bluuebunny/crossref_metadata_2025_split huggingface dataset:
72 SEASONAL VARIATION IN HYPERPARATHYROIDISM IN OLDER IRISH ADULTS
Authors: Fitzpatrick D , Laird E , Hoey L , Hughes C , McNulty H , Ward M , Strain JJ , Tracey F , Molloy A , Cunningham C , McCarroll K 
Published: October 2022

Abstract

Background
Vitamin D deficiency is common in Ireland, varies by season and can result in secondary hyperparathyroidism. High Parathyroid Hormone (PTH) levels due to low vitamin D status are associated with increased bone turnover and lower bone mineral density, especially at cortical sites such as the hip. Given the variation in vitamin D status by time of year, our study aimed to examine for seasonal differences in hyperparthyroidism in older adults.

Methods
Study participants were from a large cross-sectional study of older Irish adults recruited from hospital outpatient services and GP practices. Exclusion criteria were: eGFR&lt; 30ml/min and elevated serum calcium (&gt;2.5 mmol/l) in order to avoid primary hyperparathyroidism or elevated serum PTH due to advanced renal impairment. Hyperparathyroidism was defined as a PTH level &gt; 65 ng/ml. The relationship between hyperparathyroidism and season was examined in regression models adjusting for potential factors affecting PTH.

Results
There were 4324 participants, mean age 73.8 +/- 7.9 years, 65.4% were female. Hyperparathyroidism was more prevalent in Spring versus Autumn (17.4 vs 11.4 %, P = 0.0002). The increased prevalence remained after adjusting for age, gender, body mass index, timed up and go, dairy intake, eGFR, and smoking (OR 1.6, 1.2- 2.0, P=0.0003). This also corresponded to the seasonal variation in vitamin D status with deficiency (25(OH)D &lt; 30 nmol/l) highest in Spring (23.3%) and lowest in Autumn (16.8%).

Conclusion
We found that hyperparathyroidism fluctuates with season in an inverse relationship with vitamin D. Overall, high PTH levels were 60% more likely in Spring versus Autumn. This emphasises the importance of maintaining adequate vitamin D status all year round. While we adjusted for dairy intake, we did not have accurate measures of total dietary calcium intake which could also vary seasonally and be a contributory factor.
77 EXPERIENCES OF OLDER PEOPLE AND CARERS REFERRED TO AMBULATORY OUTREACH TEAM WITHIN INTEGRATED CARE PROGRAMME FOR OLDER PERSONS (ICPOP) SERVICE
Authors: Akhtar A , Lawlor R , Cahalane J , Gillman C , Cronin F , Daly B , Hennessy J , Naughton C 
Published: October 2022

Abstract

Background
Ambulatory outreach services are part of new pathways to reduce reliance on secondary care as outlined in the Integrated Care Programme for Older Persons. Multidisciplinary outreach teams provide urgent medical and rehabilitation services in the person’s home to stabilise a health crisis.

Methods
The study aimed to explore the experiences of older people accessing a ambulatory outreach service and identify development opportunities. Interpretive description, an inductive analytic approach, was used to seek an understanding of clinical phenomena that illuminate their characteristics, patterns and structure. Data collection used qualitative telephone interviews. A purposeful sample of older people and carers were recruited following discharge from the outreach service over a three-month period.

Results
Sixteen participants (patients n=9 and carers n=7) were interviewed, 77% were female with a mean age of 83 years. Three major themes and seven sub-themes were identified:
Theme 1: Gratitude for specialised care: a) Moment of crisis “It was absolutely brilliant”; b) Care in my home: physical and psychological benefits
Theme 2: Living with and managing complexity: c) Resilience and resignation: living in the moment “Well she’s doing good at the moment, God forbids if there is more injuries”, d) Work of patients: maintain motivation & control; task and service boundaries e) Work of Families “We’re doing it so far”.
Theme 3:Scope for pro-active planning & Integration: f) What happens next? an unpredictable future; h) Integration with GP & community, g) Unspoken plan- sub-conscious advanced care planning “Nobody makes the decision on their own they call someone else”

Conclusion
The Outreach Team was highly valued by participants and was seen as vital in regaining functional capability and confidence to cope. Future developments need to examine task and service boundaries that undermine resilience, post outreach follow-up, integration with primary care, and opportunities for advanced care conversations.
81 IMPROVING THE ASSESSMENT AND PREVENTION OF FALLS AND FRACTURES ON A REHABILITATION WARD
Authors: Nzeji CA , Rahaman F , Makhura R , Fallon A , McDonough A 
Published: October 2022

Abstract

Background
The National Steering Group and The National Institute for Health and Care Excellence provide guidelines on medical assessment and prevention of falls and fractures. This audit assesses and compares quality of practice on an Age-Related rehabilitation ward against these guidelines.

Methods
A retrospective audit, including all patients (n=31) on an off-site, Age-Related rehabilitation ward was completed. Data on falls and fractures at emergency department presentation and during admission was obtained through chart review. Following education and implementation of a falls pro-forma, a re-audit was completed at four months including all patients (n=40).

Results
In cycle 1, mean age of patients was 80 years (range 56-94), 39 Percent (%) (n=12) were admitted with a fall of whom 66.7% (n=8) had a resulting fracture. In cycle 2, mean age was 82 years (range 63–95), 48% (n=19) were admitted due to a fall, of whom 53% (n=10) had a fracture.
A falls assessment and bone health review was completed in 39% (n=12) of all patients in cycle 1, and in 37% (n=3) admitted with a fall. This increased to 83% (n=33) of all patients in cycle 2 and 100% (n=40) of those admitted with a fall. Pre-intervention, 23% (n=7) had an inpatient fall compared to 18% (n=7) post-intervention; of these, 43% (n=3) and 14% (n=1) resulted in fractures respectively.

Conclusion
Compliance with national guidelines for prevention of falls and fractures improved with education and implementation of a falls pro-forma. This resulted in a reduction in falls, particularly injurious falls, on a rehabilitation ward. In future, this pro-forma may be implemented in other hospital wards.
87 VERTEBRAL FRACTURES IN OLDER PATIENTS WITH COPD: AN UNDER-DIAGNOSED AND UNDER-TREATED ENTITY
Authors: Brennan M , Nash D , Rutherford R 
Published: October 2022

Abstract

Background
Patients with Chronic Obstructive Pulmonary Disease (COPD) are at increased risk of osteoporosis. Vertebral Fractures (VF) are the most common manifestation of osteoporosis. Only one fourth to one third of incident radiographically identified VF are clinically diagnosed. The aim of this study is to evaluate patients the prevalence of VF in a cohort of patients admitted with Acute Exacerbation of COPD (AECOPD).

Methods
A retrospective review of AECOPD admissions over a four-month period was performed. Information on baseline characteristics, prescribed medications and reports of radiological imaging were obtained from Electronic Healthcare Records, discharge summaries and clinic letters.

Results
In total 116 patients were included over the study period. In 24% (n=28), VF was present on imaging. In those with VF, females accounted for 64.3% (n=18). Median age was 80 (76-85) and median CFS was 6. In 12 cases a single VF was present, in 9 two VFs and in 7 patients 3+ VF were present. There was no documented diagnosis of osteoporosis in 67.8% (n=19). VF were initially detected on CT thorax imaging performed to assess for pulmonary pathology in 35.7% (n=10) cases. Vitamin D3 was prescribed in 60.7% (n=17), concurrently with calcium in 28.6% (n=8). Antiresorptive therapy was prescribed in 39.3% (n=11), oral bisphosphonates in 4 patients and denosumab in 7. Vitamin D (OH) level was measured in 78.6% (n= 22) patients and was insufficient (&lt;50mmol) in 25% (n=7).

Conclusion
Almost one-quarter of patients who were admitted with an AECOPD had vertebral insufficiency fracture on imaging. Identification and treatment of VF was suboptimal. Most were not identified as having osteoporosis nor prescribed antiresorptive therapy. CT imaging should be routinely reviewed for the presence of insufficiency fractures as part of case finding initiatives. Bone health assessment should be routinely performed in patients with COPD, particularly those with frequent corticosteroid usage.
89 DIAGNOSIS AND TREATMENT OF SUSPECTED OBSTRUCTIVE SLEEP APNOEA (OSA) IN OLDER PEOPLE: A RETROSPECTIVE COMPARATIVE ANALYSIS
Authors: Brennan M , Walsh S , Rutherford R , Garvey J , O'Hanlon S , Gargoum F 
Published: October 2022

Abstract

Background
Obstructive Sleep Apnoea (OSA) is common yet often undiagnosed in older people as symptoms of fatigue and poor sleep are common and non-specific. OSA screening tools also lack validity in older patients. This study aims to review the clinical presentation, use of screening tools and treatment adherence in older people.

Methods
A retrospective cohort study of patients &gt;65 years attending a tertiary sleep clinic who underwent polysomnography for suspected OSA was performed. Electronic patient records were reviewed to obtain information on clinical presentation, screening scores, polysomnography reports and treatment initiated. Correlation between variables was performed using Pearson’s correlation co-efficient and represented using R-score. To compare CPAP usage with younger people, a cohort of controls &lt;65 years were matched in 2:1 ratio for OSA severity (mild, moderate or severe) at diagnosis. Comparison of adherence rates was performed using Mann-Whitney U-test and represented using Z-scores.

Results
A convenience sample of 100 consecutive older patients were included. Fatigue was present in 53% and witness reported snoring in 86% and apnoeas in 56%. Moderate or severe OSA was confirmed by polysomnography in 91% cases. BMI and the STOP-BANG questionnaire were positively correlated with OSA severity as measured by Apnoea Hypopnea Index, while ESS and Berlin Questionnaire were not. Positive pressure ventilation was initiated in 90% patients. CPAP was extremely effective with the median AHI falling to within normal range on follow up. CPAP usage was significantly higher in older patients compared with younger matched control (85% vs 66% p=013).

Conclusion
Older people with OSA present with classical symptoms. STOP -BANG questionnaire and BMI were positively correlated with AHI values while other screening tools lacked validity. Treatment with CPAP was highly efficacious in older people with high usage rates and should be considered as first-line treatment for moderate and severe OSA in older patients.
90 A RETROSPECTIVE COHORT STUDY COMPARING THE CLINICAL CHARACTERISTICS, TREATMENT AND OUTCOMES OF BIOPSY-CONFIRMED SARCOIDOSIS IN LATE-ONSET AND YOUNGER-ONSET PATIENTS
Authors: Brennan M , Phelan S , Breen D 
Published: October 2022

Abstract

Background
Late-Onset Sarcoidosis (LOS) accounts for up to one-third of cases and is diagnostically challenging due to the difficulty in satisfactorily excluding malignancy and infection, often necessitating repeated investigations. Endobronchial Ultrasound (EBUS) is the gold standard for diagnosing pulmonary sarcoidosis. This study aims to compare the clinical presentation, treatment and outcomes in patients with biopsy confirmed sarcoidosis in older and younger patients

Methods
A retrospective cohort analysis was performed on all patients with EBUS-confirmed sarcoidosis at a tertiary referral centre between 2012 and 2019. Electronic healthcare records were reviewed to obtain information on clinical presentation, confirmatory investigations, treatment and outcomes. LOS was defined as patients aged &gt;65 years

Results
In total, 247 patients were included, 68.8% were male. LOS accounted for 9.3% (n=23).Extra-pulmonary and systemic features were less common in LOS (26.1% vs 58%, p&lt;0.002). There was no difference in systemic treatment between cohorts (84.6% vs 67.9%, p=0.21) and LOS patients experienced comparably high rates of satisfactory outcomes. At follow up, the majority of patients either improved or achieved clinical stability in both groups (92.3% vs 76.1%, p=0.18). Clinical and/or radiological progression occurred in 7% in both groups with no reported deaths. Confirmatory investigations were infrequent and EBUS was safe and well-tolerated in older patients.

Conclusion
LOS was lower than expected and extra-pulmonary involvement was uncommon suggesting a pre-selected population. Referral for EBUS should be considered as first line for older patients with unexplained thoracic adenopathy provided further diagnostic investigations are in line with their goals of care. Clinical outcomes were excellent with low rates of progression, extra-pulmonary organ involvement and systemic therapy initiation, differing from prior studies and may represent less severe disease at diagnosis, enhanced diagnostic certainty or referral bias.
98 PREPARING FOR THE COMMENCEMENT OF THE DECISION MAKING “CAPACITY” ACT (2015): REVIEWING CURRENT PRACTICE WITHIN AN OCCUPATIONAL THERAPY DEPARTMENT
Authors: O'Neill S , McNally A , Treanor C , O'Rourke S 
Published: October 2022

Abstract

Background
The Decision Making ‘Capacity’ Act (2015) will commence in 2022. This will have significant implications for health care professionals. Occupational therapists undertake a wide range of assessments of cognitive, physical and functional ability. There is a need to streamline the recording of comprehensive and holistic assessment outcomes for easier access and interpretation during the interdisciplinary assessment of Decision Making Capacity (DMC) for independent living. A working group was established to review current practices and formulate a document to support the assessment.

Methods
The model for improvement was employed, which incorporates the plan, do, study, act methodology. Current practice of the occupational therapy team was reviewed in relation to assessments used, the format of recording and the knowledge of the DMC act. A working document was formulated and reviewed with medical staff. Team education on the DMC act was provided. A qualitative questionnaire was circulated among the occupational therapy staff to ascertain the educational needs of the department. Perceptions of current practice in DMC assessment of independent living were gathered.

Results
100% of questionnaire respondents identified need for further training and education on the DMC Act 2015. No respondents agreed that the relevant assessment outcomes were easily accessible. 67% of respondents were unsatisfied with the current process in place for DMC assessment of independent living. 45% of respondents do not feel confident in completing assessments contributing to DMC assessment of independent living. There was no consistency in the format of recording assessment outcomes.

Conclusion
The group developed a clinical document to improve easy and consistent interpretation of occupational therapy assessment in relation the DMC assessment of independent living. This ensures person centred, comprehensive assessment to enhance the patient journey. The team are better prepared for the commencement of the DMC act and have identified future training needs.
99 CHILDHOOD PERSPECTIVES OF PARENTAL YOUNG-ONSET DEMENTIA: A QUALITATIVE DATA SYNTHESIS
Authors: Blake C , Hopper L 
Published: October 2022

Abstract

Background
While it is less common, young onset dementia manifests at a significantly younger age (&lt; 65). Many people with young onset dementia are parents; however, little is known about impact of the condition on children and young adults. A qualitative thematic analysis was conducted to synthesise the literature on the perspectives of children and young adults with a parent living with young onset dementia.

Methods
Electronic databases were searched in order to identify all peer-reviewed literature in relation to the perspectives of children and young adults with a parent living with young onset dementia. A thematic analysis was conducted on the relevant literature.

Results
The electronic database search resulted in 15 full texts articles. Four main themes with related subthemes emerged from the thematic analysis. The four main themes were: changing family dynamics; psychological and physical strain; stigma and coping strategies.

Conclusion
The current synthesis outlines the perspectives of children and young adults with a parent living with young onset dementia. There is a significant lack of research in this area which adds to the stereotypical view of dementia as an older person’s disease. This can lead to children and young adults being impacted by lack of awareness and stigma resulting in significant psychosocial problems. As the number of people living with dementia (including young onset) is set to increase, future research with children and young adults with a parent with young onset dementia is important in order to better support this cohort.
100 MOVING TOWARDS “NET ZERO” HEALTHCARE: THE CARBON FOOTPRINT OF A MIXED FACE-TO-FACE AND TELEHEALTH MOVEMENT DISORDER CLINIC
Authors: Trolan C 
Published: October 2022

Abstract

Background
The climate emergency disproportionately impacts older people. Providing low carbon-emitting care now is important for current and future healthcare. In “For a Greener NHS”, the NHS (National Health Service) set a target to reduce Carbon emissions for which it is directly responsible by 80% by 2028, 100% by 2040; and for emissions over which the NHS has influence by 100% by 2045. A low carbon model of care includes telehealth clinics. 3.5% of all UK road traffic is NHS travel and transport.

Methods
A sample was used to estimate modes of transport to clinics. One calendar year of telehealth clinics were reviewed to estimate distances not travelled by patients. Personal protective equipment (PPE) use was estimated. Carbon Dioxide equivalents emissions were calculated to compare face-to-face attenders with telehealth reviews.

Results
Clinician commute emitted 26.84kgCO2e. A sample of 57 face-to-face attendees indicates 89.48% travel by private vehicle, 7.02% by taxi, 1.75% by ambulance and 1.75% by bus. For the sample, this equates to 246.94kgCO2e if petrol cars used and 238.61kgCO2e if diesel cars used; 1.53kgCOe for taxi transfers; 1.92kgCOe for bus transfer. Reliable data on ambulance transport related CO2e was not found. For telehealth clinics over calendar year 2021, the total distance not travelled by patients was 14,749.8km, mean 25.51km, median 21.6km and range 1-276km. The estimated CO2e savings were: 2.30tonnes CO2e if petrol cars; 2.22tonnes CO2e if diesel cars; 215.65kgCO2e for taxis; 26.4kgCO2e for buses. The PPE related emission-savings were 128.48kgCO2e. Estimating from median travel distance 21.6km for the year: face-to-face attendances resulted in 75.17kgCO2e from taxis; 9.21kgCO2e for bus use; 801.81kgCO2e if petrol private car, 774.78kgCO2e if diesel car. 56kgCO2e in PPE related emissions.

Conclusion
Telehealth clinics can assist in reaching net zero healthcare. Sustainable and active transport needs facilitation. A specific organisational “Green Plan” is required to equitably and effectively deliver sustainable healthcare.
104 SPONTANEOUS ILIOPSOAS TENDON RUPTURE AND PSOAS HAEMATOMA ON ASPIRIN MONOTHERAPY: A CASE REPORT
Authors: Murphy E , Lopez M , Fallon A 
Published: October 2022

Abstract

Background
Spontaneous Iliopsoas Tendon (IPT) rupture is a rare condition, with a prevalence of 0.66%, occurring most commonly in athletes. Risk factors for non-athletic IPT rupture include age, female gender and steroid use. Psoas haematomas are associated with surgery, anticoagulation and coagulopathies. Only a handful of case reports have associated psoas haematoma with single antiplatelet use. We present the case of a patient who developed psoas tendon rupture and psoas haematoma.

Methods
A 77-year-old female presented with a four week history of declining mobility and left hip pain, without history of trauma. Past medical history included chronic lymphoedema and an NSTEMI, for which she was taking aspirin monotherapy. On examination, she had reduced power on left hip flexion and a tender anterior thigh, with normal sensation. CT showed asymmetric thickening of the left iliacus muscle and surrounding fat stranding. MRI demonstrated partial IPT tear with oedema extending into the iliacus muscle.

Results
After several weeks of rehabilitation, her mobility deteriorated again. A second CT was performed, which showed new expansion and fat stranding of the right iliopsoas muscle and tendon compatible with acute haemorrhage. Aspirin was held for four weeks, and she was discharged after completing rehabilitation. Her baseline mobility had disimproved and she required assistance and a frame on discharge.

Conclusion
IPT rupture and psoas haematoma are atypical causes of atraumatic hip pain in older adults. Nevertheless, they can cause significant disability. MRI is recommended as the gold standard for diagnosis. Treatment is commonly conservative, focused on physiotherapy and pain control to maintain mobility. While aspirin is not commonly associated with tendon rupture or haemorrhage, it is widely used in primary prevention of cardiovascular disease and due consideration should be given to stopping it following the occurrence of haemorrhage.
110 DEVELOPMENT AND DELIVERY OF A MULTI-DISCIPLINARY HYBRID EDUCATION PROGRAM IN SYNCOPE AND RELATED DISORDERS DURING THE COVID-19 PANDEMIC
Authors: Rice C , Byrne L , Ortuno RR , Kenny RA , Cunningham C , Govern MM , Dsouza A , Prabhukeluskar S , Quinlan P 
Published: October 2022

Abstract

Background
Syncope and related disorders is an important area for training of all health professionals. During the COVID-19 pandemic, we adapted the delivery of our annual face-to-face certified program to a 9-month hybrid program. Here, we describe the development, delivery, and evaluation of such new program.

Methods
A pre-existing curriculum was modified to incorporate online content, online lecture delivery and interactive group learning, in addition to individual practical placements in a syncope management unit, in line with government and hospital infection control guidance at the time. Monthly content included video consultant case presentations, ECG analysis and interpretation, and instructional videos of diagnostic testing and relevant technologies. A comprehensive online week-long lecture program was developed.

Results
The lecture week included 30 clinical lectures, 10 clinical case presentations and 10 ‘how to’ practical videos for testing/monitoring procedures. Further learning over zoom incorporated learner case presentations in a small group format. At the completion of the course the leaners attended a final online half day of lectures and completed the multi choice question examination.

Conclusion
“Thank you so much for putting together such a fantastic week of training.” “The quality and expertise of the speakers was outstanding.” “I have taken a huge amount away to incorporate into my practice and local unit.”
The above learner feedback is consistent with our aim to deliver a high-quality specialist program for those interested in advancing the management of syncope and related disorders. Over time, this specialist training will aid the development of regional syncope management units across Ireland. The benefits of a hybrid learning model include multiple options to cater for all categories of learners, thus suggesting it is the cornerstone of future learning modalities.