bluuebunny/crossref_metadata_2025_split huggingface dataset:
287 SILVER TRAUMA REVIEW CLINIC – A NOVEL MODEL OF CARE FOR OLDER TRAUMA
Authors: Maoileannaigh L Ó , Mahony A , Riches R , Ramiah V , Byrne C 
Published: October 2022

Abstract

Background
Increasing numbers of older patients are presenting to Emergency Departments (ED) following trauma. These patients require multidisciplinary care that the traditional trauma model fails to provide. Therefore, a Silver Trauma Review Clinic (STRC) was developed in conjunction with the geriatric, ED and physiotherapy services. The goal of the clinic is to provide a comprehensive multidisciplinary management for older patients following non operative traumatic injuries.

Methods
A retrospective review of routinely gathered data was performed of the first 100 patients reviewed in the STRC between May 2021 and April 2022.

Results
Median patient age was 81 years old (IQR 73-86) and 69% were female. Median clinical frailty score was 3 (IQR 2-4). Median time from the patient’s initial ED presentation to clinic was 14 days (IQR 10-24) and median time from the initial review to discharge was 21 days (IQR 8-35). Mean number of assessments was 2. 70% of presentations were as a result of falls under 2 metres. Primary injuries were 17% vertebral fractures, 49% limb fracture, 17% thoracic trauma, 11% pelvic trauma with 15% of patients suffering from multiple injuries. 59% were already on bone protection and a further 29% were commenced on treatment. 21% had an abnormality on Mini-cog testing. 21% were newly diagnosed with orthostatic hypotension and 49% had difficulty with balance or walking. Only 5% required surgery.

Conclusion
The STRC is a novel approach of patient focused multidisciplinary trauma care for frail older patients following non operative trauma, ensuring timely care.
297 ADHERENCE TO DENOSUMAB PRESCRIPTION FOLLOWING DISCHARGE FROM A GERIATRIC REHABILITATION UNIT
Authors: Lynch A , Murray D , Whelan O , Mello S 
Published: October 2022

Abstract

Background
Post-acute geriatric rehabilitation units are an ideal setting to address bone health following acute admission with a fracture. Longer lengths of stay allow for vitamin D replacement and comprehensive multidisciplinary input. However, persistence with osteoporosis medications is suboptimal amongst older Irish adults, and breaks in therapy reduce the medications effectiveness. This study aims to determine adherence rates to Denosumab six-months after discharge from geriatric rehabilitation in patients with fragility fracture who either commenced or continued treatment whilst an inpatient.

Methods
Patients admitted with fragility fracture between January and October 2021 were identified through review of an online database. The type of osteoporosis medication, and dates of treatment were documented. Adherence to denosumab prescription six months post-discharge was checked using the Primary Care Reimbursement Service (PCRS) database.

Results
98 patients were admitted with fragility fractures, representing one third of total admissions. Patients were excluded for incomplete data (10), transfer back to acute facility (10) or death (4). Of the 74 included, the average age was 80 (range 65-94), and 53 (71%) female. One in five had a diagnosis of dementia. 52 Patients received first dose Denosumab as an inpatient, 4 were continuing on Denosumab, 11 were on bisphosphonates (4 changed from Denosumab on discharge) and 10 not on bone protection. The majority of patients (N=30, 57%) who had Denosumab administered in hospital did not have the second dose administered at six months.

Conclusion
In keeping with prior research, this study found that persistence with osteoporosis medications is low. Reasons are multifactorial and may include the infrequent timing of Denosumab and a lack of reminders to give the medication in primary care settings. New guidelines recommend enhanced screening for and treatment of osteoporosis in frail older adults including follow-up appointments to check adherence to treatment.
305 PHYSICAL ACTIVITY & DEPRESSION AMONG OLDER ADULTS WITH DIABETES: PRELIMINARY EVIDENCE FROM 10 YEARS OF THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
Authors: Rasmussen CL , Laird E , Kenny RA , Herring M 
Published: October 2022

Abstract

Background
Older adults living with diabetes are at increased risk of physical and mental health issues, including depression. Among older adults living with diabetes, the salutary benefits of Physical Activity (PA), including increased insulin sensitivity and improved glycaemic control, are well established; however, less is known about the relationship between PA and depression. Thus, we quantified associations between different PA doses and depressive symptoms and status among older adults living with diabetes across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing.

Methods
Older adults (n=268) living with diabetes were identified through self-report and/or medication use. PA was measured with the short-form International Physical Activity Questionnaire. Five dose categories (0, 1-&lt;600, 600-&lt;1,200, 1,200-&lt;2,400 and ≥2,400 MET.minutes per week) were examined. At all waves, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale short form; a score of ≥16 classified depression. From Waves 2-5, the Composite International Diagnostic Interview quantified diagnosis of a Major Depressive Episode during the past 12 months, or depression status. Poisson regression models quantified the associations between PA dose and depressive symptoms and status across time, adjusted for age, health/lifestyle variables, and antidepressant medication.

Results
The minimal PA dose associated with lower depressive symptoms was 1-&lt;600 MET.mins (coefficient = –0.20; 95%CI: –0.35, –0.05; p≤0.009). A dose of 600-&lt;1200 MET.min was significantly associated with lower odds of depression status (OR = 0.66; 95%CI: 0.50, 0.87; p≤0.004). Additionally, being male, having sufficient vitamin D intake and lower age were associated with lower odds of depressive symptoms.

Conclusion
Present findings suggest that even low PA doses protect against depressive symptoms among older adults living with diabetes. This further supports the importance of promoting PA for mental health among this high-risk population group.
312 DOES EXCLUDING PATIENTS WITH ORTHOSTATIC HYPOTENSION AFFECT SAFETY ESTIMATES IN HYPERTENSION TRIALS? A SYSTEMATIC REVIEW AND COMPARATIVE META-ANALYSIS
Authors: Reddin C , Hanrahan C , Murphy R , Costello M , Waters R , O'Donnell M 
Published: October 2022

Abstract

Background
In order to apply the findings of antihypertensive randomised controlled trials to older adults, it is important to understand the populations included and consider the generalizability of the results to cohorts that may have been excluded. The purpose of this study was to determine whether participants with orthostatic hypotension were included in randomised controlled trial of antihypertensive therapy and whether adverse event rates of particular importance to this cohort; namely falls or syncope differed based on their exclusion.

Methods
We performed a systematic review and meta-analysis of randomised controlled trials comparing antihypertensives to placebo, combination of antihypertensive agents compared to fewer antihypertensive or higher compared to lower blood pressure targets that reports falls or syncope outcomes. A random-effects meta-analysis was used to estimate a pooled treatment-effect overall in subgroups of trials which excluded patients with orthostatic hypotension and trials which did not exclude patients with orthostatic hypotension. Difference in treatment effect was assessed by testing P for interaction. The primary outcome measure was falls events.

Results
Forty-Seven trials were included, including 18 trials which excluded those with orthostatic hypotension and 29 trials which did not exclude those with orthostatic hypotension. Thirteen trials (n=94,222) reported falls. The baseline incidence of falls in the control group was 4.8% in trials which excluded orthostatic hypotension compared to 8.8% in trials which did not exclude participants with orthostatic hypotension. The association of antihypertensive treatment and falls was similar for trials which excluded those with orthostatic hypotension (OR 1.00; 95%CI, 0.89-1.13) and trials which did not exclude those with orthostatic hypotension (OR, 1.02; 95%CI, 0.88 –1.18).

Conclusion
The exclusion of patients with orthostatic hypotension may under-estimate the event rate of adverse events such as falls but does not appear to affect relative risk estimates associated with antihypertensives.
323 A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT FOR MANAGING NON-COGNITIVE SYMPTOMS OF DEMENTIA IN ACUTE CARE
Authors: Allen Y , Foubert M , Curtin D , Hennessy C , Twomey N , Galvin AM , Naughton C 
Published: October 2022

Abstract

Background
Over 80% of patients with dementia in acute care hospitals are prescribed an antipsychotic drug (INAD2) for management of Non-Cognitive Symptoms of Dementia (NCSD). Antipsychotics have a high side effect burden including increased mortality. Non-pharmacological interventions are first line management but many acute care wards are poorly equipped to deliver such interventions. The project aims to improve management of patients’ NCSD and reduce pro re nata (PRN)/stat and intra-muscular (IM) antipsychotic prescribing in an acute care older adult ward.

Methods
Using Plan-Do-Study-Act cycles (PDSA) a multicomponent intervention was iteratively designed and the implementation strategy is being tested. The components includes: an antipsychotic decision algorithm, Clinical Nurse Specialist (CNS) led patient review, patient behaviour charts, staff education and one-to-one coaching by CNS, patient ‘Get-to-Know-Me’ document and distraction resources. The evaluation involves a monthly point-prevalence audit of patient drug charts.

Results
Over a seven-month period, baseline data indicated wide variability in patterns of antipsychotic prescribing. A median of 14 patients per month (min 7, max 18) were prescribed an antipsychotic drug, a median of five patients (min 3, max 12) were prescribed PRN antipsychotics and a median of two patients (min1,max3) received one or more IM injection for NCSD. There was often little information on the reason for administering PRN antipsychotic medication. There was some evidence of reduced PRN and IM medication for new patient admissions (0-4 doses), but individual patients with prolonged hospital stays had high levels of antipsychotic use.

Conclusion
Reducing reliance on antipsychotic drugs requires multicomponent intervention and MDT collaboration. This intervention focussed primarily on coaching of healthcare professionals and improving the quality and consistency of prescribing. However, much more is required on environment design and access to cognitively stimulating activities to achieve a sustained improvement in patient outcomes, especially patients who experience a prolonged hospital stay.
327 REVIEW OF ONCOLOGY PATIENTS ADMITTED FROM 2019-2021: DEFINING THE NEED FOR AN ONCO-GERIATRIC SERVICE
Authors: Cummiskey AG , Briggs R , Lavan A 
Published: October 2022

Abstract

Background
With an aging population, there is an increased need to consider older patients for cancer treatment. Involvement of a Comprehensive Geriatric Assessment (CGA) in an oncology workup can help guide cancer treatment and non-pharmacological treatment in older patients. We undertook a retrospective study looking at older patients admitted during their cancer treatment to establish the need for an onco-geriatric service in our hospital.

Methods
All patients over 85 admitted under oncology from 2019-2021 had a retrospective chart review. Patient demographics, indication for admission and discharge destination were collected. Clinical markers, such as total medications, comorbidities and social history were used to generate an overall understanding of the patient’s Clinical Frailty Score (CFS). We then retrospectively implemented a geriatric assessment to see how patients would benefit from a CGA if an onco-geriatric service was implemented in our hospital.

Results
A total of 22 patients over 85 accounted for 33 admissions, with 54.5% female (n=12). The median CFS was 4 (3-5). At time of admission, 90.1% were on concomitant cancer treatment; 41.7 concurrent chemo, 13.6% concurrent RT. The mean patient had conditions 5.61 (SD3.2 and took an average of 9.2 (SD3.7) regular medications. Most admissions (n=18) required at least one consult from another service (54.5%), with palliative care and cardiology having the highest burden of consults at 11 (33%) and 8 (26.7%) respectively. Only 1 patient had a geriatric consult, while another was seen by our Falls and Syncope Unit after a fall leading to admission. Patients following each attendance were discharge home in 75.7% cases (n=25). Hospice (12.1%), convalescence (3%) and nursing home (3%).

Conclusion
We identified multiple areas in which a CGA can improve management of older patients undergoing cancer treatment, including medication rationalisation. We feel that a onco-geriatric service development in our hospital will lead to better patient care for our older population.
Do Compression Garments Prevent Subcutaneous Edema After Abdominoplasty?
Authors: Fontes de Moraes Betina Zimmermann , Ferreira Lydia Masako , Martins Maria Roberta Cardoso , Rostom Lucas , Castro Hugo Alexandre Sócrates de , Nahas Fabio Xerfan 
Published: October 2022

AbstractBackgroundThe main disadvantages of wearing a compression garment following abdominoplasty are the increase in intra-abdominal pressure and risk of venous stasis. On the one hand, the wearing of garments may increase the risk of venous thromboembolism. On the other hand, it may be beneficial in decreasing edema formation after surgery.ObjectivesThe authors sought to evaluate the effectiveness of compression garments in reducing subcutaneous edema after abdominoplasty.MethodsThirty-two women aged 19 to 50 years were selected and randomly allocated to either the garment (n = 16) or no-garment (n = 16) group. All patients underwent abdominoplasty and received 10 sessions of manual lymphatic drainage during the postoperative period. Postoperative edema formation was assessed by perimetry and bioimpedance, and seroma formation was assessed by ultrasound. Statistical tests included t test, mixed linear models, analysis of variance with repeated measures, and the Kolmogorov-Smirnov test, which were performed at a significance level α of .05 (P ≤ .05).ResultsThe no-garment group showed a trend toward lower mean waist circumference at 29 days following abdominoplasty and significantly lower waist circumference after postoperative day 35 compared with the garment group (P &lt; .001). The mean total body water was slightly lower in the no-garment group than in the garment group 7 days after surgery (P = .05).ConclusionsPatients who did not wear a compression garment after abdominoplasty showed less subcutaneous edema formation after 24 days of surgery than those who wore the garment.
Interobserver Reliability of the Nancy Index for Ulcerative Colitis: An Assessment of the Practicability and Ease of Use in a Single-Centre Real-World Setting
Authors: Le Huy Duc , Pflaum Theresa , Labrenz Johannes , Sari Soner , Bretschneider Fabienne , Tran Florian , Lassen Arne , Nikolaus Susanna , Szymczak Silke , Kormilez Diana , Rosenstiel Philip , Schreiber Stefan , Aden Konrad , Röcken Christoph 
Published: October 2022

AbstractBackgroundHistological disease severity assessment in ulcerative colitis [UC] has become a mainstay in the definition of clinical endpoints [‘histological remission’] in clinical trials of UC. Several scores have been established in the microscopic assessment of disease activity, but the Nancy index [NI] stands out as being the histological index with the fewest scoring items. To what extent histological assessment using the NI is affected by interobserver reliability in a real-word setting is poorly understood. We therefore performed a single-centre retrospective analysis of NI assessment in patients with UC.MethodsWe retrospectively evaluated the NI in two independent cohorts [total: 1085 biopsies, 547 UC patients] of clinically diagnosed UC patients, who underwent colonoscopy between 2007 and 2020. Cohort #1 consisted of 637 biopsies from 312 patients, while Cohort #2 consisted of 448 biopsies from 235 patients. Two blinded pathologists with different levels of expertise scored all biopsies from each cohort. A consensus conference was held for cases with discrepant scoring results. Finally, an overall consensus scoring was obtained from both cohorts.ResultsThe interobserver agreement of the NI was substantial after the assessment of 1085 biopsy samples (κ = 0.796 [95% confidence interval, CI: 0.771–0.820]). An improvement of the interobserver agreement was found with increasing numbers of samples evaluated by both observers (Cohort #1: κ = 0.772 [95% CI: 0.739–0.805]; Cohort #2: κ = 0.829 [95% CI: 0.793–0.864]). Interobserver discordance was highest in NI grade 1 [observer 1: n = 128; observer 2: n = 236]. Interobserver discordance was lowest in NI grades 0 [observer 1: n = 504; observer 2: n = 479] and 3 [observer 1: n = 71; observer 2: n = 66].ConclusionThe NI is an easy-to-use index with high interobserver reliability for assessment of the histological disease activity of UC patients in a real-world setting. While NI grades 0 and 3 had a high level of agreement between observers, NI grade 1 had a poorer level of agreement. This highlights the clinical need to specify histological characteristics leading to NI grade 1.
Digitalisation in the area of alcohol, drug, and tobacco during the COVID-19-pandemic: supporting the drive towards an equitable health?
Authors: Jonsson F , Schimmer R 
Published: October 2022

Abstract

Background and objectives
The COVID-19 pandemic has posed challenges for traditional public health practice. In the area of alcohol, drugs, and tobacco, local and regional actors have largely moved from physical to digital solutions to handle the barriers imposed by the pandemic. To strengthen the knowledge base in the area, this project aimed to explore how the local transition to, and management of, digital solutions within alcohol, drugs, and tobacco prevention might support the policy drive in Sweden towards equity in health.

Methods
This was a qualitative study where 13 local coordinators from 7 municipalities participated. Data were collected through 9 individual and 2 group interviews (semi-structured). The analysis was inductive and followed a thematic analysis approach to identify, analyse, and present patterns (themes) in the data.

Results
Three themes were developed illustrating how the local implementation of digital solutions in the area of alcohol, drugs, doping, and tobacco prevention might support the transition towards equity in health by ‘making time and resources available for development and innovation’, ‘improving the ability to reach and engage with vulnerable groups’, and ‘(re)shape initiatives to act inclusively’.

Conclusions
As illustrated by experiences of the local coordinators, the municipalities seemed to have managed the challenges of the pandemic in a good way. To a large extent, they appeared to have adapted their work to remain operational by transitioning into digital solutions. Considering that the pandemic has been challenging in various ways, the finding of ensuring operations were running should not be underestimated. However, besides being able to largely maintain a “status quo” in a time when traditional modes of working were inadequate or inappropriate, the results illustrated how the municipalities have added numerous (digital) tools to their toolbox for use in the continuing drive towards good and equitable health.
What are the tools provided by the EU to support health and care improvement?
Authors: Mauer N 
Published: October 2022

Abstract
Improving health and care systems is primarily the responsibility of Member States within the EU. Nevertheless, the EU provides a lot of potential support to Member States that can help to improve health systems. However, the range of EU tools that can help to strengthen health systems has grown up over decades across different policy fields, and most potential EU support is incorporated within instruments that have wider objectives. This can make it challenging to identify and optimise the use of the different instruments, as well as to create synergies across tools as part of an overall process of improving a health system. For example, the EU's wide-ranging support across diverse instruments and policy areas has contributed towards improving the prevention, monitoring, and management of cancer, as well as modernising dedicated health infrastructure and developing common cancer policy guidance in Europe over several decades. This presentation will help with understanding what different tools can be used for, showcasing content from the policy brief and how it can be helpful with addressing the challenges faced by health policy makers. Using concrete case studies, it will illustrate how different instruments might be combined in pursuit of a specific process of health system strengthening and transformation.
Impact of climate change on food systems – the One Health approach
Authors: Assunção R 
Published: October 2022

Abstract
In recent decades, changes in climate have caused impacts on natural and human systems on all continents and across the oceans. Climate change has become one of the most critical issues for the sustainable development of human societies and the functioning of ecosystems on Earth. In one hand, climate change threatens our ability to ensure global food security, eradicate poverty and achieve sustainable development. Agriculture and animal production are affected by changing rainfall patterns, drought, flooding and the geographical redistribution of pests and diseases, with consequent implications in the food availability, a key requirement for food security. On the other hand, despite less debated, climate change could also affect food safety, impacting the occurrence of food safety hazards at various stages of food chain, from “farm to fork”. The tendency to increase the use of agrochemicals to balance the effects of more frequent extreme weather events and water scarcity in some regions could become more frequent. In addition to pesticide residues, both chemical and microbiological risks are expected to impair food and feed safety as a consequence of climate change: in particular mycotoxins, marine biotoxins (phycotoxins), trace metals, among others. Humans, animals and the environment are/will be affected by the consequences of climate change, with an expected impact on the food systems. Thus, a One Health perspective, representing a holistic view of the problems, defining and establishing adequate strategies to tackle these challenges, is more than needed. On this presentation, main issues relating the impact of climate change on health of humans, animals and environment and how a One Health perspective, as a holistic approach, represent a key contribution to the definition of proper policies to ensure the public health will be approached and debated.