit Office (CA 2023/112).

Results
We report here a thrombolysis rate of 18% with 75% receiving tPa within 1 hour of hospital arrival compared to 10% and 56% reported by INAS, respectively. The median door-to-image and door-to-needle for Beaumont Hospital were 24 mins and 42 mins compared to 63 mins and 43 mins reported by INAS, respectively.

Conclusion
Beaumont Hospital is compliant and performs higher compared to the national average. Inclusion of more study participants is needed to confirm the findings of this report.
318 Impact of dedicated teaching on frailty and comprehensive geriatric assessment at undergraduate level
Authors: Ward L , Kelly D , Gorey S , Kyne L 
Published: September 2023

Abstract

Background
Undergraduate exposure to geriatric medicine is essential to equip future physicians with knowledge, skills, and attitudes to provide care to older persons. Since 2009, all UCD final year medical students complete a 6-week core community medicine module run by geriatric medicine and general practice. In recent years we have further aligned our curriculum with the 2014 European undergraduate curriculum in Geriatric Medicine and have refined a simulated Comprehensive Geriatric Assessment (CGA) workshop with includes assessment of mood, cognition, ADLs and medications. We have added an interactive session on frailty.

Methods
A cross-sectional prospective study of students participating in a dedicated frailty/CGA teaching session was performed. Students were invited to complete an electronic survey using PollEV software at the beginning and end of the teaching session. Questions were a mixture of multiple-choice and open-ended.

Results
Of a potential 135 students, we received responses from 70. The data was anonymised at point of entry, and each question was recorded as an individual datapoint; exact numbers of students who answered are not possible. Quantitative results on inevitability of frailty went from 58% of students recognising that frailty is not an inevitable result of ageing; to 100%. Qualitative results showed that 29% of students did not know what frailty was to 92% demonstrating an understanding of vulnerability and poor reserve associated with frailty. With regards to CGA, 22% of students were unclear on what was involved with another 52% choosing a single modality. Following dedicated teaching, this improved to 82% showing their understanding of the interdisciplinary approach to CGA.

Conclusion
Frailty is a common, complex condition which all future clinicians will encounter. Recognition of frailty and implementation of a management plan is part of Comprehensive Geriatric Assessment. We have shown that a dedicated teaching session improves medical students understanding of this important topic.
328 From delirium detection to correction: enhancing peri-operative care for older patients
Authors: McManus C , Murphy E , O'Regan N , Doyle P 
Published: September 2023

Abstract

Background
Delirium is a common peri-operative complications in older adults. It is associated with poorer outcomes including functional decline, increased length of hospital stays, increased admissions to long term care and higher mortality. Therefore, this project aimed to assess the peri-operative care of older patients admitted under the surgical service in accordance with the standards set by the Collaborative for Peri-operative Optimisation of People (CPOP) and British Geriatrics Society (BGS) Peri-operative Care for People Living with Frailty undergoing Elective and Emergency Surgery Guidelines.

Methods
The study examined four key aspects of the guidelines: (1) surgical staff training on delirium; (2) proactive screening in for delirium in surgical patients; (3) proactively documenting delirium and implementing delirium guidelines; and (4) documentation of delirium diagnosis in discharge summaries.

Results
Data were collected from 72 surgical admissions over a fourteen-day period, of which 26 patients were aged &gt;65. Results indicated suboptimal adherence to the guidelines, with only 4/26 older patients (15.4%) being screened for delirium. Three of 4 of these patients screened positive for delirium using the 4AT. No patients had delirium mentioned in their discharge summaries. Additionally, a survey of surgical non-consultant hospital doctors revealed that only 4/16 (25%) had received formal training on delirium.

Conclusion
In response to these findings, interventions were implemented, including teaching at surgical grand rounds, hospital-wide education for World Delirium Awareness Day, introduction of delirium care bundles, and an updated discharge summary template for surgical patients to include a delirium diagnosis. A reaudit is underway to evaluate the impact of these interventions on guideline adherence and the peri-operative care quality for older patients. These initial findings underscore the need for improved staff education and adherence to CPOP and BGS guidelines. The reaudit will provide valuable insights into the effectiveness of the implemented interventions in enhancing the perioperative care experience for the older patient cohort.
335 A service evaluation of a new dedicated clinic for older adults living with HIV: the Platinum clinic
Authors: Gallagher E , Stapleton C , Drought J , Robinson D 
Published: September 2023

Abstract

Background
The number of older adults living with HIV is increasing. Incorporation of the Comprehensive Geriatric Assessment (CGA) into their ongoing review will be a key consideration in the future care of this population. The Platinum clinic was established to provide a CGA for the patients with HIV attending the GUIDE clinic. A clinic proforma was designed with a particular focus on general health, falls history and medication review, bone health, cognition and social history.

Methods
We performed a retrospective review of the clinic proformas completed for the patients who had been assessed in the Platinum clinic. Data were collected on background medical history, frailty status, medications and social history. There was also a specific focus on falls history, bone health, cognition and psychiatric illnesses. Data were then collected on the health issues identified and planned interventions.

Results
24 patients’ charts have been reviewed to date. The average age of patients referred was 72 and 75% of patients were male. The average Rockwood Clinical Frailty Score was 2. Common co-morbidities included cardiovascular disease (29%), cerebrovascular disease (21%) and chronic respiratory disease (12%). 29% had a mood disorder. The average number of non-HIV medications was 5.9. The average MMSE was 26/30. 92% of patients had a planned intervention as a result of their assessment and there was an average of 2 interventions per patient. 24-hour blood pressure monitors were arranged for 25%, 17% were referred to the dedicated memory clinic for assessment, 50% of patients had bone health interventions. Opportunities for medication optimisation was observed in 17%. 17 patients were discharged from clinic following their first review, 9 of whom were referred to other specialist services as a result of their assessment.

Conclusion
The Platinum Clinic provides the opportunity to complete a CGA and ensure the ongoing health optimisation of the older adult living with HIV.
352 Integrated care programme for older persons—community specialist teams: evaluating the patient experiences
Authors: Geoghegan J , McCleane F , Costello M , Canavan M , Munnelly P , Gavin C , Cosgrove J , Cleary A , Donohue M , Shiel E , Mannion K , Sestak K , McDonnell C , Neachtain M Ní , Rogan M , Walsh L , Fitzmaurice C 
Published: September 2023

Abstract

Background
Following a successful Slaintecare pilot project (2019–2021) two teams were established in Community Healthcare Networks (CHN) 4&5 and CHN 6&7. The aim of our service is to provide a Comprehensive Geriatric Assessment (CGA) to older people. Service user experience/feedback are critically important to ensure that we are meeting their needs. We also looked to compare the results against previous patient experience survey undertaken in 2021.

Methods
The survey was designed by the multidisciplinary team, consisting of 15 closed/3 open questions. A Likert scale was utilised for closed questions and thematic analysis for open questions. 208 service users who attended our teams and have received a CGA from January 2023 to April 2023 were invited to participate in a postal survey. All participants received a covering letter, questionnaire and a stamped address envelope to return their completed surveys.

Results
There was a 35% response rate (73/208). 89% were aged ≥75. 49% of participants completed the survey themselves, 51% required assistance. 66% have had 2 or more interactions with the teams. Vast majority or those who responded highlighted the importance of having their care at home or at centres close to home. 97% agreed/strongly agreed that they were satisfied with the service. 99% felt they were treated with dignity/respect and had confidence in the service. 96% felt that when they had an important question they got an answer that they could understand. 94% reported their carers had the opportunity to discuss concerns.

Conclusion
Service users had an overwhelmingly positive experience when they engaged with both our teams. CGA assessment and team interventions in the home and local healthcare settings was seen as been beneficial The importance of having time to engage with members of the team, not feeling rushed was also a recurring theme.